Schistosoma prevalence in appendicitis.

BACKGROUND: Schistosomiasis is a waterborne trematode with numerous subtypes affecting different areas of the body. Rob Ferreira Hospital is located in an endemic area for schistosomiasis in the Lowveld region of South Africa. We set out to determine the prevalence of Sch istosoma in appendicitis. METHODS: From 2009 to 2013, all appendix samples removed in theatre were reviewed. A total of 304 cases were retrieved. Viable ova, calcified ova, or schistosomal granulomas was considered proof of exposure. RESULTS: Thirty-one out of the 304 cases revealed evidence of schistosomal exposure, equating to 10.2 %. CONCLUSION: A prevalence of more than 10 % is truly significant seeing as how a delayed diagnosis can lead to serious complications, or how a misdiagnosis can result in unnecessary and often protracted treatment with harmful drugs.

Improving antimicrobial prescribing: implementation of an antimicrobial i.v.-to-oral switch policy.

Antimicrobial stewardship programmes reduce the risk of hospital associated infections (HAI) and antimicrobial resistance, and include early intravenous-to-oral switch (IVOS) as a key stewardship measure. We audited the number of patients on intravenous antimicrobials suitable for oral switch, assessed whether prescribing guidelines were followed and reviewed prescribing documentation in three clinical areas in the Western General Hospital, Edinburgh, in late 2012. Following this, the first cycle results and local guidelines were presented at a local level and at the hospital grand rounds, posters with recommendations were distributed, joint infection consult and antimicrobial rounds commenced and an alert antimicrobial policy was introduced before re-auditing in early 2013. We demonstrate suboptimal prescribing of intravenous antimicrobials, with 43.9% (43/98) of patients eligible for IVOS at the time of auditing. Only 56.1% (55/98) followed empiric prescribing recommendations. Documentation of antimicrobial prescribing was poor with stop dates recorded in 14.3%, indication on prescription charts in 18.4% and in the notes in 90.8%. The commonest reason for deferring IVOS was deteriorating clinical condition or severe sepsis. Further work to encourage prudent antimicrobial prescribing and earlier consideration of IVOS is required.

Non-tuberculous mycobacterial infections in the Scottish Borders: identification, management and treatment outcomes--a retrospective review.

Non-tuberculous mycobacteria are opportunist pathogens increasingly recognised as a cause of pulmonary and extrapulmonary disease. Treatment is complicated, prolonged and potentially toxic, and due to a limited evidence base, potentially contentious and idiosyncratic. This is a retrospective review of non-tuberculous mycobacteria cases in the NHS Borders Health Board between 1992 and 2010. We consider incidence, species identified, drug sensitivity testing and treatment outcome with reference to the British and American Thoracic Society guidelines. Thirty-eight cases of non-tuberculous mycobacteria isolates were identified; 84.21% were pulmonary and 42.11% were Mycobacterium avium complex. Incidence rose from 1.92/100,000 in 1993 to 4.43/100,000 in 2010. The British Thoracic Society guidelines were followed in 45.45% of cases. A total of 36.36% were successfully treated with another 36.36% still being treated with antimicrobials. There is a clear need for more research on treatment for this group of 'emerging pathogens' and it remains to be seen if concordance with current guidelines will improve treatment outcomes.