The Role of Microbiology Testing in Controlling Infection and Promoting Antimicrobial Stewardship

AbstractThis chapter discusses the Role of Microbiology Testing in Controlling Infection and Promoting Antimicrobial Stewardship. It details the role that culture and sensitivity testing has played in creating the ‘objective’ evidence base that facilitated and nurtured midwifery empowerment, task shifting and multi-disciplinary team working. The chapter presents findings of resistance patterns of isolates from women with suspected sepsis.

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Change Processes: Multi-Disciplinary Teamwork

Anti-Microbial Resistance in Global Perspective ◽

10.1007/978-3-030-62662-4_7 ◽

2020 ◽

pp. 129-143

Author(s):

Louise Ackers ◽

Gavin Ackers-Johnson ◽

Joanne Welsh ◽

Daniel Kibombo ◽

Samuel Opio

Keyword(s):

Behaviour Change ◽

Antimicrobial Stewardship ◽

Clinical Pharmacy ◽

Change Processes ◽

Professional Boundaries ◽

Team Working ◽

Poor Patient ◽

Inappropriate Antibiotics ◽

Multi Disciplinary Team

AbstractThis chapter examines the importance of multi-disciplinary team-working to the management of antimicrobial stewardship and behaviour change processes. MDT has played a major role in improving communication and reducing professional boundaries that had previously contributed to high levels of infection; extended use of, often inappropriate antibiotics and poor patient outcomes. The functioning of such teams facilitates the role of clinical pharmacy.

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Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

10.21203/rs.3.rs-35600/v3 ◽

2020 ◽

Author(s):

Samuel MUNGAI Mbugua ◽

George Njoroge ◽

Caroline Kijogi ◽

Moses Kamita ◽

Rachel Kimani ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Health Services ◽

Antimicrobial Stewardship ◽

Building Blocks ◽

Health Concern ◽

Surveillance Systems ◽

Sensitivity Testing ◽

Therapeutics Committee ◽

Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship (AMS), the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs. This study aimed to understand the perspectives of hospital managers to AMS and identify areas of management engagement and addressing potential blockades to change.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The practice of antimicrobial stewardship is not implemented and well developed in the sampled healthcare facilities as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to the hospital and its clients alike. The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust Antimicrobial Stewardship programs in the fight against antimicrobial resistance.

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Exploring Perspectives on Antimicrobial Stewardship: A Qualitative Study of Health Managers in Kenya

10.21203/rs.3.rs-35600/v1 ◽

2020 ◽

Author(s):

Samuel Mungai Mbugua ◽

George Njoroge ◽

Caroline Kijogi ◽

Moses Kamita ◽

Rachel Kimani ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Building Blocks ◽

Health Concern ◽

Surveillance Systems ◽

Sensitivity Testing ◽

Cross Sectional ◽

Therapeutics Committee ◽

Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship, the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using QSR Nvivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, Laboratory competency and recommendations for infection prevention and management, Educational resources and communications channels available, Building blocks and low-lying fruits for ASCs. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education and training platforms (CMEs and CPDs) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against AMR.

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Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

10.21203/rs.3.rs-35600/v2 ◽

2020 ◽

Author(s):

Samuel MUNGAI Mbugua ◽

George Njoroge ◽

Caroline Kijogi ◽

Moses Kamita ◽

Rachel Kimani ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Building Blocks ◽

Health Concern ◽

Surveillance Systems ◽

Sensitivity Testing ◽

Cross Sectional ◽

Therapeutics Committee ◽

Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship, the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using QSR Nvivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, Laboratory competency and recommendations for infection prevention and management, Educational resources and communications channels available, Building blocks and low-lying fruits for ASCs. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education and training platforms (CMEs and CPDs) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against AMR.

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Arthroscopy in Arthrosis: Is It Worth it? A case Presentation

Revista de Chimie ◽

10.37358/rc.18.8.6506 ◽

2018 ◽

Vol 69 (8) ◽

pp. 2232-2235

Author(s):

Marius Moga ◽

Mark Edward Pogarasteanu ◽

Antoine Edu

Keyword(s):

Clinical Status ◽

Loose Body ◽

Point Of View ◽

The Other ◽

Joint Range Of Motion ◽

Objective Evidence ◽

Before And After ◽

Total Knee ◽

Joint Range

The role of arthroscopy in incipient and mild arthrosis, even combined with proximal tibial ostetomy, is well known and well documented. On the other hand, its role in the treatment of advanced arthrosis of the large joints, especially the knee, is a subject of controversy. The proponents of the use of arthroscopy in advanced arthrosis claim that meniscectomy, synovectomy, ostophytectomy, chondral lesion stabilization, arthroscopic release, plica and loose body removal greatly improve the quality of life for most patients, especially if followed by the use of viscoelastic injection, by diminishing pain and improving joint range of motion. The opponents claim that, even though the advantages are clear in the cases that refuse arthroplasty, in all the other cases the surgical indication should be total knee arthroplasty, as the clinical relief is temporary, but with all the risks of a surgical intervention. We have conducted an overview of the recent literature, in order to find objective evidence to sustain either point of view. We focused on articles published that included an objective measurement of before and after clinical status through clinical scores and objective measurements. We also focused on the follow-up period and on the evolution of the pathology after arthroscopy.

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Role of routine nephrectomy for non-functioning kidneys due to genitourinary tuberculosis: Data from an Indian subcontinent

Journal of Clinical Urology ◽

10.1177/2051415820987663 ◽

2021 ◽

pp. 205141582098766

Author(s):

Pradeep Prakash ◽

Prabhjot Singh ◽

Amlesh Seth ◽

Rishi Nayyar ◽

Brusabhanu Nayak

Keyword(s):

Indian Subcontinent ◽

Disease Recurrence ◽

Drug Resistant ◽

Second Line ◽

Sensitivity Testing ◽

Level Of Evidence ◽

Lower Blood ◽

Anti Tubercular Therapy ◽

Open Nephrectomy

Objective: To evaluate the role of routine nephrectomy for tuberculous non-functioning kidney (TNFK) after receiving anti-tubercular therapy (ATT) by demonstrating whether live tubercle bacilli persist in nephrectomy specimens after treatment or not. Materials and methods: Patients with TNFK who underwent nephrectomy after completion of at least 6 months of ATT were included in this prospective cohort study. We sent tissue/pus from a nephrectomy specimen for acid-fast bacilli (AFB) staining, polymerase chain reaction (PCR) and culture to look for live bacilli. Bacilli were considered alive only if AFB culture was positive. Results: Twenty-four patients underwent nephrectomy for TNFK between April 2015 and October 2017 (18 laparoscopic and 6 open nephrectomy). Laparoscopic nephrectomy was associated with lower blood loss (225 ml versus 408 ml, p = 0.0003) and shorter hospital stay (3 versus 3.8 days, p = 0.06) compared with open nephrectomy; however, mean operative time and overall complications were similar. Eight specimens were AFB smear and/or tuberculosis PCR positive, out of which three showed viable bacilli upon culture. Drug sensitivity testing showed multi-drug resistant strain in all three patients who were treated with second-line ATT. Conclusion: It is preferable to do routine nephrectomy for TNFKs as they are more likely to harbour live bacilli and lead to disease recurrence. Viability testing for AFB must be performed on all operated specimens to identify drug resistant bacilli so that patients may be treated with second-line therapy if required. Level of evidence: 4.

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466 Resection or Enucleation for Extremely Giant Hepatic Haemangiomata? A Case Report and Review of The Literature

British Journal of Surgery ◽

10.1093/bjs/znab134.284 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

R E Fraser ◽

G R Layton ◽

L L Kuan ◽

A R Dennison

Keyword(s):

Expectant Management ◽

Evidence Base ◽

Primary Treatment ◽

Cavernous Haemangioma ◽

Liver Tumours ◽

Case Presentation ◽

Best Management ◽

Anatomical Liver Resection ◽

Benign Liver

Abstract Background Cavernous hepatic haemangiomas are benign liver tumours and although common when small, giant haemangiomas (usually accepted as being greater than 10cm) are infrequent. Treatment is indicated in patients who are symptomatic or if diagnosis is unclear, although with giant haemangiomas, many support expectant management of asymptomatic lesions due to the risk of major complications. Traditionally hepatic resection has been the primary treatment option for these lesions, but a variety of other techniques, including enucleation, have been described as safe and effective alternatives. There remains equipoise in respect of the best management of giant haemangiomas above 10cm. Cases of such size are rare and so there is a paucity of data available. Case presentation We present a case of a 65-year-old male who underwent successful anatomical liver resection for a 5kg giant cavernous haemangioma of 26cm diameter following its incidental identification during an ultrasound scan. We also discuss and compare the role of resection and enucleation for the treatment of haemangiomata greater than 20cm in diameter. Conclusions This case demonstrates successful resection of an unusually giant haemangioma which, in contrast to the majority of literature, provides a valuable addition to the limited evidence base for management of this condition by anatomical resection.

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Gut microbiota influence in type 2 diabetes mellitus (T2DM)

Gut Pathogens ◽

10.1186/s13099-021-00446-0 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

A. L. Cunningham ◽

J. W. Stephens ◽

D. A. Harris

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Gut Microbiota ◽

Potential Role ◽

Evidence Base ◽

Human Metabolism ◽

Altered Glucose

AbstractA strong and expanding evidence base supports the influence of gut microbiota in human metabolism. Altered glucose homeostasis is associated with altered gut microbiota, and is clearly associated with the development of type 2 diabetes mellitus (T2DM) and associated complications. Understanding the causal association between gut microbiota and metabolic risk has the potential role of identifying susceptible individuals to allow early targeted intervention.

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