Predictors of incorrectness in antimicrobial prescription in the Bauru State Hospital (Bauru city, São Paulo State, Brazil)

The inappropriate use of antimicrobials in hospitals presents a negative impact on patient outcome and is associated with the emergence and spread of multidrug-resistant microorganisms. Antimicrobial stewardship programs (ASPs) have been instituted in order to improve the quality of prescriptions in hospitals. In this setting, the identification of patterns of inappropriate antimicrobial prescription is a valuable tool that allows ASPs to identify priorities for directing educative/restrictive policies. With this purpose, a study was conducted in the Bauru State Hospital, a teaching hospital with 285 beds affiliated to the Botucatu Medical School, São Paulo State University. The hospital maintains an active ASP since it was opened, in 2002. We selected 25% of the requests for parenteral antimicrobials (RPAs) from 2005 for analysis. Prescriptions for prophylactic purposes were excluded. All other RPAs were classified according to a modified Kunin and Jones categories. Univariate and multivariable analyses were performed to identify predictors of general inappropriateness and of specific prescription errors. Prescriptions classified as "appropriate'' or "probably appropriate" were selected as controls in all stages of the study. Among 963 RPAs included in our study, 34.6% were inappropriate. General predictors of inappropriateness were: prescription on weekends/holidays (OR = 1.67, 95% CI = 1.20-2.28, p = 0.002), patient from intensive care unit (OR = 1.57, 95% CI = 1.11-2.23, p = 0.01), peritoneal (OR = 2.15, 95% CI = 1.27-3.65, p = 0.004) or urinary tract infection (OR = 1.89, 95% CI = 1.25-2.87, p = 0.002), combined therapy with two or more antimicrobials (OR = 1.72, 95% CI = 1.15-2.57, p = 0.008) and prescriptions including penicillin (OR = 2.12, 95% CI = 1.39-3.25, p = 0.001) or first-generation cephalosporins (OR = 1.74, 95% CI = 1.01-3.00, p = 0.048). Previous consultation with an infectious diseases (ID) specialist had a protective effect against inappropriate prescription (OR = 0.34, 95% CI = 0.24-0.50, p < 0.001). Factors independently associated with specific prescription errors varied. However, consultation with an ID specialist was protective against both unnecessary antimicrobial use (OR = 0.04, 95% CI = 0.01-0.26, p = 0.001) and requests for agents with insufficient spectrum (OR = 0.14, 95% CI = 0.03-0.30, p = 0.01). In conclusion, the analysis of factors predictive of inappropriateness in antimicrobial prescription allowed us to identify issues requiring intervention. Also, it provided a positive feedback of the ASP efficacy, demonstrating the importance of previous consultation with an ID specialist to assure the quality of antimicrobial prescriptions.

Rhizoctonia solani GA-3PT es el principal patógeno asociado con el chancro del tallo y la sarna negra de la papa en Colombia

Stem canker and black scurf diseases of potatoes are caused by the basidiomycetous fungus Tanatephorus cucumeris (ana-morphic species complex Rhizoctonia solani). Tese diseases have worldwide distribution wherever potato is grown but their etiology varies depending on the predominance of distinct R. solani anastomosis groups (AGs) in a particular area. Within the species complex, several AGs have been associated with stem canker or black scurf diseases, including AG-1, AG-2-1, AG-2-2, AG-3, AG-4, AG-5 and AG-9. Tis article reports on the most comprehensive population-based study, providing evidence on the distribution of R. solani AGs in Colombian potato fields. A total of 433 isolates were sampled from the main potato cropping areas in Colombia from 2005 to 2009. Isolates were assigned to AGs by conventional PCR assays using specific primers for AG-3, sequencing of the ITS-rDNA and hyphal interactions. Most of the isolates evaluated were assigned to AG-3PT (88.45%), and a few to AG-2-1 (2.54%). Te remaining isolates were binucleate Rhizoctonia (AG-A, E, and I). Pathogenicity tests on the stems and roots of different plant species, including the potato, showed that AG-3PT affects the stems of solanaceous plants. In other plant species, damage was severe in the roots, but not the stems. AG-2-1 caused stem canker of Solanum tuberosum cv. Capiro and in R. raphanistrum and B. campestris subsp. Rapa plantlets and root rot in other plants. Te results of our study indicated that R. solani AG-3PT was the principal pathogen associated with potato stem canker and black scurf diseases of potatoes in Colombia.

Poética da cabaça: fruto de tradição, arte e comunicação

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Os significados e as implicações da extensão universitária na formação inicial e na atuação profissional em educação física

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Impactos da construção da UHE Três Irmãos sobre a atividade de mineração: importância de uma gestão ambiental

Pós-graduação em Geografia - FCT

Delimitação de unidades ambientais na bacia do Rio Capivara, Botucatu (SP)

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Diagnóstico ambiental na sub-bacia do Ribeirão Pouso Alegre com a utilização de um sistema de informação geográfica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Programa “Cidadescola” no 1º ano do Ensino Fundamental em uma escola de Presidente Prudente: entre a ludicidade e a sala de aula

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Formação de professores de Educação Infantil: perspectivas para projetos de formação e de supervisão

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A UNESCO e a governança ambiental na bacia amazônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Dinâmica da paisagem na microbacia hidrográfica do rio Mojuí, oeste do estado do Pará

Pós-graduação em Agronomia (Irrigação e Drenagem) - FCA

Contribuição para o estudo da dinâmica de populações de cães e gatos do município de Jaboticabal, São Paulo

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Distribuição espacial e amostragem sequencial de Cosmopolites sordidus (Germar) na cultura da bananeira

Pós-graduação em Agronomia (Produção Vegetal) - FCAV

Avaliação da qualidade da atenção básica no município de Bauru: desafios para um processo de mudança

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Novos táxons de Grylloidea da Floresta Latifoliada semidecídua da região de Foz do Iguaçu-PR (Orthoptera, Ensifera)

Pós-graduação em Ciências Biológicas (Zoologia) - IBB