1,721,009 research outputs found
Antibiotic stewardship and early discharge from hospital: impact of a structured approach to antimicrobial management
No full textObjectivesTo assess the impact of an infection team review of patients receiving antibiotics in six hospitals across the UK and to establish the suitability of these patients for continued care in the community.MethodsAn evaluation audit tool was used to assess all patients on antibiotic treatment on acute wards on a given day. Clinical and antibiotic use data were collected by an infection team (doctor, nurse and antibiotic pharmacist). Assessments were made of the requirement for continuing antibiotic treatment, route and duration [including intravenous (iv)/oral switch] and of the suitability of the patients for discharge from hospital and their requirement for community support.ResultsOf 1356 patients reviewed, 429 (32%) were on systemic antibiotics, comprising 165 (38%) on iv ± oral antibiotics and 264 (62%) on oral antibiotics alone. Ninety-nine (23%) patients (including 26 on iv antibiotics) had their antibiotics stopped immediately on clinical grounds. The other 330 (77%) patients (including 139 on iv antibiotics) needed to continue antibiotics, although 47 (34%) could be switched to oral. Eighty-nine (21%) patients were considered eligible for discharge, comprising 10 who would have required outpatient parenteral antibiotic therapy (OPAT), 55 who were suitable for oral outpatient treatment and 24 who had their antibiotics stopped.ConclusionsInfection team review had a significant impact on antimicrobial use, facilitating iv to oral switch and a reduction in the volume of antibiotic use, possibly reducing the risk of healthcare-associated complications and infections. It identified many patients who could potentially have been managed in the community with appropriate resources, saving 481 bed-days. The health economics are reported in a companion paper
The value of procalcitonin measurement in localized skin and skin structure infection, diabetic foot infections, septic arthritis and osteomyelitis
No full textSerum procalcitonin (PCT) is an established diagnostic marker for severe or systemic bacterial infections such as pneumonia, sepsis and septic shock. Data regarding the role of PCT in localized infections without systemic inflammatory response syndrome are scarce. The aim of this review is to assess the value of PCT measurements in localized infections such as skin and skin structure infections, diabetic foot infections, septic arthritis (SA) and osteomyelitis. It appears that serum PCT is unlikely to change the clinical practice in skin and skin structure infection. However, serum PCT could have a role in diagnosis and monitoring of diabetic foot infections in hospitalized settings. There are conflicting reports regarding the ability of serum PCT to distinguish SA from non-SA; synovial PCT may be more appropriate in these settings, including in implant-related infections. Better designed studies are needed to evaluate the usefulness of PCT with or without other biomarkers in localized infections.</p
Dynamics of Antibiotic Prescription in Royal Hampshire County Hospital in November 2016: A Prospective Study
No full textBackground: Antimicrobial Stewardship and The Start Smart – Then Focus strategy provide guidelines aimed at improving the increasing trend of antibiotic resistance. The aim of this study was to assess whether antibiotics were being prescribed at Royal Hampshire County Hospital (a district general hospital), in accordance with the hospital’s and the NICE guidelines and whether this followed the Start Smart – Then Focus approach.
Methods: During November 2016, medical notes of 12 randomly selected in-patients of Royal Hampshire County Hospital on 45 antibiotics, were used to measure the dynamics of their prescriptions.
Results: 91% of the 45 prescriptions were in accordance with hospital guidelines, 82% of cases had appropriate samples sent before commencing antibiotics, 5% out of 27% had a planned switch from intravenous administration to oral (the remaining 73% were initially started on oral regimes) and 80% had planned stop dates.
Conclusion: Appropriate samples, stop dates, planning and documentation in patient notes must be improved with regards to antibiotic use.
 
Engineered honey: In vitro antimicrobial activity of a novel topical wound care treatment
No full textSurgihoney is a novel engineered organic honey product for wound care. Its antimicrobial activity can be controlled and adjusted by the engineering process, allowing preparation of three different potencies, labelled Surgihoney 1-3. Susceptibility testing of a range of wound and ulcer bacterial isolates to Surgihoney by the disc diffusion method, minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) determination, and time-kill measurements by time suspension tests were performed. Surgihoney demonstrated highly potent inhibitory and cidal activity against a wide range of Gram-positive and Gram-negative bacteria and fungi. MICs/MBCs were significantly lower than concentrations likely to be achieved in topical clinical use. The topical concentration of Surgihoney in wounds was estimated at ca. 500 g/L. MICs/MBCs for Staphylococcus aureus were 32/125 g/L for Surgihoney 1 and 0.12/0.25 g/L for Surgihoney 3. Cidal speed depended on potency, being 48 h for Surgihoney 1 and 30 min for Surgihoney 3. Maintenance of the Surgihoney inoculum preparation for up to a week demonstrated complete cidal activity and no bacterial persistence. Surgihoney has wide potential as a highly active topical treatment combining the effects of the healing properties of honey with the potent antimicrobial activity of the engineered product for skin lesions, wounds, ulcers and cavities. It is highly active against multidrug-resistant bacteria. It is more active than other honeys tested and is comparable with chemical antiseptics in antimicrobial activity. © 2014 International Society for Chemotherapy of Infection and Cancer
‘One for all’ concerns regarding NICE antibiotic guidelines on suspected bacterial meningitis!
No full textUsing antimicrobial surgihoney to prevent caesarean wound infection
No full textCaesarean section (CS) wound infection rates are unacceptably high; around 10% according to figures from the Health Protection Agency (2012). This service evaluation assessed the effects of Surgihoney on surgical site infection rates in women undergoing caesarean section. All women presenting for CS were offered Surgihoney as a single application wound dressing at the end of the procedure. All women were followed up and examined for surgical site infection for 30 days after CS. A single application of Surgihoney dressing reduced surgical site infection (SSI) by 60.33% from a rate of 5.42% (n=590) to 2.15% (n=186) (p-value=0.042). The potential saving to the NHS of using Surgihoney as a single application achieving this level of wound infection reduction is considerable. Surgihoney offers a simple, costeffective intervention to reduce SSI in women undergoing CS. It is applicable to practice in all health economies and could potentially save considerable surgical infective morbidity in patients undergoing surgical delivery.</p
Negative pressure wound therapy and intra-articular antibiotics instillation (NPWTiai) for the treatment of chronic arthroplasty-associated infections and implant retention: An alternative approach
No full textDespite current low rates, the incidence of arthroplasty-associated infections (AAI) is likely to increase over the next few years as the number of joint replacement operations continues to rise worldwide. AAI pose a challenge for both patients and surgeons. They have become a major economic burden on healthcare systems. Debridement and implant retention is not a widely considered option for chronic AAI probably due to low success rates. Negative Pressure Wound Therapy and intra-articular antibiotics instillation using VAC ULTA/VeraFlo system is an alternative strategy in the management of chronic AAI where implant retention is sought. Further evaluations and studies are needed to address the efficacy of this strategy and its cost effectiveness.</p
Learning points from a case of severe amoebic colitis
No full textA case of amoebic colitis and liver abscess is described in a previously fit 59-year old man who had been given the incorrect diagnosis of ulcerative colitis. His symptoms were so severe that a colectomy was being considered. The patient had a significant travel history including trips to Morocco, the Gambia and Cape Verde, putting him at risk of acquiring amoebic disease. However, this history was not ascertained until much later on in the disease process. The case highlighted crucial learning points including the importance of taking a lifelong travel history, the difficulties in telling ulcerative colitis and amoebic colitis apart both clinically and histopathologically, and the importance of sending multiple stool samples for parasitological microscopy analysis in patients being investigated for inflammatory bowel disease
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