Local Antibiotic Resistance Patterns Research Articles

1232 Factors Associated With Treatment Failure in Biopsy Proven Helicobacter pylori Infection in the Rio Grande Valley: A Retrospective Review of 3 Years Data

INTRODUCTION: The 2017 American College of Gastroenterology Clinical guidelines advocate clarithromycin triple therapy (CTT) as first line H. Pylori (HP) treatment. CTT consists of a 14-day course of a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole. The national CTT eradication rate (ER) nears 80%. Many well-established factors affect treatment success including therapy duration, compliance, smoking, diabetes mellitus (DM), and local antibiotic resistance rates. Efficacy data on CTT in the Rio Grande Valley (RGV) has not been previously described. It is assumed that local resistance rates parallel those of our neighboring country due to proximity which may influence clinical practice. Aim is to determine the factors that affect biopsy-proven HP treatment failure. METHODS: A retrospective analysis of patients treated for HP in one RGV gastroenterology center between 2015 and 2018 was done. Eradication was defined by either a negative 13C Urea breath test or by a negative HP stool antigen test after treatment. ER was calculated for each regimen and compared against therapy duration, smoking, DM, health insurance status, and socioeconomic level; the latter determined by patient zip codes. We calculated raw ORs (95% CI) and adjusted with Cox and binary logistic regression. RESULTS: Of 544 patients, 71% (384) were females and 97% (526) were Hispanic. Nonsmokers were 79% (425) and diabetics were 32% (174). In total, 56% (305) received CTT and 44% (239) received quadruple therapy (QT) (ie., Tetracycline, metronidazole, bismuth, any PPI). ER was 66% for CTT and 62% for QT. Regarding both therapies, no treatment failure difference was found (P = 0.62) at 10 days, however, treatment failure decreased with 14-day therapy (P < 0.001). Regarding health insurance, 84% (452) had private, 13% (72) had government-issued, and 3% (16) were self-pay. Cox regression found no differences in treatment type. Logistic regression found that females OR 2.25 (95% CI 1.4, 3.5, P < 0.001), income <$40,000/year OR 1.78 (95% CI: 1.1, 2.8, P = 0.013), and smoking OR 1.6 (95% CI 1.03, 2.6, P = 0.034) negatively affected eradication. CONCLUSION: HP therapy efficacy was suboptimal, however, 14-day therapy improved treatment failure. More females were affected with HP. Factors negatively affecting eradication were female gender, smoking, and income <$40,000/year. Further studies are required to determine the role of patient education, HP local antibiotic resistance patterns, and physician practice on HP eradication.

Prevalence and Antibiotic Susceptibility Patterns of Salmonella and Shigella Species Isolated from Pediatric Diarrhea in Tehran

Background: Salmonella and Shigella infections are important public health concerns among children. The emergence of antibiotic resistance amongst Salmonella and particularly Shigella isolates has posed serious problems in antimicrobial treatment worldwide. Data on local antibiotic resistance patterns are essential to design suitable antibiotic treatment guidelines. Objectives: The aim of the present study was to determine the prevalence and drug susceptibility patterns of Shigella and Salmonella species in addition to the detection of extended-spectrum β-lactamase producing isolates among diarrhea samples of pediatric patients. Methods: A total of 5300 diarrheic samples from children were examined for the presence of Salmonella and Shigella species. Biochemical and microbial tests, as well as specific polyvalent antisera, were used for the identification of the bacterial species. Antibiotic susceptibility tests and extended-spectrum β-lactamase detection were conducted by disc diffusion and combination disc methods, respectively. Results: A total of 371 (7%) and 472 (8.9%) samples were positive for Salmonella and Shigella species, respectively. The most prevalent Salmonella isolate was serogroup D (n: 176, 47.5%). Of the Shigella isolates, 60.8% were found as Shigella sonnei and 39.2% as Shigella flexneri. The highest level of antibiotic resistance was noted among Shigella flexneri isolates. Overall, 35.7% of the Shigella flexneri isolates and 31% of the Shigella sonnei isolates produced extended-spectrum β-lactamases. Conclusions: This study provided information on the prevalence and antimicrobial susceptibility patterns of Salmonella and Shigella isolates in Iran. It also indicated a high-level resistance among Shigella isolates to co-trimoxazole and ampicillin and among Salmonella isolates to nalidixic acid.

Update on techniques to prevent infections associated with prostate needle biopsy.

Postbiopsy infections (PBIs) are among the most common complications associated with transrectal ultrasound-guided prostate biopsy (TRUSPB). This article discusses the pathogenesis of TRUSPB-associated infectious complications and reviews the most recent findings on techniques to prevent PBIs. Risk stratification is a powerful tool for identifying TRUSPB candidates whom warrant additional preventive measures. Bowel preparation with povidone-iodine-based enemas and needle disinfection with formalin solution are simple and attractive strategies, but their effectiveness needs to be thoroughly assessed. Antibiotic prophylaxis represents the mainstay for the prevention of PBIs: the prophylactic regimen must respect the principles of antimicrobial stewardship, and local antibiotic resistance patterns among uropathogens should always be considered. Augmented and targeted antibiotic prophylaxes are powerful options, but their role in current clinical practice has yet to be clarified. The transperineal approach has shown a near-zero rate of PBIs, and should therefore be considered for the highest-risk patients. Several procedures have been introduced to prevent TRUSPB-related infectious complication, but their utility and applicability in the clinical practice has yet to be elucidated. More robust evidence based on randomized control trials is needed to establish the efficacy of these tools in improving patient outcomes.

Implementation of an institution-specific antimicrobial stewardship smartphone application.

Smartphones are increasingly used to access clinical decision support, and many medical applications provide antimicrobial prescribing guidance. However, these applications do not account for local antibiotic resistance patterns and formularies. We implemented an institution-specific antimicrobial stewardship smartphone application and studied patterns of use over a 1-year period.

Can a smartphone app improve medical trainees' knowledge of antibiotics?

ObjectivesTo determine whether a smartphone app, containing local bacterial resistance patterns (antibiogram) and treatment guidelines, improved knowledge of prescribing antimicrobials among medical trainees. MethodsWe conducted a prospective, controlled, pre-post study of medical trainees with access to a smartphone app (app group) containing our hospital’s antibiogram and treatment guidelines compared to those without access (control group). Participants completed a survey which included a knowledge assessment test (score range, 0 [lowest possible score] to 12 [highest possible score]) at the start of the study and four weeks later. The primary outcome was change in mean knowledge assessment test scores between week 0 and week 4. Change in knowledge assessment test scores in the app group were compared to the difference in scores in the control group using multivariable linear regression. ResultsSixty-two residents and senior medical students participated in the study. In a multivariable analysis controlling for sex and prior knowledge, app use was associated with a 1.1 point (95% CI: 0.10, 2.1) [β = 1.08, t(1) = 2.08, p = 0.04] higher change in knowledge score compared to the change in knowledge scores in the control group. Among those in the app group, 88% found it easy to navigate, 85% found it useful, and about one- quarter used it daily. ConclusionsAn antibiogram and treatment algorithm app increased knowledge of prescribing antimicrobials in the context of local antibiotic resistance patterns. These findings reinforce the notion that smartphone apps can be a useful and innovative means of delivering medical education.

Evaluating the Relationship Between Hospital Antibiotic Use and Antibiotic Resistance in Common Nosocomial Pathogens.

OBJECTIVE The relationship between hospital antibiotic use and antibiotic resistance is poorly understood. We evaluated the association between antibiotic utilization and resistance in academic and community hospitals in Ontario, Canada. METHODS We conducted a multicenter observational ecological study of 37 hospitals in 2014. Hospital antibiotic purchasing data were used as an indicator of antibiotic use, whereas antibiotic resistance data were extracted from hospital indexes of resistance. Multivariate regression was performed, with antibiotic susceptibility as the primary outcome, antibiotic consumption as the main predictor, and additional covariates of interest (ie, hospital type, laboratory standards, and patient days). RESULTS With resistance data representing more than 90,000 isolates, we found the increased antibiotic consumption in defined daily doses per 1,000 patient days (DDDs/1,000 PD) was associated with decreased antibiotic susceptibility for Pseudomonas aeruginosa (-0.162% per DDD/1,000 PD; P=.119). However, increased antibiotic consumption predicted increased antibiotic susceptibility significantly for Escherichia coli (0.173% per DDD/1,000 PD; P=.005), Klebsiella spp (0.124% per DDD/1,000 PD; P=.004), Enterobacter spp (0.194% per DDD/1,000 PD; P=.003), and Enterococcus spp (0.309% per DDD/1,000 PD; P=.001), and nonsignificantly for Staphylococcus aureus (0.012% per DDD/1,000 PD; P=.878). Hospital type (P=.797) and laboratory standard (P=.394) did not significantly predict antibiotic susceptibility, while increased hospital patient days generally predicted increased organism susceptibility (0.728% per 10,000 PD; P<.001). CONCLUSIONS We found that hospital-specific antibiotic usage was generally associated with increased, rather than decreased hospital antibiotic susceptibility. These findings may be explained by community origins for many hospital-diagnosed infections and practitioners choosing agents based on local antibiotic resistance patterns. Infect Control Hosp Epidemiol 2017;38:1457-1463.

Best Practice Recommendations for Diagnosis and Management of Helicobacter pylori-Synthesizing the Guidelines.

Purpose of review Three guidelines on Helicobacter pylori have been published recently with recommendations that differ from past guidelines. In this review, we summarize the Toronto consensus statement, the Maastricht V/Florence consensus report and the American College of Gastroenterology guidelines on H. pylori, comparing and contrasting the recommendations. We also provide a proposed approach integrating the information from all three guidelines. Findings Increasing antibiotic resistance has decreased the effectiveness of past treatment regimens for H. pylori. The recommended treatment approach should be based on local and individual antibiotic resistance patterns. Empiric first-line therapy should be a 14-day course of bismuth- or antibiotic-based quadruple therapy. Clarithromycin triple therapy is not recommended unless the local clarithromycin resistance rate is less than 15%. Second-line therapy should be influenced by the failed first-line therapy. Quadruple bismuth-based therapy or levofloxacin-based therapy are suggested regimens. Testing for antibiotic resistance is recommended after multiple failed treatments. Summary Therapy of H. pylori should be based on the knowledge of local antibiotic resistance patterns. Unfortunately, these are often not available. Additional efforts are needed to define local antibiotic resistance to allow susceptibility-based treatment. In the meantime, 14-day quadruple therapy with bismuth or concomitant antibiotics is the recommended as an empiric first-line treatment approach.

Current Trends in the Management of Spontaneous Bacterial Peritonitis

Spontaneous bacterial peritonitis is a life-threatening infection that is a leading cause of mortality among patients with decompensated cirrhosis. In this article, we present current trends in the management of spontaneous bacterial peritonitis (SBP), highlighting treatment failure rates of traditional regimens and ways in which to address such challenges. Despite available management guidelines, there are data to support that these guidelines are often not adhered to, e.g., performing a diagnostic paracentesis at the time of hospital admission in a patient with ascites. Management of SBP is now further complicated by resistant organisms and an increasing prevalence of nosocomial and healthcare-associated infections. Effective treatment of SBP requires careful consideration of patient risk factors, local antibiotic resistance patterns, and clinical presentation.

Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection.

In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp) eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for Hp eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including probiotics, plants, or nutraceuticals.

A Study of Prevalence of Aerobic Bacteria and Fungi in Sputum Specimens of Patients with Post Tubercular Bronchiectasis

&lt;p&gt;&lt;strong&gt;Background:&lt;/strong&gt; Patients with Post TB bronchiectasis colonize many aerobic bacteria and fungi and lead to an increase in exacerbations and decrease in quality of life.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective:&lt;/strong&gt; To study the prevalence of aerobic bacteria and fungi in sputum specimens of patients with post tubercular bronchiectasis and to find out the local antibiotic sensitivity and resistance patterns.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materials and Methods:&lt;/strong&gt; This prospective observational study was carried out over a period of one year comprising of 50 patients with post Tubercular Bronchiectasis who were above 18 yrs, completed ATT smear negative and HRCT showing bronchiectactic changes. Identification of organisms from sputum samples were done by classical aerobic microbial staining and culture methods. Descriptive and inferential statistical analysis was carried out in this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results:&lt;/strong&gt; This study comprises of the 50 patients with a larger group of individuals under the age group of 51-60 (30%), along with bronchial colonization of aerobic bacteria being 78% and growth of fungi being 2%.Among the 39 patients,16 patients (32%) had grown Pseudomonas aeruginosa, 12 patients(24%) had grown Klebsiella pneumoniae, 8 patients(16%) had grown Streptococcus species and rest 3 patients(6%) had grown staphylococcus species. The Antibiotic resistance noted highest being Amikacin (56.4%), piperacillin-tazobactam showing the least (2.6%) and highest sensitivity with imipenem(100%).&lt;/p&gt;&lt;p&gt;&lt;strong&gt; Conclusion:&lt;/strong&gt; This study signifies that prevalence of aerobic bacteria, especially Pseudomonas aeruginosa and Klebsiella pneumonia was common in patients with post tubercular bronchiectasis. The Antibiotic resistance noted highest being Amikacin (56.4%) and sensitivity with imipenem(100%). In patients colonizing Pseudomonas aeruginosa, there was significant decline in lung function.&lt;/p&gt;

A Study of Prevalence of Aerobic Bacteria and Fungi in Sputum Specimens of Patients with Post Tubercular Bronchiectasis

Background: Patients with Post TB bronchiectasis colonize many aerobic bacteria and fungi and lead to an increase in exacerbations and decrease in quality of life. Objective: To study the prevalence of aerobic bacteria and fungi in sputum specimens of patients with post tubercular bronchiectasis and to find out the local antibiotic sensitivity and resistance patterns. Materials and Methods: This prospective observational study was carried out over a period of one year comprising of 50 patients with post Tubercular Bronchiectasis who were above 18 yrs, completed ATT smear negative and HRCT showing bronchiectactic changes. Identification of organisms from sputum samples were done by classical aerobic microbial staining and culture methods. Descriptive and inferential statistical analysis was carried out in this study. Results: This study comprises of the 50 patients with a larger group of individuals under the age group of 51-60 (30%), along with bronchial colonization of aerobic bacteria being 78% and growth of fungi being 2%.Among the 39 patients,16 patients (32%) had grown Pseudomonas aeruginosa, 12 patients(24%) had grown Klebsiella pneumoniae, 8 patients(16%) had grown Streptococcus species and rest 3 patients(6%) had grown staphylococcus species. The Antibiotic resistance noted highest being Amikacin (56.4%), piperacillin-tazobactam showing the least (2.6%) and highest sensitivity with imipenem(100%). Conclusion: This study signifies that prevalence of aerobic bacteria, especially Pseudomonas aeruginosa and Klebsiella pneumonia was common in patients with post tubercular bronchiectasis. The Antibiotic resistance noted highest being Amikacin (56.4%) and sensitivity with imipenem(100%). In patients colonizing Pseudomonas aeruginosa, there was significant decline in lung function.

Antibiotic prescribing practices: A national survey of Cambodian physicians.

Antibiotic resistance is a threat to global health security. We assessed knowledge, attitudes, and practices in regard to antibiotic prescribing and resistance in Cambodian physicians from public hospitals. A cross-sectional knowledge, attitudes, and practices survey was distributed to physicians from 19 public hospitals. The response rate was 78% (689 out of 881). The majority (88%; 607 out of 686) of physicians understood that antibiotic resistance was a local challenge. More than half (54%; 366 out of 682) believed that antibiotic prescribing was inappropriate in their hospital and 93% (638 out of 684) had difficulties in selecting appropriate antibiotics to treat common infections. The majority (86%; 574 out of 667) and one-third of physicians (36%; 236 out of 665) would prescribe antibiotics for uncomplicated common cold and diarrhea in children < 5 years of age, respectively. Half (58%; 385 out of 668) had experience treating methicillin-resistant Staphylococcus aureus infection, but the majority (73%; 188 out of 258) could not identify antibiotics to treat this infection. Only 17% (115 out of 667) had experience treating endemic melioidosis. All physicians agreed that knowledge about local antibiotic resistance, treatment guidelines, and educational programs were necessary. Cambodian physicians are aware of antibiotic resistance challenges but they do not possess the required knowledge of local antibiotic resistance patterns that would assist their prescribing practices. Cambodian physicians need support to improve antibiotic prescribing.

The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults

Helicobacter pylori infection is increasingly difficult to treat. The purpose of these consensus statements is to provide a review of the literature and specific, updated recommendations for eradication therapy in adults. A systematic literature search identified studies on H pylori treatment. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an online platform, finalized, and voted on by an international working group of specialists chosen by the Canadian Association of Gastroenterology. Because of increasing failure of therapy, the consensus group strongly recommends that all H pylori eradication regimens now be given for 14 days. Recommended first-line strategies include concomitant nonbismuth quadruple therapy (proton pump inhibitor [PPI]+ amoxicillin+ metronidazole+ clarithromycin [PAMC]) and traditional bismuth quadruple therapy (PPI+ bismuth+ metronidazole+ tetracycline [PBMT]). PPI triple therapy (PPI+ clarithromycin+ either amoxicillin or metronidazole) is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens. Recommended rescue therapies include PBMT and levofloxacin-containing therapy (PPI+ amoxicillin+ levofloxacin). Rifabutin regimens should be restricted to patients who have failed to respond to at least 3 prior options. Optimal treatment of H pylori infection requires careful attention to local antibiotic resistance and eradication patterns. The quadruple therapies PAMC or PBMT should play a more prominent role in eradication of H pylori infection, and all treatments should be given for 14 days.

Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department Based on Local Antibiotic Resistance Patterns: Implications for Antimicrobial Stewardship.

Antibiotic Prescribing for Urinary Tract Infections in the Emergency Department Based on Local Antibiotic Resistance Patterns: Implications for Antimicrobial Stewardship.

Antibiotic treatment algorithm development based on a microarray nucleic acid assay for rapid bacterial identification and resistance determination from positive blood cultures

Rapid diagnosis of bloodstream infections remains a challenge for the early targeting of an antibiotic therapy in sepsis patients. In recent studies, the reliability of the Nanosphere Verigene Gram-positive and Gram-negative blood culture (BC-GP and BC-GN) assays for the rapid identification of bacteria and resistance genes directly from positive BCs has been demonstrated. In this work, we have developed a model to define treatment recommendations by combining Verigene test results with knowledge on local antibiotic resistance patterns of bacterial pathogens. The data of 275 positive BCs were analyzed. Two hundred sixty-three isolates (95.6%) were included in the Verigene assay panels, and 257 isolates (93.5%) were correctly identified. The agreement of the detection of resistance genes with subsequent phenotypic susceptibility testing was 100%. The hospital antibiogram was used to develop a treatment algorithm on the basis of Verigene results that may contribute to a faster patient management.

Does emerging Clarithromycin resistance signal an obituary to empirical standard triple therapy for Helicobacter pylori infection?

Despite 30 years of its discovery, the ideal therapeutic regimen against Helicobacter pylori is still evasive. Clarithromycin-based standard triple therapy which has been considered the first line empirical therapy has been failing in many parts of the world, due to rising resistance against Clarithromycin, forcing the use of alternate regimens. In this context, we studied the local antibiotic resistance patterns against H. pylori and its impact on standard triple therapy in our region. All patients undergoing diagnostic upper endoscopy during the study period and detected to be positive for rapid urease test (RUT) underwent cultures of gastric mucosal specimens and had their antibiotic resistance patterns mapped out. Standard triple therapy was administered to those tested positive for H. pylori by RUT and eradication rates checked by urea breath test 4 weeks after the completion of treatment. Eradication rates with Clarithromycin-based standard triple therapy were suboptimal with a success of only (71.28%). H. pylori culture and antibiotic susceptibility studies showed high resistance to Clarithromycin (21.2%), Metronidazole (78.1%), and Levofloxacin (15%). However, the resistance to Amoxicillin (2.9%), Tetracycline (0%), and Rifabutin (4.5%) were low. Standard triple therapy is failing in our region due to high Clarithromycin resistance. We need to abandon empirical and blind triple therapy without post-treatment testing and devise alternate effective treatment strategies against H. pylori based on the local resistance patterns observed.

Helicobacter pylori.

This review focuses on new treatment options for eradicating Helicobacter pylori that have emerged as a result of decreased efficacy of standard triple therapy due to increasing antibiotic resistance. We also report on new data regarding primary and secondary gastric cancer prevention strategies and the potential role of H. pylori as a risk factor for extragastric malignancies. Treatment options have shifted from triple to various quadruple modifications. The length of therapy duration has, in general, been extended from 7 to 10 and 14 days. Nonbismuth-based quadruple therapies prescribed as sequential, concomitant, and hybrid have shown superiority as compared to standard triple therapy in the eradication of clarithromycin-resistant H. pylori. Bismuth-based quadruple therapy appears almost totally independent of antibiotic resistance and maintains high eradication rates. Levofloxacin is an adequate substitute for clarithromycin and is recommended in second-line regimens. However, it should be used prudently as H. pylori has developed resistance to levofloxacin in many regions of the world. Strategies for primary gastric cancer prevention by H. pylori eradication are effective, whereas H. pylori eradication for secondary gastric cancer prevention is uncertain. Very recent data implicate H. pylori as a risk factor for extragastric malignancies. H. pylori therapy should be tailored according to local antibiotic resistance patterns. In many regions of the world, H. pylori is becoming increasingly resistant to clarithromycin, metronidazole, and levofloxacin. Gastric cancer prevention by H. pylori eradication is most effective, if implemented early in the course of infection. New data are provided which indicate H. pylori as risk factor for extragastric malignancies.

Treatment practice of acute cystitis on the basis of national prescription data

Urinary tract infections are one of the common diseases in the primary health care. To analyse patterns of ambulatory antibiotic use in acute cystitis. Antibiotic use data was based on national-level prescription turnovers. Patterns of antibiotic use were evaluated by prescribing quality indicators. The content of different national guidelines for treatment of acute cystitis and adherence to these guidelines were also evaluated. For the treatment of acute cystitis quinolones were used predominantly. Norfloxacin (26%) and ciprofloxacin (19%) were prescribed most commonly. The use of internationally recommended agents such as sulphonamides, nitrofurans and fosfomycin shared 15%, 7% and 2%, respectively. The average adherence rate to national guidelines was 66% and certain weak points (e.g. controversial content) of the national guidelines were also identified. Antibiotic use in acute cystitis seems to be suboptimal in Hungary. Considering actual local antibiotic resistance patterns, a new national guideline should be worked out for acute cystitis treatment.

The outcome of non-carbapenem-based empirical antibacterial therapy and VRE colonisation in patients with hematological malignancies.

Febrile neutropenia (FN) is generally a complication of cancer chemotherapy. We retrospectively evaluated the febrile neutropenia episodes and their outcomes with respect to modification rates of non-carbapenem-based empirical antibacterial therapy and vancomycin-resistant enterococcus (VRE) colonisation that caused to VRE bacteremia in patients with hematological malignancies. All consecutive patients, who were older than 14 years of age and developed febrile neutropenia episodes due to hematological malignancies from September 2010 to November 2011 at the hematology department were included into the study. In total, 86 consecutive neutropenic patients and their 151 febrile episodes were evaluated. The mean MASCC prognostic index score was 18,72 ± 9,43. Among 86 patients, 28 patients experienced a total of 30 bacteremia episodes of bacterial origin. Modification rates of both, empirical monotherapy and combination therapies, were found similar, statistically (P = 0,840). Our results suggest that initiating of non-carbapenem based therapy does not provide high response rates in the treatment of febrile neutropenia attacks. Furthermore, non-carbapenem-based empirical therapy provides benefit in regard to cost-effectiveness and antimicrobial stewardship when local antibiotic resistance patterns of gram-negative bacteria are considered. Patients who are colonized with VRE are more likely to develop bacteremia with VRE strains as a result of invasive procedures and severe damage of mucosal barriers observed in this group of patients.

Infection Control to Avoid Surgical Site Infection

Infection control is a discipline that applies epidemiologic and scientific principles and statistical analysis to prevent or reduce rates of nosocomial infections. Effective infection control programs proved to reduce the rates of nosocomial infections and to be cost-effective. It is a key component of the broader discipline of hospital epidemiology. As an example, the anesthesia team acts every day in a highly complex and high risk environment for the transmission of pathogenic organisms and induction of infectious complication. In order to achieve the main goal of preventing or reducing the risk of hospital-acquired infections, a hospital epidemiology program should have the following oversight functions and responsibilities: Surveillance, either hospital-wide or targeted Education about prevention of infections. Outbreak investigations cleaning, disinfection and sterilization of equipments and disposal of infectious waste hospital employee health, specifically after exposure to either blood-borne or respiratory pathogens, Review of antibiotic utilization and its relationship to local antibiotic resistance patterns, Prevention of infections due to percutaneous intravascular devices. Development of infection control policies and procedures oversight on the use of new products that directly or indirectly relate to the risk of nosocomial infections.