Stewardship antibióticos

Surgical antibiotic prophylaxis: is the clinical practice based on evidence?

Einstein (Sao Paulo). 2020;18:eAO5427

Authors: Pereira LB, Feliciano CS, Siqueira DS, Bellissimo-Rodrigues F, Pereira LRL

Abstract
OBJECTIVE: To assess the surgical antibiotic prophylaxis.
METHODS: This was a descriptive study performed at a public tertiary care university hospital gathering prescription, sociodemographic and hospitalization data of inpatients admitted in 2014 who used antimicrobial drugs. This data were obtained from the hospital electronic database. The antimicrobial data were classified according to the anatomical, therapeutic chemical/defined daily dose per 1,000 inpatients. An exploratory analysis was performed using principal component analysis.
RESULTS: A total of 5,182 inpatients were prescribed surgical antibiotic prophylaxis. Of the total antimicrobial use, 11.7% were for surgical antibiotic prophylaxis. The orthopedic, thoracic and cardiovascular postoperative units, and postoperative intensive care unit comprised more than half of the total surgical antibiotic prophylaxis use (56.3%). The duration of antimicrobial use of these units were 2.2, 2.0, and 1.4 days, respectively. Third-generation cephalosporins and fluoroquinolones had the longest use among antimicrobial classes.
CONCLUSION: Surgical antibiotic prophylaxis was inadequate in the orthopedic, postoperative intensive care, thoracic and cardiovascular postoperative, gynecology and obstetrics, and otolaryngology units. Therefore, the development and implementation of additional strategies to promote surgical antibiotic stewardship at hospitals are essential.

PMID: 33237245 [PubMed - as supplied by publisher]

Nanotools for Sepsis Diagnosis and Treatment.

Adv Healthc Mater. 2020 Nov 25;:e2001378

Authors: Papafilippou L, Claxton A, Dark P, Kostarelos K, Hadjidemetriou M

Abstract
Sepsis is one of the leading causes of death worldwide with high mortality rates and a pathological complexity hindering early and accurate diagnosis. Today, laboratory culture tests are the epitome of pathogen recognition in sepsis. However, their consistency remains an issue of controversy with false negative results often observed. Clinically used blood markers, C reactive protein (CRP) and procalcitonin (PCT) are indicators of an acute-phase response and thus lack specificity, offering limited diagnostic efficacy. In addition to poor diagnosis, inefficient drug delivery and the increasing prevalence of antibiotic-resistant microorganisms constitute significant barriers in antibiotic stewardship and impede effective therapy. These challenges have prompted the exploration for alternative strategies that pursue accurate diagnosis and effective treatment. Nanomaterials are examined for both diagnostic and therapeutic purposes in sepsis. The nanoparticle (NP)-enabled capture of sepsis causative agents and/or sepsis biomarkers in biofluids can revolutionize sepsis diagnosis. From the therapeutic point of view, currently existing nanoscale drug delivery systems have proven to be excellent allies in targeted therapy, while many other nanotherapeutic applications are envisioned. Herein, the most relevant applications of nanomedicine for the diagnosis, prognosis, and treatment of sepsis is reviewed, providing a critical assessment of their potentiality for clinical translation.

PMID: 33236524 [PubMed - as supplied by publisher]

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Antimicrobial de-escalation is part of appropriate antibiotic usage in ICU.

Intensive Care Med. 2020 05;46(5):1039-1042

Authors: Timsit JF, Lipman J, Bassetti M

PMID: 32077998 [PubMed - indexed for MEDLINE]