The impact of a local antibiotic stewardship program: Low rate of spontaneous bacterial peritonitis and bacteriascites sustained by multidrug-resistant organisms

Overconsumption of antibiotics in hospitals has led to policy implementation, including the control of antibiotic prescriptions. The impact of these policies on the evolution of antimicrobial resistance remains uncertain. In this work, we review the possible limits of such policies and focus on the need for a more efficient approach. Establishing a causal relationship between the introduction of new antibiotics and the emergence of new resistance mechanisms is difficult. Several studies have demonstrated that many resistance mechanisms existed before the discovery of antibiotics. Overconsumption of antibiotics has worsened the phenomenon of resistance. Antibiotics are responsible for intestinal dysbiosis, which is suspected of being the source of bacterial resistance. The complexity of the intestinal microbiota composition, the impact of the pharmacokinetic properties of antibiotics, and the multiplicity of other factors involved in the acquisition and emergence of multidrug-resistant organisms, lead us to think that de-escalation, in the absence of studies proving its effectiveness, is not the solution to limiting the spread of multidrug-resistant organisms. More studies are needed to clarify the ecological risk caused by different antibiotic classes. In the meantime, we need to concentrate our efforts on limiting antibiotic prescriptions to patients who really need it, and work on reducing the duration of these treatments.

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Assessment of the Clinical Impact of Multidrug-Resistant Organisms in Spontaneous Bacterial Peritonitis

Journal of Hepatology ◽

10.1016/s0168-8278(16)00266-x ◽

2016 ◽

Vol 64 (2) ◽

pp. S250-S251

Author(s):

A. Antunes ◽

P. Costa ◽

C. Teixeira ◽

B. Peixe ◽

S. Santos ◽

...

Keyword(s):

Spontaneous Bacterial Peritonitis ◽

Multidrug Resistant ◽

Clinical Impact ◽

Bacterial Peritonitis ◽

Multidrug Resistant Organisms

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Contact precautions for colonisation with multidrug-resistant organisms and haemodialysis patient quality of life and mood: a pilot case-control study

Renal Society of Australasia Journal ◽

10.33235/rsaj.15.1.19-25 ◽

2019 ◽

pp. 19-25 ◽

Cited By ~ 1

Author(s):

Rathika Krishnasamy

Keyword(s):

Quality Of Life ◽

Qualitative Interviews ◽

Social Function ◽

Multidrug Resistant ◽

Contact Precautions ◽

Dialysis Vintage ◽

Multidrug Resistant Organisms ◽

And Gender ◽

The Impact

Background: The rate of multidrug-resistant organisms (MDRO) colonisation in dialysis populations has increased over time. This study aimed to assess the effect of contact precautions and isolation on quality of life and mood for haemodialysis (HD) patients colonised with MDRO. Methods: Patients undergoing facility HD completed the Kidney Disease Quality of Life (KDQOL–SFTM), Beck Depression Inventory (BDI) and Personal Wellbeing-Index Adult (PWI-A). Patients colonised with MDRO were case-matched by age and gender with patients not colonised. Results: A total of 16 MDRO-colonised patients were matched with 16 controls. Groups were well matched for demographics and co-morbidities, other than a trend for older dialysis vintage in the MDRO group [7.2 years (interquartile range 4.6–10.0) compared to 3.2 (1.4–7.6) years, p=0.05]. Comparing MDRO-positive with negative patients, physical (30.5±10.7 vs. 34.6±7.3; p=0.2) and mental (46.5±11.2 vs. 48.5±12.5; p = 0.6) composite scores were not different between groups. The MDRO group reported poorer sleep quality (p=0.01) and sleep patterns (p=0.05), and lower social function (p=0.02). BDI scores were similar (MDRO-positive 10(3.5–21.0) vs. MDRO-negative 12(6.5–16.0), p=0.6). PWI-A scores were also similar in both groups; however, MDRO patients reported lower scores for “feeling safe”, p=0.03. Conclusion: While overall scores of quality of life and depression were similar between groups, the MDRO group reported poorer outcomes in sleep and social function. A larger cohort and qualitative interviews may give more detail of the impact of contact precautions and isolation on HD patients. The necessity for contact precautions for different MDRO needs consideration.

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Effect of Removing Contact Precautions for Multidrug-Resistant Organisms on Hospital Infections in a Pediatric Health System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.742 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s199-s200

Author(s):

Matthew Linam ◽

Dorian Hoskins ◽

Preeti Jaggi ◽

Mark Gonzalez ◽

Renee Watson ◽

...

Keyword(s):

Hand Hygiene ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Tertiary Care ◽

Bloodstream Infections ◽

Central Line ◽

Contact Precautions ◽

Stewardship Program ◽

Tract Infections ◽

The Impact

Background: Discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) have failed to show an increase in associated transmission or infections in adult healthcare settings. Pediatric experience is limited. Objective: We evaluated the impact of discontinuing contact precautions for MRSA, VRE, and extended-spectrum β-lactamase–producing gram-negative bacilli (ESBLs) on device-associated healthcare-associated infections (HAIs). Methods: In October 2018, contact precautions were discontinued for children with MRSA, VRE, and ESBLs in a large, tertiary-care pediatric healthcare system comprising 2 hospitals and 620 beds. Coincident interventions that potentially reduced HAIs included blood culture diagnostic stewardship (June 2018), a hand hygiene education initiative (July 2018), a handshake antibiotic stewardship program (December 2018) and multidisciplinary infection prevention rounding in the intensive care units (November 2018). Compliance with hand hygiene and HAI prevention bundles were monitored. Device-associated HAIs were identified using standard definitions. Annotated run charts were used to track the impact of interventions on changes in device-associated HAIs over time. Results: Average hand hygiene compliance was 91%. Compliance with HAI prevention bundles was 81% for ventilator-associated pneumonias, 90% for catheter-associated urinary tract infections, and 97% for central-line–associated bloodstream infections. Overall, device-associated HAIs decreased from 6.04 per 10,000 patient days to 3.25 per 10,000 patient days after October 2018 (Fig. 1). Prior to October 2018, MRSA, VRE and ESBLs accounted for 10% of device-associated HAIs. This rate decreased to 5% after October 2018. The decrease in HAIs was likely related to interventions such as infection prevention rounds and handshake stewardship. Conclusions: Discontinuation of contact precautions for children with MRSA, VRE, and ESBLs were not associated with increased device-associated HAIs, and such discontinuation is likely safe in the setting of robust infection prevention and antibiotic stewardship programs.Funding: NoneDisclosures: None

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Albumin Utilization in Spontaneous Bacterial Peritonitis

Journal of Pharmacy Practice ◽

10.1177/0897190021997002 ◽

2021 ◽

pp. 089719002199700

Author(s):

Alex M. Ebied ◽

Thakul Rattanasuwan ◽

Yiqing Chen ◽

Adonice P. Khoury

Keyword(s):

High Risk ◽

Spontaneous Bacterial Peritonitis ◽

Total Bilirubin ◽

Kidney Injury ◽

Inclusion Criteria ◽

Dosing Regimen ◽

Bacterial Peritonitis ◽

Risk Patients ◽

The Impact ◽

Order Set

Background: Albumin has been shown to decrease the incidence of mortality and acute kidney injury (AKI) in patients with spontaneous bacterial peritonitis (SBP). Albumin administration in SBP is recommended within 6 hours of diagnosis and for reserved use in high-risk patients with the following baseline laboratory tests: serum creatinine >1 mg/dL, blood urea nitrogen >30 mg/dL or total bilirubin >4 mg/dL. Objective: We aimed to assess the impact of an albumin order set restricted to high-risk SBP. Methods: A retrospective cohort study was conducted between Jan 1, 2013 to Feb 28, 2018. The albumin order set was implemented on Sep 20, 2016. Patients were included if they were diagnosed with SBP and had an ascitic fluid polymorphonuclear count ≥ 250 cells/mm3. Results: Out of a total of 137 patients reviewed, 88 met the inclusion criteria. The incidence of AKI in the pre-order set and post-order set were 63.93% and 33.33% (p = 0.01), respectively. The incidence of mortality in the pre-order set and post-order set were 36.07% and 7.41% (p = 0.005), respectively. The percentage of patients administered albumin within 6 hours were 24.59% to 40.74% (p = 0.14) in the pre-order set and post-order set, respectively. The percentage of patients who received the recommended albumin dosing regimen ordered was 42.62% vs 96.30% (p < 0.001), in the pre-order set and post-order set, respectively. Conclusion: The albumin order set restricted to high-risk SBP patients significantly reduced the incidence of AKI and mortality, and improved the appropriateness of albumin regimen ordered.

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Conceptualizing the Impact of MDRO Control Measures Directed at Carriers: A Capability Approach

Ethics and Drug Resistance: Collective Responsibility for Global Public Health - Public Health Ethics Analysis ◽

10.1007/978-3-030-27874-8_13 ◽

2020 ◽

pp. 203-224

Author(s):

Morten Fibieger Byskov ◽

Babette Olga Rump ◽

Marcel Verweij

Keyword(s):

Capability Approach ◽

Ethical Dilemmas ◽

Well Being ◽

Multidrug Resistant ◽

Control Measures ◽

Human Capabilities ◽

Multidrug Resistant Organisms ◽

The Impact ◽

Specific Control

Abstract Many countries have implemented specific control measures directed at carriers of multidrug-resistant organisms (MDRO) in order to prevent further introduction and transmission of resistant organisms into hospitals and other healthcare related settings. These control measures may in many ways affect the lives and well-being of carriers of MDRO, resulting in complex ethical dilemmas that often remain largely implicit in practice. In this chapter, we propose to conceptualize the impact of MDRO control measures on the well-being of individual carriers in terms of capabilities and functionings. A capabilitarian framework for the ethical treatment of MDRO carriers commits us to conceptualize the harm done to carriers in terms of the impact that MDRO control measures have on what they are able to do or be. Adopting and adapting Nussbaum’s list of ten central human capabilities, we present a taxonomy of capabilities and functionings that are normatively relevant for the design and evaluation of MDRO control measures.

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Long-Term Impact of Universal Contact Precautions on Rates of Multidrug-Resistant Organisms in ICUs: A Comparative Effectiveness Study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.35 ◽

2018 ◽

Vol 39 (5) ◽

pp. 534-540 ◽

Cited By ~ 2

Author(s):

E. Yoko Furuya ◽

Bevin Cohen ◽

Haomiao Jia ◽

Elaine L. Larson

Keyword(s):

Comparative Effectiveness ◽

Baseline Period ◽

Multidrug Resistant ◽

Incidence Density ◽

Research Database ◽

Longitudinal Impact ◽

Contact Precautions ◽

Significant Difference ◽

Multidrug Resistant Organisms ◽

The Impact

OBJECTIVETo evaluate the impact of universal contact precautions (UCP) on rates of multidrug-resistant organisms (MDROs) in intensive care units (ICUs) over 9 yearsDESIGNRetrospective, nonrandomized observational studySETTINGAn 800-bed adult academic medical center in New York CityPARTICIPANTSAll patients admitted to 6 ICUs, 3 of which instituted UCP in 2007METHODSUsing a comparative effectiveness approach, we studied the longitudinal impact of UCP on MDRO incidence density rates, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Klebsiella pneumoniae. Data were extracted from a clinical research database for 2006–2014. Monthly MDRO rates were compared between the baseline period and the UCP period, utilizing time series analyses based on generalized linear models. The same models were also used to compare MDRO rates in the 3 UCP units to 3 ICUs without UCPs.RESULTSOverall, MDRO rates decreased over time, but there was no significant decrease in the trend (slope) during the UCP period compared to the baseline period for any of the 3 intervention units. Furthermore, there was no significant difference between UCP units (6.6% decrease in MDRO rates per year) and non-UCP units (6.0% decrease per year; P=.840).CONCLUSIONThe results of this 9-year study suggest that decreases in MDROs, including multidrug-resistant gram-negative bacilli, were more likely due to hospital-wide improvements in infection prevention during this period and that UCP had no detectable additional impact.Infect Control Hosp Epidemiol 2018;39:534–540

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High Prevalence of Multidrug Resistant Bacteria in Cirrhotic Patients with Spontaneous Bacterial Peritonitis: Is It Time to Change the Standard Antimicrobial Approach?

Canadian Journal of Gastroenterology and Hepatology ◽

10.1155/2019/6963910 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

Jerônimo De Conto Oliveira ◽

Enrique Carrera ◽

Roberta C. Petry ◽

Caroline Deutschendorf ◽

Augusto Mantovani ◽

...

Keyword(s):

Ascitic Fluid ◽

Spontaneous Bacterial Peritonitis ◽

Generation Cephalosporin ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Bacterial Peritonitis ◽

High Prevalence ◽

Cirrhotic Patients ◽

End Stage

Introduction. Spontaneous bacterial peritonitis (SBP) has a deleterious clinical impact in end-stage liver disease, and multidrug resistance has increased, raising concern about effectiveness of traditional antibiotic regimens. Patients and Methods. Single-center retrospective study of ascitic fluid infections in cirrhotic patients. Results. We analyzed medical records related to 2129 culture-positive ascitic fluid and found 183 samples from cirrhotic patients. There were 113 monobacterial SBP cases from 97 cirrhotic patients; 57% of patients were male; hepatitis C and alcohol were the main etiologies for cirrhosis. Multidrug resistant bacteria were isolated in 46.9% of SBP samples, and third-generation cephalosporin and quinolone resistant reached 38.9% and 25.7% of SBP cases. Conclusion. SBP due to multidrug resistant bacteria is a growing problem, and one should consider reported resistance profiles for the decision-making process of empirical first-line treatment prescription.

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