During the emergency department (ED) intervention, all hospitalized patients were initially placed on empiric carbapenem therapy (CP), and the results of CRE screening were promptly reported. If CRE screening results were negative, patients were discharged from CP. Patients underwent repeat screening if their stay in the ED exceeded seven days or if they were transferred to an intensive care unit (ICU).
845 patients were studied in total, 342 constituting the baseline group, and 503 being involved in the intervention. Cultural and molecular testing revealed a 34% colonization rate at admission. Acquisition rates, while hospitalized in the Emergency Department, saw a sharp decline, transitioning from 46% (11 instances out of 241) to 1% (5 of 416) during the intervention phase (P = .06). The Emergency Department's aggregated antimicrobial use underwent a notable decrease between phase 1 and phase 2, shifting from 804 defined daily doses (DDD) per 1000 patients to 394 DDD per 1000 patients. Individuals experiencing emergency department stays longer than two days were found to have a markedly increased likelihood of acquiring CRE, according to an adjusted odds ratio of 458 (95% confidence interval, 144-1458) and a statistically significant p-value of .01.
Early empirical management of community-acquired pneumonia, combined with prompt identification of patients colonized with carbapenem-resistant Enterobacteriaceae, reduces transmission in the emergency department setting. However, prolonged emergency department stays, exceeding two days, diminished the effectiveness of interventions.
The two days spent in the emergency department created obstacles that impacted subsequent endeavors.
A significant global challenge, antimicrobial resistance places a heavy burden on low- and middle-income countries. Before the coronavirus disease 2019 pandemic, this Chilean study evaluated the prevalence of fecal colonization by antimicrobial-resistant gram-negative bacteria (GNB) in hospitalized and community-dwelling adults.
Between December 2018 and May 2019, hospitalized adults from four public hospitals in central Chile, alongside community residents, participated in a study, providing fecal samples and epidemiological data. Ciprofloxacin or ceftazidime-supplemented MacConkey agar was used to plate the samples. The recovered morphotypes were identified and characterized, revealing phenotypes categorized as fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR, according to Centers for Disease Control and Prevention criteria) Gram-negative bacteria (GNB). The categories displayed non-mutually exclusive characteristics.
Among the subjects participating, there were 775 hospitalized adults and 357 community dwellers. Hospitalized individuals exhibiting colonization by FQR, ESCR, CR, or MDR-GNB were observed at rates of 464% (95% confidence interval [CI], 429-500), 412% (95% CI, 377-446), 145% (95% CI, 120-169), and 263% (95% CI, 232-294), respectively, within the study population. The community's colonization prevalence, broken down by FQR, ESCR, CR, and MDR-GNB, was 395% (95% CI, 344-446), 289% (95% CI, 242-336), 56% (95% CI, 32-80), and 48% (95% CI, 26-70), respectively.
This sample of hospitalized and community-dwelling adults demonstrated a high level of colonization with antimicrobial-resistant Gram-negative bacteria, supporting the community as a substantial reservoir for antibiotic resistance. Investigating the links between resistant strains circulating in the community and in hospitals is a priority.
A noteworthy level of antimicrobial-resistant Gram-negative bacillus colonization was observed in hospitalized and community-dwelling adults within this sample, suggesting the community as a key source of antibiotic resistance. Understanding the interrelationship between resistant strains circulating in the community and in hospitals necessitates significant effort.
The problem of antimicrobial resistance has unfortunately worsened across Latin America. Understanding the development of antimicrobial stewardship programs (ASPs) and the obstacles to their effective implementation is essential, due to the lack of robust national action plans or policies to promote ASPs in the locale.
A descriptive mixed-methods investigation into ASPs was conducted in five Latin American countries over the period of March to July 2022. lncRNA-mediated feedforward loop A hospital ASP self-assessment electronic questionnaire, coupled with a scoring system, was employed to categorize ASP development based on scores (inadequate 0-25, basic 26-50, intermediate 51-75, and advanced 76-100). Oral antibiotics Interviews with healthcare workers (HCWs) focused on antimicrobial stewardship (AS) aimed to uncover the influence of behavioral and organizational elements on AS procedures. Thematic analysis was applied to the collected interview data. To develop an explanatory framework, the results of the ASP self-assessment and interviews were integrated.
Twenty hospitals, having completed their self-assessments, subsequently saw 46 of their AS stakeholders interviewed. Alpelisib A considerable 35% of hospitals exhibited basic/inadequate ASP development skills, while 50% displayed an intermediate level, and 15% demonstrated advanced skills. Not-for-profit hospitals' scores were demonstrably lower than those achieved by for-profit hospitals. Interview data corroborated the self-assessment's conclusions, highlighting significant challenges in ASP implementation, including insufficient formal leadership support within the hospital, inadequate staffing and tools for effective AS work, a lack of awareness of AS principles among healthcare workers, and limited training opportunities.
Several impediments to ASP development were recognized within the Latin American context, highlighting the requirement for well-defined business cases to acquire the necessary funding for successful and enduring ASP initiatives.
We've identified a range of challenges impeding ASP development in Latin America, suggesting a need for meticulously crafted business cases to secure sufficient funding and guarantee the sustainable implementation and effectiveness of such programs.
While bacterial co-infection and secondary infections occurred at low rates, inpatients with COVID-19 displayed high levels of antibiotic use (AU), according to reports. The COVID-19 pandemic's impact on healthcare facilities (HCFs) in South America, concerning Australia (AU), was examined.
In the inpatient adult acute care units of two healthcare facilities (HCFs) in each of Argentina, Brazil, and Chile, we carried out an ecological evaluation of AU. The defined daily dose per 1000 patient-days served as the basis for calculating AU rates for intravenous antibiotics, drawing on pharmacy dispensing records and hospitalization data covering the periods March 2018-February 2020 (pre-pandemic) and March 2020-February 2021 (pandemic). The Wilcoxon rank-sum test was utilized to analyze the statistical significance of variations in median AU values observed between the pre-pandemic and pandemic periods. Interrupted time series analysis facilitated the examination of AU's response to the COVID-19 pandemic.
Four out of six HCFs exhibited a median increase in the difference of AU rates for all antibiotics, when compared to the pre-pandemic period (percentage change from 67% to 351%; statistically significant, P < .05). Analysis of interrupted time series data revealed that five of six healthcare facilities experienced a marked initial increase in the collective use of all antibiotics immediately after the pandemic began (range of immediate effect estimates: 154-268). Remarkably, only one of these five facilities sustained this upward trend throughout the study (change in slope: +813; P < .01). The onset of the pandemic yielded distinct outcomes for each antibiotic group, categorized by HCF.
At the onset of the COVID-19 pandemic, a notable surge in antibiotic use (AU) was documented, highlighting the importance of sustaining, or even bolstering, antibiotic stewardship programs within pandemic and emergency healthcare frameworks.
The onset of the COVID-19 pandemic showcased substantial increases in AU, signifying the critical need to either maintain or strengthen antibiotic stewardship strategies within pandemic or crisis healthcare settings.
The alarming rise in extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) poses a grave global public health risk. We ascertained potential risk factors for ESCrE and CRE colonization affecting patients within one urban and three rural Kenyan hospitals.
During the cross-sectional study period of January 2019 to March 2020, stool samples were gathered from randomly allocated inpatients and subjected to testing for ESCrE and CRE. The Vitek2 platform was instrumental in confirming isolates and determining antibiotic susceptibility. Meanwhile, least absolute shrinkage and selection operator (LASSO) regression models were applied to uncover colonization risk factors, considering fluctuations in antibiotic use.
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%). In LASSO models incorporating ceftriaxone, the odds of ESCrE colonization were markedly higher among patients with three days of hospitalization (odds ratio 232, 95% confidence interval 16-337; P < .001). Patients who were intubated showed a frequency of 173 (ranging from 103 to 291) and this difference was statistically significant (P = .009). Individuals diagnosed with human immunodeficiency virus (HIV) exhibited a statistically significant outcome (P = .029) measured by the provided data (170 [103-28]). Patients receiving ceftriaxone experienced a substantially increased probability of CRE colonization, as evidenced by an odds ratio of 223 (95% confidence interval 114-438), and a statistically significant association (P = .025). A statistically significant impact was observed for every extra day of antibiotic treatment (108 [103-113]; P = .002).