Antimicrobial Use in Outpatient Hemodialysis Units

2013 ◽  
Vol 34 (4) ◽  
pp. 349-357 ◽  
Author(s):  
Graham M. Snyder ◽  
Priti R. Patel ◽  
Alexander J. Kallen ◽  
James A. Strom ◽  
J. Kevin Tucker ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Observational Study ◽  
Prospective Study ◽  
Prospective Observational Study ◽  
Chronic Hemodialysis ◽  
Fourth Generation ◽  
Antimicrobial Use ◽  
National Guidelines ◽  
Surgical Prophylaxis ◽  
Narrow Spectrum

Objective.To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.Design.Retrospective and prospective observational study.Setting.Two outpatient hemodialysis units.Patients.All patients receiving chronic hemodialysis.Methods.The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met.Results.Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins.Conclusions.Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.

Oxytocin administration for induction and augmentation of labour in Polish maternity units– an observational study

2020 ◽  
Author(s):  
Barbara Baranowska ◽  
Anna Kajdy ◽  
Iwona Kiersnowska ◽  
Dorota Sys ◽  
Urszula Tataj-Puzyna ◽  
...  
Keyword(s):  
Observational Study ◽  
Prospective Observational Study ◽  
Mode Of Delivery ◽  
Perinatal Outcomes ◽  
Quality Of Healthcare ◽  
Study Data ◽  
Labour Induction ◽  
Healthcare Personnel ◽  
National Guidelines

Abstract BackgroundThere is not enough data regarding practices and protocols that healthcare personnel follow and the amount of oxytocin that women receive during labour. Empirical evidence indicates that compliance with the guidelines improves the quality of healthcare and reduces adverse effects. The aim of the study was to evaluate oxytocin supply practices of oxytocin for labour induction and augmentation in Polish maternity units.MethodsThe article presents a prospective observational study. Data collection took place in two selected maternity units between January 15 and July 31, 2019 (n=545). Inclusion criteria were women in term pregnancies, undergoing oxytocin induction or augmentation of labour. Exclusion criteria were women who were in preterm labour, aged less than 18 years, and women whose baby was known to have a malformation. ResultsThe average total amount of oxytocin administrated to women before birth was 7,329µg following labour induction and 3.952µg following labour augmentation. The actual administration of oxytocin deviated both from the unit and national guidelines in 93,6% of all observed labours. We found no statistically significant correlation between the amount of oxytocin administered and mode of delivery, immediate postpartum blood loss or Apgar scores. There was no observed effect of total oxytocin on short-term perinatal outcomes. Hospitals with similar protocols did not differ significantly in terms of total oxytocin amount, induction to stimulation ratio—the only observed difference was the mode of delivery. ConclusionsThere is a need for a thorough analysis to find out the reasons for the observed discrepancies between protocols and practice.

scholarly journals A New Therapeutic Application of Platelet-Rich Plasma to Chronic Breast Wounds: A Prospective Observational Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3063
Author(s):  
Juan de Dios Berná-Serna ◽  
Florentina Guzmán-Aroca ◽  
José A. García-Vidal ◽  
Dolores Hernández-Gómez ◽  
Ana Azahara García-Ortega ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Observational Study ◽  
Prospective Study ◽  
Prospective Observational Study ◽  
Wound Closure ◽  
Chronic Wounds ◽  
Platelet Rich Plasma ◽  
Therapeutic Application ◽  
History Of ◽  
A Prospective Study

The aim of this study was to investigate the usefulness of platelet-rich plasma (PRP) treatment for chronic wounds (CWs) of the breast. A prospective study was performed in 23 patients with CW of the breast who were treated with PRP. The procedure was repeated until the wound was closed completely. The study included patients with a history of breast cancer (n = 8) and patients without cancer (n = 15). The treatment with PRP was successful in all cases and observed in ≤4 weeks in 82.6% (19/23) of patients. The patients without breast cancer showed significantly less time for wound closure than the patients with a history of breast cancer. Moreover, a greater number of PRP treatments were necessary to achieve wound closure in patients undergoing conservative breast treatment. No patients had complications associated with the application of PRP. Conclusions: To the best of our knowledge, this is the first study to reveal that PRP treatment for CWs of the breast is safe, simple, useful and well-tolerated by patients.

scholarly journals Clinical manifestations in calotropis poisoning: a prospective study in Government General Hospital Nalgonda, India

2019 ◽  
Vol 6 (4) ◽  
pp. 1314 ◽  
Author(s):  
C. Yadavendra Reddy
Keyword(s):  
Abdominal Pain ◽  
Observational Study ◽  
Prospective Study ◽  
Prospective Observational Study ◽  
Clinical Manifestations ◽  
Calotropis Procera ◽  
Common Symptom ◽  
Accidental Ingestion ◽  
Male And Female ◽  
A Prospective Study

Background: Calotropis procera commonly known as Madar is common shrub all over India. Its chemical component Calotropin, which is derived from latex is known to cause injury to eyes and oral mucosa. Toxic manifestations following accidental ingestion are mostly gastrointestinal. This study was aimed at studying the various clinical manifestations of Calotropis poisoning in patients admitted to GGH Nalgonda.Methods: This prospective observational study was done from Feb 2019 to May 2019.All patients both male and female admitted to GGH Nalgonda during this period were studied. Patients below 12 years, pregnant women and patients with earlier gastritis, hepatitis, stomatitis were excluded from the study. The study was carried out in all patients fulfilling the inclusion and exclusion criteria.Results: A total of 60 patients 45 females and 15 males presented during the study period. Most of the patients presented with abdominal pain 15 (25%), hepatitis 10 (16.6%), stomatitis 12 (20%), vomiting 8 (13.3%), diarrhea 6 (10%), hyperkalemia 3 (5%), tachycardia 5 (8.3%), convulsion 1 (1.6%).Conclusions: It was observed from the study that most of the patients had abdominal pain as the major symptom. Stomatitis was the second most common symptom. It was observed consumption of the toxin in lesser quantities produced these symptoms in large quantities produced tachycardia, hyperkalemia and convulsions.

scholarly journals Effect of Antimicrobial Stewardship on Oral Quinolone Use and Resistance Patterns over 8 Years (2013–2020)

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1426
Author(s):  
Atsushi Uda ◽  
Katsumi Shigemura ◽  
Koichi Kitagawa ◽  
Kayo Osawa ◽  
Mari Kusuki ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Retrospective Study ◽  
Antimicrobial Resistance ◽  
Tertiary Hospital ◽  
Antimicrobial Use ◽  
Positive Trend ◽  
National Guidelines ◽  
Significant Positive Trend ◽  
Days Of Therapy ◽  
Resistance Patterns

Since 2014, several global and national guidelines have been introduced to address the problem of antimicrobial resistance. We conducted a campaign in a tertiary hospital to promote appropriate quinolone use through educational lectures in 2018. The aim of this retrospective study was to evaluate the changes in the following: prescription characteristics, trend of oral quinolone use, and antibiotic susceptibility of bacteria from 2013 to 2020. Antimicrobial use was assessed as days of therapy per 1000 patient-days. We found a significant reduction in unnecessary antibiotic prescriptions between December 2013 and December 2020. Significant negative trends were detected in the use of quinolones over 8 years (outpatients, coefficient = −0.15655, p < 0.001; inpatients, coefficient = −0.004825, p = 0.0016). In particular, the monthly mean use of quinolones among outpatients significantly decreased by 11% from 2013 to 2014 (p < 0.05) and reduced further by 31% from 2017 to 2020 (p < 0.001). A significant positive trend was observed in the susceptibility of Pseudomonas aeruginosa to levofloxacin (p < 0.001). These results demonstrate that the use of oral quinolones was further reduced following educational intervention and the bacterial susceptibility improved with optimal quinolone usage compared to that in 2013.

scholarly journals An observational study on the surgical antibiotic prophylaxis in the surgery ward of a tertiary care hospital

2019 ◽  
Vol 8 (7) ◽  
pp. 1647
Author(s):  
Aditi A. Kudchadkar ◽  
Sushama A. Bhounsule
Keyword(s):  
Observational Study ◽  
Antibiotic Prophylaxis ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Antibiotic Prescribing ◽  
Care Hospital ◽  
National Guidelines ◽  
Surgical Prophylaxis ◽  
Significant Burden ◽  
Surgical Antibiotic Prophylaxis

Background: Surgical site infection (SSI) is the most common postoperative complication and represents a significant burden in terms of patient morbidity, mortality and cost to health services around the world. Appropriate antibiotic prophylaxis helps in reducing the incidence of SSIs. Appropriate surgical prophylaxis is a multifactorial process that depends on proper case selection, antibiotic selection including dosing and route of administration and duration of therapy.Methods: A prospective observational study was conducted over 3 months on 200 operated patients in surgery ward of a tertiary hospital. Patient details like demography, type of surgery performed and antibiotics prescribed pre and post-surgical procedure was collected and analysed using Microsoft excel.Results: Out of 200 patients 32.5% (65) were females and 67.5% (135) were males. Total number of prophylactic antibiotics prescribed were 368. The most commonly prescribed group of antibiotics was cephalosporins (44.29%) followed by metronidazole (26.5%) and ofloxacin (9.48%). Among the cephalosporins the most commonly prescribed was cefuroxime in 82 patients (50.3%) and cefoperazone in 79 patients (48.46%). SSI developed in 3 out of 200 patients (1.5%).Conclusions: There is an urgent requirement to promote rational antibiotic prescribing among surgeons. The need of the hour is developing and implementing national guidelines for surgical prophylaxis by a multidisciplinary group of experts.

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