Proton pump inhibitors were more frequently used in SBP patients than in controls, but did not influence the prognosis in SBP. Overuse of PPIs was encountered in one-third of cirrhotic patients and should be avoided.

BackgroundThe use of antimicrobials is intense and often inappropriate in long-term care facilities. Antimicrobial resistance has increased in acute and chronic care facilities, including those in Belgium. Evidence is lacking concerning antimicrobial stewardship programmes in chronic care settings. The medical coordinator practicing in Belgian nursing homes is a general practitioner designated to coordinate medical activity. He is likely to be the key position for effective implementation of such programmes. The aim of this study was to evaluate past, present, and future developments of antimicrobial stewardship programmes by surveying medical coordinators working in long-term care facilities in Belgium.MethodsWe conducted an online questionnaire-based survey of 327 Belgian medical coordinators.The questionnaire was composed of 33 questions divided into four sections: characteristics of the respondents, organisational frameworks for implementation of the antimicrobial stewardship programme, tools to promote appropriate antimicrobial use and priorities of action. Questions were multiple choice, rating scale, or free text.ResultsA total of 39 medical coordinators (12 %) completed the questionnaire. Past or present antimicrobial stewardship initiatives were reported by 23 % of respondents. The possibility of future developments was rated 2.7/5. The proposed key role of medical coordinators was rated <3/5 by 36 % of respondents. General practitioners, nursing staff, and hospital specialists are accepted as important roles. The use of antimicrobial guidelines was reported by only 19 % of respondents. Education was considered the cornerstone for any future developments. Specific diagnostic recommendations were considered useful, but chest x-rays were judged difficult to undertake. The top priority identified was to reduce unnecessary treatment of asymptomatic urinary infections.ConclusionsOur study shows that the implementation of an antimicrobial stewardship programme is reported only in a minority of nursing homes. The possibility of future developments is uncertain. Nevertheless, the self-selected medical coordinators who responded to the survey reported a good knowledge of this complex problem. Despite a lack of optimism, medical coordinators seem to have the appropriate competencies to play a key role in antimicrobial stewardship in the future.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0106-7) contains supplementary material, which is available to authorized users.

A 68-year-old woman with a history of breast cancer presented with skin lesions and sternal pain. Clinical examination revealed ulcerative lesions on mastectomy scar and CT scan showed contiguous sternal osteolysis. The main hypothesis was a breast cancer recurrence; however, cutaneous and bone biopsies did not reveal any cancer cells. Skin tissue culture detected Pseudomonas aeruginosa, suggesting ecthyma gangrenosum despite the absence of bacteraemia in our patient and despite her immunocompetence. Surgical treatment was performed, followed by a long course of antibiotherapy.