The long-term impact of an antimicrobial stewardship program in febrile neutropenia: an 8 years follow up.

PURPOSE: To describe the long-term effects of an ASP among febrile neutropenia (FN) patients. METHODS: A quasi-experimental study was conducted between 2015 and 2023 at a tertiary care hospital in Istanbul, Türkiye. The ASP was implemented for FN patients, and the effects were assessed before and after the ASP interventions, which included FN clinical pathways and regular multi-disciplinary meetings with relevant healthcare workers. RESULTS: A total of 489 FN episodes of 290 patients were included, 42% were female, and the mean age was 56 years (SD: 15, range: 18-89 years). After the intervention, the rate of appropriate antimicrobial therapy at the levels of starting (p = 0.005), switching (p < 0.001), and de-escalation/discontinuation, (p < 0.001) significantly increased. Another positive impact of the ASP was a significant reduction in candidemia (from 4.88 to 0.74, p = 0.004), as well as a significant reduction in the 90-day mortality rate (from 19 to 5%, p < 0.001). In multivariate analysis, having a gram-negative bloodstream infection, prolonged days with fever, and a high risk for neutropenia were found to be significant predictors of 90-day mortality, while follow-up with ASP significantly reduced mortality. CONCLUSION: Implementation of ASP led to reduced candidemia and LOS without increasing mortality, even in a country with a high rate of antimicrobial resistance. Implementation of sustainable ASP for FN patients is critical in combating antimicrobial resistance.

The COVID-19 Vaccine Hesitancy Among Healthcare Workers: An Exploration of Hesitancy Reasons and Suggestions to Improve Vaccination Rates.

Objective: Vaccine hesitancy among healthcare workers (HCWs) represents a significant challenge and threat in pandemics. This study aims to identify the predictive factors influencing COVID-19 vaccine hesitancy among HCWs and offer strategies to increase the COVID-19 vaccination rate in healthcare settings. Materials and Methods: This study constitutes the qualitative portion (second part) of a mixed-methods doctoral thesis employing an explanatory design. It was conducted in two distinct pandemic hospitals and involved 23 vaccine-hesitant HCWs. To conduct the interviews, the researchers developed a semi-structured interview form based on the Health Belief Model (HBM). Results: Upon analyzing the in-depth interviews, we identified six primary reasons for vaccine hesitancy and four different sub-reasons that reinforce vaccine hesitancy. We also collected four key suggestions from vaccine-hesitant HCWs that could potentially persuade them to receive the COVID-19 vaccine. Conclusion: This study's findings, which encompass the identification of reasons for COVID-19 vaccine hesitancy, clarification of underlying factors contributing to hesitancy towards the COVID-19 vaccines, and gathering suggestions from HCWs on how to persuade them to get vaccinated, hold significant value for guiding vaccination campaigns during potential future pandemics.

The Practice of Antimicrobial Stewardship in Thoracic Surgery and its Effectiveness.

This study examines the effects of the bundle of antimicrobial stewardship measures for prophylactic antibiotics among thoracic surgery patients. A local protocol, based on current guidelines starting from December 2014, was developed by the Infection Control and Thoracic Surgery Teams. The effects of this protocol were assessed by monitoring a total of 1380 patients before and after its implementation from January 1, 2011, to December 31, 2022.

Uptake of COVID-19 vaccines among healthcare workers and the effect of nudging interventions: A mixed methods study.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, vaccination of healthcare workers (HCWs) has a critical role because of their high-risk exposure and being a role model. Therefore, we aimed to investigate vaccine hesitancy and the role of mandatory polymerase chain reaction (PCR) testing and education for vaccine uptake. METHODS: We conducted an explanatory sequential designed observational mixed-methods study, including quantitative and qualitative sections consecutively in two different pandemic hospitals between 15 September 2021 and 1 April 2022. The characteristics of vaccinated and unvaccinated HCWs were compared. The vaccine hesitancy scales were applied, and the effect of nudging, such as mandatory PCR and education, were evaluated. In-depth interviews were performed to investigate the COVID-19 vaccine hesitancy among HCWs according to Health Belief Model. RESULTS: In total, 3940 HCWs were included. Vaccine hesitancy was more common among males than females, the ancillary workers than other health professions, and nonmedical departments than other departments. After the mandatory weekly PCR request nudge, 83.33 % (130/156) vaccine-hesitant HCWs were vaccinated, and 8.3 % (13/156) after the small group seminars and mandatory PCR every two days. The rate of COVID-19 vaccination was raised from 95.5 % to 99.67  % (3927/3940). At the end of in-depth interviews (n = 13), the vaccine hesitancy determinants were distrust, fear of uncertainty, immune confidence and spirituality, the media effect, social pressure, and obstinacy. CONCLUSIONS: The nudging interventions such as mandatory PCR testing and small group seminars helped raise the rate of COVID-19 vaccination; the most effective one is mandatory PCR.

The Effectiveness of Bundle Applications in the Prevention of Central Line-associated Bloodstream Infections: Nine Years of Observation.

Objective: This study aimed to assess the effectiveness of chlorhexidine-impregnated dressing in a bundle of interventions to reduce the rate of central line-associated bloodstream infections (CLABSIs). Materials and Methods: We performed a bundle of interventions to reduce the CLABSIs from 2012. As one bundle component, we started using the chlorhexidine impregnated catheter dressing. We used a document describing applying central venous catheters for the practicing physicians and nurses, and we organized several educational meetings. An interrupted time-series analysis was performed. Results: Seventy-six CLABSI events were detected in total between January 1, 2011, and December 31, 2019. Twenty-six cases were detected in the pre-intervention period (January 1, 2011, to December 31, 2011), and 50 patients were seen in the post-intervention term (January 1, 2012, to December 31, 2019). The annual CLABSI rate was 2.60/1000 catheter days in the pre-intervention period and 0.46/1000 catheter days (p=0.0328) in the post-intervention period. The CLABSI rate among hematology-oncology inpatients decreased from 3.39 to 0.71 (p=0.0101) in the same term. Conclusion: By using bundle form including chlorhexidine impregnated dressing, the rate of CLABSIs decreased significantly. This effect has been observed consistently for nine years, and the clinical pathway use has become the standard care protocol.

Elimination of healthcare-associated Acinetobacter baumannii infection in a highly endemic region.

This paper describes the elimination of healthcare-associated Acinetobacter baumannii infections in a highly endemic region. A prospective, observational study was performed between October 2012 and October 2017. Acinetobacter baumannii were isolated from 59 patients, and >95% similarity was demonstrated among isolates of seven patients (DiversiLab™, BioMérieux). Carbapenemase activity was detected in 15 of 17 (88%) isolates, and all were OXA-23 type. The control of Acinetobacter baumannii outbreaks can be achieved by close follow-up supported by molecular techniques, strict application of infection control measures, and isolation of transferred patients.

COVID-19 Severity among Healthcare Workers: Overweight Male Physicians at Risk.

We performed a prospective longitudinal cohort study in two healthcare settings. In total, 909 HCWs out of 3982 (23.35%) were diagnosed with COVID-19 before the vaccination era. Eighty-five per cent of COVID-19 positive HCWs (n = 774) were asymptomatic or mild, and 15% were moderate or severe. The mean age of the infected HCWs in the moderate or severe group was higher than the mild or asymptomatic group (35.4 vs. 31.3 years, p < 0.001). Thirty-two per cent of HCWs were male and the rate of male gender was more frequent in the moderate/severe group (p = 0.009). The rate of those who have cardiovascular diseases (p = 0.003) and diabetes mellitus (p = 0.044) were significantly higher among the HCWs with moderate or severe COVID-19. In multivariate analysis, male gender (OR:1.65, CI:1.11−2.46, p = 0.013), BMI > 30 (OR: 1.9, CI: 1.09−3.51, p = 0.024), and being physician (OR: 2.56, CI:1.45−4.52, p = 0.001) were found to be associated with moderate or severe COVID-19.

The seroprevalence of SARS-CoV-2 antibodies among health care workers before the era of vaccination: a systematic review and meta-analysis.

BACKGROUND: The prevalence of SARS-CoV-2 infection among health care workers (HCWs) provides information about the spread of COVID-19 within health care facilities, and the risk groups. OBJECTIVES: We aimed to describe the rate of SARS-CoV-2 seroprevalence and its determinants among HCWs. DATA SOURCES: We used Web of Science, PubMed, Scopus, MEDLINE, EBSCOhost and Cochrane Library. STUDY ELIGIBILITY CRITERIA: We included the reports of SARS-CoV-2 seroprevalence with a sample size of minimum 1000 HCWs. METHODS: The study was registered at the International Prospective Register of Systematic Reviews (PROSPERO, no. CRD42021230456). We used PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. The keywords were "COVID-19", "SARS-CoV-2", "Coronavirus", "seroprevalence", "health care workers" and "risk factors". RESULTS: In total 4329 reports were retrieved, duplications were removed; after filtering according to the title and abstract, 25 studies were selected. Risk of bias was assessed in 25 studies; it was low in 13 studies, medium in four studies, and high in eight studies. In meta-analysis using the random effect model, the weighted average of seroprevalence was calculated as 8% (95% CI 6-10%). The pooled seroprevalence rates of the selected variables that have a rate above the average were male HCWs with 9% (95% CI 7-11%); HCWs from ethnic minorities with 13% (95% CI 9-17%); high exposure 9% (95% CI 6-13%); exposure to the virus outside the health care setting 22% (95% CI 14-32%). CONCLUSIONS: Our analysis indicates a SARS-CoV-2 seroprevalence rate of 8% among studies that included >1000 HCWs for the year 2020, before vaccinations started. The most common risk factors associated with higher seroprevalence rate were ethnicity, male gender and having a higher number of household contacts. Working as a frontline HCW was inconsistent in its association with higher seroprevalence.

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department.

OBJECTIVE: We aimed to demonstrate the benefits of implementing a clinical pathway to decrease the inappropriate use of antibiotics in upper respiratory tract infections (URTI) in an emergency department (ED). METHODS: The study was performed in a hospital with 300 beds. All patients who applied with URTI from 1st to 30th of April 2017 were included and the appropriateness of the antibiotics were compared with the patients in the same period in 2016. A checklist for the clinical pathway of URTI was completed by the ED physicians. RESULTS: 351 patients were included, 176 these patients were in pre-ASP period and 175 patients were in post-ASP period. The rate of prescriptions including antibiotics was 49% in pre-ASP period and has decreased to 29% in post-ASP period (p < 0.001). Adherence to clinical pathway has increased from 50% to 80% (p < 0.001). In the post-ASP period, clinical pathway was used in 133 out of 175 patients (76%) and the consequently rate of appropriate antibiotic use was 82%. CONCLUSION: The implementation of clinical pathway for URTI has decreased inappropriate antibiotic use in ED. As the secondary effect, using clinical pathway in ED also has increased the awareness of ED physicians who did not adhere to clinical pathway.

Implementation of an antimicrobial stewardship program for patients with febrile neutropenia.

BACKGROUND: We aimed to describe the effectiveness of our standardized protocol for febrile neutropenia (FN), which was targeted to minimize unintended outcomes and reduce antimicrobial consumption. METHODS: The study was performed in a private hospital with 300 beds. We included all adult hematologic and oncologic cancer inpatients admitted between January 1, 2015-December 31, 2015, and January 1, 2016-May 31, 2017. The outcomes of the study were fatality, infections, and adherence to the antimicrobial stewardship program (ASP). RESULTS: We included 152 FN attacks of 95 adult inpatients from hematology and oncology wards; of these, 43% were women, and the median age was 57 years. The case fatality rate was 30% in the pre-ASP period and decreased to 11% in the post-ASP period (P = .024). The appropriate adding or changing (P = .006) and appropriate continuation or de-escalation or discontinuation of antimicrobials improved (P < .001). In the post-ASP period, Staphylococcus spp infections (from 22% to 8%, P = .02) and gram-negative infections decreased (from 43% to 20%, P = .003). In the multivariate analysis, appropriate continuation or de-escalation or discontinuation was increased in the post-ASP period (odds ratio [OR], 4.3; 95% confidence interval [CI], 1.82-10.41; P = .001), and gram-positive infections were decreased (OR, 0.32; 95% CI, 0.11-0.95, P = .041). Vancomycin and fluoroquinolone use decreased significantly. CONCLUSIONS: After implementation of the ASP, the case fatality rate among the patients with FN decreased. Appropriate antimicrobial use increased and overall antimicrobial consumption was reduced. Bacterial infections and Candida infections decreased.