scholarly journals Antimicrobial Management of Respiratory Infections in Severe Acute Respiratory Syndrome Coronavirus 2 Patients: Clinical and Antimicrobial Stewardship Programs Conundrums

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Ellie J C Goldstein ◽  
Glenn Tillotson ◽  
Mark Redell
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Antimicrobial Stewardship ◽  
Respiratory Infections ◽  
Antimicrobial Treatment ◽  
Current Data ◽  
Antimicrobial Use ◽  
Appropriate Treatment ◽  
Antimicrobial Management ◽  
Review Current

Abstract The role of empirical and even directed antimicrobial management of patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is problematic; antibiotics are used frequently among these patients to treat confirmed or suspected coinfection or just the symptoms. In the rapidly changing clinical landscape of SARS-CoV-2, there is minimal guidance for selecting appropriate treatment versus non-antimicrobial treatment, and clinicians are pressed to make daily decisions under the stress of absence of data while watching patients deteriorate. We review current data and patterns of antimicrobial use and the potential approach for antimicrobial stewardship in the context of SARS-CoV-2.

Principles of Judicious Use of Antimicrobial Agents for Pediatric Upper Respiratory Tract Infections

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_1) ◽  
pp. 163-165 ◽  
Author(s):  
Scott F. Dowell ◽  
S. Michael Marcy ◽  
William R. Phillips ◽  
Michael A. Gerber ◽  
Benjamin Schwartz
Keyword(s):  
Respiratory Tract ◽  
Antimicrobial Agents ◽  
Respiratory Infections ◽  
The United States ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Upper Respiratory Tract ◽  
Oral Agents ◽  
Upper Respiratory ◽  
Tract Infections

This article introduces a set of principles to define judicious antimicrobial use for five conditions that account for the majority of outpatient antimicrobial use in the United States. Data from the National Center for Health Statistics indicate that in recent years, approximately three fourths of all outpatient antibiotics have been prescribed for otitis media, sinusitis, bronchitis, pharyngitis, or nonspecific upper respiratory tract infection.1Antimicrobial drug use rates are highest for children1; therefore, the pediatric age group represents the focus for the present guidelines. The evidence-based principles presented here are focused on situations in which antimicrobial therapy could be curtailed without compromising patient care. They are not formulated as comprehensive management strategies. For most upper respiratory infections that require antimicrobial treatment, there are several appropriate oral agents from which to choose. Although the general principles of selecting narrow-spectrum agents with the fewest side effects and lowest cost are important, the principles that follow include few specific antibiotic selection recommendations.

The role of electronic health record and “add-on” clinical decision support systems to enhance antimicrobial stewardship programs

2019 ◽  
Vol 40 (05) ◽  
pp. 501-511 ◽  
Author(s):  
Kristi M. Kuper ◽  
Jerod L. Nagel ◽  
Jarrod W. Kile ◽  
Larissa S. May ◽  
Francesca M. Lee
Keyword(s):  
Antimicrobial Stewardship ◽  
Clinical Decision Support Systems ◽  
Clinical Decision ◽  
Healthcare Systems ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Reporting Requirements ◽  
It Systems ◽  
Stewardship Program

AbstractIncreasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.

scholarly journals Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

2020 ◽  
Author(s):  
Jiaojiao Song ◽  
Rongsheng Zhu ◽  
Leiqing Li ◽  
Lingcheng Xu ◽  
Quan Zhou ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Second Generation ◽  
Antimicrobial Treatment ◽  
Clinical Isolates ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Lactamase Inhibitor

Abstract Objective This study aimed to evaluate the effect of a comprehensive antimicrobial stewardship program (ASP) and provide clinical evidence for the scientific stewardship of antimicrobials in intensive care units (ICUs) of a teaching hospital.Methods Between January 2013 and December 2018, we conducted a prospective study, based on an antimicrobial computerized clinical decision support system (aCDSS) deployed in 2015 in ICUs of a tertiary and teaching hospital. The primary outcomes included initial and overall use prevalence of antimicrobials. The second outcomes were the detection rate of common clinical isolates before and after therapeutic antimicrobial use, and the change in patterns of resistance of 5 common clinical isolates in the ICU.Results Various types of broad-spectrum antimicrobial use prevalence continued to increase from 2013 to 2015, since 2016, where initial use of carbapenems and glycopeptides were counterbalanced by an increase in use of the first/second-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations and linezolid. From 2015 to 2018, the proportion of extended-broad spectrum antimicrobials alone, wide-coverage therapy and combination therapy decreased significantly (P<0.05). Similarly, where use of carbapenems, glycopeptides, third/fourth-generation cephalosporins and anti-fungi agents were counterbalanced by an increase in overall use of the first/second-generation cephalosporins and β-lactam and β-lactamase inhibitor combinations. A total of 21891 strains of bacteria and fungi were detected in ICUs from 2015 to 2018, of them, 6.5% (1426/21891) strains were detected before antimicrobial treatment. The detection proportion of Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae and fastidious bacteria were significantly higher before antimicrobial treatment (P<0.05), while Acinetobacter baumannii , Burkholderia cepacia , and Candida spp were significantly lower in all non-repetitive clinical isolates (P<0.05).Conclusions The implementation of a comprehensive ASP combining CDSS in ICUs seems to be effective to improve outcomes on antimicrobial utilization and clinical isolates distribution in critically ill patients.

Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriuria

2014 ◽  
Vol 35 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Denise Kelley ◽  
Patrick Aaronson ◽  
Elaine Poon ◽  
Yvette S. McCarter ◽  
Ben Bato ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Educational Initiative ◽  
Educational Initiatives ◽  
Academic Medical ◽  
Inappropriate Treatment

An antimicrobial stewardship educational initiative provided to physicians and pharmacists was evaluated at an academic medical center to minimize inappropriate treatment of asymptomatic bacteriuria (ASB). A significant decrease in empirical antimicrobial use for ASB was observed after education. Multifaceted educational initiatives can reduce inappropriate antimicrobial treatment of ASB.

Physician Perceptions Regarding Antimicrobial Use in End-of-Life Care

2018 ◽  
Vol 39 (4) ◽  
pp. 383-390 ◽  
Author(s):  
Christopher E. Gaw ◽  
Keith W. Hamilton ◽  
Jeffrey S. Gerber ◽  
Julia E. Szymczak
Keyword(s):  
Decision Making ◽  
End Of Life ◽  
Antimicrobial Stewardship ◽  
Patient Population ◽  
Improve Patient Care ◽  
Antimicrobial Treatment ◽  
Free Text ◽  
Antimicrobial Use ◽  
Physician Decision Making ◽  
Patient Pain

BACKGROUNDThe decision to utilize antimicrobials in end-of-life situations is complex. Understanding the reasons why physicians prescribe antimicrobials in this patient population is important for informing the design of antimicrobial stewardship interventions.METHODSA 51-item survey containing both closed and open-ended questions on end-of-life antimicrobial use was administered to physicians affiliated with the University of Pennsylvania and Children’s Hospital of Philadelphia from January through April 2017. A mixed-methods approach was used to analyze responses.RESULTSOf 637 physicians surveyed, 283 responses (44.4%) were received. Most (86.2%) physicians believed that respecting a patient’s wish to continue antimicrobials was important. Approximately half of physicians (49.8%) believed that antimicrobial use at the end of life contributes to resistance. A higher proportion of pediatricians would often or always continue antimicrobial treatment for active infections and for hospice patients whose death was imminent compared to adult physicians (P<.001). Analysis of free-text responses revealed additional reasons why physicians may continue antimicrobials at end of life, including meeting family expectations, wanting to avoid the perception of “giving up,” uncertainty about prognosis, and reducing patient pain or discomfort.CONCLUSIONSPhysician decision making concerning antimicrobial use in patients at the end of life is multifactorial. Clinicians may overweigh the benefits of antimicrobial therapy in end-of-life situations and view the importance of adhering to stewardship policies differently. Pediatric and adult clinicians have different approaches to this patient population. Better understanding of the complex decision making that occurs in the end-of-life patient population can help guide antimicrobial stewardship policies and improve patient care.Infect Control Hosp Epidemiol 2018;39:383–390

The role of microbiology in gonococcal control in the West: helping to understand the enemy

2017 ◽  
Vol 38 (4) ◽  
pp. 171
Author(s):  
David J Speers
Keyword(s):  
Public Health ◽  
Health Services ◽  
Health Management ◽  
Diagnostic Testing ◽  
The Public ◽  
Appropriate Treatment ◽  
Antimicrobial Management ◽  
Laboratory Surveillance ◽  
Public Health Challenge

Western Australia (WA), Australia's largest state by area, has one of the highest notification rates of gonorrhoea in the world. This is likely a reflection of the challenges of providing health services over a vast remote area combined with a unique set of sociocultural aspects. Despite this, microbiology can play a pivotal role in the public health management of gonorrhoea even if the primary health services are thousands of kilometres away from the laboratory. However, it requires new approaches to how diagnostic testing and laboratory surveillance are conducted and the repurposing of existing technologies to cater for novel demands. In this article I describe some of the microbiological approaches that have been undertaken in WA to help address the public health challenge of gonorrhoea. That is, facilitating the appropriate antimicrobial management of gonorrhoea in an era of increasing resistance to prevent treatment failure, timely provision of an accurate diagnosis to inform appropriate treatment, and providing molecular insights to better understand gonococcal transmission (Table 1).

scholarly journals Strategies for Improving Antimicrobial Use and the Role of Antimicrobial Stewardship Programs

2011 ◽  
Vol 53 (suppl_1) ◽  
pp. S15-S22 ◽  
Author(s):  
Thomas M. File ◽  
Joseph S. Solomkin ◽  
Sara E. Cosgrove
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Use

scholarly journals A review on role of Pratimarsha Nasya with Anutaila in the prevention of covid-19

2021 ◽  
Vol 5 (02) ◽  
Author(s):  
Ashwini R. Parkanthe ◽  
Brijesh Mishra
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Respiratory Disease ◽  
Respiratory Infections ◽  
Promising Result ◽  
Preventive Measure ◽  
Sars Coronavirus ◽  
The Family ◽  
The World ◽  
Novel Coronavirus

The severe acute respiratory syndrome (SARS) coronavirus-2 is a novel coronavirus belonging to the family coronaviridae and is now known to be responsible for the outbreak of a series of recent acute atypical respiratory infections originating in Wuhan, China. The disease caused by this virus, termed coronavirus disease 19 or simply Covid-19, has rapidly spread throughout the world at an alarming pace and has been declared a pandemic by the WHO on March 11, 2020. In Ayurveda pandemic is explained in Charak Samhita viman sthana under Janpadodhwansiya adhyaya. Till date no medicine or therapy has demonstrated promising result in Covid-19. So, we can prevent and defend this disease by boosting own immunity. Which can be achieved by adopting ayurvedic measures such as following proper Dincharya, Ritucharya, Sadvritta, Achar Rasayan Panchkarma etc. These practices lay emphasis on prevention of disease and promotion of health, one of such preventive measure is Pratimarsha nasya. Pratimarsha Nasya with Anutaila explained in Dincharya. Most of ingredients of Anutaila possess Anti-inflammatory, Anti-pyretic, Anti-viral properties ultimately these functions of Anutaila will lead to enhancement of respiratory immunity and will help in prevention of covid-19 a respiratory disease.

scholarly journals The role of Toll-like receptors (TLRs) in virus-related cancers: a mini review

2020 ◽  
Vol 33 (4) ◽  
pp. 225-227
Author(s):  
Anna Dworzanska ◽  
Małgorzata Polz-Dacewicz
Keyword(s):  
Innate Immune System ◽  
Viral Infections ◽  
Research Work ◽  
Current Data ◽  
Innate Immune ◽  
Toll Like Receptors ◽  
Epstein Barr ◽  
Inflammatory Autoimmune Disease ◽  
Review Current

Abstract The modulation of the host innate immune system is a well-established carcinogenesis feature of several tumors, including human Epstein-Barr (EBV) and Papillomavirus-(HPV) related cancers. These viruses are able to interrupt the initial events of the immune response, including the expression of Toll-like receptors (TLRs), cytokines, and inflammation. The aim of the study is to review current data and summarize knowledge on the TLRs and their role in the development of cancer, especially viral-related cancers (EBV and HPV). Research work shows a correlation between the TLRs polymorphism and the development of oropharyngeal and gastric cancer (GC), especially related to viral infections. Many studies suggest the important role for TLRs in inflammatory, autoimmune disease and human cancers. However, further efforts are necessary to draw a precise conclusion.

Environmental Tobacco Smoke and Otitis Media

1994 ◽  
Vol 111 (1) ◽  
pp. 6-8 ◽  
Author(s):  
A. Julianna Gulya
Keyword(s):  
American Academy ◽  
Environmental Tobacco Smoke ◽  
Tobacco Smoke ◽  
Secondhand Smoke ◽  
Health Hazard ◽  
Neck Surgery ◽  
Current Data ◽  
Tube Current ◽  
Review Current

Environmental tobacco smoke (secondhand smoke) is a health hazard experienced by one half to two thirds of the nation's children younger than 5 years of age. Although the role of environmental tobacco smoke in the genesis of pulmonary disease in children has been increasingly recognized, somewhat less attention has been paid to the role of environmental tobacco smoke in the development of childhood otitis. This presentation will review current data regarding environmental tobacco smoke, with a particular emphasis on its effects on the ears and eustachian tube. Current American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc. education efforts will also be discussed.

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