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Initial blood culture collection practices and the associated factors upon continued empiric piperacillin-tazobactam usage
- Satoshi Kitaura, Koh Okamoto, Ryo Yamaguchi, Takehito Yamamoto, Toshiyuki Kishida, Daisuke Inoue, Hirotaka Miyashita, Masayuki Ueda, Hideki Hashimoto, Sohei Harada, Shu Okugawa, Takeya Tsutsumi, Kyoji Moriya
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 3 / Issue S2 / June 2023
- Published online by Cambridge University Press:
- 29 September 2023, pp. s30-s31
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Background: Approaches to the prescription behavior of broad-spectrum antibiotics, including preauthorization and prospective audit and feedback (PAF), are a focus of antimicrobial stewardship (ASP). However, preprescription behavior, such as blood-culture collection before empiric prescription, is understudied and merits more attention given its influence on the usage of broad-spectrum antibiotics. At the University of Tokyo Hospital, carbapenems are subject to PAF, which has resulted in a compensatory increase in piperacillin-tazobactam use. To evaluate the inherent preprescription behavior associated with a broad-spectrum antibiotic, we investigated the initial blood-culture collection practices upon hospitalization in patients who were continued on empiric piperacillin-tazobactam. Methods: A retrospective observational study was conducted at the University of Tokyo Hospital, a tertiary-care hospital in Tokyo, Japan. Patients who were administered piperacillin-tazobactam on the day of hospitalization between April 2016 and December 2017 were included. Patients aged <=18 years and/or patients who discontinued piperacillin-tazobactam within two days were excluded. Only 1 admission per patient was kept for analysis. The medical records of 250 randomly selected patients were reviewed to obtain data on demographics, blood-culture collection, severity, specialties, and risk factors for multidrug-resistant organisms. A multivariable logistic regression analysis was used to identify factors associated with blood-culture collection. Results: In total, 960 discrete patients fulfilled the study criteria. Of the randomly selected 250 patients, blood cultures were collected from 162 patients (64.8%), and microbial growth was observed in 30 cases (18.5%). Enterobacterales and anaerobes accounted for 73.3% of the microbial population. Gastroenterologists (94, 37.6%) and general surgeons (52, 20.8%) were the most common prescribers. Hepatobiliary (83, 33.2%), respiratory (58, 23.2%), and intra-abdominal infections (IAI; 34, 13.6%) were the major suspected diagnoses. Blood-culture collection was associated with the use of immunosuppressive agents (OR, 3.48; 95% CI, 1.49–8.99), intrabdominal infection (OR, 0.28; 95% CI, 0.12–0.67), systemic inflammatory response syndrome criteria ≥ 2 (OR, 4.50; 95% CI, 2.25–9.42), and surgical specialty (OR, 0.33; 95% CI, 0.18–0.60). Conclusions: More than one-third of patients requiring hospitalization and empiric piperacillin-tazobactam did not undergo blood-culture collection. The finding that blood cultures were less likely to be obtained in patients with suspected IAI requiring hospitalization and by surgical specialties raises a concern regarding suboptimal evaluation. Further assessment of the appropriateness of blood-culture collection in the setting of broad-spectrum antibiotic prescription and tailored promotion of blood-culture collection to surgical specialties may be warranted.
Disclosures: S.K.: The author (during graduate school (PhD) was involved in antiviral research relevant to a neglected tropical disease and favipiravir. During this graduate school research, favipiravir was provided by FUJIFILM Toyama Chemical Co. Ltd
Solid-State Ionics in the 21st Century: Current Status and Future Prospects
- Sangtae Kim, Shu Yamaguchi, James A. Elliott
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- Journal:
- MRS Bulletin / Volume 34 / Issue 12 / December 2009
- Published online by Cambridge University Press:
- 31 January 2011, pp. 900-906
- Print publication:
- December 2009
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The phenomenon of ion migration in solids forms the basis for a wide variety of electrochemical applications, ranging from power generators and chemical sensors to ionic switches. Solid-state ionics (SSI) is the field of research concerning ionic motions in solids and the materials properties associated with them. Owing to the ever-growing technological importance of electrochemical devices, together with the discoveries of various solids displaying superior ionic conductivity at relatively low temperatures, research activities in this field have grown rapidly since the 1960s, culminating in “nanoionics”: the area of SSI concerned with nanometer-scale systems. This theme issue introduces key research issues that we believe are, and will remain, the main research topics in nanoionics and SSI during the 21st century. These include the application of cutting-edge experimental techniques, such as secondary ion mass spectroscopy and nuclear magnetic resonance, to investigate ionic diffusion in both bulk solids and at interfaces, as well as the use of atomic-scale modeling as a virtual probe of ionic conduction mechanisms and defect interactions. We highlight the effects of protonic conduction at the nanometer scale and how better control of interfaces can be employed to make secondary lithium batteries based on nanoionics principles. Finally, in addition to power generation and storage, the emergence of atomic switches based on cation diffusion shows great promise in developing next-generation transistors using SSI.