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Antibiotic clinical decision support

Yannick Wirz, Marc A Meier, Lila Bouadma, Charles E Luyt, Michel Wolff, Jean Chastre, Florence Tubach, Stefan Schroeder, Vandack Nobre, Djillali Annane, Konrad Reinhart, Pierre Damas, Maarten Nijsten, Arezoo Shajiei, Dylan W deLange, Rodrigo O Deliberato, Carolina F Oliveira, Yahya Shehabi, Jos A H van Oers, Albertus Beishuizen, Armand R J Girbes, Evelien de Jong, Beat Mueller, Philipp Schuetz
BACKGROUND: The clinical utility of serum procalcitonin levels in guiding antibiotic treatment decisions in patients with sepsis remains unclear. This patient-level meta-analysis based on 11 randomized trials investigates the impact of procalcitonin-guided antibiotic therapy on mortality in intensive care unit (ICU) patients with infection, both overall and stratified according to sepsis definition, severity, and type of infection. METHODS: For this meta-analysis focusing on procalcitonin-guided antibiotic management in critically ill patients with sepsis of any type, in February 2018 we updated the database of a previous individual patient data meta-analysis which was limited to patients with respiratory infections only...
August 15, 2018: Critical Care: the Official Journal of the Critical Care Forum
Gabriela Schmid-Mohler, Ann-Louise Caress, Rebecca Spirig, Christian Benden, Janelle Yorke
AIM AND OBJECTIVES: To explore the experience of pulmonary exacerbation from the perspective of adults with cystic fibrosis. BACKGROUND: While management of pulmonary exacerbations is a pillar of cystic fibrosis care, little is known of patients' perspectives. Understanding the patient's experience is essential for developing and evaluating interventions in support of patient self-management. DESIGN: Qualitative study with longitudinal study in a subsample...
August 9, 2018: Journal of Clinical Nursing
Tenielle Watkins, Sandra M Aguero, Michael Jaecks
Failure to appropriately document patient medical information, such as allergies, is an important cause of medication errors. Lack of allergy details in the electronic medical record (EMR) may prolong the pharmacist order verification process. A retrospective chart review was conducted in October 2017, to evaluate the impact of incomplete allergy details on time to antibiotic order resolution at the Einstein Medical Center Philadelphia. Details were present on 71% of orders. The difference in median time to order resolution, for orders with versus without details, was ⁻21 min (95% CI (confidence interval), ⁻39 to ⁻2...
August 3, 2018: Pharmacy (Basel, Switzerland)
Armando Vázquez-Rangel
El acceso vascular es el primer eslabón para la terapia de apoyo extracorpórea renal. A diferencia de la terapia de reemplazo renal para pacientes con enfermedad renal crónica donde la fístula arteriovenosa es la primera opción, seguida del catéter tunelizado, en pacientes con lesión renal aguda el acceso vascular de elección es el catéter temporal. El presente estudio constituye una revisión narrativa de resumen de los estudios que analizan la elección, colocación y cuidados del acceso vascular temporal para apoyo renal agudo...
2018: Gaceta Médica de México
Emily S Patterson, Courtney M Dewart, Kurt Stevenson, Awa Mbodj, Mark Lustberg, Erinn M Hade, Courtney Hebert
Our objective is to operationalize a novel antibiotic advisor, called the personalized weighted incidence syndromic combination antibiogram (pWISCA), intended to help physicians with initial antibiotic choice in hospitals. Clinical decision support tools are a promising technology for providing evidence-based guidance that incorporates data about patients from electronic health records. Nevertheless, congruence with policies and procedures and local experts' opinions, as well as taking into account local resistance data for the medical center's patient population, is needed when selecting and ordering the antibiotic medication options provided by pWISCA...
June 2018: Proceedings of the International Symposium of Human Factors and Ergonomics in Healthcare. International Symposium of Human Factors and Ergonomics in Healthcare
Nay Myo Oo, Ian A Scott, Raquel Maggacis, Nalaka Rajakaruna
Objective The aims of this study were to assess: (1) concordance between patient preferences stated in advance care plans (ACPs) and hospital care over the subsequent 12 months; (2) change in preferences over time; (3) justifications for discordant care; and (4) effects of ACP completion on hospital utilisation. Methods A retrospective study was conducted of 198 patients with an ACP form registered with an ACP registry and tagged with a hospital unique record number. Data collected from ACP forms and hospital records comprised ACP completion and revisions, care preferences, patient characteristics and hospital care...
July 23, 2018: Australian Health Review: a Publication of the Australian Hospital Association
Amar Mandalia, Erik-Jan Wamsteker, Matthew DiMagno
This review highlights advances made in recent years in the diagnosis and management of acute pancreatitis (AP). We focus on epidemiological, clinical, and management aspects of AP. Additionally, we discuss the role of using risk stratification tools to guide clinical decision making. The majority of patients suffer from mild AP, and only a subset develop moderately severe AP, defined as a pancreatic local complication, or severe AP, defined as persistent organ failure. In mild AP, management typically involves diagnostic evaluation and supportive care resulting usually in a short hospital length of stay (LOS)...
2018: F1000Research
Enrique Castro-Sánchez, Michiyo Iwami, Raheelah Ahmad, Rifat Atun, Alison H Holmes
Background: National action plans determine country responses to anti-microbial resistance (AMR). These plans include interventions aimed at citizens. As the language used in documents could persuade certain behaviours, we sought to assess the positioning and implied responsibilities of citizens in current European AMR plans. This understanding could lead to improved policies and interventions. Methods: Review and comparison of national action plans for AMR (NAP-AMR) obtained from the European Centre for Disease Prevention and Control (plans from 28 European Union and four European Economic Area/European Free Trade Association countries), supplemented by European experts (June-September 2016)...
July 4, 2018: European Journal of Public Health
Antonio Morales, Manuel Campos, Jose M Juarez, Bernardo Canovas-Segura, Francisco Palacios, Roque Marin
BACKGROUND: Local cumulative antibiograms are useful tools with which to select appropriate empiric or directed therapies when treating infectious diseases at a hospital. However, data represented in traditional antibiograms are static, incomplete and not well adapted to decision-making. METHODS: We propose a decision support method for empiric antibiotic therapy based on the Number Needed to Fail (NNF) measure. NNF indicates the number of patients that would need to be treated with a specific antibiotic for one to be inadequately treated...
August 2018: Journal of Biomedical Informatics
Justin R Chen, Scott A Tarver, Kristin S Alvarez, Wenjing Wei, David A Khan
Background: Patients reporting penicillin allergy often receive unnecessary and costly broad-spectrum alternatives such as aztreonam with negative consequences. Penicillin allergy testing improves antimicrobial therapy but is not broadly used in hospitals due to insufficient testing resources and short-term expenses. We describe a clinical decision support (CDS) tool promoting pharmacist-administered penicillin allergy testing in patients receiving aztreonam and its benefits toward antimicrobial stewardship and costs...
June 2018: Open Forum Infectious Diseases
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
Peter Daley, Yuvraj Gill, William Midodzi
INTRODUCTION: Urine specimens for quantitative culture for the diagnosis of urinary tract infection may be unreliable due to bacterial overgrowth within 4 h after collection, at room temperature. Because specimen transportation may take longer than 4 h, urine preservatives may reduce overgrowth. Further evidence is needed to support a recommendation for use of preservative and to compare preservative products. METHODS: Consecutive midstream urine specimens submitted for culture were quantitatively cultured on receipt and then inoculated into 3 storage conditions [BD Urine Vacutainer (BD), Copan UriSwab (US), and refrigeration, with a room temperature control] for 72 h, with quantitative culture performed every 24 h...
June 1, 2018: Diagnostic Microbiology and Infectious Disease
Benedict Hayhoe, Christopher C Butler, Azeem Majeed, Sonia Saxena
Antimicrobial resistance represents a growing threat to global health, yet antibiotics are frequently prescribed in primary care for acute childhood illness, where there is evidence of very limited clinical effectiveness. Moral philosophy supports the need for doctors to consider wider society, including future patients, when treating present individuals, and it is clearly wrong to waste antibiotics in situations where they are largely clinically ineffective at the expense of future generations. Doctors should feel confident in applying principles of antibiotic stewardship when treating children in primary care, but they must explain these to parents...
June 22, 2018: Journal of Antimicrobial Chemotherapy
Traci D Yates, Marion E Davis, Yhenneko J Taylor, Lisa Davidson, Crystal D Connor, Katherine Buehler, Melanie D Spencer
BACKGROUND: Inappropriate prescribing of antibiotics poses an urgent public health threat. Limited research has examined factors associated with antibiotic prescribing practices in outpatient settings. The goals of this study were to explore elements influencing provider decisions to prescribe antibiotics, identify provider recommendations for interventions to reduce inappropriate antibiotic use, and inform the clinical management of patients in the outpatient environment for infections that do not require antibiotics...
June 23, 2018: BMC Family Practice
Heather L Young, Katherine C Shihadeh, Alisha A Skinner, Bryan C Knepper, Jeffrey Sankoff, Jeremy Voros, Timothy C Jenkins
Smartphones are increasingly used to access clinical decision support, and many medical applications provide antimicrobial prescribing guidance. However, these applications do not account for local antibiotic resistance patterns and formularies. We implemented an institution-specific antimicrobial stewardship smartphone application and studied patterns of use over a 1-year period.
June 21, 2018: Infection Control and Hospital Epidemiology
Ann F Chou, Christopher J Graber, Yue Zhang, Makoto Jones, Matthew Bidwell Goetz, Karl Madaras-Kelly, Matthew Samore, Peter A Glassman
Objectives: Inappropriate antibiotic use poses a serious threat to patient safety. Antimicrobial stewardship programmes (ASPs) may optimize antimicrobial use and improve patient outcomes, but their implementation remains an organizational challenge. Using the Promoting Action on Research Implementation in Health Services (PARiHS) framework, this study aimed to identify organizational factors that may facilitate ASP design, development and implementation. Methods: Among 130 Veterans Affairs facilities that offered acute care, we classified organizational variables supporting antimicrobial stewardship activities into three PARiHS domains: evidence to encompass sources of knowledge; contexts to translate evidence into practice; and facilitation to enhance the implementation process...
June 4, 2018: Journal of Antimicrobial Chemotherapy
Natalia Blanco, Lyndsay M O'Hara, Gwen L Robinson, Jeanine Brown, Emily Heil, Clayton H Brown, Brian D Stump, Bryant W Sigler, Anusha Belani, Heidi L Miller, Amber N Chiplinski, Rebecca Perlmutter, Lucy Wilson, Daniel J Morgan, Surbhi Leekha
BACKGROUND: Clostridium difficile infection (CDI) is associated with significant morbidity and mortality. Computerized clinical decision support (CCDS) tools can aid process improvement in infection prevention and antibiotic stewardship, but implementation and health care workers (HCWs) uptake of these tools is often variable. The objective of this study was to describe HCWs' perceptions of barriers and facilitators related to uptake of CCDS tools as part of a CDI reduction bundle. METHODS: We conducted a qualitative study among HCWs at 2 acute care hospitals in Maryland...
May 23, 2018: American Journal of Infection Control
Thomas Neß
Endophthalmitis is a severe intraocular infection with potentially devastating consequences, such as becoming blind or loss of an eyeball. It can be exogenous (postoperative or posttraumatic) or endogenous. The most frequent causes of postoperative endophthalmitis are cataract surgery and intravitreal injections. Typical symptoms are pain and loss of visual acuity. Hypopyon and infiltration of the vitreous body with the loss of the red reflex are the most important clinical findings for endophthalmitis. The diagnosis is primarily clinical and supported by microbiological cultures and PCR from the vitreous body and/or anterior chamber and is of use for a targeted treatment...
May 25, 2018: Der Ophthalmologe: Zeitschrift der Deutschen Ophthalmologischen Gesellschaft
Rosy Tsopra, Jean-Baptiste Lamy, Karima Sedki
Clinical practice guidelines provide evidence-based recommendations. However, many problems are reported, such as contradictions and inconsistencies. For example, guidelines recommend sulfamethoxazole/trimethoprim in child sinusitis, but they also state that there is a high bacteria resistance in this context. In this paper, we propose a method for the semi-automatic detection of inconsistencies in guidelines using preference learning, and we apply this method to antibiotherapy in primary care. The preference model was learned from the recommendations and from a knowledge base describing the domain...
July 2018: Artificial Intelligence in Medicine
Nathan I Shapiro, Wesley H Self, Jeffrey Rosen, Stephan C Sharp, Michael R Filbin, Peter C Hou, Amisha D Parekh, Michael C Kurz, Robert Sambursky
BACKGROUND: FebriDx is a 10-minute disposable point-of-care test designed to identify clinically significant systemic host immune responses and aid in the differentiation of bacterial and viral respiratory infection by simultaneously detecting C-reactive protein (CRP) and myxovirus resistance protein A (MxA) from a fingerstick blood sample. FebriDx diagnostic accuracy was evaluated in the emergency room and urgent care setting. METHODS: A prospective, multicentre, observational cohort study of acute upper respiratory tract infections (URIs), with and without a confirmed fever at the time of enrolment, was performed to evaluate the diagnostic accuracy of FebriDx to identify clinically significant bacterial infection with host response and acute pathogenic viral infection...
May 18, 2018: Annals of Medicine
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