4 research outputs found
A global point prevalence survey of antimicrobial use in neonatal intensive care units : the no-more-antibiotics and resistance (NO-MAS-R) study
Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0 100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >=1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were “rule-out” sepsis (32%) and “culture-negative” sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and “culture-negative” infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide
International train the trainer neonatal antibiotic stewardship program for South African pharmacists
Hospital-acquired antimicrobial-resistant infections are a leading cause of neonatal
mortality in South African (SA) neonatal intensive care units (NICU). There is an
urgent need for NICU Antibiotic Stewardship Programs (ASP). We describe the development
of an international Train-the-Trainer (TTT) NICU-ASP mentoring program for
SA pharmacists. A partnership between the South Africa Antimicrobial Stewardship in 2019. A baseline assessment of four SA NICUs was done to guide the development
of a TTT NICU-ASP mentoring of SA pharmacists utilizing the existing workforce. The
program included bilateral site visits. Pre-post surveys were used to assess SA
mentee's NICU experiences, barriers to clinical pharmacy services and confidence to
train additional pharmacists in NICU ASP. Four mentees from private (n = 1) and public
hospitals (n = 3) completed a 2-week TTT NICU-ASP in the US that included; education,
patient care rounds, role-playing, peer-to-peer sessions and behavioral
interventions followed by ongoing support and mentoring by SAASP mentors. None
of the hospitals had pharmacists participating in daily patient care rounds or had multidisciplinary
NICU-ASPs due to lack of NICU trained pharmacists and dedicated time
for ASP. Post surveys showed improved confidence to train additional pharmacists in
NICU-ASP. Subsequently, these SA mentees provided NICU-ASP education to over
700 health care professionals and trained six additional pharmacists in NICU-ASP.
Mentors and mentees developed a comprehensive NICU ASP toolkit for ongoing
training of additional pharmacists. A new research collaboration between TTT NICUASP
mentors, mentees and physician members of the South Africa National Neonatal
Sepsis Task Force has formed and the first national NICU-ASP study is underway in
12 hospitals. Shared leadership between U.S. and SA mentors led to developing a
TTT NICU-ASP for pharmacists tailored to existing resources and local needs.Merck; Pfizer; Bill and Melinda Gates Foundation grant.http://wileyonlinelibrary.com/journal/jac5am2022Pharmacolog
Objects and occlusion from motion labeling
The problem of segmenting color video sequences is addressed. Boundary motion and occlusion relations expressed
by labeling rules are argued to be of key importance for segmentation. Interframe motion of object(s)
and background is approximated by a similarity or affine transforms. The computation proceeds in several steps:
(1) color gradient edges are fuzzy-clustered according to their motion; (2) boundaries of regions formed by a
color segmenter are assigned weights and labeled according to their motion; (3) un-ambiguously moving regions
and “conflict” regions are identified by a label relaxation procedure; (4) ambiguities and conflicts are resolved
by multiframe analysis
A global point prevalence survey of antimicrobial use in neonatal intensive care units : The no-more-antibiotics and resistance (NO-MAS-R) study
Background: Global assessment of antimicrobial agents prescribed to infants in the neonatal intensive care unit (NICU) may inform antimicrobial stewardship efforts. Methods: We conducted a one-day global point prevalence study of all antimicrobials provided to NICU infants. Demographic, clinical, and microbiologic data were obtained including NICU level, census, birth weight, gestational/chronologic age, diagnoses, antimicrobial therapy (reason for use; length of therapy), antimicrobial stewardship program (ASP), and 30-day in-hospital mortality. Findings: On July 1, 2019, 26% of infants (580/2,265; range, 0-100%; median gestational age, 33 weeks; median birth weight, 1800 g) in 84 NICUs (51, high-income; 33, low-to-middle income) from 29 countries (14, high-income; 15, low-to-middle income) in five continents received >= 1 antimicrobial agent (92%, antibacterial; 19%, antifungal; 4%, antiviral). The most common reasons for antibiotic therapy were "rule-out" sepsis (32%) and "culture-negative" sepsis (16%) with ampicillin (40%), gentamicin (35%), amikacin (19%), vancomycin (15%), and meropenem (9%) used most frequently. For definitive treatment of presumed/confirmed infection, vancomycin (26%), amikacin (20%), and meropenem (16%) were the most prescribed agents. Length of therapy for culture-positive and "culture-negative" infections was 12 days (median; IQR, 8-14) and 7 days (median; IQR, 5-10), respectively. Mortality was 6% (42%, infection-related). An NICU ASP was associated with lower rate of antibiotic utilization (p = 0.02). Interpretation: Global NICU antibiotic use was frequent and prolonged regardless of culture results. NICU-specific ASPs were associated with lower antibiotic utilization rates, suggesting the need for their implementation worldwide