Infectious disease clinics of North America
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Infect. Dis. Clin. North Am. · Jun 2014
ReviewHospital antimicrobial stewardship in the nonuniversity setting.
Inappropriate antimicrobial use and antimicrobial resistance persist across the healthcare continuum. Antimicrobial stewardship guidelines assist healthcare institutions in establishing antimicrobial stewardship programs but rely on infectious diseases expertise and leadership, which are not available in all settings. Despite this, many institutions have found ways to use available resources to perform stewardship activities, with improvements in antimicrobial use and reductions in resistance and cost. This article highlights success stories in nonuniversity hospital settings and proposes antimicrobial stewardship strategies that may be more feasible in settings with limited infectious diseases expertise, information technology, or financial resources.
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Infect. Dis. Clin. North Am. · Jun 2014
ReviewAntimicrobial stewardship in immunocompromised hosts.
The global spread of antimicrobial resistance has limited the availability of antimicrobial agents to treat infections that affect immunocompromised hosts. Efforts to optimize the selection, dosing, and duration of antimicrobial therapy to improve patient outcomes and minimize selective pressure on antimicrobial resistance are relevant to immunocompromised patients. Collaborative efforts between health care providers with expertise in the diagnosis and treatment of patients with various degrees of immunosuppression are pivotal for the success of antimicrobial stewardship programs in immunocompromised patients.
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Infect. Dis. Clin. North Am. · Jun 2014
ReviewAntimicrobial stewardship in long-term care facilities.
Although antimicrobial stewardship has been shown to improve microbiologic susceptibility patterns, decrease drug toxicities, and lower overall drug costs in the inpatient setting, there are few studies assessing programs in the long-term care (LTC) setting. Implementing antimicrobial stewardship programs in LTC settings can be challenging as the LTC setting houses a unique population of frail and older adults with several preexisting conditions and multiple risk factors for colonization with multidrug-resistant organisms. Antimicrobial stewardship has an important role in decreasing inappropriate antibiotic use, encouraging targeted treatment of specific disease states, and limiting the untoward effects and costs of antimicrobials in this vulnerable population.
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Infect. Dis. Clin. North Am. · Jun 2014
ReviewThe role of the microbiology laboratory in antimicrobial stewardship programs.
One of the impediments to the success of antimicrobial stewardship is the lack of availability of rapid and sensitive laboratory tests. The last decade has seen an explosion in new technologies that permit, in less than 4 hours, the identification of organisms and their resistance markers. ⋯ Clinical microbiology laboratories also contribute to the success of stewardship programs through compilation of aggregate antimicrobial susceptibility data. This article reviews rapid diagnostics, the use of biomarkers, and antibiogram development to antimicrobial stewardship activities and the subsequent impact on patient outcomes.
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Infect. Dis. Clin. North Am. · Mar 2014
ReviewDiagnosis and management of urinary tract infection in older adults.
Urinary tract infection (UTI) is a commonly diagnosed infection in older adults. Despite consensus guidelines developed to assist providers in diagnosing UTI, distinguishing symptomatic UTI from asymptomatic bacteriuria (ASB) in older adults is problematic, as many older adults do not present with localized genitourinary symptoms. This article summarizes the recent literature and guidelines on the diagnosis and management of UTI and ASB in older adults.