The introduction of an antimicrobial stewardship (AMS) program is associated with a change in antimicrobial prescribing behavior. A proposed mechanism for this change is by impacting the prescribing etiquette described in qualitative studies. This study sought to detect a change in prescribing attitudes 12 months after the introduction of AMS and gauge utility of various AMS interventions. Surveys were distributed to doctors in two regional Australian hospitals on a convenience basis 6 months before, and 12 months after, the introduction of AMS. Agreement with 20 statements describing attitudes (cultural, behavioral and knowledge) towards antimicrobial prescribing was assessed on a 4-point Likert scale. Mean response scores were compared using the Wilcoxon Rank sum test. 155 responses were collected before the introduction of AMS, and 144 afterwards. After the introduction of AMS, an increase was observed in knowledge about available resources such as electronic decision support systems (EDSS) and therapeutic guidelines, with raised awareness about the support available through AMS rounds and the process to be followed when prescribing restricted antimicrobials. Additionally, doctors were less likely to rely on pharmacy to ascertain when an antimicrobial was restricted, depend on infectious diseases consultant advice and use past experience to guide antimicrobial prescribing. Responses to this survey indicate that positive changes to the antimicrobial prescribing etiquette may be achieved with the introduction of an AMS program. Use of EDSS and other resources such as evidence-based guidelines are perceived to be important to drive rational antimicrobial prescribing within AMS programs.
Background: Improvements in fungal species identification in the clinical laboratory has seen an increased recognition of cryptic Aspergillus species as a cause of invasive aspergillosis. Case: An 18-year-old male presented to hospital after a 1-month history of nasal congestion and facial headache. He had no significant medical history. An initial CT sinuses showed evidence of chronic sinusitis. He was discharged with oral amoxicillinclavulanate and prednisolone with a plan for outpatient management. Shortly thereafter he developed CNIII and CNIV palsy and was admitted to hospital with an MRI brain showing an expansile mass centred on the clivus extending into the posterior and pituitary fossa. A surgical procedure and sinus tissue biopsy was taken which demonstrated fungal hyphae. IV liposomal amphotericin B and posaconazole were commenced. Suede-like beige colonies were noted on the Sabouraud agar plate from culture of intraoperative specimens. Internal transcribed spacer (ITS) region sequencing (577 bp) identified it as Aspergillus felis. Despite antifungal therapy, his CNS infection progressed, and he died 2 weeks from admission to hospital. Conclusion: Aspergillus felis is a member of the A. viridinutans complex. It was named after the first host in which clinical disease was described. This is the first documented death in a human from A. felis infection.
Abstract. Neisseria meningitidis is a rare cause of prosthetic joint infection (PJI), with only three cases
previously reported. Here we report three further cases, all of which were
successfully treated with implant retention and short-course antibiotics (<6 weeks).
1,2 The implementation of this method was evaluated over a 6-month period. Method: Eligible blood culture isolates that flagged positive within an appropriate timeframe were set up using the EUCAST RAST method. AST results were confirmed at 16-20 hours using Vitek2. Result: Forty-seven significant isolates flagged within an appropriate timeframe. Thirty (64%) were validated organisms in pure culture, of which 20 (67%) had reportable AST on the same day [4 (20%) at 4 hours, 13 (65%) at 6 hours, 3 (15%) at 8 hours]. For one, this changed treatment from an ineffective antibiotic, with identification of a vancomycin resistant E. faecium. There was 100% concordance vs Vitek2 (with no false susceptibility). Conclusion: Implementing the EUCAST RAST method was easy and effective in the private laboratory setting, providing earlier identification of resistance and antimicrobial guidance in a significant proportion of blood culture isolates. The expected expansion of the method to include 8-12 hour breakpoints in the near future is likely to facilitate an even greater number of isolates reported early.
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