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Antimicrobial stewardship

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https://www.readbyqxmd.com/read/28748196/developing-interactive-antimicrobial-stewardship-and-infection-prevention-curricula-for-diverse-learners-a-tailored-approach
#1
Priya Nori, Theresa Madaline, Iona Munjal, Shubha Bhar, Yi Guo, Susan K Seo, Andrea Porrovecchio, Elizabeth Gancher, Joshua Nosanchuk, Liise-Anne Pirofski, Belinda Ostrowsky
BACKGROUND: To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center. METHODS: We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28748178/community-based-prescribing-for-impetigo-in-remote-australia-an-opportunity-for-antimicrobial-stewardship
#2
Stefanie Jane Oliver, James Cush, Jeanette E Ward
BACKGROUND: To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. WHAT WE DID: Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing...
2017: Frontiers in Public Health
https://www.readbyqxmd.com/read/28745260/implementation-of-an-antimicrobial-stewardship-program-in-a-neonatal-intensive-care-unit
#3
Nneka I Nzegwu, Michelle R Rychalsky, Loren A Nallu, Xuemei Song, Yanhong Deng, Amber M Natusch, Robert S Baltimore, George R Paci, Matthew J Bizzarro
OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012...
July 26, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28743946/identification-of-the-eskape-pathogens-by-mass-spectrometric-analysis-of-microbial-membrane-glycolipids
#4
Lisa M Leung, William E Fondrie, Yohei Doi, J Kristie Johnson, Dudley K Strickland, Robert K Ernst, David R Goodlett
Rapid diagnostics that enable identification of infectious agents improve patient outcomes, antimicrobial stewardship, and length of hospital stay. Current methods for pathogen detection in the clinical laboratory include biological culture, nucleic acid amplification, ribosomal protein characterization, and genome sequencing. Pathogen identification from single colonies by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF-MS) analysis of high abundance proteins is gaining popularity in clinical laboratories...
July 25, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28743282/a-hospital-based-surveillance-of-metallo-beta-lactamase-producing-gram-negative-bacteria-in-nepal-by-imipenem-edta-disk-method
#5
Pratigya Thapa, Dinesh Bhandari, Dhiraj Shrestha, Hiramani Parajuli, Prakash Chaudhary, Jyoti Amatya, Ritu Amatya
BACKGROUND: A rising threat of the rapid spread of acquired metallo-beta-lactamases (MBLs) among major Gram-negative pathogens is a matter of public health concern worldwide. Hence, for a low income nation like Nepal, surveillance data on MBL producing clinical isolates via a cost effective technique is necessary to prevent their dissemination as well as formulation and regulation of antimicrobial stewardship policy. METHODS: The prospective study was conducted at Nepal Medical College, Kathmandu from May to October, 2014 to assess the prevalence of MBL production among ceftazidime-resistant Gram-negative rods (GNRs) isolates...
July 25, 2017: BMC Research Notes
https://www.readbyqxmd.com/read/28742143/impact-of-rapid-identification-of-positive-blood-cultures-using-the-verigene-system-on-antibiotic-prescriptions-a-prospective-study-of-community-onset-bacteremia-in-a-tertiary-hospital-in-japan
#6
Kayoko Hayakawa, Kazuhisa Mezaki, Masao Kobayakawa, Kei Yamamoto, Yoshikazu Mutoh, Motoyuki Tsuboi, Takehiro Hasimoto, Maki Nagamatsu, Satoshi Kutsuna, Nozomi Takeshita, Yuichi Katanami, Masahiro Ishikane, Norio Ohmagari
BACKGROUND: Rapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear. METHODS: We prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately...
2017: PloS One
https://www.readbyqxmd.com/read/28739223/decreased-mortality-in-patients-prescribed-vancomycin-after-implementation-of-antimicrobial-stewardship-program
#7
Erin L Conway, John A Sellick, Amy Horey, Kristen Fodero, Michael C Ott, Michael P Krajewski, Kari A Mergenhagen
BACKGROUND: The impact of an antimicrobial stewardship program (ASP) on 30-day mortality rates was evaluated in patients prescribed vancomycin in a Veterans Affairs hospital. METHODS: A retrospective chart review of patients receiving a minimum of 48 hours of vancomycin during October 2006-July 2014. A multivariate logistic regression analysis was used to determine predictors of mortality. Interventions of the ASP consist of appropriate antibiotic selection, dosing, microbiology, and treatment duration...
July 21, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28733718/antimicrobial-resistance-in-the-next-30%C3%A2-years-humankind-bugs-and-drugs-a-visionary-approach
#8
REVIEW
Matteo Bassetti, Garyphallia Poulakou, Etienne Ruppe, Emilio Bouza, Sebastian J Van Hal, Adrian Brink
PURPOSE: To describe the current standards of care and major recent advances with regard to antimicrobial resistance (AMR) and to give a prospective overview for the next 30 years in this field. METHODS: Review of medical literature and expert opinion were used in the development of this review. RESULTS: There is undoubtedly a large clinical and public health burden associated with AMR in ICU, but it is challenging to quantify the associated excess morbidity and mortality...
July 21, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28732743/antimicrobial-stewardship-in-the-treatment-of-skin-and-soft-tissue-infections
#9
Julie A Gibbons, Hayden L Smith, Sudhir C Kumar, Katherine Johnson Duggins, Amanda M Bushman, Jayme M Danielson, William J Yost, Jonathan J Wadle
BACKGROUND: Research on treating skin and soft tissue infections (SSTI) has shown improved patient outcomes with effective pharmaceutic prescribing. Antimicrobial stewardship programs can reduce consequences of broad-spectrum antimicrobial administration in SSTI treatment. METHODS: Prospective and historic control data were collected during two 7-month periods. Intervention consisted of implementing a new SSTI evidence-based treatment algorithm and provider education, including calls and medical record notes targeted at physicians...
July 18, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28730922/investigating-the-ways-in-which-health-information-technology-can-promote-antimicrobial-stewardship-a-conceptual-overview
#10
Abby King, Kathrin M Cresswell, Jamie J Coleman, Sarah K Pontefract, Ann Slee, Robin Williams, Aziz Sheikh
Antimicrobial resistance is now recognised as a threat to health worldwide. Antimicrobial stewardship aims to promote the responsible use of antibiotics and is high on international and national policy agendas. Health information technology has the potential to support antimicrobial stewardship in a number of ways, but this field is still poorly characterised and understood. Building on a recent systematic review and expert roundtable discussions, we take a lifecycle perspective of antibiotic use in hospitals and identify potential targets for health information technology-based interventions to support antimicrobial stewardship...
January 1, 2017: Journal of the Royal Society of Medicine
https://www.readbyqxmd.com/read/28727741/antimicrobial-resistance-rates-in-gram-positive-bacteria-do-not-drive-glycopeptides-use
#11
Beryl Primrose Gladstone, Andrea Cona, Parichehr Shamsrizi, Tuba Vilken, Winfred V Kern, Nisar Malek, Evelina Tacconelli
Surveillance data are considered essential to appropriate empiric antibiotic therapy and stewardship. The objective of this study was to determine if a change in the rates of antibiotic resistance impacts antibiotic use in European hospitals. Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because of the restricted spectrum against resistant gram positive bacteria. PubMed, ECDC databases and national/regional surveillance systems were searched to identify glycopeptides´ consumption in defined daily dose per 1000 inhabitant-days (DID) and rate of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-resistant enterococci (VRE) in bloodstream infections (BSIs) in European countries between 1997 and 2015...
2017: PloS One
https://www.readbyqxmd.com/read/28726037/can-a-collaborative-subspecialty-antimicrobial-stewardship-intervention-have-lasting-effects
#12
Kaushal B Shah, Ramzy H Rimawi, Mark A Mazer, Paul P Cook
OBJECTIVE: We previously demonstrated the benefit of direct, daily collaboration between infectious disease (ID) and critical care practitioners (CCP) on guideline adherence and antibiotic use in the medical intensive care unit (MICU). In this post-intervention review, we sought to establish whether the effect on antibiotic use and guideline adherence was sustainable. DESIGN: A retrospective review of 87 patients, admitted to the 24-bed MICU, was done 3 (n = 45) and 6 months (n = 42) after the intervention...
July 19, 2017: Infection
https://www.readbyqxmd.com/read/28724882/using-beta-lactam-antibiotics-in-patients-with-a-history-of-beta-lactam-allergy-current-concepts
#13
Esther Moreno, Elena Laffond, Francisco Javier Muñoz-Bellido, María Teresa Gracia, Eva María Macías, Ignacio Dávila
Beta-lactams (BLs) are the most widely used antibiotic family but they are also the most common cause of drug-induced hypersensitivity reactions. The estimated prevalence of reported penicillin allergy ranges between 9-12%, although a high percentage of patients with a history of penicillin allergy have no subsequent reactions on re-exposure to BLs. A self-reported penicillin allergy has been associated with antimicrobial resistance, increased cost, intensive care admission, and death, making essential an accurate diagnosis...
July 19, 2017: Polish Archives of Internal Medicine
https://www.readbyqxmd.com/read/28717037/impact-of-a-carbapenem-antimicrobial-stewardship-program-on-patient-outcomes
#14
Valerie Xue Fen Seah, Rina Yue Ling Ong, Ashley Shi Yuan Lim, Chia Yin Chong, Natalie Woon Hui Tan, Koh Cheng Thoon
Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobials use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when de-escalation or discontinuation of broad-spectrum antibiotics are recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers.We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014...
July 17, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28712667/antibiotic-stewardship-in-low-and-middle-income-countries-same-but-different
#15
REVIEW
Janneke A Cox, Erika Vlieghe, Marc Mendelson, Heiman Wertheim, Linus Ndegwa, Maria Virginia Villegas, Ian Gould, Gabriel Levy Hara
BACKGROUND: Antibiotic resistance (ABR) is a quickly worsening problem worldwide, also in low-and middle-income countries (LMICs). Appropriate antibiotic use in humans and animals, i.e. antibiotic stewardship (ABS), is one of the corner stones of the World Health Organization's global action plan for ABR. Many LMICs are in the process of developing stewardship policies and programs. AIMS: We highlight the challenges for ABS initiatives in LMICs, give an outline of the (inter)national recommendations and demonstrate examples of effective, contextualised stewardship interventions...
July 13, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28711429/-appropriateness-of-antibiotic-prescribing-in-paediatric-patients-in-a-hospital-emergency-department
#16
Borja Croche Santander, Elena Campos Alonso, Adela Sánchez Carrión, Laura Marcos Fuentes, Isabel Diaz Flores, Juan Carlos Vargas, Bárbara Fernández Domínguez, Cristóbal Toro Ibañez
INTRODUCTION: Antibiotics represent one of the most widely prescribed therapeutic agents in children. It has been estimated that 30-50% of antibiotic prescriptions for this population are inappropriate. In this scenario, analysis of prescription data provides an invaluable source of information as a basis for implementing strategies for improvement in this field. OBJECTIVE: To assess the appropriateness of antibiotic prescriptions in a paediatric population at an emergency department...
July 12, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28711345/working-at-the-intersection-of-context-culture-and-technology-provider-perspectives-on-antimicrobial-stewardship-in-the-emergency-department-using-electronic-health-record-clinical-decision-support
#17
Phillip Chung, Jean Scandlyn, Peter S Dayan, Rakesh D Mistry
BACKGROUND: Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. METHODS: Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado...
July 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28709439/enhanced-antimicrobial-de-escalation-for-pneumonia-in-mechanically-ventilated-patients-a-cross-over-study
#18
Tracy Trupka, Kristen Fisher, Scott T Micek, Paul Juang, Marin H Kollef
BACKGROUND: Antibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in mechanically ventilated patients with suspected pneumonia cared for in an academic closed intensive care unit (ICU). METHODS: This was a prospective cross-over trial comparing routine antibiotic management (RAM) and enhanced antimicrobial de-escalation (EAD) performed within two medical ICUs (total 34 beds) at Barnes-Jewish Hospital, an academic referral center...
July 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28706384/antimicrobial-susceptibility-risk-factors-and-prevalence-of-bla-cefotaximase-temoneira-and-sulfhydryl-variable-genes-among-escherichia-coli-in-community-acquired-pediatric-urinary-tract-infection
#19
Kallyadan V Nisha, Shetty A Veena, Shenoy D Rathika, Shenoy M Vijaya, Shetty K Avinash
INTRODUCTION: The emergence of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has become an important challenge among pediatric patients with community-acquired urinary tract infection (UTI). OBJECTIVES: The aim of this study was to assess the antimicrobial susceptibility patterns, associated risk factors and to survey the frequency of bla cefotaximase (CTX-M), bla temoneira (TEM), and bla sulfhydryl variable (SHV) genotypes in ESBL-producing E...
July 2017: Journal of Laboratory Physicians
https://www.readbyqxmd.com/read/28705665/bloodstream-infections-due-to-esbl-producing-enterobacteriaceae-among-patients-with-malignancy-a-systematic-review-and-meta-analysis
#20
Michail Alevizakos, Apostolos Gaitanidis, Nikolaos Andreatos, Karuppiah Arunachalam, Myrto Eleni Flokas, Eleftherios Mylonakis
BACKGROUND: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) are an increasing cause of resistant infections among patients with malignancy. METHODS: We sought to estimate the prevalence of bloodstream infections (BSIs) caused by ESBL-PE in this population, and examine regional and temporal differences. We searched the PubMed and EMBASE databases (to April 30, 2016) to identify studies reporting ESBL-PE BSI rates among patients with malignancies...
July 10, 2017: International Journal of Antimicrobial Agents
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