bluuebunny/crossref_metadata_2025_split huggingface dataset:
P05 Introducing new laboratory equipment for blood culture tests to improve the timeliness of antimicrobial susceptibility results in sepsis patients: a quality improvement project
Authors: Paul Rachel , Rajendran Rajesh , Eccles Simon , Worsley Michelle 
Published: June 2023

Abstract

Background
Blood culture tests are crucial for identifying microorganisms causing sepsis and planning targeted antimicrobial therapy based on susceptibility results. However, the traditional testing method has remained unchanged for the last 60 years, resulting in a delay of approximately four days for final antimicrobial susceptibility results. This delay contributes to increased antimicrobial resistance, broad-spectrum antimicrobial use and healthcare costs. This project aims to reduce the time taken for antimicrobial susceptibility results.

Methods
An initial pilot study trial of 100 samples with a new system will be conducted, followed by a qualitative and quantitative evaluation strategy, keeping the existing system as a gold standard. The project scope was defined to avoid scope creep, and a detailed SWOT analysis was conducted to identify the best equipment available on the market.

Interventions
A process map was created, and a detailed fish bone (Ishikawa) problem analysis was done to identify key issues and potential bottlenecks. A robust stakeholder analysis has been planned, and a detailed GANTT chart has been prepared. Implementing effective communication, leadership and nudge theory can engage stakeholders and mitigate risks. A cost-benefit analysis predicted a cost savings of nearly a million pounds within one hospital of seven within the Trust.

Conclusions
The introduction of new laboratory equipment for blood culture tests has the potential to reduce the turnaround time for antimicrobial susceptibility results significantly to less than 24 h, leading to early diagnosis and treatment of sepsis with targeted antimicrobial therapy. This initiative also counters various problems, including antimicrobial resistance, broad-spectrum antimicrobial use and healthcare costs. This project proposal is an important step towards improving blood culture testing and the timeliness of antimicrobial susceptibility results. Organizations like the NHS must seek to improve continuously for long-term effectiveness, and this project is one such change that will reap many long-term benefits.
P12 Partial implementation of procalcitonin measurement as an antibiotic stewardship in the ICU
Authors: Gill Simon , Phillips Ryan , Cain David , Powell Neil 
Published: June 2023

Abstract

Background
Procalcitonin (PCT) was introduced to the Royal Cornwall Hospital ICU in April 2020. A local PCT testing and decision support algorithm was developed using published consensus guidelines. We report our adherence to this algorithm in the ICU.

Methods
This retrospective observational study included all patients discharged from ICU from 1 February 2022 to 28 February 2022. Patients who received antibiotics during their admission were identified. Data on antibiotic indication, antibiotic course length in the ICU and pre-ICU and PCT testing were collected and compared with local PCT-based antibiotic prescribing guideline.

Results
Of 50 patients discharged, 34 (68%) received antibiotics and 26 for acute infections and 8 for deep-seated infections or surgical prophylaxis. A baseline PCT was sent in 10 (38%) patients with acute infections, with 4 having repeat PCT testing. Of four patients with a low baseline PCT, three were repeated and remained low. Two of these patients had antibiotics stopped as per PCT algorithm. A further patient with a low PCT was not initiated on antibiotics. Six patients had a high baseline PCT (&gt;0.5) and one had a repeat PCT which remained high. Antibiotics were continued in all 6 patients. 16 patients with acute infections did not have baseline PCT testing with one having a random PCT during the antibiotic course. Five patients had deep-seated infections, and therefore, PCT testing was not indicated. However, 2 had baseline and repeat PCTs, with repeat PCTs low (&lt;0.5) and antibiotics continued. Median course lengths were 5 days in the ICU and 6 days when pre-ICU antibiotics were included.

Conclusions
PCT testing in our ICU is low with only a third of eligible patients having a baseline PCT test with repeat PCT testing in accordance with local guidelines in the minority of these. There is some limited evidence that PCT testing is impacting antibiotic decision making in our ICU. We have identified that antibiotic course lengths in our ICU are relatively short. We have introduced PCT measurement as part of antimicrobial stewardship in our ICU. Fully embedding PCT testing, and PCT-guided antibiotic decision making, may further reduce antibiotic use. How to achieve this is challenging—there is a paucity of published PCT implementation studies.
P15 Direct provocation test for penicillin allergy delabelling: a 4-year retrospective review
Authors: Sugrue Ellen , McKee Edward D H , Sutherland Rebecca K 
Published: June 2023

Abstract

Background
Penicillin allergy is the most commonly reported drug allergy.1 Over 90% of these are mislabelled1. Labelled penicillin allergy is associated with increased broad-spectrum antibiotic use, increased antibiotic costs, and increased length of admission. A recent meta-analysis of delabelling studies showed that drug provocation test (DPT) is a low-risk procedure in patients with multiple clinical and financial benefits.2

Methods
Retrospective analysis of all patients who had DPT in hospital across one health trust 2019–2022. Hospital and GP electronic records of drug allergies were reviewed. GPs of patients who retained an allergy status post-DPT were contacted.

Results
46 DPTs were documented during this time. The PENFAST3 score was used to identify those suitable for DPT. One delayed reaction was recorded. No anaphylaxis was recorded. Infectious diseases were the primary specialty for DPT (67%). In total, 78% were carried out on medical patients. ID consult service was responsible for 100% of DPTs in surgical specialties. Seven patients who received DPT had been relabelled penicillin allergic post-DPT. Two were self-reported on presentation to hospital. Five were from physician review of historic documentation in hospital settings. In total, 56% of patients had not had GP documentation regarding allergy status updated.

Conclusions
This review concludes that DPT is safe in an inpatient population and inpatient review of reported penicillin allergy is an opportunity to identify mislabelled allergy. Infection specialists were the primary teams for DPT however given the safety profile of the DPT non-infection, and allergy specialists should be encouraged to use the protocol. Enhanced communication is needed with GPs to ensure the correct status is known in the community. Relabelling of penicillin allergy is a risk, and further education must be given to patients and healthcare providers post-DPT to ensure continuation of delabelled status.
P26 Epidemiology and risk factors associated with and clinical approach to Staphylococcus aureus bacteraemia at North West Anglia Foundation Trust (NWAFT)
Authors: Katherine Wong Wai Ying , Mlangeni Dennis 
Published: June 2023

Abstract

Background
Staphylococcus aureus bacteraemia (SAB) is associated with high mortality and morbidity. Certain patient groups are predisposed to developing SAB. Careful monitoring of these patients for persistence of bacteraemia and development of complications is important to improve prognosis. There is international consensus on (i) treating patients with at least 2 weeks of IV antibiotics, (ii) performing echocardiography to evaluate for infective endocarditis and (iii) repeating blood cultures 2–4 days after initiating empirical treatment. Adherence to trust antimicrobial guidelines is also imperative to national antimicrobial stewardship.

Objectives
To characterize patients at risk of SAB and make recommendations to reduce the incidence and complications of SAB.

Methods
Retrospective review of case notes of patients whose blood culture results were positive for S. aureus from April to September 2022 in NWAFT. 57 results from 51 patients aged 0 to 96 years were included. The four audit standards were compliance with (i) trust empirical antimicrobial guidelines, (ii) 2-week duration of IV therapy, (iii) echocardiography evaluation for endocarditis, and (iv) repeat blood cultures 48–96 hours after initiating empirical treatment. Patients who were on palliative pathway were excluded from analysis of standards two to four. Prognostic outcomes were examined in terms of hospital readmission, recurrence and mortality.

Results
36 patients (70.6%) were found to harbour known risk factors, with the presence of indwelling prosthetic devices (83.3%) and type 2 diabetes (25.0%) being the most common. The most frequent sources of infection were unknown (27.5%) as well as the skin or soft tissue (17.6%). MRSA bacteraemia accounted for 10.5% of all cases. The compliances with (i) trust empirical antimicrobial guidelines, (ii) 2-week duration of IV therapy, (iii) echocardiography evaluation of endocarditis and (iv) repeat blood cultures 48–96 hours after initial blood culture were 52.8%, 75.0%, 57.8% and 66.0%, respectively. Rates of hospital readmission, recurrence and mortality were 39.5%, 11.4% and 35.3%, respectively.

Conclusions
The incidence of SAB correlates with the presence of risk factors, and SAB is associated with adverse outcomes. There was partial compliance with the audited outcomes. Introduction of trust SAB guidelines to guide clinical approach and adherence to local antimicrobial prescribing guidelines are imperative to improving patient outcomes.
P27 Rezafungin treatment of candidaemia and invasive candidiasis: outcomes stratified by baseline renal function—analysis of the Phase 2 + Phase 3 trials
Authors: Sandison Taylor , Vazquez Jose A , Honore Patrick M , Soriano Alex , Horcajada Juan P , Slavin Monica 
Published: June 2023

Abstract

Background
Rezafungin (RZF) once weekly (QWk) is a next-generation echinocandin in development for treatment of candidaemia and invasive candidiasis (IC) and prevention of invasive fungal disease caused by Candida, Aspergillus, and Pneumocystis spp. in BMT. RZF QWk was compared with caspofungin (CAS) QD in two double-blind, randomized, controlled trials of treatment of candidaemia and/or IC: STRIVE (Phase 2, NCT02734862) and ReSTORE (NCT03667690).

Objectives
Trial data (Phase 2 + Phase 3) were analysed to evaluate outcomes stratified by renal function at baseline: CrCl ≥ 60 mL/min (normal/mild impairment [Norm/Mild]) and &lt;60 mL/min (moderate/severe impairment [Mod/Sev]).

Methods
Outcomes were evaluated for differences between CrCl categories and between treatment groups: RZF QWk 400 mg on Wk 1 then 200 mg versus CAS QD 70 mg on Day (D)1 then 50 mg, for ≥14 days (≤4 Wks) w/optional oral fluconazole stepdown for CAS.

Results
D30 all-cause mortality (ACM)—Mod/Sev: RZF, 13% (7/54); CAS, 30.5% (18/59); Norm/Mild: RZF, 22.7% (17/75); CAS, 10.8% (9/83). Mycological eradication (ME) at D5—Mod/Sev: RZF, 75.9% (41/54); CAS, 61.0% (36/59); Norm/Mild: RZF, 74.7% (56/75); CAS, 66.3% (55/83). ME at D14—Mod/Sev: RZF, 75.9% (41/54); CAS, 57.6% (34/59); Norm/Mild: RZF, 69.3% (52/75); CAS, 74.7% (62/83). ≥1 treatment-emergent AE—Mod/Sev: RZF, 93.2% (55/59); CAS, 88.9% (56/63); Norm/Mild: RZF, 88.9% (72/81); CAS, 76.7% (69/90).

Conclusions
RZF efficacy was comparable across CrCl categories, with higher ME and lower D30 ACM in the Mod/Sev group. Further analyses are needed to evaluate the observed differences between treatment groups.
P31 Frequency, resistance pattern and antibiogram of bacterial pathogens isolated in Yastebsheron Hospital, Khartoum, Sudan
Authors: Altahir Mihad , Saeed Mohammed 
Published: June 2023

Abstract

Background
This study focused on providing a report about the current situation of AMR in Yastebsheron Hospital in Khartoum, Sudan, monitoring and identifying the resistant trends in clinical isolates, highlighting the gaps in the IPC and ASP through antibiogram analysis, and implementing its data to improve antibiogram-guided empirical antibiotic therapy selection.

Method
A retrospective longitudinal study. The study retrieved data from microbiology laboratory records from 1 January 2022 to 31 December 2022, at Yastebsheron Hospital. A total of 1182 clinical specimens were processed in 2022.

Results
The most frequent samples were urine, with a prevalence rate of 59.3%, of which 69.8% were female and 30.2% were male. The total Gram-positives were 52.6%, with Staphylococcus aureus accounted for 98%; out of the total specimens, MRSA accounted for 48.6%, and MSSA accounted for 11.8%. The total Gram-negative isolates were 48.3%, of which Escherichia coli Enterobacter, Proteus mirabilis, Pseudomonas aeruginosa and Klebsiella pneumoniae represented 25.4%, 21.8%, 9.8%, 9.4% and 3.8%, respectively. MSSA were highly susceptible to meropenem (97%) and vancomycin (95%), and luckily, MRSA isolates were susceptible to levofloxacin and colistin at 86% and to meropenem (84%), with minimal susceptibility to clindamycin (37%) and nalidixic acid (12%). Meropenem, colistin and nitrofurantoin were the most effective antibiotics against E. coli with more than 80% susceptibility rates, while cephalosporins and nalidixic acid showed minimal efficacy. Meropenem and levofloxacin were highly effective against Enterobacter, P. mirabilis, while the susceptibility rates for second-, third- and fourth-generation cephalosporins were less than 50% for both of them, and less than 30% for P. aeruginosa, P. aeruginosa was 100% susceptible to colistin.

Conclusions
Among infections, UTIs had the highest incidence rates. The majority of the isolates were S. aureus, then came Enterobacteriaceae, particularly E. coli, and then P. aeruginosa. Contrary to ciprofloxacin and norfloxacin, meropenem showed high efficacy against G-positive and G-negative isolates, while levofloxacin displayed moderately high results. Except for MSSA, the effectiveness of second-, third- and fourth-generation cephalosporins against G-positive and G-negative organisms was compromised. In order to stop the deterioration of the AMR status, it is crucial to implement the ASP strategies and tools effectively, as the emergence of MDR strains is alarming. Antibiogram’s formulation is essential for directing empirical antibiotic therapy and tracking the emergence of resistance.
P34 Gentamicin labels: improving the timing of gentamicin levels and reducing delay in dose administrations
Authors: Zakariya Muhammad Zakwan , Palenzuela Esperanza , Sutherland Rebekah , Lockman Khalida Ann 
Published: June 2023

Abstract

Background
Due to its narrow therapeutic index and significant risks of ototoxicity and nephrotoxicity, gentamicin requires meticulous prescribing, administration and monitoring. Despite readily available guidelines, gentamicin use continues to be associated with errors, with recent Datix reports within NHS Lothian recording incidents such as incorrectly prescribed doses or frequencies, missed levels, and delayed or omitted doses. In response to this, an audit was undertaken to investigate errors in gentamicin use within the Acute Medical Unit (AMU) at the Royal Infirmary of Edinburgh and evaluate the barriers to adherence to guidelines to unearth possible areas for improvement.

Methods
The initial audit studied patients prescribed gentamicin in AMU within a 3-week period, excluding those who received prophylactic or single one-off doses of gentamicin. The following parameters were examined both on their paper and electronic prescribing charts: (i) dose, (ii) dosing interval/frequency, (iii) time of level sampling, and (iv) administration times of the first and second gentamicin doses. After identifying issues with delayed gentamicin levels and subsequent dose administration times, we introduced the use of gentamicin labels in each AMU bay, in hopes of increasing staff awareness towards patients on gentamicin, thereby promoting timely level sampling and dose administration. The aforementioned parameters were re-audited for a further 3 weeks following this intervention.

Results
The baseline audit highlighted that only 23/31 (74%) patients had levels taken within the recommended window, and 23/31 (74%) received their second gentamicin doses at the right time. Following the introduction of the gentamicin labels, the second audit observed a slight improvement, with 31/40 (78%) patients having their levels taken within the recommended window, and 30/40 (75%) patients receiving their subsequent doses at the right interval. Noteworthily, in both the pre- and post-intervention groups, the majority of patients who had their second doses delayed received their first doses in the emergency department (ED) prior to admission to AMU.

Conclusions
In addition to improving staff awareness towards patients on gentamicin, a further overarching issue needs to be addressed: the delays in gentamicin administration which more commonly occurs for patients who transition from ED into AMU. Further interventions should therefore target improving the handover of time-critical medicines between ED and AMU.
P39 A qualitative study investigating the views of nurses and doctors on the management of urinary tract infections in long-term care facilities
Authors: Fleming Aoife , Monaghan Áine , Benjamin-Payne Natasha , Shah Mala , Barbosa Teresa M 
Published: June 2023

Abstract

Background
The most commonly reported infections in older persons’ long-term care facilities (LTCFs) are urinary tract infections (UTIs). UTIs contribute to high rates of antimicrobial prescribing, for the treatment and prophylaxis of UTI. Antimicrobials are often inappropriately prescribed and can increase the risk of antimicrobial resistance and other negative outcomes in LTCF populations.1

Objectives
To explore the views and experiences of nurses and doctors working in LTCF on the management of UTIs.

Methods
Qualitative, semi-structured interviews were conducted with nurses and GPs who work in or provide medical service in LTCFs in November 2022. Interviews were conducted online or by telephone, and recordings transcribed. Thematic analysis was conducted, and the themes were mapped to the Theoretical Domains Framework (TDF)1.2

Results
Seven nurses and eight GPs were interviewed. Key domains such as knowledge, memory, attention and decision making and beliefs about consequences had an influential role on UTI management as reported by participants. Contextual factors such as the time taken to obtain urine culture results, and social factors such as the key role of the LTCF nurse, were reported as key issues. Variability in practice and inconsistent knowledge of urine dipstick and UTI management guidelines were acknowledged in the management of UTIs and urine dipstick practices between participants.

Conclusions
This study identified social factors, contextual LTCF factors and variability in the management of UTI and urine dipstick practices across the participants. LTCFs require improved access to urine culture results, improved communication between all healthcare professionals involved and increased implementation of dipstick and UTI management guidelines.
P41 Use of delafloxacin in osteomyelitis: a case report
Authors: Vidwans Madhuri , Mitria Andra , Kandil Hala 
Published: June 2023

Abstract

Background
Data and experience with delafloxacin use in osteomyelitis (OM) and other deep-seated infections are limited, yet the burden of OM on healthcare systems is significant. We hereby describe the first case, to our knowledge, of delafloxacin use in OM.

Case description
A 94-year-old male with a history of prostate cancer, hypertension and heart failure was admitted to hospital in June 2022 with grade 4 bilateral heel ulcers. Empirical IV co-amoxiclav was started and then escalated to IV piperacillin/tazobactam. MRI scans confirmed the diagnosis of OM, and tissue and bone samples grew MDR Pseudomonas aeruginosa (piperacillin/tazobactam-resistant and ciprofloxacin intermediate), an additional challenge. Due to this result and poor clinical response, IV meropenem was prescribed. Off-label use of delafloxacin was discussed within the multidisciplinary team (MDT) to switch to oral administration, decrease length of hospital stay and account for the patient’s age and co-morbidities. Minimum inhibitory concentration of the MDR P. aeruginosa using EUCAST guidelines demonstrated delafloxacin susceptibility (0.125 mg/L). Delafloxacin also has good bioavailability and does not require therapeutic drug monitoring. The patient was started on 450 mg delafloxacin twice daily with monitoring of clinical response. After 10 days of initial in-hospital clinical monitoring, the patient was discharged home with 450 mg twice daily delafloxacin to complete 28 days of therapy. Follow-up imaging was not planned given his age and co-morbidities. District nurses reported improvement in his heel ulcers. On follow-up telephone consultation with the treating consultant in November 2022, the patient reported feeling well and noted improvement in his ulcers. Readmission and adverse events have not been reported to date and the ulcers continue to improve.

Conclusions
This case presents the first successful use of delafloxacin in osteomyelitis, with good tolerability and clinical response against MDR P. aeruginosa. Delafloxacin enabled our patient to be discharged 3 weeks earlier than planned which would otherwise not have been possible, improving his quality of life and reducing risk of hospital-acquired infections with associated costs. Delafloxacin also enables early IV to oral switch in support of the antimicrobial stewardship agenda.
Outcome, risk factors and therapeutic strategies in carbapenem-resistant Gram-negative bacteraemia from Pakistan
Authors: Fatima Mehreen , Dodani Sunil Kumar , Babar Zaheer Udin , Badlani Sanjay , Rani Beena , Mushtaq Maryam , Nadeem Ali , Nasim Asma 
Published: June 2023

Abstract

Background
Carbapenem-resistant Gram-negative (CRGN) bacteraemia has high mortality and limited therapeutic options. We assessed the risk factors and outcome of CRGN bacteraemia treated with limited options.

Methods
A prospective cohort study done at a tertiary care hospital in Pakistan, from October 2021 to August 2022. All patients &gt;18 years with CRGN bacteraemia were assessed for demographics, source, risk factors and treatment received. Outcome was assessed as bacterial clearance and all-cause mortality at Day 14 of bacteraemia.

Results
We included 175 patients. Median age was 45 years (IQR 30–58) and the majority of our patients were on haemodialysis (75%). We found 14 day mortality in 26.8% of our patients; in addition, microbiological clearance was achieved in 95%. The central line (49.7%) was the most common source and Klebsiella spp. (47%) the most common organism. On multivariate analysis, risk factors for mortality were Foley’s catheter [aOR 2.7 (95% CI 1.1–6.5)], mechanical ventilation [aOR 5.1 (95% CI 1.6–15.8)] and Pitt bacteraemia score &gt;4 [aOR 3.48 (95% CI 1.1–10.5)]. Source control was a significant protective factor [aOR 0.251 (95% CI 0.09–0.6)]. The majority received a colistin-based regimen with no difference in mortality between monotherapy and combination therapy.

Conclusions
Our cohort of CRGN bacteraemia is unique, comprising younger patients mostly on haemodialysis with a central line as the source of bacteraemia and we have found 14 day mortality of 27%. Colistin with various combinations can be an effective option in patients with renal failure having prompt source control.