Revitalizing the blood culture volume!

Blood cultures are undoubtedly the most critical investigation for bloodstream infections. However, insufficient blood culture volumes frequently impair diagnostic yield. Thus, we investigated the volume of blood culture bottles being filled at our institution. Then we looked at whether an educational intervention could increase the volume of blood culture bottles

Penggunaan ubat-ubatan tidak berlesen dan luar label di kalangan pesakit dewasa di Unit Rawatan Rapi, Pusat Perubatan Universiti Kebangsaan Malaysia

Penggunaan ubat-ubatan tidak berlesen dan luar label di kalangan orang dewasa jarang dilaporkan dengan penyelidikan yang lebih terhad berbanding kanak-kanak. Kajian ini dijalankan untuk mencirikan penggunaan ubat-ubatan tidak berlesen dan luar label di kalangan pesakit dewasa unit rawatan rapi (ICU) di Pusat Perubatan Universiti Kebangsaan Malaysia. Data berkaitan ubat-ubatan yang dipreskrib kepada pesakit-pesakit dikumpulkan dari rekod perubatan pesakit dan klasifikasi setiap ubat sama ada tidak berlesen atau luar label ditetapkan. Seramai 49 (73.1%) dan 20 (29.9%) pesakit daripada sejumlah 67 pesakit menerima sekurang-kurangnya satu ubat tidak berlesen atau luar label, setiap satunya. Sebab utama penggunaan ubat luar label adalah frekuensi pendosan yang lebih tinggi berbanding frekuensi pendosan yang dilesenkan (29.6%). Penggunaan ubat tanpa lesen dan luar label yang paling kerap masing-masing adalah tablet amlodipine (5.8%) dan injeksi metoclopromide (11.1%). Tempoh penginapan di ICU merupakan prediktor yang signifikan untuk penggunaan ubat-ubatan tanpa lesen (OR 1.219; 95% CI 1.022-1.456; p = 0.028), manakala bilangan ubat-ubatan yang dipreskrib merupakan prediktor yang signifikan untuk penggunaan ubat-ubatan luar label (OR 1.130; 95% CI 1.010-1.263; p = 0.032). Penggunaan ubat-ubatan tidak berlesen yang lebih kerap berbanding ubat-ubatan luar label di kalangan pesakit dewasa di ICU menunjukkan perlunya lebih banyak penyelidikan dijalankan memandangkan keadaan pesakit yang kritikal

Plethora of Antibiotics Usage and Evaluation of Carbapenem Prescribing Pattern in Intensive Care Units: A Single-Center Experience of Malaysian Academic Hospital

Excessive antibiotic consumption is still common among critically ill patients admitted to intensive care units (ICU), especially during the coronavirus disease 2019 (COVID-19) period. Moreover, information regarding antimicrobial consumption among ICUs in South-East Asia remains scarce and limited. This study aims to determine antibiotics utilization in ICUs by measuring antibiotics consumption over the past six years (2016–2021) and specifically evaluating carbapenems prescribed in a COVID-19 ICU and a general intensive care unit (GICU) during the second year of the COVID-19 pandemic. (2) Methods: This is a retrospective cross-sectional observational analysis of antibiotics consumption and carbapenems prescriptions. Antibiotic utilization data were estimated using the WHO Defined Daily Doses (DDD). Carbapenems prescription information was extracted from the audits conducted by ward pharmacists. Patients who were prescribed carbapenems during their admission to COVID-19 ICU and GICU were included. Patients who passed away before being reviewed by the pharmacists were excluded. (3) Results: In general, antibiotics consumption increased markedly in the year 2021 when compared to previous years. Majority of carbapenems were prescribed empirically (86.8%). Comparing COVID-19 ICU and GICU, the reasons for empirical carbapenems therapy in COVID-19 ICU was predominantly for therapy escalation (64.7% COVID-19 ICU vs. 34% GICU, p < 0.001), whereas empirical prescription in GICU was for coverage of extended-spectrum beta-lactamases (ESBL) gram-negative bacteria (GNB) (45.3% GICU vs. 22.4% COVID-19 ICU, p = 0.005). Despite microbiological evidence, the empirical carbapenems were continued for a median (interquartile range (IQR)) of seven (5–8) days. This implies the need for a rapid diagnostic assay on direct specimens, together with comprehensive antimicrobial stewardship (AMS) discourse with intensivists to address this issue

Guidelines for the use and interpretation of assays for monitoring autophagy (4th edition)

In 2008, we published the first set of guidelines for standardizing research in autophagy. Since then, this topic has received increasing attention, and many scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Thus, it is important to formulate on a regular basis updated guidelines for monitoring autophagy in different organisms. Despite numerous reviews, there continues to be confusion regarding acceptable methods to evaluate autophagy, especially in multicellular eukaryotes. Here, we present a set of guidelines for investigators to select and interpret methods to examine autophagy and related processes, and for reviewers to provide realistic and reasonable critiques of reports that are focused on these processes. These guidelines are not meant to be a dogmatic set of rules, because the appropriateness of any assay largely depends on the question being asked and the system being used. Moreover, no individual assay is perfect for every situation, calling for the use of multiple techniques to properly monitor autophagy in each experimental setting. Finally, several core components of the autophagy machinery have been implicated in distinct autophagic processes (canonical and noncanonical autophagy), implying that genetic approaches to block autophagy should rely on targeting two or more autophagy-related genes that ideally participate in distinct steps of the pathway. Along similar lines, because multiple proteins involved in autophagy also regulate other cellular pathways including apoptosis, not all of them can be used as a specific marker for bona fide autophagic responses. Here, we critically discuss current methods of assessing autophagy and the information they can, or cannot, provide. Our ultimate goal is to encourage intellectual and technical innovation in the field