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Antibiotic stewardship

Leanne Teoh, Kay Stewart, Rodrigo Marino, Michael McCullough
Antibiotic resistance is a well-established global public health crisis, with the use and misuse of antibiotics being the principal cause of bacterial resistance. Studies in both Australia and overseas have demonstrated that the dental prescribing of antibiotics is increasing, and that dentists tend to prescribe antibiotics unnecessarily and for incorrect clinical indications. Dental practitioners in Australia also prefer to prescribe moderate to broad spectrum antibacterial agents and make some inappropriate antibiotic prescribing choices...
July 14, 2018: Australian Dental Journal
Ingrid Torjesen
No abstract text is available yet for this article.
July 13, 2018: BMJ: British Medical Journal
E Junaid, L Jenkins, H Swanepoel, Z North, T Gould
Antimicrobial stewardship programmes have been introduced worldwide in response to the rise in antimicrobial resistance. The World Health Organization has mandated each Member State to produce a plan to address this problem. We report on the organic development of an antibiotic stewardship programme in a rural regional hospital in a resource-limited setting in South Africa. This has resulted in organisational change with increased awareness, participation, monitoring and education in antibiotic stewardship throughout the hospital...
June 26, 2018: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
(no author information available yet)
Doctors and the farming industry are often blamed for overuse of antibiotics that spurs the growing problem of antimicrobial resistance. Ingrid Torjesen reports from an expert discussion jointly hosted by Vet Record and The BMJ to identify ways to tackle it.
July 14, 2018: Veterinary Record
Liben Chen, Dong Jin Shin, Shuyu Zheng, Johan H Melendez, Charlotte Gaydos, Tza-Huei Wang
Multidrug-resistant gonorrhea has become an urgent issue for global public health. As the causative agent of gonorrhea ─ Neisseria gonorrhoeae ─ has been progressively developing resistance to nearly all prescribed antimicrobial drugs, monitoring its antimicrobial resistance on a broader scale has become a crucial agenda for effective antibiotic stewardship. Unfortunately, gold standard antimicrobial susceptibility testing (AST) relies on time and labor-intensive phenotypic assays, which lag behind the current diagnostic workflow for N...
July 12, 2018: ACS Infectious Diseases
Gowri Raman, Esther E Avendano, Jeffrey Chan, Sanjay Merchant, Laura Puzniak
Background: Identifying risk factors predicting acquisition of resistant Pseudomonas aeruginosa will aid surveillance and diagnostic initiatives and can be crucial in early and appropriate antibiotic therapy. We conducted a systematic review examining risk factors of acquisition of resistant P. aeruginosa among hospitalized patients. Methods: MEDLINE®, EMBASE®, and Cochrane Central were searched between 2000 and 2016 for studies examining independent risk factors associated with acquisition of resistant P...
2018: Antimicrobial Resistance and Infection Control
Uwe Koppe, Anja von Laer, Lars E Kroll, Ines Noll, Marcel Feig, Marc Schneider, Hermann Claus, Tim Eckmanns, Muna Abu Sin
Background: Carbapenem resistance in Klebsiella pneumoniae is of significant public health concern and recently spread across several countries. We investigated the extent of carbapenem non-susceptibility in K. pneumoniae isolates in Germany. Methods: We analysed 2011-2016 data from the German Antimicrobial Resistance Surveillance (ARS) System, which contains routine data of antimicrobial susceptibility testing from voluntarily participating German laboratories...
2018: Antimicrobial Resistance and Infection Control
Giorgia Montrucchio, Gabriele Sales, Silvia Corcione, Francesco G De Rosa, Luca Brazzi
More than two-thirds of critically ill patients receive an antimicrobial therapy with a percentage between 30 and 50% of all prescribed antibiotics reported to be unnecessary, inappropriate or misused. Since inappropriate prescription of antibiotic drugs concurs to dissemination of the multi-drug resistant organisms, a reasoned antibiotics use is crucial especially in Intensive Care Unit (ICU), where up to 60% of the admitted patients develops an infection during their ICU stay. Even if the concept of Antimicrobial Stewardship (AS) has been clearly described as a series of coordinated interventions designed to improve antimicrobial agents use, few studies are reporting about its effectiveness to improve outcomes, reduce adverse events and costs and decrease resistance rate spread...
July 9, 2018: Minerva Anestesiologica
Francesco M Labricciosa, Massimo Sartelli, Sofia Correia, Lilian M Abbo, Milton Severo, Luca Ansaloni, Federico Coccolini, Carlos Alves, Renato Bessa Melo, Gian Luca Baiocchi, José-Artur Paiva, Fausto Catena, Ana Azevedo
Background: Antibiotic resistance (AMR) is a growing public health problem worldwide, in part related to inadequate antibiotic use. A better knowledge of physicians' motivations, attitudes and practice about AMR and prescribing should enable the design and implementation of effective antibiotic stewardship programs (ASPs). The objective of the study was to assess attitudes and perceptions concerning AMR and use of antibiotics among surgeons who regularly perform emergency or trauma surgery...
2018: World Journal of Emergency Surgery: WJES
George Sakoulas, Matthew Geriak, Victor Nizet
The majority of patients with reported penicillin allergy are not allergic when tested or challenged. Penicillin allergy testing has been shown to significantly reduce future annual healthcare expenditures. Data have emerged showing beta-lactams to be multi-dimensional antibacterial effects in vivo, far beyond what is appreciated in standard bacteriological susceptibility testing media. These include enhancing bacterial killing by the innate immune system. Supporting the clinical relevance of these secondary underappreciated effects are recent clinical and pharmaco-economic analyses that show worse outcomes in patients with reported penicillin allergies who receive non-beta lactam antibiotics when compared to their non-penicillin allergic counterparts...
July 9, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Xiang-Sheng Chen, Yue-Ping Yin, Xin-Yu Li
Gonococcal antimicrobial resistance (AMR) has become a global threat significantly hampering the control of gonorrhea. Many socio-economic, biological, behavioral, and programmatic factors have played an important role in driving the emergence, transmission and spread of gonococcal AMR. However, research to address these scientific and programmatic questions is limited in China. Here we propose a ROADMAP (resistance surveillance, outcomes due to AMR, antibiotic stewardship and application, diagnostic tools, mechanisms of AMR, antimicrobial assessment, and population pharmacokinetics and pharmacodynamics) plan for expanding interdisciplinary collaborations to address the research needs in China...
July 9, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Ella J Ariza-Heredia, Roy F Chemaly
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms...
July 9, 2018: CA: a Cancer Journal for Clinicians
Tanaya Bhowmick, Thomas J Kirn, Frances Hetherington, Shandurai Takavarasha, Sarbjit S Sandhu, Shveta Gandhi, Navaneeth Narayanan, Melvin P Weinstein
BACKGROUND: Rapid identification of Gram-positive cocci in clusters (GPCC) in positive blood cultures (pBC) may limit exposure to unnecessary or inappropriate antibiotics. METHODS: Inpatients with pBC showing GPCC between October 2013 and December 2017 were included. In the baseline period (BL), final ID and susceptibility results were reported in the electronic medical record (EMR) within 48 h of telephoned Gram stain report. The laboratory introduced rapid phenotypic identification and direct susceptibility testing (INT1), later replaced by PCR (INT2)...
May 29, 2018: Diagnostic Microbiology and Infectious Disease
Patrick J Lindsay, Sagar Rohailla, Linda R Taggart, David Lightfoot, Thomas Havey, Nick Daneman, Christopher Lowe, Matthew P Muller
Background: Antimicrobial stewardship programs (ASP) using audit and feedback in the intensive care unit setting (ICU) can reduce harms related to inappropriate antibiotic use. However, inappropriate discontinuation or narrowing of antibiotic treatment could increase infection-related mortality in this population. Individual ASP studies are underpowered to detect mortality differences. Methods: We conducted a systematic review and meta-analysis of audit and feedback in the ICU setting using mortality as our outcome...
June 30, 2018: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Antonio Morales, Manuel Campos, José M Juárez, Bernardo Cánovas-Segura, Francisco Palacios, Roque Marín
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...
July 5, 2018: Journal of Biomedical Informatics
Rehema Marando, Jeremiah Seni, Mariam M Mirambo, Linda Falgenhauer, Nyambura Moremi, Martha F Mushi, Neema Kayange, Festo Manyama, Can Imirzalioglu, Trinad Chakraborty, Stephen E Mshana
The study was conducted to establish predictors of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) neonatal sepsis and mortality in a tertiary hospital, Tanzania. Between July and December 2016, blood culture was performed in neonates with clinical features of sepsis and neonates/mothers/guardians were screened for ESBL colonization. Selected isolates underwent whole genome sequencing to investigate relatedness. Logistic regression analysis was performed to determine predictors for ESBL-PE associated neonatal sepsis and mortality...
July 2, 2018: International Journal of Medical Microbiology: IJMM
William J F Le Quesne, Craig Baker-Austin, David W Verner-Jeffreys, Hanan A Al-Sarawi, Hanan H Balkhy, Brett P Lyons
It is becoming increasingly clear that the genetic diversity and abundance of antimicrobial resistance (AMR) in non-clinical settings has been underestimated and that the environment plays an integral role in enabling the development of AMR. Due to specific demographic and environmental factors the Gulf Cooperation Council (GCC) region may be particularly susceptible to the threat of AMR, with the marine and aquatic environment potentially playing a specific role in its development and propagation. The demographic factors include rapid population growth, significant international population movements, heavy antibiotic use and insufficient antibiotic stewardship...
July 3, 2018: Environment International
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
Tommaso Cai, Andrea Cocci, Daniele Tiscione, Marco Puglisi, Fabrizio Di Maida, Gianni Malossini, Paolo Verze, Alessandro Palmieri, Vincenzo Mirone, Truls E Bjerklund Johansen
OBJECTIVE: To evaluate the efficacy of a phytotherapic combination of L-Methionine associated with Hibiscus sabdariffa and Boswellia serrata for treatment of acute episodes of uncomplicated urinary tract infections (UTI) in women affected by recurrent UTIs. MATERIALS AND METHODS: In this randomized phase III clinical trial, adult females with uncomplicated UTI were enrolled into one of the following treatment groups: Group A: phytotherapic combination 1 tablet in the morning and 1 tablet in the evening for 7 days; Group B: Short term antibiotic treatment according to international guidelines recommendations...
June 30, 2018: Archivio Italiano di Urologia, Andrologia
Roderick M Card, Emma Stubberfield, Jon Rogers, Javier Nunez-Garcia, Richard J Ellis, Manal AbuOun, Ben Strugnell, Christopher Teale, Susanna Williamson, Muna F Anjum
Brachyspira hyodysenteriae is the aetiological agent of swine dysentery, a globally distributed disease that causes profound economic loss, impedes the free trade and movement of animals, and has significant impact on pig health. Infection is generally treated with antibiotics of which pleuromutilins, such as tiamulin, are widely used for this purpose, but reports of resistance worldwide threaten continued effective control. In Brachyspira hyodysenteriae pleuromutilin resistance has been associated with mutations in chromosomal genes encoding ribosome-associated functions, however the dynamics of resistance acquisition are poorly understood, compromising stewardship efforts to preserve pleuromutilin effectiveness...
2018: Frontiers in Microbiology
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