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Antimicrobial stewardship

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https://www.readbyqxmd.com/read/28302674/urine-culture-follow-up-and-antimicrobial-stewardship-in-a-pediatric-urgent-care-network
#1
Dipanwita Saha, Jimisha Patel, Don Buckingham, David Thornton, Terry Barber, Joshua R Watson
BACKGROUND AND OBJECTIVES: Empiric antibiotic therapy for presumed urinary tract infection (UTI) leads to unnecessary antibiotic exposure in many children whose urine culture results fail to confirm the diagnosis. The objective of this quality improvement study was to improve follow-up management of negative urine culture results in the off-campus urgent care network of Nationwide Children's Hospital to reduce inappropriate antibiotic exposure in children. METHODS: A multidisciplinary task force developed and implemented a protocol for routine nurse and clinician follow-up of urine culture results, discontinuation of unnecessary antibiotics, and documentation in the electronic medical record...
March 16, 2017: Pediatrics
https://www.readbyqxmd.com/read/28300019/clostridium-difficile-infection-in-acute-care-hospitals-systematic-review-and-best-practices-for-prevention
#2
Irene K Louh, William G Greendyke, Emilia A Hermann, Karina W Davidson, Louise Falzon, David K Vawdrey, Jonathan A Shaffer, David P Calfee, E Yoko Furuya, Henry H Ting
OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates...
April 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28298480/antimicrobial-stewardship-programmes-bedside-rationing-by-another-name
#3
Simon Oczkowski
Antimicrobial therapy is a cornerstone of therapy in critically ill patients; however, the wide use of antibiotics has resulted in increased antimicrobial resistance and outbreaks of resistant disease. To counter this, many hospitals have instituted antimicrobial stewardship programmes as a way to reduce the inappropriate use of antibiotics. However, uptake of antimicrobial stewardship programmes has been variable, as many clinicians fear that they may put individual patients at risk of treatment failure. In this paper, I argue that antimicrobial stewardship programmes are indeed a form of bedside rationing, and explore the risks and benefits of such programmes for individual patients in the intensive care unit, and the critically ill population in general...
March 15, 2017: Journal of Medical Ethics
https://www.readbyqxmd.com/read/28298366/antibiotics-for-acute-respiratory-tract-infections-a-mixed-methods-study-of-patient-experiences-of-non-medical-prescriber-management
#4
Molly Courtenay, Samantha Rowbotham, Rosemary Lim, Rhian Deslandes, Karen Hodson, Katie MacLure, Sarah Peters, Derek Stewart
OBJECTIVE: To (1) explore patients' expectations and experiences of nurse and pharmacist non-medical prescriber-led management of respiratory tract infections (RTIs), (2) examine whether patient expectations for antibiotics affect the likelihood of receiving them and (3) understand factors influencing patient satisfaction with RTI consultations. DESIGN: Mixed methods. SETTING: Primary care. PARTICIPANTS: Questionnaires from 120 patients and follow-up interviews with 22 patients and 16 nurse and pharmacist non-medical prescribers (NMPs)...
March 15, 2017: BMJ Open
https://www.readbyqxmd.com/read/28295646/the-epidemiology-of-clostridium-difficile-infection-in-a-national-kidney-transplant-centre
#5
C Kennedy, C Waldron, M Skally, L Gaughan, C Magee, K Burns, F Fitzpatrick
BACKGROUND: We aimed to describe the epidemiology and outcomes of CDI in a national kidney transplant centre from 2008-2015. METHODS: Adult kidney and kidney-pancreas transplant recipients were included for analysis if they met the surveillance CDI case definition. Rates of new healthcare-associated CDI (HA-CDI) were expressed per 10,000 KTR/KTPR bed days used (BDU) to facilitate comparisons. RESULTS: Fifty-two cases of CDI were identified in 42 KTRs and KPTRs...
March 15, 2017: Clinical Transplantation
https://www.readbyqxmd.com/read/28294077/variability-in-antifungal-and-antiviral-use-in-hospitalized-children
#6
Jennifer L Goldman, Rachael K Ross, Brian R Lee, Jason G Newland, Adam L Hersh, Matthew P Kronman, Jeffrey S Gerber
We analyzed antifungal and antiviral prescribing among high-risk children across freestanding children's hospitals. Antifungal and antiviral days of therapy varied across hospitals. Benchmarking antifungal and antiviral use and developing antimicrobial stewardship strategies to optimize use of these high cost agents is needed. Infect Control Hosp Epidemiol 2017;1-4.
March 15, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28291632/necessity-of-carbapenem-use-when-prescribed-per-infectious-diseases-specialists
#7
Kellie J Goodlet, Michael D Nailor
Preauthorization strategies, including restricting broad-spectrum antimicrobials such as carbapenems to infectious diseases physicians (ID) are commonly employed by stewardship programs. The appropriateness, or "necessity" of empiric carbapenem therapy by ID, defined as an isolated organism sensitive to the carbapenem and resistant to cefepime, was evaluated over a 6month span and included 84 patients. Additionally, 30 patients followed by ID who were not prescribed a carbapenem until final susceptibilities were included as a definitive therapy group...
February 27, 2017: Diagnostic Microbiology and Infectious Disease
https://www.readbyqxmd.com/read/28288838/routine-ertapenem-prophylaxis-for-transrectal-ultrasound-guided-prostate-biopsy-does-not-select-for-carbapenem-resistant-organisms-a-prospective-cohort-study
#8
Maxim G Bloomfield, Matthew J Page, Alice G McLachlan, Rodney C Studd, Timothy K Blackmore
PURPOSE: Post-transrectal ultrasound-guided prostate biopsy sepsis is an increasing problem in this era of rising antibiotic resistance. Ertapenem prophylaxis has proven very effective at our institution for reducing this, however has raised local and regional antimicrobial stewardship concerns. This study investigated the possible selective effect of single dose ertapenem prophylaxis on fecal colonization with carbapenem-resistant Enterobacteriaceae. MATERIALS AND METHODS: Patients had a rectal swab taken prior to receiving pre-biopsy ertapenem prophylaxis...
March 10, 2017: Journal of Urology
https://www.readbyqxmd.com/read/28284685/identifying-priorities-to-improve-paediatric-in-hospital-antimicrobial-use-by-cross-sectional-evaluation-of-prevalence-and-appropriateness-of-prescription
#9
Walter Alfredo Goycochea-Valdivia, Francisco Moreno-Ramos, José Ramón Paño-Pardo, Francisco Javier Aracil-Santos, Fernando Baquero-Artigao, Teresa Del Rosal-Rabes, María José Mellado-Peña, Luis Escosa-García
INTRODUCTION: Information about paediatric in-hospital antimicrobial usage and prescribing patterns to guide improvement strategies is scant. We aim to use an evaluation of the prevalence and appropriateness of antimicrobial prescription to identify antimicrobial stewardship priorities in children. METHODS: A cross-sectional point study was performed on hospitalised paediatric patients in a Spanish tertiary hospital, assessing the prevalence of antimicrobial prescription (PAP) and appropriateness of antimicrobial prescription (AAP)...
March 8, 2017: Enfermedades Infecciosas y Microbiología Clínica
https://www.readbyqxmd.com/read/28283829/the-efficacy-of-the-direct-clinical-intervention-for-infectious-diseases-by-a-pediatric-infectious-disease-specialist-in-the-pediatric-ward-of-a-tertiary-medical-facility-without-a-pediatric-antimicrobial-stewardship-program
#10
T Hoshina, N Yamamoto, M Ogawa, T Nakamoto, K Kusuhara
Antimicrobial stewardship programs (ASPs) have been introduced in most hospital complexes; however, they are not always useful for pediatric patients. The aim of this study is to investigate the efficacy of direct clinical intervention for infectious diseases by a pediatric infectious disease specialist in a tertiary medical facility without pediatric ASP. This retrospective study included 1,821 patients who were hospitalized in the pediatric ward of a large metropolitan hospital from 2010 to 2015. The clinical course, the use of intravenous antimicrobial agents and the results of a microbiological analysis were compared between the period after the beginning of direct intervention by the specialist (post-intervention period) and the previous period (pre-intervention period)...
March 10, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/28279787/implementation-of-a-cefazolin-based-stewardship-pathway-for-methicillin-susceptible-staphylococcus-aureus-bloodstream-infections-paired-with-infectious-diseases-consultation
#11
Benjamin J Lee, Sonia N Rao, Sheila K Wang, Jane Y Lee, Irfana Y Lakada, Elise M Gilbert, Viktorija O Barr, Michael J Postelnick, Sarah H Sutton, Teresa R Zembower, Maureen Bolon, Marc H Scheetz, Nathaniel J Rhodes
Methicillin-susceptible Staphylococcus aureus (MSSA) infections have been successfully treated both with cefazolin and antistaphylococcal penicillins; cefazolin appears effective in MSSA bloodstream infections (BSIs). Thus, our antimicrobial stewardship programme (ASP) implemented a clinical pathway supporting cefazolin use in MSSA-BSIs and restricting oxacillin use to infectious diseases (ID) consultation due to cefazolin's lower cost and more convenient dosing. This before and after quasi-experimental study was conducted to describe the impact on outcomes and process of care measures associated with implementing this pathway among patients with MSSA-BSI...
March 6, 2017: International Journal of Antimicrobial Agents
https://www.readbyqxmd.com/read/28274985/role-of-postgraduate-year-2-pharmacy-residents-in-providing-weekend-antimicrobial-stewardship-coverage-in-an-academic-medical-center
#12
Justin Siegfried, Cristian Merchan, Marco R Scipione, John Papadopoulos, Arash Dabestani, Yanina Dubrovskaya
PURPOSE: The integration of pharmacy residents into an antimicrobial stewardship program (ASP) is described, and data on the residents' ASP interventions and outcomes are reported. SUMMARY: ASP coverage of nighttime, holiday, and weekend shifts is often provided by infectious diseases (ID) medical fellows and staff pharmacists, potentially leading to inconsistent stewardship practices. As part of an initiative by a large urban hospital to provide around-the-clock, comprehensive ASP services 7 days a week, postgraduate year 2 (PGY2) pharmacy residents in ID or critical care were assigned to provide ASP coverage on weekends...
March 15, 2017: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/28270546/variability-in-antibiotic-prescribing-for-community-acquired-pneumonia
#13
Lori K Handy, Matthew Bryan, Jeffrey S Gerber, Theoklis Zaoutis, Kristen A Feemster
BACKGROUND AND OBJECTIVES: Published guidelines recommend amoxicillin for most children with community-acquired pneumonia (CAP), yet macrolides and broad-spectrum antibiotics are more commonly prescribed. We aimed to determine the patient and clinician characteristics associated with the prescription of amoxicillin versus macrolide or broad-spectrum antibiotics for CAP. METHODS: Retrospective cohort study in an outpatient pediatric primary care network from July 1, 2009 to June 30, 2013...
March 7, 2017: Pediatrics
https://www.readbyqxmd.com/read/28270268/antibiotic-stewardship-new-frontier-familiar-journey
#14
Caren McHenry Martin
Recent changes in regulations by the Centers for Medicare & Medicaid Services require long-term care facilities to meet specific requirements on antibiotic stewardship, promoting the appropriate use of antibiotics and antimicrobials. The goal is to improve patient outcomes and decrease the spread of infections caused by multi-drug-resistant organisms. Consultant pharmacists can help facility personnel implement policies and procedures for effective antibiotic stewardship, assist prescribers and facility staff in understanding how to use the facility's antibiogram, find appropriate resources, and provide facility personnel with feedback on their antimicrobial stewardship efforts...
March 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28265870/correlation-between-antibiotic-consumption-and-resistance-of-bloodstream-bacteria-in-a-university-hospital-in-north-eastern-italy-2008-2014
#15
Marta Mascarello, Omar Simonetti, Anna Knezevich, Ludovica Ilaria Carniel, Jacopo Monticelli, Marina Busetti, Paolo Schincariol, Lucio Torelli, Roberto Luzzati
PURPOSE: The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. METHODS: Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year...
March 6, 2017: Infection
https://www.readbyqxmd.com/read/28260148/anticipating-the-unpredictable-a-review-of-antimicrobial-stewardship-and-acinetobacter-infections
#16
REVIEW
Eric Wenzler, Debra A Goff, Romney Humphries, Ellie J C Goldstein
Acinetobacter remains one of the most challenging pathogens in the field of infectious diseases owing primarily to the uniqueness and multiplicity of its resistance mechanisms. This resistance often leads to devastatingly long delays in time to appropriate therapy and increased mortality for patients afflicted with Acinetobacter infections. Selecting appropriate empiric and definitive antibacterial therapy for Acinetobacter is further complicated by the lack of reliability in commercial antimicrobial susceptibility testing devices and limited breakpoint interpretations for available agents...
March 4, 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/28258225/antimicrobial-resistance-in-healthcare-agriculture-and-the-environment-the-biochemistry-behind-the-headlines
#17
REVIEW
Henrietta Venter, Michael L Henningsen, Stephanie L Begg
The crisis of antimicrobial resistance (AMR) is one of the most serious issues facing us today. The scale of the problem is illustrated by the recent commitment of Heads of State at the UN to coordinate efforts to curb the spread of AMR infections. In this review, we explore the biochemistry behind the headlines of a few stories that were recently published in the public media. We focus on examples from three different issues related to AMR: (i) hospital-acquired infections, (ii) the spread of resistance through animals and/or the environment and (iii) the role of antimicrobial soaps and other products containing disinfectants in the dissemination of AMR...
February 28, 2017: Essays in Biochemistry
https://www.readbyqxmd.com/read/28257317/pulmonary-infections-in-critical-intensive-care-rapid-diagnosis-and-optimizing-antimicrobial-usage
#18
Ivor S Douglas
PURPOSE OF REVIEW: Diagnosis of pulmonary infection, including hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) in the critically ill patient remains a common and therapeutically challenging diagnosis with significant attributable morbidity, mortality, and cost. Current clinical approaches to surveillance, early detection and, conventional culture-based microbiology are inadequate for optimal targeted antibiotic treatment and stewardship. Efforts to enhance diagnosis of HAP and VAP and the impact of these novel approaches on rational antimicrobial selection and stewardship are the focus of recent studies reviewed here...
March 2, 2017: Current Opinion in Pulmonary Medicine
https://www.readbyqxmd.com/read/28254470/tackling-inpatient-penicillin-allergies-tools-for-antimicrobial-stewardship
#19
Kimberly G Blumenthal, Paige G Wickner, Shelley Hurwitz, Nicholas Pricco, Alexandra E Nee, Karl Laskowski, Erica S Shenoy, Rochelle P Walensky
BACKGROUND: Reported penicillin allergy rarely reflects penicillin intolerance. Failure to address inpatient penicillin allergies results in more broad-spectrum antibiotic use, treatment failures, and adverse drug events. OBJECTIVE: We aimed to determine the optimal approach to penicillin allergies among medical inpatients. METHODS: We evaluated internal medicine inpatients reporting penicillin allergy in three periods: (1) standard of care (SOC), (2) penicillin skin testing (ST), and (3) computerized guideline application with decision support (APP)...
February 27, 2017: Journal of Allergy and Clinical Immunology
https://www.readbyqxmd.com/read/28250702/an-evaluation-of-selected-indications-and-appropriateness-of-ampicillin-sulbactam-an-unrestricted-antimicrobial-at-a-single-center
#20
Dorothy McCoy, Rani Sebti, Arpi G Kuyumjian
BACKGROUND: With antimicrobial resistance on the rise and few new agents in development, it is important to exercise prudent judgment when utilizing antimicrobials. The Antimicrobial Stewardship Program (ASP) is responsible for facilitating the appropriate use of antimicrobials at the institution. Restricted antimicrobials and select additional antimicrobials are monitored by the ASP team to determine if the indications chosen by the ordering prescribers correspond to and are appropriate for the patients' infections...
March 2017: P & T: a Peer-reviewed Journal for Formulary Management
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