Practical Guides

Consult these on-line Clinical Booklets for in-depth, practical guidance on Bacterial Resistance, Antimicrobial Stewardship and Clostridium difficile associated disease.

The objective of this booklet is to provide practical recommendations for healthcare workers in hospitals to improve the quality of antibiotic prescribing and thereby improve patient clinical outcomes. Most of the recommendations within this booklet have been adapted from the IDSA Guidelines [Dellit et al., 2007], the Australian Hospital Stewardship Guidance produced by the Australian Commission on Safety And Quality in Healthcare [Duguid et al., 2010], National Stewardship Guidance from Scotland [Nathwani et al., 2006], the UK [ DOH-ARHAI, Start smart then Focus, 2011] and, although less literature is available, from other countries whenever possible. We hope that this booklet will inform, encourage and support health professionals wishing to pursue the implementation of antimicrobial stewardship initiatives, as well as combating antimicrobial resistance.

Prof. Dilip Nathwani , MB; DTM&H, FRCP

Consultant Physician and Honorary Professor of Infection Ninewells Hospital and Medical School Dundee, Scotland, UK

dilip.nathwani@nhs.net

Dr Jacqueline Sneddon , MRPharmS, MSc, PhD

Project Lead for Scottish Antimicrobial Prescribing Group Healthcare Improvement Scotland Glasgow, Scotland, UK

jacqueline.sneddon@nhs.net

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This brochure is intended to provide succinct answers to common questions about the performance of in vitro antimicrobial susceptibility testing of bacteria and fungi and the value of the results in guiding antimicrobial therapy. This brochure was compiled with the help of John Turnidge and Jan Bell, SA Pathology, Adelaide, South Australia.

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Clostridium difficile Associated Disease (CDAD) is currently defined as a nosocomial infection induced by antibiotic treatment. Clostridium difficile was identified as the cause of diarrhea and colitis in the late 1970s, and now accounts for 20 % of antibiotic-associated diarrhea cases. Previously C. difficile was considered to be no more than a clinical nuisance, but since 2003 with strains causing more severe outbreaks and increased mortality in US and Canadian healthcare facilities, the C. difficile pattern has evolved for many to the “N°1 Superbug”. In August 2006, the US CDC considered the pathogen to behave in alarming new ways, with the emergence of deadly hyper-virulent strains and evidence suggesting the spread out of the hospital environment. Increasing communication and information from National & International Health Organizations on measures for C. difficile detection and control, highlight the importance of this rising new health threat. This document should provide basic information to understand CDAD, as well as its diagnosis, treatment and prevention in healthcare facilities. Available guidelines and case descriptions are also reported. Although not exhaustive, this booklet is intended as a succinct and practical reminder for laboratory professionals and clinicians.

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