Unit-dose-versorgung: Auswirkungen auf patienten- und mitarbeiterzufriedenheit innerhalb eines universitätskünikums

Background: A high quality drug supply is guaranteed, if the so called "5-R-rule" applies. This means that the right drug at the right time in the right dose is correctly applied to the right patient. It is questionable how a new form of drug supply, the unit-dose-system, will effect satisfaction of patients and employees in comparison to the normal ward stock system. Aim: The major aim was to measure the satisfaction of patients and employees, resulting from different drug provision systems. Method: Performing a prospective, consecutive observational study with a control and treatment phase (from 06/2005-12/2006). For each group 80 patients were included. The study was placed in selected surgical and internal wards of the Klinikum rechts der Isar (MRI) at the Technical University of Munich. Patient satisfaction, which was measured by a standardised questionnaire as well as the experiences, findings and estimations of the employees, which were surveyed using interviews with professionals, acted as parameters. Data retrieved by the patient questionnaires were analysed using statistical and multivariate methods. For the interpretation of the interviews with the professionals the qualitative content analysis according to Mayring was applied. Results: Between the study groups, both the demographical and medical characteristics are comparable. The satisfaction of patients with the hospital pharmacy supply increases from 79.3 % by 7.3 percentage points to 86.6 % (p = 0.008). The results of the staff survey show a heterogeneous image. In most instances the consulting and information services of the hospital pharmacists were appraised as good. Positive aspects of the new supply organisation are e. g. improved transparency in prescription and automatic picking of the drugs in the hospital pharmacy. Negative aspects include the risk of new error source in the electronic prescription and the dependence on electronic systems. The lack of spontaneity and flexibility as well as the high efforts of coordination of the new system are the main critical points. On the surgical wards, the outcomes of the qualitative parameters are better than on the internal wards. Discussion and conclusion: The implementation of the study in an academic hospital restricts the generalisability of the results to other suppliers. In this study the unit-dose-supply lead to a higher patient satisfaction with drug supply. Due to better results regarding all qualitative parameters on the surgical wards, the unit-dose-system should be implemented in these areas first. Decision-makers should integrate the staff from the first step of implementation onwards so that they can handle the new system in an efficient way

In vitro susceptibility to 19 agents other than beta-lactams among third-generation cephalosporin-resistant Enterobacteriaceae recovered on hospital admission

Objectives: As part of the multicentre Antibiotic Therapy Optimisation Study, MIC values of 19 non-b-lactam agents were determined for third-generation cephalosporin-resistant Escherichia coli, Klebsiella species and Enterobacter species (3GCREB) isolates collected in German hospitals. Methods: A total of 328 E. coli, 35 Klebsiella spp. (1 Klebsiella oxytoca and 34 Klebsiella pneumoniae) and 16 Enterobacter spp. (1 Enterobacter aerogenes and 15 Enterobacter cloacae) isolates were submitted to broth microdilution antimicrobial susceptibility testing with the MICRONAUT system. MICs of fluoroquinolones (levofloxacin and moxifloxacin), aminoglycosides (gentamicin, tobramycin, amikacin, streptomycin, neomycin and paromomycin), tetracyclines (tetracycline, minocycline and tigecycline), macrolides (erythromycin, clarithromycin and azithromycin) and miscellaneous agents [trimethoprim/sulfamethoxazole, chloramphenicol, nitrofurantoin, colistin and fosfomycin intravenous (iv)] were determined and reviewed against 2016 EUCAST breakpoints. Results: The MIC of levofloxacin was >2 mg/L for 128 of 328 E. coli and 8 of 35 Klebsiella spp., but only 1 of 16 Enterobacter spp. Rates of resistance to trimethoprim/sulfamethoxazole were high (>70%), except for Enterobacter spp. Rates of resistance to colistin and fosfomycin iv were still low. About 20% of the tested isolates were resistant to chloramphenicol. Only 1 (of 328) E. coli isolate had an MIC of amikacin >16 mg/L and only 33 of 328 E. coli and 1 of 35 Klebsiella spp. had an MIC of tobramycin >4 mg/L, whereas average gentamicin MICs were in general more elevated. A tigecycline MIC.2 mg/L was only found for 1 of 16 Enterobacter spp., but in none of the E. coli or Klebsiella spp. isolates. Conclusions: Our study gives insight into previously unreported non-b-lactam MIC distributions of 3GCREB isolates

Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors

The objectives of this study were to prospectively assess the rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB) in non-ICU patients on hospital admission and to investigate resistance mechanisms and risk factors for carriage. Adult patients were screened for 3GCREB carriage at six German tertiary care hospitals in 2014 using rectal swabs or stool samples. 3GCREB isolates were characterized by phenotypic and molecular methods. Each patient answered a questionnaire about potential risk factors for colonization with MDR organisms (MDROs). Univariable and multivariable risk factor analyses were performed to identify factors associated with 3GCREB carriage. Of 4376 patients, 416 (9.5%) were 3GCREB carriers. Escherichia coli was the predominant species (79.1%). ESBLs of the CTX-M-1 group (67.3%) and the CTX-M-9 group (16.8%) were the most frequent beta-lactamases. Five patients (0.11%) were colonized with carbapenemase-producing Enterobacteriaceae. The following risk factors were significantly associated with 3GCREB colonization in the multivariable analysis (P<0.05): centre; previous MDRO colonization (OR=2.12); antibiotic use within the previous 6 months (OR=2.09); travel outside Europe (OR=2.24); stay in a long-term care facility (OR=1.33); and treatment of gastroesophageal reflux disease (GERD) (OR=1.22). To our knowledge, this is the largest admission prevalence study of 3GCREB in Europe. The observed prevalence of 9.5% 3GCREB carriage was higher than previously reported and differed significantly among centres. In addition to previously identified risk factors, the treatment of GERD proved to be an independent risk factor for 3GCREB colonization