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Stewardship antibiotic

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
P Puerta-Alcalde, Cardozo C, M Suárez-Lledó, O Rodríguez-Núñez, L Morata, C Fehér, F Marco, A Del Río, J A Martínez, J Mensa, M Rovira, J Esteve, A Soriano, C Garcia-Vidal
OBJECTIVES: We aimed to describe the current time to positivity (TTP) of blood cultures in onco-hematological patients with febrile neutropenia. We assessed the probability of having multidrug-resistant gram-negative bacilli (MDR-GNB) bloodstream infection (BSI) 24h after cultures were taken, to use this information for antibiotic de-escalation strategies. METHODS: BSI episodes were prospectively collected (2003-2017). When a patient experienced more than one BSI, only one episode was randomly chosen...
August 7, 2018: Clinical Microbiology and Infection
Giuseppe Magistro, Christian G Stief
Urinary tract infections (UTIs) are among the most common bacterial infections. Its management has become increasingly challenging due to antimicrobial resistance. The four mainstays to tackle this crisis rely on the development of new antibiotic agents, the introduction of preventive and alternative antimicrobial strategies, the concept of antimicrobial stewardship, and effective hygiene measures. One of the most effective approaches to prevent UTIs is the design of a potent vaccine. OM-89 is a lyophilised preparation of membrane proteins from 18 different uropathogenic Escherichia coli strains...
August 6, 2018: European Urology Focus
Norman Beatty, Jessica August, Joe Anthony Saenz, David E Nix, Kathryn R Matthias, Mayar Al Mohajer
Skin and soft-tissue infections (SSTIs) are commonly encountered by medical students, residents, and trainees. The Infectious Diseases Society of America (IDSA) has updated its recommendations regarding SSTI diagnosis and management in June 2014. We assessed knowledge, attitude, and practices toward diagnosis and management of SSTIs using an online survey. We disseminated the survey to medical students, residents, and attending physicians practicing in family and internal medicine department at a university-based hospital...
July 2018: Avicenna Journal of Medicine
Nicholas K Goldner, Christopher Bulow, Kevin Cho, Meghan Wallace, Fong-Fu Hsu, Gary J Patti, C A Burnham, Paul Schlesinger, Gautam Dantas
Daptomycin, a last-line-of-defense antibiotic for treating Gram-positive infections, is experiencing clinical failure against important infectious agents, including Corynebacterium striatum The recent transition of daptomycin to generic status is projected to dramatically increase availability, use, and clinical failure. Here we confirm the genetic mechanism of high-level daptomycin resistance (HLDR; MIC = >256 µg/ml) in C. striatum , which evolved within a patient during daptomycin therapy, a phenotype recapitulated in vitro In all 8 independent cases tested, loss-of-function mutations in phosphatidylglycerol synthase ( pgsA2 ) were necessary and sufficient for high-level daptomycin resistance...
August 8, 2018: MSphere
Sean N Avedissian, Marc H Scheetz, Teresa R Zembower, Christina Silkaitis, Robert Maxwell, Charles Jenkins, Michael J Postelnick, Sarah H Sutton, Nathaniel J Rhodes
Objectives: To quantify the impact of varying the at-risk days definition on the overall report of at-risk days and on the calculated standardized consumption rates (SCRs) for piperacillin/tazobactam, amikacin, daptomycin and vancomycin. Methods: Data were evaluated for two system hospitals, an 894 bed academic centre and a 114 bed community hospital. Aggregate inpatient antibiotic administration and occupancy data were extracted from electronic databases at the facility-wide level...
August 6, 2018: Journal of Antimicrobial Chemotherapy
P Antonioli, A Formaglio, D Gamberoni, L Bertoni, P Perrone, A Stefanati, M Libanore, R Cultrera, G Gabutti
Introduction: The appropriate use of antibiotics is a global priority in order to avoid antibiotic resistance. Up to 50% of antibiotics usage in hospital is inappropriate (e.g. prolonged surgical prophylaxis, "defensive medicine" approach). In 2015, at the Ferrara University Hospital, an antimicrobial stewardship intervention to reduce antimicrobial prescription at the time of hospital discharge in patients at risk of surgical site infection was implemented. This programme included: update meetings for health professionals, focused meetings for critical wards, reviews of some surgical prophylaxis protocols, recommendations to reduce broad-spectrum antimicrobials use, and planning of an audit...
June 2018: Journal of Preventive Medicine and Hygiene
L Hayley Burgess, Karla Miller, Mandelin Cooper, Julia Moody, Jane Englebright, Edward Septimus
BACKGROUND: Antimicrobial stewardship is recommended as a crucial mechanism to reduce the emergence of antimicrobial resistance. The purpose of this article was to describe implementation of antimicrobial management programs (AMPs) across a large health system of community hospitals. METHODS: The initiative was structured in 4 phases. Although each phase was implemented sequentially, facilities could progress at their own pace. Phase goals needed to be met before moving to the next phase...
August 3, 2018: American Journal of Infection Control
Tommaso Cai
Empirical antibiotic treatment of urinary tract infections: from everyday clinical practice to EAU guidelines 2017 Recent epidemiological data confirm the increasing problem of antimicrobial resistance not only for hospitalized, healthcare-associated patients but also for outpatients. In particular, the progressive increase in resistance to broad-spectrum antibiotics, such as third-generation cephalosporins, fluoroquinolones, or carbapenems in Enterobacteriaceae, is an alarming situation for all urologists and general practitioners...
July 2018: Urologia
Carlo Tascini
Antibiotic stewardship: a milestone in everyday clinical practice Infectious diseases caused by multi-resistant pathogens are increasing worldwide and are challenging for clinicians, also in urological setting. The alarming situation is worsened by the limited perspective of new antibiotic developments. Several authors demonstrated that in Italy we have alarming data about resistance rates: in Campania about 58% of Escherichia coli are resistant to fluroquinolones, as 46% to sulfamethoxazole-trimethoprim. On the other hand, the resistance rate against fosfomycin is still low less than 5%...
July 2018: Urologia
Michele Rizzo, Carlo Trombetta
Antibiotic prophylaxis in urological procedures Thousands of patients receive every day an antibiotic prophylaxis before diagnostic or therapeutic urological procedures. Aim of antibiotic prophylaxis is to reduce the risk of infective complications, unfortunately good quality evidences for the best choice of prophylaxis strategy are often lacking. Nowadays antimicrobial resistance is a major health problem caused primarily by overuse of antibiotics. It is the responsibility of all physicians to practice antibiotic stewardship avoiding the unnecessary use of this precious drugs...
July 2018: Urologia
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
Marco Falcone, Mical Paul, Dafna Yahav, Gabriella Orlando, Giusy Tiseo, Virginie Prendki, Robert Güerri-Fernández, Gaetan Gavazzi, Nico T Mutters, Barry Cookson, Marco Tinelli
BACKGROUND: Antimicrobials are amongst the most frequently prescribed drugs in long-term care facilities (LTCFs). Implementation of antimicrobial stewardship programs (ASPs) is often challenging, due to scarce data in this setting. OBJECTIVES: This narrative review aimed to provide data about antibiotic consumption in LTCFs and need, implementation and organization of antimicrobial stewardship programs (ASPs) in this setting. SOURCE: PubMed was searched for studies assessing antimicrobial consumption and implementation of ASPs in LTCFs...
August 1, 2018: Clinical Microbiology and Infection
Jenifer Barrie, Saurabh Jamdar, Neil Smith, Simon J McPherson, Ajith K Siriwardena, Derek A O'Reilly
BACKGROUND: International guidelines for the management of acute pancreatitis state that antibiotics should only be used to treat infectious complications. Antibiotic prophylaxis is not recommended. The aim of this study was to analyse antibiotic use, and its appropriateness, from a national review of acute pancreatitis. METHODS: Data were collected from The National Confidential Enquiry into Patient Outcome and Death (NCEPOD) study into the management of acute pancreatitis...
May 24, 2018: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Daniel J Miller, Patrick J Cahill, Joseph A Janicki, Lindsay P Stephenson, Paul D Choi
BACKGROUND: Enhancing the safety, quality, and value of care provided is a point of emphasis for modern health care systems. We performed a review of recent literature to highlight those efforts relevant to pediatric musculoskeletal care. METHODS: We searched the PubMed database for all papers related to quality improvement, patient safety, and/or value in pediatric orthopaedics published from October 1, 2012 to October 31, 2017, yielding 193 papers. RESULTS: A total of 36 papers were selected for review based upon new findings...
August 1, 2018: Journal of Pediatric Orthopedics
Tahmineh Khazaei, Jacob T Barlow, Nathan G Schoepp, Rustem F Ismagilov
Antimicrobial-resistant Neisseria gonorrhoeae is an urgent public-health threat, with continued worldwide incidents of infection and rising resistance to antimicrobials. Traditional culture-based methods for antibiotic susceptibility testing are unacceptably slow (1-2 days), resulting in the use of broad-spectrum antibiotics and the further development and spread of resistance. Critically needed is a rapid antibiotic susceptibility test (AST) that can guide treatment at the point-of-care. Rapid phenotypic approaches using quantification of DNA have been demonstrated for fast-growing organisms (e...
August 2, 2018: Scientific Reports
Neil Powell, Kate McGraw-Allen, Alasdair Menzies, Bradley Peet, Callie Simmonds, Abigail Wild
Evidence-based audit tools were used to identify the antibiotic stewardship improvements necessary to meet the NHS England targets in a 750-bed teaching hospital.Antibiotic prescribing was reviewed against published evidence-based audit tools for 139 patients treated with antibiotics. Severe community-acquired pneumonia (CAP) median course length was 8.5 days. Ninety-six percent of non-severe CAP patients were initiated on intravenous antibiotics (IV); median antibiotic course length 9 days. Twenty-six percent of urinary tract infection (UTI) patients without an indwelling catheter met the UTI diagnostic criteria...
August 2018: Clinical Medicine: Journal of the Royal College of Physicians of London
U Abubakar, S A Syed Sulaiman, A G Adesiyun
Background Audit of antibiotic prophylaxis is an important strategy used to identify areas where stewardship interventions are required. Objectives To evaluate compliance with surgical antibiotic prophylaxis in obstetrics and gynaecology surgeries and determine the Defined Daily Dose (DDD) of antibiotic. Settings Three public tertiary hospitals located in Northern Nigeria. Methods This prospective study included women who had obstetrics and gynaecology surgeries with no infection at the time of incision. Appropriateness of antibiotic prophylaxis was determined by a clinical pharmacist...
July 27, 2018: International Journal of Clinical Pharmacy
Giulia la Martire, Christine Robin, Nadia Oubaya, Raphaël Lepeule, Florence Beckerich, Mathieu Leclerc, Walid Barhoumi, Andréa Toma, Cécile Pautas, Sébastien Maury, Wiem Akrout, Catherine Cordonnier-Jourdin, Vincent Fihman, Mario Venditti, Catherine Cordonnier
Febrile neutropenia (FN) is the main reason for antibiotic prescription in hematology wards where, on the other hand, antibiotic stewardship (AS) is poorly explored. The objectives of the present study were to evaluate (1) the impact of an AS intervention on antibiotic consumption and (2) the applicability and acceptance rate of the intervention and its clinical impact. A persuasive AS intervention based on European Conference on Infection in Leukaemia (ECIL) guidelines for FN was implemented in a high-risk hematology ward in a tertiary referral public university hospital...
July 26, 2018: European Journal of Clinical Microbiology & Infectious Diseases
Biljana Mijović, Milena Dubravac Tanasković, Maja Račić, Janja Bojanić, Slobodan Stanić, Dušica Banković Lazarević
Aim To synthesize evidence about the influence of individual antimicrobial stewardship programs (ASP) related to the prevention of Clostridium difficile (C. difficile) infection on primary and secondary outcomes. Methods Relevant databases such as Medline, PUBMED, COCHRANE library and EBSCO were searched from 1 April to 27 April 2017. Additional studies were reached by the manual search for original articles in relevant journals. We included all randomized controlled, quasi-experimental and observational studies, published in the English language from 2007 onward, that evaluated effectiveness of ASP in preventing and controlling C...
August 1, 2018: Medicinski Glasnik
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