Assuntos
Anticorpos Neutralizantes/metabolismo , Autoanticorpos/metabolismo , COVID-19/diagnóstico , Interferon gama/genética , Infecções por Mycobacterium não Tuberculosas/diagnóstico , Micobactérias não Tuberculosas/fisiologia , SARS-CoV-2/fisiologia , Coinfecção , Humanos , Interferon gama/imunologia , Masculino , Pessoa de Meia-Idade , Índice de Gravidade de DoençaAssuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Compostos Heterocíclicos com 3 Anéis/uso terapêutico , Hospitais de Ensino , Rifampina/uso terapêutico , Tuberculose/tratamento farmacológico , Adulto , Quimioterapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Oxazinas , Piperazinas , Piridonas , Resultado do Tratamento , Reino UnidoRESUMO
AIMS: Given the threat of rising antimicrobial resistance (AMR), 10 audit standards were selected to audit antimicrobial stewardship (AMS) in secondary care to assess guideline adherence and establish quality improvement initiatives in antimicrobial prescribing. METHODS: Patients were included if they received intravenous (IV) antibiotics across seven medical wards in Waikato or Thames hospitals, New Zealand, in November 2021. Audit standards were defined from the regional antimicrobial prescribing policy and adult antimicrobial guidelines. RESULTS: In total, 205 patients were audited. Microbiological sampling standards were met in 87 of 126 occasions (69.0%). Antimicrobial choices adhered to guidelines in 89 of 163 patients (54.6%), where guidelines were available. Documentation of antimicrobial indications in the medical notes and antimicrobial review at 48 to 72 hours met the standards at over 90%. Only 2 of 13 patients (15.4%) receiving piperacillin/tazobactam or a carbapenem were discussed with Infectious Diseases (ID). Documentation of indications and durations on paper-based medication charts was infrequent, around 12%. Evaluating for health equity, similar results were observed for Maori and non-Maori. CONCLUSIONS: Our audit identified specific areas for AMS quality improvement initiatives. Regular audit should become an essential element of the New Zealand AMS strategy. We believe increased AMS resources are required.
Assuntos
Anti-Infecciosos , Gestão de Antimicrobianos , Adulto , Humanos , Anti-Infecciosos/administração & dosagem , Anti-Infecciosos/uso terapêutico , Pacientes Internados , Nova Zelândia , Melhoria de Qualidade , Auditoria Médica , Administração IntravenosaRESUMO
We report a case of Buruli ulcer in a tourist from the United Kingdom. The disease was almost certainly acquired in Brazil, where only 1 case had previously been reported. The delay in diagnosis highlights the need for physicians to be aware of the disease and its epidemiology.
Assuntos
Úlcera de Buruli/diagnóstico , Úlcera de Buruli/epidemiologia , Adulto , Antibacterianos/uso terapêutico , Brasil/etnologia , Úlcera de Buruli/microbiologia , Úlcera de Buruli/terapia , Doenças Transmissíveis Emergentes/diagnóstico , Doenças Transmissíveis Emergentes/epidemiologia , Doenças Transmissíveis Emergentes/microbiologia , Doenças Transmissíveis Emergentes/terapia , Humanos , América Latina/etnologia , Masculino , Mycobacterium ulcerans/genética , Mycobacterium ulcerans/isolamento & purificação , Transplante de Pele , Viagem , Reino Unido/epidemiologiaRESUMO
This is a presentation of a case of disseminated fungal infection in a renal transplant patient with Nannizziopsis obscura, a species not previously reported as having caused disseminated disease in humans and not previously reported in the UK. The fungus was isolated from a intramuscular collection and from a lymph node. The patient responded well to a course of posaconazole.