Background: Antimicrobial resistance is a global public health crisis. This is especially true for infections due to gram negative organisms (GNOs). Carbapenems are some of the broadest spectrum antibiotics available and are often used to treat infections due to multi-drug resistant GNOs. However, carbapenem use has led to the widespread emergence of carbapenem resistance. Our study describes relative carbapenem use across medical wards at a tertiary academic medical center in the United States via the novel Proportion of Carbapenem Consumption (PoCC) metric. The PoCC can be utilized by Antimicrobial Stewardship Programs (ASPs) to assess for potential carbapenem overuse. Our institution did not restrict Meropenem usage by ASP pre-authorization during the study period. Methods & Materials: A performance metric to compare the relative use of Carbapenems to Cefepime and Pipercillin/Tazobactam (PT) known as PoCC was created. We examined the PoCC for medical wards at VCU medical center from August 2012-June 2017. Statistical data were created using the linear regression function of Microsoft Excel's statistical package. Results: We saw a significant decrease in the PoCC for one acute care medical ward (N9) across the study period. We did not see any other significant increases or decreases for the other wards during the study period. We did note a relatively high PoCC score on one medical unit (CCH3).Tabled 1WardMean PoCC*PoCC=[(meropenem DOT/1000 PDs)/(meropenem DOT/1000 PDs+cefepime DOT/1000 PDs+PT DOT/1000 PDs)].Slopep-valueMean Meropenem use (DOT^/1000 PDs^^)Hematology/Oncology0.2413910.000600.36176.5625General Medicine (CCH3)0.41472150.000730.335100.9372General Medicine (N5)0.2341087−0.000570.42239.6864Acute Care/Step down Medicine (N9)0.2838209-0.001690.00574.2003^DOT = Days of Therapy.^^PDs = Patient Days.* PoCC = [(meropenem DOT/1000 PDs)/(meropenem DOT/1000 PDs + cefepime DOT/1000 PDs + PT DOT/1000 PDs)]. Open table in a new tab ^DOT = Days of Therapy. ^^PDs = Patient Days. Conclusion: Our study revealed a significant decrease in the PoCC on one acute care medicine ward over the study period. Additionally, a ward with a relatively high PoCC was identified. We believe the PoCC metric can be useful to ASPs in identifying hospital wards with possible carbapenem overutilization. More research is needed to investigate ideal use of the PoCC metric by ASPs.

Background: Access to clean water is a major health issue for many living in rural Honduras. In June 2008, clay water filters were distributed to individual homes in La Hicaca, a rural mountain community in the Yoro area of Honduras. In June 2009, a needs assessment survey was administered to residents in this area. Methods: In June 2009, a needs assessment survey was administered in La Hicaca and other communities in the Yoro area that collected data on demographics, water source and principle health concerns. One question asked, “What are the three biggest health care problems that you worry about? (Check all that apply)” There were 15 options in the areas of water sanitation, nutrition, education, maternal/child health, access to doctors and medicine and specific disease concerns. Survey respondents in La Hicaca who used clay water filters and all other respondents were compared regarding their principle health concerns. Respondents were excluded if they filtered their water but did not live in La Hicaca or if they did not respond to the question regarding health concerns. Results: Of 101 completed surveys, 12 survey respondents from La Hicaca used clay water filters and 70 respondents from the Yoro area did not. For the respondents who did not use filtered water, water sanitation (48.6%) and nutrition (42.9%) were the principle health concerns. For the La Hicaca residents who utilized water filters, access to healthcare in terms of distance (41.7%) and overall cost of healthcare (50%) were the principle concerns. Conclusion: When comparing the primary health concerns of rural Hondurans in La Hicaca who utilize clay water filters to those who use a different water purification method, the principle health concerns differ. Water sanitation and nutrition were the principle concerns for those who do not use filtered water, and access to healthcare in terms of distance and cost were the concerns for those respondents who utilize water filters. As far as perceived health concerns are an indicator, the distribution of clay water filters in one rural Honduran community may have had a positive health impact. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive

Background: Socio-environmental conditions vary across rural Honduras. As medical relief missions target rural communities, planning should focus on highly prevalent concerns. We assessed the needs and disease perceptions of people in the Department of Yoro area of rural Honduras Methods: A needs assessment survey was administered in June 2008 in the Department of Yoro area of Honduras. The survey consisted of 29 multiple-choice questions that collected data on demographic information, environmental health pressures such as home environment, access to clean water and sanitation. The survey also assessed access to healthcare and the top 3 perceived critical issues affecting health. Surveys were randomly administered at multiple clinic sites. Surveys were voluntary, anonymous and in Spanish. A descriptive analysis of the responses was performed. The association between concern for infectious diseases and socio-environmental factors was explored. The Chi-square test was employed for statistical significance. Results: 70 surveys were collected. The mean age was 38. Twenty-one men and 49 women completed the survey. Only 8% of the respondents had completed 12 years of education. Thirty-eight (54%) were employed. The average number of adults living in a given home was 4.4. Forty-eight (69%) of respondents obtained their water from plumbing, with 14 (20%) reporting no purification treatment of water. Forty-seven percent of respondents used outhouses or latrines. Thirty-nine (56%) reported the presence of farm animals within their home. Sixteen percent of homes were constructed with adobe and 39% of all homes had dirt floors. The most common healthcare concerns were water sanitation (19, 32%), nutrition (19, 32%), infectious diseases (18, 31%) and access to doctors and medications (18, 31%). There was no statistically significant association between concern for infectious diseases and crowded household (>4 people/house) (p=0.90), dirt flooring (p=0.48) or the presence of farm animals in the home (p-0.48). Conclusion: Despite differences in socio-environmental factors in rural Honduras, the principal health concerns were water sanitation, nutrition, infectious diseases and access to doctors and medications. There were no associations between infectious diseases concerns and socio-environmental factors. Medical relief missions to rural Honduras should anticipate widespread infectious diseases related concerns and should prepare accordingly. Abstracts for SupplementInternational Journal of Infectious DiseasesVol. 14Preview Full-Text PDF Open Archive