The Journal of antimicrobial chemotherapy
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J. Antimicrob. Chemother. · Jun 2006
CommentAntimicrobial resistance: paradox, actions and economics.
The threat from antimicrobial-resistant organisms is accumulating and accelerating. One strand of the action that an adequate response to this threat demands is good clinical governance through management and audit of antimicrobial prescribing in hospitals. This is the subject of another article in this issue of the Journal, which describes the guidelines developed by the Scottish Medicines Consortium and Scottish Health Executive to tackle this problem. ⋯ There are grounds for serious concern that the current economic model is not capable of responding adequately. Governments need to acknowledge and address this fact. Patient outcomes will suffer increasingly if governments do not act to change the status quo.
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J. Antimicrob. Chemother. · Jun 2006
Comparison of mortality of patients with Acinetobacter baumannii bacteraemia receiving appropriate and inappropriate empirical therapy.
To evaluate the effect of inappropriate empirical antimicrobial treatment on the mortality of patients with Acinetobacter baumannii bacteraemia. ⋯ A. baumannii bacteraemia was associated with worse outcome regarding the cure of infection in patients who received inappropriate empirical antimicrobial treatment compared with those who received appropriate treatment.
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J. Antimicrob. Chemother. · May 2006
Spread of bla(CTX-M-type) and bla(PER-2) beta-lactamase genes in clinical isolates from Bolivian hospitals.
To assess the prevalence and types of genes encoding extended-spectrum beta-lactamases (ESBLs) in clinical isolates of Enterobacteriaceae, Pseudomonas aeruginosa and Acinetobacter spp. from Bolivia. ⋯ This is the first study on ESBL-producing strains in Bolivia and it reveals a high prevalence of bla(CTX-M) genes. The PER-2 enzyme was less prevalent, but its gene was detected in several species, including P. aeruginosa, which is consistent with horizontal transfer.
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Prescribing of antibiotics, often in the empirical setting, frequently falls on training-grade or junior doctors, who are often the least experienced in this. Indeed, improving the knowledge base of training-grade doctors or senior medical students through education has been identified as one of the key measures to improve antibiotic prescribing behaviour. ⋯ Overall, there was a significant improvement in doctors' understanding of sepsis and knowledge of the source of information that they utilized to select the antibiotic of choice, although the majority did not acknowledge the price difference between intravenous and oral forms of antibiotics.