SASPI Ltd.
Systematic review/Scoping review with large effect size
Analysis of antibiotic strategies to prevent vascular graft or endograft infection after surgical treatment for infective native aortic aneurysms: a systematic review
Citation:- Antimicrob Resist Infect Control. 2024 Oct 1;13(1):116. doi: 10.1186/s13756-024-01477-3
Authors: Wu SJ, Sun S, Tan YH, Chien CY
Abstract
Introduction: Some patients with an infective native aortic aneurysm (INAA) develop an aortic vascular graft or endograft infection (VGEI) even after successful open surgical repair or endovascular intervention. The aim of the systematic review and meta-analysis performed herein was to compare the clinical outcomes of different surgical and antibiotic treatment strategies.
Methods: We systematically searched PubMed, MEDLINE, EMBASE and Web of Science. The keywords used for the search were “mycoticaortic aneurysm”, “infected aortic aneurysm”, “infective native aortic aneurysm”, “antibiotics”, “surgery”, and “endovascular”. The searchwas limited to articles written in English and to studies involving humans. Articles published before 2000 were excluded. Case reports and review articles were excluded.
Results: Of the 524 studies retrieved from our search of the databases, 47 articles were included in this study. Among the 47 articles (1546 patients, 72.8% of whom were male) retrieved, five articles were excluded from the subgroup analysis because the data concerning open surgical repair and endovascular intervention could not be separated. The remaining 42 articles included a total of 1179 patients who underwent open surgical repair (622 patients) or endovascular intervention (557 patients) for INAA. There was a statistically significant difference (p = 0.001) in the pooled in-hospital mortality rate between the open surgical repair group (13.2%, 82/622) and the endovascularintervention group (7.2%, 40/557). However, there was a statistically significant difference (p < 0.001) in the aortic VGEI rate between the open surgical repair group (5.4%). 29/540) and endovascular intervention (13.3%, 69/517) group. For patients who underwent open surgical repair, a lower rate of aortic vascular graft infection was associated with long-term antibiotic use (p = 0.005). For patients who underwent endovascular intervention, there was a trend of association (p = 0.071) between the lower rate of aortic endograft infection and life long antibiotic use.
Conclusion: Infective native aortic aneurysms are life-threatening. The pooled in-hospital mortality rate of the open surgical repair group was significantly higher than that of the endovascular intervention group, whereas the rate of the aortic VGEI in the open surgical repair group was significantly lower than that in the endovascular intervention group. Regardless of whether open surgical repair or endovascular intervention is performed, better long-term outcomes can be achieved with aggressive antibiotic treatment, which is especially important for patients who undergo endovascular intervention.
Multi-centric observational study with large effect
Multicentre external validation of the Neonatal Healthcare-associated infecti On Prediction (NeoHoP) score: a retrospective case-control study
Citation:- BMJ Paediatr Open. 2024 Oct 1;8(1):e002748. doi: 10.1136/bmjpo-2024-002748.
Authors: Lloyd LG, Dramowski A, Bekker A, Ballot DE, Ferreyra C, Gleeson B, Nana T, Sharland M, Velaphi SC, Wadula J, Whitelaw A, van Weissenbruch MM.
Abstract
Background and objectives: Neonatal mortality due to severe bacterial infections is a pressing global issue, especially in low-middle-income countries (LMICs) with constrained healthcare resources. This study aims to validate the Neonatal Healthcare-associated infectiOnPrediction (NeoHoP) score, designed for LMICs, across diverse neonatal populations.
Methods: Prospective data from three South African neonatal units in the Neonatal Sepsis Observational (NeoOBS) study were analysed.The NeoHoP score, initially developed and validated internally in a South African hospital, was assessed using an external cohort of 573 sepsis episodes in 346 infants, focusing on different birth weight categories. Diagnostic metrics were evaluated, including sensitivity,specificity, positive predictive value and area under the receiver operating characteristic curve.
Results: The external validation cohort displayed higher median birth weight and gestational age compared with the internal validation cohort. A significant proportion were born before reaching healthcare facilities, resulting in increased sepsis evaluation, and diagnosed healthcare-associated infections (HAIs). Gram-negative infections predominated, with fungal infections more common in the external validation cohort.The NeoHoP score demonstrated robust diagnostic performance, with 92% specificity, 65% sensitivity and a positive likelihood ratio of 7.73. Subgroup analysis for very low birth weight infants produced similar results. The score’s generalisability across diverse neonatal populations was evident, showing comparable performance across different birth weight categories.
Conclusion: This multicentre validation confirms the NeoHoP score as a reliable ‘rule-in’ test for HAI in neonates, regardless of birth weight. Its potential as a valuable diagnostic tool in LMIC neonatal units addresses a critical gap in neonatal care in low-resource settings.
Systematic review/Scoping review with large effect size
Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050
Citation:- Lancet. 2024 Sep 28;404(10459):1199-1226. doi: 10.1016/S0140-6736(24)01867-1. Epub 2024 Sep 16.
Authors: GBD 2021 Antimicrobial Resistance Collaborators.
Abstract
Background: Antimicrobial resistance (AMR) poses an important global health challenge in the 21st century. A previous study has quantified the global and regional burden of AMR for 2019, followed with additional publications that provided more detailed estimates for several WHO regions by country. To date, there have been no studies that produce comprehensive estimates of AMR burden across locations that encompass historical trends and future forecasts.
Methods: We estimated all-age and age-specific deaths and disability-adjusted life-years (DALYs) attributable to and associated with bacterial AMR for 22 pathogens, 84 pathogen-drug combinations, and 11 infectious syndromes in 204 countries and territories from 1990 to 2021. We collected and used multiple cause of death data, hospital discharge data, microbiology data, literature studies, single drug resistance profiles, pharmaceutical sales, antibiotic use surveys, mortality surveillance, linkage data, outpatient and inpatient insurance claims data, and previously published data, covering 520 million individual records or isolates and 19 513 study-location-years. We used statistical modelling to produce estimates of AMR burden for all locations, including those with no data. Our approach leverages the estimation of five broad component quantities: the number of deaths involving sepsis; the proportion of infectious deaths attributable to a given infectious syndrome; the proportion of infectious syndrome deaths attributable to a given pathogen; the percentage of a given pathogen resistant to an antibiotic of interest; and the excess risk of death or duration of an infection associated with this resistance. Using these components, we estimated disease burden attributable to and associated with AMR, which we define based on two counterfactuals; respectively, an alternative scenario in which all drug-resistant infections are replaced by drug-susceptible infections, and an alternative scenario in which all drug-resistant infections were replaced by no infection. Additionally, we produced global and regional forecasts of AMR burden until 2050 for three scenarios: a reference scenario that is a probabilistic forecast of the most likely future; a Gram-negative drug scenario that assumes future drug development that targets Gram-negative pathogens; and a better care scenario that assumes future improvements in health-care quality and access to appropriate antimicrobials. We present final estimates aggregated to the global, super-regional, and regional level.
Findings: In 2021, we estimated 4·71 million (95% UI 4·23-5·19) deaths were associated with bacterial AMR, including 1·14 million (1·00-1·28) deaths attributable to bacterial AMR. Trends in AMR mortality over the past 31 years varied substantially by age and location. From 1990 to 2021, deaths from AMR decreased by more than 50% among children younger than 5 years yet increased by over 80% for adults 70 years and older. AMR mortality decreased for children younger than 5 years in all super-regions, whereas AMR mortality in people 5 years and older increased in all super-regions. For both deaths associated with and deaths attributable to AMR, meticillin-resistant Staphylococcus aureus increased the most globally (from 261 000 associated deaths [95% UI 150 000-372 000] and 57 200 attributable deaths [34 100-80 300] in 1990, to 550 000 associated deaths [500 000-600 000] and 130 000 attributable deaths [113 000-146 000] in 2021). Among Gram-negative bacteria, resistance to carbapenems increased more than any other antibiotic class, rising from 619 000 associated deaths (405 000-834 000) in 1990, to 1·03 million associated deaths (909 000-1·16 million) in 2021, and from 127 000 attributable deaths (82 100-171 000) in 1990, to 216 000 (168 000-264 000) attributable deaths in 2021. There was a notable decrease in non-COVID-related infectious disease in 2020 and 2021. Our forecasts show that an estimated 1·91 million (1·56-2·26) deaths attributable to AMR and 8·22 million (6·85-9·65) deaths associated with AMR could occur globally in 2050. Super-regions with the highest all-age AMR mortality rate in 2050 are forecasted to be south Asia and Latin America and the Caribbean. Increases in deaths attributable to AMR will be largest among those 70 years and older (65·9% [61·2-69·8] of all-age deaths attributable to AMR in 2050). In stark contrast to the strong increase in number of deaths due to AMR of 69·6% (51·5-89·2) from 2022 to 2050, the number of DALYs showed a much smaller increase of 9·4% (-6·9 to 29·0) to 46·5 million (37·7 to 57·3) in 2050. Under the better care scenario, across all age groups, 92·0 million deaths (82·8-102·0) could be cumulatively averted between 2025 and 2050, through better care of severe infections and improved access to antibiotics, and under the Gram-negative drug scenario, 11·1 million AMR deaths (9·08-13·2) could be averted through the development of a Gram-negative drug pipeline to prevent AMR deaths.
Interpretation: This study presents the first comprehensive assessment of the global burden of AMR from 1990 to 2021, with results forecasted until 2050. Evaluating changing trends in AMR mortality across time and location is necessary to understand how this important global health threat is developing and prepares us to make informed decisions regarding interventions. Our findings show the importance of infection prevention, as shown by the reduction of AMR deaths in those younger than 5 years. Simultaneously, our results underscore the concerning trend of AMR burden among those older than 70 years, alongside a rapidly ageing global community. The opposing trends in the burden of AMR deaths between younger and older individuals explains the moderate future increase in global number of DALYs versus number of deaths. Given the high variability of AMR burden by location and age, it is important that interventions combine infection prevention, vaccination, minimisation of inappropriate antibiotic use in farming and humans, and research into new antibiotics to mitigate the number of AMR deaths that are forecasted for 2050.
Other specific ISP article suggested by Editorial Board
Team-based infection preventionist review improves inter-rater reliability in identification of healthcare-associated infections
Authors: David Granton et al.
Abstract
Accurate reporting of healthcare-associated infections (HAIs) to the National Healthcare Safety Network (NHSN) is a critical function of infection prevention and control (IPC) teams. Validation was performed to increase inter-rater reliability in HAI adjudication among infection preventionists. Benefits included improved data integrity, enhanced team performance, and individual growth.
Other specific DSP article suggested by Editorial Board
Effect of automated identification of antimicrobial stewardship opportunities for suspected urinary tract infections
Citation:- Antimicrob Steward Health Epidemiol. 2024 Oct 3;4(1):e158. doi: 10.1017/ash.2024.437. eCollection 2024.
Authors: Deri CR, Moehring RW, Turner NA, Spivey J, Advani SD, Wrenn RH, Yarrington ME.
Abstract
Objective: We aimed to determine whether automated identification of antibiotic targeting suspected urinary tract infection (UTI) shortenedthe time to antimicrobial stewardship (AS) intervention.
Design: Retrospective before-and-after study.
Setting: Tertiary and quaternary care academic medical center.
Patients: Emergency department (ED) or admitted adult patients meeting best practice alert (BPA) criteria during pre- and post-BPAperiods.
Methods: We developed a BPA to alert AS pharmacists of potential ASB triggered by the following criteria: ED or admitted status, antibioticorder with genitourinary indication, and a preceding urinalysis with ≤ 10 WBC/hpf. We evaluated the median time from antibiotic order to ASintervention and overall percent of UTI-related interventions among patients in pre-BPA (01/2020-12/2020) and post-BPA (04/15/2021-04/30/2022) periods.
Results: 774 antibiotic orders met inclusion criteria: 355 in the pre- and 419 in the post-BPA group. 43 (35 UTI-related) pre-BPA and 117 (94UTI-related) post-BPA interventions were documented. The median time to intervention was 28 hours (IQR 18-65) in the pre-BPA groupcompared to 16 hours (IQR 2-34) in the post-BPA group (P< 0.01). Despite absent pyuria, there were six cases with gram-negativebacteremia presumably from a urinary source.
Conclusions: Automated identification of antibiotics targeting UTI without pyuria on urinalysis reduced the time to stewardship interventionand increased the rate of UTI-specific interventions. Clinical decision support aided in the efficiency of AS review and syndrome-targetedimpact, but cases still required AS clinical review.
Other specific ASP article suggested by Editorial Board
Implementing the Infectious Diseases Society of America Antimicrobial Stewardship Core Curriculum: Survey Results and Real-World Strategies to Guide Fellowship Programs
Citation:- Open Forum Infect Dis. 2024 Oct 2;11(10):ofae542. doi: 10.1093/ofid/ofae542. eCollection 2024 Oct.
Authors: Hojat LS, Patel PK, Ince D, Kang AY, Fong G, Cherabuddi K, Nori P, Al Lawati H, Stohs EJ, Beeler C, Van Schooneveld TC, Lee MS, Hamilton KW, Justo JA, Spicer JO, Logan A, Bennani K, Williams R, Shnekendorf R, Bryson-Cahn C, Willis ZI, Moenster RP, Brennan-Krohn T, Paras ML, Holubar M, Gaston DC, Advani SD, Luther VP.
Abstract
Background: The Infectious Diseases Society of America (IDSA) developed the Core Antimicrobial Stewardship (AS) Curriculum to meet theincreasing demand for infectious diseases (ID) providers with AS expertise. Notable diversity in implementation approaches has beenobserved among ID fellowship programs using the curriculum. We sought to describe individual approaches and develop a curriculumimplementation roadmap.
Methods: We surveyed ID fellowship programs that had previously implemented the IDSA Core AS curriculum. The survey includedquestions regarding program characteristics, curriculum participants and presentation format, resources and barriers, and implementationstrategies. Commonly reported program features were summarized in the context of the self-reported implementation strategies.Implementation guides were developed based on the most common characteristics observed.
Results: Of 159 programs that had purchased the curriculum, 37 responded, and 34 (21%) were included in the analysis. The curriculum wasprimarily taught by AS physicians (85%) and AS pharmacists (47%). The most common conference structure was a longitudinal conferenceseries (32%), and eLearning was the most common presentation format. Limited AS faculty time (76%) and limited first-year fellowavailability (62%) were frequently reported as barriers, and dedicated AS curricular time was a resource available to most programs (67%);implementation guides were created for these 3 program features.
Conclusions: Programs reported a variety of implementation barriers and resources, with several common themes emerging, allowing forthe development of tailored curriculum planners for 3 commonly observed program characteristics. This work will equip fellowship programswith curriculum implementation strategies and guide future enhancements of the IDSA Core and Advanced AS curricula.
Other specific ASP article suggested by Editorial Board
The Characteristics of Postgraduate Antimicrobial Stewardship Education Resources: A Nationwide Survey in Japan
Citation:- J Hosp Infect. 2024 Oct 3:S0195-6701(24)00320-7. doi: 10.1016/j.jhin.2024.09.012. Online ahead of print.
Authors: Miwa T, Okamoto K, Nishizaki Y, Tokuda Y.
Abstract
Antimicrobial stewardship (AS) education is important for resident physicians who are at the “shaping behaviour” stage. Not only are they involved in prescribing antimicrobials but they are also expected to play an influential future role as attending physicians. We previously reported that infectious disease (ID) physicians’ bedside teaching may improve resident physicians’ perceptions and attitudes toward AS. Given the shortage of ID physicians and their workload stress. however, their involvement in AS education may be insufficient. This study aimed to depict the current landscape of AS education for resident physicians including the availability of ID physicians.
Other specific ASP article suggested by Editorial Board
Factors associated with the change of antimicrobial prescription before and after the National Action Plan on Antimicrobial Resistance: Additional analysis of a nationwide survey conducted by the Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases
Citation:- J Infect Chemother. 2024 Oct 2:S1341-321X(24)00273-3. doi: 10.1016/j.jiac.2024.09.021. Online ahead of print.
Authors: Morioka S, Tsuzuki S, Gu Y, Fujitomo Y, Soeda H, Nakahama C, Hasegawa N, Maesaki S, Maeda M, Matsumoto T, Miyairi I, Ohmagari N.
Abstract
Background: A nationwide survey conducted by the Japanese Society of Chemotherapy and the Japanese Association for InfectiousDiseases in 2020 provided insights into antimicrobial prescription practices among clinic doctors. This study aimed to investigate factorsinfluencing changes in antimicrobial prescriptions post-implementation of the National Action Plan on Antimicrobial Resistance (NAPAR) and doctors’ inclination to prescribe antimicrobials for common cold cases.
Methods: In September 2020, randomly selected questionnaires were distributed to 3000 community-based medical clinics in Japan. The primary objective was to assess the reduction in antimicrobial prescriptions post-NAPAR implementation. Multivariate linear regressionanalysis was employed to identify associated factors.
Results: Analysis of 632 responses (response rate: 21.1%) revealed determinants of decreased antimicrobial prescriptions, including familiarity with the Guide to Antimicrobial Stewardship (β = 0.482, t = 3.177, p = 0.002) and awareness of NAPAR (β = 0.270, t = 2.301, p =0.022).
Conclusion: Interventions such as the Guide to Antimicrobial Stewardship may have contributed to the reduction in antimicrobial prescriptions among Japanese physicians. However, targeted strategies are needed to address high-prescription groups. Enhancing awareness and education on appropriate antimicrobial use should be integral components of future initiatives to combat antimicrobialresistance effectively.