18 research outputs found
Lessons from an educational invasive fungal disease conference on hospital antifungal stewardship practices across the UK and Ireland
Invasive fungal disease (IFD) is a growing health burden. High mortality rates, increasing numbers of at-risk hosts, and a limited availability of rapid diagnostics and therapeutic options mean that patients are increasingly exposed to unnecessary antifungals. High rates of prescriptions promote patient exposure to undue toxicity and drive the emergence of resistance. Antifungal stewardship (AFS) aims to guide antifungal usage and reduce unnecessary exposure and antifungal consumption whilst maintaining or improving outcomes. Here, we examine several AFS approaches from hospitals across the UK and Ireland to demonstrate the benefits of AFS practices and support the broader implementation of AFS as both a necessary and achievable strategy. Since the accuracy and turnaround times (TATs) of diagnostic tools can impact treatment decisions, several AFS strategies have included the development and implementation of diagnostic-driven care pathways. AFS informed treatment strategies can help stratify patients on a risk basis ensuring the right patients receive antifungals at the optimal time. Using a multidisciplinary approach is also key due to the complexity of managing and treating patients at risk of IFD. Through knowledge sharing, such as The Gilead Antifungal Information Network (GAIN), we hope to drive practices that improve patient management and support the preservation of antifungals for future use
Where to start? The Irish Emergency Department Antimicrobial Discharge (EDAD) study:a multicentre, prospective cohort analysis
Objectives: To determine the percentage of patients across Ireland who are discharged from the Emergency Department (ED) with an antimicrobial prescription, the indication, classification of infections, and guideline compliance. To identify potential areas for antimicrobial stewardship (AMS) interventions in the ED. Patients and methods: A multicentre, prospective cohort analysis study in EDs across eight hospitals in Ireland. At each site, patients aged 1 month and older who presented to the ED and were discharged directly from the ED were included. A random selection of records of patients discharged from the ED were reviewed until a minimum of 30 records with an infection diagnosis resulting in an antibiotic prescription were obtained per hospital. The number of patient discharges with no antibiotic prescriptions were included to calculate the denominator. The indication, infection classification and guideline compliance data were collected on the 30 prescriptions in the participating hospitals. Results: A total of 2619 patient records were reviewed. Of these, 249 (9.5%) patients were discharged with antimicrobial prescriptions from the ED. Most (158; 63%) were classified as probable bacterial infection, 21 (8%) as probable viral, and 18 (7%) had no documented evidence of infection. Three indications accounted for 73% of antimicrobial prescriptions: skin/soft tissue infection; ear, nose and throat infection; and urinary tract infection. Overall guideline compliance was 64%. Conclusions: Several areas for AMS interventions to optimize antimicrobial prescribing in the ED were identified, including targeted local and national guideline reviews, delayed prescribing, improved point-of-care testing and prescriber and patient education
Predictors for prolonged hospital stay solely to complete intravenous antifungal treatment in patients with candidemia: Results from the ECMM candida III multinational European observational cohort study
Background
To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp. continue to increase. The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous (iv) antifungal treatment (AF Tx).
Methods
Each participating hospital (number of eligible hospitals per country determined by population size) included the first ~ 10 blood culture proven adult candidemia cases occurring consecutively after July 1st, 2018, and treating physicians answered the question on whether hospital stay was prolonged only for completion of intravenous antifungal therapy. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx.
Findings
Hospital stay was prolonged solely for the completion of iv AF Tx in 16% (100/621) of candidemia cases by a median of 16 days (IQR 8 – 28). In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx (aOR 2.87, 95% CI 1.55 – 5.32, p < 0.001), while (i) neutropenia, (ii) intensive care unit admission, (iii) catheter related candidemia, (iv) total parenteral nutrition, and (v) C. parapsilosis as causative pathogen were found to be negative predictors (aOR 0.22 – 0.45; p < 0.03).
Interpretation
Hospital stays were prolonged due to need of iv AF Tx in 16% of patients with candidemia. Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. parapsilosis
Fungal Infections Complicating COVID-19: With the Rain Comes the Spores.
Within the last 12 months, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread globally to pandemic proportions [...
Fungal Infections Complicating COVID-19: With the Rain Comes the Spores
Within the last 12 months, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread globally to pandemic proportions [...
Recommended from our members
Fungal Infections Complicating COVID-19: With the Rain Comes the Spores.
Within the last 12 months, coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) spread globally to pandemic proportions [...]
An Integrated Clinical Microbiology Service Ensures Optimal Early Empirical Antimicrobial Therapy for Methicillin-Resistant Staphylococcus aureus
Evaluating patient attitudes to increased patient engagement with antimicrobial stewardship: a quantitative survey
BackgroundAntimicrobial stewardship (AMS) describes
interventions designed to optimize antimicrobial therapy, minimize adverse
treatment consequences and reduce the spread of antimicrobial resistance (AMR).
Previous research has investigated the patient’s role in healthcare infection
prevention but the patient’s role in AMS has not been extensively explored. ObjectivesTo investigate the willingness of hospital
inpatients to question staff about prudent antimicrobial use in an Irish
hospital and evaluate the impact of patient and public involvement in research
(PPI) on this study. MethodsA survey was co-designed with the hospital Patient
Representative Group (PRG) to evaluate patient willingness to engage with
prudent antimicrobial treatment. A random sample of 200 inpatients was selected
to self-complete the survey using pen and paper. PRG members provided feedback
on their involvement. ResultsOf the 200 inpatients randomly selected to
participate, 120 did not fulfil the inclusion criteria. Of the remaining 80, 67
participated (response 84%). Median respondent age was 58 years, 30% were
employed and 30% had a third-level education degree. Over 90% had not heard of
AMS while just over 50% had not heard of AMR. Patients preferred asking factual
questions rather than challenging ones but did not have a preference in asking
questions of doctors compared with nurses. Older patients were less likely to
ask questions. PRG members reported an overall positive experience as research
collaborators. Conclusions
Future patient-centred AMS interventions should
empower patients to ask about antimicrobial treatment, in particular the older
patient cohort. PPI is a valuable component of patient-centred research.</div
Post-influenzal triazole-resistant aspergillosis following allogeneic stem cell transplantation
Influenza virus infection is now recognised as a risk factor for invasive pulmonary aspergillosis (IPA). Delays in diagnosis contribute to delayed commencement of antifungal therapy. In addition, the emergence of resistance to first-line triazole antifungal agents puts emphasis on early detection to prevent adverse outcomes. We present 2 allogeneic stem cell transplant patients who developed IPA due to triazole-resistant Aspergillus fumigatus following influenza infection. We underline the challenges faced in the management of these cases, the importance of early diagnosis and need for surveillance given the emergence of triazole resistance