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He R, Luo B, Hu C, Li Y, Niu R. Differences in distribution and drug sensitivity of pathogens in lower respiratory tract infections between general wards and RICU. J Thorac Dis 2014; 6:1403-10. [PMID: 25364517 PMCID: PMC4215154 DOI: 10.3978/j.issn.2072-1439.2014.09.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 08/18/2014] [Indexed: 11/14/2022]
Abstract
BACKGROUND Lower respiratory tract infections (LRTIs) are common among patients in hospitals worldwide, especially in patients over the age of 60. This study investigates the differences in distribution and drug sensitivity of pathogens in LRTIs. METHODS The clinical and laboratory data of 4,762 LRTI patients in the general ward and respiratory intensive care unit (RICU) of Xiangya Hospital (Changsha) were retrospectively analyzed. RESULTS The infection rate of Gram-negative bacteria was significantly higher than that of Gram-positive bacteria in both the general ward and RICU (P<0.05). The incidence of Gram-negative bacteria infection was significantly higher in the RICU than in the general ward (P<0.05), whereas the incidence of Gram-positive bacteria infection is less in the RICU than in the general ward (P<0.05). In the general ward, the incidence of Gram-negative bacteria infection significantly increased (P<0.05) over time, whereas the incidence of Gram-positive bacteria infection significantly decreased from 1996 to 2011 (P<0.05). In the RICU, the incidence of Gram-positive bacteria infection decreased, while Gram-negative bacteria infections increased without statistical significance (P>0.05). Staphylococcus pneumoniae and Staphylococcus aureus were found to be the predominant Gram-positive strains in the general ward (34.70-41.18%) and RICU (41.66-54.87%), respectively (P>0.05). Pseudomonas aeruginosa and Acinetobacter baumannii were the predominant gram negative strains in the general ward (19.17-21.09%) and RICU (29.60-33.88%), respectively (P>0.05). Streptococcus pneumoniae is sensitive to most antibiotics with a sensitivity of more than 70%. Staphylococcus aureus is highly sensitive to vancomycin (100%), linezolid (100%), chloramphenicol (74.36-82.19%), doxycycline (69.57-77.33%), and sulfamethoprim (67.83-72.46%); however, its sensitivity to other antibiotics is low and decreased each year. Sensitivity of Pseudomonas aeruginosa to most β-lactam, aminoglycoside, and quinolone group antibiotics decreased each year. CONCLUSIONS The distribution and drug sensitivity of LRTI pathogens exhibit a high divergence between the general ward and RICU. Streptococcus pneumoniae may not be the predominant pathogen in LRTIs in some areas of China.
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Affiliation(s)
- Ruoxi He
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Bailing Luo
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Chengping Hu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ying Li
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ruichao Niu
- Department of Respiratory Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
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Blakeway LV, Power PM, Jen FEC, Worboys SR, Boitano M, Clark TA, Korlach J, Bakaletz LO, Jennings MP, Peak IR, Seib KL. ModM DNA methyltransferase methylome analysis reveals a potential role for Moraxella catarrhalis phasevarions in otitis media. FASEB J 2014; 28:5197-207. [PMID: 25183669 DOI: 10.1096/fj.14-256578] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Moraxella catarrhalis is a significant cause of otitis media and exacerbations of chronic obstructive pulmonary disease. Here, we characterize a phase-variable DNA methyltransferase (ModM), which contains 5'-CAAC-3' repeats in its open reading frame that mediate high-frequency mutation resulting in reversible on/off switching of ModM expression. Three modM alleles have been identified (modM1-3), with modM2 being the most commonly found allele. Using single-molecule, real-time (SMRT) genome sequencing and methylome analysis, we have determined that the ModM2 methylation target is 5'-GAR(m6)AC-3', and 100% of these sites are methylated in the genome of the M. catarrhalis 25239 ModM2 on strain. Proteomic analysis of ModM2 on and off variants revealed that ModM2 regulates expression of multiple genes that have potential roles in colonization, infection, and protection against host defenses. Investigation of the distribution of modM alleles in a panel of M. catarrhalis strains, isolated from the nasopharynx of healthy children or middle ear effusions from patients with otitis media, revealed a statistically significant association of modM3 with otitis media isolates. The modulation of gene expression via the ModM phase-variable regulon (phasevarion), and the significant association of the modM3 allele with otitis media, suggests a key role for ModM phasevarions in the pathogenesis of this organism.
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Affiliation(s)
| | | | | | | | | | - Tyson A Clark
- Pacific Biosciences, Menlo Park, California, USA; and
| | - Jonas Korlach
- Pacific Biosciences, Menlo Park, California, USA; and
| | - Lauren O Bakaletz
- Center for Microbial Pathogenesis, Research Institute at Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Ian R Peak
- Institute for Glycomics and School of Medical Science, Griffith University, Southport, Queensland, Australia
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Keller LE, Friley J, Dixit C, Nahm MH, McDaniel LS. Nonencapsulated Streptococcus pneumoniae Cause Acute Otitis Media in the Chinchilla That Is Enhanced by Pneumococcal Surface Protein K. Open Forum Infect Dis 2014; 1:ofu037. [PMID: 25734113 PMCID: PMC4281809 DOI: 10.1093/ofid/ofu037] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 05/26/2014] [Indexed: 12/27/2022] Open
Abstract
Nonencapsulated Streptococcus pneumoniae (NESp) is an emerging human pathogen, and NESp produced acute otitis media in the chinchilla. Increased epithelial cell adhesion correlated to pathogenesis. The expression of pneumococcal surface protein K (PspK) increased NESp virulence. Background Use of the pneumococcal conjugate vaccine has led to serotype replacement of carriage and acute otitis media (AOM) pneumococcal isolates. Increases in nonencapsulated Streptococcus pneumoniae (NESp) isolates have also occurred, and there are increasing reports of NESp-associated disease. Disease prevalence and virulence factors of NESp isolates have not been studied. Methods A chinchilla model of pneumococcal AOM was utilized, and disease was assessed through bacterial enumeration along with scoring visible signs of pathology. An adhesion-invasion assay using a human epithelial cell line was performed. Results Nonencapsulated Streptococcus pneumoniae strains containing pneumococcal surface protein K (PspK) were more likely to cause AOM and pathology upon infection. Deletion of PspK from an isolate significantly reduced bacterial loads. Increased epithelial cell adhesion correlated with increased virulence of NESp isolates naturally lacking PspK. Furthermore, expression of PspK by an avirulent NESp resulted in virulence. Conclusions The presence of PspK increased the disease potential of NESp. Pneumococcal surface protein K is not the only virulence factor of NESp in AOM. Expression of PspK in an avirulent NESp mediated the progression to pneumococcal disease. Genetic exchange between pneumococci may allow dissemination of PspK, increasing the potential of NESp disease. The current study is the first report of a NESp-specific virulence factor.
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Affiliation(s)
| | | | | | - Moon H Nahm
- Departments of Pathology ; Microbiology , University of Alabama at Birmingham
| | - Larry S McDaniel
- Departments of Microbiology ; Surgery ; Division of Infectious Diseases , University of Mississippi Medical Center, Jackson, Mississippi
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154
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Cope A, Francis N, Wood F, Mann MK, Chestnutt IG. Systemic antibiotics for symptomatic apical periodontitis and acute apical abscess in adults. Cochrane Database Syst Rev 2014:CD010136. [PMID: 24967571 DOI: 10.1002/14651858.cd010136.pub2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dental pain can have a considerable detrimental effect on an individual's quality of life. Symptomatic apical periodontitis and acute apical abscess are common causes of dental pain and arise from an inflamed or necrotic dental pulp, or infection of the pulpless root canal system. Clinical guidelines recommend that the first-line treatment for teeth with symptomatic apical periodontitis or an acute apical abscess should be removal of the source of inflammation or infection by local, operative measures, and that systemic antibiotics are currently only recommended for situations where there is evidence of spreading infection (cellulitis, lymph node involvement, diffuse swelling) or systemic involvement (fever, malaise). Despite this, there is evidence that dentists continue to prescribe antibiotics for these conditions. There is concern that this could contribute to the development of antibiotic-resistant bacterial colonies both within the individual and within the community as a whole. OBJECTIVES To evaluate the effects of systemic antibiotics provided with or without surgical intervention (such as extraction, incision and drainage of a swelling or endodontic treatment), with or without analgesics, for symptomatic apical periodontitis or acute apical abscess in adults. SEARCH METHODS We searched the following electronic databases: Cochrane Oral Health Group's Trials Register (to 1 October 2013); Cochrane Central Register of Controlled Trials (The Cochrane Library 2013, Issue 9); MEDLINE via OVID (1946 to 1 October 2013); EMBASE via OVID (1980 to 1 October 2013) and CINAHL via EBSCO (1980 to 1 October 2013). We searched the World Health Organization (WHO) International Trials Registry Platform and the US National Institutes of Health Trials Registry (ClinicalTrials.gov) on 1 October 2013 to identify ongoing trials. We searched for grey literature using OpenGrey (to 1 October 2013) and ZETOC Conference Proceedings (1993 to 1 October 2013). We placed no restrictions on the language or date of publication when searching the electronic databases. SELECTION CRITERIA Randomised controlled trials of systemic antibiotics in adults with a clinical diagnosis of symptomatic apical periodontitis or acute apical abscess, with or without surgical intervention (considered in this situation to be extraction, incision and drainage or endodontic treatment) and with or without analgesics. DATA COLLECTION AND ANALYSIS Two review authors screened the results of the searches against inclusion criteria, extracted data and assessed risk of bias independently and in duplicate. We calculated mean differences (MD) (standardised mean difference (SMD) when different scales were reported) and 95% confidence intervals (CI) for continuous data and, where results were meta-analysed, we used a fixed-effect model as there were fewer than four studies. We contacted study authors to obtain missing information. MAIN RESULTS We included two trials in this review, with 62 participants included in the analyses. Both trials were conducted in university dental schools in the USA and compared the effects of oral penicillin V potassium (penicillin VK) versus a matched placebo given in conjunction with a surgical intervention (total or partial pulpectomy) and analgesics to adults with acute apical abscess or symptomatic necrotic tooth (no signs of spreading infection or systemic involvement (fever, malaise)). We assessed one study as having a high risk of bias and the other study as having unclear risk of bias.The primary outcome variables presented were participant-reported pain and swelling (one trial also reported participant-reported percussion pain). One study reported the type and number of analgesics taken by participants. One study recorded the incidence of postoperative endodontic flare-ups (people who returned with symptoms that necessitated further treatment). Adverse effects as reported in one study were diarrhoea (one participant, placebo group) and fatigue and reduced energy postoperatively (one participant, antibiotic group). No studies reporting quality of life measurements were suitable for inclusion. Objective 1: systemic antibiotics versus placebo with surgical intervention and analgesics for symptomatic apical periodontitis or acute apical abscess. Two studies provided data for the comparison between systemic antibiotics (penicillin VK) and a matched placebo for adults with acute apical abscess or a symptomatic necrotic tooth. Participants in one study all underwent a total pulpectomy of the affected tooth while participants in the other study had their tooth treated by either partial or total pulpectomy. Participants in both trials received oral analgesics. There were no statistically significant differences in participant-reported measures of pain or swelling at any of the time points assessed within the review. The MD for pain (short ordinal numerical scale 0 to 3) was -0.03 (95% CI -0.53 to 0.47) at 24 hours; 0.32 (95% CI -0.22 to 0.86) at 48 hours and 0.08 (95% CI -0.38 to 0.54) at 72 hours. The SMD for swelling was 0.27 (95% CI -0.23 to 0.78) at 24 hours; 0.04 (95% CI -0.47 to 0.55) at 48 hours and 0.02 (95% CI -0.49 to 0.52) at 72 hours. The body of evidence was assessed as at very low quality. Objective 2: systemic antibiotics without surgical intervention for adults with symptomatic apical periodontitis or acute apical abscess. We found no studies that compared the effects of systemic antibiotics with a matched placebo delivered without a surgical intervention for symptomatic apical periodontitis or acute apical abscess in adults. AUTHORS' CONCLUSIONS There is very low quality evidence that is insufficient to determine the effects of systemic antibiotics on adults with symptomatic apical periodontitis or acute apical abscess.
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Affiliation(s)
- Anwen Cope
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, PCPH, 3rd Floor, Neuadd Meirionnydd, Heath Park, Cardiff, UK, CF14 4YS
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155
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Lee GC, Reveles KR, Attridge RT, Lawson KA, Mansi IA, Lewis JS, Frei CR. Outpatient antibiotic prescribing in the United States: 2000 to 2010. BMC Med 2014; 12:96. [PMID: 24916809 PMCID: PMC4066694 DOI: 10.1186/1741-7015-12-96] [Citation(s) in RCA: 170] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 05/16/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of antibiotics is the single most important driver in antibiotic resistance. Nevertheless, antibiotic overuse remains common. Decline in antibiotic prescribing in the United States coincided with the launch of national educational campaigns in the 1990s and other interventions, including the introduction of routine infant immunizations with the pneumococcal conjugate vaccine (PCV-7); however, it is unknown if these trends have been sustained through recent measurements. METHODS We performed an analysis of nationally representative data from the Medical Expenditure Panel Surveys from 2000 to 2010. Trends in population-based prescribing were examined for overall antibiotics, broad-spectrum antibiotics, antibiotics for acute respiratory tract infections (ARTIs) and antibiotics prescribed during ARTI visits. Rates were reported for three age groups: children and adolescents (<18 years), adults (18 to 64 years), and older adults (≥65 years). RESULTS An estimated 1.4 billion antibiotics were dispensed over the study period. Overall antibiotic prescribing decreased 18% (risk ratio (RR) 0.82, 95% confidence interval (95% CI) 0.72 to 0.94) among children and adolescents, remained unchanged for adults, and increased 30% (1.30, 1.14 to 1.49) among older adults. Rates of broad-spectrum antibiotic prescriptions doubled from 2000 to 2010 (2.11, 1.81 to 2.47). Proportions of broad-spectrum antibiotic prescribing increased across all age groups: 79% (1.79, 1.52 to 2.11) for children and adolescents, 143% (2.43, 2.07 to 2.86) for adults and 68% (1.68, 1.45 to 1.94) for older adults. ARTI antibiotic prescribing decreased 57% (0.43, 0.35 to 0.52) among children and adolescents and 38% (0.62, 0.48 to 0.80) among adults; however, it remained unchanged among older adults. While the number of ARTI visits declined by 19%, patients with ARTI visits were more likely to receive an antibiotic (73% versus 64%; P <0.001) in 2010 than in 2000. CONCLUSIONS Antibiotic use has decreased among children and adolescents, but has increased for older adults. Broad-spectrum antibiotic prescribing continues to be on the rise. Public policy initiatives to promote the judicious use of antibiotics should continue and programs targeting older adults should be developed.
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Affiliation(s)
| | | | | | | | | | | | - Christopher R Frei
- College of Pharmacy, The University of Texas at Austin, Austin, TX, USA.
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156
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Hwang SM, Lim MS, Han M, Hong YJ, Kim TS, Lee HR, Song EY, Park KU, Song J, Kim EC. Comparison of xTAG respiratory virus panel and Verigene Respiratory Virus Plus for detecting influenza virus and respiratory syncytial virus. J Clin Lab Anal 2014; 29:116-21. [PMID: 24796703 PMCID: PMC6807105 DOI: 10.1002/jcla.21738] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 12/12/2013] [Indexed: 11/21/2022] Open
Abstract
Background Nucleic acid amplification tests have allowed simultaneous detection of multiple respiratory viruses. Methods We compared the results of a liquid bead array xTAG Respiratory Virus Panel (RVP; (Luminex Corporation, Toronto, Canada) and a solid microarray Verigene Respiratory Virus Plus (RV+; Nanosphere, Northbrook, IL) for the detection of influenza A virus (INF A), influenza B virus (INF B), and respiratory syncytial virus (RSV) in 170 respiratory specimens from hospitalized patients. Results Overall, xTAG RVP demonstrated sensitivities and specificities of 97.6 and 100% for INF A, 100 and 99.4% for INF B, and 100 and 100% for RSV, while the Verigene RV+ test sensitivities and specificities were 95.1 and 98.5%, 100.0 and 99.4%, and 97.1 and 100%, respectively. There were no significant differences in the area under the curves between the two assays for each virus (P = 0.364 for INF A, P = 1.000 for INF B, P = 0.317 for RSV). Comparing the results of two assays, discordant results were present mostly due to subtype assignments and identification of coinfections. The detection of viruses was not significantly different (P = 1.000) and the virus/subtype assignment showed good agreement with kappa coefficients of 0.908. Conclusion The xTAG RVP and Verigene RV+ showed high sensitivities and specificities, and good overall agreement in detection and identification of INF and RSV. These assays can be used in clinical settings for a reliable detection of respiratory viruses found commonly in hospitalized patients.
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Affiliation(s)
- Sang Mee Hwang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea; Department of Laboratory Medicine, Seoul National University College of Medicine, Seoul, Korea
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157
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Thomas NM, Brook I. Otitis media: an update on current pharmacotherapy and future perspectives. Expert Opin Pharmacother 2014; 15:1069-83. [PMID: 24793547 DOI: 10.1517/14656566.2014.903920] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Acute otitis media (AOM) is the most common childhood bacterial infection and also the leading cause of conductive hearing loss in children. Currently, there is an urgent need for developing novel therapeutic agents for treating AOM. AREAS COVERED Structured search of current literature. PubMed was searched for published literature in areas of pharmacotherapeutics, preventive therapies and complementary treatments for OM. The intent of this review is to provide a comprehensive evaluation of therapeutics for AOM, including preventive modalities and complementary medicine. EXPERT OPINION the management of AOM in young children is still evolving and depends on patterns of bacterial colonization and antimicrobial resistance in the community. The introduction of vaccinations against potential respiratory tract pathogens has altered the frequency of recovery of pathogens causing ear infections in children. Even though not all patients require antimicrobial therapy to overcome their infection, these agents improve symptoms faster and lead to fewer treatment failures. Further studies are warranted to evaluate which patients would best benefit from antimicrobial therapy.
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Affiliation(s)
- Nicole M Thomas
- Uniformed Services University of the Health Sciences, Department of Pediatrics , Bethesda, MD , USA
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158
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Michaelidis CI, Zimmerman RK, Nowalk MP, Fine MJ, Smith KJ. Cost-effectiveness of procalcitonin-guided antibiotic therapy for outpatient management of acute respiratory tract infections in adults. J Gen Intern Med 2014; 29:579-86. [PMID: 24234394 PMCID: PMC3965735 DOI: 10.1007/s11606-013-2679-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 09/20/2013] [Accepted: 10/09/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Two clinical trials suggest that procalcitonin-guided antibiotic therapy can safely reduce antibiotic prescribing in outpatient management of acute respiratory tract infections (ARTIs) in adults. Yet, it remains unclear whether procalcitonin testing is cost-effective in this setting. OBJECTIVE To evaluate the cost-effectiveness of procalcitonin-guided antibiotic therapy in outpatient management of ARTIs in adults. DESIGN Cost-effectiveness model based on results from two published European clinical trials, with all parameters varied widely in sensitivity analyses. PATIENTS Two hypothetical cohorts were modeled in separate trial-based analyses: adults with ARTIs judged by their physicians to require antibiotics and all adults with ARTIs. INTERVENTIONS Procalcitonin-guided antibiotic therapy protocols versus usual care. MAIN MEASURES Costs and cost per antibiotic prescription safely avoided. KEY RESULTS We estimated the health care system willingness-to-pay threshold as $43 (range $0–$333) per antibiotic safely avoided, reflecting the estimated cost of antibiotic resistance per outpatient antibiotic prescribed. In the cohort including all adult ARTIs judged to require antibiotics by their physicians, procalcitonin cost $31 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored compared to usual care was 58.4 % in a probabilistic sensitivity analysis. In the analysis that included all adult ARTIs, procalcitonin cost $149 per antibiotic prescription safely avoided and the likelihood of procalcitonin use being favored was 2.8 %. CONCLUSIONS Procalcitonin-guided antibiotic therapy for outpatient management of ARTIs in adults would be cost-effective when the costs of antibiotic resistance are considered and procalcitonin testing is limited to adults with ARTIs judged by their physicians to require antibiotics.
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Affiliation(s)
- Constantinos I. Michaelidis
- />University of Pittsburgh School of Medicine, M240 Scaife Hall, 3550 Terrace Street, Pittsburgh, PA 15261 USA
| | - Richard K. Zimmerman
- />Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Mary Patricia Nowalk
- />Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
| | - Michael J. Fine
- />Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
- />Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA USA
| | - Kenneth J. Smith
- />Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA USA
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159
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Waller JL, Diaz MH, Petrone BL, Benitez AJ, Wolff BJ, Edison L, Tobin-D'Angelo M, Moore A, Martyn A, Dishman H, Drenzek CL, Turner K, Hicks LA, Winchell JM. Detection and characterization of Mycoplasma pneumoniae during an outbreak of respiratory illness at a university. J Clin Microbiol 2014; 52:849-53. [PMID: 24371236 PMCID: PMC3957776 DOI: 10.1128/jcm.02810-13] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 12/20/2013] [Indexed: 01/14/2023] Open
Abstract
An outbreak at a university in Georgia was identified after 83 cases of probable pneumonia were reported among students. Respiratory specimens were obtained from 21 students for the outbreak investigation. The TaqMan array card (TAC), a quantitative PCR (qPCR)-based multipathogen detection technology, was used to initially identify Mycoplasma pneumoniae as the causative agent in this outbreak. TAC demonstrated 100% diagnostic specificity and sensitivity compared to those of the multiplex qPCR assay for this agent. All M. pneumoniae specimens (n=12) and isolates (n=10) were found through genetic analysis to be susceptible to macrolide antibiotics. The strain diversity of M. pneumoniae associated with this outbreak setting was identified using a variety of molecular typing procedures, resulting in two P1 genotypes (types 1 [60%] and 2 [40%]) and seven different multilocus variable-number tandem-repeat analysis (MLVA) profiles. Continued molecular typing of this organism, particularly during outbreaks, may enhance the current understanding of the epidemiology of M. pneumoniae and may ultimately lead to a more effective public health response.
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Affiliation(s)
- Jessica L. Waller
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Maureen H. Diaz
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Brianna L. Petrone
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Alvaro J. Benitez
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Bernard J. Wolff
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laura Edison
- Georgia Department of Public Health, Atlanta, Georgia, USA
- Epidemiology Workforce Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Ashley Moore
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Audrey Martyn
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | - Hope Dishman
- Georgia Department of Public Health, Atlanta, Georgia, USA
| | | | - Kim Turner
- Fulton County Department of Health and Wellness, Atlanta, Georgia, USA
| | - Lauri A. Hicks
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jonas M. Winchell
- Respiratory Diseases Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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160
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Alweis R, Greco M, Wasser T, Wenderoth S. An initiative to improve adherence to evidence-based guidelines in the treatment of URIs, sinusitis, and pharyngitis. J Community Hosp Intern Med Perspect 2014; 4:22958. [PMID: 24596644 PMCID: PMC3937558 DOI: 10.3402/jchimp.v4.22958] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/31/2013] [Accepted: 01/03/2014] [Indexed: 11/27/2022] Open
Abstract
Background Upper respiratory infections, acute sinus infections, and sore throats are common symptoms that cause patients to seek medical care. Despite well-established treatment guidelines, studies indicate that antibiotics are prescribed far more frequently than appropriate, raising a multitude of clinical issues. Methods The primary goal of this study was to increase guideline adherence rates for acute sinusitis, pharyngitis, and upper respiratory tract infections (URIs). This study was the first Plan-Do-Study-Act (PDSA) cycle in a quality improvement program at an internal medicine resident faculty practice at a university-affiliated community hospital internal medicine residency program. To improve guideline adherence for respiratory infections, a package of small-scale interventions was implemented aimed at improving patient and provider education regarding viral and bacterial infections and the necessity for antibiotics. The data from this study was compared with a previously published study in this practice, which evaluated the adherence rates for the treatment guidelines before the changes, to determine effectiveness of the modifications. After the first PDSA cycle, providers were surveyed to determine barriers to adherence to antibiotic prescribing guidelines. Results After the interventions, antibiotic guideline adherence for URI improved from a rate of 79.28 to 88.58% with a p-value of 0.004. The increase of adherence rates for sinusitis and pharyngitis were 41.7–57.58% (p=0.086) and 24.0–25.0% (p=0.918), respectively. The overall change in guideline adherence for the three conditions increased from 57.2 to 78.6% with the implementations (p<0.001). In planning for future PDSA cycles, a fishbone diagram was constructed in order to identify all perceived facets of the problem of non-adherence to the treatment guidelines for URIs, sinusitis, and pharyngitis. From the fishbone diagram and the provider survey, several potential directions for future work are discussed. Conclusions Passive interventions can result in small changes in antibiotic guideline adherence, but further PDSA cycles using more active methodologies are needed.
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Affiliation(s)
- Richard Alweis
- Department of Medicine, The Reading Hospital and Medical Center, West Reading, PA, USA ; Department of Medicine, Jefferson Medical College, Philadelphia, PA, USA
| | | | - Thomas Wasser
- Consult-Stat: Complete Statistical Services, Macungie, PA, USA
| | - Suzanne Wenderoth
- Department of Medicine, The Reading Hospital and Medical Center, West Reading, PA, USA
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161
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Abstract
Otitis media is a major cause of morbidity in 80% of all children less than 3 years of age and often goes undiagnosed in the general population. There is evidence to suggest that the incidence of otitis media is increasing. The major cause of otitis media is infection of the middle ear with microbes from the nasopharynx. The anatomical orientation of the eustachian tube, in association with a number of risk factors, predisposes infants and young children to the infection. Bacteria are responsible for approximately 70% of cases of acute otitis media, with Streptococcus pneumoniae, nontypeable Haemophilus influenzae and Moraxella catarrhalis predominating as the causative agents. The respiratory viruses, respiratory syncytial virus, rhinovirus, parainfluenza and influenza, account for 30% of acute otitis media cases. Over the past decade, there has been a profound increase in the reported resistance to antibiotics, which, with increased disease burden, has focussed attention on vaccine development for otitis media. A polymicrobial formulation containing antigens from all major pathogens would have the greatest potential to deliver a sustained reduction in the disease burden globally. The disappointing outcomes for otitis media seen with the polysaccharide pneumococcal conjugate vaccine have raised major challenges for the vaccination strategy. Clearly, more knowledge is required concerning immune mechanisms in the middle ear, as well as vaccine formulations containing antigens that are more representative of the polymicrobial nature of the disease. Antigens that have been extensively tested in animal models are now available for testing in human subjects.
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Affiliation(s)
- Allan W Cripps
- Griffith University, School of Medicine, Gold Coast Campus, PMB 50, Gold Coast, MC, QLD, 9726, Australia.
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162
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Antibiotic utilization for acute respiratory tract infections in U.S. emergency departments. Antimicrob Agents Chemother 2013; 58:1451-7. [PMID: 24342652 DOI: 10.1128/aac.02039-13] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Inappropriate use of antibiotics for acute respiratory tract infections (ARTIs) has decreased in many outpatient settings. For patients presenting to U.S. emergency departments (EDs) with ARTIs, antibiotic utilization patterns are unclear. We conducted a retrospective cohort study of ED patients from 2001 to 2010 using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS). We identified patients presenting to U.S. EDs with ARTIs and calculated rates of antibiotic utilization. Diagnoses were classified as antibiotic appropriate (otitis media, sinusitis, pharyngitis, tonsillitis, and nonviral pneumonia) or antibiotic inappropriate (nasopharyngitis, unspecified upper respiratory tract infection, bronchitis or bronchiolitis, viral pneumonia, and influenza).There were 126 million ED visits with a diagnosis of ARTI, and antibiotics were prescribed in 61%. Between 2001 and 2010, antibiotic utilization decreased for patients aged<5 presenting with antibiotic-inappropriate ARTI (rate ratio [RR], 0.94; confidence interval [CI], 0.88 to 1.00). Utilization also decreased significantly for antibiotic-inappropriate ARTI patients aged 5 to 19 years (RR, 0.89; CI, 0.85 to 0.94). Utilization remained stable for antibiotic-inappropriate ARTI among adult patients aged 20 to 64 years (RR, 0.99; CI, 0.97 to 1.01). Among adults, rates of quinolone use for ARTI increased significantly from 83 per 1,000 visits in 2001 to 2002 to 105 per 1,000 in 2009 to 2010 (RR, 1.08; CI, 1.03 to 1.14). Although significant progress has been made toward reduction of antibiotic utilization for pediatric patients with ARTI, the proportion of adult ARTI patients receiving antibiotics in U.S. EDs is inappropriately high. Institution of measures to reduce inappropriate antibiotic use in the ED setting is warranted.
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163
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Gidengil CA, Kruskal BA, Lee GM. Initial Antibiotic Choice in the Treatment of Group A Streptococcal Pharyngitis and Return Visit Rates. J Pediatric Infect Dis Soc 2013; 2:361-7. [PMID: 26619498 DOI: 10.1093/jpids/pit043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 05/02/2013] [Indexed: 11/12/2022]
Abstract
BACKGROUND Our objectives were to describe the incidence of return visits for children with Group A Streptococcal (GAS) pharyngitis (ie, clinical treatment failure) and to assess whether initial treatment with amoxicillin or penicillin was associated with the rate of retreatment for GAS pharyngitis. METHODS This analysis was a retrospective cohort study of 5533 children 0-17 years from a multisite practice. Eligible visits (n = 6585) were associated with a positive test for GAS, receipt of antibiotics within 7 days, no allergies to penicillins or cephalosporins, and no codiagnoses requiring antibiotic treatment. Retreatment for GAS pharyngitis was defined as an index visit followed by another visit within 1-4 weeks. Five hundred episodes (250 treatment failures and 250 controls) were randomly selected for chart review to validate cases. RESULTS Amoxicillin or penicillin was the initial antibiotic treatment at 76.1% of visits, and retreatment for GAS pharyngitis occurred after 5.8% of initial visits. Children initially prescribed amoxicillin or penicillin had higher odds of retreatment of GAS pharyngitis even after adjusting for age, sex, symptoms, and community-level covariates such as race, income, and education (odds ratio, 1.51; 95% confidence interval, 1.07-2.13). CONCLUSIONS Retreatment for GAS pharyngitis was uncommon and associated with receipt of amoxicillin or penicillin, although the impact of GAS carriage is unknown. Recommendations for initial treatment of GAS pharyngitis should reflect both individual and societal considerations, including the potential impact on antibiotic resistance in the community.
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Affiliation(s)
- Courtney A Gidengil
- RAND Corporation Division of Infectious Diseases, Boston Children's Hospital Harvard Medical School
| | - Benjamin A Kruskal
- Department of Pediatrics, Harvard Medical School Harvard Vanguard Medical Associates
| | - Grace M Lee
- Division of Infectious Diseases, Boston Children's Hospital Department of Population Medicine, Harvard Medical School Harvard Pilgrim Health Care Institute Department of Laboratory Medicine, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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164
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Outpatient antibiotic use in France between 2000 and 2010: after the nationwide campaign, it is time to focus on the elderly. Antimicrob Agents Chemother 2013; 58:71-7. [PMID: 24126584 DOI: 10.1128/aac.01813-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Antibiotic overconsumption is the main force driving the emergence of multidrug-resistant bacterial strains. To promote better antibiotic use in France, a nationwide campaign has been run every year from October to March since 2002. In 2007, it was shown that winter outpatient antibiotic consumption had decreased by 26.5% compared to the 2000-2002 baseline period. Here, we quantified outpatient antibiotic use between 2000 and 2010 as a follow-up analysis of the nationwide campaign. Reimbursed outpatient antibiotic prescriptions were extracted from computerized French National Health Insurance databases. Entire series and age group and antibiotic class analyses were computed. Time series analyses used autoregressive moving-average models with exogenous variables and intervention functions. Two periods were considered: October to March "campaign" periods and April to September "warm" periods. Compared to the precampaign (2000-2002) baseline period, the numbers of weekly antibiotic prescriptions per 1,000 inhabitants during campaign periods decreased until winter 2006 to 2007 (-30% [95% confidence interval {CI}, -36.3 to -23.8%]; P < 0.001) and then stabilized except for individuals >60 years of age, for whom prescriptions reached the precampaign level. During the warm periods from April to September, no significant differences were estimated compared to the baseline level for the entire series, but seniors had an increasing trend that became significant as of 2005, reaching +21% (95% CI, +12.9 to +29.6%) in 2009 (P < 0.0001). These results highlight the need for a better understanding of antibiotic use by the elderly, requiring research with targeted and tailored public health actions for this population.
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165
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Llor C, Moragas A, Bayona C, Morros R, Pera H, Plana-Ripoll O, Cots JM, Miravitlles M. Efficacy of anti-inflammatory or antibiotic treatment in patients with non-complicated acute bronchitis and discoloured sputum: randomised placebo controlled trial. BMJ 2013; 347:f5762. [PMID: 24097128 PMCID: PMC3790568 DOI: 10.1136/bmj.f5762] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the efficacy of oral anti-inflammatory or antibiotic treatment compared with placebo in the resolution of cough in patients with uncomplicated acute bronchitis and discoloured sputum. DESIGN Multicentre, parallel, single blinded placebo controlled, randomised clinical trial. SETTING Nine primary care centres in Spain. PARTICIPANTS Adults aged 18 to 70 presenting symptoms associated with respiratory tract infection of less than one week's duration, with cough as the predominant symptom, the presence of discoloured sputum, and at least one other symptom of lower respiratory tract infection (dyspnoea, wheezing, chest discomfort, or chest pain). INTERVENTIONS Patients were randomised to receive either ibuprofen 600 mg three times daily, amoxicillin-clavulanic acid 500 mg/125 mg three times daily, or placebo three times daily for 10 days. The duration of symptoms was measured with a diary card. MAIN OUTCOME MEASURE Number of days with frequent cough after the randomisation visit. RESULTS 416 participants were randomised (136 to ibuprofen, 137 to antibiotic, and 143 to placebo) and 390 returned their symptom diaries fully completed. The median number of days with frequent cough was slightly lower among patients assigned to ibuprofen (9 days, 95% confidence interval 8 to 10 days) compared with those receiving amoxicillin-clavulanic acid (11 days, 10 to 12 days) or placebo (11 days, 8 to 14 days), albeit without statistically significant differences. Neither amoxicillin-clavulanic acid nor ibuprofen increased the probability of cough resolution (hazard ratio 1.03, 95% confidence interval 0.78 to 1.35 and 1.23, 0.93 to 1.61, respectively) compared with placebo. Adverse events were observed in 27 patients, and were more common in the antibiotic arm (12%) than ibuprofen or placebo arms (5% and 3%, respectively; P<0.01). CONCLUSION No significant differences were observed in the number of days with cough between patients with uncomplicated acute bronchitis and discoloured sputum treated with ibuprofen, amoxicillin-clavulanic acid, or placebo. TRIAL REGISTRATION Current Controlled Trials ISRCTN07852892.
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Affiliation(s)
- Carl Llor
- Department of General Pathology. University Rovira i Virgili, Primary Care Centre Jaume I, c Felip Pedrell, 45-47 43005 Tarragona, Spain
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166
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Angoulvant F, Rouault A, Prot-Labarthe S, Boizeau P, Skurnik D, Morin L, Mercier JC, Alberti C, Bourdon O. Randomized controlled trial of parent therapeutic education on antibiotics to improve parent satisfaction and attitudes in a pediatric emergency department. PLoS One 2013; 8:e75590. [PMID: 24086581 PMCID: PMC3784452 DOI: 10.1371/journal.pone.0075590] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 08/19/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate therapeutic education delivered in a pediatric emergency department to improve parents' satisfaction and attitudes about judicious antibiotic use. METHODS In an emergency department of a tertiary pediatric hospital, children aged 1 month to 6 years and discharged with an oral antibiotic prescription for an acute respiratory or urinary tract infection were randomized to a patient therapeutic education on antibiotic use (intervention group) or fever control (control group) delivered to the parents (in the presence of the children) by a pharmacist trained in therapeutic education. Education consisted in a 30-minute face-to-face session with four components: educational diagnosis, educational contract, education, and evaluation. The main outcome measure was parent satisfaction about information on antibiotics received at the hospital, as assessed by a telephone interview on day 14. The secondary outcome was attitudes about antibiotic use evaluated on day 14 and at month 6. RESULTS Of the 300 randomized children, 150 per arm, 259 were evaluated on day 14. Parent satisfaction with information on antibiotics was higher in the intervention group (125/129, 96.9%, versus 108/130, 83.0%; P=0.002, exact Fisher test). INTERVENTION Group parents had higher proportions of correct answers on day 14 to questions on attitudes about judicious antibiotic use than did control-group parents (P=0.017, Mann-Whitney U test). CONCLUSION Therapeutic education delivered by a clinical pharmacist in the pediatric emergency department holds promise for improving the use of antibiotics prescribed to pediatric outpatients. TRIAL REGISTRATION ClinicalTrials.gov NCT00948779 http://clinicaltrials.gov/show/NCT00948779.
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Affiliation(s)
- François Angoulvant
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Service d’Accueil des Urgences Pédiatriques, Paris, France
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Unité d’Épidémiologie Clinique INSERM CIE5, Paris, France
- * E-mail:
| | - Anne Rouault
- AP-HP, Hôpital Robert Debré, Faculté de Pharmacie, Université Paris Descartes, Département de Pharmacie, Paris, France
- Université Paris 13-Bobigny, Sorbonne Paris Cité. Laboratoire de Pédagogie de la Santé EA 3412, Paris, France
| | - Sonia Prot-Labarthe
- AP-HP, Hôpital Robert Debré, Faculté de Pharmacie, Université Paris Descartes, Département de Pharmacie, Paris, France
| | - Priscilla Boizeau
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Unité d’Épidémiologie Clinique INSERM CIE5, Paris, France
| | - David Skurnik
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Laurence Morin
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Service d’Accueil des Urgences Pédiatriques, Paris, France
| | - Jean-Christophe Mercier
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Service d’Accueil des Urgences Pédiatriques, Paris, France
| | - Corinne Alberti
- AP-HP, Hôpital Robert Debré, Université Paris Diderot, Sorbonne Paris Cité, Unité d’Épidémiologie Clinique INSERM CIE5, Paris, France
| | - Olivier Bourdon
- AP-HP, Hôpital Robert Debré, Faculté de Pharmacie, Université Paris Descartes, Département de Pharmacie, Paris, France
- Université Paris 13-Bobigny, Sorbonne Paris Cité. Laboratoire de Pédagogie de la Santé EA 3412, Paris, France
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167
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Aabenhus R, Thorsen H, Siersma V, Brodersen J. The development and validation of a multidimensional sum-scaling questionnaire to measure patient-reported outcomes in acute respiratory tract infections in primary care: the acute respiratory tract infection questionnaire. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2013; 16:987-992. [PMID: 24041348 DOI: 10.1016/j.jval.2013.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/16/2013] [Accepted: 06/07/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Patient-reported outcomes are seldom validated measures in clinical trials of acute respiratory tract infections (ARTIs) in primary care. We developed and validated a patient-reported outcome sum-scaling measure to assess the severity and functional impacts of ARTIs. METHODS Qualitative interviews and field testing among adults with an ARTI were conducted to ascertain a high degree of face and content validity of the questionnaire. Subsequently, a draft version of the Acute Respiratory Tract Infection Questionnaire (ARTIQ) was statistically validated by using the partial credit Rasch model to test dimensionality, objectivity, and reliability of items. Test of known groups' validity was conducted by comparing participants with and without an ARTI. RESULTS The final version of the ARTIQ consisted of 38 items covering five dimensions (Physical-upper, Physical-lower, Psychological, Sleep, and Medicine) and five single items. All final dimensions were confirmed to fit the Rasch model, thus enabling sum-scaling of responses. The ARTIQ scores in participants with an ARTI were significantly higher than in those without ARTI (known groups' validity). CONCLUSION A self-administered, multidimensional, sum-scaling questionnaire with high face and content validity and adequate psychometric properties for assessing severity and functional impacts from ARTIs in adults is available to clinical trials and audits in primary care.
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Affiliation(s)
- Rune Aabenhus
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
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168
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Pillet S, Lardeux M, Dina J, Grattard F, Verhoeven P, Le Goff J, Vabret A, Pozzetto B. Comparative evaluation of six commercialized multiplex PCR kits for the diagnosis of respiratory infections. PLoS One 2013; 8:e72174. [PMID: 24058410 PMCID: PMC3751960 DOI: 10.1371/journal.pone.0072174] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 07/12/2013] [Indexed: 11/26/2022] Open
Abstract
The molecular diagnosis of respiratory infection can be performed using different commercial multiplex-based PCR kits whose performances have been previously compared individually to those of conventional techniques. This study compared the practicability and the diagnostic performances of six CE-marked kits available in 2011 on the French market, including 2 detecting viruses and atypical bacteria (from Pathofinder and Seegene companies) and 4 detecting only viruses (from Abbott, Genomica, Qiagen and Seegene companies). The respective sensitivity, specificity, accuracy and agreement of each multiplex technique were calculated by comparison to commercial duplex PCR tests (Argene/bioMérieux) used as gold standard. Eighty-eight respiratory specimens with no pathogen (n = 11), single infections (n = 33) or co-infections (n = 44) were selected to cover 9 viruses or groups of viruses and 3 atypical bacteria. All samples were extracted using the NUCLISENS® easyMAG™ instrument (bioMérieux). The overall sensitivity ranged from 56.25% to 91.67% for viruses and was below 50% with both tests for bacteria. The overall specificity was excellent (>94% for all pathogens). For each tested kit, the overall agreement with the reference test was strong for viruses (kappa test >0.60) and moderate for bacteria. After the extraction step, the hands-on time varied from 50 min to 2h30 and the complete results were available in 2h30 to 9 h. The spectrum of tested agents and the technology used to reveal the PCR products as well as the laboratory organization are determinant for the selection of a kit.
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Affiliation(s)
- Sylvie Pillet
- Laboratory of Bacteriology and Virology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Marina Lardeux
- Laboratory of Bacteriology and Virology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Julia Dina
- Laboratory of Virology, University Hospital of Caen, Caen, France
| | - Florence Grattard
- Laboratory of Bacteriology and Virology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Paul Verhoeven
- Laboratory of Bacteriology and Virology, University Hospital of Saint-Etienne, Saint-Etienne, France
| | - Jérôme Le Goff
- Université Paris Diderot, Sorbonne Paris Cité, Microbiology Department, Saint-Louis Hospital, APHP, Paris, France
| | - Astrid Vabret
- Laboratory of Virology, University Hospital of Caen, Caen, France
| | - Bruno Pozzetto
- Laboratory of Bacteriology and Virology, University Hospital of Saint-Etienne, Saint-Etienne, France
- * E-mail:
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Scaglione F, Bertazzoni Minelli E, De Sarro A, Esposito S, Legnani D, Mazzei T, Mini E, Passali D, Pea F, Stefani S, Viano I, Novelli A. TheChartaof Milan: Basic Criteria for the Appropriate and Accurate Use of Antibiotics: Recommendations of the Italian Society of Chemotherapy. J Chemother 2013; 21:475-81. [DOI: 10.1179/joc.2009.21.5.475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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170
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Role of the zinc uptake ABC transporter of Moraxella catarrhalis in persistence in the respiratory tract. Infect Immun 2013; 81:3406-13. [PMID: 23817618 DOI: 10.1128/iai.00589-13] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Moraxella catarrhalis is a human respiratory tract pathogen that causes otitis media in children and lower respiratory tract infections in adults with chronic obstructive pulmonary disease. We have identified and characterized a zinc uptake ABC transporter that is present in all strains of M. catarrhalis tested. A mutant in which the znu gene cluster is knocked out shows markedly impaired growth compared to the wild type in medium that contains trace zinc; growth is restored to wild-type levels by supplementing medium with zinc but not with other divalent cations. Thermal-shift assays showed that the purified recombinant substrate binding protein ZnuA binds zinc but does not bind other divalent cations. Invasion assays with human respiratory epithelial cells demonstrated that the zinc ABC transporter of M. catarrhalis is critical for invasion of respiratory epithelial cells, an observation that is especially relevant because an intracellular reservoir of M. catarrhalis is present in the human respiratory tract and this reservoir is important for persistence. The znu knockout mutant showed marked impairment in its capacity to persist in the respiratory tract compared to the wild type in a mouse pulmonary clearance model. We conclude that the zinc uptake ABC transporter mediates uptake of zinc in environments with very low zinc concentrations and is critical for full virulence of M. catarrhalis in the respiratory tract in facilitating intracellular invasion of epithelial cells and persistence in the respiratory tract.
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171
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Persell SD, Friedberg MW, Meeker D, Linder JA, Fox CR, Goldstein NJ, Shah PD, Knight TK, Doctor JN. Use of behavioral economics and social psychology to improve treatment of acute respiratory infections (BEARI): rationale and design of a cluster randomized controlled trial [1RC4AG039115-01]--study protocol and baseline practice and provider characteristics. BMC Infect Dis 2013; 13:290. [PMID: 23806017 PMCID: PMC3701464 DOI: 10.1186/1471-2334-13-290] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 06/20/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic prescribing for nonbacterial infections leads to increases in the costs of care, antibiotic resistance among bacteria, and adverse drug events. Acute respiratory infections (ARIs) are the most common reason for inappropriate antibiotic use. Most prior efforts to decrease inappropriate antibiotic prescribing for ARIs (e.g., educational or informational interventions) have relied on the implicit assumption that clinicians inappropriately prescribe antibiotics because they are unaware of guideline recommendations for ARIs. If lack of guideline awareness is not the reason for inappropriate prescribing, educational interventions may have limited impact on prescribing rates. Instead, interventions that apply social psychological and behavioral economic principles may be more effective in deterring inappropriate antibiotic prescribing for ARIs by well-informed clinicians. METHODS/DESIGN The Application of Behavioral Economics to Improve the Treatment of Acute Respiratory Infections (BEARI) Trial is a multisite, cluster-randomized controlled trial with practice as the unit of randomization. The primary aim is to test the ability of three interventions based on behavioral economic principles to reduce the rate of inappropriate antibiotic prescribing for ARIs. We randomized practices in a 2 × 2 × 2 factorial design to receive up to three interventions for non-antibiotic-appropriate diagnoses: 1) Accountable Justifications: When prescribing an antibiotic for an ARI, clinicians are prompted to record an explicit justification that appears in the patient electronic health record; 2) Suggested Alternatives: Through computerized clinical decision support, clinicians prescribing an antibiotic for an ARI receive a list of non-antibiotic treatment choices (including prescription options) prior to completing the antibiotic prescription; and 3) Peer Comparison: Each provider's rate of inappropriate antibiotic prescribing relative to top-performing peers is reported back to the provider periodically by email. We enrolled 269 clinicians (practicing attending physicians or advanced practice nurses) in 49 participating clinic sites and collected baseline data. The primary outcome is the antibiotic prescribing rate for office visits with non-antibiotic-appropriate ARI diagnoses. Secondary outcomes will examine antibiotic prescribing more broadly. The 18-month intervention period will be followed by a one year follow-up period to measure persistence of effects after interventions cease. DISCUSSION The ongoing BEARI Trial will evaluate the effectiveness of behavioral economic strategies in reducing inappropriate prescribing of antibiotics. TRIALS REGISTRATION ClinicalTrials.gov: NCT01454947.
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Affiliation(s)
- Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Institute for Healthcare Studies, Feinberg School of Medicine, Northwestern University, 750 N, Lake Shore Drive, 10th Floor, 60611, Chicago, IL, USA.
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Abstract
BACKGROUND The common cold is a spontaneously remitting infection of the upper respiratory tract, characterised by a runny nose, nasal congestion, sneezing, cough, malaise, sore throat and fever (usually < 37.8˚C). The widespread morbidity it causes worldwide is related to its ubiquitousness rather than its severity. The development of vaccines for the common cold has been difficult because of antigenic variability of the common cold virus and the indistinguishable multiple other viruses and even bacteria acting as infective agents. There is uncertainty regarding the efficacy and safety of interventions for preventing the common cold in healthy people. OBJECTIVES To assess the clinical effectiveness and safety of vaccines for preventing the common cold in healthy people. SEARCH METHODS We searched CENTRAL (2012, Issue 12), MEDLINE (1948 to January week 1, 2013), EMBASE (1974 to January 2013), CINAHL (1981 to January 2013) and LILACS (1982 to January 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) of any virus vaccines to prevent the common cold in healthy people. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated methodological quality and extracted trial data. Disagreements were resolved by discussion or by consulting a third review author. MAIN RESULTS This review included one RCT with 2307 healthy participants; all of them were analysed. This trial compared the effect of an adenovirus vaccine against a placebo. No statistically significant difference in common cold incidence was found: there were 13 events in 1139 participants in the vaccines group and 14 events in 1168 participants in the placebo group; risk ratio (RR) 0.95, 95% confidence interval (CI) 0.45 to 2.02, P = 0.90). No adverse events related to the live vaccine were reported. AUTHORS' CONCLUSIONS This Cochrane review has found a lack of evidence on the effects of vaccines for the common cold in healthy people. Only one RCT was found and this did not show differences between comparison groups; it also had a high risk of bias. There are no conclusive data to support the use of vaccines for preventing the common cold in healthy people. We identified the need for well-designed, adequately powered RCTs to investigate vaccines for the common cold in healthy people. Unless RCTs provide evidence of a treatment effect and the trade-off between potential benefits and harms is established, policy-makers, clinicians and academics should not recommend the use of vaccines for preventing the common cold in healthy people. Any future trials on medical treatments for preventing the common cold should assess a variety of virus vaccines for this condition. Outcome measures should include common cold incidence, vaccine safety and mortality related to the vaccine.
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Affiliation(s)
- Daniel Simancas-Racines
- Facultad de Ciencias de la Salud Eugenio Espejo, Universidad Tecnológica Equinoccial, Quito, Ecuador.
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Weiss JR, Tessema B, Brown SM. Complementary and integrative treatments: upper respiratory infection. Otolaryngol Clin North Am 2013; 46:335-44. [PMID: 23764813 PMCID: PMC7118453 DOI: 10.1016/j.otc.2012.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The combination of nasal congestion, rhinorrhea, sore throat, cough, and malaise is the symptomatic profile that constitutes an uncomplicated upper respiratory tract infection (URI), also known as the common cold. Because no known cure exists for a URI, numerous products are available, each marketed with the promise of alleviating the associated symptoms and/or shortening the duration of illness. The evidence supporting these claims is variable and is the focus of this article, with an emphasis on complementary and integrative therapies.
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Affiliation(s)
- Jessica R Weiss
- Deparment of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Connecticut School of Medicine, Farmington, CT 06030, USA.
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174
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Grindrod K. How the threat of antibiotic apocalypse helped a pharmacist find her voice. Can Pharm J (Ott) 2013; 146:151-4. [PMID: 23795199 PMCID: PMC3676209 DOI: 10.1177/1715163513486864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Kelly Grindrod
- School of Pharmacy, University of Waterloo, Waterloo, Ontario
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175
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Hafrén L, Kentala E, Einarsdottir E, Kere J, Mattila PS. Current knowledge of the genetics of otitis media. Curr Allergy Asthma Rep 2013; 12:582-9. [PMID: 22886440 DOI: 10.1007/s11882-012-0292-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Otitis media is one of the most common childhood infections leading to doctor's visits and a leading cause of antibiotic prescriptions in children. Twin and family studies have confirmed that the predisposition of developing a bacterial middle ear infection is genetically determined. Several case-control studies have been performed to analyze genes involved in inflammatory processes in search of potential associations. Modern genome-wide association approaches that require no prior assumptions of the involvement of a given gene locus in the risk of otitis media are currently being used to identify otitis media genes, and will hopefully give more detailed information on the pathogenesis of childhood otitis media. That information could be used in finding the high-risk patient, in the prevention of the disease, and in the design of new treatments.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology, Helsinki University Central Hospital, University of Helsinki, P.O. Box 220, 00029, HUS, Finland.
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Abstract
Cytokines are a group of diverse molecules that influence the function of every organ system. They are most well studied in their effects on the immune system and their integral role in mediating inflammation. The common cold and otitis media are two such disease states, and much has been learned about the various effects of cytokines in each disease. Most often the viruses isolated include rhinovirus (RV), respiratory syncytial virus (RSV), adenovirus, coronavirus, and picornavirus. Otitis media, sinusitis, bronchiolitis, pneumonia, and asthma exacerbation are commonly accepted as complications of viral upper respiratory tract infections. Furthermore, otitis media and upper respiratory infections are inextricably linked in that the majority (>70 %) of cases of acute otitis media occur as complications of the common cold. Cytokine polymorphisms have been associated with the severity of colds as well as the frequency of otitis media. This article attempts to update the reader on various studies that have recently been published regarding the role of cytokines in these two disease entities.
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Affiliation(s)
- Todd M Wine
- Division of Pediatric Otolaryngology, Children's Hospital of Pittsburgh of UPMC, Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
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Stol K, Verhaegh SJ, Graamans K, Engel JA, Sturm PD, Melchers WJ, Meis JF, Warris A, Hays JP, Hermans PW. Microbial profiling does not differentiate between childhood recurrent acute otitis media and chronic otitis media with effusion. Int J Pediatr Otorhinolaryngol 2013; 77:488-93. [PMID: 23369612 PMCID: PMC7132406 DOI: 10.1016/j.ijporl.2012.12.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Revised: 12/13/2012] [Accepted: 12/15/2012] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Otitis media (OM) is one of the most frequent diseases of childhood, with a minority of children suffering from recurrent acute otitis media (rAOM) or chronic otitis media with effusion (COME), both of which are associated with significant morbidity. We investigated whether the microbiological profiling could be used to differentiate between these two conditions. METHODS Children up to five years of age, with rAOM (n = 45) or COME (n = 129) and scheduled for tympanostomy tube insertion were enrolled in a prospective study between 2008 and 2009. Middle ear fluids (n = 119) and nasopharyngeal samples (n = 173) were collected during surgery for bacterial culture and PCR analysis to identify Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, and to detect 15 distinct respiratory viruses. RESULTS The occurrence of bacterial and viral pathogens in middle ear fluids did not significantly differ between patients suffering from rAOM and COME. In both patient cohorts, H. influenzae and rhinovirus were the predominant pathogens in the middle ear and nasopharynx. Nasopharyngeal carriage with two or three bacterial pathogens was associated with the presence of bacteria in middle ear fluid (P = 0.04). The great majority of the bacteria isolated from middle ear fluid were genetically identical to nasopharyngeal isolates from the same patient. CONCLUSIONS Based on these results, we propose that the common perception that rAOM is associated with recurrent episodes of microbiologically mediated AOM, whereas COME is generally a sterile inflammation, should be reconsidered.
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Affiliation(s)
- Kim Stol
- Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Suzanne J.C. Verhaegh
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Kees Graamans
- Department of Otorhinolaryngology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joost A.M. Engel
- Department of Otorhinolaryngology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Patrick D.J. Sturm
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Willem J.G. Melchers
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jacques F. Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Adilia Warris
- Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - John P. Hays
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Peter W.M. Hermans
- Department of Pediatrics, Radboud University Medical Centre, Nijmegen, The Netherlands,Corresponding author at: Department of Pediatrics, Radboud University Medical Centre, P.O. Box 9101 (Internal Post 224), 6500 HB Nijmegen, The Netherlands. Tel.: +31 24 3666407; fax: +31 24 3666352
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Jenkins TC, Irwin A, Coombs L, Dealleaume L, Ross SE, Rozwadowski J, Webster B, Dickinson LM, Sabel AL, Mackenzie TD, West DR, Price CS. Effects of clinical pathways for common outpatient infections on antibiotic prescribing. Am J Med 2013; 126:327-335.e12. [PMID: 23507206 PMCID: PMC3666348 DOI: 10.1016/j.amjmed.2012.10.027] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 10/05/2012] [Accepted: 10/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antibiotic overuse in the primary care setting is common. Our objective was to evaluate the effect of a clinical pathway-based intervention on antibiotic use. METHODS Eight primary care clinics were randomized to receive clinical pathways for upper respiratory infection, acute bronchitis, acute rhinosinusitis, pharyngitis, acute otitis media, urinary tract infection, skin infections, and pneumonia and patient education materials (study group) versus no intervention (control group). Generalized linear mixed effects models were used to assess trends in antibiotic prescriptions for non-pneumonia acute respiratory infections and broad-spectrum antibiotic use for all 8 conditions during a 2-year baseline and 1-year intervention period. RESULTS In the study group, antibiotic prescriptions for non-pneumonia acute respiratory infections decreased from 42.7% of cases at baseline to 37.9% during the intervention period (11.2% relative reduction) (P<.0001) and from 39.8% to 38.7%, respectively, in the control group (2.8% relative reduction) (P=.25). Overall use of broad-spectrum antibiotics in the study group decreased from 26.4% to 22.6% of cases, respectively (14.4% relative reduction) (P<.0001) and from 20.0% to 19.4%, respectively, in the control group (3.0% relative reduction) (P=.35). There were significant differences in the trends of prescriptions for acute respiratory infections (P<.0001) and broad-spectrum antibiotic use (P=.001) between the study and control groups during the intervention period, with greater declines in the study group. CONCLUSIONS This intervention was associated with declining antibiotic prescriptions for non-pneumonia acute respiratory infections and use of broad-spectrum antibiotics over the first year. Evaluation of the impact over a longer study period is warranted.
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Affiliation(s)
- Timothy C Jenkins
- Department of Medicine, Denver Health Medical Center, Denver, CO 80204, USA.
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Abstract
BACKGROUND This is an updated version of the original review published in Issue 2, 2007 of The Cochrane Library. Acute laryngitis is a common illness worldwide. Diagnosis is often made by case history alone and treatment is often directed toward controlling symptoms. OBJECTIVES To assess the effectiveness and safety of different antibiotic therapies in adults with acute laryngitis. A secondary objective was to report the rates of adverse events associated with these treatments. SEARCH METHODS We searched CENTRAL 2012, Issue 12, MEDLINE (January 1966 to January week 3, 2013), EMBASE (1974 to January 2013), LILACS (1982 to January 2013) and BIOSIS (1980 to January 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) comparing any antibiotic therapy with placebo for acute laryngitis. The main outcome was objective voice scores. DATA COLLECTION AND ANALYSIS Two review authors independently extracted and descriptively synthesised data. MAIN RESULTS Only two trials met the study inclusion criteria after extensive literature searches. One hundred participants were randomised to receive either penicillin V (800 mg twice a day for five days), or an identical placebo, in a study of acute laryngitis in adults. A tape recording of each patient reading a standardised text was obtained during the first visit, subsequently during re-examination after one and two weeks, and at follow-up after two to six months. No significant differences were found between the groups. The trial also measured symptoms reported by participants and found no significant differences.The second trial investigated erythromycin for treating acute laryngitis in 106 adults. The mean objective voice scores measured at the first visit, at re-examination after one and two weeks, and at follow-up after two to six months did not significantly differ between control and intervention groups. At one week there were significant beneficial differences in the severity of reported vocal symptoms as judged by the participants (P = 0.042). Comparing the erythromycin and placebo groups on subjective voice scores, the a priori risk ratio (RR) was 0.7 (95% confidence interval (CI) 0.51 to 0.96, P = 0.034) and the number needed to treat for an additional beneficial outcome (NNTB) was 4.5. AUTHORS' CONCLUSIONS Antibiotics appear to have no benefit in treating acute laryngitis. Erythromycin could reduce voice disturbance at one week and cough at two weeks when measured subjectively. We consider that these outcomes are not relevant in clinical practice. The implications for practice are that prescribing antibiotics should not be done in the first instance as they will not objectively improve symptoms.
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Affiliation(s)
- Ludovic Reveiz
- Research Promotion and Development Team, Health Systems Based on Primary Health Care (HSS), Pan American Health Organization,Washington DC, USA.
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McGregor JC, Bearden DT, Townes JM, Sharp SE, Gorman PN, Elman MR, Mori M, Smith DH. Comparison of antibiograms developed for inpatients and primary care outpatients. Diagn Microbiol Infect Dis 2013; 76:73-9. [PMID: 23541690 DOI: 10.1016/j.diagmicrobio.2013.01.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 11/30/2012] [Accepted: 01/24/2013] [Indexed: 10/27/2022]
Abstract
To support antimicrobial stewardship, some healthcare systems have begun creating outpatient antibiograms. We developed inpatient and primary care outpatient antibiograms for a regional health maintenance organization (HMO) and academic healthcare system (AHS). Antimicrobial susceptibilities from 16,428 Enterococcus, Staphylococcus aureus, Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa cultures from 2010 were summarized and compared. Methicillin susceptibility among S. aureus was similar in inpatients and primary care outpatients (HMO: 61.2% versus 61.9%, P = 0.951; AHS: 62.9% versus 63.3%, P > 0.999). E. coli susceptibility to trimethoprim/sulfamethoxazole was also similar (HMO: 81.8% versus 83.6%, P = 0.328; AHS: 77.2% versus 80.9%, P = 0.192), but ciprofloxacin susceptibility differed (HMO: 88.9% versus 94.6%, P < 0.001; AHS: 81.2% versus 90.6%, P < 0.001). In the HMO, ciprofloxacin-susceptible P. aeruginosa were more frequent in primary care outpatients than in inpatients (91.4% versus 79.0%, P = 0.007). Comparison of cumulative susceptibilities across settings yielded no consistent patterns; therefore, outpatient primary care antibiograms may more accurately inform prudent empiric antibiotic prescribing.
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Affiliation(s)
- Jessina C McGregor
- Department of Pharmacy Practice, College of Pharmacy, Oregon State University/Oregon Health & Science University, Portland, OR 97239, USA.
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Mukherjee M, Basu S, Mukherjee SK, Majumder M. Multidrug-Resistance and Extended Spectrum Beta-Lactamase Production in Uropathogenic E. Coli which were Isolated from Hospitalized Patients in Kolkata, India. J Clin Diagn Res 2013; 7:449-53. [PMID: 23634394 DOI: 10.7860/jcdr/2013/4990.2796] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Accepted: 11/18/2012] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Urinary Tract Infections (UTIs) are mostly caused by Escherichia coli. The appropriate therapy demands a current knowledge on the antimicrobial susceptibility pattern amongst these pathogens, as an inappropriate use of antibiotics may lead to complications and treatment failure. The UTIs which are caused by multidrug resistant Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria further pose a severe problem, as the treatment options are limited. The aim of this study was to identify the pattern of multi drug resistance amongst the uropathogenic E. coli (UPEC) isolates which were obtained from hospitalized patients. MATERIALS AND METHODS Forty UPEC were isolated from 200 urine samples of hospitalized patients who were clinically suspected for UTIs. Antimicrobial susceptibility screening was performed by using 16 antibiotics, by the Kirby Bauer disk diffusion technique. The isolates which were resistant to the third generation cephalosporins were subjected to the ESBL confirmatory test by using drug and drug-inhibitor combination disks by following the CLSI guidelines. RESULTS All the 40 isolates except three were multidrug resistant. They showed the highest sensitivities for nitrofurantoin (72.5%) and amikacin (70%). A high level of resistance was observed against ampicillin (97.5%), nalidixic acid and cefelexin (95%), amoxicillin (92.5%), cotrimoxazole (82.5%) and ciprofloxacin (80%) respectively. Thirty different antibiotic resistance patterns were observed against the different antibiotics. Twenty-eight out of the 40 isolates were resistant to the third generation cephalosporins. However, the phenotypic test for the ESBL confirmation indicated that eighteen out of the twenty-eight isolates were ESBL producers and that eleven different drug resistance patterns were observed amongst them. CONCLUSIONS Therefore, this study accounts for the varied multidrug resistance pattern amongst the uropathogenic E. coli which were isolated from hospitalized patients in Kolkata, an eastern region of India. Nitrofurantoin and amikacin should be assigned as potent drugs to treat this infection in this region of the country. These varied resistance patterns present major therapeutic and infection control challenges and they suggest a heterogeneous population of the uropathogenic E. coli isolates which circulate in this sector of India.
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Affiliation(s)
- Mandira Mukherjee
- Department of Biochemistry and Medical Biotechnology, Calcutta School of Tropical Medicine , Kolkata, West Bengal, India
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Lin YK, Chang CK, Chang SC, Chen PS, Lin C, Wang YC. Temperature, nitrogen dioxide, circulating respiratory viruses and acute upper respiratory infections among children in Taipei, Taiwan: a population-based study. ENVIRONMENTAL RESEARCH 2013; 120:109-18. [PMID: 23040210 PMCID: PMC7127042 DOI: 10.1016/j.envres.2012.09.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 08/30/2012] [Accepted: 09/11/2012] [Indexed: 05/22/2023]
Abstract
OBJECTIVE This study investigated whether outpatient visits of acute upper respiratory infections for children aged less than 15 years are associated with temperature, air pollutants and circulating respiratory viruses in Taipei, Taiwan, from 2003 to 2007. METHODS Outpatient records for acute upper respiratory infections (ICD9 CM codes: 460, 462, 463,464, 465.9 and 487) in a randomly selected sample (n=39,766 children in 2005) was used to estimate the cumulative relative risks (RR) associated with average temperature lasting for 8 days (lag 0-7 days), air pollutants (NO2, O3 and PM(2.5)) lasting for 6 days (lag 0-5 days), and virus-specific positive isolation rate lasting for 11 days (lag 0-10 days) using distributed lag non-linear models after controlling for relative humidity, wind speed, day of week, holiday effects and long-term trend. RESULTS Average temperature of 33 °C was associated with the lowest risk for outpatient visits of acute upper respiratory infections. Relative to 33 °C, cumulative 8-day RR was highest at 15 °C of ambient average temperature [RR=1.94; 95% confidence interval (CI): 1.78, 2.11]. With the first quartile as reference, cumulative 6-day RRs were 1.25 (95% CI: 1.21, 1.29) for NO2, 1.04 (95% CI: 1.01, 1.06) for O3, and 1.00 (95% CI: 0.98, 1.03) for PM(2.5) at the 95th percentile. Per-standard deviation (SD) increase of virus-specific isolation rate for influenza type A (SD=13.2%), type B (SD=8.76%), and adenoviruses (SD=5.25%) revealed statistical significance for overall 11-day RRs of 1.02 (95% CI: 1.01, 1.03), 1.05 (95% CI: 1.03, 1.06) and 1.04 (95% CI: 1.03, 1.05), respectively. CONCLUSIONS Current study suggested a positive association between outpatient visits for acute upper respiratory infections and ambient environment factors, including average temperature, air pollutants, and circulating respiratory viruses.
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Affiliation(s)
- Yu-Kai Lin
- Institute of Environmental Health, College of Public Health, National Taiwan University, 17 Xu-Zhou Road, Taipei 10055, Taiwan
- Environmental and Occupational Medicine and Epidemiology Program, Department of Environmental Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Chin-Kuo Chang
- Department of Health Service and Population Research, King’s College London, Denmark Hill, London SE5 8AF, UK
| | - Shuenn-Chin Chang
- School of Public Health, National Defense Medical Center, 161 Sec. 6, Min-Chuan East Road, Taipei 114, Taiwan
- Taiwan Environmental Protection Administration, 83 Sec. 1, Jhonghua Road, Taipei City 10042, Taiwan
| | - Pei-Shih Chen
- Institute and Department of Public Health, College of Health Science, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, Kaohsiung 807, Taiwan
| | - Chitsan Lin
- Department of Marine Environmental Engineering, College of Ocean Engineering, National Kaohsiung Marine University, 142 Haijhuan Road, Nanzih District, Kaohsiung City 811, Taiwan
| | - Yu-Chun Wang
- Department of Bioenvironmental Engineering, College of Ocean Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Chung Li 320, Taiwan
- Corresponding author at: Department of Bioenvironmental Engineering, Chung Yuan Christian University, 200 Chung-Pei Road, Chung Li 320, Taiwan. Fax: +886 3 265 4949.
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183
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Ting PJ, Lin CH, Huang FL, Lin MC, Hwang KP, Huang YC, Chiu CH, Lin TY, Chen PY. Epidemiology of acute otitis media among young children: a multiple database study in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 45:453-8. [PMID: 22823943 DOI: 10.1016/j.jmii.2012.06.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Revised: 08/01/2011] [Accepted: 08/31/2011] [Indexed: 11/26/2022]
Abstract
BACKGROUND/PURPOSE Acute otitis media (AOM) is a common complication of upper respiratory tract infection (URTI) among children. The purpose of this study was to evaluate the epidemiology of AOM among young children in Taiwan, including the age incidence and seasonality by combining multiple databases. METHODS Two country-based questionnaire survey studies had been conducted to evaluate the experience of otitis media (OM) among young children: one in 2007 and the other between 2005 and 2010. The number of OM cases (5% of population younger than 7 years) in 2005 and annual visiting rates for URTI from 2005 to 2010 obtained from the National Health Insurance Research Database of Taiwan were collected and comprised the third database. The fourth database comprised ambulatory visits of children with OM to a medical center in central Taiwan between 2005 and 2010. RESULTS Data from a total of 1099 questionnaires were entered into Database I in 2007, and data from 9705 questionnaires between 2005 and 2010 comprised Database II. There were 86,702 children (younger than 7 years, representing 5% of the whole population for this age group) retrieved from Database III in 2007, and 5,904 cases of OM in children between 2005 and 2010 in a hospital. In Database I, 7.46% children experienced at least one episode of AOM compared with 9.21% in Database II for children aged 5 years and younger. In Database III, 13.2% children younger than 7 years had AOM in 2005. The peak season of AOM among children was from March to May (Databases III and IV). CONCLUSION AOM was thought to be a very common disease among children; however, this comparative analysis showed that the overall prevalence of AOM among children younger than 5 years was only 20%, much lower than in other countries. AOM was more prevalent during the spring season, and still was similarly common after age 2 years.
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Affiliation(s)
- Pei-Ju Ting
- Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
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184
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Logan JL, Yang J, Forrest G. Outpatient antibiotic prescribing in a low-risk veteran population with acute respiratory symptoms. Hosp Pract (1995) 2012; 40:75-80. [PMID: 22406883 DOI: 10.3810/hp.2012.02.948] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Acute respiratory tract infections are usually caused by viruses and are self-limited in healthy adults. Providers frequently provide antibiotic prescriptions for sinusitis, bronchitis, pharyngitis, and nonspecific upper respiratory tract infections, despite no evidence of improved clinical outcomes. We sought to determine: 1) primary care providers' antibiotic prescribing practices for acute respiratory tract infections in low-risk outpatient veterans and 2) short-term health outcome differences between those receiving and not receiving an antibiotic prescription. METHODS We performed a retrospective electronic medical record review for veterans presenting to 1 of 3 primary care outpatient Veterans Affairs clinics in Portland, OR between July 1, 2008 and June 30, 2009 for acute respiratory symptoms. Demographics, signs and symptoms, antibiotic prescriptions, nonantibiotic prescriptions, and laboratory and imaging study variables were abstracted from medical charts. Descriptive frequencies, bivariate analyses (t tests, rank sums, Chi square tests, and Fisher's exact tests), and multivariate analyses (logistic regression) were performed. RESULTS 35.4% of patients received antibiotic prescriptions. Of those antibiotics, 87.8% were not indicated. Antibiotic regimen prescriptions varied widely for each diagnosis. Short-term outcomes of hospitalization, follow-up visits, later antibiotic prescriptions, and death at 30 days were not associated with receipt of antibiotics. CONCLUSION Many low-risk veterans received antibiotics for acute respiratory tract infections despite guidelines indicating that symptomatic treatment is sufficient for most patients. Novel interventions are required to reduce unnecessary and potentially harmful antibiotic use for low-risk outpatients with acute respiratory complaints.
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Affiliation(s)
- Jennifer L Logan
- Portland Veterans Affairs Medical Center, Portland, OR 97239, USA
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185
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Aabenhus R, Jensen JUS. Procalcitonin-guided antibiotic treatment of respiratory tract infections in a primary care setting: are we there yet? PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 20:360-7. [PMID: 21808938 DOI: 10.4104/pcrj.2011.00064] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Clinical signs of infection do not allow for correct identification of bacterial and viral aetiology in acute respiratory infections. A valid tool to assist the clinician in identifying patients who will benefit from antibiotic therapy, as well as patients with a potentially serious infection, could greatly improve patient care and limit excessive antibiotic prescriptions. Procalcitonin is a new marker of suspected bacterial infection that has shown promise in guiding antibiotic therapy in acute respiratory tract infections in hospitals without compromising patient safety. Procalcitonin concentrations in primary care are low and can be used primarily to rule out serious infection. However, procalcitonin measurement should not be used as the sole basis for clinical decisions; clinical skills are prerequisites for the correct use of this new tool in practice. At present there is no point-of-care test for procalcitonin with acceptable precision, severely hampering its application in primary care. This article reviews the physiology of procalcitonin, describes the assays available for its measurement, evaluates the present evidence from primary care on its use to identify correctly patients who are likely to benefit from antibiotic treatment and to rule out serious infections, and comments on further research to determine a future role for procalcitonin in primary care.
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Affiliation(s)
- Rune Aabenhus
- Research Unit for General Practice, University of Copenhagen, Denmark.
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186
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Morris AM, Brener S, Dresser L, Daneman N, Dellit TH, Avdic E, Bell CM. Use of a structured panel process to define quality metrics for antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2012; 33:500-6. [PMID: 22476277 DOI: 10.1086/665324] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Antimicrobial stewardship programs are being implemented in health care to reduce inappropriate antimicrobial use, adverse events, Clostridium difficile infection, and antimicrobial resistance. There is no standardized approach to evaluate the impact of these programs. OBJECTIVE To use a structured panel process to define quality improvement metrics for evaluating antimicrobial stewardship programs in hospital settings that also have the potential to be used as part of public reporting efforts. DESIGN A multiphase modified Delphi technique. SETTING Paper-based survey supplemented with a 1-day consensus meeting. PARTICIPANTS A 10-member expert panel from Canada and the United States was assembled to evaluate indicators for relevance, effectiveness, and the potential to aid quality improvement efforts. RESULTS There were a total of 5 final metrics selected by the panel: (1) days of therapy per 1000 patient-days; (2) number of patients with specific organisms that are drug resistant; (3) mortality related to antimicrobial-resistant organisms; (4) conservable days of therapy among patients with community-acquired pneumonia (CAP), skin and soft-tissue infections (SSTI), or sepsis and bloodstream infections (BSI); and (5) unplanned hospital readmission within 30 days after discharge from the hospital in which the most responsible diagnosis was one of CAP, SSTI, sepsis or BSI. The first and second indicators were also identified as useful for accountability purposes, such as public reporting. CONCLUSION We have successfully identified 2 measures for public reporting purposes and 5 measures that can be used internally in healthcare settings as quality indicators. These indicators can be implemented across diverse healthcare systems to enable ongoing evaluation of antimicrobial stewardship programs and complement efforts for improved patient safety.
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Affiliation(s)
- Andrew M Morris
- Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada.
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187
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Thoolen B, de Ridder D, van Lensvelt-Mulders G. Patient-oriented interventions to improve antibiotic prescribing practices in respiratory tract infections: a meta-analysis. Health Psychol Rev 2012. [DOI: 10.1080/17437199.2011.552061] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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188
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Rowbotham S, Chisholm A, Moschogianis S, Chew-Graham C, Cordingley L, Wearden A, Peters S. Challenges to nurse prescribers of a no-antibiotic prescribing strategy for managing self-limiting respiratory tract infections. J Adv Nurs 2012; 68:2622-32. [PMID: 22364215 DOI: 10.1111/j.1365-2648.2012.05960.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To report a qualitative study of the experiences of nurse prescribers in managing patients with self-limiting respiratory tract infections. BACKGROUND Patients frequently attend primary care with respiratory tract infections. Although a no-prescribing strategy is recommended for these consultations, general practitioners frequently prescribe antibiotics, citing non-clinical reasons such as patient pressure. Nurses increasingly manage people with respiratory tract infections, but research has not yet explored their experiences within such consultations. DESIGN Semi-structured interviews and focus groups. METHODS Fifteen semi-structured interviews and three focus groups (n=5, n=4, and n=12) with a purposive sample of nurse prescribers (n=34) and other non-medical prescribers (n=2) were conducted between November 2009-November 2010. A qualitative approach was used to develop conceptual categories from the dataset, and emerging themes were explored in subsequent interviews/focus groups. FINDINGS Although participants reported experiencing numerous challenges within these consultations, they believed that they possessed some of the communication skills to deal effectively with patients without prescribing antibiotics. Participants reported that protocols supported their decision-making and welcomed the benefits of peer support in dealing with 'demanding' patients. However, the newness of nurses and other non-medical prescribers to the prescribing role meant that some were cautious in dealing with patients with respiratory tract infections. CONCLUSION Training for nurses and other non-medical prescribers should focus on building their confidence and skills to manage people with respiratory tract infections without recourse to antibiotics. Further work should seek to explore which strategies are most effective in managing respiratory tract infections while maintaining patient satisfaction with care.
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189
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Kozer E, Lotem Z, Elgarushe M, Torgovicky R, Cohen R, Cohen HA, Berkovitch M. RCT of montelukast as prophylaxis for upper respiratory tract infections in children. Pediatrics 2012; 129:e285-90. [PMID: 22218843 DOI: 10.1542/peds.2011-0358] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Infections with viruses causing upper respiratory tract infection (URI) are associated with increased leukotriene levels in the upper airways. Montelukast, a selective leukotriene-receptor antagonist, is an effective treatment of asthma and allergic rhinitis. OBJECTIVE To determine whether prophylactic treatment with montelukast reduces the incidence and severity of URI in children. METHODS A randomized, double-blind, placebo-controlled study was performed in 3 primary care pediatric ambulatory clinics in Israel. Healthy children aged 1 to 5 years were randomly assigned in a 1:1 ratio to receive 12-week treatment with 4 mg oral montelukast or look-alike placebo. Patients were excluded if they had a previous history of reactive airway disease. A study coordinator contacted the parents by phone once a week to obtain information regarding the occurrence of acute respiratory episodes. The parents received a diary card to record any acute symptoms of URI. The primary outcome measure was the number of URI episodes. RESULTS Three hundred children were recruited and randomly assigned into montelukast (n = 153) or placebo (n = 147) groups. One hundred thirty-one (85.6%) of the children treated with montelukast and 129 (87.7%) of the children treated with placebo completed 12 weeks of treatment. The number of weeks in which URI was reported was 30.4% in children treated with montelukast and 30.7% in children treated with placebo. There was no significant difference in any of the secondary variables between the groups. CONCLUSIONS In preschool-aged children, 12-week treatment with montelukast, compared with placebo, did not reduce the incidence of URI.
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Affiliation(s)
- Eran Kozer
- Pediatric Emergency Unit, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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Impact of Long-Term Antibiotic Use for Acne on Bacterial Ecology and Health Outcomes: A Review of Observational Studies. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-011-0001-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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191
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Hafrén L, Kentala E, Järvinen TM, Leinonen E, Onkamo P, Kere J, Mattila PS. Genetic background and the risk of otitis media. Int J Pediatr Otorhinolaryngol 2012; 76:41-4. [PMID: 22018929 DOI: 10.1016/j.ijporl.2011.09.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 09/21/2011] [Accepted: 09/24/2011] [Indexed: 10/16/2022]
Abstract
OBJECTIVE Otitis media is a multifactorial disease where genetic background may have an important role. For genome-wide association studies, it is important to understand the degree of heritability. The objective of this study was to estimate the heritability of recurrent acute otitis media and chronic otitis media with effusion. METHODS Children operated because of recurrent or chronic otitis media at the Helsinki University Central Hospital, Finland, as well as their families were recruited during 2008-2009. A cohort of 2436 subjects was enrolled consisting of 1279 children and their parents. The study subjects answered a questionnaire concerning their otitis media history and treatment, as well as tobacco exposure, allergy and asthma history. Heritability estimates were calculated for recurrent acute, chronic and any episodes of otitis media using software especially designed for estimating heritability in family cohorts. RESULTS Altogether 901 subjects suffered from recurrent otitis media and 559 from chronic otitis media with effusion. The heritability estimates in our cohort were 38.5% for recurrent (P=7.3 × 10(-9)), 22.1% for chronic (P=4.6 × 10(-3)) and 47.8% for any otitis media (P=1.5 × 10(-11)). CONCLUSIONS Our results demonstrate a moderately strong and statistically significant genetic component for both recurrent acute otitis media and chronic otitis media with effusion. These results highlight the importance of unraveling the genetic factors for otitis media that are still poorly known.
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Affiliation(s)
- Lena Hafrén
- Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, PO Box 220, 00029 HUS, Finland.
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192
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Affiliation(s)
- Jung Hyun Choi
- Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Seoul, Korea
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193
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Peters BM, Jabra-Rizk MA, O'May GA, Costerton JW, Shirtliff ME. Polymicrobial interactions: impact on pathogenesis and human disease. Clin Microbiol Rev 2012; 25:193-213. [PMID: 22232376 PMCID: PMC3255964 DOI: 10.1128/cmr.00013-11] [Citation(s) in RCA: 455] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Microorganisms coexist in a complex milieu of bacteria, fungi, archaea, and viruses on or within the human body, often as multifaceted polymicrobial biofilm communities at mucosal sites and on abiotic surfaces. Only recently have we begun to appreciate the complicated biofilm phenotype during infection; moreover, even less is known about the interactions that occur between microorganisms during polymicrobial growth and their implications in human disease. Therefore, this review focuses on polymicrobial biofilm-mediated infections and examines the contribution of bacterial-bacterial, bacterial-fungal, and bacterial-viral interactions during human infection and potential strategies for protection against such diseases.
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Affiliation(s)
- Brian M. Peters
- Graduate Program in Life Sciences, Molecular Microbiology and Immunology Program, University of Maryland—Baltimore, Baltimore, Maryland, USA
- Department of Microbial Pathogenesis, University of Maryland—Baltimore, Dental School, Baltimore, Maryland, USA
| | - Mary Ann Jabra-Rizk
- Department of Oncology and Diagnostic Sciences, Dental School, University of Maryland—Baltimore, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, School of Medicine, University of Maryland—Baltimore, Baltimore, Maryland, USA
| | - Graeme A. O'May
- Department of Microbial Pathogenesis, University of Maryland—Baltimore, Dental School, Baltimore, Maryland, USA
| | - J. William Costerton
- Department of Orthopedic Surgery, Center for Genomic Sciences, Allegheny-Singer Research Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania, USA
| | - Mark E. Shirtliff
- Department of Microbial Pathogenesis, University of Maryland—Baltimore, Dental School, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, School of Medicine, University of Maryland—Baltimore, Baltimore, Maryland, USA
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194
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Hersh AL, Shapiro DJ, Pavia AT, Shah SS. Antibiotic prescribing in ambulatory pediatrics in the United States. Pediatrics 2011; 128:1053-61. [PMID: 22065263 DOI: 10.1542/peds.2011-1337] [Citation(s) in RCA: 329] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antibiotics are commonly prescribed for children with conditions for which they provide no benefit, including viral respiratory infections. Broad-spectrum antibiotic use is increasing, which adds unnecessary cost and promotes the development of antibiotic resistance. OBJECTIVE To provide a nationally representative analysis of antibiotic prescribing in ambulatory pediatrics according to antibiotic classes and diagnostic categories and identify factors associated with broad-spectrum antibiotic prescribing. PATIENTS AND METHODS We used the National Ambulatory and National Hospital Ambulatory Medical Care surveys from 2006 to 2008, which are nationally representative samples of ambulatory care visits in the United States. We estimated the percentage of visits for patients younger than 18 years for whom antibiotics were prescribed according to antibiotic classes, those considered broad-spectrum, and diagnostic categories. We used multivariable logistic regression to identify demographic and clinical factors that were independently associated with broad-spectrum antibiotic prescribing. RESULTS Antibiotics were prescribed during 21% of pediatric ambulatory visits; 50% were broad-spectrum, most commonly macrolides. Respiratory conditions accounted for >70% of visits in which both antibiotics and broad-spectrum antibiotics were prescribed. Twenty-three percent of the visits in which antibiotics were prescribed were for respiratory conditions for which antibiotics are not clearly indicated, which accounts for >10 million visits annually. Factors independently associated with broad-spectrum antibiotic prescribing included respiratory conditions for which antibiotics are not indicated, younger patients, visits in the South, and private insurance. CONCLUSIONS Broad-spectrum antibiotic prescribing in ambulatory pediatrics is extremely common and frequently inappropriate. These findings can inform the development and implementation of antibiotic stewardship efforts in ambulatory care toward the most important geographic regions, diagnostic conditions, and patient populations.
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Affiliation(s)
- Adam L Hersh
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84108, USA.
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195
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Price EL, Mackenzie TD, Metlay JP, Camargo CA, Gonzales R. A computerized education module improves patient knowledge and attitudes about appropriate antibiotic use for acute respiratory tract infections. PATIENT EDUCATION AND COUNSELING 2011; 85:493-498. [PMID: 21392929 DOI: 10.1016/j.pec.2011.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 01/21/2011] [Accepted: 02/06/2011] [Indexed: 05/30/2023]
Abstract
BACKGROUND Over-use of antibiotics for acute respiratory infections (ARIs) increases antimicrobial resistance, treatment costs, and side effects. Patient desire for antibiotics contributes to over-use. OBJECTIVE To explore whether a point-of-care interactive computerized education module increases patient knowledge and decreases desire for antibiotics. METHODS Bilingual (English/Spanish) interactive kiosks were available in 8 emergency departments as part of a multidimensional intervention to reduce antibiotic prescribing for ARIs. The symptom-tailored module included assessment of symptoms, knowledge about ARIs (3 items), and desire for antibiotics on a 10-point visual analog scale. Multivariable analysis assessed predictors of change in desire for antibiotics. RESULTS Of 686 adults with ARI symptoms, 63% initially thought antibiotics might help. The proportion of patients with low (1-3 on the scale) desire for antibiotics increased from 22% pre-module to 49% post-module (p<.001). Self-report of "learning something new" was associated with decreased desire for antibiotics, after adjusting for baseline characteristics (p=.001). CONCLUSION An interactive educational kiosk improved knowledge about antibiotics and ARIs. Learning correlated with changes in personal desire for antibiotics. PRACTICE IMPLICATIONS By reducing desire for antibiotics, point-of-care interactive educational computer technology may help decrease inappropriate use for antibiotics for ARIs.
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Levy-Hara G, Amábile-Cuevas CF, Gould I, Hutchinson J, Abbo L, Saxynger L, Vlieghe E, Cardoso FLL, Methar S, Kanj S, Ohmagari N, Harbarth S. "Ten Commandments" for the Appropriate use of Antibiotics by the Practicing Physician in an Outpatient Setting. Front Microbiol 2011; 2:230. [PMID: 22164154 PMCID: PMC3225075 DOI: 10.3389/fmicb.2011.00230] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Accepted: 10/29/2011] [Indexed: 12/25/2022] Open
Abstract
A multi-national working group on antibiotic stewardship, from the International Society of Chemotherapy, put together ten recommendations to physicians prescribing antibiotics to outpatients. These recommendations are: (1) use antibiotics only when needed; teach the patient how to manage symptoms of non-bacterial infections; (2) select the adequate ATB; precise targeting is better than shotgun therapy; (3) consider pharmacokinetics and pharmacodynamics when selecting an ATB; use the shortest ATB course that has proven clinical efficacy; (4) encourage patients' compliance; (5) use antibiotic combinations only in specific situations; (6) avoid low quality and sub-standard drugs; prevent prescription changes at the drugstore; (7) discourage self-prescription; (8) follow only evidence-based guidelines; beware those sponsored by drug companies; (9) rely (rationally) upon the clinical microbiology lab; and (10) prescribe ATB empirically - but intelligently; know local susceptibility trends, and also surveillance limitations.
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Affiliation(s)
- Gabriel Levy-Hara
- Division of Infectious Diseases, Hospital Carlos Durand, University of Buenos AiresBuenos Aires, Argentina
| | | | - Ian Gould
- Medical Microbiology, Aberdeen Royal Infirmary, ForesterhillAberdeen, UK
| | - Jim Hutchinson
- Division of Medical Microbiology, Island Medical Program, University of British ColumbiaVictoria, BC, Canada
| | - Lilian Abbo
- Division of Infectious Diseases, Jackson Memorial Hospital, University of MiamiCoral Gables, FL, USA
| | - Lynora Saxynger
- Division of Infectious Diseases, University of AlbertaEdmonton, AB, Canada
| | - Erika Vlieghe
- Department of Clinical Sciences, Institute of Tropical MedicineAntwerp, Belgium
| | - Fernando L. Lopes Cardoso
- Infectious Diseases and Hospital Infection Control, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
| | - Shaheen Methar
- Unit for Infection Prevention and Control, Tygerberg Hospital and Faculty of Health Sciences, Stellenbosch UniversityCape Town, South Africa
| | - Souha Kanj
- Division of Infectious Diseases and Infection Control Program, American University of Beirut Medical CenterBeirut, Lebanon
| | - Norio Ohmagari
- Division of Infectious Diseases, Shizuoka Cancer Center HospitalShizuoka, Japan
| | - Stephan Harbarth
- Service Prévention et Contrôle de l’Infection, Hôpitaux Universitaires de GenèveGenève, Switzerland
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Hu J, Miyanaga K, Tanji Y. Diffusion of bacteriophages through artificial biofilm models. Biotechnol Prog 2011; 28:319-26. [DOI: 10.1002/btpr.742] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Revised: 09/21/2011] [Indexed: 01/21/2023]
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Peters S, Rowbotham S, Chisholm A, Wearden A, Moschogianis S, Cordingley L, Baker D, Hyde C, Chew-Graham C. Managing self-limiting respiratory tract infections: a qualitative study of the usefulness of the delayed prescribing strategy. Br J Gen Pract 2011; 61:e579-89. [PMID: 22152745 PMCID: PMC3162181 DOI: 10.3399/bjgp11x593866] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 03/21/2011] [Accepted: 04/28/2011] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite respiratory tract infections usually being viral and self-limiting, most primary care consultations still result in an antibiotic prescription. The National Institute for Health and Clinical Excellence (NICE) introduced the 'delayed prescribing' (DP) strategy. It remains unknown how useful UK clinicians find this approach. AIM To investigate how DP is used within UK primary care, and the benefits and challenges associated with this strategy. DESIGN AND SETTING Qualitative interview and focus group study in UK scheduled and unscheduled care primary care settings. METHOD Data were gathered through semi-structured interviews (n = 49) and six focus groups with GPs, trainee GPs, and nurse prescribers (NPs). An iterative analysis approach, using grounded theory principles, was used to generate themes from the dataset. RESULTS Prescribers were familiar with DP but used it infrequently. DP was often used to manage diagnostic uncertainty, although NPs, trainee GPs, and GPs working in unscheduled care services preferred patients to reconsult under these circumstances. Prescribers used DP to avoid conflict, although some had found more effective strategies to achieve this. Prescribers were generally uncomfortable giving clinical responsibility to patients, and DP was perceived to communicate a conflicting message to patients about antibiotic efficacy. CONCLUSION DP was not considered to be a helpful strategy for managing patients with self-limiting respiratory tract infections within primary care and the findings do not support the centrality of DP in NICE guidelines as a primary means of reducing antibiotic prescribing. Future training and guidelines should encourage alternative ways of communicating empathy, addressing patient beliefs, and encouraging self-management.
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Affiliation(s)
- Sarah Peters
- School of Psychological Sciences, University of Manchester, Manchester, UK.
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199
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Mertz D, Tjam EY, Poss J, Hirdes JP, Arai B, Johnstone J, Jantzi M, Loeb M. Prevalence and predictors of antibiotic use in community-based elderly in Ontario, Canada. Infect Control Hosp Epidemiol 2011; 32:710-3. [PMID: 21666404 DOI: 10.1086/660101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Little is known about antibiotic use in the elderly receiving home care. We found that 6,873 (5.4%) of 126,339 home care patients in Ontario received antibiotic treatment; 26% of the antibiotics administered were fluoroquinolones. Antibiotic treatment was most frequent in patients less than 65 years of age and among those with a poorer health status.
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Affiliation(s)
- Dominik Mertz
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
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200
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Prymula R, Chlibek R, Ivaskeviciene I, Mangarov A, Mészner Z, Perenovska P, Richter D, Salman N, Šimurka P, Tamm E, Tešović G, Urbancikova I, Usonis V. Paediatric pneumococcal disease in Central Europe. Eur J Clin Microbiol Infect Dis 2011; 30:1311-20. [DOI: 10.1007/s10096-011-1241-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 03/21/2011] [Indexed: 11/30/2022]
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