Adjunctive Therapy Case

Gold standard procedures should be implemented with the aim of providing timely and accurate results. (Schentag) The culture result should be accompanied by its clinical significance, selective reporting of susceptibility testing results in accordance with hospital antimicrobial therapy guidelines and suggested management. (Schentag) This encourages appropriate prescribing and minimises unnecessary use of antimicrobials. The clinical microbiology team should also provide reports to AMS regarding resistant organisms.

With a quantitative approach, a descriptive, prospective, cross-sectional method was used to collect data. Utilizing medical records from 51 patients hospitalized between February and April of 2013, data such as age, Braden Scale scores, comorbidities and length of stay were collected. Clinical data obtained was then organized in an Excel table and input into the statistical software, Epi Info, to be arranged for statistical analysis (Oliveira de Carvalho et al.,

Preventable infections regardless of the causative agent, have become major triggers of unintended patient outcome, increased morbidity, and mortality (Arias, 2010). Methicillin Sensitive Staphylococcus Aureus (MSSA) and Methicillin Resistant Staphylococcus Aureus (MRSA) are the most common causes of healthcare associated infections (HAI) and outbreaks in acute care hospitals and community settings (CADTH, 2010). The widespread infection with the MRSA pathogen is believed to have increased from 2.4 percent in 1975 to 29 percent in 1991 and 2003 in hospitals across the United States (U S) (CADTH, 2010). The prevalence is even greater among Intensive Care Unit (ICU) patients at 53 percent (CADTH, 2010) and continues to rise due to the widespread

Meanwhile, the quality improvement team selected potential subjects and added their medical record numbers to the database. The team decided to utilize a quality improvement toolbox technique to create surveys for physicians to complete on a daily basis. The survey form requested patient demographics along with the patient’s medical history. The physicians were asked to estimate the patient’s risk of ARTI complications due to chronic illnesses such as diabetes or cardiovascular disease. Finally, the physician recorded the patient’s final diagnosis and the type of antibiotic prescribed. The data collected from the physician forms was entered into a database (REDCaps) for statistical analysis. The working hypothesis stated that the overall antibiotic prescription rate would be reduced by 5% through education and intervention. Overall, their final results support their hypothesis, all of their stated goals met expectations. The overall prescription rate was reduced from 69% to 55%, and broad spectrum antibiotic prescriptions fell from 68% to 59%. The interventions also reduced antibiotic use in otherwise healthy patients and delayed treatment with antibiotics from a baseline of 8.3 days to 9.7 days (Grover DO, et al.,

Antibiotics differ from many other drugs in the fact that the treatment is for a very short time compared to drugs used to treat hypertension, diabetes, Parkinson’s, or cancer. The latter disorders have in common that the treatment, from the moment of diagnosis, is life-long. The treatment period for antibiotics is only a few weeks, making the return of investment poor. Increasing demands of authorities in both development and marketing phase and in legislation increase the costs of new antibiotics.[1] [3]

Thirty to 50 percent of the 400,000 to 500,000 cases of sepsis in the United States each year are fatal, emphasizing the seriousness of this public health concern [2]. Recent research into possible alternative treatment options indicates that patients being treated with statin therapy are less likely to develop sepsis from a serious infection, die from sepsis or develop serious complications due to sepsis; however, the mechanism of action is unknown and therefore is the focus of this study [2, 6, 10-12]. Possible mechanisms of action include a direct interaction of the statin with the sepsis-causing organism, an interaction between the statin and the host immune system or a combination of the two [9, 14, 16-17]. Additionally, recent studies indicate that statins may have a direct antimicrobial effect and has suggested that statins may diminish the replication and infectivity of some pathogens responsible for sepsis [11, 14, 16-17]. Thus, we hypothesized that statins could benefit septic patients by

Although declining, inappropriate antibiotic prescribing continues to be a problem, especially the use of broad-spectrum antibiotics for infections of predominantly viral etiology, increasing risk for developing drug-resistant infection complications (Aspinall, Good, Metlay, Mor, & Fine, 2008; Garau & Dagan, 2003). Few interventions have been effective in moderating antibiotic overuse for acute URTIs (Legare et al., 2012). Emphasis on infection control alone is inadequate to address the rise of resistant infections. Judicious prescribing is the

Research has revealed how overprescribing antibiotic creates several adverse outcomes, including the development of multidrug resistant organisms, Clostridium difficile infection, and increased costs of health care (Myung et al., 2015). The Consumer Report (2015) raised concern for the overuse of antibiotics and how it leads to the loss of the ability to treat serious infections. Doctors,

There is an abundance of information identifying central line acquired bloodstream infection (CLABSI) as a serious adverse event during hospitalization resulting in increased morbidity, mortality, and health care cost. Present data from research indicates that CLABSI is the second most avoidable cause of death during hospitalization (Shah, Schwartz, & Cullen, 2016). The above concepts that CLABSI is preventable yet it continues to yield a yearly cost of 2.3 billion dollars and remains a quality metric for national offices such as Joint Commission indicates a foundation for research (Son et al., 2012). Upon the literature review, CLABSI rates were significantly reduced when specific techniques were implemented. Furthermore, all the articles

Preventative efforts to reduce stress ulcer development include pharmacological agents such as proton pump inhibitors (PPIs) and histamine 2 receptor antagonists (H2RA) (Kersh et al, 2017). The continued use of SUP, such as PPIs, may increase the risk of ventilator-associated pneumonia and Clostridium difficile infections (CDIs) by suppressing gastric acid of bacteriostatic effect (Ro et al, 2016). Because of widespread prophylactic use of pharmacologic agents and the development of hospital-acquired infections (HAIs), healthcare costs have increased by $14,000 per patient (Barletta & Sclar, 2013). Although some evidence suggested that SUP should be implemented for those at increased risk for stress ulcers, it is unclear to whether or not

PICOT question: In patients with sepsis, does prophylactic antibiotic treatment, compared to no antibiotic or delaying treatment while waiting for labs results, make a difference in the progression to septic shock?

In 1992 Shapiro et al. published their research informing providers prophylactic antimicrobial treatment is not routinely indicated [2] There were a total of 387 patients in the controlled trial, 203 patients assigned to receive amoxicillin and 182 were given a placebo [2]. Either 250mg of amoxicillin or a placebo was given to subjects three times a day for ten days. 15 subjects dropped out and 7

First, the article provides a short explanation regarding central line associated bloodstream infections (CLABSI) and CLABSI related deaths that occur annually in the US. A national campaign, ‘On the CUSP,’ is briefly discussed. This was a collaborative cohort study of 1,071 adult intensive care units (ICUs) in 44 states, Puerto Rico, and Washington D.C. Their goal was to evaluate the impact of the ‘On the CUSP’ campaign in relation to CLASI reduction. Extensive education and training was provided prior and during the intervention. The multi-level Poisson regression model showed CLABSIs dropped from 1.96 to 1.15 per 1,000 line-days, a 43% decrease. Limitations included: this was not a randomized controlled trial (RCT), lack of resources to validate CLABSI data or collect intervention compliance data. However, the study indicates CLABSIs are preventable with standardized nursing interventions, which improves patient outcomes.

PICC-related bloodstream infections were found less frequently in patients with the antimicrobial PICC. The nonintervention group had a total of 8 CLABSIs (rate ¼ 4.18/1,000 catheter days). There was 1 CLABSI (rate ¼ 0.47/1,000 catheter days) in the intervention group. Along the course of the study there were limitations affecting its applicability. For example, the 2 study groups were not fully comparable with respect to underlying conditions or admitting diagnosis that might have predisposed the patients to CLABSI. The variables collected on each diagnosis varied greatly between patients and did not offer a pattern to code effectively for known CLABSI risk factors. The quasiexperimental design could only provide evidence of probability. The retrospective data for the nonintervention group was another limitation. In addition, the inability of the researcher to determine the significance of nursing compliance with maintenance practices could have introduced bias into this

Central line associated bloodstream infections (CLABSI) is the second leading cause of death from healthcare acquired infection in the US (Boubekri, 2013), contributing to a high mortality rate of 12%-25% (CDC, 2011), and they are costly to treat, averaging more than $45,000 per case (Kaler, 2014). The Center for Medicare and Medicaid Services (CMS) stops reimbursing providers for the care and treatment of CLABSIs while patient was under their care because these are potentially considered preventable events through the use of evidence-based practices (Saladow, 2010). At the Cardiovascular Step down (CVSD) unit, almost all of the patients who were coming