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Antimicrobial Use in Outpatient Hemodialysis Units
- Graham M. Snyder, Priti R. Patel, Alexander J. Kallen, James A. Strom, J. Kevin Tucker, Erika M. C. D'Agata
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 34 / Issue 4 / April 2013
- Published online by Cambridge University Press:
- 02 January 2015, pp. 349-357
- Print publication:
- April 2013
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Objective.
To quantify and characterize overall antimicrobial use, including appropriateness of indication, among patients receiving chronic hemodialysis.
Design.Retrospective and prospective observational study.
Setting.Two outpatient hemodialysis units.
Patients.All patients receiving chronic hemodialysis.
Methods.The rate of parenteral antimicrobial use (number of doses per 100 patient-months) was calculated retrospectively from September 2008 through July 2011. Indication and appropriateness of antimicrobial doses were characterized prospectively from August 2010 through July 2011. Inappropriate administration was defined as occasions when criteria for infection based on national guidelines were not met, failure to choose a more narrow-spectrum antimicrobial on the basis of culture data, or occasions when indications for surgical prophylaxis were not met.
Results.Over the 35-month retrospective study period, the rate of parenteral antimicrobial use was 32.9 doses per 100 patient-months. Vancomycin was the most commonly prescribed antimicrobial, followed by cefazolin and third- or fourth-generation cephalosporins. Over the 12-month prospective study, 1,003 antimicrobial doses were prescribed. Among the 926 (92.3%) doses for which an indication for administration was available, 276 (29.8%) were classified as inappropriate. Of these, a total of 146 (52.9%) did not meet criteria for infection, 74 (26.8%) represented failure to choose a more narrow-spectrum antimicrobial, and 56 (20.3%) did not meet criteria for surgical prophylaxis. The most common inappropriately prescribed antimicrobials were vancomycin and third- or fourth- generation cephalosporins.
Conclusions.Parenteral antimicrobial use was extensive, and as much as one-third was categorized as inappropriate. The findings of this study provide novel information toward minimizing inappropriate antimicrobial use.
Key conservation issues for migratory land- and waterbird species on the world's major flyways
- Jeff S. Kirby, Alison J. Stattersfield, Stuart H. M. Butchart, Michael I. Evans, Richard F. A. Grimmett, Victoria R. Jones, John O'Sullivan, Graham M. Tucker, Ian Newton
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- Journal:
- Bird Conservation International / Volume 18 / Issue S1 / September 2008
- Published online by Cambridge University Press:
- 07 August 2008, pp. S49-S73
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- Article
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An estimated 19% of the world's 9,856 extant bird species are migratory, including some 1,600 species of land- and waterbirds. In 2008, 11% of migratory land- and waterbirds were classed by BirdLife International as threatened or near-threatened on the IUCN Red List. Red List indices show that these migrants have become more threatened since 1988, with 33 species deteriorating and just six improving in status. There is also increasing evidence of regional declines. Population trend data show that more Nearctic–Neotropical migrants have declined than increased in North America since the 1980s, and more Palearctic–Afrotropical migrants breeding in Europe declined than increased during 1970–2000. Reviews of the status of migratory raptors show unfavourable conservation status for 51% of species in the African–Eurasian region (in 2005), and 33% of species in Central, South and East Asia (in 2007). Land-use change owing to agriculture is the most frequently cited threat affecting nearly 80% of all threatened and near-threatened species. However, while agricultural intensification on the breeding grounds is often proposed as the major driver of declines in Palearctic–Afrotropical migrants, some species appear to be limited by the quantity and quality of available habitat in non-breeding areas, notably the drylands of tropical Africa. Forest fragmentation in breeding areas has contributed to the declines of Nearctic–Neotropical migrants with deforestation in non-breeding areas another possible factor. Infrastructure development including wind turbines, cables, towers and masts can also be a threat. Over-harvesting and persecution remain serious threats, particularly at key migration locations. Climate change is affecting birds already, is expected to exacerbate all these pressures, and may also increase competition between migratory and non-migratory species. The conservation of migratory birds thus requires a multitude of approaches. Many migratory birds require effective management of their critical sites, and Important Bird Areas (IBAs) provide an important foundation for such action; however to function effectively in conserving migratory species, IBAs need to be protected and the coherence of the network requires regular review. Since many migratory species (c. 55%) are widely dispersed across their breeding or non-breeding ranges, it is essential to address the human-induced changes at the wider landscape scale, a very considerable challenge. Efforts to conserve migratory birds in one part of the range are less effective if unaddressed threats are reducing these species' populations and habitats elsewhere. International collaboration and coordinated action along migration flyways as a whole are thus key elements in any strategy for the conservation of migratory birds.