ABSTRACT
Primary care antimicrobial stewardship program (ASP) interventions can reduce the over-prescription of unnecessary antibiotics, but the impact on the reduction in bacterial resistance is less known, and there is a lack of available data. We implemented a prolonged educational counseling ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, which was compared to a pre-intervention period, a significant reduction in antibiotic prescriptions occurred, particularly those associated with greater harmful effects and resistance selection. There was also a decrease in methicillin-resistant Staphylococcus aureus (MRSA) strains and in their co-resistance to other antibiotics, particularly those with an ecological impact.
ABSTRACT
Antimicrobial stewardship programs (ASPs) are a central component in reducing the overprescription of unnecessary antibiotics, with multiple studies showing benefits in the reduction of bacterial resistance. Less commonly, ASPs have been performed in outpatient settings, but there is a lack of available data in these settings. We implemented an ASP in a large regional outpatient setting to assess its feasibility and effectiveness. Over a 5-year post-implementation period, compared to the pre-intervention period, a significant reduction in antibiotic prescription occurred, with a reduction in resistance in E. coli urinary isolates. ASP activities also were found to be cost-effective, with a reduction in medication prescription.
ABSTRACT
No disponible
Subject(s)
Humans , Male , Adolescent , Arthritis, Infectious/complications , Arthritis, Infectious/diagnosis , Arthritis, Infectious/therapy , Osteomyelitis/complications , Osteomyelitis/diagnosis , Scedosporium , Scedosporium/isolation & purification , Enterobacter cloacae/isolation & purification , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Voriconazole/therapeutic use , Enterobacter cloacae , Synovitis/complications , Synovitis/physiopathology , Synovitis , Tibial Fractures/complications , Tibial Fractures/therapy , Tibial Fractures , Early DiagnosisSubject(s)
Arthritis, Infectious/microbiology , Knee Injuries/microbiology , Knee Joint/microbiology , Mycoses/microbiology , Osteomyelitis/microbiology , Scedosporium/isolation & purification , Wound Infection/microbiology , Adolescent , Anti-Bacterial Agents/therapeutic use , Antifungal Agents/therapeutic use , Arthritis, Infectious/drug therapy , Arthritis, Infectious/etiology , Arthritis, Infectious/surgery , Combined Modality Therapy , Debridement , Enterobacter cloacae/isolation & purification , Enterobacteriaceae Infections/complications , Enterobacteriaceae Infections/microbiology , Humans , Immunocompetence , Male , Mycoses/drug therapy , Mycoses/surgery , Osteomyelitis/drug therapy , Osteomyelitis/etiology , Osteomyelitis/surgery , Synovial Fluid/microbiology , Wounds, Penetrating/microbiologySubject(s)
Giant Cell Arteritis/etiology , Influenza Vaccines/adverse effects , Aged , Humans , MaleABSTRACT
No disponible
Subject(s)
Humans , Male , Aged , Influenza Vaccines/adverse effects , Giant Cell Arteritis/etiologyABSTRACT
BACKGROUND AND OBJECTIVE: To identify the infection risk factors in knee and hip total prosthesis. METHOD: Case-control study of arthoplasties performed during 10 years. RESULTS: By means of conditional multivariate analysis, infection risk factors with greater odds ratio (OR) were surgical risk rate >or= 2, according to the National Nosocomial Infections Surveillance (NNIS) (OR, 3.3; 95% confidence interval [CI], 1.1-10.8) and post-operative non-infectious complications (OR, 8.9; 95% CI, 1.1-83.1) (p < 0.05). The global infection rate was 2.4% (95% CI, 1.6%-3.2%) of 1,666 joint implants. Gram-positive cocci were the principal involved microorganisms (63%). CONCLUSIONS: A high NNIS together with non-infectious post-operative complications increase the risk of prosthesis infection.
Subject(s)
Hip Prosthesis/adverse effects , Knee Prosthesis/adverse effects , Prosthesis-Related Infections/epidemiology , Aged , Case-Control Studies , Female , Humans , Male , Risk FactorsABSTRACT
Fundamento y objetivo: El propósito del presente estudio es identificar los factores de riesgo de infección en prótesis totales de rodilla y cadera. Método: Se ha realizado un estudio de casos y controles entre las artroplastias efectuadas durante 10 años. Resultados: Mediante el ajuste con una regresión logística condicional múltiple, los factores de riesgo asociados a una mayor odds ratio (OR) de infección fueron: un índice de riesgo quirúrgico mayor o igual a 2 según el National Nosocomial Infections Surveillance (NNIS) (OR = 3,3; intervalo de confianza [IC] del 95%, 1,1-10,8) y las complicaciones no infecciosas posquirúrgicas (OR = 8,9; IC del 95%, 1,1-83,1) (p < 0,05). La tasa de infección global de las artroplastias fue del 2,4% (IC del 95%, 1,6-3,2%) sobre 40 casos de 1.666 implantes y los principales microorganismos fueron cocos grampositivos (63%). Conclusiones: Un índice NNIS elevado y las complicaciones posquirúrgicas no infecciosas incrementan el riego de infección de las prótesis articulares de rodilla y cadera
Background and objective: To identify the infection risk factors in knee and hip total prosthesis. Method: Case-control study of arthoplasties performed during 10 years. Results: By means of conditional multivariate analysis, infection risk factors with greater odds ratio (OR) were surgical risk rate >= 2, according to the National Nosocomial Infections Surveillance (NNIS) (OR, 3.3; 95% confidence interval [CI], 1.1-10.8) and post-operative non-infectious complications (OR, 8.9; 95% CI, 1.1-83.1) (p < 0.05). The global infection rate was 2.4% (95% CI, 1.6%-3.2%) of 1,666 joint implants. Gram-positive cocci were the principal involved microorganisms (63%). Conclusions: A high NNIS together with non-infectious post-operative complications increase the risk of prosthesis infection
Subject(s)
Male , Female , Aged , Humans , Arthroplasty, Replacement/adverse effects , Prosthesis-Related Infections/microbiology , Risk Adjustment/methods , Risk Factors , Postoperative Complications , Osteoarthritis/complicationsSubject(s)
Acetamides/therapeutic use , Anti-Bacterial Agents/therapeutic use , Knee Prosthesis , Methicillin Resistance , Oxazolidinones/therapeutic use , Prosthesis-Related Infections/drug therapy , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis , Female , Humans , Linezolid , Middle AgedABSTRACT
No disponible
