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1721. Assessment of factors that influence timely administration of initial antibiotic dose using collaborative process mapping at a referral hospital in Malawi: a case study of pneumonia patients. Full Text available with Trip Pro

Assessment of factors that influence timely administration of initial antibiotic dose using collaborative process mapping at a referral hospital in Malawi: a case study of pneumonia patients. Timely initiation of antibiotics within one hour of prescription is one of the recommended antibiotic stewardship interventions when managing patients with pneumonia in the emergency department. Effective implementation of this intervention depends on effective communication, a well-established (...) coordination process and availability of resources. Understanding what may influence this aspect of care by using process mapping is an important component when planning for improvement interventions. The aim of the study was to identify factors that influence antibiotic initiation following prescription in the Adult Emergency and Trauma Centre of the largest referral hospital in Malawi.We conducted a prospective observational case study using process mapping of two purposively selected adult pneumonia

2018 BMC Infectious Diseases

1722. Why did some practices not implement new antibiotic prescribing guidelines on urinary tract infection? A cohort study and survey in NHS England primary care. Full Text available with Trip Pro

Why did some practices not implement new antibiotic prescribing guidelines on urinary tract infection? A cohort study and survey in NHS England primary care. To describe trends and geographical variation in prescribing of trimethoprim and nitrofurantoin to treat urinary tract infections, to describe variation in implementing guideline change and to compare actions taken to reduce trimethoprim use in high- and low-using Clinical Commissioning Groups (CCGs).A retrospective cohort study (...) , then fell gradually to <50% in 2017; this reduction was more rapid following the introduction of the 'Quality Premium'. There was substantial variation in the speed of change between CCGs. As of April 2017, for the 10 CCGs with the lowest trimethoprim ratios, 9 had reported at least one of: formulary change, work plan or incentive scheme to change prescribing behaviour. None of the 10 highest-ratio CCGs did so.Many CCGs failed to implement an important change in antibiotic prescribing guidance

2018 Journal of Antimicrobial Chemotherapy

1723. Prophylactic systemic antibiotics for anterior epistaxis treated with nasal packing in the emergency department. (Abstract)

Prophylactic systemic antibiotics for anterior epistaxis treated with nasal packing in the emergency department. Emergency Department (ED) patients presenting with spontaneous epistaxis who have anterior nasal packing are routinely prescribed systemic prophylactic antibiotics in spite of the lack of supporting evidence-based literature. Although there is literature that discusses infection rates with nasal packing for epistaxis and prophylactic antibiotics prescribing practices (...) of otolaryngologists, this is the first study to our knowledge that examines the practices of emergency physicians.The main objective of this study was to compare the infection rate between patients who were and were not prescribed prophylactic systemic antibiotics for anterior nasal packing in spontaneous epistaxis and to examine current management practices of antibiotic prescribing for these patients.A retrospective review of ED patients ≥ 18 years old with the discharge diagnosis of epistaxis was performed

2018 American Journal of Emergency Medicine

1724. Green Tea Seed Isolated Saponins Exerts Antibacterial Effects against Various Strains of Gram Positive and Gram Negative Bacteria, a Comprehensive Study <i>In Vitro</i> and <i>In Vivo</i>. Full Text available with Trip Pro

Green Tea Seed Isolated Saponins Exerts Antibacterial Effects against Various Strains of Gram Positive and Gram Negative Bacteria, a Comprehensive Study In Vitro and In Vivo. Bacteria are one of the major causes of severe infections and diseases of plants and animals. Salmonella are crucially important due to infection in poultry leading to huge economical loses. Due to high cost and microbial resistance to the currently available chemical antibiotics, demand of screening natural (...) products with antibiotics effects is increased. Plants are rich sources of natural bioactive compounds with antibiotic effects. Saponins are natural compounds of plant sources having a diverse range of applications. In present study we investigated the in vitro and in vivo antibacterial activities of green tea seed extracted saponins. Green tea seeds crude extract was prepared in 70% ethanol by continuous reflux in heating mantel for 5 hours. Crude saponins were extracted from the crude ethanolic

2018 Evidence-based Complementary and Alternative Medicine (eCAM)

1725. Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis. (Abstract)

Antibiotic choice and methicillin-resistant Staphylococcus aureus rate in children hospitalized for atopic dermatitis. Systemic antibiotics are commonly used in hospitalized patients with severe atopic dermatitis (AD) exacerbation. However, the antibiotic prescribing patterns are unclear.To compare the prescribing patterns of antibiotics for children who were hospitalized for AD exacerbation and infectious complications.Electronic medical records were reviewed for patients younger than 18 years (...) who were hospitalized for AD exacerbation or infectious complications based on International Classification of Diseases, Ninth Revision, Clinical Modification and International Classification of Diseases, Tenth Revision, Clinical Modification codes from 2003 to 2018. The following information was obtained: history, physical examination findings, physician discharge summary, antibiotic treatments, serum tests, and wound cultures. The t test was used to compare clinical and laboratory features.A

2018 Asthma & Immunology

1726. Decreased Fecal Calprotectin Levels in Cystic Fibrosis Patients After Antibiotic Treatment for Respiratory Exacerbation. (Abstract)

Decreased Fecal Calprotectin Levels in Cystic Fibrosis Patients After Antibiotic Treatment for Respiratory Exacerbation. In all patients with cystic fibrosis (CF), gastrointestinal (GI) tract CF transmembrane conductance regulator dysfunction occurs early in life. The identical pathophysiological triad of obstruction, infection, and inflammation causes disease of the airways and in the intestinal tract (CF enteropathy). Mucus accumulation within GI tract is a niche for abnormal microbial (...) colonization, leading to dysbiosis. Fecal calprotectin (FC) is a neutrophil cytosolic protein released during apoptosis and necrosis and reflects inflammatory status. Systemic antibiotic treatment for pulmonary exacerbations has been shown to improve systemic inflammatory markers and serum and sputum calprotectin. Antibiotic treatment aimed at pulmonary complaints may improve GI tract inflammatory status. We hypothesized that high levels of FC present during pulmonary exacerbation are due, in part

2018 Journal of Pediatric Gastroenterology and Nutrition

1727. Re: 'Determinants of in-hospital antibiotic prescription behaviour' by Lambregts et al. (Abstract)

Re: 'Determinants of in-hospital antibiotic prescription behaviour' by Lambregts et al. 30594653 2019 02 04 1469-0691 2018 Dec 28 Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases Clin. Microbiol. Infect. Cognitive biases in the decision-making process of antibiotic prescribing. S1198-743X(18)30798-5 10.1016/j.cmi.2018.12.010 Peiffer-Smadja N N Hopital Bichat Claude Bernard, Infectious Diseases Department (...) , Paris, France; INSERM, Infection Antimicrobials Modelling Evolution, Paris, France. Electronic address: nathan.psmadja@gmail.com. Lescure F X FX Hopital Bichat Claude Bernard, Infectious Diseases Department, Paris, France; INSERM, Infection Antimicrobials Modelling Evolution, Paris, France. Maatoug R R Hopital Universitaire Pitie Salpetriere, Department of Psychiatry, Paris, France. Rohaut B B Institut du Cerveau et de la Moelle epiniere, PICNIC Lab, Paris, France; Columbia University Department

2018 Clinical Microbiology and Infection

1728. The availability, price and affordability of essential antibacterials in Hubei province, China. Full Text available with Trip Pro

The availability, price and affordability of essential antibacterials in Hubei province, China. China ranks first amongst the countries for the abuse of antibacterials. Essential antibacterials could help solve the problem. The aim of the work is to evaluate the availability, price and affordability of essential antibacterials in Hubei province, China.The standardized methodology developed by the World Health Organization and Health Action International was used to collect data (...) on the availability and prices of 16 antibacterials in 5 cities of Hubei province, China.First, in total, the median availability of originator brands and lowest-priced generics for the essential antibacterials was low, 3.0% (0.0, 18.2%) and 33.3% (0.0, 87.9%) for each, respectively. Second, the median price ratio of originator brands for the antibacterials was 20.30 (4.71, 35.80), while for generics, it was 0.49 (0.07, 1.18). Third, the affordability of originator brands for the antibacterials was 28.14 (21.70

2018 BMC health services research

1729. Prolonged antibiotic administration for surgical site infection in pediatric laryngotracheal surgery. (Abstract)

Prolonged antibiotic administration for surgical site infection in pediatric laryngotracheal surgery. Incidence of surgical site infection (SSI) after laryngotracheal (LT) surgery is relatively high, especially in children.Retrospective and prospective cohort study.Clinical records of children who underwent open LT surgery at the Istituto Giannina Gaslini Children's Hospital from January 2008 to August 2017 were reviewed for development of SSI. Standard antibiotic prophylaxis was administered (...) until February 2015. In March 2015, an antibiotic treatment tailored on pathogens isolated from surveillance cultures and prolonged until extubation was introduced. Incidence and risk factors for SSI before and after the new protocol implementation were analyzed by means of univariate and multivariable analyses.A total of 57 procedures were analyzed. SSI incidence was 36% in patients receiving standard prophylaxis and 4% in those treated with the new strategy (P = .004), with an absolute benefit

2018 Laryngoscope

1730. Continuous Antibiotic Therapy Can Reduce Recurrence of Prosthetic Joint Infection in Patients Undergoing 2-Stage Exchange. (Abstract)

Continuous Antibiotic Therapy Can Reduce Recurrence of Prosthetic Joint Infection in Patients Undergoing 2-Stage Exchange. Reimplantation microbiology and serum C-reactive protein have low diagnostic accuracy in predicting recurrence in patients with prosthetic joint infection (PJI) undergoing 2-stage exchange. We aimed at identifying factors relating to failure and comparing effect of continuous antibiotic therapy versus a holiday antibiotic period pre-reimplantation.This observational study (...) included patients with PJI undergoing 2-stage exchange. Group A patients did not discontinue antibiotic treatment pre-reimplantation; in group B patients, antibiotic treatment was followed with 2 weeks of holiday antibiotic period pre-reimplantation. We defined cure as absence of recurrence for 96 weeks post-reimplantation. Statistical analyses were performed using Mann-Whitney U test, Fisher exact test, and multivariate analysis.We evaluated 196 patients with PJI (median age, 66 years [interquartile

2018 Journal of Arthroplasty

1731. Management and outcome of obstructive ureteral stones in the emergency department: Emphasis on urine tests and antibiotics usage. (Abstract)

Management and outcome of obstructive ureteral stones in the emergency department: Emphasis on urine tests and antibiotics usage. Kidney stone related complaints in the Emergency Department (ED) are common. Current guidelines recommend antibiotic therapy for infected obstructive stones and stone removal in a timely fashion, but there is no clear recommendation for prophylactic antibiotic use for bacteriuria or pyuria in the setting of obstructive ureteral stones.The aim of this study (...) is to evaluate the current management of patients with obstructive ureteral stones in a single ED with emphasis on urine tests and antibiotics use.The picture archiving and communication system (PACS) was used to filter the list of patients who received a computed tomography (CT) scan of the abdomen and pelvis that positively identified obstructive ureteral stones. Demographics and clinical data were also recorded and analyzed.Of the patients discharged, 278 patients did not receive antibiotics in the ED

2018 American Journal of Emergency Medicine

1732. Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012: A nationwide multicenter study. Full Text available with Trip Pro

Trends and correlation between antibiotic usage and resistance pattern among hospitalized patients at university hospitals in Korea, 2004 to 2012: A nationwide multicenter study. The aim of this study was to evaluate the changing pattern of antibiotic usage and antimicrobial resistance of bacterial pathogens among hospitalized patients in Korea. We simultaneously investigated the correlation between antimicrobial resistance and antibiotic consumption.Data on total antibiotic prescriptions (...) , patient days, and antimicrobial sensitivity tests among inpatients from 6 university hospitals in Korea in 2004, 2008, and 2012 were collected. The consumption of each antibiotic class was converted to defined daily dose/1000 patient-days by using the anatomical therapeutic chemical classification system by the World Health Organization. We defined third-generation cephalosporins (3rd CEPs), fourth-generation cephalosporins, beta-lactam/beta-lactamase inhibitors, and fluoroquinolones (FQs) as broad

2018 Medicine

1733. Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). Full Text available with Trip Pro

Optimising the antibiotic treatment of uncomplicated acute appendicitis: a protocol for a multicentre randomised clinical trial (APPAC II trial). Based on epidemiological and clinical data acute appendicitis can present either as uncomplicated (70-80%) or complicated (20-30%) disease. Recent studies have shown that antibiotic therapy is both safe and cost-effective for a CT-scan confirmed uncomplicated acute appendicitis. However, based on the study protocols to ensure patient safety (...) , these randomised studies used mainly broad-spectrum intravenous antibiotics requiring additional hospital resources and prolonged hospital stay. As we now know that antibiotic therapy for uncomplicated acute appendicitis is feasible and safe, further studies evaluating optimisation of the antibiotic treatment regarding both antibiotic spectrum and shorter hospital stay are needed to evaluate antibiotics as the first-line treatment for uncomplicated acute appendicitis.APPAC II trial is a multicentre, open-label

2018 BMC Surgery Controlled trial quality: predicted high

1734. Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study. Full Text available with Trip Pro

Relationship between prescribing of antibiotics and other medicines in primary care: a cross-sectional study. High levels of antibiotic prescribing are a major concern as they drive antimicrobial resistance. It is currently unknown whether practices that prescribe higher levels of antibiotics also prescribe more medicines in general.To evaluate the relationship between antibiotic and general prescribing levels in primary care.Cross-sectional study in 2014-2015 of 6517 general practices (...) in England using NHS digital practice prescribing data (NHS-DPPD) for the main study, and of 587 general practices in the UK using the Clinical Practice Research Datalink for a replication study.Linear regression to assess determinants of antibiotic prescribing.NHS-DPPD practices prescribed an average of 576.1 antibiotics per 1000 patients per year (329.9 at the 5th percentile and 808.7 at the 95th percentile). The levels of prescribing of antibiotics and other medicines were strongly correlated

2018 British Journal of General Practice

1735. Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate. (Abstract)

Extended Oral Antibiotic Prophylaxis in High-Risk Patients Substantially Reduces Primary Total Hip and Knee Arthroplasty 90-Day Infection Rate. Total joint arthroplasty (TJA) episodic payment models shift risk and cost of periprosthetic joint infection (PJI) to surgeons and hospitals, causing some to avoid treating high-risk patients. Furthermore, there are little data to support optimization of host factors preoperatively to decrease PJI, and recent literature supports using extended (...) antibiotic prophylaxis following reimplantation TJA. The purpose of this study was to evaluate whether extended oral antibiotic prophylaxis minimized PJI after primary TJA in high-risk patients.A retrospective cohort study was performed of 2,181 primary total knee arthroplasties (TKAs) and primary total hip arthroplasties (THAs) carried out from 2011 through 2016 at a suburban academic hospital with modern perioperative and infection-prevention protocols. Beginning in January 2015, extended oral

2018 The Journal of Bone and Joint Surgery. American Volume

1736. Trends in Outpatient Antibiotic Use in 3 Health Plans. Full Text available with Trip Pro

Trends in Outpatient Antibiotic Use in 3 Health Plans. Previous analyses of data from 3 large health plans suggested that the substantial downward trend in antibiotic use among children appeared to have attenuated by 2010. Now, data through 2014 from these same plans allow us to assess whether antibiotic use has declined further or remained stable.Population-based antibiotic-dispensing rates were calculated from the same health plans for each study year between 2000 and 2014. For each health (...) plan and age group, we fit Poisson regression models allowing 2 inflection points. We calculated the change in dispensing rates (and 95% confidence intervals) in the periods before the first inflection point, between the first and second inflection points, and after the second inflection point. We also examined whether the relative contribution to overall dispensing rates of common diagnoses for which antibiotics were prescribed changed over the study period.We observed dramatic decreases

2018 Pediatrics

1737. Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS? Full Text available with Trip Pro

Is greater antibiotic therapy prior to ESS associated with differences in surgical outcomes in CRS? Antibiotics have been a mainstay of chronic rhinosinusitis therapy; however, data suggest that antibiotics may also result in several adverse unintended consequences. We aimed to evaluate if greater antibiotic use prior to sinus surgery was associated with differences in surgical outcomes.Adult CRS patients enrolled in a prospective, multi-institutional, observational cohort study were asked (...) to recall systemic antibiotic use in the 90 days prior to endoscopic sinus surgery (ESS). Antibiotic use was examined in relation to demographics, disease characteristics, and outcomes.Data were collected for 271 study participants followed for a mean of 14.9 [± 5.1] months across four institutions, with a mean preoperative antibiotic use of 27.8 [± 22.7] days out of the 90 preceding ESS. After ESS, significant improvement (P < 0.001) was reported for patient-reported outcome measures and endoscopy

2018 Laryngoscope

1738. Bone and Joint Tissues Penetration of the Staphylococcus-Selective Antibiotic Afabicin in Patients Undergoing Elective Hip Replacement Surgery. Full Text available with Trip Pro

Bone and Joint Tissues Penetration of the Staphylococcus-Selective Antibiotic Afabicin in Patients Undergoing Elective Hip Replacement Surgery. Afabicin (formerly Debio 1450, AFN-1720) is a prodrug of afabicin desphosphono (Debio 1452, AFN-1252), a novel antibiotic in development which targets the staphylococcal enoyl-acyl carrier protein reductase (FabI) and exhibits selective potent antibacterial activity against staphylococcal species, including methicillin-resistant Staphylococcus aureus (...) desphosphono concentration was beyond the MIC90 of S. aureus over the complete dosing interval. These findings, along with preclinical efficacy data, clinical efficacy data for skin and soft tissue staphylococcal infection, the availability of both intravenous and oral formulations, and potential advantages over broad-spectrum antibiotics for the treatment of staphylococcal bone or joint infections, support the clinical development of afabicin for bone and joint infections. (This study has been registered

2018 Antimicrobial Agents and Chemotherapy

1739. Pharmacokinetic/Pharmacodynamic Evaluation of a Novel Aminomethylcycline Antibiotic, KBP-7072, in the Neutropenic Murine Pneumonia Model against <i>S. aureus</i> and <i>S. pneumoniae</i>. Full Text available with Trip Pro

Pharmacokinetic/Pharmacodynamic Evaluation of a Novel Aminomethylcycline Antibiotic, KBP-7072, in the Neutropenic Murine Pneumonia Model against S. aureus and S. pneumoniae. KBP-7072 is a novel aminomethylcycline antibiotic in clinical development for community-acquired pneumonia. The goal of present studies was to determine which pharmacokinetic/pharmacodynamic (PK/PD) parameter magnitude correlated with efficacy in the murine pneumonia infection model against Staphylococcus

2018 Antimicrobial Agents and Chemotherapy

1740. Utilization of vector autoregressive and linear transfer models to follow up the antibiotic resistance spiral in Gram-negative bacteria from cephalosporin consumption to colistin resistance. Full Text available with Trip Pro

Utilization of vector autoregressive and linear transfer models to follow up the antibiotic resistance spiral in Gram-negative bacteria from cephalosporin consumption to colistin resistance. Increasing antibiotic resistance may reciprocally affect consumption and lead to using broader-spectrum alternatives; a vicious cycle that may gradually limit therapeutic options. The study aims at demonstrating the abovementioned vicious cycle in Gram-negative bacteria and at showing the utility of vector (...) and decreased carbapenem resistance of P. aeruginosa but not of A. baumannii.Vector autoregressive models allow analysis of consumption and resistance series in a bidirectional manner. The reconstructed resistance spiral involved cephalosporin use augmenting cephalosporin resistance primarily in E. coli. This led to increased carbapenem use, provoking spread of carbapenem resistant A. baumannii and consequent colistin use. Emergence of panresistance is fuelled by such antibiotic resistance spirals.

2018 Clinical Infectious Diseases

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