Catheter associated urinary tract infection: role of the setting of catheter insertion

BACKGROUND This study aimed to describe Catheter-associated urinary tract infections (CAUTIs) epidemiology in patients admitted to a surgical ward in Central Italy, and to analyze the associated risk factors. METHODS: An active surveillance program for CAUTI was carried out in patients catheterized for at least 48 hours. Place of catheter insertion (operating room, hospital ward, cystoscopy room, emergency care unit), indication for catheterization , and its duration, amongst other risk factors were monitored until discharge. Antibiotic resistance profiles of isolates were analysed. RESULTS: 641 catheterized patients, were monitored for CAUTI onset. 40 of them (6.2%) developed a CAUTI (rates were 15.1/1000 catheter-days, 95%CI:11.9–22.6 and 8.7/1000 patient-days,95%CI:6.9–13.1. Patients with CAUTI were older (p<0.05), and their durations of hospitalization and catheterization were both longer compared to not-affected (p<0.05). Catheterization exceeding four days (OR8.21,95%CI:3.79-17.73,p<0.05) and place of catheter insertion different from the Operating Room (OR7.9,95%CI:2.83-22.08,p<0.05 for catheters placed in the ward) were associated to CAUTI. Among the microorganisms isolated in CAUTIs, the most common were Pseudomonas aeruginosa (41.5%), Klebsiella pneumoniae (19.5%) and Escherichia coli (12.2%); 82.5% of them was resistant to different classes of antibiotics. CONCLUSION: These results highlight the role played by the setting of catheter insertion in CAUTIs onset, thus reflecting the importance of hand hygiene and proper aseptic insertion techniques as crucial determinants in CAUTIs prevention

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

Antimicrobial Resistance: A Challenge for the Future

The global emergence of antibiotic-resistance, together with the lack of/reduced development of new antibiotic molecules, currently represents a serious public health problem as it can mean the return to a pre-antibiotic era in which infections caused by multiple-resistant pathogens are intractable. Since the beginnings, the interest of the Institutes of Microbiology, Hygiene and Public Health, and Infectious Diseases was focused on antibiotic resistance: from molecular mechanisms, through epidemiology and clinical issues, to prevention. Future perspectives include the search of new strategies and/or new compounds for prevention and control of difficult-to-treat pathogens in a multidisciplinary approach

A Global Declaration on Appropriate Use of Antimicrobial Agents across the Surgical Pathway

This declaration, signed by an interdisciplinary task force of 234 experts from 83 different countries with different backgrounds, highlights the threat posed by antimicrobial resistance and the need for appropriate use of antibiotic agents and antifungal agents in hospitals worldwide especially focusing on surgical infections. As such, it is our intent to raise awareness among healthcare workers and improve antimicrobial prescribing. To facilitate its dissemination, the declaration was translated in different languages