Assessing Antibiotic Adherence and Improving Antibiotic Stewardship in Common Interventional Radiology Procedures

PurposeIn 2018, The Journal of Vascular and Interventional Radiology (JVIR) updated its guidelines regarding periprocedural antibiotics. However, some institutions are slower to adopt these new guidelines. Additionally, antibiotic-resistant bacteria and sepsis are serious concerns due in part to incorrect usage of antibiotics. The purpose of this study is to assess institutional adherence to 2018 JVIR guidelines for the purpose of improving antibiotic stewardship.Materials and methodsA total of 800 cases over a 10-month time period were retrospectively identified and charted following the release of guidelines. Inclusion criteria for the study were adults aged 21 years or older undergoing mediport placement, tunneled central line (TCL) placement, nephrostomy tube exchange, percutaneous biliary drain, or cholecystostomy tube exchange. Exclusion criteria included immunocompromised and pregnant individuals as 2018 guidelines may not fit these patient populations. Guideline adherence for each procedure was recorded as a percentage; the timing of the antibiotic usage was also recorded and compared to the guidelines (within 60 minutes before incision).ResultsIn total, 49 mediport placements, 118 tunneled central line placements – 44 hemodialysis (HD) catheters and 74 nonhemodialysis (non-HD) catheters, 100 nephrostomy exchanges, and 82 biliary tube exchanges were included. Antibiotics were used in 83.6% (41/49) of mediport patients, 11.3% (5/44) of non-HD TCL patients, 20.5% (15/74) of HD TCL patients, 55% (55/100) nephrostomy tube changes, and 65.4% (55/84) of biliary or cholecystostomy tube exchanges. Out of those given prophylaxis, guideline-recommended antibiotics were used in 100% (41/41) of mediport, 100% (20/20) of TCL (both HD and non-HD catheters), 9% (5/55) of nephrostomy tube exchanges, and 1.8% (1/55) of biliary tube exchanges. Guideline-recommended timing was followed in 75.3% across all cases (ranging from 72.2% in mediports to 79.3% in biliary exchanges).ConclusionThis study of antibiotic practices at a single university-based academic institution revealed that antibiotic usage is not fully up to date with 2018 guidelines. For mediports, non-HD TCL placements, and nephrostomy tube exchanges, institutional changes should be made to reduce periprocedural antibiotic use, as antibiotics are no longer recommended for these procedures. For HD TCL and biliary exchanges, proper adherence to recommended prophylactic antibiotics should be followed. In addition, education about the correct antibiotic timing should be emphasized to increase compliance with guidelines.     

Management of recurrent urinary tract infections in adults

Many women will experience one or more urinary tract infection (UTI) during their life. The most unfortunate will have many. Men presenting with infections, and women with recurrent episodes, require further investigation. A diagnosis of a UTI is often based on a typical spectrum of symptoms, with confirmatory urine cultures lagging a few days behind. Unfortunately, symptoms of a UTI may not be typical, and other conditions can manifest similarly. Treatment of UTI with antibiotics is usually required, but there is increasing awareness of the need for antimicrobial stewardship to avoid the misuse and overuse of antibiotics, even as patients are increasingly reluctant to take them. Recurrent UTI can cause significant morbidity and disruption to daily activities yet investigations rarely demonstrate a reversible cause. There are a host of different antibiotic and non-antibiotic interventions that aim to lower the risk of further infections. However, these are not reliably effective, bring side effects of their own and are often proposed to this desperate population of patients on the back of weak evidence of efficacy.     

生命早期抗生素使用与儿童哮喘:因果关系还是混杂效应?

儿童哮喘的发病率逐年上升.基于卫生假说,抗生素使用可能减少了微生物暴露,从而增加了过敏性疾病发生的风险.近十年来,就早期抗生素暴露与儿童哮喘的关系进行的大量的流行病学调查的结果并不一致.大多数回顾性研究发现正相关联系,但前瞻性研究未发现联系或联系强度较弱.逆向因果和指示混淆可部分解释两者的关系,但也难以否定因果关系的存在.     

常见抗生素与新型抗菌药物在临床上的研究应用进展

摘要：抗生素的研发与使用有效杀灭和抑制了众多病原菌，挽救了无数人的生命，但由于抗生素的不合理使用，导致细菌耐 药不断出现，耐药菌的感染已严重地威胁人类的生命健康。为此，本文主要对近年来临床上常用的抗生素如β-内酰胺类、喹诺酮 类、氨基糖苷类药物以及新型抗菌药物如抗菌肽和纳米颗粒的应用研究进行总结分析与探讨，为临床上治疗疾病提供一些参考。     

Photodynamic therapy to control microbial biofilms

Microorganisms thrive in well-organized biofilm ecosystems. Biofilm-associated cells typically show increased resistance to antibiotics and contribute significantly to treatment failure. This has prompted investigations aimed at developing advanced and novel antimicrobial approaches that could effectively overcome the shortcomings associated with conventional antibiotic therapy. Studies are ongoing to develop effective curative strategies ranging from the use of peptides, small molecules, nanoparticles to bacteriophages, sonic waves, and light energy targeting various structural and physiological aspects of biofilms. In photodynamic therapy, a light source of a specific wavelength is used to irradiate non-toxic photosensitizers such as tetrapyrroles, synthetic dyes or, naturally occurring compounds to generate reactive oxygen species that can exert a lethal effect on the microbe especially by disrupting the biofilm. The photosensitizer preferentially binds to and accumulates in the microbial cells without causing any damage to the host tissue. Currently, photodynamic therapy is increasingly being used for the treatment of oral caries and dental plaque, chronic wound infections, infected diabetic foot ulcers, cystic fibrosis, chronic sinusitis, implant device-associated infections, etc. This approach is recognized as safe, as it is non-toxic and minimally invasive, making it a reliable, realistic, and promising therapeutic strategy for reducing the microbial burden and biofilm formation in chronic infections. In this review article, we discuss the current and future potential strategies of utilizing photodynamic therapy to extend our ability to impede and eliminate biofilms in various medical conditions.     

应用庆大霉素溶液与生理盐水行手外伤清创的效果比较

目的 探讨应用庆大霉素溶液与生理盐水对手外伤清创效果的差异。方法 对102例急诊手外伤患者，随机分为庆大霉素组（45例）和生理盐水组（57例）两组，分别由同一名医师进行常规清创，术后口服头孢氨苄胶囊预防感染5d，每3～4d伤口换药，观察伤口情况，于术后12d拆线，对伤口做出评价。结果 伤口愈合情况：庆大霉素组，甲级愈合20例，乙级愈合17例，丙级愈合8例；生理盐水组，甲级愈合24例，乙级愈合20例，雨级愈合13例。感染率：庆大霉素组17．78％，肥皂水组22．81％，平均为20．9％，两组比较差异无统计学意义（x^2=0．39，P〉0．05）。结论 使用庆大霉素溶液对伤口进行冲洗，并不能降低手外伤清创后的感染率。     

天津医科大学第三医院抗生素类药物的利用分析

目的：对抗生素类药物利用状况进行分析，以考察应用情况，促进用药合理性，方法：查阅药库2000年药品购入目录，采用药物利用状况分析法，对抗生素用药频度和药物费用等进行分析。结果：该院应用的抗生素主要为头孢菌素，喹诺酮类；DDDs排序靠前的是诺氟沙星，羟氨苄青霉素和复方新诺明等。结论：该院用药基本合理，但水平较低。     

Effects of antimicrobial agents on spontaneous and endotoxin-induced cytokine release of human peripheral blood mononuclear cells

 Because the immunomodulatory effects of antibiotics could possibly influence the degree of the systemic and local response to infection, knowledge of their intrinsic influence on the host's inflammatory response appears to be essential. Therefore, this study investigated the effects of frequently used antimicrobial agents (β-lactams, quinolones gentamicin, vancomycin and metronidazole) on the in-vitro tumor necrosis factor (TNF)-α and interleukin (IL)-6 production of isolated human peripheral blood mononuclear cells (PBMNC), cultured with or without endotoxin, in comparison with those effects obtained in a whole-blood assay system. In the presence of ciprofloxacin, ofloxacin, gentamicin, vancomycin, and metronidazole, a significant inhibition of the endotoxin-stimulated TNF-α production of human peripheral blood mononuclear cells (PBMNC) was found at therapeutic levels. Only ofloxacin showed a significant inhibitory influence on the endotoxin-induced IL-6 production of PBMNC. In the whole-blood assay, significant effects were not detectable. None of the antibiotics showed cytotoxicity. It is concluded that, at present, the direct immunological effects of antibiotics should be interpreted carefully with regard to the experimental conditions, and regardless of the therapeutic implications. To assess the potential direct immunomodulatory effect of antimicrobial agents, different cell culture procedures should be used. Received: October 19, 2001 / Accepted: February 15, 2002     

临床感染病原菌的变迁及其与抗菌药物应用的关系

目的:分析医院病原菌的结构和耐药的变迁趋势,探讨病原菌的变迁与临床抗菌药物使用的关系。方法:对解放军总医院第一附属医院1995年以来11年临床标本病原菌的分离鉴定结果进行统计分析,结合同期临床抗菌药物的使用强度,分析病原菌变迁与抗菌药物使用的相关性。结果:11年间从临床标本中共分离出病原菌15914株。①G 菌中金黄色葡萄球菌(金葡菌)和耐甲氧西林金葡菌(MRSA)的构成比上升趋势明显,凝固酶阴性葡萄球菌(CNS)和肠球菌属的构成比波动幅度较大,但变化趋势不明显。G-菌中,铜绿假单胞菌的构成比虽有波动,但始终维持在高水平;大肠杆菌和变形杆菌的构成比明显下降,不动杆菌的构成比明显上升。②1995年构成比最高的3种病原菌依次为大肠杆菌、铜绿假单胞菌和金葡菌,2005年变为铜绿假单胞菌、金葡菌和不动杆菌。③我院抗菌药物的使用强度在2005年达70DDD/100人天,使用最多的药物种类为喹诺酮类、二代头孢菌素和含酶抑制剂的三代头孢菌素;单一品种药物为左氧氟沙星、头孢呋辛和阿奇霉素。④大环内酯类、糖肽类、碳青霉烯类和3代头孢/抑制剂等药物的使用强度变化与多种病原菌构成比的变化呈显著正相关,MR-SA构成比的变化与多种药物使用强度变化呈显著正相关。结论:常见病原菌的耐药水平逐渐升高,将会增大抗感染治疗的难度;抗菌药物使用强度的变化有可能导致病原菌结构和耐药水平的变化。