scholarly journals 2417. Feasibility and Safety of Using a Probiotic Comprised of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 for C. difficile Infection Prevention Among Antibiotic Users: 15-Years of Prospective Results from a Single-Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S834-S835
Author(s):  
Pierre-Jean Maziade ◽  
Daniel Lussier ◽  
Francoise Dubé
Keyword(s):  
Health System ◽  
Lactobacillus Acidophilus ◽  
Infection Prevention ◽  
Health Agency ◽  
Antibiotic Use ◽  
Limited Data ◽  
Prevention Strategies ◽  
The Past ◽  
To Receive

Abstract Background Hospitals use multiple concurrent prevention strategies to curb nosocomial C. difficile infection, but there are limited data on the long-term feasibility or safety of using a probiotic. Pierre-Le Gardeur Hospital, Québec, has been administering a probiotic comprised of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2 since 2004 with documented results through March 31, 2014. Here we present an update for the past 5 years. Methods Several nosocomial infection prevention practices were running concurrently at the hospital. Adult inpatients treated with antibiotics from April 1, 2014 to March 31, 2019 were eligible to receive the probiotic. The hospital pharmacy ensured that each patient took the probiotic capsules (Bio-K+® 50 Billion) daily from the initiation of antibiotic use. Confirmed nosocomial cases of C. difficile infection were recorded and reported to the provincial public health agency. The rate of nosocomial CDI for this hospital was compared with other non-University affiliated hospitals in the health region with more than 110 beds and fewer than 45% of patients age 65 and older, and, to all other hospitals in the health system. Results Cumulatively over the past 15 years, more than sixty thousand antibiotic-treated adult inpatients took the probiotic daily during antibiotic use. Among 13 comparable hospitals, Pierre-Le Gardeur Hospital had the lowest rate of nosocomial CDI in 2014–2015, 2015–2016, 2016–2017, 2017–2018 and on average had the lowest rate for 2013–2018 (1.1 CDI cases per 10,000 patient-days). Compared with all hospitals in the Province of Quebec health system, N = 95, the hospital had the lowest nosocomial CDI rate on average for 2013–2018. No cases of Lactobacillus bacteremia were detected. Conclusion The overall infection prevention strategy has been highly effective, resulting in a consistently low rate of nosocomial CDI. We found that it is feasible to administer this probiotic to antibiotic-treated inpatients with few restrictions. No Lactobacillus infections were observed from any of the three strains of bacteria for this probiotic when given to more than sixty thousand adult inpatients. Disclosures All authors: No reported disclosures.

scholarly journals 2446. Longitudinal Results and Cost Savings Using a Bundle of C. difficile Infection Prevention Strategies in a Long-Term Care Facility

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S845-S846
Author(s):  
Bridget A Olson ◽  
Michael L Butera ◽  
Noam Ship
Keyword(s):  
Infection Prevention ◽  
Long Term Care ◽  
Care Facility ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Prevention Strategies ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

Abstract Background Long-term care patients are at high risk of C. difficile infections (CDI) due to advanced age, high comorbid illness burden, and frequent antibiotic use. Primary infection prevention of CDI is challenging and not frequently studied. Following a period of high CDI incidence, the Long-Term Care facility at Sharp Coronado Hospital implemented a bundle of strategies. Methods Patient census, the incidence of CDI (primary and recurrent cases), transfers to acute care and length-of-stay were collected from Jul 2008 through December 2018. In the first phase, 2010, a bundle of CDI prevention strategies was initiated, including an Antimicrobial Stewardship Program (ASP), reduction of acid suppression, and L. acidophilus and S. boulardii probiotics with antibiotic use. From 2012, there was further refinement of the ASP and the probiotic was changed to capsules of a 3-species combination of Lactobacillus acidophilus CL1285, L. casei LBC80R and L. rhamnosus CLR2, 100 Billion CFU daily. In October 2016, a protocol was put in place delegating authority to pharmacists to add probiotics to all antibiotic courses. The average CDI rates were calculated and compared for each time period. The net cost of CDI was calculated from the number of CDI cases, hospital length-of-stay and probiotic purchases. Results The incidence of facility-onset CDI cases decreased significantly with each policy change from 7.6 cases/10,000 patient-days (2008–09), to 2.8 (2010–11, p = 0.028), to 0.91 (2012-Q3 2016, p = 0.0015) and to the present incidence 0.24 (Q4 2016–2018, p = 0.048). The annual cost of facility-onset CDI was $214k initially. The annual cost, including the purchase of probiotic, decreased to $161k with introduction of the bundle, to $57k in switching probiotics, and to $18k with initiation of a probiotic policy. Conclusion Implementing a bundle of concurrent infection prevention strategies resulted in a significant reduction in CDI incidence. Refinements to the bundle led to significant reductions in CDI incidence, along with switching the type of probiotic, and delegating ordering authority to pharmacists to ensure probiotic compliance. Cumulatively, there was a 95% decrease in CDI incidence at the Long-Term Care facility and meaningful cost savings with each refinement. Disclosures All authors: No reported disclosures.

The Past, Present, and Future of Healthcare-Associated Infection Prevention in Pediatrics: Catheter-Associated Bloodstream Infections

2010 ◽  
Vol 31 (S1) ◽  
pp. S27-S31 ◽  
Author(s):  
Kristina A. Bryant ◽  
Danielle M. Zerr ◽  
W. Charles Huskins ◽  
Aaron M. Milstone
Keyword(s):  
Infection Prevention ◽  
Bloodstream Infections ◽  
Central Line ◽  
Morbidity And Mortality ◽  
Prevention Strategies ◽  
Healthcare Associated Infection ◽  
Research Topics ◽  
The Past ◽  
Healthcare Associated ◽  
Current Practices

Central line–associated bloodstream infections cause morbidity and mortality in children. We explore the evidence for prevention of central line–associated bloodstream infections in children, assess current practices, and propose research topics to improve prevention strategies.

scholarly journals Long-Term Use of Antibiotics and Risk of Parkinson’s Disease in the Nurses’ Health Study

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Natalia Palacios ◽  
Éilis J O’Reilly ◽  
Michael A. Schwarzschild ◽  
Alberto Ascherio
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Total Duration ◽  
Antibiotic Use ◽  
Health Study ◽  
Environmental Predictors ◽  
Definitive Evidence ◽  
The Past ◽  
Cox Proportional Hazard Regression

Objective. Antibiotic use is one of the strongest environmental predictors of an altered and less diverse gut microbiome, which has been linked to Parkinson’s disease. To our knowledge, no prior study has examined the association between long-term antibiotic use and Parkinson’s disease. Design. We conducted a prospective study of 59,637 women in the Nurses’ Health Study who reported total duration of antibiotic use at ages 20–39, 40–59, 60 +, or during the past 4 years. We used Cox Proportional Hazard regression to estimate hazard ratios and 95% confidence intervals for the association between categories of antibiotic use and risk of PD. Results. One hundred and eighty cases of PD were confirmed during the follow-up. Self-reported antibiotic use at ages 20–39, 40–59, and 60 +, as assessed in 2004, was not significantly associated with PD risk in our cohort. The hazard ratio comparing participants who used antibiotics for 2 or more months vs. 1–14 days at age 20–39 was 0.98 (95% CI: 0.54, 1.78), at age 40–59 was 1.44 (95% CI: 0.88, 2.33), and at age 60 +was 0.88 (95% CI: 0.53, 1.47). Antibiotic use during the past four years, as assessed in 2008, was also not associated with future risk of PD (HR: 1.14, 95% CI: 0.62, 2.10). Conclusion. In this cohort study, we did not observe a significant association between antibiotic use and incidence PD. A major limitation of our study is assessment of exposure, which required many participants to recall their antibiotic use decades in the past. Thus, although the results of this study do not support an effect of antibiotic use on PD risk, larger investigations relying on records of antibiotic prescriptions would provide more definitive evidence.

scholarly journals Stability of the bedrock of castle building for geotourism purposes

2021 ◽  
Vol 906 (1) ◽  
pp. 012028
Author(s):  
Miloš Duraj ◽  
Dominik Niemiec ◽  
Estevao Mendes ◽  
Erik Sombathy
Keyword(s):  
Slovak Republic ◽  
Complete Solution ◽  
Geological Structure ◽  
Petrographic Composition ◽  
The Past ◽  
Tectonic Disturbances ◽  
The Stability ◽  
Continuous Work ◽  
To Receive

Abstract The geological structure of the Slovak Republic is very complex and varied. This fact in the course of centuries has had an impact on the castle buildings built here. The subsoil of these structures has different petrographic composition, tectonic disturbances and other geological complexities that threaten the stability of these structures and endanger the objects in their surroundings. In recent years, these structures have begun to receive deserved attention. In the past, the problems of severely disturbed blocks in the subsoil were mainly addressed and had to be rehabilitated for these reasons. These were mainly buildings whose subsoil is built with carbonate rocks. A perfect example of a long-term solution to these complex problems is also the Strecno Castle. A lot of effort and money has already been devoted to solving the stability of the bedrock, which also adversely affects the stability of the castle. However, the extensive set of works that have been carried out here over a long period of time have not brought a complete solution to the problems that occur here. For this reason, continuous work is being carried out here under the guidance of experts to eliminate the effects of erosion of the bedrock in particular. In the present work, the activities and measures that have been implemented here in stages up to the present are briefly described chronologically.

1261Geographical variations in the incidence of CIED infection and infection prevention strategies: Update from the global WRAP-IT study

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
C Kennergren ◽  
J E Poole ◽  
B L Wilkoff ◽  
S Mittal ◽  
G R Corey ◽  
...  
Keyword(s):  
North America ◽  
South America ◽  
Infection Rate ◽  
Infection Prevention ◽  
Patient Characteristics ◽  
Prevention Strategies ◽  
Infection Rates ◽  
Major Infection ◽  
Geographical Variations ◽  
To Receive

Abstract Funding Acknowledgements Medtronic, Inc. Introduction Cardiac Implantable Electronic Device (CIED) infections lead to significant morbidity, mortality, and use of health care resources. There is variation in infection prevention strategies among centers, and it is not clear whether there is also variation in infection rates across different geographies. Recently, WRAP-IT, the largest global randomized trial to evaluate an infection reduction strategy, randomized 6,983 patients to receive an antibacterial envelope (treatment) vs. no envelope (control). The results demonstrated a significant reduction in major CIED infection with the TYRX antibiotic envelope (12-mo infection rate for envelope vs. control 0.7% and 1.2%, respectively; HR, 0.60; 95% [CI], 0.36 to 0.98; P = 0.04).  The purpose of this analysis is to assess geographical variations in patient characteristics, procedural routines, and infection rates. Methods The WRAP-IT study enrolled patients undergoing a CIED pocket revision, generator replacement, or system upgrade or an initial implantation of a cardiac resynchronization therapy defibrillator and randomized them to receive the envelope or not, in addition to mandated pre-procedure intravenous antibiotic prophylaxis. To assess geographical variations in infection rates, the control group (per protocol) baseline demographics and procedural characteristics were identified. Major infection was defined as CIED infections resulting in system extraction or revision, long-term antibiotic therapy with infection recurrence, or death. Results A total of 3429 control patients were evaluated and followed for a mean of 20.9 ± 8.3 months; 2530 patients from 123 centers in North America, 777 patients from 46 centers in Europe, and 122 patients from 11 centers in Asia/South America. The 24-month Kaplan-Meier major infection rates were 1.2% in North America (30 pts), 2.5% in Europe (16 pts), and 4.3% Asia/South America (5 pts) (see Figure). These geographical variations in the incidence of major CIED infections were significant (overall P = 0.008, univariate). There were differences in baseline patient characteristics, including age, sex, medication use, NYHA Class, and number of previous devices across geographies. Differences also included procedural characteristics, such as device type, use of pocket wash, skin preparation, pre-operative antibiotic drug use, and procedure time. Conclusion Major CIED infection rates vary significantly across geographies. The effect of patient demographics and procedural characteristics on these findings will be assessed and presented at EHRA. Insights into geographical variability of CIED infections is important to mitigate infection risk, reduce morbidity and cost. Abstract Figure. Major CIED Infection Rate by Geography

Perioperative Anticoagulation Practices of Surgeons in a Health System

2000 ◽  
Vol 35 (5) ◽  
pp. 504-510
Author(s):  
Donna Barnhart ◽  
Luis S. Gonzalez
Keyword(s):  
Health System ◽  
Randomized Trials ◽  
Warfarin Therapy ◽  
Practice Patterns ◽  
Management Strategies ◽  
Optimal Management ◽  
Intravenous Heparin ◽  
Perioperative Anticoagulation ◽  
To Receive

Several different management strategies for patients receiving long-term warfarin therapy who require surgery have been recommended in the literature. A recent article by Kearon and Hirsch made new recommendations based on estimating the risk of thromboembolism and bleeding from randomized trials and prospective studies. Because of the potential for variability in practice patterns, we surveyed physicians in our health system to identify their perioperative anticoagulation practices. Our results confirm variability in practice patterns. Perioperative intravenous heparin was the most frequently reported method of prophylaxis. Fifty-three percent of the surveyed physicians admitted patients to the hospital two or more days prior to surgery to receive prophylaxis. Further research is necessary to determine optimal management of perioperative anticoagulation.

scholarly journals Long-term use of antibiotics and risk of type 2 diabetes in women: a prospective cohort study

2020 ◽  
Vol 49 (5) ◽  
pp. 1572-1581
Author(s):  
Jinqiu Yuan ◽  
Yanhong Jessika Hu ◽  
Jie Zheng ◽  
Jean Hee Kim ◽  
Tim Sumerlin ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Cohort Study ◽  
Family History ◽  
Antibiotic Use ◽  
Family History Of Diabetes ◽  
The Past ◽  
Increased Risk ◽  
History Of

Abstract Background Accumulating evidence suggested that long-term antibiotic use may alter the gut microbiome, which has, in turn, been linked to type 2 diabetes. We undertook this study to investigate whether antibiotic use was associated with increased risk of type 2 diabetes. Methods This prospective cohort study included women free of diabetes, cardiovascular disease and cancer in the Nurses’ Health Study (NHS 2008–2014) and NHS II (2009–2017). We evaluated the overall duration of antibiotics use in the past 4 years and subsequent diabetes risk with Cox proportional-hazards regression adjusting for demography, family history of diabetes and lifestyle factors. Results Pooled analyses of NHS and NHS II (2837 cases, 703 934 person-years) revealed that a longer duration of antibiotic use in the past 4 years was associated with higher risk of diabetes [Trend-coefficient = 0.09, 95% confidence interval (CI) 0.04 to 0.13]. Participants who received antibiotics treatment for a medium duration of 15 days to 2 months [hazard ratio (HR) 1.23, 95% CI 1.10 to 1.39] or long duration of >2 months (HR 1.20, 95% CI 1.02 to 1.38) had higher risk of type 2 diabetes as compared with non-users. Subgroup analyses suggested that the associations were unlikely to be modified by age, family history of diabetes, obesity, smoking, alcohol drinking, physical activity and overall diet quality. Conclusions A longer duration of antibiotic use in recent years was associated with increased risk of type 2 diabetes in women. Physicians should exercise caution when prescribing antibiotics, particularly for long-term use.

scholarly journals Impending scope of Water Sanitation and Hygiene (WASH) in the post COVID19 pandemic era: An opportunity call

2020 ◽  
Vol 32 (2 (Supp)) ◽  
pp. 244-247
Author(s):  
Pachillu Kalpana ◽  
Poonam Trivedi ◽  
Krupali Patel ◽  
Sandul Yasobant ◽  
Deepak Saxena
Keyword(s):  
Infection Prevention ◽  
Geographical Location ◽  
Preventive Measure ◽  
Infection Prevention And Control ◽  
Prevention Strategies ◽  
Population Demographics ◽  
Healthcare Facilities ◽  
The Past ◽  
Sanitation And Hygiene ◽  
And Control

COVID19 pandemic is now testing health systems of countries globally irrespective of geographical location, environmental conditions, and population demographics. Among various prevention strategies as suggested by WHO and others, hand hygiene has emerged as the most important public health preventive measure to control similar outbreaks in the past (SARS & MERS) also including the current COVID19 pandemic. The COVID19 pandemic provides a well-timed opportunity to stress the importance of water, sanitation, and hygiene (WASH) in the healthcare facilities (HCFs) and optimize infection prevention control across the globe. It also gives an opportunity to extend beyond conventional WASH and includes domains of biomedical waste management, Infection Prevention, and Control activities and also environmental hygiene. This perspective piece elaborates on the importance of optimal WASH and future scopes in HCFs during the post COVID19 pandemic era.

scholarly journals Prognostic information for people with MS: Impossible or inevitable?

2018 ◽  
Vol 26 (7) ◽  
pp. 771-773 ◽  
Author(s):  
Christoph Heesen ◽  
Antonio Scalfari ◽  
Ian Galea
Keyword(s):  
Multiple Sclerosis ◽  
Unmet Need ◽  
Blind Spot ◽  
Evidence Based ◽  
Nocebo Effect ◽  
Prognostic Information ◽  
The Past ◽  
Long Term Prognosis ◽  
To Receive

Delivering prognostic information is a challenging issue in medicine and has been largely neglected in the past. A major reason has been a suspected nocebo effect of pessimistic estimates, although this is largely unproven. Among people with multiple sclerosis (MS), there is a strong unmet need to receive long-term prognostic information. This viewpoint discusses reasons for this blind spot in physicians’ attitude, foremost among which is the uncertainty of prognostic estimates. Possible strategies to move forward include tools to identify matching patients from large well-defined databases, to deliver an evidence-based individualized estimate of long-term prognosis, and its confidence interval, in a clinical setting.

Provision of Remedies for Violation of Economic, Social and Cultural Rights: A Comparative Study of the United Nations, Inter-American and African Human Rights Systems

2020 ◽  
Vol 28 (2) ◽  
pp. 298-318
Author(s):  
Roman Girma Teshome
Keyword(s):  
Human Rights ◽  
United Nations ◽  
Comparative Study ◽  
Economic Rights ◽  
Regional Monitoring ◽  
Cultural Rights ◽  
The Past ◽  
The United Nations ◽  
To Receive

The effectiveness of human rights adjudicative procedures partly, if not most importantly, hinges upon the adequacy of the remedies they grant and the implementation of those remedies. This assertion also holds water with regard to the international and regional monitoring bodies established to receive individual complaints related to economic, social and cultural rights (hereinafter ‘ESC rights’ or ‘socio-economic rights’). Remedies can serve two major functions: they are meant, first, to rectify the pecuniary and non-pecuniary damage sustained by the particular victim, and second, to resolve systematic problems existing in the state machinery in order to ensure the non-repetition of the act. Hence, the role of remedies is not confined to correcting the past but also shaping the future by providing reforming measures a state has to undertake. The adequacy of remedies awarded by international and regional human rights bodies is also assessed based on these two benchmarks. The present article examines these issues in relation to individual complaint procedures that deal with the violation of ESC rights, with particular reference to the case laws of the three jurisdictions selected for this work, i.e. the United Nations, Inter-American and African Human Rights Systems.

Sign in / Sign up

Export Citation Format

Share Document