Infection Specialists Research Articles

Survey of delivery of parenteral antimicrobials in non-inpatient settings across Europe

Delivery of parenteral antimicrobials in non-inpatient settings (DPANS) may be through a dedicated outpatient parenteral antimicrobial therapy (OPAT) service, co-ordinated by hospital- or community-based specialised teams, or via an infusion service involving community-based health professionals (nurses, general practitioners) without centralised hospital oversight, or through ad hoc arrangements. DPANS varies among countries. Our objective was to describe how DPANS is organised at a national level in European countries. A survey (65-item self-administered questionnaire) was conducted from February-June 2019 among infection specialists in 34 European countries on behalf of the ESCMID Study Group for Antimicrobial Stewardship (ESGAP) and the British Society for Antimicrobial Chemotherapy (BSAC) OPAT initiative. Most countries (28/34; 82.4%) participated in the survey. DPANS was available in almost all (27/28; 96.4%) responding countries. DPANS was predominantly provided either via specialised OPAT services (17/28; 60.7%) or via infusion services (16/28; 57.1%), with 11 countries (39.3%) providing both services. A formal OPAT team structure with specifically trained staff was reported in only six countries (6/17; 35.3%). Some countries (4/28; 14.3%) had no structured services but practiced DPANS via ad hoc arrangements. The costs of all stages of the process were covered for patients managed by specialised OPAT/infusion services, either completely, partially or for specific patient groups in the majority (20/28; 71.4%) of countries. The main barriers to implement OPAT/infusion services were lack of organisational structure or guidelines. In conclusion, DPANS with respect to availability and organisation is highly heterogeneous in Europe. National/European guidelines may help improve and standardise DPANS.

P33 Day 3 reviews led by pharmacy technicians—encouraging antimicrobial stewardship

BackgroundA documented 72 h antimicrobial review is a national target that we are expected to achieve at the Leeds Teaching Hospital. Current practice within LTHT provides a pharmacist-led antimicrobial stewardship ward round where IV antimicrobials are reviewed at Day 3 (72 h). Patients prescribed IV antimicrobials are reviewed within 72 h and a decision is made to continue, stop, switch to oral or refer to the outpatient parenteral antimicrobial therapy (OPAT) service. The Healthcare Associated Infection (HCAI) Annual Programme for this year highlights the importance of expanding antimicrobial stewardship within the pharmacy team. This presented an opportunity to develop a new antimicrobial stewardship strategy by leading a virtual pharmacy technician-led antimicrobial stewardship ward round. This allowed for a greater number of patients that were prescribed IV antimicrobials to reviewed and the potential for less patients to remain on broad-spectrum IV antimicrobials for extended durations.ProblemClinicians and pharmacists struggle to undertake this review due to the demands of the daily ward rounds and other reviews that take priority that are needed to ensure patients safety. The electronic prescribing system used within the trust prompts users to undertake Day 3 reviews; however, this is not utilized. This often leads to a greater number of patients remaining on broad-spectrum IV antimicrobials, alongside a lack of justification for remaining on IV antimicrobials despite robust, easily accessible guidelines, education, training and electronic systems.Assessment of problem and analysis of causesFirstly, it is a large teaching hospital that has a variation of different specialities and departments, a lot of patients and fewer people to do the reviews and large turnover of staff and patients. Antimicrobial stewardship is complex, everybody has a role to play in making sure that we use antibiotics appropriately and effectively as IV antibiotics can delay discharge, they are costly, the patients are at risk of line infection, they require IV access and they require more nursing time, so it is necessary to embed antimicrobial stewardship good practice principles throughout the trust and promote that everyone needs to play an active role in this. On identifying the problem, I gained feedback from the pharmacy technicians as to why this review could not be done by them; they reported a lack of knowledge of how to review eligibility of patients for oral switch and with the appropriate training this would be something that they would be happy to do within their daily tasks.MethodsOne pharmacy technician (specializing with infectious disease/pharmacy infection team) was appropriately trained to complete virtual reviews, utilizing an electronic LTHT IV antimicrobial reviewing tool which is available to upload to the patient's electronic records. Patients were identified using a daily antimicrobial prescribing list and filtered for those that had been prescribed IV antimicrobials for 3 days. This allowed for a variety of specialities to be included within the audit. Inclusion criteria: patients aged >16 years, inpatients prescribed IV antibiotics for 72 h. Exclusion criteria: patient aged <16 years, antimicrobial prescribed for the treatment of cystic fibrosis, patients prescribed directed antimicrobial therapy based on an infection specialist recommendation (not empirical treatment), those on oral antibiotics, prophylactic antimicrobials. Data were collected throughout the improvement projected as a baseline audit to understand the impact the intervention made, and results were collated and recorded into an Excel spreadsheet and processed:ResultsA total of 38 patients were included in the audit as having had IV antimicrobial reviews completed. Of these, 28 patients fitted the criteria for a switch from IV to oral antimicrobials and therefore recommendations reflecting this were documented. Advice to de-escalate to oral antimicrobials was followed for 20 patients resulting in a hospital discharge after 24 h. The other 10 patients were advised to continue IV treatment until more clinically stable (advice was followed for 9 patients). Overall recommendations were followed in 76% of cases.ConclusionsOverall, pharmacy technician-led antimicrobial virtual reviews have shown a positive impact on antimicrobial stewardship, by reducing the number of inappropriate IV antimicrobial continued beyond 3 days and ensuring that a greater number of clinical reviews have been documented for the empirical prescribing of IV antimicrobials. This project highlights the potential for a greater number of pharmacy technicians to get involved with IV antimicrobial reviews (once appropriately trained) to complete a small number of reviews weekly, which in turn could provide a reduction of inpatient bed days, decrease harm to patients through the prescribing of antimicrobials, decrease medication costs and improve patient care by facilitating discharge and safeguarding antimicrobials. Additionally, this could help to upskill staff, allowing for greater job satisfaction alongside improved antimicrobial stewardship within the trust.

The utility of 16S rRNA gene sequencing on intraoperative specimens from intracranial infections: an 8-year study in a regional UK neurosurgical unit

Background Optimal management of intracranial infections relies on microbiological diagnosis and antimicrobial choice, but conventional culture-based testing is limited by pathogen viability and pre-sampling antimicrobial exposure. Broad-range 16S rRNA gene sequencing has been reported in the management of culture-negative infections but its utility in intracranial infection is not well-described. We studied the efficacy of 16S rRNA gene sequencing to inform microbiological diagnosis and antimicrobial choice in intracranial infections. Methods This was a retrospective study of all intraoperative neurosurgical specimens sent for 16S rRNA gene sequencing over an 8-year period at a regional neurosurgical centre in the UK. Specimen selection was performed using multidisciplinary approach, combining neurosurgical and infection specialist discussion. Results Twenty-five intraoperative specimens taken during neurosurgery from 24 patients were included in the study period. The most common reason for referral was pre-sampling antimicrobial exposure (68%). Bacterial rDNA was detected in 60% of specimens. 16S rRNA gene sequencing contributed to microbiological diagnosis in 15 patients and informed antimicrobial management in 10 of 24 patients with intracranial infection. These included targeted antibiotics after detection of a clinically-significant pathogen that had not been identified through other microbiological testing (3 cases), detection of commensal organisms in neurosurgical infection which justified continued broad cover (2 cases) and negative results from intracranial lesions with low clinical suspicion of bacterial infection which justified avoidance or cessation of antibiotics (5 cases). Conclusion Overall, 16S rRNA gene sequencing represented an incremental improvement in diagnostic testing and was most appropriately used to complement, rather than replace, conventional culture-based testing for intracranial infection.

935. A Hospital Cluster of the Emerging Drug-resistant Yeast Saprochaete clavata

Background Saprochaete clavata, an ascomycetous yeast intrinsically resistant to echinocandins, is a rare yet emerging pathogen associated with invasive infections in immunosuppressed patients, particularly those with haematological malignancies. It is commonly misidentified as the closely-related S. capitata. Outbreaks have been associated with a high mortality rate of >50%, due in part to delayed diagnosis and resistance to commonly-used antifungals. Environmental source identification is challenging, although dishwashers and milk flasks have been implicated in previous hospital clusters.MethodsWe describe a cluster of five haematology-oncology patients with disseminated S. clavata infections between April 2020 and April 2021 following current or recent admissions to the same ward. ResultsAll had prolonged (median=24 days, range=9-210) and profound immunosuppression from chemotherapy and/or stem cell transplantation for acute myeloid leukaemia (n=3) or lymphoma (n=2) at the time of culture positivity. Four were severely neutropaenic (median=0.08/mm3, range=0.01-0.26). Median patient age was 62 years (range=58-73). S. clavata was isolated from blood (n=3), urine (n=2), and liver tissue (n=1) samples. Whole genome sequencing of these isolates was performed to confirm the presence of an outbreak. All patients received empirical treatment with intravenous caspofungin before culture-guided therapy with intravenous liposomal amphotericin B +/- oral flucytosine. Two of the five patients died although both had advanced refractory malignancy. Detailed environmental sampling of fridges/freezers, drains, and vents in patient rooms and clean areas for handling or storage of food and medication failed to identify a clear point source despite isolation of multiple environmental organisms. No further cases have emerged after intensification of the cleaning regimen in these areas.ConclusionOur experience highlights the emerging threat of drug-resistant yeasts particularly in the immunocompromised. Management of such outbreaks requires a multidisciplinary approach incorporating antifungal stewardship, infection control, and environmental microbiology, alongside close clinical liaison between haemato-oncologists and infection specialists.Disclosures All Authors: No reported disclosures

How to investigate and manage a patient with a Staphylococcus aureus bacteraemia

Staphylococcus aureus bacteraemia is common, and associated with significant morbidity and mortality as a result of its high relapse rate and the risk of complicated infection. A positive blood culture for S. aureus should prompt a thorough patient assessment to identify a potential focus of infection, and the risk factors for the development or presence of complicated infection. Clinical management depends on the patient's characteristics and presenting features. This article gives a systematic approach to the patient with S. aureus bacteraemia, including points to look for on history and examination, the markers of complicated infection, and when to request transoesophageal echocardiography and further imaging. Treatment principles outlined include the rationale for choice of antibiotic treatment and need to involve infection specialists.

Nurses’ experience in interacting with the infection prevention and control nurse

This study aim is to explore the experience of nurses in interacting with the infection prevention and control nurse (IPCN). This study was conducted on 11 participants who had interacted with the IPCN. In-depth interviews were conducted in 30-60min with participants from different hospital's service units. Audio-recorded interviews were then made into transcripts and thematically analyzed by data triangulation, peer-reviewed, and supervised by qualitative research sources. There were seven themes found in this study show what the nurse feels, effectiveness, and expectation to the IPCN. This study recommends optimizing the nurses' understanding of the IPCN's role by involving management and optimizing the role of the IPCN in the implementation of nursing care through formal education in infection specialist nursing so that the presence of the IPCN is increasingly felt by nurses.

Incidentally detected isolated Aspergillus fumigates infection of the renal allograft

Fungal infection represents 5% of the infections of post renal transplant recipients. The frequency of invasive Aspergillus ranges from 0.5% to 2.2% with a mortality rate of 88%. In renal transplantation, Aspergillus infection usually affects primarily the lungs with occasional dissemination and the central nervous system. Involvement of a renal allograft in the isolated form is rare. A-35-year-old male post-renal transplant patient presented in our institute for routine follow up examination. Ultrasound and computed tomography (CT) were conducted in our radiology department, suggestive of abscess formation in mid pole of transplanted kidney. The patient did not have any clinical symptoms. His serum creatinine level was also within normal limit. Diagnosis of Aspergillus fumigates was made by aspiration of pus. Treatment started according to culture and sensitivity report. Ultimately graft nephrectomy was performed to control infection. Aspergillus infection of a renal allograft remains a key issue for nephrologists and infection specialists. For diagnosis of fungal infection, a high index of suspicious is necessary. In the present case, the infected allograft nephrectomy and the elimination of immune-compromised state and the prompt administration of antifungal therapy, made recovery possible. However, early diagnosis remains difficult.

Mild encephalopathy with reversible extensive white matter lesions in a child with acute adenoviral infection and a literature review

Mild encephalopathy with a reversible splenial lesion (MERS) is a known clinical-radiological description. However, MERS with extensive lesions (MERS type-2) is rarely associated with adenovirus. There are only three published cases of MERS type-2 associated with adenovirus infection. We present a 10-year-old previously healthy girl who presented with speech difficulty and mild encephalopathy after three days of prodromal illness. The magnetic resonance imaging (MRI) revealed bilateral diffusion restriction in the parietal white matter, splenium and genu of the corpus callosum without mass effect and slight thickening at the splenium of corpus callosum with no contrast enhancement. With empirical and support treatment, her neurological examination was completely normal by the 18th hour. The nasopharyngeal respiratory adenoviral PCR resulted positive. She was discharged with total clinical and radiological resolution on the 10th day of admission. The case was diagnosed with MERS type-2 which is rarely associated with adenoviral infection. This report is the first case of adenovirus related MERS type-2 in a Turkish child. Pediatricians, child neurologists, child infection specialists and radiologists should recognize this condition to ensure appropriate diagnosis.

A Prospective Cohort Study of the Quick Sequential Organ Failure Assessment (qSOFA) Score versus Systemic Inflammatory Response Syndrome (SIRS) Criteria in the Determination and Prognostication of Sepsis in a Philippine Tertiary Hospital

Background. Sepsis is a leading cause of mortality both locally and worldwide. Despite this, early diagnosis of sepsis remains challenging, with a significant number not fulfilling SIRS (Systemic Inflammatory Response Syndrome) criteria. In 2016, the Sepsis-3 guidelines modified its definition to include the qSOFA (Quick Sequential Organ Failure Assessment) score in an attempt to include a significant number of SIRS-negative septic patients. Methods. To compare the two, 295 adult patients in the emergency room with suspected infection were included in the study and simultaneously determined their qSOFA score and SIRS criteria. Three infection specialists adjudicated the presence of sepsis, and outcomes within the first 48 hours were acquired. Sensitivity, specificity, positive predictive and negative predictive values for qSOFA and SIRS were computed using constructed confusion matrices, and overall predictive accuracy was measured by the Area under the Receiver Operating Characteristic (AUROC) curve. Results. Of the 295 patients included in the study, 95 (32.2%) were deemed sepsis positive via adjudication. The qSOFA score was a specific (95.5%) but a poorly sensitive (46.3%) test compared to the SIRS criteria (sensitivity 73.7% and specificity 60%). Both qSOFA and the SIRS criteria significantly correlated with sepsis positivity, but the qSOFA score had superior overall predictive accuracy at 70.9% compared to the SIRS criteria. The adjudicators had moderate strength in agreement (Fleiss’ kappa = 0.39) and a percentage agreement of 60%. Conclusion. We concluded that the qSOFA score was a more accurate predictor of sepsis and a reliable predictor of in-hospital mortality, but should not be used as a sepsis screening tool due to the low sensitivity. We recommend that the SIRS criteria be maintained as a screening tool and to use the qSOFA score concurrently for time management.

Treating infections caused by carbapenemase-producing Enterobacterales (CPE): a pragmatic approach to antimicrobial stewardship on behalf of the UKCPA Pharmacy Infection Network (PIN).

The emergence of carbapenemase-producing Enterobacterales (CPE) as a major cause of invasive infection both within the UK and internationally poses a very real concern for all providers of healthcare. The burden of morbidity and mortality associated with CPE infections is well described. The need for early, targeted, effective and safe antimicrobial therapy remains key for the management of these infected patients yet reliable antimicrobial treatment options remain scarce. In the absence of a universal treatment for these CPE invasive infections, individual treatment options tailored to susceptibilities and severity of infection are required. This working group from within the UK Clinical Pharmacy Association (UKCPA) Pharmacy Infection Network has developed evidence-based treatment recommendations to support infection specialists in managing these complex infections. A systematic review of peer-reviewed research was performed and analysed. We report consensus recommendations for the management of CPE-associated infections. The national expert panel makes therapeutic recommendations regarding the pharmacokinetic and pharmacodynamic properties of the drugs and pharmacokinetic targets, dosing, dosage adjustment and monitoring of parameters for novel and established antimicrobial therapies with CPE activity. This manuscript provides the infection specialist with pragmatic and evidence-based options for the management of CPE infections.

Aerobic vaginitis - An underdiagnosed cause of vaginal discharge - Narrative review.

The concept of vaginal dysbiosis was for long considered synonymous with bacterial vaginosis (BV), which is characterized by a homogenous non-inflammatory vaginal discharge. The inflammatory variant of vaginal dysbiosis, called aerobic vaginitis (AV), has remained unknown to a large part of the global dermatology and venereology community, gynaecologists and reproductive tract infection specialists with consequential under diagnosis. AV significantly differs from BV, in clinical presentation, diagnostic criteria and management. The deleterious impact of untreated AV on pregnancy merits discussion. Understanding AV is also crucial for better comprehension of desquamative inflammatory vaginitis (DIV), the most severe form of the same entity. We review the condition's epidemiology, risk factors and suspected aetiology, symptoms and signs, and the latest evidence-backed approach to diagnosis and treatment. The ideal diagnostic approach and treatment for AV/DIV are yet to be established. The currently recommended diagnostic approach for AV/DIV merits an overhaul by incorporating changes to render it feasible for resource-constraint countries. The diagnostic criteria lack a uniform applicability in different physiological groups of women and cannot be used in postpartum or postmenopausal states at the same cut-off levels. Similarly, treatment guidelines merit a relook, and customization, given the equivocality of options suggested by different investigators.

Impact of rapid microbial identification on clinical outcomes in bloodstream infection: the RAPIDO randomized trial

ObjectivesBloodstream infection has a high mortality rate. It is not clear whether laboratory-based rapid identification of the organisms involved would improve outcome. MethodsThe RAPIDO trial was an open parallel-group multicentre randomized controlled trial. We tested all positive blood cultures from hospitalized adults by conventional methods of microbial identification and those from patients randomized (1:1) to rapid diagnosis in addition to matrix-assisted desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) performed directly on positive blood cultures. The only primary outcome was 28-day mortality. Clinical advice on patient management was provided to members of both groups by infection specialists. ResultsFirst positive blood culture samples from 8628 patients were randomized, 4312 into rapid diagnosis and 4136 into conventional diagnosis. After prespecified postrandomization exclusions, 2740 in the rapid diagnosis arm and 2810 in the conventional arm were included in the mortality analysis. There was no significant difference in 28-day survival (81.5% 2233/2740 rapid vs. 82.3% 2313/2810 conventional; hazard ratio 1.05, 95% confidence interval 0.93–1.19, p 0.42). Microbial identification was quicker in the rapid diagnosis group (median (interquartile range) 38.5 (26.7–50.3) hours after blood sampling vs. 50.3 (47.1–72.9) hours after blood sampling, p < 0.01), but times to effective antimicrobial therapy were no shorter (respectively median (interquartile range) 24 (2–78) hours vs. 13 (2–69) hours). There were no significant differences in 7-day mortality or total antibiotic consumption; times to resolution of fever, discharge from hospital or de-escalation of broad-spectrum therapy or 28-day Clostridioides difficile incidence. ConclusionsRapid identification of bloodstream pathogens by MALDI-TOF MS in this trial did not reduce patient mortality despite delivering laboratory data to clinicians sooner.

Outcomes of Staphylococcus aureus bacteraemia attributed to blood culture contamination

Staphylococcus aureus is a common skin commensal and leading cause of bloodstream infection. Given the formidable mortality and morbidity associated with S. aureus bacteraemia (SAB), it is uncertain whether S. aureus can be viewed safely as a blood culture contaminant. 19 episodes of SAB over two years were identified that were prospectively attributed as contaminants using Health Protection Scotland criteria and compared these with 168 cases of genuine SAB. All cases were assessed by an infection specialist and underwent multidisciplinary review to agree the source. Follow-up was a minimum of six months. Female sex, cognitive impairment and chronic skin conditions were more common in the contaminant group. No single clinical or laboratory feature reliably predicted contamination. No patients in the contaminant group subsequently developed a SAB or metastatic complications associated with SAB. Eighteen patients (95%) survived to hospital discharge. Compared to patients with genuine SAB surviving to discharge, the contaminant group had a shorter duration of hospital stay (median 14 days versus 19.5 days), a briefer exposure to intravenous antibiotics (median 1 day versus 14 days) and received less total antibiotic (median 7 days versus 19 days). Twelve patients received at least five days of antibiotics active against their SAB, though none would have been deemed appropriate SAB treatment under current guidelines. The careful attribution of SAB as a contaminant by an infection specialist, combined with appropriate follow-up, is associated with favourable clinical outcomes, shorter hospital stay and reduced antibiotic use. A more robust definition of genuine SAB is needed.

Carbapenem stewardship in a large teaching English hospital - are we improving?

Background:Overuse of antibiotics has been linked to the global growth of antimicrobial resistance (AMR). In 2018, increase in meropenem usage in our hospital revealed that we achieved the “Start Smart” but not “Then Focus” element. Following revised carbapenem stewardship, we aimed to evaluate the adherence to guidelines, by monitoring patients initiated on meropenem. Methods:As part of the antimicrobial stewardship (AMS) at our 1800-bed teaching hospital, carbanepem stewardship was revised in September 2018 and required consultant approval for all carbapenem initiation or continuation following specialist advice. Meropenem prescriptions in adult and paediatric patients were generated from the electronic prescription system and reviewed daily for one week in August 2019 to ascertain if prescribed in line with guideline recommendations or on the advice of microbiology or infectious diseases. Results:Sixty patients were reviewed. Microbiology or Infectious Diseases recommendation was obtained in 37% of patients. 95% had samples taken where blood cultures accounted for 85% but over a third of these had no growth reported. Meropenem was initiated empirically in 50% of patients mainly for neutropenic sepsis while 28% were culture directed. 35% of patients were escalated from piperacillin-tazobactam of which 57% had neutropenia while de-escalation occurred in 10%. Conclusion:AMR is related directly to antibiotic use at a patient level. Our revised strategy resulted in a reduction of total carbapenem DDD/1000 Admission from 128 (June 2018) to 87 (June 2019) through improved adherence to guideline and infection specialists recommendations however more work is required to promote switch to narrower-spectrum choice.

Tractable targets for meropenem-sparing antimicrobial stewardship interventions.

BackgroundAs meropenem is a restricted antimicrobial, lessons learned from its real-life usage will be applicable to antimicrobial stewardship (AMS) more generally.ObjectivesTo retrospectively evaluate meropenem usage at our institution to identify targets for AMS interventions.MethodsPatients receiving meropenem documented with an ‘alert antimicrobial’ form at two tertiary care UK hospitals were identified retrospectively. Clinical records and microbiology results were reviewed.ResultsA total of 107 adult inpatients receiving meropenem were identified. This was first-line in 47% and escalation therapy in 53%. Source control was required in 28% of cases after escalation, for predictable reasons. Those ultimately requiring source control had received more prior antimicrobial agents than those who did not (P = 0.03). Meropenem was rationalized in 24% of cases (after median 4 days). Positive microbiology enabled rationalization (OR 12.3, 95% CI 2.7–55.5, P = 0.001) but rates of appropriate sampling varied. In cases with positive microbiology where meropenem was not rationalized, continuation was retrospectively considered clinically and microbiologically necessary in 8/40 cases (0/17 empirical first-line usage). Rationalization was more likely when meropenem susceptibility was not released on the microbiology report (OR 5.2, 95% CI 1.3–20.2, P = 0.02). Input from an infection specialist was associated with a reduced duration of meropenem therapy (P < 0.0001). Early review by an infection specialist has the potential to further facilitate rationalization.ConclusionsIn real-life clinical practice, core aspects of infection management remain tractable targets for AMS interventions: microbiological sampling, source control and infection specialist input. Further targets include supporting rationalization to less familiar carbapenem-sparing antimicrobials, restricting first-line meropenem usage and selectively reporting meropenem susceptibility.

Impact of the French Infectious Diseases Society's (SPILF) proposals for shorter antibiotic therapies

ObjectiveTo compare the practices of French infection specialists related to antibiotic therapy duration between 2016 and 2018. MethodsWe conducted two identical surveys (in 2016 and 2018) targeting hospital-based infection specialists (medical physicians, pharmacists) who gave at least weekly advice on antibiotic prescriptions. The questionnaire included 15 clinical vignettes. Part A asked about the durations of antibiotic therapies they would usually advise to prescribers, and part B asked about the shortest duration they would be willing to advise for the same clinical situations. ResultsWe included 325 specialists (165 in 2016 and 160 in 2018), mostly infectious disease specialists (82.4%, 268/325), members of antibiotic stewardship teams in 72% (234/325) of cases. Shorter antibiotic treatments (as compared with the literature) were advised to prescribers in more than half of the vignettes by 71% (105/147) of respondents in 2018, versus 46% (69/150) in 2016 (P<0.001). Guidelines used by participants displayed fixed durations for 77% (123/160) of cases in 2018 versus 21% (35/165) in 2016. Almost all respondents (89%, 131/160) declared they were aware of the 2017 SPILF's proposal. ConclusionThe release of guidelines promoting shorter durations of antibiotic therapy seems to have had a favourable impact on practices of specialists giving advice on antibiotic prescriptions.

Escherichia coli bloodstream infection outcomes and preventability: a six-month prospective observational study

BackgroundEscherichia coli bloodstream infection (BSI) is a common and serious problem, and incidence and antibiotic resistance are increasing. AimTo understand the drivers of outcomes and factors associated with preventable cases at the study institution. MethodsBetween 1st November 2017 and 30th April 2018, cases of E. coli BSI in adults treated as inpatients at the study institution were included in a prospective cohort. Clinical, demographic and laboratory features were recorded, with seven-, 30- and 90-day mortality and length of hospital stay post BSI. Qualitative data on preventability were reviewed independently by two infection specialists. FindingsIn total, 195 cases in 188 patients were included in the analysis. Empirical antibiotics showed in-vitro resistance in 30.9% of cases. Thirty-day mortality was 23.6%, with a median length of hospital stay of seven days. On multi-variable analysis, 30-day mortality was associated with higher Charlson score, residential home residency, higher respiratory rate and higher serum urea, whilst prolonged length of stay was associated with hospital-acquired E. coli BSI. Fifty patients were felt to have avoidable BSI, all of which were health care associated; urinary catheter use, antibiotic-related and procedural complications were the areas of preventability. ConclusionsE. coli BSI has an appreciable mortality, with little in the way of modifiable risk factors for mortality or prolonged hospital stay. Attention to urinary catheter use is likely to be the most useful way to reduce the incidence, but current UK reduction targets may be unachievable.

Outpatient Parenteral Antimicrobial Therapy in Children.

Over recent years, there has been a marked increase in the number of centres delivering paediatric outpatient parenteral antimicrobial therapy (pOPAT). Various factors have fuelled this drive, including the significant economic pressures faced by high-income countries to contain the cost of healthcare, resulting in a significant reduction of in-patient beds over the past 20years. It is essential that pOPAT services have formal clinical governance structures in place to ensure the safe and effective management of children being ambulated on intravenous antibiotics. They also require oversight of antimicrobial decisions by a medically qualified infection specialist to ensure that the principles of antimicrobial stewardship are adhered to. This review aims to provide an evidence-based framework for delivering pOPAT services. There is increasing data supporting the implementation of admission avoidance strategies for children with cellulitis and pyelonephritis. In addition, recent data supports the management of a subset of children with febrile neutropenia within pOPAT services. Above all, there is a clear recognition that embedding antimicrobial stewardship within pOPAT services reduces duration of intravenous antibiotics (IVAbs) and improves patient management. pOPAT services are safe, cost-effective and associated with high levels of parent/patient satisfaction. Further research is required to develop risk prediction models for children being considered for pOPAT. Further data about the use of elastomeric devices in children and the acceptability of parental administration of IVAbs are also required.

Can intravenous antifungal therapy be safely used in the outpatient parenteral antimicrobial therapy (OPAT) setting?

Outpatient parenteral antimicrobial therapy (OPAT) is an established treatment option for patients with a variety of infections who require a period of intravenous therapy, are clinically stable, and do not require continuous monitoring. Many patients with fungal infections require prolonged therapy due to resistance or intolerance to oral antifungal agents. Despite the widespread use of OPAT by infection specialists, antifungal agents appear infrequently used in this setting. We suggest that with appropriate patient selection, patients with fungal infections could successfully be treated on OPAT.

Application of media technologies in prevention of HIV infection among the young people of the Republic of Khakassia

This article analyzes the previously unknown aspects of using media technologies as tools for preventing the spread of HIV infection among young people in the Siberian region. Accordingly, the purpose of this article is to analyze the effectiveness of video cases in the prevention of HIV infection among young people. The authors rely on the idea of social prevention of dangerous diseases as a social institution that is functionally focused on the development, active assimilation and use of socio-cultural norms and skills, the risk of spreading diseases. The theoretical and methodological basis of the work is the approaches of well-known foreign scientists related to the issues of preserving society, stability of social systems, and coordination of the interests of the state and the individual. This article is based on materials of the monitoring study, which was conducted in 2019-2020 in the framework of preventive measures of HIV infection specialists of the “Center for Preventing and Fighting AIDS” in conjunction with volunteers. The authors of this article analyze the results of the survey: the questions were aimed at studying the awareness of young people about possible transmission routes, potential risk groups, clinical features of HIV infection and AIDS, as well as the awareness of young people about the HIV infection in general before and after preventive measures with the help of video sessions. This study makes a number of conclusions concerning the dynamics of students’ general awareness and their relationship to the HIV infection, as well as the effectiveness of media in preventing the HIV infection among the youth of the Republic of Khakassia. The results show that in the contemporary period of active usage of digital technologies, it is advisable to prevent HIV infection in the youth environment by using video cases. At the same time, educational organizations and educational institutions are the most optimal platform for performing HIV prevention work with young people. Finally, the main priority of HIV prevention should be to understand and understand the possibility of infection due to risky behavior of young people.