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Kraef C, Öbrink-Hansen K, Hertz M, Hagen TL, Deutch S, Holler JG, Olesen BR, Holm M, Gaini S, Koch A, Benfield T, Rosenvinge FS, Johansen IS. Hospital-based antimicrobial stewardship in Denmark, Greenland and the Faroe Islands - current landscape and barriers. J Hosp Infect 2024; 146:66-75. [PMID: 38354955 DOI: 10.1016/j.jhin.2024.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 01/09/2024] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
OBJECTIVES To describe the current organization and implementation of formalized, multi-disciplinary hospital-based antimicrobial stewardship (AMS) structures in Denmark, the Faroe Islands and Greenland. METHODS A structured electronic questionnaire was sent to all trainees and specialists in clinical microbiology (N=207) and infectious diseases (N=260), as well as clinical pharmacists (N=20) and paediatricians (N=10) with expertise in infectious diseases. The survey had 30 multiple-choice, rating-scale, and open-ended questions based on an international consensus checklist for hospital AMS, adapted to a Danish context. RESULTS Overall, 145 individual responses representing 20 hospitals were received. Nine hospitals (45%) reported a formal AMS strategy, eight (40%) a formal organizational multi-disciplinary structure and a multi-disciplinary AMS team, and six (30%) a designated professional as a leader of the AMS team. A majority of hospitals reported access to updated guidelines (80%) and regularly monitored and reported the quantity of antibiotics prescribed (70% and 65%, respectively). Only one hospital (5%) reported a dedicated, sustainable and sufficient AMS budget, three hospitals (15%) audited courses of therapy for specific agents/clinical conditions and four hospitals (20%) had a document clearly defining roles, procedures of collaboration and responsibilities for AMS. A total of 42% of all individual respondents had received formal AMS training. Main barriers were a lack of financial resources (52%), a lack of mandate from the hospital management (30%) and AMS not being a priority (18%). CONCLUSIONS Core elements important for multi-disciplinary hospital-based AMS can be strengthened in Danish hospitals. Funding, clear mandates, prioritization from the hospital management and the implementation of multi-disciplinary AMS structures may help close the identified gaps.
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Affiliation(s)
- C Kraef
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - K Öbrink-Hansen
- Department of Infectious Diseases, Internal Medicine, Gødstrup Hospital, Herning, Denmark
| | - M Hertz
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - T L Hagen
- Department of Internal Medicine, Aalborg University Hospital Thisted, Thisted, Denmark
| | - S Deutch
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - J G Holler
- Department of Pulmonary and Infectious Diseases, North Zealand Hospital, Hillerød, Denmark
| | - B R Olesen
- Pharmacist, Administration, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - M Holm
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - S Gaini
- Medical Department, National Hospital of the Faroe Islands, Tórshavn, Faroe Islands; Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
| | - A Koch
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Center for Health Research in Greenland, Ilisimatusarfik, University of Greenland, Greenland; Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - T Benfield
- Department of Infectious Diseases, Copenhagen University Hospital - Hvidovre, Copenhagen, Denmark
| | - F S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - I S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
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Christensen AJ, Mwayi J, Mbabazi J, Juncker M, Kallestrup P, Kraef C. Fighting cervical cancer in Africa: a cross-sectional study on prevalence and risk factors for precancerous lesions in rural Uganda. Public Health 2023; 225:87-95. [PMID: 37922591 DOI: 10.1016/j.puhe.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To identify risk factors for precancerous cervical lesions and factors associated with treatment delay among women in the rural Busoga Region, Uganda. STUDY DESIGN A retrospective cross-sectional study from a regional cervical cancer screening program and from cervical cancer patients enrolled in a region-wide palliative care program. METHODS Logistic regression analysis was conducted to assess risk factors for screening positive for precancerous lesions. In a separate analysis, factors associated with treatment delay were assessed among women enrolled in the palliative care program. RESULTS Three thousand nine hundred forty-six women were included from the screening program and 334 from the palliative care program. In total, 7.6% of screening participants had precancerous lesions. Within Busoga Region, the highest positivity rate was found in Bugweri and Namayingo Districts. Abnormal vaginal bleeding (adjusted odds ratio [aOR] 1.60; 95% confidence interval [CI] 1.15-2.21; p = 0.005) and older age at first menstrual period (aOR 1.08; 95% CI 1.01-1.16; p = 0.03) were associated with having a precancerous lesion. Among palliative care patients, a history of previous contact with the health care system was associated with a delay in enrolment (≥12 months from first symptom presentation until commencement in palliative care; aOR 5.23; 95% CI 1.16-36.54; p = 0.047). CONCLUSIONS The results underline an unmet need for broad-scale cervical cancer screening focusing on all women in the reproductive age. Abnormal bleeding was the only substantial risk factor for precancerous lesions, indicating that specific algorithms to identify high-risk populations may not be applicable in this population. Increased awareness, resources, and funding are still necessary to achieve global cervical cancer elimination.
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Affiliation(s)
| | - J Mwayi
- Rays of Hope Hospice Jinja, Uganda
| | | | | | - P Kallestrup
- Department of Public Health, Aarhus University, Denmark; Danish Non-Communicable-Disease Alliance, Denmark
| | - C Kraef
- Department of Infectious Diseases, Rigshospitalet Copenhagen, Denmark; Heidelberg Institute of Global Health, University of Heidelberg, Germany; Centre of Excellence for Health, Immunity and Infections (CHIP), Copenhagen University Hospital - Rigshospitalet, Denmark
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Kraef C, Yedilbayev A, Seguy N, Bentzon A, Podlekareva D, Cirillo DM, van der Werf MJ, Kirk O. Uptake of the lateral flow urine LAM test in Europe and Central Asia. Int J Tuberc Lung Dis 2022; 26:835-841. [PMID: 35996279 PMCID: PMC9423022 DOI: 10.5588/ijtld.21.0656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION: Since 2015 (updated in 2019), the WHO has recommended to include the commercial lateral flow urine lipoarabinomannan TB test (LF-LAM), AlereLAM, in the diagnostic toolkit for severely ill people living with HIV. METHODS: To assess the current use and barriers to the implementation of the test, we conducted an electronic survey among national focal points and managers of TB and HIV programmes in the 53 Member States of the WHO European Region and a European network of clinicians working in TB and HIV medicine. RESULTS: In all, 45 individual responses (37 countries) were received from programme managers and focal points and 17 responses (14 countries) from clinicians. Only eight countries reported adopting LF-LAM policies, with only four currently using the AlereLAM (Armenia, Belarus, Ukraine and Uzbekistan). The most commonly reported barriers to implementing the test were the small number of eligible patients (with HIV-TB co-infections), the test not being included in the TB or HIV programme’s mandate and lack of budget allocation. CONCLUSION: Consistent with findings from high TB burden countries in Africa and Asia, the survey demonstrated that uptake of AlereLAM is almost non-existent. Addressing the identified barriers and the intrinsic limitations of the test could help to increase the use of the test.
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Affiliation(s)
- C Kraef
- Centre of Excellence for Health, Immunity and Infections (CHIP), University of Copenhagen, Copenhagen, Denmark, Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - A Yedilbayev
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - N Seguy
- WHO Regional Office for Europe, Copenhagen, Denmark
| | - A Bentzon
- Centre of Excellence for Health, Immunity and Infections (CHIP), University of Copenhagen, Copenhagen, Denmark
| | - D Podlekareva
- Centre of Excellence for Health, Immunity and Infections (CHIP), University of Copenhagen, Copenhagen, Denmark, Department of Pulmonary Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - D M Cirillo
- WHO Collaborating Centre in Tuberculosis Laboratory Strengthening and the TB Supranational Reference Laboratory, San Raffaele Scientific Institute, Milan, Italy
| | - M J van der Werf
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - O Kirk
- Centre of Excellence for Health, Immunity and Infections (CHIP), University of Copenhagen, Copenhagen, Denmark, Department of Infectious Disease, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Huson MAM, Kalkman R, Remppis J, Beyeme JO, Kraef C, Schaumburg F, Alabi AS, Grobusch MP. Methicillin-resistant Staphylococcus aureus as a cause of invasive infections in Central Africa: a case report and review of the literature. Infection 2014; 42:451-7. [DOI: 10.1007/s15010-014-0589-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 01/10/2014] [Indexed: 11/29/2022]
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