scholarly journals Appropriateness of antibiotics for medical prophylaxis: evaluation of data from the Italian PPS-2

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A Cremona ◽  
J Garlasco ◽  
I Gintoli ◽  
A D'Ambrosio ◽  
F Quattrocolo ◽  
...  
Keyword(s):  
Empirical Therapy ◽  
Infectious Complications ◽  
High Rate ◽  
National Guidelines ◽  
Prevalence Survey ◽  
Inappropriate Use ◽  
Healthcare Associated ◽  
Evaluation Of Data ◽  
The Eu ◽  
Made In

Abstract Background Antibiotics (AB) are administered for medical prophylaxis (MP) to prevent infectious complications. The second national point prevalence survey (PPS) of healthcare-associated infections and AB use was conducted in Italy in 2016-2017. The survey found MP accounted for nearly 25% of all registered ABs, more than twice the EU/EEA proportion. The aim of this study was to evaluate how many ABs were administered for MP and how frequently general indications were followed. Methods Data from the PPS were used to evaluate the prevalence of indications for MP over the total number of ABs, the proportion - among these indications - of those justified by a motivation in the patients' charts, and the prevalence of ABs considered appropriate for MP. The evaluation was made in 12 hospitals out of 14 participating in the PPS in Piedmont, chosen on the basis of patient traceability. According to national guidelines, the indications for MP that were considered appropriate in this study were: Trimethoprim/sulfamethoxazole for P. carinii pneumonia, Rifaximin for diverticulitis, Penicillin for Streptococcal infections and for splenectomized patients, and Rifampin for TB infections. Results 1844 AB prescriptions were registered among 1334 traceable inpatients in Piedmont. The prevalence of indications for MP was 16.2% and 253 ABs (84.6%) were prescribed with a motivation. Only 3% of ABs registered as MP were appropriate for this indication: Bactrim 2%, Rifaximin 0.3%, Penicillin 0.2% and Rifampin 0.4%. Conclusions This study found an extremely high rate of inappropriate ABs for MP, that will be further investigated through qualitative analysis of medical records to evaluate whether a misunderstanding of the PPS protocol occurred and empirical therapy was confused with MP. Nevertheless, this study highlighted the need for interventions to improve prescribing appropriateness for MP. Key messages This study found that only 2.98% of ABs registered as MP among traceable patients in Piedmont were appropriate for this indication. 15.38% of prescriptions for MP were not justified by a motivation. Interventions to improve prescribing appropriateness for MP could lead to a considerable reduction in inappropriate use of ABs, which is crucial in a country facing hyperendemic levels of AMR.

scholarly journals Bacterial infections in cirrhosis: a narrative review and key points for clinical practice

2020 ◽  
Vol 14 (3) ◽  
pp. 126-135
Author(s):  
Mario Mitra ◽  
Andrea Mancuso ◽  
Flavia Politi ◽  
Alberto Maringhini
Keyword(s):  
Antibiotic Resistance ◽  
Bacterial Infections ◽  
Empirical Therapy ◽  
Multidrug Resistant ◽  
High Rate ◽  
First Episode ◽  
Bacterial Peritonitis ◽  
Prophylactic Measures ◽  
Tract Infections ◽  
Healthcare Associated

Bacterial infections are frequent complications of liver cirrhosis, accounting for severe clinical courses, and increased mortality. The reduction of the negative clinical impact of infections may be achieved by a combination of prophylactic measures to reduce the occurrence, early identification, and management. Spontaneous bacterial peritonitis (SBP), urinary tract infections, pneumonia, cellulitis, and spontaneous bacteremia are frequent in cirrhosis. The choice of initial empirical antimicrobial therapy should be based on both site, severity, and origin of infection (community-acquired, nosocomial, or healthcare-associated) and on antibiotic resistance patterns. 3rd generation cephalosporins are generally indicated as empirical therapy in most community-acquired cases. However, for nosocomial and healthcare-associated infections, due to a high rate of multidrug-resistant (MDR) pathogens, a broader spectrum treatment is appropriate. In order to prevent antibiotic resistance emergence, microbiological cultures should be collected, and a de-escalation applied when antimicrobial susceptibility tests are available. Standard measures to prevent infections and the identification of carriers of MDR bacteria are essential strategies to prevent infections in cirrhosis. Antibiotic prophylaxis should be applied only to gastrointestinal bleeding, SBP recurrence prevention, and cirrhotics at high risk of a first episode of SBP.

scholarly journals Healthcare-Associated Infections: Enterobacteriaceae Bloodstream Infections in the ICU Settings

2020 ◽  
Vol 41 (S1) ◽  
pp. s246-s247
Author(s):  
Marta KŁOS ◽  
Monika Pomorska-Wesołowska ◽  
Dorota Romaniszyn ◽  
Agnieszka Chmielarczyk ◽  
Jadwiga Wojkowska-Mach
Keyword(s):  
Drug Resistance ◽  
Hospital Care ◽  
Empirical Therapy ◽  
Bloodstream Infections ◽  
High Rate ◽  
Diffusion Method ◽  
Resistance Testing ◽  
High Level ◽  
Healthcare Associated ◽  
Hospital Acquired

Background: Bloodstream infections (BSIs) are one of the most frequently observed hospital-acquired infections (HAIs). Objectives: We aimed to describe the epidemiology and drug resistance of hospital-acquired Enterobacteriaceae BSIs and to check for any correlation with the type of hospital care. Methods: In 2015–2018, 333 Enterobacteriaceae isolates were collected from hospitalized internal medicine and surgical patients. The drug-resistance testing was conducted according to the EUCAST recommendations, using the disc-diffusion method to determine resistance to penicillin, cephalosporins, carbapenems, aminoglycosides, fluoroquinolones, and sulfamethoxazole with trimethoprim. Tests confirming the presence of extended-spectrum β-lactamases (ESBLs) and KPC, NDM, and OXA-48 carbapenemases were performed. We determined the minimum inhibitory concentration (MIC) values (mg/L) for selected antibiotics. To detect the resistance genes, a single PCR reaction, a multiplex PCR, and a real-time PCR were conducted. Results: The prevalence rate of Enterobacteriaceae bacilli in BSIs was 23.5%. Penicillin resistance remained at a very high level of almost 100%, with only the piperacillin-tazobactam resistance remaining at 19%–22%. The same was true for cephalosporins: the bacilli have only shown a high susceptibility to cefoperazone with sulbactam (4%–14% of them were resistant). Ciprofloxacin (53%–62%) and sulfamethoxazole with trimethoprim (48–55%) have proven highly resistant. Carbapenems were the only antibiotics with susceptibility at 98%–99%. No difference was found between the types of hospital care (surgical vs nonsurgical) and the levels of antimicrobial resistance in the studied Enterobacteriaceae isolates (Table 1). Conclusions: The high prevalence of Enterobacteriaceae bacilli in BSI is particularly worrying, as is the high rate of resistance to cephalosporins and aminoglycosides, which are often used in the empirical therapy. Unfortunately, our results indicate the need to base the empirical therapy on carbapenems.Funding: This work was supported by a grant from Jagiellonian Univerity Medical School (No. N41/DBS/000053)Disclosures: None

scholarly journals 1687. High-Rates of Candida auris Carriage and Co-Colonization with Multidrug-Resistant Organisms (MDROs)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S617-S617
Author(s):  
Ruby Barza ◽  
Parul Patel ◽  
Jignesh Patel ◽  
Lauren E Droske ◽  
Donna Schora ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
High Rate ◽  
Diffusion Method ◽  
Candida Auris ◽  
Prevalence Survey ◽  
E Coli ◽  
Carbapenem Resistant ◽  
Few Data ◽  
Healthcare Associated

Abstract Background Candida auris is an emerging multidrug-resistant pathogen that can persist in the environment and lead to healthcare-associated outbreaks. Residents of long-term acute care hospitals (LTACHs) are at particular risk for carriage of both MDROs and C. auris. However, there are few data on co-colonization rates of C. auris with other MDROs in LTACHs. Methods We conducted a point prevalence survey for MDROs, C. auris and C. difficile in a Chicago LTACH in March 2019. A combined axilla/groin E-swab (Copan) was collected and plated for C. auris isolation using CHROMagar Candida (Hardy). A rectal E-swab (Copan) was collected for C difficile PCR and MDRO detection including Carbapenem-resistant Enterobacteriaceae (CRE), Extended-spectrum B-lactamases (ESBLs) and Vancomycin-resistant Enterococci (VRE). Each swab was plated directly on VACC agar (Vancomycin, Amphotericin B, Ceftazidime, Clindamycin) and CHROMagar ESBL (Hardy). Bruker MALDI-TOF was used for bacterial and yeast identification and disc diffusion method for antimicrobial susceptibility testing. ESBL phenotypic confirmation was done using double-disc synergy method per CLSI guidelines. Carbapenemase production was confirmed using Xpert Carba-R assay (Cepheid). C. difficile PCR was performed using Xpert C. difficile/Epi assay (Cepheid). Results Of 38 patients 36 were eligible for the study (2 patients declined). Overall, 26/36 (72%) patients had an MDRO. Eight (22%) patients were positive for C. auris. Eight (22%) patients had ESBLs (2 P. mirabilis and 6 E. coli), six (17%) had CREs that were all blaKPC positive (4 K. pneumonia, 1 E. coli, and K. pneumoniae). Eight (22%) patients were positive for other gram-negative (GN)-MDROs including 1 A. baumanii, 3 P. aeruginosa, 2 E. cloacae, 1 E. asburiae and 1 P. aeruginosa, and A. baumanii. 20 patients (56%) had VRE colonization. Five (14%) were C. difficile PCR positive. 7/ 8 (87.5%) patients with C. auris were also colonized with another MDRO (2 VRE, 1 ESBL, 1 VRE, ESBL and KPC, 1 VRE and GN-MDRO, 1 VRE, ESBL and GN-MDRO, 1 VRE, KPC, and GN-MDRO). Conclusion We found a high rate of MDRO co-colonization among patients with C. auris carriage. Continuous active surveillance may be appropriate in LTACHs to limit the spread of C. auris and other MDROs. Disclosures All authors: No reported disclosures.

On the Future of the Financial Redistribution across Member States in the EU

2006 ◽  
Vol 56 (1) ◽  
pp. 1-43
Author(s):  
Sándor Richter
Keyword(s):  
Value Added ◽  
The Other ◽  
Current Debate ◽  
Member States ◽  
New Member States ◽  
Financial Position ◽  
Cross Member ◽  
Expenditure Structure ◽  
The Eu ◽  
Made In

The order and modalities of cross-member state redistribution as well as the net financial position of the member states are one of the most widely discussed aspects of European integration. The paper addresses selected issues in the current debate on the EU budget for the period 2007 to 2013 and introduces four scenarios. The first is identical to the European Commission's proposal; the second is based on reducing the budget to 1% of the EU's GNI, as proposed by the six net-payer countries, while maintaining the expenditure structure of the Commission's proposal. The next two scenarios represent radical reforms: one of them also features a '1% EU GNI'; however, the expenditures for providing 'EU-wide value-added' are left unchanged and it is envisaged that the requisite cuts will be made in the expenditures earmarked for cohesion. The other reform scenario is different from the former one in that the cohesion-related expenditures are left unchanged and the expenditures for providing 'EU-wide value-added' are reduced. After the comparison of the various scenarios, the allocation of transfers to the new member states in terms of the conditions prevailing in the different scenarios is analysed.

scholarly journals Clinical and microbiological characteristics of nosocomial, healthcare-associated, and community-acquired Klebsiella pneumoniae infections in Guangzhou, China

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Tingting Le ◽  
Ling Wang ◽  
Chaoying Zeng ◽  
Leiwen Fu ◽  
Zhihua Liu ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Bacterial Resistance ◽  
Empirical Therapy ◽  
Clonal Diversity ◽  
Extended Spectrum Beta Lactamase ◽  
Microbiological Characteristics ◽  
Carbapenemase Gene ◽  
Cross Transmission ◽  
Healthcare Associated

Abstract Background Klebsiella pneumoniae (K. pneumoniae) is a common pathogen associated with hospital and community-onset infections. This study aimed to compare the clinical and microbiological characteristics of nosocomial, healthcare-associated (HCA), and community-acquired (CA) K. pneumoniae infections. Methods Clinical data were extracted from electronic medical records and analyzed retrospectively. Antimicrobial susceptibility and extended-spectrum beta-lactamase (ESBL) production were determined for all identified strains. Carbapenemase and ESBL genes were amplified by PCR. Genotyping of carbapenem-resistant K. pneumoniae (CRKP) and ESBL-producing strains was performed by pulsed-field gel electrophoresis (PFGE). Results Of 379 K. pneumoniae infections, 98 (25.9%) were nosocomial, 195 (51.5%) were healthcare-associated, and 86 (22.6%) were community-acquired. Hematological malignancy (OR = 4.467), and hypertension (OR = 2.08) and cerebral vascular disease (OR = 2.486) were associated with nosocomial and HCA infections respectively, when compared to CA infections. Overall, the incidence of antimicrobial resistance for the majority of agents tested was similar between nosocomial and HCA infections (P > 0.05) and both groups had a higher incidence than CA infections (P < 0.05). Moreover, 95.1% (78/82) of CRKP strains were isolated from the nosocomial and HCA groups. The blaKPC was the most prevalent carbapenemase gene among CRKP strains (80.5%, 66/82). ESBL-producing strains were prevalent among nosocomial (40.8%), HCA (35.9%) and CA groups (24.4%). The blaCTX-M-9-group and blaCTX-M-1-group genes were predominant in nosocomial (65.0%) and CA strains (66.7%), respectively. PFGE results showed ESBL-producing and CRKP strains were genetically diverse. Identical PFGE profiles were observed among HCA and nosocomial strains. Conclusions Nosocomial and HCA K. pneumoniae infections presented similar clinical features and antimicrobial resistance, and both two types of infections were different to CA infections. CRKP and ESBL-producing strains were disseminated mainly in HCA and nosocomial groups, and showed a clonal diversity. The cross transmission of CRKP was existed among HCA and nosocomial patients. This finding suggests that similar empirical therapy should be considered for patients with nosocomial and HCA K. pneumoniae infections and bacterial resistance surveillance of these infections is necessary.

Changes in the rate of prophylactic vena cava filter insertion at a university hospital

2015 ◽  
Vol 31 (6) ◽  
pp. 403-408
Author(s):  
Andrew Smith ◽  
Demetri Adrahtas ◽  
Doreen Elitharp ◽  
Antonios Gasparis ◽  
Nicos Labropoulos ◽  
...  
Keyword(s):  
Vena Cava ◽  
Vena Cava Filter ◽  
University Hospital ◽  
High Rate ◽  
Inappropriate Use ◽  
Surgical Critical Care ◽  
Change In Practice ◽  
Filter Insertion ◽  
Level I ◽  
Second Period

Objective We previously demonstrated a high rate of prophylactic vena cava filter (VCF) insertion at our institution. We have since attempted to restrict the use of VCF to indications supported by Level-I evidence. This study was designed to evaluate the success of our interventions. Methods All patients receiving VCF between 2007–2009 and 2012–2014 at a university hospital were reviewed. After assessing the use of VCF in the first period, a meeting was convened among the Departments of Radiology, Vascular Surgery and Trauma. Policy was implemented to avoid the inappropriate use of VCF. Data were prospectively collected in the second period to assess the effect of our intervention. Results There were 156 VCF placed from 2012 to 2014. VCF was absolutely indicated in 84% of cases, relatively indicated in 9% and prophylactic in 7%. These data contrast our previous experience from 2007 to 2009. In the earlier series, a total of 244 filters were placed, in which 54% of patients had an absolute indication, 14% relative, and 32% prophylactic. There was a significant decrease in filters placed for pure prophylaxis: whereas 76 prophylactic filters were placed between 2007 and 2009, only 11 were placed between 2012 and 2014 ( p < 0.0001). No significant differences existed for relatively indicated filters. The department of trauma and surgical critical care (TSCC) observed the most dramatic change in practice. TSCC placed 61 prophylactic VCF between 2007 and 2009 (57% of all filters placed by the department), and 4 prophylactic VCF from 2012 to 2014 (15% of filters placed by TSCC) ( p < 0.0001). Conclusion These findings demonstrate a significant change in the attitudes regarding prophylactic VCF insertion between the two periods of study. Further investigations must be performed to assess changes in clinical outcomes that may result from the altered practice at our university.

scholarly journals Percutaneous Nephrostomy Tube-related Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S349-S349 ◽  
Author(s):  
Hanine El Haddad ◽  
George Viola ◽  
Ying Jiang ◽  
Issam Raad ◽  
Kenneth V Rolston ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Median Time ◽  
Antimicrobial Therapy ◽  
Urinary Tract Obstruction ◽  
Recurrent Infection ◽  
Percutaneous Nephrostomy ◽  
Infectious Complications ◽  
High Rate ◽  
History Of

Abstract Background Percutaneous nephrostomy tubes (PCN) are indicated for relief of urinary tract obstruction. These devices are prone to mechanical and infectious complications. The infection rate at 90 days is ±20%. Our objective was to determine whether discordant antimicrobial coverage provided prior to PCN exchange was associated with a higher rate of recurrent infection compared with those who received concordant therapy. Methods We retrospectively reviewed 780 patients that had undergone initial PCN placement at our institution between July 2014 and February 2017. We only included patients that had developed a definite PCN infection, subsequent PCN exchange, with a minimum 30 day post-PCN exchange follow up. We defined PCN infection as the presence of a positive urine culture (≥104 cfu/mL) plus symptoms consistent with a urinary tract infection. Recurrence was defined as a new PCN infection with the isolation of the same organism to the initial episode. Antibiotics were defined as concordant if they had activity against all organisms’ isolated based on antimicrobial susceptibilities. Results A total of 47 patients met our inclusion criteria. The median age of patients was 59, with 49% being male. The most common underlying tumors were urothelial (45%), cervical (17%) and prostate cancer (15%). Clinical characteristics included ureteral stents (17%), diabetes (19%), history of GU surgery (38%), and active chemotherapy at the time of PCN insertion (70%). The median time to onset of infection was 42 days. Infections were polymicrobial in 50% of the cases. The most common organisms encountered were Pseudomonas spp. (36%), Enterococcus spp. (23%) and Escherichia coli (18%). The median length of follow up of PCN tubes after exchange was 55 days. There were 12 (26%) recurrences occurring at a median time of 27 days. The provision of discordant antibiotics preceding PCN exchange was significantly associated with recurrence of infection (66.7% vs. 12.8%; P &lt; 0.002). Conclusion Discordant antimicrobial therapy provided during PCN exchange, in the setting of a PCN infection is associated with a higher rate of relapse. Therefore, to decrease the high rate for PCN reinfection, we propose that prior to PCN exchange secondary to infection, patients should be receiving concordant antimicrobial therapy. Disclosures All authors: No reported disclosures.

Staatsklimahaftung

2021 ◽  
Author(s):  
Isabell Böhm
Keyword(s):  
Climate Change ◽  
European Union ◽  
Greenhouse Gas ◽  
The European Union ◽  
Eu Member States ◽  
Basic Law ◽  
State Liability ◽  
Liability Claims ◽  
The Eu ◽  
Made In

Climate change litigation is becoming increasingly important. This thesis deals with the question whether state liability claims against Germany or the EU can be justified, if commitments to reduce greenhouse gas emissions are not met. For this purpose, the claim under public liability according to § 839 German Civil Code in connection with Art. 34 German Basic Law, the liability of the EU-Member States and the liability of the European Union according to Art. 340 II TFEU are discussed. At the end of the thesis, considerations on the practical perspectives of state liability are made in order to improve their prospects of success.

scholarly journals Crossing alone the Mediterranean sea. Some critical issues about unaccompanied minors in Europe

2017 ◽  
Vol 25 (51) ◽  
pp. 77-94
Author(s):  
Giovanni Giulio Valtolina ◽  
Marina D’Odorico
Keyword(s):  
Social Impact ◽  
Migrant Children ◽  
Unaccompanied Minors ◽  
Best Interest ◽  
Protection Measures ◽  
Eu Member States ◽  
Critical Issues ◽  
Common Framework ◽  
The Eu ◽  
Made In

Abstract Despite the increasing social impact of unaccompanied migrant minors (UAMs) in many European Union (EU) member states, EU regulations on UAMs are still inadequate and the necessary protection measures are thus insufficient. More specifically, the “best interest of the child”, stated in a large number of international documents, may not be properly guaranteed. In addition, there is often a discrepancy between the rights of migrant children, according to the international legislation, and the actual protection they receive. Moreover, despite the declared aim of reaching a common standard of reception and inclusion, policies and practices across Europe are still very different. The paper attempts to highlight and discuss some critical issues regarding UAMs in Europe. Over and beyond the need for the EU to develop a common framework, greater efforts should be made in order to improve inclusion of UAMs, especially to ensure the management of the phenomenon beyond the current emergency.

scholarly journals Pattern of the Antimalarials Prescription during Pregnancy in Bangui, Central African Republic

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Alexandre Manirakiza ◽  
Georges Soula ◽  
Remi Laganier ◽  
Elise Klement ◽  
Djibrine Djallé ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Providers ◽  
Central African Republic ◽  
First Trimester ◽  
High Rate ◽  
Care Providers ◽  
National Guidelines ◽  
Artemisinin Derivatives ◽  
First Trimester Of Pregnancy ◽  
Antenatal Clinics

Introduction. The aim of this study was to identify the antimalarials prescribed during the pregnancy and to document their timing. Method. From June to September 2009, a survey was conducted on 565 women who gave birth in the Castors maternity in Bangui. The antenatal clinics cards were checked in order to record the types of antimalarials prescribed during pregnancy according to gestational age. Results. A proportion of 28.8% ANC cards contained at least one antimalarial prescription. The commonest categories of antimalarials prescribed were: quinine (56.7%), artemisinin-based combinations (26.8%) and artemisinin monotherapy (14.4%). Among the prescriptions that occurred in the first trimester of pregnancy, artemisinin-based combinations and artemisinin monotherapies represented the proportions of (10.9%) and (13.3%). respectively. Conclusion. This study showed a relatively high rate (>80%) of the recommended antimalarials prescription regarding categories of indicated antimalarials from national guidelines. But, there is a concern about the prescription of the artemisinin derivatives in the first trimester of pregnancy, and the prescription of artemisinin monotherapy. Thus, the reinforcement of awareness activities of health care providers on the national malaria treatment during pregnancy is suggested.

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