10 research outputs found
The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance:An AMR Insights global perspective
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic's potential effect on the emergence and spread of global antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19 infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the authors present a brief overview of the COVID-19 pandemic and associated issues that could influence the pandemic's effect on global AMR.</p
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The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance : an AMR Insights global perspective
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health
are still being investigated, including the pandemic’s potential effect on the emergence and spread of global
antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may
predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive
use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19
infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR
awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of
vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the
authors present a brief overview of the COVID-19 pandemic and associated issues that could influence
the pandemic’s effect on global AMR.This study was supported by internal funding.https://academic.oup.com/jacamram2022School of Health Systems and Public Health (SHSPH
Practical Story: Real People, Real Urine, Unreal UTI
Objective● To describe findings from the joint collaborative between the Houston Health Department and Houston-based hospitals● To promote cross sectional partnerships and collaborations across health agenciesIntroductionAsymptomatic Bacteriuria (ASB) is defined as the presence of bacteria in the urine of a patient without signs or symptoms of a urinary tract infection (UTI). It is one of the most common reasons for inappropriate antibiotic use in hospitalized patients. Without efforts to check inappropriate use, our communities could see increased numbers of highly resistant bacterial pathogens contributing to the public health threat of antimicrobial resistance. Treatment itself may be associated with subsequent antimicrobial resistance, adverse drug effects, and cost.The Houston Health Department (HHD) has made it a priority to address antibiotic resistance and stewardship by working collaboratively with members of the healthcare community to address this patient safety issue. As such HHD, in conjunction with infectious diseases experts from the HHD Antimicrobial Stewardship Executive Committee formed a joint learning collaborative to work on an asymptomatic bacteriuria stewardship project. The goal of the project was to engage with healthcare professionals across facilities within the Houston area to work collaboratively to help reduce unnecessary testing and treatment of ASB.MethodsThe project is a joint learning collaborative between HHD and selected acute care facilities within the City of Houston. Space was limited to no more than 8 hospitals and enrollment occurred on a first come, first serve basis. Activities conducted as part of the project included a Project Launch meeting held at HHD that was attended by participants, education by project subject matter experts (SMEs), monthly calls with SMEs to provide case-based feedback and intervention tools. The project launch meeting included a brief overview of the project, review of an asymptomatic bacteruria algorithm (referred to as “Kicking UTI” algorithm), instructions on how to classify cases, project timeline and plan implementation. The project timeline was 8 months (this included the Kick off Meeting in month 1, data collection in months 2-4, intervention period during months 5-7, preliminary report in month 4 and final report at month 8. Participants were encouraged to do the interventions in one area (e.g. Emergency Room or a single ward) vs. institution wide. Intervention tools provided included a case classification form with instructions, an electronic form that was pre-formatted for local data collection (using Microsoft Access), and project launch worksheet. The project launch worksheet asked participants about their goals for the project, areas of desired improvements, units/wards to be targeted and key members of the project (e.g. executive champion, project champion, and active participants) at their facility. The agenda for the monthly calls included discussing data collection (i.e. number of cases classified), SME review of challenging cases, and utilization of education and project tools. Finally, onsite visits by the SMEs and HHD representatives were offered to participants to increase local site engagement.ResultsSeven acute care hospitals and 1 rehabilitation facility were enrolled in the collaborative. Participants from the institutions included 11 clinical pharmacists and one nurse. Half of the participants originally targeted emergency departments (ED). The remaining participants conducted interventions on the medical/surgical wards and one facility conducted interventions on the brain injury floor. Additional activities were adapted and added throughout the program period. These included: 1) choice of ward versus ED 2) targeted providers (working with mid-level providers to discourage standard urine testing in the emergency department) and 3) strategies for education. Strategies for education included utilizing nurse practitioners to educate nurses, designing project marketing tools (flyers, posters, and pocket cards), pharmacy rounds, resident orientation and one-to-one education. Site visits were conducted at 3 facilities and included a range of interventions from 1:1 peer to peer discussions to large presentations to medical staff. Outcomes for 3 sites included Pre-project ASB treatment rates of 61% and Post project ASB treatment rates of 24%, representing a 37% decrease in ASB treatment for these sites. In addition, two health systems that participated in the study utilized the information obtained from the project to work with their laboratory departments to change testing practices by increasing the threshold of urine white blood cells required in the sample before reflex to testing for the presence of bacteria.ConclusionsThis project showed that collaboration between a city Health Department and local institutions can be successful in reducing the overtreatment of ASB. HHD facilitated collaboration, assisted with eliminating barriers to knowledge sharing and served as a partner in setting transparent goals. A cross disciplinary approach to promoting patient safety indirectly lead to gains in public health. In person interaction between the Health Department, SMEs, and representatives from local facilities helped to increase engagement throughout the project. The results of this project will be shared on the Health Department website as a way of forging community practices and stretching the role of the health department to serve as an advocate for public health and patient safety. Future projects would benefit from having increased participation from facillity stakeholders to promote institutional sustainability
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A guide to research partnerships for pragmatic clinical trials.
Antimicrobial Stewardship—Qualitative and Quantitative Outcomes: The Role of Measurement
The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: An AMR Insights global perspective
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic's potential effect on the emergence and spread of global antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19 infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the authors present a brief overview of the COVID-19 pandemic and associated issues that could influence the pandemic's effect on global AMR
The potential impact of the COVID-19 pandemic on global antimicrobial and biocide resistance: an AMR Insights global perspective.
The COVID-19 pandemic presents a serious public health challenge in all countries. However, repercussions of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on future global health are still being investigated, including the pandemic's potential effect on the emergence and spread of global antimicrobial resistance (AMR). Critically ill COVID-19 patients may develop severe complications, which may predispose patients to infection with nosocomial bacterial and/or fungal pathogens, requiring the extensive use of antibiotics. However, antibiotics may also be inappropriately used in milder cases of COVID-19 infection. Further, concerns such as increased biocide use, antimicrobial stewardship/infection control, AMR awareness, the need for diagnostics (including rapid and point-of-care diagnostics) and the usefulness of vaccination could all be components shaping the influence of the COVID-19 pandemic. In this publication, the authors present a brief overview of the COVID-19 pandemic and associated issues that could influence the pandemic's effect on global AMR
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Nasal Iodophor Antiseptic vs Nasal Mupirocin Antibiotic in the Setting of Chlorhexidine Bathing to Prevent Infections in Adult ICUs
ImportanceUniversal nasal mupirocin plus chlorhexidine gluconate (CHG) bathing in intensive care units (ICUs) prevents methicillin-resistant Staphylococcus aureus (MRSA) infections and all-cause bloodstream infections. Antibiotic resistance to mupirocin has raised questions about whether an antiseptic could be advantageous for ICU decolonization.ObjectiveTo compare the effectiveness of iodophor vs mupirocin for universal ICU nasal decolonization in combination with CHG bathing.Design, setting, and participantsTwo-group noninferiority, pragmatic, cluster-randomized trial conducted in US community hospitals, all of which used mupirocin-CHG for universal decolonization in ICUs at baseline. Adult ICU patients in 137 randomized hospitals during baseline (May 1, 2015-April 30, 2017) and intervention (November 1, 2017-April 30, 2019) were included.InterventionUniversal decolonization involving switching to iodophor-CHG (intervention) or continuing mupirocin-CHG (baseline).Main outcomes and measuresICU-attributable S aureus clinical cultures (primary outcome), MRSA clinical cultures, and all-cause bloodstream infections were evaluated using proportional hazard models to assess differences from baseline to intervention periods between the strategies. Results were also compared with a 2009-2011 trial of mupirocin-CHG vs no decolonization in the same hospital network. The prespecified noninferiority margin for the primary outcome was 10%.ResultsAmong the 801 668 admissions in 233 ICUs, the participants' mean (SD) age was 63.4 (17.2) years, 46.3% were female, and the mean (SD) ICU length of stay was 4.8 (4.7) days. Hazard ratios (HRs) for S aureus clinical isolates in the intervention vs baseline periods were 1.17 for iodophor-CHG (raw rate: 5.0 vs 4.3/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 4.1 vs 4.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 18.4% [95% CI, 10.7%-26.6%] for mupirocin-CHG, P < .001). For MRSA clinical cultures, HRs were 1.13 for iodophor-CHG (raw rate: 2.3 vs 2.1/1000 ICU-attributable days) and 0.99 for mupirocin-CHG (raw rate: 2.0 vs 2.0/1000 ICU-attributable days) (HR difference in differences significantly lower by 14.1% [95% CI, 3.7%-25.5%] for mupirocin-CHG, P = .007). For all-pathogen bloodstream infections, HRs were 1.00 (2.7 vs 2.7/1000) for iodophor-CHG and 1.01 (2.6 vs 2.6/1000) for mupirocin-CHG (nonsignificant HR difference in differences, -0.9% [95% CI, -9.0% to 8.0%]; P = .84). Compared with the 2009-2011 trial, the 30-day relative reduction in hazards in the mupirocin-CHG group relative to no decolonization (2009-2011 trial) were as follows: S aureus clinical cultures (current trial: 48.1% [95% CI, 35.6%-60.1%]; 2009-2011 trial: 58.8% [95% CI, 47.5%-70.7%]) and bloodstream infection rates (current trial: 70.4% [95% CI, 62.9%-77.8%]; 2009-2011 trial: 60.1% [95% CI, 49.1%-70.7%]).Conclusions and relevanceNasal iodophor antiseptic did not meet criteria to be considered noninferior to nasal mupirocin antibiotic for the outcome of S aureus clinical cultures in adult ICU patients in the context of daily CHG bathing. In addition, the results were consistent with nasal iodophor being inferior to nasal mupirocin.Trial registrationClinicalTrials.gov Identifier: NCT03140423