Antibiotic overprescribing is a global issue that significantly contributes to increased antimicrobial resistance. Strengthening antimicrobial prescribing practices should be considered a priority. The emergency department (ED) represents a setting where antibiotics are frequently prescribed, but the determinants that influence prescribing choices are complex and multifaceted. We conducted an exploratory qualitative study to investigate the contextual factors that influence antibiotic prescribing choices among clinicians in the ED. The study employed video-reflexive ethnography (VRE) to capture prospective clinical decision-making in situated practice. Data collection involved fieldwork observations, video observations, and delivery of facilitated group reflexive sessions, where clinicians viewed a selection of recorded video snippets relating to antibiotic prescribing. Study was conducted across two EDs within the same health service in Australia. A total of 29 clinical conversations focusing on antibiotic prescribing were recorded. Additionally, 34 clinicians participated in group reflexive sessions. Thematic analysis from the transcribed data yielded four themes: 'importance of clinical judgment', 'usability of prescribing guidelines', 'managing patient expectations', and 'context-dependent disruptions'. Our findings provide insights into the challenges faced by clinicians in navigating complex ED environment, utilising electronic decision-support tools and engaging in discussions about patient treatments with senior clinicians. The findings also indicate that VRE is useful in visualising full complexity of the ED setting, and in initiating meaningful discussions among clinical teams. Integrating the use of VRE in everyday clinical settings can potentially facilitate the implementation of pragmatic solutions for delivering effective antibiotic stewardship practices.
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http://dx.doi.org/10.1177/10497323231198144 | DOI Listing |
Hinyokika Kiyo
November 2024
The Department of Urology, Nara Medical University.
A 28-year-old man was diagnosed with chlamydial urethritis by his previous doctor and was prescribed minocycline (MINO). The result of a urinary chlamydia polymerase chain reaction (PCR) test later confirmed to be negative. However, the patient visited our hospital because of persistent miction pain.
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December 2024
Department of Urology, Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
Objective: To develop, externally validate, and test a series of computer algorithms to accurately predict antibiotic susceptibility test (AST) results at the time of clinical diagnosis, up to 3 days before standard urine culture results become available, with the goal of improving antibiotic stewardship and patient outcomes.
Patients And Methods: Machine learning algorithms were developed and trained to predict susceptibility or resistance using over 4.7 million discrete AST classifications from urine cultures in a cohort of adult patients from outpatient and inpatient settings from 2012 to 2022.
Int J Antimicrob Agents
December 2024
Department of Pharmacy, Singapore General Hospital, Singapore; Emerging Infectious Diseases, Duke-National University of Singapore Medical School, Singapore; Singhealth Duke-NUS Medicine Academic Clinical Programme, Singapore. Electronic address:
J Dent
December 2024
Melbourne Dental School, Faculty of Medicine, Dental and Health Sciences, The University of Melbourne, Australia; Inflammatory Origins, Murdoch Children's Research Institute, The Royal Children's Hospital, Australia; Department of Dentistry, The Royal Children's Hospital Melbourne, Australia.
Objectives: To identify evidence and guidelines relating to the use of antibiotics in the management of odontogenic facial swellings in children and adolescents.
Data: Articles relating to odontogenic facial swellings in children and adolescents aged 0-16 years were included. Articles in which paediatric data could not be differentiated from adult data or where the age of participants were unknown were excluded.
J Cardiothorac Surg
December 2024
King Fahad Medical City, Riyad, Saudi Arabia.
Background: Antibiotic resistance is a rapidly growing problem. Methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) are major worries, particularly in developing nations where cost-effectiveness is essential. Use of vancomycin must be restricted to prevent resistant to it.
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