scholarly journals Clinical and microbiological aspects of the use of Lactobacillus rhamnosus PL1 strains in proctological patients with symptoms of chronic proctitis

2017 ◽  
Vol 89 (3) ◽  
pp. 16-22
Author(s):  
K. Borycka-Kiciak ◽  
M. Strus ◽  
P. Pietrzak ◽  
K. Wawiernia ◽  
D. Mikołajczyk ◽  
...  
Keyword(s):  
Intestinal Microbiota ◽  
Bacterial Flora ◽  
Lactobacillus Rhamnosus ◽  
Underlying Disease ◽  
Entire Study ◽  
Qualitative And Quantitative ◽  
Significant Difference ◽  
Probiotic Lactobacillus ◽  
Quantitative Changes ◽  
The Impact

Recurrent proctitis and the symptoms associated therewith pose significant clinical problem in proctological patients. The objective of this study was to assess the impact of the probiotic Lactobacillus rhamnosus PL1 strain on the clinical presentation and composition of intestinal microbiota in patients with symptoms of proctitis in the course of hemorrhoidal disease and diverticulosis. Material consisted of 24 patients in whom no complete clinical improvement could be obtained after the treatment of the underlying disease. Subject to the assessment was the presence and the intensity of clinical symptoms as well as qualitative and quantitative changes in the composition of bacterial flora detected in the stool before, during and after a 9-week supplementation with the probiotic Lactobacillus rhamnosus PL1 strain. Results: In the entire study group, the intensity of pain after 12 weeks was significantly lower (p=0,.011) compared to baseline; the intensity of flatulence and abdominal discomfort was reduced significantly as early as after 3 weeks, with the difference reaching a highly significant level after 12 weeks (pP<0,.0001). No significant difference was observed in the frequency of the reported episodes of diarrhea, constipation, as well as itching and burning in the anal region. As early as after 3 weeks of supplementation with the probiotic L. rhamnosus PL1 strain, significant qualitative and quantitative changes were observed in the composition of intestinal microbiota; the changes differed depending on the underlying disease. An increase in the total counts of the bacteria of Lactobacillus genus, particularly L. rhamnosus PL1 strain was observed regardless of the underlying disease. Conclusion: Tthe probiotic Lactobacillus rhamnosus PL1 strain appears to be useful in restoring appropriate ratios of bacterial populations in patients presenting with symptoms of proctitis in the course of the treatment of certain diseases of the lower gastrointestinal tract.

Pollinator Insects and their Impact on Crop Yield of Mustard in Kusma, Parbat, Nepal

2019 ◽  
Vol 24 (2) ◽  
pp. 68-75
Author(s):  
Narayan Subedi ◽  
Indra Prasad Subedi
Keyword(s):  
Crop Yield ◽  
Fruit Set ◽  
Apis Cerana ◽  
Qualitative And Quantitative ◽  
Significant Difference ◽  
The Difference ◽  
Four Blocks ◽  
And Control ◽  
The Impact ◽  
Pod Length

The diversity of insect pollinators and their impact on crop yield of mustard were studied in Kusma, Parbat, Nepal from December 2018 to April 2019 in four blocks with each having 12 m2 areas. Two plots; treatment and control, were established in each block. Insect diversity was observed from 8 to 16 hrs, with the interval of an hour for three consecutive months (Jan-Feb). Eighty mustard plants were randomly selected, 40 from each plot just before flowering to find the impact of insect pollination on crop yield and these selected plants were examined for various qualitative and quantitative parameters. Altogether 16 species of pollinator insects belonging to five orders and nine families were recorded. Hymenoptera (36 %) was the most abundant order visiting mustard flowers followed by Diptera (34 %), Coleoptera (17 %), Lepidoptera (12 %) and Heteroptera (1 %). The most abundant family was Apidae (35.64 %), followed by Syrphidae (31.84 %). Apis cerana and Eristalis sp. were the most important pollinator insects of mustard. Seven species were found foraging both on pollen and nectar, four species foraging only on nectar and remaining five as casual visitors. The peak foraging activities of majority of the insects were observed between 12 hr to 14 hr. A significant difference was observed in the number of pods (59.80 ± 1.967 and 70.47 ± 2.431), fruit set (70.55 ± 1.362 and 80.94 ± 0.638), number of seeds per pods (16.70 ± 0.248 and 19.30 ± 0.330), diameter of seed (0.133 ± 0.2547 and 0.275 ± 0.0051) and weight of 100 dry seeds (0.33 ± 0.058 and 0.48 ± 0.023) in control and treatment plots whereas, the difference was non-significant in case of pod length between control and treatment plots (P=0.163).

scholarly journals Role of Tryptophan-Metabolizing Microbiota On Diarrhea Mice Caused by Folium sennae Extracts

2020 ◽  
Author(s):  
Chenyang Zhang ◽  
Haoqing Shao ◽  
Dandan Li ◽  
Nenqun Xiao ◽  
Zhoujin Tan
Keyword(s):  
Cytochrome P450 ◽  
Intestinal Microbiota ◽  
Bacterial Flora ◽  
Shannon Index ◽  
Tryptophan Metabolism ◽  
Control Group ◽  
Cytochrome P450 Enzymes ◽  
Significant Difference ◽  
Tryptophan Derivatives

Abstract Background: Although reports have provided evidence that diarrhea caused by Folium sennae can result in intestinal microbiota diversity disorder, the intestinal bacterial characteristic and specific mechanism are still unknown. The objective of our study was to investigate the mechanism of diarrhea caused by Folium sennae, which was associated with intestinal bacterial characteristic reshaping and metabolic abnormality. Results: For the intervention of Folium sennae extracts, Chao1 index and Shannon index were statistical decreased. The Beta diversity clusters of mice interfered by Folium sennae extracts were distinctly separated from control group. Combining PPI network analysis, cytochrome P450 enzymes metabolism was the main signaling pathway of diarrhea caused by Folium sennae. Moreover, 10 bacterial flora communities had statistical significant difference with Folium sennae intervention: the abundance of Paraprevotella, Streptococcus, Epulopiscium, Sutterella and Mycoplasma increased significantly; and the abundance of Adlercreutzia, Lactobacillus, Dehalobacterium, Dorea and Oscillospira reduced significantly. 7 of the 10 intestinal microbiota communities were related to the synthesis of tryptophan derivatives, which affected the transformation of aminotryptophan into L-tryptophan, leading to abnormal tryptophan metabolism in the host. Conclusions: Folium sennae targeted cytochrome P450 3A4 to alter intestinal bacterial characteristic and intervene the tryptophan metabolism of intestinal microbiota, such as Streptococcus, Sutterella and Dorea, which could be the intestinal microecological mechanism of diarrhea caused by Folium sennae extracts.

scholarly journals The effect of the duration between urine culture and semirigid ureteroscopic on the rate of systemic inflammatory response syndrome postoperatively

2021 ◽  
Author(s):  
Fatih Akkaş ◽  
Emre Sam ◽  
Ahmet Cinislioglu ◽  
İbrahim Karabulut ◽  
Fatih Kursat Yilmazel ◽  
...  
Keyword(s):  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
Urine Culture ◽  
Systemic Inflammatory Response ◽  
Binary Logistic Regression Analysis ◽  
Ureteroscopic Lithotripsy ◽  
Entire Study ◽  
Significant Difference ◽  
The Impact ◽  
Bladder Urine

Purpose: The aim of this study is to analyze the preoperative and intraoperative factors that might induce systemic inflammatory response syndrome after semirigid ureteroscopic lithotripsy (SULL) , and to evaluate the impact of duration between preoperative bladder urine culture (PBUC) and surgery on postoperative systemic inflammatory response syndrome (SIRS). Methods: A retrospective review was conducted including patients who underwent SULL in our center between January 2011 and June 2020. Prior to surgery, PBUC were obtained from all patients and postoperatively patients were observed for signs of SIRS. Univariable and multivariable binary logistic regression analysis were implemented to demonstrate the factors that predict SIRS postoperatively. Results: The entire study included a cohort of 572 patients. The rate of SIRS following SULL was 1.7%. Predictive factors for SIRS were listed as stone volume, surgical time, and history of recurrent urinary tract infection. No significant difference was detected in terms of the duration between PBUC and SULL when comparing the SIRS group with the other group. Conclusion: The duration between PBUC and SULL is not an efficacious factor for SIRS. It may be useful to conduct prospective studies to enlighten this issues as endourologists deal with this duration dilemma often in daily practice. Keywords: Semirigid ureteroscopic lithotripsy, Systemic inflammatory response syndrome, Preoperative bladder urine culture

scholarly journals Comparative study on the effects of different feeding habits and diets on intestinal microbiota in Acipenser baeri Brandt and Huso huso

2019 ◽  
Author(s):  
Guanling Xu ◽  
Wei Xing ◽  
Tieliang Li ◽  
Min Xue ◽  
Zhihong Ma ◽  
...  
Keyword(s):  
Intestinal Microbiota ◽  
Feeding Habits ◽  
Siberian Sturgeon ◽  
Huso Huso ◽  
Gastrointestinal Microbiota ◽  
Acipenser Baeri ◽  
Significant Difference ◽  
Sh Group ◽  
The Impact ◽  
Beluga Sturgeon

Abstract Background: Siberian sturgeon ( Acipenser baeri Brandt) and Beluga sturgeon ( Huso huso ) are two important commercial fish in China, and the feeding habits of them are very different. Diets and feeding habits are two significant factors to affect the gastrointestinal microbiota in fish. The intestinal microbiota has been reported to play a key role in nutrition and immunity. However, it is rarely reported about the relationship between the intestinal microbiota and feeding habits/diets on different Acipenseridae fish. This study is to comparative analysis of gut microbial community in Siberian sturgeon and Beluga sturgeon fed with the same diet/Beluga sturgeon fed with different diets in order to determine the effects of different feeding habits/diets on the fish intestinal microbiota. Results: According to the experimental objectives, BL and BH groups were Beluga sturgeon ( Huso huso ) fed with low fishmeal diet and high fishmeal diet, respectively. SH group represented Siberian sturgeon ( Acipenser baeri Brandt) fed with the same diet as BH group. After 16 weeks feeding trial, the intestinal microbiota was examined by 16S rRNA high-throughput sequencing technology. On the phylum level, Proteobacteria and Bacteroidetes were significantly higher in BL group than BH group, and Cyanobacteria showed the opposite trend. Compared with BH group, Proteobacteria and Firmicutes were significantly increased in SH group, whereas Cyanobacteria were clearly decreased. At the genus level, Pseudomonas and Citrobacter in BL group were significantly higher comparing with BH group, while Bacillus , Luteibacter , Staphylococcus and Oceanobacillus was lower in BH group than SH group. Conclusions: Alpha and beta diversities indicated that the intestinal microflora were significant difference between Siberian sturgeon and Beluga sturgeon when they fed with the same diet. Meanwhile, Beluga sturgeon fed with low fishmeal diet can increase the species diversity of intestinal microbiota than it fed with high fishmeal diet. Therefore, feeding habits clearly affected the gastrointestinal microbiota of sturgeons. Moreover, the impact of changes in food on the gut microbiota of sturgeons should be taken into consideration during the process of sturgeon aquaculture.

scholarly journals THE IMPACT OF DURATION OF MENOPAUSE ON BONE METABOLISM IN DETECTING AND PREVENTING OSTEOPOROTIC FRACTURES

2021 ◽  
Author(s):  
Tirthal Rai ◽  
Rishabh M Hegde ◽  
Mayur Rai ◽  
Janice Dsa ◽  
Srinidhi Rai
Keyword(s):  
Postmenopausal Women ◽  
Statistical Significance ◽  
Osteoporotic Fractures ◽  
Serum Osteocalcin ◽  
Urinary Hydroxyproline ◽  
Entire Study ◽  
Fracture Group ◽  
Significant Difference ◽  
Post Menopausal ◽  
The Impact

Abstract ABSTRACT Background: Menopause accelerates bone loss after 10 years of cessation of the menstrual cycle causing osteoporosis. Hip fractures among postmenopausal women escalate morbidity and mortality in these women. Objective: The study was done to evaluate the effect of duration of menopause on BTMs so that it could detect post-menopausal osteoporosis at the earliest and predict the fracture risk Materials and Methods: The study was conducted in a tertiary hospital in Mangalore on 100 postmenopausal women. The duration of menopause was divided into quartiles. Evaluation and correlation of serum osteocalcin, urinary hydroxyproline, BMI, calcium, phosphorous and alkaline phosphatase was done on the duration of menopause. The subjects comprised 50 osteoporotic and 50 non-osteoporotic post-menopausal women. Continuous variables were represented as median and interquartile ranges. Comparison between two groups was done using the Mann Whitney U test. Comparison between more than two groups was done using the Kruskal Wallis test. The correlation was done using spearman’s correlation test. Statistical significance was considered at p<0.05. Results: Serum osteocalcin levels significantly declined and urinary hydroxyproline levels elevated between quartiles of duration of menopause in the entire study group and in osteoporotic women. (p<0.001). There was no significant difference in osteocalcin and hydroxyproline levels between the quartiles in the fracture group. 82% of the osteoporotic had >15 YSM. Conclusion: Osteocalcin levels plateaued after 8years of menopause and started decreasing after 15 YSM. Osteoporotic fractures were higher in more than 15 YSM and the osteocalcin level was 2.47 ng/ml in this quartile. There is no significant difference in osteocalcin levels in those with fractures, indicating no significance of screening for serum osteocalcin levels once the fractures have occurred. Hence concluding that the duration of menopause is the key indicator for osteoporosis and serum osteocalcin is a potent biomarker for detection of the risk of fracture. Monitoring of serum osteocalcin levels(<2.55ng/ml) after 8 years of menopause is very essential for early prophylactic treatment in order to prevent osteoporotic fractures and the burden associated with it. KEYWORDS: Duration of menopause, osteocalcin, quartiles, urinary hydroxyproline, osteoporotic fractures

scholarly journals DAMPAK EKONOMI PROGRAM PENGEMBANGAN USAHA MINA PEDESAAN (PUMP) PADA USAHA PENGOLAHAN DAN PEMASARAN HASIL PERIKANAN

2016 ◽  
Vol 10 (2) ◽  
pp. 229 ◽  
Author(s):  
Yayan Hikmayani ◽  
Maharani Yulisti
Keyword(s):  
Business Unit ◽  
Fish Processing ◽  
Average Income ◽  
Improvement Program ◽  
Qualitative And Quantitative ◽  
Average Production ◽  
Significant Difference ◽  
Before And After ◽  
The Impact ◽  
Banda Aceh

Sejak tahun 2011 Kementerian Kelautan dan Perikanan (KKP) telah menggulirkan program Pengembangan Usaha Mina Pedesaaan-Pengolahan dan Pemasaran Hasil Perikanan (PUMP-P2HP) untuk membantu mengembangkan usaha pengolahan dan pemasaran ikan, namun begitu belum banyak penelitian mengenai dampak program tersebut terhadap kelompok pengolah dan pemasaran hasil perikanan (Poklahsar) penerima bantuan. Untuk itu penting dilakukan penelitian dampak program PUMP-P2HP sebagai bahan infomasi untuk perbaikan program secara lebih akurat, efektif dan efisien. Penelitian dilaksanakan pada tahun 2014 di 9 lokasi penerima bantuan yaitu Kab. Pesisir Selatan, Kab. Cirebon, Kota Makasar, Kab. Tangerang, Kota Banda Aceh, Kab. Banjar, Kab. Sukabumi, Kota Sibolga, dan Kab.Lombok Timur. Penelitian dilakukan dengan pendekatan kualitatif dan kuantitatif yang berusaha membandingkan kondisi Poklahsar sebelum dan sesudah program PUMP-P2HP yang dijalankan pada tahun 2012. Pemilihan lokasi penelitian dilakukan secara purposif terhadap daerah yang menerima bantuan PUMP-P2HP dengan keterwakilan antara wilayah barat dan timur. Pengambilan sampel dilakukan secara acak terhadap 30 responden di tiap lokasi melalui wawancara dengan menggunakan kuesioner terstruktur. Analisis data menggunakan uji-t untuk menganalisa signifikansi perubahan antara tahun sebelum implementasi program dan setelah implementasi program terhadap responden yang sama. Hasil penelitian menunjukkan produksi rata-rata Poklahsar sebelum mendapatkan bantuan adalah 192 kg/siklus dengan rata-rata produktivitas 17 siklus/bulan. Produktivitas terkecil terjadi di Kota Makasar dengan angka 50 kg/siklus. Setelah mendapatkan bantuan program PUMP-P2HP, terdapat peningkatan produksi olahan ikan sebesar 66,5% pada setiap unit pengolahan dengan rata-rata produksi sebesar 320 kg/siklus. Selain itu, terdapat perbedaan pendapatan yang signifikan antara sebelum dan sesudah program PUMP. Ratarata pendapatan olahan ikan dan pemasaran perikanan sebelum adanya program PUMP-P2HP adalah Rp. 2.470.233 dan meningkat menjadi Rp. 3.727.666 setelah adanya program tersebut. Hal ini dapat disimpulkan bahwa terjadi peningkatan pendapatan pada usaha pengolahan ikan dan pemasaran perikanan di Indonesia, meskipun tidak diikuti dengan peningkatan yang signifikan pada penggunaan tenaga kerja. (Economic Impacts of PUMP Program to The Fish Processor and Marketing Enterprise)Since 2011 The Ministry of Marine Affairs and Fisheries has been implementing Program of Rural Fisheries Businesses – Processing and Marketing of Fisheries Products (PUMP-P2HP) since to develop fisheries processing and marketing businesses. However, there are limited studies on the impact to the program recipients (fish processor groups). Therefore, it is important to study the impact of the PUMPP2HP program to obtain the improvement program information more accurately, effectively and efficiently. The study was conducted in 2014 in 9 region beneficiaries: Pesisir Selatan District, Cirebon District, Makasar Municipality, Tangerang District, Banda Aceh Municipality, Banjar District, Sukabumi District, Sibolga Municipality, and Lombok Timur District. Qualitative and quantitative approaches were used on this study to compare the conditions before and after program implemented in 2012. Research location was selected purposively towards districts which received the program with representation between western and eastern regions. Sampling was collected randomly to 30 respondents in each location by using structured questionnaires. T-test was used to analyze the changes of respondents performance due to the implemented program. Results showed that the average production of fish processing groups before program was 192 kg/cycle with average production 17 cycles/month, the smallest production was in Makasar Municipality (50 kgs/cycle). There was an increasing on production of fish processing products in every recipient business unit after receiving the program (66.5%) with average production was 320 kgs/ cycle. Furthermore, there was a significant difference in income between before and after the program implemented. The average income of the fish processor before the program was IDR 2,470,233 and increased to IDR 3,727,666 after the program. It can be concluded that the revenue of fish processors increased significantly, whereas the use of labor did not improve.

scholarly journals Quantitative Assessment of Type-1 Collagen in Charcot Neuroarthropathy with Use of Harmonic Generation and Multiphoton Microscopy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0041
Author(s):  
Kaitlin Saloky ◽  
Michael Aynardi ◽  
Kempland Walley ◽  
Paul Juliano ◽  
Heather Matchik ◽  
...  
Keyword(s):  
Harmonic Generation ◽  
Quantitative Difference ◽  
Mean Intensity ◽  
Charcot Neuroarthropathy ◽  
Qualitative And Quantitative ◽  
Neuropeptide Release ◽  
Significant Difference ◽  
Orientation Index ◽  
The Impact

Category: Diabetes Introduction/Purpose: Diabetic Charcot neuroarthropathy is characterized by rapid loss of bone with accompanied disruption to the surrounding joints and is often in the absence of trauma or infection. Previous research has demonstrated neuropeptide release and osteoclast activation in addition to increased collagen turnover. Currently, there is limited understanding on the impact of the disease on type-1 collagen within the joint synovium. The purpose of this study was to analyze qualitative and quantitative differences in type-1 collagen between diabetic, neuropathic patient controls and those with Charcot neuroarthropathy. Methods: A prospective case-control study using routinely discarded surgical waste synovial tissue from diabetic, neuropathic patients with and without Charcot. The tissue was prepared in the laboratory for analysis. Microscopy was performed using multiphoton excitation fluorescence (MPEF) and second harmonic generation (SHG) microscopy techniques, utilizing a mode locked femto-second i: Sapphire Tsunami (Spectra-Physics, Mountain View, CA) synchronously pumped by a Millenia Xs J (Spectra-Physics) diode-pumped solid state laser. Qualitative and quantitative microscopic analysis was performed on Charcot specimens and controls. A statistical analysis was performed to detect a quantitative difference in type-1 collagen. Results: An analysis was performed on 8 samples; 4 neuropathic controls and 4 Charcot neuroarthropathy samples. There was a statistically significant difference between the amount, the quality and organization of type-1 collagen (p<0.0001). The Charcot group had significantly less type-1 collagen when compared to the control (p<0.0001). Qualitative analysis was performed using a mean intensity value. The control group’s mean intensity was 2561.4 nm while the Charcot group’s was 884.1 nm. The Charcot group had a significantly smaller mean intensity indicating poorer quality of collagen (p<0.0001). Orientation index was used to assess the organization of type-1 collagen in the synovium. A smaller orientation index signifies an increase in disorganization. The Charcot group had a significantly smaller orientation index of 16.5 compared to the control group’s 27.8 (p<0.0001). Conclusion: Charcot neuroarthropathy leads to significant abnormalities in type-1 collagen within the joint synovium when compared to the diabetic controls. Further research will determine if these differences are attributable to neuropeptide release and osteoclastic activation.

scholarly journals Comparative study on the effects of different feeding habits and diets on intestinal microbiota in Acipenser baeri Brandt and Huso huso

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Guanling Xu ◽  
Wei Xing ◽  
Tieliang Li ◽  
Min Xue ◽  
Zhihong Ma ◽  
...  
Keyword(s):  
Intestinal Microbiota ◽  
Feeding Habits ◽  
Siberian Sturgeon ◽  
Huso Huso ◽  
Gastrointestinal Microbiota ◽  
Acipenser Baeri ◽  
Significant Difference ◽  
Sh Group ◽  
The Impact ◽  
Beluga Sturgeon

Abstract Background Siberian sturgeon (Acipenser baeri Brandt) and Beluga sturgeon (Huso huso) are two important commercial fish in China, and the feeding habits of them are very different. Diets and feeding habits are two significant factors to affect the gastrointestinal microbiota in fish. The intestinal microbiota has been reported to play a key role in nutrition and immunity. However, it is rarely reported about the relationship between the intestinal microbiota and feeding habits/diets on different Acipenseridae fish. This study is to comparative analysis of gut microbial community in Siberian sturgeon and Beluga sturgeon fed with the same diet/Beluga sturgeon fed with different diets in order to determine the effects of different feeding habits/diets on the fish intestinal microbiota. Results According to the experimental objectives, BL and BH groups were Beluga sturgeon (Huso huso) fed with low fishmeal diet and high fishmeal diet, respectively. SH group represented Siberian sturgeon (Acipenser baeri Brandt) fed with the same diet as BH group. After 16 weeks feeding trial, the intestinal microbiota was examined by 16S rRNA high-throughput sequencing technology. On the phylum level, Proteobacteria and Bacteroidetes were significantly higher in BL group than BH group, and Cyanobacteria showed the opposite trend. Compared with BH group, Proteobacteria and Firmicutes were significantly increased in SH group, whereas Cyanobacteria were clearly decreased. At the genus level, Pseudomonas and Citrobacter in BL group were significantly higher comparing with BH group, while Bacillus, Luteibacter, Staphylococcus and Oceanobacillus was lower in BH group than SH group. Conclusions Alpha and beta diversities indicated that the intestinal microflora were significant difference between Siberian sturgeon and Beluga sturgeon when they fed with the same diet. Meanwhile, Beluga sturgeon fed with low fishmeal diet can increase the species diversity of intestinal microbiota than it fed high fishmeal diet. Therefore, feeding habits clearly affected the gastrointestinal microbiota of sturgeons. Moreover, the impact of changes in food on the gut microbiota of sturgeons should be taken into consideration during the process of sturgeon aquaculture.

scholarly journals 1075. The Impact of Physician Peer Comparison of a Novel Inpatient Antimicrobial Stewardship Metric: the Start-Stop Ratio (SSR)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S381-S381
Author(s):  
Stacy Volk ◽  
Michelle Fagenstrom
Keyword(s):  
Antimicrobial Stewardship ◽  
High Ratio ◽  
Antibiotic Prescribing ◽  
Post Intervention ◽  
Entire Study ◽  
Diagnostic Uncertainty ◽  
Open Disclosure ◽  
Days Of Therapy ◽  
Significant Difference ◽  
The Impact

Abstract Background The 48-hour “Antibiotic Timeout” (ATO), one of the CDC’s interventions defined in the Core Elements of Antimicrobial Stewardship Programs (ASP), has not reliably proven to impact inpatient antibiotic use. Given the reported history of utilizing peer-comparison data to change prescribing behavior, it was hypothesized that open disclosure of individual inpatient antibiotic start-stop ratios (SSR) would be an effective tool to increase prescribers’ tendency to (1) observe patients off antibiotics upon admission while pursuing treatments perceived more likely to provide syndromic resolution and (2) discontinue antibiotics in the setting of diagnostic uncertainty at 48 hours, or possibly even earlier, without introducing harm. Methods In a community, nonteaching hospital, all adult systemic antibiotic orders initiated by an inpatient hospitalist with at least one administration during the baseline period of January - March of 2018 were retrieved. A prescriber-specific count of all antibiotic orders (“starts”) and discontinuations (“stops”) was collected. Each provider received a document with their baseline SSR compared with the group SSR and was assigned a visual cue that corresponded to the quartile in which they performed at baseline. The same antibiotic data were then collected and evaluated for the post-intervention period of February–April 2019 to determine whether open disclosure of inpatient SSRs impacted antibiotic prescribing. Results Of 19 providers that were included in both study periods, there was no significant difference in the pre- and post-intervention SSR (1.93 to 2.09, P = 0.19). However, in the pre-intervention high-ratio target group (n = 10) for whom we felt open SSR reporting would impact the most, the SSR decreased from 2.41 to 2.26 (P = 0.24). In the entire study population, 68% of providers had a reduction or no change in their SSR. Overall facility-wide antibiotic utilization decreased from 561 to 478 days of therapy per 1,000 days present (P < 0.05). Conclusion Open reporting of antibiotic SSRs to an inpatient provider group may be utilized as an ASP tool to reduce overall inpatient antibiotic consumption, especially by providers that are found to be high-ratio prescribers at baseline. Disclosures All authors: No reported disclosures.

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