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Tang L, Liu H, Wu S, Liu J, Jiang X, Fu Y, Tao N, He Y. A point prevalence survey and monitoring indicator research on the second batch of national key monitoring and rational use drugs. Front Pharmacol 2024; 15:1416010. [PMID: 39035987 PMCID: PMC11257963 DOI: 10.3389/fphar.2024.1416010] [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: 04/11/2024] [Accepted: 06/13/2024] [Indexed: 07/23/2024] Open
Abstract
Background With the remarkable effect of controlling the increase in drug costs by the first batch of National Key Monitoring and Rational Use Drugs (first NKMRUDs), the National Health Commission of the People's Republic of China releases the second NKMRUDs to further strengthen the reasonable use of drugs. Unfortunately, the second NKMRUDs include some drugs of National Volume-based Procurement and National Essential Medicines, which challenges the management of pharmaceutical affairs on the three kinds of drugs. Objective The main objective of this study was to investigate the prevalence of the second NKMRUDs and explore their monitoring indicators. Methods An adapted WHO methodology for point prevalence surveys was conducted for the second NKMRUDs. For the monitoring indicators, we sought to explore whether the defined daily dose (DDD) and days of therapy (DOT) can be suitable for the second NKMRUDs through comparing differences between DDD and DOT with the prescribed daily dose (PDD). Results Among the 935 included patients, 29.20% of the patients received at least one of the second NKMRUDs. A total of 273 patients were administered with 487 times of the second NKMRUDs. Among them, 162 , 62 , and 49 patients were receiving one, two, and three or more agents, respectively. The most commonly prescribed second NKMRUDs were compound amino acids, budesonide, and ceftazidime. The total DDDs and DOTs of the second NKMRUDs were 3360.68 and 1819.80, respectively, with the PDDs of 1865.26. The deviations (80.17%) of DDDs from PDDs were significantly greater than those (-2.44%) of DOTs. Conclusion The prevalence of the second NKMRUDs was obtained by using the adapted PPS methodology at a tertiary university hospital. The DOT indicator is found to more accurately reflect actual consumption than the DDD indicator for second NKMRUDs. It is recommended to use the DOT indicator to monitor second NKMRUDs.
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Affiliation(s)
- Li Tang
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongmei Liu
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shasha Wu
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jing Liu
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xiaoyu Jiang
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yuanyuan Fu
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Na Tao
- Department of Pharmacy, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yong He
- Department of Pharmacy, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
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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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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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4
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Alves J, Prendki V, Chedid M, Yahav D, Bosetti D, Rello J. Challenges of antimicrobial stewardship among older adults. Eur J Intern Med 2024; 124:5-13. [PMID: 38360513 DOI: 10.1016/j.ejim.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/06/2024] [Accepted: 01/15/2024] [Indexed: 02/17/2024]
Abstract
Older adults hospitalized in internal medicine wards or long-term care facilities (LTCF) are progressively increasing. Older adults with multimorbidity are more susceptible to infections, as well as to more vulnerable to adverse effects (and interactions) of antibiotics, resulting in a need for effective and safer strategies for antimicrobial stewardship (ASM), both in hospitalization wards and long-term care facilities. Studies on antimicrobial stewardship in older patients are scarce and guidelines are required. Given the peculiarities of the optimization of antimicrobial prescription in individual older adults for common infections, tactics to overcome barriers need an update. The use of rapid diagnosis tests, biomarkers, de-escalation and switching from intravenous to oral/subcutaneous therapy strategies are examples of successful AMS interventions. AMS interventions are associated with reduced side effects, lower mortality, shorter hospital stays, and reduced costs. The proposed AMS framework in LTCF should focus on five domains: strategic vision, team, interventions, patient-centred care and awareness. Internists can partner with geriatrists, pharmacists and infectious disease specialists to address barriers and to improve patient care.
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Affiliation(s)
- Joana Alves
- Infectious Diseases Specialist, Head of Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance, Hospital de Braga, Portugal.
| | - Virginie Prendki
- Department of Internal Medicine for the Aged, Department of Rehabilitation and Geriatrics, Geneva University Hospitals, Geneva, Switzerland; Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Marie Chedid
- Department of Infectious Disease, Geneva University Hospital, Switzerland
| | - Dafna Yahav
- Infectious Diseases Unit, Sheba Medical Centre, Ramat Gan, Israel
| | - Davide Bosetti
- Department of Infectious Disease, Geneva University Hospital, Switzerland; Infection Control Programme and WHO Collaborating Centre for Infection Prevention and Control and Antimicrobial Resistance, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jordi Rello
- Medicine Department, Universitat Internacional de Catalunya, Spain; Clinical Research Pneumonia and Sepsis (CRIPS) Research Group-Vall d'Hebrón Institute Research (VHIR), Barcelona, Spain; Formation, Recherche, Evaluation (FOREVA), CHU Nîmes, Nîmes, France
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5
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Tan R, Kavishe G, Luwanda LB, Kulinkina AV, Renggli S, Mangu C, Ashery G, Jorram M, Mtebene IE, Agrea P, Mhagama H, Vonlanthen A, Faivre V, Thabard J, Levine G, Le Pogam MA, Keitel K, Taffé P, Ntinginya N, Masanja H, D'Acremont V. A digital health algorithm to guide antibiotic prescription in pediatric outpatient care: a cluster randomized controlled trial. Nat Med 2024; 30:76-84. [PMID: 38110580 PMCID: PMC10803249 DOI: 10.1038/s41591-023-02633-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/06/2023] [Indexed: 12/20/2023]
Abstract
Excessive antibiotic use and antimicrobial resistance are major global public health threats. We developed ePOCT+, a digital clinical decision support algorithm in combination with C-reactive protein test, hemoglobin test, pulse oximeter and mentorship, to guide health-care providers in managing acutely sick children under 15 years old. To evaluate the impact of ePOCT+ compared to usual care, we conducted a cluster randomized controlled trial in Tanzanian primary care facilities. Over 11 months, 23,593 consultations were included from 20 ePOCT+ health facilities and 20,713 from 20 usual care facilities. The use of ePOCT+ in intervention facilities resulted in a reduction in the coprimary outcome of antibiotic prescription compared to usual care (23.2% versus 70.1%, adjusted difference -46.4%, 95% confidence interval (CI) -57.6 to -35.2). The coprimary outcome of day 7 clinical failure was noninferior in ePOCT+ facilities compared to usual care facilities (adjusted relative risk 0.97, 95% CI 0.85 to 1.10). There was no difference in the secondary safety outcomes of death and nonreferred secondary hospitalizations by day 7. Using ePOCT+ could help address the urgent problem of antimicrobial resistance by safely reducing antibiotic prescribing. Clinicaltrials.gov Identifier: NCT05144763.
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Affiliation(s)
- Rainer Tan
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland.
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania.
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
- University of Basel, Basel, Switzerland.
| | - Godfrey Kavishe
- National Institute of Medical Research - Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Lameck B Luwanda
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Alexandra V Kulinkina
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Sabine Renggli
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Chacha Mangu
- National Institute of Medical Research - Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Geofrey Ashery
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Margaret Jorram
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | | | - Peter Agrea
- National Institute of Medical Research - Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Humphrey Mhagama
- National Institute of Medical Research - Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Alan Vonlanthen
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Vincent Faivre
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Julien Thabard
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Gillian Levine
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Marie-Annick Le Pogam
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Kristina Keitel
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
- Pediatric Emergency Department, Department of Pediatrics, University Hospital Bern, Bern, Switzerland
| | - Patrick Taffé
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Nyanda Ntinginya
- National Institute of Medical Research - Mbeya Medical Research Centre, Mbeya, United Republic of Tanzania
| | - Honorati Masanja
- Ifakara Health Institute, Dar es Salaam, United Republic of Tanzania
| | - Valérie D'Acremont
- Centre for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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6
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Castagnola E, Lorenzi I, Barabino P, Pistorio A. Antibiotic defined daily dose in pediatrics. A single center study to proof the principle that a specific pediatric definition could be not needed. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:559-562. [PMID: 36710161 DOI: 10.1016/j.eimce.2022.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To evaluate if a specific pediatric defined daily dose (PeDDD) can be replaced with the defined daily dose (DDD) indicated by World Health Organization (WHO). METHODS The 50th percentile of body weight for age of children admitted from 2016 to 2020 at Istituto Giannina Gaslini, Genoa, Italy, was used to calculate PeDDD for vancomycin at 40mg/kg and meropenem at 60mg/kg. Data obtained were then used to calculate the PeDDD number based on the amount of drugs delivered quarterly from 2012 to 2016. Subsequently the DDD number was calculated for vancomycin at 2g and meropenem at 3g. With these results two curves were generated which were then compared for parallelism and area under the curve (AUC). RESULTS PeDDD was found to be 2.6 times DDD for both drugs, but both curves obtained were parallel and the AUCs were identical CONCLUSIONS: DDD according to WHO definition could be adopted in pediatrics to measure antibiotic consumption and therefore no specific PeDDD could be needed.
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Martinez YG, Tran M, Roduta T, Lam S, Price T, Stramel S. The Impact of an Antimicrobial Stewardship Clinical Pharmacy Specialist on Antimicrobial Days of Therapy through Education Driven Policies, Procedures, and Interventions. PHARMACY 2023; 11:137. [PMID: 37736909 PMCID: PMC10514815 DOI: 10.3390/pharmacy11050137] [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: 05/14/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
The primary goal of antimicrobial stewardship is to improve patient outcomes and minimize the consequences of antibiotic use. Prospective audit and feedback cannot always be performed by an antimicrobial stewardship program member which is where policies, procedures and education can aid interventions. The purpose of this study was to evaluate the impact on antimicrobial days of therapy due to a dedicated clinical pharmacy specialist primarily responsible for developing policies and procedures and providing education. A pre-intervention and post-intervention retrospective analysis of antimicrobial days of therapy from September 2019-May 2020 and July 2020-March 2021 was performed. Inclusion criteria consisted of adults receiving IV vancomycin, azithromycin, meropenem, ciprofloxacin, and/or levofloxacin. Excluded criteria consisted of documented interventions that were not related to implemented policies and procedures or performed education and patients receiving antimicrobial surgical prophylaxis. The primary outcome was antimicrobial days of therapy. An average of 3.47 ± 2.46 days (pre-intervention, n = 203) and 3.21 ± 2.52 days (post-intervention, n = 203) were observed for the primary outcome (p < 0.04182). Pharmacists performed 75 interventions pre-intervention and 102 interventions post-intervention (p = 0.0092). The implementation of a dedicated antimicrobial stewardship clinical pharmacy specialist responsible for developing policies, procedures, and education successfully reduced antimicrobial days of therapy and documented interventions.
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Affiliation(s)
- Yolanda G. Martinez
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - MaiCuc Tran
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - Thomas Roduta
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - Susan Lam
- Memorial Hermann Health System, Houston, TX 77024, USA;
| | - Todd Price
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - Stefanie Stramel
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
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Wang X, Wang K, Xie F, Han Z, Liu Y, Pan L, Zhu G, Cao Z, Yan P, Xiao L, Duan Z, Hu Y, Xiao K, Chen X, Fu H, Shi Y, Song Y, Han X, Xie W, Xie L. Protocol of a multicenter, single-blind, randomized, parallel controlled trial evaluating the effect of microbiological rapid on-site evaluation (M-ROSE) guiding anti-infection treatment in patients with severe hospital-acquired pneumonia. Trials 2023; 24:552. [PMID: 37612723 PMCID: PMC10464107 DOI: 10.1186/s13063-023-07570-z] [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: 04/23/2023] [Accepted: 08/05/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION The mortality rate of hospitalized patients with severe hospital-acquired pneumonia (SHAP) remains high. Empirical broad-spectrum antibiotic coverage and the misuse of high-grade antibiotics could lead to the emergence of multi-drug and even pandrug-resistant bacteria. In addition to metagenomic next-generation sequencing (mNGS), microbiological rapid on-site evaluation (M-ROSE) might be a useful technique to identify the pathogens in the early stage; however, the effect of M-ROSE guiding anti-infection treatment on prognostic outcomes of SHAP patients is still unclear. METHODS/DESIGN This is a multicenter, single-blind, prospective, randomized controlled trial to evaluate the effect of M-ROSE guiding anti-infection treatment in SHAP patients, which will provide new strategies for the prevention and control of clinical multi-drug resistance bacteria. A total of 166 patients with SHAP, aged 18 years and over, will be recruited from seven centers in Beijing and randomly assigned to the intervention group (M-ROSE combined with mNGS) or the control group (mNGS only) in a 1:1 ratio using the central randomization system. Patients in the intervention group will accept M-ROSE and mNGS analysis, and the control group will accept mNGS analysis. Individualized anti-infective treatment and routine treatment will be selected according to the analysis results. The primary outcome is the ICU outcome (mortality). The safety of the intervention measures will be evaluated during the entire trial period. This trial will be the first randomized controlled trial to evaluate the effect of M-ROSE guiding treatment on mortality in patients with SHAP and may change the prevalence of multi-drug resistant bacteria. ETHICS AND DISSEMINATION This trial adheres to the Declaration of Helsinki and guidelines of Good Clinical Practice. Signed informed consent will be obtained from all participants. The trial has been approved by the Chinese PLA General Hospital (Approval Number: 20220322001). TRIAL REGISTRATION ClinicalTrials.gov NCT05300776. Registered on 25 March 2022.
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Affiliation(s)
- Xiuli Wang
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Kaifei Wang
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Fei Xie
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhihai Han
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yuhong Liu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Lei Pan
- Department of Respiratory and Critical Care, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Guangfa Zhu
- Department of Respiratory and Critical Care Medicine, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhixin Cao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Peng Yan
- Department of Respiratory and Critical Care Medicine, AMHT Group Aerospace 731 Hospital, Beijing, China
| | - Li Xiao
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Zhimei Duan
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Ye Hu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Kun Xiao
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Xuxin Chen
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Han Fu
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Yinghan Shi
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
- Chinese PLA Medical School, Beijing, China
| | - Yuwei Song
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Xiaobo Han
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China
| | - Wuxiang Xie
- Peking University Clinical Research Institute, Peking University Health Science Center, No. 38 Xueyuan Road, Haidian District, Beijing, 100191, China.
| | - Lixin Xie
- College of Pulmonary and Critical Care Medicine, Chinese PLA General Hospital, Beijing, China.
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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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10
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Pantoja A, Sveum S, Frost S, Duran A, Burks J, Schernecke C, Feinberg M. New strategies to Reduce Unnecessary Antibiotic Use in the NICU: A Quality Improvement Initiative. Pediatr Qual Saf 2023; 8:e659. [PMID: 38571732 PMCID: PMC10990351 DOI: 10.1097/pq9.0000000000000659] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 05/05/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction Early-onset sepsis (EOS) and late-onset Sepsis (LOS) are common diagnoses entertained in sick newborns treated in neonatal intensive care units (NICUs), and antibiotics are the medications most prescribed in NICUs. Antibiotic stewardship programs have an important impact on limiting unnecessary antibiotic use. Methods Following the Model for Improvement, between 2/1/16 and 1/31/17, at a level 3 NICU, a multidisciplinary team implemented PDSA cycles to promote antibiotic stewardship practices for newborns at risk of EOS and LOS. The main goal was to decrease the antibiotic usage rate (AUR) safely. Primary strategies included discontinuing antibiotics within 24 hours of life if the newborn was stable, and the blood culture was negative for EOS and implementing an "antibiotic time-out" during rounds. Results For all newborns admitted to our NICU, the AUR decreased, for EOS from 137 to 32 days per 1000 patient days (77% reduction) and for LOS from 277 to 121 days per 1000 patient days (56% reduction). We demonstrated the sustainability of both EOS-AUR and LOS-AUR during the 2 years postcompletion of the intervention period. There were no adverse effects of reducing the AUR. Conclusion Interventions that reduce unnecessary antibiotic use in the NICU are safe and prevent excessive antibiotic exposure.
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Affiliation(s)
- Alfonso Pantoja
- From the Saint Joseph Hospital, Denver, Colo
- Colorado Permanente Medical Group, Denver, CO
| | - Scott Sveum
- From the Saint Joseph Hospital, Denver, Colo
- Vail Health, Frisco, CO
| | | | | | - Jeanne Burks
- From the Saint Joseph Hospital, Denver, Colo
- Envision Physician Services, Phoenix, AZ
| | - Christi Schernecke
- From the Saint Joseph Hospital, Denver, Colo
- Methodist Dallas Medical Center, Dallas TX
| | - Michelle Feinberg
- From the Saint Joseph Hospital, Denver, Colo
- Colorado Permanente Medical Group, Denver, CO
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11
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Dutra Lima DM, Rezende RV, Oliveira Diniz LM, Anchieta LM, Maia de Castro Romanelli R. Evaluation of antimicrobial consumption in the neonatal population undergoing to stewardship programs: A systematic review Antimicrobial consumption in neonatal population. J Hosp Infect 2023; 135:106-118. [PMID: 36958700 DOI: 10.1016/j.jhin.2023.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/10/2023] [Accepted: 03/11/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND The indiscriminate antimicrobials use in neonatal sepsis treatment contributes to abusive consumption and optimize prescription programs are encouraged as way to reduce the inappropriate use. Thus, the objective was to evaluate the impact of intervention programs for adequate antimicrobial use (Antimicrobial Stewardship Programs - ASP) in consumption measurements of such drugs in neonatology. METHODS The search for articles was performed in electronic databases and manual search for citations in publications initially identified. Electronic databases searched were BVS, Cochrane Library, Embase, MEDLINE/PubMed, SciELO, Scopus and Web of Science. There was no date or period limit for including of articles. The PICO question was defined as populations of neonates admitted to neonatal intensive care units (NICU) (P) undergoing an intervention program to optimize antimicrobial therapy (I) in relation to neonates not exposed to the program (C) and the outcome obtained in antimicrobials consumption (O). RESULTS The initial search in databases resulted in 1223 articles. Articles were screened and sixteen original studies related to subject were selected, which conducted a quantitative approach to antimicrobials consumption for population of interest. Most articles used days of therapy (DOT) as the main measure of antimicrobial consumption and have had a high-quality rating by Newcastle Ottawa scale (NOS). All studies were carried out in local hospitals at a single-centre and most ones in high-income countries. CONCLUSION Of all studies resulting from search, few evaluated antimicrobial consumption in Neonatology. New studies are needed, and DOT proved to be the most adequate metric to measure consumption.
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Affiliation(s)
- Dalila Maria Dutra Lima
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Belo Horizonte, MG, Brazil.
| | | | - Lilian Martins Oliveira Diniz
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil.
| | - Lêni Márcia Anchieta
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Unidade Neonatal, Belo Horizonte, MG, Brazil.
| | - Roberta Maia de Castro Romanelli
- Universidade Federal de Minas Gerais (UFMG), Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, MG, Brazil; Universidade Federal de Minas Gerais (UFMG), Hospital das Clínicas, Comissão de Controle e Infecção Hospitalar, Belo Horizonte, MG, Brazil.
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12
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Villanueva-Bueno C, Montecatine-Alonso E, Jiménez-Parrilla F, González-López M, Manrique-Rodríguez S, Moreno-Ramos F, Cañete-Ramírez C, Dolz E, García-Robles A, Caro-Teller JM, Moral-Pumarega MT, Bergon-Sendin E, Gómez-Trevecedo Calvo MT, Gallego-Fernández C, del Vayo-Benito CÁ, Mejías-Trueba M, Gil-Navarro MV. Antimicrobial Defined Daily Dose in Neonatal Population: Validation in the Clinical Practice. Antibiotics (Basel) 2023; 12:antibiotics12030602. [PMID: 36978469 PMCID: PMC10044623 DOI: 10.3390/antibiotics12030602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/21/2023] [Accepted: 03/09/2023] [Indexed: 03/19/2023] Open
Abstract
Background: Currently, there is no validated method for estimating antimicrobial consumption in the neonatal population, as it exists for adults using Defined Daily Doses (DDD). In neonatology, although there are different methods, each one with advantages and disadvantages, there is no unified criterion for use. The aim of this study is to validate the neonatal DDD designed as a new standardised form of antimicrobial consumption over this population. Methods: The validation of the neonatal DDD, Phase II of the research project, was carried out through a descriptive observational study. Periodic cut-offs were performed to collect antimicrobial prescriptions of neonates admitted to the neonatology and intensive care units of nine Spanish hospitals. The data collected included demographic variables (gestational age, postnatal age, weight and sex), antimicrobial dose, frequency and route of administration. The selection of the optimal DDD value takes into account power value, magnitude obtained from the differences in the DDD, statistical significance obtained by the Wilcoxon test and degree of agreement in the stipulated doses. Results: Set of 904 prescriptions were collected and finally 860 were analysed based on the established criteria. The antimicrobials were mostly prescribed in the intensive care unit (63.1%). 32 different antimicrobials were collected, and intravenous administration was the most commonly used route. Neonatal DDD were defined for 11 different antimicrobials. A potency > 80% was obtained in 7 antibiotics. The 57.1% of the selected DDD correspond to phase I and 21.4% from phase II. Conclusion: DDD validation has been achieved for the majority of intravenously administered antimicrobials used in clinical practice in the neonatal population. This will make it possible to have an indicator that will be used globally to estimate the consumption of antimicrobials in this population, thus confirming its usefulness and applicability.
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Affiliation(s)
- Cristina Villanueva-Bueno
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, 28007 Madrid, Spain
- Correspondence:
| | | | | | - María González-López
- Department of Neonatology, Hospital Regional Universitario de Málaga, 29010 Málaga, Spain
| | - Silvia Manrique-Rodríguez
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañon, 28007 Madrid, Spain
| | | | - Carme Cañete-Ramírez
- Department of Pharmacy, Hospital Universitario Vall d’Hebron, 08035 Barcelona, Spain
| | - Elisenda Dolz
- Department of Pharmacy, Complejo Hospitalario Universitario Insular-Materno Infantil, 35016 Las Palmas de Gran Canarias, Spain
| | - Ana García-Robles
- Division of Pharmacy, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
| | - José Manuel Caro-Teller
- Department of Pharmacy, Hospital Universitario 12 de Octubre, Research Institute 12 de Octubre i+12, 28041 Madrid, Spain
| | | | - Elena Bergon-Sendin
- Department of Neonatology, Hospital Universitario 12 de Octubre, 28041 Madrid, Spain
| | | | | | | | - Marta Mejías-Trueba
- Department of Pharmacy, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain (M.M.-T.)
- Department of Infectious Diseases, Microbiology and Parasitology, Institute of Biomedicine of Seville, University Hospital Virgen del Rocío, Spanish National Research Council, University of Seville, 41013 Seville, Spain
| | - María Victoria Gil-Navarro
- Department of Pharmacy, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain (M.M.-T.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital, CSIC, University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, 28029 Madrid, Spain
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13
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Development of Antimicrobial Defined Daily Dose (DDD) for the Pediatric Population. Antibiotics (Basel) 2023; 12:antibiotics12020276. [PMID: 36830187 PMCID: PMC9952639 DOI: 10.3390/antibiotics12020276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 01/23/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Antimicrobial stewardship programs (ASPs) optimize antimicrobial use, improve patient outcomes, and reduce resistance. To assess the effectiveness of ASPs, it is necessary to have indicators that can be widely used. Defined daily dose (DDD) was designed by WHO for the adult population as a consumption indicator. However, there are no DDDs adapted to the pediatric population. The main objective of this study is to establish the most appropriate DDD values in this population. An observational, retrospective, multicenter study was conducted. Antimicrobial prescriptions were collected from pediatric wards of seven Spanish tertiary hospitals for 2 years. The DDDs obtained from the prescriptions were compared with the theoretical DDDs agreed upon in the first stage. To select the optimal DDD, the following were analyzed: power value, magnitude obtained from the differences in the DDD, statistical significance, and degree of agreement in the stipulated doses. A total of 4788 prescriptions were collected. Pediatric DDD was defined for 30 different antimicrobials. A potency >80% was obtained in 24 antibiotics. 51.2% of the selected DDD correspond to Phase I and 39.5% from Phase II. Pediatric DDD of different antimicrobials was obtained, providing an indicator that can be used globally in different hospitals to analyze the consumption and efficacy of ASPs.
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14
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Feng K, He Y, Liu W, Zhang X, Song P, Hua Z. Evaluation of antibiotic stewardship among near-term and term infants admitted to a neonatal unit. Eur J Pediatr 2023; 182:245-254. [PMID: 36289096 DOI: 10.1007/s00431-022-04668-5] [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: 04/26/2022] [Revised: 09/30/2022] [Accepted: 10/15/2022] [Indexed: 01/12/2023]
Abstract
UNLABELLED To evaluate the safety and effectiveness of evidence-based antibiotic stewardship in a neonatal unit in China. The study period consisted of two phases, one retrospective (the baseline period, January to December 2018, and the transition period, January 2019 to August 2020) and one prospective intervention period (September 2020 to August 2021). During the prospective period, evidence-based antibiotic stewardship was applied to neonates with suspected infections, pneumonia, and culture-negative sepsis. The antibiotic stewardship included the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis. The change in antibiotic use measured by days of therapy per 1000 patient-days between the baseline and intervention period was analyzed. Safety outcomes included reinitiation of antibiotics within 14 days, length of stay, occurrence of late-onset sepsis and necrotizing enterocolitis (Bell stage ≥ II), multidrug-resistant organism infections, and mortality. A total of 7705 neonates were enrolled during the baseline (n = 4804) and the intervention periods (n = 2901). The total antibiotic usage during the baseline period was 771 days of therapy per 1000 patient-days, while that was 525 days of therapy per 1000 patient-days during the intervention period, indicating a 32% decrease in antibiotic consumption. No significant difference in safety outcomes was observed between the baseline and intervention period (P > 0.05), whereas the length of stay was longer during the intervention period (P < 0.001). CONCLUSION The evidence-based antibiotic stewardship can safely and effectively reduce antibiotic use and shorten the duration of therapy in the neonatal unit. WHAT IS KNOWN • Overuse of antibiotics has been associated with adverse events in neonates, including necrotizing enterocolitis, multidrug-resistant organism infections, and death. • More clinical effectiveness evidence is needed to support antibiotic stewardship of neonates in China. WHAT IS NEW • Using prospective audit, targeted stewardship interventions, this study shows that a 32% reduction in overall antibiotic consumption was achieved safely. • Implementation of evidence-based neonatal antibiotic stewardship, including the observation form of neonatal infections, antibiotic therapy of no more than 48 h for suspected infections, and 5 days for pneumonia and culture-negative sepsis, is safe and effective among newborns in a developing country.
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Affiliation(s)
- Kun Feng
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Er Rd, Yuzhong District, Chongqing, 400014, China
| | - Yunyan He
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Er Rd, Yuzhong District, Chongqing, 400014, China
| | - Weiqin Liu
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Er Rd, Yuzhong District, Chongqing, 400014, China
| | - Xinyin Zhang
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Er Rd, Yuzhong District, Chongqing, 400014, China
| | - Ping Song
- Children's Medical Big Data Intelligent Application, Chongqing University Engineering Research Center, Chongqing, 400014, China
| | - Ziyu Hua
- Department of Neonatology, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/National Clinical Research Center for Child Health and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Er Rd, Yuzhong District, Chongqing, 400014, China.
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15
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Ren Z, Yang S, Han J, Nie C, Wang C, Wang J, Zheng X, Yang H, Zhang Q, Pei J, Xu F, Yang J. Reduction of antibiotic use and multi-drug resistance bacteria infection in neonates after improvement of antibiotics use strategy in a level 4 neonatal intensive care unit in southern China. Eur J Clin Microbiol Infect Dis 2023; 42:87-98. [PMID: 36409375 DOI: 10.1007/s10096-022-04522-4] [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: 08/31/2022] [Accepted: 11/04/2022] [Indexed: 11/22/2022]
Abstract
The investigation on antibiotic stewardship in neonatal intensive care unit in China is scarce. This study aimed to analyze the effect of a comprehensive 2-year antibiotic stewardship in a level 4 NICU. During this baseline period from October 1st 2017 to October 1st 2019, continuation of empirical antibiotic therapy for ruled-out sepsis courses was beyond 72 h and for pneumonia was more than 7 days. Meropenem or vancomycin was used even if they were not the only bacterial sensitive antibiotics. The intervention period was from October 2nd 2019 to August 23rd 2021. Three areas for quality improvement were targeted in our center: discontinuation of antibiotic use in ruled-out sepsis within 72 h, treatment duration for culture-negative pneumonia less than 7 days, and vancomycin or meropenem was not used unless the cultured bacteria was only susceptible to them. The total antibiotic consumption decreased from 791.1 to 466.3 days of therapy per 1000 patient days from baseline to intervention period. Antibiotics were stopped within 72 h for 47.48% patients with rule-out sepsis and within 7 days for 75.70% patients with pneumonia compared with 11.56% and 37.69% during the baseline period respectively. The prevalence of multi-drug resistance bacteria decreased from 67.20 to 48.90%. The total use rate of meropenem or vancomycin decreased from 7.6 to 1.8%. Our quality improvement approach on antibiotic strategy significantly reduced antibiotic use and prevalence of multi-drug resistance bacteria in our NICU.
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Affiliation(s)
- Zhuxiao Ren
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Shumei Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jiangxue Han
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Chuan Nie
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China.,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Cuicui Wang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jianlan Wang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xuaner Zheng
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Haoming Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China
| | - Qi Zhang
- Department of Clinical Genetic Center, Guangdong Women and Children Hospital, Guangzhou, China
| | - Jingjun Pei
- Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Xu
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China. .,Guangdong Neonatal ICU Medical Quality Control Center, Guangdong Women and Children Hospital, Guangzhou, China.
| | - Jie Yang
- Department of Neonatology, National Medical Discipline Priority, Guangdong Women and Children Hospital, Guangzhou, China. .,Department of Neonatology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
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16
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Yamaguchi K, Maeda M, Ohmagari N, Muraki Y. Association between Carbapenem Consumption and Clinical Outcomes in an In-Hospital Setting: Analysis of a Japanese Nationwide Administrative Database in 2020. Antibiotics (Basel) 2022; 11:antibiotics11121807. [PMID: 36551464 PMCID: PMC9774290 DOI: 10.3390/antibiotics11121807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 12/09/2022] [Accepted: 12/10/2022] [Indexed: 12/15/2022] Open
Abstract
This study aimed to clarify the relationship between carbapenem consumption and clinical outcome using the diagnosis procedure combination (DPC) payment system database (2020) published by the Ministry of Health, Labour, and Welfare of Japan. This study divided 5316 medical facilities subject to aggregation into five facilities and calculated the median values, including facility characteristics, clinical outcomes, and carbapenem consumption. Next, a correlation analysis was performed between carbapenem consumption and clinical outcome, as well as a multiple regression analysis between carbapenem consumption as the dependent variable and clinical outcome, bed size, and proportion of patients by disease as independent variables. Additionally, three clinical outcomes available from the DPC payment system database were selected, including cure, readmission within 4 weeks, and the average length of stay. This study revealed no relationship between carbapenem consumption and clinical outcome in university hospitals and university hospital-equivalent community hospitals; however, a relationship was suggested in the community, DPC-prepared, and non-DPC hospitals. University hospitals and university hospital-equivalent community hospitals with a high consumption of carbapenems may need to reconsider the classification because of the limited number of facilities in this classification.
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Affiliation(s)
- Kozue Yamaguchi
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo 142-8555, Japan
- Correspondence:
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuichi Muraki
- Department of Clinical Pharmacoepidemiology, Kyoto Pharmaceutical University, Kyoto 607-8414, Japan
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17
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Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study. Antibiotics (Basel) 2022; 11:antibiotics11121745. [PMID: 36551402 PMCID: PMC9774691 DOI: 10.3390/antibiotics11121745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 11/30/2022] [Accepted: 12/01/2022] [Indexed: 12/11/2022] Open
Abstract
The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs.
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18
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Chen J, Ekaney I, Shah PJ. Comparison of antimicrobial utilization metrics: Food for thought for an antimicrobial stewardship programme. Int J Antimicrob Agents 2022; 60:106681. [PMID: 36279975 DOI: 10.1016/j.ijantimicag.2022.106681] [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: 03/11/2021] [Revised: 03/31/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Given the overuse of antimicrobials and increasing antimicrobial resistance, the World Health Organization and Centers for Disease Control and Prevention recommend antimicrobial stewardship programmes to measure and assess the use of antimicrobials. Several antimicrobial use metrics have been described, including days of therapy, defined daily doses and standardized antimicrobial administration ratio. Understanding these metrics, including the advantages and disadvantages, can help antimicrobial stewardship programmes to monitor antimicrobial use at their institution, and assess the impact of antimicrobial stewardship efforts. This review discusses the three commonly used antimicrobial use metrics, their pros and cons, and how antimicrobial stewardship programmes can use these metrics to help assess the use of antimicrobials.
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Affiliation(s)
- Jingshi Chen
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Irene Ekaney
- Department of Infectious Diseases, Houston Methodist Sugar Land Hospital, Sugar Land, TX, USA
| | - Punit J Shah
- Department of Pharmacy, Houston Methodist Sugar Land Hospital, Sugar Land, TX, USA.
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19
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Antibiotic defined daily dose in pediatrics. A single center study to proof the principle that a specific pediatric definition could be not needed. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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20
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Antimicrobial Stewardship Interventions in Pediatric Oncology: A Systematic Review. J Clin Med 2022; 11:jcm11154545. [PMID: 35956160 PMCID: PMC9369733 DOI: 10.3390/jcm11154545] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 07/29/2022] [Accepted: 08/01/2022] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial stewardship programs represent efficacious measures for reducing antibiotic overuse and improving outcomes in different settings. Specific data on pediatric oncology are lacking. We conducted a systematic review on the PubMed and Trip databases according to the PRISMA guidelines, searching for reports regarding antimicrobial stewardship in pediatric oncology and hematology patients. The aim of the study was to summarize the present literature regarding the implementation of antimicrobial stewardship programs or initiatives in this particular population, and provide insights for future investigations. Nine papers were included in the qualitative analysis: three regarding antifungal interventions, five regarding antibacterial interventions, and one regarding both antifungal and antibacterial stewardship interventions. Variable strategies were reported among the included studies. Different parameters were used to evaluate the impact of these interventions, including days of therapy per 1000-patient-days, infections with resistant strains, safety analysis, and costs. We generally observed a reduction in the prescription of broad-spectrum antibiotics and an improved appropriateness, with reduced antibiotic-related side effects and no difference in infection-related mortality. Antibiotic stewardship programs or interventions are effective in reducing antibiotic consumption and improving outcomes in pediatric oncology hematology settings, although stewardship strategies differ substantially in different institutions. A standardized approach needs to be implemented in future studies in order to better elucidate the impact of stewardship programs in this category of patients.
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21
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Cantey JB, Correa CC, Dugi DD, Huff E, Olaya JE, Farner R. Remote Stewardship for Medically Underserved Nurseries: A Stepped-Wedge, Cluster Randomized Study. Pediatrics 2022; 149:e2021055686. [PMID: 35411402 PMCID: PMC9648107 DOI: 10.1542/peds.2021-055686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Antibiotic overuse is associated with adverse neonatal outcomes. Many medically underserved centers lack pediatric antibiotic stewardship program (ASP) support. Telestewardship may mitigate this disparity. Authors of this study aimed to determine the effectiveness and safety of a nursery-specific ASP delivered remotely. METHODS Remote ASP was implemented in 8 medically underserved newborn nurseries using a stepped-wedge, cluster-randomized design over 3 years. This included a 15-month baseline period, a 9-month "step-in" period using random nursery order, and a 12-month postintervention period. The program consisted of education, audit, and feedback; and 24/7 infectious diseases provider-to-provider phone consultation availability. Outcomes included each center's volume of antibiotic use and the proportion of infants exposed to any antibiotics. Safety measures included length of stay, transfer to another facility, sepsis, and mortality. RESULTS During the study period, there were 9277 infants born (4586 preintervention, 4691 postintervention). Infants exposed to antibiotics declined from 6.2% pre-ASP to 4.2% post-ASP (relative risk 0.68 [95% confidence interval, 0.63% to 0.75%]). Total antibiotic use declined from 117 to 84.1 days of therapy per 1000 patient-days (-28% [95% confidence interval -22% to -34%]. No safety signals were observed. Most provider-to-provider consultations were <5 minutes in duration and occurred during normal business hours. CONCLUSIONS The number of infants exposed to antibiotics and total antibiotic use declined in medically underserved nurseries after implementing a remote ASP. No adverse safety events were seen, and the remote ASP time demands were manageable. Remote stewardship may be a safe and effective strategy for optimizing antibiotic use in medically underserved newborn nurseries.
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Affiliation(s)
- Joseph B. Cantey
- Department of Pediatrics, Divisions of Neonatology and
Allergy, Immunology, and Infectious Diseases, University of Texas Health San
Antonio, San Antonio, Texas
| | - Cynthia C. Correa
- Department of Obstetrics and Gynecology, Dimmit Regional
Hospital, Carrizo Springs, Texas
| | - Daniel D. Dugi
- Department of Family Medicine, Cuero Regional Hospital,
Cuero, Texas
| | - Erin Huff
- Department of Obstetrics and Gynecology, Hill Country
Memorial Hospital, Fredericksburg, Texas
| | - Jorge E. Olaya
- Division of Neonatology, Department of Pediatrics,
University of Texas Health San Antonio, San Antonio, Texas
| | - Rachael Farner
- Department of Pediatrics, Divisions of Neonatology and
Allergy, Immunology, and Infectious Diseases, University of Texas Health San
Antonio, San Antonio, Texas
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22
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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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23
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Calle-Miguel L, Pérez-Méndez C, García-García E, Moreno-Pavón B, Solís-Sánchez G. Trends and Pattern of Antibiotic Use in Children in Northern Spain, Interpreting Data about Antibiotic Consumption in Pediatric Outpatients. CHILDREN 2022; 9:children9030442. [PMID: 35327815 PMCID: PMC8946892 DOI: 10.3390/children9030442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
Monitoring of antibiotic prescription and consumption behavior is crucial. The Access, Watch, and Reserve (AWaRe) classification of antibiotics has been recently introduced in order to measure and improve patterns of antibiotic use. In this study, retrospective data about systemic antibiotic consumption (expressed in defined daily dose per 1000 inhabitants per day (DID)) in pediatric outpatients in a region in northern Spain (around 100,000 children up to 14 years old) from 2005 to 2018 were analyzed and compared with antibiotic consumption in general population in Spain. The pattern of use was analyzed by the percentage of the current AWaRe categories, the Access-to-Watch index, and the amoxicillin index. Data were calculated annually and compared into two periods. Mean antibiotic consumption in pediatric outpatients was 14.0 DID (CI 95% 13.38–14.62). It remained stable throughout the study and was lower than consumption in general population in Spain, particularly from 2016. Changes in the consumption of the main active principles have led to an improvement in the three metrics of the pattern of use. It is important to have a thorough knowledge of the methodology applied in studies about antibiotic consumption. There is a lack of an optimal standardized metric for the pediatric population.
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Affiliation(s)
- Laura Calle-Miguel
- Pediatrics Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Spain;
- Correspondence:
| | - Carlos Pérez-Méndez
- Pediatrics Department, Hospital Universitario de Cabueñes, Camino los Prados, 395, 33394 Gijón, Spain;
| | - Elisa García-García
- Pediatric Primary Health Care System, C/ Severo Ochoa s/n, 33208 Gijón, Spain; (E.G.-G.); (B.M.-P.)
| | - Belén Moreno-Pavón
- Pediatric Primary Health Care System, C/ Severo Ochoa s/n, 33208 Gijón, Spain; (E.G.-G.); (B.M.-P.)
| | - Gonzalo Solís-Sánchez
- Pediatrics Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Spain;
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24
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Villanueva-Bueno C, Montecatine-Alonso E, Jiménez-Parrilla F, Fernández-Llamazares CM, Manrique-Rodríguez S, Zamora-Flores E, Dolz E, Fernández-Polo A, Catillo-Salinas F, Comuñas J, Gallego-Fernández C, González-López M, Gómez-Trevecedo Calvo MT, Gázquez-Pérez R, Álvarez Del Vayo-Benito C, Gil-Navarro MV. Antimicrobial defined daily dose in neonatal population. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:59-65. [PMID: 35120651 DOI: 10.1016/j.eimce.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. METHODS Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. RESULTS A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). CONCLUSIONS A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.
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Affiliation(s)
- Cristina Villanueva-Bueno
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Elena Montecatine-Alonso
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Cecilia M Fernández-Llamazares
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Elena Zamora-Flores
- Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
| | - Elisenda Dolz
- Department of Pharmacy, Complejo hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canarias, Spain
| | - Aurora Fernández-Polo
- Department of Pharmacy, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, PROA-NEN Project, Barcelona, Spain
| | | | - Juanjo Comuñas
- Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Rocío Gázquez-Pérez
- Department of Pharmacy, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | | | - Maria-Victoria Gil-Navarro
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
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25
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Budgell EP, Davies TJ, Donker T, Hopkins S, Wyllie DH, Peto TEA, Gill MJ, Llewelyn MJ, Walker AS. Impact of hospital antibiotic use on patient-level risk of death among 36,124,372 acute and medical admissions in England. J Infect 2021; 84:311-320. [PMID: 34963640 DOI: 10.1016/j.jinf.2021.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 12/03/2021] [Accepted: 12/17/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Initiatives to curb hospital antibiotic use might be associated with harm from under-treatment. We examined the extent to which variation in hospital antibiotic prescribing is associated with mortality risk in acute/general medicine inpatients. METHODS This ecological analysis examined Hospital Episode Statistics from 36,124,372 acute/general medicine admissions (≥16y) to 135 acute hospitals in England, 01/April/2010-31/March/2017. Random-effects meta-regression was used to investigate whether heterogeneity in adjusted 30-day mortality was associated with hospital-level antibiotic use, measured in defined-daily-doses (DDD)/1,000 bed-days. Models also considered DDDs/1,000 admissions and DDDs for narrow-spectrum/broad-spectrum antibiotics, parenteral/oral, and local interpretations of World Health Organization Access, Watch, and Reserve antibiotics. RESULTS Hospital-level antibiotic DDDs/1,000 bed-days varied 15-fold with comparable variation in broad-spectrum, parenteral, and Reserve antibiotic use. After extensive adjusting for hospital case-mix, the probability of 30-day mortality changed -0.010% (95% CI: -0.064,+0.044) for each increase of 500 hospital-level antibiotic DDDs/1,000 bed-days. Analyses of other metrics of antibiotic use showed no consistent association with mortality risk. CONCLUSIONS We found no evidence that wide variation in hospital antibiotic use is associated with adjusted mortality risk in acute/general medicine inpatients. Using low-prescribing hospitals as benchmarks could help drive safe and substantial reductions in antibiotic consumption of up-to one-third in this population.
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Affiliation(s)
- Eric P Budgell
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Timothy J Davies
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tjibbe Donker
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susan Hopkins
- National Infection Service, Public Health England, UK
| | | | - Tim E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; NIHR Biomedical Research Centre, Oxford, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK
| | - Martin J Gill
- Clinical Microbiology, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Martin J Llewelyn
- Global Health and Infectious Diseases, Brighton and Sussex Medical School, University of Sussex, Brighton, UK; Department of Microbiology and Infection, Royal Sussex County Hospital, Brighton, UK
| | - A Sarah Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK; NIHR Biomedical Research Centre, Oxford, UK; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Oxford, UK
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26
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Evolution of antibiotic consumption in pediatric outpatients of Asturias, Spain (2005-2018). An Pediatr (Barc) 2021; 95:438-447. [PMID: 34785158 DOI: 10.1016/j.anpede.2020.11.010] [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: 08/25/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Data about consumption of antibiotics in Spain are worrisome. They are mainly prescribed in the community sector and there is a high exposure to antibiotics in the pediatric population. The aim of this study is to describe the evolution of antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. METHODS Retrospective and descriptive study using data about consumption of antibacterial agents for systemic use (J01 group of the Anatomical Therapeutic Chemical Classification) in pediatric outpatients in Asturias between 2005 and 2018. Data, expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID), in three periods were compared. RESULTS Mean antibiotic consumption in pediatric outpatients in Asturias (2005-2018) was 14 DID (CI95% 13.4-14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). Remarkable data along the study were: 1) increase in amoxicillin consumption (p = 0.027), that have exceeded that of amoxicillin-clavulanate since 2011; 2) steady consumption of macrolides, with an increase in azithromycin (p < 0.001) and a decrease in clarithromycin (p = 0.001); 3) reduction of cephalosporins consumption (p < 0.001); 4) increase in quinolones consumption (p = 0.002). CONCLUSIONS Global antibiotic consumption in pediatric outpatients in Asturias between 2005 and 2018 has experienced a constant decrease lately and an improvement in patterns of antibacterial use.
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27
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Wong CP, Delate T, Hudson E, Nguyen JK, Yang SJ, Abraham M. Retrospective assessment of antimicrobial stewardship initiative in outpatient use of ertapenem for uncomplicated extended spectrum beta lactamase Enterobacteriaceae urinary tract infections. BMC Infect Dis 2021; 21:823. [PMID: 34399680 PMCID: PMC8369658 DOI: 10.1186/s12879-021-06458-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 07/18/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are often over-diagnosed and over-treated, which can induce and select for resistant pathogens. After observing wide-spread outpatient use of ertapenem, a broad-spectrum antibiotic, a structured antimicrobial stewardship initiative (ASI) to improve appropriate antimicrobial prescribing was undertaken. ASI objectives were to achieve a goal of reducing ertapenem utilization for extended spectrum beta lactamase Enterobacteriaceae (ESBL-EB) UTI by 10% and evaluate the clinical outcomes associated with the ASI. METHODS A pre-to-post cohort study was conducted at a single-center integrated healthcare system between November 1, 2014 and February 26, 2017. An intensive, 90-day, pharmacist-driven, structured ASI was implemented between November 1, 2015 and January 29, 2016. Female patients aged ≥18 years who were treated for an uncomplicated, ESBL-EB urinary tract infection (UTI) were included. Primary outcome was clinical resolution defined as cure, persistence, relapse and recurrence. Secondary outcome measured was monthly ertapenem use expressed as number of days of therapy (DOT)/1000 adjusted patient days (APD). Segmented regression analysis for interrupted time series was performed to estimate ASI intervention effect. RESULTS A total of 184 patients were included in the study. Ertapenem utilization decreased from 0.0145 DOT/1000 APD in Nov. 2014 to 0.0078 DOT/1000 APD Feb. 2017(p < 0.01). The mean ertapenem DOT declined 19% overall from the pre vs. post intervention periods (32 vs 26, p < 0.01). Frequency of recurrent UTIs between treatments did not significantly differ and no adverse effects were reported in patients treated with aminoglycosides. CONCLUSIONS A structured ASI for uncomplicated ESBL-EB UTI was associated with a clinically meaningful decrease in ertapenem utilization and once-daily, 5-day aminoglycoside treatment was well-tolerated.
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Affiliation(s)
- Carrie P Wong
- Kaiser Permanente Northern California Ambulatory Care Pharmacy, Kaiser Permanente Santa Clara Medical Center, 700 Lawrence Expy, Santa Clara, CA, 95051, USA.
| | - Thomas Delate
- Pharmacy Outcomes Research Group, Kaiser Permanente National Pharmacy, Aurora, CO, USA
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Elizabeth Hudson
- Kaiser Permanente Southern California Infectious Diseases Clinic, Panorama City Specialty Medical Office, Panorama City, CA, USA
| | - Julia K Nguyen
- Kaiser Permanente Southern California Outpatient Infusion Pharmacy, Kaiser Permanente Panorama City Medical Center, 13652 Cantara St, Bldg 4, LL, Rm L21, Panorama City, CA, 91402, USA.
| | - Su-Jau Yang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Mariana Abraham
- Kaiser Permanente Southern California Outpatient Infusion Pharmacy, Kaiser Permanente Panorama City Medical Center, 13652 Cantara St, Bldg 4, LL, Rm L21, Panorama City, CA, 91402, USA
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Herawati F, Fahmi EY, Pratiwi NA, Ramdani D, Jaelani AK, Yulia R, Andrajati R. Oral anti-tuberculosis drugs: An urgent medication reconciliation at hospitals in Indonesia. J Public Health Res 2021; 10. [PMID: 34463088 PMCID: PMC8419597 DOI: 10.4081/jphr.2021.1896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 03/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Four oral anti-tuberculosis drugs are conceived to be the most effective ones to eradicate Mycobacterium tuberculosis bacteria and to obviate the resistant organisms. However, the patients’ adherence and medication discrepancies are obstacles to achieving the goal. This study aimed to define the anti-tuberculosis drugs used in the hospitals and to detect the discrepancies in the continuity of the tuberculosis treatment. Design and Methods: This retrospective cross-sectional study was based on medical records of adult patients, and was conducted in two district tertiary care hospitals. Only 35 out of 136 patient records from Hospital A and 33 out of 85 records from Hospital B met the inclusion criteria. Results: The most common systemic anti-infective drugs in the study were ceftriaxone (51.80 DDD/100 patient-days) used in Hospital A and isoniazid (59.53 DDD/100 patient-days) used in Hospital B. The number of rifampicin prescriptions was less than that of isoniazid. Each patient received an average of two DDD/100 patient-days, which is an under dosage for an effective treatment. Conclusion: This study showed a medication discrepancy of tuberculosis therapy. Tuberculosis patients’ medical histories are not under the full attention of treating physicians wherever they are admitted. Thus, medication reconciliation is needed to accomplish the goal of a Tuberculosis-free world in 2050. Significance for public health Among other infectious diseases, tuberculosis causes not only more death in all countries and age groups, but also threatens global health with multidrugresistant TB. Tuberculosis is curable but may have uncertain diagnosis and needs continuation treatment for a minimum of six months. Recently, there is some investigation of the patient pathway for tuberculosis care-seeking; this study showed that even though the patient goes to public health services, discontinuation of therapy happens. The unfulfilled medication needs of tuberculosis patients, should increase awareness about TB resistance hazards and encourage healthcare professionals, healthcare management, and government, particularly in Indonesia, to increase microbiology capacity and develop an information system to connect patient data in the primary care and secondary care.
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Affiliation(s)
- Fauna Herawati
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Jalan Raya Kalirungkut, Surabaya; Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok .
| | - Eka Yuliantini Fahmi
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Jalan Raya Kalirungkut, Surabaya.
| | - Noer Aulia Pratiwi
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Jalan Raya Kalirungkut, Surabaya.
| | | | | | - Rika Yulia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, University of Surabaya, Jalan Raya Kalirungkut, Surabaya.
| | - Retnosari Andrajati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok.
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Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales. Sci Rep 2021; 11:14757. [PMID: 34285312 PMCID: PMC8292374 DOI: 10.1038/s41598-021-94295-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 07/09/2021] [Indexed: 11/09/2022] Open
Abstract
In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobacterales (CRE) acquisition in inpatients with 3rd generation cephalosporin-resistant (3GCR) Enterobacterales at a tertiary-care hospital in Lebanon, and suggested a risk prediction score for it. This is a retrospective matched case–control study of inpatients with 3GCR Enterobacterales that are carbapenem resistant (cases) versus those with carbapenem-sensitive isolates (controls). Data analysis was performed on IBM SPSS program, version 23.0 (Armonk, NY, USA: IBM Corp.). Categorical variables were compared between cases and controls through bivariate analysis and those with statistical significance (P < 0.05) were included in the forward stepwise multiple logistic regression analysis. To develop the CRE acquisition risk score, variables that maintained statistical significance in the multivariate model were assigned a point value corresponding to the odds ratio (OR) divided by the smallest OR identified in the regression model, and the resulting quotient was multiplied by two and rounded to the nearest whole number. Summation of the points generated by the calculated risk factors resulted in a quantitative score that was assigned to each patient in the database. Predictive performance was determined by assessing discrimination and calibration. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for different cutoffs of the score. The incidence of CRE acquisition significantly increased with time from 0.21 cases/1000 patient-days (PD) in 2015 to 1.89 cases/1000PD in 2019 (r2 = 0.789, P = 0.041). Multivariate analysis of matched data revealed that the history of cerebrovascular disease (OR 1.96; 95% CI 1.04–3.70; P = 0.039), hematopoietic cells transplantation (OR 7.75; 95% CI 1.52–39.36; P = 0.014), presence of a chronic wound (OR 3.38; 95% CI 1.73–6.50; P < 0.001), endoscopy done during the 3 months preceding the index hospitalization (OR 2.96; 95% CI 1.51–4.73; P = 0.01), nosocomial site of acquisition of the organism in question (OR 2.68; 95% CI 1.51–4.73; P = 0.001), and the prior use of meropenem within 3 months of CRE acquisition (OR 5.70; 95% CI 2.61–12.43; P < 0.001) were independent risk factors for CRE acquisition. A risk score ranging from 0 to 25 was developed based on these independent variables. At a cut-off of ≥ 5 points, the model exhibited a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 64.5%, 85.8%, 82%, 70.7% and 75%, respectively. We also showed that only meropenem consumption intensity and CRE acquisition incidence density showed a strong positive correlation(r = 0.798, P = 0.106), unlike imipenem (r = − 0.868, P = 0.056) and ertapenem (r = 0.385, P = 0.522). Patients with a score of ≥ 5 points in our model were likely to acquire CRE. Only meropenem was associated with CRE carriage. Our proposed risk prediction score would help target surveillance screening for CRE amongst inpatients at the time of hospital admission and properly guide clinicians on using anti-CRE therapy.
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van den Broek AK, Beishuizen BHH, Haak EAF, Duyvendak M, Ten Oever J, Sytsma C, van Triest M, Wielders CCH, Prins JM. A mandatory indication-registration tool in hospital electronic medical records enabling systematic evaluation and benchmarking of the quality of antimicrobial use: a feasibility study. Antimicrob Resist Infect Control 2021; 10:103. [PMID: 34217361 PMCID: PMC8254448 DOI: 10.1186/s13756-021-00973-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/18/2021] [Indexed: 12/20/2022] Open
Abstract
Objectives Evaluation of the extent and appropriateness of antimicrobial use is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Documentation of the indication at the moment of prescription might be more time-efficient. We investigated the real-life feasibility of mandatory documentation of the indication for all hospital antibiotic prescriptions for quality evaluation purposes. Methods A mandatory prescription-indication format was implemented in the Electronic Medical Record (EMR) of three hospitals using EPIC or ChipSoft HIX software. We evaluated the retrieved data of all antibiotics (J01) prescribed as empiric therapy in adult patients with respiratory tract infections (RTI) or urinary tract infections (UTI), from January through December 2017 in Hospital A, June through October 2019 in Hospital B and May 2019 through June 2020 in Hospital C. Endpoints were the accuracy of the data, defined as agreement between selected indication for the prescription and the documented indication in the EMR, as assessed by manually screening a representative sample of eligible patient records in the EMR of the three hospitals, and appropriateness of the prescriptions, defined as the prescriptions being in accordance with the national guidelines. Results The datasets of hospitals A, B and C contained 9588, 338 and 5816 empiric antibiotic prescriptions indicated for RTI or UTI, respectively. The selected indication was in accordance with the documented indication in 96.7% (error rate: 10/300), 78.2% (error rate: 53/243), and 86.9% (error rate: 39/298), respectively. A considerable variation in guideline adherence was seen between the hospitals for severe community acquired pneumonia (adherence rate ranged from 35.4 to 53.0%), complicated UTI (40.0–67.1%) and cystitis (5.6–45.3%). Conclusions After local validation of the datasets to verify and optimize accuracy of the data, mandatory documentation of the indication for antibiotics enables a reliable and time-efficient method for systematic registration of the extent and appropriateness of empiric antimicrobial use, which might enable benchmarking both in-hospital and between hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00973-0.
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Affiliation(s)
- Annemieke K van den Broek
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Berend H H Beishuizen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Eric A F Haak
- Department of Hospital Pharmacy, OLVG, Location Oost, Oosterpark 9, 1091 AC, Amsterdam, The Netherlands
| | - Michiel Duyvendak
- Department of Hospital Pharmacy, Antonius Hospital, Location Sneek, Bolswarderbaan 1, 8601 ZK, Sneek, The Netherlands
| | - Jaap Ten Oever
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Chris Sytsma
- Department of Information Technology, Antonius Hospital, Location Sneek, Bolswarderbaan 1, 8601 ZK, Sneek, The Netherlands
| | - Mieke van Triest
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Cornelia C H Wielders
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, 3721 MA, Bilthoven, The Netherlands
| | - Jan M Prins
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
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Villanueva-Bueno C, Montecatine-Alonso E, Jiménez-Parrilla F, Fernández-Llamazares CM, Manrique-Rodríguez S, Zamora-Flores E, Dolz E, Fernández-Polo A, Catillo-Salinas F, Comuñas J, Gallego-Fernández C, González-López M, Gómez-Trevecedo Calvo MT, Gázquez-Pérez R, Álvarez Del Vayo-Benito C, Gil-Navarro MV. Antimicrobial defined daily dose in neonatal population. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00191-9. [PMID: 34183175 DOI: 10.1016/j.eimc.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. METHODS Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. RESULTS A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). CONCLUSIONS A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.
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Affiliation(s)
- Cristina Villanueva-Bueno
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Elena Montecatine-Alonso
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Cecilia M Fernández-Llamazares
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Elena Zamora-Flores
- Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
| | - Elisenda Dolz
- Department of Pharmacy, Complejo hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canarias, Spain
| | - Aurora Fernández-Polo
- Department of Pharmacy, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, PROA-NEN Project, Barcelona, Spain
| | | | - Juanjo Comuñas
- Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Rocío Gázquez-Pérez
- Department of Pharmacy, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | | | - Maria-Victoria Gil-Navarro
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Gerber JS, Jackson MA, Tamma PD, Zaoutis TE. Policy Statement: Antibiotic Stewardship in Pediatrics. J Pediatric Infect Dis Soc 2021; 10:641-649. [PMID: 33595086 DOI: 10.1093/jpids/piab002] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
Antibiotic overuse contributes to antibiotic resistance, which is a threat to public health. Antibiotic stewardship is a practice dedicated to prescribing antibiotics only when necessary and, when antibiotics are considered necessary, promoting the use of the appropriate agent(s), dose, duration, and route of therapy to optimize clinical outcomes while minimizing the unintended consequences of antibiotic use. Because there are differences in common infectious conditions, drug-specific considerations, and the evidence surrounding treatment recommendations (eg, first-line therapy and duration of therapy) between children and adults, this statement provides specific guidance for the pediatric population. This policy statement discusses the rationale for inpatient and outpatient antibiotic stewardship programs (ASPs); essential personnel, infrastructure, and activities required; approaches to evaluating their effectiveness; and gaps in knowledge that require further investigation. Key guidance for both inpatient and outpatient ASPs are provided.
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Affiliation(s)
- Jeffrey S Gerber
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Mary Anne Jackson
- Department of Pediatrics, Section of Infectious Disease, Children's Mercy Hospital, UMKC School of Medicine, Kansas City, Missouri, USA
| | - Pranita D Tamma
- Department of Pediatrics, Division of Pediatric Infectious Diseases, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Theoklis E Zaoutis
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.,Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Dutey-Magni PF, Gill MJ, McNulty D, Sohal G, Hayward A, Shallcross L, Anderson N, Crayton E, Forbes G, Jhass A, Richardson E, Richardson M, Rockenschaub P, Smith C, Sutton E, Traina R, Atkins L, Conolly A, Denaxas S, Fragaszy E, Horne R, Kostkova P, Lorencatto F, Michie S, Mindell J, Robson J, Royston C, Tarrant C, Thomas J, West J, Williams H, Elsay N, Fuller C. Feasibility study of hospital antimicrobial stewardship analytics using electronic health records. JAC Antimicrob Resist 2021; 3:dlab018. [PMID: 34223095 PMCID: PMC8210026 DOI: 10.1093/jacamr/dlab018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/27/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimize antimicrobial use. Most hospitals depend on time-consuming manual audits to monitor clinicians' prescribing. But much of the information needed could be sourced from electronic health records (EHRs). OBJECTIVES To develop an informatics methodology to analyse characteristics of hospital AMS practice using routine electronic prescribing and laboratory records. METHODS Feasibility study using electronic prescribing, laboratory and clinical coding records from adult patients admitted to six specialities at Queen Elizabeth Hospital, Birmingham, UK (September 2017-August 2018). The study involved: (i) a review of AMS standards of care; (ii) their translation into concepts measurable from commonly available EHRs; and (iii) a pilot application in an EHR cohort study (n = 61679 admissions). RESULTS We developed data modelling methods to characterize antimicrobial use (antimicrobial therapy episode linkage methods, therapy table, therapy changes). Prescriptions were linked into antimicrobial therapy episodes (mean 2.4 prescriptions/episode; mean length of therapy 5.8 days), enabling several actionable findings. For example, 22% of therapy episodes for low-severity community-acquired pneumonia were congruent with prescribing guidelines, with a tendency to use broader-spectrum antibiotics. Analysis of therapy changes revealed IV to oral therapy switching was delayed by an average 3.6 days (95% CI: 3.4-3.7). Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. The proposed methods enabled fine-grained monitoring of AMS practice down to specialities, wards and individual clinical teams by case mix, enabling more meaningful peer comparison. CONCLUSIONS It is feasible to use hospital EHRs to construct rapid, meaningful measures of prescribing quality with potential to support quality improvement interventions (audit/feedback to prescribers), engagement with front-line clinicians on optimizing prescribing, and AMS impact evaluation studies.
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Affiliation(s)
- P F Dutey-Magni
- Institute of Health Informatics, University College London, London, UK
| | - M J Gill
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - D McNulty
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - G Sohal
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - A Hayward
- Institute of Epidemiology & Health Care, University College London, London, UK
| | - L Shallcross
- Institute of Health Informatics, University College London, London, UK
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Moehring RW, Phelan M, Lofgren E, Nelson A, Dodds Ashley E, Anderson DJ, Goldstein BA. Development of a Machine Learning Model Using Electronic Health Record Data to Identify Antibiotic Use Among Hospitalized Patients. JAMA Netw Open 2021; 4:e213460. [PMID: 33779743 PMCID: PMC8008288 DOI: 10.1001/jamanetworkopen.2021.3460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Comparisons of antimicrobial use among hospitals are difficult to interpret owing to variations in patient case mix. Risk-adjustment strategies incorporating larger numbers of variables haves been proposed as a method to improve comparisons for antimicrobial stewardship assessments. OBJECTIVE To evaluate whether variables of varying complexity and feasibility of measurement, derived retrospectively from the electronic health records, accurately identify inpatient antimicrobial use. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study, using a 2-stage random forests machine learning modeling analysis of electronic health record data. Data were split into training and testing sets to measure model performance using area under the curve and absolute error. All adult and pediatric inpatient encounters from October 1, 2015, to September 30, 2017, at 2 community hospitals and 1 academic medical center in the Duke University Health System were analyzed. A total of 204 candidate variables were categorized into 4 tiers based on feasibility of measurement from the electronic health records. MAIN OUTCOMES AND MEASURES Antimicrobial exposure was measured at the encounter level in 2 ways: binary (ever or never) and number of days of therapy. Analyses were stratified by age (pediatric or adult), unit type, and antibiotic group. RESULTS The data set included 170 294 encounters and 204 candidate variables from 3 hospitals during the 3-year study period. Antimicrobial exposure occurred in 80 190 encounters (47%); 64 998 (38%) received 1 to 6 days of therapy, and 15 192 (9%) received 7 or more days of therapy. Two-stage models identified antimicrobial use with high fidelity (mean area under the curve, 0.85; mean absolute error, 1.0 days of therapy). Addition of more complex variables increased accuracy, with largest improvements occurring with inclusion of diagnosis information. Accuracy varied based on location and antibiotic group. Models underestimated the number of days of therapy of encounters with long lengths of stay. CONCLUSIONS AND RELEVANCE Models using variables derived from electronic health records identified antimicrobial exposure accurately. Future risk-adjustment strategies incorporating encounter-level information may make comparisons of antimicrobial use more meaningful for hospital antimicrobial stewardship assessments.
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Affiliation(s)
- Rebekah W. Moehring
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Matthew Phelan
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
| | - Eric Lofgren
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman
| | - Alicia Nelson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Elizabeth Dodds Ashley
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Deverick J. Anderson
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, North Carolina
| | - Benjamin A. Goldstein
- Duke Clinical Research Institute, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University, Durham, North Carolina
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Calle-Miguel L, Iglesias Carbajo AI, Modroño Riaño G, Pérez Méndez C, García García E, Rodríguez Nebreda S, Solís Sánchez G. [Evolution of antibiotic consumption in pediatric outpatients of Asturias, Spain (2005-2018)]. An Pediatr (Barc) 2021; 95:S1695-4033(20)30496-3. [PMID: 33637470 DOI: 10.1016/j.anpedi.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/08/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Data about consumption of antibiotics in Spain are worrisome. They are mainly prescribed in the community sector and there is a high exposure to antibiotics in the pediatric population. The aim of this study is to describe the evolution of antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. MATERIAL AND METHODS Retrospective and descriptive study using data about consumption of antibacterial agents for systemic use (J01 group of the Anatomical Therapeutic Chemical Classification) in pediatric outpatients in Principado de Asturias between 2005 and 2018. Data, expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID), in three periods were compared. RESULTS Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4-14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). Remarkable data along the study were: 1) increase in amoxicillin consumption (p=0.027), that have exceeded that of amoxicillin-clavulanate since 2011; 2) steady consumption of macrolides, with an increase in azithromycin (p<0.001) and a decrease in clarithromycin (p=0.001); 3) reduction of cephalosporins consumption (p<0.001); 4) increase in quinolones consumption (p=0.002). CONCLUSIONS Global antibiotic consumption in pediatric outpatients in Principado de Asturias between 2005 and 2018 has experienced a constant decrease lately and an improvement in patterns of antibacterial use.
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Affiliation(s)
- Laura Calle-Miguel
- Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | | | - Gracia Modroño Riaño
- Servicio de Farmacia Hospitalaria, Hospital de Cabueñes, Gijón, Asturias, España
| | | | - Elisa García García
- Pediatría de Atención Primaria, Centro de Salud Laviada, Gijón, Asturias, España
| | | | - Gonzalo Solís Sánchez
- Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Application of Standardized Antimicrobial Administration Ratio as a Motivational Tool within a Multi-Hospital Healthcare System. PHARMACY 2021; 9:pharmacy9010032. [PMID: 33562268 PMCID: PMC7930961 DOI: 10.3390/pharmacy9010032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Abstract
The standardized antimicrobial administration ratio (SAAR) is a novel antimicrobial stewardship metric that compares actual to expected antimicrobial use (AU). This prospective cohort study examines the utility of SAAR reporting and inter-facility comparisons as a motivational tool to improve overall and broad-spectrum AU within a three-hospital healthcare system. Transparent inter-facility comparisons were deployed during system-wide antimicrobial stewardship meetings beginning in October 2017. Stakeholders were advised to interpret the results to foster competition and incorporate SAAR data into focused antimicrobial stewardship interventions. Student’s t-test was used to compare mean SAARs in the pre- (July 2017 through October 2017) and post-intervention periods (November 2017 through June 2019). The mean pre-intervention SAARs for hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Hospital B experienced significant reductions in SAAR for overall AU (from 1.09 to 0.83; p < 0.001), broad-spectrum antimicrobials used for hospital-onset infections (from 1.36 to 0.81; p < 0.001), and agents used for resistant gram-positive infections in the intensive care units (from 1.27 to 0.72; p < 0.001) after the interventions. The alignment of the SAAR across the health-system and sustained reduction in overall and broad-spectrum AU through implementation of inter-facility comparisons demonstrate the utility in the motivational application of this antimicrobial use metric.
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Mallikarjuna Reddy G, Raul Garcia J, Venkata Subbaiah M, Wen J. An efficient green approach for the synthesis of benzothiazole‐linked pyranopyrazoles as promising pharmacological agents and docking studies. J Heterocycl Chem 2021. [DOI: 10.1002/jhet.4194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Guda Mallikarjuna Reddy
- Chemical Engineering Institute Ural Federal University, 620002 Yekaterinburg Russian Federation
| | - Jarem Raul Garcia
- Department of Chemistry University of Ponta Grossa Ponta Grossa Parana state Brazil
| | - Munagapati Venkata Subbaiah
- Research Centre for Soil & Water Resources and Natural Disaster Prevention (SWAN) National Yunlin University of Science & Technology Douliou Taiwan
| | - Jet‐Chau Wen
- Research Centre for Soil & Water Resources and Natural Disaster Prevention (SWAN) National Yunlin University of Science & Technology Douliou Taiwan
- Department of Safety, Health and Environmental Engineering National Yunlin University of Science & Technology Douliou Taiwan
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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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Abstract
Antibiotic overuse contributes to antibiotic resistance, which is a threat to public health. Antibiotic stewardship is a practice dedicated to prescribing antibiotics only when necessary and, when antibiotics are considered necessary, promoting use of the appropriate agent(s), dose, duration, and route of therapy to optimize clinical outcomes while minimizing the unintended consequences of antibiotic use. Because there are differences in common infectious conditions, drug-specific considerations, and the evidence surrounding treatment recommendations (eg, first-line therapy, duration of therapy) between children and adults, this statement provides specific guidance for the pediatric population. This policy statement discusses the rationale for inpatient and outpatient antibiotic stewardship programs; essential personnel, infrastructure, and activities required; approaches to evaluating their effectiveness; and gaps in knowledge that require further investigation. Key guidance for both inpatient and outpatient antibiotic stewardship programs are provided.
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Affiliation(s)
- Jeffrey S Gerber
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
| | - Mary Anne Jackson
- Section of Infectious Disease, Department of Pediatrics, Children's Mercy Hospital and School of Medicine, University of Missouri-Kansas City, Kansas City, Missouri; and
| | - Pranita D Tamma
- Division of Pediatric Infectious Diseases, Department of Pediatrics, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Theoklis E Zaoutis
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania and Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Rahem LR, Franck B, Roy H, Lebel D, Ovetchkine P, Bussières JF. Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19. Can J Hosp Pharm 2021; 74:21-29. [PMID: 33487651 PMCID: PMC7801337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. OBJECTIVE To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. METHODS In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. RESULTS Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). CONCLUSIONS This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program.
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Affiliation(s)
- Lydia R Rahem
- is a candidate for the DPharm degree in the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec. She is also an intern with the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Bénédicte Franck
- is a candidate for the DPharm degree, Université Paul Sabatier, Toulouse, France. She is also a Research Assistant with the Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Quebec
| | - Hélène Roy
- , BPharm, MSc, is a Pharmacist with the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Denis Lebel
- , BPharm, MSc, FCSHP, is a Pharmacist and Assistant Director, Teaching and Research with the Pharmacy Practice Research Unit and the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Philippe Ovetchkine
- , MD, is a Pediatrician with the Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec
| | - Jean-François Bussières
- , BPharm, MSc, MBA, FCSHP, is a Pharmacist and Director with the Pharmacy Practice Research Unit and the Department of Pharmacy, CHU Sainte-Justine, and a Clinical Professor with the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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Sibani M, Mazzaferri F, Carrara E, Pezzani MD, Arieti F, Göpel S, Paul M, Tacconelli E, Mutters NT, Voss A. White Paper: Bridging the gap between surveillance data and antimicrobial stewardship in long-term care facilities-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks. J Antimicrob Chemother 2020; 75:ii33-ii41. [PMID: 33280047 PMCID: PMC7719406 DOI: 10.1093/jac/dkaa427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND In long-term care facilities (LTCFs) residents often receive inappropriate antibiotic treatment and infection prevention and control practices are frequently inadequate, thus favouring acquisition of MDR organisms. There is increasing evidence in the literature describing antimicrobial stewardship (AMS) activities in LTCFs, but practical guidance on how surveillance data should be linked with AMS activities in this setting is lacking. To bridge this gap, the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks joined their efforts to provide practical guidance for linking surveillance data with AMS activities. MATERIALS AND METHODS Considering the three main topics [AMS leadership and accountability, antimicrobial usage (AMU) and AMS, and antimicrobial resistance (AMR) and AMS], a literature review was performed and a list of target actions was developed. Consensus on target actions was reached through a RAND-modified Delphi process involving 40 experts from 18 countries and different professional backgrounds adopting a One Health approach. RESULTS From the 25 documents identified, 25 target actions were retrieved and proposed for expert evaluation. The consensus process produced a practical checklist including 23 target actions, differentiating between essential and desirable targets according to clinical relevance and feasibility. Flexible proposals for AMS team composition and leadership were provided, with a strong emphasis on the need for well-defined and adequately supported roles and responsibilities. Specific antimicrobial classes, AMU metrics, pathogens and resistance patterns to be monitored are addressed. Effective reporting strategies are described. CONCLUSIONS The proposed checklist represents a practical tool to support local AMS teams across a wide range of care delivery organization and availability of resources.
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Affiliation(s)
- Marcella Sibani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fulvia Mazzaferri
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fabiana Arieti
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Siri Göpel
- Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen, Germany
| | - Mical Paul
- Diseases Institute, Rambam Health Care Campus, Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
- German Centre for Infection Research (DZIF), Clinical Research Unit for Healthcare Associated Infections, Tübingen, Germany
| | - Nico T Mutters
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Andreas Voss
- Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Abstract
BACKGROUND Neonates with abdominal wall defects are at an increased infection risk because of the defect itself and prolonged neonatal intensive care unit (NICU) stays. Antibiotic prophylaxis until closure of the defect is common. However, infection risk and antibiotic use have not been well quantified in these infants. METHODS A retrospective cohort study of infants with abdominal wall defects (gastroschisis and omphalocele) admitted to a single-center NICU from 2007 to 2018. Demographic and clinical information, including microbiologic studies, antibiotic dosing and surgical care, were collected. Antibiotic use was quantified using days of therapy (DOT) per 1000 patient-days. Sepsis was defined as culture of a pathogen from a normally sterile site. RESULTS Seventy-four infants were included; 64 (86%) with gastroschisis and 10 (14%) with omphalocele. Median day of closure was 8 days [interquartile range (IQR) 6-10, range 0-31]. All infants received ≥1 course of antibiotics; median antibiotic DOT/infant was 24.5 (IQR 18-36) for an average of 416.5 DOT per 1000 patient-days. Most antibiotic use was preclosure prophylaxis (44%) and treatment of small intestinal bowel overgrowth (24%). Suspected and proven infection accounted for 26% of all antibiotic use. Skin and soft tissue infection (13/74, 18%) and late-onset sepsis (11/74, 15%) were the most common infections; 2 infants had sepsis while on antibiotic prophylaxis. All infants survived to discharge. CONCLUSIONS Most antibiotic use among infants with abdominal wall defects was prophylactic. Infection on prophylaxis was rare, but 35% of infants had infection after prophylaxis. Improved stewardship strategies are needed for these high-risk infants.
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Thabit AK, Shea KM, Guzman OE, Garey KW. Antibiotic utilization within 18 community hospitals in the United States: A 5-year analysis. Pharmacoepidemiol Drug Saf 2020; 30:403-408. [PMID: 33094502 DOI: 10.1002/pds.5156] [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: 06/23/2020] [Revised: 10/12/2020] [Accepted: 10/18/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Antibiotic overuse is associated with antibiotic resistance. We evaluated antibiotic utilization defined by days of therapy/1000 patient days (DOT/1000 PD) in various community hospitals across the United States. METHODS Community hospitals within the Cardinal Health Drug Cost Opportunity Analytics database were evaluated for the availability of DOT/1000 PD data between 2012 to 2016 for overall and specific antibiotic use and the following classes: narrow-spectrum β-lactams (ampicillin, nafcillin, oxacillin, cefazolin, and cephalexin), non-carbapenem antipseudomonal β-lactams (piperacillin/tazobactam, ceftazidime, and cefepime), carbapenems, anti-methicillin-resistant Staphylococcus aureus agents (vancomycin, linezolid, daptomycin, and tigecycline), and fluoroquinolones. Antibiotic utilization and change in utilization during the study period was calculated using linear regression (β coefficient). RESULTS Eighteen hospitals had antibiotic utilization data available. Hospitals were primarily urban (72%) with an average of 209 total beds and 22 intensive care unit beds. Mean number of pharmacists in these hospitals was nine with a mean pharmacist: bed ratio of 0.05. While all hospitals had antimicrobial stewardship programs established during the study period, only 78% and 22% had infectious diseases (ID) physician and ID pharmacist on staff, respectively. A decrease in antipseudomonal β-lactams (excluding carbapenems) and fluoroquinolones was observed (β coefficients = -1.2 and -2.6, respectively), all other antibiotic classes had increased utilization. CONCLUSION Overall antibiotic utilization increased over 5 years. The increase in narrow-spectrum β-lactams utilization along with the reduction in the use of antipseudomonal β-lactams and fluoroquinolones indicate appropriate antimicrobial stewardship. Institutional antibiotic utilization should be evaluated for appropriateness to limit the overuse of broad-spectrum antibiotics in an effort to reduce resistance development.
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Affiliation(s)
- Abrar K Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia.,Cardinal Health, Houston, Texas, USA.,University of Houston College of Pharmacy, Houston, Texas, USA
| | | | | | - Kevin W Garey
- University of Houston College of Pharmacy, Houston, Texas, USA
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Outcomes of Febrile Neutropenia in Children With Cancer Managed on an Outpatient Basis: A Report From Tertiary Care Hospital From a Resource-limited Setting. J Pediatr Hematol Oncol 2020; 42:467-473. [PMID: 32815874 DOI: 10.1097/mph.0000000000001896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
In low-risk febrile neutropenia (FN) patients, outpatient management is now an accepted treatment, but there is a scarcity of data on high-risk patients. The aim of our study was to describe the outcome of FN treated primarily in an outpatient setting on the basis of the severity of illness at presentation, irrespective of the intensity of chemotherapy, and absolute neutrophil count. In this prospective study, not severely ill (NSI) patients were treated with empiric antibiotics at the daycare center (outpatient) and were admitted subsequently if there was persistent fever or any complication arose. Severely ill (SI) children were admitted to the hospital upfront. A total of 118 FN episodes among children with cancer on chemotherapy 18 years of age and younger were studied. Among NSI patients managed as outpatients (n=103), 89 patients (86%) recovered with outpatient treatment, and 14 patients required hospitalization after the median duration of 5 days (interquartile range: 4 to 6 d) of antibiotic therapy. The main indication for hospital admission in the SI group was hypotension (n=5), and in the NSI group, it was persistent fever (n=11). Overall, 5% of patients (6/118) died, and 2 of these were in the NSI group. The results of this study suggest that carefully selected NSI patients could be successfully treated at outpatient management in resource-poor settings and subsequent admission if warranted.
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Hegewisch-Taylor J, Dreser-Mansilla A, Romero-Mónico J, Levy-Hara G. Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review. Rev Panam Salud Publica 2020; 44:e68. [PMID: 32973908 PMCID: PMC7498295 DOI: 10.26633/rpsp.2020.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. METHODS This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included 'antibiotic' or 'antimicrobial' AND 'stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions' and 33 country names. RESULTS Selected articles totalled 147 studies published in 1985 - 2019; of those, 22% used 'antimicrobial stewardship' in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. CONCLUSIONS Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.
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Affiliation(s)
- Jennifer Hegewisch-Taylor
- Health Systems Research Center, National Institute of Public HealthCuernavacaMexicoHealth Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico.
| | - Anahí Dreser-Mansilla
- Health Systems Research Center, National Institute of Public HealthCuernavacaMexicoHealth Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico.
| | - Julián Romero-Mónico
- Health Systems Research Center, National Institute of Public HealthCuernavacaMexicoHealth Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico.
| | - Gabriel Levy-Hara
- Infectious Diseases Unit, Hospital Carlos G. DurandBuenos AiresArgentinaInfectious Diseases Unit, Hospital Carlos G. Durand, Buenos Aires, Argentina.
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Redding LE, Muller BM, Szymczak JE. Small and Large Animal Veterinarian Perceptions of Antimicrobial Use Metrics for Hospital-Based Stewardship in the United States. Front Vet Sci 2020; 7:582. [PMID: 33102546 PMCID: PMC7505943 DOI: 10.3389/fvets.2020.00582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/20/2020] [Indexed: 12/23/2022] Open
Abstract
Background: Robust measurement and tracking of antimicrobial use (AMU) is a fundamental component of stewardship interventions. Feeding back AMU metrics to individual clinicians is a common approach to changing prescribing behavior. Metrics must be meaningful and comprehensible to clinicians. Little is known about how veterinary clinicians working in the United States (US) hospital setting think about AMU metrics for antimicrobial stewardship. Objective: To identify hospital-based veterinary clinicians' attitudes toward audit and feedback of AMU metrics, their perceptions of different AMU metrics, and their response to receiving an individualized prescribing report. Methods: Semi-structured interviews were conducted with veterinarians working at two hospitals in the Eastern US. Interviews elicited perceptions of antimicrobial stewardship in veterinary medicine. Respondents were shown a personalized AMU Report characterizing their prescribing patterns relative to their peers and were asked to respond. Interviews were recorded, transcribed, and analyzed using the framework method with matrices. Results: Semi-structured interviews were conducted with 34 veterinary clinicians (22 small animal and 12 large animal). Respondents generally felt positive about the reports and were interested in seeing how their prescribing compared to that of their peers. Many respondents expressed doubt that the reports accurately captured the complexities of their prescribing decisions and found metrics associated with animal daily doses (ADDs) confusing. Only 13 (38.2%) respondents felt the reports would change how they used antimicrobials. When asked how the impact of the reports could be optimized, respondents recommended providing a more detailed explanation of how the AMU metrics were derived, education prior to report roll-out, guidance on how to interpret the metrics, and development of meaningful benchmarks for goal-setting. Conclusions: These findings provide important insight that can be used to design veterinary-specific AMU metrics as part of a stewardship intervention that are meaningful to clinicians and more likely to promote judicious prescribing.
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Affiliation(s)
- Laurel E Redding
- Department of Clinical Sciences, University of Pennsylvania School of Veterinary Medicine, Philadelphia, PA, United States
| | - Brandi M Muller
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Julia E Szymczak
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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Moghnieh R, Abdallah D, Awad L, Jadayel M, Haddad N, Tamim H, Zaiter A, Awwad DC, Sinno L, El-Hassan S, Lakkis R, Khalil R, Jisr T. The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study. Ann Clin Microbiol Antimicrob 2020; 19:35. [PMID: 32762758 PMCID: PMC7412806 DOI: 10.1186/s12941-020-00377-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/30/2020] [Indexed: 12/23/2022] Open
Abstract
Background A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.
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Affiliation(s)
- Rima Moghnieh
- Division of Infectious Diseases, Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. .,Division of Infectious Diseases, Department of Internal Medicine, Hôtel Dieu de France, Beirut, Lebanon.
| | - Dania Abdallah
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Lyn Awad
- Pharmacy Department, Makassed General Hospital, Beirut, Lebanon
| | - Marwa Jadayel
- School of Pharmacy, Beirut Arab University, Beirut, Lebanon
| | - Nicholas Haddad
- Infectious Disease and Residency Program, Internal Medicine, Central Michigan University, Saginaw, MI, 48602, USA
| | - Hani Tamim
- Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Aline Zaiter
- Faculty of Medicine, Lebanese University, Beirut, Lebanon
| | | | - Loubna Sinno
- Department of Medical Research, Makassed General Hospital, Beirut, Lebanon
| | | | - Rawad Lakkis
- Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon
| | - Rabab Khalil
- Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon
| | - Tamima Jisr
- Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon
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Amaya-Villar R. Adequate antibiotic monitoring to improve what needs to be improved. Med Intensiva 2020; 44:265-266. [DOI: 10.1016/j.medin.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/15/2022]
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Reduced Antibiotic Exposure by Serial Physical Examinations in Term Neonates at Risk of Early-onset Sepsis. Pediatr Infect Dis J 2020; 39:438-443. [PMID: 32301920 DOI: 10.1097/inf.0000000000002590] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Suspected early-onset sepsis (EOS) results in antibiotic treatment of a substantial number of neonates who are uninfected. We evaluated if an approach using serial physical examinations (SPEs) can reduce antibiotic exposure for suspected EOS in term neonates during the first 3 days of life, without affecting safety. METHODS Within a quality-improvement framework, SPEs for 24-48 hours for neonates with suspected EOS was implemented in the neonatal intensive care unit, Stavanger, Norway. The proportion of neonates ≥37 weeks gestation exposed to antibiotics, antibiotic therapy-days and the safety outcome time from birth to start antibiotics were compared between a baseline period (April 2014-February 2016), when a risk factor based approach was used, and a post-SPE-implementation period (January 2017-November 2018). RESULTS We included all term live born neonates (n = 17,242) in the 2 periods. There was a 57% relative reduction in neonates exposed to antibiotics; 2.9% in the baseline and 1.3% in the post-implementation period, P < 0.001. There was a 60% relative reduction in mean antibiotic therapy-days/1000 patient-days; from 320 to 129, P < 0.001, and a 50% relative reduction in time to initiate antibiotics in suspected EOS-cases, from median (interquartile range) 14 (5-28) to 7 (3-17) hours, P = 0.003. The incidence of culture-positive EOS remained unchanged. There were no infection-attributable deaths. CONCLUSIONS Implementing SPE to guide empiric antibiotic therapy in term neonates with suspected EOS more than halved the burden of antibiotic exposure, without delay of antibiotic treatment of infected neonates or increased sepsis-related mortality.
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Al Bahar F, Curtis CE, Alhamad H, Marriott JF. The impact of a computerised decision support system on antibiotic usage in an English hospital. Int J Clin Pharm 2020; 42:765-771. [PMID: 32279235 DOI: 10.1007/s11096-020-01022-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/30/2020] [Indexed: 11/27/2022]
Abstract
Background Antimicrobial resistance is correlated with the inappropriate use of antibiotics. Computerised decision support systems may help practitioners to make evidence-based decisions when prescribing antibiotics. Objective This study aimed to evaluate the impact of computerized decision support systems on the volume of antibiotics used. Setting A very large 1200-bed teaching hospital in Birmingham, England. Main outcome measure The primary outcome measure was the defined daily doses/1000 occupied bed-days. Method A retrospective longitudinal study was conducted to examine the impact of computerised decision support systems on the volume of antibiotic use. The study compared two periods: one with computerised decision support systems, which lasted for 2 years versus one without which lasted for 2 years after the withdrawal of computerised decision support systems. Antibiotic use data from June 2012 to June 2016 were analysed (comprising 2 years with computerised decision support systems immediately followed by 2 years where computerised decision support systems had been withdrawn). Regression analysis was applied to assess the change in antibiotic consumption through the period of the study. Result From June 2012 to June 2016, total antibiotic usage increased by 13.1% from 1436 to 1625 defined daily doses/1000 bed-days: this trend of increased antibiotic prescribing was more pronounced following the withdrawal of structured prescribing (computerised decision support systems). There was a difference of means of - 110.14 defined daily doses/1000 bed days of the total usage of antibiotics in the period with and without structured prescribing, and this was statistically significant (p = 0.026). From June 2012 to June 2016, the dominant antibiotic class used was penicillins. The trends for the total consumption of all antibiotics demonstrated an increase of use for all antibiotic classes except for tetracyclines, quinolones, and anti-mycobacterial drugs, whereas aminoglycoside usage remained stable. Conclusion The implementation of computerised decision support systems appears to influence the use of antibiotics by reducing their consumption. Further research is required to determine the specific features of computerised decision support systems, which influence increased higher adoption and uptake of this technology.
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Affiliation(s)
- F Al Bahar
- School of Pharmacy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK.
- School of Pharmacy, Zarqa University, PO Box 132222, Zarqa, 13132, Jordan.
| | - C E Curtis
- School of Pharmacy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
| | - H Alhamad
- School of Pharmacy, Zarqa University, PO Box 132222, Zarqa, 13132, Jordan
| | - J F Marriott
- School of Pharmacy, College of Medical & Dental Sciences, University of Birmingham, Birmingham, B15 2TT, UK
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