All ED patients, as part of the intervention, were started on empiric carbapenem protocol (CP). CRE screening results were communicated immediately. Negative CRE results led to discontinuation of CP. Patients were retested if their ED stay surpassed seven days or if they were moved to the intensive care unit.
A total of 845 patients were enrolled, with 342 at baseline and 503 in the intervention group. According to combined culture and molecular tests performed at admission, the colonization rate was 34%. Acquisition rates during Emergency Department (ED) stays decreased from a baseline of 46% (11/241) to a significantly lower rate of 1% (5/416) during the intervention phase (P = .06). The antimicrobial usage in the ED exhibited a marked decline from phase 1 to phase 2. The reduction was from 804 defined daily doses (DDD)/1000 patients in phase 1 to 394 DDD/1000 patients in phase 2. Extended emergency department stays of more than two days were shown to significantly increase the likelihood of CRE acquisition. This association was quantified by an adjusted odds ratio of 458 (95% confidence interval, 144-1458) and a statistically significant p-value of .01.
Early experience with empirical treatment of community-acquired pneumonia and swift identification of carbapenem-resistant Enterobacteriaceae-colonized patients minimize cross-transmission within the emergency department. Nevertheless, an extended stay of greater than two days in the emergency department proved to be counterproductive.
The two days in the emergency department served to impede the effectiveness of the following attempts.
Global antimicrobial resistance has a deeply damaging effect on low- and middle-income countries. In Chile, the prevalence of fecal colonization by antimicrobial-resistant gram-negative bacteria (GNB) was estimated in hospitalized and community-dwelling adults before the coronavirus disease 2019 pandemic, according to this study.
Between December 2018 and May 2019, hospitalized adults from four public hospitals in central Chile, alongside community residents, participated in a study, providing fecal samples and epidemiological data. Upon MacConkey agar, samples were placed, with either ciprofloxacin or ceftazidime added. The recovered morphotypes were identified and characterized, revealing phenotypes categorized as fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR, according to Centers for Disease Control and Prevention criteria) Gram-negative bacteria (GNB). Categories demonstrated a lack of mutual exclusivity.
A total of 775 hospitalized adults and 357 individuals residing in the community were participants in the study. Hospitalized individuals exhibiting colonization by FQR, ESCR, CR, or MDR-GNB were observed at rates of 464% (95% confidence interval [CI], 429-500), 412% (95% CI, 377-446), 145% (95% CI, 120-169), and 263% (95% CI, 232-294), respectively, within the study population. The rates of FQR, ESCR, CR, and MDR-GNB colonization within the community were as follows: 395% (95% CI, 344-446), 289% (95% CI, 242-336), 56% (95% CI, 32-80), and 48% (95% CI, 26-70), respectively.
The prevalence of antimicrobial-resistant Gram-negative bacilli colonization was notably high among hospitalized and community-dwelling adults in this study, suggesting the community as a significant source of antibiotic resistance. To comprehend the interconnectedness of resistant strains circulating in hospitals and the community, more effort is needed.
This study of hospitalized and community-dwelling adults' samples revealed a significant prevalence of antimicrobial-resistant Gram-negative bacteria colonization, implying the importance of the community as a relevant source of antibiotic resistance. The relationship between resistant strains circulating in the community and in hospitals needs to be addressed with dedicated efforts.
Antimicrobial resistance has seen a deterioration in Latin America. The development of antimicrobial stewardship programs (ASPs) and the barriers to their implementation deserve immediate attention, considering the paucity of national action plans or policies to bolster ASPs in this region.
A descriptive mixed-methods study of ASPs was implemented across five Latin American countries in the time frame of March to July 2022. A-83-01 datasheet Utilizing an electronic questionnaire, a scoring system (hospital ASP self-assessment) was implemented to classify ASP development into categories: inadequate (0-25), basic (26-50), intermediate (51-75), or advanced (76-100). Infection model Healthcare workers (HCWs) involved in antimicrobial stewardship (AS) were interviewed to ascertain the behavioral and organizational factors impacting AS practices. Interview data were subjected to thematic coding and analysis. To develop an explanatory framework, the results of the ASP self-assessment and interviews were integrated.
The Association of Stakeholders (AS) saw 46 of its stakeholders, from among the 20 hospitals that completed self-assessments, being interviewed. biopolymeric membrane 35 percent of hospitals lacked adequate ASP development skills, while 50 percent possessed intermediate skills, and 15 percent had advanced ASP development. Not-for-profit hospitals' scores were demonstrably lower than those achieved by for-profit hospitals. The interview data underscored the challenges in ASP implementation, affirming the self-assessment's findings. These difficulties included a lack of formal hospital leadership support, insufficient staffing and tools to streamline AS work, inadequate awareness of AS principles amongst healthcare workers, and a lack of training opportunities.
Our research unearthed significant roadblocks to ASP implementation in Latin America, thereby emphasizing the crucial need for meticulous business case development to attain the financial resources for sustainable ASP deployment.
Significant roadblocks to ASP development were identified throughout Latin America, underpinning the necessity for detailed business case constructions that enable ASPs to secure the required financing for effective implementation and long-term sustainability.
Hospitalized patients with COVID-19 have displayed high rates of antibiotic use (AU) despite a relatively low incidence of bacterial co-infections and subsequent infections. Analyzing the COVID-19 pandemic's repercussions on healthcare facilities (HCFs) in South America, particularly Australia (AU), was our objective.
Our ecological assessment of AU encompassed two healthcare facilities (HCFs) in each of Argentina, Brazil, and Chile's adult inpatient acute care wards. The AU rates for intravenous antibiotics, calculated using the defined daily dose per 1000 patient-days, were derived from pharmacy dispensing records and hospital data spanning March 2018 to February 2020 (pre-pandemic) and March 2020 to February 2021 (pandemic). The Wilcoxon rank-sum test was utilized to analyze the statistical significance of variations in median AU values observed between the pre-pandemic and pandemic periods. Changes in AU during the COVID-19 pandemic were investigated using interrupted time series analysis.
Analyzing antibiotic AU rates relative to the pre-pandemic period, a median increase in the difference was observed in four of six healthcare facilities (percentage change between 67% and 351%; statistically significant, P < .05). In interrupted time series models, five of six healthcare facilities demonstrated a substantial immediate increase in the combined usage of all antibiotics at the start of the pandemic (estimated immediate effect range, 154-268), but only one facility showed a sustained upward trajectory in antibiotic use over the period (change in slope, +813; P < .01). Antibiotic groups and HCF levels displayed a range of responses to the onset of the pandemic.
A significant rise in antibiotic utilization (AU) was observed at the initiation of the COVID-19 pandemic, underscoring the need to maintain or fortify antibiotic stewardship programs as critical components of emergency and pandemic healthcare interventions.
The COVID-19 pandemic's commencement was associated with noticeable increases in AU, necessitating the continuation or augmentation of antibiotic stewardship programs within pandemic or emergency healthcare systems.
Across the globe, a major public health threat arises from the spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE). Putative risk factors for colonization by ESCrE and CRE were determined in our examination of patients treated in one urban and three rural Kenyan hospitals.
In the course of a cross-sectional study, spanning January 2019 and March 2020, stool samples from randomly selected inpatients were obtained and subsequently tested for the detection of ESCrE and CRE. Isolate identification and antibiotic resistance determination were achieved through the Vitek2 instrument. LASSO regression modeling was concurrently implemented to identify colonization risk factors contingent on variations in antibiotic use.
A substantial proportion (76%) of the 840 participants in the study received just one antibiotic in the 14 days prior to their enrollment. The specific antibiotics administered were predominantly ceftriaxone (46%), metronidazole (28%), and benzylpenicillin-gentamycin (23%). Within LASSO models incorporating ceftriaxone, a three-day hospital stay exhibited a considerable increase in the odds of ESCrE colonization (odds ratio 232, 95% confidence interval 16-337; P < .001). The group of intubated patients totalled 173 (a range of 103 to 291), demonstrating a statistically significant pattern (P = .009). The presence of human immunodeficiency virus (HIV) correlated with a distinct finding in the study population (170 [103-28], P = .029). Patients receiving ceftriaxone experienced a substantially increased probability of CRE colonization, as evidenced by an odds ratio of 223 (95% confidence interval 114-438), and a statistically significant association (P = .025). Every additional day of antibiotic use was linked to a substantial and statistically significant change in the results (108 [103-113]; P = .002).