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Stewardship antibiotic

Anouk Goerens, Dirk Lehnick, Michael Büttcher, Karin Daetwyler, Matteo Fontana, Petra Genet, Marco Lurà, Davide Morgillo, Sina Pilgrim, Katharina Schwendener-Scholl, Nicolas Regamey, Thomas J Neuhaus, Martin Stocker
Background and Aims: Neonatal ventilator associated pneumonia (VAP) is a common nosocomial infection and a frequent reason for empirical antibiotic therapy in NICUs. Nonetheless, there is no international consensus regarding diagnostic criteria and management. In a first step, we analyzed the used diagnostic criteria, risk factors and therapeutic management of neonatal VAP by a literature review. In a second step, we aimed to compare suspected vs. confirmed neonatal VAP episodes in our unit according to different published criteria and to analyze interrater-reliability of chest x-rays...
2018: Frontiers in Pediatrics
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
David L Brinker, Erina L MacGeorge, Nicole Hackman
Current guidelines recommend "watchful waiting" (WW) as an alternative to immediate antibiotic treatment. Continued high rates of antibiotic use suggest that WW may be underutilized. We conducted a retrospective chart review of 474 pediatric acute otitis media (AOM) cases at a clinic in central Pennsylvania. We assessed physical examination findings, diagnostic behavior, WW utilization, prescription writing, and filling in cases of pediatric AOM to evaluate the underutilization of WW. We evaluate diagnostic consistency with published guidelines and rates of antibiotic prescription resulting from misdiagnosis...
October 12, 2018: Clinical Pediatrics
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
Geraint B Rogers, Lito E Papanicolas, Steve L Wesselingh
No abstract text is available yet for this article.
October 2018: Lancet Infectious Diseases
Charles E Edmiston, Maureen Spencer, David Leaper
A surgical site infection (SSI) can occur at several anatomic sites related to a surgical procedure: Superficial or deep incisional or organ/space. The SSIs are the leading cause of health-care-associated infection (HAI) in industrialized Western nations. Patients in whom an SSI develops require longer hospitalization, incur significantly greater treatment costs and reduction in quality of life, and after selective surgical procedures experience higher mortality rates. Effective infection prevention and control requires the concept of the SSI care bundle, which is composed of a defined number of evidence-based interventional strategies, because of the many risk factors that can contribute to the development of an SSI...
October 9, 2018: Surgical Infections
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
Rachael A Lee, Morgan C Scully, Bernard C Camins, Russell L Griffin, Danielle F Kunz, Stephen A Moser, Craig J Hoesley, Todd P McCarty, Peter G Pappas
OBJECTIVE: Due to concerns over increasing fluoroquinolone (FQ) resistance among gram-negative organisms, our stewardship program implemented a preauthorization use policy. The goal of this study was to assess the relationship between hospital FQ use and antibiotic resistance. DESIGN: Retrospective cohort. SETTING: Large academic medical center. METHODS: We performed a retrospective analysis of FQ susceptibility of hospital isolates for 5 common gram-negative bacteria: Acinetobacter spp...
October 9, 2018: Infection Control and Hospital Epidemiology
Snigdha Vallabhaneni, James Baggs, Sharon Tsay, Arjun R Srinivasan, John A Jernigan, Brendan R Jackson
Background: Although trends in antibiotic use have been characterized, less is known about antifungal use. Data on antifungal use are important for understanding practice patterns, assessing emergence of antifungal resistance and developing antifungal stewardship programmes. We estimated national trends in inpatient antifungal use in the USA. Methods: Using billing data for antifungals from the Truven Health MarketScan® Hospital Drug Database during 2006-12, we estimated the proportion of discharges at which antifungals were given and days of therapy (DOT)/1000 patient days (PDs) by antifungal drug type, year, patient and facility characteristics...
October 1, 2018: Journal of Antimicrobial Chemotherapy
Alexander W Hirsch, Michael C Monuteaux, Mark I Neuman, Richard G Bachur
OBJECTIVE: To improve the prediction of pediatric pneumonia by developing a series of models based on clinically distinct subgroups. We hypothesized that these subgroup models would provide superior estimates of pneumonia risk compared with a single pediatric model. STUDY DESIGN: We conducted a secondary analysis of a prospective cohort being evaluated for radiographic pneumonia in an urban pediatric emergency department (ED). Using multivariate modeling, we created 4 models across subgroups stratified by age and presence of wheezing to predict the risk of pneumonia...
October 4, 2018: Journal of Pediatrics
Saransh Jain, Soumya Jagannath Mahapatra, Swatantra Gupta, Shalimar, Pramod Kumar Garg
BACKGROUND: Organ failure determines outcome in acute pancreatitis (AP). It is controversial if infected pancreatic necrosis (IPN) is also an independent determinant of mortality. We hypothesized that the predictors of mortality in AP might have changed with advances in management and consequent decline in mortality over the past decades. Our objective was to study the predictors of mortality in patients with AP. METHODS: Consecutive patients with a first episode of AP hospitalized from January 2015 to December 2016 were included in an observational study...
October 5, 2018: Clinical and Translational Gastroenterology
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
Jeremy S Stultz, Rose Kohinke, Amy L Pakyz
BACKGROUND: Identification of factors associated with antifungal utilization in neonatal, pediatric, and adult patient groups is needed to guide antifungal stewardship initiatives in academic medical centers. METHODS: For this hospital-level analysis, we analyzed antifungal use in hospitals across the United States of America, excluding centers only providing care for hematology/oncology patients. Analysis of variance was used to compare antifungal use between patient groups...
October 3, 2018: BMC Infectious Diseases
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
Jake R Morgan, Tamar F Barlam, Mari-Lynn Drainoni
Background: Antibiotic-resistant bacterial infections are a major threat to public health, yet improper use of antibiotics remains high. Infectious Diseases (ID) fellows play a major role in antibiotic stewardship efforts, but there is little research on how they view stewardship activities. We performed a qualitative study to explore ID fellows' experiences and perspectives regarding their antibiotic stewardship training and their role as future antibiotic stewards. Methods: We conducted 17 in-depth interviews with ID fellows across the country...
September 2018: Open Forum Infectious Diseases
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