J Perinatol. 2002 Oct-Nov;22(7):523-5.
The development of a group B streptococcus prevention policy at a community hospital.

Clemens CJ, Gable EK.

Department of Pediatrics, University of North Carolina, Chapel Hill, NC, USA.

BACKGROUND AND OBJECTIVES: In 1996, the Centers for Disease Control (CDC) issued guidelines for antepartum antibiotic prophylaxis of group B streptococcal (GBS)-positive women. The objective of this study is to document results of a GBS prophylaxis policy at one nonacademically affiliated, community hospital and discern its effectiveness with regard to compliance as well as in decreasing the incidence of early onset GBS (EOGBS) disease. METHODS: The development of a GBS-prevention policy at the Women's Hospital of Greensboro (WHG) was documented by means of interviews and examination of minutes of meetings. Effectiveness of the policy was assessed by calculating the percentage of all GBS+ or unknown mothers who received antepartum antibiotics during a 1-year period. Additionally, all newborns with any positive GBS culture during the past 13 years at WHG were identified. RESULTS: The policy was formulated and distributed during a 6-month period by strong leadership, community "buy-in," and an educational seminar. A preprinted physician order was written so that all GBS-positive/unknown mothers would receive antepartum antibiotics. Additionally, a clinical pathway was used to track and monitor maternal GBS status. During October 1, 1999 to September 30, 2000, 1124 (23.1%) mothers were found to be GBS positive/unknown. Of those who delivered an infant >37 weeks' gestation and who could be linked to the pharmacy database, 777 (91.1%) received antepartum antibiotics. The incidence of EOGBS disease at WHG before 1996 was 1.93 +/- 0.7/1000 births compared to 0.4 +/- 0.05/1000 after the issuance of the guidelines (p = 0.002, t-test). CONCLUSIONS: Over 90% of GBS-positive mothers were treated with antibiotics at WHG. Associated with this high adherence rate to the CDC guidelines has been a five-fold decrease in the incidence of EOGBS disease. We attribute these results to the implementation of a preprinted physician order sheet to direct intrapartum antibiotics for women with GBS positive or unknown colonization and the use of a clinical pathway to track GBS colonization status.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12368966&dopt=Abstract antibiotic, antibiotics



Enferm Infecc Microbiol Clin. 2002 Oct;20(8):384-7.
[Evolution of the use of antibiotics in a hospital long-term care center in Catalonia]

[Article in Spanish]

Vaqueiro M, Moron A, Sampere M, Nino J, Segura F.

Responsable clinico del Centro Sociosanitario Albada. Corporacio Parc Tauli. Sabadell. Barcelona. Spain. mvaqueirspt.es

INTRODUCTION: Advanced age, together with immune system changes, malnutrition, chronic disease, and the institutional environment, all contribute to a higher risk of acquiring infection in the elderly. Antibiotics are widely used in geriatric centers, but often their use is not optimal. MATERIAL AND METHODS: Study carried out during the period 1992-1999 in Centro Sociosanitario Albada (Sabadell, Spain). Data were taken from the Pharmacy Department's unidose registry. We determined the most frequently used antibiotics, the hospital units with highest consumption, the variation in these factors over time, and related costs. RESULTS: A progressive increase in overall antibiotic consumption was observed during the first 5 years of the study with subsequent stabilization. The units showing highest consumption were the Moderate and Highly-Dependent Chronic Unit, the Palliative Care Unit and the Convalescence and Rehabilitation Unit, with significant increases in the Palliative Care Unit in the last two years of the study. Amoxicillin-clavulanate, ciprofloxacin and norfloxacin were the most extensively used antibiotics. Cost increases were seen in the last three years despite the stabilization of antibiotic use. CONCLUSION: We observed a change in the consumption and profile of the antimicrobial agents used in our setting, probably related to changes in the population, increases in parenteral treatment and changes in the criteria for treatment of terminal patients. The establishment of controls for antibiotic use in long-term care centers would lead to improvements in the quality of the care provided.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12372234&dopt=Abstract antibiotic, antibiotics



Mayo Clin Proc. 2002 Oct;77(10):1053-8.
Comparison of processes and outcomes of pneumonia care between hospitalists and community-based primary care physicians.

Rifkin WD, Conner D, Silver A, Eichorn A.

Department of Medicine, Maimonides Medical Center, Brooklyn, NY 11219, USA. wrifkiaimonidesmed.org

OBJECTIVE: To compare medical care provided by hospitalists and primary care physicians to patients with community-acquired pneumonia in order to identify specific practices that might explain the improved efficiency of care provided by hospitalists. PATIENTS AND METHODS: We retrospectively reviewed the medical charts of 455 patients hospitalized with pneumonia at a community-based tertiary care center between January 1, 1998, and January 1, 1999. Exclusion criteria included human immunodeficiency virus infection, lung cancer, active tuberculosis, hospitalization within 7 days, length of stay (LOS) more than 14 days, and requirement of mechanical ventilation. All patients were cared for by either a full-time hospitalist or a primary care physician. Data collected included patient insurance status, variables to calculate each patient's Pneumonia Severity Index score, initial antibiotic selection, door-to-needle time, time to patient stability for switch to oral antibiotics, time to actual switch, unstable variables at discharge, and subspecialty consultation rate. Each patient's initial chest x-ray film was reviewed and classified as diagnostic of pneumonia, indeterminate, or clear. Outcomes measured via administrative database were mortality, LOS, costs, and readmission rate. RESULTS: Primary care physicians cared for 270 patients, and hospitalists cared for 185. Primary care physician patients were older, and this group had a higher proportion of the highest-risk patients. The mean time to stability was 3.2 days for hospitalists and 3.3 days for primary care physicians, and the mean time from stability to actual switch from intravenous to oral antibiotics was 1.6 days and 23 days, respectively (P=.003). The mean adjusted LOS was 5.6 days for hospitalists and 6.5 days for primary care physicians. Similarly adjusted costs were $594 less per patient treated by hospitalists. A difference in door-to-needle time of 0.9 hour favoring primary care physicians did not contribute to LOS. No significant differences were noted in adjusted inpatient mortality or the appropriateness of initial antibiotics used. Primary care physicians were more likely to prescribe clindamycin and ceftazidime, and they requested infectious disease consultations more often. At discharge, 14% of hospitalist patients and 7% of primary care physician patients had at least 1 unstable variable. Differences in hospital readmission rates at 15 and 30 days were not statistically significant in combined or risk-stratified analyses. CONCLUSIONS: Inpatients with community-acquired pneumonia cared for by hospitalists had a shorter adjusted LOS than those seen by primary care physicians primarily because of earlier recognition of stability and more rapid conversion from intravenous to oral antibiotics. Adjusted costs were likewise reduced. However, patients seen by hospitalists were discharged with an unstable clinical variable more often. Other than earlier switch to oral antibiotics, less use of clindamycin and ceftazidime, and fewer infectious disease consultations, hospitalists' processes of care were similar to those of primary care physicians.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12374249&dopt=Abstract antibiotic, antibiotics



Scand J Infect Dis. 2002;34(9):657-9.
Educational intervention for parents and healthcare providers leads to reduced antibiotic use in acute otitis media.

Smabrekke L, Berild D, Giaever A, Myrbakk T, Fuskevag A, Ericson JU, Flaegstad T, Olsvik O, Ringertz SH.

Regional Drug Information Centre, Tromso University Hospital, Norway. lars.smabrekknn.no

We used a controlled before-and-after design with the aims of reducing both the total consumption of antibiotics and the use of broad-spectrum antibiotics against acute otitis media (AOM), and to study to what extent prescriptions for antibiotics against AOM were dispensed. Information on evidence-based treatment of uncomplicated AOM was provided to doctors and nurses, and written guidelines were implemented. Pamphlets and oral information concerning symptomatic treatment and the limited effect of antibiotic use in AOM were given to parents. Eligible patients were 819 children aged 1-15 y. The proportion of patients receiving a prescription for antibiotics was reduced from 90% at baseline to 74% during the study period. The proportion of prescriptions for penicillin V increased from 72% at baseline to 85% during the study period. There were no significant changes at the control site. The proportion of dispensed prescriptions was 70% both at baseline and during the study period. Educational efforts reduced the total consumption of antibiotics and the use of broad-spectrum antibiotics for AOM in children aged 1-15 y at an emergency call service. Data on antibiotic use in AOM based only on prescribing overestimates the use of antibiotics.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12374355&dopt=Abstract antibiotic, antibiotics



Pneumologie. 2002 Oct;56(10):605-9.
[beta-lactam-antibiotics in the treatment of community-acquired respiratory tract infections with penicillin-resistant pneumococci]

[Article in German]

Brauers J, Ewig S, Kresken M.

Antiinfectives Intelligence GmbH, Bonn, Germany. infntiinfectives-intelligence.de

Streptococcus pneumoniae is still the most important pathogen of community-acquired respiratory tract infections. During the last decades in many countries an increase in the spread of antibiotic resistant strains (e. g. against beta-lactams, macrolides, tetracyclin) was observed. Resistance against penicillin is often associated with resistance against macrolides and other antibiotic classes. In Germany surveillance studies including isolates from patients with community-acquired respiratory tract infections have shown that about 14 % of strains show a reduced susceptibility against penicillin (MIC-values 0.12 - 1 mg/L) and up to 4 % are highly resistant against penicillin (MIC >/= 2 mg/L). Resistance against tetracycline or macrolides was detected in up to 12 and 15 % of strains, respectively. According to the treatment guidelines of the Paul-Ehrlich-Gesellschaft fur Chemotherapie and the Deutschen Atemwegsliga penicillins and cephalosporins are recommended as first line antibiotics for the treatment of community-acquired respiratory tract infections. As pneumococcal strains with reduced susceptibility against penicillin show often also a reduced susceptibility against cephalosporins the questions arises which beta-lactam antibiotics should still be used in empirical treatment of such strains. beta-Lactam-antibiotics highly differ in their in-vitro-activity against S. pneumoniae and their pharmacokinetic properties. In different models is has been demonstrated for beta-lactams that an adequate clinical and bacteriological efficacy is achievable when the serum levels of the free, i. e. not protein bound fraction of drug exceeds the MIC of the pathogen for at least 40 to 50 % of the dosing interval (T > MIC). In a clinical situation where pneumococci with reduced susceptibility against penicillin cannot be ruled out, only beta-lactam antibiotics with favourable pharmacological properties (good in-vitro activity, high and long lasting serum levels) should be used for treatment.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12375222&dopt=Abstract antibiotic, antibiotics



East Afr Med J. 2002 Jan;79(1):45-8.
Antimicrobial susceptibility of staphylococci species from cow foremilk originating from dairy farms around Gaborone, Botswana.

Guta C, Sebunya TK, Gashe BA.

Department of Biology, University of Botswana, Gaborone.

OBJECTIVE: To determine the prevalence of antibiotic susceptibility of Staphylococcus species isolated from foremilk samples. SETTING: Milk was collected from five farms within a 70 km radius of Gaborone, Botswana. SUBJECTS: Two hundred and twenty five staphylococci isolates from foremilk samples. MAIN OUTCOME MEASURES: Antibiotic susceptibility tests to penicillin G, ampicillin, tetracycline, erythromycin, cephalothin, chloramphenicol, methicillin, gentamicin and vancomycin. RESULTS: The susceptibility patterns of the staphylococcal strains to the antibiotics were as follows: penicillin G (47.1%), ampicillin (58.7%), tetracycline (62.7%), erythromycin (72%), cephalothin (72.9%), chloramphenicol (79.1%), methicillin (86.2%), gentamicin (88.9%) and vancomycin (100%). Lower susceptibility to chloramphenicol, methicillin and gentamicin was displayed by Staphylococcus epidermidis, S. haemolyticus and S. saprophyticus. Only 19 (8.5%) of the isolates were susceptible to all the antibiotics tested. The most common multiple resistance patterns encountered were penicillin-ampicillin (9.3%), penicillin-erythromycin-ampicillin (6.1%) and erythromycin-tetracycline-ampicillin (3.6%). CONCLUSION: Most of the Staphylococcus isolates were resistant to one or more of the antimicrobial agents, with none being resistant to vancomycin. Inappropriate use of antibiotics is suspected to be a major contributory factor in the relatively high level of resistance to antimicrobial agents observed in this study. Therefore, milk can act as a very good source of antibiotic resistant Staphylococcus species posing a threat to consumers.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12380871&dopt=Abstract antibiotic, antibiotics



Crit Care Nurse. 2002 Oct;22(5):38-43.
Caring for a patient with Listeria endocarditis: use of antibiotic desensitization.

Candela L.

University of Nevada, Las Vegas, USA.

Occurrence of Listeria endocarditis is rare, and the mortality rate is high, 100% in untreated cases. The use of antibiotics, specifically ampicillin, is considered a first-line treatment. Coadministration of ampicillin and gentamicin provides a synergistic effect in killing the bacteria. Antibiotics are among the most common causes of hypersensitivity reactions. Of all antibiotics, penicillin is the one that most often causes a reaction. Skin testing adds time until treatment, and all patients with sensitivity to penicillin may not be detected. In the case presented, the patient had antibiotic desensitization with ampicillin. He did not have any allergic reactions to the drug. However, his history of allergy to penicillin was uncertain, so perhaps he did not have a true, serious penicillin allergy. Also, most likely he was anergic and could not mount an immune response to ampicillin, even if truly allergic. Therefore, his response may not be a typical response to antibiotic desensitization. Understanding possible hypersensitivity reactions can help guide the medical and nursing management of patients having antibiotic desensitization.


Source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12382616&dopt=Abstract antibiotic, antibiotics