The intervention in the ED involved placing all hospitalized patients on empiric carbapenem prophylaxis (CP), and the CRE screening results were reported promptly. If the CRE screen was negative, patients were discontinued from CP. Repeat CRE testing was done for patients who remained in the ED over seven days or were transferred to intensive care.
A collective of 845 patients participated, 342 initially and 503 undergoing the intervention. A 34% colonization rate was observed upon admission, based on results from both culture and molecular testing procedures. During the intervention period in the Emergency Department (ED), acquisition rates saw a substantial decrease, dropping from 46% (11 out of 241) to 1% (5 out of 416), suggestive of a statistically significant effect (P = .06). There was a decrease in the total antimicrobial use (expressed in defined daily doses [DDD] per 1000 patients) in the Emergency Department from phase 1 to phase 2, dropping from 804 DDD/1000 patients to 394 DDD/1000 patients. A stay exceeding two days in the emergency department was correlated with a substantially elevated risk of acquiring CRE; specifically, the adjusted odds ratio was 458 (95% confidence interval, 144-1458), and this association reached statistical significance (p = .01).
Early implementation of empirical CP strategies and the rapid detection of CRE colonization in patients curbs cross-transmission within the emergency division. Even so, staying in the emergency department for more than two days impacted progress unfavorably.
The two days spent in the emergency department created obstacles that impacted subsequent endeavors.
Antimicrobial resistance, a global menace, significantly impacts low- and middle-income countries. In Chile, the prevalence of fecal colonization by antimicrobial-resistant gram-negative bacteria (GNB) was estimated in hospitalized and community-dwelling adults before the coronavirus disease 2019 pandemic, according to this study.
A study undertaken in central Chile, between December 2018 and May 2019, involved the enrollment of hospitalized adults from four public hospitals, alongside community dwellers, all contributing fecal samples and epidemiological information. Samples were deposited onto MacConkey agar, augmented with ciprofloxacin or ceftazidime. According to the phenotypes fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria), all recovered morphotypes were identified and characterized as Gram-negative bacteria (GNB). The categories' definitions were not mutually exclusive.
The study encompassed a total of 775 hospitalized adults and 357 community-based residents. In a study of hospitalized individuals, the rate of FQR, ESCR, CR, or MDR-GNB colonization was found to be 464% (95% confidence interval [CI], 429-500), 412% (95% CI, 377-446), 145% (95% CI, 120-169), and 263% (95% CI, 232-294), respectively, among hospitalized subjects. The rates of FQR, ESCR, CR, and MDR-GNB colonization within the community were as follows: 395% (95% CI, 344-446), 289% (95% CI, 242-336), 56% (95% CI, 32-80), and 48% (95% CI, 26-70), respectively.
The observed high burden of antimicrobial-resistant Gram-negative bacilli colonization in this study of hospitalized and community-dwelling adults points to the community as a critical reservoir of antibiotic resistance. Understanding the relationships among resistant strains present in the community and in hospitals requires additional work.
A substantial burden of Gram-negative bacterial colonization resistant to antimicrobials was seen in hospitalized and community-dwelling adults in this sample, indicating that the community plays a crucial role in the development of antibiotic resistance. Understanding the interrelationship between resistant strains circulating in the community and in hospitals necessitates significant effort.
Latin America now experiences a heightened level of antimicrobial resistance. Thorough examination is critically needed of the growth of antimicrobial stewardship programs (ASPs) and the impediments to implementing impactful ASPs, given the lack of national action plans or policies supporting ASPs in the region.
From March to July 2022, a descriptive mixed-methods analysis of ASPs took place across five Latin American countries. medical mycology Using an electronic questionnaire and associated scoring system (hospital ASP self-assessment), ASP development levels were categorized by the scores received. The classifications were inadequate (0-25), basic (26-50), intermediate (51-75), or advanced (76-100). latent infection In order to understand the factors, behavioral and organizational, influencing antimicrobial stewardship (AS) activities, interviews were conducted with healthcare workers (HCWs) involved in AS. The interview data were categorized into thematic groupings. To develop an explanatory framework, the results of the ASP self-assessment and interviews were integrated.
Forty-six stakeholders affiliated with the Association of Stakeholders, drawn from twenty hospitals that conducted self-assessments, were interviewed. click here Inadequate or basic ASP development was prevalent in 35% of hospitals, followed by intermediate proficiency in 50%, and advanced skills in 15%. When evaluated, for-profit hospitals' scores were higher, indicating better performance compared to not-for-profit hospitals. Interview data validated the self-assessment's observations concerning ASP implementation challenges. Key impediments included a lack of formal hospital leadership support, insufficient staffing and tools for optimal AS work, limited awareness of AS principles among healthcare workers, and a shortage of training opportunities.
Our analysis revealed numerous obstacles to ASP development in Latin America, necessitating the creation of detailed business cases to secure the required financing and foster the long-term viability of these projects.
Several obstacles to ASP development in Latin America were noted, prompting the suggestion that detailed business cases be developed for ASPs to secure the required funding for successful execution and long-term sustainability.
Hospitalized patients with COVID-19 have displayed high rates of antibiotic use (AU) despite a relatively low incidence of bacterial co-infections and subsequent infections. We investigated the consequences of the COVID-19 pandemic on healthcare facilities (HCFs) in South America, specifically in regards to Australia (AU).
Within the adult inpatient acute care wards of two hospitals in each of Argentina, Brazil, and Chile, an ecological evaluation of AU was undertaken. Based on the defined daily dose per 1000 patient-days, AU rates for intravenous antibiotics were established. Data from pharmacy dispensing records and hospitalizations, spanning March 2018-February 2020 (pre-pandemic) and March 2020-February 2021 (pandemic), were employed in the calculations. Employing the Wilcoxon rank-sum test, a comparative analysis was performed on median AU values from the pre-pandemic and pandemic periods to establish statistical significance. The interrupted time series approach was used to study how AU was affected by the COVID-19 pandemic.
A noticeable increase in the median difference of AU rates for all antibiotics, when compared to the pre-pandemic period, was observed across four out of six healthcare facilities (percentage change ranging from 67% to 351%; statistically significant, P < .05). Five of six healthcare facilities within the interrupted time series models experienced a significant immediate spike in the use of all antibiotics collectively at the beginning of the pandemic (estimated immediate impact, 154-268); however, only one of these facilities displayed a persistent upward trend in antibiotic usage over time (change in slope, +813; P < 0.01). HCF and antibiotic classifications exhibited varied susceptibility to the pandemic's initial impact.
Antibiotic utilization (AU) underwent substantial increases at the outset of the COVID-19 pandemic, necessitating the continued reinforcement, or even the enhancement, of antibiotic stewardship programs, integral to pandemic or crisis healthcare responses.
Starting the COVID-19 pandemic showed a significant rise in AU levels, suggesting that antibiotic stewardship activities must be sustained or reinforced during pandemic or crisis healthcare situations.
A critical global public health concern is the spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE). Our investigation into patients in one urban and three rural hospitals in Kenya uncovered potential risk factors for ESCrE and CRE colonization.
A cross-sectional study, spanning January 2019 and March 2020, involved the collection of stool samples from randomly assigned inpatients for testing of ESCrE and CRE. Antibiotic susceptibility and isolate confirmation were conducted using the Vitek2 device, after which least absolute shrinkage and selection operator (LASSO) regression models were utilized to identify colonization risk factors, analyzing the relationship with fluctuating antibiotic usage.
Among the 840 participants enrolled, a significant 76% had been prescribed a single antibiotic within the 14 days preceding their enrollment. These included ceftriaxone (46% of cases), metronidazole (28%), and benzylpenicillin-gentamycin (23%). LASSO models including ceftriaxone treatment revealed that a three-day hospital stay was associated with significantly increased odds of ESCrE colonization (odds ratio 232, 95% confidence interval 16-337; P < .001). A statistically significant association (P = .009) was observed in the intubated patients, with a count of 173 (varying from 103 to 291). The human immunodeficiency virus (HIV) group exhibited a statistically important result (P = .029), specifically represented by the data point (170 [103-28]). Patients on ceftriaxone demonstrated a significantly higher probability of CRE colonization, with an odds ratio of 223 (95% confidence interval 114-438) and statistical significance (p = .025). Every additional day of antibiotic use was linked to a substantial and statistically significant change in the results (108 [103-113]; P = .002).