Antibiotics In Hospital Research Articles

2026. A Current Status of Antimicrobial Stewardship Programs in Korean Large Hospitals: A Nationwide Survey in 2018

BackgroundThe aim of this study was to examine the current status of antimicrobial stewardship program (ASP) in large hospitals in South Korea, identifying problems and hurdles for implementation of proper ASP, and providing a reference for the proposal of ASP policies.MethodsThe questionnaire was designed based on the “Seven Core Elements of Hospital Antibiotic Stewardship Programs” from Centers for Diseases Control and Prevention of the U.S. and modified from the questionnaire of the previous survey on ASP in Korea, 2015. The survey targeted all the hospitals with 500 beds or more in South Korea in 2018. The online-based survey using SurveyMonkey® platform was conducted for 3 weeks from June to July 2018. Only one ASP-associated physician per hospital participated in the survey.ResultsThe response rate to the survey was 88.4% (84/95). The median number of medical personnel participating in ASP was 4 [interquartile range (IQR) 2.25–5], most of which were infectious diseases specialists (median 2, IQR 1–2). Besides, some pediatric infectious diseases specialists, pharmacists, etc. were participating in the ASPs. Only 6.0% (5/84) of hospitals had full-time workers for ASP. Restrictive measures for designated antibiotics was a widely accepted ASP strategy among Korean hospitals (88.1%, 74/84) and the median number of designated antibiotic classes was 16 (IQR 11–19). An 11.9% (10/84) of hospitals introduced monitoring and intervention program against inappropriate antibiotic combination therapy. The proportion of hospitals which had interventions for inappropriate long-term antibiotic use and parenteral to oral conversion strategy were 9.5% (8/84) and 1.2% (1/84), respectively. Lack of time, personnel, and appropriate reward were perceived as the major barriers to establishing ASP in Korean hospitals.ConclusionASP in Korean hospitals were mainly carried out by 1–2 infectious diseases specialists and it heavily depended on restrictive measures for designated antibiotics. Supporting manpower and establishment of the appropriate reward system is necessary for improvement of ASP in Korean hospitals. Disclosures All authors: No reported disclosures.

1145. Reducing Antibiotic Use In Children With Respiratory Syncitial Virus-related Bronchiolitis: Implementation of TeamSTEPPS® 2.0 to Improve Pharmacy-Physician Communication in a Community Hospital Antibiotic Stewardship Program

BackgroundOveruse of antibiotics in Respiratory Syncytial virus (RSV) bronchiolitis in children has been reported between 29–80%. Our antibiotic stewardship program (ASP) utilized a validated communication tool using TeamSTEPPS ® 2.0 principles to improve pharmacy-physician communication and improve audit-feedback technique (AFT).MethodsWe trained pharmacists and physicians in TeamSTEPPS ® 2.0 using simulation-based training. The key component of the training was: closed-loop communication and using a scripted pharmacy communication tool. The scripted pharmacy communication tool was modified from the “DESC” script used in TeamSTEPPS ® 2.0, which includes (1) Describing the situation, (2) Expressing concern, (3) providing Solutions, (4) stating Consequences and coming to an agreement. We incorporated this to improve the audit-feedback technique. We aimed to: (1) Reduce overall percentage of antibiotic (abx) use in RSV bronchiolitis by 25%, (2) reduce use of ceftriaxone, (3) reduce average antibiotic days of therapy (DOT).ResultsOur baseline data from 2017–18 RSV season showed a 42% (48/113) use of abx, of which 10% were deemed inappropriate. When compared with the 2018–2019 season, no differences were noted in patient demographics. The median length of stay between the two time periods was similar (2.9 days, IQR 1.9–4.8 days vs. 3.1 days, IQR 2.1–5.1 days, P = 0.17). More patients were admitted to the pediatric intensive care unit (PICU) in the 2018–2019 period: 35/96 (36.4%) as compared with 17/113 (15%) in the previous season. Although similar proportions of patients received abx (42% vs. 41%) in the two groups (Figure 1), average abx DOT, significantly decreased in the 2018–2019 period as compared with 2017–2018 (Figure 2). There was also a decrease in the use of ceftriaxone during the 2018–2019 (Figure 3). All physicians and pharmacists were satisfied with the communication technique and thought that it improved their interaction and understanding of the ASP process.ConclusionThough we did not reduce the overall abx use in RSV bronchiolitis, we did reduce the average abx DOT and use of ceftriaxone in our institution. The use of a validated communication tool to improve prospective AFT was crucial to the success of the ASP program. Disclosures All authors: No reported disclosures.

1037. A Pharmacist-Driven 48 Hour Antibiotic Time Out Pilot at a Large Academic Medical Center

BackgroundThe Centers for Disease Control and Prevention published The Core Elements of Hospital Antibiotic Stewardship Programs in 2014, which recommended that all clinicians perform an antibiotic time out (ATO) after 48 hours. The best methods to operationalize these recommendations remain unclear. Given our information technology barriers, we developed a targeted, pharmacist-driven, 48 hour ATO pilot.MethodsThis pre-post intervention pilot study included hospitalized adults admitted to one of the four wards between 5/1/18 and 6/30/18. Patients who received ≥48 hours of broad-spectrum intravenous antibiotics (vancomycin, piperacillin–tazobactam, cefepime, a carbapenem, or a fluoroquinolone) were prospectively identified via TheraDoc (Premier Inc., Charlotte, NC). An infectious diseases (ID) trained pharmacist reviewed patients on a daily basis during June. The primary outcome was days of therapy (DOT), which was assessed with Spearman’s rank-order correlation. All P-values were from 2-sided tests, and results were deemed statistically significant at P < 0.05.ResultsA total of 151 unique patients were identified during the study period. The most common antibiotic indications were skin and soft-tissue infection (31.1%), urinary tract infection (22.5%), and intraabdominal infection (22.5%). An ID physician was consulted on 59% of patients. The pharmacist reviewed an average of 7 patients (3 unique) each day during the intervention month. A total of 27 recommendations were made with 15 (56%) being accepted. The most common recommendations were to de-escalate therapy (n = 8), stop antibiotics (n = 6), and add a stop date to the antibiotic order (n = 4). DOT in the pre- and post-intervention period did not differ (P = 0.28).ConclusionA month-long, targeted, pharmacist-driven, 48 hour ATO pilot was unable to demonstrate a reduction in DOT. Furthermore, only 56% of pharmacist recommendations were accepted despite targeting low-acuity infections, which may have limited our ability to observe a reduction in DOT. Larger studies are warranted to further evaluate how ATOs influence DOT over time.Disclosures All authors: No reported disclosures.

Current status of antimicrobial stewardship programmes in Korean hospitals: results of a 2018 nationwide survey

Antimicrobial stewardship programmes (ASPs) are suggested as a vital strategy to address antimicrobial resistance. To examine the current status of ASPs in Korean hospitals, to identify problems and challenges for the implementation of proper ASPs, and to provide a reference for developing more effective ASP policies. A questionnaire based on the 'Seven Core Elements of Hospital Antibiotic Stewardship Programs' from the US Centers for Disease Control and Prevention was developed, modified from the previous questionnaire on ASPs in Korea, 2015. ASP-participating physicians such as infectious disease specialists (IDSs), paediatric IDSs, and directors of infection control departments were targeted. Only one ASP-associated physician per hospital participated in the survey. The survey response rate was 88.4% (84/95). The median number of medical personnel participating in ASPs was 3 (interquartile range (IQR): 1-5), most of whom were IDS (median: 2; IQR: 1-2). Only 6.0% (5/84) of hospitals had full-time workers for ASPs. Whereas restrictive measures for designated antimicrobials were widely implemented among Korean hospitals (88.1%, 74/84), the proportion of hospitals with interventions for inappropriate long-term antimicrobial use and a conversion strategy from parenteral to oral antimicrobial administration was only 9.5% (8/84) and 1.2% (1/84), respectively. Lack of time, personnel, and appropriate compensation was perceived as the major barrier to establishing an ASP in Korean hospitals. ASPs in Korean hospitals were primarily carried out by one or two IDSs, and programmes mostly comprised restrictive measures for designated antimicrobials. National-level support to implement appropriate ASPs in Korean hospitals is necessary.

Drug Utilization Evaluation of Cefepime and Meropenem Based on the Infectious Disease Society of America and Defined Daily Dose Guidelines at the Payambare-Azam Bandar Abbas Hospital: A Retrospective Study

Background: Given the significant consumption of antibiotics in hospitals and the likelihood of resistance, this study was designed to determine the pattern of meropenem and cefepime administration and prescription dose, according to Infectious Disease Society of America (IDSA) and WHO Defined Daily Dose guidelines, at Payambare-Azam Hospital in Bandar Abbas, Iran. Methods: A Retrospective study was performed from August 2016-March 2017, on 200 patients (100 patients receiving cefepime and 100 patients received meropenem) hospitalized in different wards of the hospital. A total of 189 patients were enrolled in the study, with was with consideration of the patients receiving the two antibiotics concurrently. Results: Of the examined patients, 58 (31%) were female and 131 (69%) male. In the group receiving meropenem and cefepime, 62% and 60% of the patients were above 50 years old, respectively. In terms of prescriptions, 85% cases of meropenen and 49% cefepime were performed according to the defined daily dose (DDD)’s guideline. Prescribing antibiotics for 170 (90%) of patients was empirical. Also, in the 176 (93%) patients, the dose was adjusted according to the creatinine clearance. Conclusions: Increasing the number of empirical therapy, regardless of microbial cultures and susceptibility profiles, suggests further prospective studies to evaluate the reason for this finding.

Surveillance of antibiotic agents according to §23 of the German Infection Protection Act-data and results from hospitals in FrankfurtamMain, Germany, 2012-2017

Since 2011, German hospitals have been requested to record and evaluate antibiotic use in their institution. In this publication, the use of antibiotics in hospitals belonging to the administrative district Frankfurt/Main between 2012 and 2017 is presented and discussed with regards to the targets set in 2014. These targets are to improve the perioperative prophylaxis, reduce the use of cefuroxime, and increase the penicillin/cephalosporin ratio. Since 2012, hospitals in Frankfurt/Main have been transmitting thedefined daily doses(DDD) of all antibiotics used, the absolute number of patients, and their days of treatment. Since 2013, the data have also distinguished between intensive care and other units. The Frankfurt health authority calculated the total number of antibiotics and the DDD/100patient days for all hospitals combined as well as for every hospital compared to each other. From 2012 to 2017, the number of absolute annual patient days increased from 1,592,161 to 1,615,180. Antibiotic use decreased from 1,073,975 DDD to 953,349 DDD, leading to adecrease from 67.5 DDD per 100 patient days to 59.0 DDD per 100 patient days. Cefuroxime was the most frequently used antibiotic in all hospitals. The use of cefuroxime showed asignificant decrease between 2012 and 2017 (from 250,398 in 2012 to 165,160 DDD in 2017, adecrease of 34%). The use of ceftriaxone was reduced by 27%, ciprofloxacin by 9%, and levofloxacin by 16%. The targets set in 2014 were reached in the entirety of Frankfurt hospitals. However, there were significant differences between the hospitals taking part. The results were given as feedback to the hospitals in order to support their efforts in further improving antibiotic stewardship.

Linezolid versus vancomycin cost in the treatment of staphylococcal pneumonia

ObjectiveStaphylococcusaureus is involved in around 20% of nosocomial pneumonia cases. Vancomycin used to be the reference antibiotic in this indication, but new molecules have been commercialized, such as linezolid. Previous studies comparing vancomycin and linezolid were based on models. Comparing their real costs from a hospital perspective was needed. MethodsWe performed a bicentric retrospective analysis with a cost-minimization analysis. The hospital antibiotic acquisition costs were used, as well as the laboratory test and administration costs from the health insurance cost scale. The cost of each hospital stay was evaluated using the national cost scale per diagnosis related group (DRG), and was then weighted by the stay duration. ResultsFifty-eight patients were included. All bacteria identified in pulmonary samples were S. aureus. The cost of nursing care per stay with linezolid was €234.10 (SD=91.50) vs. €381.70 (SD=184.70) with vancomycin (P=0.0029). The cost of laboratory tests for linezolid was €172.30 (SD=128.90) per stay vs. €330.70 (SD=198.40) for vancomycin (P=0.0005). The acquisition cost of linezolid per stay was not different from vancomycin based on the price of the generic drug (€54.92 [SD=20.54] vs. €40.30 [SD=22.70]). After weighting by the duration of stay observed, the mean cost per hospital stay was €47,411.50 for linezolid and €57,694.0 for vancomycin (NSD). ConclusionThese results, in favor of linezolid, support other former pharmacoeconomic study based on models. The mean cost per hospitalization stay was not statistically different between the two study groups, but a trend in favor of linezolid is emerging.

Management of febrile infants aged 1 month and less than 3 months in a French university hospital: Clinical practice evaluation

BackgroundManagement of febrile infants is challenging due to the increased risk of serious bacterial infections and it varies among physicians and hospitals. The goals of this study were to describe and compare the management of febrile infants aged 1–2 months in a hospital in 2011 and 2016. MethodsWe conducted a retrospective study in the Bordeaux Pellegrin University Hospital, France, in 2011 and 2016. All infants aged 1–2 months with diagnosis codes referring to fever were included. Data on infant characteristics, fever episodes, clinical symptoms, and management were collected from medical charts. Univariate analyses and multivariate logistic models were used. ResultsA total of 530 infants were included; 89.2% had blood testing and 81.1% urine testing; 79.6% of the infants were hospitalized, three of them in the pediatric intensive care unit. The median hospitalization duration was 3 days. In the sample investigated, 59.8% of the infants received antibiotic therapy and 128 (24.1%) had bacterial infections with no difference between 2011 and 2016. The main bacterial infection was pyelonephritis (86.7%). Urethral catheterization was implemented in 2016, whereas a urine bag was utilized for 174 out of 177 infants in 2011. The percentage of contaminated urine cultures was higher in 2011 (35.9%) than in 2016 (19.6%, P<0.001). The hospitalization rate was higher in 2016. ConclusionsManagement of febrile infants changed between 2011 and 2016. The hospitalization rate and antibiotic therapy use remained high regarding the rate of bacterial infection. Use of urethral catheterization decreased the level of contamination.

The assess of knowledge, attitude and practice of antibiotic stewardship among healthcare providers in a tertiary care hospital

Background: Antibiotics are the most commonly used drugs often associated with inappropriate use leading to resistance. While knowledge enlightens and provides an insight into the problems faced, behavioral change solely depends on the beliefs and attitude. Aim of this study to evaluate the knowledge and beliefs about antimicrobial prescribing among prescribers in a teaching tertiary care hospitalMethods: The present study was conducted in the Department of Pharmacology, ESIC Medical College and Hospital, Faridabad. after Ethical clearance from the Institutional Ethics Committee. Design of this study was a prospective, cross-sectional study carried out in the form of a survey in which a pretested, semi-structured, validated questionnaire of 30 questions was provided to Junior residents, Senior residents and Faculty of different specialties and response was recorded. Questionnaire comprises of 10 questions each in knowledge, attitude and practice section.Results: Out of 132 prescribers 86.5% believed that irrational practice will cause global resistant development. majority (92.3%) were expressing the need that sample culture should be sent before starting antibiotics but only 69.2 % were of the opinion that culture and sensitivity should be done in all infections and 92.3% were expressing the view that hospital antibiotics policy is useful in reducing AMR.Conclusions: The present survey on antibiotic usage gives useful information about the knowledge, attitudes and practices of prescribers and help plan suitable educational interventions that aim at improving the antimicrobial prescribing and minimizing the development of resistance.

Antibiotic Review Kit for Hospitals (ARK-Hospital): study protocol for a stepped-wedge cluster-randomised controlled trial

BackgroundTo ensure patients continue to get early access to antibiotics at admission, while also safely reducing antibiotic use in hospitals, one needs to target the continued need for antibiotics as more diagnostic information becomes available. UK Department of Health guidance promotes an initiative called ‘Start Smart then Focus’: early effective antibiotics followed by active ‘review and revision’ 24–72 h later. However in 2017, < 10% of antibiotic prescriptions were discontinued at review, despite studies suggesting that 20–30% of prescriptions could be stopped safely.Methods/designAntibiotic Review Kit for Hospitals (ARK-Hospital) is a complex ‘review and revise’ behavioural intervention targeting healthcare professionals involved in antibiotic prescribing or administration in inpatients admitted to acute/general medicine (the largest consumers of non-prophylactic antibiotics in hospitals). The primary study objective is to evaluate whether ARK-Hospital can safely reduce the total antibiotic burden in acute/general medical inpatients by at least 15%. The primary hypotheses are therefore that the introduction of the behavioural intervention will be non-inferior in terms of 30-day mortality post-admission (relative margin 5%) for an acute/general medical inpatient, and superior in terms of defined daily doses of antibiotics per acute/general medical admission (co-primary outcomes). The unit of observation is a hospital organisation, a single hospital or group of hospitals organised with one executive board and governance framework (National Health Service trusts in England; health boards in Northern Ireland, Wales and Scotland). The study comprises a feasibility study in one organisation (phase I), an internal pilot trial in three organisations (phase II) and a cluster (organisation)-randomised stepped-wedge trial (phase III) targeting a minimum of 36 organisations in total. Randomisation will occur over 18 months from November 2017 with a further 12 months follow-up to assess sustainability. The behavioural intervention will be delivered to healthcare professionals involved in antibiotic prescribing or administration in adult inpatients admitted to acute/general medicine. Outcomes will be assessed in adult inpatients admitted to acute/general medicine, collected through routine electronic health records in all patients.DiscussionARK-Hospital aims to provide a feasible, sustainable and generalisable mechanism for increasing antibiotic stopping in patients who no longer need to receive them at ‘review and revise’.Trial registrationISRCTN Current Controlled Trials, ISRCTN12674243. Registered on 10 April 2017.

Analysis of clinico-epidemiological profile in patients of acute appendicitis at a tertiary care centre in Karnataka: A retrospective observational study

Background: Appendix, a part of large intestine and gut associated lymphoid tissue is often inflamed resulting in acute appendicitis which is a surgical emergency. The current study is undertaken to analyse the clinic-epidemiological profile of acute appendicitis Methods: A retrospective database analysis of 98 patients of Acute appendicitis admitted in the Department of General Surgery, from January 2018 to January 2019 for age, Sex, Clinical diagnosis, Ultrasound diagnosis, Total leucocyte count, Histopathological diagnosis were noted. Results and Conclusion: Acute appendicitis was more common in males (65%) and in 15-30yrs age group. Mean TLC was 12022.73+ 434.23** with only 33.67% patients TLC more than 14000/mm3. 51% patient’s histopathological diagnosis was acute appendicitis. Early hospital admission, antibiotic therapy or early uptake for surgical procedure based on clinical examination and sonological evaluation may be the reason for more number of patients with TLC less than 11000mm3.

Antibiotic Consumption and Resistance during a 3-Year Period in Sicily, Southern Italy.

Antimicrobial resistance (AMR) is one of the biggest issues facing global public health. In 2017, Italy adopted its first National Action Plan on Antimicrobial Resistance 2017–2020, which works through the synergy between national, regional, and local levels. In the framework of a Regional Action Plan on healthcare-associated infections and AMR prevention, the Sicilian Health Authority of the Sicilian Region, Southern Italy, has implemented a surveillance system of antibiotic consumption in hospitals, in the community, and of resistance rates (RRs) in hospital settings. Data on antibiotic consumption and on antibiotic RRs have been collected from 2015 to 2017 from pharmacies and laboratories of participating hospitals and from community, respectively. Data on antibiotic consumption showed that the most consumed antibiotics in hospitals were fluoroquinolones in 2015, penicillin in 2016, and beta-lactams in 2017. From 2015 to 2017, data on Klebsiella pneumoniae showed significant increasing RRs to all antibiotic classes, except to carbapenems. RRs of third-generation cephalosporins and carbapenems Escherichia coli showed significant decreasing trends. RRs of the other microorganisms did not change significantly during the study period. The results from the present study show that in Sicily, the use of antibiotics and RRs for selected microorganisms are at a high level. Immediate strategies are needed to decrease the inappropriate usage of antibiotics and control the spread of AMR.

The inappropriate use of antibiotics in hospitalized dengue virus-infected children with presumed concurrent bacterial infection in teaching and private hospitals in Bandung, Indonesia.

BackgroundDengue virus infection (DVI) among children is a leading cause of hospitalization in endemic areas. Hospitalized patients are at risk of receiving unnecessary antibiotics.MethodsA retrospective medical review analysis study was conducted to evaluate the prevalence, indication, and choice of antibiotics given to hospitalized patients less than 15 years of age with DVI in two different hospital settings (teaching and private hospitals) in the Municipality of Bandung. Epidemiological, clinical, and laboratory data were obtained using a pre-tested standardized questionnaire from patients’ medical records admitted from January 1 to December 31, 2015.ResultsThere were 537 (17.5%) out of 3078 cases who received antibiotics. Among 176 cases admitted to the teaching hospitals, presumed bacterial upper respiratory tract infection (URTI) and typhoid fever were found in 1 (0.6%) case and 6 (0.3%) cases. In private hospitals among 2902 cases, presumed bacterial URTI was found in 324 (11.2%) cases, typhoid fever in 188 (6.5%) cases and urinary tract infection (UTI) in 18 (0.6%) cases. The prevalence of URTI and typhoid fever were significantly lower in the teaching hospitals compared to the private hospitals (p<0.0001 and p<0.05 respectively). The diagnosis of URTI in both teaching and private hospitals was merely based on clinical findings. Amoxicillin was given to 1 patient in the teaching hospitals; the 3rd generation of cephalosporins, mostly intravenous, were given in 247 (67%) cases in private hospitals. The diagnosis of typhoid fever in the teaching hospitals was based on culture in 1 (16.7%) and reactive IgM anti-Salmonella in 5 (83.3%) cases while in the private hospitals, they were based on reactive IgM anti-Salmonella in 13 (6.5%) cases, single Widal test in 61 (32.5%), and without laboratory confirmation in 114 (60.6%) cases. Most of the cases in both hospital settings were treated mostly with 3rd generation cephalosporin. The diagnosis of UTI was based on positive leucocyte esterase and nitrite in urine dipstick test in 7 (38.9%) and leucocyturia alone in 11 (61.1%) cases and was treated with 3rd generation in 15 (83.3%) cases, amoxicillin, chloramphenicol and clarithromycin, each in 1 (5.6%) case.ConclusionThe use of antibiotics in private hospitals was inappropriate in most cases while the use of antibiotics in the teaching hospital was more accountable. This study indicated that interventions, such as the implementation of the antibiotics stewardship program, are needed especially in private hospitals to reduce inappropriate use of antibiotics.

Bilateral septic arthritis of the knee caused by group B streptococci: a case report

Septic arthritis (SA) remains to be a critical diagnosis for a swollen knee at the emergency department. Here, we report a rare case of bilateral knee arthritis in a 59-year-old diabetic woman who had been immobilized 5 months prior to admission. Her right knee swelling exacerbated in 10 days leading to left knee involvement. In 5 days the clear synovial tap in the first hospital turned purulent in the second hospital and empirical antibiotics get started with high WBC count, dominant neutrophils, and Gram-positive cocci in smear. Knee arthrotomy was performed after 6 days in the third hospital with the same smear results but negative blood and synovial cultures of both knees. When followed in retrograde, two positive blood cultures were reported for Streptococcus agalactiae in the second hospital. Vancomycin was changed to ampicillin and symptoms were resolved in 4 weeks. Despite improvement, mobility was not retained. Uncommon etiologic agents of knee arthritis should be in mind specifically in debilitated patients. Timely initiation of proper antibiotics hinders permanent sequels, hence clinicians should be suspicious of such organisms.

Compliance to antibiotic guidelines leads to more appropriate use of antibiotics in skin and soft tissue infections in injecting drug users

Background: Knowledge about the treatment of skin and soft tissue infections in injecting drug users in countries with a low prevalence of antibiotic resistance is limited. We investigated bacterial antibiotic resistance and treatment of skin and soft tissue infections in Norwegian drug users.Methods: We performed a two year clinical cross-sectional observational study in a Norwegian hospital. Data were collected retrospectively from hospital records. We examined bacteriological findings and antibiotic resistance, and evaluated compliance to treatment guidelines and appropriateness of empirical antibiotic therapy relative to results of cultures and susceptibility testing. Descriptive and univariate analyses were performed.Results: Hundred and thirty-five injecting drug users were admitted with skin and soft tissue infection in the study period. Cultures were obtained from 103 (77%) abscesses and eight (24%) erysipelas and cellulitis, with bacterial growth in 80 (78%) and five (63%), respectively. Streptococci and staphylococci were the most prevalent bacteria, but methicillin-resistant Staphylococcus aureus was found in only one patient. Compliance to hospital antibiotic guidelines was 70%. Ninety-one per cent of patients in the compliant and 79% in the non-compliant group were given effective empirical antibiotics (p = .334). In the non-compliant group, significantly more patients received broad-spectrum empirical antibiotics (p < .001). In 30 cases where adjustment of antibiotic therapy was possible according to susceptibility testing, this was performed in only 14 cases.Conclusions: Bacteria and resistance patterns did not differ significantly from the skin and soft tissue infections in the general population in Norway. Compliance to antibiotic guidelines led to significantly less use of broad-spectrum antibiotics and to good bacterial coverage. General guidelines for treatment should be applied to injecting drug users with skin and soft tissue infections.

WS05-2 Empowering patients with cystic fibrosis to participate in the administration of intravenous antibiotics in hospital

WS05-2 Empowering patients with cystic fibrosis to participate in the administration of intravenous antibiotics in hospital

MON-126 Fulminant Type 1 Diabetes Caused by "Jumping"

Background: Fulminant type 1 diabetes mellitus (FT1DM) is characterized by rapid onset of disease and complete destruction of pancreatic β-cell function. It is associated with genetic susceptibility, viral infection, autoimmunity and pregnancy. In this report, the patient jumped from a 2-meter-high platform, which caused acute pancreatitis and then induced FT1DM. Clinical case: A 40-year-old male suffered from abdominal pain after jumping from a 2-meter-high platform on June 7, 2017, and the pain was relieved slightly after about half an hour. On June 8, abdominal pain was worsen with fever up to 38.5℃. He was treated with antibiotics in the local hospital. But abdominal pain gradually increased, and was relieved in prone position. He was hospitalized on June 10. Pancreatic CT showed pancreatic edema and obvious exudation. Amylase was 201U/L(15-115)and lipase normal. He was diagnosed as “acute pancreatitis” and treated with somatostatin, antibiotics, proton pump inhibitors and so on. Fasting blood glucose is 4.96mmol/L and body temperature is normal on June 11. On June 13, obvious thirst appeared. On June 14, laboratory examinations showed fasting blood glucose was 25.69mmol/L, HCO3- 13.24mmol/L, a white blood cell count of 20.22×109/L,neutrophil percentage 87.6%, amylase 872U/L, lipase 141U/L, and HbA1c was 5.69%. Insulin was given to reduce blood glucose. On June 16, fasting blood glucose was 16.49mmol/L. On June 26, somatostatin and proton pump inhibitors were stopped and abdominal pain disappeared. Hypoglycemic drugs were adjusted to insulin glargine and aspart. He was admitted to our hospital on July 1st. His height and weight were 170cm and 59.5kg, respectively (body mass index 20.95kg/m2). Serum glucose was very high (15.24mmol/L), while HbA1c was relatively low (6.8%). Fasting, normal postprandial 1h and 2h C-peptide levels were zero. Islet-related autoantibodies against GAD and ZnT8 were positive and others were negative. Pancreatic magnetic resonance imaging and MRCP were normal. IgG, IgG4, complement C3, C4, antinuclear antibody spectrum, vasculitis group, antibody to beta 2 glycoprotein, anticardiolipin antibodies, thyroid peroxidase antibody and thyroglobulin antibody were negative. He was discharged after blood glucose was controlled with insulin glargine and aspart. The patient had class II HLA gene showed DQB1*04:01-DRB1*04:05 haplotype. Conclusion: In the background of hereditary susceptibility, acute pancreatitis was induced by jumping off a 2-meter-high platform, and leaded to FT1DM. This is the first case of FT1DM caused by jumping down from a high place.

Risk factors for community-onset bloodstream infection with extended-spectrum β-lactamase-producing Enterobacteriaceae: national population-based case–control study

ObjectivesThe aim was to investigate risk factors for community-onset bloodstream infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE BSI). MethodsIt is mandatory to report EPE BSI to a national register at the Public Health Agency of Sweden. Using this register, we performed a population-based case–control study from 2007 to 2012 of 945 cases and 9390 controls. Exposure data on comorbidity, hospitalization, in- and outpatient antibiotic consumption and socio-economic status were collected from hospital and health registers. ResultsThe overall incidence of EPE BSI was 1.7 per 100 000 person-years. The 30-day mortality was 11.3%. Urological disorders inferred the highest EPE BSI risk, adjusted odds ratio (aOR) 4.32 (95% Confidence Interval (CI) 3.41–5.47), followed by immunological disorders, aOR 3.54 (CI 2.01–6.23), haematological malignancy, aOR 2.77 (CI 1.57–4.87), solid tumours, aOR 2.28 (1.76–2.94) and diabetes, aOR 2.03 (1.58–2.61). Consumption of fluoroquinolones or mostly non-EPE-active antibiotics with selective Gram-negative spectrum of activity within the previous 3 months was associated with EPE BSI, aORs 5.52 (CI 2.8–11.0) and 3.8, CI 1.9–7.7) respectively. There was a dose–response relationship in EPE BSI risk with increasing number of consecutive regimens. Antibiotic consumption >3 months before EPE BSI was not associated with increased risk. Higher age, malignancies and education ≤12 years (aORs >2) were associated with increased 30-day mortality. ConclusionsTargeted interventions should be directed towards improving care for patients with immunosuppression, urological disorders and subjects with lower socio-economic status. Antibiotic stewardship should focus on reduction of fluoroquinolones.

Potential for More Rational Use of Antibiotics in Hospitalized Children in a Country With Low Resistance: Data From eight Point Prevalence Surveys.

Antimicrobial resistance is low in Norway, but to prevent an increase, the Norwegian Government has launched a National Strategy including a 30% reduction of broad-spectrum antibiotics (BSA) in hospitals within 2020. BSA are defined as second- and third-generation cephalosporins, carbapenems, piperacillin/tazobactam and quinolones. There are no recent studies of antibiotic use in Norwegian hospitalized children. The aim of this study was to describe the use of antibiotics with emphasis on BSA in Norwegian hospitalized children and neonates to detect possibilities for optimization. Data were extracted from 8 national point prevalence surveys of systemic antibiotic prescriptions in Norwegian hospitals between 2015 and 2017. The choices of antibiotics were compared with the empirical recommendations given in available Norwegian guidelines. In total, 1323 prescriptions were issued for 937 patients. Twenty-four percent of pediatric inpatients were given antibiotics. Adherence to guidelines was 48%, and 30% (95% confidence interval: 27%-33%) of all patients on antibiotics received BSA. We identified only small variations in use of BSA between hospitals. One-third of the patients on antibiotic therapy received prophylaxis whereof 13% were given BSA. In 30% of prescriptions with BSA, no microbiologic sample was obtained before treatment. This study reveals an excess of prescriptions with BSA in relation to the low resistance rate in Norway. Our findings reveal areas for improvement that can be useful in the forthcoming antibiotic stewardship programs in Norwegian pediatric departments.

Physicians’ knowledge, attitudes, and practice concerning antimicrobial resistance &amp; prescribing: a survey in Fayoum Governorate, Egypt

Antimicrobial resistance (AMR), globally and nationally, is considered as a serious problem. We aimed to assess the knowledge, attitudes, and practices of physicians towards antimicrobial resistance. To assess the knowledge, attitudes, and practices of physicians towards antimicrobial resistance in Egypt. A cross-sectional study. The study was conducted on a group of physicians from various specialties prescribing antibiotics in different hospitals in Fayoum Governorate from January to December 2017. Data was collected using self-administered questionnaires covering four main areas (demographic characteristics, knowledge, attitudes, and practices). Knowledge score was calculated for 11 knowledge questions by giving one point for each correct answer with maximum score 11. Attitude score was calculated for 21 attitude questions by giving 2 for agree, 1 for neutral and 0 for disagree, with maximum score 42. Mean knowledge score of 302 participants was 8.65 ± 1.69 out of 11. The main knowledge score was significantly higher among physicians working at Fayoum University Hospital (FUH) than at other hospital types, among pediatricians and physicians of internal medicine specialists than surgeons & obstetricians, and among participants reporting internet as a source of knowledge (P < 0.05). Mean total attitude score was 36.4 ± 4.47. Attitude score was significantly higher among physicians working at insurance hospital, followed by those working at FUH, and physicians reporting internet as a source of knowledge (P < 0.05). Positive correlation between knowledge and attitude scores was reported (r = 0.313, P = 0.001). About 33.8% declared that they prescribe antibiotics for viral infections. With regard to factors affecting antibiotic prescribing, the most commonly reported were previous experience (85.4%), antibiotic availability (68.2), guidelines (70.2%), and microbiological advice (55.6%). Despite good knowledge and appropriate attitudes of our participants, the practices of participants need to be improved.