Impact of Implementing an Antimicrobial Stewardship Program for Optimizing Antibiotic Treatment in Gram-negative Bacilli Bacteremia.

BACKGROUND: Antibiotic Stewardship Programs (ASP) have improved empirical and directed antibiotic treatment in Gram-negative bloodstream infections. A decrease in mortality, readmission, and length of hospitalization has been reported. MATERIALS AND METHODS: A pre-post-quasi-experimental study was conducted between November and April 2015-2016 (pre-intervention period), 2016-2017, 2017-2018, and 2018-2019 (post-intervention periods), to analyse the impact of ASP on empirical, directed, and entire treatment optimization, as well as mortality, readmission, and length of hospitalization, in hospitalized patients with Gram-negative bacilli (GNB) bloodstream infections. RESULTS: One hundred seventy-four patients were included (41 in the pre-intervention group, 38 in the first-year post-intervention group, 50 in the second-year post-intervention group, and 45 in the third-year post-intervention group). There was a significant improvement in directed treatment optimization (43.9% in the pre-intervention group, 68.4% in the first-year post-intervention group, 74% in the second-year post-intervention group, and 88.9% in the third-year post-intervention group, P <0.001), as well as in entire treatment optimization (19.5%, 34.2%, 40.0%, and 46.7%, respectively, P=0.013), with increased optimal directed (adjusted odds ratio [aOR], 3.71; 95% confidence interval [CI], 1.60-8.58) and entire treatment (aOR, 3.31; 95% CI, 1.27-8.58). Although a tendency toward improvement was observed in empirical treatment after ASP implementation, it did not reach statistical significance (41.5% vs. 57.9%, P=0.065). No changes in mortality, readmission, or length of hospitalization were detected. CONCLUSION: ASP implementation improved both directed and entire treatment optimization in patients with GNB bloodstream infections over time. Nevertheless, no improvement was found in clinical outcomes such as mortality, readmission, or length of hospitalization.

Genitourinary Lesions Due to Monkeypox.

BACKGROUND: Since May 2022, 31 000 cases of monkeypox infection have been reported in nonendemic areas. OBJECTIVE: To describe a series of cases of monkeypox with genitourinary involvement. DESIGN, SETTING, AND PARTICIPANTS: This was a prospective observational study of men diagnosed with monkeypox disease with genitourinary involvement. RESULTS AND LIMITATIONS: A total of 14 patients were recruited. The median age was 42 yr. Of these patients, 43% sought a consultation for genitourinary symptomatology, and 71% had engaged in sex with other men. Eight patients (57%) were positive for human immunodeficiency virus, one diagnosed synchronously; the remainder had a median CD4 count of 663/µl. Six patients (43%) had a different sexually transmitted disease. Penile oedema was present in 43% of patients and two patients required surgical exploration. CONCLUSIONS: Genitourinary involvement is frequent in monkeypox disease and is often the reason for the consultation visit. PATIENTS SUMMARY: In this report we looked at how monkeypox disease can affect the genitourinary area, causing swelling of the penis or skin lesions.