Diagnostic stewardship: what impacts antibiotics use?

Coffey, Kelly; Morgan, Daniel J.; Claeys, Kimberly C

doi:10.1097/qco.0000000000000927

Cited by 4 publications

(1 citation statement)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A multidisciplinary antibiotic management program to limit inappropriate antibiotic use could lead to a significant reduction in nosocomial infections caused by C. difficile. 39,40 The first steps in treating patients with CDI include discontinuing the offending agent such as antimicrobials, if possible, and providing appropriate supportive care with hydration and electrolyte replacement as needed. Anti-diarrhea medications should be avoided as they can obscure symptoms and trigger toxic megacolon.…”

Section: Prevention and Treatmentmentioning

confidence: 99%

Problematik Infeksi Clostridium difficile

Tjampakasari,

Hanayurianingtyas

2023

J Biomedika dan Kesehat

View full text Add to dashboard Cite

Clostridium difficile merupakan bakteri Gram-positif, bersifat anaerob penghasil spora. Faktor virulensi dari bakteri ini adalah toksin yang dihasilkannya, yaitu enterotoksin A (TcdA ) dan sitotoksin B (TcdB). Transmisi terjadi secara fekal oral dengan menelan spora bakteri ini. Clostridium difficile penyebab paling umum dari diare terkait fulminan di rumah sakit dan fasilitas kesehatan lainnya dan menjadi perhatian yang signifikan karena meningkatnya angka morbiditas dan mortalitas serta peningkatan biaya perawatan kesehatan. Pasien lanjut usia atau pasien dengan gangguan sistem imun merupakan pasien dengan risiko tertinggi untuk kasus ini. Clostridiosis menunjukkan spektrum infeksi bervariasi, berkisar dari diare ringan yang sembuh sendiri, diare derajat ringan-sedang, hingga diare serius, pseudomembran colitis dan fulminant colitis yang mengancam jiwa sehingga dapat mengakibatkan kematian. Diagnosis ditegakkan dengan deteksi langsung toksin Clostridium difficile dalam feses. Walaupun terapi empirik telah diketahui sebagaimana vankomisin dan fidaksomisin telah digunakan sebagai antibiotik pilihan, namun identifikasi segera pasien dengan gejala infeksi Clostridium difficile sangat penting karena sebagian besar pasien merespon dengan cepat terhadap terapi antimikroba. Pencegahan paling baik dilakukan dengan penerapan tindakan pengendalian infeksi dan penggunaan agen antimikroba secara tepat. Pendidikan profesional kesehatan mengenai tindakan pencegahan seperti mencuci tangan, memakai sarung tangan, dekontamina

show abstract

Section: Prevention and Treatmentmentioning

confidence: 99%

Problematik Infeksi Clostridium difficile

Tjampakasari,

Hanayurianingtyas

2023

J Biomedika dan Kesehat

View full text Add to dashboard Cite

show abstract

Diagnostic Stewardship for Urine Cultures

Coffey,

Claeys,

Morgan

2024

Infectious Disease Clinics of North America

View full text Add to dashboard Cite

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes

Sansom,

Goldstein,

Stein

et al. 2024

Infect. Control Hosp. Epidemiol.

View full text Add to dashboard Cite

Background: Diagnostic stewardship of urine cultures from patients with indwelling urinary catheters may improve diagnostic specificity and clinical relevance of the test, but risk of patient harm is uncertain. Methods: We retrospectively evaluated the impact of a computerized clinical decision support tool to promote institutional appropriateness criteria (neutropenia, kidney transplant, recent urologic surgery, or radiologic evidence of urinary tract obstruction) for urine cultures from patients with an indwelling urinary catheter. The primary outcome was a change in catheter-associated urinary tract infection (CAUTI) rate from baseline (34 mo) to intervention period (30 mo, including a 2-mo wash-in period). We analyzed patient-level outcomes and adverse events. Results: Adjusted CAUTI rate decreased from 1.203 to 0.75 per 1,000 catheter-days (P = 0.52). Of 598 patients triggering decision support, 284 (47.5%) urine cultures were collected in agreement with institutional criteria and 314 (52.5%) were averted. Of 314 patients whose urine cultures were averted, 2 had a subsequent urine culture within 7 days that resulted in a change in antimicrobial therapy and 2 had diagnosis of bacteremia with suspected urinary source, but there were no delays in effective treatment. Conclusion: A diagnostic stewardship intervention was associated with an approximately 50% decrease in urine culture testing for inpatients with a urinary catheter. However, the overall CAUTI rate did not decrease significantly. Adverse outcomes were rare and minor among patients who had a urine culture averted. Diagnostic stewardship may be safe and effective as part of a multimodal program to reduce unnecessary urine cultures among patients with indwelling urinary catheters.

show abstract

Diagnostic stewardship: what impacts antibiotics use?

Cited by 4 publications

References 39 publications

Problematik Infeksi Clostridium difficile

Problematik Infeksi Clostridium difficile

Diagnostic Stewardship for Urine Cultures

Impact of diagnostic stewardship on catheter-associated urinary tract infections and patient outcomes

Contact Info

Product

Resources

About