Routine Use Of Antibiotics Research Articles

A Single-Center, Retrospective Study, of Risk Factors for Clostridium Difficile Infection Among Allogeneic Hematopoietic Stem Cell Transplant Recipients

Introduction Clostridium difficile infection (CDI) is a leading cause of hospital-acquired infection. Allogeneic hematopoietic stem cell transplant (aHSCT) recipients in the peri-transplant periods represent an especially vulnerable population due to chronic immunosuppression, prolonged hospital stays, and routine use of antibiotics (abx). Previous attempts to identify potential risk factors (RF) for CDI are inconsistent in the literature. Objectives Our study goals are to describe CDI incidence, associated risk factors, and CDI characteristics in our own aHSCT population. Study results will be utilized in designing future infection prevention strategies and to promote abx stewardship. Methods We retrospectively evaluated all aHSCT recipients between Jan 2011-May 2017 at Loyola University Cardinal Bernardin Cancer Center. Inclusion criteria included age >18, 1st aHSCT, and hematological malignancy. Both myeloablative and non-myeloablative conditioning regimens were included. Disease risk was defined by the ASBMT classification. RF for CDI included comorbid conditions, proton pump inhibitor (PPI) and abx use during the 1st 100 days after aHSCT, and development of acute (aGVHD) and chronic (cGVHD) graft vs host disease. Data pertaining to CDI classification was collected. aGVHD was graded based on the International BMT Registry System and cGVHD per the NIH consensus criteria. The peri-transplant period evaluated included 6 months prior to 2 years following aHSCT. Logistic regression analysis was performed to estimate adjusted odds ratios for factors associated with development of CDI. Results A total of 322 patients (pt) met our inclusion criteria, of which 89 (27.6%) developed CDI, 55 pts were classified as severe or severe-complicated per ACG criteria and 18 (20.2%) had recurrence within 60 days. Graft type consisted of 109 (33.9%) allogeneic matched related, 124 (38.5%) matched unrelated and 89 (27.6%) cord blood. This was a high risk group with most pts having either intermediate (60.1%) or high/very high (31.5%) disease risk. Infections were common, as 225 (69.9%) pts developing an infection during the 1st 100 days after aHSCT. In multivariable analysis, cord blood graft source (OR=1.99, 95% CI: 1.05-3.8, p = 0.036), PPI use (OR=2.02, 95% CI: 1.08-3.8 p = 0.028), and chronic GI GVHD (OR =5.86, 95% CI: 1.64-20.98, p = 0.018) were associated with increased odds of CDI. Lastly, female sex (OR=0.4, 95% CI: 0.25-0.78, p = 0.005) and GI tract infection (including hepatobiliary source) in first 100 days after HSCT (OR=0.41, 95% CI: 0.17-0.98 p=0.045) were associated with decreased odds of CDI. Of note, rates of II-IV aGVHD were low (N=49, 15%). Conclusion Our population had 27% incidence of CDI and we note that cord blood graft, PPI use, GI cGVHD were associated with increased risk for CDI. These findings may have important implications for the supportive care plans for aHSCT pts.

What are the challenges in choosing pharmacotherapy for rhinosinusitis?

ABSTRACTIntroduction: Rhinosinusitis is an extremely prevalent condition with significant health-care expenditure and socio-economic burden. Although symptomatically patients with acute and chronic rhinosinusitis present similarly, the underlying pathogenesis of these conditions is different.Areas covered: This perspective discusses the various treatment options for both acute and chronic rhinosinusitis and examines some of the challenges in choosing appropriate pharmacotherapy. It examines the evidence supporting the commonly used agents including saline irrigations, topical and oral corticosteroids and antibiotics and makes recommendations based on the highest level of evidence available. Furthermore, the role or precision medicine and emerging therapies such as biologics are discussed.Expert opinion: Despite being commonly prescribed, the evidence supporting the routine use of oral antibiotics for CRS and the majority of ARS is lacking. The authors suggest judicious use of these medications after clear consideration of the indications. Topical intranasal corticosteroids and saline irrigations remain a safe and effective treatment for rhinosinusitis and should be considered as first-line therapy. In patients who fail to respond to appropriate treatment, therapy should be escalated after consultation and review by a specialist.

Incidence of post operative surgical site infection in thyroid surgery following single dose of prophylactic antibiotic

Surgical site infection after thyroid surgery is a less common incidence. Prophylactic antibiotic before surgery and empirical antibiotic therapy after surgery is a common practice in our country. But international guidelines do not suggest antibiotic in clean surgical procedure.
 Aim: To compare the incidence of surgical site infection after thyroid surgery with and without empirical antibiotic therapy.
 Method: It was a cross sectional study, done from July 2010 to December 2010 in 3 medical college hospitals in Dhaka city. Total 100 cases were included in this study, 50 cases for study in which only single prophylactic antibiotic used half an hour before operation, 50 cases for control in which 7 days antibiotic used per orally in addition to prophylaxis.
 Result: Among 100 cases male were 24 & female 76 (M: F= 1:3.2). Oldest patient was 56 yrs & youngest 21yrs. 47% patient operated for solitary thyroid nodule, 35% multinodular goiter & only 6% diffuse goiter. 47% patient was done hemithyroidectomy & only 7% total thyroidectomy. All the operations were completed within 2 hours where 40% within one hour. No surgical site infections were found in both study and control cases.
 Conclusion: There is no statistical difference between routine antibiotic use and no use of antibiotic after thyroid surgery.
 Bangladesh J Otorhinolaryngol; April 2016; 22(1): 15-20

EUS-guided fiducial placement for pancreatobiliary malignancies: safety, infection risk, and use of peri-procedural antibiotics.

Background and study aims Chemoradiation with stereotactic body radiation therapy (SBRT) is increasingly being used for optimal treatment of locally advanced pancreatobiliary cancers. Fiducial markers are used to track these tumors during SBRT. Endoscopic ultrasound (EUS) is the preferred route for fiducial marker placement for ease of access to pancreatobiliary structures and accurate placement. Here we evaluate the safety and infection risk associated with EUS-guided fiducial placement for pancreatobiliary malignancies and use of peri-procedural prophylactic antibiotics. Patients and methods This was a retrospective, single-center study including consecutive patients presenting for EUS-guided fiducial placement in pancreatobiliary region by three expert interventional endoscopists for SBRT from July 2010 to February 2018 at a tertiary care center. Patient demographics, tumor characteristics, EUS technique, fiducials, use of prophylactic antibiotics, adverse events (AEs) and SBRT/Cyberknife administration were reported. Results A total of 355 patients with pancreatobiliary malignancy underwent EUS-guided fiducial placement, of whom 308 patients (86.76 %) successfully underwent SBRT. Of the patients, 304 (85.63 %) received peri-procedural prophylactic antibiotic. Of 355 total patients, 5.9 % (n = 21) were noted to develop AEs (mild to severe) with no significant difference in incidence of infection with or without use of peri-procedural prophylactic antibiotic. Only three patients developed infectious AEs, none of which were definitively related to fiducial placement. Conclusion EUS-guided fiducial placement for pancreatobiliary malignancy is safe and efficacious, and risk of infection is rare, regardless of whether or not peri-procedural antibiotics are used. We favor limiting routine use of peri-procedural antibiotics for patients undergoing EUS-guided fiducial placement in pancreaticobiliary malignancy.

A double-blind placebo-controlled trial of azithromycin to reduce mortality and improve growth in high-risk young children with non-bloody diarrhoea in low resource settings: the Antibiotics for Children with Diarrhoea (ABCD) trial protocol

BackgroundAcute diarrhoea is a common cause of illness and death among children in low- to middle-income settings. World Health Organization guidelines for the clinical management of acute watery diarrhoea in children focus on oral rehydration, supplemental zinc and feeding advice. Routine use of antibiotics is not recommended except when diarrhoea is bloody or cholera is suspected. Young children who are undernourished or have a dehydrating diarrhoea are more susceptible to death at 90 days after onset of diarrhoea. Given the mortality risk associated with diarrhoea in children with malnutrition or dehydrating diarrhoea, expanding the use of antibiotics for this subset of children could be an important intervention to reduce diarrhoea-associated mortality and morbidity. We designed the Antibiotics for Childhood Diarrhoea (ABCD) trial to test this intervention.MethodsABCD is a double-blind, randomised trial recruiting 11,500 children aged 2–23 months presenting with acute non-bloody diarrhoea who are dehydrated and/or undernourished (i.e. have a high risk for mortality). Enrolled children in Bangladesh, India, Kenya, Malawi, Mali, Pakistan and Tanzania are randomised (1:1) to oral azithromycin 10 mg/kg or placebo once daily for 3 days and followed-up for 180 days. Primary efficacy endpoints are all-cause mortality during the 180 days post-enrolment and change in linear growth 90 days post-enrolment.DiscussionExpanding the treatment of acute watery diarrhoea in high-risk children to include an antibiotic may offer an opportunity to reduce deaths. These benefits may result from direct antimicrobial effects on pathogens or other incompletely understood mechanisms including improved nutrition, alterations in immune responsiveness or improved enteric function. The expansion of indications for antibiotic use raises concerns about the emergence of antimicrobial resistance both within treated children and the communities in which they live. ABCD will monitor antimicrobial resistance. The ABCD trial has important policy implications. If the trial shows significant benefits of azithromycin use, this may provide evidence to support reconsideration of antibiotic indications in the present World Health Organization diarrhoea management guidelines. Conversely, if there is no evidence of benefit, these results will support the current avoidance of antibiotics except in dysentery or cholera, thereby avoiding inappropriate use of antibiotics and reaffirming the current guidelines.Trial registrationClinicaltrials.gov, NCT03130114. Registered on April 26 2017.

Učestalost pojave inflamatornih komplikacija nakon hirurške ekstrakcije zuba i efikasnost postoperativnih protokola za njihovo sprečavanje

Introduction: Surgical tooth extraction is one of the most common surgical procedures in oral surgery nowadays. The post-extraction period is usually uneventful, however, in some cases, the healing process may be affected by the extraction trauma or by the impact of bacteria at the surgical site. Aim: The aim of this paper is to establish the frequency of inflammatory complications, specifically surgical site infections and alveolar osteitis, after surgical extractions, and to explore the impact of antiseptics and antibiotics regarding the prevention of these complications. Material and methods: A number of 60 patients was included in this research, divided into three research groups according to the post-operative treatment type prescribed. The first group consisted of the patients who had been prescribed antibiotics, while the second group consisted of the patients who had been instructed to rinse their mouth with 0.12% chlorhexidine digluconate rinse postoperatively. Control group consisted of the patients who had not been prescribed any treatment. The postoperative check-ups were done on the second and the seventh day after the surgery, where it was checked if there were any clinical signs of infection or alveolar osteitis at the surgical site. Results: The study consisted of 60 patients, out of which a total of 67 teeth were extracted. Two patients were diagnosed alveolar osteitis, while four patients were diagnosed postoperative infection Conclusion: Statistically significant difference between the participant groups regarding the frequency of postoperative complications has not been noticed. There is insufficient evidence to justify the routine use of antibiotics or antiseptics after surgical tooth extractions.

Co-Infections in People with COVID-19: A Systematic Review and Meta-Analysis

Background: In previous influenza pandemics, bacterial co-infections have been a major cause of mortality. The significance of co-infecting pathogens in COVID-19 is unknown. Methods: We systematically searched for studies of any design which reported numeric data on co-infections in patients with confirmed COVID-19 published from 1 January 2020 to 17 April 2020. The main outcome was the proportion of patients who had a bacterial, fungal or viral co-infection. We included patients of all ages, in all settings. Pooled estimates were derived using random effects meta-analysis where appropriate. The protocol is registered on PROSPERO (CRD4202040178398). Findings: Our search retrieved 1188 records with 30 eligible for inclusion. From 18 studies, the pooled proportion of hospitalised COVID-19 patients with a bacterial co-infection was 7% (95% CI 3-12%, n=2183, I2 =92∙2%). Subgroup analysis indicated a higher proportion of ICU patients with bacterial co-infections than patients in mixed ward/ICU settings (14%, 95% CI 5-26, I2 =74∙7% versus 4%, 95% CI 1-9, I2 = 91∙7%). The commonest bacteria were Mycoplasma pneumonia, Pseudomonas aeruginosa and Haemophilus influenzae. The pooled proportion with a viral co-infection was 3% (95% CI 1-6, n=1014, 16 studies, I2 =62∙3%), with Respiratory Syncytial Virus and influenza A the commonest. Ascertainment of outcomes was a potential cause of bias in most studies as many patients remained hospitalised at censor date. Interpretation: A low proportion of patients with COVID-19 have a bacterial co-infection; much less than in previous influenza pandemics. These findings do not support the routine use of antibiotics in the management of confirmed COVID-19 infection. Funding Statement: LL and VB are funded by the National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, UK. Declaration of Interests: LL, BL and VB declare no competing interests. WSL’s institution has received unrestricted investigated-initiated research funding from Pfizer for an unrelated pneumonia cohort study in which he is the Chief Investigator.

Adjuvant Antibiotic Therapy After Incision and Drainage of Cutaneous Abscesses.

Annually more than 3 million patients present to U.S. emergency departments (EDs) with cutaneous abscess, a number that has been increasing.1 Standard treatment involves incision and drainage (I&D), while routine use of systemic antibiotics after incision and drainage is controversial. Recently, two large studies found increased cure rates with systemic antibiotics after I&D compared to placebo.

Biomarker-guided antibiotic stewardship in suspected ventilator-associated pneumonia (VAPrapid2): a randomised controlled trial and process evaluation

SummaryBackgroundVentilator-associated pneumonia is the most common intensive care unit (ICU)-acquired infection, yet accurate diagnosis remains difficult, leading to overuse of antibiotics. Low concentrations of IL-1β and IL-8 in bronchoalveolar lavage fluid have been validated as effective markers for exclusion of ventilator-associated pneumonia. The VAPrapid2 trial aimed to determine whether measurement of bronchoalveolar lavage fluid IL-1β and IL-8 could effectively and safely improve antibiotic stewardship in patients with clinically suspected ventilator-associated pneumonia.MethodsVAPrapid2 was a multicentre, randomised controlled trial in patients admitted to 24 ICUs from 17 National Health Service hospital trusts across England, Scotland, and Northern Ireland. Patients were screened for eligibility and included if they were 18 years or older, intubated and mechanically ventilated for at least 48 h, and had suspected ventilator-associated pneumonia. Patients were randomly assigned (1:1) to biomarker-guided recommendation on antibiotics (intervention group) or routine use of antibiotics (control group) using a web-based randomisation service hosted by Newcastle Clinical Trials Unit. Patients were randomised using randomly permuted blocks of size four and six and stratified by site, with allocation concealment. Clinicians were masked to patient assignment for an initial period until biomarker results were reported. Bronchoalveolar lavage was done in all patients, with concentrations of IL-1β and IL-8 rapidly determined in bronchoalveolar lavage fluid from patients randomised to the biomarker-based antibiotic recommendation group. If concentrations were below a previously validated cutoff, clinicians were advised that ventilator-associated pneumonia was unlikely and to consider discontinuing antibiotics. Patients in the routine use of antibiotics group received antibiotics according to usual practice at sites. Microbiology was done on bronchoalveolar lavage fluid from all patients and ventilator-associated pneumonia was confirmed by at least 104 colony forming units per mL of bronchoalveolar lavage fluid. The primary outcome was the distribution of antibiotic-free days in the 7 days following bronchoalveolar lavage. Data were analysed on an intention-to-treat basis, with an additional per-protocol analysis that excluded patients randomly assigned to the intervention group who defaulted to routine use of antibiotics because of failure to return an adequate biomarker result. An embedded process evaluation assessed factors influencing trial adoption, recruitment, and decision making. This study is registered with ISRCTN, ISRCTN65937227, and ClinicalTrials.gov, NCT01972425.FindingsBetween Nov 6, 2013, and Sept 13, 2016, 360 patients were screened for inclusion in the study. 146 patients were ineligible, leaving 214 who were recruited to the study. Four patients were excluded before randomisation, meaning that 210 patients were randomly assigned to biomarker-guided recommendation on antibiotics (n=104) or routine use of antibiotics (n=106). One patient in the biomarker-guided recommendation group was withdrawn by the clinical team before bronchoscopy and so was excluded from the intention-to-treat analysis. We found no significant difference in the primary outcome of the distribution of antibiotic-free days in the 7 days following bronchoalveolar lavage in the intention-to-treat analysis (p=0·58). Bronchoalveolar lavage was associated with a small and transient increase in oxygen requirements. Established prescribing practices, reluctance for bronchoalveolar lavage, and dependence on a chain of trial-related procedures emerged as factors that impaired trial processes.InterpretationAntibiotic use remains high in patients with suspected ventilator-associated pneumonia. Antibiotic stewardship was not improved by a rapid, highly sensitive rule-out test. Prescribing culture, rather than poor test performance, might explain this absence of effect.FundingUK Department of Health and the Wellcome Trust.

Combined dietary supplementation of long chain inulin and Lactobacillus acidophilus W37 supports oral vaccination efficacy against Salmonella Typhimurium in piglets

Routine use of antibiotics in livestock animals strongly contributed to the creation of multidrug-resistant Salmonella Typhimurium strains (STM). Vaccination is an alternative to the use of antibiotics but often suffers from low efficacy. The present study investigated whether long-chain inulin (lcITF) and Lactobacillus acidophilus W37 (LaW37) can support vaccination efficacy against STM and if the interventions influence possible gut microbiota changes. Piglets received daily supplementation until sacrifice. Animals were vaccinated on day 25 after birth, one day after weaning, and were challenged with STM on days 52–54. Dietary intervention with lcITF/LaW37 enhanced vaccination efficacy by 2-fold during challenge and resulted in higher relative abundance of Prevotellaceae and lower relative abundance of Lactobacillaceae in faeces. Although strongest microbial effects were observed post STM challenge on day 55, transient effects of the lcITF/LaW37 intervention were also detected on day 10 after birth, and post-weaning on day 30 where increased relative abundance of faecal lactobacilli was correlated with higher faecal consistency. LcITF treatment increased post-weaning feed efficiency and faecal consistency but did not support vaccination efficacy. Vaccination in immune-immature young animals can be enhanced with functional additives which can simultaneously promote health in an ingredient-dependent fashion.

Effect of Empiric Treatment of Asymptomatic Bacteriuria in Neurosurgical Trauma Patients on Surgical Site and Clostridium difficile Infection.

Although empiric treatment of urinary tract colonized patients remains a frequent practice in neurosurgery, the value of this practice remains debatable. To analyze the effect of screening and treatment of bacteriuria on surgical site infections, incidence of Clostridium difficile, and mortality in neurosurgical trauma patients. Database queries and direct patient chart reviews were used to gather patient chart data. T-tests, chi-square tests, binary logistic regressions, and propensity matched cohorts comparisons were performed. A total of 3563 admitted neurosurgical trauma patients were identified over an 8 yr period (1524 cranial, 1778 spinal, and 261 combined craniospinal diagnoses). Nine hundred ninety-one patients underwent an operative neurosurgical procedure. Urinalysis was significantly associated with antibiotics exposure in both operative and nonoperative patients (P < .001). Operative patients treated with empiric antibiotics did not have a reduced risk of wound infection (P = .21), including in a propensity matched cohort (P = .52). Patients treated with empiric antibiotics had significantly increased rates of C. difficile infection (P < .001). At last follow-up, neurosurgical trauma patients that developed C. difficile had an increased risk of death (P < .005); antibiotic exposure and death were also significantly associated (P = .018). The association of C. difficile with empiric antibiotics remained significant in a propensity-matched cohort (P = .0024). The routine use of urinalysis and empiric urinary antibiotics for bacteriuria in neurosurgical trauma patients without urinary symptoms increases risk of exposure to antibiotics does not decrease rates of wound infection, and is associated with increased rates of C. difficile infection and death.

113 Are Antibiotics Necessary for EUS-FNA of Pancreatic Cysts: A Retrospective Study

INTRODUCTION: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is commonly used to further characterize cystic lesions of the pancreas. Antibiotic prophylaxis has been recommended by the Americal Society for Gastrointestinal Endoscopy for EUS-FNA of cystic pancreatic lesions. The aim of this study was to compare the rate of post-procedural infection in patients who received periprocedural antibiotics for EUS-FNA of pancreatic cystic lesions versus those who did not. METHODS: A retrospective review of medical records of individuals with pancreatic cysts who underwent EUS-FNAs at a tertiary academic hospital between January 2015 and March 2018 was performed. All procedures were performed by four board-certified gastroenterologists. The data reviewed included patient demographics, cyst description, FNA needle size, cytology and use of antibiotics. Post-procedural infections were identified by the presence of leukocytosis, fever, or positive blood cultures during follow-up clinic or hospital visits for 30 days after FNA. Excluded from the study were solid neoplasms, obvious side branch intraductal papillary mucinous neoplasm without high risk features and subjects with evidence of infection or leukocytosis before the FNA. RESULTS: Two hundred and ten EUS-FNA procedures were included in this analysis. Ninety six were males and 114 were females; median age was 65 years. Cysts were 1–5 cm in diameter and evenly distributed throughout the pancreas. One hundred and fifteen of the 210 (55%) cysts were &gt;2 cm and 95 (44%) were &lt;2 cm. 27 out of 210 (13%) were pancreatitis related cysts. 22-gauge needle was used for 55% of the procedures with the remaining procedures using 19 and 25-gauge needles. Eighty nine of 210 (43%) patients received periprocedural antibiotics. Only one of the total 210 patients (0.4%) developed post-procedural gram-negative bacteremia related to EUS within 1 week of procedure. This patient had received periprocedural antibiotics. None of the patients in the “no antibiotic” group had post-procedural infections (Table 1). CONCLUSION: The evidence supporting universal use of antibiotics for all cystic lesions as recommended is lacking and overall infection risk with FNA is low, at approximately 0.3% based on small studies. Our study of 210 patients including pancreatitis related cysts demonstrate that routine use of antibiotics may not be required for FNA of pancreatic cysts. Further prospective studies may be required to support this.

Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology.

Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

Review of Systemic Antibiotic Treatments in Children with Rhinosinusitis.

Antibiotic treatment in paediatric rhinosinusitis is still a matter of debate, as the current guidelines have been drafted mainly based on clinical studies published before 2013. Recent modifications in the epidemiological basis of the disease might mean that current treatments are not completely adequate considering the evolving microbiological profile of the disease. The present paper reviews the role of systemic antibiotics in children with acute (ARS), chronic (CRS), recurrent (RARS), and complicated acute (CoARS) rhinosinusitis. A total of 14 studies (including 3 prospective non-randomised studies, 8 retrospective studies, and 3 prospective randomised studies) of the 115 initially identified papers were included in this review, corresponding to 13,425 patients. Five papers dealt with ARS, four papers with RARS or CRS, and five papers with CoARS; the remaining papers included patients with either ARS or CRS. Data about the effectiveness of antibiotic treatment in children with ARC, CRS, and CoARS is scarce, as only three randomised controlled trials have been published in the last decade, with contrasting results. There is an urgent need for dedicated controlled trials not only to test the actual clinical benefits deriving from the routine use of systemic antibiotics in different categories of patients but also to compare the effectiveness of various therapeutic protocols in terms of the type of antibacterial molecules and the duration of treatment.

Variability in catheter-associated asymptomatic bacteriuria rates among individual nurses in intensive care units: An observational cross-sectional study.

Catheter-associated asymptomatic bacteriuria (CAABU) is frequent in intensive care units (ICUs) and contributes to the routine use of antibiotics and to antibiotic-resistant infections. While nurses are responsible for the implementation of CAABU-prevention guidelines, variability in how individual nurses contribute to CAABU-free rates in ICUs has not been previously explored. This study’s objective was to examine the variability in CAABU-free outcomes of individual ICU nurses. This observational cross-sectional study used shift-level nurse-patient data from the electronic health records from two ICUs in a tertiary medical center in the US between July 2015 and June 2016. We included all adult (18+) catheterized patients with no prior CAABU during the hospital encounter and nurses who provided their care. The CAABU-free outcome was defined as a 0/1 indicator identifying shifts where a previously CAABU-free patient remained CAABU-free (absence of a confirmed urine sample) 24–48 hours following end of shift. The analytical approach used Value-Added Modeling and a split-sample design to estimate and validate nurse-level CAABU-free rates while adjusting for patient characteristics, shift, and ICU type. The sample included 94 nurses, 2,150 patients with 256 confirmed CAABU cases, and 21,729 patient shifts. Patients were 55% male, average age was 60 years. CAABU-free rates of individual nurses varied between 94 and 100 per 100 shifts (Wald test: 227.88, P<0.001) and were robust in cross-validation analyses (correlation coefficient: 0.66, P<0.001). Learning and disseminating effective CAABU-avoidance strategies from top-performers throughout the nursing teams could improve quality of care in ICUs.

Role of Postoperative Antibiotics in Patients Undergoing Type I Thyroplasty with Gore-Tex Implant

The purpose of this study was to determine the need for postoperative antibiotic administration in patients undergoing type I thyroplasty performed with Gore-Tex implant. Retrospective analysis. Medical records of patients from a quaternary care laryngology practice who underwent type I thyroplasty for glottic insufficiency using Gore-Tex (W.L. Gore, Newark, Delaware) implant between the years 2013 and 2019 were reviewed retrospectively. Subjects were divided into two groups determined by those who did or did not receive routine postoperative antibiotics. All patients received two grams of cefazolin IV (for the standard 70-kilogram patient), and 10 mg of dexamethasone as a one-time dose given 10 minutes prior to incision. Patients allergic to cefazoline who received a single preoperative dose of 600 mg of clindamycin IV. All subjects were seen in the office at least three times after the procedure: one day, one week, and approximately six weeks following surgery. Statistical analysis was performed on the collected data using χ2 analysis for categorical data and a student t test for means. A P value of less than 0.01 was considered significant. There was no significant difference in infection rate or other complications between groups. Routine use of antibiotics following type I thyroplasty with Gore-Tex (W.L. Gore, Newark, Delaware) appears unnecessary.

Ocorrência de Escherichia coli e Klebsiella spp produtoras de ESBL em Hospital Universitário, na cidade de Manaus - AM

Justificativa e Objetivos:Bactérias produtoras de betalactamase de espectro ampliado (ESBL) são crescentes, sobretudo, pelo uso &#x0D; rotineiro de antibióticos. Causam principalmente, infecções urinárias e de feridas operatórias e, caracterizam-se pela resistência às cefa-losporinas de terceira geração, aztreonam e associação de cefalosporinas com ácido clavulânico. Este estudo teve como objetivo conhecer &#x0D; a frequência de Escherichia coli ESBL e Klebsiella spp.ESBL através da análise fenotípica. Métodos:Teste de sensibilidade in vitro por &#x0D; aproximação de discos (CLSI), de bactérias isoladas de meios biológicos dos pacientes atendidos no HUGV entre 2017 e 2018. Resultados: &#x0D; 34,66% eram Escherichia coli ESBL e 46,80% Klebsiella spp.ESBL, totalizando 39,34% de amostras ESBL. Dos meios biológicos predomina-ram ESBL na: urina (56,25%) e feridas cirúrgicas (22,91%). Clínicas com maior ocorrência de ESBL: médica e cirúrgica. Conclusão: Os índices &#x0D; de ESBL no HUGV estão próximos ou até mais altos do que em algumas regiões do país. Consoante a literatura revisada, predomina a &#x0D; Escherichia coli nos isolados e há mais Klebisella spp. ESBL do queEscherichia coliESBL. &#x0D; Descritores:Fenótipo. Escherichia coli. Klebsiella. ESBL. Infecção Hospitalar

What factors contribute to the long-term persistence of Shigella species as pathogens?

The genus Shigella is a globally important pathogen responsible for the infectious disease shigellosis which causes an estimated 125 million cases worldwide and up to 100 000 deaths. Shigella species are now recognised as a priority organism by the World Health Organisation due to the increasing antimicrobial resistance (AMR) observed. For adults, treatment of Shigella infections commonly consists of ciprofloxacin, however, recently there have been confirmed cases of ciprofloxacin-resistant strains. Most Shigella is already resistant to ampicillin and trimethoprim so added resistance to ciprofloxacin is a worrying development. Also of note is the role played by toxin-antitoxin systems where they are critical for maintaining large plasmids that typically contain genes of interest such as AMR genes and virulence factors. The Murray collection comprises of several hundred bacterial strains from the pre-antibiotic era (1917–1954) from a range of geographic locations. Within this collection there are many Shigella isolates which are now publicly available for analysis. There are also available datasets for modern collections which have been sequenced for past studies. We will use these data sets to perform bioinformatic analysis and characterise the dynamic changes in the genetic composition across time. The Murray Collection isolates provide a prospective from the pre-antibiotic era and so from the comparisons with modern isolates we will observe the effect of routine antibiotic use has on the evolution of antimicrobial resistance. Through this investigation the hope is to provide unprecedented insight into how AMR and toxin-anti-toxin systems contribute to the long-term persistence and success of Shigella.

Diverse Distribution of Resistomes in the Human and Environmental Microbiomes.

The routine therapeutic use of antibiotics has caused resistance genes to be disseminated across microbial populations. In particular, bacterial strains having antibiotic resistance genes are frequently observed in the human microbiome. Moreover, multidrug-resistant pathogens are now widely spread, threatening public health. Such genes are transferred and spread among bacteria even in different environments. Advances in high throughput sequencing technology and computational algorithms have accelerated investigation into antibiotic resistance genes of bacteria. Such studies have revealed that the antibiotic resistance genes are located close to the mobility-associated genes, which promotes their dissemination. An increasing level of information on genomic sequences of resistome should expedite research on drug-resistance in our body and environment, thereby contributing to the development of public health policy. In this review, the high prevalence of antibiotic resistance genes and their exchange in the human and environmental microbiome is discussed with respect to the genomic contents. The relationships among diverse resistomes, related bacterial species, and the antibiotics are reviewed. In addition, recent advances in bioinformatics approaches to investigate such relationships are discussed.

Surgical site infection: the "Achilles Heel" of all types of abdominal wall hernia reconstruction.

Surgical site infection is the most common hospital-acquired infection in surgical patients. Recently, public health organizations have updated prevention guidelines. This review discusses surgical site infections as a complication of abdominal wall reconstruction. The authors reviewed guidelines on prevention of surgical site infections from the Center for Disease Control and Prevention, World Health Organization, and National Institute for Health and Care Excellence and put them into context with the relevant abdominal wall reconstruction literature. This was the subject of the Nyhus-Wantz lecture given at The International Hernia Congress on March 14, 2018 in Miami, FL and is summarized here. Routine use of preoperative antibiotics in prosthetic groin hernia repair is not supported by the available literature. High-quality data on antibiotic prophylaxis in ventral (both primary and incisional) hernia repair is lacking, but it is widely utilized and may reduce SSIs. Recommended preventative strategies discussed in this manuscript include: treatment of remote site infections, perioperative normothermia and normoglycemia, avoidance of hypoxemia, antiseptic preparation of surgical team hands and patient skin, treatment of obesity, smoking cessation, correction of malnutrition, and physical conditioning. Surgical site infections lead to significant morbidity and mortality, hernia recurrences, prolonged hospital stay, and increased hospital costs. This makes surgical site infections the "Achilles Heel" of abdominal wall reconstruction. Strict adherence to standardized guidelines and preoperative optimization of patients' risk profiles are crucial to decrease the incidence of surgical site infections.