Antibiotics In Hospital Research Articles

A STUDY ON DRUG UTILIZATION PATTERN OF CEPHALOSPORINS IN GENERAL MEDICINE AND SURGICAL INPATIENT DEPARTMENT

Objective: Cephalosporins are a commonly used group of antibiotics in hospitals and healthcare facilities around the world. In the developed countries through the use of older cephalosporins is declining, that of the newer generations has increased. The objective of this study was to assess Drug Utilization Pattern of Cephalosporins in General Medicine and Surgical Inpatient Departments of tertiary care hospital.Methods: The data of enrolled patients were collected from case records of admitted inpatients during the study period. The collected data was assessed by statistical analysis using descriptive analysis.Results: A total of 110 inpatients were enrolled in the study. Out of 110 patients, males were 54.5% and females were 45.5%. The results analyzed that the prescriptions are more with third-generation cephalosporins than fourth-generation cephalosporins.Conclusion: The study concludes that 3rd generation cephalosporins is widely used for treating various nosocomial infections.

Hospital-Level Variability in Broad-Spectrum Antibiotic Use for Children With Acute Leukemia Undergoing Hematopoietic Cell Transplantation.

OBJECTIVETo explore the prevalence and drivers of hospital-level variability in antibiotic utilization among hematopoietic cell transplant (HCT) recipients to inform antimicrobial stewardship initiatives.DESIGNRetrospective cohort study using data merged from the Pediatric Health Information System and the Center for International Blood and Marrow Transplant Research.SETTINGThe study included 27 transplant centers in freestanding children's hospitals.METHODSThe primary outcome was days of broad-spectrum antibiotic use in the interval from day of HCT through neutrophil engraftment. Hospital antibiotic utilization rates were reported as days of therapy (DOTs) per 1,000 neutropenic days. Negative binomial regression was used to estimate hospital utilization rates, adjusting for patient covariates including demographics, transplant characteristics, and severity of illness. To better quantify the magnitude of hospital variation and to explore hospital-level drivers in addition to patient-level drivers of variation, mixed-effects negative binomial models were also constructed.RESULTSAdjusted hospital rates of antipseudomonal antibiotic use varied from 436 to 1121 DOTs per 1,000 neutropenic days, and rates of broad-spectrum, gram-positive antibiotic use varied from 153 to 728 DOTs per 1,000 neutropenic days. We detected variability by hospital in choice of antipseudomonal agent (ie, cephalosporins, penicillins, and carbapenems), but gram-positive coverage was primarily driven by vancomycin use. Considerable center-level variability remained even after controlling for additional hospital-level factors. Antibiotic use was not strongly associated with days of significant illness or mortality.CONCLUSIONAmong a homogenous population of children undergoing HCT for acute leukemia, both the quantity and spectrum of antibiotic exposure in the immediate posttransplant period varied widely. Antimicrobial stewardship initiatives can apply these data to optimize the use of antibiotics in transplant patients.Infect Control Hosp Epidemiol 2018;797-805.

Consumption of antibiotics in Chinese public general tertiary hospitals (2011-2014): Trends, pattern changes and regional differences

BackgroundChina has a high rate of antibiotic use. The Chinese Ministry of Health (MOH) established the Center for Antibacterial Surveillance (CAS) to monitor the use of antibacterial agents in hospitals in 2005. The purpose of this study was to identify trends, pattern changes and regional differences in antibiotic consumption in 151 public general tertiary hospitals across China from 2011–2014.Materials and methodsValid data for antibiotic use were collected quarterly, and the antibiotic consumption data were expressed as the defined daily dose (DDD) per 100 inpatient days (ID). We compared the patterns of antibiotic use in different classes and geographical clusters.ResultsTotal antibiotic use significantly decreased (P = 0.018) from 75.86 DDD/100 ID in 2011 to 47.03 DDD/100 ID in 2014. The total consumption of flomoxef sodium and cefminox increased from 1.31 DDD/100 BD in 2011 to 8.6 DDD/100 BD in 2014. Cephalosporins were the most frequently used antibiotics in all regions. Third-generation cephalosporins accounted for more than 45% of the cephalosporins used. Carbapenem use substantially increased (P = 0.043). Penicillin combinations with inhibitors accounted for 50% of the penicillin used, and prescribed meropenem accounted for most of the carbapenems used in all regions in 2014. The subclasses in each antibiotic group were used differently between the seven regions, and the total hospital antibiotic use in 2014 differed significantly by region (P = 0.014).ConclusionAlthough the volume and intensity of total antibiotic use decreased, the antibiotic use patterns were not optimal, and broad-spectrum antibiotics were still the main classes. The aggregate data obtained during the study period reveal similar antibiotic consumption patterns in different regions. These findings provide useful information for improving the rational use of antibiotics. More detailed data on antibiotics linked to inpatient diseases need to be collected in future studies.

ANTIBIOTIC PRESCRIPTION TO PEDIATRIC IN HOSPITAL BENGKULU, INDONESIA: ATC/DDD INDEX

Objective: The aim of this study was to evaluate the utilization of antibiotics for children in the General Hospital of Dr. M. Yunus Bengkulu, Indonesia by using the ATC/DDD index, which is accepted as a standard method.Methods: This study was descriptive analytic research with qualitative methods. Observations conducted over six months collecting retrospective prescribing data antibiotics in children admitted in January to June 2014. Data obtained assessed antibiotics prescribed in a quantity which is calculated using ATC/DDD index. In this study, DDDs of anti-infective agents are listed for systemic use, according to ATC/DDD 2016 Index. Data pediatric patients hospitalized amounted to 447 patients while fulfilling the inclusion criteria amounted to 103 medical records and the use of antibiotics which recorded 175 prescriptions.Results: The kind of antibiotics that are widely used are gentamicin (34.9%) and ampicillin (34.3%). The highest ACI based group is penicillin group antibiotics (ampicillin) is 26 DDD/100 bed-days. Highest DDDs in this study is ampicillin (101.7). Utilization of antibiotics in hospitals in Bengkulu, Indonesia to pediatric patient higher than suggested by the WHO is based on a quantitative analysis using the ACT/DDD index.Conclusion: Analysis of antibiotic use in children is not rationally quantitatively seen from the total value of ACI in one of the government hospital is very high compared to WHO standard and based on the most antibiotic type was ampicillin followed by gentamicin.

Health care system leaders' perspectives on infection preventionist and registered nurse engagement in antibiotic stewardship

Infection preventionists (IPs) and registered nurses (RNs) have an important role to play in antibiotic stewardship programs (ASPs). Recent articles highlight their potential roles in practice, research, education, and policy; however, little is known about their actual ASP engagement. Leaders often have early knowledge of emerging trends and evolving health care worker roles. A survey was developed using the Centers for Disease Control and Prevention's Core Elements of Hospital Antibiotic Stewardship Programs to assess health care system infection prevention and control leaders' perceptions of IP and RN engagement in hospital ASPs. Thirty-five leaders representing all regions of the United States completed the survey. Their organizations tended to have significant ASP leadership support, but lacked ASP policies indicating IP and RN roles and responsibilities. IPs were more likely than RNs to be members of the ASP team and have greater ASP knowledge. Neither discipline was conducting patient education related to proper use of antibiotics, but this was identified as a future ASP role. The 2017 Joint Commission Antimicrobial Stewardship Standard was accelerating ASP implementation. IPs and RNs are well-positioned to assume greater roles in ASPs, especially in educating patients about the safe and proper use of antibiotics. However, their roles must be clearly identified, defined, and quantified. In so doing, knowledge and skill gaps can be identified and specific educational programs developed to advance their successful engagement in ASPs.

Retrospective study of single dose of antibiotic in laparoscopic appendicectomy

Background: Laparoscopic appendicectomy for interval appendix is becoming popular among the surgeon. Aim of the study is whether a single dose of antibiotic in laparoscopic appendicectomy is sufficient.Methods: A case study of 30 cases of laparoscopic appendicectomy performed with the use of single dose per-operative antibiotics in Guru Gobind Singh Hospital, Jamnagar in various surgical units from year 2015-2016.Result: Wound infection is present in 10% of the cases, with none of the patients suffering Grade 3 or 4 wound infections.Conclusions: It conclude that a single dose of antibiotic is sufficient for patient undergoing laparoscopic appendicectomy interval appendix.

Incidence of Surgical Site Infections (SSIs) and Antimicrobial Resistance their Pathogens in Ukraine

OBJECTIVE — to analyses the results of patients’ surgery, to determine the incidence rate of surgical site infections (SSIs) and to identify prevailing pathogens and their resistance to antibiotics in Ukrainian hospitals.
 MATERIALS AND METHODS. The investigation included 9,408 patients who underwent surgeries during 2015 in 12 surgical hospitals in different Ukrainian regions. In order to determine the incidence rates of SSIs were used the standard definition that were developed by the CDС (USA). The investigation included the analysis of 1,248 strains from patients with clinical symptoms SSIs. The identification and antimicrobial susceptibility of cultures were determined, using automated microbiology analyzer Vitek 2 Compact (BioMerieux, France). Susceptibility to antibiotics was determined using AST cards (BioMerieux, France). Some antimicrobial susceptibility test used Kirby — Bauer antibiotic testing. Interpretative criteria were those suggested by the CLSI (USA).
 RESULTS AND DISCUSSION. Data analysis demonstrated that 13.3 % (CI 95 %: 12.3—14.2 %) patients developed postoperative SSIs. Infection rates after various surgical procedures at surgical sites were observed. Shows the high infection rate in appendectomy (17.47 %), gastric, small and large bowel surgeries (18.23 %). The infection rate in orthopedic procedures (13.27 %), cholelithiasis (hepatobiliary) (14.93 %), uterus and adnexal structures (11.10 %), urinary tract and genitalia (9.37 %) and hernia (14.1 %) are comparatively lower. The infection rate in lower segment caesarean structure is 4.24 % and excision of dermoid cysts, lipomas 3.22 %. Staphylococcus aureus was identified as the most common causative agent of SSIs (27.6 %), followed by Escherichia coli (14.1 %), Enterococcus faecalis (13.5 %), and Pseudomonas aeruginosa (10.1 %). Frequency of Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter aerogenes, Enterococcus faecium, Streptococcus spp., Staphylococcus epidermidis and Proteus vulgaris was 7.1 %, 6.9 %, 6.1 %, 4.7 %, 4.6 %, 3.6 %, and 1.6 %, respectively. Antibiotic susceptibility testing showed that all strains of S. aureus resistant to penicillin. The most active antibiotics found were linezolid, tigecycline, and mupirocin, showing growth inhibition of 100 % strains tested, followed by nitrofurantoin, trimethoprim/ sulphamethoxazole, to fusidic acid, teicoplanin, fosfomycin, gentamycin, vancomycin. Susceptibility to tetracycline, rifampicin, erythromycin, and clindamycin was observed to be some lower. Methicillin-resistant S. aureus comprised 1 %, while Vancomycin-resistant S. aureus comprised 9.3 %. Resistance E. faecalis to ceftibuten, chloramphenicol, moxifloxacin, and teicoplanin was 100 % and to cefepime 96 %. The proportion of vancomycin-resistant enterococci was 6.9 %. 26.5 % of E. coli strains showed resistance to all tested antibiotics. The most potent antimicrobials were imipenem, tobramycin, meropenem, levofloxacin and amikacinum. The high rates of resistance were found to penicillum, lincomycin, clindamycin, ampicillin, clarithromycin, amoxicillin, and to cefuroxime. K. pneumoniae showed the lowest resistance to amikacin and imipenem, and was moderately sensitive to cefepime, gentamicin, ceftriaxone, tobramycin, piperacillin/ tazobactam, ciprofloxacin, tetracycline, ceftazidime, and aztreonam. 39.6 % of P. aeruginosa were resistant to all tested antibiotics. The most potent antimicrobials were meropenem, tobramycin, imipenem and levofloxacin. The high rates of resistance were found to penicillin, erythromycin, rifampicin, tetracycline, azithromycin, amoxicillin, cefalexin, ampicillin/sulbactam, clarithromycin, and to pefloxacin. P. aeruginosa were 100 % resistant to oxacillin, ceftibuten, tetracycline, and erythromycin.
 CONCLUSIONS. SSIs remain an important cause of postoperative morbidity. Antimicrobial resistance among these and other clinically important pathogens is an increasing problem. The clinical should choose antimicrobial drug in accordance with the local bacterial resistance characteristics for reduce the production of drug resistance and improve the effect of anti-infection treatment possibly.

PCR screening of antimicrobial resistance genes in faecal samples from Australian and Chinese children.

Recent public awareness campaigns on the risk of antibiotic resistance in pathogenic microbes has placed pressure on governments to enforce stricter antimicrobial stewardship policies on hospitals and the agricultural industry. In this study, faecal samples from Australian and Chinese children were screened for the presence of antimicrobial resistance genes (ARGs) in order to identify demographics at risk of carriage of these genes and to examine antimicrobial stewardship policies from the two countries that may influence carriage. Faecal samples from 46 Australian and 53 Chinese children were screened by PCR for the presence of six clinically relevant ARGs. Clinical and demographic data were also collected from each patient. More than 90% of faecal samples from Chinese children tested positive for β-lactam, macrolide, tetracycline and aminoglycoside resistance genes, which was substantially higher than Australian samples. Besides country of origin, no clear trend could be seen to predict carriage of ARGs. The exception to this was Chinese-born children who immigrated to Australia having higher rates of carriage of blaTEM and tetM genes than children born and still living in Australia. These data indicate that Chinese children are more likely to carry certain ARGs than Australian children. The Chinese government has recently implemented strict policies to control the overuse of antibiotics in hospitals. However, many of these policies do not extend to the agricultural industry, which could explain the differences seen in this study.

Molecular epidemiology and antimicrobial resistance of Clostridium difficile in a national geriatric hospital in Costa Rica

The epidemiology of Clostridium difficile infections (CDI) is changing rapidly worldwide; knowledge on the genotypes of C.difficile circulating in specialized geriatric hospitals and their resistance to antibiotics is scarce or non-existent. Prospective study of the molecular epidemiology of CDI, conducted in a national geriatric hospital in Costa Rica for a period of 11 months. The study patients exhibited a diverse range of comorbidities, but none were associated with CDI. Polyclonality, including three new ribotypes, and a high level of resistance to antibiotics were determined by analysing the 32 isolates obtained in these cases. Despite the diversity in strains observed, the most frequent types were NAP6/RT002 and NAP2/RT001. NAP9/RT017 was associated with community acquisition. Nineteen types of antimicrobials were used before the onset of diarrhoea in the patients; no particular genotype was associated with the onset of infection or severity. Based on the abundance of strain types observed and their resistance to antibiotics in this geriatric hospital, these results contribute to a better overall understanding of the epidemiology of CDI worldwide, and to surveillance programmes targeting geriatric populations.

Development of a patient-centred intervention to improve knowledge and understanding of antibiotic therapy in secondary care

BackgroundWe developed a personalised antimicrobial information module co-designed with patients. This study aimed to evaluate the potential impact of this patient-centred intervention on short-term knowledge and understanding of antimicrobial therapy in secondary care.MethodsThirty previous patients who had received antibiotics in hospital within 12 months were recruited to co-design an intervention to promote patient engagement with infection management. Two workshops, containing five focus-groups were held. These were audio-recorded. Data were analysed using a thematic framework developed deductively based on previous work. Line-by-line coding was performed with new themes added to the framework by two researchers. This was used to inform the development of a patient information module, embedded within an electronic decision support tool (CDSS).The intervention was piloted over a four-week period at Imperial College Healthcare NHS Trust on 30 in-patients. Pre- and post-intervention questionnaires were developed and implemented to assess short term changes in patient knowledge and understanding and provide feedback on the intervention. Data were analysed using SPSS and NVIVO software.ResultsWithin the workshops, there was consistency in identified themes. The participants agreed upon and co-designed a personalised PDF document that could be integrated into an electronic CDSS to be used by healthcare professionals at the point-of-care. Their aim for the tool was to provide individualised practical information, signpost to reputable information sources, and enhance communication between patients and healthcare professionals.Eighteen out of thirty in-patients consented to participant in the pilot evaluation with 15/18(83%) completing the study. Median (range) age was 66(22–85) years. The majority were male (10/15;66%). Pre-intervention, patients reported desiring further information regarding their infections and antibiotic therapy, including side effects of treatment. Deployment of the intervention improved short term knowledge and understanding of individuals infections and antibiotic management with median (IQR) scores improving from 3(2–5)/13 to 10(6–11)/13. 13/15(87%) reported that they would use the intervention again.ConclusionA personalised, patient-centred intervention improved understanding and short-term knowledge of infections and antibiotic therapy in participating patients’. Long term impact on attitudes and behaviours post discharge will be further investigated.

One-stage exchange with antibacterial hydrogel coated implants provides similar results to two-stage revision, without the coating, for the treatment of peri-prosthetic infection.

Aim of this study was to verify the hypothesis that a one-stage exchange procedure, performed with an antibiotic-loaded, fast-resorbable hydrogel coating, provides similar infection recurrence rate than a two-stage procedure without the coating, in patients affected by peri-prosthetic joint infection (PJI). In this two-center case-control, study, 22 patients, treated with a one-stage procedure, using implants coated with an antibiotic-loaded hydrogel [defensive antibacterial coating (DAC)], were compared with 22 retrospective matched controls, treated with a two-stage revision procedure, without the coating. At a mean follow-up of 29.3 ± 5.0 months, two patients (9.1%) in the DAC group showed an infection recurrence, compared to three patients (13.6%) in the two-stage group. Clinical scores were similar between groups, while average hospital stay and antibiotic treatment duration were significantly reduced after one-stage, compared to two-stage (18.9 ± 2.9 versus 35.8 ± 3.4 and 23.5 ± 3.3 versus 53.7 ± 5.6days, respectively). Although in a relatively limited series of patients, our data shows similar infection recurrence rate after one-stage exchange with DAC-coated implants, compared to two-stage revision without coating, with reduced overall hospitalization time and antibiotic treatment duration. These findings warrant further studies in the possible applications of antibacterial coating technologies to treat implant-related infections. III.

The effect of enteral tube feeding in cystic fibrosis: A registry based study

BackgroundLong-term effect of enteral tube feeding (ETF) in cystic fibrosis (CF) remains equivocal. MethodsA Belgian CF registry based, retrospective, longitudinal study, evaluated the pre- and post- ETF (n = 113) clinical evolution and compared each patient with 2 age, gender, pancreatic status and genotype class-matched controls. ResultsAt baseline ETF had a worse BMI z-score (p < 0.0001) and FEV1% (p < 0.0001) compared to controls. Patients eventually receiving ETF, had already a significant worse nutritional status and pulmonary function at first entry in the registry. Both parameters displayed a significant decline before ETF-introduction. ETF had more hospitalization and intravenous antibiotic (IVAB) treatment days (p < 0.0001). After ETF introduction hospitalizations and IVAB decreased significantly. After ETF-introduction BMI z-score recuperated towards the original curve before the decline, but remained below the controls. Starting ETF had no effect on rate of height gain in children. The pre-index FEV1 decline (−1.52%/year (p = 0.002)) stabilized to +0.39%/year afterwards. Controls displayed decline of −0.48%/year (p < 0.0001). ConclusionETF introduction improved BMI z-score and stabilized FEV1, associated with less hospitalizations and IVAB treatments. Higher mortality and transplantation in the ETF cases, leading to drop-outs, made determination of the effect size difficult.

A PROSPECTIVE OBSERVATIONAL STUDY ON ADVERSE DRUG REACTIONS OF ANTIBIOTICS IN A TERTIARY CARE HOSPITAL

The aim of the present study was to detect and analyze adverse drug reactions of antibiotics in a tertiary care hospital. This was a prospective observational study carried out in the Department of General Medicine (Osmania General Hospital) over a period of six months. The present study was conducted to assess the prescription pattern of antibiotic usage. Standard pro-forma was used to collect the information regarding antibiotics, its dose, duration, first line of antibiotics and second line of antibiotics and adverse drug reactions. A Total of 100 ADRs was reported from 100 patients during the study period with female predominance (72%) over males. The average age of the patients in the study was found to be 55-70 years. The majority of the ADRs occurred in the age group of 40-80 years. More number of ADRs was from General Medicine Departments in which the most affected organ systems were the GIT (22%) and the skin (19%). The antibiotic classes mostly accounted were cephalosporin (16%) followed by other. The severity assessment revealed that most of them were moderate followed by mild and severe reactions. Of the reported reactions, 30 % were definitely preventable and causality assessment was done which showed that the reactions were probable, possible. Results show that cephalosporin was extensively used in the department of General medicine. The system should promote the spontaneous reporting of Adverse drug reactions to antibiotics. Proper documentation and periodic reporting to regional Pharmacovigilance centre’s to ensure drug.

Making Sense of Antimicrobial Resistance Surveillance: A successful intervention

Background: The intensive care units are epicenters for the emergence of antibiotic resistant Gram-negative bacteria because of the high use of antibiotics, prolonged hospital stay, reduced patient immunity, use of medical devices, and the frequent contact between healthcare workers and patients. Surveillance of bacterial resistance is the key element to understand the size of the problem, drive interventions, and measures the effect of these measures. Several reports have linked the use of third generation cephalosporins with β-lactam resistance in gram-negative bacteria. Several strategies were introduced by the Antibiotic Stewardship Programs to reduce antibiotic resistance but the efficacies of these interventions are not well studied. Methods: The Microbiology Laboratory of Hamad Medical Corporation (HMC) monitors antimicrobial resistance by continuous surveillance using the National Committee for Clinical Laboratory Standards (NCCLS) - currently Clinical Laboratory Standards Institute interpretive criteria. Surveillance data were released annually and shared with clinicians and policy makers for review of the antibiotic policy and the antibiotic formulary. Results: Surveillance data in 2001 showed high level β-lactam antibiotics resistance and high level production of extended spectrum β-lactamases (ESBL) among gram-negative bacteria. As a result, the Hospital Antibiotic Policy Committee decided to withdraw ceftazidime a third –generation cephalosporin known to be a strong inducer of ESBL, from the hospital formulary. Subsequent resistance surveillance over the following three years in the Medical Intensive Care unit (MICU) demonstrated a gradual drop in the resistance of Pseudomonas aeruginosa, Klebsiella pneumoniae and Escherichia coli; the commonest isolated gram negative bacteria from MICU), not only to third and fourth generation cephalosporins, but also to Piperacillin – Tazobactam in spite of the increased use of the later drug in the MICU. Discussion and conclusion: Antibiotic resistance is an increasing global problem. Surveillance studies are needed to monitor resistance development, to guide local empirical therapy, and to implement timely and adequate countermeasures. Since resistance development is an evolutionary process, constant surveillance is necessary to gain insight into the problem in a timely fashion. Several measures were taken including antibiotic cycling, antibiotic rotation and restriction. Restriction of the use of Ceftazidime resulted in a significant drop in the resistance of the common Gram-negative bacteria to the betalactam antibiotics. The sustainability and efficacy of these measures need to be monitored over time.

Evaluation of the Gram-Negative bacilli causing Surgical-Site infections and their sensitivity to antibiotics in Al-Mowasat Hospital, Damascus, Syria

A Surgical-Site Infection (SSI) is an infection that occurs at a surgical cut within 30 days of a surgical operation. It is considered a major health issue in hospitals associated with high levels of morbidity and mortality. The infections caused by Gram-Negative Bacilli are main challenges to patients' health, because of high percentage of antibiotics resistance. This study aims to evaluate the incidence of SSIs in emergency surgical operations department, the epidemiology of Gram-Negative Bacilli in SSIs and their sensitivity to antibiotics. A total of 466 swab samples were taken from patients who had undergone surgical operations. Swabs were collected from the surgical incision or around it between December 2015 and March 2016. The results show the majority of bacterial isolates that cause the SSIs were Gram-Negative Bacilli (56%), while the Gram-Positive Cocci formed 44%, the predominant isolate was staphylococcus aureus (26/44) (59%) and the most commonly isolated Gram-Negative Bacilli were pseudomonas aeruginosa (22/56) (39.3%), followed by E.coli (14/56) (25%) and klebsiella (8/56) (14.4%). The most effective drugs were Imipenem and Meropenem followed by Amikacin.

Surgeons behavior toward prophylaxis antibiotics in sanglah hospital

Surgeons behavior toward prophylaxis antibiotics in sanglah hospital

Effectiveness of education and antibiotic control programme at All India Institute of Medical Sciences, New Delhi.

We aimed to assess the impact of antibiotic optimization education along with understanding the antibiogram on antibiotic-prescribing practices, antibiotic consumption, antimicrobial resistance and cost of antibiotics in a tertiary care hospital in New Delhi. We divided the study into 3 phases-before and after intervention and a phase of education in between. We collected data on demographics, indication for antibiotic prescription, appropriateness or reasons for inappropriate antibiotic uses, antibiotic consumption (i.e. the rate and duration of antibiotic use), bacterial resistance and antibiotic cost. Interventions included education, introduction of an antibiogram and use of antibiotic prescription forms. Similar data were collected for the post-interventional phase. The study was conducted at the Department of Medicine, All India Institute of Medical Sciences, New Delhi, India. There was an improvement in the number of patients who underwent de-escalation of antibiotics, 21/100 v. 36/100 (p = 0.019); appropriate antibiotic usage, 25/ 100 v. 46/100 (p = 0.002); switching from intravenous to oral promptly, 16/52 v. 1 9/36 (p = 0.003) and decrease in expenditure, ₹24 207.5 v. ₹16 51 7.5 per patient (p = 0.001 ); in the post-interventional phase. Significant reductions in the incidence of infections due to Acinetobacter (60% v. 31%; p<0.001) and improvement in sensitivity pattern with cephalosporin sulbactam (80% v. 100%; p<0.001) were seen. Multivariate analysis revealed that Acute Physiology and Chronic Health Evaluation (APACHE) score, hospital stay <10 days, ventilator-associated pneumonia and methicillin-resistant Staphylococcus aureus coverage were independent predictors of mortality with odds ratio of 1.14, 0.1, 9.7 and 1.14, respectively. Education and an antibiotic control programme constituted an effective and cost-saving strategy to optimise antibiotic use at a tertiary care centre.

Progress and challenges in the management of diverticular disease: which treatment?

Diverticular disease of the colon (DDC) includes a spectrum of conditions from asymptomatic diverticulosis to symptomatic uncomplicated diverticulosis, segmental colitis associated with diverticulosis, and acute diverticulitis without or with complications that may have serious consequences. Clinical and scientific interest in DDC is increasing because of the rising incidence of all conditions within the DDC spectrum, a better, although still limited understanding of the pathogenic mechanisms involved; the increasing socioeconomic burden; and the new therapeutic options being tested. The goals of treatment in DDC are symptom and inflammation relief and preventing disease progression or recurrence. The basis for preventing disease progression remains a high-fiber diet and physical exercise, although evidence is poor. Other current strategies do not meet expectations or lack a solid mechanistic foundation; these strategies include modulation of gut microbiota or dysbiosis with rifaximin or probiotics, or using mesalazine for low-grade inflammation in uncomplicated symptomatic diverticulosis. Most acute diverticulitis is uncomplicated, and the trend is to avoid hospitalization and unnecessary antibiotic therapy, but patients with comorbidities, sepsis, or immunodeficiency should receive broad spectrum and appropriate antibiotics. Complicated acute diverticulitis may require interventional radiology or surgery, although the best surgical approach (open versus laparoscopic) remains a matter of discussion. Prevention of acute diverticulitis recurrence remains undefined, as do therapeutic strategies. Mesalazine with or without probiotics has failed to prevent diverticulitis recurrence, whereas new studies are needed to validate preliminary positive results with rifaximin. Surgery is another option, but the number of acute events cannot guide this indication. We need to identify risk factors and disease progression or recurrence mechanisms to implement appropriate preventive strategies.

Análisis de susceptibilidad antimicrobiana y hallazgos microbiológicos: perfil en cirugía abdominal de urgencia

Background: Antimicrobial resistance is a worldwide problem. In patients requiring emergency surgery, antibiotics are an important assistance additional to surgical intervention. Objective: Analize peritoneal fluid cultures obtaines from patients who underwent emergency surgery. Methods: A prospective cohort of emergency abdominal surgical patients were enrolled. Peritoneal fluid cultures were taken and processed according to standarized technique. Results: A 39.4% of positive cultures was found. E. coli was the most common bacteria identified. Five positive cultures for P. aeruginosa stand out. E. coli had 25% resistance to ampicillin/sulbactam and 19% for quinolones. Conclusion: Resistance found was lower than international reports, but still noteworthy. Knowledge of local bacteria profile and antimicrobial resistance is important for local antibiotic hospital policy.

Resistance profiles and biofilm formation of coagulase negative staphylococci isolated from clinical specimens in a tertiary care hospital in Palestine

Background: Coagulase-negative staphylococci (CoNS) represent one of the major resistant nosocomial pathogens where its biofilm-related infections often fail to respond to antibiotic chemotherapy. Here, we studied the resistance profiles and biofilm formation in CoNS isolates from clinical specimens at Al Shifa hospital in Gaza, Palestine.&#x0D; Methods: This study was carried out from March to July 2016 and included 81 clinical isolates. Identification and antibiotic susceptibility testing were performed using VITEK-2 system. The presence of nuc and mecA genes was performed using multiplex PCR. Qualitative and quantitative biofilm assays were performed using standard methods.&#x0D; Results: Of the 81 clinical CoNS isolates, S. haemolyticus was the most common species (34, 42%), followed by S. epidermidis (26, 32.1%) and S. saprophyticus (13, 16%). The majority of isolates (83.9%) were from surgery, ICUs, pediatrics and medicine wards and the most common source was pus (28, 34.6%). Antibiotic resistance was highest against aminoglycosides, β-lactams, carbapenems, cephalosporins, fluoroquinolones, fosfomycin and macrolides. Though, no resistance was detected against rifampicin, vancomycin, teicoplanin, nitrofurantoin, linezolid and mupirocin. The antibiotic resistance among MR-CoNS was significantly higher than that among MS-CoNS. Nearly 88.9% of isolates were multidrug resistant with higher percentage among MR-CoNS. Most S. epidermidis (76.9%) isolates were biofilm producer, with statistically significant association between methicillin resistance and biofilm production.&#x0D; Conclusions: High rates of antibiotic resistance were found among CoNS to commonly used antibiotics and the majority were methicillin and multidrug resistance. Most S. epidermidis isolates were biofilm producer. These results justified the necessity for national programs and measures to monitor and manage the usage of antibiotics in the Palestinian hospitals and community.