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Getahun Strobel A, Prasad P, Lane CR, Naidu R, Autar S, Young-Sharma T, Richards M, Suka A, Cameron D, James R, Prasad R, Buising K, Howden BP, Prasad V. The changing epidemiology of antimicrobial resistance in Fiji: a descriptive analysis of antimicrobial susceptibility and trends of endemic and emerging pathogens, 2019-2022. Lancet Reg Health West Pac 2024; 45:101036. [PMID: 38516290 PMCID: PMC10955629 DOI: 10.1016/j.lanwpc.2024.101036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 01/04/2024] [Accepted: 02/19/2024] [Indexed: 03/23/2024]
Abstract
Background There is a paucity of data on antimicrobial resistance in Fiji. The aim of this study was to determine the antimicrobial susceptibility profile of bacterial isolates from clinical samples at Colonial War Memorial Hospital in Fiji. Methods This retrospective study reviewed four-year of data from January 1, 2019, through December 31, 2022. Laboratory testing was carried out using locally approved protocols. Selective antimicrobial susceptibility testing was performed whereby only isolates resistant to first line antimicrobials were tested against second line antimicrobials. Only the first isolate of a given species per patient in a single year were included in the analysis. WHONET software and Microsoft Excel were used for analysis. Findings A total of 29,222 bacterial isolates were included, 62% (n = 18,084) were Gram-negative bacteria. K. pneumoniae was the most common (n = 5363), followed by E. coli (n = 4321). Extended spectrum beta lactamase (ESBL) production increased from 30% in 2019 to 43% in 2022 amongst K. pneumoniae, and 10%-23% in E coli. There were 733 carbapenem-resistant isolates identified from clinical samples, 61% (n = 445) were A. baumannii, 15% (n = 110) E. coli and 14% (n = 101) P. aeruginosa. Amongst the E. coli isolates tested, susceptibility to meropenem declined from 99% (272/274) in 2019 to 79% (255/325) in 2022. The rate of methicillin resistance amongst Staphylococcus aureus was steady, remaining between 11% and 13%. Interpretation This study demonstrated a high rate of MDR amongst Gram-negative bacteria, especially ESBL producing K. pneumoniae and E. coli and carbapenem-resistant A. baumannii. The emergence and rapid spread of carbapenemase producing E. coli in Fiji's largest hospital is of particular concern. There is an urgent need to allocate resources to improve existing capacity and to develop effective multimodal strategies to detect, manage and control the spread of MDR organisms. Funding This study was supported by the Medical Research Future Fund through the Australian government (grant number APP 1200970).
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Affiliation(s)
- Aneley Getahun Strobel
- Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Prinika Prasad
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Courtney R. Lane
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ravi Naidu
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Sanjeshni Autar
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Tracey Young-Sharma
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Matthew Richards
- Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Ana Suka
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Donna Cameron
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Rodney James
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Ravendra Prasad
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Kirsty Buising
- Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
- The Royal Melbourne Hospital, Melbourne, Australia
| | - Benjamin P. Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Vinita Prasad
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
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Getahun Strobel A, Prasad P, Prasad V, Naidu R, Young-Sharma T, Suka A, Richards M, Cameron D, Lane CR, Buising K, Howden BP, Autar S. The epidemiology of enterococci in a tertiary hospital and primary healthcare facilities in Fiji (2019-2022). J Glob Antimicrob Resist 2024; 37:102-107. [PMID: 38565419 DOI: 10.1016/j.jgar.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/28/2024] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVES We analysed 4 y of laboratory data to characterise the species and determine the antimicrobial susceptibility profiles of enterococci as human pathogens in Fiji. The study also investigated the molecular epidemiology amongst the subset of vancomycin-resistant enterococci (VRE). METHODS This retrospective study reviewed bacteriological data from Colonial War Memorial Hospital (CWMH) and other healthcare facilities in the Central and Eastern divisions of Fiji. Phenotypic, antimicrobial susceptibility and vanA and vanB PCR testing were performed using locally approved protocols. The first clinical isolates per patient with antimicrobial susceptibility testing results in a single year were included in the analysis. Data was analysed using WHONET software and Microsoft Excel. RESULTS A total of 1817 enterococcal isolates were reported, 1415 from CWMH and 402 from other healthcare facilities. The majority of isolates, 75% (n = 1362) were reported as undifferentiated Enterococcus spp., 17.8% (n = 324) were specifically identified as Enterococcus faecalis and 6.7% (n = 122) as E. faecium. Overall, 10% of the enterococci isolates were from blood cultures. Among isolates from CWMH, <15% of E. faecium were susceptible to ampicillin, and 17.2% were vancomycin resistant. Overall, 874 enterococcal isolates (including the undifferentiated species) were tested against vancomycin, of which 4.8% (n = 42) were resistance. All of the VRE isolates tested (n = 15) expressed vanA genes. CONCLUSIONS This study demonstrates the clinical importance of VRE, particularly van A E. faecium in the national referral hospital in Fiji. Enhanced phenotypic and molecular surveillance data are needed to better understand enterococci epidemiology and help guide specific infection prevention and control measures and antibiotic prescribing guidelines.
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Affiliation(s)
- Aneley Getahun Strobel
- Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
| | - Prinika Prasad
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Vinita Prasad
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Ravi Naidu
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Tracey Young-Sharma
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Ana Suka
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
| | - Matthew Richards
- Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Donna Cameron
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for infection and Immunity, Melbourne, Australia
| | - Courtney R Lane
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for infection and Immunity, Melbourne, Australia
| | - Kirsty Buising
- Department of Infectious Diseases, The University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia; The Royal Melbourne Hospital, Melbourne, Australia
| | - Benjamin P Howden
- Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at Peter Doherty Institute for infection and Immunity, Melbourne, Australia.
| | - Sanjeshni Autar
- Ministry of Health and Medical Services, Colonial War Memorial Hospital, Suva, Fiji
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Ferdinand AS, McEwan C, Lin C, Betham K, Kandan K, Tamolsaian G, Pugeva B, McKenzie J, Browning G, Gilkerson J, Coppo M, James R, Peel T, Levy S, Townell N, Jenney A, Stewardson A, Cameron D, Macintyre A, Buising K, Howden BP. Development of a cross-sectoral antimicrobial resistance capability assessment framework. BMJ Glob Health 2024; 9:e013280. [PMID: 38232993 PMCID: PMC10806917 DOI: 10.1136/bmjgh-2023-013280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/28/2023] [Indexed: 01/19/2024] Open
Abstract
Antimicrobial resistance (AMR) is an urgent and growing global health concern, and a clear understanding of existing capacities to address AMR, particularly in low-income and middle-income countries (LMICs), is needed to inform national priorities, investment targets and development activities. Across LMICs, there are limited data regarding existing mechanisms to address AMR, including national AMR policies, current infection prevention and antimicrobial prescribing practices, antimicrobial use in animals, and microbiological testing capacity for AMR. Despite the development of numerous individual tools designed to inform policy formulation and implementation or surveillance interventions to address AMR, there is an unmet need for easy-to-use instruments that together provide a detailed overview of AMR policy, practice and capacity. This paper describes the development of a framework comprising five assessment tools which provide a detailed assessment of country capacity to address AMR within both the human and animal health sectors. The framework is flexible to meet the needs of implementers, as tools can be used separately to assess the capacity of individual institutions or as a whole to align priority-setting and capacity-building with AMR National Action Plans (NAPs) or national policies. Development of the tools was conducted by a multidisciplinary team across three phases: (1) review of existing tools; (2) adaptation of existing tools; and (3) piloting, refinement and finalisation. The framework may be best used by projects which aim to build capacity and foster cross-sectoral collaborations towards the surveillance of AMR, and by LMICs wishing to conduct their own assessments to better understand capacity and capabilities to inform future investments or the implementation of NAPs for AMR.
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Affiliation(s)
- Angeline S Ferdinand
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
| | - Callum McEwan
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
| | - Chantel Lin
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
| | - Kassandra Betham
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
| | - Karishma Kandan
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
| | | | - Barry Pugeva
- Burnet Institute, Melbourne, Victoria, Australia
| | - Joanna McKenzie
- Molecular Epidemiology Laboratory, School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Glenn Browning
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, The University of Melbourne, Melbourne, Victoria, Australia
| | - James Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Mauricio Coppo
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, The University of Melbourne, Melbourne, Victoria, Australia
- Escuela de Medicina Veterinaria, Universidad Andrés Bello, Santiago, Chile
| | - Rodney James
- Doherty Institute, Melbourne, Victoria, Australia
- Department of Microbiology and Immunology, University of Melbourne at the Doherty Institute, Melbourne, Victoria, Australia
| | - Trisha Peel
- Department of Infectious Diseases, Monash University and Alfred Health, Melbourne, Victoria, Australia
| | - Steph Levy
- Burnet Institute, Melbourne, Victoria, Australia
| | - Nicola Townell
- Infectious Disease Department, Sunshine Coast University Hospital, Sunshine Coast, Queensland, Australia
| | - Adam Jenney
- Department of Infectious Diseases, Monash University, Clayton, Victoria, Australia
| | - Andrew Stewardson
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Donna Cameron
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
| | - Alison Macintyre
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsty Buising
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
| | - Benjamin P Howden
- WHO Collaborating Centre for Antimicrobial Resistance, Doherty Institute, Melbourne, Victoria, Australia
- Microbiological Diagnostic Unit Public Health Laboratory, The Peter Doherty Institute for Infection and Immunity at the University of Melbourne, Melbourne, Victoria, Australia
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Chuki P, Dorji T, James R, Wangchuk K, Yangzom S, Dema Y, Wangchuk S, Wangdi D, Deki T, Limbu C, Dorji KR, Wangda S, Buising K, Thursky K. Antibiotic use and quality indicators of antibiotic prescription in Bhutan: a point prevalence survey using the Australian National Antimicrobial Prescribing Survey tool. JAC Antimicrob Resist 2023; 5:dlad100. [PMID: 37614960 PMCID: PMC10443734 DOI: 10.1093/jacamr/dlad100] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/08/2023] [Indexed: 08/25/2023] Open
Abstract
Background The National Action Plan on Antimicrobial Resistance in Bhutan promotes the rational use of antibiotics. It is important to establish baseline data on the use of antibiotics and the quality indicators of antibiotic prescriptions to identify where improvement efforts may need to be focused. Objectives To describe the prevalence and patterns of antibiotic prescription and establish baseline data regarding quality indicators of antibiotic prescriptions in four major hospitals in Bhutan. Methods This was a point prevalence survey of antibiotic use among inpatients in June 2022 conducted using the Australian National Antibiotic Prescribing Survey (NAPS). Results There were 314 patients (41.5%) receiving at least one antibiotic on the audit day. Among prescriptions reviewed, 278 (88.5%) had indications for use documented, 102 (32.5%) had a review or stop date documented and 120 (38.2%) had microbiology samples collected prior to antibiotics. Ceftriaxone (68; 21.7%), cefazolin (41; 13.1%) and metronidazole (32; 10.2%), were the common antibiotics prescribed. The most common indications for use were surgical prophylaxis (42; 13.4%), community-acquired pneumonia (39; 12.4%) and sepsis (26; 8.3%). There were 125 prescriptions (39.8%) that were compliant with national/therapeutic antibiotic guidelines and 169 (53.8%) where antibiotic prescriptions were appropriate. Conclusions This study identified key areas for targeted interventions in antimicrobial stewardship programmes in Bhutan. The prevalence of antibiotic use, indications for use, and drug choices were similar to data from other countries. Documentation plans for durations of use, prolonged surgical prophylaxis and concordance of choices with guideline recommendations present opportunities for improvement.
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Affiliation(s)
- Pem Chuki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Thinley Dorji
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Rodney James
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, Victoria, Australia
- Guidance Group, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Khando Wangchuk
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Sonam Yangzom
- Department of Internal Medicine, Eastern Regional Referral Hospital, Monggar, Bhutan
| | - Yangchen Dema
- Department of Internal Medicine, Eastern Regional Referral Hospital, Monggar, Bhutan
| | - Sangay Wangchuk
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Dorji Wangdi
- Department of Pharmacy, Central Regional Referral Hospital, Gelephu, Bhutan
| | - Tshering Deki
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Chandra Limbu
- Antimicrobial Stewardship Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | | | - Sonam Wangda
- Antimicrobial Resistance Prevention Program, Ministry of Health, Thimphu, Bhutan
| | - Kirsty Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- Department of Internal Medicine, Central Regional Referral Hospital, Gelephu, Bhutan
- Department of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, Victoria, Australia
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5
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Guterres H, Gusmao C, Pinheiro M, Martins J, Odio G, Maia C, da Conceicao V, Soares M, Osorio C, da Silva ES, Tilman A, Givney R, Oakley T, Yan J, Toto L, Amaral E, James R, Buising K, Mayo M, Kaestli M, Webb JR, Baird RW, Currie BJ, Francis JR, Muhi S. Melioidosis in Timor-Leste: First Case Description and Phylogenetic Analysis. Open Forum Infect Dis 2023; 10:ofad405. [PMID: 37577114 PMCID: PMC10414804 DOI: 10.1093/ofid/ofad405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023] Open
Abstract
Burkholderia pseudomallei, the causative agent of melioidosis, has not yet been reported in Timor-Leste, a sovereign state northwest of Australia. In the context of improved access to diagnostic resources and expanding clinical networks in the Australasian region, we report the first 3 cases of culture-confirmed melioidosis in Timor-Leste. These cases describe a broad range of typical presentations, including sepsis, pneumonia, multifocal abscesses, and cutaneous infection. Phylogenetic analysis revealed that the Timor-Leste isolates belong to the Australasian clade of B. pseudomallei, rather than the Asian clade, consistent with the phylogeographic separation across the Wallace Line. This study underscores an urgent need to increase awareness of this pathogen in Timor-Leste and establish diagnostic laboratories with improved culture capacity in regional hospitals. Clinical suspicion should prompt appropriate sampling and communication with laboratory staff to target diagnostic testing. Local antimicrobial guidelines have recently been revised to include recommendations for empiric treatment of severe sepsis.
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Affiliation(s)
| | - Celia Gusmao
- National Hospital Guido Valadares, Dili, Timor-Leste
| | | | - Joana Martins
- National Hospital Guido Valadares, Dili, Timor-Leste
| | - Gustavo Odio
- National Hospital Guido Valadares, Dili, Timor-Leste
| | | | - Virginia da Conceicao
- National Health Laboratory, Dili, Timor-Leste
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Messias Soares
- National Health Laboratory, Dili, Timor-Leste
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | | | | | | | - Rodney Givney
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Tessa Oakley
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jennifer Yan
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lucia Toto
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Elfiana Amaral
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rodney James
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Mark Mayo
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Mirjam Kaestli
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Jessica R Webb
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Robert W Baird
- Territory Pathology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Bart J Currie
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Joshua R Francis
- Menzies School of Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Stephen Muhi
- Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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6
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Barmanray RD, Kyi M, Buising K, Rushakoff RJ, Fourlanos S. Changing risk with diabetes and hyperglycaemia in the evolving COVID-19 pandemic. Intern Med J 2023; 53:1293-1294. [PMID: 37474464 DOI: 10.1111/imj.16154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/24/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Rahul D Barmanray
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Mervyn Kyi
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Robert J Rushakoff
- Division of Endocrinology and Metabolism, University of California, San Francisco, California, USA
| | - Spiros Fourlanos
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
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Landersdorfer CB, Lee WL, Nation RL, Kong DCM, Buising K, Peel TN, Choong PFM. Penetration of Vancomycin into Noninfected Bone in Patients Undergoing Total Joint Arthroplasty Evaluated by a Minimal Physiologically Based Population Pharmacokinetic Modeling Approach. Mol Pharm 2023; 20:1509-1518. [PMID: 36512679 DOI: 10.1021/acs.molpharmaceut.2c00724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Arthroplasty is a healthcare priority and represents high volume, high cost surgery. Periprosthetic joint infection (PJI) results in significant mortality, thus it is vital that the risk for PJI is minimized. Vancomycin is recommended for surgical prophylaxis in total joint arthroplasty (TJA) by current clinical practice guidelines endorsed by the Infectious Diseases Society of America. This study aimed to develop a new assay to determine vancomycin concentrations in serum and bone, and a minimal physiologically based population PK (mPBPK) model to evaluate vancomycin bone penetration in noninfected patients. Eleven patients undergoing TJA received 0.5-2.0 g intravenous vancomycin over 12-150 min before surgery. Excised bone specimens and four blood samples were collected per patient. Bone samples were pulverized under liquid nitrogen using a cryogenic mill. Vancomycin concentrations in serum and bone were analyzed by liquid chromatography-tandem mass spectrometry and subjected to mPBPK modeling. Vancomycin serum and bone concentrations ranged from 9.30 to 86.6 mg/L, and 1.94-37.0 mg/L, respectively. Average bone to serum concentration ratio was 0.41 (0.16-1.0) based on the collected samples. The population mean total body clearance was 2.12L/h/kg0.75. Inclusion of total body weight as a covariate substantially decreased interindividual variability in clearance. The bone/blood partition coefficient (Kpbone) was estimated at 0.635, reflecting the average bone/blood concentration ratio at steady-state. The model predicted median ratio of vancomycin area under the curve (AUC) for bone/AUC for serum was 44%. Observed vancomycin concentrations in bone were overall consistent with perfusion-limited distribution from blood to bone. An mPBPK model overall well described vancomycin concentrations in serum and bone.
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Affiliation(s)
- Cornelia B Landersdorfer
- Drug Delivery, Disposition, and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria3052, Australia
| | - Wee Leng Lee
- Drug Delivery, Disposition, and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria3052, Australia
| | - Roger L Nation
- Drug Delivery, Disposition, and Dynamics, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria3052, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Victoria3052, Australia
| | - Kirsty Buising
- Department of Medicine, University of Melbourne, Melbourne, Victoria3010, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria3050, Australia
| | - Trisha N Peel
- Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Victoria3004, Australia.,Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria3065, Australia
| | - Peter F M Choong
- Department of Surgery, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria3065, Australia.,Department of Orthopaedics, St Vincent's Hospital, Melbourne, Victoria3065, Australia
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8
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Tropea J, Peters S, Francis JJ, Bennett N, Fetherstonhaugh D, Buising K, Lim LL, Marshall C, Flynn M, Murray M, Yates P, Aboltins C, Johnson D, Kwong J, Long K, McCahon J, Lim WK. IMpleMenting Effective infection prevention and control in ReSidential aged carE (IMMERSE): protocol for a multi-level mixed methods implementation study. BMC Geriatr 2023; 23:109. [PMID: 36823588 PMCID: PMC9948775 DOI: 10.1186/s12877-023-03766-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/19/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Older people living in residential aged care facilities are at high risk of acquiring infections such as influenza, gastroenteritis, and more recently COVID-19. These infections are a major cause of morbidity and mortality among this cohort. Quality infection prevention and control practice in residential aged care is therefore imperative. Although appointment of a dedicated infection prevention and control (IPC) lead in every Australian residential aged care facility is now mandated, all people working in this setting have a role to play in IPC. The COVID-19 pandemic revealed inadequacies in IPC in this sector and highlighted the need for interventions to improve implementation of best practice. METHODS Using mixed methods, this four-phase implementation study will use theory-informed approaches to: (1) assess residential aged care facilities' readiness for IPC practice change, (2) explore current practice using scenario-based assessments, (3) investigate barriers to best practice IPC, and (4) determine and evaluate feasible and locally tailored solutions to overcome the identified barriers. IPC leads will be upskilled and supported to operationalise the selected solutions. Staff working in residential aged care facilities, residents and their families will be recruited for participation in surveys and semi-structured interviews. Data will be analysed and triangulated at each phase, with findings informing the subsequent phases. Stakeholder groups at each facility and the IMMERSE project's Reference Group will contribute to the interpretation of findings at each phase of the project. DISCUSSION This multi-site study will comprehensively explore infection prevention and control practices in residential aged care. It will inform and support locally appropriate evidence-based strategies for enhancing infection prevention and control practice.
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Affiliation(s)
- Joanne Tropea
- Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC, 3050, Australia. .,Department of Medicine - Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, 3010, Australia.
| | - Sanne Peters
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,grid.5596.f0000 0001 0668 7884Department of Public Health and Primary Care, University of Leuven, KU Leuven, Louvain, Belgium
| | - Jill J. Francis
- grid.1008.90000 0001 2179 088XSchool of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia ,grid.1055.10000000403978434Department of Health Services Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Oncology, Sir Peter MacCallum, University of Melbourne, Parkville, VIC 3010 Australia ,grid.412687.e0000 0000 9606 5108Ottawa Hospital Research Institute – General Campus, Centre for Implementation Research, 501 Smyth Road, Ottawa, ON K1H 8L6 Canada
| | - Noleen Bennett
- grid.1008.90000 0001 2179 088XVictorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne, VIC 3000 Australia ,grid.1008.90000 0001 2179 088XDepartment of Nursing, School of Health Sciences, University of Melbourne, Parkville, VIC 3010 Australia
| | - Deirdre Fetherstonhaugh
- grid.1018.80000 0001 2342 0938Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC 3086 Australia
| | - Kirsty Buising
- grid.416153.40000 0004 0624 1200Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC 3050 Australia ,grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - Lyn-li Lim
- grid.1008.90000 0001 2179 088XVictorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre and Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia
| | - Caroline Marshall
- grid.1008.90000 0001 2179 088XDepartment of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne VIC 3000, Australia ,grid.416153.40000 0004 0624 1200Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, VIC 3050 Australia
| | - Madelaine Flynn
- Director of Infection Prevention, Northern Health, Epping, VIC 3076 Australia ,Victorian Aged Care Response Centre, Australian Department of Health, Melbourne VIC 3000, Australia
| | - Michael Murray
- grid.1018.80000 0001 2342 0938Australian Centre for Evidence Based Aged Care (ACEBAC), La Trobe University, Bundoora, VIC 3086 Australia ,grid.410678.c0000 0000 9374 3516Department of Geriatric Medicine, Austin Health, Heidelberg, VIC 3084 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia
| | - Paul Yates
- grid.410678.c0000 0000 9374 3516Department of Geriatric Medicine, Austin Health, Heidelberg, VIC 3084 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia
| | - Craig Aboltins
- grid.410684.f0000 0004 0456 4276Department of Infectious Diseases, Northern Health, Epping, Vic 3076 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine, Northern Clinical School, University of Melbourne, Epping VIC 3076, Australia
| | - Douglas Johnson
- grid.1008.90000 0001 2179 088XDepartment of Medicine – Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3010 Australia ,grid.416153.40000 0004 0624 1200Departments of General Medicine and Infectious Diseases, Royal Melbourne Hospital, Parkville VIC 3050, Australia
| | - Jason Kwong
- grid.1008.90000 0001 2179 088XDepartment of Medicine – Austin Health, University of Melbourne, Heidelberg, VIC 3084 Australia ,grid.410678.c0000 0000 9374 3516Department of Infectious Diseases, Austin Health, Heidelberg VIC 3084, Australia ,grid.1008.90000 0001 2179 088XDepartment of Microbiology & Immunology, University of Melbourne at the Peter Doherty Institute for Infection & Immunity, Melbourne VIC 3000, Australia
| | - Karrie Long
- grid.416153.40000 0004 0624 1200Director Nursing Research Hub, Royal Melbourne Hospital, Parkville VIC 3050, Australia
| | - Judy McCahon
- Consumer Representative of the IMMERSE Research Team, and Melbourne Academic Centre for Health, Parkville VIC 3050, Australia
| | - Wen K. Lim
- grid.416153.40000 0004 0624 1200Department of Aged Care, Royal Melbourne Hospital, Level 8 CRM, 300 Grattan Street, Parkville, VIC 3050 Australia ,grid.1008.90000 0001 2179 088XDepartment of Medicine – Royal Melbourne Hospital, University of Melbourne, Parkville, VIC 3010 Australia
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9
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Barmanray RD, Gong JY, Kyi M, Kevat D, Islam MA, Galligan A, Manos GR, Nair IV, Perera N, Adams NK, Nursing A, Warren AM, Hamblin PS, MacIsaac RJ, Ekinci EI, Krishnamurthy B, Karunajeewa H, Buising K, Visvanathan K, Kay TWH, Fourlanos S. Diabetes IN hospital - Glucose and Outcomes in the COVID-19 pandemic (DINGO COVID-19): the 2020 Melbourne hospital experience prior to novel variants and vaccinations. Intern Med J 2023; 53:27-36. [PMID: 36269315 PMCID: PMC9874487 DOI: 10.1111/imj.15937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/12/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND AIMS A relationship between diabetes, glucose and COVID-19 outcomes has been reported in international cohorts. This study aimed to assess the relationship between diabetes, hyperglycaemia and patient outcomes in those hospitalised with COVID-19 during the first year of the Victorian pandemic prior to novel variants and vaccinations. DESIGN, SETTING Retrospective cohort study from March to November 2020 across five public health services in Melbourne, Australia. PARTICIPANTS All consecutive adult patients admitted to acute wards of participating institutions during the study period with a diagnosis of COVID-19, comprising a large proportion of patients from residential care facilities and following dexamethasone becoming standard-of-care. Admissions in patients without known diabetes and without inpatient glucose testing were excluded. RESULTS The DINGO COVID-19 cohort comprised 840 admissions. In 438 admissions (52%), there was no known diabetes or in-hospital hyperglycaemia, in 298 (35%) patients had known diabetes, and in 104 (12%) patients had hyperglycaemia without known diabetes. ICU admission was more common in those with diabetes (20%) and hyperglycaemia without diabetes (49%) than those with neither (11%, P < 0.001 for all comparisons). Mortality was higher in those with diabetes (24%) than those without diabetes or hyperglycaemia (16%, P = 0.02) but no difference between those with in-hospital hyperglycaemia and either of the other groups. On multivariable analysis, hyperglycaemia was associated with increased ICU admission (adjusted odds ratio (aOR) 6.7, 95% confidence interval (95% CI) 4.0-12, P < 0.001) and longer length of stay (aOR 173, 95% CI 11-2793, P < 0.001), while diabetes was associated with reduced ICU admission (aOR 0.55, 95% CI 0.33-0.94, P = 0.03). Neither diabetes nor hyperglycaemia was independently associated with in-hospital mortality. CONCLUSIONS During the first year of the COVID-19 pandemic, in-hospital hyperglycaemia and known diabetes were not associated with in-hospital mortality, contrasting with published international experiences. This likely mainly relates to hyperglycaemia indicating receipt of mortality-reducing dexamethasone therapy. These differences in published experiences underscore the importance of understanding population and clinical treatment factors affecting glycaemia and COVID-19 morbidity within both local and global contexts.
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Affiliation(s)
- Rahul D Barmanray
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
| | - Joanna Y Gong
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Mervyn Kyi
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Northern Health, Melbourne, Victoria, Australia
| | - Dev Kevat
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia.,Department of Diabetes, Monash Health, Melbourne, Victoria, Australia
| | - Mohammad A Islam
- Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Anna Galligan
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Georgina R Manos
- Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Indu V Nair
- Department of Endocrinology, Northern Health, Melbourne, Victoria, Australia
| | - Nayomi Perera
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Nicholas K Adams
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Ashvin Nursing
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia
| | - Annabelle M Warren
- Department of Endocrinology, Northern Health, Melbourne, Victoria, Australia
| | - Peter S Hamblin
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia.,Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Richard J MacIsaac
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Elif I Ekinci
- Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia.,Department of Endocrinology, Austin Health, Melbourne, Victoria, Australia.,Department of Medicine, Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia
| | - Balasubramanian Krishnamurthy
- Department of Endocrinology & Diabetes, Western Health, Melbourne, Victoria, Australia.,Department of Endocrinology & Diabetes, St Vincent's Hospital Melbourne, Melbourne, Victoria, Australia.,Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harin Karunajeewa
- Department of Medicine, Western Health, The University of Melbourne, Melbourne, Victoria, Australia.,General Internal Medicine Unit, Western Health, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Infectious Diseases, The University of Melbourne, Melbourne, Victoria, Australia
| | - Kumar Visvanathan
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - Thomas W H Kay
- Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,St Vincent's Institute, Melbourne, Victoria, Australia
| | - Spiros Fourlanos
- Department of Diabetes & Endocrinology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, Victoria, Australia.,Australian Centre for Accelerating Diabetes Innovations (ACADI), The University of Melbourne, Melbourne, Victoria, Australia
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10
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Gotterson F, Buising K, Hall L, Manias E, Rajkhowa A. 109. Exploring nurse led Antimicrobial Stewardship programs in Australian hospitals: Semi structured interviews with key informants. Infect Dis Health 2022. [DOI: 10.1016/j.idh.2022.09.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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11
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Monaghan T, Biezen R, Buising K, Hallinan C, Cheah R, Manski-Nankervis JA. Clinical insights into appropriate choice of antimicrobials for acute respiratory tract infections. Aust J Gen Pract 2022; 51:33-37. [PMID: 35098270 DOI: 10.31128/ajgp-07-21-6073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Australia has relatively high rates of antibiotic prescribing in the community. The aim of this study was to identify clinical insights regarding antibiotic prescribing choices for the management of common upper respiratory tract infections through analysis of anonymised primary care electronic medical records (EMRs). METHOD EMR data relating to 1926 antimicrobial prescriptions for tonsillitis, pharyngitis and acute rhinosinusitis in adults and acute otitis media (AOM) in children were extracted from 11 general practices in Victoria and analysed for consistency with Australian Therapeutic Guidelines recommendations. RESULTS The analysis suggests that underdosing of amoxicillin for AOM in children, prescription of phenoxymethylpenicillin at doses not consistent with Therapeutic Guidelines recommendations for tonsillitis and pharyngitis in adults, and potential overprescription of antibiotics for patients with acute rhinosinusitis are not infrequent in general practice. DISCUSSION Anonymised EMR data provide an opportunity to analyse antibiotic prescribing practices at scale and provide insights relevant to clinical practice.
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Affiliation(s)
- Tim Monaghan
- MBBS, LLB (Hons), BComm, FRACGP, Clinical Informatician, Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Vic
| | - Ruby Biezen
- BSc, MAppSc, PhD, Research Fellow @ Infection and Immunisation Lead, Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Vic
| | - Kirsty Buising
- MBBS, MD, MPH, FRACP, Deputy Director, National Centre for Antimicrobial Stewardship, University of Melbourne and Peter Doherty Institute for Infection and Immunity, Melbourne, Vic; Infectious Diseases Physician, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Vic
| | - Christine Hallinan
- PhD, MPH, BAppSc,@Research Fellow @ Biostatistics and Pharmacovigilance, Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry @ Health Science, University of Melbourne, Melbourne, Vic
| | - Ron Cheah
- BPharm, GradCertPharmPrac, MPharmPrac, Project Officer, National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, Melbourne, Vic; Pharmacy Department, Monash Health, Melbourne, Vic
| | - Jo-Anne Manski-Nankervis
- BSc (Hons), MBBS (Hons), CHIA, PhD, FRACGP, Associate Professor, Department of General Practice, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Science, University of Melbourne, Melbourne, Vic
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12
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Farrow B, Bonney A, Singh KP, Tong S, Irving L, Lim WK, Lim S, Johnson D, Marshall C, Buising K, Liu B, Cowie B, Rees M, Miller A. COVID
‐19 pandemic 2020 ‐ A tertiary Melbourne hospital's experience. Intern Med J 2022; 52:1129-1134. [DOI: 10.1111/imj.15699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 01/17/2022] [Accepted: 01/20/2022] [Indexed: 12/15/2022]
Affiliation(s)
| | - Asha Bonney
- Royal Melbourne Hospital, Respiratory Medicine
| | - Kasha P. Singh
- Royal Melbourne Hospital, Infectious Diseases The Peter Doherty Institute for Infectino and Immunity
| | - Steven Tong
- Royal Melbourne Hospital, Infectious Diseases
| | | | - Wen Kwang Lim
- Royal Melbourne Hospital, Geriatric Evaluation and Management
| | - Seok Lim
- Royal Melbourne Hospital, Hospital In the Home
| | | | - Caroline Marshall
- Royal Melbourne Hospital Infection Prevention and Surveillance University Of Melbourne, Department of Medicine
| | | | - Belinda Liu
- Royal Melbourne Hospital, Respiratory Medicine
| | | | - Megan Rees
- Royal Melbourne Hospital, Respiratory Medicine
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13
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James R, Nakamachi Y, Morris A, So M, Ponnampalavanar SSLS, Chuki P, Loong LS, Lai PSM, Chen C, Ingram R, Rajkhowa A, Buising K, Thursky K. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac012. [PMID: 35156035 PMCID: PMC8827555 DOI: 10.1093/jacamr/dlac012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The National Antimicrobial Prescribing Survey (NAPS) is a web-based qualitative auditing platform that provides a standardized and validated tool to assist hospitals in assessing the appropriateness of antimicrobial prescribing practices. Since its release in 2013, the NAPS has been adopted by all hospital types within Australia, including public and private facilities, and supports them in meeting the national standards for accreditation. Hospitals can generate real-time reports to assist with local antimicrobial stewardship (AMS) activities and interventions. De-identified aggregate data from the NAPS are also submitted to the Antimicrobial Use and Resistance in Australia surveillance system, for national reporting purposes, and to strengthen national AMS strategies. With the successful implementation of the programme within Australia, the NAPS has now been adopted by countries with both well-resourced and resource-limited healthcare systems. We provide here a narrative review describing the experience of users utilizing the NAPS programme in Canada, Malaysia and Bhutan. We highlight the key barriers and facilitators to implementation and demonstrate that the NAPS methodology is feasible, generalizable and translatable to various settings and able to assist in initiatives to optimize the use of antimicrobials.
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Affiliation(s)
- Rodney James
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Corresponding author. E-mail:
| | - Yoshiko Nakamachi
- Sinai Health-University Health Network Antimicrobial Stewardship Program, Toronto General Hospital, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | - Andrew Morris
- Sinai Health-University Health Network Antimicrobial Stewardship Program, Toronto General Hospital, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | - Miranda So
- Sinai Health-University Health Network Antimicrobial Stewardship Program, Toronto General Hospital, 585 University Avenue, Toronto, Ontario M5G 2N2, Canada
| | | | - Pem Chuki
- Jigme Dorji Wangchuck National Referral Hospital, Gongphel Lam, Thimphu, Bhutan
| | - Ly Sia Loong
- University Malaya Medical Centre, Lembah Pantai, Kuala Lumpur 59100, Malaysia
| | | | - Caroline Chen
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Robyn Ingram
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity, University of Melbourne, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
- Guidance Group, Royal Melbourne Hospital, Melbourne Health, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia
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14
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Tshering T, Wangda S, Buising K. Trends in antimicrobial consumption in Bhutan. IJID Regions 2021; 1:65-71. [PMID: 35757828 PMCID: PMC9216644 DOI: 10.1016/j.ijregi.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 09/09/2021] [Accepted: 09/26/2021] [Indexed: 11/19/2022]
Affiliation(s)
- Thupten Tshering
- Department of Pharmacy, Jigme Dorji Wangchuk National Referral Hospital, Thimphu, Bhutan
- Corresponding author. Address: Department of Pharmacy, JDWNR Hospital, Menkhang Lam, Thimphu, Bhutan.
| | - Sonam Wangda
- Department of Medical Services, Ministry of Health, Thimphu, Bhutan
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital, Melbourne, Australia
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15
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Bishop J, Jones M, Farquharson J, Summerhayes K, Tucker R, Smith M, Cowan R, Friedman ND, Schulz T, Kong D, Buising K. Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence-Practice Gap in Antibiotic Prescribing. Antibiotics (Basel) 2021; 10:antibiotics10111288. [PMID: 34827226 PMCID: PMC8615114 DOI: 10.3390/antibiotics10111288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/17/2021] [Accepted: 10/18/2021] [Indexed: 11/16/2022] Open
Abstract
Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, n = 165) and March and October 2020 (post-implementation, n = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, p = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; p = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.
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Affiliation(s)
- Jaclyn Bishop
- National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; (T.S.); (D.K.); (K.B.)
- Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine- RMH, The University of Melbourne, Royal Parade, Melbourne, VIC 3000, Australia
- Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia;
- Correspondence:
| | - Mark Jones
- Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia;
| | - James Farquharson
- Pharmacy Department, Colac Area Health, Connor Street, Colac, VIC 3250, Australia;
| | - Kathrine Summerhayes
- Clinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia; (K.S.); (R.T.)
| | - Roxanne Tucker
- Clinical Improvement, Risk and Innovation, Wimmera Health Care Group, Baillie Street, Horsham, VIC 3400, Australia; (K.S.); (R.T.)
| | - Mary Smith
- Department of Health and Human Services (Victoria), McLachlan Street, Horsham, VIC 3000, Australia;
| | - Raquel Cowan
- Department of Internal Medicine, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia;
| | - N. Deborah Friedman
- Department of Infectious Diseases, Barwon Health, Ryrie Street, Geelong, VIC 3220, Australia;
- School of Medicine, Faculty of Health, Deakin University, Pigdons Road, Waurn Ponds, VIC 3216, Australia
| | - Thomas Schulz
- National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; (T.S.); (D.K.); (K.B.)
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC 3050, Australia
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
| | - David Kong
- National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; (T.S.); (D.K.); (K.B.)
- Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine- RMH, The University of Melbourne, Royal Parade, Melbourne, VIC 3000, Australia
- Pharmacy Department, Ballarat Health Services, Drummond Street North, Ballarat, VIC 3350, Australia;
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship (NCAS), Peter Doherty Research Institute for Infection and Immunity, The University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, VIC 3000, Australia; (T.S.); (D.K.); (K.B.)
- Faculty of Medicine, Dentistry and Health Sciences, Department of Medicine- RMH, The University of Melbourne, Royal Parade, Melbourne, VIC 3000, Australia
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC 3050, Australia
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, The University of Melbourne, 792 Elizabeth Street, Melbourne, VIC 3000, Australia
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16
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Bennett N, Walker K, Buising K, Cheah R, Fang X, Ingram R, James R, Malloy MJ, Thursky K, Worth LJ. Topical antimicrobial prescribing patterns in residents of Australian aged-care facilities: use of a national point prevalence survey to identify opportunities for quality improvement. Am J Infect Control 2021; 49:1113-1117. [PMID: 33813041 DOI: 10.1016/j.ajic.2021.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Australian residential aged care facilities (RACFs) are encouraged to participate in an annual Aged Care National Antimicrobial Prescribing Survey. This data source was analysed to describe patterns of topical antimicrobial prescribing and thereby provide insight into antimicrobial stewardship (AMS) changes that might be required. METHODS 2018 and 2019 survey data was analysed. RESULTS The overall prevalence of the 52,431 audited residents (629 facilities) who were prescribed 1 or more topical antimicrobials was 2.9%. Of all prescribed antimicrobials (n=4899), 33.0% were for topical application. Most frequently prescribed topical antifungals were clotrimazole (85.3%) and miconazole (9.1%), and antibacterials chloramphenicol (64.1%) and mupirocin (21.8%). Tinea (38.3%) and conjunctivitis (23.8%) were the 2 most common indications. Topical antimicrobials were sometimes prescribed for pro re nata administration (38.8%) and greater than 6 months (11.3%). The review or stop date was not always documented (38.7%). CONCLUSIONS To reduce the possibility of adverse consequences associated with antimicrobial use, antimicrobial stewardship programs in Australian residential aged care facilities should at least ensure mupirocin is appropriately used, first line antimicrobial therapy is prescribed for tinea, chloramphenicol is prescribed for conjunctivitis only if necessary, pro re nata orders for prescriptions are discouraged and to avoid prolonged duration of prescriptions, review or stop dates are always documented.
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Affiliation(s)
- Noleen Bennett
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
| | - Katherine Walker
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Ron Cheah
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Xin Fang
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Robyn Ingram
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Michael J Malloy
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, The University of Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
| | - Leon J Worth
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Centre, Melbourne, Victoria, Australia; The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia; National Centre for Infections in Cancer, Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia
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Biezen R, Buising K, Monaghan T, Ball R, Thursky K, Cheah R, Clark M, Manski-Nankervis JA. Evaluating the Implementation of a Pilot Quality Improvement Program to Support Appropriate Antimicrobial Prescribing in General Practice. Antibiotics (Basel) 2021; 10:antibiotics10070867. [PMID: 34356788 PMCID: PMC8300821 DOI: 10.3390/antibiotics10070867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/05/2021] [Accepted: 07/13/2021] [Indexed: 11/16/2022] Open
Abstract
Inappropriate antimicrobial prescribing contributes to increasing antimicrobial resistance. An antimicrobial stewardship (AMS) program in the form of quality improvement activities that included audit and feedback, clinical decision support and education was developed to help optimise prescribing in general practice. The aim of this study was to evaluate the implementation of this program (Guidance GP) in three general practices in Melbourne, Australia, between November 2019 and August 2020. Thirty-one general practitioners (GPs) participated in the program, with 11 GPs and three practice managers participating in follow-up focus groups and interviews to explore the acceptability and feasibility of the program. Our findings showed that the quality improvement activities were acceptable to GPs, if they accurately fit GPs' decision-making process and workflow. It was also important that they provided clinically meaningful information in the form of audit and feedback to GPs. The time needed to coordinate the program, and costs to implement the program were some of the potential barriers identified. Facilitators of success were a "whole of practice" approach with enthusiastic GPs and practice staff, and an identified practice champion. The findings of this research will inform implementation strategies for both the Guidance GP program and AMS programs more broadly in Australian general practice, which will be critical for general practice participation and engagement.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
- Correspondence: ; Tel.: +61-3-9035-4886
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne 3004, Australia; (K.B.); (K.T.); (R.C.)
- The Guidance Group, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Tim Monaghan
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
| | - Rachael Ball
- North Western Melbourne Primary Health Network, Melbourne 3052, Australia;
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne 3004, Australia; (K.B.); (K.T.); (R.C.)
- The Guidance Group, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Ron Cheah
- National Centre for Antimicrobial Stewardship, Department of Infectious Diseases, The University of Melbourne, Melbourne 3004, Australia; (K.B.); (K.T.); (R.C.)
- The Guidance Group, Royal Melbourne Hospital, Melbourne 3050, Australia
| | - Malcolm Clark
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
| | - Jo-Anne Manski-Nankervis
- Department of General Practice, The University of Melbourne, Melbourne 3004, Australia; (T.M.); (M.C.); (J.-A.M.-N.)
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18
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Cheah R, Rajkhowa A, James R, Wangeman K, Koning S, Thursky K, Buising K. Case for antimicrobial stewardship pharmacy technicians in Australian hospitals. AUST HEALTH REV 2021; 44:941-943. [PMID: 33213691 DOI: 10.1071/ah19236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/10/2020] [Indexed: 11/23/2022]
Abstract
The pharmacist's role in hospital antimicrobial stewardship (AMS) programs is known to improve patient safety and the quality of care. Despite this, many Australian hospitals struggle to provide adequate pharmacy AMS program resourcing and need to explore newer models of care. The Pharmacy Board of Australia's Guidelines for Dispensing Medicines permit suitably qualified, competent and experienced pharmacy technicians to assist pharmacists in 'tasks in a pharmacy department'. The pharmacy technician workforce is expanding, and there is growing interest in career advancement and expansion of the pharmacy technician role. We propose that the pharmacy technician, a well-integrated member of many Australian hospital pharmacy departments, can play an important role in hospital AMS programs. To bolster AMS initiatives in Australian hospitals, this paper explores the existing evidence for pharmacy technicians in AMS programs and describes how this role may be better supported in Australia.
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Affiliation(s)
- Ron Cheah
- National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Vic. 3000, Australia. ; ; ; and Monash Health, Pharmacy Department, Clayton, Vic. 3168, Australia; and Corresponding author.
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Vic. 3000, Australia. ; ; ; and University of Melbourne, Department of Medicine, Melbourne, Vic. 3010, Australia.
| | - Rodney James
- National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Vic. 3000, Australia. ; ;
| | - Kym Wangeman
- Eastern Health, Pharmacy Department, Box Hill, Vic. 3128, Australia. ;
| | - Sonia Koning
- Eastern Health, Pharmacy Department, Box Hill, Vic. 3128, Australia. ; ; and Monash University, Faculty of Pharmacy and Pharmaceutical Sciences, Parkville, Vic. 3052, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Vic. 3000, Australia. ; ; ; and University of Melbourne, Department of Medicine, Melbourne, Vic. 3010, Australia. ; and Royal Melbourne Hospital, Victorian Infectious Diseases Service, Melbourne, Vic. 3050, Australia; and Peter MacCallum Cancer Centre, Department of Infectious Diseases, Melbourne, Vic. 3000, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Doherty Institute, Melbourne, Vic. 3000, Australia. ; ; ; and University of Melbourne, Department of Medicine, Melbourne, Vic. 3010, Australia. ; and Royal Melbourne Hospital, Victorian Infectious Diseases Service, Melbourne, Vic. 3050, Australia
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19
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Gregorevic K, Maier A, Miranda R, Loveland P, Miller K, Buising K, Marshall C, O'Gorman B, Tan A, Staggard K, O'Halloran T, Nguyen HXT, Disler J, Crotty F, Lim K, Cianter J, Kelly C, Lim K. Presenting symptoms of COVID-19 and clinical outcomes in hospitalised older adults. Intern Med J 2021; 51:861-867. [PMID: 33724644 PMCID: PMC8250615 DOI: 10.1111/imj.15286] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/26/2021] [Accepted: 03/05/2021] [Indexed: 12/13/2022]
Abstract
Background In July 2020, a COVID‐19 outbreak was recognised in the geriatric wards at a subacute campus of the Royal Melbourne Hospital affecting patients and staff. Patients were also admitted to this site after diagnosis in residential care. Aims To describe the early symptoms and the outcomes of COVID‐19 in older adults. Methods Patients diagnosed with COVID‐19 at the facility in July or August 2020 were identified and their medical records were examined to identify symptoms present before and after their diagnosis and to determine their outcomes. Results Overall, 106 patients were identified as having COVID‐19, with median age of 84.3 years (range 41–104 years); 64 were diagnosed as hospital inpatients after a median length of stay of 49 days, 31 were transferred from residential aged care facilities with a known diagnosis and 11 were diagnosed after discharge. There were 95 patients included in an analysis of symptom type and timing onset. Overall, 61 (64.2%) were asymptomatic at the time of diagnosis of COVID‐19, having been diagnosed through screening initiated on site. Of these, 88.6% developed symptoms of COVID‐19 within 14 days. The most common initial symptom type was respiratory, but there was wide variation in presentation, including fever, gastrointestinal and neurological symptoms, many initially not recognised as being due to COVID‐19. Of 104 patients, 32 died within 30 days of diagnosis. Conclusions COVID‐19 diagnosis is challenging due to the variance in symptoms. In the context of an outbreak, asymptomatic screening can identify affected patients early in the disease course.
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Affiliation(s)
- Kate Gregorevic
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Andrea Maier
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Department of Human Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam
| | - Roeisa Miranda
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Paula Loveland
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Katherine Miller
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Caroline Marshall
- Infection Prevention and Surveillance Service Melbourne Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Bronwyn O'Gorman
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Amanda Tan
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kylie Staggard
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tessa O'Halloran
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Huong Xuan Thi Nguyen
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jessica Disler
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Frances Crotty
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kai Lim
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Joseph Cianter
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Cate Kelly
- Clinical Governance and Medical Services, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kwang Lim
- Department of Medicine and Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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20
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Fryk JJ, Tong S, Marshall C, Rajkhowa A, Buising K, MacIsaac C, Walsham N, Thevarajan I. Knowledge, attitudes and practices of healthcare workers within an Australian tertiary hospital to managing high-consequence infectious diseases. Infect Dis Health 2021; 26:95-103. [PMID: 33189598 PMCID: PMC7657000 DOI: 10.1016/j.idh.2020.10.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/08/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Adequate preparation and support for healthcare workers (HCWs) managing high-consequence infectious diseases (HCIDs) is critical to the overall clinical management of HCIDs. Qualitative studies examining how well prepared and supported HCWs feel are lacking despite their key role. This study investigated how prepared and supported front-line HCWs at an Australian tertiary hospital felt about managing HCIDs such as viral haemorrhagic fever (VHF). METHODS A qualitative research approach was used to undertake interviews with 45 Royal Melbourne Hospital medical and nursing staff from emergency, intensive care and infectious diseases. Interview questions captured data on HCWs' role, familiarity with using protocols, psychological attributes and training for scenarios related to VHF patient management. Interviews were recorded and transcribed. Categorical responses were analysed quantitatively and open-ended responses were analysed thematically. RESULTS Ninety-eight percent of participants indicated feeling capable of undertaking their role in managing VHF patients; 77% felt supported through personnel/resources. However, 69% indicated barriers to managing these patients effectively; and 68% felt anxious at the prospect of managing VHF patients. Themes emerging from participants' observations included concerns about training frequency, miscommunication, difficulty with uncertainty, feeling underprepared, and fear of transmitting infection to others. CONCLUSION Although the majority of HCWs feel confident about their ability to care for VHF patients, they also have a moderately-high degree of anxiety. Perceptions of interviewed staff have fed into recommendations to increase HCW preparedness and reduce anxiety, which include investigating support services, and exploring training options that create multi-departmental groups of highly specialised medical officers and nurses.
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Affiliation(s)
- Jesse J Fryk
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia; School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Steven Tong
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia
| | - Caroline Marshall
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia; Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, Parkville, Australia
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, University of Melbourne, Parkville, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| | - Kirsty Buising
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia; National Centre for Antimicrobial Stewardship, Department of Medicine and Radiology, University of Melbourne, Parkville, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| | - Christopher MacIsaac
- Intensive Care Unit, The Royal Melbourne Hospital, Parkville, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Australia
| | - Nicola Walsham
- Emergency Department, The Royal Melbourne Hospital, Parkville, Australia
| | - Irani Thevarajan
- Victorian Infectious Disease Service, The Royal Melbourne Hospital, Parkville, Australia; The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Parkville, Australia.
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21
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Wong AK, Demediuk L, Tay JY, Wawryk O, Collins A, Everitt R, Philip J, Buising K, Le B. COVID-19 End-of-life Care: Symptoms and Supportive Therapy Use in an Australian Hospital. Intern Med J 2021; 51:1420-1425. [PMID: 33755283 PMCID: PMC8250873 DOI: 10.1111/imj.15300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 11/28/2022]
Abstract
Background Descriptions of symptoms and medication use at end of life in COVID‐19 are limited to small cross‐sectional studies, with no Australian longitudinal data. Aims To describe end‐of‐life symptoms and care needs of people dying of COVID‐19. Methods This retrospective cohort study included consecutive admitted patients who died at a Victorian tertiary referral hospital from 1 January to 30 September directly due to COVID‐19. Clinical characteristics, symptoms and use of supportive therapies, including medications and non‐pharmacological interventions in the last 3 days of life were extracted. Results The cohort comprised 58 patients (median age 87 years, interquartile range (IQR) 81–90) predominantly admitted from home (n = 30), who died after a median of 11 days (IQR 6–28) in the acute medical (n = 31) or aged care (n = 27) wards of the hospital. The median Charlson Comorbidity Score was 7 (IQR 5–8). Breathlessness (n = 42), agitation (n = 36) and pain (n = 33) were the most frequent clinician‐reported symptoms in the final 3 days of life, with most requiring opioids (n = 52), midazolam (n = 40), with dose escalation commonly being required. While oxygen therapy was commonly used (n = 47), few (n = 13) required an anti‐secretory agent. Conclusions This study presents one of the first and largest Australian report of the end of life and symptom experience of people dying of COVID‐19. This information should help clinicians to anticipate palliative care needs of these patients, for example, recognising that higher starting doses of opioids and sedatives may help reduce prevalence and severity of breathlessness and agitation near death.
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Affiliation(s)
- Aaron K Wong
- Department of Palliative Care, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
| | - Lucy Demediuk
- Palliative Medicine Registrar, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
| | - Jia Yin Tay
- Palliative Medicine Registrar, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
| | - Olivia Wawryk
- St Vincent's Hospital, Palliative Care Service, Victoria Parade, Fitzroy, Victoria, Australia, 3065
| | - Anna Collins
- St Vincent's Hospital, Palliative Care Service, Victoria Parade, Fitzroy, Victoria, Australia, 3065.,Department of Medicine, University of Melbourne, Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia, 3065
| | - Rachel Everitt
- Palliative Medicine Registrar, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
| | - Jennifer Philip
- Palliative Medicine Registrar, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050.,St Vincent's Hospital, Palliative Care Service, Victoria Parade, Fitzroy, Victoria, Australia, 3065.,Department of Medicine, University of Melbourne, Eastern Hill Campus, Victoria Parade, Fitzroy, Victoria, Australia, 3065
| | - Kirsty Buising
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
| | - Brian Le
- The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria, Australia, 3050
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22
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Hawes LA, Bishop J, Buising K, Mazza D. Feasibility and Validity of a Framework for Antimicrobial Stewardship in General Practice: Key Stakeholder Interviews. Antibiotics (Basel) 2020; 9:E900. [PMID: 33322126 PMCID: PMC7764540 DOI: 10.3390/antibiotics9120900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/03/2020] [Accepted: 12/10/2020] [Indexed: 11/26/2022] Open
Abstract
There is little guidance about developing systems for antimicrobial stewardship (AMS) for general practice. A literature review identified six key components: governance, monitoring of antibiotic prescribing and resistance with feedback to prescribers, consultation support, education of the public and general practitioners, pharmacist and nurse involvement, and research, which were incorporated into a potential framework for the general practice context. Objectives: to determine the feasibility and validity of the proposed AMS framework. A secondary objective was to identify likely bodies responsible for implementation in Australia. We undertook interviews with 12 key stakeholders from government, research, and professional groups. Data were analysed with a thematic approach. The framework was considered valid and feasible. No clear organisation was identified to lead AMS implementation in general practice. The current volume-based antibiotic prescription monitoring system was considered insufficient. AMS education for the public, further development of GP education, and improved consultation support were strongly recommended. The role of community-based pharmacists and nurses is largely unexplored, but their involvement was recommended. A clear leader to drive AMS in general practice is essential for an action framework to gain traction. Monitoring and feedback of antibiotic prescribing require urgent development to include monitoring of prescribing appropriateness and patient outcomes.
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Affiliation(s)
- Lesley A. Hawes
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Level 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia;
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia; (J.B.); (K.B.)
| | - Jaclyn Bishop
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia; (J.B.); (K.B.)
- Department of Medicine—Royal Melbourne Hospital, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Royal Parade, Melbourne, Victoria 3050, Australia
- Pharmacy Department, Ballarat Health Services, Drummond Street, Ballarat, Victoria 3350, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia; (J.B.); (K.B.)
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia
- Department of Infectious Diseases, Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Level 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia;
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, University of Melbourne, Level 5, 792 Elizabeth Street, Melbourne, Victoria 3000, Australia; (J.B.); (K.B.)
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23
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Gotterson F, Buising K, Manias E. Nurse role and contribution to antimicrobial stewardship: An integrative review. Int J Nurs Stud 2020; 117:103787. [PMID: 33647845 DOI: 10.1016/j.ijnurstu.2020.103787] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 01/22/2023]
Abstract
AIM To examine existing published literature regarding nurses and antimicrobial stewardship, and their potential role and contribution, to identify what is known, to evaluate methodologies used in published research, and to review and integrate findings to inform practice and future priorities for research. DESIGN Integrative review. METHODOLOGY The approach to this review was informed by Whittemore and Knafl's integrative review methodology. Electronic databases were searched for papers published since the start of the database to November 2019, with abstracts available, related to humans and published in English. Papers were included regardless of practice setting (acute, aged, and primary care) and if they were research based, included nurses as participants and reported specifically on results from nurses or that had implications for nursing practice. Excluded were conference abstracts, and papers focussed solely on nurse prescriber, nurse practitioner, or nurse manager roles. RESULTS Fifty-two papers were included in the review. Identified themes were: i) nursing knowledge, learning needs and education; ii) nurse perceptions of the nursing role and motivations for involvement; iii) nursing brokerage and influence on information flow to and from patients; iv) nursing workflow, workload and workarounds; and v) nurse leadership. Methodological quality of the included papers varied, limiting transferability and applicability of findings for some of the included studies. CONCLUSION Formal inclusion of nurses in antimicrobial stewardship activities has been associated with improved nurse knowledge, nurse confidence, and in some cases improved clinical outcomes for patients. The review reinforces nursing values as a motivator of nursing actions, and reveals the complex yet significant influence of nurses on antimicrobial prescribing. Potential opportunities to enhance nurses' participation and contribution to antimicrobial stewardship include; formal acknowledgement of the nurse role, educating nurses so that they are aware of how they can contribute, collaborating with nurses in planning and implementing local stewardship activities, and ensuring nurse leaders are involved. However, evidence on this topic remains limited. Research is needed to facilitate greater understanding about the nature, scope and influence of the nurse role in antimicrobial stewardship, how nurses enact and carry out their role, and nurses' support needs. Tweetable abstract: Integrative review explores #nurse role in #antimicrobialstewardship. Nurse contribution, influence significant, but not well understood.
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Affiliation(s)
- Fiona Gotterson
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, VIC 3010, Australia.
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, VIC 3010, Australia; Victorian Infectious Diseases Service, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC 3125, Australia; The Royal Melbourne Hospital, Department of Medicine, Royal Parade, Parkville, VIC 3052, Australia
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24
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Yeoh K, George C, Rajkhowa A, Buising K. Assessing patient understanding of their antimicrobial treatment: How are we doing and how might we improve? Infect Dis Health 2020; 25:302-308. [PMID: 32792299 DOI: 10.1016/j.idh.2020.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/09/2020] [Accepted: 07/11/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Antimicrobial Stewardship Clinical Care Standard states that patients should receive certain information about their antimicrobial therapy. How well the patient communication recommendations of the standard are followed in clinical practice is not well established. The aim of this pilot quality improvement study was to assess current practices around communication with hospitalised patients about their antimicrobial therapy, to determine compliance with current recommendations, and develop and implement quality improvement actions focused on patient communication for antimicrobial stewardship in Australia. METHODS Adult inpatients receiving one or more antimicrobials for greater than 72 h were recruited. A survey was conducted to assess rates of compliance with requirements to inform patients about the indication, duration and potential side effects of current antimicrobial therapy; modes of delivery of information; and rates of patient satisfaction with the information provided. A paper-based survey was conducted on the general medical, infectious diseases, geriatric evaluation and management, and rehabilitation wards in a 500-bed tertiary Australian hospital. A sample size of 50 was determined as adequate for a baseline analysis of patient communication practices and the development of quality improvement resources and actions. Responses to categorical questions were analysed quantitatively, with additional feedback from patients was collated and analysed qualitatively. RESULTS A total of 54 patients were surveyed. A majority (83%) of patients had been informed that they were taking antimicrobials, and, of these, 96% said they knew the indication, 18% were informed of potential side effects, and 36% knew the duration. Only 22% were informed of the review plan and 27% knew if antimicrobials would be continued on discharge. Written information was given to 11% of patients. Over half (62%) of patients either wanted more information or had concerns about their antimicrobial therapy. Patients reported difficulty in obtaining information. Fifty-eight percent of patients received antimicrobial information from doctors, 13% from nurses and 12% from pharmacists. CONCLUSIONS This study identified gaps in communication with patients regarding in-hospital antimicrobial therapy, and highlighted the need for development and delivery of local quality improvement activities to address this gap.
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Affiliation(s)
- Kim Yeoh
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Level 9 North, 300 Grattan Street, Parkville, Victoria, 3050, Australia.
| | - Catherine George
- Pharmacy Department, The Royal Melbourne Hospital, 300 Grattan Street, Parkville, Victoria, 3050, Australia; National Centre for Antimicrobial Stewardship Australia, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia.
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship Australia, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, 3010, Australia.
| | - Kirsty Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Level 9 North, 300 Grattan Street, Parkville, Victoria, 3050, Australia; National Centre for Antimicrobial Stewardship Australia, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street, Melbourne, Victoria, 3000, Australia; Department of Medicine and Radiology, The University of Melbourne, Parkville, Victoria, 3010, Australia.
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Hawes L, Buising K, Mazza D. Antimicrobial Stewardship in General Practice: A Scoping Review of the Component Parts. Antibiotics (Basel) 2020; 9:E498. [PMID: 32784918 PMCID: PMC7459857 DOI: 10.3390/antibiotics9080498] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
There is no published health-system-wide framework to guide antimicrobial stewardship (AMS) in general practice. The aim of this scoping review was to identify the component parts necessary to inform a framework to guide AMS in general practice. Six databases and nine websites were searched. The sixteen papers included were those that reported on AMS in general practice in a country where antibiotics were available by prescription from a registered provider. Six multidimensional components were identified: 1. Governance, including a national action plan with accountability, prescriber accreditation, and practice level policies. 2. Education of general practitioners (GPs) and the public about AMS and antimicrobial resistance (AMR). 3. Consultation support, including decision support with patient information resources and prescribing guidelines. 4. Pharmacist and nurse involvement. 5. Monitoring of antibiotic prescribing and AMR with feedback to GPs. 6. Research into gaps in AMS and AMR evidence with translation into practice. This framework for AMS in general practice identifies health-system-wide components to support GPs to improve the quality of antibiotic prescribing. It may assist in the development and evaluation of AMS interventions in general practice. It also provides a guide to components for inclusion in reports on AMS interventions.
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Affiliation(s)
- Lesley Hawes
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Level 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia;
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street Melbourne, Victoria 3000, Australia;
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street Melbourne, Victoria 3000, Australia;
- Acting Director, Victorian Infectious Diseases Service, Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3050, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary and Allied Health Care, Monash University, Level 1, 270 Ferntree Gully Road, Notting Hill, Victoria 3168, Australia;
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Level 5, 792 Elizabeth Street Melbourne, Victoria 3000, Australia;
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Cuningham W, Anderson L, Bowen AC, Buising K, Connors C, Daveson K, Martin J, McNamara S, Patel B, James R, Shanks J, Wright K, Yarwood T, Tong SY, McVernon J. Antimicrobial stewardship in remote primary healthcare across northern Australia. PeerJ 2020; 8:e9409. [PMID: 32765965 PMCID: PMC7382366 DOI: 10.7717/peerj.9409] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 06/02/2020] [Indexed: 12/11/2022] Open
Abstract
Background The high burden of infectious disease and associated antimicrobial use likely contribute to the emergence of antimicrobial resistance in remote Australian Aboriginal communities. We aimed to develop and apply context-specific tools to audit antimicrobial use in the remote primary healthcare setting. Methods We adapted the General Practice version of the National Antimicrobial Prescribing Survey (GP NAPS) tool to audit antimicrobial use over 2–3 weeks in 15 remote primary healthcare clinics across the Kimberley region of Western Australia (03/2018–06/2018), Top End of the Northern Territory (08/2017–09/2017) and far north Queensland (05/2018–06/2018). At each clinic we reviewed consecutive clinic presentations until 30 presentations where antimicrobials had been used were included in the audit. Data recorded included the antimicrobials used, indications and treating health professional. We assessed the appropriateness of antimicrobial use and functionality of the tool. Results We audited the use of 668 antimicrobials. Skin and soft tissue infections were the dominant treatment indications (WA: 35%; NT: 29%; QLD: 40%). Compared with other settings in Australia, narrow spectrum antimicrobials like benzathine benzylpenicillin were commonly given and the appropriateness of use was high (WA: 91%; NT: 82%; QLD: 65%). While the audit was informative, non-integration with practice software made the process manually intensive. Conclusions Patterns of antimicrobial use in remote primary care are different from other settings in Australia. The adapted GP NAPS tool functioned well in this pilot study and has the potential for integration into clinical care. Regular stewardship audits would be facilitated by improved data extraction systems.
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Affiliation(s)
- Will Cuningham
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Lorraine Anderson
- Kimberley Aboriginal Medical Services, Kimberley, Western Australia, Australia
| | - Asha C Bowen
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Kirsty Buising
- The Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia.,Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Christine Connors
- Top End Health Service, NT Department of Health, Darwin, Northern Territory, Australia
| | - Kathryn Daveson
- Queensland Statewide Antimicrobial Stewardship Program, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Department of Infectious Diseases and Microbiology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Joanna Martin
- Kimberley Aboriginal Medical Services, Kimberley, Western Australia, Australia
| | - Stacey McNamara
- Queensland Statewide Antimicrobial Stewardship Program, Metro North Hospital and Health Service, Brisbane, Queensland, Australia
| | - Bhavini Patel
- Top End Health Service, NT Department of Health, Darwin, Northern Territory, Australia.,Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rodney James
- The Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia
| | - John Shanks
- Top End Health Service, NT Department of Health, Darwin, Northern Territory, Australia
| | - Kerr Wright
- Kimberley Aboriginal Medical Services, Kimberley, Western Australia, Australia
| | - Trent Yarwood
- Queensland Statewide Antimicrobial Stewardship Program, Metro North Hospital and Health Service, Brisbane, Queensland, Australia.,Cairns Hospital, Cairns, Queensland, Australia.,Rural Clinical School, University of Queensland, Brisbane, Queensland, Australia.,College of Medicine and Dentistry, James Cook University, Townsville, Queensland, Australia
| | - Steven Yc Tong
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Victorian Infectious Diseases Service, The Royal Melbourne Hospital, and Doherty Department University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Jodie McVernon
- The Peter Doherty Institute for Infection and Immunity, The Royal Melbourne Hospital and The University of Melbourne, Melbourne, Victoria, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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27
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Manski-Nankervis JA, Biezen R, Thursky K, Boyle D, Clark M, Lo S, Buising K. Developing a Clinical Decision Support Tool for Appropriate Antibiotic Prescribing in Australian General Practice: A Simulation Study. Med Decis Making 2020; 40:428-437. [PMID: 32507028 DOI: 10.1177/0272989x20926136] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. Inappropriate antibiotic prescribing can lead to antimicrobial resistance and drug side effects. Tools that assist general practitioners (GPs) in prescribing decisions may help to optimize prescribing. The aim of this study was to explore the use, acceptability, and feasibility of a clinical decision support (CDS) tool that incorporates evidence-based guidelines and consumer information that integrates with the electronic medical record (EMR). Methods. Eight GPs completed an interview and brief survey after participating in 2 simulated consultations. The survey consisted of demographic questions, perception of realism and representativeness of consultations, Post-Study System Usability Questionnaire, and System Usability Scale. Qualitative data were analyzed using framework analysis. Video data were reviewed, with length of consultation and time spent using the CDS tool documented. Results. Survey responses indicated that all GPs thought the consultations were "real" and representative of real-life consultations; 7 of 8 GPs were satisfied with usability of the tool. Key qualitative findings included that the tool assisted with clinical decision making and informed appropriate antibiotic prescribing. Accessibility and ease of use, including content (guideline and patient education resources), layout, and format, were key factors that determined whether GPs said that they would access the tool in everyday practice. Integration of the tool at multiple sites within the EMR facilitated access to guidelines and assisted in ensuring that the tool fit the clinical workflow. Conclusion. Our CDS tool was acceptable to GPs. Key features required for the tool were easy navigation, clear and useful guideline content, ability to fit into the clinical workflow, and incorporation into the EMR. Piloting of the tool in general practices to assess the impact and feasibility of use in real-world consultations will now be undertaken.
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Affiliation(s)
| | - Ruby Biezen
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Karin Thursky
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Douglas Boyle
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Clark
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Sean Lo
- Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia
| | - Kirsty Buising
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
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28
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Dowson L, Friedman ND, Marshall C, Stuart RL, Buising K, Rajkhowa A, Gotterson F, Kong DC. Antimicrobial stewardship near the end of life in aged care homes. Am J Infect Control 2020; 48:688-694. [PMID: 31806238 DOI: 10.1016/j.ajic.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The objective of this study was to understand how aged care home health professionals perceive antimicrobial use near the end of life and how they perceive potential antimicrobial stewardship activities near the end of life in aged care homes. METHODS Qualitative semi-structured interviews were undertaken with general practitioners, nurses, and pharmacists who provide routine care in aged care homes in Victoria, Australia. Interviews were coded using frameworks for understanding behavior change. RESULTS Themes were established within 14 interviews, and an additional 6 interviews were undertaken to ensure thematic saturation. Two major themes emerged: (i) Antimicrobial stewardship activities near the end of life in aged care homes need to enable aged care home nurses to make decisions substantiated by evidence-based clinical knowledge. Antimicrobial stewardship should clearly be part of an aged care home nurse's role, and accreditation standards provide powerful motivation for behavior change. (ii) Antimicrobial stewardship activities near the end of life in aged care homes must address family confidence in resident wellbeing. Antimicrobial stewardship activities should be inclusive of family involvement, and messages should highlight the point that antimicrobial stewardship improves care. CONCLUSIONS Antimicrobial stewardship activities that reinforce evidence-based clinical decision-making by aged care home nurses and address family confidence in resident wellbeing are required near the end of life in aged care homes. Accreditation standards are important motivators for behavior change in aged care homes.
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Hui K, Patel K, Nalder M, Nelson C, Buising K, Pedagogos E, Kong DCM, Kirkpatrick CMJ. Optimizing vancomycin dosage regimens in relation to high-flux haemodialysis. J Antimicrob Chemother 2020; 74:130-134. [PMID: 30215721 DOI: 10.1093/jac/dky371] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 08/20/2018] [Indexed: 11/14/2022] Open
Abstract
Objectives To develop a population pharmacokinetic (PK) model for vancomycin in adults receiving high-flux haemodialysis (HFHD) in an effort to optimize vancomycin dosing in this population. Methods A population PK model using NONMEM was developed using retrospective data collected from 48 vancomycin courses administered to patients (n = 37) receiving HFHD. Fixed-dose [1.5 g loading dose (LD), 1 g maintenance dose (MD)], literature-adapted weight-based (WBL; 20 mg/kg LD, 10 mg/kg MD) and hospital-adapted weight-based (WBH; 25-30 mg/kg LD, 20-25 mg/kg MD) dosage regimens were then simulated using the Monte Carlo method. The PTA was an AUC24/MIC ≥400 with success being a PTA ≥90%. Results The data were best described using a two-compartment model. It was observed that fixed-dose and WBL dosage regimens resulted in a PTA ≤90% for most days. The WBH dosing achieved a PTA ≥90% on most days, but there were supratherapeutic concentrations with repeated dosing of vancomycin. If HFHD was delayed by 48-72 h after the LD, the PTA would fall below 90%. A dose-optimized regimen was developed: 30 mg/kg LD and 10 mg/kg MD given on HFHD days. An additional dose of 500 mg or 1 g was administered 24 h after the LD if HFHD occurred 48-72 h post-LD. This dose-optimized regimen afforded a PTA ≥90% on all days of therapy and achieved clinically acceptable pre-haemodialysis concentrations. Conclusions Current vancomycin dosage regimens used clinically do not achieve a PTA ≥90% for most days of therapy for people receiving HFHD. A dose-optimized regimen was developed, which could be implemented in clinical practice.
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Affiliation(s)
- Katrina Hui
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Kashyap Patel
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia.,d3 Medicine, A Certara Company, Parsippany, NJ, USA
| | - Michelle Nalder
- Department of Pharmacy, Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Craig Nelson
- Department of Nephrology, Western Health, St Albans, VIC, Australia.,Western Health Chronic Disease Alliance, Western Centre for Health Research and Education, Western Health, St Albans, VIC, Australia.,Department of Medicine, University of Melbourne, St Albans, VIC, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia.,Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, VIC, Australia
| | - Eugenie Pedagogos
- Department of Nephrology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Clinical Trials and Medical Innovation, Epworth Health, Richmond, VIC, Australia
| | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
| | - Carl M J Kirkpatrick
- Centre for Medicine Use and Safety, Monash University, Parkville, VIC, Australia
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30
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Dowson L, Friedman ND, Marshall C, Stuart RL, Buising K, Rajkhowa A, Gotterson F, Kong DCM. The role of nurses in antimicrobial stewardship near the end of life in aged-care homes: A qualitative study. Int J Nurs Stud 2019; 104:103502. [PMID: 32086026 DOI: 10.1016/j.ijnurstu.2019.103502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 11/29/2019] [Accepted: 12/04/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The excessive use of antimicrobials in aged-care homes is a widely recognised phenomenon. This is problematic because it can harm residents, and is detrimental to public health. Residents in the final month of life are increasingly likely to be prescribed an antimicrobial, commonly without having signs and symptoms of infection that support antimicrobial use. OBJECTIVES We aimed to describe the perspectives of health professionals on antimicrobial use near the end of life in aged-care homes and investigate the potential opportunities for nurses to undertake antimicrobial stewardship activities near the end of life in aged-care homes. DESIGN One-on-one, semi-structured, qualitative interviews. SETTINGS AND PARTICIPANTS Twelve nurses, six general practitioners and two pharmacists providing routine care to residents of aged-care homes in Victoria, Australia were interviewed. Diversity in terms of years of experience, aged-care funding type (government, private-for-profits and not-for-profits) and location (metropolitan and regional) were sought. METHODS Interviews were transcribed and open coded in a descriptive manner using validated frameworks for understanding behaviour change. The descriptive code was then used to build an interpretive code structure based on questions founded in grounded theory. RESULTS Thematic saturation was reached after fourteen interviews, and an additional six interviews were conducted to ensure emergent themes were consistent and definitive. There are opportunities for aged-care home nurses to undertake antimicrobial stewardship activities near the end of life in the provision of routine care. Aged-care home nurses are influential in antimicrobial decisions near the end of life in routine care because of their leadership in advance care planning, care co-ordination and care provision in an environment with stopgap and visiting medical resources. Nurses also have social influence among residents, families and medical professionals during critical conversations near the end of life. Past negative social interactions within the aged-care home environment between nurses and families can result in 'fear-based' social influences on antimicrobial prescribing. CONCLUSIONS The work of facilitating advance care planning, care coordination, care delivery, and communicating with families and medical professionals provide important opportunities for aged-care home nurses to lead appropriate antimicrobial stewardship activities near the end of life.
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Affiliation(s)
- Leslie Dowson
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia
| | - N Deborah Friedman
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; School of Medicine, Deakin University, 75 Pigdons Rd, Geelong, Victoria 3216, Australia; Department of General Medicine and Department of Infectious Diseases, Barwon Health, Ryrie St and Bellerine St, Geelong, Victoria 3220, Australia
| | - Caroline Marshall
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, Victoria 3010, Australia; Victorian Infectious Diseases Service at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Infection Prevention and Surveillance Service, The Royal Melbourne Hospital, 300 Grattan St, Parkville, Victoria 3052, Australia
| | - Rhonda L Stuart
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia; Monash Infectious Diseases and Infection Control and Epidemiology, Monash Health, 246 Clayton Rd, Clayton, Victoria 3168, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, Victoria 3010, Australia; Victorian Infectious Diseases Service at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia
| | - Fiona Gotterson
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, Victoria 3010, Australia
| | - David C M Kong
- National Centre for Antimicrobial Stewardship at The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3052, Australia; Pharmacy Department, Ballarat Health Services, 1 Drummond St N, Ballarat, Victoria 3350, Australia.
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31
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Dowson L, Rajkhowa A, Buising K, Kong DC, Stuart RL, Thursky K, Bennett N. The 2018 Aged Care National Antimicrobial Prescribing Survey: results show room for improvement. Aust Prescr 2019; 42:200-203. [PMID: 31937990 PMCID: PMC6954873 DOI: 10.18773/austprescr.2019.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The annual Aged Care National Antimicrobial Prescribing Survey aims to identify local and national prescribing issues and guide antimicrobial stewardship goals
In the 2018 point prevalence survey, medication charts of over 20,000 residents were reviewed from 407 participating facilities across Australia
On the day of the survey, almost 10% of residents were prescribed an antimicrobial
Nearly two-thirds of recently prescribed antimicrobials were for residents who had no documented signs or symptoms of infection
Over a quarter of antimicrobials had been prescribed for longer than six months
Incomplete documentation was a prominent barrier to proper review of antimicrobial therapy, with the indication, review date or stop date not documented for many prescriptions
Recommendations include using appropriate microbiological testing to guide prescribing, following national antimicrobial prescribing guidelines, documenting the indication for the antimicrobial, and its start, stop and review dates, and monitoring and re-evaluating long-term antimicrobial use
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Affiliation(s)
- Leslie Dowson
- Monash University, Melbourne, Vic.,National Centre for Antimicrobial Stewardship, Melbourne, Vic
| | - Arjun Rajkhowa
- National Centre for Antimicrobial Stewardship, Melbourne, Vic.,University of Melbourne, Vic
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Melbourne, Vic.,University of Melbourne, Vic.,Victorian Infectious Diseases Service, Melbourne, Vic
| | - David Cm Kong
- Monash University, Melbourne, Vic.,National Centre for Antimicrobial Stewardship, Melbourne, Vic.,Ballarat Health Services, Ballarat, Vic
| | - Rhonda L Stuart
- Monash University, Melbourne, Vic.,National Centre for Antimicrobial Stewardship, Melbourne, Vic.,Monash Health, Clayton, Vic
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Melbourne, Vic.,University of Melbourne, Vic.,Peter MacCallum Cancer Centre, Melbourne, Vic
| | - Noleen Bennett
- National Centre for Antimicrobial Stewardship, Melbourne, Vic.,University of Melbourne, Vic.,Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Melbourne, Vic
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32
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Hawes L, Turner L, Buising K, Mazza D. Use of electronic medical records to describe general practitioner antibiotic prescribing patterns. Aust J Gen Pract 2019; 47:796-800. [PMID: 31207679 DOI: 10.31128/ajgp-05-18-4570] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES The computerised medical records of general practice patients can inform our understanding of antibiotic prescribing and assist in antimicrobial stewardship (AMS). The aim of this study was to describe Australian general practitioner (GP) antibiotic prescribing patterns using data extracted from electronic medical records (EMR). METHOD A descriptive analysis of patient records from 44 general practices, between 2010 and 2014, in the eastern region of metropolitan Melbourne was undertaken. RESULTS Of the 615,362 antibiotic prescriptions, cefalexin, amoxicillin–clavulanic acid, roxithromycin, doxycycline and clarithromycin were the most frequently prescribed antibiotics. Except for cefalexin, prescribing rates of the antibiotics increased in winter.
Of 472,197 patients consulting a GP in one of these practices, 34.8% received an antibiotic at some point over the five years. There was a higher rate of prescribing per consultation in patients aged <20 years. DISCUSSION This study shows that it is possible to examine EMR for antibiotic prescriptions, and that a descriptive analysis can identify AMS targets.
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Affiliation(s)
- Lesley Hawes
- BSc (Hons), GCUT, MPH, MASM, PhD Fellow, Department of General Practice, Monash University; and National Centre for Antimicrobial Stewardship, Melbourne, Vic.
| | - Lyle Turner
- BSc (Hons), PhD, Manager, Data and Research Unit, Institute for Urban Indigenous Health, Qld; Department of General Practice, School of Primary and Allied Health Care, Monash University, Clayton, Vic
| | - Kirsty Buising
- MBBS, MD, MPH, FRACP, Deputy Director, National Centre for Antimicrobial Stewardship; Infectious diseases physician, Victorian Infectious Diseases Service, Royal Melbourne Hospital, Vic
| | - Danielle Mazza
- MD, MBBS, FRACGP, DRANZCOG, Grad Dip Women’s Health, GAICD, Head, Department of General Practice, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University; Conjoint Professor, School of Medicine and Public Health, University of Newcastle; Fellow, Society of Family Planning, USA; National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, Melbourne, Vic
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33
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Peel T, Astbury S, Cheng AC, Paterson D, Buising K, Spelman T, Tran-Duy A, de Steiger RS. Multicentre randomised double-blind placebo controlled trial of combination vancomycin and cefazolin surgical antibiotic prophylaxis: the Australian surgical antibiotic prophylaxis (ASAP) trial. BMJ Open 2019; 9:e033718. [PMID: 31685516 PMCID: PMC6858103 DOI: 10.1136/bmjopen-2019-033718] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Resistant Gram-positive organisms, such as methicillin-resistant staphylococci, account for a significant proportion of infections following joint replacement surgery. Current surgical antimicrobial prophylaxis guidelines recommend the use of first-generation or second-generation cephalosporin antibiotics, such as cefazolin. Cefazolin, however, does not prevent infections due to these resistant organisms; therefore, new prevention strategies need to be examined. One proposed strategy is to combine a glycopeptide antibiotic with cefazolin for prophylaxis. The clinical benefit and cost-effectiveness of this combination therapy compared with usual therapy, however, have not been established. METHODS AND ANALYSIS This randomised, double-blind, parallel, superiority, placebo-controlled, phase 4 trial will compare the incidence of all surgical site infections (SSIs) including superficial, deep and organ/space (prosthetic joint) infections, safety and cost-effectiveness of surgical prophylaxis with cefazolin plus vancomycin to that with cefazolin plus placebo. The study will be performed in patients undergoing joint replacement surgery. In the microbiological sub-studies, we will examine the incidence of SSIs in participants with preoperative staphylococci colonisation (Sub-Study 1) and incidence of VRE acquisition (Sub-Study 2). The trial will recruit 4450 participants over a 4-year period across 13 orthopaedic centres in Australia. The primary outcome is the incidence of SSI at 90 days post index surgery. Secondary outcomes include the incidence of SSI according to joint and microorganism and other healthcare associated infections. Safety endpoints include the incidence of acute kidney injury, hypersensitivity reactions and all-cause mortality. The primary and secondary analysis will be a modified intention-to-treat analysis consisting of all randomised participants who undergo eligible surgery. We will also perform a per-protocol analysis. ETHICS AND DISSEMINATION The study protocol was reviewed and approved by The Alfred Hospital Human Research Ethics Committee (HREC/18/Alfred/102) on 9 July 2018. Study findings will be disseminated in the printed media, and learnt forums. TRIAL REGISTRATION NUMBER ACTRN12618000642280.
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Affiliation(s)
- Trisha Peel
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
- Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia
| | - Sarah Astbury
- Infectious Diseases, Monash University, Melbourne, Victoria, Australia
| | - Allen C Cheng
- Infectious Diseases Unit, Alfred Hospital, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - David Paterson
- Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
- Infectious Diseases, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Kirsty Buising
- Medicine, University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Tim Spelman
- Department of Surgery, St Vincent's Hospital, The University of Melbourne, Melbourne, Victoria, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Richard S de Steiger
- Surgery, The University of Melbourne, Melbourne, Victoria, Australia
- Orthopaedics, Epworth HealthCare, Richmond, Victoria, Australia
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Madigan VM, Carter G, Buising K, Howden B, Marshall C. 2428. Whole-genome Sequencing to Determine Clostridium difficile Transmission. Open Forum Infect Dis 2019. [PMCID: PMC6810138 DOI: 10.1093/ofid/ofz360.2106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Clostridium difficile is a major problem in healthcare institutions due to its substantial attributable morbidity, mortality and costs. Although traditionally recognized as a nosocomial infection, there is increasing evidence that hospital-based transmission may not be as common as previously thought. Whole-genome sequencing (WGS) has superior discriminatory ability than other previously used techniques for C. difficile typing. This study aimed to investigate whether WGS could help to elucidate C. difficile transmission patterns at The Royal Melbourne Hospital (RMH). Methods All C. difficile isolates (N = 138) identified in patients admitted to RMH from November 1, 2015 to October 31, 2016 had molecular typing performed by WGS, multilocus sequence typing (MLST) and PCR ribotyping. Clinical epidemiological data were collected for each episode so that patient locations could be examined together with molecular typing information to determine putative transmissions in the hospital. Results After combining molecular and clinical epidemiology, a picture of diverse C. difficile emerged. Only 7 (6%) of isolates appeared to have been transmitted from other hospital patients, according to combined WGS and patient location data. However, both PCR ribotyping (33%) and MLST (44%) had significantly higher proportions of putative transmissions in this cohort. Conclusion This finding has significant implications for the Infection Prevention team as efforts toward prevention of C. difficile infection may need to be redirected away from the current focus on prevention of nosocomial transmission. Future studies are needed to broaden understanding of C. difficile transmission dynamics so that other sources can be identified and targeted for intervention. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - Glen Carter
- Microbiological Diagnostic Unit, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Kirsty Buising
- Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Benjamin Howden
- Microbiological Diagnostic Unit, Peter Doherty Institute, Melbourne, Victoria, Australia
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Biezen R, Roberts C, Buising K, Thursky K, Boyle D, Lau P, Clark M, Manski-Nankervis JA. How do general practitioners access guidelines and utilise electronic medical records to make clinical decisions on antibiotic use? Results from an Australian qualitative study. BMJ Open 2019; 9:e028329. [PMID: 31383702 PMCID: PMC6687052 DOI: 10.1136/bmjopen-2018-028329] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE This study aimed to explore how general practitioners (GPs) access and use both guidelines and electronic medical records (EMRs) to assist in clinical decision-making when prescribing antibiotics in Australia. DESIGN This is an exploratory qualitative study with thematic analysis interpreted using the Theory of Planned Behaviour (TPB) framework. SETTING This study was conducted in general practice in Victoria, Australia. PARTICIPANTS Twenty-six GPs from five general practices were recruited to participate in five focus groups between February and April 2018. RESULTS GPs expressed that current EMR systems do not provide clinical decision support to assist with antibiotic prescribing. Access and use of guidelines were variable. GPs who had more clinical experience were less likely to access guidelines than younger and less experienced GPs. Guideline use and guideline-concordant prescribing was facilitated if there was a practice culture encouraging evidence-based practice. However, a lack of access to guidelines and perceived patients' expectation and demand for antibiotics were barriers to guideline-concordant prescribing. Furthermore, guidelines that were easy to access and navigate, free, embedded within EMRs and fit into the clinical workflow were seen as likely to enhance guideline use. CONCLUSIONS Current barriers to the use of antibiotic guidelines include GPs' experience, patient factors, practice culture, and ease of access and cost of guidelines. To reduce inappropriate antibiotic prescribing and to promote more rational use of antibiotic in the community, guidelines should be made available, accessible and easy to use, with minimal cost to practicing GPs. Integration of evidence-based antibiotic guidelines within the EMR in the form of a clinical decision support tool could optimise guideline use and increase guideline-concordant prescribing.
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Affiliation(s)
- Ruby Biezen
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Cassandra Roberts
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Serivce, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, Australia
| | - Douglas Boyle
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Phyllis Lau
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
| | - Malcolm Clark
- Department of General Practice, The University of Melbourne, Carlton, Victoria, Australia
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Dowson L, Marshall C, Buising K, Friedman ND, Kong DCM, Stuart RL. Optimizing treatment of respiratory tract infections in nursing homes: Nurse-initiated polymerase chain reaction testing. Am J Infect Control 2019; 47:911-915. [PMID: 30851997 PMCID: PMC7172091 DOI: 10.1016/j.ajic.2019.02.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/03/2019] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Diagnostic testing using polymerase chain reaction (PCR) is infrequently initiated for diagnosis of respiratory tract infections (RTIs) in nursing homes. The objectives of this study were to determine the feasibility of implementing nurse-initiated PCR testing of respiratory specimens in nursing home settings and to compare antibiotic prescribing prior to and during the implementation. METHODS This was a pragmatic, historically controlled study in 3 nursing homes (181 total beds) in Melbourne, Australia. RESULTS The number of PCR tests of respiratory specimens (over 12 months) increased from 5 to 67 when nurses could initiate the tests. Residents with RTI symptoms had a virus identified by PCR in 50.7% of tests, including 14 positive for influenza. Six outbreaks were identified. When clustering was taken into consideration, incidence rates of antibiotic days of therapy did not change (incidence rate ratio = 0.94, 95% confidence interval, 0.25-3.35, P = .92) despite identification of more viral pathogens. CONCLUSIONS In nursing homes, nurse-initiated PCR testing of respiratory specimens is feasible and useful in terms of identifying the cause of many RTIs and outbreaks, and viruses are common in this context. However, the current study suggests the availability of these test results alone does not impact antibiotic prescribing.
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Affiliation(s)
- Leslie Dowson
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Caroline Marshall
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, University of Melbourne, Melbourne, Victoria, Australia; Victorian Infectious Diseases Service, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia
| | - N Deborah Friedman
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; School of Medicine, Deakin University, Geelong, Victoria, Australia; Departments of General Medicine and Infectious Diseases, Barwon Health, Geelong, Victoria, Australia
| | - David C M Kong
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Ballarat Health Services, Ballarat, Victoria, Australia
| | - Rhonda L Stuart
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infections and Immunity, Melbourne, Victoria, Australia; Department of Medicine, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia; Monash Infectious Diseases and Infection Control and Epidemiology, Monash Health, Clayton, Victoria, Australia.
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Douglas AP, Marshall C, Baines SL, Ritchie D, Szer J, Madigan V, Chan HT, Ballard SA, Howden BP, Buising K, Slavin MA. Utilizing genomic analyses to investigate the first outbreak of vanA vancomycin-resistant Enterococcus in Australia with emergence of daptomycin non-susceptibility. J Med Microbiol 2019; 68:303-308. [PMID: 30663951 DOI: 10.1099/jmm.0.000916] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION The majority of vancomycin-resistant Enterococcus faecium (VREfm) in Australia is of the vanB genotype. An outbreak of vanA VREfm emerged in our haematology/oncology unit between November 2014 and May 2015. The first case of daptomycin non-susceptible E. faecium (DNSEfm) detected was a patient with vanA VREfm bacteraemia who showed clinical failure of daptomycin therapy, prompting microbiologic testing confirming daptomycin non-susceptibility. OBJECTIVES To describe the patient profiles, antibiotic susceptibility and genetic relatedness of vanA VREfm isolates in the outbreak. METHODS Chart review of vanA VREfm colonized and infected patients was undertaken to describe the demographics, clinical features and outcomes of therapy. Whole genome sequencing of vanA VREfm isolates involved in the outbreak was conducted to assess clonality. RESULTS In total, 29 samples from 24 patients tested positive for vanA VREfm (21 screening swabs and 8 clinical isolates). Five isolates were DNSEfm (four patients colonized, one patient with bacteraemia), with only one patient exposed to daptomycin previously. In silico multi-locus sequence typing of the isolates identified 25/26 as ST203, and 1/26 as ST796. Comparative genomic analysis revealed limited core genome diversity amongst the ST203 isolates, consistent with an outbreak of a single clone of vanA VREfm. CONCLUSIONS Here we describe an outbreak of vanA VREfm in a haematology/oncology unit. Genomic analysis supports transmission of an ST203 vanA VRE clone within this unit. Daptomycin non-susceptibility in 5/24 patients left linezolid as the only treatment option. Daptomycin susceptibility cannot be assumed in vanA VREfm isolates and confirmatory testing is recommended.
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Affiliation(s)
- Abby P Douglas
- 2 Peter MacCallum Cancer Centre, Melbourne, Australia.,1 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
| | - Caroline Marshall
- 1 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia.,3 The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,4 Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Sarah L Baines
- 5 Doherty Applied Microbial Genomics, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - David Ritchie
- 2 Peter MacCallum Cancer Centre, Melbourne, Australia.,4 Department of Medicine, University of Melbourne, Melbourne, Australia.,6 Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Melbourne, Australia
| | - Jeff Szer
- 2 Peter MacCallum Cancer Centre, Melbourne, Australia.,4 Department of Medicine, University of Melbourne, Melbourne, Australia.,6 Department of Clinical Haematology and Bone Marrow Transplantation, Royal Melbourne Hospital, Melbourne, Australia
| | - Victoria Madigan
- 7 Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Hiu Tat Chan
- 7 Department of Microbiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Susan A Ballard
- 8 Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Benjamin P Howden
- 8 Microbiological Diagnostic Unit Public Health Laboratory, Department of Microbiology and Immunology, The University of Melbourne at The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia
| | - Kirsty Buising
- 1 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia.,3 The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,4 Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Monica A Slavin
- 1 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia.,3 The Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.,2 Peter MacCallum Cancer Centre, Melbourne, Australia.,4 Department of Medicine, University of Melbourne, Melbourne, Australia
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Richards (Chair) M, Cruickshank M, Cheng A, Gandossi S, Quoyle C, Stuart R, Sutton B, Turnidge J, Bennett N, Buising K, Cooper C, Cooley L, Ferguson J, Gilbert L, Greenough J, Greig S, Harrington G, Howden B, Iredell J, Lum G, Peleg A, Rogers B, Romanes F, Waters MJ. Recommendations for the control of carbapenemase-producing Enterobacteriaceae (CPE): A guide for acute care health facilities. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Bishop J, Schulz T, Kong D, Thursky K, Buising K. Antimicrobial stewardship in regional, rural and remote hospitals: Finding the X factor. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Gotterson F, Buising K, Manias E. Shining a light on the “hidden figures”: What does the literature tell us about the role of nurses in antimicrobial stewardship (AMS)? Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.09.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Hui K, Nalder M, Buising K, Pefanis A, Ooi KY, Pedagogos E, Nelson C, Kirkpatrick CMJ, Kong DCM. Patterns of use and appropriateness of antibiotics prescribed to patients receiving haemodialysis: an observational study. BMC Nephrol 2017; 18:156. [PMID: 28499421 PMCID: PMC5427537 DOI: 10.1186/s12882-017-0575-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There are limited published data on the types and appropriateness of oral and intravenous (IV) antibiotics prescribed to patients receiving haemodialysis. This information is critical to optimise antibiotic prescribing. Therefore this study aims to describe the patterns of use and the appropriateness of oral and IV antibiotics prescribed to patients receiving haemodialysis. METHODS This was a prospective, observational study across four community and two hospital inpatient haemodialysis units in Melbourne, Australia. Data were collected from July 2014 to January 2015 from participants. Antibiotic regimens prescribed were compared with nationally available antibiotic guidelines and then classified as being either appropriate, inappropriate or not assessable by an expert multidisciplinary team using the National Antimicrobial Prescribing Survey tool. RESULTS Overall, 114 participants consented to this study where 55.3% (63/114) received antibiotics and 235 antibiotic regimens were prescribed at a rate of 69.1 antibiotic regimens/100 patient-months. The most common oral antibiotics prescribed were amoxycillin/clavulanic acid and cephalexin. The most common IV antibiotics prescribed were vancomycin, piperacillin/tazobactam, cephazolin and ceftriaxone. The percentage of inappropriate antibiotic regimens prescribed were 34.9% (15/43) in the community setting and 22.1% (40/181) in the hospital setting. Furthermore, 29.4% (30/102) of oral and 20.5% (25/122) of IV antibiotic regimens were inappropriate with incorrect dosing as the primary reason. CONCLUSION Although this study is limited by the sample size, it describes the high antibiotic exposure that patients receiving haemodialysis experience. Of concern is inappropriate dose and frequency being a major issue. This requires interventions focused on the quality use of medicines and antimicrobial stewardship aspects of prescribing in this population.
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Affiliation(s)
- Katrina Hui
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia
| | - Michelle Nalder
- Department of Pharmacy, Royal Melbourne Hospital, Melbourne, Australia
| | - Kirsty Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - Aspasia Pefanis
- Department of Nephrology, Western Health, Melbourne, Australia
| | - Khai Y Ooi
- Department of Nephrology, Western Health, Melbourne, Australia
| | - Eugenie Pedagogos
- Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia
| | - Craig Nelson
- The University of Melbourne, Melbourne, Australia.,Western Centre for Health Research and Education, Western Health, Melbourne, Australia
| | | | - David C M Kong
- Centre for Medicine Use and Safety, Monash University, Melbourne, Australia.
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Avent ML, Hall L, Davis L, Allen M, Roberts JA, Unwin S, McIntosh KA, Thursky K, Buising K, Paterson DL. Antimicrobial stewardship activities: a survey of Queensland hospitals. AUST HEALTH REV 2016; 38:557-63. [PMID: 25376911 DOI: 10.1071/ah13137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/20/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. METHODS The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. RESULTS The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. CONCLUSIONS Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. WHAT IS KNOWN ABOUT THE TOPIC?: The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare-Associated Infections) of the National Safety and Quality Health Service Standards. The intent of AMS is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections, and improve patient safety and quality of care. This criterion also aligns closely with Standard 4: Medication Safety. Despite this recommendation, little is known about what AMS activities are undertaken in these facilities and what additional resources would be required in order to meet these national standards. WHAT DOES THE PAPER ADD?: This is the first survey that has been conducted of public hospital and health services in Queensland, a large decentralised state in Australia. This paper describes what AMS activities are currently being undertaken, identifies practice gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Several areas for improvement such as reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use have been identified. In addition, there appears to be a lack of resources to support AMS programs in some facilities.
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Affiliation(s)
- Minyon L Avent
- Infection and Immunity Theme, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Qld 4006, Australia.
| | - Lisa Hall
- Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia.
| | - Louise Davis
- Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia.
| | - Michelle Allen
- Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia.
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Qld 4029, Australia.
| | - Sean Unwin
- Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia.
| | - Kylie A McIntosh
- Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000.
| | - Karin Thursky
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Melbourne, Vic. 3000, Australia.
| | - Kirsty Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Melbourne, Vic. 3000, Australia.
| | - David L Paterson
- Infection and Immunity Theme, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Qld 4006, Australia.
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James R, Luu S, Avent M, Marshall C, Thursky K, Buising K. A mixed methods study of the barriers and enablers in implementing antimicrobial stewardship programmes in Australian regional and rural hospitals. J Antimicrob Chemother 2015; 70:2665-70. [DOI: 10.1093/jac/dkv159] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2015] [Accepted: 05/22/2015] [Indexed: 12/15/2022] Open
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Darby J, Black J, Buising K. Interferon-gamma release assays and the diagnosis of tuberculosis: have they found their place? Intern Med J 2015; 44:624-32. [PMID: 25041769 DOI: 10.1111/imj.12469] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 04/24/2014] [Indexed: 11/30/2022]
Abstract
Tuberculosis (TB) remains an important issue in Australia with more than 85% of active cases contributed by overseas-born persons. Other risk groups include older Australians who acquired TB in the past and indigenous people. Immune suppression is an emerging risk factor for TB, particularly due to the expanding group of conditions for which potent immunosuppressive therapies is now used. Screening for latent TB is recommended in many risk groups including recent contacts of those with transmissible TB, those undergoing immune suppressive therapy, recently arrived refugees or migrants from high-risk countries and indigenous people with high rates of TB in the local community. Interferon-gamma release assay (IGRA) has now been available for several years for the diagnosis of latent TB. It is now used in many clinical situations, and despite the rapid rate of new publications, there are still gaps in our knowledge. This paper reviews the current role of interferon-gamma release assay in various situations, to determine its place in current practice and to explore where uncertainties exist.
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Affiliation(s)
- J Darby
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, The University of Melbourne, Melbourne, Victoria, Australia; Nossal Institute for Global Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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James R, Upjohn L, Cotta M, Luu S, Marshall C, Buising K, Thursky K. Measuring antimicrobial prescribing quality in Australian hospitals: development and evaluation of a national antimicrobial prescribing survey tool. J Antimicrob Chemother 2015; 70:1912-8. [PMID: 25724986 DOI: 10.1093/jac/dkv047] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/04/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship (AMS) programmes have been developed with the intention of reducing inappropriate and unnecessary use of antimicrobials, while improving the quality of patient care and locally helping prevent the development of antimicrobial resistance. An important aspect of AMS programmes is the qualitative assessment of prescribing through antimicrobial prescribing surveys (APS), which are able to provide information about the prescribing behaviour within institutions. Owing to lack of standardization of audit tools and the resources required, qualitative methods for the assessment of antimicrobial use are not often performed. The aim of this study was to design an audit tool that was appropriate for use in all Australian hospitals, suited to local user requirements and included an assessment of the overall appropriateness of the prescription. METHODS In November 2011, a pilot APS was conducted across 32 hospitals to assess the usability and generalizability of a newly designed audit tool. Following participant feedback, this tool was revised to reflect the requirements of the respondents. A second pilot study was then performed in November 2012 across 85 hospitals. RESULTS These surveys identified several areas that can be targets for quality improvement at a national level, including: documentation of indication; surgical prophylaxis prescribed for >24 h; compliance with prescribing guidelines; and the appropriateness of the prescription. CONCLUSIONS By involving the end users in the design and evaluation, we have been able to provide a practical and relevant APS tool for quantitative and qualitative data collection in a wide range of Australian hospital settings.
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Affiliation(s)
- Rodney James
- Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Lydia Upjohn
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Menino Cotta
- Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Susan Luu
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Caroline Marshall
- Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Kirsty Buising
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Karin Thursky
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
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Chaves NJ, Cheng AC, Runnegar N, Kirschner J, Lee T, Buising K. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 2015; 44:568-74. [PMID: 25083531 DOI: 10.1111/imj.12373] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Antimicrobial stewardship programmes aim to optimise use of antibiotics and are now mandatory in all Australian hospitals. AIM We aimed to identify barriers to and enablers of appropriate antimicrobial prescribing among hospital doctors. METHODS Two paper-based and one web-based surveys were administered at three Australian university teaching hospitals from March 2010 to May 2011. The 18-item questionnaire recorded doctors’ level of experience, their knowledge regarding the use of common antimicrobials and their attitudes regarding antimicrobial prescribing. Local survey modifications allowed inclusion of specific questions on: infections in intensive care unit patients, clinical microbiology and use of local guidelines. RESULTS The respondents (n = 272) were comprised of 96 (35%) registrars, 67 (25%)residents, 57 (21%) interns and 47 (17%) consultant hospital doctors. Forty-one per cent were working in a medical specialty. Identified barriers included: gaps in antimicrobial prescribing knowledge (especially among interns), a lack of awareness about which antimicrobials were restricted and a reliance on senior colleagues to make antimicrobial prescribing decisions. Enablers of optimal prescribing included: an acknowledgement of the need for assistance in prescribing and reported readiness to consult national prescribing guidelines. These results were used to help guide and prioritise interventions to improve prescribing practices. CONCLUSION A transferable knowledge and attitudes survey tool can be used to highlight barriers and facilitators to optimal hospital antimicrobial prescribing in order to inform tailored antimicrobial stewardship interventions.
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Peel T, May D, Buising K, Thursky K, Slavin M, Choong P. Infective complications following tumour endoprosthesis surgery for bone and soft tissue tumours. Eur J Surg Oncol 2014; 40:1087-94. [PMID: 24655802 DOI: 10.1016/j.ejso.2014.02.241] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Revised: 02/11/2014] [Accepted: 02/24/2014] [Indexed: 11/29/2022] Open
Abstract
AIMS This study aims to describe the incidence of infective complications, including tumour endoprosthesis infection, in a cohort of patients undergoing tumour endoprosthesis surgery in Victoria, Australia. METHODS This retrospective cohort study was performed over 15 years (January 1996-December 2010). RESULTS 121 patients underwent tumour endoprosthesis surgery during the study period. Patients were followed for a median of 34 months (interquartile range [IQR] 17, 80). Overall, 34 patients (28%) experienced infective complications including: bacteraemia in 19 patients (16%) and tumour endoprosthesis infection in 17 (14%). The majority of patients with early and late acute infections (haematogenous) were managed with debridement and retention of the prosthesis in addition to biofilm-active antibiotics. Late chronic infections were predominantly managed by exchange of the prosthesis. The overall success rate of treatment was 71%. The success rate for debridement and retention was 75% compared with 67% for exchange procedures. CONCLUSIONS There is a significant rate of infective complications following tumour endoprosthesis surgery including 14% of patients experiencing infection involving the tumour endoprosthesis. This study is the first to report on outcomes from debridement and retention of the prosthesis; which had comparable success rates to other treatment modalities.
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Affiliation(s)
- T Peel
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Regent Street, Fitzroy, VIC 3065, Australia; Department of Infectious Diseases, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, Australia.
| | - D May
- Department of Orthopaedics, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, Australia
| | - K Buising
- Department of Infectious Diseases, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, Australia
| | - K Thursky
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Lansdowne St, East Melbourne, VIC 3002, Australia
| | - M Slavin
- Department of Infectious Diseases, Peter MacCallum Cancer Centre, Lansdowne St, East Melbourne, VIC 3002, Australia
| | - P Choong
- Department of Surgery, St Vincent's Hospital, University of Melbourne, Regent Street, Fitzroy, VIC 3065, Australia; Department of Orthopaedics, St Vincent's Hospital Melbourne, Victoria Parade, Fitzroy, VIC 3065, Australia
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Darby J, Black J, Morrison D, Buising K. An information management system for patients with tuberculosis: usability assessment with end-users. Stud Health Technol Inform 2012; 178:26-32. [PMID: 22797015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
INTRODUCTION Information systems with clinical decision support (CDS) offer great potential to assist the co-ordination of patients with chronic diseases and to improve patient care. Despite this, few have entered routine clinical use. BACKGROUND Tuberculosis (TB) is an infection of public health importance. It has complex interactions with many comorbid conditions, requires close supervised care and prolonged treatment for effective cure. These features make it suitable for use with an information management system with CDS features. In close consultation with key stakeholders, a clinical application was developed for the management of TB patients in Victoria. METHODS A formal usability assessment using semi-structured case-scenario based exercises was performed. Subjects were 12 individuals closely involved in the care of TB patients, including Infectious Diseases and Respiratory Physicians, and Public Health Nurses. Two researchers conducted the sessions, independently analysed responses and discrepancies compared to the voice record for validity. RESULTS Despite varied computer experience, responses were positive regarding user interface and content. Data location was not always intuitive, however this improved with familiarity of the program. Decision support was considered valuable, with useful suggestions for expansion of these features. Automated reporting for correspondence and notification to the Health Department were felt worth the initial investment in data entry. An important workflow-based issue regarding dismissal of alerts and several errors were detected. CONCLUSION Usability assessment validated many design elements of the system, provided a unique insight into workflow issues faced by users and hopefully will impact on its ultimate clinical utility.
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Affiliation(s)
- Jonathan Darby
- Infectious Diseases Department, St Vincent's Hospital, Melbourne, Fitzroy, Victoria.
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Marshall C, Kelso A, McBryde E, Barr IG, Eisen DP, Sasadeusz J, Buising K, Cheng AC, Johnson P, Richards M. Pandemic (H1N1) 2009 risk for frontline health care workers. Emerg Infect Dis 2011. [PMID: 21749760 PMCID: PMC3358191 DOI: 10.3201/eid1706.101030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
To determine whether frontline health care workers (HCWs) are at greater risk for contracting pandemic (H1N1) 2009 than nonclinical staff, we conducted a study of 231 HCWs and 215 controls. Overall, 79 (17.7%) of 446 had a positive antibody titer by hemagglutination inhibition, with 46 (19.9%) of 231 HCWs and 33 (15.3%) of 215 controls positive (OR 1.37, 95% confidence interval 0.84–2.22). Of 87 participants who provided a second serum sample, 1 showed a 4-fold rise in antibody titer; of 45 patients who had a nose swab sample taken during a respiratory illness, 7 had positive results. Higher numbers of children in a participant’s family and working in an intensive care unit were risk factors for infection; increasing age, working at hospital 2, and wearing gloves were protective factors. This highly exposed group of frontline HCWs was no more likely to contract pandemic (H1N1) 2009 influenza infection than nonclinical staff, which suggests that personal protective measures were adequate in preventing transmission.
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Eisen DP, Marshall C, Dean MM, Sasadeusz J, Richards M, Buising K, Cheng A, Johnson PDR, Barr IG, McBryde ES. No association between mannose-binding lectin deficiency and H1N1 2009 infection observed during the first season of this novel pandemic influenza virus. Hum Immunol 2011; 72:1091-4. [PMID: 21920399 PMCID: PMC7132715 DOI: 10.1016/j.humimm.2011.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2011] [Revised: 08/11/2011] [Accepted: 08/25/2011] [Indexed: 11/17/2022]
Abstract
Genetic variations in host immunity may influence susceptibility to novel infections like the recently emergent pandemic influenza virus. Prior studies demonstrated that mannose-binding lectin (MBL) inactivates influenza. Furthermore, MBL deficiency is common and appears to predispose to respiratory virus infections. Therefore, we studied whether MBL deficiency played a role in infection with the novel H1N1 2009 influenza strain in exposed health care workers. In a nested case-control study, we observed no association between phenotypic MBL deficiency, variously defined, and predisposition to H1N1 2009 influenza in 63 pairs of seropositive and seronegative participants. MBL appears to currently have little impact on innate immune responses to H1N1 2009 influenza.
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MESH Headings
- Antibodies, Viral/blood
- Australia
- Case-Control Studies
- Genetic Association Studies
- Genetic Predisposition to Disease
- Humans
- Immunity, Humoral
- Immunity, Innate/genetics
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Influenza, Human/blood
- Influenza, Human/epidemiology
- Influenza, Human/genetics
- Influenza, Human/immunology
- Mannose-Binding Lectin/genetics
- Pandemics
- Personnel, Hospital
- Polymorphism, Genetic
- Sequence Deletion/genetics
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Affiliation(s)
- Damon P Eisen
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Victoria, Australia.
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