Rationality and irrationality in the use of antibiotics in the epiclatino Latin American Neonatal Units
Published on: 29th March, 2021
OCLC Number/Unique Identifier: 9006851560
Background: Recent years have seen chaos in the neonatology use of antibiotics with diverse opinions and recommendations in international guidelines and societies. This has created great uncertainty in which cases to use, for how long, and which tests apply to make these decisions.
We conducted a retrospective cohort study about the use of antibiotics in the EpicLatino neonatal units and a Latin American network database, after noting these variations in the 2019 report.
Methods: For the year 2019 using the EpicLatino database, we included cases (only first admission) ≤ 32 weeks gestational age at birth, excluding one unit that did not accept to participate.
The number of cases and days receiving antibiotics were recorded as well as the progression for each unit. Inappropriate use of antibiotics was defined as greater than 3 days in patients with negative cultures (blood/CSF cultures) excluding: major malformations, urinary tract infections, necrotizing enterocolitis (NEC) and cases with suspected chorioamnionitis in the mother (the latter two only during the course of diagnosis of NEC or chorioamnionitis).
Results: A total of 6,543 days of antibiotics were observed, 49.5% of cases had at least one positive blood/CSF culture.
A total of 595 days of antibiotics without justification were found in 72 courses in 61 cases: 19.4% had no diagnosis of infection in the database, 9.7% did not document any culture throughout their stay, and 51,4% obtained only one blood/CSF culture during their entire stay. In the 58 cases with diagnosis of infection: 41% were clinical sepsis and a diagnosis of pneumonia with a poor positive culture correlation was found. Furthermore, 74% of the unit’s didn´t use pneumonia as a justification to use antibiotics.
Other diagnosis found: Conjunctivitis, NEC 1A and rotavirus NEC.
Conclusion: Although the method of reviewing the use of antibiotics in a database has a number of limitations, especially the cause that motivated the use of antibiotics and other tools used for diagnosis of infections, the notable differences between units is striking.
Although it is difficult to make recommendations to all units, it is important to control infections in some units and in others to reduce the excessive use of antibiotics, especially with diagnosis of pneumonia in neonates and negative blood/CSF cultures.
Hospital-acquired infections and antibiotic use in a geriatric hospital: a point prevalence study
Published on: 3rd March, 2023
Background: Healthcare-Associated Infections (HAIs) are the most common healthcare-associated complications, particularly in elderly patients. The aim of this study is to describe the prevalence of HAIs and associated risk factors in the IRCCS INRCA of Ancona.Methods: A cross-sectional study has been carried out. Data has been collected in accordance with the European Centre for Disease Prevention and Control (ECDC) Point Prevalence Survey 2022-2023 (PPS3) protocol in the IRCCS INRCA of Ancona in November 2022.Results: Out of the 128 patients included in our study, 75.0% were over 78 years old and 9.1% presented an active HAI on the day of the survey. The prevalence of HAIs varied based on the length of the hospital stay (OR 1.1, CI 95% 1.05 - 1.17, p < 0.001) and hospitalization > 7 days (OR 5.9, CI 95% 1.2 - 28.7, p = 0.02).Conclusion: It is clear from our findings that HAIs are associated with advanced patient age, prolonged hospital stay, and use of medical devices, especially in those patients that, due to their clinical situation, are more vulnerable. Although some of these infections can easily be treated, it is important to develop effective infection control strategies thanks to antimicrobial stewardship programs.
Trends of Antibiotic Resistance among Uropathogens in Medical vs. Non-Medical Departments of Al-Shifa Medical Complex in Gaza Strip: A Retrospective, Cross-Sectional Study
Published on: 12th January, 2024
Antibiotic resistance is a growing global crisis, straining healthcare systems and leaving us with limited options to combat drug-resistant bacteria. This retrospective, cross-sectional study examines the prevalence of antibiotic resistance patterns among urinary tract infections (UTIs) in Al-Shifa Hospital’s medical departments in comparison with non-medical departments using data from microbiology laboratory archives over a one-year period. From the examined urine cultures about 25% were obtained from internal medicine departments and double the number was obtained from non-medical departments. The positive rate was around 35% and about two-thirds of the samples were collected from female patients. Among all departments, Enterobacteriaceae spp. were found to be the most frequently isolated uropathogens, accounting for 80% of cases. However, resistance rates varied depending on the specific organism and antibiotic used. For instance, E. coli showed a resistance rate of only 5% against meropenem, while amoxicillin-clavulanic acid exhibited a resistance rate exceeding 95%.Importantly, the study revealed a significant disparity in resistance rates between medical and non-medical departments, specifically concerning third-generation cephalosporins. In internal medicine departments, resistance rates were alarmingly high, with cefotaxime, ceftriaxone, and ceftazidime showing resistance rates of 75%, 75% and 66.5% respectively. In contrast, non-medical departments displayed lower resistance rates, approximately 60%, 60% and 40%, respectively.In summary, this research sheds light on the escalating problem of antibiotic resistance in UTIs and emphasizes the discrepancy in resistance rates between medical and non-medical departments. Urgent efforts are required to address this issue and find effective solutions to prevent the rise of untreatable bacterial infections.
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