Stewardship actions for device associated infections: An intervention study in the emergency intensive care unit.

Improving the practices of antimicrobial use in hospitals, especially in developing countries, is a challenging duty. OBJECTIVES: The aim of the study was to determine the effect of certain stewardship actions on the use of antibiotics for device-associated infections in the emergency intensive care unit in Egypt. MEHODS: The intervention included establishment of AS team, design an antibiogram and preparation of antibiotic use guidelines, education, and infection prevention and control measures. Pre- and postinterventions surveys tookplace including: antibiotic prescription compliance, antibiotic cost, bacterial profile and antibiotic resistance rates. RESULTS: Antibiotic prescription compliance improved, especially for prophylactic antibiotics prescription; in preintervention phase, 27.4% of cases received unindicated antibiotic prophylaxis vs 5.8% after intervention. A statistically significant decrease in cost after the intervention was reported (p = 0.04). Acinetobacter baumannii and Klebsiella pneumonia were the most frequently isolated pathogens (25.6%) and (21.8%) in pre and post-intervention phases respectively. A statistically significant decrease in the prevalence of MDR (X² = 11.9, p = 0.009) was observed. The most prevalent XDR is K-pneumonia (45% vs 17%) in phase 1&3. No pan drug-resistant isolates were detected. CONCLUSION: Sound antibiotic guidelines coupled with effective infection control precautions and education would be a good intervention, particularly with a leadership commitment. The use of microbiology tests to direct prescribing decisions should be a underscored. Sustained research initiatives may support the proper implementation of AS programmes in limited resource settings.

Role of Candida Albicans Germ Tube Antibody in Diagnosis of Invasive Candidiasis in End Stage Liver Disease Patients.

Candida species are the leading cause of invasive fungal infections and a common cause of hospital-acquired bloodstream infections. Invasive candidiasisis a highly lethal infection associated with mortality rates between 40 and 60 %. This study was conducted with aim of assessing the role of Candida albicans germ tube antibody (CAGTA) level in the early diagnosis of invasive candidiasis and in monitoring the efficacy of antifungal drugs in patients with end stage liver disease. Sixty two end stage liver disease patients were included in this study. Candida albicans germ tube antibody (CAGTA) test was done for all cases by indirect immunofluorescence technique, and it was positive with (titre ≥ 1/160) in 18 cases including the 10 blood culture positive cases. Compared to positive blood culture, the sensitivity, specificity, negative predictive value, positive predictive value and accuracy of CAGTA test were 100%, 84.6 %, 55.6 %, 100 % and 73.3 % respectively. Candida albicans germ tube antibody (CAGTA) test is sensitive and specific test, that can be used for early diagnosis of invasive candidiasis and in monitoring the effect of treatment with antifungal drugs in end stage liver disease patients.