The Global Alliance for Infections in Surgery : defining a model for antimicrobial stewardship-results from an international cross-sectional survey

Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p <0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.Peer reviewe

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs

Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action

Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or “golden rules,” for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice

Dental Service Utilization and Barriers to Dental Care for Individuals with Autism Spectrum Disorder in Jordan: A Case-Control Study

Individuals with disabilities are at higher risk for oral diseases such as caries and periodontal disease. Therefore, regular dental care is essential to maintain oral health. However, individuals with disabilities encounter difficulties in accessing dental care. The challenges and barriers to oral care faced by individuals with autism spectrum disorder (ASD) have not been addressed in Jordan. The aim of this study was to examine the use of dental services in individuals with ASD in Jordan and identify barriers that affect their access to dental care in comparison with individuals without ASD. A case-control study was carried out among 296 parents/caregivers of individuals with ASD and individuals without ASD, which involved completion of a self-designed questionnaire. The majority of the participants in both groups had visited the dentist in the year preceding completion of the questionnaire. The main reason for visiting dental services was toothache (43%), and the least common reason was routine checkup (11.6%), with a significant difference (P<0.05) observed between the two groups. Barriers including embarrassment (43.5%), a lack of specialized dental staff (28.6%), a lack of knowledge of how to treat people with disabilities (26.6%), and inadequate facilities (34%) were significantly (P<0.05) more likely to be reported by individuals with ASD than the controls. In conclusion, knowing and understanding the barriers to accessing dental care could improve overall health for individuals with ASD. Furthermore, recognizing the challenges in accessing dental care for this population could help oral health professionals to minimize these difficulties

A Postcolonial Approach to the Problem of Subalternity in Toni Morrison's God Help the Child

This study focuses on the different forms of subalternity, the effect of marginalizing subaltern characters, and the postcolonial discourse among characters coming from different backgrounds in Toni Morrison’s God Help the Child (2015). A close reading of this novel shows how subalternity shapes the novel as a whole, both in its form and content. The title, language, tone, multiple points of view, and characters, all form a postcolonial frame and setting to the whole novel which highlights the problems of racism and child abuse in the United States of America in the twenty-first century. The novel is mainly about a dark child named Bride. She is born in a white family and represents children’s marginalization in a white society because of a very long history of discrimination against black people. In addition to Bride, the study shows many other examples of racism and child abuse. So, one can argue that postcolonialism is one of the best approaches that can help the reader better understand the marginalized characters. A postcolonial approach will shed more light on the suffering of all these people and help the reader find out the victim and the victimizer. As a whole, God Help the Child necessitates a totally different approach to the problem of subalternity. Instead of Spivak’s view that the subaltern cannot speak, it is possible to anticipate a near future in which the subaltern might be able to speak

Antimicrobials: a global alliance for optimizing their rational use in intra-abdominal infections (AGORA)

Abstract Intra-abdominal infections (IAI) are an important cause of morbidity and are frequently associated with poor prognosis, particularly in high-risk patients. The cornerstones in the management of complicated IAIs are timely effective source control with appropriate antimicrobial therapy. Empiric antimicrobial therapy is important in the management of intra-abdominal infections and must be broad enough to cover all likely organisms because inappropriate initial antimicrobial therapy is associated with poor patient outcomes and the development of bacterial resistance. The overuse of antimicrobials is widely accepted as a major driver of some emerging infections (such as C. difficile), the selection of resistant pathogens in individual patients, and for the continued development of antimicrobial resistance globally. The growing emergence of multi-drug resistant organisms and the limited development of new agents available to counteract them have caused an impending crisis with alarming implications, especially with regards to Gram-negative bacteria. An international task force from 79 different countries has joined this project by sharing a document on the rational use of antimicrobials for patients with IAIs. The project has been termed AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections). The authors hope that AGORA, involving many of the world's leading experts, can actively raise awareness in health workers and can improve prescribing behavior in treating IAIs