Archive for January 30, 2018

Long-term acute care hospitals.

Clinical Infectious Diseases August 1, 2009  V.49 N.3 P.438-43.     

Munoz-Price LS1.

Author information

1 simunozprice@gmail.com

Abstract

Long-term acute care hospitals (LTACHs) are health care facilities that admit complex patients with acute care needs (eg, mechanical ventilator weaning, administration of intravenous antibiotics, and complex wound care) for a mean duration of stay of 25 days. LTACHs are different than nursing homes and were initially created in the 1990s in an effort to decrease Medicare costs by facilitating prompt discharge from intensive care units of patients with difficulty weaning mechanical ventilation; however, current admission diagnoses are quite broad. Patients admitted to these facilities have multiple comorbidities and are at risk for colonization with multidrug-resistant organisms. LTACH patients have been shown to have high rates of hospital-acquired infections, including central vascular catheter-associated bloodstream infection and ventilator-associated pneumonia. In addition, LTACHs have been implicated in various regional outbreaks of multidrug-resistant organisms. This review summarizes the limited amount of scientific literature on LTACHs while highlighting their infection control problems, as well as the role LTACHs play on regional outbreaks.

abstract

https://academic.oup.com/cid/article/49/3/438/499066

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January 30, 2018 at 4:08 pm

Continued high rates of antibiotic prescribing to adults with respiratory tract infection: survey of 568 UK general practices

BMJ Journals 2014

Martin C Gulliford1, Alex Dregan1, Michael V Moore2, Mark Ashworth1, Tjeerd van Staa3,4, Gerard McCann3, Judith Charlton1, Lucy Yardley2, Paul Little2, Lisa McDermott1

Author affiliations

King’s College London, Primary Care and Public Health Sciences, London, UK

Department of Primary Care and Population Sciences, University of Southampton, Southampton, UK

Clinical Practice Research Datalink (CPRD) Division, Medicines and Healthcare Products Regulatory Agency, London, UK

Health eResearch Centre, Farr Institute for Health Informatics Research, University of Manchester, London, UK

Abstract

Objectives

Overutilisation of antibiotics may contribute to the emergence of antimicrobial drug resistance, a growing international concern. This study aimed to analyse the performance of UK general practices with respect to antibiotic prescribing for respiratory tract infections (RTIs) among young and middle-aged adults.

Setting

Data are reported for 568 UK general practices contributing to the Clinical Practice Research Datalink.

Participants

Participants were adults aged 18–59 years. Consultations were identified for acute upper RTIs including colds, cough, otitis-media, rhino-sinusitis and sore throat.

Primary and secondary outcome measures

For each consultation, we identified whether an antibiotic was prescribed. The proportion of RTI consultations with antibiotics prescribed was estimated.

Results

There were 568 general practices analysed. The median general practice prescribed antibiotics at 54% of RTI consultations. At the highest prescribing 10% of practices, antibiotics were prescribed at 69% of RTI consultations. At the lowest prescribing 10% of practices, antibiotics were prescribed at 39% RTI consultations. The median practice prescribed antibiotics at 38% of consultations for ‘colds and upper RTIs’, 48% for ‘cough and bronchitis’, 60% for ‘sore throat’, 60% for ‘otitis-media’ and 91% for ‘rhino-sinusitis’. The highest prescribing 10% of practices issued antibiotic prescriptions at 72% of consultations for ‘colds’, 67% for ‘cough’, 78% for ‘sore throat’, 90% for ‘otitis-media’ and 100% for ‘rhino-sinusitis’.

Conclusions

Most UK general practices prescribe antibiotics to young and middle-aged adults with respiratory infections at rates that are considerably in excess of what is clinically justified. This will fuel antibiotic resistance.

FULL TEXT

http://bmjopen.bmj.com/content/4/10/e006245.long

PDF

http://bmjopen.bmj.com/content/bmjopen/4/10/e006245.full.pdf

 

January 30, 2018 at 3:41 pm


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