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1721. Integrating bedside nurses into antibiotic stewardship: A practical approach. (Abstract)

Integrating bedside nurses into antibiotic stewardship: A practical approach. Nurses view patient safety as an essential component of their work and have reported a general interest in embracing an antibiotic steward role. However, antibiotic stewardship (AS) functions have not been formally integrated into nursing practice despite nurses' daily involvement in clinical activities that impact antibiotic decisions (e.g., obtaining specimens for cultures, blood drawing for therapeutic drug (...) monitoring). Recommendations to expand AS programs to include bedside nurses are generating support at a national level, yet a practical guidance on how nurses can be involved in AS activities is lacking. In this review, we provide a framework identifying selected practices where nurses can improve antibiotic prescribing practices through appropriate obtainment of Clostridioides difficile tests, appropriate urine culturing practices, optimal antibiotic administration, accurate and detailed documentation

2019 Infection control and hospital epidemiology

1722. Effect of physicians' knowledge on antibiotics rational use in China's county hospitals. (Abstract)

Effect of physicians' knowledge on antibiotics rational use in China's county hospitals. Irrational prescriptions of antibiotics have received significant international attention. In China, previous studies have described the impact of physicians' knowledge on antibiotic use, however, empirical studies of the relationship between physician knowledge and antibiotic prescription behavior are limited.This study aimed to examine physicians' knowledge of antibiotic and explore the effects (...) of physicians' knowledge on rational antibiotic use in county hospitals in China.A sample of 360 physicians from 60 county hospitals was designed. Questionnaires were used to evaluate the physicians' knowledge of antibiotic use. We assessed the rationality of antibiotic use by evaluating the physicians' prescriptions. Antibiotic prescriptions were evaluated according to percentage of encounters where an antibiotic was prescribed, percentage of encounters with combined antibiotics prescriptions

2019 Social Science & Medicine

1723. Pathways of antibiotic use in Bangladesh: qualitative protocol for the PAUSE study. Full Text available with Trip Pro

Pathways of antibiotic use in Bangladesh: qualitative protocol for the PAUSE study. Global actions to reduce antimicrobial resistance (AMR) include optimising the use of antimicrobial medicines in human and animal health. In countries with weak healthcare regulation, this requires a greater understanding of the drivers of antibiotic use from the perspective of providers and consumers. In Bangladesh, there is limited research on household decision-making and healthcare seeking in relation (...) to antibiotic use and consumption for humans and livestock. Knowledge is similarly lacking on factors influencing the supply and demand for antibiotics among qualified and unqualified healthcare providers.The aim of this study is to conduct integrated research on household decision-making for healthcare and antibiotic use, as well as the awareness, behaviours and priorities of healthcare providers and sellers of antibiotics to translate into policy development and implementation.In-depth interviews

2019 BMJ open

1724. Antibiotic susceptibility of <i>Propionibacterium acnes</i> isolated from patients with acne in a public hospital in Southwest China: prospective cross-sectional study. Full Text available with Trip Pro

Antibiotic susceptibility of Propionibacterium acnes isolated from patients with acne in a public hospital in Southwest China: prospective cross-sectional study. Antibiotics have been routinely used for several decades against Propionibacterium acnes (P. acnes), but antibiotic resistance of P. acnes is becoming a global problem. Only one related Chinese study is available. The aim of this study was to assess the antibiotic susceptibility of P. acnes obtained from patients with acne (...) %) were susceptible to tetracycline, followed by clindamycin and clarithromycin in 101 (44.5%) and 102 (44.93%) isolates, respectively. Susceptibility of P. acnes was detected for erythromycin in 96 (42.3%) patients, followed by azithromycin in 94 (41.4%). Subjects who received antibiotics (topical and oral) had higher frequencies of antibiotic-resistant P. acnes as well as increased antibiotic minimum inhibitory concentrations compared with patients without antibiotic treatment.P. acnes was highly

2019 BMJ open

1725. Antibiotic Prescription Practice for Pediatric Urinary Tract Infection in a Tertiary Center. Full Text available with Trip Pro

Antibiotic Prescription Practice for Pediatric Urinary Tract Infection in a Tertiary Center. Prescribing antibiotics for suspected urinary tract infection (UTI) is common practice and may lead to unnecessary antibiotic exposure. We aimed to review UTI diagnosis and management in the emergency department and to identify targets for antimicrobial stewardship.Single-center, retrospective cohort study of children aged 12 weeks to younger than 18 years discharged from the emergency department (...) and unnecessary antibiotic exposure. We identified targets to reduce unnecessary antibiotic exposure including improving the diagnostic accuracy of UTIs, a process to discontinue antibiotics for negative cultures and standardizing antimicrobial duration.

2019 Pediatric Emergency Care

1726. Antibiotic prescription for febrile children in European emergency departments: a cross-sectional, observational study. (Abstract)

Antibiotic prescription for febrile children in European emergency departments: a cross-sectional, observational study. Prevalence of serious bacterial infections in children in countries in western Europe and the USA is low. Antibiotic stewardship aims at a more rational use of antibiotics but information on the frequency of antibiotic prescription to children in emergency departments is scarce. We aimed to quantify and explain variability in antibiotic prescription in children attending (...) comorbidities who received antibiotic prescriptions by country, focus of infection, and type of antibiotic. We then did a detailed analysis of the same population, using a multilevel logistic regression analysis, into the variability in prescriptions across hospitals, focusing particularly on respiratory tract infections and correcting for a combination of result-dependent factors. Random group assignment was done by computer randomisation.Of 5177 children in total, 617 children had comorbidities

2019 Lancet infectious diseases

1727. Emergency department door-to-antibiotic time and long-term mortality in sepsis. Full Text available with Trip Pro

Emergency department door-to-antibiotic time and long-term mortality in sepsis. The impact of antibiotic timing on sepsis outcomes remains controversial due to conflicting results from previous studies.This study investigated the association of door-to-antibiotic time with long-term mortality in ED patients with sepsis.This retrospective cohort study included nontrauma adult ED patients with clinical sepsis admitted to four hospitals from 2013 to 2017. Only patients' first eligible encounter (...) was included. Multivariable logistic regression was used to measure the adjusted association between door-to-antibiotic time and 1-year mortality. Secondary analyses used alternative antibiotic timing measures (antibiotic initiation within 1 or 3 h and separate comparison of antibiotic exposure at each hour up to hour 6), alternative outcomes (hospital, 30-day, and 90-day mortality), and alternative statistical methods to mitigate indication bias.Among 10,811 eligible patients, median door-to-antibiotic

2019 Chest

1728. Editorial Comment from Dr Sadahira et al. to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study. (Abstract)

Editorial Comment from Dr Sadahira et al. to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study. 30659661 2019 03 03 1442-2042 26 3 2019 Mar International journal of urology : official journal of the Japanese Urological Association Int. J. Urol. Editorial Comment from Dr Sadahira et al. to Use of fosfomycin as targeted antibiotic prophylaxis before prostate biopsy: A prospective randomized study. 399 10.1111/iju.13907 Sadahira Takuya T

2019 International journal of urology : official journal of the Japanese Urological Association Controlled trial quality: uncertain

1729. Antibiotic Overconsumption and Resistance in Turkey. Full Text available with Trip Pro

Antibiotic Overconsumption and Resistance in Turkey. In its latest Health Policy Studies report, OECD stated that the highest rates of antimicrobial resistance (around 35% in Turkey, Korea and Greece) were seven times higher than the lowest rates among its member countries in 2015. As the OECD country with the highest resistance (38.8%) despite a 15-year hospital antibiotic restriction programme, Turkey is in urgent need of revising its policies and drawing an effective action plan to reverse (...) the current trend. In this commentary, we review previous measures taken to tackle antimicrobial overuse and resistance in Turkey and discuss their effectiveness.Copyright © 2019. Published by Elsevier Ltd.

2019 Clinical Microbiology and Infection

1730. Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single Dose Is as Effective as Multiple Doses. (Abstract)

Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Single Dose Is as Effective as Multiple Doses. Recent surgical site infection prevention guidelines recommend that no additional prophylactic antibiotics be administered after the surgical incision is closed in clean-contaminated procedures. Although there is ample evidence to support this recommendation in non-arthroplasty surgery, there is concern about extending these guidelines to surgical procedures with an implant (...) such as total joint arthroplasty (TJA). The aim of this study was to compare the efficacy of a single dose of prophylactic antibiotics with that of multiple doses of antibiotics for prevention of periprosthetic joint infection (PJI) in patients undergoing TJA.A retrospective study of 20,682 primary TJAs carried out from 2006 to 2017 was performed. Patients who received a single dose of prophylactic antibiotics (n = 4,523) were compared with patients who received multiple doses of antibiotics (n = 16,159

2019 The Journal of Bone and Joint Surgery. American Volume

1731. Spectrophotometric analysis of discoloration and internal bleaching after use of different antibiotic pastes. (Abstract)

Spectrophotometric analysis of discoloration and internal bleaching after use of different antibiotic pastes. To investigate teeth's antibiotic-induced color differences after bleaching using two different techniques.One hundred twenty extracted maxillar human incisors were examined. The specimens were randomly divided into six groups, each receiving one of six antibiotic paste fillings: (1) triple antibiotic paste (TAP) with minocycline, (2) double antibiotic paste (DAP), (3) TAP (...) with amoxicillin, (4) TAP with cefaclor, (5) TAP with doxycycline, and (6) no filling (control group). Spectrophotometric measurements were obtained at baseline and then during the first, second, and third weeks after paste placement. The specimens discolored by antibiotics pastes were randomly divided into two subgroups: (1) internal bleaching with hydrogen peroxide (H2O2) and (2) internal bleaching with H2O2 plus Nd-YAG laser irradiation. The ∆E value was calculated and analyzed using a two-way analysis

2019 Clinical oral investigations

1732. Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey. Full Text available with Trip Pro

independent factors associated with ESBL-PE carriage in the multivariate logistic regression model.While the role of trans-border transmission of antimicrobial resistance is well known, we may have to examine the current recommendation that all antibiotics courses have to be completed. Clinical trials to determine the optimum duration of treatment for common infections are critically important.© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights (...) Relating knowledge, attitude and practice of antibiotic use to extended-spectrum beta-lactamase-producing Enterobacteriaceae carriage: results of a cross-sectional community survey. To study the correlation between knowledge, attitude and practices (KAP) of antibiotic consumption with epidemiology and molecular characteristics of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) carriage, in order to identify modifiable factors and public health interventions to reduce

2019 BMJ open

1733. Geographical and temporal variation in the frequency and antimicrobial susceptibility of bacteria isolated from patients hospitalized with bacterial pneumonia: results from 20 years of the SENTRY Antimicrobial Surveillance Program (1997-2016). (Abstract)

Geographical and temporal variation in the frequency and antimicrobial susceptibility of bacteria isolated from patients hospitalized with bacterial pneumonia: results from 20 years of the SENTRY Antimicrobial Surveillance Program (1997-2016). The SENTRY Antimicrobial Surveillance Program monitors the frequency of occurrence and antimicrobial susceptibility of organisms from various infection types worldwide.A total of 102 995 bacterial isolates were consecutively collected (one per patient (...) of the investigation. Among Klebsiella spp. isolates, susceptibility to ceftriaxone/meropenem decreased from 85.9%/99.3% to 58.6%/85.8% in Europe and from 91.8%/99.5% to 81.6%/93.9% in APAC during the study period.Rank order and susceptibility rates varied widely by geographical region and over time. The occurrence of some resistance phenotypes increased, though others decreased over the 20 years of the SENTRY Antimicrobial Surveillance Program.© The Author(s) 2019. Published by Oxford University Press on behalf

2019 Journal of Antimicrobial Chemotherapy

1734. Antibiotic Resistance and Typhoid. Full Text available with Trip Pro

Antibiotic Resistance and Typhoid. Multiple drug (antibiotic) resistance (MDR) has become a major threat to the treatment of typhoid and other infectious diseases. Since the 1970s, this threat has increased in Salmonella enterica serovar Typhi, driven in part by the emergence of successful genetic clades, such as haplotype H58, associated with the MDR phenotype. H58 S. Typhi can express multiple antibiotic resistance determinants while retaining the ability to efficiently transmit and persist

2019 Clinical Infectious Diseases

1735. Micro-organisms attached to the lumens and balloons of indwelling urinary catheters and correlation with symptoms, antibiotic use and catheter specimen of urine results. Full Text available with Trip Pro

Micro-organisms attached to the lumens and balloons of indwelling urinary catheters and correlation with symptoms, antibiotic use and catheter specimen of urine results. To determine micro-organisms attached to removed urethral catheters and relate this to patient-specific information. Indwelling urethral catheters were collected from patients at a UK teaching hospital. The balloon and lumen were sonicated, and micro-organisms were enumerated. Catheter specimen urine results were (...) retrospectively reviewed. Escherichia coli and Enterococcus faecalis were the most common isolates from 61 catheters. 19.7% of patients received antibiotics and 25 % of those had a multi-drug-resistant (MDR) organism in the lumen. Only 2.04% of catheters from patients not receiving antibiotics had a MDR organism. All lumens were colonized irrespective of antibiotic use. Symptom presentation did not correlate with numbers of colonizing organisms or species. Despite heavy colonization, only 8/61 patients were

2019 Journal of Medical Microbiology

1736. Comparing prescribing and dispensing databases to study antibiotic use: a validation study of the Electronic Medical Record Administrative data Linked Database (EMRALD). Full Text available with Trip Pro

Comparing prescribing and dispensing databases to study antibiotic use: a validation study of the Electronic Medical Record Administrative data Linked Database (EMRALD). Monitoring and studying community antibiotic use is a critical component in combating rising antimicrobial resistance.To validate an electronic medical record dataset containing antibiotic prescriptions and to quantify some important differences between prescribing and dispensing databases.We evaluated antibiotics prescribed (...) and dispensed to patients ≥65 years of age during 2011-15. We compared the EMRALD prescribing database with the validated Ontario Drug Benefit (ODB) dispensing database. Using ODB as the gold standard and limiting to EMRALD physicians, we calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) with 95% CIs. We also compared the relative change in antibiotic use prescribed by all physicians to this population over time between the databases using Poisson

2019 Journal of Antimicrobial Chemotherapy

1737. In vitro antibacterial and anti-encrustation performances of silver-polytetrafluoroethylene nanocomposite coated urinary catheter. Full Text available with Trip Pro

In vitro antibacterial and anti-encrustation performances of silver-polytetrafluoroethylene nanocomposite coated urinary catheter. Catheter-associated urinary tract infections (CAUTIs) are some of the most common hospital-acquired infections, leading to increased morbidity and mortality. One major reason is that current urinary catheters are yet not capable of preventing CAUTIs.To develop an anti-infective urinary catheter.We deposited an efficient silver-polytetrafluoroethylene (Ag-PTFE (...) ) nanocomposite coating onto whole silicone catheters, and designed two in vitro bladder models to respectively test the antibacterial (against Escherichia coli) and the anti-encrustation (against Proteus mirabilis) performances. Each model was challenged with two different concentrations of bacterial suspension.Compared with uncoated catheters, coated catheters could significantly inhibit bacterial migration and biofilm formation along the external catheter surfaces. The time to developing bacteriuria

2019 Journal of Hospital Infection

1738. In Vivo Bioluminescence Imaging in a Rabbit Model of Orthopaedic Implant-Associated Infection to Monitor Efficacy of an Antibiotic-Releasing Coating. Full Text available with Trip Pro

In Vivo Bioluminescence Imaging in a Rabbit Model of Orthopaedic Implant-Associated Infection to Monitor Efficacy of an Antibiotic-Releasing Coating. In vivo bioluminescence imaging (BLI) provides noninvasive monitoring of bacterial burden in animal models of orthopaedic implant-associated infection (OIAI). However, technical limitations have limited its use to mouse and rat models of OIAI. The goal of this study was to develop a larger, rabbit model of OIAI using in vivo BLI to evaluate (...) the efficacy of an antibiotic-releasing implant coating.A nanofiber coating loaded with or without linezolid-rifampin was electrospun onto a surgical-grade locking peg. To model OIAI in rabbits, a medial parapatellar arthrotomy was performed to ream the femoral canal, and a bright bioluminescent methicillin-resistant Staphylococcus aureus (MRSA) strain was inoculated into the canal, followed by retrograde insertion of the coated implant flush with the articular surface. In vivo BLI signals were confirmed

2019 The Journal of Bone and Joint Surgery. American Volume

1739. Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation. (Abstract)

Decreased Antibiotic Utilization After Sinus Surgery in Cystic Fibrosis Patients With Lung Transplantation. Patients with cystic fibrosis (CF) who have undergone lung transplantation frequently require hospitalizations and antibiotic treatments for respiratory tract infections. Although endoscopic sinus surgery (ESS) improves sinonasal quality of life in CF patients, it is unclear if ESS offers additional benefit in terms of antibiotics for pulmonary infection, hospitalization, and pulmonary (...) function.To determine whether ESS impacts antibiotic use or hospitalizations for pulmonary indications or pulmonary function in CF patients after lung transplantation.This is a single-institution retrospective study of all patients who underwent lung transplantation for CF from 2005 to 2017. Patients who underwent ESS at least 1 year after transplant were included. Paired bivariate analyses were performed to determine whether there was a difference in the frequency and length of hospitalizations

2019 American journal of rhinology & allergy

1740. Perinatal antibiotics alter preterm infant EEG and neurobehavior in the Family Nurture Intervention trial. Full Text available with Trip Pro

Perinatal antibiotics alter preterm infant EEG and neurobehavior in the Family Nurture Intervention trial. Early exposure to antibiotics has been shown to increase risk for poor neurobehavioral development, particularly with regard to attention deficit disorders. Clinically, electroencephalography (EEG) is increasingly used as a biomarker of these deficits. Less is known about the effects of antibiotics on neurobehavioral and neurophysiological outcomes in preterm infants, a population (...) at particularly high risk for attention deficits and perinatal antibiotic exposure. This study examines the effects of perinatal antibiotic exposure on neonatal EEG and attention deficits as measured by the Child Behavior Checklist in 4- to 5-year-old children who were enrolled in an NICU-based randomized controlled trial comparing Family Nurture Intervention (FNI) to standard care. Antibiotic-exposed infants had increased attention problems and there was a main effect of antibiotic exposure such that exposed

2019 Developmental psychobiology Controlled trial quality: uncertain

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