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Kanda N, Ohbe H, Jo T, Matsui H, Fushimi K, Hatakeyama S, Yasunaga H. Trends in inpatient antimicrobial consumption using days of therapy and days of antibiotic spectrum coverage: A nationwide claims database study in Japan. J Infect Chemother 2024; 30:228-235. [PMID: 37852373 DOI: 10.1016/j.jiac.2023.10.012] [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: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Days of antibiotic spectrum coverage (DASC), a novel metric for both antimicrobial volume and spectrum, was proposed to measure inpatient antimicrobial consumption in 2022. The DASC may better reflect efforts toward antimicrobial stewardship; however, no previous study has described the distribution of trends in DASC in hospitals or the association between the trend in DASC and days of therapy (DOT). This study assessed trends in antimicrobial consumption for inpatients at acute care hospitals in Japan using the DOT and DASC. METHODS This retrospective observational study used the nationwide administrative inpatient claims database of Japanese acute care hospitals between 2014 and 2018. The prescriptions of all antibiotics were identified to calculate DOT/1000 patient-days, DASC/1000 patient-days, and DASC/DOT. We described the five-year trend in these metrics and examined the association between the trends in DOT and DASC. RESULTS In total, 26,301,685 admissions from 634 hospitals were included. The DOT/1000 patient-days and DASC/1000 patient-days increased significantly by 6.1% and 5.6%, respectively. The DASC/DOT ratio did not change significantly (P = 0.35). Moreover, there was little correlation between DOT/1000 patient-days and DASC/DOT (R2 = 0.01). There was also little correlation between the five-year changes in DOT/1000 patient-days and those in DASC/DOT (R2 = 0.02). CONCLUSIONS It may be difficult to assess trends in the antibiotic spectrum using DASC alone. However, the combination of DOT as a quantity indicator and DASC/DOT as a spectrum indicator may allow for a more appropriate evaluation of stewardship efforts.
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Affiliation(s)
- Naoki Kanda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Shuji Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan; Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Mimura W, Shinjo D, Shoji K, Fushimi K. Prescribed daily-dose-based metrics of oral antibiotic use for hospitalized children in Japan. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e24. [PMID: 36819770 PMCID: PMC9932642 DOI: 10.1017/ash.2023.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
Objective Defined daily-dose (DDD)-based metrics are frequently used to measure antibiotic consumption. However, they are unsuitable for the pediatric population because they are defined using the maintenance dose for 70-kg adults. Moreover, children have large body weight variations. We assessed the prescribed daily dose (PDD) and PDD-based metrics of oral antibiotics for children to develop an alternative to DDD-based metrics in Japan. Design We performed observational study using data from the Japanese administrative claims database between April 2018 and March 2019. Methods Of 453,001 patients (aged 1 month-15 years), 564,326 admissions to 1,159 hospitals were included. We showed the median PDD (mg/day and mg/kg/day) and PDD-based metrics for 8 antibiotics for each age category (1 month to <1 year old and 1-6, 7-12, and 13-15 years old). We also assessed the relationship between PDD-based metrics and days of therapy (DOT)-based metrics using a scatter plot and correlation. Results In total, 86,389 patients (19.1%) were prescribed oral antibiotics; amoxicillin, macrolides, and third-generation cephalosporins were the most common. The PDD (mg/day) for each antibiotic increased with age to 7-12 years old, when an adult dose was reached. The PDD (mg/kg/day) decreased with age to 13-15 years old, due to increasing body weight. The relationship between PDD per 1,000 patient days and DOT per 1,000 patient days differed depending on the antibiotic. Conclusions PDD-based metrics stratified by age could characterize antibiotic consumption, even with body-weight variations. Therefore, PDD-based metrics, in addition to DOT-based metrics, are helpful benchmarks for antibiotic use in children.
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Affiliation(s)
- Wataru Mimura
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Daisuke Shinjo
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Yamaguchi K, Maeda M, Ohmagari N, Muraki Y. Association between Carbapenem Consumption and Clinical Outcomes in an In-Hospital Setting: Analysis of a Japanese Nationwide Administrative Database in 2020. Antibiotics (Basel) 2022; 11:antibiotics11121807. [PMID: 36551464 PMCID: PMC9774290 DOI: 10.3390/antibiotics11121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to clarify the relationship between carbapenem consumption and clinical outcome using the diagnosis procedure combination (DPC) payment system database (2020) published by the Ministry of Health, Labour, and Welfare of Japan. This study divided 5316 medical facilities subject to aggregation into five facilities and calculated the median values, including facility characteristics, clinical outcomes, and carbapenem consumption. Next, a correlation analysis was performed between carbapenem consumption and clinical outcome, as well as a multiple regression analysis between carbapenem consumption as the dependent variable and clinical outcome, bed size, and proportion of patients by disease as independent variables. Additionally, three clinical outcomes available from the DPC payment system database were selected, including cure, readmission within 4 weeks, and the average length of stay. This study revealed no relationship between carbapenem consumption and clinical outcome in university hospitals and university hospital-equivalent community hospitals; however, a relationship was suggested in the community, DPC-prepared, and non-DPC hospitals. University hospitals and university hospital-equivalent community hospitals with a high consumption of carbapenems may need to reconsider the classification because of the limited number of facilities in this classification.
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Affiliation(s)
- Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
- Correspondence:
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto 607-8414, Japan
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Maeda M, Nakata M, Naito Y, Yamaguchi K, Yamada K, Kinase R, Takuma T, On R, Tokimatsu I. Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study. Antibiotics (Basel) 2022; 11:1745. [PMID: 36551402 PMCID: PMC9774691 DOI: 10.3390/antibiotics11121745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs.
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Affiliation(s)
- Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Mari Nakata
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Yuika Naito
- Department of Hospital Pharmaceutics, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Kaho Yamada
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Ryoko Kinase
- Division of Infection Control Sciences, Department of Clinical Pharmacy, Showa University School of Pharmacy, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Takahiro Takuma
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Rintaro On
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
| | - Issei Tokimatsu
- Division of Infection Diseases, Department of Medicine, Showa University School of Medicine, 1-5-8, Hatanodai, Shinagawa-ku, Tokyo 142-8555, Japan
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Kramer TS, Salm F, Schwab F, Geffers C, Behnke M, Gastmeier P, Piening B. Reduction of antibacterial use in patients with very low birth weight on German NICUs after implementation of a mandatory surveillance system. A longitudinal study with national data from 2013 to 2019. J Infect 2022; 85:8-16. [DOI: 10.1016/j.jinf.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 11/02/2021] [Accepted: 05/10/2022] [Indexed: 11/17/2022]
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Baier J, Höpner J, Haase R, Diexer S, Stareprawo S, Mikolajczyk R, Moritz S. Monitoring Antibiotic Consumption in Pediatrics. How Close to Reality Are Days of Therapy and Recommended Daily Dose Methods? Pediatr Infect Dis J 2022; 41:e126-e132. [PMID: 35027511 DOI: 10.1097/inf.0000000000003446] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hospitals are advised to monitor antibiotic use. Several approximation methods do exist to perform this task. Adult cohorts can easily be monitored using the defined daily dose method, or its German adaption recommended daily doses (RDD) method, that seems inapplicable in pediatric cohorts due to body weight variations. Guidelines recommend the days of therapy (DOT) method in pediatrics. Still, there is a need for more detailed analysis regarding the performance of both methods. METHODS Based on data from 4½ years of our fully computerized patient care data managing system in a combined neonatal and pediatric intensive care unit, we compare the results for DOT and RDD per 100 patient days with exact measurement of antibiotic consumption (individual daily dose per 100 patient days) as internal reference. RESULTS The DOT method reflected antibiotic consumption in our cohort on the level of total consumption, subgroups, and agents with almost always high accuracy (correlation with individual daily dose between 0.73 and 1.00). The RDD method showed poor correlation on the level of total consumption (r = 0.21) and fluctuating results on more detailed levels (correlation, 0.01-0.94). A detailed analysis of body weight distribution and ordered packaging sizes of single agents revealed that RDD seems to work well when only one package size of the agent was ordered in our pharmacy. CONCLUSION The DOT method is superior to RDD for monitoring antibiotic drug consumption in pediatric cohorts. RDD seems to work satisfactory well for selected antibiotic agents that are administered with little variation in packaging size.
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Affiliation(s)
- Jan Baier
- From the Department for Operative and Nonoperative Pediatrics and Adolescent Medicine, Section for Neonatology and Pediatric Critical Care, University Hospital, Halle, Germany
| | - Jens Höpner
- Institute for Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Roland Haase
- From the Department for Operative and Nonoperative Pediatrics and Adolescent Medicine, Section for Neonatology and Pediatric Critical Care, University Hospital, Halle, Germany
| | - Sophie Diexer
- Institute for Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | | | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometry and Informatics, Medical Faculty, Martin Luther University of Halle-Wittenberg, Halle, Germany
| | - Stefan Moritz
- Section of Clinical Infectious Diseases, University Hospital, Halle, Germany
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Egle L, Sauter K, Ockfen S, Haber M, Becker S, Wagenpfeil G, Zemlin M, Meyer S, Simon A. Retrospective audit of antibiotic use in a university general pediatrics department using hospital pharmacy dispensing data. GMS INFECTIOUS DISEASES 2021; 9:Doc06. [PMID: 34956817 PMCID: PMC8662896 DOI: 10.3205/id000075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Antibiotics are among the most frequently prescribed drugs in children's hospitals, which is why regular monitoring of antibiotic use in hospitals is of great importance. This retrospective audit (60 months, January 2014 - December 2018) analyzes the antibiotic consumption at a university inpatient department of general pediatrics including neonatal and pediatric intensive care based on pharmacy dispensing data in units of grams per 100 patient days and in Defined Daily Doses per 100 patient days. The results provide potential targets for Antibiotic Stewardship interventions. Conversely, this audit elicits methodological limitations of the method of antibiotic surveillance in pediatrics recommended by the Robert Koch Institute, Berlin.
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Affiliation(s)
- Leonie Egle
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Katharina Sauter
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Svenja Ockfen
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Manfred Haber
- Pharmacy, Saarland University Hospital, Homburg/Saar, Germany
| | - Sören Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University Hospital, Homburg/Saar, Germany
| | - Gudrun Wagenpfeil
- Institute for Medical Biometry, Epidemiology and Medical Informatics, University Medical Center, Saarland University, Campus Homburg, Homburg, Germany
| | - Michael Zemlin
- Department Clinic for General Pediatrics and Neonatology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Sascha Meyer
- Department Clinic for General Pediatrics and Neonatology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany
| | - Arne Simon
- Pediatric Hematology and Oncology, Children’s Hospital Medical Center, Saarland University Hospital, Homburg/Saar, Germany,*To whom correspondence should be addressed: Arne Simon, Pediatric Oncology and Hematology, Children’s Hospital Medical Center, Saarland University Hospital, Kirrberger Str. Building 09, 66424 Homburg/Saar, Germany, Phone: +49 6841 1628409, Fax: +49 6841 1628424, E-mail:
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Sri Ranganathan S, Wanigatunge C, Senadheera GPSG, Beneragama BVSH. A national survey of antibacterial consumption in Sri Lanka. PLoS One 2021; 16:e0257424. [PMID: 34520501 PMCID: PMC8439449 DOI: 10.1371/journal.pone.0257424] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 08/31/2021] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy. OBJECTIVES To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector. METHODS The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors. FINDINGS From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively. CONCLUSIONS A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.
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Affiliation(s)
| | - Chandanie Wanigatunge
- Department of Pharmacology, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka
| | - G. P. S. G. Senadheera
- Department of Pharmacy and Pharmaceutical Sciences, Faculty of Allied Health Sciences, University of Sri Jayewardenepura, Sri Jayewardenepura, Sri Lanka
| | - B. V. S. H. Beneragama
- National focal point for combating antimicrobial resistance in Sri Lanka, Ministry of Health, Colombo, Sri Lanka
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Shawki MA, AlSetohy WM, Ali KA, Ibrahim MR, El-Husseiny N, Sabry NA. Antimicrobial stewardship solutions with a smart innovative tool. J Am Pharm Assoc (2003) 2021; 61:581-588.e1. [PMID: 33962893 DOI: 10.1016/j.japh.2021.04.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 04/04/2021] [Accepted: 04/19/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Antimicrobial consumption has been increasing lately. Hence, effective strategies are required to control antimicrobial use and decrease the development of antimicrobial resistance. OBJECTIVE To evaluate the impact of the use of a mobile app on the implementation of antimicrobial stewardship program (ASP) interventions. METHODS This was a longitudinal study conducted at El-Nile Badrawi Hospital in Cairo, Egypt, on inpatients receiving antimicrobials from January 2018 to December 2019. The study included 2 phases: the preimplementation phase, which included a paper-based ASP developed according to the Centers for Disease Control and Prevention Core Elements of Hospital Antibiotic Stewardship Programs 2014, and the mobile app phase where the MEDIcare Pro mobile app was developed and used in ASP intervention implementation. The study outcomes were antimicrobial consumption and cost, length of hospital and intensive care unit (ICU) stay, 30-day mortality rate and readmission rate, and detection of drug-related problems (DRPs). RESULTS The mobile app statistically significantly decreased antimicrobial consumption from 75.1 defined daily dose (DDD)/100 bed-days in the preimplementation phase to 64.65 DDD/100 bed-days in the mobile app phase, with a total cost savings of E£1,237,476. There was a significant reduction in the length of ICU stay, with a mean difference of 1.63 days between the 2 phases, but no significance was detected regarding length of hospital stay or readmission rate. There was a statistically significant decrease in mortality rate from 1.17% in the preimplementation phase to 0.83% in the mobile app phase (P = 0.02). The frequency of DRPs detected by pharmacists statistically significantly increased from 0.54/100 bed-days in the preimplementation phase to 3.23/100 bed-days in the mobile app phase. CONCLUSION The use of a mobile app was found to be effective, applicable, and usable in guiding health professionals on rational antimicrobial use.
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Prospective monitoring of carbapenem use and pseudomonal resistance across pediatric institutions. Infect Control Hosp Epidemiol 2020; 41:1042-1047. [PMID: 32484118 DOI: 10.1017/ice.2020.234] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine whether carbapenem consumption and Pseudomonas aeruginosa resistance rates can be used as benchmarks to compare and improve antimicrobial stewardship programs across multiple pediatric hospitals. DESIGN A prospective study. SETTING AND PARTICIPANTS Healthcare institutions in Japan with >100 pediatric beds. METHODS An annual survey of the total days of therapy (DOT) per 1,000 patient days for carbapenem antibiotics (meropenem, imipenem-cilastatin, panipenem-betamipron, doripenem) and susceptibility rates of Pseudomonas aeruginosa to meropenem and imipenem-cilastatin from each institution was conducted over a 7-year period. Data were reported to the administration, as well as to the infection control team, of each institution annually. RESULTS Data were obtained from 32 facilities. The median total carbapenem DOT per 1,000 patient days was 16.6 and varied widely, with a range of 2.7 to 59.0. The median susceptibility to meropenem was 86.6%, ranging from 78.6% to 96.6%. We detected an inverse correlation between total carbapenem DOT versus susceptibility (r = - 0.36; P < .01). Over the 7-year period, the DOT per 1,000 patient days of carbapenem decreased by 27% from a median of 16.0 to 11.7 (P < .01). We also observed an improvement in susceptibility to meropenem from a median of 87% to 89.7% (P = .01) and to imipenem-cilastatin from 79% to 85% (P < .01). The decreases in the use of carbapenem were greater in institutions with antimicrobial stewardship programs led by pediatric infectious disease specialists. CONCLUSIONS Antimicrobial use and resistance, targeting carbapenems and P. aeruginosa, respectively, can serve as benchmarks that can be utilized to promote antimicrobial stewardship across pediatric healthcare institutions.
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Kim B, Lee M, Moon S, Park S, Song KH, Lee H, Park J, Lee M, Choi SM, Yeom JS, Kim J, Kim CJ, Chang HH, Kim E, Kim T, Kim H. Current status of antimicrobial stewardship programmes in Korean hospitals: results of a 2018 nationwide survey. J Hosp Infect 2020; 104:172-180. [DOI: 10.1016/j.jhin.2019.09.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 09/03/2019] [Indexed: 12/31/2022]
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Abbasian H, Hajimolaali M, Yektadoost A, Zartab S. Antibiotic Utilization in Iran 2000-2016: Pattern Analysis and Benchmarking with Organization for Economic Co-operation and Development Countries. J Res Pharm Pract 2019; 8:162-167. [PMID: 31728348 PMCID: PMC6830016 DOI: 10.4103/jrpp.jrpp_19_42] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 04/29/2019] [Indexed: 12/13/2022] Open
Abstract
Objectives: Antibiotic resistance is the main threat to health all over the world. The consumption of antibiotics is one of the factors causing the emergence of multidrug resistance. The purpose of this study was to recognize the patterns, trends, and changes of consumption in Iran and to compare them with those of Organization for Economic Co-operation and Development (OECD) countries. Methods: The data were collected from a national pharmaceutical wholesale data bank. Defined daily dose (DDD) or DDDs per 1000 inhabitants per day (DID) was calculated as a standard indicator for the consumption over 17 years. Results: Were benchmarked with the consumption of OECD countries. Drug utilization 90% (DU90%) method was used to assess the drug consumption pattern. Findings: The antibiotic consumption jumped up from 33.6 DID to 60 DID from 2000 to 2016. Compared to the average consumption of OECD countries, Iran has consumed antibiotics almost triple times. There were 9–11 chemical substances in the DU90% list during these years. Changes in DU90% list occurred within antibiotics classes during the study period. Although the total consumption growth was equal to 79% during these years, consumption of some pharmacological subgroups such as sulfonamide and aminoglycosides has decreased. Conclusion: Albeit the existence of surveillance system for health-related infectious diseases, the consumption of antibiotics has increased drastically, which illustrates the necessity of comprehensive and effective national antibiotic stewardship.
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Affiliation(s)
- Hadi Abbasian
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran
| | - Mohammad Hajimolaali
- Department of Drug and Food Control, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Yektadoost
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran
| | - Saman Zartab
- Department of Pharmacoeconomics and Pharmaceutical Administration, Tehran University of Medical Science, Tehran, Iran
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Bosman AL, Loest D, Carson CA, Agunos A, Collineau L, Léger DF. Developing Canadian Defined Daily Doses for Animals: A Metric to Quantify Antimicrobial Use. Front Vet Sci 2019; 6:220. [PMID: 31380397 PMCID: PMC6660253 DOI: 10.3389/fvets.2019.00220] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 06/18/2019] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial use surveillance data need to be analyzed and reported in a standardized and harmonized way. In veterinary medicine, one approach is to use defined daily doses (DDD) for animals. DDD for animals are technical standards used in various measures or metrics that quantify antimicrobial use. The European Medicines Agency published principles for assigning DDDvet values based on information on dosing obtained from nine European countries. For measuring antimicrobial use in livestock within Canada, DDDs for animals reflective of Canadian veterinary antimicrobial use (DDDvetCAs) were needed. Our objectives were (1) to describe the development of DDDvetCA standards for pigs and poultry (broiler chickens and turkeys) for authorized and compounded antimicrobial active ingredients used in Canada, including those used extra-label; and (2) to compare the DDDvetCAs with EMA's DDDvets, where possible. Species-specific DDDvetCAs were assigned based on the average of unique antimicrobial daily doses obtained from product information, stratified by route of administration and age indication (where applicable). The feed, water and bolus DDDvetCAs were compared to oral DDDvets, and injectable DDDvetCAs to parenteral DDDvets, that matched by antimicrobial active ingredient. Seventy-five DDDvetCAs were assigned for pigs; 51 for poultry. Seventeen injectable DDDvetCAs could be compared to 14 EMA's parenteral DDDvets and 53 feed, water, and bolus DDDvetCAs could be compared to 40 oral DDDvets. Feed and water DDDvetCAs were generally lower than EMA's oral DDDvets, although differences in methodology between Canada and Europe make comparisons challenging. The assignment of DDDvetCAs was a resource intensive and iterative process. EMA's published principles for assigning DDDvets were an invaluable source of information. The use of DDDvetCAs will reflect exposure of Canadian animals to antimicrobials, be useful for evaluating associations between use and resistance within Canada and provide information for risk assessment and stewardship policies. However, when reporting antimicrobial use data internationally, using the same DDD standards as other reporting countries will facilitate between country comparisons, although differences in which antimicrobial active ingredients are licensed between countries may create challenges. Future steps include assigning DDDvetCAs for other food animal species, such as cattle, veal, and farmed fish.
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Affiliation(s)
- Angelina L. Bosman
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
- Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Daleen Loest
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - Carolee A. Carson
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - Agnes Agunos
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
| | - Lucie Collineau
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - David F. Léger
- Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON, Canada
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Gradl G, Teichert M, Kieble M, Werning J, Schulz M. Comparing outpatient oral antibiotic use in Germany and the Netherlands from 2012 to 2016. Pharmacoepidemiol Drug Saf 2018; 27:1344-1355. [PMID: 30264894 PMCID: PMC6585743 DOI: 10.1002/pds.4643] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 06/21/2018] [Accepted: 07/25/2018] [Indexed: 11/21/2022]
Abstract
PURPOSE Overuse of antibiotics is of concern, but may differ between European countries. This study compares outpatient use of oral antibiotics between Germany (DE) and the Netherlands (NL). METHODS For DE, we used the DAPI database with information on dispensings at the expense of the Statutory Health Insurance Funds from > 80% of community pharmacies. For NL, data were obtained from the Dutch Foundation for Pharmaceutical Statistics. Use of oral antibiotics was estimated as defined daily doses per 1000 inhabitants per day (DID), except for age comparisons as packages per 1000 inhabitants annually. National time trends were assessed with linear regression, stratified for the major antibiotic classes, and individual substances. RESULTS From 2012 to 2016, outpatient antibiotic use was lower in NL than in DE (9.64 vs 14.14 DID in 2016) and non-significantly decreased slightly over time in both countries. In DE, dispensings of oral antibiotics to children were higher compared with NL for the age groups 2 to 5 (2.0-fold in 2016) and 6 to 14 years (2.7-fold in 2016). Use of cephalosporins was very low in NL (0.02 DID in 2016), but the second most frequently dispensed class in DE (2.95 DID in 2016). CONCLUSION From 2012 to 2016, outpatient use of oral antibiotics was lower in NL than in DE. Differences were primarily observed in the age groups 2 to 5 and 6 to 14 years, although the recommendations of evidence-based guidelines in both countries were in agreement.
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Affiliation(s)
- Gabriele Gradl
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
| | - Martina Teichert
- Department of Clinical Pharmacy and ToxicologyLeiden University Medical CenterLeidenThe Netherlands
| | - Marita Kieble
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
| | - Johanna Werning
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
| | - Martin Schulz
- German Institute for Drug Use Evaluation (DAPI)BerlinDEGermany
- Department of MedicineABDA—Federal Union of German Associations of PharmacistsBerlinDEGermany
- Department of Clinical Pharmacy and Biochemistry, Institute of PharmacyFreie Universitaet BerlinBerlinDEGermany
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Cižman M, Plankar Srovin T. Antibiotic consumption and resistance of gram-negative pathogens (collateral damage). GMS INFECTIOUS DISEASES 2018; 6:Doc05. [PMID: 30671336 PMCID: PMC6301726 DOI: 10.3205/id000040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Antibiotics are commonly prescribed in community and hospital care. Overuse and misuse favors emergence and spread of resistant bacteria. The ATC/DDD methodology is commonly used for presenting the drug utilization data. In primary care, the consumption is usually expressed in DDD per 1,000 inhabitants per day, in hospital, preferably in DDD per 100 bed days and DDD per 100 admissions. The alternative metric is days of therapy (DOT), which needs IT support. Antibiotics have ecological adverse effects at individual and population level. Antibiotics select resistant bacteria among pathogens and normal flora. Broad-spectrum antibiotics, low dosage and prolonged antibiotic therapy favor the development of resistance. Although total use of antibiotics in hospital is much less than in the community, the intensity of use magnified by cross infection ensures a multitude of resistant bacteria in today's hospitals. Reversal of resistance is complex and might persist for many years despite the introduction of antimicrobial containment and stewardship programs.
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Affiliation(s)
- Milan Cižman
- University Medical Center, Department of Infectious Diseases, Ljubljana, Slovenia
| | - Tina Plankar Srovin
- University Medical Center, Department of Infectious Diseases, Ljubljana, Slovenia
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Först G, de With K, Weber N, Borde J, Querbach C, Kleideiter J, Seifert C, Hagel S, Ambrosch A, Löbermann M, Schröder P, Steib-Bauert M, Kern WV. Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study. J Antimicrob Chemother 2018; 72:2931-2937. [PMID: 29091214 DOI: 10.1093/jac/dkx244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/20/2017] [Indexed: 01/23/2023] Open
Abstract
Background The WHO/ATC (Anatomical Therapeutic Chemical) index DDD (WHO-DDD) is commonly used for drug consumption measurement. Discrepancies between WHO-DDD and actual prescribed daily doses (PDD) in hospitals have prompted alternative dose definitions adapted to doses recommended in hospital practice guidelines [recommended daily doses (RDD)]. Methods In order to validate RDD we performed modified point prevalence surveys in 24 acute care hospitals and recorded 20620 PDD of antibiotics given to 4226 adult patients on the day of the survey and the 6 preceding days. We calculated RDD and WHO-DDD and compared them with PDD. Results The rate of RDD corresponding to PDD was higher than the corresponding rate for WHO-DDD (pooled data, 55% versus 30%) and the differences were similar across the hospital sample, but varied according to drug/drug class, route of administration, indication and renal function. RDD underestimated actual consumption by 14% overall, while WHO-DDD overestimated total antibacterial consumption by 28% (pooled data; median values RDD -10% versus WHO-DDD +32%). The deviations of estimated from actual drug use volumes were largest for β-lactams (RDD -11% versus WHO-DDD +49%), in particular for penicillins (-11% versus +64%), if WHO-DDD were used. Conclusions Hospital antibiotic consumption surveillance systems using current WHO-DDD should address the uneven discrepancies between actual prescribing and consumption estimates according to drug class that may lead to misclassification in benchmark analyses. We recommend using validated RDD as a supplementary measure to the WHO-DDD for detailed analyses.
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Affiliation(s)
- Gesche Först
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Pharmacy Service, University Hospital and Medical Center, Freiburg, Germany
| | - Katja de With
- Clinical Infectious Disease Unit, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Nadine Weber
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Johannes Borde
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Infectious Diseases Section, Ortenau-Klinikum, Achern-Oberkirch, Germany
| | - Christiane Querbach
- Pharmacy, 'Rechts der Isar' Hospital of the Technical University, Munich, Germany
| | | | - Claudia Seifert
- Pharmacy Service, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Stefan Hagel
- Center for Infection and Infection Control, University Hospital, Jena, Germany
| | - Andreas Ambrosch
- Department of Laboratory Medicine, Microbiology and Infection Control, 'Barmherzige Brüder' Hospital, Regensburg, Germany
| | - Micha Löbermann
- Department of Infectious Diseases and Tropical Medicine, University Medical Center, Rostock, Germany
| | - Philipp Schröder
- Department of Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Michaela Steib-Bauert
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany
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Kim B, Hwang H, Kim J, Lee MJ, Pai H. A few antibiotics can represent the total hospital antibiotic consumption. BMC Infect Dis 2018; 18:247. [PMID: 29855273 PMCID: PMC5984315 DOI: 10.1186/s12879-018-3132-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 05/04/2018] [Indexed: 12/26/2022] Open
Abstract
Background Appropriate antibiotic use has become an important issue. However, collecting data on the use of all antibiotics in a hospital is difficult without an advanced computerized system and dedicated staff. This paper examines if 1–3 antibiotics can satisfactorily represent the total antibiotic consumption at the hospital level. Methods We collected antibiotic data from six large university hospitals in Korea for some years between 2004 and 2012. Since the total antibiotics consist of a few chosen representative antibiotics and the rest, we used those chosen antibiotics along with additional variables constructed only with t (time) such as t, t2, and t3 to capture the time trend and whether t belongs to each month or not to capture the monthly variations. The ordinary least squares method was used to explain the total antibiotic amount with these variables, and then the estimated model was employed to predict the use for 2013. To determine which antibiotics were the most representative in tracking general trends in antibiotic use over time, we tried various combinations of antibiotics to find the combination that best minimized the 2013 prediction error. Results We found that fluoroquinolones and aminoglycosides were the most representative, followed by beta-lactam/beta-lactamase inhibitors and 4th-generation and 3rd-generation cephalosporins. The mean prediction error over 12 months in 2013 with these few antibiotics was only 1–3% of the monthly antibiotic consumption amount. Conclusions The total antibiotic consumption amount at the hospital level can be represented sufficiently by a few antibiotics, such as fluoroquinolones and aminoglycosides, which means that hospitals can save resources by tracing only the usage of those few antibiotics instead of the entire inventory. Since the choice of fluoroquinolones and aminoglycosides is based solely on our Korean data, other hospitals may follow the same modelling methodology to find their own representative antibiotics. Electronic supplementary material The online version of this article (10.1186/s12879-018-3132-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Hyeonjun Hwang
- School of Economic Sciences, Washington State University, Pullman, USA
| | - Jieun Kim
- Department of Internal medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea
| | - Myoung-Jae Lee
- Department of Economics, College of Political Science & Economics, Korea University, 145 Anam-ro, Sungbuk-gu, Seoul, 02841, South Korea.
| | - Hyunjoo Pai
- Department of Internal medicine, College of Medicine, Hanyang University, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04763, South Korea.
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Galankin TL, Kolbin AS, Sidorenko SV, Kurylev AA, Malikova EA, Lobzin YV, Ivanov DO, Shabalov NP, Mikhailov AV, Klimko NN, Dolgov GV. Retrospective surveillance of antibiotic use in maternity wards and neonatal intensive care units in Saint Petersburg, Russia. Eur J Clin Microbiol Infect Dis 2018; 37:1531-1537. [DOI: 10.1007/s10096-018-3280-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 05/09/2018] [Indexed: 12/15/2022]
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19
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Youngster I, Avorn J, Belleudi V, Cantarutti A, Díez-Domingo J, Kirchmayer U, Park BJ, Peiró S, Sanfélix-Gimeno G, Schröder H, Schüssel K, Shin JY, Shin SM, Simonsen GS, Blix HS, Tong A, Trifirò G, Ziv-Baran T, Kim SC. Antibiotic Use in Children - A Cross-National Analysis of 6 Countries. J Pediatr 2017; 182:239-244.e1. [PMID: 28012694 DOI: 10.1016/j.jpeds.2016.11.027] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Revised: 09/13/2016] [Accepted: 11/07/2016] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To describe the rates of pediatric antibiotic use across 6 countries on 3 continents. STUDY DESIGN Cross-national analysis of 7 pediatric cohorts in 6 countries (Germany, Italy, South Korea, Norway, Spain, and the US) was performed for 2008-2012. Antibiotic dispensings were identified and grouped into subclasses. We calculated the rates of antimicrobial prescriptions per person-year specific to each age group, comparing the rates across different countries. RESULTS A total of 74 744 302 person-years from all participating centers were included in this analysis. Infants in South Korea had the highest rate of antimicrobial consumption, with 3.41 prescribed courses per child-year during the first 2 years of life. This compares with 1.6 in Lazio, Italy; 1.4 in Pedianet, Italy; 1.5 in Spain; 1.1 in the US; 1.0 in Germany; and 0.5 courses per child-year in Norway. Of antimicrobial prescriptions written in Norway, 64.8% were for first-line penicillins, compared with 38.2% in Germany, 31.8% in the US, 27.7% in Spain, 25.1% in the Italian Pedianet population, 9.8% in South Korea, and 8% in the Italian Lazio population. CONCLUSIONS We found substantial differences of up to 7.5-fold in pediatric antimicrobial use across several industrialized countries from Europe, Asia, and North America. These data reinforce the need to develop strategies to decrease the unnecessary use of antimicrobial agents.
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Affiliation(s)
- Ilan Youngster
- Division of Infectious Diseases, Boston Children's Hospital, Boston, MA.
| | - Jerry Avorn
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Valeria Belleudi
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Anna Cantarutti
- Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
| | - Javier Díez-Domingo
- Health Services Research Unit, Center for Public Health Research, Valencia, Spain
| | - Ursula Kirchmayer
- Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Salvador Peiró
- Health Services Research Unit, Center for Public Health Research, Valencia, Spain
| | | | - Helmut Schröder
- Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany
| | - Katrin Schüssel
- Wissenschaftliches Institut der AOK WIdO (Scientific Institute of the AOK), Berlin, Germany
| | - Ju-Young Shin
- Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Sun Mi Shin
- Korea Institute of Drug Safety and Risk Management, Seoul, Republic of Korea
| | - Gunnar Skov Simonsen
- Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway
| | - Hege Salvesen Blix
- Department of Pharmacoepidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Angela Tong
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Gianluca Trifirò
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Tomer Ziv-Baran
- Department of Epidemiology and Preventive Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Seoyoung C Kim
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Gharbi M, Doerholt K, Vergnano S, Bielicki JA, Paulus S, Menson E, Riordan A, Lyall H, Patel SV, Bernatoniene J, Versporten A, Heginbothom M, Goossens H, Sharland M. Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK. BMJ Open 2016; 6:e012675. [PMID: 27810974 PMCID: PMC5129034 DOI: 10.1136/bmjopen-2016-012675] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance. METHODS We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates. RESULTS A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam. CONCLUSIONS We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.
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Affiliation(s)
- Myriam Gharbi
- NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection—Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Katja Doerholt
- Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
| | - Stefania Vergnano
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Julia Anna Bielicki
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Stéphane Paulus
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Esse Menson
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Andrew Riordan
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Hermione Lyall
- Department of Infectious Diseases, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
| | - Sanjay Valabh Patel
- Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Jolanta Bernatoniene
- Paediatric Infectious Disease and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Bristol, UK
| | - Ann Versporten
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
| | | | - Herman Goossens
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
| | - Mike Sharland
- Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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Hillerton JE, Irvine CR, Bryan MA, Scott D, Merchant SC. Use of antimicrobials for animals in New Zealand, and in comparison with other countries. N Z Vet J 2016; 65:71-77. [PMID: 27030313 DOI: 10.1080/00480169.2016.1171736] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
AIM To describe the use of antimicrobial drugs for food animals in New Zealand, based on sales data reported to government, changes over time, and in comparison with other countries and human use. METHODS Data were sourced from official government and industry reports covering 26 European countries, Australia, Canada, New Zealand and the United States of America in 2012, the last year data were available for all countries. The data included antimicrobial sales, and animal and human populations. Antimicrobial use was estimated based on the amount of active ingredient sold, per standardised biomass (population correction unit). RESULTS The estimated usage of antimicrobials for food animals in New Zealand for 2012 was 9.4 mg active ingredient/kg biomass. Total sales of antimicrobials between 2005-14 increased on average by 2.5% or 1.5 tonnes per year. Over the same time total animal biomass decreased by an estimated 4.3%, with the main decrease being in sheep (25%) and beef cattle (17%), while dairy cattle increased (28%). In the countries examined, the estimated usage of antimicrobials in food producing animals in 2012 varied from 3.8 to 341 mg active ingredient/kg biomass, in Norway and Italy, respectively, with use in New Zealand being the third lowest. Usage of antimicrobials for human health in New Zealand in 2012 was estimated at 121 mg active ingredient/kg biomass, being ranked sixteenth of the countries compared. Use in humans was 12.9 times the use in animals. CONCLUSIONS New Zealand was the third lowest user of antimicrobials in animal production and used much less than in human medicine. This is the first report of baseline data which may be used by the New Zealand animal health industry to develop, and measure success in, approaches to maximise the life of antimicrobials for animal health and welfare. CLINICAL RELEVANCE New Zealand veterinarians will soon have to make changes to adopt the World Health Organisation's global action plan to manage antimicrobial resistance. Having a benchmark of current antimicrobial use will inform priorities and allow measurement of the impact of future programmes.
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Affiliation(s)
- J E Hillerton
- a Drumlanrig , 163 Flume Road, RD4, Cambridge 3496 , New Zealand
| | - C R Irvine
- b New Zealand Veterinary Association , PO Box 11212, Wellington 6011 , New Zealand
| | - M A Bryan
- c VetSouth , Cnr Great North and Welsh Roads, PO Box 12, Winton , New Zealand
| | - D Scott
- d Ethical Agents , 470 Parnell Road, Auckland , New Zealand
| | - S C Merchant
- e Pet Doctors , 743 Mount Eden Road, Mount Eden, Auckland 1024 , New Zealand
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Sharma M, Damlin A, Pathak A, Stålsby Lundborg C. Antibiotic Prescribing among Pediatric Inpatients with Potential Infections in Two Private Sector Hospitals in Central India. PLoS One 2015; 10:e0142317. [PMID: 26540104 PMCID: PMC4634959 DOI: 10.1371/journal.pone.0142317] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/19/2015] [Indexed: 11/19/2022] Open
Abstract
Introduction Infectious diseases are one of the major causes of child mortality in India. Pediatric patients are commonly prescribed antibiotics for non-bacterial infections. Monitoring of local antibiotic prescribing with respect to the diagnosis is necessary to improve the prescribing practices. The aim of the study was to describe antibiotic prescribing for potential infections among patients admitted in pediatric departments in two private sector hospitals; one teaching (TH) and one non-teaching (NTH) in Central India. Methods Data from all patients admitted at the pediatric departments of both study hospitals was collected manually, for 3 years (2008–2011) using a customized form. Data from inpatients aged 0–18 years, diagnosed with; acute gastroenteritis (AGE), respiratory tract infections, enteric fever, viral fever or unspecified fever were focused for analysis. Antibiotic prescriptions were analysed using the WHO Anatomical Therapeutic Chemical (ATC) classification system and defined daily doses (DDDs). Adherence to the Indian Academy of Pediatrics list of essential medicines (IAP-LEM) was investigated. P-values <0.05 were considered significant. Results Oftotal6, 825 inpatients admitted at two pediatric departments, 510 patients from the TH and 2,479from the NTH were selected based on the assigned potential infectious diagnoses. Of these, 224 patients (44%) at the TH and 2,088 (84%) at the NTH were prescribed at least one antibiotic during hospital stay (odds ratio-0.69, 95%confidence interval-0.52 to 0.93; p<0.001). Patients with AGE, viral- and enteric fever were frequently prescribed antibiotics at both hospitals, yet higher proportion were prescribed antibiotics at the NTH compared to the TH. Broad-spectrum antibiotics were the most commonly prescribed antibiotic class in both hospitals, namely third generation cephalosporins, J01DD (69%) at the TH, and new fixed dose combinations of antibiotics J01R (FDCs, 42%) at the NTH. At the TH, 37% of the antibiotic prescriptions were comprised of antibiotics listed in the IAP-LEM, compared to 24% at the NTH (p<0.05). Conclusions Broad-spectrum antibiotics were prescribed frequently in both hospitals also for the un-indicated conditions such as viral fever and enteric fever. At the NTH, new FDCs were more frequently prescribed and adherence to the IAP-LEM was substantially lower at the NTH compared to the TH. The results demonstrate need to develop diagnosis-specific prescribing guidelines to facilitate rational use of antibiotics and implement antibiotic stewardship program.
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Affiliation(s)
- Megha Sharma
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
- * E-mail:
| | - Anna Damlin
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
| | - Ashish Pathak
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
- Department of Pediatrics, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- Department of Women and Children’s Health, International Maternal and Child Health Unit, Uppsala University, SE 751 85 Uppsala, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Public Health Sciences, Global Health—Health Systems and Policy (HSP): Medicines, focusing antibiotics, Karolinska Institutet, Tomtebodavägen 18A, 17177 Stockholm, Sweden
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Yoon YK, Park GC, An H, Chun BC, Sohn JW, Kim MJ. Trends of Antibiotic Consumption in Korea According to National Reimbursement Data (2008-2012): A Population-Based Epidemiologic Study. Medicine (Baltimore) 2015; 94:e2100. [PMID: 26579825 PMCID: PMC4652834 DOI: 10.1097/md.0000000000002100] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
This study determined the trends in the quantities and patterns of nationwide antibiotic consumption in the Republic of Korea (ROK).This nationwide descriptive epidemiological study was conducted in the ROK between 2008 and 2012. The quantities and patterns of total systemic antibiotic prescriptions were analyzed using National Health Insurance claims data collected through the Health Insurance Review and Assessment service. Data concerning systemic antibiotics were collected using measurement units of the defined daily dose (DDD) per 1000 people per day according to the Anatomical Therapeutic Chemical classification.Over the 5-year study period, the annual consumption of systemic antibiotics ranged from 21.68 to 23.12 DDD per 1000 people per day. Outpatient antibiotic use accounted for 80.9% of total consumption. A regression model with autoregressive errors showed significant increased consumption of major antibiotic subgroups, including 3rd-generation cephalosporins, carbapenems, and glycopeptides (P < 0.001). However, the antibiotic use of 1st- (P = 0.003), 2nd- (P = 0.004), and 3rd-generation (P = 0.018) cephalosporins among patients who underwent surgery under monitoring by the antimicrobial stewardship programs for perioperative prescription was significantly lower than in those who underwent surgery without monitoring programs. In time-series analysis, total antibiotic consumption demonstrated significant seasonality (P < 0.001).The consumption of broad-spectrum antibiotics was noted to have increased in the ROK from 2008 to 2012, providing a possible explanation for the changing epidemiology of multidrug resistance. Larger prospective studies are needed to investigate the impact on public health of monitoring programs of perioperative antibiotic usage.
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Affiliation(s)
- Young Kyung Yoon
- From the Division of Infectious Diseases, Department of Internal Medicine (YKY, JWS, MJK), Institute of Emerging Infectious Diseases (YKY, JWS, MJK), Department of Biostatistics (GCP, HA), and Department of Preventive Medicine (BCC), Korea University College of Medicine, Seoul, Republic of Korea
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24
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Gharbi M, Moore LSP, Gilchrist M, Thomas CP, Bamford K, Brannigan ET, Holmes AH. Forecasting carbapenem resistance from antimicrobial consumption surveillance: Lessons learnt from an OXA-48-producing Klebsiella pneumoniae outbreak in a West London renal unit. Int J Antimicrob Agents 2015; 46:150-6. [PMID: 25979640 PMCID: PMC4526541 DOI: 10.1016/j.ijantimicag.2015.03.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 03/12/2015] [Accepted: 03/12/2015] [Indexed: 11/28/2022]
Abstract
This study aimed to forecast the incidence rate of carbapenem resistance and to assess the impact of an antimicrobial stewardship intervention using routine antimicrobial consumption surveillance data. Following an outbreak of OXA-48-producing Klebsiella pneumoniae (January 2008-April 2010) in a renal cohort in London, a forecasting ARIMA model was derived using meropenem consumption data [defined daily dose per 100 occupied bed-days (DDD/100OBD)] from 2005-2014 as a predictor of the incidence rate of OXA-48-producing organisms (number of new cases/year/100,000OBD). Interrupted times series assessed the impact of meropenem consumption restriction as part of the outbreak control. Meropenem consumption at lag -1 year (the preceding year), highly correlated with the incidence of OXA-48-producing organisms (r=0.71; P=0.005), was included as a predictor within the forecasting model. The number of cases/100,000OBD for 2014-2015 was estimated to be 4.96 (95% CI 2.53-7.39). Analysis of meropenem consumption pre- and post-intervention demonstrated an increase of 7.12 DDD/100OBD/year (95% CI 2.97-11.27; P<0.001) in the 4 years preceding the intervention, but a decrease thereafter. The change in slope was -9.11 DDD/100OBD/year (95% CI -13.82 to -4.39). Analysis of alternative antimicrobials showed a significant increase in amikacin consumption post-intervention from 0.54 to 3.41 DDD/100OBD/year (slope +0.72, 95% CI 0.29-1.15; P=0.01). Total antimicrobials significantly decreased from 176.21 to 126.24 DDD/100OBD/year (P=0.05). Surveillance of routinely collected antimicrobial consumption data may provide a key warning indicator to anticipate increased incidence of carbapenem-resistant organisms. Further validation using real-time data is needed.
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Affiliation(s)
- M Gharbi
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK.
| | - L S P Moore
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - M Gilchrist
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - C P Thomas
- Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - K Bamford
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - E T Brannigan
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
| | - A H Holmes
- The National Centre for Infection Prevention and Management, Imperial College London, Du Cane Road, London W12 ONN, UK; Imperial College Healthcare NHS Trust, Du Cane Road, London W12 OHS, UK
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25
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Raastad R, Tvete IF, Abrahamsen TG, Berild D, Leegaard TM, Walberg M, Müller F. A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital. Acta Paediatr 2015; 104:687-92. [PMID: 25753620 DOI: 10.1111/apa.12994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/29/2014] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
AIM The World Health Organization recommends the defined daily dose (DDD) as the standard unit of measurement for antibiotic use, but this is not applicable in children. We aimed to assess paediatric antibiotic use in a Norwegian tertiary care hospital using a novel weight-adjusted method. METHODS We obtained antibiotic purchase data from the hospital pharmacy and administrative data for all admissions from 2002 to 2009 to the paediatric wards at Oslo University Hospital, Rikshospitalet. Recommended daily doses per 100 kg days (RDDs/kg days) were calculated based on national guidelines for paediatric antibiotic use, length of stay and estimated weight for sex and age using national growth references. RESULTS Total antibiotic use increased significantly from 51.8 to 65.5 RDDs/100 kg days. We found statistically significant annual increases in the consumption of carbapenems (18.0%), third-generation cephalosporins (6.0%) and imidazole derivatives (6.6%) and a considerable difference between total antibiotic use measured in RDDs/100 kg days and DDDs/100 bed days for neonates. CONCLUSION Weight-adjusted antibiotic use provided a more meaningful description of the quantities of antibiotics consumed than DDDs/100 bed days, particularly for neonates. Total antibiotic use, use of meropenem, third-generation cephalosporins and imidazole derivatives increased significantly despite low prevalence of antibiotic-resistant pathogens.
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Affiliation(s)
- Ragnhild Raastad
- Department of Infectious Diseases; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | | | - Tore G. Abrahamsen
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Pediatrics; Oslo University Hospital; Oslo Norway
| | - Dag Berild
- Department of Infectious Diseases; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Truls M. Leegaard
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology and Infection Control; Akershus University Hospital; Lørenskog Norway
| | - Mette Walberg
- Microbiology Section; Laboratory Centre; Vestre Viken Hospital Trust; Rud Norway
| | - Fredrik Müller
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology; Oslo University Hospital; Oslo Norway
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26
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Prospective surveillance of antibiotic use in the neonatal intensive care unit: results from the SCOUT study. Pediatr Infect Dis J 2015; 34:267-72. [PMID: 25191849 DOI: 10.1097/inf.0000000000000542] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prolonged or unnecessary antibiotic use is associated with adverse outcomes in neonates. Our objectives were to quantify all antibiotic use in a Level-III neonatal intensive care unit and to identify scenarios where their use could be reduced. METHODS Surveillance and evaluation of all antibiotic use provided to every infant admitted to a Level-III neonatal intensive care unit from 10/3/11 to 11/30/12 was performed. Types of antibiotics, reasons for their initiation, discontinuation and duration, as well as clinical, laboratory and outcome data were recorded. Antibiotic use was quantified by days of therapy (DOT) per 1000 patient-days (PD). RESULTS A total of 1607 infants were included. The total antibiotic use was 9165 DOT (343.2 DOT/1000 PD; 5.7 DOT/infant). Seventy-two percent of infants received 1 (43%) or more (29%) courses of antibiotics. Gentamicin (46%), ampicillin (39%) and oxacillin (8%) were the most frequently used agents. Ninety-four percent of antibiotic use (323 DOT/1000 PD) was empiric therapy for suspected infection. Sixty-three percent (216.2 DOT/1000 PD) was discontinued at approximately 48 hours when cultures were sterile (68%>48 hours, 32%≤48 hours). Twenty-six percent of all antibiotic use (89.4 DOT/1000 PD) was therapy for ≥5 days despite sterile cultures; pneumonia (16%) and "culture-negative" sepsis (8%) were the major contributors. Five percent (17.4 DOT/1000 PD) of antibiotic use was for culture-proven sepsis, 5% (16.6 DOT/1000 PD) was penicillin prophylaxis for group B Streptococcus and 1% (3.5 DOT/1000 PD) was preprocedural prophylaxis. CONCLUSIONS Narrow-spectrum therapy accounted for >92% of antibiotic use and would not be monitored by most stewardship programs. Only 5% of antibiotic usage was due to culture-proven infection. Pneumonia and "culture-negative" sepsis were frequent reasons for prolonged therapy; further study of these conditions may allow reduction in treatment duration.
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Huttner B, Jones M, Madaras-Kelly K, Neuhauser MM, Rubin MA, Goetz MB, Samore MH. Initiation and termination of antibiotic regimens in Veterans Affairs hospitals. J Antimicrob Chemother 2014; 70:598-601. [PMID: 25288680 DOI: 10.1093/jac/dku388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To assess rates of starting or stopping antibiotics across different hospitals. METHODS We used barcode medication administration data to measure antibiotic use on acute-care wards in 128 Veterans Affairs medical centres (VAMCs) in 2010. A treatment day (TD) was defined as the administration of any antibiotic on a given day. A treatment period (TP) was defined as an interval of inpatient antimicrobial therapy with gaps of ≤1 day in TDs. The rate of starting antibiotics was calculated for inpatients who had not yet started antibiotics, as the number of start events divided by the 'person-time at risk'. The rate of stopping antibiotics was calculated analogously for inpatients that were on antibiotics. Once individuals had stopped antibiotics they were removed from further analysis. Per-day start and stop rates were also calculated for each day of hospitalization. RESULTS The hospital mean rate of starting the first TP was 18.1 start events/100 days at risk (range 8.4-25.6/100 days at risk). The mean hospital stopping rate was 21.1 stop events/100 days at risk (range 13.3-29.5/100 days at risk). The ratio of a facility's starting and stopping rates was highly correlated with overall antibiotic use in TDs/1000 patient-days (rs=0.92, P<0.001), while starting and stopping rates individually were only moderately correlated (rs=0.39, P<0.001). CONCLUSIONS VAMCs with similar antibiotic use showed marked differences in their starting and stopping rates of antibiotics. It may be useful to target empirical therapy when starting rates are high and definitive therapy when stopping rates are low.
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Affiliation(s)
- Benedikt Huttner
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA
| | - Makoto Jones
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA
| | - Karl Madaras-Kelly
- Boise VA Medical Center, Boise, ID 83702, USA College of Pharmacy, Idaho State University, Meridian, ID 83713, USA
| | - Melinda M Neuhauser
- Department of Veterans Affairs Pharmacy Benefit Management Services, Hines, IL, USA
| | - Michael A Rubin
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA
| | - Matthew Bidwell Goetz
- VA Greater LA Healthcare System, Los Angeles, CA 90073, USA David Geffen School of Medicine at UCLA, Los Angeles, CA 90024, USA
| | - Matthew H Samore
- VA Salt Lake City Health Care System, IDEAS Center, Salt Lake City, UT 84148, USA Division of Epidemiology, University of Utah, Salt Lake City, UT 84132, USA
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