bioMérieux.

The IMM service proved very effective and can be used as a template to support the implementation of comprehensive pharmaceutical care as a routine service across Northern Ireland and beyond.

No abstract

The results of this study confirm the value of infection control policies as well as suggest the usefulness of restricting the use of certain antimicrobial classes to control MRSA.

The study indicated clear benefits from the involvement of a hospital based community liaison pharmacist in achieving seamless pharmaceutical care between the primary and secondary healthcare settings.

Balancing access to antibiotics with control of antibiotic resistance is a global public health priority. Currently, antibiotic stewardship is informed by a 'use it and lose it' principle, in which population antibiotic use is linearly related to resistance rates. However, theoretical and mathematical models suggest use-resistance relationships are non-linear. One explanation is that resistance genes are commonly associated with 'fitness costs', impairing pathogen replication or transmissibility. Therefore, resistant genes and pathogens may only gain a survival advantage where antibiotic selection pressures exceed critical thresholds. These thresholds may provide quantitative targets for stewardship: optimising control of resistance while avoiding over-restriction of antibiotics. We evaluated the generalisability of a nonlinear time-series analysis approach for identifying thresholds using historical prescribing and microbiological data from five populations in Europe. We identified minimum thresholds in temporal relationships between use of selected antibiotics and rates of carbapenem-resistant Acinetobacter baumannii (in Hungary), extended spectrum β-lactamase producing Escherichia coli (Spain), cefepime-resistant Escherichia coli (Spain), gentamicin-resistant Pseudomonas aeruginosa (France), and methicillin-resistant Staphylococcus aureus (Northern Ireland) in different epidemiological phases. Using routinely generated data, our approach can identify context-specific quantitative targets for rationalising population antibiotic use and controlling resistance. Prospective intervention studies restricting antibiotic consumption are needed to validate Results Identifying non-linear temporal relationships: from experiment to applicationIn a Monte Carlo experiment we compared the ability of linear and non-linear time-series analysis (Multivariate Adaptive Regression Splines, MARS) to identify pre-defined relationships between simulated explanatory and outcome time-series (Supplementary Figure 1). Non-linear time-series analysis (NL-TSA) accurately identified both truly linear and nonlinear associations. However, linear time-series analysis provided biased estimations and overall poorer data-fit if relationships were non-linear. NL-TSA models applied to retrospective time-series data from five European study populations (examples 1-5), frequently identified minimum thresholds in antibiotic useresistance relationships, (figures 1-5 and Supplementary Table 1). 'Ceiling effects', in which further increases in explanatory variables did not affect resistance rates, were found at highlevels of use of some antibiotics and hand hygiene. Non-linearities in autoregression and population interaction terms further indicated the complexity of transmission dynamics within and between clinical populations. Example 1: Carbapenem-resistant Acinetobacter baumannii (Debrecen, Hungary) We examined ecological determinants of carbapenem-resistant A. baumannii (CRAb) in a tertiary hospital population in Debrecen, Hungary (figure 1). Betwee...

The restriction of the high-risk antibiotics contributed to both a reduction in their use and a reduction in the incidence of CDI in the study site hospital. Time-series analysis can be utilized as a risk classification tool with utility in antibiotic stewardship design and quality improvement programmes.

Aims Helicobacter pylori (H. pylori) eradication rate varies according to the treatment regimen used and other factors, e.g. antimicrobial resistance and patient compliance. The aim of the present study was to evaluate the in¯uence of patient counselling and follow-up on H. pylori eradication rates and to document the effectiveness of a 1 week eradication regimen consisting of lansoprazole (30 mg once daily), amoxicillin (1 g twice daily) and clarithromycin (500 mg twice daily). Methods Seventy-six dyspeptic patients, who at endoscopy were found to have gastritis, duodenitis or ulceration, and a positive H. pylori urease test, were recruited. Patients were randomly assigned to an intervention group (n=38) or a control group (n=38). Intervention patients received their medicines via the hospital pharmacy and were counselled (and followed up) by a hospital pharmacist. Control patients were given a standard advice sheet and referred to their GP who prescribed the same therapy.Results Intervention patients exhibited a statistically signi®cant improvement in the H. pylori eradication rate (94.7% vs 73.7%; P=0.02) and compliance (92.1% vs 23.7; P<0.001). Of the 64 H. pylori eradicated patients, 62 were able to eliminate their antisecretory medication compared with only 12 of the H. pylori persistent patients (P<0.001). A pharmacoeconomic evaluation indicated that counselling and follow-up reduced the direct costs of eradication by approximately £30 per patient. Conclusions Structured patient counselling and follow-up can have a signi®cant effect on H. pylori eradication rates and should be a routine part of therapy.