ABSTRACT
Background: Antimicrobial stewardship (AMS) programmes are established across the world to treat infections efficiently, prioritize patient safety, and reduce the emergence of antimicrobial resistance. One of the core elements of AMS programmes is guidance to support and direct physicians in making efficient, safe and optimal decisions when prescribing antibiotics. To optimize and tailor AMS, we need a better understanding of prescribing physicians' experience with AMS guidance. Objectives: To explore the prescribing physicians' user experience, needs and targeted improvements of AMS guidance in hospital settings. Methods: Semi-structured interviews were conducted with 36 prescribing physicians/AMS guidance users from hospital settings in Canada, Germany, Israel, Latvia, Norway and Sweden as a part of the international PILGRIM trial. A socioecological model was applied as an overarching conceptual framework for the study. Results: Research participants were seeking more AMS guidance than is currently available to them. The most important aspects and targets for improvement of AMS guidance were: (i) quality of guidelines; (ii) availability of infectious diseases specialists; and (iii) suitability of AMS guidance to department context. Conclusions: Achieving prudent antibiotic use not only depends on individual and collective levels of commitment to follow AMS guidance but also on the quality, availability and suitability of the guidance itself. More substantial commitment from stakeholders is needed to allocate the required resources for delivering high-quality, available and relevant AMS guidance to make sure that the prescribers' AMS needs are met.
ABSTRACT
Infections with OXA-244-carbapenemase-producing Escherichia coli with sequence type (ST)38 have recently increased in Europe. Due to its low-level activity against carbapenems, OXA-244 can be difficult to detect. Previous assessments have not revealed a clear source and route of transmission for OXA-244-producing E. coli, but there are indications of non-healthcare related sources and community spread. Here we report a hospital-associated outbreak of OXA-244-producing E. coli ST38 involving three hospitals in Western Norway in 2020. The outbreak occurred over a 5-month period and included 12 cases identified through clinical (n = 6) and screening (n = 6) samples. The transmission chain was unclear; cases were identified in several wards and there was no clear overlap of patient stay. However, all patients had been admitted to the same tertiary hospital in the region, where screening revealed an outbreak in one ward (one clinical case and five screening cases). Outbreak control measures were instigated including contact tracing, isolation, and screening; no further cases were identified in 2021. This outbreak adds another dimension to the spread of OXA-244-producing E. coli ST38, illustrating this clone's ability to establish itself in the healthcare setting. Awareness of challenges concerning OXA-244-producing E. coli diagnostic is important to prevent further spread.
Subject(s)
Escherichia coli Infections , Escherichia coli , Humans , Escherichia coli/genetics , Escherichia coli Infections/diagnosis , Escherichia coli Infections/epidemiology , beta-Lactamases/genetics , Disease Outbreaks , Tertiary Care Centers , Norway/epidemiology , Bacterial Proteins , Klebsiella pneumoniaeABSTRACT
BAKGRUNN: I norsk helsevesen gjennomføres omfattende tiltak for å hindre spredning av meticillinresistente Staphylococcus aureus (MRSA). Vi ønsket å undersøke hvor mange smitteoppsporinger som gjøres rundt nyoppdagede MRSA-tilfeller hos pasienter og ansatte i sykehus, og hvor ofte smitteoppsporingene fører til ytterligere funn hos helsepersonell. MATERIALE OG METODE: I denne retrospektive observasjonsstudien bidro smittevernenhetene ved åtte helseforetak i landets fire helseregioner med opplysninger om MRSA-funn hos helsepersonell etter gjennomførte MRSA-smitteoppsporinger. Data ble innhentet fra 14 ulike somatiske sykehus i årene 2012-15. RESULTATER: 10 142 ansatte i helsevesenet ble testet for MRSA, med positivt funn hos 31 ansatte (0,31 %). Hos 19 ansatte (0,19 %) ble det påvist samme MRSA-stamme som hos indekskasus. I kun to av 351 smitteoppsporinger (0,57 %) ble samme MRSA-stamme funnet hos mer enn én ansatt. FORTOLKNING: MRSA-smitteoppsporing i norske sykehus har et betydelig omfang, men det er sjelden det påvises MRSA hos helsepersonell i forbindelse med smitteoppsporing.
