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https://www.readbyqxmd.com/read/27909252/nurses-as-antibiotic-brokers-institutionalized-praxis-in-the-hospital
#1
Alex Broom, Jennifer Broom, Emma Kirby, Graham Scambler
We are likely moving rapidly toward a post-antibiotic era, as a result of escalating antimicrobial resistance, rapidly declining antibiotic production and profligate overuse. Hitherto research has almost exclusively focused on doctors' prescribing, with nurses' roles in antibiotic use remaining virtually invisible. Drawing on interviews with 30 nurses, we focus on nurses as brokers of doctors' antibiotic decisions, nursing capacity to challenge doctors' decisions, and, "back stage" strategies for circumnavigating organizational constraints...
November 30, 2016: Qualitative Health Research
https://www.readbyqxmd.com/read/27899924/global-antimicrobial-stewardship-a-closer-look-at-the-formidable-implementation-challenges
#2
John J L Tiong, Jason S E Loo, Chun-Wai Mai
Antimicrobial stewardship (AMS) has been touted as one of the key strategies required in tackling worldwide escalation of antibiotic resistance. Although AMS has optimized antibiotic usage and reduced the incidence of resistance development in some regions, its full global potential has been curtailed by various AMS-impeding factors. This article seeks to highlight in a detailed perspective, the key challenges that hamper global AMS endeavors, some of which include the paucity of effective implementation strategies that cater for the challenging settings of developing nations, the slow response of governments, uncoordinated AMS activities as well as implementation fragmentation across different sectors and countries...
2016: Frontiers in Microbiology
https://www.readbyqxmd.com/read/27898208/-design-and-implementation-of-an-outpatient-parenteral-antimicrobial-therapy-program-in-primary-care-the-experience-at-a-second-level-hospital
#3
M Ruiz-Campuzano, E García-Vázquez, J J Hernández-Roca, J Gómez-Gómez, M Canteras-Jordana, E Mené-Fenor, A Hernández-Torres, A Peláez-Ballesta
OBJECTIVE: Outpatient parenteral antimicrobial therapy (OPAT) programs are a good assistance option in a wide variety of infectious diseases. Our aim was to design and implement an OPAT program in the area of influence of a second-level hospital, with no Home Hospitalization Service available, being necessary close collaboration between hospitalization and Primary Care teams, describe our cohort, analyse the antimicrobial treatment indicated and evaluate the prognostic and risk factors associated with readmission and mortality...
November 28, 2016: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/27894805/leaching-behavior-of-veterinary-antibiotics-in-animal-manure-applied-soils
#4
Min Pan, L M Chu
Agricultural fields worldwide are being contaminated by the escalating application of veterinary antibiotics (VAs) via animal manure and biosolids applied as fertilizers or of wastewater for irrigation, resulting in soil degradation and damage to the health of terrestrial environments. This paper describes a series of column studies investigating the leaching behavior of five VAs, tetracycline (TC), sulfamethazine (SMZ), norfloxacin (NOR), erythromycin (ERY) and chloramphenicol (CAP), under different simulated rainfall conditions that could occur in agricultural environments...
November 25, 2016: Science of the Total Environment
https://www.readbyqxmd.com/read/27864449/what-are-the-critical-steps-in-processing-blood-cultures-a-prospective-audit-evaluating-current-practice-of-reporting-blood-cultures-in-a-centralised-laboratory-serving-secondary-care-hospitals
#5
Manjula Meda, James Clayton, Reela Varghese, Jayakeerthi Rangaiah, Clive Grundy, Farnaz Dashti, David Garner, Katherine Groves, Karen Fitzmaurice, E Hutley
AIMS: To assess current procedures of processing positive blood cultures against national standards with an aim to evaluate its clinical impact and to determine the utility of currently available rapid identification and susceptibility tests in processing of blood cultures. METHODS: Blood cultures from three secondary care hospitals, processed at a centralised laboratory, were prospectively audited. Data regarding processing times, communication with prescribers, changes to patient management and mortality within 30 days of a significant blood culture were collected in a preplanned pro forma for a 4-week period...
November 18, 2016: Journal of Clinical Pathology
https://www.readbyqxmd.com/read/27850332/693-de-escalation-of-antibiotics-in-culture-positive-critically-ill-adults-with-pneumonia
#6
Peter Zepke, Jeffrey Fish
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27850331/692-practice-patterns-for-antibiotic-de-escalation-in-mrsa-culture-negative-sepsis
#7
Farid Sadaka, Matthew Korobey, Alexis Dumm, Greggory Wegener, Rachna Kumar, Alex Bryant, Jackyln O'Brien
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27845849/an-experimental-model-for-the-rapid-screening-of-compounds-with-potential-use-against-mycobacteria
#8
Sofia Santos Costa, Elizeth Lopes, Elisa Azzali, Diana Machado, Tatiane Coelho, Pedro Eduardo Almeida da Silva, Miguel Viveiros, Marco Pieroni, Isabel Couto
Infections caused by Mycobacterium tuberculosis and other mycobacteria are major challenges for global public health. Particularly worrisome are infections caused by multidrug-resistant bacteria, which are increasingly difficult to treat because of the loss of efficacy of the current antibacterial agents, a problem that continues to escalate worldwide. There has been a limited interest and investment on the development of new antibacterial agents in the past decades. This has led to the current situation, in which there is an urgent demand for innovative therapeutic alternatives to fight infections caused by multidrug-resistant pathogens, such as multidrug-resistant tuberculosis...
November 2016: Assay and Drug Development Technologies
https://www.readbyqxmd.com/read/27811073/laboratory-diagnosis-of-pneumonia-in-the-molecular-age
#9
REVIEW
Antoni Torres, Nelson Lee, Catia Cilloniz, Jordi Vila, Menno Van der Eerden
Pneumonia remains a worldwide health problem with a high rate of morbidity and mortality. Identification of microbial pathogens which cause pneumonia is an important area for optimum clinical management of pneumonia patients and is a big challenge for conventional microbiological methods. The development and implementation of molecular diagnostic tests for pneumonia has been a major advance in the microbiological diagnosis of respiratory pathogens in recent years. However, with new knowledge regarding the microbiome, together with the recognition that the lungs are a dynamic microbiological ecosystem, our current concept of pneumonia is not totally realistic as this new concept of pneumonia involves a dysbiosis or alteration of the lung microbiome...
December 2016: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/27798219/impact-of-antibiotic-de-escalation-on-clinical-outcomes-in-community-acquired-pneumococcal-pneumonia
#10
Diego Viasus, Antonella F Simonetti, Carolina Garcia-Vidal, Jordi Niubó, Jordi Dorca, Jordi Carratalà
BACKGROUND: Although antibiotic de-escalation is regarded as a measure that reduces selection pressure, adverse drug effects and costs, evidence supporting this practice in community-acquired pneumococcal pneumonia (CAPP) is lacking. METHODS: We carried out a retrospective analysis of prospectively collected data of a cohort of hospitalized adults with CAPP. Pneumococcal aetiology was established in patients with one or more positive cultures for Streptococcus pneumoniae obtained from blood, sterile fluids or sputum, and/or a positive urinary antigen test...
October 20, 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27795305/carbapenem-resistant-acinetobacter-baumannii-and-enterobacteriaceae-in-south-and-southeast-asia
#11
REVIEW
Li-Yang Hsu, Anucha Apisarnthanarak, Erum Khan, Nuntra Suwantarat, Abdul Ghafur, Paul Anantharajah Tambyah
Carbapenem-resistant Gram-negative bacteria, in particular the Acinetobacter baumannii-calcoaceticus complex and Enterobacteriaceae, are escalating global public health threats. We review the epidemiology and prevalence of these carbapenem-resistant Gram-negative bacteria among countries in South and Southeast Asia, where the rates of resistance are some of the highest in the world. These countries house more than a third of the world's population, and several are also major medical tourism destinations. There are significant data gaps, and the almost universal lack of comprehensive surveillance programs that include molecular epidemiologic testing has made it difficult to understand the origins and extent of the problem in depth...
January 2017: Clinical Microbiology Reviews
https://www.readbyqxmd.com/read/27741119/predictive-factors-of-true-bacteremia-and-the-clinical-utility-of-blood-cultures-as-a-prognostic-tool-in-patients-with-community-onset-pneumonia
#12
Jong Hoo Lee, Yee Hyung Kim
Although blood cultures (BCs) are an important component of diagnostic practice for antibiotic management in patients with pneumonia, several studies have questioned whether they should be performed. The objective of this study was to evaluate the predictive factors of bacteremia and the role of BCs in patients with community-onset pneumonia (community-acquired pneumonia and healthcare-associated pneumonia).This study was retrospectively conducted in patients with community-onset pneumonia who were hospitalized at Jeju National University Hospital between January 2012 and December 2014...
October 2016: Medicine (Baltimore)
https://www.readbyqxmd.com/read/27736855/where-to-from-here-the-treatment-of-impetigo-in-children-as-resistance-to-fusidic-acid-emerges
#13
Alison Vogel, Diana Lennon, Emma Best, Alison Leversha
Admissions for skin and soft-tissue infections have been increasing steadily in children and in the general population. Concerns have been raised recently about the increasing widespread use of topical fusidic acid and concurrent increase of fusidic acid-resistant Staphylococcus aureus. Fusidic acid resistance and methicillin resistant Staphylococcus aureus (MRSA) are both more prevalent in youngest age group (<5 year-olds) and particularly in the North island. In New Zealand, fusidic acid is recommended for treatment of minor impetigo and is the only fully-funded topical antibiotic...
October 14, 2016: New Zealand Medical Journal
https://www.readbyqxmd.com/read/27692736/the-effect-of-smoking-and-age-on-the-response-to-first-line-therapy-of-hidradenitis-suppurativa-an-institutional-retrospective-cohort-study
#14
George Denny, Milan J Anadkat
BACKGROUND: Treatment for hidradenitis suppurativa is often empiric and inadequate, and determining which patients will respond is difficult. OBJECTIVE: We sought to determine which patient factors are associated with a positive response to first-line medical therapy. METHODS: A single-center retrospective cohort study of all patients with hidradenitis suppurativa seen between January 1, 1992, and October 1, 2014, was conducted. Response to first-line medical therapy (oral/topical antibiotics, intralesional corticosteroids, and topical washes) was examined at follow-up within 6 months of initiating therapy...
September 28, 2016: Journal of the American Academy of Dermatology
https://www.readbyqxmd.com/read/27686471/targeted-de-escalation-rounds-may-effectively-and-safely-reduce-meropenem-use
#15
U Ni Riain, M Tierney, C Doyle, A Vellinga, C Fleming, M Cormican
OBJECTIVE: Use of meropenem in our hospital has doubled in recent years. An audit in 2013 showed that although initiation of therapy with meropenem was generally appropriate, therapy was rarely subsequently reviewed and de-escalated where appropriate. Therefore, a structured stewardship initiative focussed on meropenem de-escalation was developed. METHODS: A local guideline for review and de-escalation of meropenem was developed and approved by the Antimicrobial Stewardship Team...
September 29, 2016: Irish Journal of Medical Science
https://www.readbyqxmd.com/read/27676388/fate-of-sulfamethoxazole-in-groundwater-conceptualizing-and-modeling-metabolite-formation-under-different-redox-conditions
#16
Paula Rodríguez-Escales, Xavier Sanchez-Vila
Degradation of emerging organic compounds in saturated porous media is usually postulated as following simple low-order models. This is a strongly oversimplified, and in some cases plainly incorrect model, that does not consider the fate of the different metabolites. Furthermore, it does not account for the reversibility in the reaction observed in a few emerging organic compounds, where the parent is recovered from the metabolite. One such compound is the antibiotic sulfamethoxazole (SMX). In this paper, we first compile existing experimental data to formulate a complete model for the degradation of SMX in aquifers subject to varying redox conditions, ranging from aerobic to iron reducing...
November 15, 2016: Water Research
https://www.readbyqxmd.com/read/27663838/antimicrobial-peptides-amps-ancient-compounds-that-represent-novel-weapons-in-the-fight-against-bacteria
#17
J M Ageitos, A Sánchez-Pérez, P Calo-Mata, T G Villa
Antimicrobial peptides (AMPs) are short peptidic molecules produced by most living creatures. They help unicellular organisms to successfully compete for nutrients with other organisms sharing their biological niche, while AMPs form part of the immune system of multicellular creatures. Thus, these molecules represent biological weapons that have evolved over millions of years as a result of an escalating arms race for survival among living organisms. All AMPs share common features, such as a small size, with cationic and hydrophobic sequences within a linear or cyclic structure...
September 20, 2016: Biochemical Pharmacology
https://www.readbyqxmd.com/read/27661968/a-real-world-evaluation-of-repeat-paracentesis-guided-management-of-spontaneous-bacterial-peritonitis
#18
Aparna Goel, Mollie Biewald, Shirish Huprikar, Thomas Schiano, Gene Y Im
BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a common infection in cirrhosis associated with high mortality. More than 20% of patients with SBP do not respond to initial antibiotics. Guidelines differ in recommendations to repeat paracentesis (retap) to confirm antibiotic efficacy. We aim to evaluate the effect of retap-guided management of SBP on antibiotic escalation and 30-day transplant-free survival. MATERIALS AND METHODS: Retrospective cohort study of cirrhotic patients with SBP admitted to a single transplant center from 2010 to 2014...
September 22, 2016: Journal of Clinical Gastroenterology
https://www.readbyqxmd.com/read/27626951/de-escalation-adequacy-of-antibiotic-therapy-and-culture-positivity-in-septic-patients-an-observational-study
#19
Rafael Barberena Moraes, Julián Alberto Viteri Guillén, William Javier Castillo Zabaleta, Flavia Kessler Borges
OBJECTIVE: To evaluate the prevalence of antibiotic de-escalation in patients diagnosed with severe sepsis or septic shock at a public academic tertiary hospital and to evaluate antibiotic adequacy and culture positivity. METHODS: The prevalence of antibiotic de-escalation, the adequacy of antibiotic treatment and the rates of culture positivity were analyzed in patients with severe sepsis and septic shock between April and December 2013 at an intensive care unit in a tertiary university hospital...
September 2016: Revista Brasileira de Terapia Intensiva
https://www.readbyqxmd.com/read/27621509/taking-an-antibiotic-time-out-utilization-and-usability-of-a-self-stewardship-time-out-program-for-renewal-of-vancomycin-and-piperacillin-tazobactam
#20
EDITORIAL
Christopher J Graber, Makoto M Jones, Peter A Glassman, Charlene Weir, Jorie Butler, Kevin Nechodom, Chad L Kay, Amy E Furman, Thuong T Tran, Christopher Foltz, Lori A Pollack, Matthew H Samore, Matthew Bidwell Goetz
BACKGROUND: Antibiotic time-outs can promote critical thinking and greater attention to reviewing indications for continuation. OBJECTIVE: We pilot tested an antibiotic time-out program at a tertiary care teaching hospital where vancomycin and piperacillin-tazobactam continuation past day 3 had previously required infectious diseases service approval. METHODS: The time-out program consisted of 3 components: (1) an electronic antimicrobial dashboard that aggregated infection-relevant clinical data; (2) a templated note in the electronic medical record that included a structured review of antibiotic indications and that provided automatic approval of continuation of therapy when indicated; and (3) an educational and social marketing campaign...
November 2015: Hospital Pharmacy
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