Incidence Of Drug-resistant Organisms Research Articles

Efficacy of a Postprescription Review of Broad-Spectrum Antimicrobial Agents With Feedback: A 4-Year Experience of Antimicrobial Stewardship at a Tertiary Care Center.

BackgroundAn inpatient antimicrobial stewardship program is vital for judicious antimicrobial use. We began a hospital-wide, postprescription review with feedback (PPRF) in 2014; the present study evaluated its impact on antimicrobial consumption and clinical outcomes over 4 years.MethodsOnce-weekly PPRF for carbapenems and piperacillin/tazobactam was implemented. We tracked the data on each antimicrobial use as days of therapy (DOT) per 1000 patient-days (PD). Changes in the incidence of drug-resistant organisms, in-hospital mortality, and length of hospital stay per month were analyzed by an interrupted time series.ResultsCarbapenem use continued to decline in the preintervention and intervention periods (−0.73 and −0.003 DOT/1000 PD, respectively), and although monthly average use remained low in the intervention period (8.3 DOT/1000 PD), more importantly, the postintervention change in the slope diminished significantly. Piperacillin/tazobactam use showed a steeper decline in the intervention period, but the change in the slope was not statistically significant (change in slope: −0.20 DOT/1000 PD per month [P = .16]). Postintervention use of narrower-spectrum antimicrobials including ampicillin/sulbactam (change in slope: +0.58 DOT/1000 PD per month [P < .001]) increased. The antimicrobial cost and the monthly average length of hospital stay also declined (−37.4 USD/1000 PD per month [P < .001] and −0.04 days per month [P < .001], respectively), whereas few postintervention changes in the incidence of drug-resistant organisms were observed.ConclusionsIn our study, the 4-year PPRF for broad-spectrum antimicrobials coincided with a reduction in the use of targeted antimicrobials and resulted in an improvement in 1 patient-centered outcome, thus conferring the additional benefit of reducing expenditures for antimicrobials.

Clinical implications of Paracoccus yeeii bacteremia in a patient with decompensated cirrhosis

Infections in patients with cirrhosis are common among those who develop variceal hemorrhage. Prophylactic antimicrobial treatment with third generation cephalosporins is recommended in patients with advanced cirrhosis and gastrointestinal hemorrhage. However no infectious source is identified in up to 50% of patients with cirrhosis and clinical sepsis. We report the first case of Paracoccus yeeii bacteremia in a patient with decompensated cirrhosis who presented with variceal hemorrhage. This rare gram negative organism that occurs naturally in the soil has been difficult to isolate until recent technological advances and may not be susceptible to third generation cephalosporins. Our case reinforces the challenges in isolating rare infections in patients with cirrhosis, the need to consider uncommon organisms in infected but culture negative patients with cirrhosis, and the importance of optimizing antimicrobials to reduce the incidence of drug resistant organisms.

The use of antimicrobial drugs in agriculture.

Antibacterial drugs have been used widely in animal production for treatment and prevention of disease and for growth promotion. Concern has been expressed about possible harm to humans, through the use of drugs, in the following ways: increased microbial drug resistance; drug residues in food; allergic reactions and sensitization to antimicrobials; and drug toxicity. Research has shown that microbial resistance in people can develop from drugs used in animals. Farmers, butchers, etc., have been shown to have an increased incidence of drug-resistant organisms. Resistance to antibiotics can develop in two ways; genetic mutation and natural selection, and through R-factor plasmid transfer. Allergic reactions have been reported following the ingestion of penicillin-containing milk; however, residues in other foods have not caused allergic reactions. Sensitization of humans to antimicrobials through the consumption of drug residues in foods has never been documented. Evidence suggests that the residue levels in food are too low to cause sensitization. Drug toxicity, other than allergic reactions, appears not to result from residues of antimicrobial drugs in food. While it has been studied many times, monitoring programs have failed to find any evidence of a problem. This appears to reflect the low toxicity of these agents and the small amounts obtained in the food, however, it could also reflect failure of the monitoring systems.

Drug resistance and R plasmids in Escherichia coli isolated from laboratory animals.

A total of 1, 840 strains of fecal Escherichia coli isolated from laboratory animals in the colonies of 21 research laboratories and commercial breeders in Japan in 1980, were tested for resistance to 13 drugs and for conjugative R plasmids. Of the 1, 840 strains examined, 78(4.2%) from only 6 animal colonies were drug resistant. The drug resistance was detectable in strains from mice, rats and rabbits at incidence of 1.1, 10.3 and 1.9%, respectively, whereas all organisms from guineapigs and captured rodents were sensitive to all drugs tested. High incidence of drug resistant organisms was demonstrated in the animal colonies where treatment with tetracycline had been undertaken. In colonies in which treatment with tetracycline had been discontinued one to three years before the sampling, no resistant organisms were detectable. Conjugation anlysis revealed that all the resistant strains from mice and rabbits and 83.3% of those from rats carried their resistance determinants on R plasmids. It seemed that the majority of laboratory animals were free of drug resistant E. coli while antibiotic treatments increased the incidence of drug resistant organisms and conjugative R plsmids in laboratory animal colonies.

Current Aspects of the Surgical Management of Tuberculosis

With the current increase in the incidence of drug-resistant organisms causing tuberculosis, there is an increasing number of adults with mycobacterial disease requiring surgical consideration. The technical difficulties associated with resection for tuberculous disease dictate a posterolateral approach to thoracotomy.