RESUMEN
We characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Definitive prescribing of carbapenems decreased from 48.4% to 16.1% (P = .01) and ß-lactam-ß-lactamase inhibitor combination increased from 19.4% to 61.3% (P = .002). Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.
Asunto(s)
Antibacterianos/uso terapéutico , Carbapenémicos/uso terapéutico , Utilización de Medicamentos/estadística & datos numéricos , beta-Lactamas/clasificación , beta-Lactamas/uso terapéutico , Centros Médicos Académicos , Enterobacteriaceae , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Philadelphia , Estudios RetrospectivosRESUMEN
Objectives: Underfilling of blood culture bottles decreases the sensitivity of the culture. We attempt to increase average blood culture fill volumes (ABCFVs) through an educational program. Methods: Partnerships were established with four hospital units (surgical intensive care unit [SICU], medical intensive care unit [MICU], medical intermediate care unit [MIMCU], and hematology and oncology unit [HEME/ONC]). ABCFVs were continuously tracked and communicated to each unit monthly. Educational sessions were provided to each unit. Results: ABCFVs for the SICU, MICU, MIMCU, and HEME/ONC were 4.8, 5.0, 5.0, and 6.3 mL/bottle, respectively. After the final education session, the SICU, MICU, MIMCU, and HEME/ONC were able to maintain an ABCFV of 6.8, 8.1, 7.9, and 8.2 mL/bottle, respectively. Conclusions: Partnering with a specific unit and providing monthly volume reports with educational sessions has a direct positive correlation on increasing ABCFVs. Increasing ABCFVs has the potential to decrease false-negative blood cultures, time to detection of positive blood cultures, and time to appropriate and specific antimicrobial therapy, as well as improve patient outcomes in high-acuity patient care units.
Asunto(s)
Cultivo de Sangre/tendencias , Recolección de Muestras de Sangre/tendencias , Modelos Estadísticos , Programas Informáticos , Cultivo de Sangre/instrumentación , Cultivo de Sangre/normas , Recolección de Muestras de Sangre/instrumentación , Recolección de Muestras de Sangre/normas , Servicio de Educación en Hospital , Reacciones Falso Negativas , Personal de Salud , Unidades Hospitalarias , Humanos , Laboratorios de Hospital , Personal de Enfermería en Hospital , Atención al Paciente , Sensibilidad y EspecificidadRESUMEN
This study describes a clinical case of a 71-year-old male with a history of ischemic cardiomyopathy after left ventricular assist device (LVAD) endocarditis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) and a rare linezolid-resistant Streptococcus sanguinis strain (MIC, 32 µg/ml). The patient received courses of several antimicrobial agents, including linezolid for 79 days. The S. sanguinis strain had mutations in the 23S rRNA (T2211C, T2406C, G2576T, C2610T) and an amino acid substitution (N56D) in L22 and exhibited cross-resistance to ribosome-targeting agents.
Asunto(s)
Acetamidas/farmacología , Antibacterianos/farmacología , Farmacorresistencia Bacteriana , Endocarditis Bacteriana/microbiología , Oxazolidinonas/farmacología , Infecciones Estreptocócicas/microbiología , Streptococcus/efectos de los fármacos , Streptococcus/aislamiento & purificación , Acetamidas/uso terapéutico , Anciano , Antibacterianos/uso terapéutico , Coinfección/microbiología , Humanos , Linezolid , Masculino , Mutación Missense , Oxazolidinonas/uso terapéutico , Fenotipo , Mutación Puntual , ARN Ribosómico 23S/genética , Proteínas Ribosómicas/genética , Infecciones Estafilocócicas/microbiología , Staphylococcus epidermidis/efectos de los fármacos , Staphylococcus epidermidis/aislamiento & purificaciónRESUMEN
We describe a rare case of Francisella novicida bacteremia following a near-drowning event in seawater. We highlight the challenges associated with laboratory identification of F. novicida and differences in the epidemiology of F. novicida and Francisella tularensis infections.
Asunto(s)
Bacteriemia/diagnóstico , Bacteriemia/microbiología , Francisella/aislamiento & purificación , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Ahogamiento Inminente/complicaciones , Anciano , Bacteriemia/patología , Técnicas Bacteriológicas/métodos , Análisis por Conglomerados , ADN Bacteriano/química , ADN Bacteriano/genética , ADN Ribosómico/química , ADN Ribosómico/genética , Francisella/clasificación , Francisella/genética , Francisella tularensis/genética , Infecciones por Bacterias Gramnegativas/patología , Humanos , Masculino , Datos de Secuencia Molecular , Filogenia , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADNRESUMEN
OBJECTIVE: To describe the first case of left vagus nerve stimulation (VNS) following FDA approval and to review this in the context of existing literature. METHODS: A case report of the first patient undergoing VNS post-FDA approval is described. Indications, challenges, post-operative outcomes, and long-term implications are discussed. RESULTS: The patient treated had suicidal ideation, extensive alcoholism related to depression, and severely blunted affect with other major depressive symptoms. He failed multiple antidepressant medications, and over 50 electroconvulsive therapy treatments. Following stimulator implantation and subsequent stimulation, he had significant improvement over two weeks with respect to integration into his family, work, and abstinence from alcohol. In the context of these findings, existing literature on the use of VNS for treatment-resistant depression is reviewed. CONCLUSION: In selected cases, VNS has a significant role in treatment-resistant depression; the data suggest improvement in one-third of patients. Thus, they should be cautioned about side effects and should have a realistic level of expectation.