Trends in the Epidemiology of Opportunistic Fungal Infections: Predisposing Factors and the Impact of Antimicrobial Use Practices

Fungal infections and invasive mycoses, despite the continuous medicine progress, are an important globally therapeutic problem. Multicompartment dosage formulations (e.g., microparticles) ensure a short drug diffusion way and high surface area of drug release, which as a consequence can provide improvement of therapeutic efficiency compared to the traditional drug dosage forms. As fucoidan is promising component with wide biological activity per se, the aim of this study was to prepare fucospheres (fucoidan microparticles) and fucoidan/gelatin microparticles with posaconazole using the one-step spray-drying technique. Pharmaceutical properties of designed fucospheres and the impact of the gelatin addition on their characteristics were evaluated. An important stage of this research was in vitro evaluation of antifungal activity of developed microparticles using different Candida species. It was observed that gelatin presence in microparticles significantly improved swelling capacity and mucoadhesiveness, and provided a sustained POS release. Furthermore, it was shown that gelatin addition enhanced antifungal activity of microparticles against tested Candida spp. strains. Microparticles formulation GF6, prepared by the spray drying of 20% fucoidan, 5% gelatin and 10% Posaconazole, were characterized by optimal mucoadhesive properties, high drug loading and the most sustained drug release (after 8 h 65.34 ± 4.10% and 33.81 ± 5.58% of posaconazole was dissolved in simulated vaginal fluid pH 4.2 or 0.1 M HCl pH 1.2, respectively).

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152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.197 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S86-S86

Author(s):

Ann F Chou ◽

Yue Zhang ◽

Makoto M Jones ◽

Christopher J Graber ◽

Matthew B Goetz ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Clinical Pharmacist ◽

Antibiotic Use ◽

Feedback Mechanism ◽

Health Care Facilities ◽

Antimicrobial Use ◽

Time Points ◽

The Difference ◽

The Impact ◽

Over Time

Abstract Background About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time. Methods This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity. Results Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324). Conclusion The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation. Disclosures All Authors: No reported disclosures

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Antimicrobial Use in COVID-19 Patients in the First Phase of the SARS-CoV-2 Pandemic: A Scoping Review

Antibiotics ◽

10.3390/antibiotics10060745 ◽

2021 ◽

Vol 10 (6) ◽

pp. 745

Author(s):

Wenjuan Cong ◽

Ak Narayan Poudel ◽

Nour Alhusein ◽

Hexing Wang ◽

Guiqing Yao ◽

...

Keyword(s):

Critical Illness ◽

Scoping Review ◽

Clinical Evidence ◽

Length Of Hospital Stay ◽

Severity Of Illness ◽

Antibiotic Prescribing ◽

Antimicrobial Use ◽

Clinical Scenarios ◽

Scoping Reviews ◽

The Impact

This scoping review provides new evidence on the prevalence and patterns of global antimicrobial use in the treatment of COVID-19 patients; identifies the most commonly used antibiotics and clinical scenarios associated with antibiotic prescribing in the first phase of the pandemic; and explores the impact of documented antibiotic prescribing on treatment outcomes in COVID-19 patients. The review complies with PRISMA guidelines for Scoping Reviews and the protocol is registered with the Open Science Framework. In the first six months of the pandemic, there was a similar mean antibiotic prescribing rate between patients with severe or critical illness (75.4%) and patients with mild or moderate illness (75.1%). The proportion of patients prescribed antibiotics without clinical justification was 51.5% vs. 41.9% for patients with mild or moderate illness and those with severe or critical illness. Comparison of patients who were provided antibiotics with a clinical justification with those who were given antibiotics without clinical justification showed lower mortality rates (9.5% vs. 13.1%), higher discharge rates (80.9% vs. 69.3%), and shorter length of hospital stay (9.3 days vs. 12.2 days). In the first 6 months of the pandemic, antibiotics were prescribed for COVID-19 patients regardless of severity of illness. A large proportion of antibiotic prescribing for mild and moderate COVID-19 patients did not have clinical evidence of a bacterial co-infection. Antibiotics may not be beneficial to COVID-19 patients without clinical evidence of a bacterial co-infection.

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Reducing Broad Spectrum Antimicrobial Use in Extracorporeal Membrane Oxygenation (ECMO): Reduce AMMO Study

Clinical Infectious Diseases ◽

10.1093/cid/ciab118 ◽

2021 ◽

Author(s):

Aditya Shah ◽

Priya Sampathkumar ◽

Ryan W Stevens ◽

John K Bohman ◽

Brian D Lahr ◽

...

Keyword(s):

Time Series ◽

Extracorporeal Membrane Oxygenation ◽

Broad Spectrum ◽

Antimicrobial Prophylaxis ◽

Current Evidence ◽

Antimicrobial Use ◽

Infection Rates ◽

Interrupted Time Series Analysis ◽

Membrane Oxygenation ◽

The Impact

Abstract Background The use of extracorporeal membrane oxygenation (ECMO) in critically ill adults is increasing. There are currently no guidelines for antimicrobial prophylaxis. We analyzed 7 years of prophylactic antimicrobial use across three time series for patients on ECMO at our institution in the development, improvement, and streamlining of our ECMO antimicrobial prophylaxis protocol. Study design and Methods In this quasi-experimental interrupted time series analysis, we evaluated the impact of an initial ECMO antimicrobial prophylaxis protocol, implemented in 2014, on antimicrobial use and NHSN reportable infection rates. Then, following a revision and streamlining of the protocol in November 2018, we re-evaluated the same metrics. Results Our study population included 338 ICU patients who received ECMO between July 2011 and November 2019. After implementation of the first version of the protocol we did not observe significant changes in antimicrobial use or infection rates in these patients; however, following revision and streamlining of the protocol, we demonstrated a significant reduction in broad spectrum antimicrobial use for prophylaxis in patients on ECMO without any evidence of a compensatory increase in infection rates. Conclusion Our final protocol significantly reduces broad spectrum antimicrobial use for prophylaxis in patients on ECMO. We propose a standard antimicrobial prophylaxis regimen for patients on ECMO based on current evidence and our experience.

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Promoting Antimicrobial Stewardship Education Among Pediatricians Through a Maintenance of Certification Part 4 Quality Impro

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.53 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s29-s29

Author(s):

Prachi Singh ◽

Brian Lee ◽

Jenna Holmen

Keyword(s):

Antimicrobial Stewardship ◽

Transition Period ◽

Surgical Patients ◽

Antimicrobial Use ◽

Maintenance Of Certification ◽

Stewardship Program ◽

Surgical Antibiotic Prophylaxis ◽

Baseline Knowledge ◽

Initial Survey ◽

The Impact

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None

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Sterol-response pathways mediate alkaline survival in diverse fungi

10.1101/2020.03.26.010983 ◽

2020 ◽

Author(s):

Hannah E. Brown ◽

Calla L. Telzrow ◽

Joseph W. Saelens ◽

Larissa Fernandes ◽

J. Andrew Alspaugh

Keyword(s):

Fungal Pathogens ◽

Fungal Infections ◽

Membrane Integrity ◽

Microbial Pathogens ◽

Alkaline Ph ◽

Ph Response ◽

Ph Tolerance ◽

Alkaline Conditions ◽

Host Infection ◽

The Impact

AbstractThe ability for cells to maintain homeostasis in the presence of extracellular stress is essential for their survival. Stress adaptations are especially important for microbial pathogens to respond to rapidly changing conditions, such as those encountered during the transition from the environment to the infected host. Many fungal pathogens have acquired the ability to quickly adapt to changes in extracellular pH to promote their survival in the various micro-environments encountered during a host infection. For example, the fungal-specific Rim/Pal alkaline response pathway has been well characterized in many fungal pathogens, including Cryptococcus neoformans. However, alternative mechanisms for sensing and responding to host pH have yet to be extensively studied. Recent observations from a genetic screen suggest that the C. neoformans sterol homeostasis pathway is required for growth at elevated pH. This work explores interactions among mechanisms of membrane homeostasis, alkaline pH tolerance, and Rim pathway activation. We find that the sterol homeostasis pathway is necessary for growth in an alkaline environment, and that an elevated pH is sufficient to induce Sre1 activation. This pH-mediated activation of the Sre1 transcription factor is linked to the biosynthesis of ergosterol, but is not dependent on Rim pathway signaling, suggesting that these two pathways are responding to alkaline pH independently. Furthermore, we discover that C. neoformans is more susceptible to membrane-targeting antifungals in alkaline conditions highlighting the impact of micro-environmental pH on the treatment of invasive fungal infections. Together, these findings further connect membrane integrity and composition with the fungal pH response and pathogenesis.

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Eyelid fungal infections are rare, and often associated with predisposing factors. We present the case of a child with an ulcerated lesion of fungal etiology on the eyelid.

Canadian Journal of Ophthalmology ◽

10.1016/j.jcjo.2016.08.002 ◽

2017 ◽

Vol 52 (1) ◽

pp. e28-e29

Author(s):

Roshmi Gupta ◽

Parvathi Hari ◽

Venkataramana Anandula

Keyword(s):

Fungal Infections ◽

Predisposing Factors

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The impact of healthcare workers job environment on their mental-emotional health. Coping strategies: the case of a local general hospital

Health Psychology Research ◽

10.4081/hpr.2015.1984 ◽

2015 ◽

Vol 3 (1) ◽

Cited By ~ 34

Author(s):

Aristotelis Koinis ◽

Vasiliki Giannou ◽

Vasiliki Drantaki ◽

Sophia Angelaina ◽

Elpida Stratou ◽

...

Keyword(s):

Quality Of Life ◽

Social Support ◽

General Hospital ◽

Healthcare Professionals ◽

Emotional Health ◽

Predisposing Factors ◽

Workplace Stress ◽

Stressful Events ◽

The Impact

Workplace stress can influence healthcare professionals’ physical and emotional well-being by curbing their efficiency and having a negative impact on their overall quality of life. The aim of the present study was to investigate the impact that work environment in a local public general hospital can have on the health workers’ mental-emotional health and find strategies in order to cope with negative consequences. The study took place from July 2010 to October 2010. Our sample consisted of 200 healthcare professionals aged 21-58 years working in a 240-bed general hospital and the response rate was 91.36%). Our research protocol was first approved by the hospital’s review board. A standardized questionnaire that investigates strategies for coping with stressful conditions was used. A standardized questionnaire was used in the present study Coping Strategies for Stressful Events, evaluating the strategies that persons employ in order to overcome a stressful situation or event. The questionnaire was first tested for validity and reliability which were found satisfactory (Cronbach’s α=0.862). Strict anonymity of the participants was guaranteed. The SPSS 16.0 software was used for the statistical analysis. Regression analysis showed that health professionals’ emotional health can be influenced by strategies for dealing with stressful events, since positive re-assessment, quitting and seeking social support are predisposing factors regarding the three first quality of life factors of the World Health Organization Quality of Life -BREF. More specifically, for the physical health factor, positive re-assessment (t=3.370, P=0.001) and quitting (t=−2.564, P=0.011) are predisposing factors. For the ‘mental health and spirituality’ regression model, positive re-assessment (t=5.528, P=0.000) and seeking social support (t=−1.991, P=0.048) are also predisposing factors, while regarding social relationships positive re-assessment (t=4.289, P=0.000) is a predisposing factor. According to our findings, there was a notable lack of workplace stress management strategies, which the participants usually perceive as a lack of interest on behalf of the management regarding their emotional state. Some significant factors for lowering workplace stress were found to be the need to encourage and morally reward the staff and also to provide them with opportunities for further or continuous education.

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Częstość występowania robaczyc u dzieci w wieku przedszkolnym ? określenie czynników predysponujących

Medycyna Rodzinna ◽

10.25121/mr.2018.21.4.315 ◽

2018 ◽

Vol 21 (4) ◽

Author(s):

Piotr Kaleta ◽

Marta Palacz-Wróbel ◽

Łukasz Chajec

Keyword(s):

Statistical Data ◽

Predisposing Factors ◽

The Body ◽

Personal Hygiene ◽

Parasitic Infections ◽

Parasitic Diseases ◽

Frequency Of Occurrence ◽

The World ◽

Parasitic Worms ◽

The Impact

Introduction. Parasitic diseases are common and pose threats to the health and lives of people around the world. Globally improving sanitary conditions also do not provide a sufficient method of preventing the parasitic infections that trigger them. Statistical data show a huge rate of parasitism in the world and a very large share of parasitic diseases in the number of deaths. Worms among pre-school children are quite common to a certain extent, and factors that favor them ? if properly identified, can be significantly reduced. This paper presents the frequency of occurrence of worms in this age range compared to statistical data and a list of factors predisposing the occurrence of these diseases. Aim. The aim of the study was to assess the frequency and predisposing factors for the occurrence of helminthia among children in pre-school age in Poland. Material and methods. An original questionnaire was used to conduct the research. Results. The frequency of occurrence of worms reaches about 10% of confirmed infections. The most common prevalence among children is oatosis. The most important factors predisposing to parasitic worms infection are: inadequate personal hygiene, inadequate food hygiene and its preparation, the impact of places with higher risk of infection (sandpits, playgrounds, kindergartens, nurseries, orphanages). Invasions, when the massiveness of parasite invasions is not large enough, often goes asymptomatically ? that is why the parent's perceptiveness and knowledge about the basic symptoms of the most common worms play a key role. The level of parents’ knowledge and awareness of the risk of being infected with parasitic worms is high. Most of the parents surveyed correctly diagnosed symptoms performed tests for the presence of parasites in the body of their children. Conclusions. Elimination of predisposing factors significantly minimizes the occurrence of helminthiasis.

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The impact of digital interventions on antimicrobial stewardship in hospitals: A qualitative synthesis of systematic reviews (Preprint)

10.2196/preprints.27959 ◽

2021 ◽

Author(s):

Bethany A Van Dort ◽

Jonathan Penm ◽

Angus Ritchie ◽

Melissa T Baysari

Keyword(s):

Systematic Reviews ◽

Antimicrobial Stewardship ◽

Digital Health ◽

Hospital Setting ◽

Antimicrobial Use ◽

Qualitative Synthesis ◽

Large Variability ◽

Antimicrobial Prescribing ◽

Digital Interventions ◽

The Impact

BACKGROUND Antimicrobial stewardship (AMS) programs aim to optimize antimicrobial use by utilizing a suite of coordinated strategies. With the increased use of health information technology in hospitals, AMS processes that were traditionally paper-based are becoming computerized and streamlined. A number of reviews on digital interventions supporting AMS have been performed, so we performed a review of reviews to consolidate findings OBJECTIVE To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. METHODS Databases: Medline, Embase, Scopus, CINAHL and the Cochrane Database of Systematic Reviews were searched from 2010 onwards. Papers were eligible if they included studies that examined the effectiveness of digital health interventions related to antimicrobial prescribing and monitoring, in an inpatient hospital setting. Papers were excluded if they did not include a clearly defined search strategy, if they were limited to a pediatric setting, or they were not in English. RESULTS Seven systematic reviews were included for data extraction. Five reviews were of moderate quality and two of low quality. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. There was a large variability in outcome measures used. Six reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. CONCLUSIONS The results of this review indicate digital interventions, regardless of type, reduce antimicrobial use and improve antimicrobial appropriateness in hospitals. We recommend hospitals consider implementing one or more digital interventions to facilitate AMS programs.

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