Infectious Diseases Specialist Consultation Research Articles

Hepatitis B clinical care provision in pregnancy: A whole-of-population linkage study in Victoria, Australia.

Pregnancy is a key setting for engagement in chronic hepatitis B (CHB) care, due to the implications for transmission to the infant and antenatal diagnosis representing an opportunity for ongoing follow-up. This study aimed to identify the coverage and predictors of clinical care for women with CHB during and after pregnancy in a population-level cohort. Notified CHB cases in Victoria, Australia, were linked with hospitalizations, medical services, and prescribing data, covering the period 1991-2018. Women with an admission for a live birth were identified and services provided during pregnancy were assessed, including general practitioner (GP) or specialist visits, viral load and serology testing, and antiviral treatment. Viral load and serology testing coverage ware also assessed for the 2-year period following pregnancy. Demographic and clinical predictors of viral load testing during pregnancy were assessed. A total of 11015 birth events occurred for 6090 women with CHB. During pregnancy most had a GP consultation (91.6%); however, only 39.5% had viral load testing and 41.4% had a gastroenterology or infectious diseases specialist consultation. Viral load testing and serology testing in the 2years after pregnancy occurred in approximately half (47.9% and 52.2%, respectively) with increases over time. Viral load testing was more likely in those born overseas, those with more than one previous birth, and those living in Melbourne. Despite improvements over time, key gaps were identified in the provision of CHB clinical care during and after pregnancy, with implications for ongoing transmission and adverse outcomes.

Staphylococcus aureus bacteremia in alcoholics.

Alcoholism associates with increased Staphylococcus aureus bacteremia incidence and mortality. The objective was to compare disease progression, treatment and prognosis of Staphylococcus aureus bacteremia in alcoholics versus non-alcoholics. The study design was a multicenter retrospective analysis of methicillin-sensitive Staphylococcus aureus bacteremia with 90-day follow-up. Patients were stratified as alcoholics or non-alcoholics based on electronic health record data. Altogether 617 Staphylococcus aureus bacteremia patients were included of which 83 (13%) were alcoholics. Alcoholics, versus non-alcoholics, were younger, typically male and more commonly had community-acquired Staphylococcus aureus bacteremia. No differences in McCabe´s classification of underlying conditions was observed. Higher illness severity at blood culture sampling, including severe sepsis (25% vs. 7%) and intensive care unit admission (39% vs. 17%), was seen in alcoholics versus non-alcoholics. Clinical management, including infectious disease specialist (IDS) consultations and radiology, were provided equally. Alcoholics, versus non-alcoholics, had more pneumonia (49% vs. 35%) and fewer cases of endocarditis (7% vs. 16%). Mortality in alcoholics versus non-alcoholics was significantly higher at 14, 28 and 90 days (14% vs. 7%, 24% vs. 11% and 31% vs. 17%), respectively. Considering all prognostic parameters, male sex (OR 0.19, p = 0.021) and formal IDS consultation (OR 0.19, p = 0.029) were independent predictors of reduced mortality, whereas ultimately or rapidly fatal comorbidity in McCabe´s classification (OR 12.34, p < 0.001) was an independent predictor of mortality in alcoholics. Alcoholism deteriorates Staphylococcus aureus bacteremia prognosis, and our results suggests that this is predominantly through illness severity at bacteremia onset. Three quarters of Staphylococcus aureus bacteremia patients we studied had identified deep infection foci, and of them alcoholics had significantly less endocarditis but nearly half of them had pneumonia.

Effect of Infectious Diseases Specialist Consultation on the Management and Outcome of Patients in a Public Sector Hospital

Aim: To assess the effect of infectious diseases specialist consultation on the management and outcome of patients in a public sector hospital. Materials and Methods: This was a prospective cohort study in which a total of 313 patients were enrolled. This study was conducted in Dr Ruth Km Pfau Civil Hospital Karachi. The study duration was 6 month from 1st January, 2023 to 30 June, 2023. Data were collected from the medicine, surgery and allied departments of Civil Hospital Karachi by the study investigators themselves. For statistical analysis we used SPSS Version 25. Results: We included a total of 313 patients in our study, with a mean age of 52.31±10.51 years and an average length of stay of 13.04±5.50. These patients were distributed across various departments, with 91 (29.1%) from medicine, 110 (35.1%) from surgery, and the remaining 112 (35.8%) from other allied departments. The majority of patients, 63 (20.1%), were diagnosed with bacteremia, while 52 (16.6%) had urine infections, and 56 (17.9%) experienced urinary tract infections (UTI). Other diagnoses included Ventilator-associated pneumonia/hospital-acquired pneumonia (17.9%), Mixed infections (3.2%), Necrotizing Fasciitis (11.2%), Peritonitis (9.6%), Pancreatitis (2.6%), Surgical Site Infections (SSI) (6.4%), Diabetic foot infections (4.5%), Osteomyelitis (4.8%), and Meningitis (3.2%) respectively. Patients were categorized based on the etiology of infection, revealing that 14 (4.5%) patients had unexplained fever. Additionally, malaria was found in 21 (6.7%) patients, Dengue in 32 (10.2%), Tuberculosis in 27 (8.6%), ATT-induced hepatitis in 9 (2.9%), Multidrug-Resistant Organisms (MDROs) in 148 (47.3%), Methicillin-resistant Staphylococcus aureus (MRSA) in 49 (15.7%), Fungal infections in 11 (3.5%), and Viral infections in 2 (0.6%). Regarding outcomes, 229 (73.2%) patients exhibited clearance of bacterial or fungal cultures, 13 (4.2%) showed no disability at the time of discharge, 229 (76.7%) demonstrated improvement in signs and symptoms, and mortality occurred in 1 (0.3%) patient. Conclusion: It was concluded that consulting with experts in infectious diseases has a major impact on patient management and results. Keywords: Infectious Disease specialist, management, consultation.

Evaluation of Clinical Approach and Outcomes Staphylococcus aureus Bacteremia.

Despite appropriate treatment and early diagnosis methods, Staphylococcus aureus bacteremia (SAB) is still associated with a high mortality rate. This study aims to evaluate the clinical features and approaches to SAB and to analyze the parameters that may affect 7-day and 30-day mortality. Adult patients with SAB data between 2011 and 2018 were evaluated retrospectively. Clinical data, patient demographics, and 7-day and 30-day mortality rates were obtained from their medical records. In total, 144 patients were included in the study; 57.6% (83/144) of patients were men, and the mean age was 65.2±16.5 years. The most common source of infection was the central-line catheter (38.9%), followed by intra-abdominal (21%), respiratory (16.7), infective endocarditis (5.6%), and osteoarticular foci (2.1%). Fifteen percent (15%) of the strains were methicillin resistant. Transthoracic echocardiography (TTE) was performed for 80.6% (116/144) patients. Infectious diseases specialist consultation within 96 hours from blood culture signal was requested in 79.9%. Overall, 7-day mortality was 11.8%, and 30-day mortality was 21.5%. Staying in intensive care units (ICU) increased the risk of 30-day mortality by 1.1 times, and respiratory-focused SAB increased the risk by 4.3 times. SAB is still a big threat. Staphylococcal pneumonia remains a severe infection. Several prognostic factors influence mortality. Identifying the source, ensuring source control, and appropriate initial therapy as soon as possible are critical for reducing mortality and morbidity in SAB.

Enterococcus faecalis bloodstream infection: does infectious disease specialist consultation make a difference?

PurposeTo evaluate the relationship between mortality or relapse of bloodstream infection (BSI) due to Enterococcus faecalis and infectious diseases specialist consultation (IDC) and other factors potentially associated with outcomes.MethodsIn a tertiary-care center, consecutive adult patients with E. faecalis BSI between January 1, 2016 and January 31, 2019, were prospectively followed. The management of E. faecalis BSI was evaluated in terms of adherence to evidence-based quality-of-care indicators (QCIs). IDC and other factors potentially associated with 90-day-mortality or relapse of E. faecalis BSI were analyzed by multivariate logistic regression.ResultsA total of 151 patients with a median age of 68 years were studied. IDC was performed in 38% of patients with E. faecalis BSI. 30 cases of endocarditis (20%) were diagnosed. All-cause in-hospital mortality was 23%, 90-day mortality was 37%, and 90-day relapsing E. faecalis BSI was 8%. IDC was significantly associated with better adherence to 5 QCIs. Factors significantly associated with 90-day mortality or relapsing EfB in multivariate analysis were severe sepsis or septic shock at onset (HR 4.32, CI 2.36e7.88) and deep-seated focus of infection (superficial focus HR 0.33, CI 0.14e0.76).ConclusionEnterococcus faecalis bacteremia is associated with a high mortality. IDC contributed to improved diagnostic and therapeutic management.

Infectious diseases specialist consultation in Staphylococcus lugdunensis bacteremia.

BackgroundCommensal coagulase negative Staphylococcus lugdunensis may cause severe bacteremia (SLB) and complications. Treatment of SLB is not fully established and we wanted to evaluate if infectious diseases specialist consultation (IDSC) would improve management and prognosis.MethodsMulticenter retrospective study of SLB patients followed for 1 year. Patients were stratified according to bedside (formal), telephone (informal) or lack of IDSC within 7 days of SLB diagnosis.ResultsAltogether, 104 SLB patients were identified: 24% received formal bedside and 52% informal telephone IDSC whereas 24% were managed without any IDSC. No differences in demographics, underlying conditions or severity of illness were observed between the groups. Patients with bedside IDSC, compared to telephone IDSC or lack of IDSC, had transthoracic echocardiography more often performed (odds ratio [OR] 4.00; 95% confidence interval [CI] 1.31–12.2; p = 0.012) and (OR 16.0; 95% CI, 4.00–63.9; P<0.001). Bedside IDSC was associated with more deep infections diagnosed compared to telephone IDSC (OR, 7.44; 95% CI, 2.58–21.4; p<0.001) or lack of IDSC (OR, 9.56; 95% CI, 2.43–37.7; p = 0.001). The overall mortality was 7%, 10% and 17% at 28 days, 90 days and 1 year, respectively. Considering all prognostic parameters, patients with IDSC, compared to lack of IDSC, had lower 90 days and 1 year mortality (OR, 0.11; 95% CI, 0.02–0.51; p = 0.005) and (OR, 0.22; 95% CI, 0.07–0.67; p = 0.007).ConclusionIDSC may improve management and outcome of Staphylococcus lugdunensis bacteremia.

CAUGHT BY CONFUSA: A RARE CASE OF WEISELLA CONFUSA IN A LIVER TRANSPLANT PATIENT

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Weisella confusa is a gram-positive bacteria typically found in gut flora. It is a rare cause of bacteremia in immunocompromised patients, especially those with malignancy. When grown in blood culture isolates, it serves as a harbinger of polymicrobial infection. It is inherently vancomycin resistant and treatment is based on susceptibility panel. In this case, we demonstrate W. confusa bacteremia in the setting of broad-spectrum antibiotic prophylaxis but no immunosuppressive therapy. CASE PRESENTATION: A 57-year-old woman with ulcerative colitis and autoimmune hepatitis and primary sclerosing cholangitis (PSC) overlap requiring liver transplant complicated by recurrent PSC was admitted for odynophagia due to a tongue lesion. She developed progressive synthetic liver dysfunction resulting in altered mental status, oliguric renal failure, and Klebsiella bacteremia with concurrent C. difficile colitis. Triple immunosuppressive therapy was halted and linezolid, aztreonam and oral vancomycin were initiated. Though she completed an antibiotic course with rapid clearance of bacteremia, prophylactic meropenem, micafungin, and oral vancomycin were administered and weekly surveillance cultures were drawn in anticipation of repeat transplant.One month later, four of four blood cultures grew W. confusa, followed by Lactobacillus rhamnosus, Enterococcus faecalis, and Candida krusei soon thereafter. Antimicrobials were escalated to amphotericin B, daptomycin, aztreonam, linezolid, and metronidazole, though she developed shock requiring multiple vasopressors. Computed tomography was obtained for source identification and demonstrated a right upper lobe pulmonary abscess and multiple hepatic abscesses. Upon discussions with the patient's family, care was withdrawn and she died soon after. DISCUSSION: W. confusa is a rare isolate from blood cultures and is generally associated with polymicrobial infections. Previous studies have shown that the majority of cases occur in the setting of malignancy, though there has been one other documented case in a liver transplant patient. In addition, a study conducted in pediatric liver transplant patients demonstrated Weisella isolates in stool samples, reflecting increased gut colonization with this organism. It is a naturally vancomycin resistant organism and misidentification as Lactobacillus by traditional speciation methods often results in inappropriate therapy. Here we demonstrate a case of Weisella bacteremia likely secondary to gut translocation. Given its natural vancomycin resistance, it is likely that prophylactic oral vancomycin for C. difficile resulted in W. confusa overgrowth and facilitated her decompensation via pre-existing defects to the gut mucosal barrier from ulcerative colitis. CONCLUSIONS: W. confusa should be considered an opportunistic bacteria warranting infectious disease specialist consultation to assist in management. REFERENCE #1: 1. Kamboj, K., Vasquez, A., & Balada-Llasat, J. M. (2015). Identification and significance of Weissella species infections. Frontiers in microbiology, 6, 1204. https://doi.org/10.3389/fmicb.2015.012042. Kumar, A., Augustine, D., Sudhindran, S., et. al. (2011). Weisella confusa: a rare cause of vancomycin-resistant Gram-positive bacteremia. Journal of Medical Microbiology, 60(10), 1538-41.3. Spiegelhauer, M. R., Yusibova, M., Rasmussen, I., Fuglsang, K. A., Thomsen, K., & Andersen, L. P. (2020). A case report of polymicrobial bacteremia with Weissella confusa and comparison of previous treatment for successful recovery with a review of the literature. Access microbiology, 2(5), acmi000119. https://doi.org/10.1099/acmi.0.0001194. Green, M., Barbadora, K., & Michaels, M. (1991). Recovery of vancomycin-resistant gram-positive cocci from pediatric liver transplant recipients. Journal of clinical microbiology, 29(11), 2503–2506. https://doi.org/10.1128/JCM.29.11.2503-2506.19915. Salimnia, H., Alangaden, G. J., Bharadwaj, R., Painter, T. M., Chandrasekar, P. H., & Fairfax, M. R. (2011). Weissella confusa: an unexpected cause of vancomycin-resistant gram-positive bacteremia in immunocompromised hosts. Transplant infectious disease : an official journal of the Transplantation Society, 13(3), 294–298. https://doi.org/10.1111/j.1399-3062.2010.00586.x6. Fairfax, M. R., Lephart, P. R., & Salimnia, H. (2014). Weissella confusa: problems with identification of an opportunistic pathogen that has been found in fermented foods and proposed as a probiotic. Frontiers in microbiology, 5, 254. https://doi.org/10.3389/fmicb.2014.00254 DISCLOSURES: No relevant relationships by Samuel Chung, source=Web Response No relevant relationships by Ashwin Kelkar, source=Web Response No relevant relationships by Joseph Mailman, source=Web Response

Antibiotic escalation with the inclusion of a checklist in the pediatric intensive care unit

Antibiotic surveillance improves the appropriate antibiotic therapy. To decrease the antibiotic scaling, 48 hours after starting prescription in the pediatric intensive care unit (PICU). A ambispective cohort study was performed in the PICU including patients admitted in whom antibiotic therapy was started and a checklist was applied prospectively. They were compared with a historical cohort, prior the checklist. The main outcome was the antibiotic scaling 48 hours after starting and the secondary endpoints were consultation with infectious diseases (ID) specialist and vancomycin prescription. To compare the variables between the two cohorts, the χ2 test, Fischer test and U Mann-Whitney test were used. The results of the main variables were expressed in RR and RAR. The study was approved by the institution's Ethics Committee. 70 patients were admitted in the checklist cohort and they were compared with 124 patients of the historical cohort. The checklist implementation decreased the antibiotic scaling at 48 h after starting from 56.4 to 21.4% (p < 0.0001) ARR = 35% and vancomycin prescription from 64.5 to 40% (p < 0.001) ARR =24.5%. The consultation with ID specialist increased from 9.6 to 32.8% (p < 0.0001). There were no differences in mortality and duration of antibiotic therapy at 10 days of hospitalization. The checklist implementation decreased the antibiotic scaling,48 hs after starting and the vancomycin prescription while the ID specialist consultation increased.

Infectious disease specialist consultations in a Japanese cancer center: a retrospective review of 776 cases

BackgroundLittle is known about the impact of infectious disease (ID) consultations on the management of patients with cancer. This study aimed to describe the consultation services provided by ID specialists to all departments in a comprehensive cancer center in Japan.MethodsWe conducted a retrospective review of ID consultations with adult patients at a comprehensive cancer center in Japan from April 2017 to March 2018.ResultsDuring the study period, 776 patients with cancer had an ID consultation. Of these, 414 (53.4%) were hospital inpatients. Reasons for the ID consultation comprised clinical management (n = 481, 62.0%), immunization (n = 272, 35.1%), and infection control (n = 23, 3.0%). Of the 474 ID consultations for diagnostic purposes, the most frequent condition was fever or elevated inflammatory markers of unknown origin (n = 125, 26.4%). The most frequent diagnoses after the diagnostic ID consultation were hepatobiliary infections (n = 97, 22.4%), respiratory infections (n = 89, 20.618.8%), and intra-abdominal infections (n = 71, 16.4%). The commonest reasons for immunization consultations were to prevent seasonal influenza (n = 193, 71.0%) and post-splenectomy vaccination (n = 58, 21.3%). The commonest reasons for infection control consultations were suspected tuberculosis or contact with tuberculosis (n = 11, 47.8%) and herpes zoster infection (shingles) (n = 7, 30.4%).ConclusionsID specialists play an important role in the clinical management of patients with cancer. ID physicians who work in cancer centers need to be specialized in treating IDs, diagnosing the causes of fevers of unknown origin, and controlling infection.

Group A streptococcal bacteremias in Southwest Finland 2007\u20132018: epidemiology and role of infectious diseases consultation in antibiotic treatment selection

The incidence of invasive group A streptococcal (GAS) infections has shown a fluctuating but increasing trend in Finland. The impact of infectious diseases specialist consultation (IDSC) on the antimicrobial therapy of GAS bacteremia has not been studied earlier. A retrospective study on adult GAS bacteremia in The Hospital District of Southwest Finland (HDSWF) was conducted from 2007 to 2018. Data on incidence of bacteremic GAS cases were gathered from the National Infectious Disease Register. Clinical data were obtained by reviewing the electronic patient records. The overall incidence of GAS bacteremia in HDSWF was 3.52/100,000, but year-to-year variation was observed with the highest incidence of 7.93/100,000 in 2018. A total of 212 adult GAS bacteremia cases were included. A record of IDSC was found (+) in 117 (55.2%) cases, not found (−) in 71 (33.5%) cases and data were not available in 24 (11.3%) cases. Among IDSC+ cases, 57.3% were on penicillin G treatment whereas in the group IDSC− only 22.5%, respectively (OR = 4.61, 95% CI 2.37–8.97; p < 0.001). The use of clindamycin as adjunctive antibiotic was more common among IDSC+ (54.7%) than IDSC− (21.7%) (OR = 4.51, 95% CI 2.29–8.87; p < 0.001). There was an increasing trend in incidence of GAS bacteremia during the study period. Narrow-spectrum beta-lactam antibiotics were chosen, and adjunctive clindamycin was more commonly used, if IDSC took place. This highlights the importance of availability of IDSC but calls for improved practice among infectious diseases specialists by avoiding combination therapy with clindamycin in non-severe invasive GAS infections.

Formal Infectious Diseases Specialist Consultation Improves Long-term Outcome of Methicillin-Sensitive Staphylococcus aureus Bacteremia.

BackgroundFormal infectious diseases specialist (IDS) consultation has been shown to improve short-term outcomes in Staphylococcus aureus bacteremia (SAB), but its effect on long-term outcomes lacks evaluation.MethodsThis retrospective study followed 367 methicillin-sensitive (MS) SAB patients for 10 years. The impact of formal IDS consultation on risk for new bacteremia and outcome during long-term follow-up was evaluated. Patients who died within 90 days were excluded to avoid interference from early deceased patients.ResultsThree hundred four (83%) patients had formal IDS consultation, whereas 63 (17%) received informal or no IDS consultation. Formal consultation, compared with informal or lack of consultation, was associated with a reduced risk of new bacteremia caused by any pathogen within 1 year (odds ratio [OR], 0.39; 95% confidence interval [CI], 0.18–0.84; P = .014; 8% vs 17%) and within 3 years (OR, 0.39; 95% CI, 0.19–0.80; P = .010; 9% vs 21%), whereas a trend toward lower risk was observed within 10 years (OR, 0.56; 95% CI, 0.29–1.08; P = .079; 16% vs 25%). Formal consultation, compared with informal or lack of consultation, improved outcomes at 1 year (OR, 0.16; 95% CI, 0.06–0.44; P < .001; 3% vs 14%), at 3 years (OR, 0.19; 95% CI, 0.09–0.42; P < .001; 5% vs 22%), and at 10 years (OR, 0.43; 95% CI, 0.24–0.74; P = .002; 27% vs 46%). Considering all prognostic parameters, formal consultation improved outcomes (HR, 0.42; 95% CI, 0.27–0.65; P < .001) and lowered risk for any new bacteremia (OR, 0.45; 95% CI, 0.23–0.88; P = .02) during 10 years of follow-up.ConclusionsMS-SAB management by formal IDS consultation, compared with informal or lack of IDS consultation, reduces risk for new bacteremia episodes and improves long-term prognosis up to 10 years.

Assessing the knowledge, attitudes and perceptions of junior doctors on antimicrobial use and antimicrobial resistance in Greece

ObjectivesUnderstanding antimicrobial prescribing attitudes and perceptions, especially in the early stages of medical training, is an important driver for appropriate interventions. This study examined junior doctors’ knowledge, attitudes and perceptions regarding antimicrobial use and antimicrobial resistance in Greece. MethodsA self-administered, internet-based questionnaire survey was completed by trainees and residents of all primary care centres and hospitals in Crete, Greece. ResultsFrom the 313 invited junior doctors, 214 (68.4%) fully completed the questionnaire. The mean correct knowledge score (four items) was 60%. The highest confidence rates with prescribing were recorded in accurately diagnosing an infection that needs antimicrobial treatment, selecting an appropriate administration route, and selecting the appropriate dosage. The lowest confidence rates were recorded in modifying antimicrobial treatment based on clinical and/or microbiological evidence, prescribing antimicrobial combinations and not prescribing an antimicrobial in a febrile patient without severity criteria and uncertain diagnosis of infection. Use of guidelines and expert consultation were perceived as the most important factors influencing antimicrobial prescribing practices. Most participants were aware of the antimicrobial resistance problem in Greece, and considered excessive prescribing of antimicrobials and broad-spectrum antimicrobials to be the most important causes. Availability of local and national guidelines and antimicrobial resistance data, senior consultation and infectious diseases specialist consultation were the preferred interventions to improve antimicrobial prescribing. ConclusionsThe findings of this study will contribute to the design of appropriate interventions, based on local evidence, for the establishment of antimicrobial stewardship programs in a country characterised by excessive use of antimicrobials and high resistance rates.

Unsolicited consultation by infectious diseases specialist improves outcomes in patients with bloodstream infection: A prospective cohort study

The objective of this study was to evaluate the impact of an intervention based on unsolicited consultations by an infectious diseases specialist (IDS) on the adequacy of antimicrobial treatment and mortality in patients with BSI. A prospective cohort study was performed in a 410-bed hospital. An intervention based on unsolicited consultation by an IDS for patients with BSI was performed only on days when an IDS was available. Outcomes were the percentage of days on optimal antimicrobial treatment (PDOAT) and mortality. Analyses were performed by linear regression and multivariate logistic regression. Of 400 episodes of BSI included, 292 received the intervention. The median (interquartile range) PDOAT among those with and without the intervention was 93 (6-100) and 0 (0-53), respectively. The intervention was independently associated with a higher PDOAT (r = 0.5; p < 0.001) but not with mortality. The IDS recommendations were followed in full in 183 episodes, and not in 109. Mortality was 10.4% and 27.6%, respectively. Adherence to recommendations was associated with lower mortality (adjusted OR = 0.3; 95% CI: 0.1-0.5). An intervention based on unsolicited IDS consultation for BSI episodes was associated with improved use of antibiotics and, when the recommendations were fully followed, with lower mortality.

Commentary

Commentary

Antibiotics in ICU : The Challenges of Use, Cost and Response in a Tertiary Care Hospital

Antibiotic resistance can lead to increased morbidity, mortality, length of hospital stay, and health care expenditures. The study is designed to observe the challenges of antibiotic consumption, related costs and their resistance pattern in critically ill patients. The study was conducted in ICU from July to December 2016, in Holy Family Red Crescent Medical College Hospital The demographic data, antibiotic sensitivity report, the administration of different classes of antibiotics as well as individual drugs and their costs were recorded. In 216 patients, meropenem was the most commonly prescribed antibiotic followed by levofloxacin and ceftriaxone. Meropenem with one or more class of antibiotics had the higher cost (1985/-and 2800/- BDT/ per day) per patient. Though the cephalosporins are the initial choice as the safest, cheaper antibiotics in developed countries, but high rate of resistance was observed in this ICU. The overall sterilization and strict control of nosocomial infections may play vital role in overcoming the challenges. Use of local antibiogram, narrow spectrum antibiotics, infectious disease specialist consultation, and restricted authorization to prescribe antibiotics can effectively shift the antibiotic sensitivity and minimize the cost in ICU stay.

Antibiotics in ICU : The Challenges of Use, Cost and Response in a Tertiary Care Hospital

Antibiotic resistance can lead to increased morbidity, mortality, length of hospital stay, and health care expenditures. The study is designed to observe the challenges of antibiotic consumption, related costs and their resistance pattern in critically ill patients. The study was conducted in ICU from July to December 2016, in Holy Family Red Crescent Medical College Hospital The demographic data, antibiotic sensitivity report, the administration ofdifferent classes of antibiotics as well as individual drugs and their costs were recorded. In 216 patients, meropenem was the most commonly prescribed antibiotic followed by levofloxacin and ceftriaxone. Meropenem with one or more class of antibiotics had the higher cost (1985/-and 2800/- BDT/ per day) per patient. Though the cephalosporins are the initial choice as the safest, cheaper antibiotics in developed countries, but high rate of resistance was observed in this ICU. The overall sterilization and strict control of nosocomial infections may play vital role in overcoming the challenges. Use of local antibiogram, narrow spectrum antibiotics, infectious disease specialist consultation, and restricted authorization to prescribe antibiotics can effectively shift the antibiotic sensitivity and minimize the cost in ICU stay.

Clinical Outcomes of Staphylococcus aureus Bacteremia Following Introduction of Mandatory Infectious Disease Specialist Consultation: A Retrospective 12-Month Study

Clinical Outcomes of Staphylococcus aureus Bacteremia Following Introduction of Mandatory Infectious Disease Specialist Consultation: A Retrospective 12-Month Study

Diagnostic and therapeutic appropriateness in bone and joint infections: results of a national survey

The impact of infectious diseases (ID) specialist consultation in the management of many types of bacterial infections has been fully demonstrated but not for bone and joint infections (BJIs). Nineteen ID Italian centres collected of data from June 2009 to May 2012. Italian guidelines (2009) were used to determine the appropriateness of the diagnostic and therapeutic process of BJIs before and after consulting an ID specialist. Data on 311 patients were collected: 111 cases of prosthetic joint infection, 99 osteomyelitis, 64 spondylodiscitis and 37 fixation device infection. A significant increase of microbiological investigations, imaging techniques and blood inflammation markers were noted after consulting the ID specialist. Moreover, inappropriateness of treatment duration, dosage, and number of administrations significantly decreased after consultation. Infectious disease specialist intervention in the management of BJIs significantly increases the appropriateness both in performing instrumental and laboratory analysis, but especially in determining the correct therapy.

Prescribing Pattern in an Intensive Car Unit in a Tertiary Care Teaching Hospital, Bangalore, South India

INTRODUCTION: Critical care presents with a major patient safety challenges and requires fast-paced, complex and urgent high-risk decisionmaking, by physicians with varying levels of critical care training. In Intensive Care Unit (ICU) settings, the rate of preventable and potential Adverse Drug Events (ADEs) is even higher, being almost twice as high as in non-ICUs.Many studies states that, the presence of clinical pharmacists in ICUs has reduced the number of adverse events, improved cost savings and medications, stay, and shortened the duration of ICU admission. AIM : To study the prescribing pattern in an Intensive Care Unit (ICU). METHOD : A prospective - observational study on prescription pattern was done in the ICU Department of a tertiary care teaching hospital in Bangalore for a period of 6 months. All patients admitted in the ICU above 18 years were included in the study and patients who were admitted in ICU for less than 24 hours were excluded. Patients satisfying Inclusion criteria were enrolled after obtaining Informed Consent (IC) and their medication orders were observed for Prescription Pattern and analysed. RESULTS and DISCUSSION : A total of 120 cases were observed and analysed in which 45% were females and 55% were males. Majority of the patients belong to the age category of above 50 years. A total of 1165 drugs were prescribed out of which 20% were antibiotics followed by broncho dilators (9.2%), anti-hypertensives (9.4%), corticosteroids and analgesics (7.4%) each, anti-diabetics (5.6%), antidotes (1.6 %) and others (38.8%). Antibiotics were the uppermost class prescribed, among which Ceftriaxone or Cefaperazone -Sulbactum combination was widely found. Atropine (52.6%) was the most commonly prescribed antidote. Among bronchodilators, combination of anti-cholinergics and beta blockers was prescribed more (49%). Short acting glucocorticoid and para- aminophenol derivatives with 81.6% and 85% respectively, were the most prescribed corticosteroid and analgesics. CONCLUSION : The results of the study highlights areas that need improvement among which most importantly, there is a need to implement local antibiotic management program or infectious disease specialist consultation which could lead to marked reductions in antibiotic consumption. There are considerable variations in the practice of emergency medications by various professionals in the ICU, hence preparation and implementation of emergency medication practice guidelines may bridge the variations among practitioners and continually improve the quality of care to the patients.

Inpatient infectious disease consultations requested by surgeons at a comprehensive cancer center.

The aim of this study was to describe the value of infectious disease specialist consultations for surgeons at comprehensive cancer centers. A total of 151 cancer surgery inpatients were retrospectively assessed during a 12-month period. We focused on the characteristics of the infectious disease consultations from surgical departments: the referring surgical divisions, the referral phases, and the reasons for the infectious disease consultations. Three-quarters of all consultation requests were made after the day of surgery. Approximately, 60 % of these requests were made within 30 days after surgery for cancer. The reasons for the infectious disease consultations could be classified into three categories: diagnosis and management (54 %), management of established infections (44 %), and surgical antimicrobial prophylaxis (3 %). The most requested reason for consultations was the diagnosis and management of fever or elevated inflammatory markers of unknown etiology. Among the management of established infections, the antimicrobial management of surgical site infections was most frequently requested. Many surgeons would prefer infectious disease specialists to assume a more direct role in the care of difficult or perplexing cases (such as fevers of unknown origin) while also maintaining a traditional relationship in which the consultant recommends antimicrobial agents during a perioperative period. Particularly at cancer centers where oncology specialists account for a significant proportion of the providers, the knowledge and skill of infectious disease physicians are valued.