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Chae J, Kim DS, Shin J, Kim YC, Ji SY, Kim Y, Ryu M. Ten-year trends of antibiotics used for patients with pneumonia at long-term care hospitals in the Republic of Korea: An analysis based on national health insurance claims data. Heliyon 2024; 10:e33047. [PMID: 39021963 PMCID: PMC11252976 DOI: 10.1016/j.heliyon.2024.e33047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 06/12/2024] [Accepted: 06/13/2024] [Indexed: 07/20/2024] Open
Abstract
Aim To determine the trends in the usage of antimicrobial drugs by patients with pneumonia with prescriptions from long-term care (LTC) hospitals in the Republic of Korea. Method This retrospective study was conducted from 2011 to 2022 using the National Health Insurance Review and Assessment Service claim data in Korea. We calculated antibiotic usage expressed as a daily defined dose (DDD) per 1000 patients per day (DID). Results The number of patients with pneumonia in LTC hospitals increased by 2.7 times, from 30,000 in 2011 to 79,000 in 2022. Furthermore, antibiotic consumption per episode by patients with pneumonia in LTC hospitals increased from 17.14 DDD in 2011 to 18.11 DDD in 2022. Among the Access, Watch, and Reserve classification groups, the Watch group showed the highest usage; further, the Access group showed a decreasing trend, whereas the Watch and Reserve groups showed an increasing trend (p < 0.01). In the Watch group, the most commonly used antibiotic was J01CR05 (piperacillin and beta-lactamase inhibitor), followed in order by J01DD04 (ceftriaxone), J01MA12 (levofloxacin), and J01DH02 (meropenem). In the Reserve group, J01XB01 (colistin) and J01AA12 (tigecycline) were commonly used. Conclusion The antibiotics prescribed for pneumonia in LTC hospitals have continuously increased the use of broad-spectrum antibiotics. Accordingly, appropriate use of antibiotics in LTC hospital settings and assessment of antibiotics used are warranted.
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Affiliation(s)
- Jungmi Chae
- Review and Assessment Research Department, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Dong-Sook Kim
- Department of Health Administration, College of Nursing and Health, Kongju National University, Gongju, Republic of Korea
| | - Jihye Shin
- Review and Assessment Research Department, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Yong Chan Kim
- Division of Infectious Diseases, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Seung Yeon Ji
- Review and Assessment Research Department, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Yeseul Kim
- Review and Assessment Research Department, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Mikyung Ryu
- Department of Nursing, College of Nursing and Public Health, Daegu University, Republic of Korea
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Raban MZ, Gates PJ, Gasparini C, Westbrook JI. Temporal and regional trends of antibiotic use in long-term aged care facilities across 39 countries, 1985-2019: Systematic review and meta-analysis. PLoS One 2021; 16:e0256501. [PMID: 34424939 PMCID: PMC8382177 DOI: 10.1371/journal.pone.0256501] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/08/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Antibiotic misuse is a key contributor to antimicrobial resistance and a concern in long-term aged care facilities (LTCFs). Our objectives were to: i) summarise key indicators of systemic antibiotic use and appropriateness of use, and ii) examine temporal and regional variations in antibiotic use, in LTCFs (PROSPERO registration CRD42018107125). METHODS & FINDINGS Medline and EMBASE were searched for studies published between 1990-2021 reporting antibiotic use rates in LTCFs. Random effects meta-analysis provided pooled estimates of antibiotic use rates (percentage of residents on an antibiotic on a single day [point prevalence] and over 12 months [period prevalence]; percentage of appropriate prescriptions). Meta-regression examined associations between antibiotic use, year of measurement and region. A total of 90 articles representing 78 studies from 39 countries with data between 1985-2019 were included. Pooled estimates of point prevalence and 12-month period prevalence were 5.2% (95% CI: 3.3-7.9; n = 523,171) and 62.0% (95% CI: 54.0-69.3; n = 946,127), respectively. Point prevalence varied significantly between regions (Q = 224.1, df = 7, p<0.001), and ranged from 2.4% (95% CI: 1.9-2.7) in Eastern Europe to 9.0% in the British Isles (95% CI: 7.6-10.5) and Northern Europe (95% CI: 7.7-10.5). Twelve-month period prevalence varied significantly between regions (Q = 15.1, df = 3, p = 0.002) and ranged from 53.9% (95% CI: 48.3-59.4) in the British Isles to 68.3% (95% CI: 63.6-72.7) in Australia. Meta-regression found no association between year of measurement and antibiotic use prevalence. The pooled estimate of the percentage of appropriate antibiotic prescriptions was 28.5% (95% CI: 10.3-58.0; n = 17,245) as assessed by the McGeer criteria. Year of measurement was associated with decreasing appropriateness of antibiotic use over time (OR:0.78, 95% CI: 0.67-0.91). The most frequently used antibiotic classes were penicillins (n = 44 studies), cephalosporins (n = 36), sulphonamides/trimethoprim (n = 31), and quinolones (n = 28). CONCLUSIONS Coordinated efforts focusing on LTCFs are required to address antibiotic misuse in LTCFs. Our analysis provides overall baseline and regional estimates for future monitoring of antibiotic use in LTCFs.
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Affiliation(s)
- Magdalena Z. Raban
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter J. Gates
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Claudia Gasparini
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
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3
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Simon M, Pereira O, Hulscher MEJL, Schouten J, Thilly N, Pulcini C. Quantity Metrics and Proxy Indicators to Estimate the Volume and Appropriateness of Antibiotics Prescribed in French Nursing Homes: A Cross-sectional Observational Study Based on 2018 Reimbursement Data. Clin Infect Dis 2021; 72:e493-e500. [PMID: 32822471 DOI: 10.1093/cid/ciaa1221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/20/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Antibiotic resistance is an increasing threat to public health globally. Indicators on antibiotic prescribing are required to guide antibiotic stewardship interventions in nursing homes. However, such indicators are not available in the literature. Our main objective was to provide a set of quantity metrics and proxy indicators to estimate the volume and appropriateness of antibiotic use in nursing homes. METHODS Recently published articles were first used to select quantity metrics and proxy indicators, which were adapted to the French nursing home context. A cross-sectional observational study was then conducted based on reimbursement databases. We included all community-based nursing homes of the Lorraine region in northeastern France. We present descriptive statistics for quantity metrics and proxy indicators. For proxy indicators, we also assessed performance scores, clinimetric properties (measurability, applicability, and room for improvement), and conducted case-mix and cluster analyses. RESULTS A total of 209 nursing homes were included. We selected 15 quantity metrics and 11 proxy indicators of antibiotic use. The volume of antibiotic use varied greatly between nursing homes. Proxy indicator performance scores were low, and variability between nursing homes was high for all indicators, highlighting important room for improvement. Six of the 11 proxy indicators had good clinimetric properties. Three distinct clusters were identified according to the number of proxy indicators for which the acceptable target was reached. CONCLUSIONS This set of 15 quantity metrics and 11 proxy indicators may be adapted to other contexts and could be used to guide antibiotic stewardship programs in nursing homes.
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Affiliation(s)
- Maïa Simon
- Université de Lorraine, APEMAC, Nancy, France
| | - Ouarda Pereira
- Direction Régionale du Service Médical Grand Est, Strasbourg, France
| | - Marlies E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Jeroen Schouten
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ Healthcare), Nijmegen, The Netherlands
| | - Nathalie Thilly
- Université de Lorraine, APEMAC, Nancy, France.,Département Méthodologie, Promotion, Investigation, Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,Département de Maladies Infectieuses, Université de Lorraine, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
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Ishikane M, Kusama Y, Tanaka C, Hayakawa K, Kuwahara T, Ohmagari N. Epidemiology of Antimicrobial Use among Nursing Homes in Japan, 2016: a Pilot Study. Jpn J Infect Dis 2020; 73:293-295. [PMID: 32009058 DOI: 10.7883/yoken.jjid.2019.476] [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] [Indexed: 11/17/2022]
Abstract
Antimicrobial resistance is an emerging problem in both acute care hospitals and nursing homes. From January to December 2016, we conducted a pilot, descriptive epidemiological study to examine antimicrobial use (AMU) among 6 nursing homes in Tokyo, Japan. AMU was extracted from prescription data of a pharmacy that received all prescriptions from the 6 nursing homes. To standardize the comparison of drug usage, AMU was measured using the defined daily dose (DDD) and estimated as DDDs/1,000 resident-days. The overall AMU was 15.3/1,000 resident-days, including oral antimicrobials (15.2/1,000 resident-days [99.3%]). The most frequently prescribed oral-antimicrobials was macrolides (5.8/1,000 resident-days [38.2%]) and quinolones (4.2/1,000 resident-days [27.6%]). Oral macrolides and quinolones were thought to be a convenience in prescription among nursing homes with resource limiting due to smaller defined the number of daily doses compared to penicillins and cephalosporins. In addition, multicenter studies that include resident-specific data (demographics and diagnosis) and focus on the purpose of antimicrobials (treatment or prevention) are needed to evaluate the appropriateness of antimicrobials.
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Affiliation(s)
- Masahiro Ishikane
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan.,Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan.,Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Japan
| | - Chika Tanaka
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Kayoko Hayakawa
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan.,Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan
| | - Takeshi Kuwahara
- Department of Pharmacy, National Center for Global Health and Medicine, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan.,Disease Control and Prevention Center, National Center for Global Health and Medicine, Japan.,Collaborative Chairs Emerging and Reemerging Infectious Diseases, National Center for Global Health and Medicine, Graduate School of Medicine, Tohoku University, Japan
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A Point Prevalence Study of Antimicrobial Use and Practice Among Nursing Homes in Singapore. Drugs Aging 2019; 36:559-570. [DOI: 10.1007/s40266-019-00651-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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