A Sustained Reduction of Methicillin Resistant Staphylococcus aureus (MRSA) in an Intensive Care Unit (ICU) at an Australian Tertiary Hospital over an 8-Year Period in the Absence of Intensive Infection Control Measures

Background: Intensive efforts to control nosocomial MRSA remain controversial. We report a decline in MRSA blood stream and other clinical isolates from our ICU in the absence of specific interventions against MRSA. Methods: Retrospective time series analysis of Staphylococcus aureus (SA) isolates from the Royal Melbourne Hospital ICU 2000-2007. Clinical isolates were electronically extracted from the microbiology database. Screening swabs and duplicate isolates collected within 7d from sterile and 30d from non-sterile sites respectively were excluded. Results: Consecutive 6 monthly MRSA (& total SA) clinical isolates/1000 occupied ICU bed days and MRSA (& total SA) blood culture isolates (unadjusted for occupancy) from 2000-2007 is presented in table 1. Trauma, cardiothoracic & other surgical comprised 63% (mean) of ICU admissions/ year. No MRSA specific interventions i.e. active screening, decolonisation or isolation were implemented. Interventions included antibiotic stewardship incorporating a computerized program (Jan 2001), regular rounds by infectious diseases physicians (April 2004), temporary screening & barrier nursing of Acinetobacter colonised patients during an outbreak of non-multiresistant Acinetobacter (Nov 2004-Dec 2005) and hand hygiene education (May 2005). Conclusions: Sustained reduction of endemic MRSA was achieved by quality improvement measures and limited infection control interventions. Intensive and expensive control measures may not always be necessary

Pandemic (H1N1) 2009 Risk for Frontline Health Care Workers

To determine whether frontline health care workers (HCWs) are at greater risk for contracting pandemic (H1N1) 2009 than nonclinical staff, we conducted a study of 231 HCWs and 215 controls. Overall, 79 (17.7%) of 446 had a positive antibody titer by hemagglutination inhibition, with 46 (19.9%) of 231 HCWs and 33 (15.3%) of 215 controls positive (OR 1.37, 95% confidence interval 0.84–2.22). Of 87 participants who provided a second serum sample, 1 showed a 4-fold rise in antibody titer; of 45 patients who had a nose swab sample taken during a respiratory illness, 7 had positive results. Higher numbers of children in a participant’s family and working in an intensive care unit were risk factors for infection; increasing age, working at hospital 2, and wearing gloves were protective factors. This highly exposed group of frontline HCWs was no more likely to contract pandemic (H1N1) 2009 influenza infection than nonclinical staff, which suggests that personal protective measures were adequate in preventing transmission

Improving antibiotic prescribing for adults with community acquired pneumonia: Does a computerised decision support system achieve more than academic detailing alone? – a time series analysis

BACKGROUND: The ideal method to encourage uptake of clinical guidelines in hospitals is not known. Several strategies have been suggested. This study evaluates the impact of academic detailing and a computerised decision support system (CDSS) on clinicians' prescribing behaviour for patients with community acquired pneumonia (CAP). METHODS: The management of all patients presenting to the emergency department over three successive time periods was evaluated; the baseline, academic detailing and CDSS periods. The rate of empiric antibiotic prescribing that was concordant with recommendations was studied over time comparing pre and post periods and using an interrupted time series analysis. RESULTS: The odds ratio for concordant therapy in the academic detailing period, after adjustment for age, illness severity and suspicion of aspiration, compared with the baseline period was OR = 2.79 [1.88, 4.14], p < 0.01, and for the computerised decision support period compared to the academic detailing period was OR = 1.99 [1.07, 3.69], p = 0.02. During the first months of the computerised decision support period an improvement in the appropriateness of antibiotic prescribing was demonstrated, which was greater than that expected to have occurred with time and academic detailing alone, based on predictions from a binary logistic model. CONCLUSION: Deployment of a computerised decision support system was associated with an early improvement in antibiotic prescribing practices which was greater than the changes seen with academic detailing. The sustainability of this intervention requires further evaluation

WHO global research priorities for antimicrobial resistance in human health

The WHO research agenda for antimicrobial resistance (AMR) in human health has identified 40 research priorities to be addressed by the year 2030. These priorities focus on bacterial and fungal pathogens of crucial importance in addressing AMR, including drug-resistant pathogens causing tuberculosis. These research priorities encompass the entire people-centred journey, covering prevention, diagnosis, and treatment of antimicrobial-resistant infections, in addition to addressing the overarching knowledge gaps in AMR epidemiology, burden and drivers, policies and regulations, and awareness and education. The research priorities were identified through a multistage process, starting with a comprehensive scoping review of knowledge gaps, with expert inputs gathered through a survey and open call. The priority setting involved a rigorous modified Child Health and Nutrition Research Initiative approach, ensuring global representation and applicability of the findings. The ultimate goal of this research agenda is to encourage research and investment in the generation of evidence to better understand AMR dynamics and facilitate policy translation for reducing the burden and consequences of AMR

Fever of short duration

[Extract] Fever is a common presenting symptom. It ranks in the top ten of presentations to general practitioners, and accounts for about 5% of patients seen in hospital emergency departments. Infect ion is the most common cause of fever of short duration. The assessment and management of febrile patients varies according to the severity, duration and tempo of the illness, the clinical feat ures, the patient's background, and the epidemiological setting

Fever of short duration

[Extract] Fever is a common presenting symptom. It ranks in the top ten of presentations to general practitioners, and accounts for about 5% of patients seen in hospital emergency departments. Infect ion is the most common cause of fever of short duration. The assessment and management of febrile patients varies according to the severity, duration and tempo of the illness, the clinical feat ures, the patient's background, and the epidemiological setting