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Antimicrobial stewardship regional

Cliodna McNulty, Meredith Hawking, Donna Lecky, Leah Jones, Rebecca Owens, André Charlett, Chris Butler, Philippa Moore, Nick Francis
Objectives: To determine whether local trainer-led TARGET antibiotic interactive workshops improve antibiotic dispensing in general practice. Methods: Using a McNulty-Zelen-design randomized controlled trial within three regions of England, 152 general practices were stratified by clinical commissioning group, antibiotic dispensing rate and practice patient list size, then randomly allocated to intervention (offered TARGET workshop that incorporated a presentation, reflection on antibiotic data, promotion of patient and general practice (GP) staff resources, clinical scenarios and action planning, 73 practices) or control (usual practice, 79 practices)...
March 5, 2018: Journal of Antimicrobial Chemotherapy
Silvia Forni, Giulio Toccafondi, Bruno Viaggi, Maddalena Grazzini, Sara D'Arienzo, Fabrizio Gemmi, Andrea Vannucci, Giorgio Tulli
Antimicrobial resistance is a global threat caused by the rapid spread of multiresistant microorganisms. Antimicrobial stewardship (AS) is a coordinated intervention designed to improve the appropriate use of antimicrobials by promoting the selection of the optimal drug regimen, dose, duration of therapy and route of administration. AS programs have proved effective in reducing antimicrobial resistance, inappropriate antimicrobial use and in improving patient outcomes. Recently developed rapid diagnostic technologies in microbiology (RDTM) allows a faster and etiological diagnosis of infection and a reduction in the use of unnecessary empirical therapies...
February 2018: Recenti Progressi in Medicina
Alexandra S Simões, Daniela A Alves, João Gregório, Isabel Couto, Sónia Dias, Pedro Póvoa, Miguel Viveiros, Luzia Gonçalves, Luís V Lapão
OBJECTIVE: Since physicians play an important role on antibiotic usage, it is vital to understand their antibiotic-prescribing behaviour and knowledge on antimicrobial resistance, in order to develop and implement effective antibiotic stewardship interventions. The aim of this study was to evaluate Portuguese physicians' knowledge, and understand prescription behaviours, difficulties and barriers in their antibiotic prescription process to promote better and well adapted antibiotic stewardship policies...
January 30, 2018: Journal of Global Antimicrobial Resistance
Susan Rogers Van Katwyk, Sara L Jones, Steven J Hoffman
BACKGROUND: Antimicrobial resistance is an important global issue facing society. Healthcare workers need to be engaged in solving this problem, as advocates for rational antimicrobial use, stewards of sustainable effectiveness, and educators of their patients. To fulfill this role, healthcare workers need access to training and educational resources on antimicrobial resistance. METHODS: To better understand the resources available to healthcare workers, we undertook a global environmental scan of educational programs and resources targeting healthcare workers on the topic of antimicrobial resistance and antimicrobial stewardship...
February 5, 2018: Human Resources for Health
Haishaerjiang Wushouer, Ye Tian, Xiao-Dong Guan, Sheng Han, Lu-Wen Shi
The consumption of antibiotics is a major driver in the development of antimicrobial resistance. This study aims to identify the trends and patterns of the total antibiotic consumption in China's tertiary hospitals from 2011 to 2015 by retrospectively analyzing aggregated monthly surveillance data on antibiotic sales made to 468 hospitals from 28 provinces. Antibiotic consumption was expressed in DDD per 1,000 inhabitants per day (DID). We compared population weighted antibiotic consumption patterns in China with European countries using indicators from the European Surveillance of Antimicrobial Consumption (ESAC)...
2017: PloS One
Carlos Andrés Vargas-Alzate, Luis Felipe Higuita-Gutiérrez, Lucelly López López, Astrid Vanessa Cienfuegos Gallet, Judy Natalia Jiménez Quiceno
BACKGROUND: The financial burden of antibiotic resistance is a serious concern worldwide. The aim of this study is to describe the excess costs associated with pneumonia, bacteremia, surgical site infections and intra-abdominal infections caused by carbapenem-resistant gram-negative bacilli in Medellín, Colombia, an endemic region for carbapenem resistance. METHODS: A cohort study was conducted in a third level hospital from 2014 to 2015. All patients with carbapenem-resistant and carbapenem-susceptible gram-negative bacteria infections were included...
December 22, 2017: International Journal of Antimicrobial Agents
U V Ukah, M Glass, B Avery, D Daignault, M R Mulvey, R J Reid-Smith, E J Parmley, A Portt, P Boerlin, A R Manges
We examined risk factors associated with the intestinal acquisition of antimicrobial-resistant extraintestinal pathogenic Escherichia coli (ExPEC) and development of community-acquired urinary tract infection (UTI) in a case-control study of young women across Canada. A total of 399 women were recruited; 164 women had a UTI caused by E. coli resistant to ⩾1 antimicrobial classes and 98 had a UTI caused by E. coli resistant to ⩾3 antimicrobial classes. After adjustment for age, student health service (region of Canada) and either prior antibiotic use or UTI history, consumption of processed or ground chicken, cooked or raw shellfish, street foods and any organic fruit; as well as, contact with chickens, dogs and pet treats; and travel to Asia, were associated with an increased risk of UTI caused by antimicrobial resistant E...
January 2018: Epidemiology and Infection
Lenneke Schrier, Adamos Hadjipanayis, Stefano Del Torso, Tom Stiris, Marieke Emonts, Hans Juergen Dornbusch
Antimicrobial stewardship (AMS) aims to optimise treatment, minimise the risk of adverse effects and reduce health care costs. In addition, it is recognised as a key component to stop the current spread of antimicrobial resistance in Europe. Educational programmes are particularly important for the successful implementation of AMS. Training should start during medical school, continue during clinical training and be reinforced throughout postgraduate training. National core curricula for paediatric training should include passive and active training of competencies needed for AMS and future paediatricians should be skilled in taking leadership roles in AMS initiatives...
February 2018: European Journal of Pediatrics
Ana R Freitas, Carla Novais, Bárbara Duarte, Ana P Pereira, Teresa M Coque, Luísa Peixe
This study evaluated the occurrence of enterococci resistant to clinically relevant antibiotics in long-term care facility (LTCF) residents in Porto, Portugal, a region with high rates of multidrug-resistant enterococci in infected patients and healthy carriers. Faecal samples from 48 residents in two LTCFs (2015-2016) were enriched (with/without antibiotics) and plated on Slanetz-Bartley with/without the same antibiotics (ampicillin/vancomycin/linezolid). Two colonies per morphology/sample were selected for susceptibility testing and species identification...
November 23, 2017: International Journal of Antimicrobial Agents
Ursula Theuretzbacher
Resistance in Gram-negative bacteria has become a serious problem in many regions of the world as it may reduce the treatment options substantially. Carbapenem-resistance is a good marker for such situations and is most prevalent in Acinetobacter, Pseudomonas but also increasingly in Enterobacteriaceae, especially Klebsiella. This review gives a rough global picture highlighting the epicentres of resistance. The medical need for novel treatment options globally is undeniable even if many countries with good stewardship and infection control conditions are not highly affected...
October 2017: Current Opinion in Microbiology
Peter Lokamar Nyanga, Jackson Onyuka, Mark Kilongosi Webale, Tom Were, Valentine Budambula
Aim: In the present study, we investigated the prevalence of E. coli pathotypes and Shigella sero-groups and their antimicrobial profiles among diarrheic children in Nairobi city, Kenya. Background: Although diarrheagenic E. coli pathotypes and Shigella sero-groups are leading causes of diarrhea in children under five years in developing countries, their distribution and antimicrobial resistance vary from place to place and over time in a given region. Methods: In a cross-sectional study, we enrolled diarrheic children (n=354) under five years seeking treatment at Mbagathi Hospital, Nairobi city, Kenya,...
2017: Gastroenterology and Hepatology From Bed to Bench
Philip Howard, Benedikt Huttner, Bojana Beovic, Guillaume Beraud, Diamantis P Kofteridis, José Pano Pardo, Jeroen Schouten, Céline Pulcini
Background: A variety of indicators is commonly used to monitor antibiotic prescriptions as part of national antimicrobial stewardship (AMS) programmes. Objectives: To make an inventory of indicators that assess antibiotic prescriptions and are linked to specific targets and incentives, at a national level. Methods: A cross-sectional survey (three-item questionnaire) was conducted in 2017 among all ESGAP (ESCMID Study Group for Antimicrobial stewardshiP) members, coming from 23 European countries and 16 non-European countries...
October 1, 2017: Journal of Antimicrobial Chemotherapy
Ruchir Chavada, Harry N Walker, Deborah Tong, Amy Murray
The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS...
October 2, 2017: Infectious Disease Reports
Haishaerjiang Wushouer, Zhao-Xia Zhang, Jian-Hua Wang, Ping Ji, Qing-Fang Zhu, Renagu Aishan, Lu-Wen Shi
PURPOSES: The objective of the study was to identify the trends and relations between antimicrobial resistance (AMR) and antibiotic use in the Xinjiang Uyghur Autonomous Region in Western China from 2014 to 2016. METHODS: A retrospective, descriptive analysis of AMR prevalence, and trends and relations between AMR and antibiotic use during the 3-year period was performed. RESULTS: Third-generation cephalosporin-resistant Escherichia coli was the most prevalent resistant pathogen in terms of both resistance density and resistance proportion...
October 7, 2017: Journal of Infection and Public Health
Anthony J Guarascio, Laura M Brickett, Timothy J Porter, Nancy D Lee, Erin E Gorse, Jordan R Covvey
BACKGROUND: Hospitals and other facilities utilize antibiograms as tools for optimal antibiotic selection. Currently, no measures compare broad trends on the regional level, despite interest for more comprehensive data, particularly for antibiotic-resistant ESKAPE organisms. OBJECTIVE: To collect and compare regional health-care facility antibiogram data for ESKAPE organisms to form a cumulative antibiogram. METHODS: Health-care facilities were identified using the publicly accessible Pennsylvania Department of Health web site...
January 1, 2017: Journal of Pharmacy Practice
Ziad Nasr, Bridget Paravattil, Kyle J Wilby
Antimicrobial resistance is a global health problem and antimicrobial stewardship is an essential component of hospital policies worldwide yet little is known regarding effective implementation strategies in the Middle East. We conducted a review of studies carried out in this region that deployed different antimicrobial stewardship strategies to assess antimicrobial appropriateness and prescribing behaviours. A search of MEDLINE, EMBASE, International Pharmaceutical Abstracts, Google and Google Scholar was conducted...
August 20, 2017: Eastern Mediterranean Health Journal, la Revue de Santé de la Méditerranée Orientale
E Duffy, S Ritchie, S Metcalfe, B Van Bakel, M G Thomas
WHAT IS KNOWN AND OBJECTIVE: Interventions intended to slow the emergence and spread of antibacterial resistance through enhanced antimicrobial stewardship will be more effective if informed by an accurate knowledge of current patterns of antibacterial consumption. For example, knowledge of the relative magnitude of community antibacterial consumption in relation to hospital antibacterial consumption within each nation or region should help guide decisions about the relative importance of community and hospital antimicrobial stewardship programmes...
August 18, 2017: Journal of Clinical Pharmacy and Therapeutics
Patrick N A Harris, M Diletta Pezzani, Belén Gutiérrez-Gutiérrez, Pierluigi Viale, Po-Ren Hsueh, Patricia Ruiz-Garbajosa, Mario Venditti, Mario Tumbarello, Carolina Navarro-Francisco, Esther Calbo, Murat Akova, Helen Giamarellou, Antonio Oliver, Benito Almirante, Oriol Gasch, Luis Martínez-Martínez, Mitchell J Schwaber, George Daikos, Johann Pitout, Carmen Peña, Alicia Hernández-Torres, Yohei Doi, Federico Pérez, Felipe Francisco Tuon, Evelina Tacconelli, Yehuda Carmeli, Robert A Bonomo, Álvaro Pascual, David L Paterson, Jesús Rodríguez-Baño
We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE...
November 2017: International Journal of Antimicrobial Agents
Stefanie Jane Oliver, James Cush, Jeanette E Ward
BACKGROUND: To support antibiotic prescribing for both hospital and community-based health professionals working in remote North Western Australia, a multidisciplinary Antimicrobial Stewardship (AMS) Committee was established in 2013. This Committee is usually focused on hospital-based prescribing. A troubling increase in sulfamethoxazole/trimethoprim resistance in Staphylococcus aureus antibiograms from 9 to 18% over 1 year prompted a shift in gaze to community prescribing. WHAT WE DID: Finding a paucity of relevant research, we first investigated contextual factors influencing local prescribing...
2017: Frontiers in Public Health
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...
October 2017: Infection Control and Hospital Epidemiology
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