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1841. Decreasing the Time to Administration of First Dose of Antibiotics in Children With Severe Sepsis. (Abstract)

Decreasing the Time to Administration of First Dose of Antibiotics in Children With Severe Sepsis. To measure difference in median time to antibiotic administration in severe sepsis before and after making process changes and clinical outcomes such as duration of hospitalization and mortality.The study was carried out in the emergency department in children <17 years of age with severe sepsis/septic shock. In phase 1, data were collected and reasons for delayed antibiotic administration were (...) identified. Following this, process changes like creating a triage tool, re-enforcing the severe sepsis protocol and increasing the number of nurses were made to correct the delay. In phase 2, we measured outcomes to compare the effect of the process changes.A total of 28 and 13 children each were included during phase 1 and phase 2 of the study respectively. The median interquartile range time to administration of antibiotics from the time of admission decreased significantly from 50 minutes (18, 65

2018 Journal for Healthcare Quality

1842. Local Versus Systemic Antibiotics for Surgical Infection Prophylaxis in a Rat Model. (Abstract)

Local Versus Systemic Antibiotics for Surgical Infection Prophylaxis in a Rat Model. The purpose of this study was to compare the local application of a variety of antimicrobial agents with intravenous (IV) antibiotics for infection prophylaxis in a rat model.A total of 120 adult male Sprague-Dawley rats were implanted with an expanded polytetrafluoroethylene (ePTFE) vascular graft in a submuscular position and challenged with 2 × 10 colony-forming units of methicillin-sensitive Staphylococcus (...) powder were significantly lower compared with Betadine lavage, IV vancomycin, IV cefazolin, and local cefazolin powder (p < 0.000001).Local antimicrobial prophylaxis with vancomycin and tobramycin powder for infections in the rat model was statistically superior to systemic prophylaxis with IV antibiotics, local cefazolin powder, and Betadine lavage.This study supports the findings of prior clinical reports that intrawound vancomycin powder reduces the risk of surgical site infection. Local

2018 The Journal of Bone and Joint Surgery. American Volume

1843. Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle. (Abstract)

Combined Intramedullary Nail Coated With Antibiotic-Containing Cement and Ring Fixation for Limb Salvage in the Severely Deformed, Infected, Neuroarthropathic Ankle. The severely deformed, infected, and unstable neuroarthropathic ankle is challenging to treat. We evaluated our preliminary experience and results of combined internal and external ring fixation for a complex neuropathic population.We retrospectively reviewed medical records and radiographs for 8 patients with unilateral severely (...) deformed ankle neuroarthropathy associated with infection and ulceration. Treatment included single-stage reconstruction arthrodesis with an interlocked intramedullary nail coated with antibiotic-containing cement combined with ring fixation. Taylor Spatial Frame™ technology was used when the deformity was not amenable to acute correction (5 patients). Protected postoperative weightbearing was permitted. Their mean age averaged 55.6 (range, 42-66) years with an average body mass index of 38.4 (range

2018 Foot & Ankle International

1844. Successful six-week antibiotic treatment for early surgical-site infections in spinal surgery. (Abstract)

Successful six-week antibiotic treatment for early surgical-site infections in spinal surgery. The incidence of spinal surgical site infections (SSI) remains stable at less than 10%. Surgical reinterventions may be hampered by decubitus, treatment-related adverse events, and cost. In the context of emergence of bacterial resistance, a short duration of antimicrobial treatment is of critical importance. If the duration of treatment for SSI is currently 12 weeks, the aim of our study (...) was to assess the efficacy of an antimicrobial treatment shortened to six weeks.This prospective study was carried out from November 2014 to July 2016 in an 827-bed teaching hospital. After surgical management of SSI, patients received broad-spectrum antibiotics, intravenously for 10 days and orally for the remainder, for a total of six weeks. Success was defined as absence of relapse, superinfection or surgical failure at the end of treatment and at one-year follow-up.Eighty-five patients were included

2018 Clinical Infectious Diseases

1845. Antibiotic consumption in Germany: first data of a newly implemented web-based tool for local and national surveillance. (Abstract)

Antibiotic consumption in Germany: first data of a newly implemented web-based tool for local and national surveillance. The features of a newly established, web-based surveillance system for hospital antibiotic consumption are described and data on broad-spectrum antibiotic use in German acute care hospitals are presented.The watch- and reserve-group antibiotics, two categories of antibiotics derived from the WHO Essential Medicines List comprising key agents for antimicrobial stewardship (...) types support different approaches to analysis, and different complementing quantification measures of antimicrobial consumption are available. Watch- and reserve-group antibiotics accounted for 42% and 2% of total antibiotic use, respectively. Surgical services presented with considerably lower median ACDs of the watch-group antibiotics compared with medical services. Tertiary care hospitals exhibited higher ACDs of the reserve-group antibiotics and carbapenems than primary/secondary care hospitals

2018 Journal of Antimicrobial Chemotherapy

1846. Time trends and geographical variation in prescribing of antibiotics in England 1998-2017. Full Text available with Trip Pro

Time trends and geographical variation in prescribing of antibiotics in England 1998-2017. Reducing antibiotic overuse is a key NHS priority. The majority of antibiotics are prescribed in primary care.To describe antibiotic prescribing trends in NHS England primary care for the years 1998-2017 using various measures. We investigated trends and variation between practices and geographical areas, out-of-hours prescribing, and seasonality.We used publicly available prescribing datasets (...) and calculated antibiotic prescribing rates per 1000 age-sex-adjusted population units, percentage prescribed as broad-spectrum, and course length. We report national time trends for 1998-2016, geographical variation across 2017 and variation trends for 2010-17. We calculated percentiles and ranges, and plotted maps.The overall rate of antibiotic prescribing has reduced by 18% since 2010, with the steepest decline since 2013. The percentage prescribed as broad-spectrum declined since 2006, from 18.0 to 8.4

2018 Journal of Antimicrobial Chemotherapy

1847. Holistic approach in patients with presumed Lyme borreliosis leads to less than 10% of confirmation and more than 80% of antibiotics failure. Full Text available with Trip Pro

Holistic approach in patients with presumed Lyme borreliosis leads to less than 10% of confirmation and more than 80% of antibiotics failure. There is no precise idea whether patients with chronic symptoms attributed to Lyme borreliosis (LB) have LB or another disease.We evaluated patients consulting for a presumed LB with a holistic approach including presumptive treatment. We included symptomatic patients who consulted with a presumed LB. They were classified as confirmed LB when they had (...) four criteria, and possible LB if three with a positive clinical response to presumptive treatment.Amongst the 301 patients, 275 (91%) were exposed to tick bites, and 165 (54%) were bitten by a tick. At presentation, 151 patients (50.1%) had already been treated with a median of one (1-22) course of antimicrobials, during 34 (28-730) days. The median number of symptoms was three (1-12) with a median duration of 16 (1 - 68) months. Median number of signs was zero (0 - 2). ELISA was positive in 84

2018 Clinical Infectious Diseases

1848. Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016. Part 1. (Abstract)

Current prescribing trends of antibiotics by dentists in Australia from 2013 to 2016. Part 1. Improving antibiotic stewardship by dentists may help.

2018 British Dental Journal

1849. Tri-chlorination of a teicoplanin type glycopeptide antibiotic by the halogenase StaI evades resistance. Full Text available with Trip Pro

Tri-chlorination of a teicoplanin type glycopeptide antibiotic by the halogenase StaI evades resistance. Glycopeptide antibiotics (GPAs) include clinically important drugs used for the treatment of infections caused by Gram-positive pathogens. These antibiotics are specialized metabolites produced by several genera of actinomycete bacteria. While many GPAs are highly chemically modified, A47934 is a relatively unadorned GPA lacking sugar or acyl modifications, common to other members (...) of the class, but which is chlorinated at three distinct sites. The biosynthesis of A47934 is encoded by a 68-kb gene cluster in Streptomyces toyocaensis NRRL 15009. The cluster includes all necessary genes for the synthesis of A47934, including two predicted halogenase genes, staI and staK In this study, we report that only one of the halogenase genes, staI, is necessary and essential for A47934 biosynthesis. Chlorination of the A47934 scaffold is important for antibiotic activity, as assessed by binding

2018 Antimicrobial Agents and Chemotherapy

1850. Antibiotic prescribing for acute respiratory infections in New York City: A model for collaboration. Full Text available with Trip Pro

Antibiotic prescribing for acute respiratory infections in New York City: A model for collaboration. To assess the status of antibiotic prescribing in the ambulatory setting for adult patients with acute respiratory infections (ARIs) and to identify opportunities and barriers for outpatient antibiotic stewardship programs (ASPs).Mixed methods including point prevalence using chart reviews, surveys, and collaborative learning.Hospital-owned clinics in the New York City area.Participants (...) /PatientsIn total, 31 hospital-owned clinics from 9 hospitals and health systems participated in the study to assess ARI prescribing practices for patients >18 years old.InterventionsEach clinic performed a survey of current stewardship practices, retrospective chart reviews of prescribing in 30 randomly selected ARI patients from October 2015 to March 2016, and surveys of provider characteristics and knowledge. Clinics participated in collaborative learning with peers and experts in antibiotic

2018 Infection control and hospital epidemiology

1851. Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis. Full Text available with Trip Pro

Appropriate duration of post-surgical intravenous antibiotic therapy for pyogenic spondylodiscitis. Most guidelines recommend 6 to 12 weeks of parenteral antibiotic treatment for pyogenic spondylodiscitis. When surgical debridement is adequately performed, further intravenous antibiotic treatment duration can be reduced than that of conservative treatment alone theoretically. However, the appropriate duration of post-surgical parenteral antibiotic treatment is still unknown. This study aimed (...) to identify the risk factors of recurrence and evaluate the appropriate duration after surgical intervention.This 3-year retrospective review included 102 consecutive patients who were diagnosed with pyogenic spondylodiscitis and underwent surgical intervention. Recurrence was defined as recurrent signs and symptoms and the need for another unplanned parenteral antibiotic treatment or operation within one year. This study included two major portions. First, independent risk factors for recurrence were

2018 BMC Infectious Diseases

1852. Antibiotic resistance in Vietnam: moving towards a One Health surveillance system. Full Text available with Trip Pro

Antibiotic resistance in Vietnam: moving towards a One Health surveillance system. The international community strongly advocates the implementation of multi-sectoral surveillance policies for an effective approach to antibiotic resistance, in line with the One Health concept. To comply with these international recommendations, the Vietnamese government has issued an inter-ministerial surveillance strategy for antibiotic resistance, including an integrated surveillance system. However, one may (...) that the operationalisation of the collaborative surveillance strategy requires the full adhesion of stakeholders and the provision of appropriate resources. Based on these findings, we have proposed a guidance framework together with recommendations to move towards a more suitable governance and operational model for One Health surveillance of antibiotic resistance in Vietnam. To lever and promote successful inter-sectoral collaboration, a participatory "learning by doing" process could be applied to guide, frame

2018 BMC Public Health

1853. Sexual dimorphism in the response to broad-spectrum antibiotics during T cell-mediated colitis. Full Text available with Trip Pro

Sexual dimorphism in the response to broad-spectrum antibiotics during T cell-mediated colitis. Broad-spectrum antibiotics [Abx], including combination therapy with ciprofloxacin and metronidazole, are often prescribed during the treatment of inflammatory bowel disease [IBD] to alleviate symptoms, but with varying success. In this pilot study, we studied the effects of Abx on the course of experimental colitis, with a particular focus on sex as a determinant of the microbial and inflammatory (...) a differential response to both inflammation and Abx between male and female mice, The findings may be relevant to current practice and also as the basis for further studies on the differential gender effects during long-term antibiotic exposure in IBD.

2018 Journal of Crohn's & colitis

1854. Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013-15: a retrospective observational study. (Abstract)

Pattern of antibiotic prescriptions for outpatients with acute respiratory tract infections in Japan, 2013-15: a retrospective observational study. In this age of antimicrobial resistance, unnecessary use of antibiotics to treat non-bacterial acute respiratory tract infections (ARTIs) and inappropriate use of antibiotics in treating bacterial ARTIs are public health concerns.Our aim is to identify the pattern of oral antibiotic prescriptions for outpatients with ARTIs in Japan.We analysed (...) health insurance claims data of patients (aged ≤74 years) from 2013 to 2015, to determine the pattern of antibiotic prescriptions for outpatient ARTIs and calculated the proportion of each antibiotic.Data on 4.6 million antibiotic prescriptions among 1559394 outpatients with ARTIs were analysed. The most commonly prescribed classes of antibiotics included cephalosporins (41.9%), macrolides (32.8%) and fluoroquinolones (14.7%). The proportion of first-, second- and third-generation cephalosporins

2018 Family Practice

1855. Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality. (Abstract)

Staphylococcus aureus Bacteremia in Children: Antibiotic Resistance and Mortality. Staphylococcus aureus (SA) is a major cause of bacteremia in children. Methicillin-resistant SA (MRSA) is considered a public health threat; however, the differences in the prognosis of children with methicillin-susceptible SA (MSSA) vs. MRSA bacteremia are not well defined.Data from all SA bacteremia events in children (0-16 years) from 2002 to 2016 in a single Israeli tertiary center were collected. Positive

2018 Pediatric Infectious Dsease Journal

1856. Two-Stage Revision Total Hip Arthroplasty With a Specific Articulating Antibiotic Spacer Design: Reliable Periprosthetic Joint Infection Eradication and Functional Improvement. (Abstract)

Two-Stage Revision Total Hip Arthroplasty With a Specific Articulating Antibiotic Spacer Design: Reliable Periprosthetic Joint Infection Eradication and Functional Improvement. Two-stage revision utilizing spacers loaded with high-dose antibiotic cement prior to reimplantation remains the gold standard for treatment of periprosthetic joint infections (PJI) in total hip arthroplasty (THA) in North America, but there is a paucity of data on mid-term outcomes. We sought to analyze the survivorship (...) free of infection, clinical outcomes, and complications of a specific articulating spacer utilized during 2-stage revision.One hundred thirty-five hips (131 patients) undergoing a 2-stage revision THA for PJI with a specific articulating antibiotic spacer design from 2005 to 2013 were retrospectively reviewed. Infections were classified according to the Musculoskeletal Infection Society criteria. Mean age at resection was 65 years and mean follow-up was 5 years (rang, 2-10).Survivorship free of any

2018 Journal of Arthroplasty

1857. Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial. (Abstract)

Infection Control in Teeth with Apical Periodontitis Using a Triple Antibiotic Solution or Calcium Hydroxide with Chlorhexidine: A Randomized Clinical Trial. This randomized clinical study compared the antibacterial effectiveness of treatment protocols using either a triple antibiotic solution (1 mg/mL) or calcium hydroxide/chlorhexidine paste as interappointment medication in infected canals of teeth with primary apical periodontitis.The root canals of single-rooted teeth with apical (...) periodontitis were prepared by using a reciprocating single-instrument technique with 2.5% sodium hypochlorite irrigation and then medicated for 1 week with either a triple antibiotic solution (minocycline, metronidazole, and ciprofloxacin) at 1 mg/mL (n = 24) or a calcium hydroxide paste in 2% chlorhexidine gluconate (n = 23). Samples were taken from the canal at the baseline (S1), after chemomechanical preparation (S2), and after intracanal medication (S3). DNA extracts from clinical samples were

2018 Journal of Endodontics Controlled trial quality: uncertain

1858. Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection. Full Text available with Trip Pro

the findings with the resistance data of the Antimicrobial Resistance Surveillance System (ARS).General practitioners and internists in private practice prospectively recruited all of their adult patients with symptoms of a urinary tract infection from May 2015 to February 2016. Urine specimens from all patients were tested (including urine culture testing and antibiotic susceptibility) and infections were defined as uncomplicated or complicated UTIs.1245 participants from 58 medical practices were (...) Antibiotic-Resistant E. coli in Uncomplicated Community-Acquired Urinary Tract Infection. Routine urine culture testing is not recommended for uncomplicated urinary tract infections (UTIs). As a result, the antibiotic resistance patterns or the organisms causing UTIs are not adequately reflected in routine data. We studied the sensitivity of Escherichia coli (E. coli) to trimethoprim (TMP) and to cotrimoxazole (i.e., trimethoprim/sulfamethoxazole, TMP/SMX) in community-acquired UTI and compared

2018 Deutsches Arzteblatt international

1859. Emergency Department Revisits After an Initial Parenteral Antibiotic Dose for UTI. Full Text available with Trip Pro

Emergency Department Revisits After an Initial Parenteral Antibiotic Dose for UTI. Although oral antibiotics are recommended for the management of most urinary tract infections (UTIs), the administration of parenteral antibiotics before emergency department (ED) discharge is common. We investigated the relationship between the administration of a single dose of parenteral antibiotics before ED discharge and revisits requiring admission among children with UTIs.A retrospective analysis (...) factors.We studied 29 919 children with a median age of 8.6 (interquartile range: 5.1-13.8) months. Of those studied, 36% of the children received parenteral antibiotics before discharge. Patients who received parenteral antibiotics had similar adjusted rates of revisits leading to admission as those who did not receive parenteral antibiotics (1.3% vs 1.0%, respectively; risk difference: 0.3% [95% confidence interval: -0.01% to 0.6%]), although overall revisit rates were higher among patients who

2018 Pediatrics

1860. Remission in Diabetic Foot Infections: Duration of Antibiotic Therapy and Other Possible Associated Factors. (Abstract)

Remission in Diabetic Foot Infections: Duration of Antibiotic Therapy and Other Possible Associated Factors. To determine the most appropriate duration of antibiotic therapy for diabetic foot infections (DFIs).Using a clinical pathway for adult patients with DFIs (retrospective cohort analysis), we created a cluster-controlled Cox regression model to assess factors related to remission of infection, emphasizing antibiotic-related variables. We excluded total amputations as a result of DFI (...) and DFI episodes with a follow-up time of <2 months.Among 1018 DFI episodes in 482 patients, we identified 392 episodes of osteomyelitis, 626 soft tissue infections, 246 large abscesses, 322 episodes of cellulitis and 335 episodes of necrosis; 313 cases involved revascularization. Patients underwent surgical debridement for 824 episodes (81%), of which 596 (59%) required amputation. The median total duration of antibiotic therapy was 20 days. After a median follow-up of 3 years, 251 of the episodes

2018 obesity & metabolism

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