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The evolution of Antimicrobial Resistance is outpacing the ability to create novel antibiotics, which is proving to be a global problem in the fact of climate change, population growth, demographic shifts toward aging populations, emerging infections, and other crises. Therefore, clinicians are forced to use the existing antimicrobials more responsibly to preserve their longevity for generations to come. In a parallel vein, there has been a recent regulatory acknowledgement of the importance of prudent antimicrobial prescribing, mandating the implementation of Antimicrobial Stewardship across all healthcare settings. This is harder to manage in a non-traditional setting, which include long-term care facilities, outpatient care clinics, urgent care centers, and others. Given the trends in patient care in these settings—particularly where the aging community is concerned—this is proving to be a growing problem. This is troublesome even for spaces that have university and large hospital affiliations. There is a plethora of data describing the implementation and outcomes of Antimicrobial Stewardship Programs in acute-care hospitals with open-access, evidence-based guidelines endorsed by the Infectious Diseases Society of America. However, non-traditional settings often find themselves struggling to implement the same practices and procedures due to their unique needs and limited resources. There may be variability in access to resources, applicability, and patient-type. This book seeks to inform those in non-traditional healthcare settings on the principles, practice, and outcomes of Antimicrobial Stewardship Programs to improve patient care across all settings. The text begins by unpacking Antimicrobial Stewardship in nontraditional settings then covers specific environments, including long-term care facilities, outpatient clinics, and emergency departments. The text also covers special topics, including veterinary medicine, HIV, oncology, and immunocompromised patients, pediatrics, neonates, transplant, and critical care patients.
The National Strategy for Combating Antibiotic Resistant Bacteria, published in 2014, sets out a plan for government work to mitigate the emergence and spread of resistant bacteria. Direction on the implementation of this strategy is provided in five-year national action plans, the first covering 2015 to 2020, and the second covering 2020 to 2025. Combating Antimicrobial Resistance and Protecting the Miracle of Modern Medicine evaluates progress made against the national strategy. This report discusses ways to improve detection of resistant infections and estimate the risk to human health from environmental sources of resistance. In addition, the report considers the effect of agricultural practices on human and animal health and animal welfare and ways these practices could be improved, and advises on key drugs and diseases for which animal-specific test breakpoints are needed.
This practical reference guide from experts in the field details why and how to establish successful antibiotic stewardship programs.
This issue of Medical Clinics, guest edited by Dr. Cheston B. Cunha, is devoted to Antimicrobial Stewardship. Articles in this issue include: Principles of Antimicrobial Stewardship; Antibiotic Resistance in Stewardship; Therapy of Resistant Organisms: A Stewardship Approach; Optimal Antibiotic Dosing Strategies; The Importance of Interdisciplinary Collaboration in Antimicrobial Stewardship; Role of Education in Antimicrobial Stewardship; Role of the Hospital Epidemiologist in Antimicrobial Stewardship; Role of the Clinical Microbiology Laboratory in Antimicrobial Stewardship; Role of New and Rapid Diagnostics In Antimicrobial Stewardship; Antimicrobial Stewardship in the Community Hospital; Antimicrobial Stewardship in Long-Term Care Facilities; Role of the Pharmacist in Antimicrobial Stewardship; Pharmacoeconomic Considerations of Antimicrobial Stewardship Programs; Principles of IV-to-PO Switch and PO therapy; Role of Technology in Antimicrobial Stewardship; and Metrics of Antimicrobial Stewardship Programs.
This issue of Infectious Disease Clinics, edited by Sara Cosgrove, MD, Pranita Tamma, MD, and Arjun Srinvasan, MD, is devoted to Infection Prevention and Stewardship. Articles in this issue include Behavior Issues in Antimicrobial Stewardship; Research Methods and Measurement Approaches for Analyzing the Impact of Antimicrobial Stewardship Programs; The Role of the Microbiology Laboratory in Antimicrobial Stewardship; Antimicrobial Stewardship in Long Term Care Facilities; Antimicrobial Stewardship in the NICU; Antimicrobial Stewardship in Immuno-compromised Populations; Antimicrobial Stewardship in Community Hospitals/Lower Resources Settings; Antimicrobial Stewardship in the Outpatient Setting; Informatics and Antimicrobial Stewardship; Antimicrobial Stewardship Interventions; and Teaching and Education in Antimicrobial Stewardship.
This book provides a detailed overview of the progress and challenges of non-traditional approaches for tackling antimicrobial resistance. The first chapter covers the factors that make microbes more likely to develop multidrug resistance. The book goes on to discuss the antimicrobial properties of propolis, essential oils and other microbial constituents that are used or under investigation to treat multidrug-resistant infections. Additionally, it covers alternative compounds that work as antimicrobial agents, their mechanisms of action, and how they might be utilized in conjunction with conventional drugs to circumvent drug resistance. The book explores the application of phage therapy and recent advancements in phage-based infection control with an emphasis on multidrug-resistant infections and discusses drug repurposing as a strategy to develop new antimicrobial agents efficiently and expeditiously. Additionally, it discusses the uses of nanoparticles in the treatment of infections brought on by multidrug-resistant pathogens and examines the use of different nanotechnology-based approaches to fudge microbial resistance mechanisms. It concludes by reviewing recent studies on microbial quorum-sensing systems and focuses on the significance of quorum-sensing systems in controlling microbial resistance mechanisms and at the same time highlights the importance and role of antimicrobial stewardship program to fight microbial infections. The book is an invaluable source of knowledge and information for academics, basic and clinical researchers, clinicians, and paramedic staff involved in one way or the other in the development and use of antimicrobial agents and strategies to combat multidrug resistance.​
Antibiotic resistance threatens the effective prevention and treatment of infections. Antimicrobial Stewardship provides a practical guide on this growing area, supported by the review of the available evidence, including example case studies.
This book provides step-by-step instructions on how to analyze text generated from in-depth interviews and focus groups, relating predominantly to applied qualitative studies. The book covers all aspects of the qualitative data analysis process, employing a phenomenological approach which has a primary aim of describing the experiences and perceptions of research participants. Similar to Grounded Theory, the authors' approach is inductive, content-driven, and searches for themes within textual data.
Health care-associated infections (HAI) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life. At any one time, up to 7% of patients in developed and 10% in developing countries will acquire at least one HAI. These infections also present a significant economic burden at the societal level. However, a large percentage are preventable through effective infection prevention and control (IPC) measures. These new guidelines on the core components of IPC programmes at the national and facility level will enhance the capacity of Member States to develop and implement effective technical and behaviour modifying interventions. They form a key part of WHO strategies to prevent current and future threats from infectious diseases such as Ebola, strengthen health service resilience, help combat antimicrobial resistance (AMR) and improve the overall quality of health care delivery. They are also intended to support countries in the development of their own national protocols for IPC and AMR action plans and to support health care facilities as they develop or strengthen their own approaches to IPC. These are the first international evidence-based guidelines on the core components of IPC programmes. These new WHO guidelines are applicable for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.
The emergence of multidrug-resistant (MDR) organisms in the community poses significant threat and burden to community-based healthcare. As the development pipeline of new antibiotics continues to diminish, measures to contain the rising trend of MDR organisms have increasingly relied on effective infection control and antimicrobial stewardship (AMS) strategies. However, these strategies are generally less developed in the community in comparison to the hospital setting. Fundamentally, surveillance activities to monitor the magnitude of infections, antibiotic use and MDR organisms will be crucial to guide timely infection control interventions in high-risk community-based healthcare settings. Two major community-based healthcare settings [residential aged care facilities (RACFs) and emergency departments (EDs)] have been targeted for further research, given their potential as a "reservoir and gateway" for MDR organism transmission into hospitals or other healthcare institutions. To date, a systematic surveillance system for tracking infection rates in Australian RACFs remains to be established. Furthermore, data describing the burden of healthcare-associated infections (HCAIs) and antibiotic use in the Australian RACF setting is limited. A retrospective observational study was initiated to explore the longitudinal trend of infection burden in four co-located Australian RACFs. The average yearly incidence of HCAIs in these facilities (4.16 episodes/1000 occupied bed-days) was found to be comparable to the rates reported in RACFs abroad. However, routine infection surveillance in the absence of more proactive intervention did not result in noticeable reduction of infection burden over time. Importantly, several areas where antibiotic use was likely to be inappropriate have been identified, and up to 37% of antibiotic use was for presumed episodes of infections not meeting the McGeer criteria for symptomatic infections.Evidence from overseas has suggested that residents in RACFs are an important reservoir for transmission of MDR organisms in the community; however, such data are lacking in Australia. The frequent patient transfer between RACFs and acute-care hospitals, and the complexity of their healthcare needs render this population at high-risk for MDR organism transmission. Accordingly, an active surveillance was conducted to explore the carriage of three major groups of MDR organisms in the aforementioned RACFs. The study has revealed significant carriage of various MDR organisms, with 36% of residents carrying at least one type of MDR organisms. Higher prevalence of MDR Gram-negative bacilli (GNB, 21%) colonisation relative to methicillin-resistant Staphylococcus aureus (MRSA, 16%) and vancomycin-resistant enterococci (VRE, 6%) have been shown, proposing that existing infection control strategies that have focused primarily on the containment of MRSA and VRE may need to be modified. Furthermore, these MDR GNB strains were found to have strong clonal relatedness, suggesting the possibility of person-to-person transmission of these organisms within and between RACFs. Specific risk factors for MRSA and MDR GNB colonisation, which may facilitate targeted management of high-risk residents, in particular community-based drivers such as advanced dementia [adjusted odd ratio (AOR) 3.5 [1.2 - 10.2], P=0.02] and prior fluoroquinolone use [AOR 4.3 (1.2 - 15.3), P=0.025], were also identified.The high burden of antibiotic use and MDR organism colonisation among this vulnerable population (as shown in the aforementioned studies) highlights the important role of AMS in the RACF setting. Unfortunately, AMS activities in the RACF setting are substantially behind those in acute-care hospitals. Adopting a comprehensive model of the hospital-based AMS programs into the RACF setting with minimal medical resources is unrealistic. Consequently, the views of general practitioners, executive nurses, nurse unit managers, registered nurses and pharmacists servicing RACFs affiliated with four major public healthcare services within Victoria were explored to understand their perceptions towards AMS interventions in the RACF setting. Using qualitative and observational methods, significant gaps in the RACF organisational workflow and culture in relation to antibiotic prescribing practices were observed, highlighting the unique challenges for the implementation of an AMS program in this setting. Knowledge gaps, especially among nursing staff, in relation to issues of antibiotic over-prescribing and antibiotic resistance were noted. Importantly, the notion of AMS interventions was deemed useful and supported by all key stakeholder groups. This study has identified modifiable factors that will assist resource allocation for potential areas of AMS intervention. The information gathered about the feasibility, barriers and facilitators of various AMS interventions will be useful to guide the development of a feasible model of AMS intervention specifically for the Australian RACFs.ED is another community-based healthcare setting, where surveillance of MDR organisms and identification of high-risk patients (e.g. RACF population) are critical, particularly in severe infections such as bloodstream infections (BSIs). Therefore, a ten-year longitudinal trend, risk factors and clinical outcomes for community-onset (CO) BSI associated with MDR organisms in an Australian ED were studied. Whilst MRSA bacteraemia remained at high levels (20% - 30%) over ten years, the proportion of MDR Escherichia coli causing COBSI was found to be increasing from 9% - 26% (P