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Antibiotic/ antimicrobial stewardship

Tolga Taymaz, Önder Ergönül, Ayda Kebapcı, Rifat Okyay
OBJECTIVE: We aimed to describe the factors associated with antibiotic use in upper respiratory tract infections (URTI) in post-pandemic influenza period. METHODS: We included all the consecutive patients, who applied to emergency and outpatient departments with the symptoms of influenza like illness (ILI) between January and June 2011 in a private 265 bed hospital in Istanbul, Turkey. RESULTS: Out of 1270 patients, 100 were tested for Sreptocococcus A infection and 16 (16%) were found to be positive, 36 were tested for RSV and five patients were found to be positive...
October 10, 2018: International Journal of Infectious Diseases: IJID
Safa S Almarzoky Abuhussain, Michelle A Burak, Danyel K Adams, Kelsey N Kohman, Serina B Tart, Athena L V Hobbs, Gabrielle Jacknin, Michael D Nailor, Katelyn R Keyloun, David P Nicolau, Joseph L Kuti
Background: Acute bacterial skin and skin structure infections (ABSSSIs) are a frequent cause of emergency department (ED) visits. Providers in the ED have many decisions to make during the initial treatment of ABSSSI. There are limited data on the patient factors that influence these provider decisions. Methods: An anonymous survey was administered to providers at 6 EDs across the United States. The survey presented patient cases with ABSSSIs ≥75 cm2 and escalating clinical scenarios including relapse, controlled diabetes, and sepsis...
October 2018: Open Forum Infectious Diseases
Agnes Loo Yee Cheah, Allen C Cheng, Denis Spelman, Roger L Nation, David C M Kong, Emma S McBryde
BACKGROUND: Clinical studies and mathematical simulation suggest that active surveillance with contact isolation is associated with reduced vancomycin-resistant enterococci (VRE) prevalence compared to passive surveillance. Models using pre- and post-intervention data that account for the imperfect observation and serial dependence of VRE transmission events can better estimate the effectiveness of active surveillance and subsequent contact isolation; however, such analyses have not been performed...
October 11, 2018: BMC Infectious Diseases
Sten Saar, Vladislav Mihnovitš, Thomas Lustenberger, Mariliis Rauk, Erast-Henri Noor, Edgar Lipping, Karl-Gunnar Isand, Jaak Lepp, Andrus Lomp, Urmas Lepner, Peep Talving
BACKGROUND: Recent investigations noted noninferiority in short-course antimicrobial treatments following source control in abdominal infections. We set out to investigate noninferiority of a short and fixed (24-hour) antibiotic administration compared to extended treatment after source control in complicated appendicitis in a prospective single-center open-label randomized controlled trial. METHODS: After IRB approval, all consecutive adult patients (age ≥18 years) with complicated appendicitis including gangrenous appendicitis, perforated appendicitis, and appendicitis with periappendicular abscess between 5/2016 and 2/2018 were randomly allocated to antibacterial therapy limited to 24 hours (short) vs...
October 11, 2018: Journal of Trauma and Acute Care Surgery
Vinay P Rao, Jianhua Wu, Richard Gillott, M Wazir Baig, Pankaj Kaul, Jonathan A T Sandoe
OBJECTIVES: Surgery is often required for acute infective endocarditis (IE) to repair or replace damaged heart valves. Traditionally, long courses of antibiotic treatment have been prescribed after surgery for active IE for fear of infecting newly implanted/repaired valves, but the need for this, in the present era of enhanced antimicrobial stewardship, has been questioned. In our institution, the choice and duration of antimicrobial therapy is tailored to individual patients by a multidisciplinary team with an interest in IE...
October 10, 2018: European Journal of Cardio-thoracic Surgery
Amy L Carr, Mitchell J Daley, Kathryn Givens Merkel, Dusten Rose
There are significant clinical and financial consequences to both inadequate and unnecessary exposure to broad-spectrum antibiotics. As such, antimicrobial stewardship programs seek objective, reliable, and cost-effective tests to identify patients at highest or lowest risk for drug-resistant organisms to guide empiric antimicrobial selection. Utilization of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening to rule out MRSA in lower respiratory tract infections has led to significant reductions in duration of vancomycin therapy...
October 9, 2018: Pharmacotherapy
Michael Pulia, Robert Redwood, Larissa May
The emergency department (ED) is the hub of the US health care system. Acute infectious diseases are frequently encountered in the ED setting, making this a critical setting for antimicrobial stewardship efforts. Systems level and behavioral stewardship interventions have demonstrated success in the ED setting but successful implementation depends on institutional support and the presence of a physician champion. Antimicrobial stewardship efforts in the ED should target high-impact areas: antibiotic prescribing for nonindicated respiratory tract conditions, such as bronchitis and sinusitis; overtreatment of asymptomatic bacteriuria; and using two antibiotics (double coverage) for uncomplicated cases of cellulitis or abscess...
November 2018: Emergency Medicine Clinics of North America
Chunmei Lu, Qing Liu, Hao Yuan, Laishuan Wang
OBJECTIVES: We aimed to implement our Smart Use of Antibiotics Program to ensure the proper use of antimicrobials, improve patient care and outcomes, and reduce the risks of adverse effects and antimicrobial resistance. DESIGN: We compared the time periods before (baseline) and after (intervention) the implementation of an antibiotic protocol by performing surveillance and assessments of all antibiotic use during a 29-month interrupted period. SETTING: Level 3-4 neonatal ICU in one referral center...
October 3, 2018: Critical Care Medicine
Hyeonjun Hwang, Bongyoung Kim
The aim of this study was to evaluate the impact of an infectious diseases specialist (IDS)-led antimicrobial stewardship programmes (ASPs) in a large Korean hospital. An interrupted time series analysis assessing the trends in antibiotic use and antimicrobial resistance rate of major pathogens between September 2015 and August 2017 was performed in an 859-bed university-affiliated hospital in Korea. The restrictive measure for designated antibiotics led by an IDS reduced carbapenems usage by -4.57 days of therapy (DOT)/1,000 patient-days per month in general wards (GWs) (95% confidence interval [CI], -6...
October 3, 2018: Scientific Reports
Eunah Cheon, Harold W Horowitz
It is well-appreciated that patients with documented penicillin allergies often receive broader-spectrum antibiotics. This practice has been associated with increased antimicrobial resistance and cost. In recent years, considerable efforts have been made to spread awareness on the implications of self-reported penicillin allergies. The use of penicillin skin testing to evaluate for true allergies has been strongly recommended by major organizations for decades. However, testing remains underutilized. Current literature has suggested various models incorporating penicillin allergy screening and testing by different health-care practitioners (i...
October 3, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Candace Bishop, Zeeshan Yacoob, Mary Jo Knobloch, Nasia Safdar
BACKGROUND: Antibiotic resistance is one of the world's most pressing public health problems, resulting in over 23,000 deaths per year. One of the main contributing factors to antimicrobial resistance is antibiotic misuse and overuse. Community pharmacists can play a role in reducing antibiotic resistance, since they are one of the most accessible healthcare professionals. OBJECTIVE: The purpose of this paper is to describe community pharmacy interventions and strategies to reduce antibiotic misuse and overuse and to discuss the implications for pharmacy training...
September 26, 2018: Research in Social & Administrative Pharmacy: RSAP
Jin-Hong Yoo
Carbapenem-resistant Enterobacteriaceae (CRE) are now spread worldwide. In Korea, the number of CRE isolation is rapidly increasing, and impending endemicity is a concern. To cope well with CRE, thorough infection control, such as active surveillance, early detection, strict contact precaution, cleaning the environment, and antibiotic stewardship is very important. Therapeutic options include polymyxin, tigecycline, fosfomycin or the combination of them with carbapenem, which is currently the mainstay of treatment...
October 1, 2018: Journal of Korean Medical Science
Ozden Turel, Semih L Mirapoglu, Mine Yuksel, Aysenur Ceylan, Bilge Sumbul Gultepe
BACKGROUND: For perforated appendicitis in children microbiological cultures should always be sought if adequate sample is available. Knowledge of local epidemiology is important for optimal selection of antimicrobial agents. OBJECTIVE: We aimed to evaluate etiology and susceptibility of pathogens in patients with perforated appendicitis. METHODS: Microbiological results of tissue samples obtained at surgery from children with acute appendicitis during 24 months were evaluated retrospectively...
September 27, 2018: Journal of Global Antimicrobial Resistance
Elena Montecatine-Alonso, María-Victoria Gil-Navarro, Cecilia M Fernández-Llamazares, Aurora Fernández-Polo, Pere Soler-Palacín, Jesús Llorente-Gutiérrez, María-Teresa Gómez-Travecedo Calvo, María-Dolores Esquivel-Mora, Icíar Pérez-Rodrigo, José M Cisneros, Walter-Alfredo Goycochea-Valdivia, Olaf Neth
INTRODUCTION: Antimicrobial defined daily dose (DDD), has limitations for antimicrobial consumption measurement in paediatrics. An alternative DDD design applicable for children is proposed. METHODS: Children (<16 years-old) from 10 Spanish hospitals during a 12-months period were included. Weight for age (50th percentile) was calculated for the median age of the cohort using standardized World Health Organization tables. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication...
September 26, 2018: Enfermedades Infecciosas y Microbiología Clínica
Jiong Zhou, Xiaojun Ma
OBJECTIVES: We aimed to assess the status and possible problems of Antimicrobial stewardship (AMS) in Grade-A tertiary hospitals in China. METHODS: A questionnaire was designed according to the U.S. Centers for Disease Control and Prevention "Core Elements of Hospital Antibiotic Stewardship Programs". We extracted 10%-15% from Grade A tertiary hospitals in every province of mainland China, a total of 165 hospitals were selected. Electronic questionnaires were forwarded to these hospitals...
September 26, 2018: Clinical Microbiology and Infection
E B Warremana, M M C Lambregtsa, R H P Wouters, L G Visser, H Staats, E van Dijk, M G J de Boer
BACKGROUND: Knowledge of determinants that influence antibiotic prescription behaviour (APB) is essential for the successful implementation of antimicrobial stewardship interventions. The theory of planned behaviour (TPB) is an established model that describes how cognitions drive human behaviour. OBJECTIVES: The objective of this study was to identify the socio-cultural and behavioural determinants that affect APB and construct a TPB-framework of behavioural intent...
September 26, 2018: Clinical Microbiology and Infection
C Lévin, N Thilly, M Dousak, G Beraud, M Klesnik, S Uhan, D Nathwani, B Beovic, C Pulcini
OBJECTIVES: To assess the perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance, and then to identify the characteristics of junior physicians associated with appropriate practices of antibiotic use. METHOD: European junior physicians received an email invitation to complete a 49 item web questionnaire between September 2015 and January 2016. We present the French data. Multivariate regression models were used to identify the characteristics of junior physicians associated with appropriate prescription practices and with consideration of the antibiotic prescription consequences...
September 25, 2018: Médecine et Maladies Infectieuses
Donald E Fry
BACKGROUND: Bacterial resistance to available antibiotics has resulted in enhanced efforts at antibiotic stewardship but also has led to investigation into alternative methods for managing surgical infections. Antimicrobial peptides (AMPs) are naturally occurring compounds produced by all prokaryotic and eukaryotic cells that have potential as an alternative to conventional antibiotics. METHODS: The published literature was reviewed for investigations that were relevant to infections commonly seen by surgeons and the potential applicability of AMPs for surgical care...
September 28, 2018: Surgical Infections
Kelli Stein, Julie Farmer, Sonica Singhal, Fawziah Marra, Susan Sutherland, Carlos Quiñonez
BACKGROUND: To describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review. TYPES OF STUDIES REVIEWED: The authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice...
October 2018: Journal of the American Dental Association
Marta Ferranti, Elisabetta Schiaroli, Melissa Ida Palmieri, Antonella Repetto, Anna Vecchiarelli, Daniela Francisci, Antonella Mencacci, Claudia Monari
The global dissemination of carbapenemase-producing Enterobacteriaceae (CPE) is of great concern for public health. These bacteria have the potential for rapid dissemination in healthcare settings and cause infections associated with high rates of morbidity and mortality. A total of 221 carbapenem non-susceptible Enterobacteriaceae isolates were collected from patients admitted to an Italian general hospital from January 2016 to March 2017. Among these isolates, 78.3% were carbapenemase producers: 96% were positive for the blaKPC gene and the remainder for the blaVIM gene (allelic variant VIM-1)...
September 25, 2018: New Microbiologica
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