2251
|
Pakyz A, Powell JP, Harpe SE, Johnson C, Edmond M, Polk RE. Diversity of Antimicrobial Use and Resistance in 42 Hospitals in the United States. Pharmacotherapy 2008; 28:906-12. [DOI: 10.1592/phco.28.7.906] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
2252
|
Santos R, Mayo T, Siegel J. Healthcare Epidemiology: Active Surveillance Cultures and Contact Precautions for Control of Multidrug‐Resistant Organisms: Ethical Considerations. Clin Infect Dis 2008; 47:110-6. [DOI: 10.1086/588789] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
|
2253
|
Lancaster JW, Lawrence KR, Fong JJ, Doron SI, Garpestad E, Nasraway SA, Devlin JW. Impact of an Institution-Specific Hospital-Acquired Pneumonia Protocol on the Appropriateness of Antibiotic Therapy and Patient Outcomes. Pharmacotherapy 2008; 28:852-62. [DOI: 10.1592/phco.28.7.852] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
2254
|
Miliani K, L'Heriteau F, Alfandari S, Arnaud I, Costa Y, Deliere E, Carbonne A, Astagneau P. Specific control measures for antibiotic prescription are related to lower consumption in hospitals: results from a French multicentre pilot study. J Antimicrob Chemother 2008; 62:823-9. [DOI: 10.1093/jac/dkn277] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
2255
|
Kuster SP, Ruef C, Bollinger AK, Ledergerber B, Hintermann A, Deplazes C, Neuber L, Weber R. Correlation between case mix index and antibiotic use in hospitals. J Antimicrob Chemother 2008; 62:837-42. [DOI: 10.1093/jac/dkn275] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
2256
|
MacDougall C, Polk RE. Variability in rates of use of antibacterials among 130 US hospitals and risk-adjustment models for interhospital comparison. Infect Control Hosp Epidemiol 2008; 29:203-11. [PMID: 18257689 DOI: 10.1086/528810] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe variability in rates of antibacterial use in a large sample of US hospitals and to create risk-adjusted models for interhospital comparison. METHODS We retrospectively surveyed the use of 87 antibacterial agents on the basis of electronic claims data from 130 medical-surgical hospitals in the United States for the period August 2002 to July 2003; these records represented 1,798,084 adult inpatients. Hospitals were assigned randomly to the derivation data set (65 hospitals) or the validation data set (65 hospitals). Multivariable models predicting rates of antibacterial use were created using the derivation data set. These models were then used to predict rates of antibacterial use in the validation data set, which was compared with observed rates of antibacterial use. Rates of antibacterial use was measured in days of therapy per 1,000 patient-days. RESULTS Across the surveyed hospitals, a mean of 59.3% of patients received at least 1 dose of an antimicrobial agent during hospitalization (range for individual hospitals, 44.4%-73.6%). The mean total rate of antibacterial use was 789.8 days of therapy per 1,000 patient-days (range, 454.4-1,153.4). The best model for the total rate of antibacterial use explained 31% of the variance in rates of antibacterial use and included the number of hospital beds, the number of days in the intensive care unit per 1,000 patient-days, the number of surgeries per 1,000 discharges, and the number of cases of pneumonia, bacteremia, and urinary tract infection per 1,000 discharges. Five hospitals in the validation data set were identified as having outlier rates on the basis of observed antibacterial use greater than the upper bound of the 90% prediction interval for predicted antibacterial use in that hospital. CONCLUSION Most adult inpatients receive antimicrobial agents during their hospitalization, but there is substantial variability between hospitals in the volume of antibacterials used. Risk-adjusted models can explain a significant proportion of this variation and allow for comparisons between hospitals for benchmarking purposes.
Collapse
Affiliation(s)
- Conan MacDougall
- Department of Clinical Pharmacy, School of Pharmacy, University of California-San Francisco, San Francisco, California, USA
| | | |
Collapse
|
2257
|
Paladino JA, Sunderlin JL, Singer ME, Adelman MH, Schentag JJ. Influence of extended-spectrum β-lactams on gram-negative bacterial resistance. Am J Health Syst Pharm 2008; 65:1154-9. [DOI: 10.2146/ajhp070435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Joseph A. Paladino
- Clinical Outcomes Research, CPL Associates LLC, Buffalo, NY, and Clinical Professor, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, State University of New York (SUNY), Buffalo
| | | | - Mendel E. Singer
- Case School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Jerome J. Schentag
- CPL Associates LLC, and Professor, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, SUNY
| |
Collapse
|
2258
|
Buising KL, Thursky KA, Robertson MB, Black JF, Street AC, Richards MJ, Brown GV. Electronic antibiotic stewardship--reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting. J Antimicrob Chemother 2008; 62:608-16. [PMID: 18550680 DOI: 10.1093/jac/dkn218] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVES Antibiotic stewardship is important, but the ideal strategy for providing stewardship in a hospital setting is unknown. A practical, sustainable and transferable strategy is needed. This study evaluates the impact of a novel computerized antimicrobial approval system on antibiotic-prescribing behaviour in a hospital. Effects on drug consumption, antibiotic resistance patterns of local bacteria and patient outcomes were monitored. METHODS The study was conducted at a tertiary referral teaching hospital in Melbourne, Australia. The system was deployed in January 2005 and guided the use of 28 restricted antimicrobials. Data were collected over 7 years: 5 years before and 2 years after deployment. Uptake of the system was evaluated using an in-built audit trail. Drug utilization was prospectively monitored using pharmacy data (as defined daily doses per 1000 bed-days) and analysed via time-series analysis with segmental linear regression. Antibiograms of local bacteria were prospectively evaluated. In-hospital mortality and length of stay for patients with Gram-negative bacteraemia were also reported. RESULTS Between 250 and 300 approvals were registered per month during 2006. The gradients in the use of third- and fourth-generation cephalosporins (+0.52, -0.05, -0.39; P < 0.01), glycopeptides (+0.27, -0.53; P = 0.09), carbapenems (+0.12, -0.24; P = 0.21), aminoglycosides (+0.15, -0.27; P < 0.01) and quinolones (+0.76, +0.11; P = 0.08) all fell after deployment, while extended-spectrum penicillin use increased. Trends in increased susceptibility of Staphylococcus aureus to methicillin and improved susceptibility of Pseudomonas spp. to many antibiotics were observed. No increase in adverse outcomes for patients with Gram-negative bacteraemia was observed. CONCLUSIONS The system was successfully adopted and significant changes in antimicrobial usage were demonstrated.
Collapse
Affiliation(s)
- K L Buising
- Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Vic. 3050, Australia.
| | | | | | | | | | | | | |
Collapse
|
2259
|
Lode HM. Rational antibiotic therapy and the position of ampicillin/sulbactam. Int J Antimicrob Agents 2008; 32:10-28. [PMID: 18539004 DOI: 10.1016/j.ijantimicag.2008.02.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2008] [Accepted: 02/04/2008] [Indexed: 01/22/2023]
Abstract
In the current context of increasing antimicrobial resistance, it is important to use antibiotics rationally and to re-assess regularly the clinical usefulness of commonly used agents. This review focuses on the efficacy of the beta-lactam ampicillin co-administered with the beta-lactamase inhibitor sulbactam, either parenterally (ampicillin/sulbactam) or orally (sultamicillin), for the treatment of bacterial infections. Clinical findings from the past decade confirm the results of numerous older studies and together provide good evidence to support the continued use of ampicillin/sulbactam and sultamicillin in hospital- and community-acquired infections both in adults and children. This is also recognised in recent published national and international guidelines, many of which recommend ampicillin/sulbactam as first-line therapy for various respiratory and skin infections.
Collapse
Affiliation(s)
- Hartmut M Lode
- Research Centre for Medical Studies, Institute of Clinical Pharmacology, Charité Universitätsmedizin Berlin, Hohenzollerndamm 2, Berlin, Germany.
| |
Collapse
|
2260
|
Abstract
Based on the worldwide prevalence of multidrug-resistant strains of Pseudomas aeruginosa and the fact that no newer antipseudomonal agents are available, this article aims to investigate therapeutic solutions for combating infections caused by P aeruginosa, including multidrug-resistant strains. The article focuses mainly on colistin, the re-emerging old antibiotic that possesses prominent antipseudomonal activity in vitro and on doripenem, a newer carbapenem that seems to be close to its global marketing. Regarding older antipseudomonal antibiotics that have been reviewed extensively, only newer aspects on their use are considered in this article.
Collapse
|
2261
|
Mermel L, Jefferson J, Devolve J. Knowledge and Use of Cumulative Antimicrobial Susceptibility Data at a University Teaching Hospital. Clin Infect Dis 2008; 46:1789. [DOI: 10.1086/588050] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
2262
|
Spellberg B, Gilbert D, Bradley J, Boucher H, Scheld W, Bartlett J, Edwards, Jr. J. Reply to Kunin: Rationale for Antibiotic Development Incentives. Clin Infect Dis 2008. [DOI: 10.1086/588058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
2263
|
Antimicrobial optimisation in secondary care: the pharmacist as part of a multidisciplinary antimicrobial programme—a literature review. Int J Antimicrob Agents 2008; 31:511-7. [DOI: 10.1016/j.ijantimicag.2008.01.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Accepted: 01/15/2008] [Indexed: 11/22/2022]
|
2264
|
Burgess DS, Rapp RP. Bugs versus drugs: Addressing the pharmacist’s challenge. Am J Health Syst Pharm 2008; 65:S4-15. [DOI: 10.2146/ajhp080075] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- David S. Burgess
- College of Pharmacy, The University of Texas at Austin and The University of Texas Health Science Center at San Antonio, Pharmacotherapy Education and Research Center, 7703 Floyd Curl Drive - MSC 6220, San Antonio, TX 78229-3900, and
| | - Robert P. Rapp
- College of Pharmacy, University of Kentucky Medical Center, C-114D Chandler Medical Center, University of Kentucky, Lexington, KY 40536
| |
Collapse
|
2265
|
Struelens MJ, Costers M. Hospital antibiotic management in Belgium – results of the ABS maturity survey of the ABS International group. Wien Klin Wochenschr 2008; 120:284-8. [DOI: 10.1007/s00508-008-0969-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
2266
|
Nicolau DP. Bugs versus drugs: what is the pharmacist's challenge? Am J Health Syst Pharm 2008; 65:S2-3. [PMID: 18436736 DOI: 10.2146/ajhp080074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- David P Nicolau
- Center for Anti-Infective Research & Development, Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
| |
Collapse
|
2267
|
Owens RC. Antimicrobial stewardship: concepts and strategies in the 21st century. Diagn Microbiol Infect Dis 2008; 61:110-28. [DOI: 10.1016/j.diagmicrobio.2008.02.012] [Citation(s) in RCA: 125] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2008] [Accepted: 02/25/2008] [Indexed: 01/12/2023]
|
2268
|
|
2269
|
A controlled intervention study to improve antibiotic use in a Russian paediatric hospital. Int J Antimicrob Agents 2008; 31:478-83. [DOI: 10.1016/j.ijantimicag.2008.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 01/09/2008] [Accepted: 01/10/2008] [Indexed: 01/22/2023]
|
2270
|
Kollef M, Morrow L, Baughman R, Craven D, McGowan, Jr. J, Micek S, Niederman M, Ost D, Paterson D, Segreti J. Health Care–Associated Pneumonia (HCAP): A Critical Appraisal to Improve Identification, Management, and Outcomes—Proceedings of the HCAP Summit. Clin Infect Dis 2008; 46 Suppl 4:S296-334; quiz 335-8. [DOI: 10.1086/526355] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
|
2271
|
Cortoos PJ, De Witte K, Peetermans WE, Simoens S, Laekeman G. Opposing expectations and suboptimal use of a local antibiotic hospital guideline: a qualitative study. J Antimicrob Chemother 2008; 62:189-95. [PMID: 18397925 DOI: 10.1093/jac/dkn143] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the opinions and problems concerning the use of a local antibiotic hospital guideline in a 1900-bed tertiary-care, university teaching hospital. METHODS A qualitative study using focus group discussions explored the usability and applicability of local antibiotic guidelines together with possible supportive measures. The sample included 22 physicians, deliberately divided between internal medicine (59.1%) and surgery (40.9%), and levels of experience (59.1% residents; 40.9% supervisors). Focus groups were conducted within one specific subgroup. Analysis was carried out using a framework analysis approach. RESULTS General acceptance of local guidelines was high but clear differences were present between subgroups with different desires and requirements from guideline contents. Opposing views were present towards supportive measures, especially multidisciplinary collaboration. Guideline distribution and accessibility appeared to be confusing, resulting in delayed application. An important supplementary barrier was the need to collect the guideline personally. Supervisors in their role as opinion leaders were mentioned as highly influential towards residents' practice. CONCLUSIONS Locally developed hospital guidelines experience the same barriers as other guidelines. Within one hospital, prescribers have to be seen as a number of different target groups instead of a homogeneous population. For an optimal effect, interventions will have to consider these differences. Also, in order to improve local guideline use and antibiotic consumption, supervisors have to be aware of how their role as opinion leaders can influence residents. Lastly, active guideline distribution and promotion remains critical to ensure efficient guideline use. Future research should focus on how to adapt interventions to these different target groups.
Collapse
Affiliation(s)
- Pieter-Jan Cortoos
- Research Centre for Pharmaceutical Care and Pharmaco-Economics, Katholieke Universiteit Leuven, O&N 2, Herestraat 49, PB 521, B-3000 Leuven, Belgium.
| | | | | | | | | |
Collapse
|
2272
|
Limited efficacy of a nonrestricted intervention on antimicrobial prescription of commonly used antibiotics in the hospital setting: results of a randomized controlled trial. Eur J Clin Microbiol Infect Dis 2008; 27:597-605. [PMID: 18392866 DOI: 10.1007/s10096-008-0482-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2007] [Accepted: 02/01/2008] [Indexed: 10/22/2022]
Abstract
Most interventions aimed at diminishing the use of antimicrobials in hospitals have focussed on newly introduced antibiotics and very few have been randomly controlled. We evaluated the impact on antibiotic consumption of an intervention without restrictions in antibiotic use, focussed on commonly used antibiotics with a controlled randomized trial. All new prescriptions of levofloxacin, carbapenems, or vancomycin in hospitalized patients were randomized to an intervention or a control group. Intervention consisted of an antibiotic regimen counselling targeted to match local antibiotic guidelines, performed using only patients' charts. Clinical charts of patients assigned to the control group were reviewed daily by a pharmacist. The primary endpoint was a reduction in consumption of the targeted antibiotics. Two hundred seventy-eight prescriptions corresponding to 253 patients were included: 146 were assigned to the intervention and 132 to the control group. Total consumption of the targeted antibiotics (median [IQR]) was slightly lower in the intervention (8 [4-12] defined daily doses [DDDs] per patient) than in the control group (10 [6-16] DDDs per patient; p = 0.04). No differences in number of DDDs were observed when antibiotics of substitution were included (11.05 [6-18.2] vs 10 [6-16.5] in the intervention and control groups, respectively, p = 0.13). The total number of days on treatment with the targeted antibiotics was lower in the intervention (4 [3-7] days per patient) than in the control group (6 [4-10] days per patient; p = 0.002). Differences in number of days on treatment only reached statistical significance in the prescriptions of carbapenems. There were no differences between intervention and control groups in terms of number of deaths, hospital readmissions, length of hospital stay, or antibiotic costs. In this trial, an intervention without restrictions focussed on antimicrobial prescriptions of commonly used antibiotics in the hospital setting had a limited efficacy to reduce consumption and did not save costs. Future strategies to promote a more rational antimicrobial use should be evaluated with a randomized controlled design.
Collapse
|
2273
|
Gerding DN, Muto CA, Owens RC. Treatment of Clostridium difficile infection. Clin Infect Dis 2008; 46 Suppl 1:S43-9. [PMID: 18177219 DOI: 10.1086/521861] [Citation(s) in RCA: 216] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Recent outbreaks of Clostridium difficile infection (CDI) in North America have been due to a more virulent, possibly more resistant strain that causes more-severe disease, making prompt recognition of cases and optimal management of infection essential for a successful therapeutic outcome. Treatment algorithms are presented to help guide the management of patients with CDI. Metronidazole has been recommended as initial therapy since the late 1990s and continues to be the first choice for all but seriously ill patients and those with complicated or fulminant infections or multiple recurrences of CDI, for whom vancomycin is recommended. Other options for recurrent CDI, such as probiotics and currently available anion-exchange resins, have limited efficacy and are potentially harmful. Intravenous immunoglobulin may benefit patients with refractory, recurrent, or severe disease, but no controlled data are available. Two antimicrobials available in the United States for other indications, nitazoxanide and rifaximin, have been used successfully for CDI treatment but, like metronidazole, lack United States Food and Drug Administration approval for this indication. Experimental treatments currently in clinical development include a toxin-binding polymer, tolevamer; 2 poorly absorbed antimicrobials, OPT-80 (formerly known as Difimicin) and ramoplanin; monoclonal antibodies; and a C. difficile vaccine.
Collapse
|
2274
|
Owens RC, Donskey CJ, Gaynes RP, Loo VG, Muto CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008; 46 Suppl 1:S19-31. [PMID: 18177218 DOI: 10.1086/521859] [Citation(s) in RCA: 448] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Antimicrobial therapy plays a central role in the pathogenesis of Clostridium difficile infection (CDI), presumably through disruption of indigenous intestinal microflora, thereby allowing C. difficile to grow and produce toxin. Investigations involving animal models and studies performed in vitro suggest that inhibitory activity against C. difficile and differences in the propensity to stimulate toxin production may also influence the likelihood that particular drugs may cause CDI. Although nearly all antimicrobial classes have been associated with CDI, clindamycin, third-generation cephalosporins, and penicillins have traditionally been considered to harbor the greatest risk. Recent studies have also implicated fluoroquinolones as high-risk agents, a finding that is most likely to be related in part to increasing fluoroquinolone resistance among epidemic strains (i.e., restriction-endonuclease analysis group BI/North American PFGE type 1 strains) and some nonepidemic strains of C. difficile. Restrictions in the use of clindamycin and third-generation cephalosporins have been associated with reductions in CDI. Because use of any antimicrobial has the potential to induce the onset of CDI and disease caused by other health care-associated pathogens, antimicrobial stewardship programs that promote judicious use of antimicrobials are encouraged in concert with environmental and infection control-related efforts.
Collapse
|
2275
|
Spellberg B, Guidos R, Gilbert D, Bradley J, Boucher HW, Scheld WM, Bartlett JG, Edwards J. The epidemic of antibiotic-resistant infections: a call to action for the medical community from the Infectious Diseases Society of America. Clin Infect Dis 2008; 46:155-64. [PMID: 18171244 DOI: 10.1086/524891] [Citation(s) in RCA: 1058] [Impact Index Per Article: 66.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The ongoing explosion of antibiotic-resistant infections continues to plague global and US health care. Meanwhile, an equally alarming decline has occurred in the research and development of new antibiotics to deal with the threat. In response to this microbial "perfect storm," in 2001, the federal Interagency Task Force on Antimicrobial Resistance released the "Action Plan to Combat Antimicrobial Resistance; Part 1: Domestic" to strengthen the response in the United States. The Infectious Diseases Society of America (IDSA) followed in 2004 with its own report, "Bad Bugs, No Drugs: As Antibiotic Discovery Stagnates, A Public Health Crisis Brews," which proposed incentives to reinvigorate pharmaceutical investment in antibiotic research and development. The IDSA's subsequent lobbying efforts led to the introduction of promising legislation in the 109 th US Congress (January 2005-December 2006). Unfortunately, the legislation was not enacted. During the 110 th Congress, the IDSA has continued to work with congressional leaders on promising legislation to address antibiotic-resistant infection. Nevertheless, despite intensive public relations and lobbying efforts, it remains unclear whether sufficiently robust legislation will be enacted. In the meantime, microbes continue to become more resistant, the antibiotic pipeline continues to diminish, and the majority of the public remains unaware of this critical situation. The result of insufficient federal funding; insufficient surveillance, prevention, and control; insufficient research and development activities; misguided regulation of antibiotics in agriculture and, in particular, for food animals; and insufficient overall coordination of US (and international) efforts could mean a literal return to the preantibiotic era for many types of infections. If we are to address the antimicrobial resistance crisis, a concerted, grassroots effort led by the medical community will be required.
Collapse
Affiliation(s)
- Brad Spellberg
- Division of Infectious Diseases, Harbor-University of California-Los Angeles (UCLA) Medical Center, Torrance, CA 90502, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
2276
|
McFarland LV. Update on the changing epidemiology of Clostridium difficile-associated disease. ACTA ACUST UNITED AC 2008; 5:40-8. [PMID: 18174906 DOI: 10.1038/ncpgasthep1029] [Citation(s) in RCA: 108] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2007] [Accepted: 10/15/2007] [Indexed: 12/12/2022]
Abstract
In the past, Clostridium difficile-associated disease (CDAD) was thought of mainly as a nosocomial disease associated with the use of broad-spectrum antibiotics, but its epidemiology seems to be changing. Since 2002, outbreaks of severe CDAD associated with increased mortality and reduced effectiveness of treatment with metronidazole have focused attention on this challenging pathogen. A fluoroquinolone-resistant strain of C. difficile (BI/NAP1/027) has been predominantly associated with these outbreaks. Changes in the epidemiology of CDAD include the emergence of new at-risk populations and the increased incidence of the disease. Infection control programs and more effective treatments offer hope that future outbreaks of CDAD can be controlled.
Collapse
Affiliation(s)
- Lynne V McFarland
- Department of Health Services Research and Development, Puget Sound VA Health Care System, Seattle, WA, USA.
| |
Collapse
|
2277
|
Abstract
The aim of antimicrobial management or stewardship programmes is to ensure proper use of antimicrobial agents in order to provide the best treatment outcomes, to lessen the risk of adverse effects (including antimicrobial resistance), and to promote cost-effectiveness. Increasingly, long-term sustainability is found to be the major focus of antimicrobial stewardship. Implementing structural measures in healthcare institutions is therefore a major, but not the sole, focus of attention in promoting prudent use of antibiotics. The problem of antimicrobial resistance requires common strategies at all levels--for the prescribers and at ward, departmental, hospital, national and international levels.
Collapse
|
2278
|
Maki DG, Crnich CJ, Safdar N. Nosocomial Infection in the Intensive Care Unit. Crit Care Med 2008. [PMID: 18431302 PMCID: PMC7170205 DOI: 10.1016/b978-032304841-5.50053-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
2279
|
Godke J, Karam G. Principles Governing Antimicrobial Therapy in the Intensive Care Unit. Crit Care Med 2008. [DOI: 10.1016/b978-032304841-5.50054-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
2280
|
Abstract
Objective: To review the efficacy, safety, pharmacology, pharmacokinetics, pharmacodynamics, and in vitro microbiology susceptibilities of ceftobiprole, a new broad-spectrum cephalosporin. Data Sources: A PubMed and Internet search (2000–September 2007) was conducted, using the key words ceftobiprole, Ro 63–9141, BAL5788, and BAL9141. Cochrane Library and International Pharmaceutical Abstracts (2000–September 2007) were accessed and reference citations from publications identified were reviewed. Study Selection and Data Extraction: All English-language articles identified from the data sources were reviewed. Phase 3 studies were included in the evaluation. Data Synthesis: Two multinational, double-blind, pivotal Phase 3 studies involving more than 1,600 patients have shown ceftobiprole to have in vitro activity against penicillin-resistant Streptococcus pneumoniae, Pseudomonas spp., and methicillin-resistant Staphylococcus aureus (MRSA). In addition, the cure rates associated with ceftobiprole for complicated skin and skin structure infections (cSSSI) were comparable with those of a single drug or a 2-drug comparator combination. Adverse effects included nausea, vomiting, taste disturbance, headache, and diarrhea. Conclusions: Ceftobiprole is an essential addition to the antimicrobial armamentarium for use against MRSA and/or multidrug-resistant gram-negative infections. Ceftobiprole is approved for the treatment of cSSSI, including diabetic foot infections; however, studies related to the treatment of hospital-acquired and community-acquired pneumonia requiring hospitalization are ongoing. The safety profile is consistent with that of the cephalosporin class of antibiotics. Ceftobiprole will serve as empiric or definitive antimicrobial therapy for resistant gram-negative and gram-positive pathogens. The challenge will be to maintain judicious use through antibiotic stewardship programs and deescalation strategies.
Collapse
Affiliation(s)
- Tripp Dixon
- TRIPP DIXON PharmD, Clinical Pharmacy Specialist, Department of Pharmacy, Huntsville Hospital, Huntsville, AL
| | - Edward H Eiland
- EDWARD H EILAND III PharmD MBA BCPS CGP, Clinical Practice and Business Supervisor, Department of Pharmacy, Huntsville Hospital
| |
Collapse
|
2281
|
Eiland EH, Robinson JB. Effect of linezolid on the occurrence of vancomycin-resistant enterococci. Am J Health Syst Pharm 2007; 64:2535-6. [DOI: 10.2146/ajhp070254] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Edward H. Eiland
- Department of Pharmacy
Huntsville Hospital
101 Sivley Road
Huntsville, AL 35801
| | | |
Collapse
|
2282
|
|
2283
|
Lautenbach E, Polk RE. Resistant gram-negative bacilli: A neglected healthcare crisis? Am J Health Syst Pharm 2007; 64:S3-21; quiz S22-4. [DOI: 10.2146/ajhp070477] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ebbing Lautenbach
- University of Pennsylvania School of Medicine, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021
| | - Ron E. Polk
- Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University/Medical College of Virginia Campus, 410 North 12th Street, PO Box 980533, Richmond, VA 23298-0533
| |
Collapse
|
2284
|
Jodlowski TZ. Infectious diseases pharmacy residency programs. Am J Health Syst Pharm 2007; 64:2330, 2332-3. [PMID: 17989442 PMCID: PMC7110091 DOI: 10.2146/ajhp070214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
|
2285
|
Apisarnthanarak A, Srichomkwun P, Sutepvarnon A, Bailey TC, Fraser VJ. The Long-Term Outcomes of an Antibiotic Control Program with and without Education. Clin Infect Dis 2007; 45:1245-7. [DOI: 10.1086/522279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
2286
|
Connor DM, Binkley S, Fishman NO, Gasink LB, Linkin D, Lautenbach E. Impact of automatic orders to discontinue vancomycin therapy on vancomycin use in an antimicrobial stewardship program. Infect Control Hosp Epidemiol 2007; 28:1408-10. [PMID: 17994524 DOI: 10.1086/523864] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2007] [Accepted: 08/15/2007] [Indexed: 11/03/2022]
Abstract
We examined the possible unintended consequences of a 72-hour automatic order to discontinue vancomycin therapy in an antimicrobial stewardship program (ASP). Of 120 patients, 11 had vancomycin therapy discontinued at 72 hours without a call to the ASP, and 7 experienced a treatment interruption of 6-36 hours. All discontinuation of therapy was considered appropriate, and the 7 treatment interruptions did not have clear clinical consequences. Only one-third of patients had ASP stickers that warned of impending discontinuation of vancomycin therapy placed appropriately in the medical record.
Collapse
Affiliation(s)
- Denise M Connor
- Division of Infectious Diseases, Department of Medicine, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania School of Medicine, Philadelphia, PA 19104-6021, USA
| | | | | | | | | | | |
Collapse
|
2287
|
Wada H, Okazaki M, Yokoyama T, Kurai D, Goto H. [Antimicrobials and infection control]. Nihon Yakurigaku Zasshi 2007; 130:380-385. [PMID: 18000352 DOI: 10.1254/fpj.130.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
|
2288
|
Declercq P, Petré D, Gordts B, Voss A. Complicated Community-Acquired Soft Tissue Infection by MRSA from Porcine Origin. Infection 2007; 36:590-2. [DOI: 10.1007/s15010-007-7029-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 06/14/2007] [Indexed: 01/04/2023]
|
2289
|
Guerra CM, Pereira CAP, Neves Neto AR, Cardo DM, Correa L. Physicians' perceptions, beliefs, attitudes, and knowledge concerning antimicrobial resistance in a Brazilian teaching hospital. Infect Control Hosp Epidemiol 2007; 28:1411-4. [PMID: 17994525 DOI: 10.1086/523278] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2007] [Accepted: 08/03/2007] [Indexed: 11/03/2022]
Abstract
This cross-sectional survey assessed physicians' perceptions, knowledge and practices concerning antimicrobial resistance. Ninety-nine percent of participants reported that they perceived antimicrobial resistance as an important problem, and 86.7% agreed that antimicrobials are overprescribed, but only 2.9% rated "practicing antimicrobial control" as the most important strategy for preventing resistance. The results of this study warrant educational programs on antimicrobial resistance and the distribution of information regarding local antimicrobial susceptibility testing.
Collapse
|
2290
|
Alfandari S, Baudlot I, Caillaux M, Senneville E, Thirard L, Zawadzki E, Leroy O. [Compliance to the antibiotic committee guidelines in Tourcoing Hospital]. PATHOLOGIE-BIOLOGIE 2007; 55:486-9. [PMID: 17920785 DOI: 10.1016/j.patbio.2007.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
AIMS OF THE STUDY We evaluated the compliance to the antibiotic committee guidelines of Tourcoing Hospital. METHODS A national nosocomial infections prevalence study was conducted in June 2006. We collected additional data on the name and indication of prescribed antibiotics compared to recommended drugs in our therapeutic guidelines. Endpoints were antibiotic indication, compliance to local guidelines, unjustified combination therapy and deescalation therapy if possible. Situations non included in the guidelines were evaluated on a case to case basis after discussion with the prescribing physician. Pediatric (N=5) or prophylaxis (N=4) prescriptions were not analysed. RESULTS Antibiotics were used in 97/669 (14.5%) patients including 32% in acute care, 11% in rehab and 0,9% in long term care. Drugs recommended in the guidelines were used in 63 cases (60.5%) including 56.3% first line and 4.2% justified second line therapy. When including situations not included in the guidelines and judged as correct, compliance reached 64.9%. The 41 variations from guidelines observed in 34 patients concerned: molecule choice (N=12), lack of antibiotic indication (N=12), unjustified combination therapy (N=12), drug choice in combination therapy (N=5), lack of deescalation (N=1). Lower respiratory tract (N=12) and urinary tract (N=7) infections as well as fluoroquinolones (N=12) were the most frequent deviations from guidelines. CONCLUSION Compliance rate is encouraging. This study pinpoints specific targets for future interventions.
Collapse
Affiliation(s)
- S Alfandari
- Service de Réanimation et Maladies Infectieuses, Centre Hospitalier de Tourcoing, France.
| | | | | | | | | | | | | |
Collapse
|
2291
|
Deresinski S. Principles of Antibiotic Therapy in Severe Infections: Optimizing the Therapeutic Approach by Use of Laboratory and Clinical Data. Clin Infect Dis 2007; 45 Suppl 3:S177-83. [PMID: 17712744 DOI: 10.1086/519472] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The increasingly daunting problem of antimicrobial resistance has led to an intense focus on optimization of antibiotic therapy, with simultaneous goals of improving patient outcomes and minimizing the contribution of that therapy to making the available antibiotics obsolete. Although even appropriate antibiotic therapy drives resistance, inappropriate therapy may also have adverse effects on the individual patient, as well as on the bacterial ecology. Recent research has validated the benefit of intelligent utilization of both microbiological data and clinical assessment in the empirical selection of initial broad-spectrum therapy and in further guidance of therapeutic decisions throughout the course of illness by use of a systems approach. Thus, the optimal approach to the critically ill patient with infection involves the initiation of aggressive broad-spectrum empirical therapy followed by timely responses to microbiological and clinical results as they become available. An appropriate response to this information often involves de-escalation of therapy or even its discontinuation.
Collapse
Affiliation(s)
- Stan Deresinski
- Division of Infectious Disease and Geographic Medicine, Department of Medicine, Stanford University, Stanford, CA, USA.
| |
Collapse
|
2292
|
|
2293
|
Nathwani D, Christie P. The Scottish approach to enhancing antimicrobial stewardship. J Antimicrob Chemother 2007; 60 Suppl 1:i69-71. [PMID: 17656387 DOI: 10.1093/jac/dkm162] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In 2002, the Scottish Executive produced the Antimicrobial Resistance Strategy and Scottish Action Plan, which highlighted antimicrobial stewardship as a key objective in combating resistance. An important response, as a part of the Ministerial Healthcare Associated Infection Task Force work programme was the publication of 'Antimicrobial Prescribing Policy and Practice in Scotland: recommendations for good antimicrobial practice in acute hospitals' in 2005. This article briefly reviews the core components of the Scottish approach, reviews progress with some key goals and explores how many of these goals are being taken forward through a cohesive Scottish national multifaceted strategy, which incorporates primary and secondary care. Much of this will spring from the current review of the Scottish Action Plan. While recognizing the significant progress achieved by the Appropriate Antimicrobial Prescribing for Tomorrow's Doctors Project Group in the education of undergraduate medical students, the article also reviews the NHS Education Scotland-supported Scottish National Antimicrobial Prescribing Project, aimed at foundation training doctors in Scotland. We hope that this experience can be shared and further developed with colleagues within the United Kingdom and European Union.
Collapse
Affiliation(s)
- Dilip Nathwani
- Infection Unit, East Block, Level 4, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK.
| | | |
Collapse
|
2294
|
Abstract
Specialist pharmacists have become an established feature of the antibiotic stewardship landscape in hospitals throughout the UK over the last decade. This review examines the origins of the specialist antibiotic pharmacist and how the role has developed in recent years. Antibiotic pharmacists fulfil a vital function in modern National Health Service hospitals as key members of the infection control team with overall responsibility for initiatives to promote rational antibiotic prescribing. Evidence of the impact of antibiotic pharmacists on clinical, microbiological and financial outcomes is presented along with examples of innovative practice. Finally, a vision for the future of the antibiotic pharmacist role is outlined.
Collapse
Affiliation(s)
- Kieran Hand
- Pharmacy Department, Southampton University Hospitals NHS Trust, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
| |
Collapse
|
2295
|
Summary of the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2007. [DOI: 10.1097/ipc.0b013e318068b1c0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
2296
|
Atkinson M, Yanney M, Stephenson T, Smyth A. Effective treatment strategies for paediatric community-acquired pneumonia. Expert Opin Pharmacother 2007; 8:1091-101. [PMID: 17516873 PMCID: PMC7103692 DOI: 10.1517/14656566.8.8.1091] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pneumonia is the leading cause of death in children under 5 years of age worldwide and a cause of morbidity in a considerable number of children. A number of studies have sought to identify the ideal choice of antibiotics, route of administration and optimum duration of treatment based on the most likely aetiological agents. Emerging bacterial resistance to antibiotics is also an important consideration in treatment. However, inconsistent clinical and radiological definitions of pneumonia make comparison between studies difficult. There is also a lack of well designed adequately powered randomised controlled trials. This review describes the difficulties encountered in diagnosing community-acquired pneumonia, aetiology, treatment strategies with recommendations and highlights areas for further research.
Collapse
Affiliation(s)
- Maria Atkinson
- Specialist Registrar, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Michael Yanney
- Specialist Registrar, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Terence Stephenson
- Professor of Child Health, Division of Child Health, University of Nottingham, Nottingham, UK
| | - Alan Smyth
- Senior Lecturer in Child Health, Division of Respiratory Medicine, Clinical Sciences Building, Nottingham City Hospital, Hucknall Road, Nottingham, NG5 1PB, UK.
| |
Collapse
|
2297
|
Affiliation(s)
- John S Bradley
- Children's Hospital San Diego, University of California, San Diego, USA.
| |
Collapse
|
2298
|
File TM, Gross PA. Performance Measurement in Community-Acquired Pneumonia: Consequences Intended and Unintended. Clin Infect Dis 2007; 44:942-4. [PMID: 17342645 DOI: 10.1086/512436] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Accepted: 12/28/2006] [Indexed: 11/03/2022] Open
|
2299
|
Polk RE, Fox C, Mahoney A, Letcavage J, MacDougall C. Measurement of Adult Antibacterial Drug Use in 130 US Hospitals: Comparison of Defined Daily Dose and Days of Therapy. Clin Infect Dis 2007; 44:664-70. [PMID: 17278056 DOI: 10.1086/511640] [Citation(s) in RCA: 291] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2006] [Accepted: 10/19/2006] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Hospitals are advised to measure antibiotic use and monitor its relationship to resistance. The World Health Organization's recommended metric is the defined daily dose (DDD). An alternative measure is the number of days of therapy (DOT). The purpose of this study was to contrast these measures. METHODS We measured the use of 50 antibacterial drugs that were administered to adults who were discharged from 130 US hospitals during 1 August 2002-31 July 2003. RESULTS Of 1,795,504 patients, 1,074,174 received at least 1 dose of an antibacterial drug (59.8%). The mean (+/- standard deviation) of total antibacterial drug use measured by the number of DDDs per 1000 patient-days and the number of DOTs per 1000 patient-days were not significantly different (792+/-147 and 776+/-120, respectively; P=.137), although the correlation was poor (r=0.603). For some individual drugs, such as levofloxacin and linezolid, there was no significant difference between DDDs per 1000 patient-days and DOTs per 1000 patient-days, because the administered daily dosage was nearly equivalent to the DDD. When the administered dosage exceeded the DDD, such as for ampicillin-sulbactam and cefepime, estimates of use based on DDDs per 1000 patient-days significantly exceeded those based on DOTs per 1000 patient-days (P<.001). When the administered dosage was less than the DDD, such as for piperacillin-tazobactam and ceftriaxone, estimates of use based on DDDs per 1000 patient-days were significantly lower than those based on DOTs per 1000 patient-days (P<.001). CONCLUSION The measurement of aggregate hospital antibiotic use by DDDs per 1000 patient-days and DOTs per 1000 patient-days is discordant for many frequently used antibacterial drugs, because the administered dose is dissimilar from the DDD recommended by the World Health Organization. DDD methods are useful for benchmarking purposes but cannot be used to make inferences about the number of DOTs or relative use for many antibacterial drugs.
Collapse
Affiliation(s)
- Ronald E Polk
- School of Pharmacy, Department of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, VA 23298, USA.
| | | | | | | | | |
Collapse
|
2300
|
Owens RC, Ambrose PG. Antimicrobial stewardship and the role of pharmacokinetics-pharmacodynamics in the modern antibiotic era. Diagn Microbiol Infect Dis 2007; 57:77S-83S. [PMID: 17292579 DOI: 10.1016/j.diagmicrobio.2006.12.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 12/12/2006] [Indexed: 01/22/2023]
Abstract
Antimicrobial stewardship, a term coined by Dale Gerding, is defined as the optimal selection, dose, and duration of an antimicrobial that results in the best clinical outcome for the treatment or prevention of infection, with minimal toxicity to the patient and minimal impact on subsequent resistance development. Methods to promote and ensure good antimicrobial stewardship have been implemented and studied, and have typically provided tangible benefits in terms of a reduction in overall or targeted antimicrobial usage and resistance emergence. Although most of the programmatic antimicrobial stewardship efforts have been conducted in acute care inpatient settings, some strategies usually involving education have been evaluated in the outpatient venue. In this review, we shall discuss issues related to why antimicrobial stewardship is of particular importance in the modern antibiotic era. In addition, general pharmacokinetic-pharmacodynamic (PK-PD) concepts will be reviewed and specific PK-PD analyses that support the optimal selection, dosing, and duration of therapy for beta-lactam antimicrobials will be provided.
Collapse
Affiliation(s)
- Robert C Owens
- Department of Clinical Pharmacy Services, Division of Infectious Diseases, Maine Medical Center, Portland, ME 04102, USA.
| | | |
Collapse
|