Importance Of Antibiotic Stewardship Research Articles

Review of the national usage of antibiotics in arthroplasty surgery: a need for evidence-based prescribing.

Surgical site infections (SSI) remain one of the most serious complications of arthroplasty surgery. The role of antibiotic prophylaxis in preventing SSI post-arthroplasty is well established. However, there is considerable heterogeneity in prophylactic prescribing across the United Kingdom (UK), which is contradicted by the contemporaneous evidence. This descriptive study aimed to compare the current first-line antibiotic recommendations across hospitals in the UK and The Republic of Ireland for elective arthroplasty procedures. The MicroGuide mobile phone application was used to access hospital antibiotic guidelines. First-line antibiotic recommendation and dosing regimen for primary elective arthroplasties were recorded. A total of nine distinct antibiotic regimens were identified through our search. The most frequently used first-line antibiotic was cefuroxime. This was recommended by 30 of the 83 (36.1%) hospitals in the study. This was followed by a combination of flucloxacillin and gentamicin, which was used by 38 of 124 (31%) hospitals. There was also significant heterogeneity in dosing regimens. A single prophylactic dose was most commonly recommended (52%); 4% of hospitals recommended two prophylactic doses, 19% three doses and 23% four doses. Single-dose prophylaxis is recognised as at least noninferior to multiple-dose prophylaxis in primary arthroplasty. There is considerable variation in the local antibiotic recommendations for surgical site prophylaxis post-primary arthroplasty surgery, with respect to both recommended first-line antibiotic and dosing regimens. With increasing emphasis on the importance of antibiotic stewardship and the emergence of antibiotic resistance, this study highlights the need for an evidence-based approach to prophylactic dosing across the UK.

MP02-07 THE IMPACT OF COVID-19 AND TELEMEDICINE ON EMPIRIC UTI TREATMENT IN WOMEN

You have accessJournal of UrologyCME1 May 2022MP02-07 THE IMPACT OF COVID-19 AND TELEMEDICINE ON EMPIRIC UTI TREATMENT IN WOMEN Madeline Epsten, Jennifer Ferraro, Fareesa Khan, Cynthia Brincat, and Kristin Jacobs Madeline EpstenMadeline Epsten More articles by this author , Jennifer FerraroJennifer Ferraro More articles by this author , Fareesa KhanFareesa Khan More articles by this author , Cynthia BrincatCynthia Brincat More articles by this author , and Kristin JacobsKristin Jacobs More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infection (UTI), one of the most common reasons women seek acute care, is responsible for 15% of all community-prescribed antibiotics. The effects of the pandemic and telemedicine on UTI treatment are largely unknown. Here, we evaluated the impact of Covid-19 and telemedicine on empiric UTI treatment in women. We hypothesized that increased use of telemedicine during the pandemic would increase the rate of empiric UTI treatment. METHODS: This is a retrospective cohort study of treatment patterns of female patients aged 18-65 using ICD-10 codes for acute cystitis with (N30.00) and without (N30.01) hematuria during the first 6 months of the pandemic (March 2020 – August 2020) versus the 6 months preceding the pandemic (September 2019 – February 2020). Our primary outcome was presence of empiric antibiotic treatment, defined by treatment based on clinical picture with or without pending urine testing. Secondary analysis included determining which antibiotics were most commonly prescribed and treatment adjustment. To reach 80% power to detect a 10% difference with p≤0.05, we included 222 patients. Exclusion criteria included inpatient encounter, long-term facility residence, urinary procedure in last 2 weeks, previous UTI treatment within 30 days. RESULTS: The average age of participants was 42 years. Fifty-two percent were white, 23% Black, and 23% Hispanic. No demographic differences existed between cohorts. During the pandemic, 36.6% of UTI encounters were conducted via telemedicine, compared to 1.5% pre-pandemic (p<.0001). The rate of empiric treatment increased from 58.2% pre-pandemic to 70.5% during the pandemic (p=.055). The rate of treatment based on clinical picture with no pending urine testing was significantly higher during the pandemic (p<.0001). Nitrofurantoin or trimethoprim/sulfamethoxazole was used in 79% of patients prescribed an antibiotic. The overall rate of treatment adjustment was 17.1%; there was no significant difference by time period. CONCLUSIONS: Covid-19 dramatically increased telemedicine utilization by women with UTI symptoms. Empiric treatment approached significance and confirmatory urine testing was done significantly less during the pandemic. Given the importance of antibiotic stewardship, it is important to further characterize telemedicine’s impact on treatment of this common condition. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e12 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Madeline Epsten More articles by this author Jennifer Ferraro More articles by this author Fareesa Khan More articles by this author Cynthia Brincat More articles by this author Kristin Jacobs More articles by this author Expand All Advertisement PDF DownloadLoading ...

Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs.

The importance of antibiotic stewardship is increasingly emphasized in accordance with the increasing incidences of multidrug-resistant organisms and accompanying increases in disease burden. This review describes the obstacles in operating an antibiotic stewardship program (ASP), and whether the use of biomarkers within currently available resources can help. Surveys conducted around the world have shown that major obstacles to ASPs are shortages of time and personnel, lack of appropriate compensation for ASP operation, and lack of guidelines or appropriate manuals. Sufficient investment, such as the provision of full-time equivalent ASP practitioners, and adoption of computerized clinical decision systems are useful measures to improve ASP within an institution. However, these methods are not easy in terms of both time commitments and cost. Some biomarkers, such as C-reactive protein, procalcitonin, and presepsin are promising tools in ASP due to their utility in diagnosis and forecasting the prognosis of sepsis. Recent studies have demonstrated the usefulness of algorithmic approaches based on procalcitonin level to determine the initiation or discontinuation of antibiotics, which would be helpful in decreasing antibiotics use, resulting in more appropriate antibiotics use.

Incidence of Clostridium difficile infection and associated risk factors among hospitalized children: A retrospective study

Objectives: Clostridium difficile infection (CDI) is the single most common cause of nosocomial diarrhea in both adults and children; however, available data regarding the incidence and associated risk factors in hospitalized children remains limited. This study aimed to determine the incidence of CDI and its associated risk factors. The secondary objectives are to evaluate treatment protocols (cured, failure, recurrence), associated outcomes, and the importance of antibiotic stewardship to reduce the risk of CDI. Methods: A retrospective …

Current management of Clostridioides (Clostridium) difficile infection in adults: a summary of recommendations from the 2017 IDSA/SHEA clinical practice guideline.

Clostridioides (formerly Clostridium) difficile infection (CDI) is the most common cause of health care–associated infectious diarrhea in the developed world. The Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America clinical guidelines on CDI were updated in 2017. The update reflects a decline in the incidence of CDI caused by ribotype 027 and an increased incidence of community‑associated CDI, current challenges in CDI diagnosis, the importance of antibiotic stewardship and contact and isolation precautions in infection prevention and control, and many significant changes in CDI management. This review summarizes and examines these new guidelines, how they compare to other recommendations, and more recent data on CDI management.

The use and misuse of antibiotics in dentistry: A scoping review

BackgroundTo describe antibiotic prescribing behaviors in dentistry, including clinical and nonclinical indications for their use, the type and regimen of antibiotics prescribed, and factors influencing their prescription, the authors conducted a scoping review. Types of Studies ReviewedThe authors conducted a scoping review of published literature by searching multiple databases. Key search terms included dentist, antibiotic, antimicrobial, antibacterial, prophylaxis, prescription, pattern, habit, knowledge, and practice. Two authors independently reviewed titles and abstracts by using detailed eligibility criteria. The authors placed no restrictions on study design or publication year. The authors qualitatively assessed studies by using a modified version of the Center for Evidence-Based Management’s critical appraisal of a survey checklist. ResultsThe authors identified 1,912 studies but considered only 118 studies eligible for review. Most included studies were either cross-sectional surveys (81 studies) or prescription audits (25 studies) from various geographic locations. Publication dates ranged from 1982 through 2017. The authors examined prophylactic and therapeutic antibiotic use in 48 and 29 studies, respectively. Another 29 studies examined the use of both prophylactic and therapeutic antibiotics in dentistry. Overall, dentists prescribed a wide variety of antibiotic regimens for various clinical and nonclinical indications. Dentists have acquired their prescribing knowledge from a variety of sources and have changed their antibiotic prescribing practices throughout their careers for various reasons. Conclusions and Practical ImplicationsConsidering the seriousness of antibiotic resistance, the authors highlight trends in antibiotic prescribing practices, characterize factors contributing to the use and misuse of antibiotics in dentistry, provide insight into the importance of antibiotic stewardship in the oral health setting, and encourage dentists to reflect on their antibiotic prescription practices.

The Effect of a Piperacillin/Tazobactam Shortage on Antimicrobial Prescribing and Clostridium difficile Risk in 88 US Medical Centers.

Anti-infective shortages are a pervasive problem in the United States. The objective of this study was to identify any associations between changes in prescribing of antibiotics that have a high risk for CDI during a piperacillin/tazobactam (PIP/TAZO) shortage and hospital-onset Clostridium difficile infection (HO-CDI) risk in 88 US medical centers. We analyzed electronically captured microbiology and antibiotic use data from a network of US hospitals from July 2014 through June 2016. The primary outcome was HO-CDI rate and the secondary outcome was changes in antibiotic usage. We fit a Poisson model to estimate the risk of HO-CDI associated with PIP/TAZO shortage that were associated with increased high-risk antibiotic use while controlling for hospital characteristics. A total of 88 hospitals experienced PIP/TAZO shortage and 72 of them experienced a shift toward increased use of high-risk antibiotics during the shortage period. The adjusted relative risk (RR) of HO-CDI for hospitals experiencing a PIP/TAZO shortage was 1.03 (95% confidence interval [CI], .85-1.26; P = .73). The adjusted RR of HO-CDI for hospitals that both experienced a shortage and also showed a shift toward increased use of high-risk antibiotics was 1.30 (95% CI, 1.03-1.64; P < .05). Hospitals that experienced a PIP/TAZO shortage and responded to that shortage by shifting antibiotic usage toward antibiotics traditionally known to place patients at greater risk for CDI experienced greater HO-CDI rates; this highlights an important adverse effect of the PIP/TAZO shortage and the importance of antibiotic stewardship when mitigating drug shortages.

Adverse consequences of neonatal antibiotic exposure.

Antibiotics have not only saved lives and improved outcomes, but they also influence the evolving microbiome. This review summarizes reports on neonatal infections and variation in antibiotic utilization, discusses the emergence of resistant organisms, and presents data from human neonates and animal models demonstrating the impact of antibiotics on the microbiome, and how microbiome alterations impact health. The importance of antibiotic stewardship is also discussed. Infections increase neonatal morbidity and mortality. Furthermore, the clinical presentation of infections can be subtle, prompting clinicians to empirically start antibiotics when infection is a possibility. Antibiotic-resistant infections are a growing problem. Cohort studies have identified extensive center variations in antibiotic usage and associations between antibiotic exposures and outcomes. Studies of antibiotic-induced microbiome alterations and downstream effects on the developing immune system have increased our understanding of the mechanisms underlying the associations between antibiotics and adverse outcomes. The emergence of resistant microorganisms and recent evidence linking antibiotic practice variations with health outcomes has led to the initiation of antibiotic stewardship programs. The review encourages practitioners to assess local antibiotic use with regard to local microbiology, and to adopt steps to reduce infections and use antibiotics wisely.

Antibiotic stewardship in urologic surgery.

Antibiotic stewardship in urologic surgery.

Community-associated Methicillin-resistant Staphylococcus aureus Disease in Children in Taiwan: The Importance of Antibiotic Stewardship

Since it was first reported in the 1960s, methicillinresistant Staphylococcus aureus (MRSA) has been a major cause of a variety of infectious syndromes in patients exposed to the healthcare environment.1 In Taiwan, MRSA was first documented in the early 1980s and increased rapidly in the 1990s.1 Nowadays, MRSA is endemic in most hospitals in Taiwan and accounts for 53–83% of all S. aureus isolates.1 However, from the late 1990s, community-associated (CA) MRSA has become a major concern worldwide.2 CA-MRSA causes a variety of diseases, ranging from skin or soft tissue infection to severe invasive diseases, such as sepsis, necrotizing pneumonia, and necrotizing fasciitis.1,2 CA-MRSA strains worldwide are thought to have unique microbiological characteristics such as limited antibiotic resistance (except to β-lactam antimicrobial agents), different exotoxin gene profiles (e.g. Panton–Valentine leukocidin; PVL), and smaller staphylococcal cassette chromosome mec (SCCmec) variants: either SCCmec type IV, or less frequently, type V or a variant, type VT. In Taiwan, CA-MRSA infections have been reported increasingly in pediatric patients since 2002. The rate of MRSA was estimated as 44% in pediatric cases of CA S. aureus infections, after pooling the data from retrospective studies with similar designs between 1997 and 2001.1 Currently, the CA-MRSA strains that cause infection in Taiwan are characterized by multiple antibiotic resistance (including clindamycin, erythromycin, tetracycline and chloramphenicol), which differs from those in the United States,4 with skin and superficial soft tissue infections being the major clinical manifestations. However, significant morbidity and mortality from CA-MRSA infections have been reported increasingly in pediatric cases.1,5 They have common pulsed-field gel electrophoresis (PFGE) patterns that differ from those of the major pandemic clones of hospitalacquired MRSA isolates. Also, the genotype has been identified as sequence type (ST) 59 by multilocus sequencing typing; they possess PVL and staphylococcal enterotoxin B and may have acquired SCCmec type VT (now designated type VII), or less frequently, type IV.4,6,7 The importance of antibiotic stewardship for CA-MRSA disease in Taiwan can be demonstrated in four different ways. Several previous community-based studies and the latest islandwide survey have assessed the extent of MRSA in the community, and have revealed a high prevalence of colonization with multidrug-resistant MRSA.3,6,8 Compared with that among healthy children during the period 2001–2002, the prevalence of nasal MRSA colonization among healthy