Management of Bacteriuria in Veterans Affairs Hospitals

Spivak, Emily S; Burk, Muriel; Zhang, Rongping; Jones, Makoto; Neuhauser, Melinda M.; Goetz, Matthew Bidwell; Cunningham, Francesca

doi:10.1093/cid/cix474

Cited by 68 publications

(62 citation statements)

References 21 publications

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“…Given the high mortality and poor outcomes associated with invasive fungal disease, this seems to be a logical first step. Inappropriate management of UTIs is not specific to yeast, as similar trends exist for bacterial UTIs (25). Although investigators have reported stewardship interventions focusing on the management of asymptomatic bacteriuria, the same is not true for candiduria (26,27).…”

Section: Discussionmentioning

confidence: 99%

Overtreatment of Asymptomatic Candiduria among Hospitalized Patients: a Multi-institutional Study

Jacobs

Dilworth

Beyda

et al. 2018

Antimicrob Agents Chemother

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Candiduria is common in hospitalized patients, and asymptomatic candiduria contributes to antifungal overuse. The guidelines for management of asymptomatic candiduria do not recommend antifungal use, but rather the elimination of predisposing factors. It is unknown whether these recommendations are being followed. The primary objective of this study was to characterize candiduria management among hospitalized patients. This was a retrospective cohort study of a random sample of 305 hospitalized patients with candiduria at four U.S. medical centers from January 2010 to December 2013. Patients were classified as asymptomatic or symptomatic based on established criteria, and data were collected by chart review. Infectious Diseases Society of America (IDSA) treatment guideline adherence and its association with clinical outcomes, including candiduria recurrence (short- and long-term) and 30-day readmission, were assessed. Eighty percent of patients were classified as having asymptomatic candiduria. Overall, 143 (47%) patients were not managed according to recommended guidelines, including 105/243 (43%) in the asymptomatic candiduria group and 38/62 (61%) in the symptomatic group ( = 0.01). Discordance among asymptomatic patients was driven by overtreatment with an antifungal (98/105 [93%]). Thirty-three percent of patients with asymptomatic candiduria not managed according to the guidelines were treated for over 7 days, and 5% received over 14 days of therapy. Fluconazole was the most commonly used empirical antifungal among asymptomatic candiduria patients (96%), followed by micafungin (4%). Asymptomatic candiduria patients not managed according to the guidelines had a trend toward higher 30-day readmission (35% versus 26%, = 0.27). Inappropriate management of candiduria among hospitalized patients was high, leading to overtreatment with antifungal therapy.

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Section: Discussionmentioning

confidence: 99%

Overtreatment of Asymptomatic Candiduria among Hospitalized Patients: a Multi-institutional Study

Jacobs

Dilworth

Beyda

et al. 2018

Antimicrob Agents Chemother

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“…Specific vaccines recommended vary between jurisdictions, but commonly include pertussis and influenza. There are also new maternal vaccines in development, including group B streptococcus 3 and respiratory syncytial virus (RSV). 4 This highlights the fundamental and expanding role of the midwife in counselling parents about the importance of vaccination.…”

mentioning

confidence: 99%

Is immunisation education in midwifery degrees adequate?

Attwell

Yusuf

Frawley

2018

Human Vaccines & Immunotherapeutics

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Maternal and childhood vaccination decisions begin during pregnancy, and midwives are an important information resource. Their role is set to increase with the expansion of maternal immunisations into new jurisdictions, and new maternal vaccines in development. Meanwhile, other health providers are orienting parents towards vaccine acceptance, using strategies at odds with midwifery norms around information provision and maternal autonomy. To better understand and address the implications of these developments, we conducted a pilot study to ascertain how midwifery students in Australian universities are taught about immunisation, including dedicated time, assessment, who teaches it, and when. We also analysed teaching materials, looking for messaging regarding the importance of vaccination and whether midwives should be advocating for it. We found that education on immunisation comprises less than four hours of the degree, and encountered the norm of midwives informing about rather than recommending vaccination. The considerations we brought to our small project, and what it illuminated, suggest that midwifery university education is an important arena for developing future vaccine advocates. However, midwifery ideology and professional practice mean that such efforts will be challenging, and must commence from a position of respect for the values midwives hold.

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“…Of interest, both PCV15 formulations elicited higher OPA GMTs and IgG GMCs than PCV13 to serotype 3, a serotype that is still associated with a significant burden of pneumococcal disease in children and older adults despite high uptake of PCV13 in children in many countries for several years. [42][43][44] Although serotype-specific OPA GMTs or IgG GMCs were observed to be numerically higher for a given study vaccine than the 2 other study vaccines, the clinical significance of such differences are unknown as no serotype-specific correlate of protection against pneumococcal disease has been established in adults. No clear underlying biological or chemical reasons were found and such differences could be due to chance alone given the number of comparisons tested between PCV15-A, PCV15-B and PCV13.…”

Section: Discussionmentioning

confidence: 99%