Identifying targets for quality improvement in hospital antibiotic prescribing.

OBJECTIVES: To audit antibiotic use in a university hospital and to identify targets for quality improvement in a setting with low antibiotic use and resistance rates. METHODOLOGY: A point-prevalence survey (PPS), using a patient-based audit tool for antibiotic use, was executed in the Radboud University Medical Centre in May 2013. On one index day, all patients on systemic antibiotics hospitalised > 24 hours were included. Data regarding antibiotic prescriptions were extracted from the medical records. Multiple logistic regression analysis was performed in order to predict whether a variable was associated with low guideline compliance or a low rate of consulting an infectious disease specialist. RESULTS: 428 hospitalised patients were included, of whom 40.9% received antibiotics. Overall, 75.7% of all prescriptions were compliant with the guidelines in place and for 87.8% the reason for prescription was documented. Amoxicillin/clavulanic acid (OR = 4.08, 95% CI 1.57-10.56), and respiratory tract infections (RTI) (OR = 6.17, 95% CI 2.55-14.94) were associated with low compliance with guidelines. An infectious disease physician or medical microbiologist was less often consulted for empirical therapy (OR 23.21, 95% CI 6.37-84.51) or empirical therapy continued > 72 hours (OR 14.69, 95% CI 3.56-60.56) compared with prescriptions that were based on culture results. In addition, fewer consultations were requested for RTI (OR 4.47, 95% CI 1.39-14.35). CONCLUSION: A PPS is a good tool to identify targets for antibiotic stewardship in routine clinical practice. Several areas for improvement, such as a low compliance with guidelines for amoxicillin/clavulanic acid and RTI, and a low rate of consulting an infectious disease physician or medical microbiologist concerning antibiotic therapy in case of RTI and empirical therapy continued > 72 hours were identified.

Seroprevalence and risk factors for Toxoplasma gondii infection in domestic cats in The Netherlands.

Cats, as definitive hosts, play an important role in the transmission of Toxoplasma gondii. To determine the seroprevalence and risk factors for T. gondii infection in Dutch domestic cats, serum samples of 450 cats were tested for T. gondii antibodies by indirect ELISA. Binary mixture analysis was used to estimate the seroprevalence, the optimal cut-off value and the probability of being positive for each cat. The seroprevalence was estimated at 18.2% (95% CI: 16.6-20.0%) and showed a decrease with age in very young cats, an increase up to about 4 years old and ranged between 20 and 30% thereafter. Hunting (OR 4.1), presence of a dog in the household (OR 2.1), former stray cat (OR 3.3) and feeding of raw meat (OR 2.7) were identified as risk factors by multivariable logistic regression analysis. Prevalence differences were estimated by linear regression on the probabilities of being positive and used to calculate the population attributable fractions for each risk factor. Hunting contributed most to the T. gondii seroprevalence in the sampled population (35%).

Mycobacterium avium ssp. paratuberculosis recombinant heat shock protein 70 interaction with different bovine antigen-presenting cells.

Abstract Heat shock proteins (Hsp) can deliver antigen into the major histocompatibility complex class I presentation pathway of antigen-presenting cells (APC), a process called cross priming, thus stimulating antigen-specific CD8+ T-cell reactions. Hsp were shown to elicit proinflammatory responses in APC. Both processes require interaction of Hsp with APC via specific receptors. This study describes the interaction of recombinant Hsp70 (rHsp70) of Mycobacterium avium subspecies paratuberculosis with bovine peripheral blood mononuclear cells that was restricted to CD14+ cells. Characterized monocyte-derived macrophages, monocyte-derived dendritic cells (DC) and BoMac, an immortalized bovine macrophage cell line, were used to investigate the interaction of rHsp70 with different bovine APC. Saturation of immature DC with high concentrations of rHsp70 is demonstrated, and it was found that interaction of rHsp70 with DC was related to the maturation stage of the DC. Involvement of CD91 as a cellular receptor for rHsp70 was demonstrated; however, competition studies with immature DC demonstrated that other receptors exist on bovine APC. These data suggest that rHsp70-based vaccines may be useful for the successful immunization of cattle.