scholarly journals An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia

2021 ◽  
pp. 175717742110127
Author(s):  
Christopher A Okeahialam ◽  
Ali A Rabaan ◽  
Albert Bolhuis
Keyword(s):  
Patient Outcome ◽  
Saudi Arabia ◽  
Antimicrobial Stewardship ◽  
Laboratory Data ◽  
Repeated Testing ◽  
Middle Income ◽  
Clostridioides Difficile ◽  
Hospitalised Patients ◽  
Long Term Impact ◽  
The Impact

Background: Antimicrobial stewardship has been associated with a reduction in the incidence of healthcare-associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognised in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalised patients may offer an alternative metric for these settings, but its utility remains largely untested. Aim/objective: To examine the impact of antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalised patients presenting with diarrhea Methods: A 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programme. Result: There was a significant decline in the rate of toxigenic C. difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship programme, and a reversal of a rising trend. Discussion: The rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long-term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is, however, dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.

scholarly journals An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia

2021 ◽  
Author(s):  
Christopher A. Okeahialam ◽  
Ali A. Rabaan ◽  
Albert Bolhuis
Keyword(s):  
Patient Outcome ◽  
Saudi Arabia ◽  
Antimicrobial Stewardship ◽  
Laboratory Data ◽  
Hospitalized Patients ◽  
Antimicrobial Stewardship Program ◽  
Repeated Testing ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Impact

AbstractBackgroundAntimicrobial stewardship has been associated with a reduction in the incidence of health care associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognized in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalized patients may offer an alternative metric for these settings, but its utlity remains largely untested.Aim/ObjectiveTo examine the impact of an antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalized patients presenting with diarrhoeaMethodsA 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programResultThere was a significant decline in the rate of toxigenic C difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship program, and a reversal of a rising trend.DiscussionThe rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is however dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.

Clinical impact of a pharmacist-led antimicrobial stewardship initiative evaluating patients with Clostridioides difficile colitis

2020 ◽  
Vol 68 (4) ◽  
pp. 888-892 ◽  
Author(s):  
Paige A Bishop ◽  
Carmen Isache ◽  
Yvette S McCarter ◽  
Carmen Smotherman ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Clinical Success ◽  
Audit And Feedback ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Usa ◽  
The Impact

Clostridioides difficile is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficile infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

scholarly journals Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 816
Author(s):  
Ana Guisado-Gil ◽  
Carmen Infante-Domínguez ◽  
Germán Peñalva ◽  
Julia Praena ◽  
Cristina Roca ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Incidence Density ◽  
Antimicrobial Consumption ◽  
Global Trend ◽  
Long Term Impact ◽  
Hospital Acquired ◽  
The Impact

During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

scholarly journals Measuring the impact of COVID-19 surveillance variables over the international oil market

2022 ◽  
Vol 9 (1) ◽  
pp. 27-33
Author(s):  
Alshdadi et al. ◽  
Keyword(s):  
Saudi Arabia ◽  
Crude Oil ◽  
Global Economy ◽  
Oil Prices ◽  
Oil Reserves ◽  
Oil Market ◽  
Crude Oil Prices ◽  
Oil Markets ◽  
Long Term Impact ◽  
The Impact

Coronavirus (COVID-19) has turned to be an alarm for the whole world both in terms of health and economics. It is striking the global economy and increasing the unpredictability of the financial market in several ways. Significantly, the pandemic spread stimulated the social distancing which led to the lockdown of the countries’ businesses, financial markets, and daily life events. International oil markets have accommodated the crude oil prices during the early COVID-19 period. However, after the first 50 days, Saudi Arabia has surged the market with oil, which caused a certain decrease in crude oil prices, internationally. Saudi Arabia is one of the biggest oil reserves in the world. International trade is based on oil reservoirs which in turn, have been significantly dislodged by the pandemic. Therefore, it is crucial to study the impact of COVID-19 on the international oil market. The purpose of this study is to investigate the short-term and long-term impact of COVID-19 on the international oil market. The daily crude oil price data is used to analyze the impact of daily price fluctuation over COVID-19 surveillance variables. The correlation between surveillance variables and international crude oil prices is calculated and analyzed. Consequently, the project will help in stabilizing the expected world economic crises and particularly will provide the implications for the policymakers in the oil market.

scholarly journals Introduction to Antimicrobial Resistance and the Maternal Sepsis Intervention

2020 ◽  
pp. 1-9
Author(s):  
Louise Ackers ◽  
Gavin Ackers-Johnson ◽  
Joanne Welsh ◽  
Daniel Kibombo ◽  
Samuel Opio
Keyword(s):  
Antimicrobial Resistance ◽  
Global Health ◽  
Antimicrobial Stewardship ◽  
Action Plan ◽  
Middle Income ◽  
Middle Income Countries ◽  
Global Action ◽  
Maternal Sepsis ◽  
The Impact ◽  
Global Action Plan

AbstractThis chapter describes the threat to global health and security caused by the growing resistance of infectious organisms to antibiotics or antimicrobial resistance (AMR). Growing global connectivity ensures that AMR is a threat to us all wherever we are and with specific impacts on Low- and Middle-Income Countries (LMICs). The chapter outlines international responses to AMR including the Global Action Plan and the impact this has had on one LMIC; Uganda. It then introduces a recent UK funding call focused on improving the management of antibiotics or ‘Antimicrobial Stewardship’.

scholarly journals Opportunities and Challenges for Improving Anti-Microbial Stewardship in Low- and Middle-Income Countries; Lessons Learnt from the Maternal Sepsis Intervention in Western Uganda

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 315 ◽  
Author(s):  
Louise Ackers ◽  
Gavin Ackers-Johnson ◽  
Maaike Seekles ◽  
Joe Odur ◽  
Samuel Opio
Keyword(s):  
Action Research ◽  
Maternal Mortality ◽  
Antimicrobial Stewardship ◽  
Health Workers ◽  
Junior Doctors ◽  
Middle Income ◽  
Mortality And Morbidity ◽  
Health Partnership ◽  
Maternal Sepsis ◽  
The Impact

This paper presents findings from an action-research intervention designed to identify ways of improving antimicrobial stewardship in a Ugandan Regional Referral Hospital. Building on an existing health partnership and extensive action-research on maternal health, it focused on maternal sepsis. Sepsis is one of the main causes of maternal mortality in Uganda and surgical site infection, a major contributing factor. Post-natal wards also consume the largest volume of antibiotics. The findings from the Maternal Sepsis Intervention demonstrate the potential for remarkable changes in health worker behaviour through multi-disciplinary engagement. Nurses and midwives create the connective tissue linking pharmacy, laboratory scientists and junior doctors to support an evidence-based response to prescribing. These multi-disciplinary ‘huddles’ form a necessary, but insufficient, grounding for active clinical pharmacy. The impact on antimicrobial stewardship and maternal mortality and morbidity is ultimately limited by very poor and inconsistent access to antibiotics and supplies. Insufficient and predictable stock-outs undermine behaviour change frustrating health workers’ ability to exercise their knowledge and skill for the benefit of their patients. This escalates healthcare costs and contributes to anti-microbial resistance.

Impact of California’s mandate for antimicrobial stewardship programs on rates of methicillin-resistant Staphylococcus aureus and Clostridioides difficile infection in acute-care hospitals

2020 ◽  
pp. 1-7
Author(s):  
Alessandra B. Garcia Reeves ◽  
Sally C. Stearns ◽  
Justin G. Trogdon ◽  
James W. Lewis ◽  
David J. Weber ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Fixed Effects ◽  
Acute Care Hospitals ◽  
The United States ◽  
Methicillin Resistant ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Impact

Abstract Objective: To estimate the impact of California’s antimicrobial stewardship program (ASP) mandate on methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile infection (CDI) rates in acute-care hospitals. Population: Centers for Medicare and Medicaid Services (CMS)–certified acute-care hospitals in the United States. Data Sources: 2013–2017 data from the CMS Hospital Compare, Provider of Service File and Medicare Cost Reports. Methods: Difference-in-difference model with hospital fixed effects to compare California with all other states before and after the ASP mandate. We considered were standardized infection ratios (SIRs) for MRSA and CDI as the outcomes. We analyzed the following time-variant covariates: medical school affiliation, bed count, quality accreditation, number of changes in ownership, compliance with CMS requirements, % intensive care unit beds, average length of stay, patient safety index, and 30-day readmission rate. Results: In 2013, California hospitals had an average MRSA SIR of 0.79 versus 0.94 in other states, and an average CDI SIR of 1.01 versus 0.77 in other states. California hospitals had increases (P < .05) of 23%, 30%, and 20% in their MRSA SIRs in 2015, 2016, and 2017, respectively. California hospitals were associated with a 20% (P < .001) decrease in the CDI SIR only in 2017. Conclusions: The mandate was associated with a decrease in CDI SIR and an increase in MRSA SIR.

scholarly journals Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Masoud Mardani ◽  
Sara Abolghasemi ◽  
Shiva Shabani
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Consumption ◽  
Multidrug Resistant ◽  
Marrow Transplant ◽  
Blood Cultures ◽  
University Hospital ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Quasi Experimental ◽  
The Impact

Abstract Objective The The impact of a hospital antimicrobial stewardship was determined on antimicrobial-resistant, Clostridioides difficile rates and the amount of antimicrobial consumed in cancer patients.The intervention effects of antimicrobial stewardship (ASP) plans in 2017–2018 and 2018–2019 were respectively evaluated among hematology/oncology and bone marrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (meropenem and vancomycin) consumption gr-year, the number of positive Clostridioides difficile infection and multidrug-resistant positive cases in blood cultures. Results The number of MDR cases in the periods of 2017–2018 and 2018–2019 were 145 and 75, respectively (p = 0.011). A significant reduction in all positive blood cultures from 2017–2018 to 2018–2019 was found (p = 0.001). 574 patients admitted to our hospital in these periods of 2017- 2018 and 2018- 2019were assessed for MPM and VMN use. The amounts of MPM prescriptions in 2018–2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms, and CDI can highly promote patients’ health and decreasing medical costs and long-term defects for patients.

scholarly journals Assessing the Impact of COVID-19 on Antimicrobial Stewardship Activities/Programs in the United Kingdom

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 110
Author(s):  
Diane Ashiru-Oredope ◽  
Frances Kerr ◽  
Stephen Hughes ◽  
Jonathan Urch ◽  
Marisa Lanzman ◽  
...  
Keyword(s):  
United Kingdom ◽  
Antimicrobial Stewardship ◽  
Bacterial Infections ◽  
Audit Quality ◽  
Negative Impact ◽  
The United Kingdom ◽  
Ward Rounds ◽  
Long Term Impact ◽  
The Uk ◽  
The Impact

Since first identified in late 2019, the acute respiratory syndrome coronavirus (SARS-CoV2) and the resulting coronavirus disease (COVID-19) pandemic has overwhelmed healthcare systems worldwide, often diverting key resources in a bid to meet unprecedented challenges. To measure its impact on national antimicrobial stewardship (AMS) activities, a questionnaire was designed and disseminated to antimicrobialstewardship leads in the United Kingdom (UK). Most respondents reported a reduction in AMS activity with 64% (61/95) reporting that COVID-19 had a negative impact on routine AMS activities. Activities reported to have been negatively affected by the pandemic include audit, quality improvement initiatives, education, AMS meetings, and multidisciplinary working including ward rounds. However, positive outcomes were also identified, with technology being increasingly used as a tool to facilitate stewardship, e.g., virtual meetings and ward rounds and increased the acceptance of using procalcitonin tests to distinguish between viral and bacterial infections. The COVID-19 pandemic has had a significant impact on the AMS activities undertaken across the UK. The long-term impact of the reduced AMS activities on incidence of AMR are not yet known. The legacy of innovation, use of technology, and increased collaboration from the pandemic could strengthen AMS in the post-pandemic era and presents opportunities for further development of AMS.

scholarly journals National Policies for Women Empowerment: The Impact of Policy on Women Unemployment Rate in Saudi Arabia 2010-2019

2021 ◽  
Vol 14 (4) ◽  
pp. 81
Author(s):  
Shabbab Alotaibi
Keyword(s):  
Saudi Arabia ◽  
Labor Market ◽  
Unemployment Rate ◽  
Positive Impact ◽  
Women Empowerment ◽  
National Policies ◽  
Laws And Policies ◽  
Long Term Impact ◽  
The Impact

This paper aims to explore the impact of national policies that are directed toward women empowerment in Saudi Arabia. The study focuses primarily on the impact that these policies had on women unemployment rate from the period of 2010 to 2019. During this period, the Saudi government issued multiple laws and policies to ensure a positive impact on women participation in labor market. This study assesses the short-term impact of each policy to understand the effect of policy on women&rsquo;s participation in labor force. The results of this study show that there was a slight increase in women&rsquo;s participation in labor market. However, we recommend that further studies should be conducted to study the long-term impact on women&rsquo;s unemployment rate.

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