Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Prediction model to identify infectious COVID-19 patients in the emergency department.","authors":"Myat Oo Aung, Indumathi Venkatachalam, Jean X Y Sim, Liang En Wee, May K Aung, Yong Yang, Edwin P Conceicao, Shalvi Arora, Marcus A B Lee, Chang H Sia, Kenneth B K Tan, Moi Lin Ling","doi":"10.1017/ash.2024.82","DOIUrl":"10.1017/ash.2024.82","url":null,"abstract":"<p><strong>Background: </strong>Real-time reverse-transcriptase polymerase chain reaction (RT-PCR) has been the gold standard for diagnosing coronavirus disease 2019 (COVID-19) but has a lag time for the results. An effective prediction algorithm for infectious COVID-19, utilized at the emergency department (ED), may reduce the risk of healthcare-associated COVID-19.</p><p><strong>Objective: </strong>To develop a prototypic prediction model for infectious COVID-19 at the time of presentation to the ED.</p><p><strong>Material and methods: </strong>Retrospective cohort study of all adult patients admitted to Singapore General Hospital (SGH) through ED between March 15, 2020, and December 31, 2022, with admission of COVID-19 RT-PCR results. Two prediction models were developed and evaluated using area under the curve (AUC) of receiver operating characteristics (ROC) to identify infectious COVID-19 patients (cycle threshold (Ct) of <25).</p><p><strong>Results: </strong>Total of 78,687 patients were admitted to SGH through ED during study period. 6,132 of them tested severe acute respiratory coronavirus 2 positive on RT-PCR. Nearly 70% (4,226 of 6,132) of the patients had infectious COVID-19 (Ct<25). Model that included demographics, clinical history, symptom and laboratory variables had AUROC of 0.85 with sensitivity and specificity of 80.0% & 72.1% respectively. When antigen rapid test results at ED were available and added to the model for a subset of the study population, AUROC reached 0.97 with sensitivity and specificity of 95.0% and 92.8% respectively. Both models maintained respective sensitivity and specificity results when applied to validation data.</p><p><strong>Conclusion: </strong>Clinical predictive models based on available information at ED can be utilized for identification of infectious COVID-19 patients and may enhance infection prevention efforts.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving shared decision-making around antimicrobial-prescribing during the end-of-life period: a qualitative study of Veterans, their support caregivers and their providers.","authors":"Cassie Cunningham Goedken, Erin Balkenende, Daniel Livorsi, Karleen Giannitrapani, Matthew McCaa, Gosia Clore, Michihiko Goto, Alexandre R Marra, Eli N Perencevich","doi":"10.1017/ash.2024.61","DOIUrl":"10.1017/ash.2024.61","url":null,"abstract":"<p><strong>Objective: </strong>Antimicrobials are frequently used for palliation during end-of-life care, but adverse effects, such as antimicrobial resistance, are a concern. Shared decision-making is beneficial in end-of-life care conversations to help align antimicrobial-prescribing with patient preferences. However, there is limited data regarding optimal incorporation of antimicrobial-prescribing discussions into shared decision-making conversations. We explored healthcare provider, patient, and support caregiver (eg, family member/friend) perceptions of barriers and facilitators to discussing antimicrobial-prescribing during the end-of-life period.</p><p><strong>Design: </strong>Qualitative study.</p><p><strong>Participants: </strong>Healthcare providers; palliative care/hospice care patients/caregivers.</p><p><strong>Methods: </strong>We conducted semi-structured interviews on shared attitudes/beliefs about antimicrobial-prescribing during end-of-life patient care at one acute-care and one long-term-care facility. Interviews were analyzed for thematic content.</p><p><strong>Results: </strong>Fifteen providers and 13 patients/caregivers completed interviews. Providers recognized the potential benefit of leveraging shared decision-making to guide antimicrobial-prescribing decisions. Barriers included limited face-to-face time with the patient and uncertainty of end-of-life prognosis. Patients/caregivers cited trust, comprehension, and feeling heard as important characteristics which act as facilitators in fostering effective shared decision-making around antimicrobial use. Communication in which providers ensure patients are involved in shared decision-making discussions could be increased to ensure patients and their providers develop a mutually agreeable care plan.</p><p><strong>Conclusions: </strong>Shared decision-making is a practice that can guide antimicrobial-prescribing decisions during end-of-life care, thus potentially minimizing antimicrobial-related adverse effects. Our findings highlight opportunities for increased shared decision-making around antimicrobial use during end-of-life care. Interventions designed to address the identified barriers to shared decision-making have the potential to improve antimicrobial-prescribing practices at end-of-life.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106728/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterizing healthcare personnel attitudes toward receipt of a voluntary bivalent COVID-19 booster vaccine during a COVID-19 outbreak at a behavioral health hospital in Connecticut.","authors":"Scott C Roberts, Kathryn Willebrand, Jacqueline Fredrick, Lauren Pischel, Kavin Patel, Thomas S Murray, Richard A Martinello","doi":"10.1017/ash.2024.78","DOIUrl":"10.1017/ash.2024.78","url":null,"abstract":"<p><p>COVID-19 vaccine uptake in healthcare personnel (HCP) is poor. A cross-sectional survey study of behavioral health HCP was performed. Commonly identified reasons for vaccination were protecting others and oneself. Reasons against were a lack of perceived protection, dosing intervals, and side effects. Assessing vaccination attitudes can assist in uptake strategy.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A cluster of <i>Candida parapsilosis</i> displaying fluconazole-trailing in a neonatal intensive care unit successfully contained by multiple infection-control interventions.","authors":"Hiroaki Baba, Hajime Kanamori, Asami Nakayama, Takami Sato, Makoto Katsumi, Takae Chida, Shinobu Ikeda, Rio Seki, Teppei Arai, Katsuhiko Kamei, Koichi Tokuda","doi":"10.1017/ash.2024.77","DOIUrl":"10.1017/ash.2024.77","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate and contain a cluster of invasive candidiasis cases caused by fluconazole-resistant <i>Candida parapsilosis</i> (FRC) in a neonatal intensive care unit.</p><p><strong>Methods: </strong>Active surveillance was initiated. Direct observations of hand-hygiene compliance (HHC) among staff were conducted before and after the implementation of hand-hygiene (HH) education. Thirty-five environmental cultures were obtained. Phylogenetic analysis of FRC was performed using Fourier-transform infrared spectroscopy and microsatellite genotyping.</p><p><strong>Results: </strong>A total of 14 patients (mean birth weight = 860 g, gestational age = 25 weeks) infected with FRC were identified using the fully automated analyzer, including 5 with clinical infection (three with catheter-related bloodstream infection, one with cutaneous infection, and one with fatal peritonitis) and 9 with colonization. The HHC rate in nurses before performing a sterile or aseptic procedure significantly improved after the HH education (<i>P</i> < .05). Sinks near the patients were contaminated with FRC. All FRC strains were confirmed to be susceptible to fluconazole using the CLSI method, and the microdilution procedure indicated a trailing effect. Phylogenetic analysis showed that all the fluconazole-trailing isolates from patients were clustered together and had the same genotype. Sinks were successfully decontaminated using accelerated hydrogen peroxide and drainage pipes were replaced. Ultraviolet-C decontamination was applied in the milk preparation room. No new cases were detected after the education and disinfection interventions.</p><p><strong>Conclusions: </strong>Sinks are an important reservoir of <i>C. parapsilosis</i>. Active surveillance, environmental hygiene, and constant staff education on maintaining a high level of HHC are necessary to limit the spread of <i>C. parapsilosis</i>.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11106732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141077312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contact tracing in the hospital setting during the omicron wave of the coronavirus disease 2019 pandemic: persons and periods of concern for nosocomial infection prevention and control.","authors":"Lubna Sato, Yasuaki Tagashira, Narumi Shigeno, Yoshiaki Gu","doi":"10.1017/ash.2024.80","DOIUrl":"10.1017/ash.2024.80","url":null,"abstract":"<p><p>This study evaluating the efficacy of coronavirus disease 2019 contact tracing in the hospital setting during the omicron variant era found a high incidence of nosocomial severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission in outbreaks, especially among individuals having close contact with infected persons. Identifying close contacts and outbreaks is essential to prevent nosocomial SARS-CoV-2 transmission.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11094374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appropriateness of Antibiotic Prescribing in US Emergency Department Visits, 2016-2021.","authors":"Joseph Benigno Ladines-Lim, Michael A Fischer, Jeffrey A Linder, Kao-Ping Chua","doi":"10.1017/ash.2024.79","DOIUrl":"10.1017/ash.2024.79","url":null,"abstract":"<p><p>In this national analysis of US emergency department visits with antibiotic prescribing during 2016-2021, 27.6% of visits resulted in inappropriate antibiotic prescribing: 14.9% had diagnosis codes plausibly antibiotic-related (eg, acute bronchitis), suggesting actual inappropriate prescribing, and 12.6% had diagnosis codes not plausibly antibiotic-related (eg, hypertension), suggesting poor coding quality.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11094377/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends of antibiotic use at the end-of-life of cancer and non-cancer decedents: a nationwide population-based longitudinal study (2006-2018).","authors":"Nak-Hyun Kim, Kyungdo Han, Eunjeong Ji, Soyeon Ahn, Yunsang Choi, Seong Jin Choi, Song Mi Moon, Kyoung-Ho Song, Eu Suk Kim, Hong Bin Kim","doi":"10.1017/ash.2024.75","DOIUrl":"10.1017/ash.2024.75","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to assess the actual burden of antibiotic use among end-of-life (EOL) patients in South Korea and to compare trends between cancer and non-cancer decedents.</p><p><strong>Design: </strong>Population-based mortality follow-back study.</p><p><strong>Setting: </strong>Data from the Korean National Health Insurance Database, covering the period from January1, 2006, to December 31, 2018, provided for research by the National Health Insurance Service (NHIS), were used.</p><p><strong>Participants: </strong>All decedents from 2006 to 2018 were included and categorized as cancer decedents or non-cancer decedents.</p><p><strong>Methods: </strong>Annual antibiotic consumption rates and prescription rates were calculated, and Poisson regression was used to estimate their trends.</p><p><strong>Results: </strong>Overall antibiotic consumption rates decreased slightly among decedents in their final month with a less pronounced annual decrease rate among cancer decedents compared to non-cancer decedents (0.4% vs 2.3% per year, <i>P</i> <.001). Over the study period, although narrow spectrum antibiotics were used less, utilization and prescription of broad-spectrum antibiotics steadily increased, and prescription rates were higher in cancer decedents compared to non-cancer controls. Specifically, carbapenem prescription rates increased from 5.6% to 18.5%, (RR 1.087, 95% CI 1.085-1.088, <i>P</i> <.001) in cancer decedents and from 2.9% to 13.2% (RR 1.115, 95% CI 1.113-1.116, <i>P</i> <.001) in non-cancer decedents.</p><p><strong>Conclusions: </strong>Our findings show that patients at the EOL, especially those with cancer, are increasingly and highly exposed to broad-spectrum antibiotics. Measures of antibiotic stewardship are required among this population.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11094383/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five steps to high quality antimicrobial stewardship research.","authors":"Bradley J Langford, Pamela Bailey, Daniel J Livorsi, Kevin A Brown, Sonali D Advani, Elizabeth Dodds Ashley, Gonzalo Bearman, Priya Nori","doi":"10.1017/ash.2024.73","DOIUrl":"10.1017/ash.2024.73","url":null,"abstract":"<p><p>The escalating threat of antimicrobial resistance (AMR) necessitates impactful, reproducible, and scalable antimicrobial stewardship strategies. This review addresses the critical need to enhance the quality of antimicrobial stewardship intervention research. We propose five considerations for authors planning and evaluating antimicrobial stewardship initiatives. Antimicrobial stewards should consider the following mnemonic ABCDE: (A) plan <b>A</b>head using implementation science; (B) <b>B</b>e clear and thoroughly describe the intervention by using the TidIER checklist; (C) Use a <b>C</b>hecklist to comprehensively report study components; (D) Select a study <b>D</b>esign carefully; and (E) Assess <b>E</b>ffectiveness and implementation by selecting meaningful outcomes. Incorporating these recommendations will help strengthen the evidence base of antimicrobial stewardship literature and support optimal implementation of strategies to mitigate AMR.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11094375/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140946014","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-prevalence survey of antimicrobial use in intensive care units in Nepal.","authors":"Sabin Koirala, Agnimshwor Dahal, Hem Raj Paneru, Astha Thapa, Surendra Bhusal, Roshni Shakya, Subekshya Luitel, Kanchan Koirala, Diptesh Aryal","doi":"10.1017/ash.2024.83","DOIUrl":"10.1017/ash.2024.83","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to investigate the prevalence and practices of antibiotic use in intensive care units (ICUs) in Nepal and to identify potential areas for implementing antimicrobial stewardship programs.</p><p><strong>Design: </strong>A point prevalence survey was conducted to characterize and quantify the antimicrobial utilization in level III ICUs of Nepal.</p><p><strong>Methods: </strong>Data on antibiotic prescription rates, reasons for prescribing antibiotics, and prescribing practices were collected and analyzed. The prevalence of antimicrobial resistance was also assessed.</p><p><strong>Results: </strong>The antibiotic prescribing rate was found to be very high, with 92.85% of patients in ICU on antibiotics. Prolonged surgical prophylaxis was the most common reason for prescribing antibiotics. Empirical therapy accounted for 67.5% of all antibiotic prescriptions. Prescribing practices were poor, with low adherence to guidelines and best practices. Broad-spectrum antibiotics were commonly used even for surgical prophylaxis or community-acquired infections. High resistance was observed against commonly used antibiotics.</p><p><strong>Conclusions: </strong>The study underscores the urgent need for effective antimicrobial stewardship programs in ICUs of Nepal. Implementing robust stewardship programs could help optimize antibiotic utilization, improve patient outcomes, and combat the global threat of antimicrobial resistance. The findings serve as a stepping stone toward understanding and improving antibiotic prescribing practices in ICUs of Nepal.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077596/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140893162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Assessment of the characteristics of COVID-19 infection among healthcare personnel working in long-term care facilities.","authors":"Armaghan-E-Rehman Mansoor, Caroline A O'Neil, David McDonald, Victoria J Fraser, Hilary M Babcock, Jennie H Kwon","doi":"10.1017/ash.2024.72","DOIUrl":"10.1017/ash.2024.72","url":null,"abstract":"<p><p>Between May and June 2021, healthcare personnel at two long-term care facilities underwent SARS-CoV-2 anti-nucleocapsid immunoglobulin G testing and completed a survey on COVID-19 exposures and symptoms. Antibody positivity rate was 8.9%. Similar rates of COVID-19 exposure occurred in non-occupational and occupational settings, with high self-reported adherence to workplace infection prevention practices.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077591/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}