Medical Professionals

Some of the factors that may lead to suboptimal prescribing of antibiotics are listed in Table 2.1. A major factor is imperfect knowledge of the prescriber. This lack of knowledge has to do with insufficient knowledge of infectious diseases, the potential causative microorganisms and their susceptibility to antimicrobials, and expertise on antimicrobial drugs. With regard to the latter, there is probably too little emphasis in most medical curricula on the relevance of prudent antibiotic...

Conclusion and Recommendation

HA-MRSA is a major nosocomial pathogen with major impact on the healthcare systems of almost every country in the world. In countries with high rates of HA-MRSA, mortality and morbidity attributed to infections caused by this organism is high, as is the financial burden of therapy and prolonged hospitalization. In countries with low rates, the prevention of MRSA from becoming endemic is responsible for a lower, but still significant financial outlay. However, prevention is less expensive than...

The Role of the Microbiology Laboratory

Given the preeminence of the MIC in modern PK PD concepts, it is obviously important, for the outcome of critical infections, that the laboratory can accurately measure the MIC of causative organisms in real time, in order to guide appropriate therapy and dosing schedules. In the absence of a pathogen or on preliminary identification, an estimate of the MICs of likely pathogens, based on data from the previous year's isolates, can be used to inform decisions on therapy. For instance, if a...

Prevention and Control of Multiresistant Infections

Equally relevant to the epidemiology of antibiotic resistance, particularly in hospitals, are the initiatives taken at national and individual hospital level to prevent spread of multiresistant organisms within healthcare institutions. Active infection control programs are also inconsistently present in hospitals of the region. Whereas infection control is a national requirement in almost all European countries, the same does not apply in the rest of the region (Table 9.1). Borg et al. (2005)...

Aspects of Virulence Toxin Production

It has been known for some time that antibiotics are capable of modifying the metabolic processes of bacteria when they are incorporated into culture media at subinhibitory concentrations (Lorian and Gemmell 1991). This includes the expression of virulence-associated genes in pathogens. Not all antibiotics exert the same effect, however, since there appears to be a differential effect dependent on the pathogen and antibiotic pair under investigation (Worlitzsch etal. 2001, Drummond, Smith and...

Preoperative Use of Topical Antibiotics Active Against MRSA

The impact of topical antibiotic for eradication of MSSA and or MRSA is best known for mupirocin, a compound synthesized by Pseudomonas fluorescens that inhibits bacterial protein synthesis by reversibly binding to bacterial isoleucyl-tRNA synthetase. Several studies have demonstrated the efficacy of mupirocin for the eradication of MRSA and MSSA in different populations (Laupland and Colby 2003). Its effect in healthy healthcare workers (Doebbeling et al. 1993, Fernandez et al. 1995, Reagan et...

Risk Factors for MRSA Infection in Surgical Patients

The main and most frequently reported risk factors for colonization with or infection by MRSA in all hospitalized patients include a history of previous MRSA colonization or infection, previous hospital stay, the length of the current hospital stay, the presence of invasive devices, previous antibiotic treatments, contact with a roommate who carries MRSA, chronic skin ulcers, and diabetes mellitus (Graffunder and Venezi 2002, Tacconelli et al. 2004, Troillet et al. 1998). In addition, belonging...

Antibiotic Heterogeneity and Antibiotic Cycling

Antibiotic cycling or rotation has been advocated as a potential strategy for reducing the emergence of antimicrobial resistance (Kollef 2001). In theory, a class of antibiotics or a specific antibiotic is withdrawn from use for a defined time period and later reintroduced in an attempt to limit bacterial resistance to the cycled antimicrobial agents. Outbreaks of infection by a specific strain of resistant bacteria can be successfully managed by restricted access to specific antibiotics,...

Resistance to Fluoroquinolones

Fluoroquinolones are an important group of antibiotics for the oral treatment of P. aeruginosa infection in the CF lung and in the Copenhagen CF Center ciprofloxacin has routinely been used since 1987 together with colistin inhalations for the early aggressive treatment of P. aeruginosa. This therapeutic strategy prevents chronic P aeruginosa infection in 80 of the patients in the treated group compared to untreated controls (Valerius et al. 1991) and changed the epidemiology of the infection,...

Pseudomonas aeruginosa

P. aeruginosa is typically an opportunist that seldom causes disease in healthy subjects and is mostly a nosocomial pathogen. According to the data of the CDC National Nosocomial Infection Surveillance System, P. aeruginosa was the second most common cause of nosocomial pneumonia, third most common cause of urinary tract infections, and seventh most common cause of nosocomial bacteremia.112 UTIs caused by P. aeruginosa are usually related to catheterization or other invasive procedures.113,114...

What Data Should Be Collected during an Antibiotic Prevalence Survey

The simplest prevalence surveys record only the antibiotics prescribed by directly reviewing prescription charts. When electronic prescribing is in place, this process can potentially be more time-efficient.32 Data generated give an indication of the range and volume of agents used as well as the duration of therapy and timing of IV-to-oral switch. Appropriate dosing and dosing interval can also be assessed. The major advantage of this type of survey is that the data are readily available and...

Assembling Patients Data

The variables needed to prescribe antibiotics pertain to the patient's medical history, laboratory results, current and former microbiological samples, and more. Nowadays, and increasingly in the future, these data will be available electronically. For example, the finding that a patient has undergone a urological procedure 2 weeks before presentation with a urinary tract infection will influence the bacterial spectrum and thus the antibiotic chosen. Another patient might have had a urine...

Antibiotic Decision Making

The process of prescribing antibiotic treatment is more complex than prescription of any other drug or intervention in medicine. It affects not only the patient at the time of prescription, but also the patient's future with regard to infections, the possibility to treat them, and future patients. Prescription of a last resort drug to one patient might mean no antibiotic treatment for the next patient. Alternatively, withholding antibiotic treatment from one patient might mean cure for another....

Urinary Tract Infections

UTI is an important problem with regard to its frequency. Of women between 20 and 40 years of age, 25 to 35 have had at least one episode of UTI.13 UTIs are most often caused by Gram-negative bacilli approximately 80 of uncomplicated UTIs are caused by Escherichia coli, and the rest with others such as enterococci, Staphy-lococcus saprophyticus, Klebsiella spp., and Proteus mirabilis.14 Unfortunately, many strains of E. coli have become resistant to ampicillin because of expression of...

Coordinating an Antibiotic Point Prevalence Survey

Given the potential complexity of data collection, particularly if done over several hospital sites, a detailed guideline document should be available for users on how to administer and complete the survey tool. Meetings between those who are coordinating and collecting data should be held to clarify how clinical data should be collected and recorded. Ideally the audit tool should be piloted to ensure its suitability for the given situation. Clinical pharmacists are ideally suited to both...

Introduction

As long as we are able to identify the causative microorganism for infections, Staphylococcus aureus has been the most important cause of nosocomial infections (Archer 2000). The consequences of infections are severe, especially when there is no effective antimicrobial treatment available. In 1941 the mortality rate of S. aureus bacteremia at the Boston City hospital was reported to be 82 (Skinner and Keefer 1941). A recent study estimated that inpatients with S. aureus infections in U.S....

References

Stich, et al. (2005) Proteomic fingerprinting for the diagnosis of human African trypanosomiasis. Trends Parasitol 21(4) 154-7. Anon (2003) Winning Ways Working together to reduce healthcare associated infection in England. Report of the Chief Medical Officer, Department of Health. Anon (2004) Improving patient care by reducing the risk of hospital acquired infection A progress report. U.K. National Audit Office. Belanger, S. D., M. Boissinot, etal. (2003) Rapid detection of...