Colonization of patients occurs before development into invasive candidiasis. There is a need to determine the incidences of Candida colonization and infection in SICU patients, and evaluate the usefulness of beta-D-glucan (BDG) assay in diagnosing invasive candidiasis when patients are colonized. Clinical data and fungal surveillance cultures in 28 patients were recorded from November 2010, and January to February 2011. Susceptibilities of Candida isolates to fluconazole, voriconazole, amphotericin B, micafungin, caspofungin and anidulafungin were tested via Etest. The utilities of BDG, Candida score and colonization index for candidiasis diagnosis were compared via ROC. 30 BDG assays were performed in 28 patients. Four assay cases had concurrent colonization and infection; 23 had concurrent colonization and no infection; three had no concurrent colonization and infection. Of 136 surveillance swabs, 52 (38.24 %) were positive for Candida spp, with C. albicans being the commonest. Azole resistance was detected in C. albicans (7 %). C. glabrata and C. tropicalis were, respectively, 100 and 7 % SDD to fluconazole. All 3 tests showed high sensitivity of 75–100 % but poor specificity ranging 15.38–38.46 %. BDG performed the best (AUC of 0.89). Despite that positive BDG is common in surgical patients with Candida spp colonization, BDG performed the best when compared to CI and CS.

Laparoscopic cholecystectomy and liver resections are commonly performed surgical procedures which require no or less (cefazolin only) antimicrobial prophylaxis respectively in light of recent evidence. To assess the validity of this data in the local context and increase compliance to such regimens, a multi-modal intervention including, changes to hospital antibiotic prophylaxis guidelines, departmental emphasis, information technology aids (involving the creation of order templates within our electronic medical system) and physical aids (in the form of cards given to junior staff) was implemented. Results comparing a 6-month preintervention period (January 2018 to June 2018) showed no significant increase in 30-day hospital readmission rates (P = 0.8, 0.7) despite a significant rise in compliance (P = 0.04, 0.03) in laparoscopic cholecystectomy (n = 371) and liver resections respectively (n = 193) compared to the 6-month intervention period (July 2018 to December 2018). Additionally, prescription behavior for liver resections was more varied than that of laparoscopic cholecystectomy likely due to the different anatomical considerations in the prior. In conclusion, removal of antibiotic prophylaxis in laparoscopic cholecystectomy and use of cefazolin only in liver resection is not associated with any significant increase in 30-day hospital readmission rates.

Background: Vancomycin-resistant Enterococcus (VRE) has emerged as a major nosocomial pathogen. A recent surveillance of our hospital identified a concerning rise in VRE bacteremia since 2020, despite the stable use of broad-spectrum antibiotics. This trend, coupled with the increased use of daptomycin and linezolid for drug-resistant Gram-positive bacteremia (GPB), prompted an evaluation of their usage beyond approved hospital indications. Methods: A retrospective analysis was carried out from 1 February 2023 to 31 July 2023, during which 100 and 195 patients received linezolid and daptomycin, respectively. Patients’ data were extracted from the hospital’s electronic medical records, and the appropriateness of the antibiotics prescribed was assessed. The amount of daptomycin and linezolid utilization during the study period was also retrieved, as was the incidence of VRE bacteremia. Results: A total of 295 courses of VRE-active agents, linezolid (n = 100) and daptomycin (n = 195), were assessed for appropriateness in this study. Linezolid and daptomycin use were judged as inappropriate 5.0% and 9.2% of the time, respectively. The primary reason for inappropriate linezolid use was overly broad empirical therapy where first-line options like cefazolin and vancomycin could have been prescribed. Daptomycin was often used inappropriately in non-VRE infections, and surgical prophylaxis or use was extended unnecessarily without microbiological justification. Conclusions: Linezolid and daptomycin were prescribed appropriately. Nevertheless, our findings suggest the need to re-evaluate the empirical treatment strategies especially in VRE-colonized patients. Implementation of robust risk-based criteria as well as in-house hospital guidelines or protocols on the initiation of VRE-active agents may help support more judicious prescribing practices of these agents.