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Antimicrobial stewardship program

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https://www.readbyqxmd.com/read/28792800/national-antimicrobial-resistance-monitoring-system-two-decades-of-advancing-public-health-through-integrated-surveillance-of-antimicrobial-resistance
#1
Beth E Karp, Heather Tate, Jodie R Plumblee, Uday Dessai, Jean M Whichard, Eileen L Thacker, Kis Robertson Hale, Wanda Wilson, Cindy R Friedman, Patricia M Griffin, Patrick F McDermott
Drug-resistant bacterial infections pose a serious and growing public health threat globally. In this review, we describe the role of the National Antimicrobial Resistance Monitoring System (NARMS) in providing data that help address the resistance problem and show how such a program can have broad positive impacts on public health. NARMS was formed two decades ago to help assess the consequences to human health arising from the use of antimicrobial drugs in food animal production in the United States. A collaboration among the Centers for Disease Control and Prevention, the U...
August 9, 2017: Foodborne Pathogens and Disease
https://www.readbyqxmd.com/read/28758610/reducing-second-gram-negative-antibiotic-therapy-on-pediatric-oncology-and-hematopoietic-stem-cell-transplantation-services
#2
Rachel L Wattier, Emily R Levy, Amit J Sabnis, Christopher C Dvorak, Andrew D Auerbach
OBJECTIVE To evaluate interventions to reduce avoidable antibiotic use on pediatric oncology and hematopoietic stem cell transplantation (HSCT) services. DESIGN Interrupted time series. SETTING Academic pediatric hospital with separate oncology and HSCT services. PARTICIPANTS Children admitted to the services during baseline (October 2011-August 2013) and 2 intervention periods, September 2013-June 2015 and July 2015-June 2016, including 1,525 oncology hospitalizations and 301 HSCT hospitalizations. INTERVENTION In phase 1, we completed an update of the institutional febrile neutropenia (FN) guideline for the pediatric oncology service, recommending first-line β-lactam monotherapy rather than routine use of 2 gram-negative agents...
July 31, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28757087/associations-between-antimicrobial-stewardship-program-elements-and-clostridium-difficile-infection-performance
#3
Giulia Barlow, Julie Patterson, Jeremy Stultz, Amy L Pakyz
Hospitals are categorized as better, no different, or worse at a national level based on their Clostridium difficile infection performance. Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown. We found that a higher proportion of hospitals with either a worse or no different rank used a postprescription audit and feedback strategy than hospitals with a better rank...
July 27, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28749885/good-nursing-is-good-antibiotic-stewardship
#4
Rita D Olans, Richard N Olans, David J Witt
: Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The most promising approach to this national crisis is a new understanding of the need for the careful and responsible use of antibiotics, both for the benefit of society and for the optimal care of each patient. This multidisciplinary approach, called antimicrobial stewardship, has typically involved specialists but not necessarily nurses, who perform numerous antibiotic-related activities daily and should be an integral part of antimicrobial stewardship programs...
August 2017: American Journal of Nursing
https://www.readbyqxmd.com/read/28748196/developing-interactive-antimicrobial-stewardship-and-infection-prevention-curricula-for-diverse-learners-a-tailored-approach
#5
Priya Nori, Theresa Madaline, Iona Munjal, Shubha Bhar, Yi Guo, Susan K Seo, Andrea Porrovecchio, Elizabeth Gancher, Joshua Nosanchuk, Liise-Anne Pirofski, Belinda Ostrowsky
BACKGROUND: To impart principles of antimicrobial stewardship (AS) and infection prevention and control (IPC), we developed a curriculum tailored to the diverse aptitudes of learners at our medical center. METHODS: We integrated case-based modules, group learning activities, smartphone applications (apps), decision support tools, and prescription audit and feedback into curricula of the medical school, medicine residency program, infectious diseases (ID) fellowship program, and hospital medicine program operations...
2017: Open Forum Infectious Diseases
https://www.readbyqxmd.com/read/28745260/implementation-of-an-antimicrobial-stewardship-program-in-a-neonatal-intensive-care-unit
#6
Nneka I Nzegwu, Michelle R Rychalsky, Loren A Nallu, Xuemei Song, Yanhong Deng, Amber M Natusch, Robert S Baltimore, George R Paci, Matthew J Bizzarro
OBJECTIVE To evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP). DESIGN Quasi-experimental, interrupted time-series study. SETTING A 54-bed, level IV NICU in a regional academic and tertiary referral center. PATIENTS AND PARTICIPANTS All neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion. INTERVENTION Implementation of a NICU-specific ASP beginning July 2012...
July 26, 2017: Infection Control and Hospital Epidemiology
https://www.readbyqxmd.com/read/28742143/impact-of-rapid-identification-of-positive-blood-cultures-using-the-verigene-system-on-antibiotic-prescriptions-a-prospective-study-of-community-onset-bacteremia-in-a-tertiary-hospital-in-japan
#7
Kayoko Hayakawa, Kazuhisa Mezaki, Masao Kobayakawa, Kei Yamamoto, Yoshikazu Mutoh, Motoyuki Tsuboi, Takehiro Hasimoto, Maki Nagamatsu, Satoshi Kutsuna, Nozomi Takeshita, Yuichi Katanami, Masahiro Ishikane, Norio Ohmagari
BACKGROUND: Rapid identification of positive blood cultures is important for initiation of optimal treatment in septic patients. Effects of automated, microarray-based rapid identification systems on antibiotic prescription against community-onset bacteremia (COB) remain unclear. METHODS: We prospectively enrolled 177 patients with 185 COB episodes (occurring within 72 h of admission) over 17 months. Bacteremia episodes due to gram-positive bacteria (GP) and gram-negative bacteria (GN) in the same patient were counted separately...
2017: PloS One
https://www.readbyqxmd.com/read/28739223/decreased-mortality-in-patients-prescribed-vancomycin-after-implementation-of-antimicrobial-stewardship-program
#8
Erin L Conway, John A Sellick, Amy Horey, Kristen Fodero, Michael C Ott, Michael P Krajewski, Kari A Mergenhagen
BACKGROUND: The impact of an antimicrobial stewardship program (ASP) on 30-day mortality rates was evaluated in patients prescribed vancomycin in a Veterans Affairs hospital. METHODS: A retrospective chart review of patients receiving a minimum of 48 hours of vancomycin during October 2006-July 2014. A multivariate logistic regression analysis was used to determine predictors of mortality. Interventions of the ASP consist of appropriate antibiotic selection, dosing, microbiology, and treatment duration...
July 21, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28732743/antimicrobial-stewardship-in-the-treatment-of-skin-and-soft-tissue-infections
#9
Julie A Gibbons, Hayden L Smith, Sudhir C Kumar, Katherine Johnson Duggins, Amanda M Bushman, Jayme M Danielson, William J Yost, Jonathan J Wadle
BACKGROUND: Research on treating skin and soft tissue infections (SSTI) has shown improved patient outcomes with effective pharmaceutic prescribing. Antimicrobial stewardship programs can reduce consequences of broad-spectrum antimicrobial administration in SSTI treatment. METHODS: Prospective and historic control data were collected during two 7-month periods. Intervention consisted of implementing a new SSTI evidence-based treatment algorithm and provider education, including calls and medical record notes targeted at physicians...
July 18, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28717037/impact-of-a-carbapenem-antimicrobial-stewardship-program-on-patient-outcomes
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
REVIEW
Sarah B Doernberg, Henry F Chambers
Antimicrobial stewardship programs aim to monitor, improve, and measure responsible antibiotic use. The intensive care unit (ICU), with its critically ill patients and prevalence of multiple drug-resistant pathogens, presents unique challenges. This 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...
September 2017: Infectious Disease Clinics of North America
https://www.readbyqxmd.com/read/28683699/impact-of-an-antimicrobial-stewardship-program-on-critical-haematological-patients
#19
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
#20
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
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