Antimicrobial stewardship policy: time to revisit the strategy?

Recent data indicate that both the overall numbers of antibiotic prescription and the frequency of multidrug-resistant bacteria are increasing significantly. These threatening features are observed, despite national antimicrobial stewardship (AMS) policies aimed at decreasing antibiotic use. AMS should also focus on the initial steps leading to antibiotic prescription. Physicians and their patients should benefit from the structured clinical pathways, the latter being adapted to regional epidemiological data and resources. Continuous evaluation of these predefined clinical paths through a computerized medical dashboard will allow a critical review and finally the optimization of medical practices. These innovative behavioural approaches for clinicians will supply precise information on the relationship among the diagnosis, therapeutics and outcome. This changing environment will carry out the adapted therapeutic procedures, and appropriate antibiotic use will inherently improve.

Antimicrobial stewardship program and quality of antibiotic prescriptions.

OBJECTIVE: National recommendations have been issued to define which optimal organization in hospitals could improve the quality of antibiotic prescription. Our aim was to check whether there was a link between applying these national recommendations and the quality of antibiotic prescriptions. PATIENTS AND METHODS: A prospective study was carried out in three French regional hospitals (A to C), to assess how recommendations were applied. Hospital organization was measured with the ICATB score (antimicrobial stewardship index) and the appropriateness of antibiotic prescription was assessed by an audit during 1 week by two investigators, who shadowed physicians during bedside visits, in various medical and surgical departments. RESULTS: There was a considerable difference in the organization of these three hospitals in terms of computerized prescriptions, formulary restriction, availability of recommendations, and antibiotic consumption defined as delivered daily-dose. Institution A had strictly followed recommendations for hospital organization, but these were less observed in institution B and C. The prevalence of antibiotic treatment was comparable in the three hospitals, and concerned over 25% of patients. In institution A, 60% of antibiotic prescriptions were inadequate, 23% were not appropriate and 17% were optimal. In institution B, these figures reached 36%, 34%, and 34%, while in institution C they reached 25%, 55%, and 20%, respectively. CONCLUSION: There is no clear link between applying national recommendations for antibiotic prescription and optimization of hospital organization and the quality of antibiotic prescriptions.

[Risk factors for dryness or irritation of staff hands in nine healthcare institutions]. / Étude des facteurs de risque de sécheresse et d'irritation des mains du personnel dans neuf établissements de soins.

OBJECTIVE: We performed a prospective multicenter study to assess dryness and irritation of hands of staff in care facilities, and to show that disinfection with alcohol-based hand rub is better tolerated than classic hand washing with mild soap. METHOD: Dryness and irritation were self-evaluated by volunteers and hetero-evaluated by a team of investigators. The study took into account most of the individual and environmental risk factors of dryness and irritation (season, age, gender, use of protective agent, constitutional, personal and external factors, institution, function, number of consecutive working days). RESULTS: The results from the 1932 assessments collected showed that traditional hand washing was a risk factor for dryness or irritation, while alcohol-based hand rubs caused no skin deterioration and had a protective effect even when used intensively. COMMENT: These results should help to fight non-adherence to the use of alcohol-based hand rubs.

[Epidemiology of Enterobacteriaceae producing extended-spectrum beta-lactamase in Grasse Hospital (2005-2008)]. / Epidémiologie des entérobactéries sécrétrices de bêta-lactamases à spectre étendu (E-BLSE) au centre hospitalier de Grasse (2005-2008).

BACKGROUND: The CASFM 2008 don't recommend to search a BLSE for Enterobacteriaceae (E-BLSE) having a aac(6'). So we wanted to take stock of antibiotics co-resistances in our laboratory for these bacteria. We look for the aminoglycosides and quinolones FQ. METHODS: We studies all E-BLSE isolated in our laboratory from the 1(st) six month of 2005 to the 1st six month of 2008. Only one isolate per patient were included in this study. For each bacterial strain aminoglycosides and quinolones FQ (nalidixic acid [NA], ciprofloxacin [CIP]) were tested. RESULTS: A total of 124 E-BLSE isolates were studied. Escherichia coli increases (12 to 86%) and Enterobacter spp decreases (33 to 5%). We can note an increase of sensibles strains (6 to 23%).The mainly resistance associated is the FQ resistance (CIP: 88 to 68%). The resistance of aminoglycosides is almost associated with the NA resistance (59 to 36%). The presence of aac(6') decreases (29 to 1%). CONCLUSION: BLSE are mainly produced by Escherichia coli and antibiotics coresistances change: increase sensibles strains, supremacy of FQ resistance and decrease of the aac(6').This results can have repercussions on antibiotherapy.

Psychological aspects and coping in haemophilic patients: a case-control study.

Although enormous progress has been made in recent years in the field of haemophilia, some problems still await solution, such as the risk of sudden haemorrhage, the sequelae of haemophilic arthropathy and social activities. We, therefore, carried out a case-control study in which some psychological dimensions (social expectations, tendency to depression, state of anxiety and self-esteem) were evaluated in a group of 60 haemophiliacs. A control group was formed of 78 healthy subjects matched for age, socio-economic class and level of education. The methodology used was the administration of self-assessment questionnaires which investigate and provide a quantitative measure of psychological dimensions. The results can be subjected to statistical analysis. Three self-assessment questionnaires were used: (i) the Marlowe-Crowne scale, (ii) the Beck Inventory version modified by Cusinato and (iii) the S.T.A.I.-form. Our aim was to evaluate: (i) whether there are significant differences in the considered psychological aspects between haemophiliacs and healthy subjects; (ii) whether there is a significant correlation between the psychological dimensions considered in the haemophiliacs and in the healthy subjects. The results showed that the haemophiliacs have a good psychological adaptation to their disease with the exception of their greater tendency to have less self-esteem than do the healthy subjects. As far as concerns the second aim, we found than self-esteem correlated with all the psychological variables investigated. This information could indicate the enormous importance that the psychological variable 'self-esteem' plays in haemophiliacs with respect to whether or not they develop depressive disorders and/or anxiety states.

Psychological aspects and coping of parents with a haemophilic child: a quantitative approach.

Although haemophilia is a relatively rare hereditary disease, and is curable by blood products, the psychological and social problems of haemophilic patients and of their families are always serious. Anxiety for the risks of bleedings and the fear for infections transmitted by blood products cause stress and difficulty in coping with the situation. The aim of this paper is to assess resources, stress, and coping in parents with a haemophilic child. In order to measure the dimensions related to family stress and resources, social desirability, tendency to depression, and anxiety, the subjects were administered the short-form of the Questionnaire on Resources and Stress by Friedrich et al. revised by Saviolo & Cristante, along with the Social Desirability Scale, the Beck Depression Inventory, and the Ipat Anxiety Scale. The subjects of this study were 20 couples who were the parents of haemophilic sons. We analysed how the parents perceived the behavioural characteristics of their child, the differences between mothers and fathers in the questionnaire scores, and the correlation among the considered dimensions. The results show that the parents paid great attention to the problems of their sons, but mothers were more depressed and anxious about the disease of their child.

Olfactory deficits in Down subjects: a link with Alzheimer disease.

Two groups of subjects, 14 young (ages 20 to 31 years) and 14 adults (ages 32 to 54 years), both groups with Down Syndrome, were examined on a matching and naming olfactory task. On the former, subjects were required to recognize among four a previously sniffed odour, while on the latter they had to label an odour by choosing among four alternatives provided by the examiner. Analysis indicated that the adults with Down Syndrome scored worse than the young group on both tasks and that the impairment of the two groups was more pronounced on the matching task. On considering the similarity between the neurodegenerative brain pathology exhibited by Alzheimer patients and Down subjects and a recent observation that the former show pathological changes also in the olfactory epithelium (neuritic plaques and neurofibrillary tangles), these two olfactory tasks could represent a useful noninvasive diagnostic method.

Teachers' attitudes towards plastic surgery in children with Down's syndrome.

The problem of whether to improve on the physical appearance of children with Down's syndrome by means of plastic surgery is a much debated question which involves bio-ethical and ideological concepts. In this research, the opinions of a group (n = 132) of Italian elementary and junior school teachers are investigated on the basis of a questionnaire. Data are analysed through the application of log-linear models, and parameter estimates are calculated for each response category and interactions between response categories and types of teachers. Results show a greater acceptance of children with Down's syndrome as they are by people who have daily experience of them and who can get to know them better from all points of view. On the other hand, plastic surgery for children with Down's syndrome is considered with more favour by people who are less psychologically involved with them.

Observations on the visual-perceptual abilities and adaptive behavior in adults with Down syndrome.

In this research, we consider some psychological, social, and clinical implications of premature aging in persons with Down syndrome (DS). Perceptual and adaptive tests contribute to a better knowledge of the characteristics of mental decline and self-government in DS adults. Visual-perceptual abilities (as measured by the Frosting Development Test of Visual Perception) and behavioral and social adaptation (measured by the Brown Adaptive Behavioral Inventory) were examined in 44 DS subjects aged 14 to 43 years. The results indicated a general decline in performance in the older groups (over 25 years), except in the visual-motor subtest, where a decline is less evident, as this ability continues to be exercised in craft work. Statistical analysis indicates a significant correlation between perceptual abilities, adaptive scales, and mental age. From the data collected, we draw some general conclusions about the trend of perceptual abilities and self-government in relation to aging in DS persons.

Observations on the effect of an excitatory-inhibitory stimulus on the landing reaction of the fly, Calliphoridae.

This research investigates at a behavioral level the sensitivity to movement of the visual system of Calliphora, inferred from the motor response of the landing reaction, to observe the variations of the threshold of velocity of the landing reaction during simultaneous introduction of both excitatory (landing) and inhibitory (antilanding) stimuli. Analysis supports the hypothesis that the interaction of opposing stimuli decreases the sensitivity to movement. Moreover, no effect was observed when the number of stimuli per unit time increased.