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Matteson CL, Czaja CA, Kronman MP, Ziniel S, Parker SK, Dodson DS. Impact of the coronavirus disease 2019 (COVID-19) pandemic on antimicrobial stewardship programs in Colorado hospitals. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e172. [PMID: 36483407 PMCID: PMC9726577 DOI: 10.1017/ash.2022.24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 01/21/2022] [Indexed: 06/17/2023]
Abstract
Using a mixed-methods approach, we assessed the effect of the coronavirus disease 2019 (COVID-19) pandemic on antimicrobial stewardship programs (ASPs) in Colorado hospitals. ASP leaders reported decreased time and resources, reduced rigor of stewardship interventions, inability to complete new initiatives, and interpersonal challenges. Stewardship activities may be threatened during times of acute resource pressure.
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Affiliation(s)
- Caleb L. Matteson
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | | | - Matthew P. Kronman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Seattle Children’s Hospital, University of Washington, Seattle, Washington
| | - Sonja Ziniel
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah K. Parker
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Daniel S. Dodson
- Colorado Department of Public Health and Environment, Denver, Colorado
- Section of Pediatric Infectious Diseases, Department of Pediatrics, University of California Davis, Sacramento, California
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152
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Doolan JA, Williams GT, Hilton KLF, Chaudhari R, Fossey JS, Goult BT, Hiscock JR. Advancements in antimicrobial nanoscale materials and self-assembling systems. Chem Soc Rev 2022; 51:8696-8755. [PMID: 36190355 PMCID: PMC9575517 DOI: 10.1039/d1cs00915j] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Indexed: 11/21/2022]
Abstract
Antimicrobial resistance is directly responsible for more deaths per year than either HIV/AIDS or malaria and is predicted to incur a cumulative societal financial burden of at least $100 trillion between 2014 and 2050. Already heralded as one of the greatest threats to human health, the onset of the coronavirus pandemic has accelerated the prevalence of antimicrobial resistant bacterial infections due to factors including increased global antibiotic/antimicrobial use. Thus an urgent need for novel therapeutics to combat what some have termed the 'silent pandemic' is evident. This review acts as a repository of research and an overview of the novel therapeutic strategies being developed to overcome antimicrobial resistance, with a focus on self-assembling systems and nanoscale materials. The fundamental mechanisms of action, as well as the key advantages and disadvantages of each system are discussed, and attention is drawn to key examples within each field. As a result, this review provides a guide to the further design and development of antimicrobial systems, and outlines the interdisciplinary techniques required to translate this fundamental research towards the clinic.
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Affiliation(s)
- Jack A Doolan
- School of Chemistry and Forensic Science, University of Kent, Canterbury, Kent CT2 7NH, UK.
- School of Biosciences, University of Kent, Canterbury, Kent CT2 7NJ, UK.
| | - George T Williams
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Kira L F Hilton
- School of Chemistry and Forensic Science, University of Kent, Canterbury, Kent CT2 7NH, UK.
| | - Rajas Chaudhari
- School of Chemistry and Forensic Science, University of Kent, Canterbury, Kent CT2 7NH, UK.
| | - John S Fossey
- School of Chemistry, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Benjamin T Goult
- School of Biosciences, University of Kent, Canterbury, Kent CT2 7NJ, UK.
| | - Jennifer R Hiscock
- School of Chemistry and Forensic Science, University of Kent, Canterbury, Kent CT2 7NH, UK.
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153
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Smith JT, Manickam RN, Barreda F, Greene JD, Bhimarao M, Pogue J, Jones M, Myers L, Prescott HC, Liu VX. Quantifying the breadth of antibiotic exposure in sepsis and suspected infection using spectrum scores. Medicine (Baltimore) 2022; 101:e30245. [PMID: 36254043 PMCID: PMC9575768 DOI: 10.1097/md.0000000000030245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022] Open
Abstract
A retrospective cohort study. Studies to quantify the breadth of antibiotic exposure across populations remain limited. Therefore, we applied a validated method to describe the breadth of antimicrobial coverage in a multicenter cohort of patients with suspected infection and sepsis. We conducted a retrospective cohort study across 21 hospitals within an integrated healthcare delivery system of patients admitted to the hospital through the ED with suspected infection or sepsis and receiving antibiotics during hospitalization from January 1, 2012, to December 31, 2017. We quantified the breadth of antimicrobial coverage using the Spectrum Score, a numerical score from 0 to 64, in patients with suspected infection and sepsis using electronic health record data. Of 364,506 hospital admissions through the emergency department, we identified 159,004 (43.6%) with suspected infection and 205,502 (56.4%) with sepsis. Inpatient mortality was higher among those with sepsis compared to those with suspected infection (8.4% vs 1.2%; P < .001). Patients with sepsis had higher median global Spectrum Scores (43.8 [interquartile range IQR 32.0-49.5] vs 43.5 [IQR 26.8-47.2]; P < .001) and additive Spectrum Scores (114.0 [IQR 57.0-204.5] vs 87.5 [IQR 45.0-144.8]; P < .001) compared to those with suspected infection. Increased Spectrum Scores were associated with inpatient mortality, even after covariate adjustments (adjusted odds ratio per 10-point increase in Spectrum Score 1.31; 95%CI 1.29-1.33). Spectrum Scores quantify the variability in antibiotic breadth among individual patients, between suspected infection and sepsis populations, over the course of hospitalization, and across infection sources. They may play a key role in quantifying the variation in antibiotic prescribing in patients with suspected infection and sepsis.
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Affiliation(s)
- Joshua T. Smith
- Pharmacy Quality and Medication Safety, Kaiser Permanente Northern California, Oakland, CA
| | - Raj N. Manickam
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Fernando Barreda
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - John D. Greene
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Meghana Bhimarao
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Jason Pogue
- College of Pharmacy, University of Michigan, Ann Arbor, MI
| | - Makoto Jones
- Division of Epidemiology, VA Salt Lake City Health Care System, Salt Lake City, UT
- Division of Epidemiology, University of Utah, Salt Lake City, UT
| | - Laura Myers
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Hallie C. Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- VA Center for Clinical Management Research, Ann Arbor, MI
| | - Vincent X. Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
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154
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Use of leading practices in US hospital antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2022:1-8. [DOI: 10.1017/ice.2022.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Objective:
To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey.
Setting:
Acute-care hospitals.
Participants:
ASP leaders.
Methods:
Advance letters and electronic questionnaires were initiated February 2020. Primary outcomes were percentage of hospitals that (1) implemented facility-specific treatment guidelines (FSTG); (2) performed interactive prospective audit and feedback (PAF) either face-to-face or by telephone; (3) optimized diagnostic testing; (4) measured antibiotic utilization; (5) measured C. difficile infection (CDI); and (6) measured adherence to FSTGs.
Results:
Of 948 hospitals invited, 288 (30.4%) completed the questionnaire. Among them, 82 (28.5%) had <99 beds, 162 (56.3%) had 100–399 beds, and 44 (15.2%) had ≥400+ beds. Also, 230 (79.9%) were healthcare system members. Moreover, 161 hospitals (54.8%) reported implementing FSTGs; 214 (72.4%) performed interactive PAF; 105 (34.9%) implemented procedures to optimize diagnostic testing; 235 (79.8%) measured antibiotic utilization; 258 (88.2%) measured CDI; and 110 (37.1%) measured FSTG adherence. Small hospitals performed less interactive PAF (61.0%; P = .0018). Small and nonsystem hospitals were less likely to optimize diagnostic testing: 25.2% (P = .030) and 21.0% (P = .0077), respectively. Small hospitals were less likely to measure antibiotic utilization (67.8%; P = .0010) and CDI (80.3%; P = .0038). Nonsystem hospitals were less likely to implement FSTGs (34.3%; P < .001).
Conclusions:
Significant variation exists in the adoption of ASP leading practices. A minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs. Additional efforts are needed to expand adoption of leading practices across all acute-care hospitals with the greatest need in smaller hospitals.
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155
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Núñez-Núñez M, Perez-Galera S, Girón-Ortega JA, Sandoval Fernández-Del-Castillo S, Beltrán-García M, De Cueto M, Suárez-Barrenechea AI, Palacios-Baena ZR, Terol-Barrero P, Oltra-Hostalet F, Arenzana-Seisdedos Á, Rodriguez-Baño J, Retamar-Gentil P. Predictors of inappropriate antimicrobial prescription: Eight-year point prevalence surveys experience in a third level hospital in Spain. Front Pharmacol 2022; 13:1018158. [PMID: 36299899 PMCID: PMC9592087 DOI: 10.3389/fphar.2022.1018158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
Antibiotic stewardship programs (ASP) have already demonstrated clinical benefits. We aimed to describe the Point Prevalence Surveys (PPS) methodology implemented in our hospital as an efficient tool to guide ASP strategies. Annually repeated PPS were conducted from 2012 to 2019 at a 750-bed university hospital in South Spain. Key quality indicators and inappropriateness of antimicrobial treatment, defined strictly according to local guidelines, were described. Variables associated with inappropriate treatment were identified by bi/multivariable analysis. A total of 1,600 patients were included. We found that 49% of the prescriptions were inappropriate due to unnecessary treatment (14%), not first line drug recommended (14%), inadequate drug according to microbiological results (9%), unsuitable doses (8%), route (3%) or duration (7%). Samples collection presented a significant protective effect together with sepsis presentation at onset and intensive care unit admission. However, age, receiving an empirical treatment and an unknown or urinary source of the infections treated were independent risk factors for inappropriateness. Site and severity of infection were documented in medical charts by prescribers (75 and 61% respectively). PPS may allow identifying the main risk factors for inappropriateness. This simple methodology may be useful for ASP to select modifiable factors to be prioritized for targeted interventions.
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Affiliation(s)
- María Núñez-Núñez
- Hospital Pharmacy Department, University Hospital Virgen Macarena, Seville, Spain
- Hospital Pharmacy Department, San Cecilio Clinical University Hospital, Granada, Spain
- Biosanitary Research Institute of Granada (Ibs.Granada), Granada, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
- *Correspondence: María Núñez-Núñez,
| | | | | | | | | | - Marina De Cueto
- Institute of Biomedicine of Seville (IBiS) and CSIC, Seville, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena,Sevilla, Spain
- Department of Microbiology, University of Seville, Seville, Spain
| | | | - Zaira R. Palacios-Baena
- Institute of Biomedicine of Seville (IBiS) and CSIC, Seville, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena,Sevilla, Spain
- Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), Madrid, Spain
| | | | | | | | - Jesús Rodriguez-Baño
- Institute of Biomedicine of Seville (IBiS) and CSIC, Seville, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena,Sevilla, Spain
- Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), Madrid, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Pilar Retamar-Gentil
- Institute of Biomedicine of Seville (IBiS) and CSIC, Seville, Spain
- Infectious Diseases and Microbiology Clinical Unit, University Hospital Virgen Macarena,Sevilla, Spain
- Consortium for Biomedical Research in Infectious Diseases (CIBERINFEC), Madrid, Spain
- Department of Medicine, University of Seville, Seville, Spain
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156
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Wang Y, Zhou C, Liu C, Liu S, Liu X, Li X. The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design. Front Public Health 2022; 10:1012690. [PMID: 36262226 PMCID: PMC9574199 DOI: 10.3389/fpubh.2022.1012690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 01/27/2023] Open
Abstract
Background Inappropriate use of antibiotics has become a major driver for the spread of antimicrobial resistance globally, particularly common in China. Antimicrobial stewardship programs are effective in optimizing antimicrobial use and decreasing the emergence of multi-drug-resistant organisms, and the pharmacist has performed a leading role in this program. Objective To evaluate the impact of antimicrobial stewardship programs driven by pharmacists on antibiotic consumption and costs and the appropriateness of antibiotic use. Methods A single-center retrospective quasi-experimental design was conducted in two independent hepatobiliary surgery wards and two independent respiratory wards in a county-level tertiary general hospital in Jiangsu, China. Each intervention group was served with antimicrobial stewardship programs with prescriptions audit and feedback, antibiotics restriction, education, and training. The propensity score matching method was employed to balance confounding variables between the intervention group and control group, and a difference-in-differences analysis was used to evaluate the impact of antimicrobial stewardship programs. The primary outcome was measured by scores of rationality evaluation of antibiotics. Results The DID results demonstrated that the implementation of the antimicrobial stewardship programs was associated with a reduction in the average length of hospital stay (coefficient = -3.234, p = 0.006), DDDs per patient (coefficient = -2.352, p = 0.047), and hospitalization costs (coefficient = -7745.818, p = 0.005) in the hepatobiliary surgery ward, while it was associated with a decrease in DDDs per patient (coefficient = -3.948, p = 0.029), defined daily doses per patient day (coefficient = -0.215, p = 0.048), and antibiotic costs (coefficient = -935.087, p = 0.014) in the respiratory ward. The program was also associated with a decrease in rationality evaluation scores (p < 0.001) in two wards. Conclusion The result reveals that the implementation of the antimicrobial stewardship programs is effective in reducing the length of hospital stay, decreasing antibiotics consumption and costs, and improving the appropriateness of antimicrobial use such as decreasing irrational use of cephalosporins, reducing combinations, and improving timely conversion. However, great attention ought to be paid to the improper use of broad-spectrum antibiotics. The government is responsible for providing sustainable formal education for pharmacists, and more funding and staff support to promote antimicrobial stewardship programs.
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Affiliation(s)
- Ying Wang
- Department of Infection Management, The First Affiliated Hospital of Soochow University, Suzhou, China,School of Health Policy and Management, Nanjing Medical University, Nanjing, China
| | - Chongchong Zhou
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China
| | - Chengying Liu
- Department of Respiratory Medicine, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Shuanghai Liu
- Department of Hepatobiliary Surgery, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China
| | - Xiaoliang Liu
- Department of Infection Management, The Affiliated Jiangyin Hospital of Nantong University, Jiangyin, China,Xiaoliang Liu
| | - Xin Li
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China,Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China,*Correspondence: Xin Li
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157
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Gonzales G, Tornes K, Saklad SR. Stewardship applied to antipsychotics: Development of an antipsychotic stewardship program in inpatient settings for monitoring and optimizing outcomes. Ment Health Clin 2022; 12:320-326. [DOI: 10.9740/mhc.2022.10.320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 08/02/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Antipsychotic (AP) medications are prescribed for various psychiatric diagnoses that require routine monitoring to ensure optimal use, effectiveness, adherence, and for potentially severe adverse effects. There is currently no comprehensive protocol for institutional supervision of prescribing and monitoring AP. Antibiotics (ABX) are commonly associated with stewardship programs aimed at optimizing use and mitigating harm. These programs have proven to result in positive outcomes in both safety and efficacy parameters for numerous institutions. Given that AP are also associated with significant adverse effects and often misused, the concept of stewardship can be applied to this class of agents to optimize their use and improve overall patient outcomes. The objective of this paper is to provide guidance for the implementation of antipsychotic stewardship programs (APSP) in the inpatient setting. The development of this APSP was designed based on ABX stewardship programs and the Centers for Disease Control and Prevention, Agency for Healthcare Research and Quality, and the American Psychiatric Association practice guidelines on the treatment of patients with schizophrenia. In conclusion, APSPs have the potential to enhance and standardize institutional supervision of prescribing and monitoring practices of AP, leading to improved clinical outcomes and the reduction of adverse effects. APSP teams should be multidisciplinary, consisting of clinicians and administrators, working in conjunction with patients and patient advocates to design individualized recovery plans that consider the individual patient's history and desired outcomes. Monitoring, stewardship interventions, and outcomes should be documented on both an individual and deidentified institutional basis, analyzed, and summarized periodically as measures for quality improvement.
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Affiliation(s)
- Gillian Gonzales
- 1 PGY1 Resident, VA Eastern Colorado Health Care System, Aurora, Colorado; previously: The University of Texas at Austin College of Pharmacy, San Antonio, Texas
| | - Kari Tornes
- 2 PGY1 Resident, University Health System, San Antonio, Texas; previously: The University of Texas at Austin College of Pharmacy, San Antonio, Texas
| | - Stephen R. Saklad
- 3 (Corresponding author) Clinical Professor and Director of Psychiatric Pharmacy, Pharmacotherapy Division, College of Pharmacy, University of Texas at Austin, San Antonio, Texas,
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158
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Chen CS, Huang TS, Lee SSJ, Chien FC, Yang CH, Li SS, Hsu CJ, Sy CL, Wu KS. Using a Knowledge-Based Clinical Decision Support System to Reduce the Time to Appropriate Antimicrobial Therapy in Hospitalized Patients With Bloodstream Infections: A Single-Center Observational Study. Open Forum Infect Dis 2022; 9:ofac522. [PMID: 36320200 PMCID: PMC9605697 DOI: 10.1093/ofid/ofac522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 10/03/2022] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND Inappropriate antimicrobial use is a crucial determinant of mortality in hospitalized patients with bloodstream infections. Current literature reporting on the impact of clinical decision support systems on optimizing antimicrobial prescription and reducing the time to appropriate antimicrobial therapy is limited. METHODS Kaohsiung Veterans General Hospital implemented a hospital-wide, knowledge-based, active-delivery clinical decision support system, named RAPID (Real-time Alert for antimicrobial Prescription from virtual Infectious Diseases experts), to detect whether there was an antimicrobial agent-pathogen mismatch when a blood culture result was positive. Once RAPID determines the current antimicrobials as inappropriate, an alert text message is immediately sent to the clinicians in charge. This study evaluated how RAPID impacted the time to appropriate antimicrobial therapy among patients with bloodstream infections. RESULTS During the study period, 633 of 11 297 recorded observations (5.6%) were determined as inappropriate antimicrobial prescriptions. The time to appropriate antimicrobial therapy was significantly shortened after the implementation of RAPID (1.65 vs 2.45 hours, P < .001), especially outside working hours (1.24 vs 6.43 hours, P < .001), in the medical wards (1.40 vs 2.14 hours, P < .001), in participants with candidemia (0.74 vs 5.36 hours, P < .001), and for bacteremia due to non-multidrug-resistant organisms (1.66 vs 2.49 hours, P < .001). CONCLUSIONS Using a knowledge-based clinical decision support system to reduce the time to appropriate antimicrobial therapy in a real-world scenario is feasible and effective. Our results support the continued use of RAPID.
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Affiliation(s)
- Chii-Shiang Chen
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Tsi-Shu Huang
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Fu-Chin Chien
- Ultron Technology Company Limited, Kaohsiung, Taiwan
| | - Ching-Hsiang Yang
- Department of Pharmacy, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Sin-Sian Li
- Department of Information Management, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chia-Jung Hsu
- Department of Information Management, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng Len Sy
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
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159
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Santos CAQ, Martinez AI, Won SY, Varughese CA, Tseng M, Zhang H, Trick WE. Computing antimicrobial use/antimicrobial resistance ratios: A novel way to assess inpatient antimicrobial utilization using current National Healthcare Safety Network metrics. Transpl Infect Dis 2022; 24:e13924. [PMID: 36254516 DOI: 10.1111/tid.13924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current methods for benchmarking inpatient antimicrobial use (AU) could benefit from combining AU with antimicrobial resistance (AR) information to provide metrics benchmarked to microbiological data; this may yield more instructive and better risk-adjusted measurements than AU and AR in isolation. METHODS In this retrospective single-center study, we computed facility-wide AU/AR ratios from 2019 to 2020 for specific antimicrobial agents and corresponding AR events, and compared median monthly AU/AR ratios between March 2019 through December 2019 (pre-COVID period) and March 2020 through December 2020 (COVID period). Aggregate AU was expressed as a ratio to aggregate AR events for antimicrobials that typically have activity against the AR organism and are frequently used to treat the AR organism in clinical practice. We also computed AU/AR ratios in our surgical intensive care unit in the pre-COVID period. RESULTS High-median facility-wide monthly AU/AR ratios were observed for intravenous vancomycin/methicillin-resistant Staphylococcus aureus, with 130.0 in the pre-COVID period and 121.3 in the COVID period (p =.520). Decreases in facility-wide median monthly AU/AR ratios were observed between periods for meropenem/ESBL Enterobacterales (20.9 vs. 7.9, p < .001), linezolid/vancomycin-resistant Enterococcus (48.5 vs. 15.8, p =.004), and daptomycin/vancomycin-resistant Enterococcus (32.2 vs. 4.8, p = .002). Increases in facility-wide median monthly AU/AR ratios were observed between periods for ceftazidime-avibactam/carbapenem-resistant Enterobacterales (0.0 vs. 3.2, p = .020) and ceftazidime-avibactam/multidrug-resistant Pseudomonas aeruginosa (0.0 vs. 4.0, p = .017). The AU/AR ratio for intravenous vancomycin/methicillin-resistant S. aureus in the surgical intensive care unit was 191.5 in the pre-COVID period. CONCLUSIONS AU/AR ratios may be used to supplement current AU and AR metrics. Future directions should include the development of more AU metrics benchmarked to microbiological information. AU metrics more specific to transplant infectious diseases should be developed.
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Affiliation(s)
- Carlos A Q Santos
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Ashley I Martinez
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, Illinois, USA.,Division of Therapeutics and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Sarah Y Won
- Division of Infectious Diseases, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Christy A Varughese
- Department of Pharmacy, Rush University Medical Center, Chicago, Illinois, USA
| | - Marion Tseng
- Medical Research Analytics and Informatics Alliance, Chicago, Illinois, USA
| | - Huiyuan Zhang
- Health Research and Solutions, Cook County Health, Chicago, Illinois, USA
| | - William E Trick
- Health Research and Solutions, Cook County Health, Chicago, Illinois, USA
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160
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Chotiprasitsakul D, Bruminhent J, Watcharananan SP. Current state of antimicrobial stewardship and organ transplantation in Thailand. Transpl Infect Dis 2022; 24:e13877. [DOI: 10.1111/tid.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Darunee Chotiprasitsakul
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
| | - Jackrapong Bruminhent
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
| | - Siriorn P. Watcharananan
- Department of Medicine Faculty of Medicine Ramathibodi Hospital, Mahidol University Bangkok Thailand
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161
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Arteche-Eguizabal L, Corcuera-Martínez de Tobillas I, Melgosa-Latorre F, Domingo-Echaburu S, Urrutia-Losada A, Eguiluz-Pinedo A, Rodriguez-Piacenza NV, Ibarrondo-Olaguenaga O. Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services. Antibiotics (Basel) 2022; 11:antibiotics11101336. [PMID: 36289994 PMCID: PMC9598292 DOI: 10.3390/antibiotics11101336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/13/2022] [Accepted: 09/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. OBJECTIVE Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at the emergency department and then admitted to the internal medicine service of the Alto Deba Hospital-Osakidetza Basque Country Health Service (Spain). METHODS Observational, retrospective study, based on the review of medical records of patients with community-acquired pneumonia attended at the hospital between January and May 2021. The review was made considering the following items: antimicrobial treatment indication, choice of antibiotic, time of administration of the first dose, adequacy of the de-escalation-sequential therapy, duration of treatment, monitoring of efficacy and adverse effects, and registry in the medical records. The review was made by the research team (professionals from the emergency department, internal medicine, and pharmacy services). RESULTS Fifty-five medical records were reviewed. The adequacy of the treatments showed that antibiotic indication, time of administration of the first dose, and monitoring of efficacy and adverse effects were the items with the greatest agreement between the three departments. This was not the case with the choice of antibiotic, de-escalation/sequential therapy, duration of treatment, and registration in the medical record, which have been widely discussed. The choice of antibiotic was optimal in 63.64% and might have been better in 25.45%. De-escalation/oral sequencing might have been better in 50.91%. The treatment duration was optimal in 45.45% of the patients and excessive in 45.45%. DISCUSSION The team agreed to disseminate these data among the hospital professionals and to propose audits and feedback through an antibiotic stewardship program. Besides this, implementing the local guideline and defining stability criteria to apply sequential therapy/de-escalation was considered essential.
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Affiliation(s)
- Lorea Arteche-Eguizabal
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
- Correspondence:
| | | | - Federico Melgosa-Latorre
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Emergency Service, 20500 Arrasate/Mondragón, Spain
| | - Saioa Domingo-Echaburu
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
| | - Ainhoa Urrutia-Losada
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Pharmacy Service, 20500 Arrasate/Mondragón, Spain
| | - Amaia Eguiluz-Pinedo
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Internal Medicine Service, 20500 Arrasate/Mondragón, Spain
| | | | - Oliver Ibarrondo-Olaguenaga
- Osakidetza Basque Health Service, Debagoiena Integrated Health Organization, Research Unit, 20500 Arrasate/Mondragón, Spain
- Biodonostia Health Research Institute, 20014 Donostia-San Sebastián, Spain
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162
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Schena CA, de’Angelis GL, Carra MC, Bianchi G, de’Angelis N. Antimicrobial Challenge in Acute Care Surgery. Antibiotics (Basel) 2022; 11:antibiotics11101315. [PMID: 36289973 PMCID: PMC9598495 DOI: 10.3390/antibiotics11101315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/24/2022] [Accepted: 09/26/2022] [Indexed: 12/07/2022] Open
Abstract
The burden of infections in acute care surgery (ACS) is huge. Surgical emergencies alone account for three million admissions per year in the United States (US) with estimated financial costs of USD 28 billion per year. Acute care facilities and ACS patients represent boost sanctuaries for the emergence, development and transmission of infections and multi-resistant organisms. According to the World Health Organization, healthcare-associated infections affected around 4 million cases in Europe and 1.7 million in the US alone in 2011 with 39,000 and 99,000 directly attributable deaths, respectively. In this scenario, antimicrobial resistance arose as a public-health emergency that worsens patients’ morbidity and mortality and increases healthcare costs. The optimal patient care requires the application of comprehensive evidence-based policies and strategies aiming at minimizing the impact of healthcare associated infections and antimicrobial resistance, while optimizing the treatment of intra-abdominal infections. The present review provides a snapshot of two hot topics, such as antimicrobial resistance and systemic inflammatory response, and three milestones of infection management, such as source control, infection prevention, and control and antimicrobial stewardship.
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Affiliation(s)
- Carlo Alberto Schena
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Gian Luigi de’Angelis
- Gastroenterology and Endoscopy Unit, Department of Medicine and Surgery, University Hospital of Parma, 43126 Parma, Italy
- Correspondence:
| | - Maria Clotilde Carra
- Rothschild Hospital, AP-HP, Université Paris Cité, U.F.R. of Odontology, 75006 Paris, France
| | - Giorgio Bianchi
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
| | - Nicola de’Angelis
- Unit of Digestive and HPB Surgery, CARE Department, Henri Mondor Hospital, AP-HP, 94010 Créteil, France
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Sadeq AA, Hasan SS, AbouKhater N, Conway BR, Abdelsalam AE, Shamseddine JM, Babiker ZOE, Nsutebu EF, Bond SE, Aldeyab MA. Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11101306. [PMID: 36289964 PMCID: PMC9598859 DOI: 10.3390/antibiotics11101306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/18/2022] [Accepted: 09/21/2022] [Indexed: 11/30/2022] Open
Abstract
Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: -0.99; 95% CI: -2.38, 0.39) and a significant reduction in antibiotics' days of therapy (MD: -2.73; 95% CI: -3.92, -1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.
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Affiliation(s)
- Ahmed A. Sadeq
- Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. Box 11001, United Arab Emirates
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Noha AbouKhater
- Department of Medicine, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. Box 11001, United Arab Emirates
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Abeer E. Abdelsalam
- Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. Box 11001, United Arab Emirates
| | - Jinan M. Shamseddine
- Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. Box 11001, United Arab Emirates
| | - Zahir Osman Eltahir Babiker
- Division of Infecious Diseases, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. Box 11001, United Arab Emirates
| | - Emmanuel Fru Nsutebu
- Division of Infecious Diseases, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. Box 11001, United Arab Emirates
| | - Stuart E. Bond
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield WF1 4DG, UK
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK
- Correspondence: ; Tel.: +44-01484-472825
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Boyd AR, Lewis AL, Dallas S, Xenakis E, Ramsey PS. Comparison of obstetric to institutional antibiogram as an approach to advance antimicrobial stewardship in maternal care. J Matern Fetal Neonatal Med 2022; 35:10226-10231. [PMID: 36117423 DOI: 10.1080/14767058.2022.2122793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
OBJECTIVE To create an antibiogram derived exclusively from our obstetric population and compare the clinical isolates and susceptibilities to our institutional antibiogram. METHODS Data collected by the University Hospital Clinical Microbiology Laboratory in SSC Soft from 01/01/2018 to 12/31/2018 was used to generate our institutional antibiogram. For comparison, we created an obstetric (OB) antibiogram using all clinical isolates collected during the same time interval from OB triage, labor & delivery, antepartum and postpartum wards. The antibiotic susceptibilities of the OB clinical isolates were compared to the institutional clinical isolates. RESULTS In total, we identified 929 clinical isolates from our OB population in 2018. Urine was the predominant source of clinical isolates (76.3%). The remaining sources included wound (10.1%), genital (9.0%), blood and other fluids (4.6%). Escherichia coli (E. coli) accounted for nearly half of all isolates (48.7%) followed by Group B Streptococcus (10.7%), Enterococcus spp. (9%), and Klebsiella pneumoniae (7.2%). There was no difference in susceptibilities of Gram-positive organisms in the OB antibiogram compared to the institutional antibiogram. Conversely, common Gram-negative organisms demonstrated less antibiotic resistance in the OB antibiogram compared to the institutional antibiogram. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis were significantly more susceptible in the OB antibiogram compared to the institutional antibiogram to most antimicrobials tested. CONCLUSION Compared to our institutional antibiogram, gram-negative clinical isolates in our OB population exhibit less antibiotic resistance. Creation of an OB-specific antibiogram, which more accurately reflects antibiotic resistance patterns within our unique patient population, may promote appropriate antimicrobial use by assisting in more informed antibiotic selection and limit unnecessary use of broad-spectrum antibiotics.
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Affiliation(s)
- Angela R Boyd
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, TX, USA
| | - Ariana L Lewis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, TX, USA
| | - Steven Dallas
- Clinical Microbiology Laboratory, University Hospital, TX, USA
| | - Elly Xenakis
- Alice L. Walton School of Medicine, Bentonville, AR, USA
| | - Patrick S Ramsey
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Texas Health San Antonio, TX, USA
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165
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Schartz WR, Bennett N, Aragon L, Kennedy K, Wilson A, Boyd S, Humphrey M, Essmyer C. Templated microbiology comments with candiduria to enhance antimicrobial stewardship. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e156. [PMID: 36483356 PMCID: PMC9726485 DOI: 10.1017/ash.2022.292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To evaluate the effect of templated microbiology reporting comments on antifungal utilization in patients with candiduria. DESIGN In this retrospective, quasi-experimental study, we evaluated a preimplementation cohort (June 2018-January 2019) compared with a postimplementation cohort (June 2019-January 2020). SETTING A multisite health system including 1 academic hospital and 4 community hospitals. PATIENTS Patients were aged ≥18 years, were hospitalized, and had candiduria documented at least once during their admission. The study included 156 patients in the preimplementation period and 141 patients in the postimplementation period. METHODS In June 2019, Saint Luke's Health System implemented the use of templated comments for urine cultures with Candida spp growth. When Candida is isolated, the following comment appears in the microbiology result section: "In the absence of symptoms, Candida is generally considered normal flora. No therapy indicated unless high risk (pregnant, neonate, or neutropenic) or undergoing urologic procedure. If Foley catheter present, remove or replace when able." The primary outcome was rate of antifungal prescribing. RESULTS Antifungal administration within 72 hours of a culture identifying a Candida spp occurred in 75 patients in the preimplementation group and 48 patients in the postimplementation group (48.1% vs 34.0%; P = .02). We did not detect a difference between groups in antifungal administration between 73 and 240 hours (1.3% vs 3.5%; P = .26), nor did we detect a difference in median antifungal duration (4 vs 3 days; P = .43). CONCLUSION Using a templated comment with urine cultures reduced antifungal prescription rates in hospitalized patients with candiduria. This strategy is a low-resource technique to improve antimicrobial stewardship.
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Affiliation(s)
- Weston R. Schartz
- Department of Pharmacy, Saint Luke’s Health System, Kansas City, Missouri
| | - Nicholas Bennett
- Antimicrobial and Diagnostic Advisement Program, Saint Luke’s Health System, Kansas City, Missouri
| | - Laura Aragon
- Antimicrobial and Diagnostic Advisement Program, Saint Luke’s Health System, Kansas City, Missouri
| | - Kevin Kennedy
- Department of Biostatistics, Saint Luke’s Health System, Kansas City, Missouri
| | - Austin Wilson
- Department of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sarah Boyd
- Antimicrobial and Diagnostic Advisement Program, Saint Luke’s Health System, Kansas City, Missouri
- Department of Infectious Diseases, Saint Luke’s Health System, Kansas City, Missouri
| | - Matthew Humphrey
- Department of Microbiology, Saint Luke’s Health System, Kansas City, Missouri
| | - Cynthia Essmyer
- Department of Microbiology, Saint Luke’s Health System, Kansas City, Missouri
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166
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Antibiotic Use among Patients Visiting Primary Hospitals in Northwest Ethiopia: A Multicenter Cross-Sectional Survey. Adv Pharmacol Pharm Sci 2022. [DOI: 10.1155/2022/2306637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Antimicrobial medications are becoming ineffective because of the surge in antimicrobial resistance. Poor knowledge and inappropriate beliefs combined with the misuse of antibiotics may be common in the community and public health institutions. This study assessed the knowledge, belief, and antibiotic use practice among patients visiting rural hospitals in Northwest Ethiopia. Methods. A facility-based multicenter cross-sectional survey was conducted in Northwest Ethiopian primary hospitals from August to September 2020. The data are presented as frequencies and means (±SD) of our findings. The independent samples T test and One-Way Analysis of Variance (ANOVA) were used to explore the mean knowledge differences of antibiotic use among respondents. A
value of <0.05 with 95% CI was considered significant. Results. More than half of the participants (57.2%) were males, and the mean age was 34.8 ± 13.4 years. The mean (±SD) knowledge score of the respondents was 3.69 (±1.7) (range: 0 to 10), and the majority (69.7%) had poor knowledge. The mean (±SD) belief score (acceptance towards antibiotic use) of the respondents was 20.08 ± 4 (range: 7 to 35) and most (70.1%) of the respondents had moderate levels of perception regarding antibiotic use. The majority (69.5%) of respondents took antibiotics over the past year. Participants practiced inappropriate uses of antibiotics such as medication discontinuation (49.5%), keeping unused antibiotics for future use (35.5%), and sharing medications with/from others (30.1%). Diploma holder participants had significantly higher mean knowledge scores on antibiotic use than those who were unable to read and write (
). Similarly, students had higher mean knowledge scores compared with farmers (
), merchants (
), and housewives (
). Conclusion. Our study showed a widespread misuse of antibiotics in Northwest Ethiopia. Malpractice such as dose interrupting, sharing of antibiotics for/from the others, and keeping leftover drugs for future use were common among the respondents. These findings suggest that a greater effort is required in public education related to proper and safe uses of antibiotics and that greater efforts are needed to enforce the control of antibiotic use to overcome the emergence of antibiotic resistance.
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167
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Spectrum scores: Toward a better definition of de-escalation. Infect Control Hosp Epidemiol 2022:1-3. [DOI: 10.1017/ice.2022.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Spectrum scores measure antimicrobial utilization while also quantifying the spectrum of activity. Accordingly, changes in spectrum score can be used to identify antimicrobial de-escalation. We show that spectrum-score–based de-escalation has a 95.7% positive percentage agreement and 81.6% negative percentage agreement versus de-escalation defined as stopping either antistaphylococcal or antipseudomonal agents.
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168
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Katzman M, Cohrs AC, Hnatuck PE, Greene WH, Reed SM, Ward MA, Glasser FD, Loser MF, Hale CM. Impact of a Multipronged Approach to Reduce the Incidence of Clostridioides difficile Infections in Hospitalized Patients. Am J Infect Control 2022; 51:668-674. [PMID: 36075295 DOI: 10.1016/j.ajic.2022.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Effective approaches to reduce Clostridioides difficile infections (CDI) in hospitalized patients are needed. We report data from 3 years preceding and 3 years following interventions that proved successful, with detailed analysis of all cases the first year after implementation. METHODS Interventions included a nursing protocol to identify cases present on admission by asking if the patient had 1 or more liquid stools in the last 24 hours, and a 2-step testing algorithm with samples positive by polymerase chain reaction (PCR) for the C. difficile toxin gene reflexing to an enzyme immunoassay (EIA) for the toxin antigen. RESULTS Healthcare-associated infections due to CDI fell from ∼160 in each of the preceding 3 years to <65 in each of the subsequent 3 years (P<0.001), while the ratio of observed-to-expected hospital-onset cases diminished to ∼0.50 (P<0.02). In the first year, 395 samples were PCR(+), but only 118 (29.9%) of these were EIA(+). 55 (46.6%) of the PCR(+)/EIA(+) samples were from hospital day 1 or 2 and classified as present on admission. The mean time from stool collection to report of PCR results was ∼7.5 hours, and the EIA took on average only 68 additional minutes to be reported. CONCLUSIONS The number of incident CDI cases can be dramatically decreased by implementing an admission screening question and a 2-step testing algorithm.
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Affiliation(s)
- Michael Katzman
- Department of Medicine and Department of Microbiology and Immunology, Penn State College of Medicine, Milton S. Hershey Medical Center, Hershey, PA.
| | - Austin C Cohrs
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA
| | - Patricia E Hnatuck
- Department of Quality and Infection Prevention, Milton S. Hershey Medical Center, Hershey, PA
| | - Wallace H Greene
- Department of Clinical Pathology, Milton S. Hershey Medical Center, Hershey, PA
| | - Stephanie M Reed
- Department of Nursing, Milton S. Hershey Medical Center, Hershey, PA
| | | | | | | | - Cory M Hale
- Department of Pharmacy, Milton S. Hershey Medical Center, Hershey, PA
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169
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Brigadoi G, Gastaldi A, Moi M, Barbieri E, Rossin S, Biffi A, Cantarutti A, Giaquinto C, Da Dalt L, Donà D. Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis. Antibiotics (Basel) 2022; 11:antibiotics11091192. [PMID: 36139971 PMCID: PMC9494981 DOI: 10.3390/antibiotics11091192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings.
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Affiliation(s)
- Giulia Brigadoi
- Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
- Correspondence: ; Tel.: +39-3476959589
| | - Andrea Gastaldi
- Department of Pediatrics, Women’s and Children’s Health, University of Verona, Piazz. Stefani 1, 37126 Verona, Italy
| | - Marco Moi
- Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Elisa Barbieri
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Sara Rossin
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Via Giustiani 3, 35128 Padua, Italy
| | - Annalisa Biffi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Anna Cantarutti
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, 20126 Milan, Italy
| | - Carlo Giaquinto
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
| | - Liviana Da Dalt
- Pediatric Emergency Department, Department for Woman and Child Health, University of Padua, Via Giustiani 3, 35128 Padua, Italy
| | - Daniele Donà
- Division of Pediatric Infectious Diseases, Department for Women’s and Children’s Health, University of Padua, Via Giustiniani 3, 35128 Padua, Italy
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170
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Self-reported antibiotic stewardship and infection control measures from 57 intensive care units: An international ID-IRI survey. J Infect Public Health 2022; 15:950-954. [DOI: 10.1016/j.jiph.2022.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/12/2022] [Accepted: 07/21/2022] [Indexed: 11/23/2022] Open
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171
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Martín Guerra JM, Moreta Rodríguez M. Cefditoren-induced hepatitis. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2022; 114:563-564. [PMID: 35373567 DOI: 10.17235/reed.2022.8801/2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
There are many daily antibiotic prescriptions, especially beta-lactams in trivial infections such as cystitis in young women. Many of these drugs carry an implicit probability of producing hepatotoxicity, manifested by a nonspecific general picture and elevated analytical transaminases. We must take it into account when making the differential diagnosis in the hepatotoxicity study and suspend it as soon as we recognize it.
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172
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Lim AH, Ab Rahman N, Ong SM, Paraja J, Rashid R, Parmar IS, Dahlan SN, Tan ZSS, Bohari I, Peariasamy KM, Sivasampu S. Evaluation of BNT162b2 vaccine effectiveness in Malaysia: test negative case-control study. Vaccine 2022; 40:5675-5682. [PMID: 36030123 PMCID: PMC9399819 DOI: 10.1016/j.vaccine.2022.08.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 12/01/2022]
Abstract
There is a notable lack of vaccine effectiveness studies using test-negative case-controlled approach in low- and middle-income countries which have different logistic, demographic and socio-economic conditions from high-income countries. We aimed to estimate the effectiveness of BNT162b2 vaccine against COVID-19 infection over time, intensive care unit admission, severe or critical disease and death due to COVID-19. This study was conducted in the resident population of Labuan aged ≥18 years who had been tested for SARS-CoV-2 by Reverse-Transcriptase Polymerase Chain Reaction between 1 March 2021 and 31 October 2021. We used a test-negative case-control design where 2644 pairs of cases and controls were matched by age, sex, testing date, nationality and testing reason. Analysis was stratified by age group to estimate age effect (<60 years and ≥60 years). Of 22217 individuals tested by Reverse-Transcriptase Polymerase Chain Reaction, 5100 were positive for SARS-CoV-2 and aged 18 years and above. Overall vaccine effectiveness ≥ 14 days after the second dose was 65.2% (95% CI: 59.8–69.9%) against COVID-19 infection, 92.5% (95% CI: 72.3–98.8%) against intensive care unit admission, and 96.5% (95% CI: 82.3–99.8%) against COVID-19 deaths. Among infected individuals, vaccine effectiveness was 79.2% (95% CI: 42.3–94.1%) in preventing severe or critical disease due to COVID-19. Vaccine effectiveness for ≥60 years was 72.3% (95% CI: 53.4–83.9%) in fully vaccinated individuals, higher than 64.8% (95% CI: 49.3–59.1%) for those <60 years. Two doses of BNT162b2 were highly effective against COVID-19 infection, severe or critical disease, intensive care unit admission and death due to COVID-19. This study addresses a gap in literature on BNT162b2 vaccine effectiveness in low- and middle-income populations and demonstrates the feasibility of such a study design in a resource limited setting while supporting evidence of waning immunity.
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Affiliation(s)
- Audrey Huili Lim
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia.
| | - Norazida Ab Rahman
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Su Miin Ong
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | | | - Rahmah Rashid
- Labuan State Health Department, Ministry of Health, Malaysia
| | | | | | | | - Ismuni Bohari
- Labuan State Health Department, Ministry of Health, Malaysia
| | - Kalaiarasu M Peariasamy
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
| | - Sheamini Sivasampu
- Institute for Clinical Research, National Institutes of Health, Ministry of Health, Malaysia
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Kapadia C, Kachhdia R, Singh S, Gandhi K, Poczai P, Alfarraj S, Ansari MJ, Gafur A, Sayyed RZ. Pseudomonas aeruginosa inhibits quorum-sensing mechanisms of soft rot pathogen Lelliottia amnigena RCE to regulate its virulence factors and biofilm formation. Front Microbiol 2022; 13:977669. [PMID: 36090086 PMCID: PMC9450810 DOI: 10.3389/fmicb.2022.977669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 01/21/2023] Open
Abstract
The quorum-sensing (QS) cascade is responsible for the colonization and phenotypic behavior of the pathogenic organism and the regulation of diverse signal molecules. The disruption of the quorum-sensing system is an effective strategy to overcome the possibility of antibiotic resistance development in the pathogen. The quorum quenching does not kill the microbes. Instead, it hinders the expression of pathogenic traits. In the present experiment, Pseudomonas aeruginosa RKC1 was used to extract the metabolites responsible for quorum-sensing inhibition in soft rot pathogen Lelliottia amnigena RCE. During the initial screening, P. aeruginosa RKC1 was found to be most promising and inhibits violacein of Chromobacterium violaceum MTCC2656 pyocyanin, swarming-swimming motility of P. aeruginosa MTCC2297. The characterization of metabolites produced by the microbes which are responsible for quorum-sensing inhibition through GC-MS is very scarce in scientific literature. The ethyl acetate extract of P. aeruginosa RKC1 inhibits biofilm formation of L. amnigena RCE while inhibiting growth at higher concentrations. The GC-MS analysis suggested that Cyclic dipeptides (CDPs) such as Cyclo (L-prolyl-L-valine), Cyclo (Pro-Leu), and Cyclo(D-phenylalanyl-L-prolyl) were predominantly found in the ethyl acetate extract of the P. aeruginosa RKC1 (93.72%). This diketopiperazine (DKPs) exhibited quorum-sensing inhibition against the pathogen in liquid media during the active growth phase and regulated diverse metabolites of the pathogen. Moreover, the metabolites data from the clear zone around wells showed a higher concentration of DKSs (9.66%) compared to other metabolites. So far, very few reports indicate the role of DKPs or CDPs in inhibiting the quorum-sensing system in plant pathogenic bacteria. This is one such report that exploits metabolites of P. aeruginosa RKC1. The present investigation provided evidence to use quorum-sensing inhibitor metabolites, to suppress microbes' pathogenesis and thus develop an innovative strategy to overcome antibiotic resistance.
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Affiliation(s)
- Chintan Kapadia
- Department of Plant Molecular Biology and Biotechnology, ASPEE College of Horticulture and Forestry, Navsari Agricultural University, Navsari, India
- *Correspondence: Chintan Kapadia
| | - Rinkal Kachhdia
- Department of Plant Molecular Biology and Biotechnology, ASPEE College of Horticulture and Forestry, Navsari Agricultural University, Navsari, India
| | - Susheel Singh
- Food Quality Testing Laboratory, N. M. College of Agriculture, Navsari Agricultural University, Navsari, India
| | - Kelvin Gandhi
- Food Quality Testing Laboratory, N. M. College of Agriculture, Navsari Agricultural University, Navsari, India
| | - Peter Poczai
- Finnish Museum of Natural History, University of Helsinki, Helsinki, Finland
- Peter Poczai
| | - Saleh Alfarraj
- Zoology Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Javed Ansari
- Department of Botany, Hindu College, Moradabad (Mahatma Jyotiba Phule Rohilkhand University Bareilly), Moradabad, India
| | - Abdul Gafur
- Sinarmas Forestry Corporate Research and Development, Perawang, Indonesia
| | - R. Z. Sayyed
- Department of Microbiology, PSGVP Mandals, S I Patil Arts, G B Patel Science and STKV Sangh Commerce College, Shahada, India
- R. Z. Sayyed
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174
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Siachalinga L, Mufwambi W, Lee LH. Impact of Antimicrobial Stewardship Interventions to Improve Antibiotic Prescribing for Hospital Inpatients in Africa: A Systematic Review and Meta-analysis. J Hosp Infect 2022; 129:124-143. [PMID: 35970382 DOI: 10.1016/j.jhin.2022.07.031] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) interventions to improve antibiotic use are being implemented in Africa, but their impact is not fully known. AIM To estimate the effectiveness of interventions to improve antibiotic prescribing for hospital inpatients. METHODS Systematically searched for studies from PubMed, Embase, African Journals online and Google scholar from January 2010 to July 2022. Studies were included if they reported the impact of AMS interventions on outcomes of interest for hospital inpatients in Africa. Risk of bias was evaluated using the Cochrane Effective Practice and Organization of Care guidelines and the National Heart, Lung and Blood Institute tool. Findings were summarized in tables and meta-analyses were performed using random-effects models. FINDINGS Twenty-eight studies were included, 89% being uncontrolled before and after studies. Most interventions employed were multifaceted and found to be effective, evidenced by increased compliance, reduction in antibiotic utilization and cost, and slight reduction or no difference in mortality and length of hospital stay (LOS). Meta-analysis generated a relative risk of 0.82 (95% CI: 0.70∼0.97) for mortality, and a standard mean difference of -0.30 (95% CI: -0.41∼-0.19) for LOS. Generally, a decrease in resistance to most microorganisms was observed. Despite an increase in the number of AMS studies conducted in Africa, the studies lack in most quality design features for AMS studies. CONCLUSION Antimicrobial stewardship interventions are likely to be effective, however efforts are still required to align the study design with the quality design features required for validity and to inform practice.
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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, 50110, Zambia
| | - Lyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
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175
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Amin D, Garzón-Orjuela N, Garcia Pereira A, Parveen S, Vornhagen H, Vellinga A. Artificial intelligence to improve antimicrobial prescribing: A protocol for a systematic review. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13582.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: The inappropriate use of antimicrobials is a threat to their effectiveness and often results in antimicrobial resistance (AMR) and difficult to treat infections. Different methods have been implemented to control AMR, and in recent years, artificial intelligence (AI) has been used to improve antimicrobial prescribing. However, there is insufficient information about the contribution of AI in improving antimicrobial prescribing. This systematic review aims to determine whether the use of AI can improve antimicrobial prescribing for human patients. Methods: Observational studies that examine the potential or actual use of AI in improving antimicrobial prescribing cited in IEEE Xplore, ScienceDirect, Scopus, Web of Science, OVID, EMBASE and ACM will be included in this systematic review. There will be no restriction on language, nor the setting (i.e.: primary care or hospital) nor the time when the studies included were conducted. The primary outcome of this systematic review is the relative reduction in prescribed antimicrobials, while the secondary outcome is the relative reduction in patients’ consultations, whether for infection recurrence or worsening of symptoms. Data will be meta-analyzed with a Random Effects Model. The I2 statistic for heterogeneity will be calculated and the Newcastle Ottawa Scale Tool will be used to assess risk of bias. Dissemination: The results will be disseminated through a peer-reviewed publication and scientific sessions. PROSPERO Registration: This protocol has been registered in PROSPERO online database (CRD42022329049; 14 May 2022).
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176
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Yamaguchi R, Yamamoto T, Okamoto K, Tatsuno K, Ikeda M, Tanaka T, Wakabayashi Y, Sato T, Okugawa S, Moriya K, Suzuki H. Prospective audit and feedback implementation by a multidisciplinary antimicrobial stewardship team shortens the time to de-escalation of anti-MRSA agents. PLoS One 2022; 17:e0271812. [PMID: 35905080 PMCID: PMC9337637 DOI: 10.1371/journal.pone.0271812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 07/07/2022] [Indexed: 11/18/2022] Open
Abstract
Prospective audit and feedback (PAF) is considered an effective procedure for appropriate antibiotic use. However, its effect on the time to de-escalation is unclear. We aimed to evaluate the effect of daily PAF implementation, focusing on the time to de-escalation of anti-methicillin‐resistant Staphylococcus aureus (MRSA) agents as an outcome measure. To this end, a single-center, retrospective, quasi-experimental study including patients treated with intravenous anti-MRSA agents during pre-PAF (April 1, 2014 to March 31, 2015) and post-PAF (April 1, 2015 to March 31, 2016) periods was conducted. The time to de-escalation was estimated using the Kaplan–Meier method, and Cox proportional hazard analysis was performed to assess the effect of daily PAF implementation on the time to de-escalation. Interrupted time series analysis was used to evaluate the relationship between daily PAF implementation and anti-MRSA agent utilization data converted to defined daily dose (DDD) and days of therapy (DOT) per 1,000 patient days. The median time to de-escalation was significantly shorter in the post-PAF period than in the pre-PAF period (6 days vs. 7 days, P < 0.001). According to multivariate analysis, PAF implementation was independently associated with a shorter time to de-escalation (hazard ratio [HR], 1.18; 95% confidence interval [CI], 1.02 to 1.35). There were no significant differences in hospital mortality, 30-day mortality, and length of stay between the two periods. Interrupted time series analysis showed significant reductions in the trends of DDD (trend change, –0.65; 95% CI, –1.20 to –0.11) and DOT (trend change, –0.74; 95% CI, –1.33 to –0.15) between the pre-PAF and post-PAF periods. Daily PAF implementation for patients treated with intravenous anti-MRSA agents led to a shorter time to de-escalation and lower consumption of anti-MRSA agents without worsening the clinically important outcomes.
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Affiliation(s)
- Ryo Yamaguchi
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
- * E-mail:
| | - Takehito Yamamoto
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
- The Education Center for Clinical Pharmacy, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Keita Tatsuno
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Mahoko Ikeda
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Takehiro Tanaka
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | | | - Tomoaki Sato
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
| | - Shu Okugawa
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Kyoji Moriya
- Department of Infection Control and Prevention, The University of Tokyo Hospital, Tokyo, Japan
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Hiroshi Suzuki
- Department of Pharmacy, The University of Tokyo Hospital, Tokyo, Japan
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Elligsen M, Wan M, Lam PW, Lo J, Taggart LR, Chan AJ, Downing M, Gough K, Seah J, Leung E. Trends in hospital antibiotic utilization during the coronavirus disease 2019 (COVID-19) pandemic: A multicenter interrupted time-series analysis. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e128. [PMID: 36483375 PMCID: PMC9726493 DOI: 10.1017/ash.2022.268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To describe the evolution of respiratory antibiotic prescribing during the coronavirus disease 2019 (COVID-19) pandemic across 3 large hospitals that maintained antimicrobial stewardship services throughout the pandemic. DESIGN Retrospective interrupted time-series analysis. SETTING A multicenter study was conducted including medical and intensive care units (ICUs) from 3 hospitals within a Canadian epicenter for COVID-19. METHODS Interrupted time-series analysis was used to analyze rates of respiratory antibiotic utilization measured in days of therapy per 1,000 patient days (DOT/1,000 PD) in medical units and ICUs. Each of the first 3 waves of the pandemic were compared to the baseline. RESULTS Within the medical units, use of respiratory antibiotics increased during the first wave of the pandemic (rate ratio [RR], 1.76; 95% CI, 1.38-2.25) but returned to the baseline in waves 2 and 3 despite more COVID-19 admissions. In ICU, the use of respiratory antibiotics increased in wave 1 (RR, 1.30; 95% CI, 1.16-1.46) and wave 2 of the pandemic (RR, 1.21; 95% CI, 1.11-1.33) and returned to the baseline in the third wave, which had the most COVID-19 admissions. CONCLUSIONS After an initial surge in respiratory antibiotic prescribing, we observed the normalization of prescribing trends at 3 large hospitals throughout the COVID-19 pandemic. This trend may have been due to the timely generation of new research and guidelines developed with frontline clinicians, allowing for the active application of new research to clinical practice.
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Affiliation(s)
- Marion Elligsen
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Michael Wan
- Department of Pharmacy, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Philip W. Lam
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Lo
- Department of Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Linda R. Taggart
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - April J. Chan
- Department of Pharmacy, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Mark Downing
- Division of Infectious Diseases, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Kevin Gough
- Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Medicine, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jenny Seah
- Department of Pharmacy, St Joseph’s Health Centre, Unity Health Toronto, Toronto, Ontario, Canada
| | - Elizabeth Leung
- Department of Pharmacy, St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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178
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Van Dort BA, Carland JE, Penm J, Ritchie A, Baysari MT. Digital interventions for antimicrobial prescribing and monitoring: a qualitative meta-synthesis of factors influencing user acceptance. J Am Med Inform Assoc 2022; 29:1786-1796. [PMID: 35897157 PMCID: PMC9471701 DOI: 10.1093/jamia/ocac125] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/16/2022] [Accepted: 07/16/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To understand and synthesize factors influencing user acceptance of digital interventions used for antimicrobial prescribing and monitoring in hospitals. MATERIALS AND METHODS A meta-synthesis was conducted to identify qualitative studies that explored user acceptance of digital interventions for antimicrobial prescribing and/or monitoring in hospitals. Databases were searched and qualitative data were extracted and systematically classified using the unified theory of acceptance and use of technology (UTAUT) model. RESULTS Fifteen qualitative studies met the inclusion criteria. Eleven papers used interviews and four used focus groups. Most digital interventions evaluated in studies were decision support for prescribing (n = 13). Majority of perceptions were classified in the UTAUT performance expectancy domain in perceived usefulness and relative advantage constructs. Key facilitators in this domain included systems being trusted and credible sources of information, improving performance of tasks and increasing efficiency. Reported barriers were that interventions were not considered useful for all settings or patient conditions. Facilitating conditions was the second largest domain, which highlights the importance of users having infrastructure to support system use. Digital interventions were viewed positively if they were compatible with values, needs, and experiences of users. CONCLUSIONS User perceptions that drive users to accept and utilize digital interventions for antimicrobial prescribing and monitoring were predominantly related to performance expectations and facilitating conditions. To ensure digital interventions for antimicrobial prescribing are accepted and used, we recommend organizations ensure systems are evaluated and benefits are conveyed to users, that utility meets expectations, and that appropriate infrastructure is in place to support use.
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Affiliation(s)
- Bethany A Van Dort
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Jane E Carland
- Department of Clinical Pharmacology and Toxicology, St Vincent's Hospital Sydney, Sydney, New South Wales, Australia.,St Vincent's Clinical School, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jonathan Penm
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Pharmacy, Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, New South Wales, Australia.,Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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Koomanachai P, Srisompong J, Chayangsu S, Ruangkriengsin D, Thamlikitkul V, Wangchinda W, Sirijatuphat R, Rattanaumpawan P. Implementation of Clinical Practice Guidelines for Empirical Antibiotic Therapy of Bacteremia, Urinary Tract Infection, and Pneumonia: A Multi-Center Quasi-Experimental Study. Antibiotics (Basel) 2022; 11:antibiotics11070903. [PMID: 35884157 PMCID: PMC9311984 DOI: 10.3390/antibiotics11070903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 11/16/2022] Open
Abstract
A quasi-experimental study was conducted on the implementation of locally developed clinical practice guidelines (CPGs) for empirical antibiotic (ATB) therapy of common infections (bacteremia, urinary tract infection (UTI), pneumonia) in the hospitals from January 2019 to December 2020. The CPGs were developed using data from patients with these infections at individual hospitals. Relevant CPG data pre- and post-implementation were collected and compared. Of the 1644 patients enrolled in the study, 808 and 836 were in the pre- and post-implementation periods, respectively, and patient outcomes were compared. Significant reductions in the mean durations of intensive care unit stay (3.44 ± 9.08 vs. 2.55 ± 7.89 days; p = 0.035), ventilator use (5.73 ± 12.14 vs. 4.22 ± 10.23 days; p = 0.007), piperacillin/tazobactam administration (0.954 ± 3.159 vs. 0.660 ± 2.217 days, p = 0.029), and cefoperazone/sulbactam administration (0.058 ± 0.737 vs. 0.331 ± 1.803 days, p = 0.0001) occurred. Multivariate analysis demonstrated that CPG-implementation was associated with favorable clinical outcomes (adjusted odds ratio 1.286, 95% confidence interval: 1.004–1.647, p = 0.046). Among patients who provided follow-up cultures (n = 284), favorable microbiological responses were significantly less frequent during the pre-implementation period than the post-implementation period (80.35% vs. 91.89%; p = 0.01). In conclusion, the locally developed CPG implementation is feasible and effective in improving patient outcomes and reducing ATB consumption. Hospital antimicrobial stewardship teams should be able to facilitate CPG development and implementation for antimicrobial therapy for common infections.
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Affiliation(s)
- Pornpan Koomanachai
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.K.); (V.T.); (W.W.); (R.S.)
| | | | | | | | - Visanu Thamlikitkul
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.K.); (V.T.); (W.W.); (R.S.)
| | - Walaiporn Wangchinda
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.K.); (V.T.); (W.W.); (R.S.)
| | - Rujipas Sirijatuphat
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.K.); (V.T.); (W.W.); (R.S.)
| | - Pinyo Rattanaumpawan
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand; (P.K.); (V.T.); (W.W.); (R.S.)
- Correspondence:
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180
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Doyle D, Rennert-May E, Somayaji R. Antimicrobial Stewardship in Wound Care. Adv Skin Wound Care 2022; 35:405-407. [PMID: 35723959 DOI: 10.1097/01.asw.0000831884.62594.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Doyle
- At the University of Calgary, Alberta, Canada, Department of Medicine, Daniel Doyle, MD, is Infectious Diseases Resident; Elissa Rennert-May, MD, MSc, FRCPC, is Assistant Professor, Infectious Diseases Specialist; and Ranjani Somayaji, BScPT, MD, MPH, FRCPC, is Assistant Professor, Infectious Diseases Specialist, Department of Microbiology, Immunology and Infectious Disease. Submitted August 9, 2021; accepted in revised form November 1, 2021
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181
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Elsawah H, Samir A, Elrazzaz M, Ramadan A, Elnaggar A, Taema K. Carbapenems consumption and Klebsiella resistance in intensive care units in Egypt: A study to evaluate the effect of an antimicrobial stewardship program. J Infect Prev 2022; 23:142-148. [PMID: 37256159 PMCID: PMC10226057 DOI: 10.1177/17571774211060436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 08/31/2021] [Indexed: 09/20/2023] Open
Abstract
Background The high prevalence of carbapenem-resistant Klebsiella imposes optimizing antibiotic consumption. We aimed to evaluate the impact of antibiotic stewardship program on carbapenem consumption and the Klebsiella resistance. Method We retrospectively evaluated critically ill patients with isolated Klebsiella species from Elaraby hospital, Egypt during the period from April 2017 to January 2019. We collected data related to carbapenems consumption and Klebsiella clinical isolates with their antimicrobial susceptibility. Based on susceptibility, Klebsiella isolates were classified into sensitive, extended spectrum beta-lactamase (ESBL) producer, and carbapenem-resistant Klebsiella (CRK), respectively. Our primary outcome was the change in carbapenems consumption after implementing the program, while the secondary outcomes were the changes in the incidence of CRK. Results The study included 205 patients with isolated Klebsiella species during the study period. The antibiotic stewardship program started in March 2018. Out of the 205 patients, 61 patients (29.8%) represented the pre-intervention sample, and 144 patients (70.2%) represented the post-intervention sample. Applying the antibiotic stewardship program was associated with a significant decrease in the carbapenems consumption from 38.9 to 26.6 defined daily dose/1000 patient-days (p = 0.02). The incidence of CRK was decreased from 85.25% of total Klebsiella isolates to 48.6% (p < 0.001). Klebsiella species were more likely to be in a lower category of resistance after applying the program with an odds ratio of 6.3 (2.88-13.73) using ordinal logistic regression. Conclusion Applying the antibiotic stewardship program could reduce the unnecessary carbapenems use in the ICU with a subsequent decrease in the emergence of the Klebsiella-resistant strains.
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Affiliation(s)
- Hozaifa Elsawah
- Biostatistics Department, High Institute of Public Health, Alexandria University, Egypt
| | | | | | | | | | - Khaled Taema
- Critical Care Department, Kasr Alainy Hospitals, Cairo University, Egypt
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182
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Papanikolopoulou A, Maltezou HC, Kritikou H, Papadopoulos T, Kandalepas G, Pentzouris A, Kartsonakis I, Chronopoulou G, Gargalianos-Kakolyris P, Pantazis N, Tsakris A, Kantzanou M. Six-Year Time-Series Data on Multidrug-Resistant Bacteremia, Antibiotic Consumption, and Infection Control Interventions in a Hospital. Microb Drug Resist 2022; 28:806-818. [PMID: 35834622 DOI: 10.1089/mdr.2022.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
Background: Multidrug-resistant (MDR) bacteremia is a serious health care-associated infection with significant morbidity and excess hospitalization costs. Our aim is to study the association between incidences of MDR bacteremia, antibiotic consumption, and infection control measures in a hospital from 2013 to 2018. Methods: We analyzed the following indices: (1) incidence of bacteremia (carbapenem-resistant Acinetobacter baumanii, Pseudomonas aeruginosa, and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococci); (2) use of antibiotics; (3) consumption of disinfectant solutions for hand hygiene; and (4) isolation rates of MDR carrier patients. Findings: The use of advanced antibiotics (p = 0.001) and carbapenems (p = 0.008) decreased significantly in all hospital departments but the incidence of total MDR bacteremia did not change significantly. Increased use of hand disinfectant solutions was statistically associated with decreased incidence of total MDR bacteremia (incidence rate ratio [IRR]: 0.94, confidence interval [95% CI]: 0.90-0.99, p: 0.020) in all hospital. Also, increased isolation rates of MDR carrier patients 2 months before correlated with decreased incidence of bacteremia due to carbapenem-resistant gram-negative pathogens (IRR: 0.35, 95% CI: 0.18-0.66, p: 0.001) in adults intensive care unit. Conclusion: In our hospital, hand hygiene and isolation of MDR carrier patients controlled MDR bacteremia.
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Affiliation(s)
| | - Helena C Maltezou
- Directorate of Research, Studies and Documentation, National Public Health Organization, Athens, Greece
| | - Helen Kritikou
- Department of Pharmacy, Alexandra General Hospital, Athens, Greece
| | - Thomas Papadopoulos
- Department of Pharmacy, European Interbalkan Medical Center, Thessaloniki, Greece
| | | | | | | | | | | | - Nikos Pantazis
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Kantzanou
- Department of Hygiene, Epidemiology and Medical Statistics, Faculty of Medicine, School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
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Antimicrobial Stewardship in Public-Sector Hospitals in KwaZulu-Natal, South Africa. Antibiotics (Basel) 2022; 11:antibiotics11070881. [PMID: 35884134 PMCID: PMC9311864 DOI: 10.3390/antibiotics11070881] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/06/2022] [Accepted: 06/09/2022] [Indexed: 01/27/2023] Open
Abstract
Antimicrobial resistance (AMR) is a serious global public-health threat. Evidence suggests that antimicrobial stewardship (AMS) is a valuable tool to facilitate rational antibiotic use within healthcare facilities. A cross-sectional situational analysis using a questionnaire was conducted to determine the current status of antimicrobial stewardship (AMS) activities in all public-sector hospitals in KwaZulu-Natal (KZN). The survey had a 79% (57, N = 72) response rate. A total of 75% of hospitals had an antimicrobial stewardship committee (AMSC), 47% (20, N = 43) had a formal written statement of support from leadership, and 7% (3, N = 43) had budgeted financial support. Only 37% (16, N = 43) had on-site or off-site support from a clinical microbiologist, and 5% (2, N = 43) had an on-site infectious disease (ID) physician. Microbiologist input on pathogen surveillance data (aOR: 5.12; 95% CI: 4.08–22.02; p-value = 0.001) and microbiological investigations prior to the commencement of antibiotics (aOR: 5.12; 95% CI: 1.08–42.01; p-value = 0.041) were significantly associated with having either on- or off-site microbiology support. Respondents that had a representative from microbiology on the AMSC were significantly associated with having and interrogating facility-specific antibiograms (P = 0.051 and P = 0.036, respectively). Those facilities that had access to a microbiologist were significantly associated with producing an antibiogram (aOR: 4.80; 95% CI: 1.25–18.42; p-value = 0.022). Facilities with an ID physician were significantly associated with having a current antibiogram distributed to prescribers within the facility (P = 0.010) and significantly associated with sending prescribers personalized communication regarding improving prescribing (P = 0.044). Common challenges reported by the facilities included suboptimal hospital management support; a lack of clinicians, pharmacists, nurses, microbiologists, and dedicated time; the lack of a multidisciplinary approach; low clinician buy-in; inadequate training; a lack of printed antibiotic guidelines; and financial restrictions for microbiological investigations. The survey identified the need for financial, IT, and management support. Microbiology and infectious disease physicians were recognized as scarce human resources.
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Abstract
BACKGROUND Diverticulitis is a complication of the common condition, diverticulosis. Uncomplicated diverticulitis has traditionally been treated with antibiotics, as diverticulitis has been regarded as an infectious disease. Risk factors for diverticulitis, however, may suggest that the condition is inflammatory rather than infectious which makes the use of antibiotics questionable. OBJECTIVES The objectives of this systematic review were to determine if antibiotic treatment of uncomplicated acute diverticulitis affects the risk of complications (immediate or late) or the need for emergency surgery. SEARCH METHODS For this update, a comprehensive systematic literature search was conducted in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, ClinicalTrials.gov and WHO International Clinical Trial Registry Platform on February 2021. SELECTION CRITERIA Randomised controlled trials (RCTs), including all types of patients with a radiologically confirmed diagnosis of left-sided uncomplicated acute diverticulitis. Comparator and interventions included antibiotics compared to no antibiotics, placebo, or to any other antibiotic treatment (different regimens, routes of administration, dosage or duration of treatment). Primary outcome measures were complications and emergency surgery. Secondary outcomes were recurrence, late complications, elective colonic resections, length of hospital stay, length to recovery of symptoms, adverse events and mortality. DATA COLLECTION AND ANALYSIS Two authors performed the searches, identification and assessment of RCTs and data extraction. Disagreements were resolved by discussion or involvement of the third author. Authors of trials were contacted to obtain additional data if needed or for preliminary results of ongoing trials. The Cochrane Collaboration's tool for assessing risk of bias was used to assess the methodological quality of the identified trials. The overall quality of evidence for outcomes was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Effect estimates were extracted as risk ratios (RRs) with 95% confidence intervals. Random-effects meta-analyses were performed with the Mantel-Haenzel method. MAIN RESULTS The authors included five studies. Three studies compared no antibiotics to antibiotics; all three were original RCTs of which two also published long-term follow-up information. For the outcome of short-term complications there may be little or no difference between antibiotics and no antibiotics (RR 0.89; 95% CI 0.30 to 2.62; 3 studies, 1329 participants; low-certainty evidence). The rate of emergency surgery within 30 days may be lower with no antibiotics compared to antibiotics (RR 0.47; 95% CI 0.13, 1.71; 1329 participants; 3 studies; low-certainty evidence). However, there is considerable imprecision due to wide confidence intervals for this effect estimate causing uncertainty which means that there may also be a benefit with antibiotics. One of the two remaining trials compared single to double compound antibiotic therapy and, due to wide confidence intervals, the estimate was imprecise and indicated an uncertain clinical effect between these two antibiotic regimens (RR 0.70; 95% CI 0.11 to 4.58; 51 participants; 1 study; low-certainty evidence). The last trial compared short to long intravenous administration of antibiotics and did not report any events for our primary outcomes. Both trials included few participants and one had overall high risk of bias. Since the first publication of this systematic review, an increasing amount of evidence supporting the treatment of uncomplicated acute diverticulitis without antibiotics has been published, but the total body of evidence is still limited. AUTHORS' CONCLUSIONS The evidence on antibiotic treatment for uncomplicated acute diverticulitis suggests that the effect of antibiotics is uncertain for complications, emergency surgery, recurrence, elective colonic resections, and long-term complications. The quality of the evidence is low. Only three RCTs on the need for antibiotics are currently available. More trials are needed to obtain more precise effect estimates.
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Affiliation(s)
- Marie-Louise Dichman
- Department of Surgical Gastroenterology , Hvidovre University Hospital, Copenhagen, Denmark
| | - Steffen Jais Rosenstock
- Department of Surgical Gastroenterology , Hvidovre University Hospital , Copenhagen, Denmark
| | - Daniel M Shabanzadeh
- Department of Surgical Gastroenterology , Hvidovre University Hosipital , Copenhagen, Denmark
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Coye TL, Foote C, Stasko P, Demarco B, Farley E, Kalia H. Predictive Value of MRSA Nares Colonization in Diabetic Foot Infections: A Systematic Review and Bivariate Random Effects Meta-Analysis. J Foot Ankle Surg 2022; 62:576-582. [PMID: 36922315 DOI: 10.1053/j.jfas.2022.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/06/2022] [Accepted: 06/10/2022] [Indexed: 03/18/2023]
Abstract
The primary objective of this study was to assess the negative predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal swabs in MRSA diabetic foot infections. MEDLINE and Cochrane Library were searched from inception to May 1, 2020. The following search string was used: (methicillin-resistant S. aureus OR MRSA) AND (nasal OR nares) AND (diabetic OR foot OR diabetic foot infections). All studies that contained data comparing MRSA nasal swab positivity to wound cultures from diabetic foot infections and met the inclusion criteria were included. Among the 86 relevant studies, 6 studies with 8706 diabetic patients were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline extension for Diagnostic Test Accuracy reviews was followed. The primary meta-analysis outcomes were the negative and positive predictive values of MRSA nasal swabs for MRSA diabetic foot infections. The pooled specificity and pooled sensitivity were determined by generating hierarchical summary receiver characteristic operating curves. In the bivariate meta-analysis, involving the 6 studies, pooled sensitivity and specificity was 41.7% (95% confidence interval = 32.9, 51) and 94.1% (95% confidence interval = 89.5, 96.8), respectively. In low-moderate MRSA prevalence levels (<15%), negative predictive value of MRSA nasal swab was >90% and positive predictive value was <55%. This meta-analysis suggests that in patients with diabetic foot infections, the nasal swab MRSA screen has a poor positive predictive value but an excellent negative predictive value in regions of low to moderate prevalence of MRSA diabetic foot infections.
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Affiliation(s)
- Tyler L Coye
- Resident (PGY-3), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY.
| | - Courtney Foote
- Resident (PGY-3), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
| | - Paul Stasko
- Physician, Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
| | - Bethany Demarco
- Resident (PGY-2), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
| | - Eileen Farley
- Resident (PGY-2), Division of Podiatric Medicine and Surgery, Department of Orthopedics, Rochester General Hospital, Rochester, NY
| | - Hemant Kalia
- Department of Physical Medicine & Rehabilitation, Rochester Regional Health System, Rochester, NY
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186
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Nasr ZG, Moustafa DAH, Dahmani S, Wilby KJ. Investigating pharmacy students' therapeutic decision-making with respect to antimicrobial stewardship cases. BMC MEDICAL EDUCATION 2022; 22:467. [PMID: 35710400 PMCID: PMC9203133 DOI: 10.1186/s12909-022-03542-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 06/07/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) play a big role in minimizing antimicrobial resistance. Pharmacists are essential members of the health care team and in order for them to fulfill roles on ASP teams and become antimicrobial stewards, they must be prepared adequately by pharmacy schools prior to entry into actual practice. Although programming has been implemented into entry-to-practice programs worldwide, little is known about how students interpret antimicrobial stewardship (AMS) data and arrive at clinical decisions. We aimed to explore students' cognitive processes and determine how they formulate therapeutic decisions when presented with AMS cases. METHODS This was a qualitative study conducted using a case study approach, in which a sample (n=20) of pharmacy students was recruited to interpret AMS cases. Semi-structured 1-on-1 interviews were arranged with each participant. A think-aloud procedure with verbal protocol analysis was adopted to determine students' decision-making processes. Thematic analysis was used to interpret themes from the interview data. RESULTS Two themes were interpreted from the data: students' focus and students' approach to case interpretation. Students' focus relates to external factors students consider when interpreting AMS case data and use to make and justify therapeutic decisions including patient-centered factors, drug-related factors, AMS interventions, and pharmacist's role. Students' clinical reasoning describes the approach that students use to interpret the data and the decision-making processes they employ to arrive at a clinical decision including a systematic approach versus non-systematic approach. CONCLUSIONS Students vary in their focus and the cognitive strategies used to interpret AMS cases. Findings support the notion that clinical reasoning and decision-making should be explicitly taught in pharmacy curricula, in order to help students become aware of their own cognitive processes and decision-making abilities.
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Affiliation(s)
- Ziad G. Nasr
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | | | - Sara Dahmani
- College of Pharmacy, QU Health, Qatar University, PO Box 2713, Doha, Qatar
| | - Kyle J. Wilby
- College of Pharmacy, Dalhousie University, Halifax, Canada
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187
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Hughes G, Cunney R, Mockler D, Talento AF, Leary AO, Bergin C. The use of complexity theory to inform antimicrobial stewardship: a scoping review. J Hosp Infect 2022:S0195-6701(22)00191-8. [PMID: 35716862 DOI: 10.1016/j.jhin.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 06/02/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Complexity theory has previously been used as a conceptual lens in human healthcare research. Antimicrobial stewardship (AMS) is an inherently complex healthcare intervention; however, the extent to which complexity has been operationalized in AMS is currently unclear. AIM To investigate if, and how, complexity theory has been used to inform AMS in human healthcare. METHODS Scoping review methodology. Empirical research or policy specifically referencing complexity in relation to AMS were considered in any human healthcare setting and geographical location. Databases searched were: Cinahl, Cochrane Library, Embase, Medline, National Institute for Health and Care Excellence, PsycInfo, Scopus and Web of Science from inception to June 2020. Grey literature and other databases searched: EVIPNet, Google, Mednar, Proquest Theses, and the World Health Organization library of national antimicrobial resistance action plans. Non-English language articles were excluded. RESULTS Of 612 records retrieved, 8 articles were included. Heterogeneity in study design and geographical location were noted. Three interventional studies evaluated AMS in hospital (n = 2) and long-term care (n = 1) settings. Remaining studies were non-interventional and proposed AMS strategies conceptualized through complexity theory. The importance of close engagement between researchers or policy administrators and the target population was emphasized in all studies, as a means of ensuring AMS relevance and success. CONCLUSIONS There is a paucity of AMS research informed by complexity theory, and no policy documents could be located using complexity as a guiding theory. Mixed methods, informed by complexity theory, is a potentially suitable strategy to develop, implement and evaluate AMS as a complex intervention.
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Affiliation(s)
- Gerry Hughes
- Infectious diseases, St. James's Hospital Dublin Ireland; School of Medicine, Trinity College Dublin, Ireland.
| | - Robert Cunney
- School of Medicine, Trinity College Dublin, Ireland; Clinical Microbiology, Children's Health Ireland, Temple Street, Dublin, Ireland
| | | | - Alida Fe Talento
- Clinical Microbiology, Children's Health Ireland, Temple Street, Dublin, Ireland; Clinical Microbiology, Royal College of Surgeons, Dublin, Ireland
| | - Aisling O' Leary
- National Centre for Pharmacoeconomics, St. James's Hospital Dublin, Ireland; School of Pharmacy, Royal College of Surgeons, Dublin, Ireland
| | - Colm Bergin
- Infectious diseases, St. James's Hospital Dublin Ireland; School of Medicine, Trinity College Dublin, Ireland
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Keikha M, Kamali H, Ghazvini K, Karbalaei M. Conceptual framework of antibiotic stewardship programs in reducing ESBL-producing Enterobacteriaceae: a systematic review and meta-analysis. J Chemother 2022; 34:483-491. [PMID: 35706130 DOI: 10.1080/1120009x.2022.2085473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Today, the phenomenon of antibiotic resistance has become one of the main concerns of health system around the world. Antimicrobial stewardship programs (ASPs) are considered as the most important strategy in optimizing antibiotic consumption, which in turn reduce the emergence of multidrug/extensively drug-resistant (MDR/XDR) microorganisms, as well as reducing mortality and healthcare costs. However, the effectiveness of APSs in controlling the spread of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae has not been investigated. The pooled odds ratio for the effectiveness of ASPs in reducing ESBL-producing Enterobacteriaceae was 0.82 (95% CI: 0.70-0.98; P value: 0.03); our results showed that in group with implemented ASPs, the prevalence of infection associated with these bacteria had been reduced by 11.8%. Overall, antimicrobial stewardship strategies are significantly effective in reducing ESBL-producing Enterobacteriaceae infections. The present study concluded that a comprehensive stewardship program will certainly reduce the mortality rate, as well as hospitalization stay and treatment costs. In general, our findings strongly support the performance of ASPs in healthcare centers.
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Affiliation(s)
- Masoud Keikha
- Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Kamali
- Department of Pharmaceutics, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Kiarash Ghazvini
- Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Karbalaei
- Department of Microbiology and Virology, Faculty of Medicine, Jiroft University of Medical Sciences, Jiroft, Iran
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189
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Pharmacist-led antimicrobial stewardship programme in a small hospital without infectious diseases physicians. Sci Rep 2022; 12:9501. [PMID: 35680946 PMCID: PMC9184508 DOI: 10.1038/s41598-022-13246-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 05/23/2022] [Indexed: 11/08/2022] Open
Abstract
Pharmacists may be tasked to lead antibiotic stewardship programmes (ASP) implementation in small hospitals in absence of infectious diseases (ID) physicians. The objectives are to evaluate the effectiveness of a pharmacist-led ASP in a hospital without ID physician support, with special focus on indicators of the hospital use of antimicrobial agents based on consumption and asess the potential clinical and economic impact of pharmacist interventions (PIs) through the CLEO tool. A prospective quasi-experimental study to implement an ASP in a 194-bed hospital. We evaluated changes in antimicrobial use measured as mean defined daily doses per 1000 patient-days (AUD) for intervention versus preintervention period. A total of 847 antimicrobial PIs were proposed, being 88.3% accepted. Discontinuation due to excessive duration was the most frequently performed PI (23.4%). Most of PIs was classified as major or moderate clinical impact, 41.7% and 37.8% respectively. The global consumption of antimicrobial was reduced from 907.1 to 693.8 AUD, with a signifcant drop in carbapenems and quinolones. Direct expenditure of antibiotics decreased significantly. Pharmacist-led ASP has being effective in reducing consumption of antibiotics. In the absence of ID physician´s support and oversight, pharmacists could lead the improvement of the use of antimicrobials.
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190
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Lautenbach E, Hamilton KW, Grundmeier R, Neuhauser MM, Hicks LA, Jaskowiak-Barr A, Cressman L, James T, Omorogbe J, Frager N, Menon M, Kratz E, Dutcher L, Chiotos K, Gerber JS. Development of an Electronic Algorithm to Target Outpatient Antimicrobial Stewardship Efforts for Acute Bronchitis and Pharyngitis. Open Forum Infect Dis 2022; 9:ofac273. [PMID: 35854991 PMCID: PMC9291392 DOI: 10.1093/ofid/ofac273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 05/28/2022] [Indexed: 11/17/2022] Open
Abstract
Background A major challenge for antibiotic stewardship programs is the lack of accurate and accessible electronic data to target interventions. We developed and validated separate electronic algorithms to identify inappropriate antibiotic use for adult outpatients with bronchitis and pharyngitis. Methods We used International Classification of Diseases, 10th Revision, diagnostic codes to identify patient encounters for acute bronchitis and pharyngitis at outpatient practices between 3/15/17 and 3/14/18. Exclusion criteria included immunocompromising conditions, complex chronic conditions, and concurrent infections. We randomly selected 300 eligible subjects each with bronchitis and pharyngitis. Inappropriate antibiotic use based on chart review served as the gold standard for assessment of the electronic algorithm, which was constructed using only data in the electronic data warehouse. Criteria for appropriate prescribing, choice of antibiotic, and duration were based on established guidelines. Results Of 300 subjects with bronchitis, 167 (55.7%) received an antibiotic inappropriately based on chart review. The electronic algorithm demonstrated 100% sensitivity and 95.3% specificity for detection of inappropriate prescribing. Of 300 subjects with pharyngitis, 94 (31.3%) had an incorrect prescribing decision. Among 29 subjects with a positive rapid streptococcal antigen test, 27 (93.1%) received an appropriate antibiotic and 29 (100%) received the correct duration. The electronic algorithm demonstrated very high sensitivity and specificity for all outcomes. Conclusions Inappropriate antibiotic prescribing for bronchitis and pharyngitis is common. Electronic algorithms for identifying inappropriate prescribing, antibiotic choice, and duration showed excellent test characteristics. These algorithms could be used to efficiently assess prescribing among practices and individual clinicians. Interventions based on these algorithms should be tested in future work.
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Affiliation(s)
- Ebbing Lautenbach
- Correspondence: Ebbing Lautenbach, MD, MPH, MSCE, Perelman School of Medicine, University of Pennsylvania, 712 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6073 ()
| | - Keith W Hamilton
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Robert Grundmeier
- Division of General Pediatrics, Department of Pediatrics, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Melinda M Neuhauser
- Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Lauri A Hicks
- Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Anne Jaskowiak-Barr
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Leigh Cressman
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Tony James
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jacqueline Omorogbe
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Nicole Frager
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Muida Menon
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Ellen Kratz
- Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Lauren Dutcher
- Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kathleen Chiotos
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
| | - Jeffrey S Gerber
- Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA,Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia (CHOP), Philadelphia, Pennsylvania, USA
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191
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Overproduction of Chromosomal ampC β-Lactamase Gene Maintains Resistance to Cefazolin in Escherichia coli Isolates. Microbiol Spectr 2022; 10:e0005822. [PMID: 35658712 PMCID: PMC9241650 DOI: 10.1128/spectrum.00058-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cefazolin, an active in vitro agent against Escherichia coli, is used to treat urinary and biliary tract infections. Cefazolin is used widely as an antibiotic, and the increase in the emergence of cefazolin-resistant E. coli in many countries is a major concern. We investigated the changes in the susceptibility of E. coli clinical isolates to cefazolin following exposure. A total of 88.9% (16/18 strains) of the strains acquired resistance to cefazolin. All strains with an MIC to cefazolin of 2 μg/mL became resistant. The expression of chromosomal ampC (c-ampC) increased up to 209.1-fold in the resistant strains. Moreover, 11 of the 16 E. coli strains (68.8%) that acquired cefazolin resistance maintained the resistant phenotype after subculture in cefazolin-free medium. Therefore, the acquisition and maintenance of cefazolin resistance in E. coli strains were associated with the overexpression of c-ampC. Mutations in the c-ampC attenuator regions are likely to be maintained and are one of the key factors contributing to the increase in the number of cefazolin-resistant E. coli worldwide. IMPORTANCE This study is the first to demonstrate that mutations in the chromosomal-ampC attenuator region are responsible for the emergence of cefazolin resistance in Escherichia coli strains. The resistance was maintained even after culturing E. coli without cefazolin. This study highlights one of the key factors contributing to the increase in the number of cefazolin-resistant E. coli strains, which can pose a considerable challenge for treating common infections, such as urinary tract infections.
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192
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Shukla S, Cortez J, Renfro B, Makker K, Timmons C, Nandula PS, Hazboun R, Dababneh R, Hoopes C, VanRavestein J, McCarter Y, Middlebrooks M, Ingyinn M, Alvarez A, Hudak ML. Charge Nurses Taking Charge, Challenging the Culture of Culture-Negative Sepsis, and Preventing Central-Line Infections to Reduce NICU Antibiotic Usage. Am J Perinatol 2022; 39:861-868. [PMID: 33142341 DOI: 10.1055/s-0040-1719079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We aimed to reduce our monthly antibiotic usage rate (AUR, days of treatment per 1,000 patient-days) in the neonatal intensive care unit (NICU) from a baseline of 330 (July 2015-April 2016) to 200 by December 2018. STUDY DESIGN We identified three key drivers as follows: (1) engaging NICU charge nurses, (2) challenging the culture of culture-negative sepsis, and (3) reducing central-line associated bloodstream infections (CLABSI). Our main outcome was AUR. The percentage of culture-negative sepsis that was treated with antibiotics for >48 hours and CLABSI was our process measure. We used hospital cost/duration of hospitalization and mortality as our balancing measures. RESULTS After testing several plan-do-study-act (PDSA) cycles, we saw a modest reduction in AUR from 330 in the year 2016 to 297 in the year 2017. However, we did not find a special-cause variation in AUR via statistical process control (SPC) analysis (u'-chart). Thereafter, we focused our efforts to reduce CLABSI in January 2018. As a result, our mean AUR fell to 217 by December 2018. Our continued efforts resulted in a sustained reduction in AUR beyond the goal period. Importantly, cost of hospitalization and mortality did not increase during the improvement period. CONCLUSION Our sequential quality improvement (QI) efforts led to a reduction in AUR. We implemented processes to establish a robust antibiotic stewardship program that included antibiotic time-outs led by NICU charge nurses and a focus on preventing CLABSI that were sustained beyond the QI period. KEY POINTS · This is a quality improvement project to reduce antibiotic usage in NICU.. · Charge nurses should take charge to reduce infections in NICU.. · Central line infections should be reduced to decrease antibiotic usage..
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Affiliation(s)
- Samarth Shukla
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Josef Cortez
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Bill Renfro
- Department of Pharmacy, University of Florida Health, Jacksonville, Florida
| | - Kartikeya Makker
- Division of Neonatology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colleen Timmons
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - P Sireesha Nandula
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Rita Hazboun
- Division of Neonatology, Children's Hospital of Richmond, Virginia Commonwealth University, Richmond, Virginia
| | - Rima Dababneh
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Cristina Hoopes
- Department of Women's and Children's Nursing Services, University of Florida Health, Jacksonville, Florida
| | - Jenny VanRavestein
- Department of Women's and Children's Nursing Services, University of Florida Health, Jacksonville, Florida
| | - Yvette McCarter
- Department of Pathology and Laboratory Medicine, University of Florida Health, Jacksonville, Florida
| | - Marilyn Middlebrooks
- Department of Infection Prevention and Control, University of Florida Health, Jacksonville, Florida
| | - Ma Ingyinn
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Ana Alvarez
- Division of Infectious Diseases and Immunology, University of Florida College of Medicine, Jacksonville, Florida
| | - Mark L Hudak
- Division of Neonatology, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
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Falconer N, Paterson DL, Peel N, Welch A, Freeman C, Burkett E, Hubbard R, Comans T, Hanjani LS, Pascoe E, Hawley C, Gray L. A multimodal intervention to optimise antimicrobial use in residential aged care facilities (ENGAGEMENT): protocol for a stepped-wedge cluster randomised trial. Trials 2022; 23:427. [PMID: 35597993 PMCID: PMC9123829 DOI: 10.1186/s13063-022-06323-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 04/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Inappropriate antibiotic use can cause harm and promote antimicrobial resistance, which has been declared a major health challenge by the World Health Organization. In Australian residential aged care facilities (RACFs), the most common indications for antibiotic prescribing are for infections of the urinary tract, respiratory tract and skin and soft tissue. Studies indicate that a high proportion of these prescriptions are non-compliant with best prescribing guidelines. To date, a variety of interventions have been reported to address inappropriate prescribing and overuse of antibiotics but with mixed outcomes. This study aims to identify the impact of a set of sustainable, multimodal interventions in residential aged care targeting three common infection types. METHODS This protocol details a 20-month stepped-wedge cluster-randomised trial conducted across 18 RACFs (as 18 clusters). A multimodal multi-disciplinary set of interventions, the 'AMS ENGAGEMENT bundle', will be tailored to meet the identified needs of participating RACFs. The key elements of the intervention bundle include education for nurses and general practitioners, telehealth support and formation of an antimicrobial stewardship team in each facility. Prior to the randomised sequential introduction of the intervention, each site will act as its own control in relation to usual care processes for antibiotic use and stewardship. The primary outcome for this study will be antibiotic consumption measured using defined daily doses (DDDs). Cluster-level rates will be calculated using total occupied bed numbers within each RACF during the observation period as the denominator. Results will be expressed as rates per 1000 occupied bed days. An economic analysis will be conducted to compare the costs associated with the intervention to that of usual care. A comprehensive process evaluation will be conducted using the REAIM Framework, to enable learnings from the trial to inform sustainable improvements in this field. DISCUSSION A structured AMS model of care, incorporating targeted interventions to optimise antimicrobial use in the RACF setting, is urgently needed and will be delivered by our trial. The trial will aim to empower clinicians, residents and families by providing a robust AMS programme to improve antibiotic-related health outcomes. TRIAL REGISTRATION US National Library of Medicine Clinical Trials.gov ( NCT04705259 ). Prospectively registered in 12th of January 2021.
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Affiliation(s)
- Nazanin Falconer
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia.
- Department of Pharmacy, Princess Alexandra Hospital, Metro South Health, Brisbane, QLD, 4102, Australia.
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia.
| | - David L Paterson
- UQ Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
- Royal Brisbane and Women's Hospital, Metro North Health, Butterfield Street, Herston, Brisbane, QLD, 4029, Australia
| | - Nancye Peel
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Alyssa Welch
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Christopher Freeman
- School of Pharmacy, Faculty of Health and Behavioural Sciences, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Ellen Burkett
- Department of Emergency Medicine, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Ruth Hubbard
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Tracy Comans
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Leila Shafiee Hanjani
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Elaine Pascoe
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
| | - Carmel Hawley
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
- Princess Alexandra Hospital Southside Clinical Unit, Faculty of Medicine, The University of Queensland, Woolloongabba, Brisbane, QLD, 4102, Australia
| | - Leonard Gray
- UQ Centre for Health Services Research, Faculty of Medicine, The University of Queensland, The University of Queensland, Brisbane, QLD, 4102, Australia
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194
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Rahman MM, Alam Tumpa MA, Zehravi M, Sarker MT, Yamin M, Islam MR, Harun-Or-Rashid M, Ahmed M, Ramproshad S, Mondal B, Dey A, Damiri F, Berrada M, Rahman MH, Cavalu S. An Overview of Antimicrobial Stewardship Optimization: The Use of Antibiotics in Humans and Animals to Prevent Resistance. Antibiotics (Basel) 2022; 11:667. [PMID: 35625311 PMCID: PMC9137991 DOI: 10.3390/antibiotics11050667] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Antimicrobials are a type of agent widely used to prevent various microbial infections in humans and animals. Antimicrobial resistance is a major cause of clinical antimicrobial therapy failure, and it has become a major public health concern around the world. Increasing the development of multiple antimicrobials has become available for humans and animals with no appropriate guidance. As a result, inappropriate use of antimicrobials has significantly produced antimicrobial resistance. However, an increasing number of infections such as sepsis are untreatable due to this antimicrobial resistance. In either case, life-saving drugs are rendered ineffective in most cases. The actual causes of antimicrobial resistance are complex and versatile. A lack of adequate health services, unoptimized use of antimicrobials in humans and animals, poor water and sanitation systems, wide gaps in access and research and development in healthcare technologies, and environmental pollution have vital impacts on antimicrobial resistance. This current review will highlight the natural history and basics of the development of antimicrobials, the relationship between antimicrobial use in humans and antimicrobial use in animals, the simplistic pathways, and mechanisms of antimicrobial resistance, and how to control the spread of this resistance.
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Affiliation(s)
- Md. Mominur Rahman
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Mst. Afroza Alam Tumpa
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Mehrukh Zehravi
- Department of Clinical Pharmacy Girls Section, Prince Sattam Bin Abdul Aziz University, Alkharj 11942, Saudi Arabia;
| | - Md. Taslim Sarker
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Yamin
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Rezaul Islam
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Md. Harun-Or-Rashid
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Muniruddin Ahmed
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh; (M.A.A.T.); (M.T.S.); (M.Y.); (M.R.I.); (M.H.-O.-R.); (M.A.)
| | - Sarker Ramproshad
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Banani Mondal
- Department of Pharmacy, Ranada Prasad Shaha University, Narayanganj 1400, Bangladesh; (S.R.); (B.M.)
| | - Abhijit Dey
- Department of Life Sciences, Presidency University, Kolkata 700073, India;
| | - Fouad Damiri
- Labortory of Biomolecules and Organic Synthesis (BioSynthO), Department of Chemistry, Faculty of Sciences Ben M’Sick, University Hassan II of Casablanca, Casablanca 20000, Morocco; (F.D.); (M.B.)
| | - Mohammed Berrada
- Labortory of Biomolecules and Organic Synthesis (BioSynthO), Department of Chemistry, Faculty of Sciences Ben M’Sick, University Hassan II of Casablanca, Casablanca 20000, Morocco; (F.D.); (M.B.)
| | - Md. Habibur Rahman
- Department of Global Medical Science, Wonju College of Medicine, Yonsei University, Wonju 26426, Korea
| | - Simona Cavalu
- Faculty of Medicine and Pharmacy, University of Oradea, P-ta 1 Decembrie 10, 410087 Oradea, Romania
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195
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Hayes JF. Fighting Back against Antimicrobial Resistance with Comprehensive Policy and Education: A Narrative Review. Antibiotics (Basel) 2022; 11:antibiotics11050644. [PMID: 35625288 PMCID: PMC9137785 DOI: 10.3390/antibiotics11050644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Globally, antimicrobial resistance has emerged as a significant threat. A comprehensive plan is required to combat antimicrobial resistance. There have been national and international efforts to address this global health problem, but much work remains. Enhanced funding and regulations to support antimicrobial stewardship policy and program development, reforms to incentivize drug development to treat resistant pathogens, and efforts to strengthen One Health programs are areas for collaboration and innovation. Finally, implementation of educational interventions for trainees encompassing these key areas along with training on policy and leadership development is critical to enable sustainability of these efforts to fight back against antimicrobial resistance.
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Affiliation(s)
- Justin F Hayes
- Department of Medicine, Division of Infectious Diseases, Banner University Medical Center-Tucson and South, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
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196
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Akhloufi H, van der Sijs H, Melles DC, van der Hoeven CP, Vogel M, Mouton JW, Verbon A. The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing. BMC Med Inform Decis Mak 2022; 22:127. [PMID: 35538525 PMCID: PMC9087957 DOI: 10.1186/s12911-022-01860-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 01/17/2022] [Indexed: 11/15/2022] Open
Abstract
Background To describe and evaluate a clinical decision support system (CDSS) for empirical antibiotic therapy using a systematic framework. Methods A reporting framework for behavior change intervention implementation was used, which includes several domains: development, evaluation and implementation. Within the development domain a description is given of the engagement of stakeholders, a rationale for how the CDSS may influence antibiotic prescribing and a detailed outline of how the system was developed. Within the evaluation domain a technical validation is performed and the interaction between potential users and the CDSS is analyzed. Within the domain of implementation a description is given on how the CDSS was tested in the real world and the strategies that were used for implementation and adoption of the CDSS. Results Development: a CDSS was developed, with the involvement of stakeholders, to assist empirical antibiotic prescribing by physicians. Evaluation: Technical problems were determined during the validation process and corrected in a new CDSS version. A usability study was performed to assess problems in the system-user interaction. Implementation: In 114 patients the antibiotic advice that was generated by the CDSS was followed. For 54 patients the recommendations were not adhered to. Conclusions This study describes the development and validation of a CDSS for empirical antibiotic therapy and shows the usefulness of the systematic framework for reporting CDSS interventions. In addition it shows that CDSS recommendations are not always adhered to which is associated with incorrect use of the system. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-022-01860-3.
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Affiliation(s)
- H Akhloufi
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| | - H van der Sijs
- Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - D C Melles
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - C P van der Hoeven
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Vogel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - J W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Division of Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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197
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Kimbowa IM, Ocan M, Eriksen J, Nakafeero M, Obua C, Stålsby Lundborg C, Kalyango J. Characteristics of antimicrobial stewardship programmes in hospitals of Uganda. PLoS One 2022; 17:e0268032. [PMID: 35536856 PMCID: PMC9089898 DOI: 10.1371/journal.pone.0268032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/20/2022] [Indexed: 11/22/2022] Open
Abstract
While interest in antimicrobial stewardship programmes (ASPs) is growing in most low- and middle-income countries (LMICs), there is a paucity of information on their adoption or implementation in Africa, particularly Uganda. The study assessed the presence and characteristics of ASPs, implemented antimicrobial stewardship (AMS) strategies and the challenges to their implementation in hospitals in Uganda. We conducted a cross-sectional study among heads of infection prevention committees (IPCs) in regional referral hospitals, general hospitals, and private-not-for-profit (PNFP) hospitals from November 2019 to February 2020. An interviewer-administered questionnaire was used to collect data. We analysed data using descriptive statistics. A total of 32 heads of IPCs were enrolled in the study. Of these, eight were from regional referral hospitals, 21 were from general hospitals, and three were from PNFPs. Most heads of IPC were pharmacists (17/32, 53.1%) with a mean age and standard deviation (sd) of 36.1 (±1.1) years. A formal ASP was adopted or implemented in 14 out of the 32 (44%, 95% CI 26-62) studied hospitals. Thirty out of 32 hospitals implemented at least one type of AMS strategy. Sixty-eight percent (22/32) of the hospitals implemented pre-authorisation and approval as their primary AMS core strategy to optimise antibacterial use. The most commonly reported challenges to the implementation of ASP across all 32 hospitals (with or without ASP) were lack of time for the ASP team (29/32, 90.6%) and lack of allocated funding for antimicrobial stewardship team (29/32, 90.6%). In this study, most hospitals in Uganda implemented at least one AMS strategy despite the low implementation of ASPs in hospitals. The ministry of health needs to sensitise and support the establishment of ASP in hospitals across the country.
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Affiliation(s)
- Isaac Magulu Kimbowa
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses Ocan
- Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Jaran Eriksen
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
- Unit of Infectious diseases/Venhälsan, Stockholm South Hospital, Stockholm, Sweden
| | - Mary Nakafeero
- School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Celestino Obua
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Joan Kalyango
- Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University College of Health Sciences, Kampala, Uganda
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198
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Huriez P, Ourghanlian C, Razazi K, Vindrios W, Hulin A, Lepeule R, Habibi A, Gallien S. Probenecid, an old β-lactams pharmacokinetic enhancer for a renewed use: a retrospective study. Infect Dis Now 2022; 52:273-279. [DOI: 10.1016/j.idnow.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 04/13/2022] [Accepted: 05/23/2022] [Indexed: 11/28/2022]
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199
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Naito Y, Maeda M, Nagatomo Y, Ugajin K, Akima E, Tanaka M, Tokimatsu I, Sasaki T. Impact of the Antimicrobial Stewardship Team Intervention Focusing on Changes in Prescribing Trends and the Rate of Carbapenem-resistant <i>P. aeruginosa</i>. YAKUGAKU ZASSHI 2022; 142:527-534. [DOI: 10.1248/yakushi.21-00202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Yuika Naito
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy
| | - Yasuhiro Nagatomo
- Department of Infection Prevention and Control, Showa University Hospital
| | - Kazuhisa Ugajin
- Department of Infection Prevention and Control, Showa University Hospital
| | - Etsuko Akima
- Department of Infection Prevention and Control, Showa University Hospital
| | - Michiko Tanaka
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy
| | - Issei Tokimatsu
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine
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200
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Richie C. Environmental sustainability and the carbon emissions of pharmaceuticals. JOURNAL OF MEDICAL ETHICS 2022; 48:334-337. [PMID: 33853877 DOI: 10.1136/medethics-2020-106842] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 02/09/2021] [Accepted: 03/20/2021] [Indexed: 06/12/2023]
Abstract
The US healthcare industry emits an estimated 479 million tonnes of carbon dioxide each year; nearly 8% of the country's total emissions. When assessed by sector, hospital care, clinical services, medical structures, and pharmaceuticals are the top emitters. For 15 years, research has been dedicated to the medical structures and equipment that contribute to carbon emissions. More recently, hospital care and clinical services have been examined. However, the carbon of pharmaceuticals is understudied. This article will focus on the carbon emissions of pharmaceuticals since they are consistently calculated to be among the top contributors to healthcare carbon and assess the factors that contribute to pharmaceutical carbon emissions. Specifically, overprescription, pharmaceutical waste, antibiotic resistance, routine prescriptions, non-adherence, drug dependency, lifestyle prescriptions, and drugs given due to a lack of preventive healthcare will be identified. Prescribing practices have environmental ramifications. Carbon reduction, when focused on pharmaceuticals, can lead to cleaner, more sustainable healthcare.
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Affiliation(s)
- Cristina Richie
- Philosophy and Ethics of Technology, Technische Universiteit Delft, Delft 2628, The Netherlands
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