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Asiltürk D, Güner R, Kaya Kalem A, Özkoçak Turan I, Hasanoğlu I, Eser F, Malhan S, Kayaaslan B. Antibiotic management programme in a tertiary intensive care unit: effects of a carbapenem-restricted period on clinical and laboratory parameters and costs of infections. J Hosp Infect 2024; 148:87-94. [PMID: 38521418 DOI: 10.1016/j.jhin.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Carbapenems are antibiotics used for serious infections. The consumption of carbapenems has increased worldwide due to increasing microbial resistance. AIM To investigate the effects of a carbapenem-restricted antimicrobial stewardship programme (ASP) on changes in the resistance profiles of infectious agents, the amount of antibiotics used, length of stay in the intensive care unit (ICU), mortality, and costs. METHODS Patients hospitalized in ICU between July 1st, 2020 and May 1st, 2021 were divided into two periods: the carbapenem-non-restricted period (CNRP); and the carbapenem-restricted period (CRP) in which alternative antibiotics to carbapenems were preferred during infection. The defined daily dose (DDD) per 100 patient-day methodology was used to calculate the antibiotic consumption. FINDINGS Of the 572 patients included in the study, 62.2% were male, and mean age was 70.5 years. In the blood culture the most frequently Gram-negative agent was Acinetobacter baumannii (25%). A. baumannii bloodstream infections with multidrug-resistant and extensively drug resistant micro-organisms were significantly different between the two periods (CNRP: 95.6% (N = 22), CRP: 66.6% (N = 8); P = 0.04). There was a gradual decrease in the incidence density and rate of nosocomial infection (P = 0.06), and a significant decrease in meropenem consumption between the two periods (CNRP vs CRP: 21.19 vs 6.37 DDD per 100 patient-days respectively; P = 0.007). ASP yielded US$8,600 of antibiotic cost savings and a total of 14% patient cost savings (P < 0.05) per patient. CONCLUSION Combining an effective ASP with a comprehensive infection control programme may mitigate the emergence of antimicrobial-resistant bacteria.
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Affiliation(s)
- D Asiltürk
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, Ankara, Turkey.
| | - R Güner
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, Ankara, Turkey
| | - A Kaya Kalem
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, Ankara, Turkey
| | - I Özkoçak Turan
- Anesthesia and Reanimation, Bilkent City Hospital, Ankara, Turkey
| | - I Hasanoğlu
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, Ankara, Turkey
| | - F Eser
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, Ankara, Turkey
| | - S Malhan
- Department of Health Care Management, Başkent University, Ankara, Turkey
| | - B Kayaaslan
- Infection Disease and Clinical Microbiology, Bilkent City Hospital, Ankara, Turkey
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2
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Lee SJ, Lee R, Cho SY, Nho D, Ahn HL, Lee DG. Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea. Korean J Intern Med 2024; 39:399-412. [PMID: 38715230 PMCID: PMC11076883 DOI: 10.3904/kjim.2023.504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 05/12/2024] Open
Abstract
Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.
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Affiliation(s)
- Soo Jin Lee
- Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul,
Korea
| | - Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dukhee Nho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hye Lim Ahn
- Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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3
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Cabrera-Aguas M, Chidi-Egboka N, Kandel H, Watson SL. Antimicrobial resistance in ocular infection: A review. Clin Exp Ophthalmol 2024; 52:258-275. [PMID: 38494451 DOI: 10.1111/ceo.14377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 02/22/2024] [Accepted: 03/03/2024] [Indexed: 03/19/2024]
Abstract
Antimicrobial resistance (AMR) is a global public health threat with significant impact on treatment outcomes. The World Health Organization's Global Action Plan on AMR recommended strengthening the evidence base through surveillance programs and research. Comprehensive, timely data on AMR for organisms isolated from ocular infections are needed to guide treatment decisions and inform researchers and microbiologists of emerging trends. This article aims to provide an update on the development of AMR in ocular organisms, AMR in bacterial ocular infections and on AMR stewardship programs globally. The most common ocular pathogens are Pseudomonas aeruginosa, Staphylococcus spp., Streptococcus pneumoniae, and Haemophilus influenzae in ocular infections. A variety of studies and a few surveillance programs worldwide have reported on AMR in these infections over time. Fluoroquinolone resistance has increased particularly in Asia and North America. For conjunctivitis, the ARMOR cumulative study in the USA reported a slight decrease in resistance to ciprofloxacin. For keratitis, resistance to methicillin has remained stable for S. aureus and CoNS, while resistance to ciprofloxacin has decreased for MRSA globally. Methicillin-resistance and multidrug resistance are also emerging, requiring ongoing monitoring. Antimicrobial stewardship (AMS) programmes have a critical role in reducing the threat of AMR and improving treatment outcomes. To be successful AMS must be informed by up-to-date AMR surveillance data. As a profession it is timely for ophthalmology to act to prevent AMR leading to greater visual loss through supporting surveillance programmes and establishing AMS.
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Affiliation(s)
- Maria Cabrera-Aguas
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Eye Hospital, Sydney, New South Wales, Australia
| | - Ngozi Chidi-Egboka
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Himal Kandel
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
| | - Stephanie L Watson
- Faculty of Medicine and Health, Save Sight Institute, The University of Sydney, Sydney, New South Wales, Australia
- Sydney Eye Hospital, Sydney, New South Wales, Australia
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Burgener-Gasser AV, Fasel J, Halbeisen D, Hartmann K, Weisser-Rohacek M, Kaufmann C, Tschudin-Sutter S. Assessing the rationale of prescribing carbapenems among hospitalized patients with documented penicillin allergy: implications for stewardship. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e37. [PMID: 38500716 PMCID: PMC10945937 DOI: 10.1017/ash.2024.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/13/2023] [Accepted: 12/17/2023] [Indexed: 03/20/2024]
Abstract
Background A reported history of penicillin allergy frequently leads to the prescription of carbapenems as a substitute for penicillin to avoid allergic reactions. Such self-reported allergies need to be accurately characterized to identify targeted antibiotic stewardship interventions that potentially minimize unnecessary carbapenem use. Design Retrospective cohort study. Method The proportion of hospitalized patients with penicillin allergy history receiving carbapenem prescriptions was evaluated between January 1st, 2017 and December 31st, 2018 at the University Hospital Basel, Switzerland. The appropriateness of carbapenem prescription of each patient was evaluated using institutional guidelines based on previously published recommendations. Results Our analysis revealed that among 212 patients with recorded penicillin allergy, of the 247 carbapenem treatment episodes, 79 (32%) were unjustified. Abdominal and lower respiratory tract infections were most frequently associated with inappropriate carbapenem use (OR 2.64, 95% CI 1.22-5.71, P = .014 and OR 2.26, 95% CI 1.08-4.73, P = .031). The recorded allergy type was not documented or unclear in 153 patients (72%) and penicillin allergy was only confirmed in 2 patients (0.9%). Inconsistencies in allergic symptom documentation and allergy types were found between the institution's two software programs. Conclusion While a multimodal approach to identify and accurately label penicillin allergies remains essential to reduce inappropriate carbapenem use, our findings highlight the need for comprehensive and easily accessible guidelines for carbapenem utilization and structured history-based allergy assessment as an initial screening tool, embedded in a tailored digital allergy record template.
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Affiliation(s)
| | - Jeanne Fasel
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Delia Halbeisen
- Division of clinical Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Karin Hartmann
- Division of Allergy, Department of Dermatology, University Hospital Basel, Basel, Switzerland
| | - Maja Weisser-Rohacek
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Carole Kaufmann
- Division of clinical Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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5
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Garcia O’Farrill N, Abi Karam M, Villegas VM, Flynn HW, Grzybowski A, Schwartz SG. New Approaches to Overcoming Antimicrobial Resistance in Endophthalmitis. Pharmaceuticals (Basel) 2024; 17:321. [PMID: 38543107 PMCID: PMC10974156 DOI: 10.3390/ph17030321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 02/22/2024] [Accepted: 02/26/2024] [Indexed: 04/01/2024] Open
Abstract
Endophthalmitis is a rare but vision-threatening infection characterized by marked inflammation of intraocular fluids and tissues, uncommonly seen following surgery and intravitreal injection. Antimicrobials are used worldwide in the prophylaxis and treatment of bacterial and fungal infections of the eye and are standard treatment in the preoperative and postoperative care of surgical patients. However, antimicrobials are reported to be overprescribed in many parts of the world, which contributes to antimicrobial resistance (AMR). AMR complicates the prophylaxis and treatment of endophthalmitis. This article examines the prevalence and mechanisms of AMR in ocular microorganisms, emphasizing the importance of understanding AMR patterns for tailored treatments. It also explores prophylaxis and management strategies for endophthalmitis, with a discussion on the use of intracameral antibiotic administration. The use of prophylactic intracameral antibiotics during cataract surgery is common in many parts of the world but is still controversial in some locations, especially in the US. Finally, it highlights the role of stewardship in ophthalmology and its benefits in the treatment of endophthalmitis.
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Affiliation(s)
- Noraliz Garcia O’Farrill
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Mariana Abi Karam
- Department of Ophthalmology, MetroHealth, Cleveland, OH 44109, USA;
- Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA
| | - Victor M. Villegas
- Department of Ophthalmology, University of Puerto Rico School of Medicine, San Juan, PR 00936, USA; (N.G.O.); (V.M.V.)
| | - Harry W. Flynn
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Andrzej Grzybowski
- Institute for Research in Ophthalmology, Foundation for Ophthalmology Development, 61-553 Poznan, Poland;
| | - Stephen G. Schwartz
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL 33136, USA
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Kumar NR, Balraj TA, Kempegowda SN, Prashant A. Multidrug-Resistant Sepsis: A Critical Healthcare Challenge. Antibiotics (Basel) 2024; 13:46. [PMID: 38247605 PMCID: PMC10812490 DOI: 10.3390/antibiotics13010046] [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: 12/02/2023] [Revised: 12/25/2023] [Accepted: 12/28/2023] [Indexed: 01/23/2024] Open
Abstract
Sepsis globally accounts for an alarming annual toll of 48.9 million cases, resulting in 11 million deaths, and inflicts an economic burden of approximately USD 38 billion on the United States healthcare system. The rise of multidrug-resistant organisms (MDROs) has elevated the urgency surrounding the management of multidrug-resistant (MDR) sepsis, evolving into a critical global health concern. This review aims to provide a comprehensive overview of the current epidemiology of (MDR) sepsis and its associated healthcare challenges, particularly in critically ill hospitalized patients. Highlighted findings demonstrated the complex nature of (MDR) sepsis pathophysiology and the resulting immune responses, which significantly hinder sepsis treatment. Studies also revealed that aging, antibiotic overuse or abuse, inadequate empiric antibiotic therapy, and underlying comorbidities contribute significantly to recurrent sepsis, thereby leading to septic shock, multi-organ failure, and ultimately immune paralysis, which all contribute to high mortality rates among sepsis patients. Moreover, studies confirmed a correlation between elevated readmission rates and an increased risk of cognitive and organ dysfunction among sepsis patients, amplifying hospital-associated costs. To mitigate the impact of sepsis burden, researchers have directed their efforts towards innovative diagnostic methods like point-of-care testing (POCT) devices for rapid, accurate, and particularly bedside detection of sepsis; however, these methods are currently limited to detecting only a few resistance biomarkers, thus warranting further exploration. Numerous interventions have also been introduced to treat MDR sepsis, including combination therapy with antibiotics from two different classes and precision therapy, which involves personalized treatment strategies tailored to individual needs. Finally, addressing MDR-associated healthcare challenges at regional levels based on local pathogen resistance patterns emerges as a critical strategy for effective sepsis treatment and minimizing adverse effects.
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Affiliation(s)
- Nishitha R. Kumar
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Tejashree A. Balraj
- Department of Microbiology, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India;
| | - Swetha N. Kempegowda
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
| | - Akila Prashant
- Department of Biochemistry, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India; (N.R.K.); (S.N.K.)
- Department of Medical Genetics, JSS Medical College and Hospital, JSS Academy of Higher Education & Research, Mysuru 570004, India
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7
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Barletta JF. Empiric Carbapenem Therapy for Sepsis: Are We Winning the Battle at the Expense of the War? Crit Care Med 2023; 51:1275-1277. [PMID: 37589521 DOI: 10.1097/ccm.0000000000005949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Jeffrey F Barletta
- Department of Pharmacy Practice, Midwestern University, College of Pharmacy-Glendale Campus, Glendale, AZ
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8
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Ronda M, Padullés A, Grau I, Tubau F, Satorra P, Shaw E, Vigués F, Carratalà J. Impact of a prospective audit and feedback antimicrobial stewardship programme on carbapenem consumption: a quasi-experimental study (IPANEMA study). J Antimicrob Chemother 2023:7185846. [PMID: 37248767 DOI: 10.1093/jac/dkad160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/24/2023] [Indexed: 05/31/2023] Open
Abstract
OBJECTIVES To test the hypothesis that a prospective audit and feedback (PAF) intervention combined with electronic tools will reduce carbapenem use without negatively affecting patient outcomes. METHODS A quasi-experimental, pre-intervention and intervention study was performed conducted in the urology department of a university hospital. The intervention involved implementing a PAF within an antimicrobial stewardship programme with the aid of an electronic tool. The primary outcome was carbapenem use, assessed by DDD/100 patient-days (PD). Secondary outcomes included evaluating the effect of the intervention on overall antibiotic use measured by DDD/100 PD and days of therapy (DOT)/100 PD, as well as patient safety. The chi-squared test or t-test was used, and the Poisson model was employed to assess the association between the intervention and outcomes. RESULTS A 9% decrease in carbapenem DDD/100 PD was observed during the intervention period (IR = 0.91; 95% CI = 0.85-0.97, P = 0.007). The proportion of patients who received carbapenem treatment dropped from 17.8% to 16.5% [incidence ratio (IR) = 0.95; 95% CI = 0.86-2.05, P = 0.31]. Carbapenem DOT/100 PD decreased from 12.4 to 11.0 (IR = 0.89; 95% CI = 0.83-0.94, P < 0.001). Overall antibiotic DDD/100 PD decreased by 3% (IR = 0.97; 95% CI = 0.94-0.99, P = 0.001) and DOT/100 PD by 7% (IR = 0.93; 95% CI = 0.91-0.95, P < 0.001). The incidence of infections caused by carbapenemase-producing microorganisms, Enterococcus faecium bacteraemia and Clostridioides difficile-associated diarrhoea episodes was similar in the pre-intervention and intervention periods. ESBL incidence rate decreased, but the differences were not statistically significant (3.94/1000 PD versus 2.88/1000 PD, P = 0.111). Length of hospital stay, in-hospital all-cause mortality, and 30 day readmission incidence remained unchanged. CONCLUSIONS The implementation of PAF combined with an electronic tool was an effective and safe intervention for reducing carbapenem use.
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Affiliation(s)
- Mar Ronda
- Infectious Disease Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
| | - Ariadna Padullés
- Pharmacy Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Imma Grau
- Infectious Disease Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Fe Tubau
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Clinical Microbiology Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
| | - Pau Satorra
- Biostatistics Unit, Institut Investigacions Biomèdiques de Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Evelyn Shaw
- Infectious Disease Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Francesc Vigués
- Urology Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
| | - Jordi Carratalà
- Infectious Disease Department, Hospital Universitari de Bellvitge-Idibell, Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
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Spernovasilis N, Kritsotakis EI, Mathioudaki A, Vouidaski A, Spanias C, Petrodaskalaki M, Ioannou P, Chamilos G, Kofteridis DP. A carbapenem-focused antimicrobial stewardship programme implemented during the COVID-19 pandemic in a setting of high endemicity for multidrug-resistant Gram-negative bacteria. J Antimicrob Chemother 2023; 78:1000-1008. [PMID: 36790896 PMCID: PMC11023244 DOI: 10.1093/jac/dkad035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/26/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Greece is among the countries characterized by high rates of antimicrobial resistance and high consumption of antibiotics, including carbapenems. OBJECTIVES To measure the impact of a carbapenem-focused antimicrobial stewardship programme (ASP) on the antibiotic consumption and patient outcomes in a Greek tertiary hospital during the COVID-19 pandemic. METHODS A quasi-experimental, before-after study, comparing a 12 month pre-intervention period with a 12 month intervention period in which a carbapenem-focused ASP was implemented. RESULTS A total of 1268 patients were enrolled. The proportion of admitted patients who received carbapenems decreased from 4.1% (842 of 20 629) to 2.3% (426 of 18 245) (-1.8%; P < 0.001). A decrease of -4.9 DDD/100 patient-days (PD) (95% CI -7.3 to -2.6; P = 0.007) in carbapenem use and an increase in the use of piperacillin/tazobactam [+2.1 DDD/100 PD (95% CI 1.0-3.3; P = 0.010)] were observed. Thirty-day mortality following initiation of carbapenem treatment and all-cause in-hospital mortality remained unaltered after ASP implementation. In contrast, length of hospital stay increased (median 17.0 versus 19.0 days; P < 0.001), while the risk of infection-related readmission within 30 days of hospital discharge decreased (24.6% versus 16.8%; P = 0.007). In the post-implementation period, acceptance of the ASP intervention was associated with lower daily hazard of in-hospital death [cause-specific HR (csHR) 0.49; 95% CI 0.30-0.80], lower odds of 30 day mortality (OR 0.36; 95% CI 0.18-0.70) and higher rate of treatment success (csHR 2.45; 95% CI 1.59-3.77). CONCLUSIONS Implementing and maintaining a carbapenem-focused ASP is feasible, effective and safe in settings with high rates of antimicrobial resistance, even during the COVID-19 pandemic.
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Affiliation(s)
- Nikolaos Spernovasilis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Evangelos I Kritsotakis
- School of Medicine, University of Crete, Heraklion, Greece
- Laboratory of Biostatistics, School of Medicine, University of Crete, Heraklion, Greece
| | - Anna Mathioudaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Alexandra Vouidaski
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Christos Spanias
- Department of Pharmacy, University Hospital of Heraklion, Heraklion, Greece
| | - Maria Petrodaskalaki
- Department of Quality & Research, University Hospital of Heraklion, Heraklion, Greece
| | - Petros Ioannou
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
| | - Georgios Chamilos
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Clinical Microbiology, University Hospital of Heraklion, Heraklion, Greece
| | - Diamantis P Kofteridis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, Heraklion, Greece
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10
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Aiesh BM, Nazzal MA, Abdelhaq AI, Abutaha SA, Zyoud SH, Sabateen A. Impact of an antibiotic stewardship program on antibiotic utilization, bacterial susceptibilities, and cost of antibiotics. Sci Rep 2023; 13:5040. [PMID: 36977796 PMCID: PMC10043847 DOI: 10.1038/s41598-023-32329-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 03/26/2023] [Indexed: 03/30/2023] Open
Abstract
Antimicrobial misuse is a worldwide issue, and antimicrobial resistance is considered the most challenging aspect of health care. It has been reported that as much as 30-50% of antimicrobials prescribed in hospitals are deemed unnecessary or inappropriate. Antibiotic stewardship programs (ASPs) include policies that apply continuous management of judicious anti-infectious treatment in the clinical setting. Therefore, the objectives of this study were to evaluate the effect of ASPs on antibiotic consumption, the costs of antibiotic expenditure, and the sensitivity of antimicrobials. A retrospective, quasi-experimental study was performed to assess the effect of ASP at An-Najah National University Hospital, a tertiary care hospital in the West Bank, Palestine, over a period of 20 months before and 17 months after the implementation of the ASP. Data on antibiotic consumption were reported monthly as days of therapy per 1000 patient-days and monthly costs (USD/1000 patient-days). A total of 2367 patients who received one or more of the targeted antibiotics (meropenem, colistin and tigecycline) during their hospital stay were included in the study. They have split into two groups: 1710 patients in the pre-ASP group, and 657 patients in the post ASP group. The most significant reduction in DOT per 1000 patient-days was seen with tigecycline, with a percentage of change of - 62.08%. Furthermore, the mean cost of the three antibiotics decreased significantly by 55.5% in the post-ASP phase compared to the pre-ASP phase. After the implementation of ASP, there was a statistically significant increase in susceptibility to meropenem, piperacillin and piperacillin/tazobactam with respect to Pseudomonas aeruginosa. However, changes in mortality rates were not statistically significant (p = 0.057). ASP positively reduced costs and antimicrobial consumption, with no statistically significant effect on the overall mortality rate. However, a long-term evaluation of the ASP's impact is needed to conclude its lasting impact on infection-related mortality and antimicrobial susceptibility pattern.
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Affiliation(s)
- Banan M Aiesh
- Infectious Disease Unit, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Maisa A Nazzal
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Aroub I Abdelhaq
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Shatha A Abutaha
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Ali Sabateen
- Infectious Disease Unit, An-Najah National University Hospital, Nablus, 44839, Palestine.
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11
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Tabriz PT, Maghsodi PH, Afarin AJ, Heydari H, Amiry F, Sazegar MR. Antibacterial composite: polymeric mesoporous silica nanoparticles and combination of imipenem/meropenem. J Mater Chem B 2023; 11:1971-1977. [PMID: 36752045 DOI: 10.1039/d2tb02442j] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Using nanomaterials is a novel strategy to eliminate drug resistance against bacteria. Nanoparticles with metal sites show antimicrobial activities that counteract or obstruct antibiotic-resistant mechanisms expressed by the pathogens. Here, a nanocomposite based on mesoporous silica nanoparticles with active sites of silver, and a combination of imipenem and meropenem as antibiotic drugs, was synthesized and characterized using different physicochemical methods. The antibacterial assessments exhibited sensitivity by Staphylococcus aureus (S. aureus), Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) toward the synthesized composite, which showed a suitable safety profile in human cells. This composite has an excellent synergic mechanism based on reactive oxygen species (ROS) to kill bacteria due to penetrating the microbial membrane. In addition, this composite is resistant to hydrolysis by plasmids and chromosomally mediated β-lactamases. This nanocomposite showed extraordinary antiseptic power against Gram-positive and Gram-negative microbes.
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Affiliation(s)
- Pegah Tabatabaei Tabriz
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Hakimiyeh, Tehran, Iran.
| | - Parisa Haji Maghsodi
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Hakimiyeh, Tehran, Iran.
| | - Alireza Jahan Afarin
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Hakimiyeh, Tehran, Iran.
| | - Hengameh Heydari
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Hakimiyeh, Tehran, Iran.
| | - Forough Amiry
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Hakimiyeh, Tehran, Iran.
| | - Mohammad Reza Sazegar
- Department of Chemistry, North Tehran Branch, Islamic Azad University, Hakimiyeh, Tehran, Iran.
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12
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Yusuf E, Zeitlinger M, Meylan S. A narrative review of the intermediate category of the antimicrobial susceptibility test: relation with dosing and possible impact on antimicrobial stewardship. J Antimicrob Chemother 2023; 78:338-345. [PMID: 36583270 DOI: 10.1093/jac/dkac413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The interpretation of 'susceptible (S)' or 'resistant (R)' results of antimicrobial susceptibility testing is easily understood, but the interpretation of the 'intermediate (I)' category can be confusing. This review critically discusses how this categorization (clinical breakpoints) comes into being with the emphasis on the use of pharmacokinetics and pharmacodynamic data. It discusses the differences between the 'I' according to the CLSI and the EUCAST. This review also discusses the recent EUCAST change of the 'I' definition, and the impact of this change from laboratory and clinical points of view.
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Affiliation(s)
- Erlangga Yusuf
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands.,Centre for Antimicrobial Treatment Optimization Rotterdam (CATOR), Rotterdam, The Netherlands
| | - Markus Zeitlinger
- Department of Clinical Pharmacology, Clinical Pharmacokinetics/Pharmacogenetics and Imaging, Medical University of Vienna, Vienna, Austria
| | - Sylvain Meylan
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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13
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Keshavarzi F. Practical Concerns about the Metrics and Methods of Financial Outcome Measurement in Antimicrobial Stewardship Programs: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:394-405. [PMID: 36117584 PMCID: PMC9445868 DOI: 10.30476/ijms.2021.92213.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
Emerging pathogens in the meantime of paucity of new antibiotics discovery, put antimicrobial stewardship in the center of attention, to preserve the existing antimicrobial effect. Implementation of antimicrobial stewardship programs, however, needs approval from healthcare system managers. The approval process can be enhanced, when the beneficial effects of stewardship programs are supported by both clinical and financial evidence. Focusing on the financial outcome evaluation, the practitioners who run the stewardship programs, may choose certain methods and metrics, depending on the clinical setting scale and type, available human resources, and budget. The wise selection of the methods and metrics warrants a comprehensive insight of the existing methods and metrics, deployed by typically published works that set good examples to follow. This review is an attempt to provide such an insight along with typical relevant examples for each metric and method.
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Affiliation(s)
- Fazlollah Keshavarzi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
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14
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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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15
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Antimicrobial Stewardship Improvement in Pediatric Intensive Care Units in Spain-What Have We Learned? CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9060902. [PMID: 35740839 PMCID: PMC9222022 DOI: 10.3390/children9060902] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 06/03/2022] [Accepted: 06/10/2022] [Indexed: 12/03/2022]
Abstract
Antibiotic misuse in pediatric intensive care units (PICUs) can lead to increased antimicrobial resistance, antibiotic-triggered side effects, hospital costs, and mortality. We performed a multicenter, prospective study, analyzing critically ill pediatric patients (≥1 month to ≤18 years) admitted to 26 Spanish PICUs over a 3-month period each year (1 April−30 June) from 2014−2019. To make comparisons and evaluate the influence of AMS programs on antibiotic use in PICUs, the analysis was divided into two periods: 2014−2016 and 2017−2019 (once 84% of the units had incorporated an AMS program). A total of 11,260 pediatric patients were included. Total antibiotic prescriptions numbered 15,448 and, overall, 8354 patients (74.2%) received at least one antibiotic. Comparing the two periods, an increase was detected in the number of days without antibiotics in patients who received them divided by the number of days in PICUs, for community-acquired infections (p < 0.001) and healthcare-associated infections (HAIs) acquired in PICUs (p < 0.001). Antibiotics were empirical in 7720 infections (85.6%), with an increase in appropriate antibiotic indications during the second period (p < 0.001). The main indication for antibiotic adjustment was de-escalation, increasing in the second period (p = 0.045). Despite the high rate of antibiotic use in PICUs, our results showed a significant increase in appropriate antibiotic use and adjustment following the implementation of AMS programs.
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16
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de Carvalho FRT, Telles JP, Tuon FFB, Rabello Filho R, Caruso P, Correa TD. Antimicrobial Stewardship Programs: A Review of Strategies to Avoid Polymyxins and Carbapenems Misuse in Low Middle-Income Countries. Antibiotics (Basel) 2022; 11:antibiotics11030378. [PMID: 35326841 PMCID: PMC8944697 DOI: 10.3390/antibiotics11030378] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/23/2022] [Accepted: 03/04/2022] [Indexed: 01/27/2023] Open
Abstract
Antibiotics misuse and overuse are concerning issues worldwide, especially in low middle-income countries. These practices contribute to the increasing rates of antimicrobial resistance. One efficient strategy to avoid them is antimicrobial stewardship programs. In this review, we focus on the possible approaches to spare the prescription of polymyxins and carbapenems for the treatment of Acinetobacter baumannii, carbapenem-resistant Enterobacterales, and Pseudomonas aeruginosas infections. Additionally, we highlight how to implement cumulative antibiograms and biomarkers to a sooner de-escalation of antibiotics.
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Affiliation(s)
- Fabrício Rodrigues Torres de Carvalho
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil;
- Correspondence: (F.R.T.d.C.); (J.P.T.)
| | - João Paulo Telles
- Department of Infectious Diseases, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil
- School of Medicine, Pontifical Catholic University, Curitiba 80215-901, PR, Brazil;
- Department of Infectious Diseases, Hospital Universitario Evangelico Mackenzie, Curitiba 80730-420, PR, Brazil
- Correspondence: (F.R.T.d.C.); (J.P.T.)
| | | | - Roberto Rabello Filho
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
| | - Pedro Caruso
- Intensive Care Unit, AC Camargo Cancer Center, São Paulo 01525-001, SP, Brazil;
| | - Thiago Domingos Correa
- Intensive Care Unit, Hospital Israelita Albert Einstein, São Paulo 05652-900, SP, Brazil; (R.R.F.); (T.D.C.)
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17
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Impact of the Acceptance of the Recommendations Made by a Meropenem Stewardship Program in a University Hospital: A Pilot Study. Antibiotics (Basel) 2022; 11:antibiotics11030330. [PMID: 35326793 PMCID: PMC8944864 DOI: 10.3390/antibiotics11030330] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 01/27/2023] Open
Abstract
Antimicrobial stewardship programs (ASP) promote appropriate antimicrobial use. We present a 4-year retrospective study that evaluated the clinical impact of the acceptance of the recommendations made by a meropenem-focused ASP. A total of 318 meropenem audits were performed. The ASP team (comprising infectious disease physicians, pharmacists and microbiologists) considered meropenem use in 96 audits (30.2%) to be inappropriate. The reasons to consider these uses inappropriate were the possibility of de-escalating to a narrower-spectrum antibiotic, in 66 (68.7%) audits, and unnecessary meropenem use, in 30 (31.3%) audits. The ASP team recommended de-escalation in 66 audits (68.7%) and discontinuation of meropenem in 30 audits (31.3%). ASP interventions were stratified according to whether or not recommendations were followed. The group in which recommendations were accepted and followed (i.e., accepted audit, AA) included 66 audits (68.7%) and the group in which recommendations were not followed (i.e., rejected audit, RA) included 30 (31.3%) audits. The comorbidity of the AA group (Charlson score) was higher than in the RA group (7.0 (5.0–9.0) vs. 6.0 (4.0–7.0), p = 0.02). Discontinuation of meropenem was recommended in 83.3% of audits in the AA group vs. 62.2% in the RA group (OR 3.05 (1.03–8.99), p = 0.04). Ertapenem de-escalation resulted in a 100% greater rate of follow-up compared with the non-carbapenem option (100% vs. 51.9%, OR 1.50 (1.21–1.860), p = 0.001). Significant differences were observed in the AA group when cultures were taken before antibiotic prescription—98.5% vs. 83.3% (p = 0.01, OR 13.0 (1.45–116.86))—or when screening cultures were taken—45.5% vs. 19.2% (p = 0.03, OR 3.5 (1.06–11.52)). There were no differences between the groups in terms of overall mortality and 30-day mortality, length of stay, Clostridiodes difficile infection, 30-day readmission or hospitalization costs. In conclusion, meropenem ASP recommendations contributed to a decrease in meropenem prescription without worsening clinical and economic outcomes.
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18
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Shirazi OU, Ab Rahman NS, Zin CS. An overview of the hospitals’ antimicrobial stewardship programs implemented to improve antibiotics’ utilization, cost and resistance patterns. JOURNAL OF PHARMACY 2022. [DOI: 10.31436/jop.v2i1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Introduction: The high reliance of the physicians and surgeons on the antibiotics since their discovery has led to an irrational antibiotic utilization which not only has raised the incidence of antimicrobial resistance (AMR) but also increased the cost of treatment with antibiotics as high use of antibiotics has been found related to the occurrence of certain nosocomial infections which need extra antibiotic courses to be cured. In order to overcome these antibiotic utilization related problems an antimicrobial stewardship (AMS) program being the set of various persuasive, restrictive and structural interventions is considered an effective tool to rationalize the in-patient antimicrobial utilization worldwide.
Method: The focus of this review is on the interventions that are being implemented during the in-patient AMS programs and have been described effective in controlling the antibiotic utilization, their cost of treatment and an overall infection control. The literature containing the information about various AMS interventions effecting the utilization and cost patterns along with the impact on AMR was searched in various databases such as PubMed, Google Scholar, Science Direct, Ovid (Medline) and Scopus. The categorical sorting of the published data is based on various AMS interventions such as the guideline development, formulary restriction (pre-authorization), educative interventions, clinical pathway development and prospective (post prescription) audit. Considering the objectives of the study such as the goal to curb overutilization of antibiotics, control of their cost of treatment for in-patients and infection control the sorted literature is presented in three different tables describing the AMS impact on the said outcomes.
Results: The post AMS changes in utilization patterns are described as fall of antibiotics defined daily doses (DDD) and days of therapy (DOT) which resulted in the reduction of the cost of treatment with antibiotics. The reduction of the cost of treatment with antibiotics also resulted due to the AMS impact on the control of various nosocomial and multi-drug resistant (MDR) infections.
Conclusion: It has been concluded that the AMS program if implemented under the supervision of an expert AMS team mainly comprising of an infectious disease (ID) physician, clinical pharmacists and microbiologists with considerable support by the hospital authorities could be a highly efficient tool of the pharmacovigilance for rationalizing the in-patient antimicrobial practice.
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19
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Kagami K, Ishiguro N, Yamada T, Niinuma Y, Iwasaki S, Taki K, Fukumoto T, Hayasaka K, Nishida M, Sugita J, Teshima T, Sugawara M, Takekuma Y. Clinical outcomes of intervention for carbapenems and anti-methicillin-resistant Staphylococcus aureus antibiotics by an antimicrobial stewardship team. Am J Infect Control 2021; 49:1493-1498. [PMID: 34416316 DOI: 10.1016/j.ajic.2021.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/12/2021] [Accepted: 08/12/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND There are no reports on the effects of interventions, such as discontinuation and change and/or de-escalation of carbapenems and anti-methicillin-resistant Staphylococcus aureus (MRSA) antibiotics by an antimicrobial stewardship team focusing on detailed patient outcomes. This study aimed to evaluate these effects. METHODS This retrospective cohort study was conducted at a tertiary care hospital from December 2018 to November 2019. RESULTS Favorable clinical responses were obtained in 165 of 184 cases (89.7%) in the intervention-accepted group, higher than those in the not accepted group (14/19 cases, 73.7%; P = .056). All-cause 30 day mortality was lower in the accepted group than in the not accepted group (1.1% and 10.5%, respectively; P = .045). The microbiological outcomes were similar between the two groups. Duration of carbapenem and anti-MRSA antibiotic use in the accepted group was significantly lower than that in the not accepted group (median [interquartile range]: 8 days [5-13] versus 14 days [8-15], respectively, P = .026 for carbapenem; 10 days [5.3-15] vs 15.5 days [13.8-45.3], respectively, P = .014 for anti-MRSA antibiotic). CONCLUSIONS This is the first study to investigate the effects of interventions such as discontinuation and change and/ or de-escalation of antibiotics on detailed outcomes. Our intervention could reduce the duration of carbapenem and anti-MRSA antibiotic use without worsening clinical and microbiological outcomes.
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20
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O'Riordan F, Shiely F, Byrne S, O'Brien D, Ronayne A, Fleming A. Antimicrobial use and antimicrobial resistance in Enterobacterales and Enterococcus faecium: a time series analysis. J Hosp Infect 2021; 120:57-64. [PMID: 34780809 DOI: 10.1016/j.jhin.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/02/2021] [Accepted: 11/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Irish and European antimicrobial resistance (AMR) surveillance data have highlighted increasing AMR in Enterobacterales and vancomycin resistance in Enterococcus faecium (VRE). Antimicrobial consumption (AC) in Irish hospital settings is also increasing. METHODS A retrospective time series analysis (TSA) was conducted to evaluate the trends and possible relationship between AC of selected antimicrobials and AMR in Enterobacterales and vancomycin resistance in E. faecium, from January 2017 to December 2020. RESULTS Increased AC was seen with ceftriaxone (p= 0.0006), piperacillin/tazobactam (p = 0.03) and meropenem (p = 0.05), while ciprofloxacin and gentamicin use trended downwards. AMR rates in E. coli, K. pneumoniae and other Enterobacterales were largely stable, an increase in ertapenem resistance in the latter from 0.58% in 2017 to 5.19% in 2020 (p= 0.003) being the main concern. The proportion of E. faecium that was VRE did not changed significantly (64% in 2017; 53% in 2020, p = 0.1). TSA identified a correlation between piperacillin/tazobactam use and the decreasing rate of ceftriaxone resistance in E. coli. CONCLUSION Our data suggest that hospital antimicrobial stewardship programme is largely containing, but not reducing AMR in key nosocomial pathogens. An increase in AC following the COVID-19 pandemic appears as yet to have had no impact on AMR rates.
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Affiliation(s)
- F O'Riordan
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland.
| | - F Shiely
- HRB Clinical Research Facility Cork, Mercy University Hospital, Grenville Place, Cork, Ireland; School of Public Health, University College Cork, Cork, Ireland
| | - S Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - D O'Brien
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Ronayne
- Department of Microbiology, Mercy University Hospital, Grenville Place, Cork, Ireland
| | - A Fleming
- Pharmacy Department, Mercy University Hospital, Grenville Place, Cork, Ireland; Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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21
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Yoon YK, Kwon KT, Jeong SJ, Moon C, Kim B, Kiem S, Kim HS, Heo E, Kim SW. Guidelines on Implementing Antimicrobial Stewardship Programs in Korea. Infect Chemother 2021; 53:617-659. [PMID: 34623784 PMCID: PMC8511380 DOI: 10.3947/ic.2021.0098] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Korean Society for Antimicrobial Therapy, Seoul, Korea
| | - Ki Tae Kwon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Korean Society of Infectious Diseases, Seoul, Korea
| | - Chisook Moon
- Korean Society of Infectious Diseases, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Bongyoung Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungmin Kiem
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyung-Sook Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Eunjeong Heo
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Shin-Woo Kim
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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22
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Matsumoto T, Darlington O, Miller R, Gordon J, McEwan P, Ohashi T, Taie A, Yuasa A. Estimating the Economic and Clinical Value of Reducing Antimicrobial Resistance to Three Gram-negative Pathogens in Japan. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2021; 8:64-75. [PMID: 34703834 PMCID: PMC8494726 DOI: 10.36469/001c.28327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 06/13/2023]
Abstract
Background: Antimicrobial resistance (AMR) represents a significant global public health crisis. Despite ample availability of Gram-positive antibiotics, there is a distinct lack of agents against Gram-negative pathogens, including carbapenem-resistant Enterobacterales, which remains a real threat in Japan. The AMR Action Plans aim to mitigate the growing public health concern posed by AMR. Objective: This study aims to estimate the clinical and economic outcomes of drug-resistant Gram-negative pathogens forecasts for Japan to guide resource allocation defined within the upcoming National AMR Action Plan. Methods: A previously published and validated dynamic health economic model was adapted to the Japanese setting. The model used a 10-year time horizon with a willingness-to-pay threshold of ¥5 000 000 (US $46 827) and discounting was applied at a rate of 2% to costs and benefits. Clinical and economic outcomes were assessed as a function of varying AMR levels of three Gram-negative pathogens in Japan by up to 100% of the current level. Results: Reducing drug-resistant Gram-negative pathogens in Japan has the potential to save 4 249 096 life years, corresponding to 3 602 311 quality-adjusted life years. The associated maximum clinical and economic gains were estimated at up to 4 422 284 bed days saved, up to 3 645 480 defined daily doses of antibiotics avoided, up to ¥117.6 billion (US $1.1 billion) saved in hospitalization costs, and a net monetary benefit of up to ¥18.1 trillion (US $169.8 billion). Discussion: Learnings from this study can be used by the Japanese government to help inform decision-making on the strategies that may be included in the upcoming National AMR Action Plan and facilitate allocation of the required budget. Conclusions: This analysis demonstrated the considerable economic and clinical value of reducing AMR levels of three Gram-negative pathogens in Japan and could be utilized to support the valuation of antimicrobial treatment and resistance in Japan and more broadly.
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23
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Waterer G, Pickens CI, Wunderink R. Antibiotic-resistant bacteria: COVID-19 hasn't made the challenge go away. Respirology 2021; 26:1024-1026. [PMID: 34596927 PMCID: PMC8661559 DOI: 10.1111/resp.14166] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 09/22/2021] [Indexed: 12/17/2022]
Affiliation(s)
- Grant Waterer
- Faculty of Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | - Richard Wunderink
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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24
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Xie L, Du Y, Wang X, Zhang X, Liu C, Liu J, Peng X, Guo X. Effects of Regulation on Carbapenem Prescription in a Large Teaching Hospital in China: An Interrupted Time Series Analysis, 2016-2018. Infect Drug Resist 2021; 14:3099-3108. [PMID: 34408453 PMCID: PMC8364849 DOI: 10.2147/idr.s322938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose Carbapenem resistance due to the overuse of carbapenems has become a public health problem worldwide, particularly in low- and middle-income countries (LMICs). However, there are few policies guiding carbapenem prescription, and their effectiveness is still unclear. A regulation targeting carbapenem prescription was implemented in March 2017 in China. This study aimed to assess the effects of the regulation for providing evidence on the prudent use of carbapenems. Patients and Methods This was an interventional, retrospective study started in January 2017. The intervention covered establishing performance appraisal indicators, special authorisation, strict prescribing restrictions, and dedicated supervision, particularly in the intensive care unit (ICU). Data on adult inpatients who received at least one carbapenems were extracted from January 2016 to December 2018. Segmented regression analysis was performed to evaluate the effect of the regulation. Results A total of 2005 inpatients received carbapenems. Segmented regression models showed an immediate decline in the intensity of antibiotic consumption (IAC) of carbapenems (coefficient = −9.65, p < 0.001), particularly imipenem (coefficient = −6.82, p = 0.002), and the antibiotic consumption of carbapenems (coefficient = −133.60, p = 0.003) in the ICU. And there is a decreasing trend in the IAC of meropenem (coefficient = −0.03, p = 0.008) in all departments. Furthermore, the IAC of carbapenems and imipenem (coefficient = −0.36, p = 0.035; coefficient = −0.49, p = 0.025, respectively), and the average length of stay (ALoS) (coefficient = −0.73, p < 0.001) showed downward trends in the ICU. Conclusion The intervention effectively reduced the IAC of carbapenems and imipenem, carbapenem consumption and the ALoS in the ICU, and the IAC of meropenem in all departments. The effects of the intervention were significant in the ICU, which indicated an urgent need for stronger regulations focusing on critical departments in the future.
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Affiliation(s)
- Lewei Xie
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yaling Du
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, People's Republic of China
| | - Xi Peng
- First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China
| | - Xinhong Guo
- First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China
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25
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Preserving last resort antibiotics: A meropenem reduction strategy. Infect Control Hosp Epidemiol 2021; 43:1516-1517. [PMID: 34247665 DOI: 10.1017/ice.2021.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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26
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Suzuki H, Perencevich E, Goto M, Alexander B, Nair R, Puig-Asensio M, Ernst E, Livorsi DJ. A comprehensive assessment of carbapenem use across 90 Veterans Health Administration hospitals with defined stewardship strategies for carbapenems. J Antimicrob Chemother 2021; 76:1358-1365. [PMID: 33523128 DOI: 10.1093/jac/dkab008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/29/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Carbapenems are an important target for antimicrobial stewardship (AS) efforts. In this study, we sought to compare different hospital-based strategies for improving carbapenem use. METHODS We analysed a cohort of all patients hospitalized at Veterans Health Administration (VHA) acute care hospitals during 2016 and a mandatory survey that characterized each hospital's carbapenem-specific AS strategy into one of three types: no strategy (NS), prospective audit and feedback (PAF) or restrictive policies (RP). Carbapenem use was compared using risk-adjusted generalized estimating equations that accounted for clustering within hospitals. Two infectious disease (ID) physicians independently performed manual chart reviews in 425 randomly selected cases. Auditors assessed carbapenem appropriateness with an assessment score on Day 4 of therapy. RESULTS There were 429 062 admissions in 90 sites (24 NS, 8 PAF, 58 RP). Carbapenem use was lower at PAF than NS sites [rate ratio (RR) 0.6 (95% CI 0.4-0.9); P = 0.01] but similar between RP and NS sites. Carbapenem prescribing was considered appropriate/acceptable in 215 (50.6%) of the reviewed cases. Assessment scores were lower (i.e. better) at RP than NS sites (mean 2.3 versus 2.7; P < 0.01) but did not differ significantly between NS and PAF sites. ID consultations were more common at PAF/RP than NS sites (51% versus 29%; P < 0.01). ID consultations were associated with lower (i.e. better) assessment scores (mean 2.3 versus 2.6; P < 0.01). CONCLUSIONS In this VHA cohort, PAF strategies were associated with lower carbapenem use and ID consultation and RP strategies were associated with more appropriate carbapenem prescribing. AS and ID consultations may work complementarily and hospitals could leverage both to optimize carbapenem use.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eli Perencevich
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Michihiko Goto
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bruce Alexander
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Rajeshwari Nair
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Erika Ernst
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Daniel J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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27
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Hirsch JS, Brar R, Forrer C, Sung C, Roycroft R, Seelamneni P, Dabir H, Naseer A, Gautam-Goyal P, Bock KR, Oppenheim MI. Design, development, and deployment of an indication- and kidney function-based decision support tool to optimize treatment and reduce medication dosing errors. JAMIA Open 2021; 4:ooab039. [PMID: 34222830 PMCID: PMC8242134 DOI: 10.1093/jamiaopen/ooab039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 11/19/2022] Open
Abstract
Delivering clinical decision support (CDS) at the point of care has long been considered a major advantage of computerized physician order entry (CPOE). Despite the widespread implementation of CPOE, medication ordering errors and associated adverse events still occur at an unacceptable level. Previous attempts at indication- and kidney function-based dosing have mostly employed intrusive CDS, including interruptive alerts with poor usability. This descriptive work describes the design, development, and deployment of the Adult Dosing Methodology (ADM) module, a novel CDS tool that provides indication- and kidney-based dosing at the time of order entry. Inclusion of several antimicrobials in the initial set of medications allowed for the additional goal of optimizing therapy duration for appropriate antimicrobial stewardship. The CDS aims to decrease order entry errors and burden on providers by offering automatic dose and frequency recommendations, integration within the native electronic health record, and reasonable knowledge maintenance requirements. Following implementation, early utilization demonstrated high acceptance of automated recommendations, with up to 96% of provided automated recommendations accepted by users.
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Affiliation(s)
- Jamie S Hirsch
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA.,Division of Kidney Diseases and Hypertension, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Great Neck, New York, USA.,Center for Health Innovations and Outcomes Research, Institute of Health System Science, Feinstein Institutes for Medical Research, Manhasset, New York, USA
| | - Rajdeep Brar
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Christopher Forrer
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Christine Sung
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Richard Roycroft
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Pradeep Seelamneni
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Hemala Dabir
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Ambareen Naseer
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA
| | - Pranisha Gautam-Goyal
- Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
| | - Kevin R Bock
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA.,Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA
| | - Michael I Oppenheim
- Department of Information Services, Northwell Health, New Hyde Park, New York, USA.,Division of Infectious Diseases, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA
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López-Viñau T, Peñalva G, García-Martínez L, Castón JJ, Muñoz-Rosa M, Cano Á, Recio M, Cisneros JM, Pérez-Nadales E, Rumbao Aguirre J, García-Martínez E, Salcedo I, del Prado JR, de la Fuente C, Martínez-Martínez L, Gracia-Ahufinger I, Torre-Cisneros J. Impact of an Antimicrobial Stewardship Program on the Incidence of Carbapenem Resistant Gram-Negative Bacilli: An Interrupted Time-Series Analysis. Antibiotics (Basel) 2021; 10:586. [PMID: 34065645 PMCID: PMC8190633 DOI: 10.3390/antibiotics10050586] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/10/2021] [Accepted: 05/14/2021] [Indexed: 12/31/2022] Open
Abstract
Carbapenem-resistant Gram-negative bacilli (CR-GNB) are a critical public health threat, and carbapenem use contributes to their spread. Antimicrobial stewardship programs (ASPs) have proven successful in reducing antimicrobial use. However, evidence on the impact of carbapenem resistance remains unclear. We evaluated the impact of a multifaceted ASP on carbapenem use and incidence of CR-GNB in a high-endemic hospital. An interrupted time-series analysis was conducted one year before and two years after starting the ASP to assess carbapenem consumption, CR-GNB incidence, death rates of sentinel events, and other variables potentially related to CR-GNB incidence. An intense reduction in carbapenem consumption occurred after starting the intervention and was sustained two years later (relative effect -83.51%; 95% CI -87.23 to -79.79). The incidence density of CR-GNB decreased by -0.915 cases per 1000 occupied bed days (95% CI -1.743 to -0.087). This effect was especially marked in CR-Klebsiella pneumoniae and CR-Escherichia coli, reversing the pre-intervention upward trend and leading to a relative reduction of -91.15% (95% CI -105.53 to -76.76) and -89.93% (95% CI -107.03 to -72.83), respectively, two years after starting the program. Death rates did not change. This ASP contributed to decreasing CR-GNB incidence through a sustained reduction in antibiotic use without increasing mortality rates.
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Affiliation(s)
- Teresa López-Viñau
- Pharmacy Unit, Reina Sofia University Hospital, 14004 Cordoba, Spain; (T.L.-V.); (L.G.-M.); (J.R.d.P.)
- Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain; (J.J.C.); (Á.C.); (M.R.); (E.P.-N.); (J.T.-C.)
| | - Germán Peñalva
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Virgen del Rocio University Hospital, 41013 Seville, Spain; (G.P.); (J.M.C.)
| | - Lucrecia García-Martínez
- Pharmacy Unit, Reina Sofia University Hospital, 14004 Cordoba, Spain; (T.L.-V.); (L.G.-M.); (J.R.d.P.)
| | - Juan José Castón
- Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain; (J.J.C.); (Á.C.); (M.R.); (E.P.-N.); (J.T.-C.)
| | - Montserrat Muñoz-Rosa
- Microbiology Unit, Reina Sofia University Hospital, IMIBIC, Department of Agricultural Chemistry, Edafology and Microbiology, University of Cordoba, 14004 Cordoba, Spain; montserrat.munoz.sspa@xn--juntadeandaluca-ipb.es (M.M.-R.); (L.M.-M.)
| | - Ángela Cano
- Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain; (J.J.C.); (Á.C.); (M.R.); (E.P.-N.); (J.T.-C.)
| | - Manuel Recio
- Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain; (J.J.C.); (Á.C.); (M.R.); (E.P.-N.); (J.T.-C.)
| | - José Miguel Cisneros
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville, Virgen del Rocio University Hospital, 41013 Seville, Spain; (G.P.); (J.M.C.)
| | - Elena Pérez-Nadales
- Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain; (J.J.C.); (Á.C.); (M.R.); (E.P.-N.); (J.T.-C.)
| | - José Rumbao Aguirre
- Hospital Management, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.R.A.); (E.G.-M.)
| | - Elena García-Martínez
- Hospital Management, Reina Sofia University Hospital, 14004 Cordoba, Spain; (J.R.A.); (E.G.-M.)
| | - Inmaculada Salcedo
- Preventive Medicine Unit, Reina Sofia University Hospital, 14004 Cordoba, Spain;
| | - José Ramón del Prado
- Pharmacy Unit, Reina Sofia University Hospital, 14004 Cordoba, Spain; (T.L.-V.); (L.G.-M.); (J.R.d.P.)
| | | | - Luis Martínez-Martínez
- Microbiology Unit, Reina Sofia University Hospital, IMIBIC, Department of Agricultural Chemistry, Edafology and Microbiology, University of Cordoba, 14004 Cordoba, Spain; montserrat.munoz.sspa@xn--juntadeandaluca-ipb.es (M.M.-R.); (L.M.-M.)
| | - Irene Gracia-Ahufinger
- Microbiology Unit, Reina Sofia University Hospital, IMIBIC, Department of Agricultural Chemistry, Edafology and Microbiology, University of Cordoba, 14004 Cordoba, Spain; montserrat.munoz.sspa@xn--juntadeandaluca-ipb.es (M.M.-R.); (L.M.-M.)
| | - Julián Torre-Cisneros
- Infectious Diseases Unit, Reina Sofia University Hospital, Maimonides, Biomedical Research Institute of Cordoba (IMIBIC), University of Cordoba (UCO), 14004 Cordoba, Spain; (J.J.C.); (Á.C.); (M.R.); (E.P.-N.); (J.T.-C.)
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29
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García-Rodríguez JF, Bardán-García B, Juiz-González PM, Vilariño-Maneiro L, Álvarez-Díaz H, Mariño-Callejo A. Long-Term Carbapenems Antimicrobial Stewardship Program. Antibiotics (Basel) 2020; 10:antibiotics10010015. [PMID: 33375237 PMCID: PMC7823722 DOI: 10.3390/antibiotics10010015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/22/2020] [Accepted: 12/23/2020] [Indexed: 12/20/2022] Open
Abstract
Objective. To evaluate clinical and antibiotic resistance impact of carbapenems stewardship programs. Methods: descriptive study, pre-post-intervention, between January 2012 and December 2019; 350-bed teaching hospital. Prospective audit and feedback to prescribers was carried out between January 2015 and December 2019. We evaluate adequacy of carbapenems prescription to local guidelines and compare results between cases with accepted or rejected intervention. Analysis of antibiotic-consumption and hospital-acquired multidrug-resistant (MDR) bloodstream infections (BSIs) was performed. Results: 1432 patients were followed. Adequacy of carbapenems prescription improved from 49.7% in 2015 to 80.9% in 2019 (p < 0.001). Interventions on prescription were performed in 448 (31.3%) patients without carbapenem-justified treatment, in 371 intervention was accepted, in 77 it was not. Intervention acceptance was associated with shorter duration of all antibiotic treatment and inpatient days (p < 0.05), without differences in outcome. During the period 2015–2019, compared with 2012–2014, decreased meropenem consumption (Rate Ratio 0.58; 95%CI: 0.55–0.63), candidemia and hospital-acquired MDR BSIs rate (RR 0.62; 95%CI: 0.41–0.92, p = 0.02), and increased cefepime (RR 2; 95%CI: 1.77–2.26) and piperacillin-tazobactam consumption (RR 1.17; 95%CI: 1.11–1.24), p < 0.001. Conclusions: the decrease and better use of carbapenems achieved could have clinical and ecological impact over five years, reduce inpatient days, hospital-acquired MDR BSIs, and candidemia, despite the increase in other antibiotic-consumption.
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Affiliation(s)
- José Francisco García-Rodríguez
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
- Correspondence:
| | - Belén Bardán-García
- Department of Pharmacy, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain;
| | | | - Laura Vilariño-Maneiro
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
| | - Hortensia Álvarez-Díaz
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
| | - Ana Mariño-Callejo
- Infectious Diseases Unit, Department of Internal Medicine, University Hospital of Ferrol, Sergas, 15405 Ferrol, Spain; (L.V.-M.); (H.Á.-D.); (A.M.-C.)
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30
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Chatzopoulou M, Kyriakaki A, Reynolds L. Review of antimicrobial resistance control strategies: low impact of prospective audit with feedback on bacterial antibiotic resistance within hospital settings. Infect Dis (Lond) 2020; 53:159-168. [PMID: 33300825 DOI: 10.1080/23744235.2020.1846777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship constitutes an essential element of any concerted effort to tackle bacterial resistance, a rising public health threat both in community as well as hospital settings. The term comprises variable strategies which aim to optimise prescribing practices through either antibiotic restrictions or prospective audits of prescriptions with subsequent feedback to clinicians. Although highly debated, the actual effects of the latter on the antimicrobial susceptibility patterns of hospital flora are uncertain. The present study aims to review and evaluate the literature concerning the impact of persuasive stewardship strategies on antimicrobial resistance within hospitals. MATERIALS AND METHODS A literature review covering the period to 1st April 2020 was conducted using the PubMed/Medline, Embase, Global Health and CINAHL Plus databases. RESULTS Fifteen studies were retrieved, including twelve simple before-and-after, and three interrupted time-series studies. Audit frequency and compliance rates varied broadly. The rationale of treatment optimisation is not clear in most cases. Overall, surveillance of sentinel microorganisms through antibiograms indicates ambiguous results, with uncertainty as to whether the few successes are due to a causal effect, random incidence fluctuations, or confounding. The most informative approach targeted solely fluoroquinolones, reporting improvements in relevant Pseudomonas susceptibilities and MRSA, but without sufficient data on other effects of the strategy to assess its overall utility in clinical practice. CONCLUSION Higher standard research is needed to address the actual effects of persuasive stewardship strategies on antimicrobial susceptibility patterns. At present, they seem inadequate to play a decisive role in bacterial resistance control within hospitals.
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Affiliation(s)
| | - Argyrw Kyriakaki
- Department of Haematology and Transfusion Medicine, Nikaia Peiraia Agios Panteleimon, Athens, Greece
| | - Lucy Reynolds
- London School of Hygiene and Tropical Medicine, University of London, London, UK
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31
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Aaryashree, Takeda Y, Kanai M, Hatano A, Yoshimi Y, Kida M. A "Single-Use" Ceramic-Based Electrochemical Sensor Chip Using Molecularly Imprinted Carbon Paste Electrode. SENSORS (BASEL, SWITZERLAND) 2020; 20:E5847. [PMID: 33081095 PMCID: PMC7602806 DOI: 10.3390/s20205847] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 01/17/2023]
Abstract
An inexpensive disposable electrochemical drug sensor for the detection of drugs (vancomycin, meropenem, theophylline, and phenobarbital) is described. Molecularly imprinted polymer (MIP) templated with the target drugs was immobilized on the surface of graphite particles using a simple radical polymerization method and packed into the working electrode of a three-electrode ceramic-based chip sensor. Differential pulse voltammetry (DPV) was used to determine the relationship between the response current and the concentration of the targeted drug while using one sensor chip for one single operation. The time required for each DPV measurement was less than 2 min. Concentrations corresponding to the therapeutic range of these drugs in plasma were taken into account while performing DPV. In all the cases, the single-used MIP sensor showed higher sensitivity and linearity than non-imprinted polymer. The selectivity test in drugs with a structure similar to that of the target drugs was performed, and it was found that MIP-based sensors were more selective than the untreated ones. Additionally, the test in whole blood showed that the presence of interfering species had an insignificant effect on the diagnostic responses of the sensor. These results demonstrate that the disposable MIP-sensor is promising for quick and straightforward therapeutic drug monitoring to prevent the toxic side effects and the insufficient therapeutic effect due to the overdose and underdose, respectively.
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Affiliation(s)
- Aaryashree
- Department of Applied Chemistry, Shibaura Institute of Technology, Tokyo 135-8548, Japan; (A.); (Y.T.); (M.K.)
| | - Yuuto Takeda
- Department of Applied Chemistry, Shibaura Institute of Technology, Tokyo 135-8548, Japan; (A.); (Y.T.); (M.K.)
| | - Momoe Kanai
- Department of Applied Chemistry, Shibaura Institute of Technology, Tokyo 135-8548, Japan; (A.); (Y.T.); (M.K.)
| | - Akihiko Hatano
- Department of Chemistry, Shibaura Institute of Technology, Saitama 337-8570, Japan;
| | - Yasuo Yoshimi
- Department of Applied Chemistry, Shibaura Institute of Technology, Tokyo 135-8548, Japan; (A.); (Y.T.); (M.K.)
| | - Masahito Kida
- R&D Center, Technology Development Division, NGK Spark Plug, Co., Komaki 485-8510, Japan;
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32
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Shirazi OU, Ab Rahman NS, Zin CS. A Narrative Review of Antimicrobial Stewardship Interventions within In-patient Settings and Resultant Patient Outcomes. J Pharm Bioallied Sci 2020; 12:369-380. [PMID: 33679082 PMCID: PMC7909060 DOI: 10.4103/jpbs.jpbs_311_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 05/18/2020] [Accepted: 06/22/2020] [Indexed: 12/25/2022] Open
Abstract
The overuse of antibiotics has led to various healthcare problems such as the emergence of resistance in infectious microbes and mortality due to antibiotic resistant healthcare associated infections (HAIs). An antimicrobial stewardship (AMS) program is the set of interventions used worldwide to enhance the rational use of antibiotics especially for the hospitalized patients. This review aimed to describe the characteristics of the implemented AMS programs in various hospitals of the world mainly focusing on the interventions and patients outcomes. The literature about AMS program was searched through various databases such as PubMed, Google Scholar, Science Direct, Cochran Library, Ovid (Medline), Web of Science and Scopus. In this review the literature pertaining to the AMS programs for hospitalized patients is sorted on the basis of various interventions that are categorized as formulary restriction (pre-authorization), guideline development, clinical pathway development, educative interventions and prospective audit. Moreover a clear emphasis is laid on the patient outcomes obtained as a result of these interventions namely the infection control, drop in readmission rate, mortality control, resistance control and the control of an overall cost of antibiotic treatment obtained mainly by curbing the overuse of antibiotics within the hospital wards. AMS program is an efficient strategy of pharmacovigilance to rationalize the antimicrobial practice for hospitalized patients as it prevents the misuse of antibiotics, which ultimately retards the health threatening effects of various antibiotics.
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Affiliation(s)
- Ovais Ullah Shirazi
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Norny Syafinaz Ab Rahman
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.,Big Data Research in Drug Utilization Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
| | - Che Suraya Zin
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia.,Big Data Research in Drug Utilization Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, 25200 Kuantan, Pahang, Malaysia
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33
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Corcione S, Lupia T, Maraolo AE, Mornese Pinna S, Gentile I, De Rosa FG. Carbapenem-sparing strategy: carbapenemase, treatment, and stewardship. Curr Opin Infect Dis 2020; 32:663-673. [PMID: 31599774 DOI: 10.1097/qco.0000000000000598] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW describing the current role of carbapenems and carbapenem-sparing strategies in the setting of antimicrobial stewardship programs. RECENT FINDINGS sparing carbapenems with other drugs appears to be an interesting perspective for a variety of reasons in the current context of the multidrug-resistant (MDR) pandemic. Specific algorithms should also be precisely investigated to define better how to spare carbapenems within empiric and targeted regimens, with combination treatment or monotherapies, aiming at the best use of the new drugs and improving de-escalation as soon as possible for most of the patients. SUMMARY stewardship programs may be useful in reducing probable misuse and overuse of antibiotics, which has probably contributed to the emergence of carbapenem-resistant bacteria worldwide. The proposal of carbapenem-sparing strategies has then generated substantial scientific debate and, overall, the concept of sparing these drugs is well advocated together with judicious use of novel drugs, appropriate measures of infection control and prevention as well as in stewardship programs to curb the spread of MDR and XDR-strains in healthcare facilities.
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Affiliation(s)
- Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin
| | - Tommaso Lupia
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin
| | - Alberto Enrico Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples Federico II, Naples, Italy
| | | | - Ivan Gentile
- Department of Clinical Medicine and Surgery, Section of Infectious Disease, University of Naples Federico II, Naples, Italy
| | - Francesco G De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin
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Faraone A, Poggi A, Cappugi C, Tofani L, Riccobono E, Giani T, Fortini A. Inappropriate use of carbapenems in an internal medicine ward: Impact of a carbapenem-focused antimicrobial stewardship program. Eur J Intern Med 2020; 78:50-57. [PMID: 32303455 DOI: 10.1016/j.ejim.2020.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 02/21/2020] [Accepted: 03/19/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE Carbapenem consumption is a major driver for selection and spread of carbapenem-resistant Enterobacterales (CRE). We assessed the impact of a carbapenem-focused multimodal antimicrobial stewardship program (ASP) in the internal medicine unit of a medium-size acute-care hospital. METHODS We compared the percentage of inappropriate carbapenem prescriptions and the proportion of carbapenem treated patients registered in a 12-month pre-intervention and in a 24-month post-intervention period by using an interrupted time series analysis. The consumption of carbapenems, expressed in defined daily doses (DDD), was also assessed. As a secondary objective, the incidence of infections by carbapenem-resistant Klebsiella pneumoniae (CRKP) and the percentage of CRKP invasive isolates in the same time periods were compared. RESULTS After the ASP intervention, the mean monthly percentage of inappropriate carbapenem prescriptions dropped from 59% to 25%, and the mean monthly proportion of carbapenem treated patients decreased from 3% to 1%. The interrupted time series analysis confirmed a significant decrease in the percentage of inappropriate carbapenem prescriptions (-41.6%, p = 0.0262) and in the proportion of carbapenem treated patients (-2.1%, p < 0.0001). Carbapenem consumption decreased from 5.2 to 1.6 DDD x 100 patient-days. The incidence of CRKP infections remained unchanged (29.1 × 100,000 patient-days vs 28.9 × 100,000 patient-days, p = 0.9864) and the percentage of CRKP invasive isolates decreased, though not significantly, from 36.4% to 13.3% (p = 0.3478). CONCLUSIONS The implementation of a carbapenem-focused ASP was effective at limiting the inappropriate use of carbapenems and was associated with a significant decrease in carbapenem consumption. Such effects were sustained during a 24-month post-intervention period.
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Affiliation(s)
- Antonio Faraone
- Department of Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, Florence, 50143, Italy.
| | | | - Chiara Cappugi
- Department of Internal Medicine, Florence Careggi University Hospital, Florence, Italy
| | - Lorenzo Tofani
- Department of Neurosciences, Psychology, Drug Research and Child Health, University of Florence, Florence, Italy
| | - Eleonora Riccobono
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Tommaso Giani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Fortini
- Department of Internal Medicine, San Giovanni di Dio Hospital, Via di Torregalli 3, Florence, 50143, Italy
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A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight. Antimicrob Agents Chemother 2020; 64:AAC.00307-20. [PMID: 32423952 DOI: 10.1128/aac.00307-20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022] Open
Abstract
Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; P < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.
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Jover-Sáenz A, Ramírez-Hidalgo MF, Vidal MV, González MG, Cano Marrón SM, Arias AE, Sacrest MF, Castellana-Perelló D, Barcenilla-Gaite F. Antimicrobial stewardship program at a tertiary care academic medical hospital: Clinical, microbiological and economic impact. A 5-year temporary descriptive study. Infect Prev Pract 2020; 2:100048. [PMID: 34368698 PMCID: PMC8335906 DOI: 10.1016/j.infpip.2020.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
Introduction Few prospective studies analyze, with sufficient duration, the impact of an antimicrobial stewardship program (AMSP) carried out entirely in a hospital. Methods Descriptive study evaluating the consumption of antimicrobials expressed in defined daily doses (DDD) per 100 hospital occupied bed-days (OBDs) stratified in medical, surgical and intensive care unit (ICU) and the incidence of densities (ID) per 1,000 hospital OBDs of the prevalent multidrug-resistant organisms (MDRO) in a tertiary hospital, over a period of 5 years before and after the implementation of an AMSP. Analysis of direct costs and those associated with hospital stay and mortality. Results A total of 32,802 patients with antibiotic treatment were included in the intervention period (2013–2017). Non-imposed advice was exercised in 14.9%. The degree of adherence to recommendation was 87.9%, direct treatment and de-escalation being the most frequently admitted interventions (P<0.001). Overall hospital consumption of antibacterials in DDD/100s decreased by 5.7% (77.04 vs. 71.33) between 2008 and 2017. In ICU, the average DDD/100s showed a reduction from 155 to 113 (mean difference -18, P=0.005). There was a decrease in the DI/1000 OBDs of MDROs in the post-intervention period (RR 0.78; CI 95% [0.73, 0.84], P<0.001). The average annual cost of antibacterials declined from €1,435,048 to €955,805 (mean difference -€469,243; P=0.001). Conclusion Long-term maintenance of a hospital AMSP was associated with a reduction in antibiotic consumption, especially in ICU, as well as a beneficial ecological impact and economic savings.
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Affiliation(s)
- Alfredo Jover-Sáenz
- Unidad Territorial de control de Infección Nosocomial, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | | | | | | | - Alfredo Escartín Arias
- Servicio de Cirugía General y Aparato Digestivo, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Dolors Castellana-Perelló
- Unidad Territorial de control de Infección Nosocomial, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Fernando Barcenilla-Gaite
- Unidad Territorial de control de Infección Nosocomial, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Chahine EB, Durham SH, Mediwala KN, Chastain DB, Gauthier TP, Hill BK, Jones BM, Kisgen JJ, Marx AH, Stover KR, Worley MV, Bland CM, Bookstaver PB. A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2018. Open Forum Infect Dis 2019; 6:ofz450. [PMID: 31700942 PMCID: PMC6825802 DOI: 10.1093/ofid/ofz450] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 10/06/2019] [Indexed: 02/06/2023] Open
Abstract
With an increasing number of antimicrobial stewardship–related articles published each year, attempting to stay current is challenging. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship–related peer-reviewed literature that detailed an actionable intervention for 2018. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training as well as to identify potential intervention opportunities within one’s institution.
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Affiliation(s)
- Elias B Chahine
- Palm Beach Atlantic University Lloyd L. Gregory School of Pharmacy, West Palm Beach, Florida, USA
| | - Spencer H Durham
- Auburn University Harrison School of Pharmacy, Auburn, Alabama, USA
| | | | | | | | - Brandon K Hill
- University of Virginia Health System, Charlottesville, Virginia, USA
| | - Bruce M Jones
- St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Jamie J Kisgen
- Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Ashley H Marx
- UNC Medical Center, Chapel Hill, North Carolina, USA
| | - Kayla R Stover
- University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Marylee V Worley
- Nova Southeastern University College of Pharmacy, Fort Lauderdale, Florida, USA
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