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Antimicrobial stewardship in emergency

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https://www.readbyqxmd.com/read/28637307/sparing-carbapenem-usage
#1
A Peter R Wilson
Background: Carbapenem resistance in Gram-negative bacteria is increasing in many countries and use of carbapenems and antibiotics to which resistance is linked should be reduced to slow its emergence. There are no directly equivalent antibiotics and the alternatives are less well supported by clinical trials. The few new agents are expensive. Objectives: To provide guidance on strategies to reduce carbapenem usage. Methods: A literature review was performed as described in the BSAC/HIS/BIA/IPS Joint Working Party on Multiresistant Gram-negative Infection Report...
June 15, 2017: Journal of Antimicrobial Chemotherapy
https://www.readbyqxmd.com/read/28626539/resistance-to-colistin-in-klebsiella-pneumoniae-a-4-0-strain
#2
REVIEW
Guido Granata, Nicola Petrosillo
The global rise of multidrug-resistant gram-negative bacteria represents an increasing threat to patient safety. From the first observation of a carbapenem-resistant gram-negative bacteria a global spread of extended-spectrum beta-lactamases and carbapenemases producing Klebsiella pneumoniae has been observed. Treatment options for multidrug-resistant K. pneumoniae are actually limited to combination therapy with some aminoglycosides, tigecycline and to older antimicrobial agents. Unfortunately, the prevalence of colistin-resistant and tigecycline-resistant K...
May 31, 2017: Infectious Disease Reports
https://www.readbyqxmd.com/read/28614043/antibiotics-vs-appendectomy-for-acute-uncomplicated-appendicitis-in-adults-review-of-the-evidence-and-future-directions
#3
Jared M Huston, Lillian S Kao, Phillip K Chang, James M Sanders, Sara Buckman, Charles A Adams, Christine S Cocanour, Sarah E Parli, Julia Grabowski, Jose Diaz, Jeffrey M Tessier, Therese M Duane
BACKGROUND: Acute appendicitis is the most common abdominal surgical emergency in the United States, with a lifetime risk of 7%-8%. The treatment paradigm for complicated appendicitis has evolved over the past decade, and many cases now are managed by broad-spectrum antibiotics. We determined the role of non-operative and operative management in adult patients with uncomplicated appendicitis. METHODS: Several meta-analyses have attempted to clarify the debate. Arguably the most influential is the Appendicitis Acuta (APPAC) Trial...
June 14, 2017: Surgical Infections
https://www.readbyqxmd.com/read/28596021/pharmacist-driven-antimicrobial-stewardship-in-intensive-care-units-in-east-china-a-multicenter-prospective-cohort-study
#4
Zhongwang Li, Baoli Cheng, Kai Zhang, Guohao Xie, Yan Wang, Jinchao Hou, Lihua Chu, Jialian Zhao, Zhijun Xu, Zhongqiu Lu, Huaqin Sun, Jian Zhang, Zhiyi Wang, Haiya Wu, Xiangming Fang
BACKGROUND: Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. METHOD: We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls...
June 5, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28557742/viral-features-and-testing-for-streptococcal-pharyngitis
#5
Daniel J Shapiro, Christina E Lindgren, Mark I Neuman, Andrew M Fine
BACKGROUND AND OBJECTIVES: The Infectious Diseases Society of America recommends that clinicians forego testing for group A Streptococcal (GAS) pharyngitis in patients with clinical features of viral illness. The prevalence of viral features in patients tested for GAS pharyngitis is not known. The objectives of this study were as follows: to describe the prevalence of viral features in pediatric patients for whom rapid antigen detection tests (RADTs) for GAS pharyngitis are performed; and to compare the prevalence of GAS and the sensitivity of the RADT in patients with and without viral features...
May 2017: Pediatrics
https://www.readbyqxmd.com/read/28555419/assessing-guideline-concordant-prescribing-for-community-acquired-pneumonia
#6
Kaci Thiessen, Ann E Lloyd, Michael J Miller, Juell Homco, Brooke Gildon, Katherine S O'Neal
Background Current reports of outpatient antimicrobial prescribing practices may overestimate guideline concordance since they address only drug selection. Appropriate stewardship should consider all prescribing criteria (i.e., dose, frequency, duration, and route of administration) to fully assess guideline concordance. Objective Using a community-acquired pneumonia (CAP) example, the aims of this pilot study were to estimate guideline concordance in adult patients 18 years or older when all prescribing criteria are considered, and provide recommendations to optimize treatment...
May 29, 2017: International Journal of Clinical Pharmacy
https://www.readbyqxmd.com/read/28542093/feasibility-and-applicability-of-antimicrobial-stewardship-in-immunocompromised-patients
#7
Elizabeth Robilotti, Marisa Holubar, Susan K Seo, Stan Deresinski
PURPOSE OF REVIEW: Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients. RECENT FINDINGS: Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction...
May 24, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28539060/a-systematic-review-of-antimicrobial-stewardship-interventions-in-the-emergency-department
#8
Mia Losier, Tasha D Ramsey, Kyle John Wilby, Emily K Black
BACKGROUND/OBJECTIVE: To improve antimicrobial utilization, development and implementation of antimicrobial stewardship programs in the emergency department (ED) has been recommended. The primary objective of this review was to characterize antimicrobial stewardship (AMS) in the ED and to identify interventions that improve patient outcomes or process of care and/or reduce consequences of antimicrobial use. METHODS: This study was completed as a systematic review...
May 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#9
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28524255/enablers-and-barriers-to-the-use-of-antibiotic-guidelines-in-the-assessment-and-treatment-of-community-acquired-pneumonia-a-qualitative-study-of-clinicians-perspectives
#10
Antoine Sedrak, Mahesan Anpalahan, Karen Luetsch
BACKGROUND: Community-acquired pneumonia (CAP) is a common condition and a number of guidelines have been developed for its assessment and treatment. Adherence to guidelines by clinicians varies and particularly the prescribing of antibiotics often remains suboptimal. OBJECTIVE: The aim of this study was to elucidate potential barriers and enablers to the adherence to antibiotic guidelines by clinicians treating CAP in an Australian hospital. METHODS: Semi-structured interviews were conducted with purposively recruited senior prescribers who regularly treat CAP in an Australian hospital...
June 2017: International Journal of Clinical Practice
https://www.readbyqxmd.com/read/28480770/an-update-on-the-pharmacotherapeutic-management-of-lower-respiratory-tract-infections
#11
Mario Cazzola, Paola Rogliani, Stefano Aliberti, Francesco Blasi, Maria Gabriella Matera
Our knowledge about lower respiratory tract infections (LRTIs) has improved substantially in the last years, but the management of respiratory infections is still a challenge and we are still far from using precision medicine in their treatment. Areas covered: The approaches developed in recent years to improve the pharmacotherapeutic management of LRTIs, such as novel diagnostic assays to facilitate medical decision-making, attempts for selecting an optimal empiric antibiotic regimen, and the role of new and possibly unproven adjunctive therapies, are described...
May 19, 2017: Expert Opinion on Pharmacotherapy
https://www.readbyqxmd.com/read/28443360/overview-of-procalcitonin-assays-and-procalcitonin-guided-protocols-for-the-management-of-patients-with-infections-and-sepsis
#12
Philipp Schuetz, Celine Bretscher, Luca Bernasconi, Beat Mueller
Procalcitonin is a surrogate infection blood marker whose levels help estimate the likelihood of bacterial infections and correlate with their resolution. Recent trials have revealed the benefits of inclusion of procalcitonin in antibiotic stewardship protocols for initiation and discontinuation of antimicrobial therapy. Areas covered: Procalcitonin-guided antibiotic stewardship protocols have shown appreciable reductions in antibiotic use and duration of therapy in respiratory infections, sepsis, and other infections, with positive effects on clinical outcomes...
June 2017: Expert Review of Molecular Diagnostics
https://www.readbyqxmd.com/read/28411959/implementation-and-outcomes-of-an-antimicrobial-stewardship-program-effectiveness-of-education
#13
Yea-Yuan Chang, Hsin-Pai Chen, Chia-Wei Lin, Jen-Jen Tang, Ti-Ying Hsu, Yueh-Chun Weng, Yuan-Ming Lee, Wei-Shu Wang, Su-Shun Lo
BACKGROUND: Unnecessary use of antibiotics is a common occurrence in hospitals. Implementation of antibiotic stewardship programs (ASPs) has been shown to reduce both unnecessary antibiotic use and drug-resistant bacteria. Education is a fundamental component of an ASP. However, the effectiveness of proper uses of antibiotics education has not been clearly analyzed. METHODS: In a 520-bed university hospital located in northeastern Taiwan, a significantly increasing prescription of carbapenems, specifically imipenem and meropenem, was observed...
April 12, 2017: Journal of the Chinese Medical Association: JCMA
https://www.readbyqxmd.com/read/28400686/convergence-of-minds-for-better-patient-outcome-in-intensive-care-unit-infections
#14
Chand Wattal, Yash Javeri, Neeraj Goel, Debashish Dhar, Sonal Saxena, Sarman Singh, Jaswinder Kaur Oberoi, B K Rao, Purva Mathur, Vikas Manchanda, Vivek Nangia, Arti Kapil, Ashok Rattan, Supradip Ghosh, Omender Singh, Vinod Singh, Iqbal Kaur, Sanghamitra Datta, Sharmila Sen Gupta
BACKGROUND: There is emergence of resistance to the last-line antibiotics such as carbapenems in Intensive Care Units (ICUs), leaving little effective therapeutic options. Since there are no more newer antibiotics in the armamentarium in the near future, it has become imperative that we harness the interdisciplinary knowledge for the best clinical outcome of the patient. AIMS: The aim of the conference was to utilize the synergies between the clinical microbiologists and critical care specialists for better patient care and clinical outcome...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28399946/impact-of-a-multifaceted-antimicrobial-stewardship-program-a-front-line-ownership-driven-quality-improvement-project-in-a-large-urban-emergency-department
#15
Adam Jonathan Kaufman, Janine McCready, Jeff Powis
BACKGROUND: Antibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such as Clostridium difficile (C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers...
April 12, 2017: CJEM
https://www.readbyqxmd.com/read/28395369/antibiotics-prescriptions-in-the-neonatal-intensive-care-unit-how-to-overcome-everyday-challenges
#16
D Donà, E Mozzo, V Mardegan, U Trafojer, P Lago, S Salvadori, E Baraldi, C Giaquinto
Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum antibiotic appropriate for a particular case, and de-escalation or discontinuation of therapy in defined situations...
April 10, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28342095/-advances-in-diagnostic-microbiology-opportunities-and-limitations
#17
F P Maurer, M Hentschke, H Rohde
In the light of ever increasing problems related to the emergence of multidrug-resistant bacteria, rapid microbiological diagnostics are of growing importance. Timely pathogen detection and availability of susceptibility data are essential for optimal treatment, but are even more crucial for de-escalation of broad spectrum empiric therapies. Medical microbiology is, thus, an integral part of antimicrobial stewardship programs. Traditional microbiological techniques for species identification and susceptibility testing rely on bacterial growth and are, thus, characterized by inherent slowness...
March 24, 2017: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/28250702/an-evaluation-of-selected-indications-and-appropriateness-of-ampicillin-sulbactam-an-unrestricted-antimicrobial-at-a-single-center
#18
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
https://www.readbyqxmd.com/read/28248946/new-and-developing-diagnostic-technologies-for-urinary-tract-infections
#19
REVIEW
Michael Davenport, Kathleen E Mach, Linda M Dairiki Shortliffe, Niaz Banaei, Tza-Huei Wang, Joseph C Liao
Timely and accurate identification and determination of the antimicrobial susceptibility of uropathogens is central to the management of UTIs. Urine dipsticks are fast and amenable to point-of-care testing, but do not have adequate diagnostic accuracy or provide microbiological diagnosis. Urine culture with antimicrobial susceptibility testing takes 2-3 days and requires a clinical laboratory. The common use of empirical antibiotics has contributed to the rise of multidrug-resistant organisms, reducing treatment options and increasing costs...
May 2017: Nature Reviews. Urology
https://www.readbyqxmd.com/read/28216021/prevalence-antibiotic-susceptibility-and-characterization-of-antibiotic-resistant-genes-among-carbapenem-resistant-gram-negative-bacilli-and-yeast-in-intestinal-flora-of-cancer-patients-in-north-lebanon
#20
Rima Christophy, Marwan Osman, Hassan Mallat, Marcel Achkar, Azzam Ziedeh, Walid Moukaddem, Fouad Dabboussi, Monzer Hamze
The emergence and spread of carbapenem-resistant bacteria are a significant clinical and public health concern. The aim of the study is to determine the prevalence of intestinal carriage of carbapenem-resistant bacteria and yeasts in cancer patients under chemotherapy. 41 stool samples collected from cancer patients in Nini hospital in Tripoli, North Lebanon have been analyzed. After isolating yeasts and carbapenem-resistant bacteria, a biochemical identification and antimicrobial susceptibility profile were determined...
February 15, 2017: Journal of Infection and Public Health
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