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Antimicrobial stewardship in emergency

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https://www.readbyqxmd.com/read/29290744/antimicrobial-stewardship-program-using-plan-do-study-act-cycles-to-reduce-unjustified-antibiotic-prescribing-in-children-admitted-with-an-asthma-exacerbation
#1
Sasha E Dorzin, Claudia Halaby, Maria Lyn Quintos, Asif Noor, Gladys El-Chaar
OBJECTIVE: Antimicrobial stewardship programs (ASPs) ensure appropriate antibiotic use, reduce health care costs, and minimize antibiotic resistance. National asthma guidelines do not recommend antibiotics during an exacerbation unless the child has an infection or comorbidities. The American Academy of Pediatrics (AAP) established a benchmark for unjustified antibiotic use at 6.6%.9 A retrospective study at our institution showed that 7.8% of antibiotics were prescribed without justification in children admitted for asthma...
November 2017: Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG
https://www.readbyqxmd.com/read/29236303/impact-of-antimicrobial-stewardship-program-on-hospitalized-patients-at-the-intensive-care-unit-a-prospective-audit-and-feedback-study
#2
Maher R Khdour, Hussein O Hallak, Mamoon Al-Deyab, Mowafq A Nasif, Aliaa M Khalili, Ahamad A Dallashi, Mohammad B Khofash, Michael G Scott
AIMS: Inappropriate use of antibiotics is one of the most important factors contributing to the emergence of drug resistant pathogens. The purpose of this study was to measure the clinical impact of Antimicrobial Stewardship Program (ASP) interventions on hospitalized patients at the Intensive care unit at Palestinian Medical Complex. METHODS: A prospective audit with intervention and feedback by ASP team within 48-72h of antibiotic administration began in Sep, 2015...
December 13, 2017: British Journal of Clinical Pharmacology
https://www.readbyqxmd.com/read/29230891/linking-individual-level-data-on-diagnoses-and-dispensing-for-research-on-antibiotic-use-evaluation-of-a-novel-data-source-from-english-secondary-care
#3
Patrick Rockenschaub, David Ansell, Laura Shallcross
PURPOSE: There has been a focus on stewardship programmes to curb inappropriate antibiotic prescribing and reduce antimicrobial resistance. In-hospital, patient-level prescribing linked to indication is needed to support surveillance, evaluation of stewardship initiatives, as well as other antibiotic research. We evaluated whether a novel dataset linking hospital pharmacy records to Hospital Episode Statistics data can be used for antibiotic research. METHODS: Using the Hospital Treatment Insights (HTI) database, which links Hospital Episode Statistics to pharmacy records from 43 out of 153 hospital trusts in England, we estimated the proportion of missed linkage and identified characteristics associated with missing data...
December 12, 2017: Pharmacoepidemiology and Drug Safety
https://www.readbyqxmd.com/read/29229015/risk-factors-for-acquisition-of-multidrug-resistant-escherichia-coli-and-development-of-community-acquired-urinary-tract-infections
#4
U V Ukah, M Glass, B Avery, D Daignault, M R Mulvey, R J Reid-Smith, E J Parmley, A Portt, P Boerlin, A R Manges
We examined risk factors associated with the intestinal acquisition of antimicrobial-resistant extraintestinal pathogenic Escherichia coli (ExPEC) and development of community-acquired urinary tract infection (UTI) in a case-control study of young women across Canada. A total of 399 women were recruited; 164 women had a UTI caused by E. coli resistant to ⩾1 antimicrobial classes and 98 had a UTI caused by E. coli resistant to ⩾3 antimicrobial classes. After adjustment for age, student health service (region of Canada) and either prior antibiotic use or UTI history, consumption of processed or ground chicken, cooked or raw shellfish, street foods and any organic fruit; as well as, contact with chickens, dogs and pet treats; and travel to Asia, were associated with an increased risk of UTI caused by antimicrobial resistant E...
December 12, 2017: Epidemiology and Infection
https://www.readbyqxmd.com/read/29190327/control-of-healthcare-and-community-associated-mrsa-recent-progress-and-persisting-challenges
#5
Andrew Henderson, Graeme R Nimmo
Background: Healthcare adapted meticillin-resistant Staphylococcus aureus (MRSA) has spread to hospitals around the world over 50 years. More recently, other strains of MRSA have emerged with the ability to spread in the community and infect otherwise healthy individuals. Morbidity and mortality associated with MRSA remains high and its control in both the healthcare and community setting has proven challenging. Sources of data: Pubmed (Medline). Areas of agreement: The use of targeted screening and decolonization, hand hygiene and antimicrobial stewardship is supported by the most robust studies, though many studies have implemented bundles for effective healthcare-associated (HA)-MRSA control...
November 28, 2017: British Medical Bulletin
https://www.readbyqxmd.com/read/29164361/bacteraemia-in-emergency-departments-effective-antibiotic-reassessment-is-associated-with-a-better-outcome
#6
Charlotte Aillet, Didier Jammes, Agnès Fribourg, Sophie Léotard, Olivier Pellat, Patricia Etienne, Dominique Néri, Djamel Lameche, Olivier Pantaloni, Serge Tournoud, Pierre-Marie Roger
Patients with bacteraemia constitute an useful population for an audit of antibiotic treatments. Empirical antibiotic therapy (EAT) and its reassessment must take into account clinical data and microbiological results. Our aim was to determine the impact of these sequential steps of the therapy on survival. This was a retrospective multicentre study which included patients admitted to emergency departments (ED) for whom blood cultures were positive over a 4-month period. Microbial results were compiled from the database of the laboratories...
November 21, 2017: European Journal of Clinical Microbiology & Infectious Diseases
https://www.readbyqxmd.com/read/29102325/surveillance-for-control-of-antimicrobial-resistance
#7
REVIEW
Evelina Tacconelli, Frangiscos Sifakis, Stephan Harbarth, Remco Schrijver, Maaike van Mourik, Andreas Voss, Mike Sharland, Nithya Babu Rajendran, Jesús Rodríguez-Baño
Antimicrobial resistance poses a growing threat to public health and the provision of health care. Its surveillance should provide up-to-date and relevant information to monitor the appropriateness of therapy guidelines, antibiotic formulary, antibiotic stewardship programmes, public health interventions, infection control policies, and antimicrobial development. In Europe, although the European Antimicrobial Resistance Surveillance Network provides annual reports on monitored resistant bacteria, national surveillance efforts are still fragmented and heterogeneous, and have substantial structural problems and issues with laboratory data...
October 25, 2017: Lancet Infectious Diseases
https://www.readbyqxmd.com/read/29102103/frequency-antimicrobial-susceptibility-and-clonal-distribution-of-methicillin-resistant-staphylococcus-pseudintermedius-in-canine-clinical-samples-submitted-to-a-veterinary-diagnostic-laboratory-in-italy-a-3-year-retrospective-investigation
#8
G Ventrella, A Moodley, E Grandolfo, A Parisi, M Corrente, D Buonavoglia, L Guardabassi
In the last decade there has been a rapid global spread of methicillin-resistant Staphylococcus pseudintermedius (MRSP) clones displaying multidrug resistance in dogs. We investigated prevalence, antimicrobial susceptibility and clonal distribution of MRSP isolated from clinical canine samples between during 2011-2014. Following species identification by nuc PCR, MRSP were confirmed by the presence of mecA and characterized by antimicrobial susceptibility testing, Pulsed Field Gel Electrophoresis (PFGE), SCCmec typing, and Multi-Locus Sequence Typing (MLST) of a few isolates having distinct PFGE profiles...
November 2017: Veterinary Microbiology
https://www.readbyqxmd.com/read/29091191/building-a-national-infection-intelligence-platform-to-improve-antimicrobial-stewardship-and-drive-better-patient-outcomes-the-scottish-experience
#9
Marion Bennie, William Malcolm, Charis A Marwick, Kimberley Kavanagh, Jean Sneddon, Dilip Nathwani
Background: The better use of new and emerging data streams to understand the epidemiology of infectious disease and to inform and evaluate antimicrobial stewardship improvement programmes is paramount in the global fight against antimicrobial resistance. Objectives: To create a national informatics platform that synergizes the wealth of disjointed, infection-related health data, building an intelligence capability that allows rapid enquiry, generation of new knowledge and feedback to clinicians and policy makers...
October 1, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/29063523/evaluation-of-existing-and-desired-antimicrobial-stewardship-activities-and-strategies-in-swiss-hospitals
#10
M Osthoff, Julia Belicki, Andreas F-X Widmer, For Swissnoso
Antimicrobial stewardship (AMS) is an important component in the fight against antimicrobial resistance. Currently, few hospitals have an ongoing institutional AMS programme. Swissnoso - the national centre for infection prevention - has launched a national Swiss AMS initiative supported by the office of public health. To guide AMS priorities and resources, current AMS activities in Switzerland were assessed. We distributed an internet-based questionnaire directed mainly to board-certified infectious diseases specialists and, if not available, senior internal medicine staff...
October 24, 2017: Swiss Medical Weekly
https://www.readbyqxmd.com/read/29052109/assessments-of-opportunities-to-improve-antibiotic-prescribing-in-an-emergency-department-a-period-prevalence-survey
#11
Tristan T Timbrook, Aisling R Caffrey, Anais Ovalle, Maya Beganovic, William Curioso, Melissa Gaitanis, Kerry L LaPlante
INTRODUCTION: Approximately 30% of all outpatient antimicrobials are inappropriately prescribed. Currently, antimicrobial prescribing patterns in emergency departments (ED) are not well described. Determining inappropriate antimicrobial prescribing patterns and opportunities for interventions by antimicrobial stewardship programs (ASP) are needed. METHODS: A retrospective chart review was performed among a random sample of non-admitted, adult patients who received an antimicrobial prescription in the ED from January 1 to December 31, 2015...
December 2017: Infectious Diseases and Therapy
https://www.readbyqxmd.com/read/29048511/impact-of-implementing-national-guidelines-on-antibiotic-prescriptions-for-acute-respiratory-tract-infections-in-pediatric-emergency-departments-an-interrupted-time-series-analysis
#12
Naïm Ouldali, Xavier Bellêttre, Karen Milcent, Romain Guedj, Loïc de Pontual, Bogdan Cojocaru, Valérie Soussan-Banini, Irina Craiu, David Skurnik, Vincent Gajdos, Gérard Chéron, Robert Cohen, Corinne Alberti, François Angoulvant
Background: Many antibiotics are prescribed inappropriately in pediatric emergency departments (PEDs), but little data are available in these settings about effective interventions based on guidelines that follow the antimicrobial stewardship principle. Our aim was to assess the impact of implementing the 2011 national guidelines on antibiotic prescriptions for acute respiratory tract infection (ARTI) in PEDs. Method: We conducted a multicentric, quasiexperimental, interrupted time series analysis of prospectively collected electronic data from 7 French PEDs...
October 16, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/29047423/antimicrobial-nonsusceptibility-of-gram-negative-bloodstream-isolates-veterans-health-administration-system-united-states-2003-2013-1
#13
Michihiko Goto, Jennifer S McDanel, Makoto M Jones, Daniel J Livorsi, Michael E Ohl, Brice F Beck, Kelly K Richardson, Bruce Alexander, Eli N Perencevich
Bacteremia caused by gram-negative bacteria is associated with serious illness and death, and emergence of antimicrobial drug resistance in these bacteria is a major concern. Using national microbiology and patient data for 2003-2013 from the US Veterans Health Administration, we characterized nonsusceptibility trends of community-acquired, community-onset; healthcare-associated, community-onset; and hospital-onset bacteremia for selected gram-negative bacteria (Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Acinetobacter spp...
November 2017: Emerging Infectious Diseases
https://www.readbyqxmd.com/read/28971864/multicenter-study-of-the-risk-factors-for-colonization-or-infection-with-carbapenem-resistant-enterobacteriaceae-in-children
#14
Kathleen Chiotos, Pranita D Tamma, Kelly B Flett, Matthew Naumann, Manjiree V Karandikar, Warren B Bilker, Theoklis Zaoutis, Jennifer H Han
Carbapenem-resistant Enterobacteriaceae (CRE) are increasingly identified in children in the United States, but data on the epidemiology of CRE in this population are limited. The objectives of this study were to characterize the risk factors for colonization or infection with CRE and describe the microbiologic characteristics of pediatric CRE isolates. We performed a multicenter matched case-control study from January 2011 to October 2015 at three tertiary care pediatric centers. Case patients were hospitalized children with CRE isolated from clinical cultures and were matched in a 2:1 ratio to control patients with carbapenem-susceptible Enterobacteriaceae (CSE)...
December 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28922959/compliance-to-the-primary-health-care-treatment-guidelines-and-the-essential-medicines-list-in-the-management-of-sexually-transmitted-infections-in-correctional-centres-in-south-africa-findings-and-implications
#15
Tammy B Matsitse, Elvera Helberg, Johanna C Meyer, Brian Godman, Amos Massele, Natalie Schellack
BACKGROUND: The emergence of antimicrobial resistance (AMR) is a global concern and a growing health crisis. Additionally, evidence has shown that non-compliance to treatment guidelines, especially in the management of communicable diseases such as sexually transmitted infections (STIs), has the potential of further enhancing AMR rates. Data on the extent of these challenges in Primary Health Care (PHC) facilities in correctional centres in South Africa (SA) is limited. Hence this study was conducted to determine the level of compliance with the 2008 PHC Standard Treatment Guidelines and Essential Medicines List (PHC STGs/EML) in the management of STIs, and to identify potential factors contributing to the compliance and non-compliance to guide future strategies...
September 19, 2017: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/28903514/impact-of-an-antimicrobial-stewardship-program-on-antibiotic-use-at-a-nonfreestanding-children-s-hospital
#16
R Brigg Turner, Elena Valcarlos, Ann M Loeffler, Michael Gilbert, Dominic Chan
Background: Pediatric stewardship programs have been successful at reducing unnecessary antibiotic use. Data from nonfreestanding children's hospitals are currently limited. This study is an analysis of antibiotic use after implementation of an antimicrobial stewardship program at a community nonfreestanding children's hospital. Methods: In April 2013, an antimicrobial stewardship program that consisted of physician-group engagement and pharmacist prospective auditing and feedback was initiated...
September 1, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28901726/antimicrobial-stewardship-in-paediatric-oncology-impact-on-optimising-gentamicin-use-in-febrile-neutropenia
#17
Stefanie Hennig, Christine E Staatz, Daniel Natanek, Sabina Bialkowski, Carolina Consuelo Llanos Paez, Rachael Lawson, Julia Clark
OBJECTIVES: To evaluate the impact of an antimicrobial stewardship (AMS) intervention, involving introduction of new guidelines on the treatment of febrile neutropenia (FN), on improving the use of gentamicin in paediatric oncology patients. DESIGN AND INTERVENTION: Updated guidelines for gentamicin usage in paediatrics with FN were implemented at a tertiary children's teaching hospital, in Brisbane, Australia. Data on gentamicin usage before and after the guideline change were collected retrospectively from children with cancer admitted to hospital with FN between January 2012 and December 2013...
September 13, 2017: Pediatric Blood & Cancer
https://www.readbyqxmd.com/read/28892282/diabetic-foot-infection-antibiotic-therapy-and-good-practice-recommendations
#18
Nicholas D Barwell, Marion C Devers, Brian Kennon, Helen E Hopkinson, Claire McDougall, Matthew J Young, Hannah M A Robertson, Duncan Stang, Stephanie J Dancer, Andrew Seaton, Graham P Leese
BACKGROUND: Healthcare events related to diabetic foot disease carry a burden of morbidity, mortality and economic cost. Prompt identification of clinical infection with appropriate tissue sampling limits use of broad spectrum empirical antibiotics and improves antibiotic stewardship. Staphylococcus aureus remains the commonest infecting organism and high-dose flucloxacillin remains the empirical antibiotic of choice for antibiotic naïve patients. Barriers to microbe-specific treatment include: adequate tissue sampling, delays in culture results, drug allergies and the emergence of multidrug-resistant organisms which can complicate the choice of targeted antibiotics...
September 11, 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28882725/what-is-antimicrobial-stewardship
#19
REVIEW
O J Dyar, B Huttner, J Schouten, C Pulcini
BACKGROUND: The use of the term 'antimicrobial stewardship' has grown exponentially in recent years, typically referring to programmes and interventions that aim to optimize antimicrobial use. Although antimicrobial stewardship originated within human healthcare, it is increasingly applied in broader contexts including animal health and One Health. As the use of the term 'antimicrobial stewardship' becomes more common, it is important to consider what antimicrobial stewardship is, as well as what it is not...
November 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28853035/expanding-antimicrobial-stewardship-to-urgent-care-centers-through-a-pharmacist-led-culture-follow-up-program
#20
Lisa E Dumkow, Thomas S Beuschel, Kasey L Brandt
INTRODUCTION: Urgent care centers represent a high-volume outpatient setting where antibiotics are prescribed frequently but resources for antimicrobial stewardship may be scarce. In 2015, our pharmacist-led Emergency Department (ED) culture follow-up program was expanded to include two urgent care (UC) sites within the same health system. The UC program is conducted by ED and infectious diseases clinical pharmacists as well as PGY1 pharmacy residents using a collaborative practice agreement (CPA)...
September 2017: Infectious Diseases and Therapy
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