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Guideline* AND Antibiotic* AND outcome*

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
David A Talan, Darin J Saltzman, Daniel A DeUgarte, Gregory J Moran
BACKGROUND: Meta-analyses and a recent guideline acknowledge that conservative management of uncomplicated appendicitis with antibiotics can be successful for patients who wish to avoid surgery. However, guidance as to specific management does not exist. METHODS: PUBMED and EMBASE search of trials describing methods of conservative treatment was conducted according to PRISMA guidelines. RESULTS: Thirty-four studies involving 2944 antibiotic-treated participants were identified...
December 3, 2018: Journal of Trauma and Acute Care Surgery
Aurora Pop-Vicas, Stephen Johnson, Nasia Safdar
OBJECTIVE: Current practice guidelines recommend cefazolin, cefoxitin, cefotetan, or ampicillin-sulbactam as first-line antibiotic prophylaxis in hysterectomy. We undertook this systematic review and meta-analysis of randomized controlled trials (RCTs) to determine whether cefazolin, with limited antianaerobic spectrum, is as effective in preventing surgical site-infection (SSI) as the other first-choice antimicrobials that have more extensive antianaerobic activity. METHODS: We searched PubMed, Scopus, Web of Science, Cochrane Central, and EMBASE for relevant randomized controlled trials (RCT) in any language up to January 23, 2018...
December 5, 2018: Infection Control and Hospital Epidemiology
Marlene Richter Jensen, Elisabeth Arndal, Christian Von Buchwald
The aim of this review is to evaluate current guidelines for diagnosis, treatment and follow-up of patients with chronic rhinosinusitis. We discuss: 1) diagnostic criteria, 2) the use of supplementary tools like visual analogue scale, Sino-Nasal Outcome Test and Sniffin' Sticks, 3) the use of tests like allergy, serum IgE and biopsy and 4) comorbidity in relation to the unified airways concept. Furthermore, we evaluate: 1) initial treatment with topical steroids and nasal irrigation, 2) additional treatment options including surgery, systemic steroids and antibiotics and 3) treatment risks...
November 19, 2018: Ugeskrift for Laeger
Bela Köves, Peter Tenke, Zafer Tandogdu, Tommaso Cai, Florian Bogenhard, Björn Wullt, Kurt Naber, Riccardo Bartoletti, Mete Cek, Ekaterina Kulchavenya, Tamara Perepanova, Adrian Pilatz, Gernot Bonkat, Truls Erik Bjerklund Johansen, Florian Wagenlehner
Transurethral resection of the prostate (TURP) is one of the most common urological procedures. With the increasing rate of multiresistant infections including urosepsis, it is essential for all surgeons to adhere to the relevant international guidelines to prevent infectious complications. The aim of this prospective, multinational, multicentre study was to evaluate compliance with recommended infection control measures regarding TURP procedures. The study was performed as a side questionnaire to the annual Global Prevalence Study of Infections in Urology (GPIU) between 2006 and 2009...
December 3, 2018: Journal of Chemotherapy
Lukas T Martin, Shelbi Vincent, Sarah Gillian, Katherine Moore, Deanna Ratermann, Christopher A Droege
Clostridium difficile is a gram-positive, anaerobic, spore-forming bacterium that is the leading cause of nosocomial infections in hospitals in the United States. Critically ill patients are at high risk for C. difficile infection (CDI) and face potentially detrimental effects, including prolonged hospitalization, risk of recurrent disease, complicated surgery, and death. CDI requires a multidisciplinary approach to decrease hospital transmission and improve treatment outcomes. This article briefly reviews the current literature and guideline recommendations for treatment and prevention of CDI, with a focus on antibiotic treatment considerations including dosing, routes of administration, efficacy data, adverse effects, and monitoring parameters...
January 2019: Critical Care Nursing Quarterly
Brian Nuyen, Cherian K Kandathil, Katri Laimi, Shannon F Rudy, Sam P Most, Mikhail Saltychev
Importance: Although antibiotic prophylaxis following rhinoplasty is widespread, the evidence on antibiotic prophylaxis effectiveness and the superiority of particular administration regimens is controversial. To date, a meta-analysis on the topic has not been performed. Objective: To systematically review the association between use of preventive antibiotics and postoperative complications in patients undergoing rhinoplasty and quantify the review through meta-analysis...
November 29, 2018: JAMA Facial Plastic Surgery
Natalie Wu, William Muller, Elaine Morgan
There are no consensus guidelines for management of pediatric oncology patients presenting with fever and nonneutropenia, with limited research into the outcomes of withholding empiric i.v. antibiotics. We conducted a prospective cohort study assessing the safety and efficacy of observing well-appearing patients presenting with fever and nonneutropenia (absolute neutrophil count ≥ 500 cells/mm3 ). Of 238 episodes, 82.7% patients were observed with no infectious complications and low overall incidence of bacteremia (3...
November 26, 2018: Pediatric Blood & Cancer
John P Sheppard, Vera Ong, Carlito Lagman, Methma Udawatta, Courtney Duong, Thien Nguyen, Giyarpuram N Prashant, David S Plurad, Dennis Y Kim, Isaac Yang
BACKGROUND: External ventricular drain (EVD) placement is essential for the management of many neurocritical care patients. However, ventriculostomy-related infection (VRI) is a serious complication, and there remains no well-established protocol guiding use of perioperative or extended antibiotic prophylaxis to minimize risk of VRI. OBJECTIVE: To analyze published evidence on the efficacy of extended prophylactic antimicrobial therapy and antibiotic-coated external ventricular drains (ac-EVDs) in reducing VRI incidence...
November 26, 2018: Neurosurgery
Gregory Reychler, Claire Domachowski, Anne-Claire Latiers, Francois Jamar, Philippe Rombaux
BACKGROUND: Treatment of chronic rhinosinusitis (CRS) aims to treat the underlying inflammation or infection. Although the optimal modality of administration remains controversial, inhalation route is usually preferred. The aim of this systematic review was to summarize the efficacy of intranasal corticoisteroids or antibiotics delivery by nebulization on symptoms, histology, endoscopy scores, nasal obstruction, clinical outcomes and quality of life in CRS. METHOD: This systematic review followed the PRISMA guidelines...
November 24, 2018: Rhinology
Hoe Nam Leong, Asok Kurup, Mak Yong Tan, Andrea Lay Hoon Kwa, Kui Hin Liau, Mark H Wilcox
Complicated skin and soft tissue infections (cSSTIs) represent the severe form of infectious disease that involves deeper soft tissues. Involvement of methicillin-resistant Staphylococcus aureus (MRSA) further complicates cSSTI with increased hospitalization, health care costs, and overall mortality. Various international guidelines provide recommendations on the management of cSSTIs, with the inclusion of newer antibiotics. This literature-based review discusses the overall management of cSSTI, including appropriate use of antibiotics in clinical practice...
2018: Infection and Drug Resistance
Jamie Harshman, Mélissa Roy, Robert Cartotto
Background: Good burn care starts with correct management of the burn patient prior to transfer to a burn center. The purpose of this study was to perform a systematic review of the medical literature describing pre-burn center care. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for this review. Studies were included if they were published from a burn center and they measured or evaluated any aspect of pre-burn center care of adult or pediatric acute burn patients referred to that burn center...
November 19, 2018: Journal of Burn Care & Research: Official Publication of the American Burn Association
D Eggermont, M A M Smit, G A Kwestroo, R A Verheij, K Hek, A E Kunst
BACKGROUND: Patient gender as well as doctor gender are known to affect doctor-patient interaction during a medical consultation. It is however not known whether an interaction of gender influences antibiotic prescribing. This study examined GP's prescribing behavior of antibiotics at the first presentation of patients with sore throat symptoms in primary care. We investigated whether GP gender, patient gender and gender concordance have an effect on the GP's prescribing behavior of antibiotics in protocolled and non-protocolled diagnoses...
November 17, 2018: BMC Family Practice
Ester Steffens, Charlotte Quintens, Inge Derdelinckx, Willy E Peetermans, Johan Van Eldere, Isabel Spriet, Annette Schuermans
PURPOSE: This narrative review aims to describe barriers of outpatient parenteral antimicrobial therapy at home (OPAT), potentially compromising general standards of antibiotic stewardship (ABS) and facilitators of OPAT for ABS. METHODS: After a literature review, five authors determined the barriers and facilitators to discuss in this review. RESULTS: Sixty-six publications were included in the narrative review and seven barriers and five facilitators are discussed in this article...
November 15, 2018: Infection
Danya Roshdy, Rupal Jaffa, Kelly E Pillinger, Josh Guffey, Nigel Rozario, Lisa Davidson, Lewis McCurdy
Background: Acute bacterial skin and skin structure infections (ABSSSI) are a leading cause of hospitalization, but are often treated inappropriately in the inpatient setting. A multifaceted stewardship intervention was implemented to encourage prescribing of guideline-concordant therapy (GCT). Objective: To examine the impact of this initiative on antimicrobial prescribing practices and patient outcomes. Methods: This was a single-center, retrospective study of adult inpatients admitted with a primary or secondary diagnosis of ABSSSI, classified by type and severity based on signs of systemic infection...
November 2018: Therapeutic Advances in Infectious Disease
K Kc Hung, R Pk Lam, R Sl Lo, J W Tenney, M Lc Yang, M Ck Tai, C A Graham
INTRODUCTION: Emergency departments (EDs) play an important role in the early identification and management of sepsis. Little is known about local EDs' processes of care for sepsis, adoption of international recommendations, and the impact of the new Sepsis-3 definitions. METHODS: Structured telephone interviews based on the United Kingdom Sepsis Trust 'Exemplar Standards for the Emergency Management of Sepsis' were conducted from January to August 2017 with nominated representatives of all responding public hospital EDs in Hong Kong, followed by a review of hospital/departmental sepsis guidelines by the investigators...
November 14, 2018: Hong Kong Medical Journal, Xianggang Yi Xue za Zhi
Yonghong Xiao
Antimicrobial resistance (AMR) has become a serious global public health crisis, and AMR control has consequently become a priority in all countries. Specifically, the incidence of various common multidrug-resistant bacteria is high, and there are multiple problems concerning the irrational use of antimicrobial drugs. In the past decade, China has established a relatively comprehensive management system and technical support framework for antimicrobial stewardship, including regulations, guidelines, networks for the surveillance of AMR and antimicrobial consumption, and professional personnel training...
November 13, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Xiaoyu Liang, Yaxing Fan, Minjie Yang, Jing Zhang, Jufang Wu, Jicheng Yu, Jinhao Tao, Guoping Lu, Huifang Zhang, Ruilan Wang, Xiaoxing Wen, Huayin Li, Fengying Zhang, Jingqin Hang, Lihua Shen, Zhongwei Zhang, Qionghua Lin, Fengming Fu, Shengbin Wu, Bo Shen, Weifeng Huang, Chunkang Chang, Hong Zhang, Qiwei Huang, Yifan Shi, Hong Ren, Qing Yuan, Xiaolian Song, Xuming Luo, Hong Zhang
Background: Vancomycin is a first-line antibiotic used for the treatment of severe gram-positive bacterial infections. Clinical guidelines recommend that the vancomycin trough concentration be 10-15 mg/L for regular infections and 15-20 mg/L for severe infections. We investigated whether increasing the vancomycin concentration would result in better clinical outcomes with sustainable adverse effects (AEs) in the Chinese population. Methods: A prospective, open, multicenter clinical observational study was performed in patients with gram-positive bacterial infections from 13 teaching hospitals...
November 13, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Sarah C J Jorgensen, Abdalhamid M Lagnf, Sahil Bhatia, Muhammad-Daniayl Shamim, Michael J Rybak
Background: Published guidelines call for prolonged courses of intravenous (iv) antibiotics for the treatment of MRSA bloodstream infection (BSI) to ensure eradication of deep foci and decrease relapse risk. Sequential iv-to-oral antibiotic therapy has been successfully applied to other serious infections but has not been evaluated for MRSA BSI. Objectives: To compare outcomes in adults completing MRSA BSI therapy with oral versus parenteral antibiotics in the outpatient setting [oral outpatient antibiotic therapy (OOAT) versus outpatient parenteral antibiotic therapy (OPAT)]...
November 9, 2018: Journal of Antimicrobial Chemotherapy
Travis T Gilbert, Rachel J Arfstrom, Scott W Mihalovic, Ala S Dababneh, Bharath Raj Varatharaj Palraj, Ross A Dierkhising, Kristin C Mara, Sarah R Lessard
BACKGROUND: Antibiotic therapy with a macrolide and β-lactam or a fluoroquinolone for the empirical treatment of community-acquired pneumonia (CAP) in an inpatient non-intensive care setting is recommended per guidelines. Studies show that these treatments have similar outcomes, including death, adverse effects, and bacterial eradication. However, a comparison of 30-day readmission rates between these treatments is limited. STUDY QUESTION: To determine whether 30-day readmissions for patients treated for CAP in a regional hospital differed between a fluoroquinolone monotherapy and a β-lactam plus macrolide combination therapy...
May 22, 2018: American Journal of Therapeutics
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