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Antimicrobial stewardship in emergency

N Schellack, R Pretorius, A P Messina
With the global threat of antimicrobial resistance now more emergent than ever, there should be wider collaboration between members of the multidisciplinary healthcare team. This article proposes possible ways of engagement between the pharmacist, nurse and doctor. The pharmacist and nurse are placed in an ideal position through united efforts (camaraderie) to redirect healthcare towards improved patient outcomes while also reducing antimicrobial resistance.
September 23, 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
G Kampf
Chlorhexidine digluconate (CHG) is an antimicrobial agent used for different types of applications in hand hygiene, skin antisepsis, oral care, and patient washing. Increasing use raises concern regarding development of acquired bacterial resistance. Published data from clinical isolates with CHG minimum inhibitory concentrations (MICs) were reviewed and compared to epidemiological cut-off values to determine resistance. CHG resistance is rarely found in Escherichia coli, Salmonella spp., Staphylococcus aureus or coagulase-negative staphylococci...
August 26, 2016: Journal of Hospital Infection
Cheston B Cunha, Erika M C D'Agata
PURPOSE OF REVIEW: Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant gram-negative bacteria, continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns...
November 2016: Current Opinion in Nephrology and Hypertension
Andrew I T Hebbard, Monica A Slavin, Caroline Reed, Benjamin W Teh, Karin A Thursky, Jason A Trubiano, Leon J Worth
Clostridium difficile infection (CDI) is a significant cause of healthcare-associated diarrhoea, and the emergence of endemic strains resulting in poorer outcomes is recognised worldwide. Patients with cancer are a specific high-risk group for development of infection. Areas covered: In this review, modifiable and non-modifiable risk factors for CDI in adult patients with haematological malignancy or solid tumours are evaluated. In particular, the contribution of antimicrobial exposure, hospitalisation and gastric acid suppression to risk of CDI are discussed...
November 2016: Expert Review of Anti-infective Therapy
Rana F Hamdy, Theoklis E Zaoutis, Susan K Seo
Antifungal stewardship refers to coordinated interventions to monitor and direct the appropriate use of antifungal agents in order to achieve the best clinical outcomes and minimize selective pressure and adverse events. Antifungal utilization has steadily risen over time in concert with the increase in number of immunocompromised adults and children at risk for invasive fungal infections (IFI). Challenges in diagnosing IFI often lead to delays in treatment and poorer outcomes. There are also emerging data linking prior antifungal exposure and suboptimal dosing to the emergence of antifungal resistance, particularly for Candida...
September 2, 2016: Virulence
Hosam M Zowawi
Antimicrobial resistance (AMR) is increasingly being highlighted as an urgent public and animal health issue worldwide. This issue is well demonstrated in bacteria that are resistant to last-line antibiotics, suggesting a future with untreatable infections. International agencies have suggested combating strategies against AMR. Saudi Arabia has several challenges that can stimulate the emergence and spread of multidrug-resistant bacteria. Tackling these challenges need efforts from multiple sectors to successfully control the spread and emergence of AMR in the country...
September 2016: Saudi Medical Journal
Nicola Principi, Susanna Esposito
BACKGROUND: Antibiotics are among the drugs most commonly prescribed to children in hospitals and communities. Unfortunately, a great number of these prescriptions are unnecessary or inappropriate. Antibiotic abuse and misuse have several negative consequences, including drug-related adverse events, the emergence of multidrug resistant bacterial pathogens, the development of Clostridium difficile infection, the negative impact on microbiota, and undertreatment risks. In this paper, the principle of and strategies for paediatric antimicrobial stewardship (AS) programs, the effects of AS interventions and the common barriers to development and implementation of AS programs are discussed...
2016: BMC Infectious Diseases
Ana Montoya, Marco Cassone, Lona Mody
This review summarizes current literature pertaining to infection prevention in nursing home population including post-acute care patients and long-term care residents. Approximately 2 million infections occur each year and more than one-third of older adults harbor multidrug-resistant organisms in this setting. Surveillance, hand hygiene, isolation precautions, resident and employee health programs, education, and antibiotic stewardship are essential elements of infection prevention and control programs in nursing homes...
August 2016: Clinics in Geriatric Medicine
I Tuerena, N J Williams, T Nuttall, G Pinchbeck
INTRODUCTION: Antimicrobial resistance is a growing concern with implications for animal health. This study investigated the prevalence of antimicrobial resistance among commensal and environmental Escherichia coli isolated from animals sampled in referral hospitals in the UK. MATERIALS AND METHODS: Resistant Escherichia coli isolated from animal faeces and practice environments were tested for susceptibility to antimicrobial agents. PCR and sequencing techniques were used to identify extended spectrum beta-lactamase and AmpC-producer genotypes...
July 2016: Journal of Small Animal Practice
Onur Özgenç
The basic requirements of antibiotic prescribing are components of methodology; knowledge, logical reasoning, and analysis. Antimicrobial drugs are valuable but limited resources, different from other drugs and they are among the most commonly prescribed drugs all over the world. They are the only drugs which do not intentionally affect the patient. They affect the pathogens which invade the host. The emergence and spread of antibiotic-resistant pathogens are accelerated by heavy antibiotic usage. The effective antimicrobial stewardship and infection control program have been shown to limit the emergence of antimicrobial-resistant bacteria...
June 26, 2016: World Journal of Methodology
Patrick Eberechi Akpaka, Rashida Roberts, Stefan Monecke
Staphylococcus aureus continues to pose major public health challenges in many areas because of antibiotic resistance problems. In the Caribbean, especially Trinidad and Tobago, the challenge is not different. This study was performed to evaluate the antimicrobial resistance gene prevalence among S. aureus isolates in Trinidad and Tobago. Standard and molecular microbiological methods, including the Microscan automated system, DNA microarray and multi locus sequence typing (MLST) analysis, were performed on 309 clinical S...
June 18, 2016: Journal of Infection and Public Health
Stephanie J Dancer
PURPOSE OF REVIEW: More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness. RECENT FINDINGS: Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible...
August 2016: Current Opinion in Infectious Diseases
Christos A Grigoras, Fainareti N Zervou, Ioannis M Zacharioudakis, Constantinos I Siettos, Eleftherios Mylonakis
Clostridium difficile infection is the most common hospital-acquired infection. Besides infected patients, carriers have emerged as a key player in C. difficile epidemiology. In this study, we evaluated the impact of identifying and isolating carriers upon hospital admission on the incidence of CDI incidence and hospital-acquired C. difficile colonization, as a single policy and as part of bundle approaches. We simulated C. difficile transmission using a stochastic mathematical approach, considering the contribution of carriers based on published literature...
2016: PloS One
Enas Mamdouh Hefzy, Noha Anwar Hassuna
The multidrug-resistant sequence type 131 (ST131) Escherichia coli is a spreading epidemiological burden particularly among isolates resistant to fluoroquinolones. We aimed to evaluate the commonality of ST131-O25b and ST131-O16 among fluoroquinolone-resistant E. coli isolates causing community-acquired urinary tract infections (UTIs) at Fayoum University Hospital, in Egypt. Ninety-two fluoroquinolone-resistant E. coli isolates were subjected to multiplex PCR for detection of ST131 of either O25b or O16 subgroups...
May 23, 2016: Microbial Drug Resistance: MDR: Mechanisms, Epidemiology, and Disease
Amee R Manges, Theodore S Steiner, Alissa J Wright
Treatment options for multidrug-resistant (MDR) bacterial infections are limited and often less effective. Non-pharmacologic approaches to preventing or treating MDR infections are currently restricted to improved antimicrobial stewardship and infection control practices. Fecal microbiota transplantation (FMT), a highly effective treatment for recurrent Clostridium difficile infection, has emerged as a promising therapy for intestinal MDR bacterial decolonization. A total of eight case reports have been published showing FMT resulted in intestinal decolonization of extended spectrum β-lactamase (ESBL)-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant Enterococci, or methicillin-resistant Staphylococcus aureus...
August 2016: Infectious Diseases
Norazida Ab Rahman, Cheong Lieng Teng, Sheamini Sivasampu
BACKGROUND: Antibiotic overuse is driving the emergence of antibiotic resistance worldwide. Good data on prescribing behaviours of healthcare providers are needed to support antimicrobial stewardship initiatives. This study examined the differences in antibiotic prescribing rates of public and private primary care clinics in Malaysia. METHODS: We used data from the National Medical Care Survey (NMCS), a nationwide cluster sample of Malaysian public and private primary care clinics in 2014...
2016: BMC Infectious Diseases
Maia De Luca, Daniele Donà, Carlotta Montagnani, Andrea Lo Vecchio, Marta Romanengo, Claudia Tagliabue, Chiara Centenari, Patrizia D'Argenio, Rebecca Lundin, Carlo Giaquinto, Luisa Galli, Alfredo Guarino, Susanna Esposito, Mike Sharland, Ann Versporten, Herman Goossens, Giangiacomo Nicolini
BACKGROUND: Antimicrobials are the most commonly prescribed drugs. Many studies have evaluated antibiotic prescriptions in the paediatric outpatient but few studies describing the real antibiotic consumption in Italian children's hospitals have been published. Point-prevalence survey (PPS) has been shown to be a simple, feasible and reliable standardized method for antimicrobials surveillance in children and neonates admitted to the hospital. In this paper, we presented data from a PPS on antimicrobial prescriptions carried out in 7 large Italian paediatric institutions...
2016: PloS One
Nuntra Suwantarat, Karen C Carroll
BACKGROUND: Multidrug-resistant Gram-negative bacteria (MDRGN), including extended-spectrum β-lactamases (ESBLs) and multidrug-resistant glucose-nonfermenting Gram-negative bacilli (nonfermenters), have emerged and spread throughout Southeast Asia. METHODS: We reviewed and summarized current critical knowledge on the epidemiology and molecular characterization of MDRGN in Southeast Asia by PubMed searches for publications prior to 10 March 2016 with the term related to "MDRGN definition" combined with specific Southeast Asian country names (Thailand, Singapore, Malaysia, Vietnam, Indonesia, Philippines, Laos, Cambodia, Myanmar, Brunei)...
2016: Antimicrobial Resistance and Infection Control
Massimo Sartelli, Francesco Maria Labricciosa, Loredana Scoccia, Jessica Bellesi, Maria Rita Mazzoccanti, Giorgia Scaloni, Bianca Gentilozzi, Alessandro Chiodera
BACKGROUND: The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobial drug resistance and reduce adverse drug events, optimizing the selection, dosing, and duration of therapy in individual patients. METHODS: This retrospective study evaluated changes in antimicrobial agent use associated with implementation of an ASP in a general and emergency unit. The pre-intervention and post-intervention periods were defined as July 1, 2013, to December 31, 2013 (pre-intervention) and January 1, 2014, to June 30, 2014 (post-intervention)...
August 2016: Surgical Infections
Dora J Melber, Arianne Teherani, Brian S Schwartz
BACKGROUND: A strong foundational understanding of microbiology is crucial for the 21st century physician. Given recent major advances in medical microbiology, curricular changes will likely be needed. Before transforming curricula, we must first obtain a comprehensive understanding of contemporary medical student microbiology education. METHODS: We disseminated a 38-question survey to microbiology course directors and curriculum deans at 142 US medical schools accredited by the Liason Committee on Medical Education...
July 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
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