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1921. Emotional, cognitive and social factors of antimicrobial prescribing: can antimicrobial stewardship intervention be effective without addressing psycho-social factors? Full Text available with Trip Pro

and policies at hospital and community levels. The integration of behaviour experts into multidisciplinary stewardship teams seems essential to positively impact on prescribers' communication and decision-making competencies, and reduce inappropriate antibiotic prescribing.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com. (...) Emotional, cognitive and social factors of antimicrobial prescribing: can antimicrobial stewardship intervention be effective without addressing psycho-social factors? There is increasing evidence that psycho-social factors can influence antimicrobial prescribing practice in hospitals and the community, and represent potential barriers to antimicrobial stewardship interventions. Clinicians are conditioned both by emotional and cognitive factors based on fear, uncertainty, a set of beliefs, risk

2019 Journal of Antimicrobial Chemotherapy

1922. Broad-spectrum antibiotic use in Europe: more evidence of cultural influences on prescribing behaviour. Full Text available with Trip Pro

Broad-spectrum antibiotic use in Europe: more evidence of cultural influences on prescribing behaviour. Sociocultural factors have been hypothesized as important drivers of inappropriate antibiotic prescribing in European ambulatory care. This study sought to assess whether they can also explain the reported variation in broad-spectrum antibiotic (Br-Ab) use among EU/European Economic Area (EEA) countries.Correlation and regression analysis were performed, using the bootstrap method, between Br (...) variability solely using national UAI scores (P < 0.001).Br-Ab prescribing appears to be driven by the level of UAI within the country. Any interventions aimed at reducing Br-Ab in high-consuming EU/EEA countries need to address this cultural perception to maximize their chances of success.© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

2019 Journal of Antimicrobial Chemotherapy

1923. Studies of selective digestive decontamination as a natural experiment to evaluate topical antibiotic prophylaxis and cephalosporin use as population-level risk factors for enterococcal bacteraemia among ICU patients. (Abstract)

Studies of selective digestive decontamination as a natural experiment to evaluate topical antibiotic prophylaxis and cephalosporin use as population-level risk factors for enterococcal bacteraemia among ICU patients. Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) regimens appear protective against ICU-acquired overall bacteraemia. These regimens can be factorized as topical antibiotic prophylaxis (TAP) with (SDD) or without (SOD) protocolized (...) parenteral antibiotic prophylaxis (PPAP) using cephalosporins. Both TAP and cephalosporins are risk factors for enterococcal colonization although their impact on enterococcal bacteraemia within studies of SDD/SOD remains unclear.To benchmark the enterococcal bacteraemia incidence within component (control and intervention) groups of SDD/SOD studies among ICU patients versus studies without intervention (observational groups).The literature was searched for SDD/SOD studies reporting enterococcal

2019 Journal of Antimicrobial Chemotherapy

1924. Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe. Full Text available with Trip Pro

Adaptation of the WHO Essential Medicines List for national antibiotic stewardship policy in England: being AWaRe. Appropriate use of and access to antimicrobials are key priorities of global strategies to combat antimicrobial resistance (AMR). The WHO recently classified key antibiotics into three categories (AWaRe) to improve access (Access), monitor important antibiotics (Watch) and preserve effectiveness of 'last resort' antibiotics (Reserve). This classification was assessed for antibiotic (...) stewardship and quality improvement in English hospitals.Using an expert elicitation exercise, antibiotics used in England but not included in the WHO AWaRe index were added to an appropriate category following a workshop consensus exercise with national experts. The methodology was tested using national antibiotic prescribing data and presented by primary and secondary care.In 2016, 46/108 antibiotics included within the WHO AWaRe index were routinely used in England and an additional 25 antibiotics also

2019 Journal of Antimicrobial Chemotherapy

1925. Antibiotic decision making in surgical intensive care: a qualitative analysis. (Abstract)

Antibiotic decision making in surgical intensive care: a qualitative analysis. Antibiotic use in hospitals is high, particularly in surgical specialty and intensive care units. Antimicrobial stewardship programmes (ASPs) are increasingly intervening in antibiotic use by surgeons and intensivists. However, there is limited information on the features which characterize antibiotic decision making in the surgical intensive care unit (SICU), an area in hospital practice where critically ill surgery (...) , antimicrobial stewardship (AMS) interventions may have diminished success in addressing high levels of the antibiotic use in the SICU.Copyright © 2019 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

2019 Journal of Hospital Infection

1926. Levofloxacin-resistant Stenotrophomonas maltophilia: risk factors and antibiotic susceptibility patterns in hospitalized patients. (Abstract)

Levofloxacin-resistant Stenotrophomonas maltophilia: risk factors and antibiotic susceptibility patterns in hospitalized patients. Levofloxacin has been considered as an alternative treatment for Stenotrophomonas maltophilia infection. Levofloxacin-resistant S. maltophilia (LRSM), however, are emerging in the world.The retrospective matched case-control-control study is aimed to investigate LRSM risk factors in hospitalized patients. Antibiotic susceptibility patterns of collected LRSM isolates (...) . maltophilia-infected patients were analysed. The first multivariable analysis (cases vs. group A) revealed that previous fluoroquinolones use was significantly associated with LRSM occurrence, and the second multivariable analysis (cases vs. group B) revealed that previous fluoroquinolones use, previous intensive care unit (ICU) stay, and the number of previous exposures to different classes of antibiotics were significantly associated with LRSM occurrence. Of all the LRSM isolates tested for antibiotic

2019 Journal of Hospital Infection

1927. Danish experience of meticillin-resistant Staphylococcus aureus eradication with emphasis on nose-throat colonization and supplementary systemic antibiotic treatment. (Abstract)

Danish experience of meticillin-resistant Staphylococcus aureus eradication with emphasis on nose-throat colonization and supplementary systemic antibiotic treatment. The study-aim was to evaluate the Danish national Board of Health's guidance for treating MRSA carriage focusing on MRSA nose-throat carriage and use of supplementary systemic antibiotics. We analyze results of MRSA eradication treatment of 358 patients, focusing on those with nose (n=58) or throat (n=183) MRSA colonization. We

2019 Journal of Hospital Infection

1928. Altering Antibiotic Regimen as Additional Control Measure in Suspected Multi-Drug-Resistant Enterobacter cloacae Outbreak in a Neonatal Intensive Care Unit. (Abstract)

Altering Antibiotic Regimen as Additional Control Measure in Suspected Multi-Drug-Resistant Enterobacter cloacae Outbreak in a Neonatal Intensive Care Unit. Increased occurrence of a particular species of gram-negative (GN), especially when multi-drug-resistant (MDR), in routine screening surveillance in Neonatal Intensive Care Units (NICUs) can be evoked by selection pressure.To evaluate adapting the empiric antibiotic regimen for its usefulness as control measure in suspected outbreaks (...) antibiotic regimen. Over the entire period no infections with MDR-GN occurred.Altering the antibiotic regimen with regard to selection pressure may be considered as part of intervention bundle to rapidly control the emergence of MDR-GN in suspected outbreak situations in the NICU.Copyright © 2019. Published by Elsevier Ltd.

2019 Journal of Hospital Infection

1929. Factors Associated With Antibiotic Prescribing and Outcomes for Pediatric Pneumonia in the Emergency Department. (Abstract)

Factors Associated With Antibiotic Prescribing and Outcomes for Pediatric Pneumonia in the Emergency Department. Chest radiographs (CXRs) are often performed in children with respiratory illness to inform the decision to prescribe antibiotics. Our objective was to determine the factors associated with clinicians' plans to treat with antibiotics prior to knowledge of CXR results and the associations between preradiograph plans with antibiotic prescription and return to medical care.Previously (...) healthy children aged 3 months to 18 years with a CXR for suspected pneumonia were enrolled in a prospective cohort study in the emergency department. Our primary outcomes were antibiotic prescription or administration in the emergency department and medical care sought within 7 to 15 days after discharge. Inverse probability treatment weighting was used to limit bias due to treatment selection. Inverse probability treatment weighting was included in a logistic regression model estimating

2019 Pediatric Emergency Care

1930. Salvage procedure for chronic periprosthetic knee infection: the application of DAIR results in better remission rates and infection-free survivorship when used with topical degradable calcium-based antibiotics. (Abstract)

Salvage procedure for chronic periprosthetic knee infection: the application of DAIR results in better remission rates and infection-free survivorship when used with topical degradable calcium-based antibiotics. Debridement, systemic antibiotics and implant retention (DAIR) is very successful for early periprosthetic joint infection (PJI), but can fail in late-onset cases. We selected patients with PJI who were unsuitable for two-stage exchange total knee arthroplasty (TKA) and compared (...) the outcomes of DAIR with or without degradable calcium-based antibiotics.All patients fulfilled the criteria for late-onset PJI of TKA, as defined by an International Consensus Meeting in 2013, but were unsuitable for multistage procedures and TKA exchange due to operative risk. Fifty-six patients (mean age: 70.6 years, SD ± 10.8), in two historical collectives, were treated using a single-stage algorithm consisting of DAIR without antibiotics (control group, n = 33, 2012-2014), or by DAIR following

2019 Knee Surgery, Sports Traumatology, Arthroscopy

1931. Current infection prevention and antibiotic stewardship program practices: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). (Abstract)

Current infection prevention and antibiotic stewardship program practices: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). We used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus (...) , frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.

2019 Infection control and hospital epidemiology

1932. Application of an antibiotic spectrum index in the neonatal intensive care unit. (Abstract)

Application of an antibiotic spectrum index in the neonatal intensive care unit. Antimicrobial stewardship programs typically use days of therapy to assess antimicrobial use. However, this metric does not account for the antimicrobial spectrum of activity. We applied an antibiotic spectrum index to a population of very-low-birth-weight infants to assess its utility to evaluate the impact of antimicrobial stewardship interventions.

2019 Infection control and hospital epidemiology

1933. Inappropriate intravenous antimicrobial starts: An antimicrobial stewardship metric for hemodialysis facilities. (Abstract)

Inappropriate intravenous antimicrobial starts: An antimicrobial stewardship metric for hemodialysis facilities. We assessed the appropriateness of intravenous antimicrobial starts (IVASs) in Philadelphia County hemodialysis facilities using only National Healthcare Safety Network data. We classified 57.5% of IVASs as inappropriate. These findings warrant further investigation into the determinants of inappropriate IVASs in hemodialysis facilities to enhance antimicrobial stewardship.

2019 Infection control and hospital epidemiology

1934. Urinary tract infections and antibiotic use in pregnancy - qualitative analysis of online forum content. Full Text available with Trip Pro

Urinary tract infections and antibiotic use in pregnancy - qualitative analysis of online forum content. Antibiotics are standard treatment for asymptomatic and symptomatic urinary tract infections (UTIs) in pregnancy. Their overuse, however, can contribute to antimicrobial resistance (AMR) and expose the foetus to drugs that might affect its development. Preventative behaviours are currently the best option to reduce incidences of UTIs and to avoid the use of antibiotics in pregnancy. The aim (...) thematic analysis.Women's perceptions of UTIs and antibiotic use in pregnancy were driven by their pre-natal attachment to the foetus. UTIs were thought to be common and high risk in pregnancy, which meant that antibiotics were viewed as essential in the presence of suspected symptoms. The dominant view about antibiotics was that their use was safe and of little concern in pregnancy. Women reported an emotional reaction to developing a UTI. They coped by seeking information about behaviour change

2019 BMC Pregnancy and Childbirth

1935. Antibiotic prophylaxis in ragged placental membranes: a prospective, multicentre, randomized trial. Full Text available with Trip Pro

Antibiotic prophylaxis in ragged placental membranes: a prospective, multicentre, randomized trial. Ragged placental membranes is a distinct entity from retained placenta and not uncommonly reported in midwifery texts. Although the incidence of postpartum endometritis is merely 1-5% after vaginal births, it remains the most common source of puerperal sepsis, contributing up to 15% of maternal mortality in low income countries. Geographically-remote centres in Malaysia prophylactically (...) administer antibiotics for women with ragged placental membranes after vaginal birth, extrapolating evidence from retained placenta. We sought to clarify the rationale in continuing such practices.This was an open-label, prospective, multicentre, randomized trial. Three hospitals where the current protocol was to administer prophylactic amoxycillin-clavulanic acid served as the sites of recruitment. Women who delivered vaginally beyond 24+ 0 weeks of gestation with ragged membranes were invited

2019 BMC Pregnancy and Childbirth Controlled trial quality: uncertain

1936. Early antibiotic exposure and development of asthma and allergic rhinitis in childhood. Full Text available with Trip Pro

Early antibiotic exposure and development of asthma and allergic rhinitis in childhood. The prevalence of pediatric allergic diseases has increased rapidly in the United States over the past few decades. Recent studies suggest an association between the increase in allergic disease and early disturbances to the gut microbiome. The gut microbiome is a set of intestinal microorganisms that begins to form during birth and is highly susceptible to disturbance during the first year of life. Early (...) antibiotic exposure may negatively impact the gut microbiota by altering the bacterial composition and causing dysbiosis, thus increasing the risk for developing childhood allergic disease.We performed a retrospective chart review of data in Loyola University Medical Center's (LUMC) Epic system from 2007 to 2016. We defined antibiotic exposure as orders in both the outpatient and inpatient settings. Inclusion criteria were being born at LUMC with at least two follow up visits. Asthma and allergic

2019 BMC Pediatrics

1937. The Use of Prophylactic Antibiotics before Primary Palatoplasty Is Not Associated with Lower Fistula Rates: An Outcome Study Using the Pediatric Health Information System Database. (Abstract)

The Use of Prophylactic Antibiotics before Primary Palatoplasty Is Not Associated with Lower Fistula Rates: An Outcome Study Using the Pediatric Health Information System Database. Previous attempts to study the effect of prophylactic antibiotics on the outcomes of cleft palate surgery have been hampered by the need for a very large sample size to provide adequate power to discern a potentially small therapeutic effect. This limitation can be overcome by querying large databases created (...) antibiotic administration. Associations between antibiotic administration and fistula repair were assessed using random-intercept logistic regression adjusting for age, sex, race, and cleft type.Seven thousand one hundred sixty patients were available for analysis; of these, 460 (6.4 percent) had a subsequent repair of an oronasal fistula. Fistula rates were 5.9, 11.4, and 5.2 percent among patients given preoperative antibiotics, only postoperative antibiotics, and no antibiotics, respectively (p

2019 Plastic and reconstructive surgery

1938. Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections. Full Text available with Trip Pro

Improving the Transition of Intravenous to Enteral Antibiotics in Pediatric Patients with Pneumonia or Skin and Soft Tissue Infections. Despite national recommendations for early transition to enteral antimicrobials, practice variability has existed at our hospital.The aim of this study was to increase the proportion of enterally administered antibiotic doses for Pediatric Hospital Medicine patients aged >60 days admitted for uncomplicated community-acquired pneumonia or skin and soft tissue (...) process measure was the total number of enteral antibiotic doses divided by all antibiotic doses in patients receiving enteral medications on the same day. An annotated statistical process control chart tracked the impact of interventions on the administration route of antibiotic doses over time. Additional outcome measures included antimicrobial costs per patient encounter using average wholesale prices and length of stay.The percentage of enterally administered antibiotic doses increased from 44

2019 Journal of Hospital Medicine

1939. Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016. Full Text available with Trip Pro

Strong correlation between the rates of intrinsically antibiotic-resistant species and the rates of acquired resistance in Gram-negative species causing bacteraemia, EU/EEA, 2016. BackgroundAntibiotic resistance, either intrinsic or acquired, is a major obstacle for treating bacterial infections.AimOur objective was to compare the country-specific species distribution of the four Gram-negative species Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter species (...) and the proportions of selected acquired resistance traits within these species.MethodWe used data reported for 2016 to the European Antimicrobial Resistance Surveillance Network (EARS-Net) by 30 countries in the European Union and European Economic Area.ResultsThe country-specific species distribution varied considerably. While E. coli accounted for 31.9% to 81.0% (median: 69.0%) of all reported isolates, the two most common intrinsically resistant species P. aeruginosa and Acinetobacter spp. combined (PSEACI

2019 Euro Surveillance

1940. Antimicrobial use in acute care hospitals: national point prevalence survey on healthcare-associated infections and antimicrobial use, Switzerland, 2017. Full Text available with Trip Pro

antimicrobial regimens that were changed, 309 (28.3%; 95% CI: 25.7-31.0) were escalated and 337 (30.9%; 95% CI: 28.2-33.7) were de-escalated. Amoxicillin/clavulanic acid was the most frequent antimicrobial (18.8%; 95% CI: 17.7-19.8), prescribed mainly for therapeutic indications (76.0%; 95% CI: 73.3-78.7). A total of 1,931 (37.4%; 95% CI: 36.1-38.8) of the 5,158 antimicrobials for systemic use were broad-spectrum antibiotics, most frequently third- and fourth-generation cephalosporins (35.9%; 95% CI: 33.8 (...) -38.1).ConclusionsAntimicrobial consumption was at European average, the use of broad-spectrum antibiotics in the lower third. Swiss acute care hospitals should invest in antimicrobial stewardship, particularly in reducing the use of broad-spectrum antibiotics.

2019 Euro Surveillance

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