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1941. Population-level surveillance of antibiotic resistance in <i>Escherichia coli</i> through sewage analysis. Full Text available with Trip Pro

Population-level surveillance of antibiotic resistance in Escherichia coli through sewage analysis. IntroductionThe occurrence of antibiotic resistance in faecal bacteria in sewage is likely to reflect the current local clinical resistance situation.AimThis observational study investigated the relationship between Escherichia coli resistance rates in sewage and clinical samples representing the same human populations.MethodsE. coli were isolated from eight hospital (n = 721 isolates (...) ) and six municipal (n = 531 isolates) sewage samples, over 1 year in Gothenburg, Sweden. An inexpensive broth screening method was validated against disk diffusion and applied to determine resistance against 11 antibiotics in sewage isolates. Resistance data on E. coli isolated from clinical samples from corresponding local hospital and primary care patients were collected during the same year and compared with those of the sewage isolates by linear regression.ResultsE. coli resistance rates derived

2019 Euro Surveillance

1942. Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis. Full Text available with Trip Pro

Levels of outpatient prescribing for four major antibiotic classes and rates of septicemia hospitalization in adults in different US states - a statistical analysis. Rates of sepsis/septicemia hospitalization in the US have risen significantly during recent years. Antibiotic resistance and use may contribute to those rates through various mechanisms, including lack of clearance of resistant infections following antibiotic treatment, with some of those infections subsequently devolving (...) into sepsis. At the same time, there is limited information on the effect of prescribing of certain antibiotics vs. others on the rates of septicemia and sepsis-related hospitalizations and mortality.We used multivariable linear regression to relate state-specific rates of outpatient prescribing overall for oral fluoroquinolones, penicillins, macrolides, and cephalosporins between 2011 and 2012 to state-specific rates of septicemia hospitalization (ICD-9 codes 038.xx present anywhere on a discharge

2019 BMC Public Health

1943. Effects of economic and health policies on the consumption of antibiotics in a Spanish region. (Abstract)

Effects of economic and health policies on the consumption of antibiotics in a Spanish region. Objectives: Inappropriate and indiscriminate use of antibiotics is one of the main factors contributing to the increasing bacterial resistance. Surveillance of antibiotic consumption is fundamental for assessing the effects of rational use-oriented measures introduced under economic or health policies. This study quantifies and assesses the introduction of a pharmaceutical co-payment (...) and implementation of campaigns to increase awareness about and rational use in the consumption of antibiotics (volume and expenditure). Methods: Monthly official dispensations recorded by a health authority (La Rioja, Spain) between January 2009 and December 2017 (108 observations). Total and disaggregated (by active principle and patient's income level) time series for a number of packages and expenditure were studied using intervention and counterfactual analyses (Box-Jenkins methodology). Results: Co-payment

2019 Expert review of pharmacoeconomics & outcomes research

1944. Urinary tract infections in a university hospital: pathogens and antibiotic susceptibility. (Abstract)

Urinary tract infections in a university hospital: pathogens and antibiotic susceptibility. A substantial group of patients visit the emergency department (ED) with complaints of urinary tract infections (UTI). Treatment advice is based on national and local public health surveillance data. It is unclear whether this advice is adequate for hospitals with selected patient populations, such as university hospitals.We performed a retrospective study on patients visiting the ED of the Erasmus (...) University Medical Center (Erasmus MC) in the Netherlands from January 1st, 2013 until December 31st, 2014 with a suspected complicated UTI (cUTI) and positive urinary cultures. Patient data, data concerning the ED visit and microbiological data were analysed.439 patients visited the ED, of whom 429 had a cUTI. Our results were compared with NethMap data. Distribution of uropathogens was comparable with the overall distribution in the Netherlands. Antibiotic susceptibility was comparable for intravenous

2019 Netherlands Journal of Medicine

1945. Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy. (Abstract)

Concordance with antibiotic guidelines in Australian primary care: A retrospective study of prior-to-hospital therapy. Background Appropriate antibiotic prescribing improves patient outcomes and mitigates antimicrobial resistance. As the majority of antibiotics are used in the community, rational prescribing in this setting is of paramount importance. Objectives We aimed to (1) evaluate the concordance of community antibiotic prescribing with guidelines for three common infection types among (...) concordant. The most common reason for non-concordance was inappropriate drug choice (n = 143, 50.2%). Patients with the following characteristics were less likely to receive concordant therapy: diabetes (OR = 0.3, 95% CI 0.1-0.8, P = .02) and increasing age (OR = 0.99, 95% CI 0.98-1.00, P = .04). Conclusions Almost three-quarters of patients received community-initiated antibiotic therapy that was not fully guideline concordant. Antimicrobial stewardship interventions are urgently needed to improve

2019 International journal of clinical practice

1946. Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. Full Text available with Trip Pro

Evaluation of antibacterial activity of propolis on regenerative potential of necrotic immature permanent teeth in dogs. This study evaluated the antibacterial efficiency and ability of propolis to promote regeneration of immature permanent non-vital dogs' teeth.Ninety six immature permanent premolars teeth in 6 mongrel dogs were divided randomly into: experimental teeth (N = 72) and control teeth (N = 24). Periapical pathosis was induced in all experimental and positive control teeth (...) . Experimental teeth were classified according to the used intra-canal medication into: group I (N = 36), propolis paste was used and group II (N = 36), triple antibiotic paste (TAP) was used. Bacteriologic samplings were collected before and after exposure to intra-canal medicaments. After the disinfection period (3 weeks), revascularization was induced in all experimental teeth. Each group was subdivided according to the root canal orifice plug into: subgroup A (N = 18), propolis paste was used

2019 BMC Oral Health

1947. Designing a customized clinical practice guideline regarding antibiotic prophylaxis for Iranian general dentists. Full Text available with Trip Pro

Designing a customized clinical practice guideline regarding antibiotic prophylaxis for Iranian general dentists. Clinical practice guidelines produced by developed countries seemed to be not completely feasible for developing countries due to their different local context. In this study, we designed a customized guideline about antibiotic prophylaxis before dental procedures for Iranian general dentists.This study was conducted of two parts, including a qualitative part and a cross-sectional (...) analytic part. A multidisciplinary team searched for related guidelines and other documents, selected the most updated and high quality ones, customized their recommendations based on available antibiotics in Iran, prepared a draft adapted guideline and summarized its recommendations in 3 flowcharts. An expert panel (20 specialists of four Iranian dental universities) participated in a consensus process, afterwards to determine the relevance and clarity of the flowcharts and their items

2019 BMC Oral Health

1948. Antimicrobial resistance surveillance and prediction of Gram-negative bacteria based on antimicrobial consumption in a hospital setting: A 15-year retrospective study. Full Text available with Trip Pro

retrospective analyses in China between antimicrobial consumption and antimicrobial resistance. Change of the usage of several antibacterial drugs has great influence on the drug resistance of Gram-negative bacterial. Of particular, ARIMA forecasting revealed that carbapenem related bacterial resistance should be closely watched. (...) Antimicrobial resistance surveillance and prediction of Gram-negative bacteria based on antimicrobial consumption in a hospital setting: A 15-year retrospective study. Antimicrobial resistance, a major threat to human health, is mainly driven by the overuse of antimicrobials. The purpose of this study was to further investigate the relationship between antimicrobial use and resistance with a 15-year record in Southwest hospital, one of the largest hospitals in Southwest China and a university

2019 Medicine

1949. Antibiotic prescribing for acute respiratory tract infections in the United States outpatient setting. Full Text available with Trip Pro

Antibiotic prescribing for acute respiratory tract infections in the United States outpatient setting. Acute respiratory tract infections (ARIs) are common in the outpatient setting. Although they are predominantly viral, antibiotics are often prescribed for the treatment of ARIs.Using the U.S. Medical Expenditure Panel Survey (MEPS; 2010-2015), we estimated the national prevalence and predictors of outpatient antibiotic prescribing for ARIs by provider type. We categorized the trends (...) of antibiotic prescriptions (overall or broad-spectrum) for ARIs by provider type (physician and advanced practice provider [APP] which includes nurse practitioner [NP], and physician assistant [PA]). The outcome variable was defined as receipt of an antibiotic prescription during a consultation with a provider for an ARI (including outpatient clinic visit or doctor's office visit).There were 64,081,892 ARI antibiotic prescriptions written, with a decrease from 10.9 (2010) to 9.7 million (2015) during

2019 BMC Family Practice

1950. Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach. Full Text available with Trip Pro

Understanding the influence of parent-clinician communication on antibiotic prescribing for children with respiratory tract infections in primary care: a qualitative observational study using a conversation analysis approach. Acute respiratory tract infections (RTI) in children are a common reason for antibiotic prescribing. Clinicians' prescribing decisions are influenced by perceived parental expectations for antibiotics, however there is evidence that parents actually prefer to avoid (...) antibiotics. This study aimed to investigate the influence of parent-clinician communication on antibiotic prescribing for RTI in children in England.A mixed methods analysis of videoed primary care consultations for children (under 12 years) with acute cough and RTI. Consultations were video-recorded in six general practices in southern England, selected for socio-economic diversity. 56 recordings were transcribed in detail and a subset of recordings and transcripts used to develop a comprehensive

2019 BMC Family Practice

1951. Computed tomographic findings of macrolide-resistant Mycobacterium massiliense pulmonary disease and changes after antibiotic treatment. Full Text available with Trip Pro

Computed tomographic findings of macrolide-resistant Mycobacterium massiliense pulmonary disease and changes after antibiotic treatment. The purpose of this study was to present the computed tomographic (CT) findings of lung abnormalities in macrolide-resistant Mycobacterium massiliense pulmonary disease and its changes in follow-up CT after antibiotic treatment.Chest CT scans of patients with macrolide-resistant M massiliense pulmonary disease (n = 19) were retrospectively reviewed. Patients (...) were treated with multidrug therapy, and sputum examinations were performed. Follow-up CT scans obtained during antibiotic treatment after detection of macrolide resistance were also reviewed, if available (n = 13). The CT scores at detection of macrolide resistance and at the last follow-up periods were also compared.Of all patients with macrolide-resistant M massiliense pulmonary disease, 2 (11%) patients achieved sputum culture conversion during the follow-up period. The most common CT findings

2019 Medicine

1952. Potential Impact of HAP Guidelines on Empiric Antibiotics: An Evaluation of 113 VA Medical Centers. (Abstract)

Potential Impact of HAP Guidelines on Empiric Antibiotics: An Evaluation of 113 VA Medical Centers. The 2016 guidelines for hospital-acquired pneumonia (HAP) suggest applying a universal antibiogram resistance threshold in addition to patient criteria to determine empiric coverage. The impact of these recommendations is unknown.1) Describe national antibiotic use and microbiology patterns for HAP among patients with non-infectious admissions, 2) measure the predictive performance (...) of the antibiogram threshold and risk factors, and 3) estimate the change in practice with guideline implementation.We conducted a retrospective analysis of all hospitalizations without initial infection but with secondary pneumonia diagnoses at Veterans Affairs Medical Centers between 10/1/2012 and 9/30/2015. For each hospitalization we extracted: presence of MRSA and resistant GNR (R-GNR) in cultures, anti-MRSA and anti-pseudomonal antimicrobial administration, and facility-level prevalence of MRSA and R-GNR

2019 Annals of the American Thoracic Society

1953. Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding: A retrospective study using the pediatric health information system (PHIS) database. Full Text available with Trip Pro

Antibiotic use in cirrhotic children with acute upper gastrointestinal bleeding: A retrospective study using the pediatric health information system (PHIS) database. Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient (...) ), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB

2019 Medicine

1954. Antibiotic dispensation rates among participants in community-driven health research projects in Arctic Canada. Full Text available with Trip Pro

Antibiotic dispensation rates among participants in community-driven health research projects in Arctic Canada. Community-driven projects that aim to address public concerns about health risks from H. pylori infection in Indigenous Arctic communities (estimated H. pylori prevalence = 64%) show frequent failure of treatment to eliminate the bacterium. Among project participants, treatment effectiveness is reduced by antibiotic resistance of infecting H. pylori strains, which in turn (...) , is associated with frequent exposure to antibiotics used to treat other infections. This analysis compares antibiotic dispensation rates in Canadian Arctic communities to rates in urban and rural populations in Alberta, a southern Canadian province.Project staff collected antibiotic exposure histories for 297 participants enrolled during 2007-2012 in Aklavik, Tuktoyaktuk, and Fort McPherson in the Northwest Territories, and Old Crow, Yukon. Medical chart reviews collected data on systemic antibiotic

2019 BMC Public Health

1955. Outcomes of an electronic medical record (EMR)-driven intensive care unit (ICU)-antimicrobial stewardship (AMS) ward round: Assessing the "Five Moments of Antimicrobial Prescribing". (Abstract)

of Antimicrobial Prescribing" metric: (1) escalation, (2) de-escalation, (3) discontinuation, (4) switch, and (5) optimization. The secondary objectives included measuring the impact of this service on (1) antibiotic appropriateness, and (2) use of high-priority target antimicrobials.A prospective review was undertaken of the implementation and compliance with a new ICU-AMS service that utilized EMR data coupled with face-to-face recommendations. Additional patient data were collected when an AMS (...) appropriateness from 21 of 45 (46.7%) preintervention (October 2016) to 30 of 39 (76.9%) during the study period (September 2017).The integration of EMR with an ICU-AMS program allowed us to implement a new AMS service, which was associated with high clinician compliance with recommendations and improved antibiotic appropriateness. Our "5 Moments of Antimicrobial Prescribing" metric provides a framework for measuring AMS recommendation compliance.

2019 Infection control and hospital epidemiology

1956. Use of antibiotics among end-of-life hospitalized patients with advanced directives: Status examination and association with infectious disease consultation and physician burnout. (Abstract)

Use of antibiotics among end-of-life hospitalized patients with advanced directives: Status examination and association with infectious disease consultation and physician burnout. Overuse of antibiotics in end-of-life patients with advanced directives increases bacterial resistance and causes morbidity and mortality. Consultations with infectious disease (ID) physicians and burnout, which can affect antibiotic days of therapy (DOT) prescribed by physicians, have not been examined so far.To (...) assess antibiotic use by physicians in end-of-life (EOL) patients with advanced directives and to investigate the association between ID consultations, physician burnout, and antibiotic DOT in those patients.A descriptive correlational study.Acute-care and post-acute-care hospitals.The study included 213 physicians and 932 their hospitalized patients in the last 2 weeks of life.We distributed questionnaires and analyzed the data collected regarding ID consultation, EOL antibiotics prescription

2019 Infection control and hospital epidemiology

1957. Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals. Full Text available with Trip Pro

for uncomplicated infections such as acute exacerbation of chronic bronchitis, uncomplicated urinary tract infections, and acute bacterial sinusitis.4 Concerns over safety and the association with Clostridiodes difficile infection have led inpatient antimicrobial stewardship programs (ASPs) to develop initiatives to promote avoidance of quinolones. The objective of this study was to quantify the effect of the 2016 FDA "black box" update on inpatient antibiotic use among a cohort of southeastern US hospitals. (...) Impact of FDA black box warning on fluoroquinolone and alternative antibiotic use in southeastern US hospitals. We analyzed antibiotic use data from 29 southeastern US hospitals over a 5-year period to determine changes in antibiotic use after the fluoroquinolone US Food and Drug Administration (FDA) advisory update in 2016. Fluoroquinolone use declined both before and after the FDA announcement, and the use of select, alternative antibiotics increased after the announcement.Fluoroquinolones

2019 Infection control and hospital epidemiology

1958. Hospital-level high-risk antibiotic use in relation to hospital-associated <i>Clostridioides difficile</i> infections: Retrospective analysis of 2016-2017 data from US hospitals. (Abstract)

-1.21; P = .002) after adjusting for confounders.High-risk antibiotic use is an independent predictor of HA CDI. This assessment of poststewardship implementation in the United States highlights the importance of tracking trends of antimicrobial use over time as it relates to CDI. (...) Hospital-level high-risk antibiotic use in relation to hospital-associated Clostridioides difficile infections: Retrospective analysis of 2016-2017 data from US hospitals. Antibiotics are widely used by all specialties in the hospital setting. We evaluated previously defined high-risk antibiotic use in relation to Clostridioides difficile infections (CDIs).We analyzed 2016-2017 data from 171 hospitals. High-risk antibiotics included second-, third-, and fourth-generation cephalosporins

2019 Infection control and hospital epidemiology

1959. Prevalence of hospital antibiotic use in Argentina, 2018. (Abstract)

Prevalence of hospital antibiotic use in Argentina, 2018. Hospital antibiotic use in Argentina has not been described. We present results of point prevalence surveys on antibiotic use conducted in 109 Argentinian hospitals in November 2018 and submitted to the National Program of Epidemiology and Control of Hospital-Acquired Infections, and we discuss potential areas for improvement.

2019 Infection control and hospital epidemiology

1960. Errors in antibiotic transitions between hospital and nursing home: How often do they occur? (Abstract)

Errors in antibiotic transitions between hospital and nursing home: How often do they occur? We performed systematic review on 40 paired hospital and nursing home charts from a clinical trial to evaluate the fidelity of transitions of care among those discharged on antibiotics. We found that 30% of transitions included an inappropriate change to the patient's antibiotic plan of care.

2019 Infection control and hospital epidemiology

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