Antimicrobial stewardship in the neonatal unit reduces antibiotic exposure.

AIM: Antimicrobial stewardship plays an important role in ensuring that the appropriate drug, dose, route and duration are employed to provide adequate treatment while minimising the risks of unnecessary antibiotic use. Surveillance of antibiotic use with prescriber feedback is recommended as a high-impact stewardship intervention. The aim of this study was to reduce unnecessary antimicrobial use in a neonatal unit. METHODS: A prospective audit was performed to assess compliance with antimicrobial guidelines. Following this, educational interventions were applied, electronic prescribing was introduced to the neonatal unit, and re-audit was performed. The primary outcome was a reduction in days of therapy (DOT). RESULTS: There were 312 neonatal admissions. There was a significant overall reduction in the primary outcome of DOT/1000 patient days from 572 to 417 DOT. This represents a 27% reduction in total antibiotic use. Prolonged antibiotic treatment courses >36 hours in negative sepsis evaluations were reduced from 82 DOT to 7.5 DOT. Similarly, treatment courses greater than five days for culture-negative sepsis were reduced from 46.5 DOT to 7 DOT. CONCLUSION: Monitoring antibiotic prescribing data can provide useful insights into the trends of antibiotic use and also inform clinicians of potential areas where antibiotic use may be safely reduced.

Infants of hypothyroid mothers- are postnatal Thyroid Function Tests necessary? A Retrospective Study in a Regional Hospital.

Congenital hypothyroidism is a preventable cause of intellectual disability. The aim of this study was to establish whether adding an additional thyroid function check between days of life 10-14 in infants born to mothers with known hypothyroidism identified any additional cases of congenital hypothyroidism requiring treatment that were not detected by the national newborn bloodspot screening programme. Babies who had Thyroid Function Tests (TFTs) measured at 10-14 days of age were identified using the Paediatric Ward attenders log from the years 2012-2014. Data were collected on patients' TFTs and their mothers' Anti-Thyroid Peroxidase (Anti-TPO) antibody levels. Of the 121 patients included, none were found to have a significantly raised TSH requiring treatment. 40 infants had repeat TFTs performed. None of the 121 infants had a significantly raised TSH, which required treatment with thyroxine. Congenital hypothyroidism is already being screened for as part of the National Newborn Screening Programme. The findings of our study have led us to recommend stopping current practice of routinely checking TFTs on day 10-14 of life in infants of hypothyroid mothers.

Fitness to drive in cognitive impairment--a quantitative study of GPs' experience.

Assessing fitness to drive is part of the role of general practitioners. Cognitive impairment may affect an individual's ability to drive safely. The aims of our study were to question GPs about their experience of assessing patients with cognitive impairment for driving fitness and to explore their attitudes to this role. We carried out a quantitative cross-sectional anonymous postal survey of 200 GPs in counties Galway, Mayo and Roscommon. Ethical approval was obtained from the Irish College of General Practitioners. Data was analysed using Epi Info. The response rate was 62.5% (n=125). 86 (68.8%) GPs used guidelines when assessing fitness to drive in cognitive impairment. 83 (66.4%) respondents formally assess cognitive function. 52 (41.6%) GPs would certify someone as fit to drive with verbal restrictions. 102 (81.6%) respondents feel confident in assessing fitness to drive. 98 (78.4%) GPs have referred patients for further assessment.

Toxicity assay for deoxynivalenol using Caenorhabditis elegans.

The progeny production and development rates of the nematode Caenorhabditis elegans when treated with deoxynivalenol (DON) were examined. Both purified DON and a crude extract from Fusarium graminearum cultured on rice were tested on C. elegans wild-type (Bristol N2) and a mutant strain (AU1). Significant effects (Tukey-HSD, p<0.05) on brood size and the rate of larval development from egg to adulthood were observed. Both N2 and AU1 strains showed lower rates of development and smaller brood sizes when exposed to purified DON at concentrations of 500 and 1000 µg ml(-1) When they were exposed to crude extract containing 250 µg ml(-1) DON, the inhibition of egg hatching and a greatly reduced development rate were observed. The results suggest that selection of a more sensitive C. elegans mutant strain could be used as a suitable animal model for conducting DON toxicity assays.

Heat Resistance of Listeria monocytogenes Scott A and HAL 957E1 in Various Liquid Egg Products †.

The thermal destruction of Listeria monocytogenes Scott A and HAL 957E1 (an egg isolate) was determined in five liquid egg products. The egg products used were liquid whole egg (LWE), liquid whole egg with 10% NaCl (LWEN), liquid whole egg with 10% sucrose (LWES), egg yolk with 10% NaCl (EYN), and egg yolk with 10% sucrose (EYS). Each of these products was inoculated with the individual strains of L. monocytogenes at initial populations of 106 colony-forming units (CFU)/ml and exposed to temperatures of up to 70°C for various periods of time from which thermal death time (TDT) curves were constructed. The Scott A strain tended to be more heat resistant than the egg isolate, HAL 957E1. The sensitivity of both strains to heating was influenced by the type of egg product in which they were suspended. The highest rates of kill were noted in LWE, while survival was best in those products supplemented with NaCl (LWEN and EYN). For the nonsalted products, time and temperature combinations equivalent to those required for the high-temperature short-time (HTST) pasteurization of liquid egg achieved 1.7 to 4.4 log-unit reductions of L. monocytogenes populations, while reductions for the salted products were only 0.2 to 0.6 log units. These results suggest that current HTST pasteurization conditions for liquid egg will not ensure a Listeria -free product, especially with products supplemented with NaCl.

Psychosocial and physical activity changes after gastric restrictive procedures for morbid obesity.

Gastric restrictive procedures for morbid obesity are frequently performed to reduce problems arising from the physical limitations and social isolation of massive obesity. Numerous reports have described changes in weight after gastric restrictive operations, yet few studies have documented changes in the secondary effects of obesity. This report deals with changes in psychosocial status and physical activity occurring in 240 patients who remained in the study 3 years after surgery. These patients were members of a group of 310 patients who were entered into a prospective randomized trial to assess the relative benefits of three forms of gastric restrictive procedure. Prior to operation, and at yearly intervals after operation, the physical activities and psychosocial status of each patient was assessed by a standardized semi-structured interview. At the time of the three-year interview the median weight loss for these patients was 29.5 kg which represents 53% of excess weight lost. This weight loss was associated with a marked reduction in the amount of food eaten. There was a significant increase in the number of patients smoking more than 20 cigarettes a day and a mild increase in alcohol intake. There were significant improvements in the level of self-image and state of happiness. The social lives and sex lives of the majority of patients were improved and a significantly greater number of patients reported being in a stable emotional relationship at 3 years after operation than did so pre-operatively. There was a marked increase in the number of patients in full-time or part-time employment from 38% prior to surgery to 60% at 3 years after operation.(ABSTRACT TRUNCATED AT 250 WORDS)