Journal of Hospital Infection最新文献_第8页

Can screening and decontamination procedures performed on an outpatient basis reduce colonization with Staphylococcus aureus and mitigate associated complications in patients undergoing elective hospital procedures? A controlled intervention study (STAUfrei) 门诊进行的筛查和去污程序能否减少金黄色葡萄球菌的定植并减轻选择性医院手术患者的相关并发症？对照干预研究（STAUfrei）。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-12-09 DOI: 10.1016/j.jhin.2024.12.001

A. Bauer , H. Sturm , P. Martus , B. Brüggenjürgen , H. Eberhardt , E. Mayer , R. Schulz , J. Bernhold , T. Krause , P. Höllein , J. Liese , S. Wolf , S. Joos , M. Grünewald , STAUfrei Consortium

Background

Staphylococcus aureus colonization increases the risk of wound infection in surgical procedures. Prevention strategies to date have focused primarily on the hospital setting, although there are recommendations for pre-hospital decontamination at home, which can be performed by patients themselves. This study aimed to shift the process of screening and decontamination of S. aureus [meticillin-resistant S. aureus (MRSA) and meticillin-susceptible S. aureus (MSSA)] out of the hospital setting.

Methods

Between April 2019 and March 2022, 8054 (intervention group N=3390, control group 4664) patients (age >18 years) undergoing elective procedures in a hospital in Baden-Württemberg (Germany) were recruited for the study. The intervention consisted of 5 days of decontamination carried out by patients (or their caregivers) in their domestic environment. The analysis comprised a simple arm comparison of colonization rates at admission between study groups, as well as adjusted logistic regressions.

Results

After adjustment for relevant risk factors, the intervention reduced the risk of S. aureus colonization at admission by 14%; this difference was significant (odds ratio 0.86, 95% confidence interval 0.74–0.10; P=0.046). Re-admission was significantly less common in the intervention group. Signs of wound infection and recolonization after invasive procedures did not differ significantly between the study groups.

Conclusions

Outpatient decontamination measures appear to be more effective compared with routine care. As the results from logistic regressions are based on MSSA, its consideration in clinical hygiene management should be discussed. Strict adherence during the coronavirus disease 2019 pandemic was challenging, potentially underestimating the overall impact of the intervention.

背景：外科手术中金黄色葡萄球菌（SA）定殖增加伤口感染的风险。迄今为止，预防战略主要集中在医院，尽管有建议在家中进行院前消毒，这可以由患者自己进行。目前的研究旨在将SA（耐甲氧西林金黄色葡萄球菌（MRSA）和甲氧西林敏感金黄色葡萄球菌（MSSA））的筛选和净化过程转移到医院环境之外。方法：在2019年4月至2022年3月期间，在德国巴登-符腾堡州一家医院接受选择性手术的N=8054例（干预组=3390例）患者（bb0 - 18岁）纳入研究。干预包括由患者（或其护理人员）在其家庭环境中进行为期5天的净化。该分析包括对研究组入院时的定植率进行简单的对照比较以及调整后的逻辑回归。结果：调整相关危险因素后，干预使入院时SA定植的风险降低了14%，具有统计学意义(优势比：0.86 (95% CI: 0.74-0.10；p = 0.046)。干预组再次住院的频率也显著降低。有创手术后伤口感染和再定植的迹象在研究组之间没有显著差异。结论：与常规护理相比，门诊消毒措施更有效。由于logistic回归的结果是基于甲氧西林敏感SA (MSSA)，在临床卫生管理中应考虑到它。大流行期间的严格遵守具有挑战性，可能低估了干预措施的总体影响。

{"title":"Can screening and decontamination procedures performed on an outpatient basis reduce colonization with Staphylococcus aureus and mitigate associated complications in patients undergoing elective hospital procedures? A controlled intervention study (STAUfrei)","authors":"A. Bauer , H. Sturm , P. Martus , B. Brüggenjürgen , H. Eberhardt , E. Mayer , R. Schulz , J. Bernhold , T. Krause , P. Höllein , J. Liese , S. Wolf , S. Joos , M. Grünewald , STAUfrei Consortium","doi":"10.1016/j.jhin.2024.12.001","DOIUrl":"10.1016/j.jhin.2024.12.001","url":null,"abstract":"<div><h3>Background</h3><div><em>Staphylococcus aureus</em> colonization increases the risk of wound infection in surgical procedures. Prevention strategies to date have focused primarily on the hospital setting, although there are recommendations for pre-hospital decontamination at home, which can be performed by patients themselves. This study aimed to shift the process of screening and decontamination of <em>S</em>. <em>aureus</em> [meticillin-resistant <em>S. aureus</em> (MRSA) and meticillin-susceptible <em>S. aureus</em> (MSSA)] out of the hospital setting.</div></div><div><h3>Methods</h3><div>Between April 2019 and March 2022, 8054 (intervention group <em>N</em>=3390, control group 4664) patients (age >18 years) undergoing elective procedures in a hospital in Baden-Württemberg (Germany) were recruited for the study. The intervention consisted of 5 days of decontamination carried out by patients (or their caregivers) in their domestic environment. The analysis comprised a simple arm comparison of colonization rates at admission between study groups, as well as adjusted logistic regressions.</div></div><div><h3>Results</h3><div>After adjustment for relevant risk factors, the intervention reduced the risk of <em>S</em>. <em>aureus</em> colonization at admission by 14%; this difference was significant (odds ratio 0.86, 95% confidence interval 0.74–0.10; <em>P</em>=0.046). Re-admission was significantly less common in the intervention group. Signs of wound infection and recolonization after invasive procedures did not differ significantly between the study groups.</div></div><div><h3>Conclusions</h3><div>Outpatient decontamination measures appear to be more effective compared with routine care. As the results from logistic regressions are based on MSSA, its consideration in clinical hygiene management should be discussed. Strict adherence during the coronavirus disease 2019 pandemic was challenging, potentially underestimating the overall impact of the intervention.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"157 ","pages":"Pages 19-28"},"PeriodicalIF":3.9,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Cost-effectiveness of faecal microbiota transplantation compared with vancomycin monotherapy for early Clostridioides difficile infection: economic evaluation alongside a randomized controlled trial 粪便微生物群移植与万古霉素单药治疗早期艰难梭菌感染的成本效益比较：随机对照试验的经济评估。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-14 DOI: 10.1016/j.jhin.2024.11.003

C.R. Birch , S.E. Paaske , M.B. Jensen , S.M.D. Baunwall , L.H. Ehlers , C.L. Hvas

Background

For Clostridioides difficile infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode.

Aim

The aim was to investigate hospital costs of FMT as a complementary treatment compared with current standard care in patients with first or second CDI.

Findings

Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use. In the sensitivity analyses, FMT remained cost-effective as long as the treatment cost of FMT stayed below approximately €1,572 per component, corresponding to a total cost of FMT treatment (two components) of €3,144.

Conclusion

FMT was cost-effective with both lower costs and greater effectiveness than current standard care involving vancomycin monotherapy. The findings were robust to sensivity analyses, with a threshold cost for one FMT treatment consisting of two components of €3,144.

对于艰难梭菌感染（CDI），目前建议对 CDI 发作三次或三次以上的患者进行粪便微生物群移植（FMT）。最近的一项随机对照试验（RCT）表明，可以考虑尽早进行 FMT，即在 CDI 首次或第二次发作时进行干预。与针对首次或第二次 CDI 的标准治疗相比，随机接受 FMT 治疗的患者在 26 周内的住院费用降低了 1645 欧元，原因是入院次数和医院接触次数减少，用药次数减少。

{"title":"Cost-effectiveness of faecal microbiota transplantation compared with vancomycin monotherapy for early Clostridioides difficile infection: economic evaluation alongside a randomized controlled trial","authors":"C.R. Birch , S.E. Paaske , M.B. Jensen , S.M.D. Baunwall , L.H. Ehlers , C.L. Hvas","doi":"10.1016/j.jhin.2024.11.003","DOIUrl":"10.1016/j.jhin.2024.11.003","url":null,"abstract":"<div><h3>Background</h3><div>For <em>Clostridioides difficile</em> infection (CDI), faecal microbiota transplantation (FMT) is currently recommended for patients with three or more CDI episodes. A recent randomised controlled trial (RCT) show that FMT may be considered early, defined as intervention during the first or second CDI episode.</div></div><div><h3>Aim</h3><div>The aim was to investigate hospital costs of FMT as a complementary treatment compared with current standard care in patients with first or second CDI.</div></div><div><h3>Findings</h3><div>Compared with standard care for first or second CDI, patients randomised to FMT had €1,645 lower hospital costs over 26 weeks owing to fewer admissions and hospital contacts and less medication use. In the sensitivity analyses, FMT remained cost-effective as long as the treatment cost of FMT stayed below approximately €1,572 per component, corresponding to a total cost of FMT treatment (two components) of €3,144.</div></div><div><h3>Conclusion</h3><div>FMT was cost-effective with both lower costs and greater effectiveness than current standard care involving vancomycin monotherapy. The findings were robust to sensivity analyses, with a threshold cost for one FMT treatment consisting of two components of €3,144.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 145-149"},"PeriodicalIF":3.9,"publicationDate":"2024-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142640158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Mycobacteroides abscessus outbreak and mitigation in a cardiothoracic transplant population: the problem with tap water 心胸移植人群中分枝杆菌脓肿的爆发与缓解：自来水的问题。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-07 DOI: 10.1016/j.jhin.2024.10.016

S.N. Rathod , R.T. Weber , A.A. Salim , S.D. Tanna , V. Stosor , M. Malczynski , A. O'Boye , K. Hoke , J. Landon , S. McCarthy , C. Qi , M.P. Angarone , M.G. Ison , J.L. Williams , T.R. Zembower , M.K. Bolon

Background

Hospital outbreaks caused by Mycobacteroides abscessus complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population.

Aim

To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated M. abscessus complex cases in an inpatient cardiothoracic transplant population.

Methods

We extracted clinical characteristics from patients with M. abscessus pre-outbreak (March 2018 to December 2020) and during the outbreak (January 2021 to June 2022) from the electronic medical record. A multi-disciplinary team conducted the outbreak investigation and devised a mitigation strategy to implement at our institution.

Findings

The baseline incidence of healthcare-associated M. abscessus was 0.11 cases per 10,000 patient-days; this increased to 0.24 cases per 10,000 patient-days during the outbreak. There were 1/9 (11%) cardiothoracic transplant patients in the pre-outbreak group compared with 7/12 (58%) during the outbreak, and respiratory specimen types compromised 6/9 (67%) of M. abscessus results in the pre-outbreak group compared with 10/12 (83%) during the outbreak. Among the clinical care activities involving water, a variety of water sources were utilized, including filtered and tap water. The incidence of healthcare-associated M. abscessus subsequently decreased to 0.06 cases per 10,000 patient-days after implementing an outbreak-mitigation strategy of sterile water precautions.

Conclusions

Robust educational efforts from a multi-disciplinary team on eliminating exposure to tap water were effective measures to reduce healthcare-associated M. abscessus incidence at our institution. Non-tuberculous mycobacteria infection surveillance, targeted education, and water mitigation strategies may be beneficial preventative strategies for other lung transplant centres facing similar issues.

背景：目的：描述疫情调查和缓解措施，以应对心胸移植住院患者中医源性脓肿分支杆菌病例的增加：我们从电子病历中提取了脓肿分枝杆菌爆发前（2018 年 3 月至 2020 年 12 月）和爆发期间（2021 年 1 月至 2022 年 6 月）患者的临床特征。一个多学科团队对疫情进行了调查，并制定了在本机构实施的缓解策略：脓毒症基线发病率为每万个患者日0.11例，疫情爆发期间增至每万个患者日0.24例。疫情爆发前，1/9（11%）名心胸移植患者感染了脓毒性霉菌，而疫情爆发期间，7/12（58%）名心胸移植患者感染了脓毒性霉菌；疫情爆发前，6/9（67%）名呼吸道标本类型患者感染了脓毒性霉菌，而疫情爆发期间，10/12（83%）名呼吸道标本类型患者感染了脓毒性霉菌。在涉及水的临床护理活动中，使用了各种水源，包括过滤水和自来水。在实施无菌水预防措施的疫情缓解策略后，与医疗保健相关的脓毒症霉菌发病率降至每万个患者日 0.06 例：结论：多学科团队就杜绝接触自来水开展了强有力的教育工作，是降低本机构医源性脓毒症发病率的有效措施。对于面临类似问题的其他肺移植中心来说，NTM 感染监测、有针对性的教育和用水防护策略可能是有益的预防策略。

{"title":"Mycobacteroides abscessus outbreak and mitigation in a cardiothoracic transplant population: the problem with tap water","authors":"S.N. Rathod , R.T. Weber , A.A. Salim , S.D. Tanna , V. Stosor , M. Malczynski , A. O'Boye , K. Hoke , J. Landon , S. McCarthy , C. Qi , M.P. Angarone , M.G. Ison , J.L. Williams , T.R. Zembower , M.K. Bolon","doi":"10.1016/j.jhin.2024.10.016","DOIUrl":"10.1016/j.jhin.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Hospital outbreaks caused by <em>Mycobacteroides abscessus</em> complex are a major cause for concern in vulnerable patients such as the cardiothoracic transplant population.</div></div><div><h3>Aim</h3><div>To describe the outbreak investigation and mitigation steps undertaken to address an increase in healthcare-associated <em>M. abscessus</em> complex cases in an inpatient cardiothoracic transplant population.</div></div><div><h3>Methods</h3><div>We extracted clinical characteristics from patients with <em>M. abscessus</em> pre-outbreak (March 2018 to December 2020) and during the outbreak (January 2021 to June 2022) from the electronic medical record. A multi-disciplinary team conducted the outbreak investigation and devised a mitigation strategy to implement at our institution.</div></div><div><h3>Findings</h3><div>The baseline incidence of healthcare-associated <em>M. abscessus</em> was 0.11 cases per 10,000 patient-days; this increased to 0.24 cases per 10,000 patient-days during the outbreak. There were 1/9 (11%) cardiothoracic transplant patients in the pre-outbreak group compared with 7/12 (58%) during the outbreak, and respiratory specimen types compromised 6/9 (67%) of <em>M. abscessus</em> results in the pre-outbreak group compared with 10/12 (83%) during the outbreak. Among the clinical care activities involving water, a variety of water sources were utilized, including filtered and tap water. The incidence of healthcare-associated <em>M. abscessus</em> subsequently decreased to 0.06 cases per 10,000 patient-days after implementing an outbreak-mitigation strategy of sterile water precautions.</div></div><div><h3>Conclusions</h3><div>Robust educational efforts from a multi-disciplinary team on eliminating exposure to tap water were effective measures to reduce healthcare-associated <em>M. abscessus</em> incidence at our institution. Non-tuberculous mycobacteria infection surveillance, targeted education, and water mitigation strategies may be beneficial preventative strategies for other lung transplant centres facing similar issues.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 150-157"},"PeriodicalIF":3.9,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Missed Infection Prevention and Control Activities and Their Predictors: Insights from a Pre- and Post-Pandemic Study 错过的感染预防和控制活动及其预测因素：大流行前后研究的启示。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-06 DOI: 10.1016/j.jhin.2024.10.015

Chiara Moreal , Stefania Chiappinotto , Ian Blackman , Luca Grassetti , Sara Scarsini , Barbara Narduzzi , Maura Mesaglio , Carlo Tascini , Alvisa Palese

Aim

The primary aim was to compare differences, if any, in missed infection prevention and control (IPC) activities before and after the pandemic, along with the related predictors. The secondary aim was to identify relationships between missed IPC activities and unfinished nursing care.

Methods

A repeated cross-sectional design was conducted in 2019 (pre-pandemic, 184 nurses) and 2024 (post-pandemic, 240 nurses) in a large academic hospital following the Checklist for Reporting of Survey Studies guidelines. The Missed Nursing Care in Infection Prevention and Control Survey (MNC-IPC) (Part A: missed activities, Part B: reasons), the Unfinished Nursing Care Survey (UNCS), and professional data were collected homogeneously across both periods.

Findings

Self-reported missed IPC activities decreased from 2.15 out of 5 (95% CI, 2.05–2.25) to 1.51 (95% CI, 1.45–1.58) (p < 0.0005), as did the related reasons, which decreased from 2.35 out of 4 (95% CI, 2.24–2.46) to 2.20 (95% CI, 2.11–2.30) (p = 0.046). The total variance in the MNC-IPC overall scores was explained by 22.8% (pre-) and 20.7% (post-pandemic) by different predictors: system-level issues (estimated value 0.409, p = 0.008) and nurses’ intention to leave (0.107, p = 0.023) in the pre-pandemic and by the number of patients admitted in the last shift (0.015, p = 0.053), organisational issues (0.186, p < 0.0005) and priority-setting issues (0.092, p = 0.053) in the post-pandemic period. MNC-IPC and UNCS scores have reported significant correlations in both periods.

Conclusion

Missed IPC activities were less likely in the post-pandemic period possibly due to system efforts and lessons learned during the pandemic, which may have routinised IPC practices among nurses. Overall, predictors of missed IPC care changed after the pandemic, suggesting new patterns and the need for innovative interventions, particularly at the unit level and targeting younger nurses. The correlations between UNCS and MNC-IPC suggest that targeted improvements in one area are likely to yield positive outcomes in the other. However, despite their commonalities, these represent two distinct phenomena.

目的：主要目的是比较大流行前后错过的感染预防和控制 (IPC) 活动的差异（如果有的话）以及相关的预测因素。次要目的是确定错过的 IPC 活动与未完成的护理之间的关系：按照调查研究报告核对表指南，于 2019 年（大流行前，184 名护士）和 2024 年（大流行后，240 名护士）在一家大型学术医院进行了重复横断面设计。感染预防与控制护理缺失调查（MNC-IPC）（A部分：缺失活动，B部分：原因）、未完成护理调查（UNCS）和专业数据在这两个时期内统一收集：自我报告错过的 IPC 活动从 5 项中的 2.15 项（95% CI，2.05-2.25）降至 1.51 项（95% CI，1.45-1.58）（p < 0.0005），相关原因也从 4 项中的 2.35 项（95% CI，2.24-2.46）降至 2.20 项（95% CI，2.11-2.30）（p = 0.046）。不同预测因素对 MNC-IPC 总分总方差的解释分别为 22.8%（大流行前）和 20.7%（大流行后）：系统层面问题（估计值为 0.409，p = 0.008）和护士离职意向（0.107，p = 0.023），而在大流行后，上一班收治的病人数量（0.015，p = 0.053）、组织问题（0.186，p < 0.0005）和优先级设定问题（0.092，p = 0.053）。跨国公司 IPC 和 UNCS 的得分在这两个时期都有显著的相关性：大流行后，错过 IPC 活动的可能性较小，这可能是由于系统在大流行期间所做的努力和吸取的经验教训，这可能使护士的 IPC 实践常规化。总体而言，大流行后，预测 IPC 护理遗漏的因素发生了变化，这表明出现了新的模式，需要采取创新的干预措施，特别是在科室层面和针对年轻护士。UNCS 和 MNC-IPC 之间的相关性表明，有针对性地改进一个领域很可能会在另一个领域产生积极的结果。然而，尽管两者有共同之处，但它们代表了两种截然不同的现象。

{"title":"Missed Infection Prevention and Control Activities and Their Predictors: Insights from a Pre- and Post-Pandemic Study","authors":"Chiara Moreal , Stefania Chiappinotto , Ian Blackman , Luca Grassetti , Sara Scarsini , Barbara Narduzzi , Maura Mesaglio , Carlo Tascini , Alvisa Palese","doi":"10.1016/j.jhin.2024.10.015","DOIUrl":"10.1016/j.jhin.2024.10.015","url":null,"abstract":"<div><h3>Aim</h3><div>The primary aim was to compare differences, if any, in missed infection prevention and control (IPC) activities before and after the pandemic, along with the related predictors. The secondary aim was to identify relationships between missed IPC activities and unfinished nursing care.</div></div><div><h3>Methods</h3><div>A repeated cross-sectional design was conducted in 2019 (pre-pandemic, 184 nurses) and 2024 (post-pandemic, 240 nurses) in a large academic hospital following the Checklist for Reporting of Survey Studies guidelines. The Missed Nursing Care in Infection Prevention and Control Survey (MNC-IPC) (Part A: missed activities, Part B: reasons), the Unfinished Nursing Care Survey (UNCS), and professional data were collected homogeneously across both periods.</div></div><div><h3>Findings</h3><div>Self-reported missed IPC activities decreased from 2.15 out of 5 (95% CI, 2.05–2.25) to 1.51 (95% CI, 1.45–1.58) (p < 0.0005), as did the related reasons, which decreased from 2.35 out of 4 (95% CI, 2.24–2.46) to 2.20 (95% CI, 2.11–2.30) (p = 0.046). The total variance in the MNC-IPC overall scores was explained by 22.8% (pre-) and 20.7% (post-pandemic) by different predictors: system-level issues (estimated value 0.409, p = 0.008) and nurses’ intention to leave (0.107, p = 0.023) in the pre-pandemic and by the number of patients admitted in the last shift (0.015, p = 0.053), organisational issues (0.186, p < 0.0005) and priority-setting issues (0.092, p = 0.053) in the post-pandemic period. MNC-IPC and UNCS scores have reported significant correlations in both periods.</div></div><div><h3>Conclusion</h3><div>Missed IPC activities were less likely in the post-pandemic period possibly due to system efforts and lessons learned during the pandemic, which may have routinised IPC practices among nurses. Overall, predictors of missed IPC care changed after the pandemic, suggesting new patterns and the need for innovative interventions, particularly at the unit level and targeting younger nurses. The correlations between UNCS and MNC-IPC suggest that targeted improvements in one area are likely to yield positive outcomes in the other. However, despite their commonalities, these represent two distinct phenomena.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A ‘Tuba Drain’ incorporated in sink drains reduces counts of antibiotic-resistant bacterial species at the plughole: a blinded, randomized trial in 36 sinks in a hospital outpatient department with a low prevalence of sink colonization by antibiotic-resistant species 在水槽下水道中安装 "Tuba Drain "可减少塞孔处的抗生素细菌数量；一项盲法随机试验在医院门诊患者的 36 个水槽中进行，发现水槽中抗生素细菌的定植率很低。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-06 DOI: 10.1016/j.jhin.2024.10.014

S. Harris , G. Njogu , R. Galbraith , J. Galbraith , S. Hastick , N. Storey , D. Chapman-Jones , J. Soothill

Background

Multi-resistant Gram-negative bacteria (GNB) survive in hospital drains in traps that contain water and may ascend into the sink because of splashes, or biofilm growth.

Aim

To investigate whether the ‘Tuba Drain’ (TD) a long, bent, continually descending copper tube between the sink outlet and the trap prevents the ascent of bacteria.

Methods

After initial laboratory tests confirmed that the TD prevented bacteria in the U-bend from splashing upwards into the sink outlet, TDs were assessed in a randomized, blinded trial in a hospital outpatient department built in 2019. Sinks were paired into those with a similar clinical exposure and each member of each pair was randomized to receive either new, standard plumbing up to and including the trap (18 sinks) or the same new standard plumbing but including the TD inserted between the sink outlet and trap. Bacterial counts in swabs from the sink outlets were determined blindly before and monthly after the plumbing change for a year. GNB that are associated with clinical infection and carriage of resistance genes, Pseudomonas aeruginosa, Acinetobacter baumanii, Stenotrophomonas maltophilia and all Enterobacterales were the organisms of primary interest and termed target bacteria.

Findings

The TDs fitted into the required spaces and functioned without problems. The geometric means (over months) of the counts of target bacteria in TD-plumbed sinks was lower than those in their paired controls, P=0.012 (sign test, two-tailed). Prevalence of target bacteria in sinks was low.

Conclusion

TDs were effective for reducing target bacteria in sinks.

背景：目的：研究 "Tuba Drain"（TD）--水槽出口和疏水阀之间的一根弯曲、持续下降的长铜管--是否能防止细菌上升：在初步实验室测试证实 TD 可以防止 U 形弯管中的细菌向上飞溅到水槽出口后，2019 年在一家医院门诊大楼内对 TD 进行了随机、盲法试验评估。水槽被配对成具有相似临床暴露的水槽，每对水槽中的每个成员都被随机分配到新的标准冷热水管道（包括疏水阀）（18 个水槽）或相同的新标准冷热水管道（包括插入水槽出口和疏水阀之间的 TD）。在更换冷热水管道之前和之后的一年中，每月对水槽出口拭子中的细菌计数进行盲测。与临床感染和耐药基因携带有关的 GNB、铜绿假单胞菌、鲍曼不动杆菌、嗜麦芽气单胞菌和所有肠杆菌属是主要关注的细菌，被称为目标细菌：TD适合所需的空间，运行正常。水槽中目标细菌数量的几何平均（数月内）低于配对对照组，P= 0.012（符号检验双尾）。水槽中目标细菌的流行率很低：水槽中目标细菌的流行率很低。

{"title":"A ‘Tuba Drain’ incorporated in sink drains reduces counts of antibiotic-resistant bacterial species at the plughole: a blinded, randomized trial in 36 sinks in a hospital outpatient department with a low prevalence of sink colonization by antibiotic-resistant species","authors":"S. Harris , G. Njogu , R. Galbraith , J. Galbraith , S. Hastick , N. Storey , D. Chapman-Jones , J. Soothill","doi":"10.1016/j.jhin.2024.10.014","DOIUrl":"10.1016/j.jhin.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Multi-resistant Gram-negative bacteria (GNB) survive in hospital drains in traps that contain water and may ascend into the sink because of splashes, or biofilm growth.</div></div><div><h3>Aim</h3><div>To investigate whether the ‘Tuba Drain’ (TD) a long, bent, continually descending copper tube between the sink outlet and the trap prevents the ascent of bacteria.</div></div><div><h3>Methods</h3><div>After initial laboratory tests confirmed that the TD prevented bacteria in the U-bend from splashing upwards into the sink outlet, TDs were assessed in a randomized, blinded trial in a hospital outpatient department built in 2019. Sinks were paired into those with a similar clinical exposure and each member of each pair was randomized to receive either new, standard plumbing up to and including the trap (18 sinks) or the same new standard plumbing but including the TD inserted between the sink outlet and trap. Bacterial counts in swabs from the sink outlets were determined blindly before and monthly after the plumbing change for a year. GNB that are associated with clinical infection and carriage of resistance genes, <em>Pseudomonas aeruginosa</em>, <em>Acinetobacter baumanii</em>, <em>Stenotrophomonas maltophilia</em> and all Enterobacterales were the organisms of primary interest and termed target bacteria.</div></div><div><h3>Findings</h3><div>The TDs fitted into the required spaces and functioned without problems. The geometric means (over months) of the counts of target bacteria in TD-plumbed sinks was lower than those in their paired controls, <em>P</em>=0.012 (sign test, two-tailed). Prevalence of target bacteria in sinks was low.</div></div><div><h3>Conclusion</h3><div>TDs were effective for reducing target bacteria in sinks.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 123-129"},"PeriodicalIF":3.9,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142632663","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating antimicrobial utilization in 20 Korean long-term care hospitals: a call to action for antimicrobial stewardship 评估韩国 20 家长期护理医院的抗菌药物使用情况：抗菌药物管理行动呼吁书》。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-01 DOI: 10.1016/j.jhin.2024.08.005

R. Lee , S.Y. Park , J.Y. Park , B. Kim , Y.C. Kim , H. Ga , M.J. Lee , H.W. Park , I.J. Yun , S-J. Heo , S.M. Moon , H.B. Kim , Korea Study Group for Antimicrobial Stewardship (KOSGAP)

Background

Evaluation of hospital-specific antimicrobial use is necessary for successful national antimicrobial stewardship. This study aimed to identify antimicrobial use in long-term care hospitals (LCHs) in Korea.

Methods

A multi-centre retrospective study was conducted to evaluate the prescription patterns and appropriateness of antimicrobials in 20 LCHs in Korea. The medical record data of hospitalized patients who were newly prescribed antimicrobials at each hospital were collected manually between 10^th July and 31^st October 2023 to evaluate the appropriateness of antimicrobial use.

Results

The prevalence of antimicrobial prescriptions was 8.9% (365/4086) and 10.3% (402/3892) on 12^th July 2023 and 18^th October 2023, respectively. In total, 885 antimicrobials were prescribed to 740 patients. Among the antimicrobials, third- or fourth-generation cephalosporins (31.9%) represented the most prescribed antimicrobial class. A large majority of antimicrobials (96.6%, 855/885) were prescribed for the treatment of infectious diseases; however, only 37.7% (322/855) of antimicrobials were prescribed appropriately for infections. The route of administration, dosage and prescribed antimicrobial were appropriate in 99.6% (852/855), 56.1% (480/855) and 62.0% (530/855) of cases, respectively. In total, 35.2% (252/715) of patients were prescribed antimicrobials appropriately. The diagnosis of infectious disease was appropriate for 52.9% (472/892) of cases. Of the five, 15 and 10 antimicrobials used for surgical site infection prophylaxis, medical prophylaxis and other purposes, respectively, none were used appropriately.

Conclusion

The proportion of antimicrobials used appropriately is low in Korean LCHs. These data highlight the importance of establishing antimicrobial stewardship in LCHs.

背景：评估特定医院的抗菌药物使用情况对于成功实施国家抗菌药物管理非常必要。本研究旨在确定韩国长期护理医院（LCH）的抗菌药物使用情况：我们开展了一项多中心回顾性研究，评估韩国 20 家长期护理医院的抗菌药物处方模式和适当性。人工收集了 2023 年 7 月 10 日至 10 月 31 日期间各医院新开抗菌药物处方的住院患者的病历数据，以评估抗菌药物使用的适当性：结果：2023 年 7 月 12 日和 2023 年 10 月 18 日的抗菌药物处方率分别为 8.9%（365/4,086）和 10.3%（402/3,892）。740 名患者共使用了 885 种抗菌药物。在这些抗菌药物中，第三代或第四代头孢菌素（31.9%）是处方最多的抗菌药物类别。绝大多数抗菌药物（855/885，96.6%）是为治疗感染性疾病而处方的；然而，只有 37.7%（322/855）的抗菌药物是为治疗感染而适当处方的。在 99.6%（852/855）、56.1%（480/855）和 62.0%（530/855）的病例中，给药途径、剂量和处方抗菌药物都是适当的。总共有 35.2%（252/715）的患者获得了适当的抗菌药物处方。52.9%（472/892）的病例诊断为传染病。在分别用于手术部位感染预防、医疗预防和其他目的的 5 种、15 种和 10 种抗菌药物中，没有一种是合理使用的：结论：在韩国的 LCH 中，合理使用抗菌药物的比例较低。这些数据凸显了在内陆医院建立抗菌药物管理制度的重要性。

{"title":"Evaluating antimicrobial utilization in 20 Korean long-term care hospitals: a call to action for antimicrobial stewardship","authors":"R. Lee , S.Y. Park , J.Y. Park , B. Kim , Y.C. Kim , H. Ga , M.J. Lee , H.W. Park , I.J. Yun , S-J. Heo , S.M. Moon , H.B. Kim , Korea Study Group for Antimicrobial Stewardship (KOSGAP)","doi":"10.1016/j.jhin.2024.08.005","DOIUrl":"10.1016/j.jhin.2024.08.005","url":null,"abstract":"<div><h3>Background</h3><div>Evaluation of hospital-specific antimicrobial use is necessary for successful national antimicrobial stewardship. This study aimed to identify antimicrobial use in long-term care hospitals (LCHs) in Korea.</div></div><div><h3>Methods</h3><div>A multi-centre retrospective study was conducted to evaluate the prescription patterns and appropriateness of antimicrobials in 20 LCHs in Korea. The medical record data of hospitalized patients who were newly prescribed antimicrobials at each hospital were collected manually between 10<sup>th</sup> July and 31<sup>st</sup> October 2023 to evaluate the appropriateness of antimicrobial use.</div></div><div><h3>Results</h3><div>The prevalence of antimicrobial prescriptions was 8.9% (365/4086) and 10.3% (402/3892) on 12<sup>th</sup> July 2023 and 18<sup>th</sup> October 2023, respectively. In total, 885 antimicrobials were prescribed to 740 patients. Among the antimicrobials, third- or fourth-generation cephalosporins (31.9%) represented the most prescribed antimicrobial class. A large majority of antimicrobials (96.6%, 855/885) were prescribed for the treatment of infectious diseases; however, only 37.7% (322/855) of antimicrobials were prescribed appropriately for infections. The route of administration, dosage and prescribed antimicrobial were appropriate in 99.6% (852/855), 56.1% (480/855) and 62.0% (530/855) of cases, respectively. In total, 35.2% (252/715) of patients were prescribed antimicrobials appropriately. The diagnosis of infectious disease was appropriate for 52.9% (472/892) of cases. Of the five, 15 and 10 antimicrobials used for surgical site infection prophylaxis, medical prophylaxis and other purposes, respectively, none were used appropriately.</div></div><div><h3>Conclusion</h3><div>The proportion of antimicrobials used appropriately is low in Korean LCHs. These data highlight the importance of establishing antimicrobial stewardship in LCHs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"153 ","pages":"Pages 65-72"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Nosocomial infection in paediatric patients undergoing extracorporeal membrane oxygenation: a systematic review and meta-analysis 接受体外膜氧合治疗的儿科患者中的非医院感染：系统回顾与元分析》。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-01 DOI: 10.1016/j.jhin.2024.10.011

L. Li , W. Xu , W. Jiang , Y. Li , Z. Cheng , S. Wang , J. Zhou , R. Xie , C. Li

Nosocomial infection has emerged as a significant complication of extracorporeal membrane oxygenation (ECMO) treatment and is closely associated with poor prognosis. Studies have shown that paediatric patients are more likely to benefit from ECMO. However, nosocomial infection in paediatric patients has not been comprehensively analysed. The aim of this review was to systematically analyse the incidence, timing, locations, primary pathogens, antibiotic use and risk factors associated with nosocomial infection and their effects on mortality among paediatric patients undergoing ECMO. Seven databases were searched for eligible articles; Stata 15.0 was used to calculate the combined effect and 95% confidence interval, and descriptive analysis was employed for other data. A total of 31 articles were included. The incidence of nosocomial infections was 0.19, 95% confidence interval (CI, 0.17–0.22). Respiratory infection was identified as the most common infection type. Staphylococcus species were the predominant pathogens. Antibiotic use was widespread across centres. Prolonged ECMO support was associated with an increased occurrence of nosocomial infections in patients (odds ratio (OR) = 1.09, 95% CI (1.06–1.13)). Nosocomial infection was not associated with an increase in mortality (OR = 1.44, 95% CI (0.98–2.11)). In conclusion, nosocomial infection was common among paediatric ECMO patients and was affected by various factors. However, nosocomial infection did not increase the risk of mortality.

背景：院内感染已成为 ECMO 治疗的一个重要并发症，与预后不良密切相关。研究表明，儿科患者更有可能从 ECMO 中获益。目的：系统分析接受 ECMO 治疗的儿科患者的鼻内感染发生率、时间、地点、主要病原体、抗生素使用、相关风险因素及其对死亡率的影响：方法：在七个数据库中搜索符合条件的文章；使用Stata 15.0计算综合效应和95%置信区间，并对其他数据进行描述性分析：结果：共收录了 31 篇文章。院内感染发生率为 0.19，95% CI (0.17-0.22)。呼吸道感染是最常见的感染类型。葡萄球菌是最主要的病原体。各中心普遍使用抗生素。延长 ECMO 支持时间与患者院内感染发生率增加有关 [OR = 1.09，95% CI (1.06-1.13)]。非医院感染与死亡率增加无关[OR = 1.44，95% CI (0.98-2.11)]：结论：在儿科 ECMO 患者中，院内感染很常见，并受到各种因素的影响。然而，医院内感染并不会增加死亡风险。

{"title":"Nosocomial infection in paediatric patients undergoing extracorporeal membrane oxygenation: a systematic review and meta-analysis","authors":"L. Li , W. Xu , W. Jiang , Y. Li , Z. Cheng , S. Wang , J. Zhou , R. Xie , C. Li","doi":"10.1016/j.jhin.2024.10.011","DOIUrl":"10.1016/j.jhin.2024.10.011","url":null,"abstract":"<div><div>Nosocomial infection has emerged as a significant complication of extracorporeal membrane oxygenation (ECMO) treatment and is closely associated with poor prognosis. Studies have shown that paediatric patients are more likely to benefit from ECMO. However, nosocomial infection in paediatric patients has not been comprehensively analysed. The aim of this review was to systematically analyse the incidence, timing, locations, primary pathogens, antibiotic use and risk factors associated with nosocomial infection and their effects on mortality among paediatric patients undergoing ECMO. Seven databases were searched for eligible articles; Stata 15.0 was used to calculate the combined effect and 95% confidence interval, and descriptive analysis was employed for other data. A total of 31 articles were included. The incidence of nosocomial infections was 0.19, 95% confidence interval (CI, 0.17–0.22). Respiratory infection was identified as the most common infection type. <em>Staphylococcus</em> species were the predominant pathogens. Antibiotic use was widespread across centres. Prolonged ECMO support was associated with an increased occurrence of nosocomial infections in patients (odds ratio (OR) = 1.09, 95% CI (1.06–1.13)). Nosocomial infection was not associated with an increase in mortality (OR = 1.44, 95% CI (0.98–2.11)). In conclusion, nosocomial infection was common among paediatric ECMO patients and was affected by various factors. However, nosocomial infection did not increase the risk of mortality.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 60-72"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142570376","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Antimicrobial usage and stewardship in a hospice setting 安宁疗护环境中抗菌药物的使用和管理。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-01 DOI: 10.1016/j.jhin.2024.08.004

S. Gregg , C. Jansen , S. Ryan , M. Doyle

引用次数: 0

Prescription of oral antibiotics and its appropriateness for outpatients in a tertiary care hospital in Korea 韩国一家三级医院门诊患者的口服抗生素处方及其适宜性。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-01 DOI: 10.1016/j.jhin.2024.09.009

S.M. Shin , Y. Lee , E. Heo , H-S. Kim , Y.M. Jeong , J. Lee , E.E. Lee , J-Y. Lee , Y. Choi , S.J. Choi , S.M. Moon , K-H. Song , H.B. Kim , E.S. Kim

Objectives

Antimicrobial stewardship programmes (ASPs) have gained prominence, with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescription is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescription at a tertiary care hospital in Korea.

Methods

This study analysed the patterns of oral antibiotic prescription between 1^st June 2018 and 31^st May 2023 at the outpatient department of Seoul National University Bundang Hospital. The appropriateness of prescriptions issued between 15^th and 19^th May 2023 was assessed. The assessment criteria included: indication for antibiotic use; antibiotic choice; duration; and dose/frequency. Pharmacists and infectious diseases specialists performed evaluations.

Results

In total, 7,282,407 outpatient visits were recorded over the 5-year study period, and oral antibiotics were prescribed in 243,967 (3.4%) cases. The frequency of antibiotic prescription was highest in dentistry, dermatology and urology departments. The most commonly prescribed antibiotics were cephalosporins, penicillins and sulphonamides. Of the 423 prescriptions evaluated, 289 (68.3%) and 134 (31.7%) were for treatment and prophylaxis, respectively. Prescriptions were classified as inappropriate in 28.4% (82/289) and 70.9% (95/134) of treatment and prophylaxis cases, respectively. The primary reason for inappropriateness in both treatment and prophylaxis cases was inappropriate indication, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions.

Conclusions

Antibiotics were prescribed at 3.4% of all outpatient visits. The prescription was inappropriate in 28.4% of treatment cases and 70.9% of prophylactic cases. Proactive and expansive ASP activities by pharmacists should be considered in outpatient settings.

目的：随着人们对合理使用抗生素的重要性认识的提高，抗菌药物管理计划（ASPs）的重要性日益突出。然而，在门诊抗生素处方中实施 ASP 的情况并不多见，尤其是在韩国。本研究旨在分析韩国一家三级医院门诊抗生素处方的模式和合理性：我们分析了 2018 年 6 月 1 日至 2023 年 5 月 31 日期间首尔国立大学盆唐医院门诊部口服抗生素处方的模式。对2023年5月15日至5月19日期间开具的处方进行了适宜性评估。评估标准包括：抗生素使用指征、抗生素选择、持续时间、剂量和频率。药剂师和传染病专家进行了评估：结果：5 年内共记录了 7,282,407 次门诊就诊。其中 243,967 人（3.4%）被处方口服抗生素。牙科、皮肤科和泌尿科处方抗生素的频率最高。最常处方的抗生素是头孢菌素类、青霉素类和磺胺类。在评估的 423 份处方中，289 份（68.3%）和 134 份（31.7%）分别用于治疗和预防。在治疗和预防处方中，分别有 28.4%（82/289）和 70.9%（95/134）的处方被发现不恰当。治疗和预防用药不足的主要原因是适应症不当，占治疗处方的 46.3%（38/82）和预防处方的 96.8%（92/95）：结论：3.4%的门诊病人使用了抗生素，其中28.4%的治疗性抗生素和70.9%的预防性抗生素处方不当。药剂师应考虑在门诊环境中开展积极主动的 ASP 活动。

{"title":"Prescription of oral antibiotics and its appropriateness for outpatients in a tertiary care hospital in Korea","authors":"S.M. Shin , Y. Lee , E. Heo , H-S. Kim , Y.M. Jeong , J. Lee , E.E. Lee , J-Y. Lee , Y. Choi , S.J. Choi , S.M. Moon , K-H. Song , H.B. Kim , E.S. Kim","doi":"10.1016/j.jhin.2024.09.009","DOIUrl":"10.1016/j.jhin.2024.09.009","url":null,"abstract":"<div><h3>Objectives</h3><div>Antimicrobial stewardship programmes (ASPs) have gained prominence, with increased awareness regarding the importance of appropriate antibiotic use. However, ASP implementation for outpatient antibiotic prescription is uncommon, particularly in South Korea. This study aimed to analyse the patterns and appropriateness of outpatient antibiotic prescription at a tertiary care hospital in Korea.</div></div><div><h3>Methods</h3><div>This study analysed the patterns of oral antibiotic prescription between 1<sup>st</sup> June 2018 and 31<sup>st</sup> May 2023 at the outpatient department of Seoul National University Bundang Hospital. The appropriateness of prescriptions issued between 15<sup>th</sup> and 19<sup>th</sup> May 2023 was assessed. The assessment criteria included: indication for antibiotic use; antibiotic choice; duration; and dose/frequency. Pharmacists and infectious diseases specialists performed evaluations.</div></div><div><h3>Results</h3><div>In total, 7,282,407 outpatient visits were recorded over the 5-year study period, and oral antibiotics were prescribed in 243,967 (3.4%) cases. The frequency of antibiotic prescription was highest in dentistry, dermatology and urology departments. The most commonly prescribed antibiotics were cephalosporins, penicillins and sulphonamides. Of the 423 prescriptions evaluated, 289 (68.3%) and 134 (31.7%) were for treatment and prophylaxis, respectively. Prescriptions were classified as inappropriate in 28.4% (82/289) and 70.9% (95/134) of treatment and prophylaxis cases, respectively. The primary reason for inappropriateness in both treatment and prophylaxis cases was inappropriate indication, accounting for 46.3% (38/82) of treatment prescriptions and 96.8% (92/95) of prophylaxis prescriptions.</div></div><div><h3>Conclusions</h3><div>Antibiotics were prescribed at 3.4% of all outpatient visits. The prescription was inappropriate in 28.4% of treatment cases and 70.9% of prophylactic cases. Proactive and expansive ASP activities by pharmacists should be considered in outpatient settings.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"153 ","pages":"Pages 81-89"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142332621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Factors associated with antibiotics for respiratory infections in Swiss long-term care facilities 瑞士长期护理机构使用抗生素治疗呼吸道感染的相关因素。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-11-01 DOI: 10.1016/j.jhin.2024.09.011

A. Roux , D-L. Vu , A. Niquille , E. Rubli Truchard , T. Bizzozzero , A. Tahar , T. Morlan , J. Colin , D. Akpokavie , M. Grandin , A. Merkly , A. Cassini , E. Glampedakis , T. Brahier , V. Suttels , V. Prendki , N. Boillat-Blanco

Background

Long-term care facility (LTCF) residents are twice as likely to receive antibiotics compared with elderly living in the community, and studies have reported up to half of prescriptions in LTCFs as inappropriate.

Aim

To identify factors contributing to general and inappropriate antibiotic prescription among LTCF residents with lower respiratory tract infections (LRTIs).

Methods

In this prospective, multicentric, observational study, residents with LRTIs were recruited among 32 LTCFs in Western Switzerland during winter 2022–2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. Multivariate logistic regression and backward selection were used with P < 0.1 cut-off to identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription.

Findings

A total of 114 residents were included, 63% female, median age 87 years. Fifty-nine (52%) residents underwent diagnostic tests: 50 (44%) polymerase chain reaction (PCR) for respiratory viruses and 16 (14%) blood test with C-reactive protein and/or blood count. Sixty-three (55%) residents received antibiotics. Factors associated with antibiotic prescriptions were Rockwood Clinical Frailty Scale score ≥7, oxygen saturation <92%, performing a blood test, rural LTCFs, and female physician. Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with performance of respiratory virus PCR test as the only protective factor.

Conclusion

Whereas half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53–80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs.

目的确定导致下呼吸道感染（LRTI）的长期护理机构（LTCF）住院患者开具一般和不适当抗生素处方的因素：方法：前瞻性多中心观察研究。2022-2023年冬季，瑞士西部32家长期护理机构招募了患有下呼吸道感染的住院患者。住院患者在LRTI发病三天内接受肺部超声波检查（LUS），作为肺炎诊断的参考标准。为了在人口统计学、生命体征、诊断测试和 LTCF 特征中找出与（i）抗生素处方和（ii）不适当处方相关的因素，我们使用了多变量逻辑回归和反向选择，P 值截断为结果：我们纳入了 114 名住院患者，其中 63% 为女性，中位年龄为 87 岁。总体而言，59 名住院患者（52%）进行了诊断测试：50人（44%）进行了呼吸道病毒 PCR 检测，16 人（14%）进行了 CRP 和/或血细胞计数血液检测。共有 63 名住院患者（55%）接受了抗生素治疗。与抗生素处方相关的因素有：CFS≥7（aOR 6.8，95% CI 1.5-24.4）、血氧饱和度<92%（3.5，1.4-8.8）、进行血液检测（0.1，0.0-0.6）、农村 LTCF（0.3，0.1-0.7）和女医生（0.3，0.1-0.8）。在接受抗生素治疗的住院患者中，48 人（74%）的处方不当，唯一的保护因素是进行了呼吸道病毒 PCR 检测（0.1，0.0-0.4）：虽然半数患有 LRTI 的住院患者接受了抗生素治疗，属于欧洲 LTCF 处方率较低的范围（53%-80%），但大多数抗生素处方是不恰当的。诊断检测的使用与处方总量和处方不当率的降低有关，因此提倡使用诊断检测来优化 LTCF 的处方实践。

{"title":"Factors associated with antibiotics for respiratory infections in Swiss long-term care facilities","authors":"A. Roux , D-L. Vu , A. Niquille , E. Rubli Truchard , T. Bizzozzero , A. Tahar , T. Morlan , J. Colin , D. Akpokavie , M. Grandin , A. Merkly , A. Cassini , E. Glampedakis , T. Brahier , V. Suttels , V. Prendki , N. Boillat-Blanco","doi":"10.1016/j.jhin.2024.09.011","DOIUrl":"10.1016/j.jhin.2024.09.011","url":null,"abstract":"<div><h3>Background</h3><div>Long-term care facility (LTCF) residents are twice as likely to receive antibiotics compared with elderly living in the community, and studies have reported up to half of prescriptions in LTCFs as inappropriate.</div></div><div><h3>Aim</h3><div>To identify factors contributing to general and inappropriate antibiotic prescription among LTCF residents with lower respiratory tract infections (LRTIs).</div></div><div><h3>Methods</h3><div>In this prospective, multicentric, observational study, residents with LRTIs were recruited among 32 LTCFs in Western Switzerland during winter 2022–2023. Residents underwent lung ultrasound (LUS) within three days of LRTI onset, serving as the pneumonia diagnosis reference standard. Multivariate logistic regression and backward selection were used with <em>P</em> < 0.1 cut-off to identify factors among demographics, vital signs, diagnostic tests, and LTCF characteristics associated with (i) antibiotic prescription and (ii) inappropriate prescription.</div></div><div><h3>Findings</h3><div>A total of 114 residents were included, 63% female, median age 87 years. Fifty-nine (52%) residents underwent diagnostic tests: 50 (44%) polymerase chain reaction (PCR) for respiratory viruses and 16 (14%) blood test with C-reactive protein and/or blood count. Sixty-three (55%) residents received antibiotics. Factors associated with antibiotic prescriptions were Rockwood Clinical Frailty Scale score ≥7, oxygen saturation <92%, performing a blood test, rural LTCFs, and female physician. Among residents receiving antibiotics, 48 (74%) had inappropriate prescriptions, with performance of respiratory virus PCR test as the only protective factor.</div></div><div><h3>Conclusion</h3><div>Whereas half of LRTI residents received antibiotics, falling within lower ranges of European LTCFs prescription rates (53–80%), most antibiotic prescriptions were inappropriate. Utilization of diagnostic tests correlates with lower overall and inappropriate prescription, advocating for their use to optimize prescription practices in LTCFs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"153 ","pages":"Pages 90-98"},"PeriodicalIF":3.9,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0