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Journal articlePerozziello A, Routelous C, Charani E, et al., 2018,
Experiences and perspectives of implementing antimicrobial stewardship in five French hospitals: a qualitative study
, International Journal of Antimicrobial Agents, Vol: 51, Pages: 829-835, ISSN: 0924-8579ObjectiveTo describe current antimicrobial stewardship program (ASP) in France, both at policy level and at local implementation level, and to assess how ASP leaders (ASPL) worked and prioritised their activities.MethodsWe conducted a qualitative study based on face-to-face semi-structured interviews with healthcare professionals responsible for ASP across five French hospitals. Five infectious disease specialists and one microbiologist were interviewed between April and June 2016.ResultsStewards had dedicated time to perform ASP activities in two university-affiliated hospitals while in the other hospitals (one university, one general and one semi-private), ASPLs had to balance these activities with clinical practice. Consequently, they had to adapt interventions according to their resources (IT or human). Responding to colleagues' consultation requests formed baseline work. Systematic and pro-active measures allowed for provision of unsolicited counselling, while direct counselling on wards required appropriate staffing. ASPL aimed at increasing clinicians' ability to prescribe adequately and awareness of the unintended consequences of inappropriate use of antibiotics. Thus, persuasive e.g. education measures were preferred to coercive ones. ASPL faced several challenges in implementing ASP: overcoming physicians' or units' reluctance, and balancing the influence of medical hierarchy and professional boundaries.ConclusionBeyond resources constraints, ASPLs' conceptions of their work, as well as contextual and cultural aspects, led them to adopt a persuasive and collaborative approach of counselling. This is the first qualitative study about ASP in France exploring stewards' experiences and points of view.
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Journal articleBryce A, Costelloe CE, wooten A, et al., 2018,
Comparison of risk factors for, and prevalence of, antibiotic resistance in contaminating and pathogenic urinary Escherichia coli in children in primary care: prospective cohort study
, Journal of Antimicrobial Chemotherapy, Vol: 73, Pages: 1359-1367, ISSN: 0305-7453BackgroundAll-cause antibiotic prescribing affects bowel flora antimicrobial susceptibility, and may increase risk of urinary autoinoculation with antibiotic-resistant microbes. However, little is known about relative prevalence of, or risk factors for, antimicrobial resistance among potentially pathogenic microbes thought to be contaminating and infecting urine.MethodsSecondary analysis of 824 children under 5 years of age consulting in primary care for an acute illness and their Escherichia coli isolates cultured at ≥103 cfu/mL from the Diagnosis of Urinary Tract infection in Young children (DUTY) study. Multivariable logistic regression investigating risk factors for resistance to amoxicillin, co-amoxiclav, cefalexin, ciprofloxacin, trimethoprim, nitrofurantoin and cefpodoxime in microbes meeting the laboratory criteria for urinary tract infection: ‘pathogens’ (>105 cfu/mL, n = 79) and ‘contaminants’ (103 to 105 cfu/mL, n = 745).ResultsForty-three percent of E. coli were resistant to at least one tested antibiotic, with resistance highest to amoxicillin (49.37% pathogenic versus 37.32% contaminant, P = 0.04), trimethoprim (27.85% versus 16.52%, P = 0.01) and co-amoxiclav (16.46% versus 21.48%, P = 0.30). Multidrug resistance (to ≥3 antibiotic groups) was present in 17.07% of pathogens and 30.13% of contaminants (P = 0.04). No isolates were resistant to nitrofurantoin. Recent (0–3 months) exposure to antibiotics was associated with resistance in both pathogens (aOR: 1.10, 95% CI: 1.01–4.39) and contaminants (1.69, 1.09–2.67).ConclusionsPrevalence of resistance (including multidrug) was high, but there was no consistent relationship between isolate pathogen/contamination status and resistance. Recent all-cause antibiotic prescribing increased the probability of antimicrobial resistance in both pathogenic and contaminat
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Journal articleNaylor NR, Atun R, Zhu N, et al., 2018,
Estimating the burden of antimicrobial resistance: a systematic literature review
, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994Background: Accurate estimates of the burden of antimicrobial resistance (AMR) are needed to establish the magnitude of this global threat in terms of both health and cost, and to enable cost-effectiveness evaluations of interventions aiming to tackle the problem. This review aimed to establish the alternative methodologies used in estimating AMR burden in order to appraise the current evidence base. Methods: MEDLINE, EMBASE, Scopus, EconLit, PubMed and grey literature were searched. English language studies evaluating the impact of AMR (from any microbe) on patient, payer/provider and economic burden published between January 2013 and December 2015 were included. Independent screening of title/abstracts followed by full texts was performed using pre-specified criteria. A study quality score (from zero to one) was derived using Newcastle-Ottawa and Phillips checklists. Extracted study data were used to compare study method and resulting burden estimate, according to perspective. Monetary costs were converted into 2013 USD. Results: Out of 5,187 unique retrievals, 214 studies were included. 187 studies estimated patient health, 75 studies estimated payer/provider and 11 studies estimated economic burden. 64% of included studies were single centre. The majority of studies estimating patient or provider/payer burden used regression techniques. 48% of studies estimating mortality burden found a significant impact from resistance, excess healthcare system costs ranged from non-significance to $1 billion per year, whilst economic burden ranged from $21,832 per case to over $3 trillion in GDP loss. Median quality scores (interquartile range) for patient, payer/provider and economic burden studies were 0.67 (0.56-0.67), 0.56 (0.46-0.67) and 0.53 (0.44-0.60) respectively. Conclusions: This study highlights what methodological assumptions and biases can occur dependent on chosen outcome and perspective. Currently, there is considerable variability in burden estimates, whi
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Journal articleEdwards RJ, Pyzio M, Gierula M, et al., 2018,
Proteomic analysis at the sites of clinical infection with invasive Streptococcus pyogenes
, Scientific Reports, Vol: 8, ISSN: 2045-2322Invasive Streptococcus pyogenes infections are rare, with often-unexplained severity. Prompt diagnosis is desirable, as deaths can occur rapidly following onset and there is an increased, but preventable, risk to contacts. Here, proteomic analyses of clinical samples from invasive human S. pyogenes infections were undertaken to determine if novel diagnostic targets could be detected, and to augment our understanding of disease pathogenesis. Fluid samples from 17 patients with confirmed invasive S. pyogenes infection (empyema, septic arthritis, necrotising fasciitis) were analysed by proteomics for streptococcal and human proteins; 16/17 samples had detectable S. pyogenes DNA. Nineteen unique S. pyogenes proteins were identified in just 6/17 samples, and 15 of these were found in a single pleural fluid sample including streptococcal inhibitor of complement, trigger factor, and phosphoglycerate kinase. In contrast, 469 human proteins were detected in patient fluids, 177 (38%) of which could be identified as neutrophil proteins, including alpha enolase and lactotransferrin which, together, were found in all 17 samples. Our data suggest that streptococcal proteins are difficult to detect in infected fluid samples. A vast array of human proteins associated with leukocyte activity are, however, present in samples that deserve further evaluation as potential biomarkers of infection.
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Journal articleMacduff C, Rafferty AM, Prendiville A, et al., 2018,
Antimicrobial resistance: Join us for a fresh approach
, British Journal of Nursing, Vol: 27, Pages: 356-356, ISSN: 0966-0461 -
Journal articleRawson T, o'hare D, Herrero P, et al., 2018,
Delivering precision antimicrobial therapy through closed-loop control systems
, Journal of Antimicrobial Chemotherapy, Vol: 73, Pages: 835-843, ISSN: 0305-7453Sub-optimal exposure to antimicrobial therapy is associated with poor patient outcomes and the development of antimicrobial resistance. Mechanisms for optimizing the concentration of a drug within the individual patient are under development. However, several barriers remain in realizing true individualization of therapy. These include problems with plasma drug sampling, availability of appropriate assays, and current mechanisms for dose adjustment. Biosensor technology offers a means of providing real-time monitoring of antimicrobials in a minimally invasive fashion. We report the potential for using microneedle biosensor technology as part of closed-loop control systems for the optimization of antimicrobial therapy in individual patients.
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Journal articleRawson T, Moore L, Castro Sanchez E, et al., 2018,
Development of a patient-centred intervention to improve knowledge and understanding of antibiotic therapy in secondary care
, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994Introduction: We developed a personalised antimicrobial information module co-designed with patients. This study aimed to evaluate the potential impact of this patient-centred intervention on short-term knowledge and understanding of antimicrobial therapy in secondary care. Methods:Thirty previous patients who had received antibiotics in hospital within 12 months were recruited to co-design an intervention to promote patient engagement with infection management. Two workshops, containing five focus-groups were held. These were audio-recorded. Data were analysed using a thematic framework developed deductively based on previous work. Line-by-line coding was performed with new themes added to the framework by two researchers. This was used to inform the development of a patient information module, embedded within an electronic decision support tool (CDSS). The intervention was piloted over a four-week period at Imperial College Healthcare NHS Trust on 30 in-patients. Pre- and post-intervention questionnaires were developed and implemented to assess short term changes in patient knowledge and understanding and provide feedback on the intervention. Data were analysed using SPSS and NVIVO software. Results: Within the workshops, there was consistency in identified themes. The participants agreed upon and co-designed a personalised PDF document that could be integrated into an electronic CDSS to be used by healthcare professionals at the point-of-care. Their aim for the tool was to provide individualised practical information, signpost to reputable information sources, and enhance communication between patients and healthcare professionals.Eighteen out of thirty in-patients consented to participant in the pilot evaluation with 15/18(83%) completing the study. Median (range) age was 66(22-85) years. The majority were male (10/15;66%). Pre-intervention, patients reported desiring further information regarding their infections and antibiotic therapy, including side effects
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Journal articleBirgand G, Castro-Sánchez E, Hansen S, et al., 2018,
Comparison of governance approaches for the control of antimicrobial resistance: Analysis of three European countries
, Antimicrobial Resistance and Infection Control, Vol: 7, ISSN: 2047-2994Policy makers and governments are calling for coordination to address the crisis emerging from the ineffectiveness of current antibiotics and stagnated pipe-line of new ones - antimicrobial resistance (AMR). Wider contextual drivers and mechanisms are contributing to shifts in governance strategies in health care, but are national health system approaches aligned with strategies required to tackle antimicrobial resistance? This article provides an analysis of governance approaches within healthcare systems including: priority setting, performance monitoring and accountability for AMR prevention in three European countries: England, France and Germany. Advantages and unresolved issues from these different experiences are reported, concluding that mechanisms are needed to support partnerships between healthcare professionals and patients with democratized decision-making and accountability via collaboration. But along with this multi-stakeholder approach to governance, a balance between regulation and persuasion is needed.
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Journal articleBudhathoki SS, Bhattachan M, Castro Sanchez EM, et al., 2018,
Menstrual hygiene management among women and adolescent girls in the aftermath of the earthquake in Nepal: A descriptive study
, BMC Women's Health, Vol: 18, ISSN: 1472-6874Background: Menstrual hygiene management (MHM) is an essential aspect of hygiene for women and adolescent girlsbetween menarche and menopause. Despite being an important issue concerning women and girls in the menstruatingage group MHM is often overlooked in post-disaster responses. Further, there is limited evidence of menstrual hygienemanagement in humanitarian settings. This study aims to describe the experiences and perceptions of women and adolescentgirls on menstrual hygiene management in post-earthquake Nepal.Methods: A mixed methods study was carried out among the earthquake affected women and adolescent girls inthree villages of Sindhupalchowk district of Nepal. Data was collected using a semi-structured questionnaire thatcaptured experiences and perceptions of respondents on menstrual hygiene management in the aftermath of theNepal earthquake. Quantitative data were triangulated with in-depth interview regarding respondent’s personalexperiences of menstrual hygiene management.Results: Menstrual hygiene was rated as the sixth highest overall need and perceived as an immediate need by 18.8%of the respondents. There were 42.8% women & girls who menstruated within first week of the earthquake. Reusablesanitary cloth were used by about 66.7% of the respondents before the earthquake and remained a popular method(76.1%) post-earthquake. None of the respondents reported receiving menstrual adsorbents as relief materials in thefirst month following the earthquake. Disposable pads (77.8%) were preferred by respondents as they were perceivedto be clean and convenient to use. Most respondents (73.5%) felt that reusable sanitary pads were a sustainable choice.Women who were in the age group of 15-34 years (OR = 3.14; CI = (1.07-9.20), did not go to school (OR = 9.68; CI = 2.16-43.33), married (OR = 2.99; CI = 1.22-7.31) and previously used reusable sanitary cloth (OR = 5.82; CI = 2.33-14.55) weremore likely to use the reusable sanitary cloth.Conclusions: In t
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Journal articleBirgand GJC, Zahar JR, Lucet JC, 2018,
Insight into the complex epidemiology of multidrug-resistant Enterobacteriacae
, Clinical Infectious Diseases, Vol: 66, Pages: 494-496, ISSN: 1058-4838
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