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1.
Epidemiol Infect ; 146(8): 985-990, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29690946

RESUMO

Antimicrobial resistance is a limiting factor for the success of the treatment of infectious diseases and is associated with increased morbidity and cost. The present study aims to evaluate prescribing patterns of antimicrobials and quantify progress in relation to targets for quality improvement in the prescription of antimicrobials in Northern Ireland's secondary care sector using three repetitive point prevalence surveys (PPS) over a 6-year period: the European Surveillance of Antimicrobial Consumption (ESAC-PPS) in 2009 and 2011 and the Global-PPS on Antimicrobial Consumption and Resistance in 2015. Out of 3605 patients surveyed over the three time points, 1239 (34.4%) were treated with an antibiotic, the most frequently prescribed antibiotic groups were a combination of penicillins, including ß-lactamase inhibitors. Compliance with hospital antibiotic policies in 2009, 2011 and 2015 were 54.5%, 71.5% and 79.9%, respectively. Likewise, an indication for treatment was recorded in patient notes 88.5%, 87.7% and 90.6% in 2009, 2011 and 2015, respectively, and surgical prophylactic antibiotic prescriptions for >24 h was 3.9%, 3.2% and 0.7% in 2009, 2011 and 2015, respectively. Treatment based on biomarker data was used in 61.5% of cases. In conclusion, a general trend in the improvement of key antimicrobial-related quality indicators was noted. The PPS tool provided a convenient, inexpensive surveillance system of antimicrobial consumption and should be considered an essential component to establish and maintain informed antibiotic stewardship in hospitals.


Assuntos
Antibacterianos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Melhoria de Qualidade/estatística & dados numéricos , Centros de Cuidados de Saúde Secundários/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Irlanda do Norte
2.
Artigo em Inglês | MEDLINE | ID: mdl-27499852

RESUMO

BACKGROUND: Antimicrobial resistance has been recognised as a serious global Public Health problem. Prevalence of Multiple-Drug-Resistant (MDR) organism carriage in Albania is largely unknown since no national surveillance system is in place and few publications are accessible in the literature. METHODS: A 1-day point-prevalence-survey (PPS) screening for nasal methicillin-resistant Staphylococcus aureus (MRSA) and rectal MDR Gram-negative carriage was carried out at the high-dependency wards in the country's only tertiary care hospital, in Tirana. RESULTS: A total of 106 nasal and 104 rectal swabs were collected. 14.2 % of patients (95 % Confidence Interval [95 CI]: 8.1-22.3 %) were MRSA nasal carriers. Resistance to aminoglycosides and fluoroquinolones was common in these isolates (≥80 %) but no resistance was identified against glycopeptides, nitrofurantoin and the relatively newer agents, tigecycline and linezolid. Fifty Enterobacteriaceae isolates were cultivated from 33 of 104 screened patients (31.7 % [95 CI: 22.9-41.6 % 95 CI]). The prevalence of Extended Spectrum Beta-Lactamase (ESBL) production in Enterobacteriaceae was 41.3 % (95 CI: 31.8-51.4 %). The two more commonly isolated Enterobacteriaceae were E. coli ([n = 28], 24 ESBL positive; 1 AmpC positive and 3 without an identified mechanism of resistance) and Klebsiella pneumoniae ([n = 13], all ESBL positive; 1 also AmpC and metallo-ß-lactamase (MBL) positive). Susceptibility to carbapenems (≥98 %), fosfomycin (90 %) and amikacin (70 + 20 % intermediate) was high but a high level of resistance to all other agents tested was noted. Non-fermenting Gram-negative bacilli were less commonly isolated {22 isolates: Acinetobacter baumannii (9); Pseudomonas aeruginosa (8) and Stenotrophomonas maltophilia (5)}. CONCLUSION: Although a significant rate of MRSA carriage was identified, the main resistance challenge in Albania appears to be linked with Gram-negative organisms, particularly ESBL in Enterobacteriaceae.

3.
Euro Surveill ; 17(46)2012 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-23171822

RESUMO

A standardised methodology for a combined point prevalence survey (PPS) on healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals developed by the European Centre for Disease Prevention and Control was piloted across Europe. Variables were collected at national, hospital and patient level in 66 hospitals from 23 countries. A patient-based and a unit-based protocol were available. Feasibility was assessed via national and hospital questionnaires. Of 19,888 surveyed patients, 7.1% had an HAI and 34.6% were receiving at least one antimicrobial agent. Prevalence results were highest in intensive care units, with 28.1% patients with HAI, and 61.4% patients with antimicrobial use. Pneumonia and other lower respiratory tract infections (2.0% of patients; 95% confidence interval (CI): 1.8­2.2%) represented the most common type (25.7%) of HAI. Surgical prophylaxis was the indication for 17.3% of used antimicrobials and exceeded one day in 60.7% of cases. Risk factors in the patient-based protocol were provided for 98% or more of the included patients and all were independently associated with both presence of HAI and receiving an antimicrobial agent. The patient-based protocol required more work than the unit-based protocol, but allowed collecting detailed data and analysis of risk factors for HAI and antimicrobial use.


Assuntos
Anti-Infecciosos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Revisão de Uso de Medicamentos/estatística & dados numéricos , Controle de Infecções/estatística & dados numéricos , Vigilância da População/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Infecção Hospitalar/microbiologia , Revisão de Uso de Medicamentos/métodos , Europa (Continente)/epidemiologia , Estudos de Viabilidade , Feminino , Órgãos Governamentais , Inquéritos Epidemiológicos , Hospitais/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Controle de Infecções/métodos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Distribuição por Sexo , Inquéritos e Questionários , Adulto Jovem
4.
Rev Sci Tech ; 31(1): 121-33, 2012 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-22849272

RESUMO

Antibiotics have increased life expectancy. Self-medication, even over the Internet, occurs in many countries where antibiotics are classified as prescription-only medicines. Collateral damage caused by antibiotic use includes resistance, which could be reduced if the inappropriate use of antibiotics that takes place globally, especially in low-income countries, could be prevented. Surveillance of antimicrobial resistance can recognise trends in resistance patterns and novel resistances. Surveillance of antimicrobial consumption can identify and target practice areas for quality improvement, both in the community and in healthcare institutions. Antimicrobial stewardship initiatives and infection control programmes play an important role in decreasing inappropriate use and halting dissemination of resistance. Education of professionals and the public should focus on changing behaviour rather than exclusively increasing knowledge, as the latter could have a paradoxical effect by increasing demand and prescription. Behaviour change should target all prescribers, including veterinarians, since microbes know no boundaries between animals and humans and are capable of exchanging resistance genes.


Assuntos
Anti-Infecciosos/uso terapêutico , Resistência Microbiana a Medicamentos , Automedicação/efeitos adversos , Automedicação/estatística & dados numéricos , Animais , Informação de Saúde ao Consumidor , Resistência Microbiana a Medicamentos/genética , Conhecimentos, Atitudes e Prática em Saúde , Humanos
5.
Clin Microbiol Infect ; 18(10): E389-95, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-22827696

RESUMO

The study aimed to identify targets for quality improvement in antifungal use in European hospitals and determine the variability of such prescribing. Hospitals that participated in the European Surveillance of Antimicrobial Consumption Point Prevalence Surveys (ESAC-PPS) were included. The WHO Anatomical Therapeutic Chemical (ATC) classification for 'antimycotics for systemic use' (J02) 2009 version was used. Demographic data and information about indications and diagnoses were collected in 2008 and 2009. From 99,053 patients, 29,324 (29.6%) received antimicrobials. Antifungals represented 1529 of 40,878 (3.7%) antimicrobials. Antifungals were mainly (54.2%) administered orally. Hospital-acquired infections represented 44.5% of indications for antifungals followed by medical prophylaxis at 31.2%. The site of infection was not defined in 36.0% of cases but the most commonly targeted sites were respiratory (19.2%) and gastrointestinal (18.8%). The most used antifungal was fluconazole (60.5%) followed by caspofungin (10.5%). Antifungal-antibacterial combinations were frequently used (77.5%). The predominance of fluconazole use in participating hospitals could result in an increase in prevalence of inherently resistant fungi, increasing the need for newer antifungals. Although acknowledging that antifungal prophylaxis in the immunocompromised host needs further exploration, repetitive surveys using ESAC-PPS methodology may help to monitor the effects of interventions set to regulate antifungal use.


Assuntos
Antifúngicos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Hospitais/estatística & dados numéricos , Micoses/tratamento farmacológico , Adolescente , Adulto , Idoso , Antibioticoprofilaxia/estatística & dados numéricos , Criança , Pré-Escolar , Infecção Hospitalar/epidemiologia , Europa (Continente)/epidemiologia , Humanos , Lactente , Pessoa de Meia-Idade , Micoses/epidemiologia , Prevalência
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