Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community ...Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community pharmacy.Methods:A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship.Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad.In total,381 participants have completed the survey.Results:The majority of the participants(85.6%)strongly agreed/agreed that“antimicrobial stewardship programs reduce the problems of antibiotic resistance”;and 85.5%of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use.In addition,high percent of community pharmacists(88.4%)strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system.The total score of perception was significantly influenced by older age groups,postgraduate degrees,and experience of 6–10 years(p<0.001).This study also showed that 65.4%of pharmacists always/often advise patients to continue the full course of antimicrobials,and 64.9%of them reported always/often considering clinical and safety parameters before dispensing antibiotics.The role of pharmacists was significantly influenced by the younger age group,females,higher degree in pharmacy,experience of 3–5 years,and medical complex pharmacy(p<0.001).Conclusion:Community pharmacists have a good perception toward antimicrobial stewardship programs,but their role is still limited.More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.展开更多
In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and b...In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking.A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System(CARSS).The questionnaire included 5 sections regarding structure,technical support,antimicrobial use management,antimicrobial use surveillance,and education.Descriptive statistics were used for data analysis.Of the 1044 tertiary hospitals under CARSS,13.4%(140)hospitals participated in the study.Among them,99.3%(139/140)set up the AMS program.The hospital president(82.1%,115/140)and medical service department(59.3%,83/140)were responsible for AMS outcomes in most hospitals.Structured antimicrobial formulary restriction management was adopted by 99.3%(139/140)hospitals.Infectious disease department,infection control department,and microbiological laboratories were established in 87.1%(122/140),99.3%(139/140)and 100%(140/140)hospitals,respectively.Up to 85.6%(124/140)hospitals applied clinical pathways,and 33.6%(47/140)hospitals implemented hospital-specific guidelines for infectious diseases.Outpatient prescription auditing,inpatient prescription auditing,and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3%(139/140),98.6%(138/140)and 95.7%(134/140)hospitals,respectively.Up to 97.1%(136/140)hospitals participated in antimicrobial use surveillance network,and 99.3%(139/140)hospitals established the specialized management of carbapenem and tigecycline.Staff education and public education were provided with various ways and frequencies in 100%(140/140)and 90.0%(126/140)hospitals,respectively.AMS programs in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments.More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system.展开更多
Ammonia (NH_3) emissions should be mitigated to improve environmental quality.Croplands are one of the largest NH_3sources,they must be managed properly to reduce their emissions while achieving the target yields.Here...Ammonia (NH_3) emissions should be mitigated to improve environmental quality.Croplands are one of the largest NH_3sources,they must be managed properly to reduce their emissions while achieving the target yields.Herein,we report the NH_3 emissions,crop yield and changes in soil fertility in a long-term trial with various fertilization regimes,to explore whether NH_3 emissions can be significantly reduced using the 4R nutrient stewardship (4Rs),and its interaction with the organic amendments (i.e.,manure and straw) in a wheat–maize rotation.Implementing the 4Rs significantly reduced NH_3 emissions to 6 kg N ha~(–1) yr~(–1) and the emission factor to 1.72%,without compromising grain yield (12.37 Mg ha~(–1) yr~(–1))and soil fertility (soil organic carbon of 7.58 g kg~(–1)) compared to the conventional chemical N management.When using the 4R plus manure,NH_3 emissions (7 kg N ha~(–1) yr~(–1)) and the emission factor (1.74%) were as low as 4Rs,and grain yield and soil organic carbon increased to 14.79 Mg ha~(–1) yr~(–1) and 10.09 g kg~(–1),respectively.Partial manure substitution not only significantly reduced NH_3 emissions but also increased crop yields and improved soil fertility,compared to conventional chemical N management.Straw return exerted a minor effect on NH_3 emissions.These results highlight that 4R plus manure,which couples nitrogen and carbon management can help achieve both high yields and low environmental costs.展开更多
ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hos...ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).展开更多
Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) a...Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies"through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial(RCT), 22 observational and 11 case series], 29(85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin(PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop(de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.展开更多
Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding t...Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.展开更多
An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appr...An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appropriate drugs, determination of administration routes and standardization of both medication dosage and treatment duration. The program involves, but is not limited to, Hospital Staff Education, Pharmacodynamics Dose Optimization, Computer-Assisted Decision Support Programs, Pharmacist-Driven Intravenous to Oral Switch Programs, Pharmacy Dosing Programs and Antibiotic Cycling. A study was conducted to determine effectiveness of the ASP in significantly improving patient outcomes (e.g. decrease morbidity and mortality from infection). This was undertaken by collecting restrospective data on patient length of hospital stay, bed turnover rate and antibiotic consumption over a period of 2 years since the ASP was initiated. Periodic data were then compared and interpreted based on its clinical, quality and financial implications in order to measure effectiveness of the program implementation.展开更多
Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivot...Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.展开更多
Many studies have demonstrated that some of the activities of people can disturb nesting and foraging birds, particularly along coasts and estuaries. Some managers respond to human disturbance of sensitive species by ...Many studies have demonstrated that some of the activities of people can disturb nesting and foraging birds, particularly along coasts and estuaries. Some managers respond to human disturbance of sensitive species by closing beaches, but most have stewards monitor and restrict access to beaches or portions of beaches. Yet little is known about the type of visitor or their perceptions of beach stewards. This paper explores the general acceptance of beach stewards and their role in conservation of red knots </span><span><span style="font-family:Verdana;">(</span><i><span style="font-family:Verdana;">Calidris</span></i> <i><span style="font-family:Verdana;">canutus</span></i> <i><span style="font-family:Verdana;">rufa</span></i><span style="font-family:Verdana;">),</span></span><span style="font-family:Verdana;"> other shorebirds, and horseshoe crabs </span><span><span style="font-family:Verdana;">(</span><i><span style="font-family:Verdana;">Limulus</span></i> <i><span style="font-family:Verdana;">polyphemus</span></i><span style="font-family:Verdana;">) </span></span><span style="font-family:Verdana;">along the Delaware Bay (New Jersey) beaches by interviewing 279 visitors during the stopover period. While most people came to see the shorebird and horseshoe crab spectacle (60%), many came for the scenery, tranquility, and recreation. Just over half of the people interviewed said that the stewards were helpful (58%), although most of those that answered this question later said that they provided conservation value (86%), but only 40% said they relied on the stewards for information. On a Likert rating scale of 1 to 5 (the highest value), the mean rating for whether it was important for stewards to be present was 3.87 ± 0.09, and the rating for the presence of stewards who can provide information was 3.71 ± 0.11. In contrast, protection of shorebirds was rated a mean of 4.79 ± 0.04. There were significant visitor type differences in how important stewards were, but not in the importance of stewards who can provide information. Fishermen, recreationists, and people coming for scenery and tranquility rated the presence of stewards higher than those visitors who were interested in either shorebirds or crabs (or both). Ratings also differed significantly as a function of age and gender;older adults and females rated characteristics higher than did people under 30 years and males. Information needs identified by stewards are also discussed. These data can be used by the managers developing a strategy for conservation of shorebirds and other species sensitive to disturbance, and for the implementation of an effective stewardship program.展开更多
Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the W...Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.展开更多
How govemment think about regulation in the 21st century is changing. This workshop as the first session of Pacific Area Standards Congress 2019 will bring together standardizers and regulators to Look at how standard...How govemment think about regulation in the 21st century is changing. This workshop as the first session of Pacific Area Standards Congress 2019 will bring together standardizers and regulators to Look at how standards can play a part in regulatory stewardship, an innovative and proactive approach for government regulatory agencies.展开更多
The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on t...The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on time to optimization of antimicrobial therapy in hospitalized patients with gram-negative bacteremia. Time to antibiotic optimization was compared in patients with gram-negative bacilli isolated from blood cultures obtained from March-May 2011 （pre-RAIDS） versus March-May 2013 （post-RAIDS）. The results show that patients in the pre-RAIDS study group had a significantly longer time to antibiotic optimization when compared to the post-RAIDS group （median （IQR）, 27.6 （10.8-75.8） h vs. 3.1 （0.8-34.3） h, p = 0.03）. The RAIDS protocol resulted in quicker time to antibiotic de-escalation （pre- vs. post-RAIDS; median （IQR）, 27.6 （10.8-134.5） h vs. 4.3 （1.4-32.6） h, p = 0.03）. There were no differences in clinical outcomes such as clinical cure, microbiological cure, and 30-day mortality between pre-RAIDS and post-RAIDS study groups. Patients in the post-RAIDS arm were more likely to receive appropriate empiric and definitive treatment. Implementation of the RAIDS protocol, which was an ASP （antimicrobial stewardship program） initiative, resulted in quicker time to antibiotic de-escalation and overall treatment optimization. RAIDS reduced the unnecessary use of broad-spectrum antimicrobial in this study population.展开更多
Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrob...Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。展开更多
Objective:To fully understand the overall system and implementation of antimicrobial stewardship(AMS)at different levels in China,an evaluation according to the integrated AMS evaluation tool developed by World Health...Objective:To fully understand the overall system and implementation of antimicrobial stewardship(AMS)at different levels in China,an evaluation according to the integrated AMS evaluation tool developed by World Health Organization(WHO)was conducted.Methods:A comprehensive search on the AMS relevant government policies,regulations,scientific research results,public and social activities was conducted,and the implementation of AMS strategies in national,subnational and hospital level were evaluated by the standards of the WHO.Results:The results shew that the system construction,technical infrastructure and actions of AMS in China at the national level is relatively satisfied,but the AMS system needs to be further strengthened at the subnational and the medical institutional level,especially the integration of multidisciplinary teams and relevant departments;the implementation of professional intervention strategies,national education and publicity,professional education and training are relatively weak.AMS implementation is mainly promoted at the national level,and AMS in primary medical institutions is almost missing.It is necessary to carry out AMS at the provincial level and medical institutions as soon as possible.The focus is to establish a professional AMS team,prepare AMS guideline,implement AMS strategy,raise public awareness and ensure the long‐term and sustainable development of AMS in the country.Conclusion:The Chinese government has established a system for AMS,and implemented a multisectoral coordinative mechanism.However,at the subnational and district levels,an AMS system and practice should be set up soon to promote the rational use of antibiotics.展开更多
Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detri...Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.展开更多
Antimicrobial resistance is a global public health threat,and the World Health Organization(WHO)has announced a priority list of the most threatening pathogens against which novel antibiotics need to be developed.The ...Antimicrobial resistance is a global public health threat,and the World Health Organization(WHO)has announced a priority list of the most threatening pathogens against which novel antibiotics need to be developed.The discovery and introduction of novel antibiotics are time-consuming and expensive.According to WHO’s report of antibacterial agents in clinical development,only 18 novel antibiotics have been approved since 2014.Therefore,novel antibiotics are critically needed.Artificial intelligence(AI)has been rapidly applied to drug development since its recent technical breakthrough and has dramatically improved the efficiency of the discovery of novel antibiotics.Here,we first summarized recently marketed novel antibiotics,and antibiotic candidates in clinical development.In addition,we systematically reviewed the involvement of AI in antibacterial drug development and utilization,including small molecules,antimicrobial peptides,phage therapy,essential oils,as well as resistance mechanism prediction,and antibiotic stewardship.展开更多
文摘Background:This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship,in addition to identifying factors influencing their perception and practices in community pharmacy.Methods:A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship.Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad.In total,381 participants have completed the survey.Results:The majority of the participants(85.6%)strongly agreed/agreed that“antimicrobial stewardship programs reduce the problems of antibiotic resistance”;and 85.5%of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use.In addition,high percent of community pharmacists(88.4%)strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system.The total score of perception was significantly influenced by older age groups,postgraduate degrees,and experience of 6–10 years(p<0.001).This study also showed that 65.4%of pharmacists always/often advise patients to continue the full course of antimicrobials,and 64.9%of them reported always/often considering clinical and safety parameters before dispensing antibiotics.The role of pharmacists was significantly influenced by the younger age group,females,higher degree in pharmacy,experience of 3–5 years,and medical complex pharmacy(p<0.001).Conclusion:Community pharmacists have a good perception toward antimicrobial stewardship programs,but their role is still limited.More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.
基金China Medical Board(Grant No.17-270)National Natural Science Foundation of China(Grant No.81861138048 and 81973294)。
文摘In the present study,we aimed to assess the development of the antimicrobial stewardship(AMS)program in China’s tertiary hospitals to identify the potential challenges for the AMS program and provide references and benchmarks for strategic policymaking.A nationwide cross-sectional study was conducted online by sending questionnaires to tertiary hospitals under China Antimicrobial Resistance Surveillance System(CARSS).The questionnaire included 5 sections regarding structure,technical support,antimicrobial use management,antimicrobial use surveillance,and education.Descriptive statistics were used for data analysis.Of the 1044 tertiary hospitals under CARSS,13.4%(140)hospitals participated in the study.Among them,99.3%(139/140)set up the AMS program.The hospital president(82.1%,115/140)and medical service department(59.3%,83/140)were responsible for AMS outcomes in most hospitals.Structured antimicrobial formulary restriction management was adopted by 99.3%(139/140)hospitals.Infectious disease department,infection control department,and microbiological laboratories were established in 87.1%(122/140),99.3%(139/140)and 100%(140/140)hospitals,respectively.Up to 85.6%(124/140)hospitals applied clinical pathways,and 33.6%(47/140)hospitals implemented hospital-specific guidelines for infectious diseases.Outpatient prescription auditing,inpatient prescription auditing,and prophylactic antimicrobial prescription auditing of aseptic operation were performed in 99.3%(139/140),98.6%(138/140)and 95.7%(134/140)hospitals,respectively.Up to 97.1%(136/140)hospitals participated in antimicrobial use surveillance network,and 99.3%(139/140)hospitals established the specialized management of carbapenem and tigecycline.Staff education and public education were provided with various ways and frequencies in 100%(140/140)and 90.0%(126/140)hospitals,respectively.AMS programs in China’s tertiary hospitals were primarily headed by hospital presidents and involved collaboration among various disciplines and administrative departments.More efforts should be put to further promote and strengthen the development of hospital-specific guidelines and the establishment of a progress and outcome evaluation system.
基金supported by the Hainan Key Research and Development Project, China (ZDYF2021XDNY184)the Hainan Provincial Natural Science Foundation of China (422RC597)+2 种基金the National Natural Science Foundation of China (41830751)the Hainan Major Science and Technology Program, China (ZDKJ2021008)the Hainan University Startup Fund,China (KYQD(ZR)-20098)。
文摘Ammonia (NH_3) emissions should be mitigated to improve environmental quality.Croplands are one of the largest NH_3sources,they must be managed properly to reduce their emissions while achieving the target yields.Herein,we report the NH_3 emissions,crop yield and changes in soil fertility in a long-term trial with various fertilization regimes,to explore whether NH_3 emissions can be significantly reduced using the 4R nutrient stewardship (4Rs),and its interaction with the organic amendments (i.e.,manure and straw) in a wheat–maize rotation.Implementing the 4Rs significantly reduced NH_3 emissions to 6 kg N ha~(–1) yr~(–1) and the emission factor to 1.72%,without compromising grain yield (12.37 Mg ha~(–1) yr~(–1))and soil fertility (soil organic carbon of 7.58 g kg~(–1)) compared to the conventional chemical N management.When using the 4R plus manure,NH_3 emissions (7 kg N ha~(–1) yr~(–1)) and the emission factor (1.74%) were as low as 4Rs,and grain yield and soil organic carbon increased to 14.79 Mg ha~(–1) yr~(–1) and 10.09 g kg~(–1),respectively.Partial manure substitution not only significantly reduced NH_3 emissions but also increased crop yields and improved soil fertility,compared to conventional chemical N management.Straw return exerted a minor effect on NH_3 emissions.These results highlight that 4R plus manure,which couples nitrogen and carbon management can help achieve both high yields and low environmental costs.
基金supported by the Natural Science Foundation of Hubei Province(No.2021CFB348).
文摘ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).
文摘Antibiotic usage and increasing antimicrobial resistance(AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units(ICU). Antibiotic stewardship programmes(ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies"through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial(RCT), 22 observational and 11 case series], 29(85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin(PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop(de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.
文摘Introduction: The inappropriate antimicrobial usage (AMU) in chicken production has led to an increase in the prevalence of antimicrobial resistance (AMR). In Zambia, there is little information documented regarding the knowledge, attitude, and practices of poultry farmers on AMU and AMR. Therefore, this study assessed the knowledge, attitude and practices regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Methods: This was a cross-sectional study conducted among 106 poultry farmers from November to December 2021 using a structured questionnaire. Data analysis was done using IBM Statistical Package for Social Sciences (SPSS) version 26. Results: Overall, of the 106 participants, 90.6% knew what antimicrobials were, but only 29.2% were aware of AMR. The study showed that 46.2% of the participants had low knowledge, 71.7% had negative attitudes, and 61.3% had poor practices regarding AMR. The prevalence of antibiotic use in poultry production was 83%. The most used antimicrobials were tetracycline (84%) and gentamicin (35.2%). The commonly reported reason for the use of antimicrobials was for the treatment (93.2%) and prevention (89.8%) of diseases. Further, 76.9% of the administered antimicrobials were usually done without veterinarian consultation or prescription. Conclusion: The study shows that there was high AMU in poultry farms in Kitwe. However, there was low knowledge, negative attitude, and poor practices towards AMU and AMR. Therefore, there is a need for educational and sensitisation programmes regarding AMU and AMR among poultry farmers in Kitwe, Zambia. Alongside this, antimicrobial stewardship and surveillance systems should be strengthened in the livestock production sector. This will ensure food safety and public health.
文摘An Antimicrobial Stewardship Program (ASP) is established to promote cost effective and safe use of antimicrobial agents. Basically, this approach directs the management of antimicrobials in terms of selection of appropriate drugs, determination of administration routes and standardization of both medication dosage and treatment duration. The program involves, but is not limited to, Hospital Staff Education, Pharmacodynamics Dose Optimization, Computer-Assisted Decision Support Programs, Pharmacist-Driven Intravenous to Oral Switch Programs, Pharmacy Dosing Programs and Antibiotic Cycling. A study was conducted to determine effectiveness of the ASP in significantly improving patient outcomes (e.g. decrease morbidity and mortality from infection). This was undertaken by collecting restrospective data on patient length of hospital stay, bed turnover rate and antibiotic consumption over a period of 2 years since the ASP was initiated. Periodic data were then compared and interpreted based on its clinical, quality and financial implications in order to measure effectiveness of the program implementation.
文摘Background: One of the key drivers for the emergence and spread of antimicrobial resistance (AMR) is non-prudent antibiotic use, which results in selection pressure toward relevant bacteria. Pharmacy staffs have pivotal roles in facilitating the prudent use of antibiotics through antimicrobial stewardship programs. Due to limited information in Benin, this study assessed the knowledge and attitudes of pharmacy staffs on antibiotic use and resistance. Materials and Methods: This cross-sectional study was conducted among 159 pharmacy staffs using a structured questionnaire from August 2018 to December 2018 in Benin. Data analysis was done by using Stata version 13.0. Results: Of the 159 participants, 54.8% knew the definition of antibiotic therapy and 66.9% knew the definition of probabilistic antibiotic therapy. The majority (88.1%) of the participants thought that the choice of antibiotics was made according to the pathology, while 60.4% thought that it depended on the pathology and the germ involved. 49.02% of dispensers in pharmacies stated that half of the patients had requested treatment without providing a prescription at the pharmacy. The top three antibiotics that were dispensed without a prescription include amoxicillin (98.1%), cloxacillin (76.7%) and metronidazole (57.2%), all from the Access group of antibiotics. Conclusion: These results underscore the need for educational and training interventions targeting specific professional groups. There is an urgent need for regulatory measures and public awareness through improved antimicrobial stewardship to limit this practice.
文摘Many studies have demonstrated that some of the activities of people can disturb nesting and foraging birds, particularly along coasts and estuaries. Some managers respond to human disturbance of sensitive species by closing beaches, but most have stewards monitor and restrict access to beaches or portions of beaches. Yet little is known about the type of visitor or their perceptions of beach stewards. This paper explores the general acceptance of beach stewards and their role in conservation of red knots </span><span><span style="font-family:Verdana;">(</span><i><span style="font-family:Verdana;">Calidris</span></i> <i><span style="font-family:Verdana;">canutus</span></i> <i><span style="font-family:Verdana;">rufa</span></i><span style="font-family:Verdana;">),</span></span><span style="font-family:Verdana;"> other shorebirds, and horseshoe crabs </span><span><span style="font-family:Verdana;">(</span><i><span style="font-family:Verdana;">Limulus</span></i> <i><span style="font-family:Verdana;">polyphemus</span></i><span style="font-family:Verdana;">) </span></span><span style="font-family:Verdana;">along the Delaware Bay (New Jersey) beaches by interviewing 279 visitors during the stopover period. While most people came to see the shorebird and horseshoe crab spectacle (60%), many came for the scenery, tranquility, and recreation. Just over half of the people interviewed said that the stewards were helpful (58%), although most of those that answered this question later said that they provided conservation value (86%), but only 40% said they relied on the stewards for information. On a Likert rating scale of 1 to 5 (the highest value), the mean rating for whether it was important for stewards to be present was 3.87 ± 0.09, and the rating for the presence of stewards who can provide information was 3.71 ± 0.11. In contrast, protection of shorebirds was rated a mean of 4.79 ± 0.04. There were significant visitor type differences in how important stewards were, but not in the importance of stewards who can provide information. Fishermen, recreationists, and people coming for scenery and tranquility rated the presence of stewards higher than those visitors who were interested in either shorebirds or crabs (or both). Ratings also differed significantly as a function of age and gender;older adults and females rated characteristics higher than did people under 30 years and males. Information needs identified by stewards are also discussed. These data can be used by the managers developing a strategy for conservation of shorebirds and other species sensitive to disturbance, and for the implementation of an effective stewardship program.
文摘Background: Antimicrobial resistance (AMR) is one of the top 10 global public health threats facing humanity and this burden is borne largely by low and middle-income countries. As part of efforts to combat AMR, the World Health Organization has identified Antimicrobial Stewardship as one of the strategic objectives of its global action plan on antimicrobial resistance. This survey aimed to observe antimicrobial prescribing and usage patterns in the Rivers State University Teaching Hospital with the purpose of identifying gaps to inform the specific antimicrobial stewardship interventions necessary to address our specific needs. Methodology: A point prevalence survey was conducted using the protocol and web-based automated data management system designed by the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance, University of Antwerp, Belgium, in November 2021. Results: A total of 69 adult medical and surgical patients were surveyed;27 males and 18 females. Antimicrobial prevalence was 65.2%. Third generation cephalosporins (24.4%;33.3%), fluoroquinolones (17.8%;22.2%) and imidazole derivatives (20%;36.1%) were most prescribed on the medical and surgical wards. Antimicrobial guidelines were completely unavailable, most antimicrobials (93.8%) were prescribed empirically and 64.4% of these remained empirical after 72 hours of commencement. Conclusion: Antimicrobial stewardship interventions are necessary to minimize sub-optimal antimicrobial prescribing practices in our facility. Most critical are education on appropriate use of antimicrobials, support for development of antimicrobial guidelines, diagnostic stewardship, and the drive for improved use of the laboratory to guide antimicrobial prescriptions. The antimicrobial stewardship committee and team must drive this, having the requisite support from the management and prescribers, with the primary outcomes being reduced antimicrobial prevalence and improved antimicrobial prescription patterns.
文摘How govemment think about regulation in the 21st century is changing. This workshop as the first session of Pacific Area Standards Congress 2019 will bring together standardizers and regulators to Look at how standards can play a part in regulatory stewardship, an innovative and proactive approach for government regulatory agencies.
文摘The purpose of this study was to critically evaluate the impact of an institutional blood culture notification protocol called RAIDS （rapid administration of antimicrobials by an infectious diseases specialist） on time to optimization of antimicrobial therapy in hospitalized patients with gram-negative bacteremia. Time to antibiotic optimization was compared in patients with gram-negative bacilli isolated from blood cultures obtained from March-May 2011 （pre-RAIDS） versus March-May 2013 （post-RAIDS）. The results show that patients in the pre-RAIDS study group had a significantly longer time to antibiotic optimization when compared to the post-RAIDS group （median （IQR）, 27.6 （10.8-75.8） h vs. 3.1 （0.8-34.3） h, p = 0.03）. The RAIDS protocol resulted in quicker time to antibiotic de-escalation （pre- vs. post-RAIDS; median （IQR）, 27.6 （10.8-134.5） h vs. 4.3 （1.4-32.6） h, p = 0.03）. There were no differences in clinical outcomes such as clinical cure, microbiological cure, and 30-day mortality between pre-RAIDS and post-RAIDS study groups. Patients in the post-RAIDS arm were more likely to receive appropriate empiric and definitive treatment. Implementation of the RAIDS protocol, which was an ASP （antimicrobial stewardship program） initiative, resulted in quicker time to antibiotic de-escalation and overall treatment optimization. RAIDS reduced the unnecessary use of broad-spectrum antimicrobial in this study population.
基金the project:the Science and Technology Planning Project of Zhuhai City of China(No.20191206F060001)。
文摘Objective To evaluate the effect of pharmacist-driven antimicrobial stewardship based on value-based healthcare in a tertiary hospital in China.Methods The application of plan-do-check-action(PDCA)cycle and antimicrobial stewardship(AMS)were respectively used to improve the rational use of antimicrobial agents in prophylactic and therapeutic.Data were collected and the effect was assessed during the management period(2016-2019).Results and Conclusion From 2016(before implementation)to 2019(after implementation),the rational use of antibiotics were obviously enhanced in outpatients,inpatients,and emergency department.For instance,the utilization rate in type I incision operation was decreased from 26.42%to 14.60%(P=0.000),the daily doses of antibiotic per 100 patient-days decreased from 49.34±2.97 to 35.89±4.96(P=0.000),and the average antibiotic expenditures dropped from 948.53 yuan to 526.30 yuan(P=0.000).There was no significant change in infection rate,nosocomial mortality rate,and the length of hospital stay.After the implementation of clinical pharmacist-driven antimicrobial stewardship based on value-based healthcare,the consumption and cost of antibacterial have been greatly reduced.Therefore,the pharmacist-driven antimicrobial stewardship increases its value。
基金Key Research and Development Program of Zhejiang Province,Grant/Award Number:2021C03068。
文摘Objective:To fully understand the overall system and implementation of antimicrobial stewardship(AMS)at different levels in China,an evaluation according to the integrated AMS evaluation tool developed by World Health Organization(WHO)was conducted.Methods:A comprehensive search on the AMS relevant government policies,regulations,scientific research results,public and social activities was conducted,and the implementation of AMS strategies in national,subnational and hospital level were evaluated by the standards of the WHO.Results:The results shew that the system construction,technical infrastructure and actions of AMS in China at the national level is relatively satisfied,but the AMS system needs to be further strengthened at the subnational and the medical institutional level,especially the integration of multidisciplinary teams and relevant departments;the implementation of professional intervention strategies,national education and publicity,professional education and training are relatively weak.AMS implementation is mainly promoted at the national level,and AMS in primary medical institutions is almost missing.It is necessary to carry out AMS at the provincial level and medical institutions as soon as possible.The focus is to establish a professional AMS team,prepare AMS guideline,implement AMS strategy,raise public awareness and ensure the long‐term and sustainable development of AMS in the country.Conclusion:The Chinese government has established a system for AMS,and implemented a multisectoral coordinative mechanism.However,at the subnational and district levels,an AMS system and practice should be set up soon to promote the rational use of antibiotics.
文摘Pregnant and postnatal women are a high-risk population particularly prone to rapid progression to sepsis with significant morbidity and mortality worldwide.Moreover,severe maternal infections can have a serious detrimental impact on neonates with almost 1 million neonatal deaths annually attributed to maternal infection or sepsis.In this review we discuss the susceptibility of pregnant women and their specific physiological and immunological adaptations that contribute to their vulnerability to sepsis,the implications for the neonate,as well as the issues with antimicrobial stewardship and the challenges this poses when attempting to reach a balance between clinical care and urgent treatment.Finally,we review advancements in the development of pregnancy-specific diagnostic and therapeutic approaches and how these can be used to optimize the care of pregnant women and neonates.
基金supported by the National Natural Science Foundation of China(32300157)the Shanghai Municipal Science and Technology Commission(19411964900)+1 种基金the Major Research and Development Project of Innovative Drugs,Ministry of Science and Technology of China(2017ZX09304005)the Wellcome Trust.
文摘Antimicrobial resistance is a global public health threat,and the World Health Organization(WHO)has announced a priority list of the most threatening pathogens against which novel antibiotics need to be developed.The discovery and introduction of novel antibiotics are time-consuming and expensive.According to WHO’s report of antibacterial agents in clinical development,only 18 novel antibiotics have been approved since 2014.Therefore,novel antibiotics are critically needed.Artificial intelligence(AI)has been rapidly applied to drug development since its recent technical breakthrough and has dramatically improved the efficiency of the discovery of novel antibiotics.Here,we first summarized recently marketed novel antibiotics,and antibiotic candidates in clinical development.In addition,we systematically reviewed the involvement of AI in antibacterial drug development and utilization,including small molecules,antimicrobial peptides,phage therapy,essential oils,as well as resistance mechanism prediction,and antibiotic stewardship.
