scholarly journals White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

2020 ◽  
Vol 75 (Supplement_2) ◽  
pp. ii20-ii32
Author(s):  
Maria Diletta Pezzani ◽  
Elena Carrara ◽  
Marcella Sibani ◽  
Elisabeth Presterl ◽  
Petra Gastmeier ◽  
...  
Keyword(s):  
Hospital Setting ◽  
Structural Heterogeneity ◽  
White Paper ◽  
Surveillance Data ◽  
Flexible Tool ◽  
Antibiotic Policy ◽  
Antimicrobial Usage ◽  
Modified Delphi ◽  
Antimicrobial Surveillance ◽  
Practical Guidance

Abstract Background Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities. Methods A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries. Results Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist. Conclusions This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.

scholarly journals White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in the outpatient sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

2020 ◽  
Vol 75 (Supplement_2) ◽  
pp. ii42-ii51
Author(s):  
Fabiana Arieti ◽  
Siri Göpel ◽  
Marcella Sibani ◽  
Elena Carrara ◽  
Maria Diletta Pezzani ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
White Paper ◽  
Outpatient Setting ◽  
Surveillance Data ◽  
Global Perspective ◽  
Review Of The Literature ◽  
Flexible Tool ◽  
Modified Delphi ◽  
Research Areas ◽  
Outpatient Sector

Abstract Background The outpatient setting is a key scenario for the implementation of antimicrobial stewardship (AMS) activities, considering that overconsumption of antibiotics occurs mainly outside hospitals. This publication is the result of a joint initiative by the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks, which is aimed at formulating a set of target actions for linking surveillance data with AMS activities in the outpatient setting. Methods A scoping review of the literature was carried out in three research areas: AMS leadership and accountability; antimicrobial usage and AMS; antimicrobial resistance and AMS. Consensus on the actions was reached through a RAND-modified Delphi process involving over 40 experts in infectious diseases, clinical microbiology, AMS, veterinary medicine or public health, from 18 low-, middle- and high-income countries. Results Evidence was retrieved from 38 documents, and an initial 25 target actions were proposed, differentiating between essential or desirable targets according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for all targets. Further to a second review, 6 statements were re-considered and 3 were deleted, leading to a final list of 22 target actions in the form of a practical checklist. Conclusions This White Paper is a pragmatic and flexible tool to guide the development of calibrated surveillance-based AMS interventions specific to the outpatient setting, which is characterized by substantial inter- and intra-country variability in the organization of healthcare structures, maintaining a global perspective and taking into account the feasibility of the target actions in low-resource settings.

scholarly journals White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in the animal sector—practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks

2020 ◽  
Vol 75 (Supplement_2) ◽  
pp. ii52-ii66
Author(s):  
Monica Compri ◽  
Rodolphe Mader ◽  
Elena Mazzolini ◽  
Giulia de Angelis ◽  
Nico T Mutters ◽  
...  
Keyword(s):  
Veterinary Medicine ◽  
Antimicrobial Stewardship ◽  
One Health ◽  
Research Priorities ◽  
White Paper ◽  
Surveillance Data ◽  
Surveillance Systems ◽  
Modified Delphi ◽  
Control Programmes ◽  
The One

Abstract Background The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions to link the surveillance of antimicrobial usage (AMU) and antimicrobial resistance (AMR) with antimicrobial stewardship (AMS) activities in four different settings. This White Paper focuses on the veterinary setting and embraces the One Health approach. Methods A review of the literature was carried out addressing research questions in three areas: AMS leadership and accountability; AMU surveillance and AMS; and AMR surveillance and AMS. Consensus on target actions was reached through a RAND-modified Delphi process involving over 40 experts in infectious diseases, clinical microbiology, AMS, veterinary medicine and public health, from 18 countries. Results/discussion Forty-six target actions were developed and qualified as essential or desirable. Essential actions included the setup of AMS teams in all veterinary settings, building government-supported AMS programmes and following specific requirements on the production, collection and communication of AMU and AMR data. Activities of AMS teams should be tailored to the local situation and capacities, and be linked to local or national surveillance systems and infection control programmes. Several research priorities were also identified, such as the need to develop more clinical breakpoints in veterinary medicine. Conclusions This White Paper offers a practical tool to veterinary practitioners and policy makers to improve AMS in the One Health approach, thanks to surveillance data generated in the veterinary setting. This work may also be useful to medical doctors wishing to better understand the specificities of the veterinary setting and facilitate cross-sectoral collaborations.

Are Surveillance of Resistant Enteric Bacilli and Antimicrobial Usage Among Neonates in a Newborn Intensive Care Unit Useful?

PEDIATRICS ◽  
1981 ◽  
Vol 68 (1) ◽  
pp. 1-4
Author(s):  
Robert D. White ◽  
Timothy R. Townsend ◽  
Maureen A. Stephens ◽  
E. Richard Moxon
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Sepsis ◽  
Antibiotic Use ◽  
Surveillance Data ◽  
Effective Control ◽  
Antimicrobial Usage ◽  
Newborn Intensive Care Unit ◽  
Newborn Intensive Care ◽  
Colonization Rates

From March 1976 through December 1978, the prevalence of ampicillin- and gentamicin-resistant enteric bacilli was monitored in fecal cultures of neonates in an intensive care unit. Substantial fluctuations in colonization rates were observed which did not correlate with the occurrence of sepsis due to these organisms nor with variations in antibiotic use. This experience suggests that the availability of these surveillance data did not result in more effective control of neonatal sepsis due to enteric bacilli.

scholarly journals (P2-43) Utilizing a Unified Health Command Structure for Mass Gathering Preparedness and Response: Lessons Learned from the 2008 Pacific Arts Festival

2011 ◽  
Vol 26 (S1) ◽  
pp. s149-s150
Author(s):  
D.B. Bouslough ◽  
S. Lemusu ◽  
F. Avegalio
Keyword(s):  
Public Health ◽  
Interpersonal Violence ◽  
Hospital Setting ◽  
Respiratory Illness ◽  
American Samoa ◽  
Lessons Learned ◽  
Surveillance Data ◽  
Population Increase ◽  
Mass Gathering ◽  
Arts Festival

BackgroundThe Pacific Arts Festival is a mass-gathering event occurring every four years in Oceania. The 10th festival in American Samoa, July 20 to August 2, 2008, brought 2200 performers and 2500 tourists (a 15% population increase) from 27 Pacific nations to the island. Anticipated healthcare concerns included hospital surge (175% in 2004), HIV/STI transmission, imported/communicable diseases, food/water/sanitation-borne illness, interpersonal violence, and healthcare resource utilization.ObjectiveTo describe the preparedness and response efforts for this mass gathering event by emergency medical services, the hospital, and the department of health.MethodsA retrospective review of after-action reports, public health and emergency department surveillance records, and key-informant interviews was conducted. Descriptive statistics were used to evaluate data.ResultsA Unified Command structure was utilized for pre-/post-event response. Patient surveillance data was collected daily. During the festival 217 participants (42% female, 58% male, Average age 36) sought medical care. Acute illness (n = 166), injury (n = 39), other (n = 15), routine follow up (n = 9), chronic conditions (n = 6), mental health (n = 1), OB/GYN (n = 1) were complaints addressed. Predominant acute illnesses included headache (n = 49, 23%), respiratory illness (n = 30, 14%), musculoskeletal pain (n = 26, 12%), and gastroenteritis (n = 17, 8%). One fatality occurred among delegates. No public health outbreaks were reported. Visits per healthcare venue demonstrated a decentralization of patient surge from the hospital setting (37.4% venue aid stations, 28.1% delegation medical staff, 24% DOH clinic, 10.6% hospital).ConclusionA unified health command structure was effective in responding to this mass gathering event. Surveillance data was rapidly gathered and utilized to direct healthcare resources. Efforts to decentralize healthcare from the hospital were successful. Public health emergencies were avoided.

scholarly journals Rationalising antibiotic use after low-risk vaginal deliveries in a hospital setting in India

2021 ◽  
Vol 10 (Suppl 1) ◽  
pp. e001413
Author(s):  
Shakti Sharma ◽  
Nikita Kumari ◽  
Rinku Sengupta ◽  
Yashika Malhotra ◽  
Saru Bhartia
Keyword(s):  
Average Rate ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Antibiotic Usage ◽  
Low Risk ◽  
Care Providers ◽  
Antibiotic Policy ◽  
Case File ◽  
Vaginal Deliveries

BackgroundIn 2017, a postoperative multidrug resistant case of urinary tract infection made obstetricians at Sitaram Bhartia Institute of Science and Research introspect the antibiotic usage in labouring mothers. Random case file reviews indicated overuse and variability of practice among care providers. This prompted us to explore ways to rationalise antibiotic use.MethodsA multidisciplinary team of obstetricians, paediatricians and quality officers was formed to run this improvement initiative at a private hospital facility in India. Review of literature advocated formulating a departmental antibiotic policy. Creating this policy and implementing it using improvement methodology helped us rationalise antibiotic usage.InterventionsWe aimed to reduce the use of antibiotics from 42% to less than 10% in uncomplicated vaginal deliveries. We tested a series of sequential interventions using the improvement methodology of Plan–Do–Study–Act (PDSA) cycles, an approach recommended by the Institute for Healthcare Improvement. Learning from the PDSA cycle of the previous intervention helped decide the subsequent change ideas. The interventions included creation of a departmental antibiotic policy, staff engagement, and modification in documentation, concept of dual responsibility and team huddles as feedback opportunities. Information was analysed to understand the progress and improvement with change ideas.ResultsBackground analysis revealed that antibiotic usage ranged from 24% to 69% and average rate of antibiotic prophylaxis was high (42.28%) in low-risk uncomplicated vaginal deliveries. The sequential changes resulted in reduction in antibiotic usage to 10% in the target population by 4 months. Sustained improvement was noted in the following months.ConclusionWe succeeded in implementing a departmental antibiotic policy aligning it with existing international guidelines and our local challenges. Antibiotic stewardship was one of the first major steps in our journey to avoid multidrug-resistant infections. Sustaining outcomes will involve continuous feedback to ensure engagement of all stakeholders in a hospital setting.

scholarly journals Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section IV: Consensus Statements on the Assessment and Management of Pediatric Atopic Dermatitis

2019 ◽  
Vol 23 (5_suppl) ◽  
pp. 32S-39S
Author(s):  
Perla Lansang ◽  
Irene Lara-Corrales ◽  
James N. Bergman ◽  
Chih-ho Hong ◽  
Marissa Joseph ◽  
...  
Keyword(s):  
Atopic Dermatitis ◽  
Health Care Professionals ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Extensive Experience ◽  
Modified Delphi ◽  
Consensus Document ◽  
Consensus Statements ◽  
Practical Guidance ◽  
Iterative Voting

This document is intended to provide practical guidance to physicians treating pediatric atopic dermatitis (AD), especially dermatologists, pediatricians, allergists, and other health-care professionals. The recommendations contained here were formalized based on a consensus of 12 Canadian pediatric dermatologists, dermatologists, pediatricians, and pediatric allergists with extensive experience managing AD in the pediatric population. A modified Delphi process was adopted with iterative voting on a 5-point Likert scale, with a prespecified agreement cutoff of 75%. Topic areas addressed in the 17 consensus statements reflect areas of practical management, including counselling, assessment, comorbidity management, and therapy.

scholarly journals AGAR community and hospital Staphylococcus aureus surveillance

2008 ◽  
Vol 29 (3) ◽  
pp. 138
Author(s):  
Julie Pearson
Keyword(s):  
Emergency Department ◽  
Staphylococcus Aureus ◽  
General Practitioner ◽  
Antimicrobial Resistance ◽  
Hospital Setting ◽  
Point Prevalence ◽  
Community Surveys ◽  
Hospital Acquired Infections ◽  
Antimicrobial Surveillance ◽  
Hospital Acquired

Point-prevalence antimicrobial surveillance programmes conducted by the Australian Group on Antimicrobial Resistance (AGAR) from 1986-1999 included consecutive clinical isolates of Staphylococcus aureus regardless of acquisition. Following a reported increase in community-acquired infections caused by methicillin-resistant S. aureus (MRSA) in the literature, AGAR performed the first survey of infections from outpatients, emergency department and general practitioner patients in 2000. Further community surveys were conducted in 2002, 2004 and 2006. In 2005 AGAR performed the first hospital-acquired infections survey (infections acquired more than 48 hours post admission) in part to track community MRSA clones emerging in the hospital setting. This article discusses the focus and main outcomes of the AGAR hospital and community surveys.

Antimicrobial Surveillance in a Vamc Teaching Hospital–Resulting Cost Avoidance

1986 ◽  
Vol 20 (10) ◽  
pp. 803-805 ◽  
Author(s):  
Douglas A. Powers
Keyword(s):  
Economic Impact ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Substantial Reduction ◽  
Utilization Review ◽  
Antimicrobial Use ◽  
Cost Avoidance ◽  
Antimicrobial Usage ◽  
Antimicrobial Utilization ◽  
Antimicrobial Surveillance

The economic impact of an antimicrobial surveillance service is presented. The antimicrobial surveillance service operates as a component of antimicrobial utilization review and serves as a means of identifying and reporting patterns of antimicrobial usage for the hospital. A record of all antimicrobial agent orders is maintained by the pharmacy service. Concurrent antimicrobial utilization review is conducted on specific agents using previously approved criteria. All cases of antimicrobial use failing to meet established criteria receive immediate intervention. From September, 1983 to June, 1985, a total of 229 cases of antimicrobial use received clinical pharmacy intervention. The cost avoidance appreciated from the selection of a more cost-effective regimen was $65 381.60. Additionally, extensive educational efforts directed to cefazolin q8h vs. cefazolin q6h administration resulted in a substantial reduction in cefazolin expenditures. Indiscriminate/inappropriate use of antimicrobial agents delivers a tremendous economic burden to the health care system. Utilizing antimicrobial surveillance as a component of antimicrobial utilization review serves as a means for identifying and reporting patterns of antimicrobial usage for the medical center and has a positive economic impact as illustrated.

scholarly journals P125: Introduction of extracorporeal cardiopulmonary resuscitation (ECPR) into emergency care: a feasibility study

CJEM ◽  
2018 ◽  
Vol 20 (S1) ◽  
pp. S101-S101
Author(s):  
D. Rollo ◽  
P. Atkinson ◽  
J. Fraser ◽  
J. Mekwan ◽  
J. P. French ◽  
...  
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Phase 1 ◽  
Hospital Setting ◽  
Regional Hospital ◽  
Extracorporeal Cardiopulmonary Resuscitation ◽  
Modified Delphi ◽  
Phase Study ◽  
Number Of Patients ◽  
Modified Delphi Technique ◽  
Poor Outcomes

Introduction: Traditionally, out of hospital cardiac arrests (CA) have poor outcomes. Incorporation of extracorporeal cardiopulmonary resuscitation (ECPR) is being used increasingly to supplement ACLS to provide better outcomes for patients. Current literature suggests potentially improved outcomes, including neurological function. We assessed the feasibility of introduction of ECPR to a regional hospital using a 4-phase study. We report phase-1, an estimation of the number of potential candidates for ECPR in our setting. Methods: Following development and agreement on local criteria for selection of patients for ECPR using a modified Delphi Technique, inclusion and exclusion criteria were applied retrospectively, to a database comprising 4 years of emergency department (ED) cardiac arrests (n=395). This provided estimates of the number of patients who would have qualified for EMS transport for ECPR and initiation of ECPR in the ED. Results: Application of criteria would result in 20.0% (95% CI 16.2-24.3%) of CA being transported to the ED for ECPR (mean 18.5 patients per year). In the ED 4.6% (95% CI 2.83-7.26%) would be eligible to receive ECPR (4.3 patients per year). Incorporating downtime criteria, 3.0% (95% CI 1.6-5.3%) qualify. After considering local in-house cardiac catheterization hours 9.4% (95% CI 6.8-12.9%) and 5.4% (95% CI 3.5-8.2%), without and with EMS rhythm assumptions respectively, would be eligible for transport. For placement on pump, 3.0% (95% CI 1.6-5.3%) and 2.4% (95% CI 1.2-4.6%), without and with use of total downtime respectively, were eligible. Conclusion: If historical patterns of CA were to continue, we believe that an ECPR program may be feasible in our regional hospital setting, with a small number of selected cardiac arrest patients meeting eligibility for transportation and initiation of ECPR. These numbers suggest that an ECPR program would not be resource intensive, yet would be sufficiently busy to maintain adequate team competency.

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