The enormous increase in antibiotic resistance and the limited spectrum of new, effective antibiotics are the reasons why we should think about a rational approach to anti-infective therapy. The excessive and non-indicated use of antibiotics while treating critically ill patients can be found quite often in clinical practice. Antibiotic therapy is usually indicated empirically, or it is only based on therapeutic indecision, not just in ICU patients. The antibiotics are administered before taking a sample for microbiological analysis or there is no therapy adjustment based on the laboratory findings. The solution lies in antibiotic stewardship, which is the way to ensure that antibiotics will be sufficiently effective in years to come.
- Klíčová slova
- Prophylaxis, algorithm of antibiotic treatment, antibiotic stewardship, cumulative antibiograms, resistance,
- MeSH
- antibakteriální látky * terapeutické užití MeSH
- antibiotická politika * MeSH
- jednotky intenzivní péče MeSH
- kritický stav MeSH
- lidé MeSH
- péče o pacienty v kritickém stavu * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antibakteriální látky * MeSH
Antibiotic exposure at the beginning of life can lead to increased antimicrobial resistance and perturbations of the developing microbiome. Early-life microbiome disruption increases the risks of developing chronic diseases later in life. Fear of missing evolving neonatal sepsis is the key driver for antibiotic overtreatment early in life. Bias (a systemic deviation towards overtreatment) and noise (a random scatter) affect the decision-making process. In this perspective, we advocate for a factual approach quantifying the burden of treatment in relation to the burden of disease balancing antimicrobial stewardship and effective sepsis management.
- MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- antibiotická politika * MeSH
- lidé MeSH
- novorozenec MeSH
- novorozenecká sepse * farmakoterapie MeSH
- počátek lidského života MeSH
- sepse * farmakoterapie MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antibakteriální látky MeSH
In today's medicine, one of the main challenges is an extreme increase in bacterial resistance, making antibiotic treatment in both intensive care units and in the community considerably more difficult. To maintain the efficacy of existing antibiotics, close interdisciplinary cooperation is crucial for diagnosing infectious diseases as well as for selecting appropriate antibiotics so that these are only used for treating bacterial infections, not natural bacterial colonization. Antibiotic stewardship has become an ethical imperative, with cumulative antibiograms being one of its core elements. Cumulative antibiograms help with rational choice of antibiotics for initial therapy when the patient's results are still pending. However, preparation of cumulative antibiograms is not clearly defined. Only two American guidelines are available that do not correspond with the needs of clinical microbiology in hospitalized patients. The article aims to present the potential pitfalls of preparing cumulative antibiograms based on the only CLSI guidelines and a draft of recommendation for their preparation in the Czech Republic.
- MeSH
- antibakteriální látky terapeutické užití MeSH
- antibiotická politika * MeSH
- bakteriální infekce * farmakoterapie MeSH
- lidé MeSH
- mikrobiální testy citlivosti MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Geografické názvy
- Česká republika MeSH
- Názvy látek
- antibakteriální látky MeSH
In the microbiological diagnosis of bloodstream infections (BSI), blood culture (BC) is considered the gold standard test despite its limitations such as low sensitivity and slow turnaround time. A new FDA-cleared and CE-marked platform utilizing magnetic resonance to detect amplified DNA of the six most common and/or problematic BSI pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Escherichia coli; referred to as ESKAPEc) is available and may shorten the time to diagnosis and potentially improve antimicrobial utilization. Whole blood samples from hospitalized patients with clinical signs of sepsis were analyzed using the T2Bacteria Panel (T2Biosystems) and compared to simultaneously collected BC. Discrepant results were evaluated based on clinical infection criteria, combining supporting culture results and the opinion of treating physicians. A total of 55 samples from 53 patients were evaluated. The sensitivity and specificity of the T2Bacteria panel was 94% (16 out of 17 detections of T2Bacteria-targeted organisms) and 100%, respectively, with 36.4% (8 of 22) causes of BSI detected only by this method. The T2Bacteria Panel detected pathogens on average 55 hours faster than standard BC. In our study, 9 of 15 patients with positive T2Bacteria Panel results received early-targeted antibiotic therapy and/or modification of antimicrobial treatment based on T2Bacteria Panel findings. Given the high reliability, faster time to detection, and easy workflow, the technique qualifies as a point-of-care testing approach.
- Klíčová slova
- T2MR, antimicrobial stewardship, bacteremia, blood culture, rapid diagnostics, sepsis,
- MeSH
- Acinetobacter baumannii účinky léků genetika izolace a purifikace MeSH
- antibakteriální látky farmakologie MeSH
- antibiotická politika metody MeSH
- bakteriemie krev farmakoterapie mikrobiologie MeSH
- Enterococcus faecium účinky léků genetika izolace a purifikace MeSH
- Escherichia coli účinky léků genetika izolace a purifikace MeSH
- Klebsiella pneumoniae účinky léků genetika izolace a purifikace MeSH
- krev mikrobiologie MeSH
- kultivační vyšetření krve MeSH
- lidé MeSH
- prospektivní studie MeSH
- Pseudomonas aeruginosa účinky léků genetika izolace a purifikace MeSH
- Staphylococcus aureus účinky léků genetika izolace a purifikace MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Názvy látek
- antibakteriální látky MeSH
BACKGROUND: Chronic lung infections and their treatment pose risks for the development of antimicrobial resistance (AMR) in people with cystic fibrosis (PWCF). In this study, we evaluated the attitudes of healthcare providers' (HCP) and PWCF or their parents' toward AMR within the international CF community. METHODS: HCP and PWCF identified through listservs and CF-related organizations were asked to complete an AMR centered survey, with additional questions on antimicrobial stewardship (AMS) for HCP. Descriptive analyses are reported. RESULTS: The responding 443 HCP and 464 PWCF/Parents were from 30 and 25 countries, respectively. Sixty-two percent of HCP and 56% of PWCF stated they were "very concerned" about AMR, with Pseudomonas spp. and Burkholderia spp. considered the most concerning organisms for both HCP and PWCF/Parents. Non-tuberculous mycobacteria were of greater concern to HCP compared to PWCF/Parents. There was a discrepancy regarding AMR education to PWCF, with 80% of HCP stating having discussed this with PWCF/Parents, but only 50% of PWCF recalling such discussions. CONCLUSION: These results highlight that AMR is relevant to CF HCP and PWCF internationally, indicating that educational tools and research are warranted.
- Klíčová slova
- Antimicrobial resistance, Cystic fibrosis, Survey,
- MeSH
- antibiotická politika * MeSH
- bakteriální léková rezistence * MeSH
- cystická fibróza mikrobiologie MeSH
- infekce bakteriemi rodu Burkholderia farmakoterapie MeSH
- lidé MeSH
- pacienti psychologie MeSH
- průzkumy a dotazníky MeSH
- pseudomonádové infekce farmakoterapie MeSH
- zdraví - znalosti, postoje, praxe * MeSH
- zdravotnický personál psychologie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Antimicrobial resistance (AMR) should be tackled through a One Health approach, as stated in the World Health Organization Global Action Plan on AMR. We describe the landscape of AMR surveillance in the European Union/European Economic Area (EU/EEA) and underline a gap regarding veterinary medicine. Current AMR surveillance efforts are of limited help to veterinary practitioners and policymakers seeking to improve antimicrobial stewardship in animal health. We propose to establish the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) to report on the AMR situation, follow AMR trends and detect emerging AMR in selected bacterial pathogens of animals. This information could be useful to advise policymakers, explore efficacy of interventions, support antimicrobial stewardship initiatives, (re-)evaluate marketing authorisations of antimicrobials, generate epidemiological cut-off values, assess risk of zoonotic AMR transmission and evaluate the burden of AMR in animal health. EARS-Vet could be integrated with other AMR monitoring systems in the animal and medical sectors to ensure a One Health approach. Herein, we present a strategy to establish EARS-Vet as a network of national surveillance systems and highlight challenges of data harmonisation and bias. Strong political commitment at national and EU/EEA levels is required for the success of EARS-Vet.
- Klíčová slova
- Europe, animal, antibiotic, antimicrobial resistance, surveillance, veterinary,
- MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- antibiotická politika * MeSH
- Bacteria MeSH
- bakteriální léková rezistence MeSH
- One Health * MeSH
- zvířata MeSH
- Check Tag
- zvířata MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antibakteriální látky MeSH
In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.
- Klíčová slova
- Antimicrobial stewardship, Antimicrobial treatment, Clostridioides difficile infection, Clostridium difficile infection, Fecal microbiota transplantation, Infection control, Pseudomembranous colitis,
- MeSH
- antibakteriální látky terapeutické užití MeSH
- antibiotická politika MeSH
- Clostridioides difficile patogenita MeSH
- fekální transplantace metody trendy MeSH
- incidence MeSH
- klostridiové infekce diagnóza terapie MeSH
- kontrola infekce metody trendy MeSH
- lidé MeSH
- pooperační komplikace terapie MeSH
- pseudomembranózní enterokolitida etiologie prevence a kontrola MeSH
- rizikové faktory MeSH
- směrnice jako téma MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- Názvy látek
- antibakteriální látky MeSH
BACKGROUND: Surgical site infection (SSI) is one of the most common causes of healthcare-associated infection. Although the use of topical antibiotics to prevent SSI is not recommended by current guidelines, published studies document conflicting results and conclusions. OBJECTIVES: The objectives of this survey were to: (i) determine the extent of the use of topical antibiotics to prevent SSI in clinical practice; and (ii) gather the opinions of healthcare professionals most likely to be involved in their use. METHODS: A questionnaire was circulated to members of BSAC and the European Wound Management Association (EWMA). RESULTS: The questionnaire received 160 responses from a variety of healthcare professionals around the world. Most respondents (70%) did not have guidelines for the use of topical antibiotics for the prevention of SSI in their institution; if present, local guidance was based on national guidelines (20/31, 65%). Most respondents did not use or recommend topical antibiotics to prevent SSI; of those that did, gentamicin collagen sponges were most commonly used (24/96 responses, 25%). Over half of the surgeons (18/33, 55%) who responded to the survey did not use topical antibiotics for the prevention of SSI but, when used, contaminated surgery (8/33, 24%) was the most commonly stated indication. CONCLUSIONS: There are diverse opinions and practices among healthcare professionals about the use of topical antibiotics for the prevention of SSI. This considerable, and possibly inappropriate, variation in clinical practice needs to be addressed as part of antibiotic stewardship.
- MeSH
- antibakteriální látky aplikace a dávkování MeSH
- antibiotická politika MeSH
- antibiotická profylaxe metody MeSH
- aplikace lokální * MeSH
- gentamiciny aplikace a dávkování MeSH
- infekce chirurgické rány prevence a kontrola MeSH
- infekce spojené se zdravotní péčí prevence a kontrola MeSH
- konsensus MeSH
- lidé MeSH
- průzkumy a dotazníky MeSH
- směrnice pro lékařskou praxi jako téma MeSH
- zdravotnický personál * MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- Evropa MeSH
- Názvy látek
- antibakteriální látky MeSH
- gentamiciny MeSH
BACKGROUND: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. METHODS: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. RESULTS: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). CONCLUSION: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
- Klíčová slova
- Antibiotics, Antimicrobial stewardship, Infections, Surgery,
- MeSH
- antibiotická politika metody MeSH
- antiinfekční látky terapeutické užití MeSH
- celosvětové zdraví trendy MeSH
- lidé MeSH
- nitrobřišní infekce farmakoterapie MeSH
- pooperační komplikace farmakoterapie MeSH
- průřezové studie MeSH
- průzkumy a dotazníky MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- Názvy látek
- antiinfekční látky MeSH
