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1.  Catheter associated urinary tract infections 
Urinary tract infection attributed to the use of an indwelling urinary catheter is one of the most common infections acquired by patients in health care facilities. As biofilm ultimately develops on all of these devices, the major determinant for development of bacteriuria is duration of catheterization. While the proportion of bacteriuric subjects who develop symptomatic infection is low, the high frequency of use of indwelling urinary catheters means there is a substantial burden attributable to these infections. Catheter-acquired urinary infection is the source for about 20% of episodes of health-care acquired bacteremia in acute care facilities, and over 50% in long term care facilities. The most important interventions to prevent bacteriuria and infection are to limit indwelling catheter use and, when catheter use is necessary, to discontinue the catheter as soon as clinically feasible. Infection control programs in health care facilities must implement and monitor strategies to limit catheter-acquired urinary infection, including surveillance of catheter use, appropriateness of catheter indications, and complications. Ultimately, prevention of these infections will require technical advances in catheter materials which prevent biofilm formation.
doi:10.1186/2047-2994-3-23
PMCID: PMC4114799  PMID: 25075308
Urinary catheter; Bacteriuria; Urinary tract infection; Health care acquired infection; Indwelling urethral catheter
2.  Antimicrobial stewardship in long term care facilities: what is effective? 
Intense antimicrobial use in long term care facilities promotes the emergence and persistence of antimicrobial resistant organisms and leads to adverse effects such as C. difficile colitis. Guidelines recommend development of antimicrobial stewardship programs for these facilities to promote optimal antimicrobial use. However, the effectiveness of these programs or the contribution of any specific program component is not known. For this review, publications describing evaluation of antimicrobial stewardship programs for long term care facilities were identified through a systematic literature search. Interventions included education, guidelines development, feedback to practitioners, and infectious disease consultation. The studies reviewed varied in types of facilities, interventions used, implementation, and evaluation. Comprehensive programs addressing all infections were reported to have improved antimicrobial use for at least some outcomes. Targeted programs for treatment of pneumonia were minimally effective, and only for indicators of uncertain relevance for stewardship. Programs focusing on specific aspects of treatment of urinary infection – limiting treatment of asymptomatic bacteriuria or prophylaxis of urinary infection – were reported to be effective. There were no reports of cost-effectiveness, and the sustainability of most of the programs is unclear. There is a need for further evaluation to characterize effective antimicrobial stewardship for long term care facilities.
doi:10.1186/2047-2994-3-6
PMCID: PMC3931475  PMID: 24521205
Long term care facility; Antimicrobial stewardship; Pneumonia; Urinary tract infection
3.  Control of antimicrobial resistance in Canada: any lessons to learn? 
Background
Over the past 15 years, repeated national meetings have developed recommendations for a Canadian antimicrobial resistance strategy. Despite this, in 2011 there is no comprehensive, integrated national program with appropriate governance and funding to address antimicrobial resistance.
Findings
The Public Health Agency of Canada supports a reference laboratory for diagnosis and characterization of selected resistant strains, targeted surveillance programs which monitor resistance trends for selected animal and human organisms, development of national infection control guidelines including for antimicrobial resistant organisms, and a few local pilot projects to address community acquired MRSA. Sporadic programs of variable intensity and quality are supported by some provinces, health regions and individual facilities but these are not comprehensive, standardized or integrated. Individual researchers and research groups, however, have published substantial information describing the prevalence and impact of resistance in Canada.
Conclusions
Current review of activities by the Public Health Agency of Canada and initiatives by the National Coordinating Centre for Infectious Diseases may move the country forward in developing an effective national approach to address antimicrobial resistance.
doi:10.1186/2047-2994-1-6
PMCID: PMC3436613  PMID: 22958241
antimicrobial resistance; Canada; antimicrobial stewardship

Results 1-3 (3)