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'Antimicrobial Stewardship' AND (critical OR intensive) AND outcome*

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https://www.readbyqxmd.com/read/30517765/antimicrobial-stewardship-programs-in-long-term-care-settings-a-meta-analysis-and-systematic-review
#1
Julie Hui-Chih Wu, Bradley J Langford, Nick Daneman, Jan O Friedrich, Gary Garber
BACKGROUND: Antimicrobial stewardship programs have been established in hospitals, but less studied in long-term care facilities (LTCFs), a setting with unique challenges related to patient populations and available resources. This systematic review sought to provide a comprehensive assessment of antimicrobial stewardship interventions implemented in LTCFs, using meta-analysis to examine their impact on overall antimicrobial use. METHODS: Electronic searches of MEDLINE, Embase, and CINAHL (1990 to July 2018) identified any antimicrobial stewardship interventions in LTCFs, with no restriction on patient population, study design, or outcomes...
December 5, 2018: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/30373649/antimicrobial-prescription-patterns-and-ventilator-associated-pneumonia-findings-from-a-10-site-prospective-audit
#2
Rosalind M Elliott, Anthony R Burrell, Peter W Harrigan, Margherita Murgo, Kaye D Rolls, David W Sibbritt, Jonathan R Iredell, Doug Elliott
OBJECTIVE: To examine anti-microbial prescribing practices associated with ventilator-associated pneumonia from data gathered during an audit of practice and outcomes in intensive care units (ICUs) in a previously published study. RESULTS: The patient sample of 169 was 65% male with an average age of 59.7 years, a mean APACHE II score of 20.6, and a median ICU stay of 11 days. While ventilator-associated pneumonia was identified using a specific 4-item checklist in 29 patients, agreement between the checklist and independent physician diagnosis was only 17%...
October 29, 2018: BMC Research Notes
https://www.readbyqxmd.com/read/30253915/implementation-of-an-empirical-antimicrobial-protocol-in-a-critical-care-setting-a-single-center-retrospective-observational-cohort-study-in-bacteremic-patients
#3
Ken-Ichi Kano, Nobuaki Shime, Kei Nishiyama
In the treatment of severe infections in critical care settings, the selection of initial empirical antimicrobials affects patient outcomes and antimicrobial overuse. The application of a comprehensive treatment guidance might facilitate appropriate antimicrobial selection. Therefore, we developed such an antimicrobial guidance for use in emergency and critical care center and verified its efficacy. We retrospectively analyzed the data of 195 patients (96 patients before guidance introduction [control group] and 99 after guidance introduction [intervention group]) who were ultimately diagnosed with bacteremia to assess the effects of the guidance (the intervention)...
December 2018: Journal of Infection and Chemotherapy: Official Journal of the Japan Society of Chemotherapy
https://www.readbyqxmd.com/read/30126573/antimicrobial-resistance-an-antimicrobial-diagnostic-stewardship-and-infection-prevention-approach
#4
REVIEW
Edward Joel Septimus
Antimicrobial resistance (AR) is one of the most serious public health threats today, which has been accelerated by the overuse and misuse of antimicrobials in humans and animals plus inadequate infection prevention. Numerous studies have shown a relationship between antimicrobial use and resistance. Antimicrobial stewardship (AS) programs have been shown to improve patient outcomes, reduce antimicrobial adverse events, and decrease AR. AS programs, when implemented alongside infection control measures, especially hand-hygiene interventions, were more effective than implementation of AS alone...
September 2018: Medical Clinics of North America
https://www.readbyqxmd.com/read/30097272/impact-of-an-emergency-medicine-pharmacist-on-empiric-antibiotic-prescribing-for-pneumonia-and-intra-abdominal-infections
#5
Benjamin D Kulwicki, Kasey L Brandt, Lauren M Wolf, Andrew J Weise, Lisa E Dumkow
PURPOSE: It is critical to engage ED providers in antimicrobial stewardship programs (ASP). Emergency medicine pharmacists (EMPs) play an important role in ASP by working with providers to choose empiric antimicrobials. This study aimed to determine the impact of an EMP on appropriate empiric antibiotic prescribing for community-acquired pneumonia (CAP) and intra-abdominal infections (CA-IAI). METHODS: A retrospective cohort study was conducted evaluating adult patients admitted with CAP or CA-IAI...
July 29, 2018: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/30079235/appropriate-antibiotic-management-of-bacterial-lower-respiratory-tract-infections
#6
REVIEW
Charles Feldman, Guy Richards
Lower respiratory tract infections are the leading cause of infectious disease deaths worldwide and are the fifth leading cause of death overall. This is despite conditions such as pneumococcal infections and influenza being largely preventable with the use of appropriate vaccines. The mainstay of treatment for the most important bacterial lower respiratory tract infections, namely acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and community-acquired pneumonia (CAP), is the use of antibiotics...
2018: F1000Research
https://www.readbyqxmd.com/read/29991221/choosing-wisely-what-s-the-actual-role-of-antimicrobial-stewardship-in-intensive-care-units
#7
Giorgia Montrucchio, Gabriele Sales, Silvia Corcione, Francesco G De Rosa, Luca Brazzi
More than two-thirds of critically ill patients receive an antimicrobial therapy with a percentage between 30 and 50% of all prescribed antibiotics reported to be unnecessary, inappropriate or misused. Since inappropriate prescription of antibiotic drugs concurs to dissemination of the multi-drug resistant organisms, a reasoned antibiotics use is crucial especially in Intensive Care Unit (ICU), where up to 60% of the admitted patients develops an infection during their ICU stay. Even if the concept of Antimicrobial Stewardship (AS) has been clearly described as a series of coordinated interventions designed to improve antimicrobial agents use, few studies are reporting about its effectiveness to improve outcomes, reduce adverse events and costs and decrease resistance rate spread...
July 9, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29982376/antimicrobial-stewardship-and-intensive-care-unit-icu-mortality-a-systematic-review
#8
Patrick J Lindsay, Sagar Rohailla, Linda R Taggart, David Lightfoot, Thomas Havey, Nick Daneman, Christopher Lowe, Matthew P Muller
Background: Antimicrobial stewardship programs (ASP) using audit and feedback in the intensive care unit setting (ICU) can reduce harms related to inappropriate antibiotic use. However, inappropriate discontinuation or narrowing of antibiotic treatment could increase infection-related mortality in this population. Individual ASP studies are underpowered to detect mortality differences. Methods: We conducted a systematic review and meta-analysis of audit and feedback in the ICU setting using mortality as our outcome...
June 30, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29950480/study-protocol-for-a-multicentre-cluster-randomised-superiority-trial-evaluating-the-impact-of-computerised-decision-support-audit-and-feedback-on-antibiotic-use-the-computerized-antibiotic-stewardship-study-compass
#9
Gaud Catho, Marlieke De Kraker, Brigitte Waldispühl Suter, Roberta Valotti, Stephan Harbarth, Laurent Kaiser, Luigia Elzi, Rodolphe Meyer, Enos Bernasconi, Benedikt D Huttner
INTRODUCTION: Inappropriate use of antimicrobials in hospitals contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) interventions aim to improve antimicrobial prescribing, but they are often resource and personnel intensive. Computerised decision supportsystems (CDSSs) seem a promising tool to improve antimicrobial prescribing but have been insufficiently studied in clinical trials. METHODS AND ANALYSIS: The COMPuterized Antibiotic Stewardship Study trial, is a publicly funded, open-label, cluster randomised, controlled superiority trial which aims to determine whether a multimodal CDSS intervention integrated in the electronic health record (EHR) reduces overall antibiotic exposure in adult patients hospitalised in wards of two secondary and one tertiary care centre in Switzerland compared with 'standard-of-care' AMS...
June 27, 2018: BMJ Open
https://www.readbyqxmd.com/read/29802113/roles-of-the-emergency-medicine-pharmacist-a-systematic-review
#10
Cristina Roman, Gail Edwards, Michael Dooley, Biswadev Mitra
PURPOSE: Results of a systematic literature review to identify roles for emergency medicine (EM) pharmacists beyond traditionally reported activities and to quantify the benefits of these roles in terms of patient outcomes are reported. SUMMARY: Emergency department (ED)-based clinical pharmacy is a rapidly growing practice area that has gained support in a number of countries globally, particularly over the last 5-10 years. A systematic literature search covering the period 1995-2016 was conducted to characterize emerging EM pharmacist roles and the impact on patient outcomes...
June 1, 2018: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/29688433/antimicrobial-stewardship-program-in-a-pediatric-intensive-care-unit
#11
Yuta Aizawa, Junichi Suwa, Hiroshi Higuchi, Kahoru Fukuoka, Mihoko Furuichi, Tetsuji Kaneko, Yoshihiko Morikawa, Kaoru Okazaki, Naoki Shimizu, Yuho Horikoshi
We conducted an antimicrobial stewardship program in a pediatric intensive care unit. An interrupted time-series analysis revealed a significant reduction in level and trend of days of therapy per 1000 patient-days for antipseudomonal agents. No increase in adverse patient outcomes was found.
August 17, 2018: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/29661630/rapid-diagnostics-for-bloodstream-infections-a-primer-for-infection-preventionists
#12
Charles E Edmiston, Robert Garcia, Marsha Barnden, Barbara DeBaun, Helen Boehm Johnson
Accurate and rapid antimicrobial susceptibility testing with pathogen identification in bloodstream infections is critical to life results for early sepsis intervention. Advancements in rapid diagnostics have shortened the time to results from days to hours and have had positive effects on clinical outcomes and on efforts to combat antimicrobial resistance when paired with robust antimicrobial stewardship programs. This article provides infection preventionists with a working knowledge of available rapid diagnostics for bloodstream infections...
September 2018: American Journal of Infection Control
https://www.readbyqxmd.com/read/29610766/checking-procalcitonin-suitability-for-prognosis-and-antimicrobial-therapy-monitoring-in-burn-patients
#13
Luís Cabral, Vera Afreixo, Rita Meireles, Miguel Vaz, Catarina Chaves, Marisa Caetano, Luís Almeida, José Artur Paiva
Background: Due to greater infection susceptibility, sepsis is the main cause of death in burn patients. Quick diagnosis and patient stratification, early and appropriated antimicrobial therapy, and focus control are crucial for patients' survival. On the other hand, superfluous extension of therapy is associated with adverse events and arousal of microbial resistance. The use of biomarkers, necessarily coupled with close clinical examination, may predict outcomes, stratifying patients who need more intensive care, and monitor the efficacy of antimicrobial therapy, allowing faster de-escalation or stop, reducing the development of resistance and possibly the financial burden, without increasing mortality...
2018: Burns and Trauma
https://www.readbyqxmd.com/read/29534630/antibiotic-use-in-the-intensive-care-unit-optimization-and-de-escalation
#14
Maureen Campion, Gail Scully
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections...
December 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29514274/treatment-of-infections-caused-by-multidrug-resistant-gram-negative-bacteria-report-of-the-british-society-for-antimicrobial-chemotherapy-healthcare-infection-society-british-infection-association-joint-working-party
#15
Peter M Hawkey, Roderic E Warren, David M Livermore, Cliodna A M McNulty, David A Enoch, Jonathan A Otter, A Peter R Wilson
The Working Party makes more than 100 tabulated recommendations in antimicrobial prescribing for the treatment of infections caused by multidrug-resistant (MDR) Gram-negative bacteria (GNB) and suggest further research, and algorithms for hospital and community antimicrobial usage in urinary infection. The international definition of MDR is complex, unsatisfactory and hinders the setting and monitoring of improvement programmes. We give a new definition of multiresistance. The background information on the mechanisms, global spread and UK prevalence of antibiotic prescribing and resistance has been systematically reviewed...
March 1, 2018: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29493640/-the-interplay-of-diagnostic-and-antimicrobial-stewardship-for-the-management-of-septic-patients-the-tuscan-model
#16
Silvia Forni, Giulio Toccafondi, Bruno Viaggi, Maddalena Grazzini, Sara D'Arienzo, Fabrizio Gemmi, Andrea Vannucci, Giorgio Tulli
Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies...
February 2018: Recenti Progressi in Medicina
https://www.readbyqxmd.com/read/29484469/short-course-antibiotic-therapy-for-critically-ill-patients-treated-for-postoperative-intra-abdominal-infection-the-durapop-randomised-clinical-trial
#17
Philippe Montravers, Florence Tubach, Thomas Lescot, Benoit Veber, Marina Esposito-Farèse, Philippe Seguin, Catherine Paugam, Alain Lepape, Claude Meistelman, Joel Cousson, Antoine Tesniere, Gaetan Plantefeve, Gilles Blasco, Karim Asehnoune, Samir Jaber, Sigismond Lasocki, Herve Dupont
PURPOSE: Shortening the duration of antibiotic therapy (ABT) is a key measure in antimicrobial stewardship. The optimal duration of ABT for treatment of postoperative intra-abdominal infections (PIAI) in critically ill patients is unknown. METHODS: A multicentre prospective randomised trial conducted in 21 French intensive care units (ICU) between May 2011 and February 2015 compared the efficacy and safety of 8-day versus 15-day antibiotic therapy in critically ill patients with PIAI...
March 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29454592/effective-antimicrobial-stewardship-strategies-for-cost-effective-utilization-of-telavancin-for-the-treatment-of-patients-with-hospital-acquired-bacterial-pneumonia-caused-by-staphylococcus-aureus
#18
James A McKinnell, Shelby Corman, Dipen Patel, Grace H Leung, Lynne M Gordon, Thomas P Lodise
PURPOSE: Clinicians and stewardship programs are challenged with positioning of novel, higher priced antibiotic agents for the treatment of clinical infections. We developed a decision-analytic model to describe costs, including drug, total treatment costs, and health care outcomes, associated with telavancin (TLV) compared with vancomycin (VAN) for patients with Staphylococcus aureus (SA) hospital-acquired bacterial pneumonia (HABP). METHODS: This decision-analytic model assessed the treatment of SA-HABP with TLV versus VAN...
March 2018: Clinical Therapeutics
https://www.readbyqxmd.com/read/29410029/sustained-multimodal-antimicrobial-stewardship-in-an-australian-tertiary-intensive-care-unit-from-2008-2015-an-interrupted-time-series-analysis
#19
Suman Adhikari, Michael Piza, Peter Taylor, Kush Deshpande, Doris Lam, Pam Konecny
The long-term outcomes and sustainability of antimicrobial stewardship (AMS) in the intensive care unit (ICU) require evaluation. This study analysed the effect of a multimodal ICU AMS introduced in a 15-bed medical-surgical tertiary Australian adult ICU in November 2008, using interrupted time-series analysis of antibiotic usage, Gram-negative resistance and cost from November 2005 to October 2015, including national ICU average usage as a control. Overall ICU mortality, 30-day blood stream infection (BSI) mortality and length of stay (LOS) were compared over the same period...
April 2018: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/29164489/antimicrobial-stewardship-opportunities-in-critically-ill-patients-with-gram-negative-lower-respiratory-tract-infections-a-multicenter-cross-sectional-analysis
#20
Kimberly C Claeys, Evan J Zasowski, Trang D Trinh, Abdalhamid M Lagnf, Susan L Davis, Michael J Rybak
INTRODUCTION: Lower respiratory tract infections (LRTIs) are a major cause of morbidity and death. Because of changes in how LRTIs are defined coupled with the increasing prevalence of drug resistance, there is a gap in knowledge regarding the current burden of antimicrobial use for Centers for Disease Control and Prevention (CDC)-defined LRTIs. We describe the infection characteristics, antibiotic consumption, and clinical and economic outcomes of patients with Gram-negative (GN) LRTIs treated in intensive care units (ICUs)...
March 2018: Infectious Diseases and Therapy
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