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Antimicrobial stewardship in emergency

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https://www.readbyqxmd.com/read/28173888/current-state-of-antimicrobial-stewardship-in-children-s-hospital-emergency-departments
#1
Rakesh D Mistry, Jason G Newland, Jeffrey S Gerber, Adam L Hersh, Larissa May, Sarah M Perman, Nathan Kuppermann, Peter S Dayan
BACKGROUND Antimicrobial stewardship programs (ASPs) effectively optimize antibiotic use for inpatients; however, the extent of emergency department (ED) involvement in ASPs has not been described. OBJECTIVE To determine current ED involvement in children's hospital ASPs and to assess beliefs and preferred methods of implementation for ED-based ASPs. METHODS A cross-sectional survey of 37 children's hospitals participating in the Sharing Antimicrobial Resistance Practices collaboration was conducted. Surveys were distributed to ASP leaders and ED medical directors at each institution...
February 8, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28152171/mixed-methods-pilot-study-to-assess-perceptions-of-antimicrobial-stewardship-in-nursing-homes
#2
Rebecca R Carter, Michelle M Montpetite, Robin L P Jump
OBJECTIVES: To identify features of community nursing home (NH) environments associated with lower rates of overall antibiotic use. DESIGN: This pilot study used an explanatory sequential design that incorporated comparative feedback about antibiotic use to inform a discussion about antimicrobial stewardship practices in community NHs. SETTING: NHs. PARTICIPANTS: Clinical leadership of five NHs. MEASUREMENTS: For the quantitative phase, the number of antibiotic prescriptions, length of therapy, and days of therapy/1,000 days of care were measured at six NHs...
February 2, 2017: Journal of the American Geriatrics Society
https://www.readbyqxmd.com/read/28140703/a-longitudinal-online-interprofessional-education-experience-involving-family-nurse-practitioner-students-and-pharmacy-students
#3
Andrea Collins, Amy Broeseker, Jill Cunningham, Cyndi Cortes, Jennifer Beall, Amy Bigham, Jongwha Chang
Interprofessional education (IPE) continues to gain traction worldwide. Challenges integrating IPE into health profession programmes include finding convenient times, meeting spaces, and level-appropriate assignments for each profession. This article describes the implementation of a 21-month prospective cohort study pilot programme for the Master of Science in nursing family nurse practitioner (FNP) and doctor of pharmacy (PharmD) students at a private university in the United States. This IPE experience utilised a blended approach for the learning activities; these students had initial and final sessions where they met face-to-face, with asynchronous online activities between these two sessions...
January 31, 2017: Journal of Interprofessional Care
https://www.readbyqxmd.com/read/28121035/recent-developments-in-the-surgical-management-of-complex-intra-abdominal-infection
#4
REVIEW
M Soop, G L Carlson
BACKGROUND: Current guidance on the management of sepsis often applies to infection originating from abdominal or pelvic sources, which presents specific challenges and opportunities for efficient and rapid source control. Advances made in the past decade are presented in this article. METHODS: A qualitative systematic review was undertaken by searching standard literature databases for English-language studies presenting original data on the clinical management of abdominal and pelvic complex infection in adults over the past 10 years...
January 2017: British Journal of Surgery
https://www.readbyqxmd.com/read/28112086/outbreak-of-carbapenem-resistant-providencia-rettgeri-in-a-tertiary-hospital
#5
V S Tshisevhe, M R Lekalakala, N Tshuma, S Janse van Rensburg, N Mbelle
The emergence of resistance to multiple antimicrobial agents in pathogenic bacteria is a significant public health threat, as there are limited effective antimicrobial agents for infections caused by multidrug-resistant (MDR) bacteria. Several MDR bacteria are now frequently detected. Carbapenem resistance in Enterobacteriaceae is often plasmid mediated, necessitating stringent infection control practices. Wedescribe an outbreak of carbapenem-resistant Providencia rettgeri involving 4 patients admitted to intensive care and high-care units at a tertiary hospital...
December 21, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
https://www.readbyqxmd.com/read/28108091/implementation-of-a-simple-innovative-system-for-postprescription-antibiotic-review-based-on-computerized-tools-with-shared-access
#6
F Bouchand, A Dinh, A L Roux, B Davido, H Michelon, M Lepainteur, B Legendre, F El Sayed, I Pierre, J Salomon, C Lawrence, C Perronne, M Villart, A-C Crémieux
BACKGROUND: Controlling antibiotic use in healthcare establishments limits their consumption and the emergence of bacterial resistance. AIM: To evaluate the efficiency of an innovative antibiotic stewardship strategy implemented over three years in a university hospital. METHODS: An antimicrobial multi-disciplinary team (AMT) [pharmacist, microbiologist and infectious disease specialist (IDS)] conducted a postprescription review. Specific coding of targeted antibiotics (including broad-spectrum β-lactams, glycopeptides, lipopeptides, fluoroquinolones and carbapenems) in the computerized physician order entry allowed recording of all new prescriptions...
November 26, 2016: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28079629/duration-of-pneumonia-therapy-and-the-role-of-biomarkers
#7
Katerina Kaziani, Adamantia Sotiriou, George Dimopoulos
PURPOSE OF REVIEW: Increasing antimicrobial resistance is a worldwide phenomenon that is threatening public health. Lower respiratory infections are one of the leading causes of morbidity that contribute to antibiotic consumption and thus the emergence of multidrug-resistant microbial strains. The goal of shortening antibiotic regimens' duration in common bacterial infections has been prioritized by antimicrobial stewardship programs as an action against this problem. RECENT FINDINGS: Data coming from randomized controlled trials, meta-analyses, and systematic reviews support the shortening of antimicrobial regimens in community-acquired, hospital-acquired, and ventilator-associated pneumonia...
January 12, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28065331/antimicrobial-stewardship-in-kansas-results-from-a-statewide-survey
#8
Carrie Poteete, Joseph M Scaletta
BACKGROUND: The availability of effective antibiotics is considered one of the most important developments in medicine. However, many organisms that were once susceptible to common antibiotics are becoming resistant. Antimicrobial stewardship programs (ASPs) are considered to be vital for combating the emergence of resistance. To understand current antimicrobial stewardship practices in Kansas, the authors designed a 36-question survey. Results of this survey will be used to develop a coordinated, public health strategy for improving current practices...
January 1, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28028434/infection-prevention-and-control-of-clostridium-difficile-a-global-review-of-guidelines-strategies-and-recommendations
#9
Evelyn Balsells, Teodora Filipescu, Moe H Kyaw, Camilla Wiuff, Harry Campbell, Harish Nair
BACKGROUND: Clostridium difficile is the leading cause of health care-associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance. METHODS: We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine...
December 2016: Journal of Global Health
https://www.readbyqxmd.com/read/28010959/urine-culture-guided-antibiotic-interventions-a-pharmacist-driven-antimicrobial-stewardship-effort-in-the-emergency-department
#10
Xi Zhang, Nicole Rowan, Bethann Mangel Pflugeisen, Sanjin Alajbegovic
BACKGROUND: Antibiotics are overprescribed for abnormal urine tests including asymptomatic bacteriuria (AB), contributing to rising antimicrobial resistance rates. Pharmacists reviewed urine cultures daily from emergency department (ED) encounters to assess antibiotic appropriateness. We studied antibiotic prescribing practices and assessed compliance to national guidelines, correlations with urine analysis (UA) components, and opportunities for antimicrobial stewardship in the ED. METHODS: This quality improvement project (QIP) was a prospective cohort study at a community hospital ED, with data collected from finalized urine cultures resulting October 30, 2014 through January 5, 2015...
December 16, 2016: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28005932/the-use-of-procalcitonin-pct-for-diagnosis-of-sepsis-in-burn-patients-a-meta-analysis
#11
Luís Cabral, Vera Afreixo, Luís Almeida, José Artur Paiva
The continuous development of resuscitation techniques and intensive care reduced the mortality rate induced by the initial shock in burn patients and, currently, infections (especially sepsis) are the main causes of mortality of these patients. The misuse of antimicrobial agents is strongly related to antimicrobial and adverse patient outcomes, development of microbial resistance and increased healthcare-related costs. To overcome these risks, antimicrobial stewardship is mandatory and biomarkers are useful to avoid unnecessary medical prescription, to monitor antimicrobial therapy and to support the decision of its stop...
2016: PloS One
https://www.readbyqxmd.com/read/27934622/-antibioticscout-online-tool-for-antimicrobial-stewardship-in-veterinary-medicine
#12
R Peter, C Müntener, D Demuth, D Heim, M Mevissen, G Schüpbach-Regula, S Schuller, F Stucki, B Willi, H Naegeli
Resistances to antimicrobials pose serious public health challenges. This issue concerns both human and veterinary medicine and can only be solved by a multidisciplinary approach. A comprehensive concept is, therefore, being worked out within the StAR (strategy antibiotic resistance) program in order to preserve the effectiveness of antibiotics for humans as well as animals. In this context, the AntibioticScout (www.AntibioticScout. ch) offers a new online tool for the prudent use of antibiotics in veterinary medicine...
December 2016: Schweizer Archiv Für Tierheilkunde
https://www.readbyqxmd.com/read/27917707/management-of-pneumonia-in-the-pediatric-critical-care-unit-an-area-for-antimicrobial-stewardship
#13
Aimee M Dassner, David P Nicolau, Jennifer E Girotto
Pediatric pneumonia is one of the most common causes of childhood infection requiring hospitalization and is a substantial driver of antimicrobial use among hospitalized children. About 12-20% of pediatric patients hospitalized with community-acquired pneumonia (CAP) require critical care. Additionally, nosocomial pneumonias (i.e. hospital-acquired and ventilator-associated pneumonias) are responsible for 15-53% of hospital-associated infections and are the most common indication for empiric antibiotics in the pediatric intensive care unit...
December 4, 2016: Current Pediatric Reviews
https://www.readbyqxmd.com/read/27915487/the-epidemiology-of-carbapenemases-in-latin-america-and-the-caribbean
#14
Kevin Escandón-Vargas, Sergio Reyes, Sergio Gutiérrez, María Virginia Villegas
Enterobacteriaceae, Pseudomonas spp., and Acinetobacter spp. infections are major causes of morbidity and mortality, especially due to the emergence and spread of β-lactamases. Carbapenemases, which are β-lactamases with the capacity to hydrolyze or inactivate carbapenems, have become a serious concern as they have the largest hydrolytic spectrum and therefore limit the utility of most β-lactam antibiotics. Areas covered: Here, we present an update of the current status of carbapenemases in Latin America and the Caribbean...
December 20, 2016: Expert Review of Anti-infective Therapy
https://www.readbyqxmd.com/read/27908334/antimicrobial-stewardship-in-the-management-of-sepsis
#15
REVIEW
Michael S Pulia, Robert Redwood, Brian Sharp
Sepsis represents a unique clinical dilemma with regard to antimicrobial stewardship. The standard approach to suspected sepsis in the emergency department centers on fluid resuscitation and timely broad-spectrum antimicrobials. The lack of gold standard diagnostics and evolving definitions for sepsis introduce a significant degree of diagnostic uncertainty that may raise the potential for inappropriate antimicrobial prescribing. Intervention bundles that combine traditional quality improvement strategies with emerging electronic health record-based clinical decision support tools and rapid molecular diagnostics represent the most promising approach to enhancing antimicrobial stewardship in the management of suspected sepsis in the emergency department...
February 2017: Emergency Medicine Clinics of North America
https://www.readbyqxmd.com/read/27895446/a-case-of-fatal-sepsis-due-to-multidrug-resistant-corynebacterium-striatum
#16
M Chatzopoulou, T Koufakis, I Voulgaridi, I Gabranis, M Tsiakalou
BACKGROUND: Although non-diphtheria corynebacteria have traditionally been regarded as avirulent members of human bacterial flora, their pathogenic potential is increasingly recognized in our time. Reasons for this include the prolonged survival of severely ill and immunocompromised patients, the development of more invasive diagnostic and therapeutic procedures and the sub-optimal use of antibiotics that disrupts normal microbial balance and favors superinfections. CASE REPORT: We present a rare case of sepsis due to multidrug-resistant Corynebacterium striatum in a 76-year-old host...
January 2016: Hippokratia
https://www.readbyqxmd.com/read/27880718/contribution-of-jac-to-antimicrobial-stewardship
#17
REVIEW
Alan P Johnson
Antimicrobial stewardship programmes are increasingly being used to improve the quality of antimicrobial prescribing, with the dual aim of optimizing clinical outcomes and minimizing the emergence and spread of antimicrobial resistance. The Journal of Antimicrobial Chemotherapy (JAC) is celebrating its 40th anniversary and, as part of activities to commemorate this event, this article highlights the contribution of JAC to antimicrobial stewardship. Papers published in JAC have contributed to the evidence base for stewardship, have highlighted educational and behavioural change initiatives aimed at improving antibiotic prescribing practice, and have actively sought to foster the practice of antimicrobial stewardship amongst its readers...
November 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27880667/the-current-treatment-landscape-other-fungal-diseases-cryptococcosis-fusariosis-and-mucormycosis
#18
Olivier Lortholary, Mario Fernández-Ruiz, John R Perfect
Compared with major invasive mycoses such as aspergillosis and candidiasis, the antifungal stewardship management strategies of other fungal diseases have different opportunities and considerations. Cryptococcosis, fusariosis and mucormycosis are globally prevalent invasive fungal diseases (IFDs), but are not currently included in antifungal prophylaxis guidelines for immunocompromised hosts. Since the implementation of biomarkers as part of diagnostic screening strategies, the concept of pre-emptive antifungal therapy has emerged for these IFDs...
November 2016: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/27859453/past-present-and-future-of-antibacterial-economics-increasing-bacterial-resistance-limited-antibiotic-pipeline-and-societal-implications
#19
Katherine H Luepke, Katie J Suda, Helen Boucher, Rene L Russo, Michael W Bonney, Timothy D Hunt, John F Mohr
Growing antimicrobial resistance and a dwindling antibiotic pipeline have resulted in an emerging postantibiotic era, as patients are now dying from bacterial infections that were once treatable. The fast-paced "Golden Age" of antibiotic development that started in the 1940s has lost momentum; from the 1980s to the early 2000s, there was a 90% decline in the approval of new antibiotics as well as the discovery of few new novel classes. Many companies have shifted away from development due to scientific, regulatory, and economic hurdles that proved antibiotic development to be less attractive compared with more lucrative therapeutic areas...
January 2017: Pharmacotherapy
https://www.readbyqxmd.com/read/27845153/daptomycin-non-susceptible-enterococcus-faecium-in-leukemia-patients-role-of-prior-daptomycin-exposure
#20
Adam J DiPippo, Frank P Tverdek, Jeffrey J Tarrand, Jose M Munita, Truc T Tran, Cesar A Arias, Samuel A Shelburne, Samuel L Aitken
OBJECTIVES: We sought to determine the association between previous daptomycin exposure and daptomycin non-susceptible Enterococcus faecium (DNSEf) bloodstream infections (BSI) in adult leukemia patients. METHODS: We retrospectively identified adult (≥18 years old) leukemia patients with Enterococcus spp. bacteremia at The University of Texas MD Anderson Cancer Center (MDACC) from 6/1/2013 to 7/22/2015. Antimicrobial susceptibility and previous antibiotic exposure within the 90 days prior to bacteremia were collected...
November 11, 2016: Journal of Infection
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