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1.
Wien Med Wochenschr ; 171(Suppl 1): 4-8, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33560499

RESUMEN

It is more than two decades ago that a European Union conference on "The Microbial Threat" hosted by the Danish Government in Copenhagen in September 1998 issued recommendations to encourage good practice in the use of antimicrobial agents and reduce inappropriate prescribing. Essential components of those recommendations were antimicrobial teams in hospitals and the use of feedback to prescribers as well as educational activities. Two decades later, important surveillance systems on both antimicrobial resistance as well as on antibiotic consumption are functioning at the European level and in most European countries; European Committee on Antimicrobial Susceptibility Testing (EUCAST) has thoroughly re-evaluated, standardized and harmonized antibiotic susceptibility testing and breakpoints; there have been educational activities in many countries; and stewardship teams are now included in many guidelines and policy papers and recommendations. Yet, antimicrobial resistance problems in Europe have shifted from methicillin-resistant Staphylococus aureus (MRSA) to vancomycin-resistent Enterococcus faecium (VRE) and to multidrug-resistant gramnegative bacteria, while antibiotic consumption volumes, trends and patterns across countries do not show major and highly significant improvements. The way to go further is to recognize that better prescribing comes at a cost and requires investment in expert personnel, practice guideline drafting, and implementation aids, and, secondly, the setting of clear goals and quantitative targets for prescribing quality.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Enterococos Resistentes a la Vancomicina , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Europa (Continente) , Humanos
2.
Antimicrob Resist Infect Control ; 10(1): 28, 2021 02 03.
Artículo en Inglés | MEDLINE | ID: mdl-33536077

RESUMEN

BACKGROUND: The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. METHODS: One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017-2019. RESULTS: The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). CONCLUSION: During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.


Asunto(s)
Antibacterianos/uso terapéutico , Prescripciones de Medicamentos , Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Singapur/epidemiología , Centros de Atención Terciaria
5.
Antimicrob Resist Infect Control ; 10(1): 21, 2021 01 29.
Artículo en Inglés | MEDLINE | ID: mdl-33514424

RESUMEN

BACKGROUND: Antimicrobial resistance (AMR) is a growing global problem to which the ongoing COVID-19 pandemic may further contribute. With resources deployed away from antimicrobial stewardship, evidence of substantial pre-emptive antibiotic use in COVID-19 patients and indirectly, with deteriorating economic conditions fuelling poverty potentially impacting on levels of resistance, AMR threat remains significant. MAIN BODY: In this paper, main AMR countermeasures are revisited and priorities to tackle the issue are re-iterated. The need for collaboration is stressed, acknowledging the relationship between human health, animal health and environment ("One Health" approach). Among the stated priorities, the initiative by the European Medicines Regulatory Network to further strengthen the measures in combatting AMR is highlighted. Likewise, it is asserted that other emerging health threats require global collaboration with the One Health approach offering a valuable blueprint for action. CONCLUSION: The authors stress the importance of an integrated preparedness strategy to tackle this public health peril.


Asunto(s)
Antibacterianos/farmacología , Farmacorresistencia Bacteriana/genética , Salud Única/legislación & jurisprudencia , Pandemias , /patogenicidad , Alimentación Animal/análisis , Bienestar del Animal/legislación & jurisprudencia , Animales , Programas de Optimización del Uso de los Antimicrobianos/legislación & jurisprudencia , Bacterias/efectos de los fármacos , Bacterias/genética , Bacterias/patogenicidad , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/microbiología , Europa (Continente)/epidemiología , Humanos , Cooperación Internacional , Ganado/microbiología
6.
BMC Infect Dis ; 21(1): 97, 2021 Jan 21.
Artículo en Inglés | MEDLINE | ID: mdl-33478430

RESUMEN

BACKGROUND: Inappropriate antibiotic use is linked to the spread of antimicrobial resistance worldwide, but there are limited systemic data on antibiotic utilization in low- and middle-income countries. The purpose of this study was to evaluate the prevalence and patterns of antibiotic prescription in an ambulatory care setting in Sri Lanka. METHODS: This cross-sectional survey was conducted at the Outpatient Department of a public tertiary medical center in Southern Province, Sri Lanka from February to April 2019. Among consecutive outpatients presenting for care, questionnaires were verbally administered to a systematic random sample to capture information about patient demographics, illness characteristics, and visit outcomes. Prescription data were obtained from the outpatient pharmacy's electronic prescribing system. RESULTS: Of 409 surveyed patients, 146 (35.7%) were prescribed an antibiotic. The most frequently prescribed agents were amoxicillin (41 patients, 28.1% of antibiotic recipients) and first-generation cephalosporins (38, 26.0%). Respiratory indications were the most common reason for antibiotic use, comprising 69 (47.3%) of all antibiotic prescriptions. Antibiotics were prescribed for 66.1% of patients presenting with cough and 78.8% of those presenting with rhinorrhea or nasal congestion. Among all antibiotic recipients, 6 (4.1%) underwent diagnostic studies. CONCLUSIONS: A high prevalence of antibiotic prescription was observed, in particular for treatment of respiratory conditions. These data support the need for improved antimicrobial stewardship in the Sri Lankan outpatient setting.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Antibacterianos/uso terapéutico , Prescripciones/estadística & datos numéricos , Enfermedades Respiratorias/tratamiento farmacológico , Adolescente , Adulto , Programas de Optimización del Uso de los Antimicrobianos , Niño , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios , Pautas de la Práctica en Medicina , Prevalencia , Enfermedades Respiratorias/diagnóstico , Enfermedades Respiratorias/epidemiología , Sri Lanka/epidemiología , Centros de Atención Terciaria , Adulto Joven
7.
BMC Infect Dis ; 21(1): 100, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482749

RESUMEN

BACKGROUND: The increasing use of antifungal drugs (AF) in children and the concern for related adverse events and costs has led to the development of specific AF stewardship programmes (AFS). Studies in adult patients have shown improvements in AF prescription and usage after implementation, but paediatric data are scant. The aim of this PROAFUNGI study was to describe the use and appropriateness of AF in a high complexity paediatric centre. METHODS: Observational, prospective, single-centre, modified point-prevalence study (11 surveys, July-October 2018), including paediatric (< 18 years) patients receiving at least one systemic AF. Prescriptions were evaluated by the AFS team. RESULTS: The study included 119 prescriptions in 55 patients (53% males, median age 8.7 years [IQR 2.4-13.8]). The main underlying condition was cancer (45.5% of patients; HSCT in 60% of them); and the first indication for AF was prophylaxis (75 prescriptions, 63.2%). Liposomal amphotericin B was used most commonly (46% prescriptions), mainly as prophylaxis (75%). Among the 219 evaluations, 195 (89%) were considered optimal. The reason for non-optimal prescriptions was mostly lack of indication (14/24), especially in critical patients with ventricular assist devices. The use of AF without paediatric approval accounted for 8/24 inappropriate prescriptions. CONCLUSIONS: A high rate of AF appropriateness was found for the children's hospital as a whole, in relation with a well-established AFS. Nonetheless, the identification of specific areas of improvement should guide future actions of the AFS team, which will focus mainly on prophylaxis in critically ill patients receiving circulatory assistance and the use of non-approved drugs in children.


Asunto(s)
Antifúngicos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Hospitales Pediátricos/normas , Centros de Atención Terciaria/normas , Adolescente , Niño , Preescolar , Prescripciones de Medicamentos/normas , Prescripciones de Medicamentos/estadística & datos numéricos , Femenino , Humanos , Prescripción Inadecuada/estadística & datos numéricos , Masculino , Prevalencia , Estudios Prospectivos , Encuestas y Cuestionarios
8.
BMC Infect Dis ; 21(1): 105, 2021 Jan 22.
Artículo en Inglés | MEDLINE | ID: mdl-33482752

RESUMEN

BACKGROUND: Better information on the typical course and management of acute common infections in the community could inform antibiotic stewardship campaigns. We aimed to investigate the incidence, management, and natural history of a range of infection syndromes (respiratory, gastrointestinal, mouth/dental, skin/soft tissue, urinary tract, and eye). METHODS: Bug Watch was an online prospective community cohort study of the general population in England (2018-2019) with weekly symptom reporting for 6 months. We combined symptom reports into infection syndromes, calculated incidence rates, described the proportion leading to healthcare-seeking behaviours and antibiotic use, and estimated duration and severity. RESULTS: The cohort comprised 873 individuals with 23,111 person-weeks follow-up. The mean age was 54 years and 528 (60%) were female. We identified 1422 infection syndromes, comprising 40,590 symptom reports. The incidence of respiratory tract infection syndromes was two per person year; for all other categories it was less than one. 194/1422 (14%) syndromes led to GP (or dentist) consultation and 136/1422 (10%) to antibiotic use. Symptoms usually resolved within a week and the third day was the most severe. CONCLUSIONS: Most people reported managing their symptoms without medical consultation. Interventions encouraging safe self-management across a range of acute infection syndromes could decrease pressure on primary healthcare services and support targets for reducing antibiotic prescribing.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones/tratamiento farmacológico , Infecciones/patología , Derivación y Consulta/estadística & datos numéricos , Programas de Optimización del Uso de los Antimicrobianos , Estudios de Cohortes , Prestación de Atención de Salud , Inglaterra/epidemiología , Femenino , Humanos , Incidencia , Infecciones/epidemiología , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Síndrome
11.
J Infect Public Health ; 14(1): 53-60, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33341485

RESUMEN

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 was first reported in Wuhan, China in December 2019 and is associated with high levels of morbidity and mortality. Various types of bacterial and fungal infections occur in patients with COVID-19 with some resistant to antimicrobials that are associated with significantly worse outcomes and deaths. Besides, antimicrobial-resistant (AMR) co-infections are responsible for clinically significant mortality in past pandemics. There is evidence to suggest that factors such as the proliferation of adulterated antimicrobials in some developing countries, international travels, issues with healthcare financing, use/misuse by humans, and in agricultural production and climate change are determinants of AMR at various levels of society. These complex interrelated determinants intersect with AMR in current and past pandemics and could amplify the potential of a future antimicrobial resistance pandemic. Therefore, global concerted interventions targeted at all levels of society to reduce the use/misuse of antimicrobials and disrupt these multifaceted, interrelated, and interdependent factors are urgently needed. This paper leverages prior research to describe complex major determinants of antimicrobial resistance and provides fresh insights into possible intervention strategies to tackle antimicrobial resistance including in the current and future pandemics.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos , Farmacorresistencia Bacteriana , Salud Global , Humanos
13.
BMJ Open ; 10(12): e039284, 2020 12 17.
Artículo en Inglés | MEDLINE | ID: mdl-33334829

RESUMEN

OBJECTIVE: While various interventions have helped reduce antibiotic prescribing, further gains can be made. This study aimed to identify ways to optimise antimicrobial stewardship (AMS) interventions by assessing the extent to which important influences on antibiotic prescribing are addressed (or not) by behavioural content of AMS interventions. SETTINGS: English primary care. INTERVENTIONS: AMS interventions targeting healthcare professionals' antibiotic prescribing for respiratory tract infections. METHODS: We conducted two rapid reviews. The first included qualitative studies with healthcare professionals on self-reported influences on antibiotic prescribing. The influences were inductively coded and categorised using the Theoretical Domains Framework (TDF). Prespecified criteria were used to identify key TDF domains. The second review included studies of AMS interventions. Data on effectiveness were extracted. Components of effective interventions were extracted and coded using the TDF, Behaviour Change Wheel and Behaviour Change Techniques (BCTs) taxonomy. Using prespecified matrices, we assessed the extent to which BCTs and intervention functions addressed the key TDF domains of influences on prescribing. RESULTS: We identified 13 qualitative studies, 41 types of influences on antibiotic prescribing and 6 key TDF domains of influences: 'beliefs about consequences', 'social influences', 'skills', 'environmental context and resources', 'intentions' and 'emotions'. We identified 17 research-tested AMS interventions; nine of them effective and four nationally implemented. Interventions addressed all six key TDF domains of influences. Four of these six key TDF domains were addressed by 50%-67% BCTs that were theoretically congruent with these domains, whereas TDF domain 'skills' was addressed by 24% of congruent BCTs and 'emotions' by none. CONCLUSIONS: Further improvement of antibiotic prescribing could be facilitated by: (1) national implementation of effective research-tested AMS interventions (eg, electronic decision support tools, training in interactive use of leaflets, point-of-care testing); (2) targeting important, less-addressed TDF domains (eg, 'skills', 'emotions'); (3) using relevant, under-used BCTs to target key TDF domains (eg, 'forming/reversing habits', 'reducing negative emotions', 'social support'). These could be incorporated into existing, or developed as new, AMS interventions.


Asunto(s)
Programas de Optimización del Uso de los Antimicrobianos , Atención Primaria de Salud , Terapia Conductista , Personal de Salud , Humanos , Investigación Cualitativa
15.
BMC Infect Dis ; 20(1): 812, 2020 Nov 07.
Artículo en Inglés | MEDLINE | ID: mdl-33160320

RESUMEN

BACKGROUND: To verify whether a daily service of Infectious Diseases consultation (ID-cons) is more effective than a weekly service in reducing antibiotic (ATB) consumption without worsening of clinical outcomes. METHODS: Two-year observational analysis of the ID-cons provided in a hospital setting in Milan, Italy. ID-cons resulted in: start-of-ATB; no-ATB; confirmation; modification-of-ATB. The impact of a weekly (September 1, 2016 - August 31, 2017 versus a daily (September 1, 2017 - September 30, 2018) service of ID-cons was evaluated in terms of: time-from-admission-to-first-ID-cons, type of ATB-intervention and number-of-ID-cons per 100 bed-days (bd). Primary outcomes: reduction of hospital ATB consumption overall and by department and classes expressed as Defined Daily Dose (DDD)/100bd (by Wilcoxon test for paired data). SECONDARY OUTCOMES: overall and sepsis-related in-hospital annual mortality rates (as death/patient's admissions). RESULTS: Overall 2552 ID-cons in 1111 patients (mean, 2.3 ID-cons per patient) were performed (18.6% weekly vs 81.4% daily). No differences in patient characteristics were observed. In the daily-service, compared to the weekly-service, patients were seen by the ID-consultant earlier (time-from-admission-to-ID-cons: 6 days (IQR 2-13) vs 10 days (IQR 6-19), p < 0.001) and ATB was more often started by the ID-consultant (Start-of-ATB: 11.6% vs 8%, p = 0.02), rather than treating physicians. After switching to daily-service, the number-of-ID-cons increased from 0.4/100bd to 1.5/100bd (p = 0.01), with the greatest increase in the emergency department (1.5/100bd vs 6.7/100bd, p < 0.001). Total ATB consumption decreased from 64 to 60 DDD/100bd. As for the number-of-cons, the consumption of ATB decreased mainly in the emergency area. According to ATB classes, glycopeptides consumption was reduced from 3.1 to 2.1 DDD/100bd (p = 0.02) while carbapenem use decreased from 3.7 to 3.1 DDD/100bd (p = 0.07). No changes in overall mortality (5.2% vs 5.2%) and sepsis-related mortality (19.3% vs 20.9%; p = 0.7) were observed among the two time-period. CONCLUSIONS: Daily-ID-cons resulted in a more comprehensive management of the infected patient by the ID-consultant, especially in the emergency area where we also observed the highest rate of reduction of ATB-usage. No change in mortality was observed.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Carbapenémicos/uso terapéutico , Enfermedades Transmisibles/tratamiento farmacológico , Glicopéptidos/uso terapéutico , Derivación y Consulta , Anciano , Anciano de 80 o más Años , Farmacorresistencia Bacteriana Múltiple , Femenino , Estudios de Seguimiento , Hospitales , Humanos , Italia , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
16.
S Afr Med J ; 110(10): 973-981, 2020 08 26.
Artículo en Inglés | MEDLINE | ID: mdl-33205723

RESUMEN

The SARS-CoV-2 pandemic has presented clinicians with an enormous challenge in managing a respiratory virus that is not only capable of causing severe pneumonia and acute respiratory distress syndrome, but also multisystem disease. The extraordinary pace of clinical research, and particularly the surge in adaptive trials of new and repurposed treatments, have provided rapid answers to questions of whether such treatments work, and has resulted in corticosteroids taking centre stage in the management of hospitalised patients requiring oxygen support. Some treatment modalities, such as the role of anticoagulation to prevent and treat potential thromboembolic complications, remain controversial, as does the use of high-level oxygen support, outside of an intensive care unit setting. In this paper, we describe the clinical management of COVID-19 patients admitted to Groote Schuur Hospital, a major tertiary level hospital at the epicentre of South Africa's SARS-CoV-2 epidemic during its first 4 months.


Asunto(s)
Infecciones por Coronavirus/terapia , Hospitales Universitarios/organización & administración , Neumonía Viral/terapia , Centros de Atención Terciaria/organización & administración , Corticoesteroides/uso terapéutico , Anticoagulantes/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/psicología , Cuidados Críticos/organización & administración , Complicaciones de la Diabetes , Humanos , Intubación Intratraqueal , Cuerpo Médico de Hospitales/psicología , Terapia por Inhalación de Oxígeno , Cuidados Paliativos , Pandemias , Grupo de Atención al Paciente , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Neumonía Viral/psicología , Respiración Artificial , Factores de Riesgo , Apoyo Social , Sudáfrica/epidemiología
17.
Pediatrics ; 146(5)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33055227

RESUMEN

BACKGROUND: Given the risks associated with antibiotics, efforts to reduce unnecessary antibiotic use in the NICU have become increasingly urgent. In 2016, a comprehensive 3-year quality improvement (QI) initiative was conducted in a level 4 NICU that sought to decrease the antibiotic use rate (AUR) by 20%. METHODS: This local QI initiative was conducted in the context of a multicenter learning collaborative focused on decreasing unnecessary antibiotic use. Improvement strategies focused on addressing gaps in the core elements of antibiotic stewardship programs. Outcome measures included the AUR and the percent of infants discharged without antibiotic exposure. Process measures included the percent of infants evaluated for early-onset sepsis (EOS) and duration of antibiotics used for various infections. Statistical process control charts were used to display and analyze data over time. RESULTS: The AUR decreased from 27.6% at baseline to 15.5%, a 43% reduction, and has been sustained for >18 months. Changes most attributable to this decrease include implementation of the sepsis risk calculator, adopting a 36-hour rule-out period for sepsis evaluations, a 36-hour antibiotic hard stop, and novel guideline for EOS evaluation among infants <35 weeks. The percent of infants discharged without antibiotic exposure increased from 15.8% to 35.1%. The percent of infants ≥36 weeks undergoing evaluation for EOS decreased by 42.3% and for those <35 weeks by 26%. CONCLUSIONS: Our efforts significantly reduced antibiotic use and exposure in our NICU. Our comprehensive, rigorous approach to QI is applicable to teams focused on improvement.


Asunto(s)
Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Unidades de Cuidado Intensivo Neonatal , Sepsis Neonatal/tratamiento farmacológico , Mejoramiento de la Calidad , Humanos , Recién Nacido , Uso Excesivo de los Servicios de Salud/prevención & control , Sepsis Neonatal/diagnóstico , New York , Medición de Riesgo , Factores de Tiempo
18.
BMC Infect Dis ; 20(1): 776, 2020 Oct 19.
Artículo en Inglés | MEDLINE | ID: mdl-33076857

RESUMEN

BACKGROUND: Antibiotic resistance is on the rise. A contributing factor to antibiotic resistance is the misuse of antibiotics in hospitals. The current use of antibiotics in ICUs in Malawi is not well documented and there are no national guidelines for the use of antibiotics in ICUs. The aim of the study was to describe the use of antibiotics in a Malawian ICU. METHODS: A retrospective review of medical records of all admissions to the main ICU in Queen Elizabeth Central Hospital in Blantyre, Malawi, between January 2017 and April 2019. Data were extracted from the ICU patient register on clinical parameters on admission, diagnoses, demographics and antibiotics both prescribed and given for all patients admitted to the ICU. Usage of antibiotics in the ICU and bacterial culture results from samples taken in the ICU and in the peri-ICU period, (from 5 days before ICU admission to 5 days after ICU discharge), were described. RESULTS: Six hundred-and-forty patients had data available on prescribed and received medications and were included in the analyses. Of these, 577 (90.2%) were prescribed, and 522 (81.6%) received an antibiotic in ICU. The most commonly used antibiotics were ceftriaxone, given to 470 (73.4%) of the patients and metronidazole to 354 (55.3%). Three-hundred-and-thirty-three (52.0%) of the patients received more than one type of antibiotic concurrently - ceftriaxone and metronidazole was the most common combination, given to 317 patients. Forty five patients (7.0%) were given different antibiotics sequentially. One-hundred-and-thirty-seven patients (21.4%) had a blood culture done in the peri-ICU period, of which 70 (11.0% of the patients) were done in the ICU. Twenty-five (18.3%) of the peri-ICU cultures were positive and eleven different types of bacteria were grown in the cultures, of which 17.2% were sensitive to ceftriaxone. CONCLUSION: We have found a substantial usage of antibiotics in an ICU in Malawi. Ceftriaxone, the last-line antibiotic in the national treatment guidelines, is commonly used, and bacteria appear to show high levels of resistance to it, although blood culture testing is infrequently used. Structured antibiotic stewardship programs may be useful in all ICUs.


Asunto(s)
Antibacterianos/administración & dosificación , Unidades de Cuidados Intensivos , Centros de Atención Terciaria , Adulto , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Ceftriaxona , Revisión de la Utilización de Medicamentos , Femenino , Humanos , Malaui , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
19.
BMC Infect Dis ; 20(1): 799, 2020 Oct 28.
Artículo en Inglés | MEDLINE | ID: mdl-33115427

RESUMEN

BACKGROUND: Clostridioides difficile infection (CDI) is one of the most common healthcare infections. Common strategies aiming at controlling CDI include antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions. Mathematical models provide a framework to evaluate control strategies. Our objective is to evaluate the effectiveness of control strategies in decreasing C. difficile colonization and infection using an agent-based model in an acute healthcare setting. METHODS: We developed an agent-based model that simulates the transmission of C. difficile in medical wards. This model explicitly incorporates healthcare workers (HCWs) as vectors of transmission, tracks individual patient antibiotic histories, incorporates varying risk levels of antibiotics with respect to CDI susceptibility, and tracks contamination levels of ward rooms by C. difficile. Interventions include two forms of antimicrobial stewardship, increased environmental decontamination through room cleaning, improved HCW compliance, and a preliminary assessment of vaccination. RESULTS: Increased HCW compliance with CDI patients was ranked as the most effective intervention in decreasing colonizations, with reductions up to 56%. Antibiotic stewardship practices were highly ranked after contact precaution compliance. Vaccination and reduction of high-risk antibiotics were the most effective intervention in decreasing CDI. Vaccination reduced CDI cases to up to 90%, and the reduction of high-risk antibiotics decreased CDI cases up to 23%. CONCLUSIONS: Overall, interventions that decrease patient susceptibility to colonization by C. difficile, such as antibiotic stewardship, were the most effective interventions in reducing both colonizations and CDI cases.


Asunto(s)
/efectos de los fármacos , Infecciones por Clostridium/prevención & control , Infecciones por Clostridium/transmisión , Infección Hospitalaria/prevención & control , Infección Hospitalaria/transmisión , Análisis de Sistemas , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Infecciones por Clostridium/tratamiento farmacológico , Infecciones por Clostridium/microbiología , Infección Hospitalaria/microbiología , Higiene de las Manos , Personal de Salud , Humanos , Control de Infecciones/métodos , Modelos Teóricos , Vacunación
20.
Rev Med Suisse ; 16(710): 1912-1915, 2020 Oct 14.
Artículo en Francés | MEDLINE | ID: mdl-33058576

RESUMEN

The extraordinary development of medicine with the advent of solid organ and bone marrow transplants, chemotherapy and immunotherapy, as well as the explosion of invasive procedures (« foreign material ¼) has made our medicine dependant to the use of antibiotics. The overuse of « empirical ¼ antibiotics in breeding and medicine has favored the emergence and rapid dissemination of multidrug resistant pathogens (MDRs). This leaded clinicians today in a difficult situation. They should limit their empirical use of « broad-spectrum antibiotics ¼, although they face a higher risk of MDRs. To help them in this task, anti-microbial stewardship programs have been put in place, emphasizing the use of « hospital antibiograms ¼ and rapid and reliable microbiological diagnosis.


Asunto(s)
Antibacterianos , Programas de Optimización del Uso de los Antimicrobianos/métodos , Farmacorresistencia Microbiana , Resistencia a Múltiples Medicamentos , Antibacterianos/provisión & distribución , Antibacterianos/uso terapéutico , Farmacorresistencia Microbiana/efectos de los fármacos , Resistencia a Múltiples Medicamentos/efectos de los fármacos , Hospitales , Humanos
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