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Antimicrobial stewardship program

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https://www.readbyqxmd.com/read/28717037/impact-of-a-carbapenem-antimicrobial-stewardship-program-on-patient-outcomes
#1
Valerie Xue Fen Seah, Rina Yue Ling Ong, Ashley Shi Yuan Lim, Chia Yin Chong, Natalie Woon Hui Tan, Koh Cheng Thoon
Antimicrobial stewardship programs (ASPs) aim to improve appropriate antimicrobials use. However, concerns of the negative consequences from accepting ASP interventions exist, particularly when de-escalation or discontinuation of broad-spectrum antibiotics are recommended. Hence, we sought to evaluate the impact on clinical outcomes when ASP interventions for inappropriate carbapenem use were accepted or rejected by primary providers.We retrospectively reviewed all carbapenem prescriptions deemed inappropriate according to institutional guidelines with ASP interventions between July 2011 and December 2014...
July 17, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28712667/antibiotic-stewardship-in-low-and-middle-income-countries-same-but-different
#2
REVIEW
Janneke A Cox, Erika Vlieghe, Marc Mendelson, Heiman Wertheim, Linus Ndegwa, Maria Virginia Villegas, Ian Gould, Gabriel Levy Hara
BACKGROUND: Antibiotic resistance (ABR) is a quickly worsening problem worldwide, also in low-and middle-income countries (LMICs). Appropriate antibiotic use in humans and animals, i.e. antibiotic stewardship (ABS), is one of the corner stones of the World Health Organization's global action plan for ABR. Many LMICs are in the process of developing stewardship policies and programs. AIMS: We highlight the challenges for ABS initiatives in LMICs, give an outline of the (inter)national recommendations and demonstrate examples of effective, contextualised stewardship interventions...
July 13, 2017: Clinical Microbiology and Infection
https://www.readbyqxmd.com/read/28711429/-appropriateness-of-antibiotic-prescribing-in-paediatric-patients-in-a-hospital-emergency-department
#3
Borja Croche Santander, Elena Campos Alonso, Adela Sánchez Carrión, Laura Marcos Fuentes, Isabel Diaz Flores, Juan Carlos Vargas, Bárbara Fernández Domínguez, Cristóbal Toro Ibañez
INTRODUCTION: Antibiotics represent one of the most widely prescribed therapeutic agents in children. It has been estimated that 30-50% of antibiotic prescriptions for this population are inappropriate. In this scenario, analysis of prescription data provides an invaluable source of information as a basis for implementing strategies for improvement in this field. OBJECTIVE: To assess the appropriateness of antibiotic prescriptions in a paediatric population at an emergency department...
July 12, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
https://www.readbyqxmd.com/read/28711345/working-at-the-intersection-of-context-culture-and-technology-provider-perspectives-on-antimicrobial-stewardship-in-the-emergency-department-using-electronic-health-record-clinical-decision-support
#4
Phillip Chung, Jean Scandlyn, Peter S Dayan, Rakesh D Mistry
BACKGROUND: Antibiotic stewardship programs (ASPs) have not been fully developed for the emergency department (ED), in part the result of the barriers characteristic of this setting. Electronic health record-based clinical decision support (EHR CDS) represents a promising strategy to implement ASPs in the ED. We aimed to determine the cultural beliefs and structural barriers and facilitators to implementation of antimicrobial stewardship in the pediatric ED using EHR CDS. METHODS: Interviews and focus groups were conducted with hospital and ED leadership, attending ED physicians, nurse practitioners, physician assistants, and residents at a single health system in Colorado...
July 12, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28709439/enhanced-antimicrobial-de-escalation-for-pneumonia-in-mechanically-ventilated-patients-a-cross-over-study
#5
Tracy Trupka, Kristen Fisher, Scott T Micek, Paul Juang, Marin H Kollef
BACKGROUND: Antibiotics are commonly administered to hospitalized patients with infiltrates for possible bacterial pneumonia, often leading to unnecessary treatment and increasing the risk for resistance emergence. Therefore, we performed a study to determine if an enhanced antibiotic de-escalation practice could improve antibiotic utilization in mechanically ventilated patients with suspected pneumonia cared for in an academic closed intensive care unit (ICU). METHODS: This was a prospective cross-over trial comparing routine antibiotic management (RAM) and enhanced antimicrobial de-escalation (EAD) performed within two medical ICUs (total 34 beds) at Barnes-Jewish Hospital, an academic referral center...
July 15, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28702468/antimicrobial-stewardship-lessons-from-mupirocin-use-and-resistance-in-methicillin-resitant-staphylococcus-aureus
#6
Lance R Peterson, Noelle I Samia, Andrew M Skinner, Amit Chopra, Becky Smith
BACKGROUND: The quantitative relationship between antimicrobial agent consumption and rise or fall of antibiotic resistance has rarely been studied. We began all admission surveillance testing for methicillin-resistant Staphylococcus aureus (MRSA) in August 2005 with subsequent contact isolation and decolonization using nasally applied mupirocin ointment for those colonized. In October 2012, we discontinued decolonization of medical (nonsurgical service) patients. METHODS: We conducted a retrospective study from 2007 through 2014 of 445680 patients; 35235 were assessed because of mupirocin therapy and positive test results for MRSA...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28698021/impact-of-an-antimicrobial-stewardship-program-to-optimize-antimicrobial-use-for-outpatients-at-emergency-department
#7
Aurélien Dinh, Clara Duran, Benjamin Davido, Frédérique Bouchand, Laurène Deconinck, Morgan Matt, Olivia Sénard, Caroline Guyot, Anne-Sophie Levasseur, Julie Attal, David Razazi, Thomas Tritz, Alain Beauchet, Jérôme Salomon, Sébastien Beaune, Julie Grenet
BACKGROUND: Antimicrobial stewardship programs (ASPs) have proven to be effective in optimizing antibiotic use for inpatients. However, Emergency Department (ED)'s fast-paced clinical setting can be challenging for a successful ASP. AIM: In April 2015, an ASP was implemented in our ED and we aimed to determine its impact on antimicrobial use for outpatients. METHODS: Monocentric study comparing the quality of antibiotic prescriptions between a one-year period before ASP implementation (November 2012 to October 2013) and a one-year period after its implementation (June 2015 to May 2016)...
July 8, 2017: Journal of Hospital Infection
https://www.readbyqxmd.com/read/28697159/outpatient-parenteral-antimicrobial-therapy-and-judicious-use-of-pediatric-emergency-resources
#8
Michael Xu, Quynh Doan
BACKGROUND: Pediatric returns to the emergency department (RTED) vary between 3% and 13% of the total ED volume of visits. However, the incidence and contribution of scheduled RTED on pediatric emergency department (PED) utilization is less clear. Antimicrobial stewardship programs on inpatient wards have been shown to improve judicious use of outpatient parenteral antimicrobial therapy (OPAT) in upon discharge. The implementation of such programs in PEDs has yet to be reported. The objectives of this study are to quantify the burden of scheduled RTED for OPAT on PED utilization and to examine how frequently OPAT use are supported by published practice standards for 3 common pediatric infections-cellulitis, pneumonia, and urinary tract infections...
July 11, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28687210/antimicrobial-stewardship-approaches-in-the-intensive-care-unit
#9
REVIEW
Sarah B Doernberg, Henry F Chambers
Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The ICU, with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. The article reviews approaches to stewardship with application to the ICU, including the value of diagnostics, principles of empirical and definitive therapy, and measures of effectiveness. There is good evidence that antimicrobial stewardship results in more appropriate antimicrobial use, shorter therapy durations, and lower resistance rates...
July 5, 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28683699/impact-of-an-antimicrobial-stewardship-program-on-critical-haematological-patients
#10
Jesus Ruiz-Ramos, Juan Frasquet, Jose Luis Poveda-Andrés, Eva Romá, Miguel Salavert-Lleti, Álvaro Castellanos, Paula Ramirez
OBJECTIVE: Antimicrobial Stewardship Programs (ASPs) have appeared as very useful tools in order to improve the use of antimicrobial agents. The objective of this study is to assess the impact of an ASP on haematological patients hospitalized in an Intensive Care Unit (ICU). METHODS: A quasi-experimental pre-post intervention study, which included haematological patients admitted to an ICU and assessed by the ASP program during 3 years. The impact of the program on patient evolution was assessed by comparison between the previous period and the intervention period in terms of mortality, mean stay, number of re-hospitalizations, and duration of mechanical ventilation for intubated patients...
July 1, 2017: Farmacia Hospitalaria
https://www.readbyqxmd.com/read/28678309/fenticonazole-an-effective-topical-treatment-for-superficial-mycoses-as-the-first-step-of-antifungal-stewardship-program
#11
F Tumietto, L Giacomelli
The resistance of microorganisms to antimicrobial drugs is a major issue for public health, with important consequences in terms of morbidity, mortality and resource use. The phenomenon is so serious that in some areas of the world resistant strains to all available drugs have been selected. Many conditions may result in the development of resistance: they include the indiscriminate or inappropriate (e.g., for viral infection or colonization) use of antibiotics, the excessive duration of the prescribed treatment regimens, as well as inadequate dosing or administration routes...
June 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/28676346/bloodstream-infections-caused-by-acinetobacter-species-with-reduced-susceptibility-to-tigecycline-clinical-features-and-risk-factors
#12
Ga Eun Park, Cheol-In Kang, Min Kyeong Cha, Sun Young Cho, Hyeri Seok, Ji Hye Lee, Ji Yeon Kim, Young Eun Ha, Doo Ryeon Chung, Kyong Ran Peck, Nam Yong Lee, Jae-Hoon Song
INTRODUCTION: During recent decades, the rates of multidrug resistance, including resistance to carbapenems, have increased dramatically among Acinetobacter species. Tigecycline has activity against multidrug-resistant Acinetobacter spp, including carbapenem-resistant isolates. However, reports of tigecycline-resistant Acinetobacter spp are emerging from different parts of the world. The purpose of this study was to evaluate potential risk factors associated with tigecycline non-susceptible Acinetobacter bacteremia...
July 1, 2017: International Journal of Infectious Diseases: IJID
https://www.readbyqxmd.com/read/28674308/improved-clinical-outcomes-in-patients-with-positive-blood-culture-by-proactive-intervention-of-antimicrobial-use-impact-of-antimicrobial-stewardship-program-implementation-on-clinical-practice
#13
Takehiro Yamada, Keisuke Kagami, Shungo Imai, Koji Akizawa, Sumio Iwasaki, Tatsuya Fukumoto, Nobuhisa Ishiguro, Ken Iseki
 Bacteremia is one of the most serious infectious illness resulting from nosocomial infection. Therefore, appropriate antimicrobial chemotherapy should be provided as soon as possible to patients exhibiting symptoms of infectious disease and having positive blood culture results. Antimicrobial stewardship (AS) guidelines were recently released by the Infectious Diseases Society of America. The guidelines recommend "proactive intervention and feedback" as one of the core strategies for implementing optimal antimicrobial drug use to improve patient outcomes in clinical settings...
2017: Yakugaku Zasshi: Journal of the Pharmaceutical Society of Japan
https://www.readbyqxmd.com/read/28665084/an-audit-of-empiric-antibiotic-choice-in-the-inpatient-management-of-community-acquired-pneumonia
#14
F Delaney, A Jackson
Adherence to antimicrobial guidelines for empiric antibiotic prescribing in community-acquired pneumonia (CAP) has been reported to be worryingly low. We conducted a review of empiric antibiotic prescribing for sixty consecutive adult patients admitted to the Mercy University Hospital with a diagnosis of CAP. When analysed against local antimicrobial guidelines, guideline concordant empiric antibiotics were given in only 48% of cases, lower than the average rate in comparable studies. Concordance was 100% in cases where the CURB-65 pneumonia severity assessment score, on which the guidelines are based, was documented in the medical notes...
April 10, 2017: Irish Medical Journal
https://www.readbyqxmd.com/read/28655371/implementing-an-antimicrobial-stewardship-program
#15
Caren McHenry Martin
The Centers for Medicare & Medicaid Services is expected to expand requirements for antimicrobial stewardship in nursing facilities during 2016. Many facilities are looking to pharmacists to help them take the initial steps toward developing these coordinated programs to promote the appropriate use of antimicrobials.
May 1, 2017: Consultant Pharmacist: the Journal of the American Society of Consultant Pharmacists
https://www.readbyqxmd.com/read/28630187/cumulative-effect-of-an-antimicrobial-stewardship-and-rapid-diagnostic-testing-bundle-on-early-streamlining-of-antimicrobial-therapy-in-gram-negative-bloodstream-infections
#16
P B Bookstaver, E B Nimmich, T J Smith, J A Justo, J Kohn, K L Hammer, C Troficanto, H A Albrecht, M N Al-Hasan
OBJECTIVES: The use of rapid diagnostic tests (RDT) enhances antimicrobial stewardship programs (ASP) interventions in optimization of antimicrobial therapy. This quasi-experimental cohort study evaluates the combined impact of an ASP/RDT bundle on appropriateness of empirical antimicrobial therapy (EAT) and time to de-escalation of broad-spectrum agents (BSAA) in gram-negative bloodstream infections (GNBSI). METHODS: ASP/RDT bundle consisted of a system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, Matrix Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) and FilmArray® Blood Culture Identification (BCID) panel...
June 19, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28629754/improving-compliance-with-surgical-antibiotic-prophylaxis-guidelines-a-multicenter-evaluation
#17
Cristiane Schmitt, Rubia Aparecida Lacerda, Ruth Natalia Teresa Turrini, Maria Clara Padoveze
BACKGROUND: Improving surgical antibiotic prophylaxis (SAP) use is an important element in the control of antimicrobial resistance. However, compliance with SAP guidelines is unsatisfactory. This study investigated the level of compliance with SAP guidelines in neurosurgery, and institutional characteristics associated with compliance. METHODS: This study assessed surgeries in 9 Brazilian hospitals. Medical record reviews and a structured questionnaire were used to assess compliance and to describe institutional characteristics...
June 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28629753/active-identification-of-patients-who-are-methicillin-resistant-staphylococcus-aureus-colonized-is-not-associated-with-longer-duration-of-vancomycin-therapy
#18
Carlos Acuna-Villaorduna, Westyn Branch-Elliman, Judith Strymish, Kalpana Gupta
BACKGROUND: Excessive prescribing of vancomycin among patients admitted to inpatient wards is a challenge for antimicrobial stewardship programs, especially in the setting of expanded screening programs for methicillin-resistant Staphylococcus aureus (MRSA). Studies examining factors associated with longer duration of vancomycin use are limited. METHODS: We conducted a retrospective cohort study to assess the impact of universal MRSA admission screening on duration of vancomycin use at the VA Boston Healthcare System during the period from January 2013-November 2015...
June 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28626539/resistance-to-colistin-in-klebsiella-pneumoniae-a-4-0-strain
#19
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/28608289/-antibiotic-stewardship-a%C3%A2-programmatic-approach-to-improved-antimicrobial-management
#20
REVIEW
Martin Müller, Patrick Lehmann, Christian Willy
Due to the increasing selection and prevalence of multidrug-resistant gram-negative bacteria and the insufficient development of novel antibiotics, the responsible and prudent use of the available antimicrobial drugs is of major importance. In Germany the rational use of anti-infectives considering the local antimicrobial resistance situation is defined in the infection protection act of 2011. An important tool to follow legal regulations and to improve the treatment of bacterial infections is the antimicrobial stewardship (AMS) concept...
July 2017: Der Unfallchirurg
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