scholarly journals Antibiotic “Timeout” on Electronic Prescribing - Impact of Antibiotic Hardstop on Antimicrobial Stewardship Initiatives

2021 ◽  
Author(s):  
Semun Galimam ◽  
Brydon Panozzo ◽  
Kieran Muir ◽  
Ruchir Chavada
Keyword(s):  
Adverse Events ◽  
Community Acquired Pneumonia ◽  
Electronic Prescribing ◽  
Chronic Obstructive ◽  
Antimicrobial Use ◽  
Local Health ◽  
Obstructive Pulmonary Disease ◽  
Inappropriate Use ◽  
Days Of Therapy ◽  
Length Of Therapy

Abstract Background: Antimicrobial resistance (AMR) remains a major public health threat and the exploration of interventions which may reduce inappropriate antimicrobial use are of particular interest. An Antibiotic Timeout (ATO) was included within the electronic medicine (eMeds) system introduced to the Central Coast Local Health District (CCLHD) in 2018. The function allows prescribers to set a predetermined time at which antibiotic orders would cease. By default, the function set prescribed length to 5 days with a view to encourage prescribers to review existing antimicrobial orders and reduce inappropriate use.Methods: Records of adult inpatients prescribed broad spectrum antimicrobials with a registered indication of community acquired pneumonia (CAP) or an infective exacerbation of chronic obstructive pulmonary disease (IECOPD) between the 1st of March 2017 and 31st May 2017 for the pre eMeds cohort and 1st March 2019 and 31st May 2019 for the post eMeds cohort were randomly selected from our local health network’s Guidance MS® system. Baseline demographics, antimicrobial prescribing records and documented adverse events related to the antibiotic timeout function were collated/analysed. The days of therapy (DOT) and length of therapy (LOT) for each encounter were calculated manually and results analysed using a two-tailed t-test or Mann-Whitney U test.Results: Of patients eligible to have the ATO function activated during their admission, 34% (n=34) had the function deployed at least once. Following the introduction of eMeds mean DOT for the pooled indications cohort was reduced by 3.02 days (CI 95% 0.41 – 5.63, p<0.05) and mean LOT by 1.97 days (CI 95% 0.39 – 3.55, p<0.05). The timeout function resulted in 2 cases of delayed or unintentionally ceased therapies. Conclusions: Following the introduction of electronic prescribing and ATO, a significant reduction was observed in the DOT and LOT for antimicrobial use for inpatients with CAP and IECOPD without a significant increase in adverse events. Further research is required to determine the extent to which the antibiotic timeout functionality directly contributed to this effect and if the effect is present across a broader range of indications.

scholarly journals ADD it up: an evaluation of Antibiotic Duration at hospital Discharge at a community hospital

2021 ◽  
Author(s):  
Morgan Conner ◽  
William H Harris ◽  
John P Bomkamp
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Discharge ◽  
Median Duration ◽  
Unmet Need ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Duration Of Therapy ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Purpose According to the CDC, patients admitted to the hospital are commonly discharged on antibiotic therapy with prolonged courses of therapy, which contributes to excessive antibiotic exposure and adverse events. The purpose of this study was to evaluate total antibiotic duration of therapy at hospital discharge at Indiana University (IU) Health Arnett, White Memorial, and Frankfort Hospitals. Methods A multicenter, retrospective electronic health record review was conducted from January 1, 2019, to June 30, 2019. Patients were included if they were at least 18 years of age, began antibiotic therapy while admitted, and continued antibiotic therapy at hospital discharge for one of the following indications: skin/soft tissue infection (SSTI), urinary tract infection (UTI), community-acquired pneumonia (CAP) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days-of-therapy (DOT) of each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT, which was utilized to determine the appropriateness of the duration of therapy. Results Of the 547 patients included, 233 patients (42.6%) had CAP, 120 (21.9%) had UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days (IQR 7-11). Median duration for CAP was 9 days (IQR 7-10), AECOPD was 7 days (IQR 5-9), UTI was 8 days (IQR 6-10), and SSTI was 12 days (IQR 10-14). Conclusions Excess antimicrobial duration at hospital discharge represents an unmet need of antimicrobial stewardship programs.

scholarly journals Allogeneic human umbilical cord-derived mesenchymal stem/stromal cells for chronic obstructive pulmonary disease (COPD): study protocol for a matched case–control, phase I/II trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045788
Author(s):  
Duc M Hoang ◽  
Kien T Nguyen ◽  
Anh H Nguyen ◽  
Bach N Nguyen ◽  
Liem Thanh Nguyen
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Adverse Events ◽  
Phase I ◽  
Pulmonary Disease ◽  
Stromal Cells ◽  
Case Control ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Control Phase ◽  
Matched Case

IntroductionThe global prevalence of chronic obstructive pulmonary disease (COPD) is increasing, and it has become a major public health burden worldwide, including in Vietnam. A large body of preclinical and clinical studies supports the safety of mesenchymal stem/stromal cells (MSCs) in the treatment of lung injury, including COPD. The aim of this trial is to investigate the safety and potential therapeutic efficacy of allogeneic administration of umbilical cord-derived MSCs (UC-MSCs) as a supplementary intervention in combination with standard COPD medication treatments in patients with moderate-to-severe COPD based on the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2019 and Vietnam Ministry of Health’s guidelines.Methods and analysisThis matched case–control phase I/II trial is conducted at Vinmec Times City International Hospital, Hanoi, Vietnam between June 2020 and December 2021. In this study, 40 patients will be enrolled and assigned into two age-matched, gender-matched and COPD condition-matched groups, including a UC-MSC group and a control group. Both groups will receive standard COPD medication treatment based on the GOLD 2019 guidelines and the Vietnam Ministry of Health protocol. The UC-MSC group will receive two doses of thawed UC-MSC product with an intervention interval of 3 months. The primary outcome measures will include the incidence of prespecified administration-associated adverse events and serious adverse events. The efficacy will be evaluated based on the absolute changes in the number of admissions, arterial blood gas analysis, lung function and lung fibrosis via CT scan and chest X-ray. The clinical evaluation will be conducted at baseline and 3, 6 and 12 months postintervention.Ethics and disseminationEthical approval was secured from the Ethical Committee of Vinmec International Hospital (number:166/2019/QĐ-VMEC) and Vietnam Ministry of Health (number:2002/QĐ-BYT). The results will be reported to trial collaborators, publication in peer-reviewed academic journals.Trial registration numberNCT04433104.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

scholarly journals Influenza in Malaysian adult patients hospitalized with community-acquired pneumonia, acute exacerbation of chronic obstructive pulmonary disease or asthma: a multicenter, active surveillance study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Yong Kek Pang ◽  
Ahmad Izuanuddin Ismail ◽  
Yoke Fun Chan ◽  
Adelina Cheong ◽  
Yoong Min Chong ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Acute Exacerbation ◽  
Active Surveillance ◽  
Community Acquired Pneumonia ◽  
Surveillance Study ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
High Dependency ◽  
Increased Risk

Abstract Background Available data on influenza burden across Southeast Asia are largely limited to pediatric populations, with inconsistent findings. Methods We conducted a multicenter, hospital-based active surveillance study of adults in Malaysia with community-acquired pneumonia (CAP), acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and acute exacerbation of asthma (AEBA), who had influenza-like illness ≤10 days before hospitalization. We estimated the rate of laboratory-confirmed influenza and associated complications over 13 months (July 2018–August 2019) and described the distribution of causative influenza strains. We evaluated predictors of laboratory-confirmed influenza and severe clinical outcomes using multivariate analysis. Results Of 1106 included patients, 114 (10.3%) were influenza-positive; most were influenza A (85.1%), with A/H1N1pdm09 being the predominant circulating strain during the study following a shift from A/H3N2 from January–February 2019 onwards. In multivariate analyses, an absence of comorbidities (none versus any comorbidity [OR (95%CI), 0.565 (0.329–0.970)], p = 0.038) and of dyspnea (0.544 (0.341–0.868)], p = 0.011) were associated with increased risk of influenza positivity. Overall, 184/1106 (16.6%) patients were admitted to intensive care or high-dependency units (ICU/HDU) (13.2% were influenza positive) and 26/1106 (2.4%) died (2.6% were influenza positive). Males were more likely to have a severe outcome (ICU/HDU admission or death). Conclusions Influenza was a significant contributor to hospitalizations associated with CAP, AECOPD and AEBA. However, it was not associated with ICU/HDU admission in this population. Study registration, NMRR ID: NMRR-17-889-35,174.

scholarly journals Assessment of Analysis of Urinary Pneumococcal Antigen by Immunochromatography for Etiologic Diagnosis of Community-Acquired Pneumonia in Adults

2006 ◽  
Vol 13 (10) ◽  
pp. 1092-1097 ◽  
Author(s):  
Maria Luisa Briones ◽  
José Blanquer ◽  
David Ferrando ◽  
Maria Luisa Blasco ◽  
Concepción Gimeno ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Diagnostic Techniques ◽  
Community Acquired Pneumonia ◽  
Etiologic Agent ◽  
Chronic Obstructive ◽  
Pneumococcal Infections ◽  
Obstructive Pulmonary Disease ◽  
Pneumococcal Antigen ◽  
A Prospective Study ◽  
Etiologic Diagnosis

ABSTRACT The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients from two control groups to calculate the specificity of the technique. One group was comprised of in-patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma, with respiratory infection, and without pneumonia; the other group included fractures. We studied 959 pneumonia patients and determined UPA content in 911 (95%) of them. We diagnosed the etiology of 253 cases (28%) using CMM; S. pneumoniae was the most common etiologic agent (57 cases). ICT analysis was positive for 279 patients (31%). Using this technique, the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity oscillated between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Determination of UPA is a rapid, simple analysis with good sensitivity and specificity, which increased the percentage of etiologic diagnoses. Positive UPA may persist in COPD patients with probable pneumococcal colonization or recent pneumococcal infections.

scholarly journals Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003–2010

2016 ◽  
Vol 21 (25) ◽  
Author(s):  
Gunilla Skoog ◽  
Johan Struwe ◽  
Otto Cars ◽  
Håkan Hanberger ◽  
Inga Odenholt ◽  
...  
Keyword(s):  
Community Acquired Pneumonia ◽  
Point Prevalence ◽  
Antimicrobial Use ◽  
Surgical Prophylaxis ◽  
Hospital Acquired Infection ◽  
Local Implementation ◽  
Inappropriate Use ◽  
Local Feedback ◽  
Uncomplicated Cystitis ◽  
Hospital Acquired

This study sought to analyse antimicrobial pressure, indications for treatment, and compliance with treatment recommendations and to identify possible problem areas where inappropriate use could be improved through interventions by the network of the local Swedish Strategic Programme Against Antibiotic Resistance (Strama) groups. Five point-prevalence surveys were performed in between 49 and 72 participating hospitals from 2003 to 2010. Treatments were recorded for 19 predefined diagnosis groups and whether they were for community-acquired infection, hospital-acquired infection, or prophylaxis. Approximately one-third of inpatients were treated with antimicrobials. Compliance with guidelines for treatment of community-acquired pneumonia with narrow-spectrum penicillin was 17.0% during baseline 2003–2004, and significantly improved to 24.2% in 2010. Corresponding figures for quinolone use in uncomplicated cystitis in women were 28.5% in 2003–2004, and significantly improved, decreasing to 15.3% in 2010. The length of surgical prophylaxis improved significantly when data for a single dose and 1 day were combined, from 56.3% in 2003–2004 to 66.6% in 2010. Improved compliance was possibly the effect of active local feedback, repeated surveys, and increasing awareness of antimicrobial resistance. Strama groups are important for successful local implementation of antimicrobial stewardship programs in Sweden.

scholarly journals POSSIBILITIES OF USING MINIINVASIVE CATHETER TECHNOLOGIES IN THE TREATMENT OF LUNG BLEEDING

2019 ◽  
Vol 6 ◽  
pp. 41-48
Author(s):  
Kateryna Ponomarova
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Surgical Treatment ◽  
Pulmonary Disease ◽  
High Efficiency ◽  
Bronchial Artery ◽  
Pulmonary Hemorrhage ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Bronchial Arteries ◽  
Obstructive Pulmonary Disease

Aim – improve the results of the treatment of patients with pulmonary bleeding through widespread use of endovascular surgery methods for hemostasis. Materials and methods. Method of endovascular embolization of bronchial arteries is widely used in our clinic SI «Zaycev V. T. Institute of General and Emergency surgery of NAMS of Ukraine» not only as independent surgery in patients with LB, but also as way of preparation of patients with lung bleeding for planned thorax surgery. The most of the often spread nosological forms complicated by bleeding in our research were polycystic lung disease, chronic obstructive pulmonary disease, bronchiectasis disease, community-acquired pneumonia. Indications to the сatheter embolization procedure of bronchial arteries are the following: conservative treatment failure, hemoptysis in patients with bilateral inflammatory processes who was not prescribed surgical treatment for a range of reasons, absence of gross structural changes, lung resection, mainly in patients with oncologic lung injury, at massive and life-threatening profuse bleedings as a mean of temporary or constant hemostasis. Discussed treatment method is applied only in bleeding or within a 6 – 12 hour after its treatment. Successful result in embolization can be obtained in 79–99 %. Results. As a result of complete physical examination of patients with LB, it has been established that lung hemorrhage was the result of obstructive bronchitis in 14 patients (42 %), there was chronic obstructive pulmonary disease in 7 (21 %) patients and bronchiectasis was diagnosed in 6 (18 %) patients. In 2 (6 %) patients pulmonary hemorrhage was caused by community-acquired pneumonia. Central lung cancer was detected in 4 (12 %) patients. Conclusion. Therefore bronchial artery angiography gives high efficiency in solving the problem of hemostasis in oncological and nonspecific lung diseases, for determination of localization and source of bleeding. Endovascular occlusion of bronchial arteries in pulmonary hemorrhage permits: – to elaborate diagnosis because of the presence of specific angiographic signs of malignant tumour; – to perform effective endovascular hemostasis; – to gain time for stabilization the patient with the aim of planned surgical treatment.

scholarly journals Levofloxacin: the role and significance in the treatment of lower respiratory tract infections

2017 ◽  
Vol 94 (11) ◽  
pp. 851-860
Author(s):  
Aleksandr I. Sinopal’nikov
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Pulmonary Disease ◽  
Nosocomial Pneumonia ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Minimal Risk ◽  
High Concentration ◽  
Obstructive Pulmonary Disease ◽  
Atypical Pathogens ◽  
Tract Infections

The advent of the first «respiratory» fluoroquinolone in the late 1990s gave rise to a dramatic growth in popularity ofantibiotics of this class. Levofloxacin like other fluoroquinolones is highly active with respect to Gram-positive, Gram-negative, and atypical pathogens including penicillin-resistant strains of Streptococcus pneumoniae. It is recommended for the treatment of community-acquired pneumonia, nosocomial pneumonia, and exacerbations of chronic obstructive pulmonary disease. Levofloxacin is safe and characterized by high bioavailability and high concentration at the site of inflammation. Therapy with its high doses (750 and 1000 mg/day) during 5 days improves the outcome of the treatment due to improved compliance and minimal risk of development of drug resistance. nosocomial pneumonia, exacerbations of chronic obstructive pulmonary disease.

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