Ambulatory Tract Infection: A Case Study

It is thought that overuse of antibiotics is related to the development of antimicrobial resistance (AMR) (Austin). As a consequence, there has been an increasing trend to promote appropriate prescribing of antibiotics so as to maximise their therapeutic efficacy and minimise the outbreak of resistance. Antimicrobial stewardship (AMS) programs in hospitals are exemplary of a method used to promote rational prescription of antibiotics. In this review, we will briefly introduce some examples of AMR to illustrate the extent of this issue. We will then move on to describe AMS programs and the strategies required to

Antibiotics are inarguably one of the greatest advances in medical science of the past century. Although the first natural antibiotic Penicillin was not discovered until 1928 by Scottish biologist Alexander Flemming, evidence exists that certain plant and mold growths were used to treat infections in ancient Egypt, ancient India, and classical Greece (Forrest, 1982). In our modern world with the advent of synthetic chemistry synthetic antibiotics like Erithromycin and its derivative Azithromycin have been developed. Antibiotics have many uses including the treatment of bacterial and protozoan infection, in surgical operations and prophylactically to prevent the development of an infection. Through these applications, antibiotics have saved countless lives across the world and radically altered the field of medicine. Though a wonderful and potentially lifesaving tool, antibiotic use is not without its disadvantages. Mankind has perhaps been too lax in regulation and too liberal in application of antibiotics and growing antibiotic resistance is the price we must now pay. A recent study showed that perhaps 70% of bacterial infections acquired during hospital visits in the United States are resistant to at least one class of antibiotic (Leeb, 2004). Bacteria are not helpless and their genetic capabilities have allowed them to take advantage of society’s overuse of antibiotics, allowing them to develop

The authors of the study are confident that their quality improvement approach can be successfully replicated in other family practice clinics. The methods used by the project could be easily implemented, the materials from the CDC’s Get Smart about Antibiotics are inexpensive and readily available. The article does suggest that their study may have a serious flaw, called the Hawthorne Effect. The Hawthorne Effect or an observer effect acknowledges that both physicians and patients were fully aware they were participating in a quality improvement project. The project would have been more efficient if the participants were unaware they were being evaluated. When individuals believe they are not being observed the results tend to be more trustworthy. Ultimately, the project proved its hypothesis and educated individuals about the risks of overusing antibiotics. Eventually, patients and physicians will learn to be cautious, and let viral infections run their natural

Antimicrobial stewardship (AS) can be attained while fostering quality patient satisfaction. Interdisciplinary standards of practice exist to ensure evidence-based prescribing practices yet the pervasive use of antibiotics remains rampant globally. This is a multifaceted topic that impacts primary care prescribers, pharmacists, nurses, pharmaceutical companies, governing bodies, educational institutions, research teams, and the general population. This article will investigate how Canadian nurse practitioners (NPs) are in a prime position to influence an overdue revolution in AS, specifically for uncomplicated viral upper respiratory tract infections (URTIs) of children ages two to ten in primary care.

Upper respiratory tract infections (URTI), including acute otitis media (AOM) are the most common cause of ambulatory physician visits and antimicrobial prescriptions in children1,2. The most common bacterial causes of URTI are Streptococcus pneumoniae and Haemophilus influenzae, though the majority of cases are caused by viral pathogens 3–10. Distinguishing between viral and bacterial URTI can be difficult. Reports on quality of antimicrobial prescriptions have shown a 30-50% of all out-patient prescriptions due to (upper) respiratory tract infections to be inappropriate2,10,11. In Europe the quality of prescription is higher in the north of the continent, including Iceland compared to in the south12. Conversely, many factors contribute to the overuse of antimicrobials2,13–15, which in turn results to increase in antimicrobial resistance16,17. Contributing factors cited by by physicians to cause over-prescription include uncertainty of diagnosis, fear of disease complications, lack of perception of harmful effects of antimicrobials, not perceiving their own prescription practices to be a problem, pressure by patients, limited time, fear of damaging doctor-patient relationship in addition to language, cultural and educational barriers2,13–15. Antimicrobials were long a mainstay treatment against AOM in fear of rare, but dangerous complications, which have later been found to be unfounded, asnd

Antibiotic resistance is when microorganisms, such as bacteria, are able to survive an exposure to antibiotics and these bacteria are now resistant to the effects of these antibiotics. Antibiotic resistance in bacteria has been an issue since antibiotics were discovered. The fact that bacteria can become resistant to our medical treatments such as antibiotics is a natural evolutionary process, but there are certain human contributions that definitely speed up the process. For example, one of the main contributions that will be discussed is the problem of over prescription of the antibiotic drugs. The

Hospital acquired infections or healthcare associated infections (HAI’S) which is also known as nosocomial infections have been a burden to society for decades, which has gained the top ten positions in the cause of death in the united states (CDC, 2015), although there is a decrease it still poses as a problem. According to the Centers for Disease Control and Prevention (CDC) there are several types of healthcare associated infections, which “includes central line-associated bloodstream infections (CLABI), catheter-associated urinary tract infections (CAUTI), and ventilator-associated pneumonia infections (VAP)” (Centers for Disease Control and Prevention [CDC], 2015). Some other common types of HAI’s which are also Multidrug-Resistant Organisms

Antibiotics-resistant organisms have become one of the most serious threats to public health, infecting over two million people and killing approximately 23,000 people annually.1 According to the CDC, “total inappropriate antibiotic use,” such as prescribing unnecessary antibiotics or giving the wrong dose or duration, makes up to 50% of all outpatient antibiotic use,2,3 and in 2009, the United States spent $10.7 billion on antibiotics, indicating that there is a lot of potential money to save.4

Of all the hospital acquired conditions or “never-events” identified by the Centers for Medicare & Medicaid Services (CMS), infections are possibly the most frightening to consider. This holds true for lay people as well as medical professionals, perhaps because of our perception that controlling the risk for infection is more difficult than controlling non-infectious risk for injury conditions that usually result from preventable human error. Safety awareness and improved education can help on multiple fronts in the fight against most hospital acquired conditions, but with infections, the

Health care acquired infection (HCAI) exerts a massive impact on the health care services delivery and improvement of its quality. It has been reported among leading culprits of prolonged admission, increased mortality, long-term disability and complications, emergence of multidrug resistant organism (MDRO), and they are costing healthcare services a great deal of money.(1, 2) At a given time, occurrence of HCAI is 15.5 per 100 patients in developing countries and 5 to 12 per 100 patients in developed countries. It is estimated that approximately 1 out of every 20 hospitalized patients will contract an HCAI.(3) In a summery and updating reviews done in 2014 by WHO concluded that more than a quarter of the MERS-cov infections have been

A current predicament in the field of science is antibiotic resistance against superbugs.Though fighting against superbugs; which can be defined as a strain of bacteria unable to be killed using multiple antibiotics, is now a large problem, in the past it was not. The evolution of resistance in bacteria due to antibiotic abuse and lack of product development has brought upon us once again the fear of a pre-antibiotic era; one where simple, once easily defeated infections could kill. Already, infectious diseases are the 3rd leading cause of death in the US and the 2nd across the entire world, and drug resistant superbugs send 2 million Americans to hospitals every year; killing 23,000 of those people. And any bacterium can quickly and easily become multidrug resistant, the leading cause of this being antibiotic misuse in both humans and animals.( "Clinical Infectious Diseases." The Epidemic of Antibiotic-Resistant Infections: A Call to Action for the Medical Community from the Infectious Diseases Society of America. UCLA Medical School. Web. 27 Mar. 2016.)

Widespread use of antibiotics has been very controversial in the media as well in the general population. Due to these controversies, it is very misunderstood to how antibiotics work leading to many patients in the hospital setting wanting to take them when it is not necessary or refusing to take when it is necessary for their survival. Some of this controversy is due to antibiotic resistance, which has spread an alarming rate in the 21st century (Walsh, 2000). Antibiotic resistance is the result of very strong bacteria or microbes that are resistant to the antibiotic prescribed and those microbes accumulate overtime by their survival, reproduction and transfer, leading to increased levels of antibiotic resistance.

Antibiotic resistance is one of the major threats to human medicine as it can cause treatments to fail and in worse case create untreatable infections. Studies have shown that other than overuse of antibiotics by humans , the overuse and misuse of antibiotics in animal production is also an important factor. When animals are given an antibiotic that has similarities to human antibiotics for a disease, cross resistance occurs. Cross resistance is when the disease causing bacteria becomes resistant to the drug that is also used in human medicine which can be extremely dangerous. This is why the use of antibiotics is called to be “Dangerous and unjustifiable” by medical experts as the threats that the use of antibiotics in animals can pose to human medicine are extremely

The overuse of antibiotics has been a problem for well over a decade. This misuse leads to many nonvisible problems arising within the human population. As the use of antibiotics increases, the number of antibiotic resistant bacteria also increases. When bacteria become resistant to an antibiotic, another antibiotic must be used to try and kill it and the cycle becomes vicious. Michael Martin, Sapna Thottathil, and Thomas Newman stated that antimicrobial resistance is, “an increasingly serious threat to global public health that requires action across all government sectors and society” (2409).

According the World Health Organization (WHO), antibiotic resistance is one of the world’s greatest health threats to date (Haddox, 2013). In the article, The Health Threat of Antibiotic Resistance, Gail Haddox (2013) discusses the danger antibiotic resistance poses in today’s society and strategies to prevent the expansion of antibiotic resistance. In Europe alone, an estimated 25,000 deaths have been attributed to multi-resistant infections (Haddox, 2013). Common infections are now harder to treat due to the increased resistance to antibiotics across the world, in fact some are becoming untreatable. Antibiotics should be treated like oil, a non-renewable resource (Haddox, 2013).