Dissertations / Theses on the topic 'Intravenous antibiotics'

The overuse of antibiotics and consequent resistance is a common problem in medical practice worldwide. Switch therapy is a technique that can be applied to streamline antibiotic therapy reducing unnecessary prolonged Intravenous (IV) antibiotic therapy. Antibiotic switch therapy has several other benefits such as: decreasing length of hospital stay; decreasing the incidence of adverse events associated with the administration of IV antibiotics; decreasing direct and indirect hospitalisation costs while improving patients’ comfort and mobility; and decreasing the risk of acquiring nosocomial infections. Certain elements are required to make the implementation of any guideline, including a switch therapy guideline, a success and probably one of the most important is the support from a motivated multidisciplinary team. The role of such a team, in the South African context, would be filled by the Pharmacy and Therapeutics Committee (PTC). In addition, to make a guideline successful it should be continuously implemented. This responsibility traditionally falls to a pharmacist. In the United Kingdom (UK) and the United States of America (USA) pharmacists are used to promote the appropriate use of antibiotics in hospitals as this has shown to have several economic advantages. The objectives of the study were: to determine, by means of a survey, whether guidelines for IV to oral switch were employed in South African regional, tertiary and national government hospitals; to design and implement an IV to oral antibiotic switch therapy (IVOST) guideline for a local public sector tertiary level hospital; to evaluate the effectiveness of guideline implementation; and to capture, via a questionnaire, the perceptions of prescribers regarding antibiotic prescribing, including switch therapy. The Survey of Current IV Switch Therapy Practice Questionnaire was distributed to Responsible Pharmacists at regional, provincial tertiary and national central government hospitals to determine whether IVOST guidelines were employed in South African government hospitals. Following the survey, an IVOST Guideline was designed by the researcher in consultation with the Department of Medicine and the Department of Pharmacy. The IVOST Guideline was implemented following approval by the PTC at a local tertiary level government hospital. A presentation was held for prescribers, guideline documents were distributed, posters were placed in the medical wards and the ward pharmacist/researcher integrated the guideline into daily practice by placing “reminder stickers” in patient medical folders. A pre-implementation audit and two post-implementation audits, each consisting of 150 patient medical records, were conducted and compared to determine the effect of IVOST guideline implementation on prescribing patterns and to determine whether any changes could be sustained. The Prescriber Antibiotic Survey was then conducted to capture the perceptions of prescribers regarding antibiotic therapy, including switch therapy.

Antibiotic hypersensitivity represents a major clinical challenge in patients with cystic fibrosis (CF). Many patients have significant restrictions in antibiotic choice as a result of multiple previous hypersensitivity reactions; this often leads to suboptimal treatment. The majority of reactions are non-immediate and in similar cohorts of non-CF patients it has been demonstrated that they are T cell mediated. In this study we aimed to investigate the mechanism of hypersensitivity in a cohort of patients with CF and established hypersensitivity. As demonstrated in recent studies skin testing had low sensitivity in our cohort of patients. Only 13% of patients developed positive intradermal tests to piperacillin; no positives were seen with other beta-Iactams. In contrast, in-vitro Iymphocyte proliferation was seen in 68% of patients with piperacillin hypersensitivity. This is the first time drug specific Iymphocytes have been identified in patients with CF and supports the clinical viewpoint that the non-immediate reactions seen are T-cell mediated. Positive proliferation was also seen in patients with colistin hypersensitivity, including patients with neurological symptoms such as headache. Interestingly, the group of patients with neurological symptoms secondary to colistin also had positive drug specific IgG antibodies further supporting an immune mechanism. Whilst desensitisation is performed with some success at present it is not known whether any immune modulation takes place. The piperacillin model provides us with a useful tool to characterise the mechanisms of drug hypersensitivity and desensitisation. Prospective studies are needed to assess how drug sensitivity develops and whether clinical practice could be modified to reduce the risk.

Repeated cannulation of children during the course of treatment is distressing for the child, their family and to their nurses. Some paediatric units endeavour to minimise recannulation by employing strategies to reduce complications such as phlebitis and thrombosis formation. One strategy is to infuse low dose heparin and hydrocortisone (HEPHC). However, its effectiveness in prolonging cannula survival is inconclusive. There is also concern about the potential risks of administering these preparations to children. A randomised, controlled, blinded trial was conducted that examined the effectiveness of continuous infusion of low dose HEPHC in a group of children requiring long term intravenous antibiotics in a general paediatric unit. Comparisons of cannula complications and cannulae survival times were made in children receiving either continuous infusions of clear fluids or low dose HEPHC. The results demonstrated that there was no statistically significant difference (Logrank statistic=l.l, p=0.3) in cannula survival times between the two groups. It was also found that the bacterial and fungal colonisation of cannula for these children was extremely low. Based on these findings it is recommended that routine administration of low dose HEPHC to extend cannula survival time be discontinued. The findings also support current practice of removing cannula in children only when a complication occurs on completion of treatment.

Bakgrund: Inom hälso- och sjukvården kan personal råka ut för olika arbetsrelaterade besvär. Sjuksköterskan kommer i kontakt med många olika typer av läkemedel. Alla läkemedel är inte harmlösa för dem som iordningställer och administrerar dem. Då företagssköterskan ska arbeta hälsofrämjande och preventivt är det intressant att belysa sjuksköterskors arbete med intravenös antibiotika. KASAM kan vara till hjälp, på en arbetsplats, för att ta reda på vad som krävs för att kunna bevara men också förbättra hälsan hos medarbetarna.  Syfte: Att beskriva sjuksköterskors uppfattningar om risker vid arbete med intravenös antibiotika. Metod: Vald metod var kvalitativ metod. Fenomenografisk ansats användes vid analys av nio intervjuer. Resultat: Resultatet sammanfattades i tre beskrivningskategorier: Påverkan på kroppen, Utrustningens betydelse och Synliggöra risker. Slutsatser: Studiens resultat visar att sjuksköterskor är i behov av information om risker vid arbete med intravenös antibiotika. En ökad medvetenhet om riskerna kan bidra till att minska utvecklingen av både känd och icke känd överkänslighet samt minska resistensutvecklingen.

INTRODUÇÃO: Tem havido um crescente interesse em desenvolver programas para oferecer cuidados em casa para as condições que têm sido tradicionalmente tratadas nos hospitais, impulsionado por uma série de fatores, incluindo considerações de custo, a preferência do paciente e o aumento do risco de infecções adquiridas no hospital. As infecções são uma importante causa de internação e os antimicrobianos estão entre os fármacos mais comumente prescritos, o uso inadequado e disseminado está associado ao aparecimento de patógenos resistentes. Na oncologia os pacientes constituem um grupo sob especial risco de infecções. Estudos específicos sobre conversão de antimicrobianos em oncologia não são facilmente encontrados na literatura. OBJETIVO: Avaliar a eficácia do protocolo de um programa de terapia sequencial de antimicrobiano em hospital referência em oncologia. MÉTODO: Estudo retrospectivo de avaliação de intervenção, realizado em internação de um instituto de alta complexidade em oncologia, no período de maio de 2011 a maio de 2012, com etapa observacional pré-intervenção, e etapa de intervenção com aplicação do protocolo de terapia sequencial, onde ocorre a substituição do mesmo antimicrobiano de via intravenosa para a via oral. RESULTADOS: Foram incluídos 889 pacientes, 357 no período pré-intervenção e 532 no período de intervenção. Não houve diferença estatisticamente significativa na proporção de trocas entre os grupos pré-intervenção e intervenção, 33,61% e 37,59% respectivamente (OR 1,19, IC95% 0,90-1,58, p 0,23). Porém houve diferença para uso de levofloxacino, com maior chance de troca no grupo de intervenção (OR 2,94, IC95% 1,58-5,58, p 0,008). A neoplasia de mama como diagnóstico oncológico também foi associada a maior chance de troca (OR 2,10 IC95% 1,04-4,23, p 0,04). CONCLUSÃO: A implementação de protocolo de um programa de terapia sequencial em pacientes oncológicos em regime de internação não demonstrou impacto na troca de antimicrobiano IV para VO. Entretanto, resultou em maior chance de troca quando aplicada nos casos do uso de levofloxacino e naqueles cujo diagnóstico oncológico era neoplasia de mama
INTRODUCTION: There has been a growing interest in developing programs to provide home care for some conditions that have traditionally been treated in hospitals due to a number of factors, including cost considerations, the patient\'s preferences and the increased risk of infections acquired in the hospital. Infections are a major cause of hospitalization and the antimicrobials are among the most commonly prescribed drugs, their improper and widespread use is associated with the emergence of resistant pathogens. Oncology patients constitute a group at particular risk of infections. Specific studies on conversion of antimicrobial agents in Oncology are not easily found in the literature. OBJECTIVE: to evaluate the effectiveness of a program of sequential antimicrobial therapy in an Oncology hospital. METHOD: Retrospective study of intervention evaluation, conducted in hospitalized patients in an Oncology Institute from May 2011 to May 2012, with an observational pre-intervention step as well as a step of intervention with application of sequential therapy protocol, where the same antimicrobial is administered orally instead of via IV. RESULTS: Eight hundred and eighty-nine patients were included, 357 in the pre-intervention phase and 532 in the intervention phase. There was no statistically significant difference in the proportion of changing between the pre-intervention and intervention groups, 33.61% and 37.59% respectively (OR 1.19, IC95% 0.90-1.58, p 0.23). But there was difference for the use of levofloxacin, with greater chance of switching in the intervention group (OR 2.94, IC95% 1.58-5.58, p 0.008). The breast cancer diagnosis was also associated with greater chance of switching (OR 2.10 IC95% 1.04-4.23, p 0.04). CONCLUSION: The implementation of a protocol of a sequential therapy program in oncology patients in inpatient regime showed no impact on antimicrobial switch from IV to VO. However, it resulted in higher chance of switch when applied in cases of use of levofloxacin and in those whose cancer diagnosis was breast neoplasm

Dentre as afecções que acometem as articulações dos equinos, a artrite séptica e a mais grave observada. A técnica da perfusão regional e um método comprovadamente eficiente para o tratamento de equinos acometidos por infecções sinoviais. O dimetilsulfóxido (DMSO) é um líquido orgânico, que possui a capacidade de penetrar, com extrema facilidade, em órgãos, tecidos e membranas celulares e intracelulares. Neste estudo, objetivou-se avaliar a concentração intra-articular da gentamicina administrada por perfusão regional intravenosa (PRI), associada ou não ao DMSO, bem como avaliar a influência do volume total perfundido o período de tempo onde a concentração inibitória mínima (CIM) foi mais eficiente e se a associação com o DMSO aumentou a CIM no líquido sinovial. Os animais foram distribuídos em quatro grupos experimentais, cada grupo recebeu gentamicina 6,6 mg/kg por PRI, o volume a ser administrado, após o cálculo da quantidade de gentamicina acrescida ou não de DMSO, era completado com solução de ringer com lactato estéril até o volume de 60mL nos grupos G60 e GD60, e até 250mL para os grupos G250 e GD250. As colheitas de líquido sinovial foram realizadas antes do início do experimento (T0), imediatamente depois da retirada do torniquete (T1) e após 4 (T2), 8 (T3), 12 (T4), 16 (T5) e 24 (T6) horas. O método para doseamento das concentrações de gentamicina empregado foi o de difusão em ágar. Destacamos que as concentrações de gentamicina no líquido sinovial na dose de 6.6.mg/Kg podem ser consideradas como adequadas, num período de até 24 horas após a administração. Nossos resultados apontam que o volume de 60 mL, pode ser considerado como o volume ideal de perfusão, bem como a associação do DMSO aumentou as concentrações de gentamicina (µg/mL) na articulação dos equinos e possivelmente reduziu a formação de edemas e aumentos de volume locais.
Among the diseases that affect the joints of horses, septic arthritis is the most serious observed. The regional perfusion technique is a well proven method for the treatment of horses affected by synovial infections. Dimethylsulfoxide (DMSO) is an organic liquid that has the ability to penetrate, with extreme ease on organs, tissues and cellular and intracellular membranes. This study aimed to evaluate the intra-articular concentration of gentamicin administered by intravenous regional perfusion (PRI), associated or not with DMSO, and assess the influence of the total volume infused the time period in which the minimum inhibitory concentration (MIC) It was more efficient and the association with DMSO increased the CIM in the synovial fluid. The animals were divided into four groups, each group received 6.6 mg gentamicin / kg per PRI, the volume to be administered, after calculating the amount of gentamicin plus or absence of DMSO was completed with Ringer\'s lactate solution with sterile until the volume in 60mL groups G60 and GD60, and up to 250 mL and G250 GD250 groups. The synovial fluid samples were collected before the start of the experiment (T0), immediately after removal of the tourniquet (T1) and after 4 (T2), 8 (T3), 12 (T4), 16 (T5) and 24 (T6) hours. The method for determination of gentamicin concentrations was employed the agar diffusion. We emphasize that the gentamicin concentrations in synovial fluid in 6.6.mg/Kg dose may be considered suitable, a period of up to 24 hours after administration. Our results indicate that the volume of 60 ml, can be considered as the ideal volume of the infusion, as well as the association of DMSO increased the gentamicin concentrations (µg / ml) in the joint of horses and possibly reduced edema formation and increases local volume.

碩士
高雄醫學大學
藥學系碩士在職專班
103
Background: It is common that pneumonia of the ICU in Taiwan is caused by Pseudomonas aeruginosa. Due to the abuse of antibiotic prescription, the resistance of Pseudomonas aeruginosa is increasing. The previous study shows that when treating pulmonary infection, inhaled antibiotics yields higher pulmonary concentrations than intravenous administration. Whether the follow up efficacy also increased with the higher pulmonary antibiotic concentration is yet to be proven by evidence. Study design, location and subjects: This study was conducted south of a regional teaching hospital for the single-center, retrospective study of medical records. The study objects are those age between 20 and 99 years old, infected with Pseudomonas aeruginosa pneumonia in ICU and confirmed by bacterial culture from January 1st 2010 to December 31th 2013. Based on treatment methods, patients are divided into two groups, one is given antibiotics by intravenous route only and the other group is given intravenous and inhaled antibiotics in combination. Methods: All patients’ basic information and clinical data are collected by chart review. Clinical data are divided by timeline and recorded days of patients’ ICU stay, days of ventilation patient use, improvement of clinical symptoms of pneumonia and the incidence of drug-resistant bacteria, etc. Use Acute Physiology and Chronic Health Evaluation Score and Clinical Pulmonary Infection Score as assessment tool. The endpoint is mortality of 30 days after infection and all data undergo statistical analysis and comparison. Statistical analysis includes chi-square test (χ2 test), T test (t-test), and Fisher exact test (Fisher''s exact test). Results: During the study period from January 1st 2010 to December 31th 2013, a total of 67 patients were included, 44 of them used monotherapy (intravenous antibiotics alone) and 23 of then used combination therapy(intravenous and inhaled antibiotics). The patients information showed that the average age was 76.5 years old(standard deviation 13.9), male to female ratio was 71.6% to 28.4%. In comparison between the two group, other than male percentage in monotherapy group (p-0.047), there were no significant differences between the two group before treatment in age, Acute Physiology and Chronic Health Evaluation score, Clinical Pulmonary Infection Score, renal function, other infection site. More than 80 percent of patients'' age in both groups were over 60. After treatment, there were no significant difference in days of ICU stays (p= 0.452), days or ventilator use (p= 0.061), days of intravenous injection of antibiotics(p= 0.066), Acute Physiology and Chronic Health Evaluation score (p= 0.589), difference of Clinical Pulmonary Infection Scale before and after treatment (p= 0.078), ratio of elevated creatinine value more than 1(p= 0.523), re-cultured Pseudomonas aeruginosa (p= 0.46), cultured drug-resistance Pseudomonas aeruginosa(p= 0.603), or 30-day mortality(p= 0.308). Conclusions: In comparison of monotherapy with combination therapy, the latter posed no effect on renal function but yielded not significantly difference regarding symptoms of pneumonia, days of intravenous injection, days of ICU stays, Acute Physiology and Chronic Health Evaluation score when leaving ICU, re-infected rate of Pseudomonas aeruginosa, or drug resistance strains. Due to our study was a chart review retrospective one, there were more limitation comparing to prospective study with respect to strict protocol. Therefore our study was not representative of the entire patient populations. To clear all predictive variables, the best method was still prospective trials available to control various of confounding factors.

Objectives: The objectives of the research were to determine which intravenous (IV) antibiotics were cost-effective in Diabetic Foot Infections (DFIs) and to assess the impact of MRSA prevalence on clinical outcome. Methods: A Cost-effectiveness analysis (CEA) was performed on IV antibiotics used to treat moderate to severe DFIs in hospitalized patients. MRSA prevalence was taken into account by calculating an ‘Adjusted cure rate’ and re-analysing the CEA. Results: In the original CEA, imipenem/cilastatin was the cost-effective agent. When MRSA prevalence was taken into account imipenem/cilastatin, moxifloxacin, cefoxitin and ertapenem were cost-effective antibiotics. Conclusion: MRSA prevalence adjustments changed the results of the CEA and included classes of IV antibiotics that are seen being using in practice, such as fluoroquinolones and cephalosporins. These methods could potentially have an impact on the evaluation of clinical cure rates and resistance when evaluating the literature.

The insertion of a peripheral intravenous catheter (PIVC) is one of the most frequently performed invasive procedures in the hospital setting. However, PIVCs usually fail before the completion of intravenous treatment and upon insertion the risk of infection increases exponentially. There are few studies evaluating the contamination of this vascular medical device and characterizing the associated microorganisms regarding the production of virulence factors and antimicrobial resistance. A total of 110 PIVCs ends were analyzed using the Maki et al. methodology and microorganisms were identified. The Staphylococcus spp. were subsequently studied for the antimicrobial susceptibility profile by disc diffusion method and based on the cefoxitin phenotype were further classified into strains resistant to methicillin. A screening for the mecA gene was also done by PCR and MICvancomycin as determined by E-test, proteolytic and hemolytic activity on Skim milk 1% plate and blood agar, respectively. The biofilm formation was evaluated on microplate reading through iodonitrotetrazolium chloride 95% (INT). About 30% of PIVCs were contaminated and the most prevalent genus was Staphylococcus spp., 48.8%. This genus presented resistance to penicillin (91%), erythromycin (82%), ciprofloxacin (64%) and cefoxitin (59%). Thus, 59% of strains resistant to methicillin were detected. We detected the mecA gene in 82% of the isolates tested. Regarding the virulence factors, 36.4% presented hemolysis and 22.7% hemolysis, 63.6% presented a positive result for the production of proteases and 63.6% presented a biofilm formation capacity. About 36.4% were simultaneously resistant to methicillin and showed expression of proteases and/or hemolysins, biofilm formation and MIC for vancomycin greater than 2μg/mL. Thus, our study evidenced contamination of PIVCs mainly by Staphylococcus spp., with high pathogenicity demonstrated by the presence of virulence factors, as well as resistance to antibiotics. The production of virulence factors allows to strengthen the attachment and the permanence in the catheter. When we also associate antimicrobial resistance, the treatment of the related infections becomes more difficult and the scarce treatment options. These data should be considered by health professionals who must take preventive measures to minimize the risk of contamination and consequent reduction of infections related to the use of peripheral intravenous catheters
A inserção de um cateter intravenoso periférico (CVP) é um dos procedimentos invasivos mais frequentemente realizados em ambiente hospitalar. No entanto, os CVPs falham correntemente antes da conclusão do tratamento intravenoso e aquando da sua inserção o risco de infeção aumenta exponencialmente. Existem poucos estudos que avaliam a contaminação deste dispositivo médico vascular e que caracterizam os microrganismos associados quanto à produção de fatores de virulência e resistência aos antimicrobianos. Neste estudo fomos avaliar a contaminação microbiana de CVPs, identificando os microrganismos mais prevalentes e estudando os seus fatores de virulência e resistência a antibióticos. Um total de 110 pontas de CVPs foram analisadas usando a metodologia de Maki et al. e microrganismos foram identificados. Staphylococcus spp. foram posteriormente estudados quanto ao perfil de susceptibilidade aos antimicrobianos pelo método de difusão em disco e com base no fenótipo de cefoxitina foram ainda classificados em estirpes resistentes à meticilina. Foi feito também um screening para o gene mecA por PCR e MIC-Vancomicina determinado por e-test, testou-se a atividade proteolítica e hemolítica em placa de Skim milk a 1% e gelose de sangue, respetivamente. A formação de biofilme foi avaliada em microplaca com leitura através de cloreto de iodonitrotetrazólio (INT). Cerca de 30% dos CVPs estavam contaminados e o género mais prevalente foi Staphylococcus spp., 48.8%. Este género apresentou resistência à penicilina (91%), eritromicina (82%), ciprofloxacina (64%) e cefoxitina (59%). Detetou-se 59% de estirpes resistentes à meticilina e presença do gene mecA em 82% dos isolados testados. Relativamente aos fatores de virulência, 36.4% apresentaram α-hemólise e 22.7% β-hemólise, 63.6% produziam proteases e 63.6% apresentaram capacidade de formar biofilme. É de salientar que 36.4% dos isolados foram simultaneamente resistentes à meticilina e apresentaram expressão de proteases e/ou hemolisinas, formação de biofilme and MIC para vancomicina superiores a 2μg/mL. Deste modo, o nosso estudo evidenciou contaminação de CVPs principalmente por Staphylococcus spp, com elevada patogenicidade demonstrada pela presença de fatores de virulência, assim como resistência a antibióticos. A produção de fatores virulência permite fortalecer a adesão e a permanência dos microrganismos no cateter. Ao associarmos ainda a resistência aos antimicrobianos, o tratamento de infeções relacionadas torna-se mais difícil e as opções de tratamento escassas. Estes dados devem ser considerados pelos profissionais de saúde que devem adotar medidas preventivas para minimização do risco de contaminação e consequente redução das infecções relacionadas ao uso de cateteres intravenosos periféricos.
Mestrado em Microbiologia

碩士
國立成功大學
臨床藥學研究所
93
BACKGROUND: 　Antimicrobials make up an important part of hospitalization cost. As healthcare resources remain limited, cost-containment maneuver becomes attractive. Timely switch or sequential from initial intravenous to subsequent oral antibiotic treatment is better tolerated, and results in comparable efficacy and may reduce healthcare cost. However, few studies of early switch therapy focus on acute pyelonephritis. OBJECTIVE: 　To determine whether early switch from intravenous to oral antibiotic therapy in hospitalized patients with uncomplicated acute pyelonephritis could provide equivalent clinical efficacy, while reducing length of stay and cost. METHODS: 　Adult patients with discharge diagnosis of acute pyelonephritis admitted to National Cheng-Kung University Hospital between January 2003 and December 2004 were eligible for this retrospective cohort study. Enrolled patients were those with fever, flank pain and pyuria, and without any complicating factors. These patients were categorized according to if the time of switch to oral antibiotic were within 48 hours after afebrile. The primary outcomes were cure rate and recurrence rate. The secondary outcomes were length of stay and cost. RESULTS: 　Of the 40 patients enrolled, 22 were in the early switch group and 18 in the late switch group. No significant difference was found in clinical cure rate (73% vs. 72%, P > 0.95) and 3-month recurrence rate (5% vs. 11%, P = 0.579) between the two groups. The duration of intravenous therapy were shorter in the early switch group (79.0 hours vs. 105.5 hours, P = 0.032), and they were discharged earlier (4.5 days vs. 6.0 days, P = 0.006). Hospitalization cost was higher in the late switch group (NT$12,301 vs. NT$14,674 P = 0.025). Total antibiotic cost was lower in the early switch group, but the difference was not significant (NT$2,153 vs. NT$3,454, P = 0.221). CONCLUSIONS: 　Timely switch strategy resulted in reduction of the duration of intravenous antibiotic therapy, length of stay, and hospitalization cost, without compromising clinical outcomes in hospitalized patients with uncomplicated acute pyelonephritis.

The purpose of this study was to determine if there were a significant number of clients with cellulitis that were diagnosed with an infection other than cellulitis, or whose treatment was misdiagnosed and, to determine where discrepancies may have occurred. The research questions addressed were: (1) What is the proportion of CITP clients who initially have been diagnosed with an infection other than cellulitis? (2) What is the proportion of clients with cellulitis who were not trialed on oral antibiotic therapy prior to receiving parenteral antibiotic therapy? (3) What is the proportion of clients with cellulitis who were not prescribed the appropriate oral antibiotic? (4) What is the proportion of clients with cellulitis who did not remain on oral antibiotic therapy for a specific period of time prior to their doctor requesting they be placed on intravenous antibiotic therapy? (5) Does the incidence of cellulitis increase with certain underlying medical conditions, age group or gender? The research designwas a retrospective study that reviewed the computer database/charts located at The Winnipeg Community Intravenous Therapy Program. (Abstract shortened by UMI.)