ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04339.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Resistance of nosocomial and community‐acquired pathogens to antimicrobial agents is a serious problem with significant clinical consequences. Microbiologic surveillance data, such as those provided by the National Nosocomial Infections Surveillance System, supply information on current nosocomial pathogens in the United States. Many species show resistance to commonly used antimicrobials and, in many cases, it is emerging resistance. Resistance in many gram‐negative bacteria is caused by β‐lactamase production.Escherichia coli, the leading nosocomial pathogen, is capable of hyperproducing TEM‐1 β‐lactamase. A novel form of resistance inKlebsiella pneumoniaeandE. coliis caused by extended‐spectrum cephalosporinases. Many Enterobacteriaceae can be induced to produce group 1 β‐lactamase by exposure to broad‐spectrum cephalosporins and other β‐lactams. Thirty percent ofHaemophilus influenzaeisolates are resistant to ampicillin because of β‐lactamase production. Issues of concern in gram‐positive species include multiple antimicrobial resistance in methicillin‐resistantStaphylococcus aureus, enterococci, and coagulase‐negative staphylococci, and increasing β‐lactam resistance inStreptococcus pneumoniae.To minimize the development of resistance, antimicrobials must be administered judiciously, and infection‐control practi

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04340.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Several mechanisms render antimicrobials inactive; one of these, β‐lactamase hydrolysis of β‐lactam antimicrobials, is a common and serious problem resulting in loss of antimicrobial activity. Resistance in gram‐negative organisms may be caused by chromosomally or plasmid‐mediated β‐lactamases. Chromosomally mediated resistance may result from exposure to inducer compounds (induction) or by selection of stably derepressed mutants. Plasmids are extrachromosomal elements of DNA that can transfer resistance between bacteria. Common plasmid‐encoded β‐lactamases are the TEM‐ and SHV‐type enzymes, which include the newer extended‐spectrum β‐lactamases. Infections caused by resistant bacteria frequently result in longer hospital stays, higher mortality, and increased cost of treatment. When bacteria develop resistance during antimicrobial therapy therapeutic failure ensues in approximately 50% of patients. Clinical studies demonstrate that resistance mediated by β‐lactamases is a critical issue. Strategies for overcoming it include use of β‐lactam‐β‐lactamase inhibitor combinations, development of new antimicrobial compounds, and use of regimens t

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04341.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Intraabdominal infections are a wide range of diseases that include penetrating abdominal trauma, appendicitis, peritonitis, and abscess. Most are polymicrobic, involving aerobic and anaerobic bacteria. The primary treatment is surgery, but important issues regarding administration of antimicrobials may affect patient outcome. Evaluation of an antimicrobial regimen must include consideration of outcomes—survival, organ failure, adverse drug effects, and superinfection. Single‐agent regimens have demonstrated benefit in patients with acute intraabdominal contamination and established infections. Guidelines for selecting antimicrobial agents are available from the Surgical Infection Society. Regimens are effective when active against most bacteria isolated from the focus of abdominal infection. The patient's clinical response, not culture results independent of clinical findings, is the primary guide for directing changes in ther

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04342.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Ochsner Foundation Hospital of the Ochsner Medical Institutions (OMI), a 532‐bed tertiary care facility in New Orleans, uses a formulary review process common to many institutions. Considered in the selection of antimicrobial therapy are efficacy, safety, and cost. At OMI, ticarcillin‐clavulanate plus gentamicin are the standard broad‐spectrum antimicrobial agents for initial treatment of suspected mixed infections. The pharmacy department provides an aminoglycoside‐monitoring program and convenient dosing guidelines. The regimen has resulted in good therapeutic outcomes and few adverse effects. Bacterial resistance has not been detected. Future plans include a large‐scale concurrent review of patient outcomes, resistance patterns, and rates of fungal overgrowth associated with the

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04343.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Measuring clinical and financial outcomes in health care is a science in the early stages of development and implementation. Many tools and techniques are derived from industry models of continuous quality improvement and epidemiology. Epidemiologic (enumerative) and statistical process control (analytic) methods are effective alternatives to traditional quality assurance methods of evaluating patient care that encompass clinical and financial outcomes. Their use has resulted in significant improvement of clinical outcomes and financial performance, and has increased physician involvement in the process. Although cost will be the driving force of health care reform for the next few years, demonstration of high‐quality care by providers through outcomes measurement will differentiate long‐term from short‐term winners in an environment of managed competition. This fact will make the science of outcomes management increasingly more impo

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04344.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

At EHS Christ Hospital and Medical Center, an eight‐step process improvement model was developed that incorporates continuous quality improvement concepts for monitoring, evaluating, and improving patient care. Nursing home residents admitted with pneumonia were identified as the group having the most influence on mortality and costs associated with treatment of pneumonia at our hospital. A multidisciplinary team evaluated clinical resource use and patient care processes, and identified root causes of variations influencing treatment. Clinical guidelines were created and outcomes were defined, resulting in significant improvement in the clinical management of these patients. Average length of stay decreased from 8.6 days in 1992 to 7.6 days in 1993, with a charge reduction of $1830 per patient. The methodologic framework of a process improvement program combines epidemiologic, clinical, and quality improvement sciences. This mix is essential in improving patient care and quantifying outcome

ISSN:0277-0008    

DOI:10.1002/j.1875-9114.1995.tb04345.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY