scholarly journals 1423. Antibiotic Utilization and Outcomes in Patients with Sacral Osteomyelitis and Decubitus Ulcers

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S518-S519
Author(s):  
Kelly Carpenter Byrge ◽  
Amanda Bailey ◽  
Bryan Harris ◽  
Thomas Talbot ◽  
Patty Wright ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Bone Biopsy ◽  
Antibiotic Use ◽  
Decubitus Ulcer ◽  
Advanced Stage ◽  
Tissue Cultures ◽  
Decubitus Ulcers ◽  
Clinical Concern ◽  
Antibiotic Utilization ◽  
Sacral Osteomyelitis

Abstract Background Osteomyelitis is a common complication of advanced stage pressure ulcers and known to be associated with increased mortality, length of stay (LOS), and treatment costs. However, limited data and lack of guidelines regarding appropriate diagnosis and treatment result in variability in management. We sought to investigate whether microbiology data are associated with reduced antibiotic utilization in patients with osteomyelitis secondary to decubitus ulcers. Methods This retrospective cohort study included hospitalized patients from 2007 to 2015 with an advanced stage (IV or unstageable) sacral decubitus ulcer and clinical concern for osteomyelitis. The exposure group was those who underwent tissue culture (superficial swab, deep bedside or surgical tissue, or bone biopsy). The primary outcome was antibiotic days of therapy (DOT). Additional secondary outcomes including clinical characteristics at presentation, LOS, readmission rates, and antibiotic-related complications were evaluated using Fisher’s exact or Wilcoxon-Mann–Whitney test for continuous variables. Results A total of 220 cases of advanced-stage decubitus ulcer with clinical concern for osteomyelitis were identified. Data abstracted from 40 cases show that tissue cultures were obtained in 22 (55%). Bacterial growth was identified from 100% of samples sent for culture. Antibiotic use prior to admission was the most significant predictor of failure to obtain tissue cultures (P = 0.0002). MRI was performed in 15% of abstracted cases, with radiographic evidence of osteomyelitis noted in 100%. Bone biopsy was performed in 4 cases; bone pathology was not sent in any of these instances. Median antibiotic DOT was 84 days in both groups. Conclusion In cases of sacral osteomyelitis secondary to decubitus ulcers, antibiotic use prior to admission was inversely related to the likelihood of obtaining a tissue culture. When tissue cultures were obtained, they were uniformly positive; however, in our preliminary analysis of 40 cases, this did not appear to influence antibiotic utilization as determined by DOT. Bone biopsy was rarely performed, and when done, was not sent for pathology despite this being recognized as the gold standard in the diagnosis of osteomyelitis. Disclosures All authors: No reported disclosures.

scholarly journals Clinical Team Distribution and Antibiotic Use Patterns at a Tertiary-Care Academic Medical Center

2020 ◽  
Vol 41 (S1) ◽  
pp. s168-s169
Author(s):  
Rebecca Choudhury ◽  
Ronald Beaulieu ◽  
Thomas Talbot ◽  
George Nelson
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Care Hospital ◽  
Hospital Units ◽  
Antibiotic Utilization ◽  
Academic Medical ◽  
Level Data ◽  
Utilization Data

Background: As more US hospitals report antibiotic utilization to the CDC, standardized antimicrobial administration ratios (SAARs) derived from patient care unit-based antibiotic utilization data will increasingly be used to guide local antibiotic stewardship interventions. Location-based antibiotic utilization surveillance data are often utilized given the relative ease of ascertainment. However, aggregating antibiotic use data on a unit basis may have variable effects depending on the number of clinical teams providing care. In this study, we examined antibiotic utilization from units at a tertiary-care hospital to illustrate the potential challenges of using unit-based antibiotic utilization to change individual prescribing. Methods: We used inpatient pharmacy antibiotic use administration records at an adult tertiary-care academic medical center over a 6-month period from January 2019 through June 2019 to describe the geographic footprints and AU of medical, surgical, and critical care teams. All teams accounting for at least 1 patient day present on each unit during the study period were included in the analysis, as were all teams prescribing at least 1 antibiotic day of therapy (DOT). Results: The study population consisted of 24 units: 6 ICUs (25%) and 18 non-ICUs (75%). Over the study period, the average numbers of teams caring for patients in ICU and non-ICU wards were 10.2 (range, 3.2–16.9) and 13.7 (range, 10.4–18.9), respectively. Units were divided into 3 categories by the number of teams, accounting for ≥70% of total patient days present (Fig. 1): “homogenous” (≤3), “pauciteam” (4–7 teams), and “heterogeneous” (>7 teams). In total, 12 (50%) units were “pauciteam”; 7 (29%) were “homogeneous”; and 5 (21%) were “heterogeneous.” Units could also be classified as “homogenous,” “pauciteam,” or “heterogeneous” based on team-level antibiotic utilization or DOT for specific antibiotics. Different patterns emerged based on antibiotic restriction status. Classifying units based on vancomycin DOT (unrestricted) exhibited fewer “heterogeneous” units, whereas using meropenem DOT (restricted) revealed no “heterogeneous” units. Furthermore, the average number of units where individual clinical teams prescribed an antibiotic varied widely (range, 1.4–12.3 units per team). Conclusions: Unit-based antibiotic utilization data may encounter limitations in affecting prescriber behavior, particularly on units where a large number of clinical teams contribute to antibiotic utilization. Additionally, some services prescribing antibiotics across many hospital units may be minimally influenced by unit-level data. Team-based antibiotic utilization may allow for a more targeted metric to drive individual team prescribing.Funding: NoneDisclosures: None

scholarly journals RS virus diagnosis: comparison of isolation, immunofluorescence and enzyme immunoassay

1986 ◽  
Vol 81 (2) ◽  
pp. 225-232 ◽  
Author(s):  
Marilda M. Siqueira ◽  
Vanja Ferreira ◽  
Jussara P. Nascimento
Keyword(s):  
Tissue Culture ◽  
Respiratory Syncytial Virus ◽  
Enzyme Immunoassay ◽  
Bacterial Contamination ◽  
Virus Isolation ◽  
Rapid Diagnosis ◽  
Tissue Cultures ◽  
Virus Diagnosis ◽  
Under Five ◽  
Syncytial Virus

Two techniques for rapid diagnosis, immunofluorescence (IFAT) and enzyme immunoassay (EIA), have been compared with virus isolaion in tissue culture for the detection of respiratory syncytial virus (RSV) in specimens of nasopharyngeal secretions. The specimens were obtained from children under five years of age suffering from acute respiratory iliness, during a period of six months from January to June 1982. Of 471 specimens examined 54 (11.5%) were positive by virus isolation and 180 (38.2%) were positive by immunofluorescence. The bacterial contamination of inoculated tissue cultures unfortunately prevented the isolation of virus from many samples. Specimens from 216 children were tested to compare enzyme immunoassay and immunofluorescence. Of these 60 (27%) were positive by EIA and 121 (56%) were positive by IFAT. Our results suggest that the EIA technique although highly specific is rather insensitive. This may be because by the time these tests were done the originl nasopharyngeal secretions were considerably diluted and contained more mucus fragments than the call suspension used for IFAT. Of the three techniques, IFAT gives the best results although EIA may be useful where IFAT is not possible.

scholarly journals Micro-operations on cells in tissue cultures

1931 ◽  
Vol 109 (763) ◽  
pp. 380-403 ◽  
Keyword(s):  
Tissue Culture ◽  
Continuous Control ◽  
Tissue Cultures ◽  
Special Paper ◽  
Long Time

The application of the micromanipulative technique to the study of cells in tissue culture has for a long time offered an interesting, though difficult, field of research. Thus far, comparatively little has been done, the most notable contributions being those of Levi and of Peterfi and co-workers (Levi, 1926 ; Peterfi and Olivo, 1925 ; Peterfi, 1927 ; Peterfi and Kapel, 1928). Peterfi has also written a special paper on the technique (1927). The main deterrent in this work has been the lack of sufficient ease in the accurate and continuous control of the microneedles under the conditions required.

scholarly journals Sonication Culture of Antimicrobial Agent-Containing Cement Spacers Removed during Staged Revisions for Arthroplasty Infection

2018 ◽  
Vol 57 (2) ◽  
Author(s):  
Eric Gomez-Urena ◽  
Rafael J. Sierra ◽  
Kerryl E. Greenwood-Quiantance ◽  
Melissa J. Karau ◽  
James M. Steckelberg ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Antimicrobial Agent ◽  
Persistent Infection ◽  
Joint Infection ◽  
Revision Arthroplasty ◽  
Similar Proportion ◽  
Tissue Cultures ◽  
Periprosthetic Tissue ◽  
Prosthetic Joint ◽  
Sonication Culture

ABSTRACT Diagnosis of persistent infection at the time of reimplantation for staged revision of infected arthroplasties is challenging. Implant sonication culture for the diagnosis of prosthetic joint infection (PJI) has improved sensitivity compared to standard periprosthetic tissue culture. We report our experience with periprosthetic tissue culture and sonication culture of antimicrobial agent-containing cement spacers (ACSs) collected during second stages of staged revisions for arthroplasty infection. We studied 87 ACSs from 66 patients undergoing two-stage revision arthroplasty for PJI submitted for sonication culture, along with conventional periprosthetic tissue cultures. Two or more positive periprosthetic tissue cultures with the same organism were considered a positive tissue culture. For sonication culture, ≥20 CFU of bacteria per 10 ml of sonicate fluid was considered positive. The sensitivity and specificity of periprosthetic tissue and ACS sonication culture in detecting persistent infection, as well as their association with outcome, were assessed. Persistent infection occurred in 26% of cases. Periprosthetic tissue and sonicate fluid culture had specificities of 96.3 and 100% (P = 0.50), respectively, and sensitivities of 31.6 and 26.3% (P = 1.00), respectively, for the diagnosis of persistent infection. Thirteen subjects deemed not to have persistent infection at time of reimplantation and who had negative periprosthetic tissue and sonicate fluid cultures subsequently developed overt infection. Sonication culture of cement spacers identifies a similar proportion of patients with persistent infection during staged revisions, as detected by periprosthetic tissue cultures; both have low sensitivities to detect persistent infection.

scholarly journals The Effect of Daminozide, Dark/Light Schedule and Copper Sulphate in Tissue Culture of Triticum timopheevii

Plants ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 2620
Author(s):  
Dmitry Miroshnichenko ◽  
Anna Klementyeva ◽  
Sergey Dolgov
Keyword(s):  
Tissue Culture ◽  
Somatic Embryogenesis ◽  
Callus Induction ◽  
Copper Ions ◽  
Induction Medium ◽  
Tissue Cultures ◽  
Triticum Timopheevii ◽  
Dark Light ◽  
Green Plants ◽  
Callus Induction Medium

Triticum timopheevii Zhuk. is a tetraploid wheat that is utilized worldwide as a valuable breeding source for wheat improvement. Gene-based biotechnologies can contribute to this field; however, T. timopheevii exhibits recalcitrance and albinism in tissue cultures, making this species of little use for manipulation through genetic engineering and genome editing. This study tested various approaches to increasing in vitro somatic embryogenesis and plant regeneration, while reducing the portion of albinos in cultures derived from immature embryos (IEs) of T. timopheevii. They included (i) adjusting the balance between 2,4-D and daminozide in callus induction medium; (ii) cultivation using various darkness/illumination schedules; and (iii) inclusion of additional concentrations of copper ions in the tissue culture medium. We achieved a 2.5-fold increase in somatic embryogenesis (up to 80%) when 50 mg L−1 daminozide was included in the callus induction medium together with 3 mg L−1 2,4-D. It was found that the dark cultivation for 20–30 days was superior in terms of achieving maximum culture efficiency; moreover, switching to light in under 2 weeks from culture initiation significantly increased the number of albino plants, suppressed somatic embryogenesis, and decreased the regeneration of green plants. Media containing higher levels of copper ions did not have a positive effect on the regeneration of green plants; contrarily, the elevated concentrations caused albinism in plantlets. The results and relevant conclusions of the present study might be valuable for establishing an improved protocol for the regeneration of green plants in tissue cultures of T. timopheevii.

scholarly journals The impact of sonication cultures when the diagnosis of prosthetic joint infection is inconclusive

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0252322
Author(s):  
Taiana Cunha Ribeiro ◽  
Emerson Kiyoshi Honda ◽  
Daniel Daniachi ◽  
Ricardo de Paula Leite Cury ◽  
Cely Barreto da Silva ◽  
...  
Keyword(s):  
Tissue Culture ◽  
Diagnostic Criteria ◽  
Gold Standard ◽  
Joint Infection ◽  
Clinical Criterion ◽  
Tissue Cultures ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
The Impact ◽  
Sonication Culture

Background In the absence of a gold standard criterion for diagnosing prosthetic joint infections (PJI), sonication of the removed implant may provide superior microbiological identification to synovial fluid and peri-implant tissue cultures. The aim of this retrospective study was to assess the role of sonication culture compared to tissue cultures for diagnosing PJI, using different consensus and international guidelines for PJI definition. Methods Data of 146 patients undergoing removal of hip or knee arthroplasties between 2010 and 2018 were retrospectively reviewed. The International Consensus Meeting (ICM-2018), Musculoskeletal Infection Society (MSIS), Infectious Diseases Society of America (IDSA), the European Bone and Joint Infection Society (EBJIS), and a modified clinical criterion, were used to compare the performance of microbiological tests. McNemar´s test and proportion comparison were employed to calculate p-value. Results Overall, 56% (82/146) were diagnosed with PJI using the clinical criteria. Out of these cases, 57% (47/82) tested positive on tissue culture and 93% (76/82) on sonication culture. Applying this clinical criterion, the sensitivity of sonication fluid and tissue cultures was 92.7% (95% CI: 87.1%- 98.3%) and 57.3% (95% CI: 46.6%-68.0%) (p<0.001), respectively. When both methods were combined for diagnosis (sonication and tissue cultures) sensitivity reached 96.3% (95% CI: 91.5%-100%). Sonication culture and the combination of sonication with tissue cultures, showed higher sensitivity rates than tissue cultures alone for all diagnostic criteria (ICM-18, MSIS, IDSA and EBJIS) applied. Conversely, tissue culture provided greater specificity than sonication culture for all the criteria assessed, except for the EBJIS criteria, in which sonication and tissue cultures specificity was 100% and 95.3% (95% CI: 87.8–100%), respectively (p = 0.024). Conclusions In a context where diagnostic criteria available have shortcomings and tissue cultures remain the gold standard, sonication cultures can aid PJI diagnosis, especially when diagnostic criteria are inconclusive due to some important missing data (joint puncture, histology).

Neonatal and Pediatric Pressure Injuries Secondary to Limb Splinting for Intravascular Access: Case Series and Literature Review

2018 ◽  
Vol 23 (2) ◽  
pp. 108-116 ◽  
Author(s):  
Kyrie A. Sweeney ◽  
Kate Cogill ◽  
Katrina Davis ◽  
Jacqueline I. Jauncey-Cooke
Keyword(s):  
Literature Review ◽  
Case Series ◽  
Decubitus Ulcer ◽  
Evidence Base ◽  
Infants And Children ◽  
Cochrane Library ◽  
Decubitus Ulcers ◽  
Paediatric Hospital ◽  
Pressure Injury ◽  
The Cochrane Library

Abstract Aim: This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon. Background: Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016. Methods: A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies), pressure ulcer, pressure ulcers, decubitus ulcer, and decubitus ulcers. Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital. Results: Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases. Conclusions: There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended.

scholarly journals Trends in Antibiotic Utilization in Vancouver Associated With a Community Education Program on Antibiotic Use

2010 ◽  
Vol 101 (4) ◽  
pp. 304-308 ◽  
Author(s):  
Elaine Isabelle Fuertes ◽  
Bonnie Henry ◽  
Fawziah Marra ◽  
Hubert Wong ◽  
David M. Patrick
Keyword(s):  
Education Program ◽  
Community Education ◽  
Antibiotic Use ◽  
Antibiotic Utilization

scholarly journals Electronically Available Patient Claims Data Improve Models for Comparing Antibiotic Use Across Hospitals: Results From 576 US Facilities

2020 ◽  
Author(s):  
Katherine E Goodman ◽  
Lisa Pineles ◽  
Laurence S Magder ◽  
Deverick J Anderson ◽  
Elizabeth Dodds Ashley ◽  
...  
Keyword(s):  
Claims Data ◽  
External Validation ◽  
Antibiotic Use ◽  
Delphi Consensus ◽  
Variable Model ◽  
Patient Level ◽  
Antibiotic Utilization ◽  
Days Of Therapy ◽  
Control And Prevention ◽  
Antimicrobial Administration

Abstract Background The Centers for Disease Control and Prevention (CDC) uses standardized antimicrobial administration ratios (SAARs)—that is, observed-to-predicted ratios—to compare antibiotic use across facilities. CDC models adjust for facility characteristics when predicting antibiotic use but do not include patient diagnoses and comorbidities that may also affect utilization. This study aimed to identify comorbidities causally related to appropriate antibiotic use and to compare models that include these comorbidities and other patient-level claims variables to a facility model for risk-adjusting inpatient antibiotic utilization. Methods The study included adults discharged from Premier Database hospitals in 2016–2017. For each admission, we extracted facility, claims, and antibiotic data. We evaluated 7 models to predict an admission’s antibiotic days of therapy (DOTs): a CDC facility model, models that added patient clinical constructs in varying layers of complexity, and an external validation of a published patient-variable model. We calculated hospital-specific SAARs to quantify effects on hospital rankings. Separately, we used Delphi Consensus methodology to identify Elixhauser comorbidities associated with appropriate antibiotic use. Results The study included 11 701 326 admissions across 576 hospitals. Compared to a CDC-facility model, a model that added Delphi-selected comorbidities and a bacterial infection indicator was more accurate for all antibiotic outcomes. For total antibiotic use, it was 24% more accurate (respective mean absolute errors: 3.11 vs 2.35 DOTs), resulting in 31–33% more hospitals moving into bottom or top usage quartiles postadjustment. Conclusions Adding electronically available patient claims data to facility models consistently improved antibiotic utilization predictions and yielded substantial movement in hospitals’ utilization rankings.

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