Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report

Rational evaluation of the clinical application of ceftazidime-avibactam for the treatment of carbapenem-resistant Klebsiella pneumoniae infections: A real-world retrospective study

OBJECTIVES

To evaluate the rationality of the clinical use of ceftazidime-avibactam (CAZ-AVI) for carbapenem-resistant Klebsiella pneumoniae (CRKP) infections in a real-world setting.

METHODS

We established the rational evaluation criteria based on drug instructions and relevant guidelines to retrospectively evaluate the use of CAZ-AVI to treat CRKP infections from June 2020 to June 2023 in a tertiary hospital in China. Patients were divided into the rational use group and irrational use group. The differences in clinical efficacy, 14- and 28-day mortality, microbiological response and side effects between these two groups were analyzed.

RESULTS

Seventy-five adult patients were enrolled. The clinical application of CAZ-AVI was rational in 32 (42.7 %) patients. Irrational dosage and irrational treatment regimens were observed in 19 (25.3 %) and 31 (41.3 %) patients, respectively. The clinical treatment success rate of the rational use group was higher than that of the irrational use group, whereas the 28-day mortality rate was slightly lower. However, the microbial clearance rate was significantly higher in the irrational use group, probably due to the high percentage of microbial replacement. The rational use group had a lower incidence of acute kidney injury and acute drug-induced liver injury. Multivariate logistic regression analysis showed that continuous renal replacement therapy (CRRT) negatively impacted rational CAZ-AVI use (OR 0.13, 95 % CI 0.03-0.72, P = 0.019).

CONCLUSIONS

To optimize clinical outcomes and reduce side effects of CAZ-AVI, unnecessary combination therapy should be avoided, and dose adjustments should be made according to the drug instructions.

Three-Year Point Prevalence Survey of Antimicrobial Use in a Chinese University Hospital

To evaluate the prevalence and quality of antimicrobial prescriptions using a Global Point Prevalence Survey (PPS) tool and help identify targets for improvement of antimicrobial prescribing and inform the development of antimicrobial stewardship activities. Antimicrobial prescriptions for inpatients staying at a hospital overnight were surveyed on one weekday in October 2018, November 2019, and November 2020. Data including basic patient information, antimicrobial drugs, quality evaluation of antimicrobial drug prescription, and the risk factors of nosocomial infection were collected from doctor network workstation. Patient information was anonymized and entered in the PPS Web application by physicians. A total of 720 patients (median age, 62 years) were surveyed. Of them, 246 (34.2%) were prescribed antimicrobials on the survey days. Hospital-wide antimicrobial use had a significantly decreasing trend (P < 0.001). The most commonly prescribed antimicrobial drugs were third-generation cephalosporins (40.5%), followed by quinolones (21.8%) and second-generation cephalosporin (12.5%). In our study, cefoperazone/sulbactam, ceftazidime, and levofloxacin were the most commonly used antimicrobials. The most common indication for antimicrobial use was pneumonia or lower respiratory tract infection (159/321, 49.5%). Antimicrobial for surgical prophylaxis represented 16.2% of the total antibiotic doses. Of those, 67.3% were administered for more than 24 h. The rate of adherence to antibiotic guidelines was 61.4%. The indications for antimicrobials were not documented in 54.5% of the prescriptions. Stop/review date was documented for 36.8% of prescriptions. The PPS tool is useful in identifying targets to enhance the quality of antimicrobial prescriptions to improve the adherence rate in hospitals. This survey can be used as a control to assess the rational application quality of antimicrobial after regular application of antimicrobial intervention.