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Objective To determine whether adding urine culture to urinary tract infection diagnosis in pregnant women from refugee camps in Lebanon reduced unnecessary antibiotic use. Methods We conducted a prospective, cross-sectional study between April and June 2022 involving pregnant women attending a Medecins Sans Frontieres sexual reproductive health clinic in south Beirut. Women with two positive urine dipstick tests (i.e. a suspected urinary tract infection) provided urine samples for culture. Bacterial identification and antimicrobial sensitivity testing were conducted following European Committee on Antimicrobial Susceptibility Testing guidelines. We compared the characteristics of women with positive and negative urine culture findings and we calculated the proportion of antibiotics overprescribed or inappropriately used. We also estimated the cost of adding urine culture to the diagnostic algorithm. Findings The study included 449 pregnant women with suspected urinary tract infections: 18.0% (81/449) had positive urine culture findings. If antibiotics were administered following urine dipstick results alone, 368 women would have received antibiotics unnecessarily: an overprescription rate of 82% (368/449). If administration was based on urine culture findings plus urinary tract infection symptoms, 144 of 368 women with negative urine culture findings would have received antibiotics unnecessarily: an overprescription rate of 39.1% (144/368). The additional cost of urine culture was 0.48 euros per woman. Conclusion A high proportion of pregnant women with suspected urinary tract infections from refugee camps unnecessarily received antibiotics. Including urine culture in diagnosis, which is affordable in Lebanon, would greatly reduce antibiotic overprescription. Similar approaches could be adopted in other regions where microbiology laboratories are accessible. Objectif Determiner si l'ajout d'une uroculture pour diagnostiquer une infection urinaire chez les femmes enceintes dans les camps de refugies au Liban permet d'eviter de recourir inutilement aux antibiotiques. Methodes Nous avons mene une etude transversale prospective entre avril et juin 2022 sur des femmes enceintes frequentant une clinique de sante sexuelle et reproductive geree par Medecins Sans Frontieres dans le sud de Beyrouth. Les femmes presentant deux tests positifs par bandelette urinaire (c'est-a-dire souffrant potentiellement d'une infection urinaire) ont fourni des echantillons d'urine pour culture. Les tests d'identification bacterienne et de sensibilite aux antimicrobiens ont ete effectues conformement aux lignes directrices du Comite europeen des antibiogrammes. Nous avons compare les caracteristiques des femmes ayant obtenu des resultats d'uroculture positifs et negatifs puis nous avons calcule la proportion d'antibiotiques surprescrits ou utilises de fagon inappropriee. Enfin, nous avons estime combien couterait l'ajout d'une uroculture a l'algorithme de diagnostic. Resultats Letude a porte sur 449 femmes enceintes susceptibles de souffrir d'infections urinaires: 18,0% (81/449) ont obtenu des resultats positifs lors de l'uroculture. Si des antibiotiques avaient ete administres uniquement sur la base des resultats aux tests par bandelette urinaire, 368 femmes en auraient regu sans en avoir besoin, ce qui equivaut a un taux de surprescription de 82% (368/449). S'ils avaient ete administres sur la base des resultats de l'uroculture ainsi que des symptomes d'infection urinaire, 144 des 368 femmes ayant obtenu des resultats negatifs auraient regu des antibiotiques sans en avoir besoin, ce qui represente un taux de surprescription de 39,1% (144/368). La mise en place de l'uroculture a engendre un cout supplemental de 0,48 euro par femme. Conclusion Dans les camps de refugies, une proportion elevee de femmes enceintes potentiellement atteintes d'infections urinaires se sont vu prescrire des antibiotiques sans que ce ne soit necessaire. Inclure dans le diagnostic une uroculture, proposee a prix abordable au Liban, permettrait de reduire considerablement leur surprescription. Des approches similaires pourraient en outre etre adoptees dans d'autres regions ou des laboratoires de microbiologie sont accessibles. Objetivo Determinar si la adicion del urocultivo al diagnostico de infeccion urinaria en mujeres embarazadas de campos de refugiados en Libano redujo el uso innecesario de antibioticos. Metodos Entre abril y junio de 2022, se realizo un estudio prospectivo transversal en el que participaron mujeres embarazadas que acudian a una clinica de salud reproductiva sexual de Medicos Sin Fronteras en el sur de Beirut. Las mujeres con dos pruebas de tira reactiva en orina positivas (es decir, sospecha de infeccion urinaria) proporcionaron muestras de orina para cultivo. La identificacion bacteriana y las pruebas de sensibilidad antimicrobiana se realizaron siguiendo las directrices del Comite Europeo sobre Pruebas de Susceptibilidad Antimicrobiana. Se compararon las caracteristicas de las mujeres con urocultivos positivos y negativos, y se calculo el porcentaje de antibioticos prescritos en exceso o utilizados de forma inadecuada. Tambien se calculo el coste de anadir el urocultivo al algoritmo diagnostico. Resultados En el estudio participaron 449 mujeres embarazadas con sospecha de infeccion urinaria: el 18,0% (81/449) tuvieron resultados positivos en el urocultivo. Si la administracion de antibioticos se basaba unicamente en los resultados de la tira reactiva de orina, 368 mujeres habrian recibido antibioticos sin necesidad: una tasa de prescripcion excesiva del 82% (368/449). Si la administracion se basaba en los resultados del urocultivo mas los sintomas de infeccion urinaria, 144 de las 368 mujeres con resultados negativos del urocultivo habrian recibido antibioticos sin necesidad: una tasa de sobreprescripcion del 39,1% (144/368). El coste adicional del urocultivo fue de 0,48 [euro] por mujer. Conclusion Un alto porcentaje de embarazadas con sospecha de infeccion urinaria procedentes de campos de refugiados recibieron antibioticos innecesariamente. La inclusion del urocultivo en el diagnostico, asequible en Libano, reduciria en gran medida la prescripcion excesiva de antibioticos. Se podrian adoptar enfoques similares en otras regiones donde se pueda acceder a los laboratorios de microbiologia. [phrase omitted], Introduction Inappropriate antibiotic use is one of the main drivers of anti-microbial resistance. (1) The standard of care for pregnant women is to give antibiotics to prevent complications, particularly in [...]

Introduction. Multiple efficacy studies have shown that treatment provided via video consultation (VC) can be equivalent to in-person (IP) consultation for people with psychiatric diagnoses. However, despite the great promise of VC, it has not been widely implemented in psychiatric outpatient services. This study investigated the feasibility aspects of VC in clinical practice and examined a range of factors associated with the implementation of this modality of treatment within psychiatric outpatient services. Methods. This study had a pragmatic design, where 40 consecutive referrals for people with anxiety, personality, or depressive disorders were given the choice to receive eight weekly treatment sessions via VC or IP modality within an outpatient psychiatric setting. Information on demand, acceptance, engagement, implementation, and potential negative effects for treatment conducted via VC were collected to help identify factors that may impact on the uptake of VC within the psychiatric outpatient service. Results. There was a high demand and acceptance for VC, with 44% (n=15) of the patients choosing to receive eight weekly treatment sessions via VC, and acceptance was rated highly. Engagement with VC modality was good, with only a very small percentage (13%, n=2) not completing treatment. A good level of working alliance was established and largely maintained throughout treatment for patients and case managers. There were differences in the utilization of VC compared to the IP modality, with the VC modality having a greater focus on supportive counseling and IP modality having a greater focus on psychotherapy. Overall, the duration of treatment conducted via VC was also slightly shorter than that of IP consultations. There were no negative effects registered for consultations via video. Conclusions. Findings suggest a high patient demand and acceptance for VC within psychiatric services, with good levels of engagement and alliance reported. Differences in focus and duration in VC compared to IP may reflect clinicians' different attitudes and/or approaches to providing treatment, depending on whether it is VC or IP consultations., Author(s): Ali Abbas Shaker (corresponding author) [1]; Stephen F. Austin [1,2]; John Aasted Sørensen [3]; Kristine Hæstrup Tarp [4]; Henrik Bechmann [3]; Erik Simonsen [5] 1. Introduction Video consultation (VC) [...]