2101
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Kontoyiannis DP. Antifungal prophylaxis in hematopoietic stem cell transplant recipients: the unfinished tale of imperfect success. Bone Marrow Transplant 2010; 46:165-73. [DOI: 10.1038/bmt.2010.256] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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2102
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2103
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Uso prudente de antibióticos y propuestas de mejora desde la medicina hospitalaria. Enferm Infecc Microbiol Clin 2010; 28 Suppl 4:28-31. [DOI: 10.1016/s0213-005x(10)70039-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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2104
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2105
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Kaye KS, Auwaerter P, Bosso JA, Dean NC, Doern GV, Kays MB, Pogue JM, Ritchie DJ, Wispelwey B. Strategies to Address Appropriate Fluoroquinolone Use in the Hospital. Hosp Pharm 2010. [DOI: 10.1310/hpj4511-844] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose Strategies to optimally use fluoroquinolones in the hospital setting are reviewed. Summary Fluoroquinolones possess broad-spectrum antimicrobial coverage and are widely used to treat a variety of infections including some serious, life-threatening conditions. Overuse and inappropriate use of fluoroquinolones has led to rapid emergence of fluoroquinolone-resistant organisms as well as multidrug-resistant pathogens. Preserving the fluoroquinolone class is important, especially given the lack of new antibiotics currently in clinical development. Maintaining the fluoroquinolone class as a therapeutic option requires the successful implementation of guidelines to promote appropriate, optimal use of these agents. Among many recommendations to control the growing problem of antimicrobial resistance, antimicrobial stewardship programs offer the most comprehensive solution to gain appropriate antimicrobial prescribing. Effective programs include selection of the most effective agents, specific dosages, frequency of administration, routes of administration, and duration of therapy. Additionally, a dual fluoroquinolone formulary, which typically incorporates one respiratory fluoroquinolone and ciprofloxacin, has been employed to increase the diversity of fluoroquinolone treatment and thus reduce the selective antimicrobial pressure. A combination of antimicrobial stewardship programs and a dual formulary option has been demonstrated to be a good approach to optimize the use of fluoroquinolones in the hospital. Two successful experiences in applying such strategies have been reported; in both cases the empiric fluoroquinolone prescribing was reduced. Conclusion Implementation of aggressive optimization strategies such as the combined use of antimicrobial stewardship programs and a dual fluoroquinolone formulary may maintain the efficacy of fluoroquinolones and preserve their utility for future patients.
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Affiliation(s)
- Keith S. Kaye
- Department of Medicine, and Infection Prevention, Epidemiology and Antimicrobial Stewardship, Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - Paul Auwaerter
- Division of Infectious Diseases, and Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - John A. Bosso
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Medical University of South Carolina Campus, Charleston, South Carolina
| | - Nathan C. Dean
- Pulmonary and Critical Care Medicine, Respiratory ICU, LDS Hospital and Intermountain Medical Center, and Department of Internal Medicine, University of Utah, Murray, Utah
| | - Gary V. Doern
- Department Pathology, and University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Michael B. Kays
- Department of Pharmacy Practice, Purdue University School of Pharmacy, Indianapolis, Indiana
| | - Jason M. Pogue
- Department of Pharmacy Services, Sinai-Grace Hospital, and Detroit Medical Center, Wayne State University, Detroit, Michigan
| | - David J. Ritchie
- Infectious Diseases, Barnes-Jewish Hospital, and Pharmacy Practice, St. Louis College of Pharmacy, St. Louis, Missouri
| | - Brian Wispelwey
- Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia Health Center, Charlottesville, Virginia
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2106
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Pharmacokinetics, pharmacodynamics, and Monte Carlo simulation: selecting the best antimicrobial dose to treat an infection. Pediatr Infect Dis J 2010; 29:1043-6. [PMID: 20975453 DOI: 10.1097/inf.0b013e3181f42a53] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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2107
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Patel SJ, Rosen E, Zaoutis T, Prasad P, Saiman L. Neonatologists' perceptions of antimicrobial resistance and stewardship in neonatal intensive care units. Infect Control Hosp Epidemiol 2010; 31:1298-300. [PMID: 20979494 DOI: 10.1086/657334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Sameer J Patel
- Division of Infectious Diseases, Department of Pediatrics, Columbia University, New York, NY 10032, USA.
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2108
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Stender H. AntibioDx. Expert Rev Mol Diagn 2010; 10:841-3. [PMID: 20964601 DOI: 10.1586/erm.10.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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2109
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Dumartin C, Rogues AM, Amadeo B, Pefau M, Venier AG, Parneix P, Maurain C. Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005-2008. J Hosp Infect 2010; 77:123-8. [PMID: 20884081 DOI: 10.1016/j.jhin.2010.07.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/17/2010] [Indexed: 10/19/2022]
Abstract
French hospitals are required to implement antibiotic stewardship programmes (ABS) to improve antibiotic use. We analysed the legal framework on ABS and assessed its impact on hospitals' ABS development in Southwestern France. For each official text, required measures, date of issue, means of control and incentives were analysed. Annual retrospective surveys were conducted in 84 hospitals from 2005 to 2008 to monitor implementation of ABS components: organisation, resources and actions. Evolution of individual measures and of a structure and process indicator (SPI) reflecting ABS was described for each hospital. From 2002, official texts issued by health authorities set out requirements on ABS, based on previous professional guidelines. Incentives and means of control were reinforced in 2006 and in 2007 with mandatory reporting of SPI for public disclosure. ABS implementation improved during the course of the study period. In 2008, at least 98% of hospitals had implemented formularies, antibiotic committees, surgical prophylaxis guidelines, and monitored antibiotic use; antibiotic advisors were appointed in 85% of hospitals. Little progress was made regarding time dedicated by pharmacists to antibiotic management and restrictive dispensation using stop-orders. Computerised tools, continuing education and audits remained under-used. SPI values were higher in private hospitals and rehabilitation centres than in others. Official texts and the SPI public disclosure increased professionals' and hospital managers' commitment to develop ABS, resulting in improvements. However, some actions still need to be reinforced. It appears crucial to monitor practical implementation to better approach ABS effectiveness and to adapt requirements.
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Affiliation(s)
- C Dumartin
- Southwestern Regional Coordinating Centre for Nosocomial Infection Control (CCLIN), Bordeaux, France.
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2110
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Cooke J, Alexander K, Charani E, Hand K, Hills T, Howard P, Jamieson C, Lawson W, Richardson J, Wade P. Antimicrobial stewardship: an evidence-based, antimicrobial self-assessment toolkit (ASAT) for acute hospitals. J Antimicrob Chemother 2010; 65:2669-73. [DOI: 10.1093/jac/dkq367] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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2111
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Miyawaki K, Miwa Y, Tomono K, Kurokawa N. Impact of antimicrobial stewardship by infection control team in a Japanese teaching hospital. YAKUGAKU ZASSHI 2010; 130:1105-11. [PMID: 20686215 DOI: 10.1248/yakushi.130.1105] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The objective of this study is to investigate an effect on the antimicrobial appropriate use of the antimicrobial stewardship. We investigated the consumption of injectable antimicrobials from 2001 to 2007 and the administration period of specific antimicrobials (carbapenems, fourth-generation cephalosporins, anti-methicillin-resistant Staphylococcus aureus (MRSA) agents) in the individual patient. Since September 2004, the infection control team at Osaka University Hospital has been promoting appropriate use of antimicrobials through consultation, education, and weekly surveillance of specific antimicrobial usage. We obtained the amount of all antimicrobial injections as titer from the medical information database of the electronic medical chart system retrospectively. Antimicrobial use densities (AUD) were evaluated by measuring the number of doses administered/1000 patient-days. Although the number of inpatient admissions and operations increased 1.53- and 1.39-fold, respectively, in the seven years from 2001 to 2007, the expenditure on specific antimicrobials decreased markedly with AUD of specific antimicrobials decreasing from 39.6 to 29.2. The percentage of inpatients receiving specific antimicrobials decreased from 19.8% to 9.8%, and the ratio of the number of inpatients administered a specific antimicrobial within seven days to the number of inpatients administered each specific antimicrobial increased to over 60%. This led to reduction in the total expenditure of antimicrobials by about 100 million yen annually. The incidence of hospital-associated MRSA (HA-MRSA) infection decreased from 0.93% (2003) to 0.68% (2007). We can reduce the expenditure of antimicrobials without increasing incidence of the HA-MRSA by antimicrobial stewardship, and we think that appropriate use of antimicrobials is achieved progressively.
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Affiliation(s)
- Koji Miyawaki
- Department of Pharmacy, Osaka University Hospital, Suita, Osaka, Japan.
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2112
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Bassetti M, Nicolini L, Repetto E, Righi E, Del Bono V, Viscoli C. Tigecycline use in serious nosocomial infections: a drug use evaluation. BMC Infect Dis 2010; 10:287. [PMID: 20920273 PMCID: PMC2956728 DOI: 10.1186/1471-2334-10-287] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Accepted: 09/29/2010] [Indexed: 11/20/2022] Open
Abstract
Background Tigecycline is a novel antibiotic with activity against multidrug resistant bacteria. The aim of this study was to assess the efficacy of tigecycline use in serious hospital-acquired infections (HAI) Case presentation Prospective observational study of tigecycline use was conducted in a 1500 beds university hospital. From January 1, 2007 and January 31, 2010, 207 pts were treated with tigecycline for the following indications: intra-abdominal, pneumonia, bloodstream and complicated skin and soft tissue infections and febrile neutropenia. The therapy was targeted in 130/207 (63%) and empirical in 77/207 (37%) patients. All bacteria treated were susceptible to tigecycline. Median duration of tigecycline therapy was 13 days (range, 6-28). Clinical success was obtained in 151/207 (73%) cases, with the highest success rate recorded in intra-abdominal infections [81/99 (82%)]. Microbiological success was achieved in 100/129 (78%) treated patients. Adverse clinical events were seen in 16/207 patients (7.7%): Conclusions Considering the lack of data on tigecycline for critically ill patients, we think that the reported data of our clinical experience despite some limitations can be useful for clinicians.
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Affiliation(s)
- Matteo Bassetti
- Infectious Diseases Division, San Martino Hospital and University of Genoa School of Medicine, Genoa, Italy.
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2113
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Abstract
Surgical and trauma intensive care units provide the facilities, resources, and personnel needed to care for patients who have been severely injured, present with acute surgical emergencies, require prolonged and complex elective surgical procedures, or have severe underlying medical conditions. Correcting the immediately evident physiologic derangement is only the first step in the care of these patients, because in many cases their prognosis and ultimate outcome will depend on whether additional insults accrued during their intensive care unit and hospital stay will prevent them from a full recovery. The nature, number, and complexity of the interventions used to provide advanced support requires a unique attention to the concept of patient safety, particularly when the population involved is that most vulnerable to injury and with the least amount of physiologic reserve to recover from it. The medical community, the public, and even regulatory agencies have focused on specific preventable complications that are common in surgical and injured patients, such as medical errors, healthcare-associated infections, and venous thromboembolism. Enough scientific knowledge has been obtained through well-conducted clinical trials to generate detailed evidence-based guidelines for the prevention and management of some of these pathologies, but still there are outstanding questions in terms of the applicability of the recommendations to the critically ill. In addition to clinical and technical expertise, performance improvement and quality monitoring activities provide direction for system solutions required to properly address many complications that are not provider specific.
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2114
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Masterton RG, Williams C. Approaches to improving antibiotic management. Br J Hosp Med (Lond) 2010; 71:437-41. [PMID: 20852484 DOI: 10.12968/hmed.2010.71.8.77665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
New information is available to improve antibiotic outcomes in severe sepsis where increasing resistance and reducing novel compound development make reaching the right decisions ever more difficult and important.
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2115
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2116
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Patel SJ, Saiman L. Antibiotic resistance in neonatal intensive care unit pathogens: mechanisms, clinical impact, and prevention including antibiotic stewardship. Clin Perinatol 2010; 37:547-63. [PMID: 20813270 PMCID: PMC4440667 DOI: 10.1016/j.clp.2010.06.004] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antimicrobial-resistant pathogens are of increasing concern in the neonatal intensive care unit population. A myriad of resistance mechanisms exist in microorganisms, and management can be complex because broad-spectrum antibiotics are increasingly needed. Control and prevention of antibiotic-resistant organisms (AROs) require an interdisciplinary team with continual surveillance. Judicious use of antibiotics; minimizing exposure to risk factors, when feasible; and effective hand hygiene are crucial interventions to reduce infection and transmission of AROs.
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Affiliation(s)
- Sameer J. Patel
- Assistant Professor of Pediatrics, Department of Pediatrics, Columbia University, New York, NY
| | - Lisa Saiman
- Professor of Clinical Pediatrics, Department of Pediatrics, Columbia University, New York, NY,Hospital Epidemiologist, Department of Infection Prevention & Control, Morgan Stanley Children’s Hospital of NewYork-Presbyterian, New York, NY
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2117
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Bogotá, 2.600 metros más cerca de un uso prudente de los antimicrobianos. INFECTIO 2010. [DOI: 10.1016/s0123-9392(10)70107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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2118
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Recognition and prevention of healthcare-associated urinary tract infections in the intensive care unit. Crit Care Med 2010; 38:S373-9. [PMID: 20647795 DOI: 10.1097/ccm.0b013e3181e6ce8f] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urinary tract infection is the most common healthcare-associated infection in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. The predominant microorganisms causing catheter-associated urinary tract infection (CAUTI) in the intensive care unit are enteric Gram-negative bacilli, enterococci, Candida species, and Pseudomonas aeruginosa. Multidrug resistance is a significant problem in urinary pathogens. Duration of catheterization is the most important risk factor for development of CAUTI. Diagnosis, particularly in the intensive care unit setting, is very difficult, as asymptomatic bacteriuria may be difficult to differentiate from symptomatic CAUTI. In general, asymptomatic bacteriuria should not be treated, and treatment of CAUTI often requires removal of the catheter along with systemic antimicrobial therapy. General strategies for prevention of CAUTI apply to all healthcare-associated infections and include measures such as adherence to hand hygiene. Targeted strategies for prevention of CAUTI include limiting the use and duration of urinary catheterization, using aseptic technique for catheter insertion, and adhering to proper catheter care.
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2119
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Gandhi TN, DePestel DD, Collins CD, Nagel J, Washer LL. Managing antimicrobial resistance in intensive care units. Crit Care Med 2010; 38:S315-23. [PMID: 20647789 DOI: 10.1097/ccm.0b013e3181e6a2a4] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The challenges in managing patients with infection in the intensive care unit are increased in an era where there are dwindling antimicrobial choices for multidrug-resistant pathogens. Clinicians in the intensive care unit must balance between choosing appropriate antimicrobial treatment for patients with suspected infection and utilizing antimicrobials in a judicious fashion. Improving antimicrobial utilization is a critical component to reducing antimicrobial resistance. Although providing effective antimicrobial therapy and improving antimicrobial utilization may seem to be competing goals, there are effective strategies to accomplish both. Antimicrobial stewardship programs provide an organized way to implement these strategies and can enhance the intensive care unit physician's success in improving patient outcomes and combating antimicrobial resistance in the intensive care unit.
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Affiliation(s)
- Tejal N Gandhi
- Department of Internal Medicine, Division of Infectious Diseases, University of Michigan, Ann Arbor, MI, USA.
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2120
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Curcio D. Antibiotic stewardship: the "real world" when resources are limited. Infect Control Hosp Epidemiol 2010; 31:666-8. [PMID: 20433352 DOI: 10.1086/653073] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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2121
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2122
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Affiliation(s)
- Mazen S Bader
- McMaster University, Faculty of Health Sciences, Division of Infectious Diseases, Hamilton, Ontario, Canada.
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2123
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Abstract
BACKGROUND Increasing rates of resistant gram-positive coccal infections led to an increased use of vancomycin. We evaluated the impact of implementing an Antimicrobial Stewardship Program on density of vancomycin use at a pediatric tertiary-care teaching hospital. METHODS An Antimicrobial Stewardship Program was implemented April 1, 2004. Indications for vancomycin use were incorporated as mandatory fields using the integrated computerized information system. An automated report of vancomycin prescriptions, doses, patient demographics, and microbiology data was reviewed by an infectious disease pharmacist Monday through Friday. Interventions were discussed with a pediatric infectious disease physician and real-time feedback provided to clinicians. Density of vancomycin use was evaluated by measuring the number of doses administered/1000 patient-days. RESULTS Density of vancomycin use declined overtime from 378 doses administered/1000 patient-days to 255 doses administered/1000 patient-days despite increasing rates of Staphylococcus aureus infected patients, and was not associated with increased use of other antibiotics with similar antimicrobial activity. Nonapproved vancomycin indications were selected in 28% of vancomycin doses administered. Of the 317 Antimicrobial Stewardship Program interventions performed, 190 qualified as vancomycin prescription errors, most commonly, vancomycin dosing and premature stop. After the implementation of the program, the rate of vancomycin prescription errors decreased. CONCLUSIONS Implementation of an integrated Antimicrobial Stewardship Program using real-time evaluation and feedback to physicians, and optimization of the clinical informatics system, reduced vancomycin utilization and vancomycin prescribing errors, improving the quality of care and safety of hospitalized children in our institution.
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2124
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Budwall B. The role of pharmacists in training doctors about infections and antimicrobial prescribing. J Infect Prev 2010. [DOI: 10.1177/1757177410363515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This paper highlights the role of clinical pharmacists in training doctors about infections and optimal antibiotic prescribing. Although these principles can be equally applied to both primary and secondary care, this paper will focus on such activity in secondary care alone. Most NHS trusts in the United Kingdom now have a specialist antimicrobial pharmacist taking the lead, but all pharmacists can take effective measures to educate prescribers and nurses about the prudent use of antimicrobials and improve the management of infections. Such quality efforts need to be maintained to ensure a sustained approach in the ever-changing field of infection.
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Affiliation(s)
- B. Budwall
- Dudley Group of Hospitals NHS Foundation Trust, Dudley, DY1 2HQ, UK,
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2125
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Barriers to intravenous penicillin use for treatment of nonmeningitis pneumococcal disease. J Clin Microbiol 2010; 48:3372-4. [PMID: 20610674 DOI: 10.1128/jcm.01012-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Infectious disease physicians were surveyed to determine whether the new penicillin breakpoint change will translate into increased penicillin use and to identify barriers to intravenous (i.v.) penicillin use for pneumococcal infections. The inconvenience of i.v. penicillin may limit its use despite a reduction in numbers of infections considered resistant.
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2126
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Dresser L, Nelson S. Practice spotlight: pharmacists in an antimicrobial stewardship program. Can J Hosp Pharm 2010; 63:328-9. [PMID: 22478997 DOI: 10.4212/cjhp.v63i4.938] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Linda Dresser
- Pharmacotherapy Specialist - Antimicrobial Stewardship, University Health Network, Assistant Professor, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
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2127
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Jamieson CE, Woodford Guegan EM. Specialist antimicrobial pharmacists. J Infect Prev 2010. [DOI: 10.1177/1757177410366324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Recent years have seen the development of specialist roles for hospital pharmacists within the sphere of infection management. This paper examines the background to this role, describes current activities and looks to future developments in this important area.
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Affiliation(s)
- CE Jamieson
- Pharmacy Team Leader - Antimicrobial Therapy, Sandwell and West Birmingham NHS Trust, Birmingham, B18 7QH, UK,
| | - EM Woodford Guegan
- Senior Research Fellow, European HTA, NETSCC, University of Southampton, Southampton, UK
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2128
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Filice GA, Nyman JA, Lexau C, Lees CH, Bockstedt LA, Como-Sabetti K, Lesher LJ, Lynfield R. Excess costs and utilization associated with methicillin resistance for patients with Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2010; 31:365-73. [PMID: 20184420 DOI: 10.1086/651094] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine differences in healthcare costs between cases of methicillin-susceptible Staphylococcus aureus (MSSA) infection and methicillin-resistant S. aureus (MRSA) infection in adults. DESIGN Retrospective study of all cases of S. aureus infection. SETTING Department of Veterans Affairs hospital and associated clinics. PATIENTS There were 390 patients with MSSA infections and 335 patients with MRSA infections. METHODS We used medical records, accounting systems, and interviews to identify services rendered and costs for Minneapolis Veterans Affairs Medical Center patients with S. aureus infection with onset during the period from January 1, 2004, through June 30, 2006. We used regression analysis to adjust for patient characteristics. RESULTS Median 6-month unadjusted costs for patients infected with MRSA were $34,657, compared with $15,923 for patients infected with MSSA. Patients with MRSA infection had more comorbidities than patients with MSSA infection (mean Charlson index 4.3 vs 3.2; P < .001). For patients with Charlson indices of 3 or less, mean adjusted 6-month costs derived from multivariate analysis were $51,252 (95% CI, $46,041-$56,464) for MRSA infection and $30,158 (95% CI, $27,092-$33,225) for MSSA infection. For patients with Charlson indices of 4 or more, mean adjusted costs were $84,436 (95% CI, $79,843-$89,029) for MRSA infection and $59,245 (95% CI, $56,016-$62,473) for MSSA infection. Patients with MRSA infection were also more likely to die than were patients with MSSA infection (23.6% vs 11.5%; P < .001). MRSA infection was more likely to involve the lungs, bloodstream, and urinary tract, while MSSA infection was more likely to involve bones or joints; eyes, ears, nose, or throat; surgical sites; and skin or soft tissue (P < .001). CONCLUSIONS Resistance to methicillin in S. aureus was independently associated with increased costs. Effective antimicrobial stewardship and infection prevention programs are needed to prevent these costly infections.
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Affiliation(s)
- Gregory A Filice
- Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA.
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2129
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Yang Y, McBride MV, Rodvold KA, Tverdek F, Trese AM, Hennenfent J, Schiff G, Lambert BL, Schumock GT. Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistantStaphylococcus aureus. Am J Health Syst Pharm 2010; 67:1017-24. [DOI: 10.2146/ajhp090563] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Yoojung Yang
- Center for Pharmacoeconomic Research, University of Illinois at Chicago (UIC), Chicago
| | - Martin V. McBride
- Pharmacy Services, Operations Department, Broadlane Inc., Dallas, TX
| | | | - Frank Tverdek
- Department of Pharmacy Services, Tenet–Saint Louis University Hospital, St. Louis, MO
| | - Anne Marie Trese
- Infectious Disease, Forest Research Institute, Jersey City, NJ; when this article was written, she was Director, The Preference Group, Broadlane Inc
| | | | - Gordon Schiff
- Center for Patient Safety Research and Practice, Brigham and Women’s Hospital, and Associate Professor of Medicine, Harvard Medical School, Boston, MA
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2130
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Rotation of antimicrobial therapy in the intensive care unit: impact on incidence of ventilator-associated pneumonia caused by antibiotic-resistant Gram-negative bacteria. Eur J Clin Microbiol Infect Dis 2010; 29:1015-24. [PMID: 20524138 DOI: 10.1007/s10096-010-0964-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Accepted: 05/06/2010] [Indexed: 10/19/2022]
Abstract
The development of antibiotic resistance is associated with high morbidity and mortality, particularly in the intensive care unit (ICU) setting. We evaluated the effect of an antibiotic rotation programme on the incidence of ventilator-associated pneumonia (VAP) caused by antibiotic-resistant Gram-negative bacteria. We conducted a 2-year before-and-after study at two medical-surgical ICUs at two different tertiary referral hospitals. We included all mechanically ventilated patients admitted for > or =48 h who developed VAP. From 1 January through 31 December 2007, a quarterly rotation of antibiotics (piperacillin/tazobactam, fluoroquinolones, carbapenems and cefepime/ceftazidime) for the empirical treatment of VAP was implemented. We analysed the incidence of VAP and the antibiotic resistance patterns of the responsible pathogens in 2006, before (P1) and, in 2007, after (P2) the introduction of the scheduled rotation programme. Overall, there were 79 VAP episodes in P1 and 44 in P2; the mean incidence of VAP was 20.96 cases per 1,000 days of mechanical ventilation (MV) during P1 and 14.97 in P2, with no significant difference between periods on segmented regression analysis. We observed a non-significant reduction of the number of both the poly-microbial (14 [17.7%] in P1 and 5 [10.6%] in P2 [p = 0.32]) and of the antibiotic-resistant Gram-negative bacteria-related VAP (42 [45.2%] in P1 and 16 [34%] in P2 [p = 0.21]). Conversely, the number of VAP caused by Pseudomonas aeruginosa passed from 8.35 per 1,000 days of MV in P1 to 2.33 per 1,000 days of MV in P2 (p = 0.02). No difference in ICU mortality and crude in-hospital mortality between P1 and P2 was noted. Moreover, no significant change of microbial flora isolated through clinical cultures was observed. We were able to conclude that, despite global microbial flora not being affected by such a programme, antibiotic therapy rotation may reduce the incidence of VAP caused by antibiotic-resistant Gram-negative bacteria in the ICU, such as Pseudomonas aeruginosa. The application of this programme may also improve antibiotic susceptibility. However, further studies are needed to confirm our results.
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Abstract
Clostridium difficile is a gram-positive, spore-forming, toxin-producing anaerobic bacillus identified as the causal agent of a variety of manifestations typically isolated to the colon, but in its severe form, it can lead to sepsis and death. C. difficile infection due to a toxin gene variant strain (BI/NAP1) has been identified at the center of outbreaks and has resulted in increased mortality. Many questions remain as to how this strain appeared so quickly and has harmed or killed so many patients. We present a review of C. difficile infection, discussing its clinical presentation, diagnosis, management, and prevention.
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2132
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Abstract
Traditionally, pneumonia developing in patients who receive health care services in the outpatient environment, such as nursing homes, long-term care facilities, and dialysis centers, has been classified and treated as community-acquired pneumonia (CAP). Recent studies, however, have shown that this type of infection, known as health care-associated pneumonia (HCAP) is distinct from CAP in terms of its epidemiology and etiology, and increases the risk for infection with multidrug-resistant (MDR) pathogens. A review of available clinical data about HCAP was conducted to determine effective empiric treatment strategies and improve clinical outcomes. Analysis of multi-institutional clinical data showed that mortality associated with HCAP is higher than with CAP, suggesting that patients with HCAP may have been treated as hospitalized patients with CAP and received inappropriate initial empiric antibiotic treatment. All patients presenting to the hospital with suspected HCAP or CAP should be evaluated for their underlying risk of infection with MDR pathogens. Because HCAP may be similar to hospital-acquired pneumonia (HAP) both clinically and etiologically, it should be treated as HAP until culture data become available. A greater recognition of HCAP as a new class of pneumonia with a distinct epidemiologic, microbiologic, and clinical profile should lead physicians to initiate appropriate empiric antibiotic therapy more often, thereby improving the likelihood for optimal clinical outcomes and patient care.
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Affiliation(s)
- Alpesh Amin
- University of California, Irvine School of Medicine, Orange, CA 92868, USA.
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Le J, Ashley ED, Neuhauser MM, Brown J, Gentry C, Klepser ME, Marr AM, Schiller D, Schwiesow JN, Tice S, VandenBussche HL, Wood GC. Consensus Summary of Aerosolized Antimicrobial Agents: Application of Guideline Criteria. Pharmacotherapy 2010; 30:562-84. [DOI: 10.1592/phco.30.6.562] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Vellinga A, Murphy AW, Hanahoe B, Bennett K, Cormican M. A multilevel analysis of trimethoprim and ciprofloxacin prescribing and resistance of uropathogenic Escherichia coli in general practice. J Antimicrob Chemother 2010; 65:1514-20. [PMID: 20457673 DOI: 10.1093/jac/dkq149] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES A retrospective analysis of databases was performed to describe trimethoprim and ciprofloxacin prescribing and resistance in Escherichia coli within general practices in the West of Ireland from 2004 to 2008. METHODS Antimicrobial susceptibility testing was performed by disc diffusion methods according to the CLSI methods and criteria on significant E. coli isolates (colony count >10(5) cfu/mL) from urine samples submitted from general practice. Data were collected over a 4.5 year period and aggregated at practice level. Data on antimicrobial prescribing of practices were obtained from the national Irish prescribing database, which accounts for approximately 70% of all medicines prescribed in primary care. A multilevel model (MLwiN) was fitted with trimethoprim/ciprofloxacin resistance rates as outcome and practice prescribing as predictor. Practice and individual routinely collected variables were controlled for in the model. RESULTS Seventy-two general practices sent between 13 and 720 (median 155) samples that turned out to be E. coli positive. Prescribing at practice level was significantly correlated with the probability of antimicrobial-resistant E. coli with an odds ratio of 1.02 [95% confidence interval (CI) 1.01-1.04] for every additional prescription of trimethoprim per 1000 patients per month in the practice and 1.08 (1.04-1.11) for ciprofloxacin. Age was a significant risk factor in both models. Higher variation between practices was found for ciprofloxacin as well as a yearly increase in resistance. Comparing a 'mean' practice with 1 prescription per month with one with 10 prescriptions per month showed an increase in predicted probability of a resistant E. coli for the 'mean' patient from 23.9% to 27.5% for trimethoprim and from 3.0% to 5.5% for ciprofloxacin. CONCLUSIONS A higher level of antimicrobial prescribing in a practice is associated with a higher probability of a resistant E. coli for the patient. The variation in antimicrobial resistance levels between practices was relatively higher for ciprofloxacin than for trimethoprim.
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Affiliation(s)
- Akke Vellinga
- Discipline of General Practice, School of Medicine, NUI Galway, Ireland.
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Takesue Y, Nakajima K, Ichiki K, Ishihara M, Wada Y, Takahashi Y, Tsuchida T, Ikeuchi H. Impact of a hospital-wide programme of heterogeneous antibiotic use on the development of antibiotic-resistant Gram-negative bacteria. J Hosp Infect 2010; 75:28-32. [DOI: 10.1016/j.jhin.2009.11.022] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2009] [Accepted: 11/13/2009] [Indexed: 11/29/2022]
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Jacoby T, Kuchenbecker R, dos Santos R, Magedanz L, Guzatto P, Moreira L. Impact of hospital-wide infection rate, invasive procedures use and antimicrobial consumption on bacterial resistance inside an intensive care unit. J Hosp Infect 2010; 75:23-7. [DOI: 10.1016/j.jhin.2009.11.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 11/18/2009] [Indexed: 11/29/2022]
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Lyman GH, Rolston KVI. How we treat febrile neutropenia in patients receiving cancer chemotherapy. J Oncol Pract 2010; 6:149-52. [PMID: 20808559 PMCID: PMC2868641 DOI: 10.1200/jop.091092] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2010] [Indexed: 11/20/2022] Open
Abstract
Although improved supportive care has reduced mortality associated with febrile neutropenia, it continues to cause chemotherapy limitations, morbidity, mortality, and cost among patients with cancer.
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Affiliation(s)
- Gary H. Lyman
- Department of Medicine, Duke University School of Medicine and Duke Comprehensive Cancer Center, Durham, NC, and Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, TX
| | - Kenneth V. I. Rolston
- Department of Medicine, Duke University School of Medicine and Duke Comprehensive Cancer Center, Durham, NC, and Department of Infectious Diseases, The University of Texas M. D. Anderson Cancer Center, Houston, TX
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Diggs NG, Surawicz CM. Clostridium difficileinfection: still principally a disease of the elderly. ACTA ACUST UNITED AC 2010. [DOI: 10.2217/thy.10.17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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O'Neill E, Morris-Downes M, Rajan L, Fitzpatrick F, Humphreys H, Smyth E. Combined audit of hospital antibiotic use and a prevalence survey of healthcare-associated infection. Clin Microbiol Infect 2010; 16:513-5. [DOI: 10.1111/j.1469-0691.2009.02822.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Buyle F, Vogelaers D, Peleman R, Van Maele G, Robays H. Implementation of guidelines for sequential therapy with fluoroquinolones in a Belgian hospital. ACTA ACUST UNITED AC 2010; 32:404-10. [PMID: 20358404 DOI: 10.1007/s11096-010-9384-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE This study measured the impact of three interventions for physicians, in order to implement guidelines for sequential therapy (intravenous to oral conversion) with fluoroquinolones. SETTING A Belgian university hospital with 1,065 beds. Method The first intervention consisted of the hospital-wide publication of guidelines in the local drug letter towards all prescribers. The consumption of fluoroquinolones was measured by means of an interrupted time-series (ITS) analysis 21 months before (period A) and 24 months after publication (period B). The second intervention was an educational interactive session, by infectious disease specialists, to the medical staff of orthopaedics and endocrinology. The third intervention comprised a proactive conversion programme on the abdominal surgery, gastro-enterology and plastic surgery wards, where pharmacists attached a pre-printed note with a suggestion to switch to an oral treatment every time a patient met the criteria for switching. The second and third intervention took place 6 months after the first intervention. Fluoroquinolone treatments were evaluated during a 2 month period before (group 1) and after the introduction of the second (group 2) and third (group 3) intervention. MAIN OUTCOME MEASURE The monthly ratio of intravenous versus total fluoroquinolone consumption (daily defined doses per 1,000 bed days) was measured to assess the impact of the first intervention. The impact of the second and third intervention was measured in relation to the number of days that intravenous therapy continued beyond the day that the patient fulfilled the criteria for sequential therapy and the antibiotic cost. RESULTS The ITS demonstrated a reduction of 3.3% in the ratio of intravenous versus total consumption after the publication of the guidelines (P = 0.011). In group 1, patients were treated intravenously for 4.1 days longer than necessary. This parameter decreased in group 2 to 3.5 days and in group 3 to 1.0 day (P = 0.006). The mean additional cost for longer intravenous treatment decreased from 188.0 euro in group 1, to 103.0 euro in group 2 and 44.0 euro in group 3 (P = 0.037). CONCLUSION This study demonstrated that active implementation of guidelines is necessary. A proactive conversion programme by a pharmacist resulted in a reduction in the duration of the intravenous treatment, and the treatment cost.
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Affiliation(s)
- Franky Buyle
- Pharmacy Department, Ghent University Hospital, De Pintelaan 185, 9000, Ghent, Belgium.
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Koomanachai P, Bulik CC, Kuti JL, Nicolau DP. Pharmacodynamic modeling of intravenous antibiotics against gram-negative bacteria collected in the United States. Clin Ther 2010; 32:766-79. [DOI: 10.1016/j.clinthera.2010.04.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
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Manuel O, Burnand B, Bady P, Kammerlander R, Vansantvoet M, Francioli P, Zanetti G. Impact of standardised review of intravenous antibiotic therapy 72 hours after prescription in two internal medicine wards. J Hosp Infect 2010; 74:326-31. [DOI: 10.1016/j.jhin.2009.07.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 07/15/2009] [Indexed: 10/20/2022]
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Kubiak DW, Bryar JM, McDonnell AM, Delgado-Flores JO, Mui E, Baden LR, Marty FM. Evaluation of caspofungin or micafungin as empiric antifungal therapy in adult patients with persistent febrile neutropenia: A retrospective, observational, sequential cohort analysis. Clin Ther 2010; 32:637-48. [DOI: 10.1016/j.clinthera.2010.04.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2010] [Indexed: 10/19/2022]
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Alfandari S, Levent T, Descamps D, Hendricx S, Bonenfant C, Taines V, Cattoen C, Arimane O, Grandbastien B. Evaluation of glycopeptide use in nine French hospitals. Med Mal Infect 2010; 40:232-7. [DOI: 10.1016/j.medmal.2009.10.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 07/20/2009] [Accepted: 10/29/2009] [Indexed: 11/26/2022]
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ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control. Am J Health Syst Pharm 2010; 67:575-7. [DOI: 10.2146/sp100001] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Laible BR, Nazir J, Assimacopoulos AP, Schut J. Implementation of a Pharmacist-Led Antimicrobial Management Team in a Community Teaching Hospital. J Pharm Pract 2010; 23:531-5. [DOI: 10.1177/0897190009358775] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Antimicrobial stewardship is an important process proven to combat antimicrobial resistance, improve patient outcomes, and reduce costs. The Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) have provided guidelines for the provision of antimicrobial stewardship. According to these recommendations, antimicrobial stewardship teams should be multidisciplinary in nature, with core members consisting of an infectious disease physician and an infectious disease–trained clinical pharmacist. Due to limited resources, our institution chose to implement a pharmacist-led antimicrobial stewardship service on 1 medical/surgical ward, with the existing clinical pharmacist and 3 infectious disease physicians as core members. This clinical pharmacist was not trained in infectious disease specialty, and stewardship activities were only one part of his daily activities. Pharmacy residents and students were extensively utilized to assist in the stewardship process. Approximately two thirds of stewardship recommendations were accepted using primarily a prospective audit and feedback approach.
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Affiliation(s)
- Brad R. Laible
- Department of Pharmacy Practice, South Dakota State University College of Pharmacy, Sioux Falls, SD, USA
- Clinical Pharmacy Specialist, Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
| | - Jawad Nazir
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD and Infectious Disease Specialists, PC, Sioux Falls, SD, USA
| | - Aris P. Assimacopoulos
- Sanford School of Medicine, University of South Dakota, Sioux Falls, SD and Infectious Disease Specialists, PC, Sioux Falls, SD, USA
| | - Jennifer Schut
- Avera McKennan Hospital and University Health Center, Sioux Falls, SD, USA
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Hulscher MEJL, Grol RPTM, van der Meer JWM. Antibiotic prescribing in hospitals: a social and behavioural scientific approach. THE LANCET. INFECTIOUS DISEASES 2010; 10:167-75. [PMID: 20185095 DOI: 10.1016/s1473-3099(10)70027-x] [Citation(s) in RCA: 227] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Antibiotics have dramatically changed the prognoses of patients with severe infectious diseases over the past 50 years. However, the emergence and dissemination of resistant organisms has endangered the effectiveness of antibiotics. One possible approach to the resistance problem is the appropriate use of antibiotic drugs for preventing and treating infections. This Review describes how the volume and appropriateness of antibiotic use in hospitals vary between countries, hospitals, and physicians. At each specific level-cultural, contextual, and behavioural-we discuss the determinants that influence hospital antibiotic use and the possible improvement strategies to make it more appropriate. Changing hospital antibiotic use is a challenge of formidable complexity. On each level, many determinants play a part, so that the measures or strategies undertaken to improve antibiotic use need to be equally diverse. Although various strategies for improving antibiotic use are available, a programme with activities at all three levels is needed for hospitals. Evaluating these programme activities in a way that provides external validity of the conclusions is crucial.
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Affiliation(s)
- Marlies E J L Hulscher
- Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, Netherlands.
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Njoku JC, Hermsen ED. Antimicrobial Stewardship in the Intensive Care Unit: A Focus on Potential Pitfalls. J Pharm Pract 2010; 23:50-60. [DOI: 10.1177/0897190009356554] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients in the intensive care unit (ICU) have many risk factors for resistant pathogens such as prolonged length of stay, frequent and broad-spectrum antimicrobial therapy, presence of foreign materials, and proximity with other patients. However, of the risk factors associated with acquisition of resistant pathogens, inappropriate use of antimicrobial agents has been the most implicated. Thus, many health care institutions have adopted antimicrobial stewardship programs (ASPs) as a mechanism to ensure more appropriate antimicrobial use. ASPs can have a significant impact in the ICU, leading to improved antimicrobial use and resistance patterns and decreased infection rates and costs, due to the inherent nature of infections encountered and high and often inappropriate antibiotic utilization in this setting. However, certain challenges exist for ASPs in the ICU including issues with infrastructure and personnel, information technology, the core ASP strategy, patient-specific factors, conversion of intravenous to oral therapy, and dose optimization. The combination of comprehensive infection control (IC) and effective antimicrobial stewardship can prevent the emergence of resistance among microorganisms and may decrease the negative consequences associated with antimicrobial misuse.
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Affiliation(s)
- Jessica C. Njoku
- Pharmacy Relations & Clinical Decision Support, The Nebraska Medical Center, Omaha, NE, USA
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, Omaha, NE, USA
| | - Elizabeth D. Hermsen
- Pharmacy Relations & Clinical Decision Support, The Nebraska Medical Center, Omaha, NE, USA
- University of Nebraska Medical Center, College of Pharmacy, Department of Pharmacy Practice, Omaha, NE, USA
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2150
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George P, Morris AM. Pro/con debate: Should antimicrobial stewardship programs be adopted universally in the intensive care unit? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2010; 14:205. [PMID: 20236505 PMCID: PMC2875495 DOI: 10.1186/cc8219] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
You are director of a large multi-disciplinary ICU. You have recently read that hospital-wide antibiotic stewardship programs have the potential to improve the quality and safety of care, and to reduce the emergence of multi-drug resistant organisms and overall costs. You are considering starting one of these programs in your ICU, but are concerned about the associated infrastructure costs. You are debating whether it is worth bringing the concept forward to your hospital's administration to consider investing in.
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Affiliation(s)
- Philip George
- Division of Critical Care, Department of Medicine, Mount Sinai Hospital and University Health Network, Mount Sinai Hospital, 600 University Avenue, Suite 18-206, Toronto, ON M5G 1X5, Canada.
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