Stewardship antibióticos

  • Epidemiology and risk factors for healthcare-associated infections caused by Pseudomonas aeruginosa.

    Epidemiology and risk factors for healthcare-associated infections caused by Pseudomonas aeruginosa.

    J Chemother. 2020 Sep 30;:1-8

    Authors: Folic MM, Djordjevic Z, Folic N, Radojevic MZ, Jankovic SM

    Abstract
    Pseudomonas aeruginosa (PA) is a globally recognized cause of healthcare-associated infections (HAIs). The aim of our cross-sectional study, conducted in a Serbian tertiary care hospital, was to investigate clinical characteristics of HAIs caused by the PA, the prevalence of various drug-resistant phenotypes of this pathogen, and risk factors for their occurrence. Prolonged ICU stay and previous carbapenem administration were independent risk factors for HAIs caused by carbapenem-resistant PA, while HAIs caused by multidrug-resistant PA were more frequent in patients with prolonged stay in an ICU, who were previously hospitalized at another department and previously treated with aminoglycosides, fluoroquinolones or glycopeptides. The prolonged ICU stay was the only significant risk factor for HAIs caused by extensively drug-resistant PA. To decrease the incidence of HAIs caused by drug-resistant PA, a multifaceted approach is necessary, including staff education, antibiotic stewardship, improving hygiene, shortening hospitalization, and minimizing exposure to invasive medical procedures/devices.

    PMID: 32996875 [PubMed - as supplied by publisher]


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  • Seasonal Incidence of Respiratory Viral Infections in Telangana, India: Utility of a Multiplex PCR assay to Bridge the Knowledge Gap.

    Seasonal Incidence of Respiratory Viral Infections in Telangana, India: Utility of a Multiplex PCR assay to Bridge the Knowledge Gap.

    Trop Med Int Health. 2020 Sep 29;:

    Authors: Anand M, Pavani N

    Abstract
    OBJECTIVE: The diagnosis of acute viral respiratory tract infections(RTI) is a challenge due to overlapping clinical presentations and lack of availability of robust diagnostic methods. This in turn leads to lack of data regarding incidence and seasonality of viral RTIs which could potentially help to implement efficient strategies of antimicrobial stewardship as well as vaccine administration. Here we utilize a commercial Multiplex PCR assay for the early diagnosis of acute respiratory tract infections and discuss their epidemiology.
    METHODS: A prospective, observational study was conducted over a period of 3 years (2017-2019). Respiratory samples received from outpatients and inpatients with suspected acute RTIs from 3 multispeciality hospitals located in the twin cities of Hyderabad-Secunderabad were subjected to FilmArray Respiratory Panel (RP) (BioFire Diagnostics, Inc.). Results were tabulated and statistically analysed.
    RESULTS: Of 513 samples 261 (50.9%) were positive for one or more pathogens. The viruses detected included Influenza A - H1 2009(26.0%), Human Rhinovirus/Enterovirus(21.5%), Influenza A - H3N2 (17.0%), Human Metapneumovirus (9.4%), Influenza B (6.6%), Coronavirus (4.9%), Para-influenza virus (4.5%), Respiratory syncytial virus (3.1%) and Adenovirus (2.1%). The largest number of samples was positive during the monsoon season (43.8%). TInfluenza A - H1 2009 peaked in the monsoon season with another, smaller peak in February.
    CONCLUSIONS: There is a bimodal peak of respiratory infections relative to the seasons, and vaccine administration should take place in April-May before the advent of the monsoons in this part of the country. Multiplexed PCR may be used as first line for diagnosis of viral infections so that infection control measures can be prioritized and antibiotic administration can be avoided in those who do not require it.

    PMID: 32996228 [PubMed - as supplied by publisher]


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  • Rational antibiotic prescribing in primary care: qualitative study of opportunities and obstacles.

    Rational antibiotic prescribing in primary care: qualitative study of opportunities and obstacles.

    BJGP Open. 2020 Sep 29;:

    Authors: Sundvall PD, Skoglund I, Hess-Wargbaner M, Åhrén C

    Abstract
    BACKGROUND: The Swedish strategic programme against antibiotic resistance (Strama) has worked towards rational use of antibiotics, and Swedish antibiotic prescribing is low.
    AIM: To explore how opportunities and obstacles for rational antibiotic prescribing were perceived by primary health care centres (PHCCs).
    DESIGN & SETTING: A qualitative study of 50 randomly selected reports from approximately 200 PHCCs in 2013 and 2016 in Region Västra Götaland, Sweden.
    METHOD: One assigned GP at each PHCC reported yearly in an open-ended questionnaire on how the PHCC worked to improve antibiotic prescribing. The report included several antibiotic-related tasks and a summary of reflective meetings with the doctors, the head of the PHCC, and, preferably, also the nurses. The reports were qualitatively analysed using Malterud's systematic text condensation (STC).
    RESULTS: 'Everyone wants to do right, but sometimes you do not know what's right or wrong.' Knowledge about diagnosis and treatment of infectious diseases was highlighted. Knowledge and skills had to be internalised by the clinician in order to bring about behavioural change. This could be achieved through reflective, collegial dialogues where consensus often was found. Structural factors at the PHCC could provide good conditions for 'doing right', but could also constitute obstacles. Teamwork involving all personnel was important to achieve rational antibiotic prescribing.
    CONCLUSION: Enablers for rational antibiotic prescribing were knowledge, reflective collegial dialogues, a well organised workplace, and a collaborating team. Obstacles were lack of knowledge, insufficient staffing, perceived lack of time, and overuse of laboratory tests. Patients' attitudes and expectations could be both.

    PMID: 32994207 [PubMed - as supplied by publisher]


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  • Implementing Antibiotic Stewardship in a Network of Urgent Care Centers.

    Implementing Antibiotic Stewardship in a Network of Urgent Care Centers.

    Jt Comm J Qual Patient Saf. 2020 Sep 06;:

    Authors: Laude JD, Kramer HP, Lewis M, Winiarz M, Harrison CK, Zhang Z, Drees M

    Abstract
    BACKGROUND: Most antibiotics are prescribed in outpatient settings, including urgent care clinics (UCCs); however, few UCCs have described implementing antibiotic stewardship. This study describes interventions to reduce total antibiotic and azithromycin use in a UCC network.
    METHODS: The researchers conducted a prospective performance improvement project in five UCCs in Delaware, with > 40 providers and > 75,000 visits annually. In April 2017 all providers received in-person education on guideline-recommended management of common infections. The UCC lead physician performed chart audits and provided group and individual feedback. Individual antibiotic utilization rates were provided beginning in February 2018, and chart audits ceased in May 2018. Patient education included posters in waiting and exam rooms, discharge materials, and external website revisions. The researchers used control charts to analyze trends in prescribing over time, and calculated rate ratios (RRs) between pre-/early, mid- and postintervention periods.
    RESULTS: Compared to the pre-/early intervention study period (54.7 prescriptions per 100 visits), total antibiotic use declined to 40.2 (RR, 0.74; 95% confidence interval [CI] = 0.72-0.75) in the mid-intervention period and to 35.0 (RR, 0.42; 95% CI = 0.40-0.44) in the postintervention period. Azithromycin use declined from 8.5 prescriptions/100 visits to 3.5 (RR 0.64; 95% CI = 0.63-0.65) and 1.9 (RR 0.22; 95% CI = 0.21-0.24), respectively. The control charts indicated decreasing mean antibiotic prescribing rates as well as decreased variability.
    CONCLUSION: A multifaceted and iterative approach significantly reduced prescribing of all antibiotics, including azithromycin, regardless of diagnosis. Although the approach was initially resource-intensive, sending prescribing data directly to providers automated the process without an observed rebound in prescribing.

    PMID: 32994132 [PubMed - as supplied by publisher]


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  • Impact of preoperative chlorhexidine gluconate (CHG) application methods on preoperative CHG skin concentration.

    Impact of preoperative chlorhexidine gluconate (CHG) application methods on preoperative CHG skin concentration.

    Infect Control Hosp Epidemiol. 2020 Sep 30;:1-3

    Authors: Warren BG, Nelson A, Warren DK, Baker MA, Miller C, Habrock T, Bongu J, Gowda A, Johnson J, Anderson DJ, CDC Prevention Epicenters Program

    Abstract
    Elective surgical patients routinely bathe with chlorhexidine gluconate (CHG) at home days prior to their procedures. However, the impact of home CHG bathing on surgical site CHG concentration is unclear. We examined 3 different methods of applying CHG and hypothesized that different application methods would impact resulting CHG skin concentration.

    PMID: 32993846 [PubMed - as supplied by publisher]


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