Survey of Antibiotic Control Policies in University-Affiliated Teaching Institutions

1996 ◽  
Vol 30 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Timothy S Lesar ◽  
Laurie L Briceland
Keyword(s):  
Infectious Disease ◽  
Antibiotic Use ◽  
University Hospital ◽  
Control Policies ◽  
Control Programs ◽  
Policies And Procedures ◽  
The Us ◽  
Infectious Disease Service ◽  
The University ◽  
Antibiotic Control

OBJECTIVE: To determine the type and extent of antibiotic control policies currently in use in a group of university-affiliated teaching institutions. DESIGN: A survey of antibiotic control policies and procedures (e.g., antibiotic order sheets, formulary restrictions, automatic stop orders for specific indications) was developed. SETTING: The University Hospital Consortium (UHC), a nonprofit group of academic health centers located in 33 states throughout the US. PARTICIPANTS: The survey was mailed to 60 UHC members. RESULTS: The survey was returned by 48 (80%) institutions. Most hospitals use either restrictions (81%) and/or official recommendations (56%) to manage antibiotic use. Antibiotics were restricted most commonly by service or unit (69%), indication (69%), or to the infectious disease service (60%). Antibiotic order sheets are used in 21 (44%) of the hospitals, of which 14 require completion by the prescriber. Monitoring of compliance with established restrictions is primarily the responsibility of the pharmacist processing the order (84%) and/or a clinical pharmacist (53%). When an order does not comply with restrictions or compliance cannot be determined, the prescriber is contacted prior to dispensing in 77% and 83% of the cases, respectively. In cases of noncompliance in which the prescriber refuses to alter an order to meet restrictions, 40% of hospitals refuse to dispense the drug and 35% dispense the drug but refer the case to another authority (infectious disease service or pharmacy and therapeutics committee). CONCLUSIONS: Considering the widespread use of antibiotic control programs, further investigation of the success of such programs in optimizing drug therapy, improving patient outcome, and curtailing the antibiotic budget within and among specific institutions is warranted.

scholarly journals How Does Antimicrobial Stewardship Affect Inappropriate Antibiotic Therapy in Urological Patients?

Antibiotics ◽  
2020 ◽  
Vol 9 (2) ◽  
pp. 63 ◽  
Author(s):  
Atsushi Uda ◽  
Katsumi Shigemura ◽  
Koichi Kitagawa ◽  
Kayo Osawa ◽  
Kenichiro Onuma ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Disease Management ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Retrospective Review ◽  
Antibiotic Use ◽  
University Hospital ◽  
Annual Changes ◽  
Inappropriate Medications

Antimicrobial stewardship teams (ASTs) have been well-accepted in recent years; however, their clinical outcomes have not been fully investigated in urological patients. The purpose of this study was to evaluate the outcomes of intervention via a retrospective review of urological patients, as discussed in the AST meetings, who were treated with broad-spectrum antibiotics between 2014 and 2018 at the Department of Urology, Kobe University Hospital in Japan. Interventions were discussed in AST meetings for patients identified by pharmacists as having received inappropriate antibiotic therapy. The annual changes in numbers of inappropriate medications and culture submissions over five years at the urology department were statistically analyzed. Among 1,033 patients audited by pharmacists, inappropriate antibiotic therapy was found in 118 cases (11.4%). The numbers of inappropriate antibiotic use cases and of interventions for indefinite infections had significantly decreased during the study period (p = 0.012 and p = 0.033, respectively). However, the number of blood and drainage culture submissions had significantly increased (p = 0.009 and p = 0.035, respectively). Our findings suggest that urologists have probably become more familiar with infectious disease management through AST intervention, leading to a decrease in inappropriate antibiotic use and an increase in culture submissions.

The role of Harvey Cushing and Walter Dandy in the evolution of modern neurosurgery in the Netherlands, illustrated by their correspondence

2013 ◽  
Vol 118 (3) ◽  
pp. 539-549 ◽  
Author(s):  
Rob J. M. Groen ◽  
Peter J. Koehler ◽  
Alfred Kloet
Keyword(s):  
World War Ii ◽  
The Netherlands ◽  
University Hospital ◽  
Neurosurgical Department ◽  
Personal Involvement ◽  
Harvey Cushing ◽  
Medical Library ◽  
The Us ◽  
General Surgeons ◽  
The University

The development of modern neurosurgery in the Netherlands, which took place in the 1920s, was highly influenced by the personal involvement of both Harvey Cushing and Walter Dandy, each in his own way. For the present article, the authors consulted the correspondence (kept at the Cushing/Whitney Medical Library in New Haven and the Alan Mason Chesney Medical Archives in Baltimore) of Cushing and Dandy with their Dutch disciples. The correspondence provides a unique inside view into the minds of both neurosurgical giants. After the neurologist Bernard Brouwer had paved the way for sending the Dutch surgeon Ignaz Oljenick overseas, Cushing personally took the responsibility to train him (1927–1929). On his return to Amsterdam, Oljenick and Brouwer established the first neurosurgical department in the country. Encouraged by Oljenick's favorable results, a number of Dutch general surgeons started asking Cushing for support. Cushing strategically managed and deflected these requests, probably aiming to increase the advantage of Oljenick and Brouwer. However, the University Hospital in Groningen persisted in the plans to establish its own neurosurgical unit and sent Ferdinand Verbeek to the US in 1932. Although staying at Cushing's department initially, Verbeek ultimately applied to Walter Dandy for a position of visiting voluntary assistant, staying until the end of 1934. Verbeek and Dandy became lifelong friends. On his return to Groningen, Verbeek started practicing neurosurgery, isolated in the northern part of the country. He relied on the support of Dandy, with whom he kept up a regular correspondence, discussing cases and seeking advice. Dandy, on his part, used Verbeek as the ambassador in Europe for his operative innovations. At the beginning of World War II, Oljenick had to flee the country, which concluded the direct line with the Cushing school in the Netherlands. After Dandy's death (1946), Verbeek continued practicing neurosurgery following his style and philosophy. By the time Verbeek died in 1958, the strong American influence on everyday practice of Dutch neurosurgeons had been established.

scholarly journals Evaluation of Strategies for Fire Blight Control in Organic Pome Fruit Without Antibiotics

Plant Disease ◽  
2013 ◽  
Vol 97 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Kenneth B. Johnson ◽  
Todd N. Temple
Keyword(s):  
Fire Blight ◽  
Erwinia Amylovora ◽  
Antibiotic Use ◽  
Apple Fruit ◽  
Pome Fruit ◽  
Biological Products ◽  
Control Programs ◽  
National Organic Program ◽  
Antibiotic Control ◽  
Fruit Load

Apple and pear produced organically under the U.S. National Organic Program (NOP) standard can be treated with antibiotics for suppression of fire blight caused by Erwinia amylovora. Recent regulatory actions by the NOP, however, have lessened the likelihood of antibiotic use after the 2014 season. In response, western U.S. organic apple and pear stakeholders identified two immediate-need research objectives related to fire blight control: development of effective non-antibiotic control programs based on combinations of registered biological products; and, in apple, integration of these products with lime sulfur, which is sprayed at early bloom to reduce fruit load. In orchard trials in Oregon, increasing the frequency of treatment with biological products improved suppression of floral infection. In apple, fruit load thinning with 2% lime sulfur plus 2% fish oil (LS+FO) at 30 and 70% bloom significantly (P ≤ 0.05) reduced the proportion of blighted flower clusters in four of five orchard trials. Moreover, lime sulfur significantly (P ≤ 0.05) suppressed epiphytic populations of E. amylovora after their establishment on apple flowers. Over four trials, treatment with Aureobasidium pullulans (Blossom Protect) after LS+FO reduced the incidence of fire blight by an average of 92% compared with water only; this level of control was similar to treatment with streptomycin. In three seasons, a spray of a Pantoea agglomerans product after the 70% bloom treatment of LS+FO established the antagonist on a significantly (P ≤ 0.05) higher proportion of flowers compared with a spray of this bacterium before the thinning treatment. Consequently, in apple, biological treatments for fire blight control are not advised until after lime sulfur treatments for fruit load thinning are completed.

Impact of the inpatient infectious disease consultations at a tertiary care university hospital

2019 ◽  
Author(s):  
Rami Waked ◽  
Danielle Jaafar ◽  
Marie Chedid ◽  
Gebrael Saliba ◽  
Elie Haddad ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Infectious Diseases ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
University Hospital ◽  
Therapeutic Approaches ◽  
Infectious Diseases Consultation ◽  
Disease Specialist

Abstract The role of the infectious disease specialist continues to evolve. The purpose of this study is to demonstrate the value of infectious disease consultation in the inpatient setting.METHODS This is a prospective cohort study that took place in a tertiary care university hospital. During the period from April to June 2016, 224 cases of patients receiving antibiotics in the hospital with the request of an infectious diseases’ consultation, were evaluated. The following variables were assessed: the referring department, purpose of the consultation, the antibiotic used before requesting the infectious diseases consultation, the antibiotic modifications after the infectious disease’s visit (changing the type, dose or range of the antibiotic when applicable, modifying the duration of antibiotic use), whenever the antibiotic usage was switched to a mono or bi-therapy.RESULTS The most frequent requesting departments were Oncology (23.2%) and Urology (21.4%). The purpose of the consultations was diagnosis (29%), therapy (41%), both diagnosis and therapy (21%), and prophylaxis (9%). An infectious diseases consultation was given at a rate of 4.9 consultations per 100 hospitalized patients. Antibiotic was discontinued in 14.7% of cases. There was no indication for the antibiotic treatment in 11.6% of cases. Modifying the antibiotic therapy was done in 25.4% of cases. Adjusting the antibiotic dosage was done in only one case. Carbapenem antibiotics were discontinued in 31.6% of cases and Quinolones discontinuation accounted for 22.7% of cases.CONCLUSION Infectious disease consults contributed to the optimization of the diagnostic and therapeutic approaches for suspected or confirmed infections in hospitalized patients.

scholarly journals 82. Post-Prescription Review with Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S58
Author(s):  
Nandita S Mani ◽  
Kristine F Lan ◽  
Rupali Jain ◽  
H Nina Kim ◽  
John B Lynch ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Medical Center ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Percentage Change ◽  
Post Intervention ◽  
Sustained Reduction ◽  
Days Of Therapy ◽  
The University ◽  
The Impact

Abstract Background Following a meropenem shortage, we implemented a post-prescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses > 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and post-intervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1,000 patient-days, and data were analyzed by an interrupted time series. Results There were 4,066 and 2,552 patients in the pre- and post-intervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1,000 patient-days occurred at both hospitals (UWMC: percentage change -72.1%, (95% CI -76.6, -66.9), P < 0.001; HMC: percentage change -43.6%, (95% CI -59.9, -20.7), P = 0.001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the post-intervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P < 0.001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P < 0.001) at HMC. Meropenem and Imipenem DOT (January 2013 – November 2019) Conclusion Mandatory ID consultation and PPRF for meropenem and imipenem beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage. Disclosures All Authors: No reported disclosures

Infection control audit of Clostridium difficile-associated diarrhoea at the University Hospital of Wales

2002 ◽  
Vol 3 (6) ◽  
pp. 16-18
Author(s):  
L Jenkins ◽  
D Hilt ◽  
J Brazier ◽  
I Hosein
Keyword(s):  
Clostridium Difficile ◽  
Antibiotic Treatment ◽  
Antibiotic Use ◽  
University Hospital ◽  
Beta Lactam ◽  
National Guidelines ◽  
Single Room ◽  
Hospitalised Patients ◽  
The University ◽  
Clostridium Difficile Associated Diarrhoea

Clostridium difficile is identified as the most common cause of diarrhoea among hospitalised patients, and has been implicated in a number of outbreaks with significant morbidity and mortality. It is widely regarded as a hospital-acquired problem, associated with antibiotic use. An audit aimed at reviewing compliance against local Clostridium difficile- associated diarrhoea (CDAD) policy at the University Hospital of Wales, Cardiff was undertaken from May to July 1999. Despite the difficulty in adhering to national guidelines on single-room isolation, the prevalence of CDAD at our hospital has decreased in recent years. Community acquired CDAD accounted for 15% of our cases, which supports increasing levels of community CDAD (Kalstrom et al 1998). Recent antibiotic treatment was recorded for 82% of the audit cases, with beta-lactam being the most frequently prescribed. Antibiotic treatment for infection other than CDAD was stopped for only 11% of the cases. Where treatment was given for CDAD, clinical staff followed approved guidance.

scholarly journals Antibiotic use and association with bacterial resistance in a hospital in Southern Brazil

2020 ◽  
Vol 9 (6) ◽  
pp. e154963405
Author(s):  
Fagner Klain Sanches ◽  
Lisiane Martins Volcão ◽  
Andrea Von Groll ◽  
Flávio Manoel Rodrigues da Silva Júnior ◽  
Pedro Eduardo Almeida da Silva ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Bacterial Resistance ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
New Drugs ◽  
University Hospital ◽  
Southern Brazil ◽  
Using Data ◽  
The University ◽  
Prevalent Species

Introduction. The increased production of new drugs is parallel with the bacterial adaptation to adverse conditions. There are several factors that have been pointed out as the cause of this, such as: globalization; the abusive use of antibiotics; and the arbitrary prescription of these drugs. Therefore, the objective of the present study was to evaluate antimicrobial usage with antibiotic resistance in 2012 and 2013 at a university hospital in Southern Brazil. Material and Methods. This study was performed at the University Hospital Dr. Miguel Riet Correa Jr. in Rio Grande/RS, Brazil. The data were collected between January 2012 and December 2013, using data from the medical clinic and two intensive care units. Results.  Were observed, 385 and 464 cases of bacterial infections, during the years of 2012 and 2013, respectively. Acinetobacter baumannii, Escherichia coli and Klebsiella pneumoniae were the most prevalent species. The total antibiotic consumption in the University Hospital (HU-FURG) in this period was 3.865 units/dose, with 1.995 units/dose in the year 2012 and 1.870 units/dose in the year 2013. Relationships between the rates of main resistant pathogens isolated and the annual consumption of the corresponding antibiotic (carbapenems, cephalosporins, sulfonamides and other β-lactams) were observed; however, they did not show significant positive associations in increased resistance associated with increased consumption. Conclusion. This study reveals the need for the dissemination and feedback of these data to clinicians and decision-makers at the hospital, as it may be crucial to improve policies on prescribing antibiotics and to implement effective infection control.

scholarly journals Postprescription Review With Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

2020 ◽  
Author(s):  
Nandita S Mani ◽  
Kristine F Lan ◽  
Rupali Jain ◽  
Chloe Bryson-Cahn ◽  
John B Lynch ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Medical Center ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Percentage Change ◽  
Antimicrobial Use ◽  
Sustained Reduction ◽  
Days Of Therapy ◽  
The University ◽  
The Impact

Abstract Background Following a meropenem shortage, we implemented a postprescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses > 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and postintervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1000 patient-days, and data were analyzed by an interrupted time series. Results There were 4066 and 2552 patients in the pre- and postintervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1000 patient-days occurred at both hospitals (UWMC: percentage change −72.1% (95% confidence interval [CI] −76.6, −66.9), P < .001; HMC: percentage change −43.6% (95% CI −59.9, −20.7), P = .001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the postintervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P < .001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P < .001) at HMC. Conclusions PPRF and mandatory ID consultation for meropenem and imipenem use beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage.

Effect of Educational Programs, Rigid Sharps Containers, and Universal Precautions on Reported Needlestick Injuries in Healthcare Workers

1991 ◽  
Vol 12 (4) ◽  
pp. 214-219 ◽  
Author(s):  
Calvin C. Linnemann ◽  
Constance Cannon ◽  
Martha DeRonde ◽  
Bruce Lanphear
Keyword(s):  
Infection Control ◽  
General Hospital ◽  
Educational Program ◽  
Healthcare Workers ◽  
University Hospital ◽  
Needlestick Injuries ◽  
Universal Precautions ◽  
Control Programs ◽  
University Of Cincinnati ◽  
The University

AbstractObjective:To evaluate the effect of infection control programs on reported needlestick injuries in a general hospital.Design:Surveillance of all reported needlestick injuries at the University of Cincinnati Hospital was maintained by the infection control department for five years, from 1985 through 1989. Data on individual workers were collected, tabulated on a monthly basis, and reviewed continually to monitor trends in injuries. During this time, the effects of each of three new infection control programs on reported injuries were evaluated sequentially.Setting:A 700-bed general hospital that serves as the main teaching hospital of the University of cincinnati.Participants:All employees of University Hospital who reported to personnel health for management of needlestick injuries.Interventions:In 1986, an educational program to prevent injuries was initiated and continued throughout the surveillance period. In 1987, rigid sharps disposal containers were placed in all hospital rooms. In 1988, universal precautions were introduced with an intensive inservice.Results:Surveillance identified 1,602 needlestick injuries (320/year) or 104/1 ,000/ year. After the educational program began, reported injuries increased rather than decreased, and this was attributed to increased reporting. Subsequently, after installation of the new disposal containers, reported injuries returned to the levels seen prior to the educational program, but recapping injuries showed a significant decrease from 63/year to 30, or 20/1,000/year to 10. This decrease was observed in nurses but not in other healthcare workers. After universal precautions were instituted, total injuries increased slightly, but recapping injuries remained at 50% of the levels reported prior to the use of rigid sharps disposal containers.Conclusions: The three infection control programs failed to produce a major reduction in reported needlestick injuries, except for a decrease in recapping injuries associated with the placement of rigid sharps disposal containers in all patient rooms. These observations indicate that new approaches are needed to reduce needlestick injuries.

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