Opportunities for Antimicrobial Stewardship in Caring for Febrile Pediatric Inpatients in Abu Dhabi.

Antimicrobial stewardship programs seek to improve patient outcomes, reduce cost, and hinder development of antimicrobial resistance. Collection of inpatient antimicrobial use data is foundational to these programs, and decisions to initiate and discontinue antibiotics are potentially amenable to improvement. In order to better understand our current practices and with a view toward improved antimicrobial stewardship, we reviewed charts of previously healthy children to age 16 years hospitalized with fever (without an evident localized source) and/or other findings suggestive of serious bacterial infection. Of 105 patients (18% 0-2 months of age, 42% 3-12 months, 25% 2-5 years), 100 (95%) received antibiotics, 72% for more than 2 days. Of 98 patients with negative body fluid cultures, 23 received antibiotics for 2 days or less, and 70 received antimicrobial therapy for more than 2 days. Focusing on selective initiation and earlier discontinuation of antimicrobial therapy in hospitalized children might reduce unnecessary antibiotic use.

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis.

Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: -0.99; 95% CI: -2.38, 0.39) and a significant reduction in antibiotics' days of therapy (MD: -2.73; 95% CI: -3.92, -1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.

Impact of Multidisciplinary Team Escalating Approach on Antibiotic Stewardship in the United Arab Emirates.

Antimicrobial stewardship programs (ASP) are an essential strategy to combat antimicrobial resistance. This study aimed to measure the impact of an ASP multidisciplinary team (MDT) escalating intervention on improvement of clinical, microbiological, and other measured outcomes in hospitalised adult patients from medical, intensive care, and burns units. The escalating intervention reviewed the patients' cases in the intervention group through the clinical pharmacists in the wards and escalated complex cases to ID clinical pharmacist and ID physicians when needed, while only special cases required direct infectious disease (ID) physicians review. Both non-intervention and intervention groups were each followed up for six months. The study involved a total of 3000 patients, with 1340 (45%) representing the intervention group who received a total of 5669 interventions. In the intervention group, a significant reduction in length of hospital stay (p < 0.01), readmission (p < 0.01), and mortality rates (p < 0.01) was observed. Antibiotic use of the WHO AWaRe Reserve group decreased in the intervention group (relative rate change = 0.88). Intravenous to oral antibiotic ratio in the medical ward decreased from 4.8 to 4.1. The presented ASP MDT intervention, utilizing an escalating approach, successfully improved several clinical and other measured outcomes, demonstrating the significant contribution of clinical pharmacists atimproving antibiotic use and informing antimicrobial stewardship.

Advancing quality in sepsis management: a large-scale programme for improving sepsis recognition and management in the North West region of England.

OBJECTIVE: To evaluate the impact of a collaborative programme for the early recognition and management of patients admitted with sepsis in the northwest of England. SETTING: 14 hospitals in the northwest of England. INTERVENTION: A quality improvement programme (Advancing Quality (AQ) Sepsis) that promoted a sepsis care bundle including time-based recording of early warning scores, documenting systemic inflammatory response syndrome criteria and suspected source of infection, taking of blood cultures, measuring serum lactate levels, administration of intravenous antibiotics, administration of oxygen, fluid resuscitation, measurement of fluid balance and senior review. MAIN OUTCOME MEASURES: Inpatient mortality, 30-day readmission rates and duration of hospital ≥10 days. RESULTS: Data for 7776 patients were included in this study between 1 July 2014 and 29 December 2015. Participation in the AQ Sepsis programme was associated with a reduction in readmissions within 30 days (OR 0.81 (0.69-0.95)) and hospital stays over 10 days (OR 0.69 (0.60-0.78)). However, there was no reduction in mortality. Administration of a second litre of intravenous fluid within 2 hours, oxygen therapy and review by a senior clinician were associated with increased mortality. Starting a fluid balance chart within 4 hours was the only clinical process measure that did not affect mortality. Taking a blood culture sample, administering antibiotic therapy and measuring serum lactate within 3 hours of hospital arrival were all associated with reduced mortality (OR 0.69 (0.59-0.81), OR 0.77 (0.67-0.89) and OR 0.64 (0.54-0.77), respectively) and shorter hospitalisations (OR 0.58 (0.49-0.69), OR0.81 (0.70-0.94) and OR 0.54 (0.45-0.66), respectively). However, none of these measures had an impact on the risk of readmission to hospital within 30 days. CONCLUSIONS: The AQ Sepsis collaborative in northwest of England improved readmission and length of stay for patients admitted with sepsis but did not affect mortality. Further cost-effectiveness evaluation of the programme is needed.

Prevalence of typhoid fever in febrile patients with symptoms clinically compatible with typhoid fever in Cameroon.

Typhoid fever is difficult to differentiate from other causes of infection such as malaria because their signs and symptoms often overlap. There has been an unprecedented increase in the number of typhoid fever cases diagnosed in Cameroon. Febrile patients are often treated for malaria and typhoid fever simultaneously. This cross-sectional study was carried out to determine the prevalence of typhoid fever in 200 consecutive patients with fever and symptoms clinically compatible with typhoid fever to verify recent estimates of a high prevalence of typhoid fever in Cameroon. Patients were enrolled in three of the 10 provinces of Cameroon. Blood culture, thick and thin blood smears and Widal tests using acute sera were performed in all cases; stool culture for 120 patients. Typhoid fever was confirmed in only 2.5% as evidenced either by culture (four cases) or high salmonella antibody titres (one case); malaria was diagnosed in 94 (47%) patients. Typhoid fever is not as endemic in Cameroon as recently feared.

The increase in occurrence of typhoid fever in Cameroon: overdiagnosis due to misuse of the Widal test?

This study investigates the cause of an apparent increase in occurrence of typhoid fever in Cameroon. The reasons explored include an overdiagnosis of the illness related to poor performance of the Widal test in laboratories and interpretation by prescribers. Questionnaires were used in 1996 to evaluate the use and interpretation of the Widal test, and checklists were used to assess its laboratory performance in 2 of the 10 provinces in Cameroon. The majority of prescribers from 20 health facilities (an average of 76% of the doctors and 61% of the nurses) could detect patients who truly had positive Widal tests and needed treatment. However, an average of 48% of the doctors and 84% of the nurses would treat patients who did not require treatment based on the Widal test result. Patients may therefore be treated unnecessarily. Most (88%) of the visited laboratories performed the Widal rapid slide agglutination test as opposed to the conventional tube agglutination test. About 14% of the laboratories that performed the rapid slide agglutination test had a score above average for each criterion evaluated. Misdiagnosis of typhoid fever leads to unnecessary expenditure and exposure of patients to the side-effects of antibiotics. In addition, misdiagnosis may result in delayed diagnosis and treatment of malaria, and other acute febrile illness.

The distribution of anti-Salmonella antibodies in the sera of blood donors in Yaoundé, Cameroon.

This cross-sectional study in late 1996 on a group of 230 consecutive blood donors in Yaoundé, Cameroon, found a baseline titre of 1:100 for antisalmonella O antibodies. The seroprevalence and baseline titre for antisalmonella H antibodies was much higher (1:400), suggesting that the H antibody is of limited diagnostic value in Cameroon.