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Oda K, Hayashi H, Yamamoto K, Kondo S, Katanoda T, Okamoto S, Miyakawa T, Iwanaga E, Nosaka K, Kawaguchi T, Nakata H. Antibiotic spectrum coverage scoring as a potential metric for evaluating the antimicrobial stewardship team activity: a single-center study. Infect Control Hosp Epidemiol 2024:1-9. [PMID: 39387201 DOI: 10.1017/ice.2024.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2024]
Abstract
OBJECTIVE Days of antibiotic spectrum coverage (days of ASC: DASC) is a metric for antibiotic usage calculated by ASC scores for spectrum and addresses limitations of days of therapy (DOT), which does not include spectrum. This study aims to investigate whether ASC-related metrics offer different aspects compared to aggregated DOT for all antibiotics (DOTtotal) and to assess their correlation in evaluating the impact of antimicrobial stewardship team (AST) programs. DESIGN Retrospective. SETTING A single center within an 845-bed hospital. METHODS Trends in DOTtotal, DASC, and the DASC/DOT ratio, representing the average spectrum coverage per therapy day, were analyzed pre- and post-AST programs (April 2018) from January 2015 to December 2023, using interrupted time series analysis. Independent of the DASC/DOT, we also advocated ASC-stratified DOT (ASDOT), which facilitates comprehensive evaluation of DOT across ASC scores of <6, 6-10, and >10, representing narrow-, intermediate-, and broad-spectrum antibiotics. RESULTS Among inpatients, AST programs significantly moderated the increasing trends of these metrics. Specifically, although the rates of increase in DOTtotal and DASC were slowed or plateaued, the DASC/DOT ratio decreased (P < 0.001). ASDOT metrics revealed a decrease and subsequent plateau in DOTtotal for the broad- and intermediate-spectrum antibiotics, with an increase observed for the narrow-spectrum antibiotics (P < 0.001 for each). DASC did not provide additional insights in the outpatient's population. CONCLUSIONS The study demonstrates that ASC-related metrics may yield different and useful conclusions about the effectiveness of AST programs for inpatients.
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Affiliation(s)
- Kazutaka Oda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
| | - Hideyuki Hayashi
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Keiichi Yamamoto
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Shoji Kondo
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
| | - Tomomi Katanoda
- Department of Pharmacy, Kumamoto University Hospital, Kumamoto, Japan
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
| | - Shinichiro Okamoto
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Respiratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Toshikazu Miyakawa
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Hematology, Kumamoto Shinto General Hospital, Kumamoto, Japan
| | - Eisaku Iwanaga
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Kisato Nosaka
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Tatsuya Kawaguchi
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Medical Technology, Kumamoto Health Science University, Kumamoto, Japan
| | - Hirotomo Nakata
- Department of Infection Control, Kumamoto University Hospital, Kumamoto, Japan
- Department of Hematology, Rheumatology and Infectious Diseases, Kumamoto University School of Medicine, Kumamoto University Hospital, Kumamoto, Japan
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2
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Hovind MJ, Berdal JE, Dalgard O, Lyngbakken MN. Impact of antibiotic therapy in patients with respiratory viral infections: a retrospective cohort study. Infect Dis (Lond) 2024:1-9. [PMID: 39042560 DOI: 10.1080/23744235.2024.2375592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 06/28/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVES The impact of antibiotics in patients with positive polymerase chain reaction (PCR) for respiratory viruses without evidence of a respiratory bacterial co-infection is largely unknown. The aim of this study was to assess the association of antibiotics on 30-day mortality and length of hospital stay in patients with an acute respiratory infection and PCR documented presence of respiratory viruses. METHODS We conducted a retrospective cohort study of adult patients admitted to hospital between 2012 and 2021 with positive PCR for influenza virus (H3N2, H1N1, influenza B), respiratory syncytial virus, human metapneumovirus or severe acute respiratory syndrome coronavirus 2. We used logistic regression, the Kaplan-Meier estimator and Poisson's regression to assess the impact of antibiotic therapy on outcomes. RESULTS Among 3979 patients, 67.7% received antibiotics. In adjusted analyses, antibiotics initiated in the emergency department (adjusted OR 1.23, 95% CI 0.77-1.96) and days of antibiotic therapy (adjusted OR per day of therapy 0.98, 95% CI 0.95-1.00) had no significant impact on mortality, whereas antibiotics initiated later during admission (adjusted OR 2.25, 95% CI 1.26-4.02) was associated with increased mortality. Patients prescribed antibiotics had longer duration of hospital admission. CONCLUSIONS We observed no protective association between in-hospital antibiotic therapy and outcomes, suggesting overuse of antibiotics in respiratory infections with proven respiratory viruses. A restrictive antibiotic strategy may be warranted.
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Affiliation(s)
- M J Hovind
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - J E Berdal
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - O Dalgard
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
| | - M N Lyngbakken
- Department of Infectious Diseases, Akershus University Hospital, Lørenskog, Norway
- Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Mittal N, Tayal A, Kumar S, Dhawan R, Goel N, Mittal R. Longitudinal Trends in In-Patient Antibiotic Consumption According to the WHO Access, Watch, Reserve (AWaRe) Antibiotic Groups and Cost: An Analysis of Data at a National Antimicrobial Consumption Network (NAC-NET) Site in North India over 7 Years (2017-2023). Antibiotics (Basel) 2024; 13:673. [PMID: 39061355 PMCID: PMC11273674 DOI: 10.3390/antibiotics13070673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
(1) Background: Antibiotic surveillance data are crucial to map out strategies to promote their optimal use at hospital and community levels. We conducted a comprehensive analysis of longitudinal trends in antibiotic consumption over 7 years at a core "National Antimicrobial Consumption Network" site in North India. (2) Methods: In-patient antibiotic consumption data (2017-2023) were obtained from the hospital's central drug store and organised as follows: defined daily dose per 100 bed-days; antibiotic consumption as per the WHO access, watch and reserve classification; trends in overall and different antibiotic classes' consumption; paediatric formulations of antibiotics; and hospital's annual expenditure on antibiotics. (3) Results: During the 7-year study period, no significant trend could be observed in the overall antibiotic consumption (average annual percent change, AAPC: 9.22; 95% CI: -16.46, 34.9) and cost (AAPC: 13.55; -13.2, 40.3). There was a higher proportion of the consumption of antibiotics in the "reserve" group from 2021 onwards compared to previous years, but the overall trend over 7 years was not significant (AAPC: 319.75; -137.6, 777.1). Antibiotic combinations, classified under the WHO "not recommended" category, comprised a significant proportion of antibiotics consumed. A remarkably increased consumption of azithromycin and doxycycline was recorded during 2020 and 2021, coinciding with the COVID-19 pandemic. (4) Conclusions: Some recommendations to optimise antibiotic use are promoting the use of narrow spectrum "access" group agents; linking antimicrobial resistance and consumption data to formulate effective therapeutic and prophylactic antibiotic use guidelines; and the adoption of restrictive antibiotic policy.
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Affiliation(s)
- Niti Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India; (S.K.); (R.D.); (R.M.)
| | - Ashish Tayal
- Department of Microbiology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India; (A.T.); (N.G.)
| | - Suneel Kumar
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India; (S.K.); (R.D.); (R.M.)
| | - Reevanshi Dhawan
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India; (S.K.); (R.D.); (R.M.)
| | - Nidhi Goel
- Department of Microbiology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India; (A.T.); (N.G.)
| | - Rakesh Mittal
- Department of Pharmacology, Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak 124001, Haryana, India; (S.K.); (R.D.); (R.M.)
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4
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Deshwal PR, Tiwari P. Investigating the Variability among Indicators for Quantifying Antimicrobial Use in the Intensive Care Units: Analysis of Real-world Evidence. Indian J Crit Care Med 2024; 28:662-676. [PMID: 38994266 PMCID: PMC11234130 DOI: 10.5005/jp-journals-10071-24745] [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: 03/15/2024] [Accepted: 05/21/2024] [Indexed: 07/13/2024] Open
Abstract
This study investigated variability among four indicators for quantifying antimicrobial use in intensive care units (ICUs): defined daily doses (DDD), prescribed daily doses (PDD), duration of therapy (DOT), and length of therapy (LOT) and recommended the most clinically relevant approach. Retrospective data from patients who had received at least one antimicrobial was analyzed. Patients whose records were incomplete or expired were excluded. Duration of therapy (24433/1000 PDs) and LOTs (12832/1000 PDs) underestimated the overall consumption of antimicrobials compared with DDD of 28391/1000 PDs. Whereas PDD (46699/1000 PDs) overestimated it. Comparison analysis detected % differences of 13.94, 23.92, and 54.80% between DDD and DOT, DDD and PDD, and DDD and LOT, indicators respectively. Linear regression revealed stronger (r 2 = 0.86), moderate (r 2 = 0.50), and moderate (r 2 =0.60) correlation between DDD and DOT, DDD and PDD and DDD and LOT indicators respectively. According to findings, combining DOT and DDD is a more practical method to quantify antimicrobial consumption in hospital ICUs. How to cite this article Deshwal PR, Tiwari P. Investigating the Variability among Indicators for Quantifying Antimicrobial Use in the Intensive Care Units: Analysis of Real-world Evidence. Indian J Crit Care Med 2024;28(7):662-676.
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Affiliation(s)
- Prity R Deshwal
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), Mohali, Punjab, India
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5
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Winroth A, Andersson M, Fjällström P, Johansson AF, Lind A. Automated surveillance of antimicrobial consumption in intensive care, northern Sweden: an observational case study. Antimicrob Resist Infect Control 2024; 13:67. [PMID: 38890711 PMCID: PMC11186282 DOI: 10.1186/s13756-024-01424-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/13/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND The digitalization of information systems allows automatic measurement of antimicrobial consumption (AMC), helping address antibiotic resistance from inappropriate drug use without compromising patient safety. OBJECTIVES Describe and characterize a new automated AMC surveillance service for intensive care units (ICUs), with data stratified by referral clinic and linked with individual patient risk factors, disease severity, and mortality. METHODS An automated service collecting data from the electronic medical record was developed, implemented, and validated in a healthcare region in northern Sweden. We performed an observational study from January 1, 2018, to December 31, 2021, encompassing general ICU care for all ≥18-years-olds in a catchment population of 270000 in secondary care and 900000 in tertiary care. We used descriptive analyses to associate ICU population characteristics with AMC outcomes over time, including days of therapy (DOT), length of therapy, defined daily doses, and mortality. RESULTS There were 5608 admissions among 5190 patients with a median age of 65 (IQR 48-75) years, 41.2% females. The 30-day mortality was 18.3%. Total AMC was 1177 DOTs in secondary and 1261 DOTs per 1000 patient days and tertiary care. AMC varied significantly among referral clinics, with the highest total among 810 general surgery admissions in tertiary care at 1486 DOTs per 1000 patient days. Case-mix effects on the AMC were apparent during COVID-19 waves highlighting the need to account for case-mix. Patients exposed to more than three antimicrobial drug classes (N = 242) had a 30-day mortality rate of 40.6%, with significant variability in their expected rates based on admission scores. CONCLUSION We introduce a new service and instructions for automating local ICU-AMC data collection. The versatile long-term ICU-AMC metrics presented, covering patient factors, referral clinics and mortality outcomes, are expected to be beneficial in refining antimicrobial drug use.
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Affiliation(s)
- Andreas Winroth
- Department of Clinical Microbiology, Umeå University, SE-90187, Umeå, Sweden.
| | - Mattias Andersson
- Center for Intensive Care (IT unit), Norrlands universitetssjukhus, 90185, Umeå, SE, Sweden
| | - Peter Fjällström
- Department of Clinical Microbiology, Umeå University, SE-90187, Umeå, Sweden
- Department of Infection Prevention and Control Region Västerbotten, Norrlands universitetssjukhus, SE-90185, Umeå, Sweden
| | - Anders F Johansson
- Department of Clinical Microbiology, Umeå University, SE-90187, Umeå, Sweden
| | - Alicia Lind
- Department of Diagnostics and Intervention, Umeå University, SE-90187, Umeå, Sweden
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6
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Tanuma M, Sakurai T, Nakaminami H, Tanaka M. Evaluation of antimicrobial stewardship activities using antibiotic spectrum coverage. Sci Rep 2024; 14:13998. [PMID: 38886220 PMCID: PMC11183056 DOI: 10.1038/s41598-024-64944-2] [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: 02/21/2024] [Accepted: 06/14/2024] [Indexed: 06/20/2024] Open
Abstract
Recently, the days of antibiotic spectrum coverage (DASC) using the antibiotic spectrum coverage (ASC) score was reported as a new tool for measuring antimicrobial use. The days of therapy (DOT) are required to calculate the DASC, making it impossible to use when patient-level information is unavailable. Therefore, we have defined a new measure of antimicrobial use for antimicrobial spectrum coverage (AUSC) using antimicrobial use density (AUD) and ASC scores. In this study, we have investigated the use of antimicrobial agents retrospectively examined for monthly prescriptions between 2016 and 2022, and whether the AUSC could be used as a new measure. Our data showed that the AUD, AUSC, DOT, and DASC increased, whereas AUSC/AUD and DASC/DOT decreased over the study period. In addition, no correlation was found between DOT and DASC/DOT (ρ = - 0.093, p = 0.399), whereas there was a weak correlation between AUD and AUSC/AUD (ρ = - 0.295, p = 0.006). Therefore, in this study, the use of AUSC is considered less beneficial when DASC can be calculated based on DOT. On the other hand, in institutional settings where DOT cannot be calculated, AUSC may be useful as a new measure to evaluate antimicrobial use.
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Affiliation(s)
- Michiya Tanuma
- Department of Pharmacy, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan.
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan.
| | - Takayuki Sakurai
- Department of Infectious Diseases, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
| | - Hidemasa Nakaminami
- Department of Clinical Microbiology, School of Pharmacy, Tokyo University of Pharmacy and Life Sciences, 1432-1 Horinouchi, Hachioji, Tokyo, 192-0392, Japan
| | - Masayo Tanaka
- Department of Pharmacy, NTT Medical Center Tokyo, 5-9-22 Higashi-gotanda, Shinagawa-ku, Tokyo, 141-8625, Japan
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7
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Flannery DD, Coggins SA, Medoro AK. Antibiotic Stewardship in the Neonatal Intensive Care Unit. J Intensive Care Med 2024:8850666241258386. [PMID: 38835250 DOI: 10.1177/08850666241258386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Antibiotic stewardship is a multidisciplinary, evidence-based approach to optimize antibiotic use and mitigate development of antibiotic resistance. Neonates have high rates of antibiotic exposure, particularly those born preterm and admitted to the NICU, and mounting evidence describes the adverse consequences of such exposures in the absence of infection. Here, we review the general principles of antibiotic stewardship and how they can be applied in NICUs. The unique characteristics of NICUs and patients cared for in this setting, which warrant unique implementation strategies and special considerations are discussed. We summarize current antibiotic use metrics for assessment of responses to stewardship interventions and changes over time, and review evidence-based infection prevention practices in the NICU. Current recommendations for empiric antibiotic use in the NICU and the utility of infection biomarkers are summarized. Lastly, given the growing global threat of increasing antibiotic resistance, specific threats in the NICU are highlighted.
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Affiliation(s)
- Dustin D Flannery
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sarah A Coggins
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexandra K Medoro
- Division of Neonatology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Division of Infectious Diseases, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine and Children's Hospital of Philadelphia, Philadelphia, PA, USA
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8
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Del Fabro G, Venturini S, Avolio M, Basaglia G, Callegari A, Bramuzzo I, Basso B, Zanusso C, Rizzo A, Tonutti G, Chittaro M, Fiappo E, Tonizzo M, Crapis M. Time is running out. No excuses to delay implementation of antimicrobial stewardship programmes: impact, sustainability, resilience and efficiency through an interrupted time series analysis (2017-2022). JAC Antimicrob Resist 2024; 6:dlae072. [PMID: 38752207 PMCID: PMC11094472 DOI: 10.1093/jacamr/dlae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 04/20/2024] [Indexed: 05/18/2024] Open
Abstract
Introduction The WHO declared antimicrobial resistance (AMR) a significant concern in 2014, sparking initiatives to ensure responsible antibiotic use. In human medicine, Antimicrobial Stewardship Programmes (ASPs) in hospitals play a pivotal role in combating AMR. Although evidence supports the effectiveness of ASPs in optimizing antimicrobial use, often the lack of resources becomes an excuse to limit their dissemination and use. This paper provides a comprehensive report on a 6-year analysis of an ASP implemented in a healthcare region in north-east Italy. Methods A retrospective data collection was conducted to assess the programme's impact on antibiotic consumption expressed as DDDs/100 patient-days, its sustainability over time, resilience during the COVID-19 pandemic and the efficiency of the ASP (relationship between workload and human resources). Results A substantial overall reduction in antibiotic consumption (-14%), particularly in fluoroquinolones (-64%) and carbapenems (-68%), was demonstrated, showcasing the programme's impact. Sustainability was confirmed through enduring trends in antibiotic consumption and ecological analysis over time. The ASP demonstrates resilience by maintaining positive trends even amid the challenging COVID-19 pandemic. Efficiency was underscored by an increase in on-site consultations despite consistent human resources until 2021. Conclusions This study offers insights into the prolonged success of a resource-efficient ASP, emphasizing the crucial role of long-term commitment in fostering responsible antibiotic use in the context of global health challenges such as AMR.
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Affiliation(s)
- Giovanni Del Fabro
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Sergio Venturini
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Manuela Avolio
- Department of Microbiology, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Giancarlo Basaglia
- Department of Microbiology, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Igor Bramuzzo
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
| | - Barbara Basso
- Hospital Pharmacy, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Chiara Zanusso
- Hospital Pharmacy, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Anna Rizzo
- Hospital Pharmacy, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Giuseppe Tonutti
- Hospital Health Direction, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Michele Chittaro
- Hospital Health Direction, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Eva Fiappo
- Hospital Health Direction, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO ‘Santa Maria degli Angeli’ Hospital of Pordenone, via Montereale 24, Pordenone 33170, Italy
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9
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Langford BJ, Bailey P, Livorsi DJ, Brown KA, Advani SD, Dodds Ashley E, Bearman G, Nori P. Five steps to high quality antimicrobial stewardship research. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e82. [PMID: 38751942 PMCID: PMC11094375 DOI: 10.1017/ash.2024.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 05/18/2024]
Abstract
The escalating threat of antimicrobial resistance (AMR) necessitates impactful, reproducible, and scalable antimicrobial stewardship strategies. This review addresses the critical need to enhance the quality of antimicrobial stewardship intervention research. We propose five considerations for authors planning and evaluating antimicrobial stewardship initiatives. Antimicrobial stewards should consider the following mnemonic ABCDE: (A) plan Ahead using implementation science; (B) Be clear and thoroughly describe the intervention by using the TidIER checklist; (C) Use a Checklist to comprehensively report study components; (D) Select a study Design carefully; and (E) Assess Effectiveness and implementation by selecting meaningful outcomes. Incorporating these recommendations will help strengthen the evidence base of antimicrobial stewardship literature and support optimal implementation of strategies to mitigate AMR.
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Affiliation(s)
- Bradley J. Langford
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Daniel J. Livorsi
- Center for Access and Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
- Division of Infectious Diseases, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Kevin A. Brown
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Elizabeth Dodds Ashley
- Division of Infectious Diseases, Duke University School of Medicine and Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, USA
| | - Gonzalo Bearman
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA, USA
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Bronx, NY, USA
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10
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Moon SM, Kim B, Kim HB. Quantitative and qualitative evaluation of antimicrobial usage: the first step for antimicrobial stewardship. Korean J Intern Med 2024; 39:383-398. [PMID: 38715229 PMCID: PMC11076899 DOI: 10.3904/kjim.2023.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 05/12/2024] Open
Abstract
The identification of antimicrobial use patterns is essential for determining key targets for antimicrobial stewardship interventions and evaluating the effectiveness thereof. Accurately identifying antimicrobial use patterns requires quantitative evaluation, which focuses on measuring the quantity and frequency of antimicrobial use, and qualitative evaluation, which assesses the appropriateness, effectiveness, and potential side effects of antimicrobial prescriptions. This paper summarizes the quantitative and qualitative methods used to evaluate antimicrobials, drawing insights from overseas and domestic cases.
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Affiliation(s)
- Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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11
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Tsai YV, Bookstaver PB, Kohn J, Justo JA, Childress D, Stramel S, Slain D, Tu P, Wingler MJB, Jones BM, Anderson DT, Seddon MM, Cretella DA, Eudy J, Winders H, Antosz K, Bailey P, Al-Hasan MN. The prevalence of gram-negative bacteria with difficult-to-treat resistance and utilization of novel β-lactam antibiotics in the southeastern United States. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e35. [PMID: 38500714 PMCID: PMC10945936 DOI: 10.1017/ash.2024.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/02/2024] [Accepted: 02/04/2024] [Indexed: 03/20/2024]
Abstract
Objective To evaluate temporal trends in the prevalence of gram-negative bacteria (GNB) with difficult-to-treat resistance (DTR) in the southeastern United States. Secondary objective was to examine the use of novel β-lactams for GNB with DTR by both antimicrobial use (AU) and a novel metric of adjusted AU by microbiological burden (am-AU). Design Retrospective, multicenter, cohort. Setting Ten hospitals in the southeastern United States. Methods GNB with DTR including Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter spp. from 2015 to 2020 were tracked at each institution. Cumulative AU of novel β-lactams including ceftolozane/tazobactam, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/cilastatin/relebactam, and cefiderocol in days of therapy (DOT) per 1,000 patient-days was calculated. Linear regression was utilized to examine temporal trends in the prevalence of GNB with DTR and cumulative AU of novel β-lactams. Results The overall prevalence of GNB with DTR was 0.85% (1,223/143,638) with numerical increase from 0.77% to 1.00% between 2015 and 2020 (P = .06). There was a statistically significant increase in DTR Enterobacterales (0.11% to 0.28%, P = .023) and DTR Acinetobacter spp. (4.2% to 18.8%, P = .002). Cumulative AU of novel β-lactams was 1.91 ± 1.95 DOT per 1,000 patient-days. When comparing cumulative mean AU and am-AU, there was an increase from 1.91 to 2.36 DOT/1,000 patient-days, with more than half of the hospitals shifting in ranking after adjustment for microbiological burden. Conclusions The overall prevalence of GNB with DTR and the use of novel β-lactams remain low. However, the uptrend in the use of novel β-lactams after adjusting for microbiological burden suggests a higher utilization relative to the prevalence of GNB with DTR.
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Affiliation(s)
| | - P. Brandon Bookstaver
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Julie Ann Justo
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | | | - Stefanie Stramel
- Department of Pharmacy, Memorial Hermann Memorial City Medical Center, Houston, TX, USA
| | - Douglas Slain
- Department of Clinical Pharmacy and Section of Infectious Diseases, West Virginia University, Morgantown, WV, USA
| | - Patrick Tu
- Department of Pharmacy, Charlie Norwood VA Medical Center, Augusta, GA, USA
| | - Mary Joyce B. Wingler
- Department of Antimicrobial Stewardship, University of Mississippi Medical Center, Jackson, MS, USA
| | | | - Daniel T. Anderson
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | | | - David A. Cretella
- Department of Antimicrobial Stewardship, University of Mississippi Medical Center, Jackson, MS, USA
| | - Joshua Eudy
- Department of Pharmacy, Augusta University Medical Center, Augusta, GA, USA
| | | | - Kayla Antosz
- Department of Clinical Pharmacy and Outcomes Sciences, University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Pamela Bailey
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Majdi N. Al-Hasan
- Prisma Health-Midlands, Columbia, SC, USA
- Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
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12
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de Barros Fernandes T, Ramos SF, Leitzke LRF, Júnior RGA, de Araújo JM, de Souza Júnior AS, da Silva ARO, Heineck I, de França Fonteles MM, Bracken LE, Peak M, de Lyra Junior DP, Osorio-de-Castro CGS, Lima EC. Use of antimicrobials in pediatric wards of five Brazilian hospitals. BMC Pediatr 2024; 24:177. [PMID: 38481225 PMCID: PMC10936065 DOI: 10.1186/s12887-024-04655-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 02/19/2024] [Indexed: 03/17/2024] Open
Abstract
The use of antimicrobials (AMs) in pediatric infections is common practice and use may be inappropriate leading to antimicrobial resistance. Off-label AM use is also common in this group and can result in drug-related problems. There is lack of DUR data in Brazil and in Latin America, specially for AM pediatric use. The aim of this study was to describe the utilization of AMs in hospitalized children in five hospitals in Brazil. We conducted an observational study of the utilization of AMs in pediatric wards in hospitals in the states of Ceará (CE), Sergipe (SE), Rio de Janeiro (RJ), Rio Grande do Sul (RS) and the Federal District (DF). Data derived from patient medical records and prescriptions were collected over a six-month period in each hospital. The number of AMs used by each patient was recorded, and AM use was assessed using Days of therapy (DOT) and Length of therapy (LOT) per 1000 patient days according to different patient characteristics. Off-label (OL) use was described according to age. The study analyzed data from 1020 patients. The sex and age distributions were similar across the five hospitals. However, differences were found for comorbidities, history of ICU admission and length of hospital stay. The most common diseases were respiratory tract infections. There were wide variations in DOT/1000PD (278-517) and LOT/1000PD (265-390). AM utilization was highest in the hospital in SE. The consumption of second-generation penicillins and cephalosporins was high. The prevalence of OL use of AMs was higher for patients in the RJ hospital, in infants, in patients who underwent prolonged hospital stays, and in patients who used multiple AMs. The AM that showed the highest prevalence of OL use was azithromycin, in both oral and parenteral formulations. Overall AM use was high and showed differences in each setting, possibly influenced by local characteristics and by prescribing standards adopted by pediatricians.
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Affiliation(s)
- Thais de Barros Fernandes
- Sergio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, 21041-210, Brazil.
| | - Sheila Feitosa Ramos
- Center for Biological and Health Sciences, Federal University of Western Bahia, Barreiras, Brazil
| | - Luísa Rodrigues Furtado Leitzke
- Postgraduate Program in Pharmaceutical Services, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | - Isabela Heineck
- Postgraduate Program in Pharmaceutical Services, Faculty of Pharmacy, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Louise E Bracken
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Matthew Peak
- Paediatric Medicines Research Unit, Institute in the Park, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Divaldo Pereira de Lyra Junior
- Health Sciences Graduate Program, Social Pharmacy Teaching and Research Laboratory (LEPFS), Federal University of Sergipe, São Cristóvão, Brazil
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13
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Saif NT, Dooley C, Baghdadi JD, Morgan DJ, Coffey KC. Clinical decision support for gastrointestinal panel testing. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e22. [PMID: 38415090 PMCID: PMC10897720 DOI: 10.1017/ash.2024.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 02/29/2024]
Abstract
Objective This study aimed to assess the impact of clinical decision support (CDS) to improve ordering of multiplex gastrointestinal polymerase chain reaction (PCR) testing panel ("GI panel"). Design Single-center, retrospective, before-after study. Setting Tertiary care Veteran's Affairs (VA) Medical Center provides inpatient, outpatient, and residential care. Patients All patients tested with a GI panel between June 22, 2022 and April 20, 2023. Intervention We designed a CDS questionnaire in the electronic medical record (EMR) to guide appropriate ordering of the GI panel. A "soft stop" reminder at the point of ordering prompted providers to confirm five appropriateness criteria: 1) documented diarrhea, 2) no recent receipt of laxatives, 3) C. difficile is not the leading suspected cause of diarrhea, 4) time period since a prior test is >14 days or prior positive test is >4 weeks and 5) duration of hospitalization <72 hours. The CDS was implemented in November 2022. Results Compared to the pre-implementation period (n = 136), fewer tests were performed post-implementation (n = 92) with an IRR of 0.61 (p = 0.003). Inappropriate ordering based on laxative use or undocumented diarrhea decreased (IRR 0.37, p = 0.012 and IRR 0.25, p = 0.08, respectively). However, overall inappropriate ordering and outcome measures did not significantly differ before and after the intervention. Conclusions Implementation of CDS in the EMR decreased testing and inappropriate ordering based on use of laxatives or undocumented diarrhea. However, inappropriate ordering of tests overall remained high post-intervention, signaling the need for continued diagnostic stewardship efforts.
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Affiliation(s)
- Nadia T. Saif
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Cara Dooley
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jonathan D. Baghdadi
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Daniel J. Morgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Veteran’s Affairs (VA) Maryland Healthcare System, Baltimore, MD, USA
| | - KC Coffey
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
- Department of Medicine, Veteran’s Affairs (VA) Maryland Healthcare System, Baltimore, MD, USA
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14
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Moehring R, Vaughn VM. Development of Inpatient Stewardship Metrics: Is It Time for Public Reporting? Infect Dis Clin North Am 2023; 37:853-871. [PMID: 37661471 DOI: 10.1016/j.idc.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Abstract
Given the complexity and nuance needed to make antimicrobial prescribing decisions, metrics aiming to assess these decisions can be complex in method, require resource investment for measurement, and demand thoughtfulness in how to use data for program implementation and messaging to key partners. Antimicrobial stewardship programs today use several metrics of antimicrobial use in parallel with other clinical data for a multitude of purposes and audiences. Here, we discuss goals for inpatient stewardship metrics, current metrics used by stewardship programs locally and nationally, and future directions for antimicrobial use metric development.
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Affiliation(s)
| | - Valerie M Vaughn
- Division of General Internal Medicine, University of Utah, 30 Mario Capecchi Drive, 3S149, Salt Lake City, UT 84112, USA
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15
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Nelson GE, Narayanan N, Onguti S, Stanley K, Newland JG, Doernberg SB. Principles and Practice of Antimicrobial Stewardship Program Resource Allocation. Infect Dis Clin North Am 2023; 37:683-714. [PMID: 37735012 DOI: 10.1016/j.idc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Antimicrobial Stewardship Programs (ASP) improve individual patient outcomes and clinical care processes while reducing antimicrobial-associated adverse events, optimizing operational priorities, and providing institutional cost savings. ASP composition, resources required, and priority focuses are influenced by myriad factors. Despite robust evidence and broad national support, individual ASPs still face challenges in obtaining appropriate resources. Though understanding the current landscape of ASP resource allocation, factors influencing staffing needs, and strategies required to obtain desired resources is important, acceptance of recommended staffing levels and appropriate ASP resource allocation are much needed to facilitate ASP sustainability and growth across the complex and diverse health care continuum.
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Affiliation(s)
- George E Nelson
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 MCN, Nashville, TN 37232-2582, USA.
| | - Navaneeth Narayanan
- Department of Pharmacy Practice and Administration, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Sharon Onguti
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 MCN, Nashville, TN 37232-2582, USA
| | - Kim Stanley
- Department of Quality and Patient Safety, Division of Hospital Epidemiology and Infection Prevention, University of San Francisco, California, San Francisco, CA, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Sarah B Doernberg
- Department of Medicine, Division of Infectious Diseases, University of San Francisco, California, 513 Parnassus Avenue, Box 0654, San Francisco, CA 94143, USA
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16
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Giamarellou H, Galani L, Karavasilis T, Ioannidis K, Karaiskos I. Antimicrobial Stewardship in the Hospital Setting: A Narrative Review. Antibiotics (Basel) 2023; 12:1557. [PMID: 37887258 PMCID: PMC10604258 DOI: 10.3390/antibiotics12101557] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/13/2023] [Accepted: 10/18/2023] [Indexed: 10/28/2023] Open
Abstract
The increasing global threat of antibiotic resistance, which has resulted in countless fatalities due to untreatable infections, underscores the urgent need for a strategic action plan. The acknowledgment that humanity is perilously approaching the "End of the Miracle Drugs" due to the unjustifiable overuse and misuse of antibiotics has prompted a critical reassessment of their usage. In response, numerous relevant medical societies have initiated a concerted effort to combat resistance by implementing antibiotic stewardship programs within healthcare institutions, grounded in evidence-based guidelines and designed to guide antibiotic utilization. Crucial to this initiative is the establishment of multidisciplinary teams within each hospital, led by a dedicated Infectious Diseases physician. This team includes clinical pharmacists, clinical microbiologists, hospital epidemiologists, infection control experts, and specialized nurses who receive intensive training in the field. These teams have evidence-supported strategies aiming to mitigate resistance, such as conducting prospective audits and providing feedback, including the innovative 'Handshake Stewardship' approach, implementing formulary restrictions and preauthorization protocols, disseminating educational materials, promoting antibiotic de-escalation practices, employing rapid diagnostic techniques, and enhancing infection prevention and control measures. While initial outcomes have demonstrated success in reducing resistance rates, ongoing research is imperative to explore novel stewardship interventions.
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Affiliation(s)
- Helen Giamarellou
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
| | - Lamprini Galani
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
| | - Theodoros Karavasilis
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
| | - Konstantinos Ioannidis
- Clinical Pharmacists, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece;
| | - Ilias Karaiskos
- 1st Department of Internal Medicine-Infectious Diseases, Hygeia General Hospital, 4 Erythrou Stavrou & Kifisias, Marousi, 15123 Athens, Greece; (L.G.); (T.K.); (I.K.)
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17
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Zirpe KG, Kapse US, Gurav SK, Tiwari AM, Deshmukh AM, Suryawanshi PB, Bhoyar AP, Wankhede PP, Desai D, Suryawanshi R, John R, Bhagat S. Impact of an Antimicrobial Stewardship Program on Broad Spectrum Antibiotics Consumption in the Intensive Care Setting. Indian J Crit Care Med 2023; 27:737-742. [PMID: 37908433 PMCID: PMC10613868 DOI: 10.5005/jp-journals-10071-24543] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023] Open
Abstract
Background and objectives Antibiotics are the most commonly exploited agents in intensive care units. An antimicrobial stewardship program (ASP) helps in the optimal utilization of antibiotics and prevents the development of antibiotic resistance. The aim of this study was to assess the impact of ASP on broad-spectrum antibiotic consumption in terms of defined daily dose (DDD) and days of therapy (DOT) before and after the implementation of an ASP. Materials and methods It was a prospective, quasi-experimental, pre- and post-study. Group A consisted of 5 months of ASP data, ASP activities were implemented during the next 2 months and continued. Group B (post-ASP) data was collected for the next 5 months. Total and individual DDDs and DOTs of broad-spectrum antibiotics utilized were compared between group A and group B. Results Total DDDs used per 100 patient bed days were reduced by 18.72% post-ASP implementation (103.46 to 84.09 grams). The total DOT per 100 patient bed days used was 90.91 vs 71.25 days (21.62% reduction). As per the WHO classification of antibiotics use, the watch category (43.4% vs 43.04%) as well as reserve category (56.6% vs 56.97%) used between the two groups were found similar. The average length of stay (8.9 ± 2 days) after ASP was found significantly lesser than baseline (10.8 ± 3.4 days) (p < 0.05), however, there was no significant change in mortality between the two groups. Conclusion Antimicrobial stewardship program implementation may reduce overall antibiotic consumption both in terms of DDD and DOT. How to cite this article Zirpe KG, Kapse US, Gurav SK, Tiwari AM, Deshmukh AM, Suryawanshi PB, et al. Impact of an Antimicrobial Stewardship Program on Broad Spectrum Antibiotics Consumption in the Intensive Care Setting. Indian J Crit Care Med 2023;27(10):737-742.
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Affiliation(s)
- Kapil Gangadhar Zirpe
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Upendrakumar S Kapse
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma Kirtikumar Gurav
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand Mohanlal Tiwari
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhijit Manikrao Deshmukh
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Abhaya Pramodrao Bhoyar
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prajkta Prakash Wankhede
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Devashish Desai
- Department of Infectious Diseases Specialist, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rupali Suryawanshi
- Department of Laboratory, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rebecca John
- Medical Director Office, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Soniya Bhagat
- Department of Quality Assurance, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
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18
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McIntyre MT, Saha S, Morris AM, Lapointe-Shaw L, Tang T, Weinerman A, Fralick M, Agarwal A, Verma A, Razak F. Physician antimicrobial prescribing and patient outcomes on general medical wards: a multicentre retrospective cohort study. CMAJ 2023; 195:E1065-E1074. [PMID: 37604522 PMCID: PMC10442238 DOI: 10.1503/cmaj.221732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 08/23/2023] Open
Abstract
BACKGROUND Variability in antimicrobial prescribing may indicate an opportunity for improvement in antimicrobial use. We sought to measure physician-level antimicrobial prescribing in adult general medical wards, assess the contribution of patient-level factors to antimicrobial prescribing and evaluate the association between antimicrobial prescribing and clinical outcomes. METHODS Using the General Medicine Inpatient Initiative (GEMINI) database, we conducted a retrospective cohort study of physician-level volume and spectrum of antimicrobial prescribing in adult general medical wards in 4 academic teaching hospitals in Toronto, Ontario, between April 2010 and December 2019. We stratified physicians into quartiles by hospital site based on volume of antimicrobial prescribing (days of therapy per 100 patient-days and antimicrobial-free days) and antibacterial spectrum (modified spectrum score). The modified spectrum score assigns a value to each antibacterial agent based on the breadth of coverage. We assessed patient-level differences among physician quartiles using age, sex, Laboratory-based Acute Physiology Score, discharge diagnosis and Charlson Comorbidity Index. We evaluated the association of clinical outcomes (in-hospital 30-day mortality, length of stay, intensive care unit [ICU] transfer and hospital readmission) with antimicrobial volume and spectrum using multilevel modelling. RESULTS The cohort consisted of 124 physicians responsible for 124 158 hospital admissions. The median physician-level volume of antimicrobial prescribing was 56.1 (interquartile range 51.7-67.5) days of therapy per 100 patient-days. We did not find any differences in baseline patient characteristics by physician prescribing quartile. The difference in mean prescribing between quartile 4 and quartile 1 was 15.8 days of therapy per 100 patient-days (95% confidence interval [CI] 9.6-22.0), representing 30% higher antimicrobial prescribing in the fourth quartile than the first quartile. Patient in-hospital deaths, length of stay, ICU transfer and hospital readmission did not differ by physician quartile. In-hospital mortality was higher among patients cared for by prescribers with higher modified spectrum scores (odds ratio 1.13, 95% CI 1.04-1.24). INTERPRETATION We found that physician-level variability in antimicrobial prescribing was not associated with differences in patient characteristics or outcomes in academic general medicine wards. These findings provide support for considering the lowest quartile of physician antimicrobial prescribing within each hospital as a target for antimicrobial stewardship.
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Affiliation(s)
- Mark T McIntyre
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont.
| | - Sudipta Saha
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Andrew M Morris
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Lauren Lapointe-Shaw
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Terence Tang
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Adina Weinerman
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Michael Fralick
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Arnav Agarwal
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Amol Verma
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
| | - Fahad Razak
- Sinai Health (McIntyre, Fralick), Toronto, Ont.; Leslie Dan Faculty of Pharmacy (McIntyre), University of Toronto; Li Ka Shing Knowledge Institute (Saha, Verma, Razak), St. Michael's Hospital, Toronto, Ont.; Department of Social and Behavioral Sciences (Saha), Harvard T.H. Chan School of Public Health, Boston, Mass.; Department of Medicine (Morris, Lapointe-Shaw, Weinerman, Fralick, Verma, Razak), University of Toronto; Department of Medicine (Morris), Mount Sinai Hospital and University Health Network; Department of Medicine (Lapointe-Shaw), University Health Network, Toronto, Ont.; Trillium Health Partners (Tang), Mississauga, Ont.; Department of Medicine (Weinerman), Sunnybrook Health Sciences Centre; Division of General Internal Medicine (Agarwal); Department of Medicine (Agarwal), McMaster University, Hamilton, Ont
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19
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Kagami K, Ishiguro N, Iwasaki S, Taki K, Fukumoto T, Hayasaka K, Oyamada R, Watanabe T, Nakakubo S, Niinuma Y, Sugawara M, Takekuma Y. Correlation between antibiotic use and resistance of gram-negative bacteria at a university hospital in Japan from 2013 to 2021: a study using the Japan Surveillance for Infection Prevention and Healthcare Epidemiology system. Eur J Hosp Pharm 2023:ejhpharm-2023-003797. [PMID: 37438092 DOI: 10.1136/ejhpharm-2023-003797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
OBJECTIVES The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system aggregates information related to antimicrobial resistance (AMR) measures. We aimed to investigate the correlation between antibiotic use and AMR at a university hospital from 2013 to 2021 in a time series analysis using the J-SIPHE system. We also studied this correlation in each ward (inter-ward analysis). METHODS Data on antibiotic use and resistance rates were collected from the J-SIPHE system, except for the resistance rate in each ward, which was calculated from the source data prepared for this system. RESULTS Piperacillin/tazobactam use was positively correlated with piperacillin/tazobactam resistance in Escherichia coli and Klebsiella pneumoniae in the inter-ward analysis, and in Pseudomonas aeruginosa in both analyses. Carbapenem use was positively correlated with meropenem resistance in Enterobacter cloacae in the time series analysis and in P. aeruginosa in both analyses, and imipenem/cilastatin resistance in P. aeruginosa in inter-ward analysis. Quinolone use was positively correlated with levofloxacin resistance in E. coli in both analyses, and in K. pneumoniae in inter-ward analysis. CONCLUSIONS This is the first study to investigate the correlation between antibiotic use and AMR at a single hospital in time series and inter-ward analyses using the J-SIPHE system and data prepared for this system, suggesting that this system may be useful for promoting AMR measures.
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Affiliation(s)
- Keisuke Kagami
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
| | - Nobuhisa Ishiguro
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
| | - Sumio Iwasaki
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Keisuke Taki
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Tatsuya Fukumoto
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Kasumi Hayasaka
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
- Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Sapporo, Japan
| | - Reiko Oyamada
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
| | - Tsubasa Watanabe
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
| | - Sho Nakakubo
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Yusuke Niinuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
- Department of Infection Control and Prevention, Hokkaido University Hospital, Sapporo, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
- Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Sapporo, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Sapporo, Japan
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20
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Kagami K, Ishiguro N, Iwasaki S, Usami T, Fukumoto T, Hayasaka K, Oyamada R, Watanabe T, Nakakubo S, Niinuma Y, Hagino T, Abe Y, Fujimoto I, Maekawa H, Fujibayashi R, Fuke S, Asahi K, Ota S, Nagakura T, Okubo T, Asanuma H, Ito T, Okano S, Komatsu E, Sasaki K, Hashimoto K, Washiya K, Kato Y, Kusumi K, Asai Y, Saito Y, Sakai Y, Sakurada M, Sakimoto Y, Ichikawa Y, Kinebuchi T, Kondo D, Kanno S, Kobayashi M, Hirabayashi K, Saitou S, Saito K, Ebina Y, Koshizaki Y, Chiba M, Yasuda A, Sato T, Togashi A, Abe T, Fujita T, Umehara K, Amishima M, Murakami N, Yagi T, Fujimoto S, Tajima T, Sugawara M, Takekuma Y. Correlation between antibiotic use and antibiotic resistance: A multicenter study using the Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system in Hokkaido, Japan. Am J Infect Control 2023; 51:163-171. [PMID: 35671846 DOI: 10.1016/j.ajic.2022.05.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) system aggregates information related to antimicrobial resistance (AMR) measures in participating medical institutions nationwide and is intended to be used for promotion of AMR measures in participating facilities and their communities. This multicenter study aimed to determine the usefulness of the J-SIPHE system for evaluating the correlation between antibiotic use and antibiotic resistance in Hokkaido, Japan. METHODS Data on antibiotic use and detection rate of major resistant Gram-negative bacteria at 19 hospitals in 2020 were collected from the J-SIPHE system, and data correlations were analyzed using JMP Pro. RESULTS The detection rate of carbapenem-resistant Pseudomonas aeruginosa was significantly positively correlated with carbapenem use (Spearman's ρ = 0.551; P = .015). There were significant positive correlations between the detection rate of fluoroquinolone-resistant Escherichia coli and the use of piperacillin/tazobactam, carbapenems, and quinolones [ρ = 0.518 (P = .023), ρ = 0.76 (P < .001), and ρ = 0.502 (P = .029), respectively]. CONCLUSIONS This is the first multicenter study to investigate the correlation between antibiotic use and antibiotic resistance using the J-SIPHE system. The results suggest that using this system may be beneficial for promoting AMR measures.
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Affiliation(s)
- Keisuke Kagami
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan.
| | - Nobuhisa Ishiguro
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Sumio Iwasaki
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Takayuki Usami
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Tatsuya Fukumoto
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Kasumi Hayasaka
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Division of Laboratory and Transfusion Medicine, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Reiko Oyamada
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Tsubasa Watanabe
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Sho Nakakubo
- Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Yusuke Niinuma
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Takashi Hagino
- Infection Control Room, NTT Medical Center Sapporo, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Yoshifumi Abe
- Infection Control Room, NTT Medical Center Sapporo, Chuo-ku, Sapporo, Hokkaido, Japan
| | - Ikuya Fujimoto
- Department of Pharmacy, Kitasapporo Hospital, Kita-ku, Sapporo, Hokkaido, Japan
| | - Hideki Maekawa
- Department of Pharmacy, Hokkaido Gastroenterology Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Ryo Fujibayashi
- Department of Pharmacy, Hokkaido Gastroenterology Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Satoshi Fuke
- Department of Respiratory Medicine, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Kuniko Asahi
- Department of Infection Control and Prevention, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan; Department of Laboratory Medicine, KKR Sapporo Medical Center, Toyohira-ku, Sapporo, Hokkaido, Japan
| | - Shuichi Ota
- Department of Hematology, Sapporo Hokuyu Hospital, Shiroishi-ku, Sapporo, Hokkaido, Japan; Department of Infection Control and Prevention, Sapporo Hokuyu Hospital, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Tatsuya Nagakura
- Department of Infection Control and Prevention, Sapporo Hokuyu Hospital, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Toshinari Okubo
- Department of Pharmacy, IMS Sapporo Internal Medicine Rehabilitation Hospital, Teine-ku, Sapporo, Hokkaido, Japan
| | - Hideomi Asanuma
- Department of Neonatology, Hokkaido Medical Center for Child Health and Rehabilitation, Teine-ku, Sapporo, Hokkaido, Japan
| | - Toshihiro Ito
- Department of Cardiology, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Sho Okano
- Department of Pharmacy, Sapporo Teishinkai Hospital, Higashi-ku, Sapporo, Hokkaido, Japan
| | - Erika Komatsu
- Department of Pharmacy, Ebetsu City Hospital, Ebetsu, Hokkaido, Japan
| | - Kota Sasaki
- Department of Clinical Laboratory, Ebetsu City Hospital, Ebetsu, Hokkaido, Japan
| | - Kei Hashimoto
- Department of Pharmacy, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Kazutoshi Washiya
- Department of Pharmacy, Hakodate Goryoukaku Hospital, Hakodate, Hokkaido, Japan
| | - Yumiko Kato
- Department of Infection Control and Prevention, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Katsunori Kusumi
- Department of Pharmacy, Hakodate Central General Hospital, Hakodate, Hokkaido, Japan
| | - Yasufumi Asai
- Department of Cardiology, Hakodate Shintoshi Hospital, Hakodate, Hokkaido, Japan
| | - Yuichi Saito
- Department of Pharmacy, Hakodate Shintoshi Hospital, Hakodate, Hokkaido, Japan
| | - Yoshiyuki Sakai
- Department of Pediatrics, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Minoru Sakurada
- Department of Pharmacy, Hakodate Municipal Hospital, Hakodate, Hokkaido, Japan
| | - Yuji Sakimoto
- Department of Pharmacy, Yakumo General Hospital, Yakumo Town, Futami-gun, Hokkaido, Japan; Infection Control Room, Yakumo General Hospital, Yakumo Town, Futami-gun, Hokkaido, Japan
| | - Yukari Ichikawa
- Infection Control Management, Asahikawa Red Cross Hospital, Asahikawa, Hokkaido, Japan
| | - Takahiro Kinebuchi
- Department of Laboratory Medicine, Social Welfare Corporation Hokkaido Social Work Association Furano Hospital, Furano, Hokkaido, Japan
| | - Dai Kondo
- Department of Pharmacy, Social Welfare Corporation Hokkaido Social Work Association Furano Hospital, Furano, Hokkaido, Japan
| | - Syuhei Kanno
- Department of Pharmacy, Oji General Hospital, Tomakomai, Hokkaido, Japan; Infection Control Room, Oji General Hospital, Tomakomai, Hokkaido Japan
| | - Minoru Kobayashi
- Infection Control Room, Oji General Hospital, Tomakomai, Hokkaido Japan
| | - Kagami Hirabayashi
- Department of Cardiologists, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan; Department of Infection Control and Prevention, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan
| | - Shinako Saitou
- Department of Infection Control and Prevention, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan; Department of Infection Prevention and Control Certified Nurse, Tomakomai City Hospital, Tomakomai, Hokkaido, Japan
| | - Katsuhiko Saito
- Department of Pharmacy, Nemuro City Hospital, Nemuro, Hokkaido, Japan
| | - Yuuki Ebina
- Department of Pharmacy, Obihiro Kosei General Hospital, Obihiro, Hokkaido, Japan
| | - Yuusuke Koshizaki
- Department of Clinical Laboratory Technology, Obihiro Kosei General Hospital, Obihiro, Hokkaido, Japan
| | - Makoto Chiba
- Department of Pharmacy, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
| | - Atsushi Yasuda
- Department of Clinical Laboratory, Kitami Red Cross Hospital, Kitami, Hokkaido, Japan
| | - Toshiya Sato
- Department of Pediatrics, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan; Department of Infection Prevention Office, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan
| | - Atsuo Togashi
- Department of Pediatrics, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan; Department of Infection Prevention Office, Iwamizawa Municipal General Hospital, Iwamizawa, Hokkaido, Japan
| | - Takashi Abe
- Department of Laboratory Medicine, Takikawa Municipal Hospital, Takikawa, Hokkaido, Japan
| | - Takahiro Fujita
- Department of Infectious Diseases, National Hospital Organization Hokkaido Cancer Center, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Kengo Umehara
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center, Shiroishi-ku, Sapporo, Hokkaido, Japan
| | - Masaru Amishima
- Office for Infection Control and Prevention, NHO Hokkaido Medical Center, Nishi-ku, Sapporo, Hokkaido, Japan
| | - Nobuo Murakami
- Center for Regional Medicine, Gifu University School of Medicine, Yanagido, Gifu, Japan; Gifu General Healthcheckup Centre, Hikie, Gifu, Japan
| | - Tetsuya Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Showa-ku, Nagoya, Japan
| | - Shuhei Fujimoto
- Department of Bacteriology and Bacterial Infection, Division of Host Defense Mechanism, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Taichi Tajima
- AMR Clinical Reference Center, National Center for Global Health and Medicine, Shinjuku, Tokyo, Japan
| | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan; Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University, Kita-ku, Sapporo, Hokkaido, Japan
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital, Kita-ku, Sapporo, Hokkaido, Japan
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Londoño-Ruiz JP, Gutierrez-Tobar IF, Bermúdez-Bohórquez NL, Rodríguez AE. First publication of endemic channels as part of a pediatric Antimicrobial Stewardship Program: when to turn on the alarms? Recommendations of a pediatric ASP program. BMC Infect Dis 2023; 23:21. [PMID: 36631755 PMCID: PMC9833633 DOI: 10.1186/s12879-022-07916-z] [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: 06/27/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Pediatric Antimicrobial Stewardship Programs (ASP) consider DOT a fundamental measure to quantify the impact of ASP. Novel strategies have been described, but no endemic channels (EC) have been reported to compare antibiotic use within historical patterns. This report describes the process of constructing an EC and analyzing its interpretation. METHODS This was a descriptive study of the construction, implementation, and analysis of EC. The median and quartile method, as well as the geometric mean (GM) and confidence interval (CI) methods using DOT for the last 4 years were used. ECs have also been elaborated on in critical services (PICU). RESULTS GM and CI method seem to be more sensitive in identifying changes in antimicrobial use. Ceftriaxone increased its use starting in December 2021, reaching the warning zone in March 2022 in relation to increased cases of bacterial and complicated pneumonia. Piperacillin-tazobactam showed an important increase in PICU during the first 8 months of 2021, reaching the alert zone until August 2021; thereafter, its use decreased, and this variation was related to a modification in the presentation of complicated appendicitis during the COVID 19 pandemic restrictions. The use of ampicillin-sulbactam has increased since January 2022 because of a change in local guidelines regarding its use in appendicitis and peritonitis. The changes identified in each EC allowed ASP to take different conducts. CONCLUSION EC allowed us to construct a new tool to measure ASP impact, internal comparison of antibiotic use facilitated taking timely interventions. EC could be useful for all pediatric and adult ASP.
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Affiliation(s)
- Juan Pablo Londoño-Ruiz
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pediatric Infectious Diseases, Clinica Infantil Santa Maria del Lago, Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940Department of Pediatrics, Universidad del Rosario, Bogota, Colombia
| | - Ivan Felipe Gutierrez-Tobar
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pediatric Infectious Diseases, Clinica Infantil Santa Maria del Lago, Bogotá, Colombia
| | - Naddya Lheidy Bermúdez-Bohórquez
- Antimicrobial Stewardship Program, Clinica Infantil Colsubsidio, Bogotá, Colombia ,Pharmacy Department, Clinica Infantil Colsubsidio, Bogotá, Colombia
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22
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Singh S, Ark R, Tatlock J, Mandalia S, Chung C, Azadian B, Hughes S, Mughal N, Moore LSP, Singh S. Evaluating the long-term impact of an antimicrobial stewardship programme in a Central London mixed medical and surgical intensive care unit. JAC Antimicrob Resist 2022; 4:dlac108. [PMID: 36226228 PMCID: PMC9549738 DOI: 10.1093/jacamr/dlac108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 09/16/2022] [Indexed: 02/05/2023] Open
Abstract
Background Antimicrobial overuse causes increased antimicrobial resistance in ICUs; antimicrobial stewardship programmes (ASPs) aim to optimize usage. Following an MDR Acinetobacter baumannii (MRAb) outbreak in 2008, an ASP was implemented at a London ICU, and then continued as a long-term programme. This study aimed to determine long-term changes in antimicrobial prescribing 9 years on. Methods Data were collected from ICU patients in 2008 immediately before ASP implementation, and thereafter for 6 month cohort periods in 2010-2011, 2012 and 2017. Antimicrobial usage in DDD per 1000 occupied bed days (OBD) were compared. Multivariate linear regression models for antimicrobial days were fitted, adjusting for APACHE II score and patient days. Antimicrobial resistance in Pseudomonas aeruginosa (as an indicator organism) was compared across cohort periods. Findings Across 400 patients over 9 years, antimicrobial use changed significantly (P < 0.011) and remained lower in all post-ASP cohorts compared with pre-ASP [(2008; 1827 DDD/1000 OBD), (2010; 1264 DDD/1000 OBD), (2012; 1270 DDD/1000 OBD) and (2017; 1566 DDD/1000 OBD)]. There was reduction in usage of all antimicrobial classes except β-lactams (where there was no significant increase nor decrease, P = 0.178) and aminoglycosides (where there was a significant increase in usage, P < 0.0001). The latter was temporally associated with restrictions on specific carbapenems. There was an increase in carbapenem-resistant P. aeruginosa in 2012 only (P = 0.028) but not subsequently. Conclusions Following ASP implementation after an outbreak of MRAb, reduced antimicrobial prescribing was maintained 9 years on. We identify several factors influencing successful long-term maintenance of ASPs in ICUs.
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Affiliation(s)
| | | | - Jason Tatlock
- Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, UK
| | - Sundhiya Mandalia
- Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
| | - Christine Chung
- Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, UK
| | - Berge Azadian
- Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, UK
| | - Stephen Hughes
- Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, UK
| | - Nabeela Mughal
- Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
| | - Luke S P Moore
- Faculty of Medicine, Imperial College London, South Kensington Campus, London SW7 2AZ, UK
- Adult Intensive Care Unit, Chelsea and Westminster Hospital NHS Foundation Trust, 369 Fulham Road, UK
- North West London Pathology, Imperial College Healthcare NHS Trust, Fulham Palace Road, London W6 8RF, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Du Cane Road, London W12 0NN, UK
| | - Suveer Singh
- Corresponding author. E-mail: @respitudoc, @dr_luke_moore
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23
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Keshavarzi F. Practical Concerns about the Metrics and Methods of Financial Outcome Measurement in Antimicrobial Stewardship Programs: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:394-405. [PMID: 36117584 PMCID: PMC9445868 DOI: 10.30476/ijms.2021.92213.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
Emerging pathogens in the meantime of paucity of new antibiotics discovery, put antimicrobial stewardship in the center of attention, to preserve the existing antimicrobial effect. Implementation of antimicrobial stewardship programs, however, needs approval from healthcare system managers. The approval process can be enhanced, when the beneficial effects of stewardship programs are supported by both clinical and financial evidence. Focusing on the financial outcome evaluation, the practitioners who run the stewardship programs, may choose certain methods and metrics, depending on the clinical setting scale and type, available human resources, and budget. The wise selection of the methods and metrics warrants a comprehensive insight of the existing methods and metrics, deployed by typically published works that set good examples to follow. This review is an attempt to provide such an insight along with typical relevant examples for each metric and method.
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Affiliation(s)
- Fazlollah Keshavarzi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
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24
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Siachalinga L, Mufwambi W, Lee LH. Impact of Antimicrobial Stewardship Interventions to Improve Antibiotic Prescribing for Hospital Inpatients in Africa: A Systematic Review and Meta-analysis. J Hosp Infect 2022; 129:124-143. [PMID: 35970382 DOI: 10.1016/j.jhin.2022.07.031] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) interventions to improve antibiotic use are being implemented in Africa, but their impact is not fully known. AIM To estimate the effectiveness of interventions to improve antibiotic prescribing for hospital inpatients. METHODS Systematically searched for studies from PubMed, Embase, African Journals online and Google scholar from January 2010 to July 2022. Studies were included if they reported the impact of AMS interventions on outcomes of interest for hospital inpatients in Africa. Risk of bias was evaluated using the Cochrane Effective Practice and Organization of Care guidelines and the National Heart, Lung and Blood Institute tool. Findings were summarized in tables and meta-analyses were performed using random-effects models. FINDINGS Twenty-eight studies were included, 89% being uncontrolled before and after studies. Most interventions employed were multifaceted and found to be effective, evidenced by increased compliance, reduction in antibiotic utilization and cost, and slight reduction or no difference in mortality and length of hospital stay (LOS). Meta-analysis generated a relative risk of 0.82 (95% CI: 0.70∼0.97) for mortality, and a standard mean difference of -0.30 (95% CI: -0.41∼-0.19) for LOS. Generally, a decrease in resistance to most microorganisms was observed. Despite an increase in the number of AMS studies conducted in Africa, the studies lack in most quality design features for AMS studies. CONCLUSION Antimicrobial stewardship interventions are likely to be effective, however efforts are still required to align the study design with the quality design features required for validity and to inform practice.
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Affiliation(s)
- Linda Siachalinga
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea
| | - Webrod Mufwambi
- Department of Pharmacy, School of Health Sciences, University of Zambia, Lusaka, 50110, Zambia
| | - Lyn-Hyang Lee
- College of Pharmacy, Yeungnam University, Gyeongsan, 38541, Republic of Korea.
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Rizk NA, Zahreddine N, Haddad N, Ahmadieh R, Hannun A, Bou Harb S, Haddad SF, Zeenny RM, Kanj SS. The Impact of Antimicrobial Stewardship and Infection Control Interventions on Acinetobacter baumannii Resistance Rates in the ICU of a Tertiary Care Center in Lebanon. Antibiotics (Basel) 2022; 11:911. [PMID: 35884165 PMCID: PMC9311570 DOI: 10.3390/antibiotics11070911] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 07/04/2022] [Accepted: 07/05/2022] [Indexed: 12/24/2022] Open
Abstract
Antimicrobial resistance is a serious threat to global health, causing increased mortality and morbidity especially among critically ill patients. This toll is expected to rise following the COVID-19 pandemic. Carbapenem-resistant Acinetobacter baumannii (CRAb) is among the Gram-negative pathogens leading antimicrobial resistance globally; it is listed as a critical priority pathogen by the WHO and is implicated in hospital-acquired infections and outbreaks, particularly in critically ill patients. Recent reports from Lebanon describe increasing rates of infection with CRAb, hence the need to develop concerted interventions to control its spread. We set to describe the impact of combining antimicrobial stewardship and infection control measures on resistance rates and colonization pressure of CRAb in the intensive care units of a tertiary care center in Lebanon before the COVID-19 pandemic. The antimicrobial stewardship program introduced a carbapenem-sparing initiative in April 2019. During the same period, infection control interventions involved focused screening, monitoring, and tracking of CRAb, as well as compliance with specific measures. From January 2018 to January 2020, we report a statistically significant decrease in carbapenem consumption and a decrease in resistance rates of isolated A. baumannii. The colonization pressure of CRAb also decreased significantly, reaching record low levels at the end of the intervention period. The results indicate that a multidisciplinary approach and combined interventions between the stewardship and infection control teams can lead to a sustained reduction in resistance rates and CRAb spread in ICUs.
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Affiliation(s)
- Nesrine A. Rizk
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.A.R.); (S.B.H.); (S.F.H.)
| | - Nada Zahreddine
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.Z.); (R.A.)
| | - Nisrine Haddad
- Department of Pharmacy, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (A.H.); (R.M.Z.)
| | - Rihab Ahmadieh
- Infection Control and Prevention Program, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.Z.); (R.A.)
| | - Audra Hannun
- Department of Pharmacy, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (A.H.); (R.M.Z.)
| | - Souad Bou Harb
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.A.R.); (S.B.H.); (S.F.H.)
| | - Sara F. Haddad
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.A.R.); (S.B.H.); (S.F.H.)
| | - Rony M. Zeenny
- Department of Pharmacy, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.H.); (A.H.); (R.M.Z.)
| | - Souha S. Kanj
- Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon; (N.A.R.); (S.B.H.); (S.F.H.)
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Chakrabarti A, Mohamed N, Capparella MR, Townsend A, Sung AH, Yura R, Muñoz P. The role of diagnostics-driven antifungal stewardship in the management of invasive fungal infections: a systematic literature review. Open Forum Infect Dis 2022; 9:ofac234. [PMID: 35873300 PMCID: PMC9297315 DOI: 10.1093/ofid/ofac234] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/10/2022] [Indexed: 12/02/2022] Open
Abstract
Antifungal stewardship (AFS) programs are key to optimizing antifungal use and improving outcomes in patients with invasive fungal infections. Our systematic literature review evaluated the impact of diagnostics in AFS programs by assessing performance and clinical measures. Most eligible studies were from Europe and the United States (n = 12/17). Diagnostic approaches included serum β-1–3-D-glucan test (n/N studies, 7/17), galactomannan test (4/17), computed tomography scan (3/17), magnetic resonance (2/17), matrix-assisted laser desorption and ionization time-of-flight mass spectrometry (MALDI-TOF MS; 2/17), polymerase chain reaction (1/17), peptide nucleic acid fluorescent in situ hybridization (PNA-FISH) assay (1/17), and other routine methods (9/17). Time to species identification decreased significantly using MALDI-TOF and PNA-FISH (n = 2). Time to targeted therapy and length of empiric therapy also decreased (n = 3). Antifungal consumption decreased by 11.6%–59.0% (7/13). Cost-savings ranged from 13.5% to 50.6% (5/10). Mortality rate (13/16) and length of stay (6/7) also decreased. No negative impact was reported on patient outcomes. Diagnostics-driven interventions can potentially improve AFS measures (antifungal consumption, cost, mortality, and length of stay); therefore, AFS implementation should be encouraged.
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Affiliation(s)
- Arunaloke Chakrabarti
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | | | - Andy Townsend
- Correspondence: Andy Townsend, PhD, 2 Valley View Congleton, CW12 4EN ()
| | | | - Renee Yura
- WRD & Medical, Pfizer, Cambridge, Massachusetts, USA
| | - Patricia Muñoz
- Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Madrid, Spain
- Medicine Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- CIBER Enfermedades Respiratorias – CIBERES (CB06/06/0058), Madrid, Spain
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Mantadakis E, Kopsidas I, Coffin S, Dimitriou G, Gkentzi D, Hatzipantelis E, Kaisari A, Kattamis A, Kourkouni E, Papachristidou S, Papakonstantinou E, Polychronopoulou S, Roilides E, Spyridis N, Tsiodras S, Tsolia MN, Tsopela GC, Zaoutis T, Tragiannidis A. A national study of antibiotic use in Greek pediatric hematology oncology and bone marrow transplant units. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e71. [PMID: 36483391 PMCID: PMC9726537 DOI: 10.1017/ash.2022.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE We surveyed antimicrobials used in Greek pediatric hematology-oncology (PHO) and bone marrow transplant (BMT) units before and after an intervention involving education regarding the 2017 clinical practice guidelines (CPG) for the management of febrile neutropenia in children with cancer and hematopoietic stem-cell transplant recipients. DESIGN Antibiotic prescribing practices were prospectively recorded between June 2016 and November 2017. INTERVENTION In December 2017, baseline data feedback was provided, and CPG education was provided. Prescribing practices were followed for one more year. For antibiotic stewardship, days of therapy, and length of therapy were calculated. SETTING Five of the 6 PHO units in Greece and the single pediatric BMT unit participated. PARTICIPANTS Admitted children in each unit who received the first 15 new antibiotic courses each month. RESULTS Administration of ≥4 antibiotics simultaneously and administration of antibiotics with overlapping activity for ≥2 days were significantly more common in PHO units in general hospitals compared to children's hospitals. Use of at least 1 antifungal was recorded in ∼47% of the patients before and after the intervention. De-escalation and/or discontinuation of antibiotics on day 6 of initial treatment increased significantly from 43% to 53.5% (P = .032). Although the number of patients requiring intensive care support for sepsis did not change, a significant drop was noted in all-cause mortality (P = .008). CONCLUSIONS We recorded the antibiotic prescribing practices in Greek PHO and BMT units, we achieved improved prescribing with a simple intervention, and we identified areas in need of improvement.
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Affiliation(s)
- Elpis Mantadakis
- Democritus University of Thrace Faculty of Medicine, University General Hospital of Alexandroupolis, Alexandroupolis, Greece
| | - Ioannis Kopsidas
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | - Susan Coffin
- Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Gabriel Dimitriou
- Patras Medical School, University General Hospital of Patras, Patra, Greece
| | - Despoina Gkentzi
- Patras Medical School, University General Hospital of Patras, Patra, Greece
| | - Emmanouel Hatzipantelis
- Children & Adolescent Hematology–Oncology Unit, Second Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Aikaterini Kaisari
- Stem Cell Transplant Unit, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Antonis Kattamis
- First Department of Pediatrics, National and Kapodistrian University of Athens, Aghia Sophia Children’s Hospital, Athens, Greece
| | - Eleni Kourkouni
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
| | | | | | - Sophia Polychronopoulou
- Department of Pediatric Hematology–Oncology (T.A.O.), Aghia Sophia Children’s Hospital, Athens, Greece
| | - Emmanuel Roilides
- Third Department of Pediatrics, Aristotle University of Thessaloniki, Hipppokration General Hospital, Thessaloniki, Greece
| | - Nikos Spyridis
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon Hospital, Athens, Greece
| | - Maria N. Tsolia
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Athens, Greece
- Infectious Diseases Unit, Second Department of Pediatrics, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | - Athanasios Tragiannidis
- Children & Adolescent Hematology–Oncology Unit, Second Pediatric Department, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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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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Setiawan E, Abdul-Aziz MH, Roberts JA, Cotta MO. Hospital-Based Antimicrobial Stewardship Programs Used in Low- and Middle-Income Countries: A Scoping Review. Microb Drug Resist 2022; 28:566-584. [PMID: 35333607 DOI: 10.1089/mdr.2021.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database inception until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability-Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive-based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimicrobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.
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Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Clinical and Community Pharmacy; and Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, Surabaya, Indonesia
| | - Mohd-Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Chen JZ, Hoang HL, Yaskina M, Kabbani D, Doucette KE, Smith SW, Lau C, Stewart J, Zurek K, Schultz M, Cervera C. Efficacy and safety of antimicrobial stewardship prospective audit and feedback in patients hospitalized with COVID-19: A protocol for a pragmatic clinical trial. PLoS One 2022; 17:e0265493. [PMID: 35320289 PMCID: PMC8942275 DOI: 10.1371/journal.pone.0265493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 03/01/2022] [Indexed: 11/19/2022] Open
Abstract
Background
The use of broad-spectrum antibiotics is widespread in patients with COVID-19 despite a low prevalence of bacterial co-infection, raising concerns for the accelerated development of antimicrobial resistance. Antimicrobial stewardship (AMS) is vital but there are limited randomized clinical trial data supporting AMS interventions such as prospective audit and feedback (PAF). High quality data to demonstrate safety and efficacy of AMS PAF in hospitalized COVID-19 patients are needed.
Methods and design
This is a prospective, multi-center, non-inferiority, pragmatic randomized clinical trial evaluating AMS PAF intervention plus standard of care (SOC) versus SOC alone. We include patients with microbiologically confirmed SARS-CoV-2 infection requiring hospital admission for severe COVID-19 pneumonia. Eligible ward beds and critical care unit beds will be randomized prior to study commencement at each participating site by computer-generated allocation sequence stratified by intensive care unit versus conventional ward in a 1:1 fashion. PAF intervention consists of real time review of antibacterial prescriptions and immediate written and verbal feedback to attending teams, performed by site-based AMS teams comprised of an AMS pharmacist and physician. The primary outcome is clinical status at post-admission day 15 measured using a 7-point ordinal scale. Patients will be followed for secondary outcomes out to 30 days. A total of 530 patients are needed to show a statistically significant non-inferiority, with 80% power and 2.5% one-sided alpha assuming standard deviation of 2 and the non-inferiority margin of 0.5.
Discussion
This study protocol presents a pragmatic clinical trial design with small unit cluster randomization for AMS intervention in hospitalized COVID-19 that will provide high-level evidence and may be adopted in other clinical situations.
Trial registration
This study is being performed at the University of Alberta and is registered at ClinicalTrials.gov (NCT04896866) on May 17, 2021.
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Affiliation(s)
- Justin Z. Chen
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- * E-mail:
| | - Holly L. Hoang
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Maryna Yaskina
- Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Karen E. Doucette
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie W. Smith
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Cecilia Lau
- Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jackson Stewart
- Pharmacy Services, Alberta Health Services, Edmonton, Alberta, Canada
| | - Karen Zurek
- Pharmacy Services, Covenant Health, Edmonton, Alberta, Canada
| | - Morgan Schultz
- Pharmacy Services, Covenant Health, Edmonton, Alberta, Canada
| | - Carlos Cervera
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Doltrario AB, Gaspar GG, Ungari AQ, Martinez R, Pazin Filho A, Maciel BC, Bellissimo-Rodrigues F, Santana RDC. Assessment of preauthorization and 24-hour expert consultation as a restrictive antimicrobial stewardship bundle in a Brazilian tertiary-care hospital: an interrupted time series analysis. Infect Prev Pract 2022; 4:100201. [PMID: 35141515 PMCID: PMC8810400 DOI: 10.1016/j.infpip.2022.100201] [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: 08/26/2021] [Accepted: 01/04/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Worldwide, healthcare facilities face high and often inappropriate consumption of antimicrobials. However, there are limited antimicrobial stewardship (ASP) studies from low- and middle-income countries that include restrictive measures and their impacts on antimicrobial consumption. AIM This study aims to assess the impact of a restrictive bundle (preauthorization requirements and offering consultation with an infectious diseases physician 24 hours a day) on antimicrobial consumption, in a tertiary hospital in Brazil. METHODS We conducted an interrupted time series analysis (ITS) with pharmacy-based data from January 2010 to December 2018 to evaluate changes of level and slope in antimicrobial consumption (expressed in DDD/1,000 patient-days) after the implementation of the restrictive bundle in September 2014. Fourteen restricted antimicrobials (amphotericin B deoxycholate, liposomal amphotericin B, micafungin, voriconazole, ganciclovir, amikacin, ampicillin/sulbactam, daptomycin, ertapenem, levofloxacin, linezolid, piperacillin/tazobactam, polymyxin B, and tigecycline) and eight unrestricted were analysed. FINDINGS Among the 14 restricted antimicrobials, four presented a significant negative level change: micafungin (-2,14, p=.027), voriconazole (-14.72, p<.001), ertapenem (-1.89, p=.007) and amikacin (-13.98, p<.001). The only negative slope change was observed for the liposomal amphotericin B, -0.532 (p=.009). The restricted antibiotics group presented an increased consumption trend (1.068, p=.002) compared to the pre-intervention period, a similar change was observed for the unrestricted antibiotics group (1.360, p<.001). CONCLUSION Preauthorization and 24 hour expert consultation were partially effective as a restrictive antimicrobial stewardship bundle in a Brazilian tertiary-care hospital. Increased consumption of unrestricted antimicrobials was observed as a side effect of the intervention.
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Affiliation(s)
- Andréa Beltrami Doltrario
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Gilberto Gambero Gaspar
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Andrea Queiroz Ungari
- Division of Pharmacy, Hospital das Clínicas. Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Roberto Martinez
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Antonio Pazin Filho
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Benedito Carlos Maciel
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Fernando Bellissimo-Rodrigues
- Social Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Rodrigo de Carvalho Santana
- Internal Medicine Department, Ribeirão Preto Medical School, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
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Murphy CV, Reed EE, Herman DD, Magrum B, Beatty JJ, Stevenson KB. Antimicrobial Stewardship in the ICU. Semin Respir Crit Care Med 2022; 43:131-140. [PMID: 35172363 DOI: 10.1055/s-0041-1740977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Increasing rates of infection and multidrug-resistant pathogens, along with a high use of antimicrobial therapy, make the intensive care unit (ICU) an ideal setting for implementing and supporting antimicrobial stewardship efforts. Overuse of antimicrobial agents is common in the ICU, as practitioners are challenged daily with achieving early, appropriate empiric antimicrobial therapy to improve patient outcomes. While early antimicrobial stewardship programs focused on the financial implications of antimicrobial overuse, current goals of stewardship programs align closely with those of critical care providers-to optimize patient outcomes, reduce development of resistance, and minimize adverse outcomes associated with antibiotic overuse and misuse such as acute kidney injury and Clostridioides difficile-associated disease. Significant opportunities exist in the ICU for critical care clinicians to support stewardship practices at the bedside, including thoughtful and restrained initiation of antimicrobial therapy, use of biomarkers in addition to rapid diagnostics, Staphylococcus aureus screening, and traditional microbiologic culture and susceptibilities to guide antibiotic de-escalation, and use of the shortest duration of therapy that is clinically appropriate. Integration of critical care practitioners into the initiatives of antimicrobial stewardship programs is key to their success. This review summarizes key components of antimicrobial stewardship programs and mechanisms for critical care practitioners to share the responsibility for antimicrobial stewardship.
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Affiliation(s)
- Claire V Murphy
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erica E Reed
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Derrick D Herman
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - BrookeAnne Magrum
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Julia J Beatty
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kurt B Stevenson
- Division of Infectious Diseases, Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio.,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio
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Lau TMM, Daniel R, Hughes K, Wootton M, Hood K, Gillespie D. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac013. [PMID: 35233529 PMCID: PMC8874134 DOI: 10.1093/jacamr/dlac013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction Antimicrobial stewardship interventions (ASIs) aim to reduce the emergence of antimicrobial resistance. We sought to systematically evaluate how microbiological outcomes have been handled and analysed in randomized controlled trials (RCTs) evaluating ASIs. Methods We searched PubMed and Embase from 2011–21. Studies were selected if they were RCTs evaluating ASIs. A narrative synthesis approach was taken, identifying whether the study reported any microbiological data (bacterial genus/species; bacterial colony counts; prevalence of bacterial, microbiologically defined infections; and antibiotic susceptibility, measured pre-randomization or post-randomization in one arm only) or outcomes (post-randomization data compared between arms). Studies with or without microbiological data/outcomes were summarized in terms of study characteristics, methods of reporting and analysis of these outcomes. Results We identified 117 studies, with 34 (29.1%) collecting microbiological data and 18 (15.4%) reporting microbiological outcomes. Most studies with microbiological outcomes were conducted in secondary care (12/18, 66.7%) and targeted adult populations (14/18, 77.8%), and the intervention involved biomarker-guided rapid diagnostic testing (7/18, 38.9%). The overall quality of reporting and analysing microbiological outcomes was low and inconsistent. The selected study population in analyses and methods of handling missing data were unclear. Conclusions This review demonstrates that the quality of handling and reporting microbiological outcomes in RCTs of ASIs was low. The lack of consistency and clarity made it difficult to compare the findings across studies, limiting policy- and clinical decision-making. Therefore, there is a clear need for the development of guidance for handling microbiological outcomes in RCTs and adopting appropriate methods to evaluate these data carefully.
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Affiliation(s)
- Tin Man Mandy Lau
- Centre for Trials Research, Cardiff University, Cardiff, UK
- Corresponding author. E-mail:
| | - Rhian Daniel
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Kathryn Hughes
- PRIME Centre Wales, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales, University Hospital of Wales, Cardiff, UK
| | - Kerry Hood
- Centre for Trials Research, Cardiff University, Cardiff, UK
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Saseedharan S, Shaffi N, Rambhad S, Kadam V, Mathew EJ. A retrospective review of a 2-year strong antimicrobial stewardship program in a tertiary care institute in Mumbai. Indian J Pharmacol 2022; 54:253-257. [PMID: 36204808 PMCID: PMC9804118 DOI: 10.4103/ijp.ijp_466_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND INFORMATION Many institutes have implemented a strict antimicrobial stewardship (AMS) program in the postantibiotic era. AIM To investigate how the resistance pattern changes after implementation of a stringent AMS programme. METHODOLOGY It employs a defined daily dose methodology (DDD). The formulae listed below are used to compute this for two periods: October 2015 to October 2017 (Period 1) and October 2017 to October 2019 (Period 2) (Period 2). DDD = Antibiotics used in total (g) per year The length of stay was determined using the data from the hospital's information system (HIS). The patterns of resistance to the limited antibiotics are vancomycin, linezolid, tigecycline, and colistin. In both Periods 1 and 2, skin and soft-tissue infections, urinary tract infections, bloodstream infections, and respiratory tract infections were studied in both periods. RESULTS In the year from October 2015 to October 2017, 4569 patients received limited antibiotics out of a total of 14,544 admissions. The average length of stay was 7.48 days in Period 1, however, it was reduced to 3.96 days in Period 2 out of 15,199 patients. In vitro isolate sensitivities to vancomycin, linezolid, tigecycline, and colistin were increased. CONCLUSION Some of the most common antibiotics were used less frequently. This appears to be linked to a shorter stay in the hospital and increased antibiotic susceptibility.
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Affiliation(s)
- Sanjith Saseedharan
- Department of Critical Care, S.L. Raheja Hospital - A Fortis Associate, Mahim, Mumbai, Maharashtra, India,Address for correspondence: Dr. Sanjith Saseedharan, S.L. Raheja Hospital Mahim, Mumbai, Maharashtra, India. E-mail:
| | - Nausheen Shaffi
- Department of Critical Care, S.L. Raheja Hospital - A Fortis Associate, Mahim, Mumbai, Maharashtra, India
| | - Sonal Rambhad
- Department of Critical Care, S.L. Raheja Hospital - A Fortis Associate, Mahim, Mumbai, Maharashtra, India
| | - Vaijyanti Kadam
- Department of Critical Care, S.L. Raheja Hospital - A Fortis Associate, Mahim, Mumbai, Maharashtra, India
| | - Elizabeth J. Mathew
- Department of Critical Care, S.L. Raheja Hospital - A Fortis Associate, Mahim, Mumbai, Maharashtra, India
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Abstract
Background Antimicrobial stewardship (AMS) programmes in hospitals support optimal antimicrobial use by utilizing strategies such as restriction policies and education. Several systematic reviews on digital interventions supporting AMS have been conducted but they have focused on specific interventions and outcomes. Objectives To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. Methods Multiple databases were searched from 2010 onwards. Review papers were eligible if they included studies that examined the effectiveness of AMS digital interventions in an inpatient hospital setting. Papers were excluded if they were not systematic reviews, were limited to a paediatric setting, or were not in English. Results Eight systematic reviews were included for data extraction. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. Due to the heterogeneity of the interventions and outcome measures, a meta-analysis could not be performed. The majority of reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. Conclusions Digital interventions reduce antimicrobial use and improve antimicrobial appropriateness in hospitals, but no firm conclusions can be drawn about the degree to which different types of digital interventions achieve these outcomes. Evaluation of sociotechnical aspects of digital intervention implementation is limited, despite the critical role that user acceptance, uptake and feasibility play in ensuring improvements in AMS are achieved with digital health.
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Affiliation(s)
| | - Jonathan Penm
- The University of Sydney, School of Pharmacy, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Angus Ritchie
- Health Informatics Unit, Sydney Local Health District, Camperdown, Australia
- The University of Sydney, Faculty of Medicine and Health, Concord Clinical School, Sydney, New South Wales, Australia
| | - Melissa T Baysari
- The University of Sydney, Biomedical Informatics and Digital Health, School of Medical Sciences, Charles Perkins Centre, Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Khanina A, Tio SY, Ananda‐Rajah MR, Kidd SE, Williams E, Chee L, Urbancic K, Thursky KA. Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021. Intern Med J 2021; 51 Suppl 7:18-36. [DOI: 10.1111/imj.15586] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Anna Khanina
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Victoria Australia
| | - Shio Yen Tio
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Sir Peter MacCallum Department of Oncology The University of Melbourne Melbourne Victoria Australia
| | - Michelle R. Ananda‐Rajah
- Department of General Medicine Alfred Health Melbourne Victoria Australia
- Department of Infectious Diseases Alfred Health Melbourne Victoria Australia
| | - Sarah E. Kidd
- National Mycology Reference Centre Microbiology and Infectious Diseases, SA Pathology Adelaide South Australia Australia
- School of Biological Sciences University of Adelaide Adelaide South Australia Australia
| | - Eloise Williams
- Department of Microbiology Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Microbiology and Immunology The Peter Doherty Institute for Immunity and Infection, The University of Melbourne Melbourne Parkville Victoria Australia
| | - Lynette Chee
- Department of Clinical Haematology Peter MacCallum Cancer Centre and Royal Melbourne Hospital Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
| | - Karen Urbancic
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
- Pharmacy Department Austin Health Melbourne Victoria Australia
- National Centre for Antimicrobial Stewardship Melbourne Victoria Australia
| | - Karin A. Thursky
- National Centre for Infections in Cancer Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Department of Medicine The University of Melbourne Melbourne Victoria Australia
- National Centre for Antimicrobial Stewardship Melbourne Victoria Australia
- Department of Infectious Diseases Peter MacCallum Cancer Centre Melbourne Victoria Australia
- Victorian Infectious Diseases Service The Peter Doherty Institute for Immunity and Infection, Royal Melbourne Hospital Melbourne Victoria Australia
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Kakiuchi S, Livorsi DJ, Perencevich EN, Diekema DJ, Ince D, Prasidthrathsint K, Kinn P, Percival K, Heintz BH, Goto M. Days of Antibiotic Spectrum Coverage (DASC): A Novel Metric for Inpatient Antibiotic Consumption. Clin Infect Dis 2021; 75:567-576. [PMID: 34910130 DOI: 10.1093/cid/ciab1034] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Days of Therapy (DOT), the most widely used benchmarking metric for antibiotic consumption, may not fully measure stewardship efforts to promote use of narrow-spectrum agents and may inadvertently discourage the use of combination regimens when single-agent alternatives have greater adverse effects. To overcome DOT's limitations, we developed a novel metric, Days of Antibiotic Spectrum Coverage (DASC), and compared hospitals' performances using this novel metric with DOT. METHODS We evaluated 77 antibiotics in 16 categories of antibacterial activity to develop our spectrum scoring system. DASC was then calculated as cumulative daily spectrum scores. To compare hospital benchmarking using DOT and DASC, we conducted a retrospective cohort study of adult patients admitted to acute care units within the Veterans Health Administration system in 2018. Antibiotic administration data were aggregated to calculate each hospital's DOT and DASC per 1,000 days present (DP) for ranking. RESULTS The spectrum score for each antibiotic ranged from 2 to 15. There was little correlation between DOT per 1,000 DP and DASC per DOT, indicating that lower antibiotic consumption at a hospital does not necessarily mean more frequent use of narrow-spectrum antibiotics. The differences in each hospital's ranking between DOT and DASC per 1,000 DP ranged from -29.0% to 25.0%, respectively, with 27 (21.8%) hospitals having differences >10%. CONCLUSIONS We propose a novel composite metric for antibiotic stewardship, DASC, that combines consumption and spectrum as a potential replacement for DOT. Further studies are needed to evaluate whether benchmarking using the DASC will improve evaluations of stewardship.
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Affiliation(s)
- Satoshi Kakiuchi
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Daniel J Livorsi
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Eli N Perencevich
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Daniel J Diekema
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | - Dilek Ince
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA
| | | | - Patrick Kinn
- Department of Pharmaceutical Care, University of Iowa, Iowa City, IA, USA
| | - Kelly Percival
- Department of Pharmaceutical Care, University of Iowa, Iowa City, IA, USA
| | - Brett H Heintz
- Pharmacy Service, Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Michihiko Goto
- Department of Internal Medicine, University of Iowa, Iowa City, IA, USA.,Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
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Romo-Castillo HF, Pazin-Filho A. Towards implementing an Antibiotic Stewardship Intervention (ASI) in Ecuador - Evaluating antibiotic consumption and the impact of an ASI in a tertiary hospital according to the World Health Organization (WHO) recommendations. J Glob Antimicrob Resist 2021; 29:462-467. [PMID: 34788689 DOI: 10.1016/j.jgar.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/22/2021] [Accepted: 11/05/2021] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION Ecuador is a lower-to-middle income country (LMIC) not yet adherent to World Health Organization Antibiotic Stewardship Strategies (WHO-ASI) and we still lack data regarding basic metrics. METHODS We conducted a retrospective study of an ASI consisting of a restrictive measure to carbapenems dispensation pending on required preauthorization and expert audit. We evaluated antibiotic consumption and its relationship to carbapenems resistance at a 610-bed, tertiary level hospital in Quito, Ecuador. We used prescription data from 2010 to 2017 and converted into Defined Daily Doses (DDD). We them correlated these findings with the nature of service provided and antibiotic resistance from microbiologic lab. We used descriptive statistics and interrupted time-series analysis. RESULTS Throughout the study period, we analyzed 16,984,355 prescriptions of 8,191,418.57 grams of antibiotics (5,760,479.37 DDD). The in-hospital mean (SD) antibiotic prescription was 148.8 (14.8) DDD/100 occupied bed-dayss and 293.5 (65.3) DDD/100 occupied bed-dayss in the ICU. First, second and third line antibiotics consumption were 38%, 52% and 10% respectively. Our hospital data showed a high rate of antibiotic prescription in all hospital areas, mainly broad-spectrum antibiotics. Regarding the ASI introduced in 2016, the interrupted time-series analysis showed a change in the outcome level immediately following the introduction for imipenem (-3.97; 95% CI -5.31 -2.61) but not for meropenem (0.66; 95%CI -0.37 1.71). CONCLUSION Even though our institution's ASI was successful in reducing imipenen consumption, a more embracing plan is required for further interventions to avoid unexpected effects.
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Affiliation(s)
- Hugo Fernando Romo-Castillo
- Department of Pharmacology, Universidad Central del Ecuador, Hospital Carlos Andrade Marín (IESS), Quito Ecuador.
| | - Antonio Pazin-Filho
- Full Professor, Internal Medicine Department, Ribeirao Preto Medical School, University of São Paulo, Brazil.
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Singh P, Gupta DK, Bindra A, Trikha A, Lathwal A, Malhotra R, Walia K, Mathur P. Antimicrobial consumption in intensive care unit patients at level 1 trauma centre in India. Indian J Med Microbiol 2021; 40:86-90. [PMID: 34602292 DOI: 10.1016/j.ijmmb.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Increase in the antimicrobial resistance causes a concern globally. To mitigate the rapidly rising antimicrobial resistance in the health system globally antimicrobial stewardship programs (AMSP) have been advocated. Therefore, we aim to measure aggregate antibiotic consumption by both Defined Daily Dosage (DDD) and Days of Therapy (DOT) methods. METHODS As a part of Indian Council of Medical Research initiative to develop local AMSP, this prospective study of six months was conducted at a level -1 Trauma Centre of AIIMS, New Delhi. In this, we have included all the patients of polytrauma and neurosurgical Intensive care units between April to October 2019. Consumption of antibiotics data were collected manually daily by infection control practitioners. Data were presented as Days of Therapy (DOT) and Defined Daily Dose (DDD). RESULTS During the six months of study, antimicrobial consumption of ICU was compared with empirical therapy v/s culture-based therapy. Overall average antimicrobial consumption for the six months for both empirical therapy and culture-based therapy DDD/1000 patient days was 531.8 and 460.7 whereas DOT/1000 patient days 489.9 and 426.04 respectively. CONCLUSIONS Antimicrobial Stewardship activities aim to ensure judicious consumption of antimicrobials. Such data will be of value in establishing, evaluating and monitoring the function of the AMSP in the healthcare settings.
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Affiliation(s)
- Parul Singh
- Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Kumar Gupta
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
| | - Amit Lathwal
- Department of Hospital Administration, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences New Delhi, India.
| | - Kamini Walia
- Indian Council of Medical Research, New Delhi, India.
| | - Purva Mathur
- Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
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Grau S, Hernández S, Echeverría-Esnal D, Almendral A, Ferrer R, Limón E, Horcajada JP. Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic. Antibiotics (Basel) 2021; 10:943. [PMID: 34438993 PMCID: PMC8388964 DOI: 10.3390/antibiotics10080943] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/01/2021] [Accepted: 08/03/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. METHODS Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008-2019). RESULTS Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. CONCLUSIONS The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia.
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Affiliation(s)
- Santiago Grau
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25–29, 08003 Barcelona, Spain;
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Department of Pharmacology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Sergi Hernández
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Daniel Echeverría-Esnal
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25–29, 08003 Barcelona, Spain;
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Alexander Almendral
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Ricard Ferrer
- Department of Intensive Care Medicine, Hospital Universitario Vall D’Hebron, Passeig de la Vall D’Hebron 119, 08035 Barcelona, Spain;
| | - Enric Limón
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08907 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Juan Pablo Horcajada
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Infectious Diseases Department, Hospital del Mar, Passeig Maritim 25–29, 08003 Barcelona, Spain
- Department of Medicine, CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain
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Laka M, Milazzo A, Merlin T. Can evidence-based decision support tools transform antibiotic management? A systematic review and meta-analyses. J Antimicrob Chemother 2021; 75:1099-1111. [PMID: 31960021 DOI: 10.1093/jac/dkz543] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 11/17/2019] [Accepted: 12/06/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the effectiveness of clinical decision support systems (CDSSs) at reducing unnecessary and suboptimal antibiotic prescribing within different healthcare settings. METHODS A systematic review of published studies was undertaken with seven databases from database inception to November 2018. A protocol was developed using the PRISMA-P checklist and study selection criteria were determined prior to performing the search. Critical appraisal of studies was undertaken using relevant tools. Meta-analyses were performed using a random-effects model to determine whether CDSS use affected optimal antibiotic management. RESULTS Fifty-seven studies were identified that reported on CDSS effectiveness. Most were non-randomized studies with low methodological quality. However, randomized controlled trials of moderate methodological quality were available and assessed separately. The meta-analyses indicated that appropriate antibiotic therapy was twice as likely to occur following the implementation of CDSSs (OR 2.28, 95% CI 1.82-2.86, k = 20). The use of CDSSs was also associated with a relative decrease (18%) in mortality (OR 0.82, 95% CI 0.73-0.91, k = 18). CDSS implementation also decreased the overall volume of antibiotic use, length of hospital stay, duration and cost of therapy. The magnitude of the effect did vary by study design, but the direction of the effect was consistent in favouring CDSSs. CONCLUSIONS Decision support tools can be effective to improve antibiotic prescribing, although there is limited evidence available on use in primary care. Our findings suggest that a focus on system requirements and implementation processes would improve CDSS uptake and provide more definitive benefits for antibiotic stewardship.
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Affiliation(s)
- Mah Laka
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Adriana Milazzo
- School of Public Health, University of Adelaide, Adelaide, Australia
| | - Tracy Merlin
- Adelaide Health Technology (AHTA), School of Public Health, University of Adelaide, Adelaide, Australia
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Khanina A, Urbancic KF, Haeusler GM, Kong DCM, Douglas AP, Tio SY, Worth LJ, Slavin MA, Thursky KA. Establishing essential metrics for antifungal stewardship in hospitals: the results of an international Delphi survey. J Antimicrob Chemother 2021; 76:253-262. [PMID: 33057605 DOI: 10.1093/jac/dkaa409] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 09/03/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Guidance on assessment of the quantity and appropriateness of antifungal prescribing is required to assist hospitals to interpret data effectively and structure quality improvement programmes. OBJECTIVES To achieve expert consensus on a core set of antifungal stewardship (AFS) metrics and to determine their feasibility for implementation. METHODS A literature review was undertaken to develop a list of candidate metrics. International experts were invited to participate in sequential web-based surveys to evaluate the importance and feasibility of metrics in the area of AFS using Delphi methodology. Three surveys were completed. Consensus was predefined as ≥80% agreement on the importance of each metric. RESULTS Eighty-two experts consented to participate from 17 different countries. Response rate for each survey was >80%. The panel included adult and paediatric physicians, microbiologists and pharmacists with diverse content expertise. Consensus was achieved for 38 metrics considered important to routinely include in AFS programmes, and related to antifungal consumption (n = 5), quality of antifungal prescribing and management of invasive fungal infection (IFI) (n = 24), and clinical outcomes (n = 9). Twenty-one consensus metrics were considered to have moderate to high feasibility for routine collection. CONCLUSIONS The identified core AFS metrics will provide a framework to comprehensively assess the quantity and quality of antifungal prescribing within hospitals to develop quality improvement programmes aimed at improving IFI prevention, management and patient-centred outcomes. A standardized approach will support collaboration and benchmarking to monitor the efficacy of current prophylaxis and treatment guidelines, and will provide important feedback to guideline developers.
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Affiliation(s)
- A Khanina
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - K F Urbancic
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia
| | - G M Haeusler
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Infectious Diseases Unit, Department of General Paediatrics, The Royal Children's Hospital, 50 Flemington Rd, Parkville, Victoria 3052, Australia
| | - D C M Kong
- The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia.,Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, 381 Royal Parade, Parkville, Victoria 3010, Australia.,Ballarat Health Services, 1 Drummond St N, Ballarat Central, Victoria 3350, Australia
| | - A P Douglas
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria 3010, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia
| | - S Y Tio
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria 3010, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia
| | - L J Worth
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria 3010, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia
| | - M A Slavin
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria 3010, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia
| | - K A Thursky
- The National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria 3010, Australia.,The National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth St, Melbourne, Victoria 3000, Australia.,Department of Medicine, University of Melbourne, Parkville, Victoria 3010, Australia.,Department of Infectious Diseases, Peter MacCallum Cancer Centre, 305 Grattan St, Melbourne, Victoria 3000, Australia
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Nguyen-Thi HY, Nguyen DA, Huynh PT, Le NDT. Impact of Antimicrobial Stewardship Program on Vancomycin Usage: Costs and Outcomes at Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam. Risk Manag Healthc Policy 2021; 14:2637-2646. [PMID: 34188574 PMCID: PMC8235933 DOI: 10.2147/rmhp.s307744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/27/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nowadays, with the emergence of vancomycin-resistant strains, the clinical use of vancomycin has been followed closely by applying the antimicrobial stewardship program (ASP) to enhance effectiveness in treatment and reduce cost burden for patients. Methods A descriptive cross-sectional study at the Hospital for Tropical Diseases was conducted to assess the inpatient status assigned to intravenous vancomycin and factors associated with the cost of treatment during two periods of implementing ASP, which were i) from April 1, 2016 to March 31, 2018 (previous ASP-pASP) and ii) from June 1, 2018 to March 31, 2020 (new ASP-nASP). Results Among 1375 patients who met the sampling criteria, there were 601 and 774 patients in pASP and nASP, respectively. The rate of no improvement/mortality in the pASP was higher than that in nASP (37.10% vs 25.98%, p <0.05). The proportion of patients with two or more infection episodes in nASP is lower than that in pASP (9.83% vs 18.64%, p<0.05). Besides, nASP has higher length of therapy (LOT) and higher day of therapy (DOT). The average treatment cost in the pASP is higher than that in the nASP, 1891.22 (95% CI, 1713.46–2068.98) USD vs 1775.55 (95% CI, 1576.22–1974.88) USD. There are seven factors (p<0.05) that associate with the total cost of treatment (age, number of infection episodes, length of stay, discharge status, clinical department, LOT, DOT) in pASP. On the other hand, the nASP has five factors (p<0.001), in which the log(LOT) and age are not as statistically significant (p=0.5127 and 0.3852, respectively) as in the pASP model. Conclusion The implementation and improvement of the ASP at the Hospital for Tropical Diseases have initially shown benefits for patients using intravenous vancomycin. Specifically, the ASP helps to reduce treatment costs, improve patient outcomes, reduce length of stay and decrease the average daily dose of vancomycin.
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Affiliation(s)
- Hai-Yen Nguyen-Thi
- Department of Pharmaceutical Administration, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Duy-Anh Nguyen
- Department of Pharmaceutical Administration, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Phuong-Thao Huynh
- Department of Pharmacy, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Nguyen Dang Tu Le
- Department of Pharmaceutical Administration, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Ababneh MA, Nasser SA, Rababa'h AM. A systematic review of Antimicrobial Stewardship Program implementation in Middle Eastern countries. Int J Infect Dis 2021; 105:746-752. [PMID: 33737132 DOI: 10.1016/j.ijid.2021.03.035] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a serious threat to global health. Antimicrobial Stewardship Programs (ASPs) are adopted by healthcare systems worldwide. This review aimed to evaluate the published practices of ASPs in Middle Eastern countries. METHODS Searches were carried out in PubMed/MEDLINE, Embase, EBSCO, Cochrane Library, Google, and Google Scholar electronic databases for studies published from January 2005 to December 2020 that assessed ASP practices in Middle Eastern countries, following PRISMA guidelines. RESULTS Of the 422 titles identified, 20 studies met the inclusion criteria. Eight studies were conducted in the Kingdom of Saudi Arabia, five in Qatar, two each in Lebanon and Jordan, and one each in Palestine and UAE; there was also one multinational study. Different ASP practices, including prospective auditing and feedback, pre-authorization, tracking, antibiotic restriction, education, de-escalation, and intravenous-to-oral switch, were reported. ASP practices correlated with improved susceptibility rates and decreases in antimicrobial use. CONCLUSION The outcomes of this review reveal the scarcity of data on ASP practices. The introduction of ASPs in hospitals in Middle Eastern countries has led to favorable clinical effects. Policymakers and stakeholders should promote and invest in implementing these programs as an essential component of their healthcare systems.
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Affiliation(s)
- Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan.
| | - Sara A Nasser
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Abeer M Rababa'h
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Johnson MD, Lewis RE, Dodds Ashley ES, Ostrosky-Zeichner L, Zaoutis T, Thompson GR, Andes DR, Walsh TJ, Pappas PG, Cornely OA, Perfect JR, Kontoyiannis DP. Core Recommendations for Antifungal Stewardship: A Statement of the Mycoses Study Group Education and Research Consortium. J Infect Dis 2021; 222:S175-S198. [PMID: 32756879 DOI: 10.1093/infdis/jiaa394] [Citation(s) in RCA: 76] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In recent years, the global public health community has increasingly recognized the importance of antimicrobial stewardship (AMS) in the fight to improve outcomes, decrease costs, and curb increases in antimicrobial resistance around the world. However, the subject of antifungal stewardship (AFS) has received less attention. While the principles of AMS guidelines likely apply to stewarding of antifungal agents, there are additional considerations unique to AFS and the complex field of fungal infections that require specific recommendations. In this article, we review the literature on AMS best practices and discuss AFS through the lens of the global core elements of AMS. We offer recommendations for best practices in AFS based on a synthesis of this evidence by an interdisciplinary expert panel of members of the Mycoses Study Group Education and Research Consortium. We also discuss research directions in this rapidly evolving field. AFS is an emerging and important component of AMS, yet requires special considerations in certain areas such as expertise, education, interventions to optimize utilization, therapeutic drug monitoring, and data analysis and reporting.
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Affiliation(s)
- Melissa D Johnson
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Russell E Lewis
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Elizabeth S Dodds Ashley
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Luis Ostrosky-Zeichner
- Division of Infectious Diseases, Laboratory of Mycology Research, McGovern Medical School, Houston, Texas, USA
| | - Theoklis Zaoutis
- Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George R Thompson
- Division of Infectious Diseases, Department of Internal Medicine, University of California, Davis, Sacramento, California, USA
| | - David R Andes
- Department of Medicine and Department of Medical Microbiology and Immunology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Thomas J Walsh
- Transplantation-Oncology Infectious Diseases, Weill Cornell Medicine of Cornell University, New York, New York, USA
| | - Peter G Pappas
- Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Oliver A Cornely
- Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany.,German Centre for Infection Research, partner site Bonn-Cologne, Cologne, Germany.,CECAD Cluster of Excellence, University of Cologne, Cologne, Germany.,Clinical Trials Center Cologne, University Hospital of Cologne, Cologne, Germany
| | - John R Perfect
- Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina, USA
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, MD Anderson Cancer Center, Houston, Texas, USA
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Feriani D, Souza EE, Carvalho LGM, Ibanes AS, Vasconcelos E, Barbosa VL, Kondo SK, Abboud CS. Is it cost effective to use a 2% chlorhexidine wipes bath to reduce central-line associated blood stream infection? A quasi-experimental study. Braz J Infect Dis 2021; 25:101538. [PMID: 33515494 PMCID: PMC9392115 DOI: 10.1016/j.bjid.2021.101538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/03/2020] [Accepted: 12/20/2020] [Indexed: 12/02/2022] Open
Abstract
Background Bathing with 2% chlorhexidine (CHG) wipes is an important measure regarding infection prevention in critically ill patients. The aim of this study was to evaluate the impact of CHG wipes bath to prevent central-line associated bloodstream infection (CLABSI) in critically ill patients and determine if such measure is cost-saving. Methods a quasi-experimental study, conducted from July 2017 to April 2019. Daily bath with 2% CHG was used in all patients at the unit in the intervention period. The following were evaluated: CLABSI incidence density in both periods, 30- day mortality, guided antimicrobials used to treat CLABSI and 2% CHG costs. Results CLABSI incidence density dropped from 8.69 to 1.83 per 1.000 central line-days (p = 0.001), mainly by Klebsiella pneumoniae Carbapenen Resistant (Kp-KPC) (p = 0.05). Costs with guided antimicrobials for the treatment in pre-intervention were US$ 46,114.36, and in the intervention period, US$ 4,177.50. The 2% CHG monthly cost was US$ 2,698.00, achieving 30% savings when comparing both periods. Discussion An expressive reduction of 79% in CLABSI incidence density was observed, mainly due to Kp-KPC infection and also a reduction in guided antimicrobial costs. Conclusions Bathing with 2% CHG led to evident CLABSI reduction.
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Affiliation(s)
- Diego Feriani
- Instituto Dante Pazzanese de Cardiologia, Departmento de Infectologia, São Paulo, SP, Brazil
| | | | | | - Aline Santos Ibanes
- Instituto Dante Pazzanese de Cardiologia, Departmento de Infectologia, São Paulo, SP, Brazil
| | - Eliana Vasconcelos
- Instituto Dante Pazzanese de Cardiologia, Departmento de Infectologia, São Paulo, SP, Brazil
| | - Vera Lucia Barbosa
- Instituto Dante Pazzanese de Cardiologia, Departmento de Infectologia, São Paulo, SP, Brazil
| | - Sandra Kiyomi Kondo
- Instituto Dante Pazzanese de Cardiologia, Departmento de Farmácia, São Paulo, SP, Brazil
| | - Cely S Abboud
- Instituto Dante Pazzanese de Cardiologia, Departmento de Infectologia, São Paulo, SP, Brazil.
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Shafat T, Shimoni O, Nikonov A, Nesher L. The Kinetics of an Antibiotic Stewardship Intervention: A Quasi-Experimental Study. Infect Dis Ther 2021; 10:613-619. [PMID: 33515415 PMCID: PMC7954991 DOI: 10.1007/s40121-021-00403-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Little is known about the kinetics and different phases of a successful antibiotic stewardship program (ASP) intervention. Methods We analyzed the trends of quarterly antibiotic use measured in defined daily dose (DDD)/100 days hospitalization using the Joinpoint Regression Program and interrupted time series analysis to objectively identify shifts in the trends of antibiotic use. We correlated these changes in trends with the introduction of a hospital-wide ASP intervention. Results The ASP intervention reduced the overall antibiotic use by 33%, from a prior steady state of 76.5 DDD/100 days hospitalization to a post-intervention steady state of 51.2 DDD/100 days hospitalization (p < 0.001). We identified four distinct phases in the trends: prior steady state (A), early intervention (B), accelerated phase (C), and post steady state (D). From A to B a change of slope (−1.46) [SE 0.37, 95% CI −2.23, −0.69 (p = 0.002)]; B to C, a further decrease of slope (−4.70) [SE 0.64, 95% CI −6.03, −3.37 (p = 0.001)]; between periods C and D, straightening out of the slope (+ 6.84) [SE 0.55, 95% CI 5.70, 7.98 (p < 0.001)] to a new post-intervention steady state. It took 1.5 years after completion of the intervention to reach the new steady state. Conclusions We demonstrate that ASP interventions require time to achieve the maximal effect. Successful interventions require physicians to adapt new prescribing behaviors and gain confidence in the change; this adaptation can be a prolonged process and might even take years after the introduction of the ASP. These factors should be considered when planning and implementing ASP interventions.
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Affiliation(s)
- Tali Shafat
- Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.,Clinical Research Center, Soroka University Medical Center, Beer Sheba, Israel
| | - Orly Shimoni
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.,Pharmacy Services, Soroka University Medical Center, Beer Sheba, Israel
| | - Anna Nikonov
- Pharmacy Services, Soroka University Medical Center, Beer Sheba, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
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Novel method of calculating adjusted antibiotic use by microbiological burden. Infect Control Hosp Epidemiol 2021; 42:688-693. [PMID: 33504376 DOI: 10.1017/ice.2020.1285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics. DESIGN Retrospective, observational, cross-sectional study. SETTING Hospitals in the southeastern United States. METHODS AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)-producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared. RESULTS Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016. CONCLUSIONS The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.
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Panditrao A, Shafiq N, Kumar-M P, Sekhon AK, Biswal M, Singh G, Kaur K, Ray P, Malhotra S, Gautam V, Gupta R, Gupta V, Yadav TD, Laroiya I, Kumar H, Salvania A. Impact of an antimicrobial stewardship and monitoring of infection control bundle in a surgical intensive care unit of a tertiary-care hospital in India. J Glob Antimicrob Resist 2021; 24:260-265. [PMID: 33476838 DOI: 10.1016/j.jgar.2021.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 12/29/2020] [Accepted: 01/11/2021] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship (AMS) in resource-limited settings lacks models that can be readily adapted to their settings. Here we discuss the impact of a combined strategy of AMS and monitoring of infection control practices in a tertiary-care centre of a developing country. METHODS This study was undertaken in the surgical unit of a tertiary-care hospital over an 8-month period. In the first 2 months (baseline phase), prospective audit and feedback alone was undertaken, while in the next 6 months (intervention phase) this was supplemented with strategies such as antimicrobial timeout, correction of doses and bundle approach for prevention of hospital-acquired infections. RESULTS A total of 337 patients were included (94 in the baseline phase and 243 in the intervention phase). There was a decrease in days of therapy per 1000 patient-days (1000PD) (1112.3 days vs. 1048.6 days), length of therapy per 1000PD (956 days vs. 936.3 days) and defined daily doses (DDD) per 1000PD for most antimicrobials. A decrease in double cover for Gram-negative infections (9.6% vs. 2.9%) but an increase in double anaerobic cover (4.2% vs. 7.4%) was observed. There was a decrease in the incidence of ventilator-associated pneumonia per 1000 ventilator-days in the intervention phase (46.4 vs. 35.4), whereas central line-associated bloodstream infections per 1000 central line-days remained the same (14.7 vs. 14.8). CONCLUSION This study shows that implementation of routine AMS activities with monitoring of infection control practices can help decrease overall antimicrobial use. With furtherance of measures to control infection, antimicrobial use may be further curtailed.
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Affiliation(s)
- Aditi Panditrao
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Nusrat Shafiq
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
| | - Praveen Kumar-M
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Amritpal Kaur Sekhon
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Gurpreet Singh
- Department of General Surgery, PGIMER, Chandigarh, India
| | | | - Pallab Ray
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Samir Malhotra
- Department of Pharmacology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India
| | - Vikas Gautam
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Rajesh Gupta
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Vikas Gupta
- Department of General Surgery, PGIMER, Chandigarh, India
| | - T D Yadav
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Ishita Laroiya
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Hemanth Kumar
- Department of General Surgery, PGIMER, Chandigarh, India
| | - Ajay Salvania
- Department of General Surgery, PGIMER, Chandigarh, India
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Poline J, Postaire M, Parize P, Pilmis B, Bille E, Zahar JR, Frange P, Cohen JF, Lortholary O, Toubiana J. Stewardship program on carbapenem prescriptions in a tertiary hospital for adults and children in France: a cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:1039-1048. [PMID: 33389261 PMCID: PMC7778866 DOI: 10.1007/s10096-020-04103-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/05/2020] [Indexed: 01/31/2023]
Abstract
Antimicrobial stewardship programs aim at reducing the overuse of broad-spectrum antibiotics such as carbapenems, but their impact remains unclear. We compared the use of carbapenems between paediatric and adult subjects admitted to a French tertiary hospital and described the intervention of an antibiotic stewardship team (AST). As part of AST routine activity, all adult and paediatric patients receiving carbapenems are identified in real time using a computer-generated alert system and reviewed by the AST. Data associated with carbapenem prescriptions were extracted for 2 years (2014-2015) and were compared between paediatric and adult wards. Prescription appropriateness (i.e. no clinically suitable narrower spectrum alternative to carbapenem for de-escalation) and AST intervention were analysed. In total, 775 carbapenem prescriptions for 291 children and 262 adults were included. Most patients (95%) had a comordity and 52% had known recent carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE). Most carbapenem prescriptions came from intensive care units (n = 269, 35%) and were initiated for urinary tract (n = 200, 27%), sepsis (n = 181, 25%), and lung (n = 153, 21%) infections. Carbapenems were initiated empirically in 537 (70%) cases, and an organism was isolated in 523 (67%) cases. Among the isolated organisms, 47% (n = 246) were ESBLE and 90% (n = 468) were susceptible to carbapenems, but an alternative existed in 61% (n = 320) of cases according to antibiotic susceptibility testing. Among prescriptions reviewed by the AST, 39% (n = 255) were considered non-appropriate and led to either antibiotic discontinuation (n = 47, 7%) or de-escalation (n = 208, 32%). Non-appropriate prescriptions were more frequent in paediatric wards (p = 0.01) and in microbiologically documented infections (p = 0.013), and less observed in immunocompromised patients (p = 0.009) or with a known ESBLE carriage (p < 0.001). Tailored stewardship programs are essential to better control carbapenem use and subsequent antimicrobial resistance.
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Affiliation(s)
- Julie Poline
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015 Paris, France ,Department of Gut Inflammation, Center for Research on Inflammation CRI, INSERM 1149, Université de Paris, 75006 Paris, France
| | - Martine Postaire
- Department of Pharmacy, Hôpital Necker–Enfants Malades, APHP, Université de Paris, Paris, France
| | - Perrine Parize
- Department of Infectious Diseases and Tropical Medicine, Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université de Paris, IHU Imagine, Paris, France
| | - Benoit Pilmis
- Department of Infectious Diseases and Tropical Medicine, Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université de Paris, IHU Imagine, Paris, France
| | - Emmanuelle Bille
- Department of Microbiology, Necker Enfants-Malades Hospital, APHP, Université de Paris, Paris, France
| | - Jean Ralph Zahar
- Department of Microbiology, Necker Enfants-Malades Hospital, APHP, Université de Paris, Paris, France ,Infection Control Unit, IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - Pierre Frange
- Department of Microbiology, Necker Enfants-Malades Hospital, APHP, Université de Paris, Paris, France
| | - Jérémie F. Cohen
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - Olivier Lortholary
- Department of Infectious Diseases and Tropical Medicine, Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université de Paris, IHU Imagine, Paris, France
| | - Julie Toubiana
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015 Paris, France ,Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
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