Pediatric Odontogenic Infections and Prescription Antibiotic Use

2020 ◽  
Author(s):  
Keri Discepolo
Keyword(s):  
Clinical Presentation ◽  
Vital Signs ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
High Variability ◽  
Odontogenic Infections ◽  
Prescription Practices ◽  
Different Types

Objectives: In the past several years worldwide, the discussion has developed about antibiotic resistance. Dentists, although a small percentage of the prescribers of antibiotics, can play a role in reducing antibiotic use and therefore help address this growing problem. Highly variable prescription practices illustrate the dentist’s contribution to the overuse of antibiotics. An investigation into antibiotic use and subsequent effects on clinical presentation odontogenic infections. Described are the variances in the clinical presentation of subjects who received antibiotics and those that had no antimicrobial therapy before presentation in the hospital setting. Methods: A retrospective chart review was conducted for subjects who presented with odontogenic infections to a children’s hospital emergency department. Variables collected were: pre-hospital antibiotic use, vital signs on admission, site of infection, quality of infection, and dental involvement. Results: 112 subjects: 73 male and 39 females. 49 received pre-hospital antibiotics while 63 did not have previous antibiotic therapy. Pre-hospital antimicrobials consisted of 10 different types of antibiotic therapies. No significance was found between the two groups and the clinical presentation of infection or admission vital signs. Conclusion: High variability of antibiotic use for orofacial infections was observed including the type of antimicrobial utilized and prescribing provider (non-dentist). This study provided information correlating patient physiology and the lack of clinical impact by pre-hospital antibiotic use. Due to high variability in providers' type administering antibiotic prescriptions and irregular drug and dosage practices, detailed practice guidelines and antibiotic stewardship programs should be augmented for assistance concerning odontogenic infection treatments.

scholarly journals Assessing the quality of medication documentation: development and feasibility of the MediDocQ instrument for retrospective chart review in the hospital setting

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e034609 ◽  
Author(s):  
Antje Hammer ◽  
Anke Wagner ◽  
Monika A Rieger ◽  
Tanja Manser
Keyword(s):  
Development Process ◽  
Chart Review ◽  
Clinical Decision Making ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Medication Administration ◽  
Patient Records ◽  
Mean Values ◽  
Medication Documentation

ObjectiveThe medication process requires clear and transparent documentation in patient records. Incomplete or incorrect medication documentation may contribute to inappropriate clinical decision-making and adverse events. To comprehensively assess the quality of in-hospital medication documentation, we developed a retrospective chart review (RCR) instrument. We report on the development process, the feasibility of the instrument and describe our application of the instrument to a sample of patient records.DesignCross-sectional study using an RCR instrument to evaluate paper-based, non-standardised prescription and medication administration charts (MediDocQ).SettingTwo German university hospitals.ParticipantsRecords from 1361 patients admitted between April and July 2015 were evaluated.MethodsThe MediDocQ development process comprised six consecutive stages: focused literature review, web-based search, initial patient record screening, review by project advisory board, focus groups with professionals and pilot testing. The final 54-item RCR instrument covers three key components of medication documentation: (1) completeness of documented information (including prescription, medication administration and pro re nata (PRN) medication), (2) quality of transcriptions and (3) compliance with chart structure, legibility, handling of deletions and chart corrections. Descriptive statistics are presented as mean values, SD, median and interquartile ranges for individual items.ResultsOverall, 33 out of 54 items resulted in mean values above 0.75, indicating high-quality medication documentation. Documentation quality was particularly compromised for verbal and PRN orders (which involve more steps than standard orders) and when documentation was not completed at the same time as medication administration.ConclusionsMediDocQ is a patient safety instrument that can be used to evaluate the quality of medication documentation and identify components of the process where intervention is required. In our setting, standardisation of medication documentation, particularly regarding medication administration and PRN medication is a priority.

scholarly journals Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s24-s24
Author(s):  
Marisa Hudson ◽  
Mayar Al Mohajer
Keyword(s):  
Hand Hygiene ◽  
Hospital Setting ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Hospitalized Patients ◽  
Incidence Density ◽  
Contact Precautions ◽  
Before And After ◽  
Hospital Acquired ◽  
The Impact

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

scholarly journals 2100. A Retrospective Chart Review of Emergent Antibiotic Use

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S710-S710
Author(s):  
Michelle Blyth ◽  
James McNary ◽  
Arnold Decano ◽  
Audrey Renson ◽  
Jeanne Carey
Keyword(s):  
Emergency Department ◽  
Antibiotic Stewardship ◽  
Chart Review ◽  
Vital Signs ◽  
Retrospective Chart Review ◽  
Antibiotic Use ◽  
Academic Community ◽  
Suspected Sepsis ◽  
Empiric Antibiotics ◽  
Data Points

Abstract Background The need for responsible antibiotic stewardship can be difficult to reconcile with the clinician’s task of quickly recognizing and treating sepsis. Empiric antibiotics are often given in patients with any suspicion of infection, yet antibiotics carry non-trivial risks including antibiotic resistance and susceptibility to other infections, such as Clostridium difficile. Methods This retrospective chart review includes 200 patients who were admitted to the hospital and administered antibiotics while in the Emergency Department (ED). From clinical documentation several clinical data points were gathered such as: changes to (including discontinuation of) antibiotics by the admitting team, final culture data, discharge diagnosis, vital signs and routine laboratory values. Results Our study finds that the majority of patients administered antibiotics in the ED of our academic community hospital were not diagnosed with sepsis (67%) and did not meet SIRS (62.5%) nor qSOFA (88%) criteria prior to administration of antibiotics. Vancomycin (39.7%) and piperacillin–tazobactam (22.2%) were the most frequent empiric antibiotics started. Antibiotics were stopped completely on admission by the admitting team in 22.2% of included patients. A wide variety of sources of infection were suspected, pneumonia (33%), cellulitis (15%), and cystitis (18%) being the most common. The overall mortality rate for this group during the admission was 4.5%, which was comparable to all-cause hospital mortality during the same time period. Infection was ruled out by discharge in 91 of the included 200 patients (45.5%). At least 37.5% of all included patients had received antibiotics within the last 3 months. Intriguingly, recent exposure was nearly twice as common (47.8%) among infected patients than in those without infections (24.7%), with a relative risk of 1.48 (CI 1.0993–2.0014). Conclusion These findings suggest that an opportunity exists for increased antibiotic stewardship in the emergency department in the management of suspected sepsis and/or infection. Stable patients in whom infection cannot be definitively ruled out may benefit more from prompt, thorough evaluation by an admitting team prior to the initiation of empiric antibiotics. Disclosures All authors: No reported disclosures.

Knowledge about Prescription of the Antibiotic for Endodontic’s Treatment among Final Year Students.

2021 ◽  
pp. 2901-2904
Author(s):  
Mawra Hyder ◽  
Muhammad Ali ◽  
Isma Sajjad ◽  
Nousheen Khan ◽  
Muhammad Ahmed ◽  
...  
Keyword(s):  
Drug Prescription ◽  
Hospital Setting ◽  
Sinus Tract ◽  
Good Doctor ◽  
Odontogenic Infections ◽  
Prescription Practices ◽  
Prosthetic Joint ◽  
Uncontrolled Diabetes ◽  
Radio Therapy ◽  
Dental Hospital

Background: Since antibiotic’s discovery, they have been widely utilized for treatment of the odontogenic infections. Writing a prescription is a vital determining factor of the good doctor/clinician. Drug Prescription is a dynamic and personalized clinical process, which is established as a result of necessities of the patient & acquaintance of practitioner & is also the component of curriculum of graduation. Aim: To evaluate and assess knowledge about prescription of the antibiotic during the endodontics’s treatment and the errors made by final year students at the dental hospital. Setting: Multan Medical & Dental College Multan Methodology: This survey-based research was led among 48 students of Multan Dental College Multan. A form was designed, regarding pattern of the antibiotic’s prescription & conditions/situations for which the drugs were recommended by students of final year. Results: The medication of choice was mostly Amoxicillin alone (75%) and Amoxicillin + clavulanic acid (55%). Most of antibiotic prescriptions were written for Perio-endo lesion (85%), acute apical abscess (80%). Chronic apical abscess with sinus tract (80%), Ch. apical abscess with periodontitis (65%), Patients with swelling & difficulty in swallowing (62%). In this study the greatest numbers of antibiotics prescribed were prophylactically for congenital cardiac sicknesses 69.7%, and uncontrolled diabetes mellitus 60%. Prosthetic joint in past 2 years 40% & Chemo/radio therapy 30%. Conclusion: There is a dearth of knowledge as well as information concerning the suitable indication, kind, & dose of the antibiotics in practice of dentistry. The curriculum should propose great accent on prescription, and decent prescription practices should also be taught in clinical rotation’s, using actual or imaginary cases. Keywords: Antibiotics, Endodontics, Prescription writing, prophylaxis, Root canal treatment (RCT)

Malignant Gastrointestinal Obstruction: Options for Decompression and Nutrition

2020 ◽  
Vol 04 (03) ◽  
pp. 311-322
Author(s):  
Robert J. Litwin ◽  
Johanna L. Chan ◽  
Steven Y. Huang
Keyword(s):  
Clinical Presentation ◽  
Practice Patterns ◽  
Patient Care Team ◽  
Therapeutic Interventions ◽  
Collaborative Approach ◽  
Malignant Bowel Obstruction ◽  
Advanced Malignancy ◽  
Gastrointestinal Obstruction ◽  
Malignant Gastrointestinal Obstruction

AbstractMalignant bowel obstruction (MBO) is a relatively common condition affecting patients with advanced malignancy. Therapeutic interventions should be aimed at maintaining quality of life. Given the lack of prospective controlled studies in this patient population, patient management is often based on local practice patterns and anecdotal experience. To foster a collaborative approach among the members of the patient care team involving internal medicine, oncology, palliative care, clinical nutrition, surgery, gastroenterology, and interventional radiology physicians, it is important to improve our understanding of MBO. The purpose of this article is to describe the clinical presentation, pathophysiology, as well as medical, surgical, and nonsurgical palliative options available to patients with MBO for purposes of decompression and nutrition.

Enumeration of Cryptosporidium oocysts from surface water concentrates by laser-scanning cytometry

2000 ◽  
Vol 41 (7) ◽  
pp. 197-202 ◽  
Author(s):  
F. Zanelli ◽  
B. Compagnon ◽  
J. C. Joret ◽  
M. R. de Roubin
Keyword(s):  
Surface Water ◽  
Water Samples ◽  
Laser Scanning ◽  
Immunomagnetic Separation ◽  
Entire Surface ◽  
Cryptosporidium Oocysts ◽  
Different Types ◽  
Laser Scanning Cytometry ◽  
Direct Microscopic Observation

The utilization of the ChemScan® RDI was tested for different types of water concentrates. Concentrates were prepared by cartridge filtration or flocculation, and analysed either without purification, or after Immunomagnetic separation (IMS) or flotation on percoll-sucrose gradients. Theenumeration of the oocysts was subsequently performed using the ChemScan® RDI Cryptosporidium application. Enumeration by direct microscopic observation of the entire surface of the membrane was carried out as a control, and recoveries were calculated as a ratio between the ChemScan® RDI result and the result obtained with direct microscopic enumeration. The Chemscan enumeration technique proved reliable, with recoveries yielding close to 100% in most cases (average 125%, range from 86 to 467%) for all the concentration/purification techniques tested. The quality of the antibodies was shown to be critical, with antibodies from some suppliers yielding recoveries a low as 10% in some cases. This difficulty could, however, be overcome by the utilization of the antibody provided by Chemunex. These data conclusively prove that laser scanning cytometry, which greatly facilitates the microscopic enumeration of Cryptosporidium oocysts from water samples and decreases the time of observation by four to six times, can be successfully applied to water concentrates prepared from a variety of concentration/purification techniques.

Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

2019 ◽  
Vol 17 (4) ◽  
pp. 388-395 ◽  
Author(s):  
Abdulla Shehab ◽  
Khalid F. AlHabib ◽  
Akshaya S. Bhagavathula ◽  
Ahmad Hersi ◽  
Hussam Alfaleh ◽  
...  
Keyword(s):  
Risk Factors ◽  
Myocardial Infarction ◽  
Quality Of Care ◽  
Middle East ◽  
Clinical Presentation ◽  
Middle Eastern ◽  
High Morbidity ◽  
Inhospital Mortality ◽  
Acute Stemi

Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

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