All ED patients, as part of the intervention, were started on empiric carbapenem protocol (CP). CRE screening results were communicated immediately. Negative CRE results led to discontinuation of CP. Patients were retested if their ED stay surpassed seven days or if they were moved to the intensive care unit.
A collective of 845 patients participated, 342 initially and 503 undergoing the intervention. Molecular and culture-based testing at admission indicated a 34% colonization rate. The percentage of acquisitions during Emergency Department stays plummeted from 46% (11 out of 241) to 1% (5 out of 416) when the intervention was implemented (P = .06). Aggregated antimicrobial use in the Emergency Department saw a reduction from phase 1 to phase 2. Specifically, this decrease is from 804 defined daily doses (DDD) per 1000 patients to 394 DDD per 1000 patients. A prolonged length of stay in the emergency department, exceeding two days, was a significant risk factor for the acquisition of carbapenem-resistant Enterobacteriaceae (CRE), as indicated by an adjusted odds ratio of 458 (95% confidence interval, 144-1458), and a p-value of .01.
Early experience with empirical treatment of community-acquired pneumonia and swift identification of carbapenem-resistant Enterobacteriaceae-colonized patients minimize cross-transmission within the emergency department. Even so, staying in the emergency department for more than two days impacted progress unfavorably.
A two-day stay in the emergency department hampered subsequent efforts.

Antimicrobial resistance, a global menace, significantly impacts low- and middle-income countries. The study, conducted in Chile before the onset of the coronavirus disease 2019 pandemic, sought to determine the prevalence of fecal colonization with antimicrobial-resistant gram-negative bacteria (GNB) in hospitalized and community-dwelling adults.
Fecal specimens and epidemiological details were collected from hospitalized adults at four public hospitals and community residents in central Chile, encompassing the time period from December 2018 to May 2019. Samples were transferred to MacConkey agar plates, with the addition of either ciprofloxacin or ceftazidime as a supplement. According to the phenotypes fluoroquinolone-resistant (FQR), extended-spectrum cephalosporin-resistant (ESCR), carbapenem-resistant (CR), or multidrug-resistant (MDR; as per Centers for Disease Control and Prevention criteria), all recovered morphotypes were identified and characterized as Gram-negative bacteria (GNB). Categories demonstrated a lack of mutual exclusivity.
A cohort of 775 hospitalized adults and 357 community residents was included in the study. The study of hospitalized individuals revealed colonization rates of FQR, ESCR, CR, or MDR-GNB to be 464% (95% confidence interval [CI], 429-500), 412% (95% CI, 377-446), 145% (95% CI, 120-169), and 263% (95% CI, 232-294), respectively. The community exhibited colonization prevalence of FQR at 395% (95% CI, 344-446), ESCR at 289% (95% CI, 242-336), CR at 56% (95% CI, 32-80), and MDR-GNB at 48% (95% CI, 26-70).
This sample of hospitalized and community-dwelling adults demonstrated a high level of colonization with antimicrobial-resistant Gram-negative bacteria, supporting the community as a substantial reservoir for antibiotic resistance. Understanding the relationships among resistant strains present in the community and in hospitals requires additional work.
A substantial burden of Gram-negative bacterial colonization resistant to antimicrobials was seen in hospitalized and community-dwelling adults in this sample, indicating that the community plays a crucial role in the development of antibiotic resistance. Significant effort is necessary to comprehend the correlation between circulating resistant strains in community and hospital settings.

Antimicrobial resistance has seen a deterioration in Latin America. The development trajectory of antimicrobial stewardship programs (ASPs) and the difficulties in establishing effective ASPs warrant careful consideration, given the limited national action plans or policies promoting ASPs in the region.
Our descriptive mixed-methods study encompassed ASPs in five Latin American countries from the months of March to July 2022. self medication Using an electronic questionnaire and associated scoring system (hospital ASP self-assessment), ASP development levels were categorized by the scores received. The classifications were inadequate (0-25), basic (26-50), intermediate (51-75), or advanced (76-100). this website Healthcare workers (HCWs) participating in antimicrobial stewardship (AS) were interviewed to explore how behavioral and organizational elements affect antimicrobial stewardship activities. Themes were derived from the analysis of the interview data. An explanatory framework was developed by combining data from the ASP self-assessment and interviews.
20 hospitals that completed self-assessment procedures had 46 stakeholders from the Association of Stakeholders participate in subsequent interviews. PCR Genotyping The ASP development levels in hospitals were categorized as follows: basic or inadequate in 35%, intermediate in 50%, and advanced in 15%. Scores for for-profit hospitals were higher than the scores obtained by not-for-profit hospitals. The interview data supported the self-assessment's findings regarding ASP implementation challenges. These difficulties included insufficient formal hospital leadership support, insufficient staffing and tools for effective AS work, limited healthcare worker understanding of AS principles, and a deficiency in training opportunities.
We identified critical bottlenecks in ASP development across Latin America, advocating for the formulation of robust business cases that will provide the required funding for successful and long-term ASP implementation.
Our analysis of ASP development in Latin America revealed several critical barriers, emphasizing the need for carefully constructed business cases to attract funding and ensure the long-term effectiveness and sustainability of these initiatives.

Studies have shown a significant utilization of antibiotics (AU) in inpatients with COVID-19, despite the low incidence of bacterial coinfection and secondary infection. How did the COVID-19 pandemic affect healthcare facilities (HCFs) in South America, specifically with respect to Australia (AU)?
Our ecological assessment of AU encompassed two healthcare facilities (HCFs) in each of Argentina, Brazil, and Chile's adult inpatient acute care wards. Based on the defined daily dose per 1000 patient-days, AU rates for intravenous antibiotics were established. Data from pharmacy dispensing records and hospitalizations, spanning March 2018-February 2020 (pre-pandemic) and March 2020-February 2021 (pandemic), were employed in the calculations. Applying the Wilcoxon rank-sum test, a comparison was made to determine if there were significant differences in median AU values between the periods before and during the pandemic. An interrupted time series analysis examined AU fluctuations during the COVID-19 pandemic.
The median difference in AU rates for all antibiotics, when measured against the pre-pandemic period, demonstrated an increase in four out of six HCFs (percentage change from 67% to 351%; statistically significant, P < .05). Five of six healthcare facilities within the interrupted time series models experienced a significant immediate spike in the use of all antibiotics collectively at the beginning of the pandemic (estimated immediate impact, 154-268); however, only one of these facilities displayed a persistent upward trend in antibiotic usage over time (change in slope, +813; P < 0.01). The pandemic's initiation had varying consequences for antibiotic groups and HCF.
Observing substantial increases in antibiotic use (AU) during the initial phase of the COVID-19 pandemic, it becomes imperative to maintain or strengthen antibiotic stewardship practices as part of pandemic and crisis healthcare strategies.
At the outset of the COVID-19 pandemic, a notable surge in AU was evident, prompting the imperative to uphold or enhance antibiotic stewardship practices within pandemic or crisis healthcare frameworks.

Across the globe, a major public health threat arises from the spread of extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE). The potential factors increasing the risk of ESCrE and CRE colonization among patients were examined in one urban and three rural Kenyan hospitals.
In a cross-sectional study encompassing January 2019 and March 2020, stool specimens were gathered from randomly selected inpatients, subsequently analyzed for the presence of ESCrE and CRE. The Vitek2 instrument was used for both isolate confirmation and determining antibiotic susceptibility profiles. Least absolute shrinkage and selection operator (LASSO) regression models were then applied to pinpoint colonization risk factors, taking into consideration different measures of antibiotic use.
Among the 840 individuals enrolled, 76% had been given a single antibiotic during the two weeks preceding enrollment. Ceftriaxone (46%), metronidazole (28%), and benzylpenicillin-gentamycin (23%) comprised the majority of these administrations. Among patients hospitalized for three days and receiving ceftriaxone via LASSO models, the odds of ESCrE colonization were significantly elevated (odds ratio 232, 95% confidence interval 16-337, P < .001). The intubated patient group, represented by 173 cases (with a spread from 103 to 291), displayed a statistically significant result (P = .009). The human immunodeficiency virus (HIV) group exhibited a statistically important result (P = .029), specifically represented by the data point (170 [103-28]). There was a substantially increased chance of CRE colonization in patients who received ceftriaxone, characterized by an odds ratio of 223 (95% confidence interval, 114-438) and a statistically significant p-value of .025. Antibiotic use for each additional day was associated with a statistically significant difference (108 [103-113]; P = .002).