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181. Practical advice on maintaining antimicrobial stewardship during the COVID-19 pandemic

Practical advice on maintaining antimicrobial stewardship during the COVID-19 pandemic SAPG response to COVID-19 Latest updates / / / 13 May 2020 SAPG response to COVID-19 To prioritise and support the capacity of health and social care services, Healthcare Improvement Scotland and the Scottish Antimicrobial Prescribing Group (SAPG) have taken the decision to adapt our normal ways of working. This action is supported by Scottish Government. This is an unprecedented situation requiring unusual (...) measures, and that it is important that SAPG supports NHSScotland in maintaining essential services. All meetings of the SAPG committee and project groups have been suspended until further notice. The duration of these measures is unknown and we will provide further updates in due course. In the interim, if you have any queries, please contact: We have developed some interim pragmatic practical advice for clinical teams to ensure we maintain antimicrobial stewardship during the COVID-19 pandemic

2020 Covid-19 Ad hoc papers

182. Antimicrobial and Immunomodulatory Therapy in Adult Patients with COVID-19

Antimicrobial and Immunomodulatory Therapy in Adult Patients with COVID-19 British Columbia COVID19 Therapeutics Committee (CTC) Clinical Practice Guidance for Antimicrobial and Immunomodulatory Therapy in Adult Patients with COVID-19 SEVERITY OF ILLNESS ANTIVIRAL THERAPY ANTIBACTERIAL THERAPY IMMUNOMODULATORY THERAPY Critically Ill Patients Hospitalized, ICU-based Patients requiring ventilatory and/or circulatory support; also includes patients requiring high-flow nasal cannula, or higher (...) for DVT prophylaxis Chloroquine or hydroxychloroquine (with or without azithromycin) is not recommended outside of approved clinical trials or where other indications would justify its use Lopinavir/ritonavir is not recommended outside of approved clinical trials Remdesivir* is not recommended outside of approved clinical trials Antibacterial therapy is not routinely recommended outside of approved clinical trials or where other indications would justify its use (eg. suspected bacterial co-infection

2020 Covid-19 Ad hoc guidelines

183. Chronic obstructive pulmonary disease: Antibiotics

Chronic obstructive pulmonary disease: Antibiotics Antibiotics | Prescribing information | Chronic obstructive pulmonary disease | CKS | NICE Search CKS… Menu Antibiotics Chronic obstructive pulmonary disease: Antibiotics Last revised in November 2019 Antibiotics Azithromycin Contraindications and cautions Do not prescribe azithromycin in people: With severe hepatic impairment. Prescribe azithromycin with caution in people: Who may be predisposed to prolongation of the QT interval. For example (...) any muscle pain, tenderness, or weakness. Typhoid vaccine — antibacterials might reduce the immune response. The World Health Organization (WHO) recommends that the antibacterial is stopped from 3 days before to 3 days after receiving live oral typhoid vaccine. Warfarin — concurrent use may increase the international normalized ratio (INR). Consider increasing INR monitoring as this interaction appears to develop over the first 7 days. Drugs that prolong the QT interval (such as amiodarone

2020 NICE Clinical Knowledge Summaries

184. Diarrhoea - antibiotic associated

Diarrhoea - antibiotic associated Diarrhoea - antibiotic associated | Topics A to Z | CKS | NICE Search CKS… Menu Diarrhoea - antibiotic associated Diarrhoea - antibiotic associated Last revised in March 2019 Diarrhoea is a common consequence of treatment with antibiotics, occurring in 2–25% of people taking antibiotics Management Prescribing information Background information Diarrhoea - antibiotic associated: Summary Diarrhoea is a common consequence of treatment with antibiotics, occurring (...) in 2–25% of people taking antibiotics, depending on the antibiotic prescribed. Around 20% to 30% of cases of antibiotic-associated diarrhoea are due to Clostridium difficile . Antibiotics frequently associated with C. difficile infection include clindamycin, cephalosporins (especially third and fourth generation), fluoroquinolones, and broad-spectrum penicillins. Factors that increase the risk of C. difficile infection include increased age, history of C. difficile infection, exposure to other

2020 NICE Clinical Knowledge Summaries

185. Antimicrobial Nano-Silver Sanitizer Spray

of nanotechnology. 3 Silver was known for its antibacterial effect and silver-based compounds have been used in many antimicrobial applications. 4,5 By converting bulk silver to nanosized silver, its effectiveness for controlling bacteria and viruses was increased multifold. 2 Due to their bactericidal properties, silver nanoparticles (AgNP) are the most frequently applied nanomaterials, attracting much interest and has the highest degree of commercialisation. 5,6,7 The unique property of nanosilver is mainly (...) Antimicrobial Nano-Silver Sanitizer Spray To provide brief information on the safety, effectiveness and cost-effectiveness of Antimicrobial Nano-Silver Sanitizer Spray based on request from the Director General of Health, Ministry of Health Malaysia following proposal by a company to provide and distribute 500,000 Antimicrobial Nano-Silver Sanitizer Spray to the public, beginning with Ministry of Health Malaysia hospitals and clinics to prevent COVID-19 transmission. Nanoparticles include

2020 MaHTAS Covid-19 Rapid Evidence Updates

186. Antibiotic resistance profiles of deep surgical site infections in hip hemiarthroplasty; comparing low dose single antibiotic versus high dose dual antibiotic impregnated cement Full Text available with Trip Pro

Antibiotic resistance profiles of deep surgical site infections in hip hemiarthroplasty; comparing low dose single antibiotic versus high dose dual antibiotic impregnated cement Objectives: The incidence of fractured neck of femur (FNOF) is increasing yearly. Many of these patients undergo hip hemiarthroplasty. High dose dual-antibiotic cement (HDDAC) has been shown to reduce rates of deep surgical site infection (SSI) when compared to the current standard low dose single-antibiotic cement (...) (LDSAC) in a quasi-randomised controlled trial. Some concerns exist regarding the use of HDDAC and the development of antibiotic resistance. We reviewed cases of infection in LDSAC and HDDAC bone cement with regard to causative organism and resistance profile. Methods: A retrospective analysis was undertaken of all hemiarthroplasties within our trust from April 2008 to December 2014. We identified all patients in this time period who acquired a deep SSI. The infecting organisms and susceptibility

2018 Journal of Bone and Joint Infection

187. Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance. Full Text available with Trip Pro

Tailored Helicobacter pylori eradication based on prior intake of macrolide antibiotics allows the use of triple therapy with optimal results in an area with high clarithromycin resistance. the previous intake of macrolide antibiotics is associated with a failure to eradicate Helicobacter pylori (H. pylori) with clarithromycin-containing regimens. However, the standard triple therapy achieves eradication rates of over 90% in patients without a previous use of macrolides in our health area

2019 Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva Controlled trial quality: uncertain

188. To Compare the Effectiveness of Short-term Three Dose Perioperative Antibiotic Coverage during Decisive Period with Conventional Prolonged Postoperative Antibiotic Usage in Clean Elective Surgical Cases: An Indian Perspective. Full Text available with Trip Pro

To Compare the Effectiveness of Short-term Three Dose Perioperative Antibiotic Coverage during Decisive Period with Conventional Prolonged Postoperative Antibiotic Usage in Clean Elective Surgical Cases: An Indian Perspective. Surgical site infections are the most common postoperative complications and frequently cause morbidity and mortality. Different antibiotic regimens were evaluated as prophylaxis in wound infection following elective surgical procedures. Prophylactic antibiotics should (...) be given to cover the "decisive period" which is a period after incision to mobilization of host defenses thus preventing an infection from developing.The aim is to study the effectiveness of short-term antibiotic coverage during decisive period in the prevention of postoperative wound sepsis in clean surgical cases.The prospective randomized comparative study included 50 patients divided into two groups of 25 each. Group A (short-term ceftriaxone prophylaxis) patients received three doses of 1 g

2019 Nigerian journal of surgery : official publication of the Nigerian Surgical Research Society Controlled trial quality: uncertain

189. Factors affecting the geographic variability of antibiotic-resistant healthcare-associated infections in the United States using the CDC Antibiotic Resistance Patient Safety Atlas. (Abstract)

Factors affecting the geographic variability of antibiotic-resistant healthcare-associated infections in the United States using the CDC Antibiotic Resistance Patient Safety Atlas. We utilized publicly available data from the Centers for Disease Control to explore possible causes of state-to-state variability in antibiotic-resistant healthcare-associated infections. Outpatient antibiotic prescribing rates of fluoroquinolones and cephalosporins explained some variability in extended-spectrum

2019 Infection control and hospital epidemiology

190. Regulation of virulence and antibiotic resistance in Gram-positive microbes in response to cell wall-active antibiotics. (Abstract)

Regulation of virulence and antibiotic resistance in Gram-positive microbes in response to cell wall-active antibiotics. Antibiotic stress can evoke considerable genotypic and phenotypic changes in Gram-positive bacteria. Here, we review recent studies describing altered virulence expression in response to cell wall-acting antibiotics and discuss mechanisms that coordinate regulation of the antibiotic response.Pleiotropic effects induced by antibiotic exposure include alterations to bacterial (...) metabolism, cell wall structure and antibiotic resistance. In addition, subinhibitory concentrations of cell wall-active (CWA) antibiotics have increasingly been shown to induce the production of exotoxins and biofilm formation that may influence virulence. Remarkably, phenotypes associated with comparable antibiotic stresses can vary considerably, emphasizing the need to better understand the response to CWA antibiotics. Recent studies support both direct antibiotic recognition and recognition

2019 Current Opinion in Infectious Diseases

191. Antibacterial and antibiotic-modifying activities of fractions and compounds from Albizia adianthifolia against MDR Gram-negative enteric bacteria. Full Text available with Trip Pro

) together with isolated phytochemicals were assessed for their antimicrobial as well as their antibiotic-potentiating effects towards Gram-negative multidrug resistant (MDR) bacteria.The antibacterial activities of the samples (determination of Minimal Inhibitory « MIC » and Minimal Bactericidal Concentration « MBC ») were determined by the modified rapid p-iodonitrotetrazolium chloride (INT) colorimetric assay, as well as those of antibiotics in association with the compounds. Column chromatography (...) Antibacterial and antibiotic-modifying activities of fractions and compounds from Albizia adianthifolia against MDR Gram-negative enteric bacteria. Albizia adianthifolia (Schum.) is medicinally used in Cameroon to manage bronchitis and skin diseases. Our previous study documented the antibacterial potential of its roots' methanol extract. In this study, methanol roots extract was subjected to chromatography techniques and fractions (AARa and AARb), sub-fractions (AARa1-4, AARb1-2 and AARb11-14

2019 BMC Complementary and Alternative Medicine

192. 'Antibiotic footprint' as a communication tool to aid reduction of antibiotic consumption. Full Text available with Trip Pro

in behaviour that reduce their direct and indirect consumption of antibiotics.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. (...) 'Antibiotic footprint' as a communication tool to aid reduction of antibiotic consumption. 'Superbugs', bacteria that have become resistant to antibiotics, have been in numerous media headlines, raising awareness of antibiotic resistance and leading to multiple action plans from policymakers worldwide. However, many commonly used terms, such as 'the war against superbugs', risk misleading people to request 'new' or 'stronger' antibiotics from their doctors, veterinary surgeons or pharmacists

2019 Journal of Antimicrobial Chemotherapy

193. A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts. (Abstract)

A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts. Antibiotic overuse remains a significant problem. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated health care system in order to prioritize antibiotic stewardship efforts.We conducted an epidemiologic study of antibiotic use (...) across an integrated healthcare system on 12 randomly-selected days from 2017-2018. For inpatients and perioperative patients administrations of antibiotics were recorded, whereas, prescriptions were recorded for outpatients.On the study days, 10.9% (95%CI 10.6-11.3%) of patients received antibiotics. Of all antibiotics, 54.1% were from ambulatory care (95%CI 52.6-55.7%), 38.0% were from the hospital, (95%CI 36.6-39.5%), and 7.8% (95%CI 7.1-7.8%) were perioperative. The emergency department/urgent

2019 Clinical Infectious Diseases

194. Exploring patients' understanding of antibiotic resistance and how this may influence attitudes towards antibiotic use for acute respiratory infections: a qualitative study in Australian general practice. Full Text available with Trip Pro

Exploring patients' understanding of antibiotic resistance and how this may influence attitudes towards antibiotic use for acute respiratory infections: a qualitative study in Australian general practice. To explore patients' or parents of child patients' understanding of antibiotic resistance and aspects of resistance such as resistance reversibility and its spread among those in close proximity, along with how this may influence attitudes towards antibiotic use for acute respiratory (...) infections (ARIs).Qualitative semistructured interview study using convenience sampling and thematic analysis by two researchers independently.General practices in Gold Coast, Australia.32 patients or parents of child patients presenting to general practice with an ARI.Five themes emerged: (1) antibiotic use is seen as the main cause of antibiotic resistance, but what it is that becomes resistant is poorly understood; (2) resistance is perceived as a future 'big problem' for the community, with little

2019 BMJ open

195. Parents' perceptions of antibiotic use and antibiotic resistance (PAUSE): a qualitative interview study. Full Text available with Trip Pro

of unnecessary antibiotic use and antibiotic resistance needs to focus on outcomes that parents of young children can relate to (e.g. infection recurrence) and in a format that parents will engage with (e.g. face-to-face dissemination at playgroups and parent/child community events) to make a more informed decision about the risks and benefits of antibiotics for their child.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. (...) Parents' perceptions of antibiotic use and antibiotic resistance (PAUSE): a qualitative interview study. There remains public misconception about antibiotic use and resistance. Preschool children are at particular risk of receiving unnecessary antibiotics because they commonly present in primary care and many childhood infections are self-limiting.The aim of our study was to explore parents' perceptions and understanding of antibiotic use and resistance in the context of their young child

2019 Journal of Antimicrobial Chemotherapy

196. Successful treatment of antibiotic resistant poly-microbial bone infection with bacteriophages and antibiotics combination. Full Text available with Trip Pro

Successful treatment of antibiotic resistant poly-microbial bone infection with bacteriophages and antibiotics combination. A patient with a trauma-related left tibial infection associated with extensively drug-resistant Acinetobacter baumannii and multidrug-resistant Klebsiella pneumoniae was treated with bacteriophages and antibiotics. There was rapid tissue healing and positive culture eradication. As a result, the patient's leg did not have to be amputated and he is undergoing

2019 Clinical Infectious Diseases

197. Impact of an automated antibiotic time-out alert on the de-escalation of broad-spectrum antibiotics at a large community teaching hospital. (Abstract)

Impact of an automated antibiotic time-out alert on the de-escalation of broad-spectrum antibiotics at a large community teaching hospital. Broad-spectrum antibiotic de-escalation before and after implementation of a 72-hour antibiotic time-out alert within the electronic medical record was analyzed. De-escalation occurred significantly more often after the implementation of the alert (55.0% vs 35.1%; 95% confidence interval, -0.3491 to -0.0488; P < .01).

2019 Infection control and hospital epidemiology

198. Do Prophylactic Antibiotics Reach the Operative Site Adequately?: A Quantitative Analysis of Serum and Wound Concentrations of Systemic and Local Prophylactic Antibiotics in Spine Surgery. (Abstract)

Do Prophylactic Antibiotics Reach the Operative Site Adequately?: A Quantitative Analysis of Serum and Wound Concentrations of Systemic and Local Prophylactic Antibiotics in Spine Surgery. Prospective Cohort Study OBJECTIVE.: To analyse the serum and drain concentrations of antibiotics administered by two different routes and compare the results.Systemic antibiotics are expected to reach the surgical site and maintain adequate concentrations of the drug to prevent infection. However (...) , It is unknown whether systemically administered antibiotics reach and maintain such adequate concentrations at the surgical wound or not.40 patients undergoing elective spine surgery received intra wound Vancomycin (1 GM) before the wound closure and single dose of intravenous Gentamycin (80MG) immediately after surgery. Blood and Drain samples were collected post-operatively to estimate serum and drain concentrations of Gentamycin and Vancomycin.Drug Estimation Protocol: Drug concentrations were estimated

2019 Spine

199. When not to start antibiotics: avoiding antibiotic overuse in the intensive care unit. Full Text available with Trip Pro

in the ICU.A semi-structured search of PubMed and Cochrane Library databases for articles published in English during the past 15 years was conducted.Distinguishing infection from non-infectious mimics in ICU patients is uniquely challenging. At present, we do not have access to a rapid point-of-care test that reliably differentiates between individuals who need antibiotics and those who do not. A small number of studies have attempted to compare early aggressive versus conservative antimicrobial (...) When not to start antibiotics: avoiding antibiotic overuse in the intensive care unit. Most intensive care unit (ICU) patients receive broad-spectrum antibiotics. While lifesaving in some, in others these treatments may be unnecessary and place patients at risk of antibiotic-associated harms.To review the literature exploring how we diagnose infection in patients in the ICU and address the safety and utility of a 'watchful waiting' approach to antibiotic initiation with selected patients

2019 Clinical Microbiology and Infection

200. Antibiotic Delays and Feasibility of a 1-Hour-From-Triage Antibiotic Requirement: Analysis of an Emergency Department Sepsis Quality Improvement Database. Full Text available with Trip Pro

Antibiotic Delays and Feasibility of a 1-Hour-From-Triage Antibiotic Requirement: Analysis of an Emergency Department Sepsis Quality Improvement Database. We identify factors associated with delayed emergency department (ED) antibiotics and determine feasibility of a 1-hour-from-triage antibiotic requirement in sepsis.We studied all ED adult septic patients in accordance with Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock National Quality Measures in 2 consecutive 12 (...) -month intervals. During the second interval, a quality improvement intervention was conducted: a sepsis screening protocol plus case-specific feedback to clinicians. Data were abstracted retrospectively through electronic query and chart review. Primary outcomes were antibiotic delay greater than 3 hours from documented onset of hypoperfusion (per Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock National Quality Measures) and antibiotic delay greater than 1 hour from triage

2019 Annals of Emergency Medicine

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