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Wang XT, Meng H, Pan DF, Zheng XY, Lu WW, Chen C, Su M, Su XY, Liu Z, Ma XJ, Liang PF. Multidrug-resistant organisms may be associated with bed allocation and utilization efficiency in healthcare institutions, based on national monitoring data from China (2014-2020). Sci Rep 2023; 13:22055. [PMID: 38087043 PMCID: PMC10716176 DOI: 10.1038/s41598-023-49548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/09/2023] [Indexed: 12/18/2023] Open
Abstract
Analyzing the influence of the bed allocation and utilization efficiency in healthcare institutions on the isolation proportion of Multidrug-resistant organisms (MDROs) to provide data to support prevention and control of MDROs. In this study, the provincial panel data from 2014 to 2020 in China on health resource indicators, including the number of beds per 1,000 population, hospital bed utilization rate, and average hospital stay from 2014 to 2020 in China were used to analyze the relationship between bed allocation or utilization efficiency and MDROs by the panel data quantile regression model. It was shown that the number of beds per 1,000 population had a negative effect on the isolation proportion of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, methicillin-resistant coagulase-negative Staphylococcus, and cefotaxime or ceftriaxone resistant Escherichia coli (regression coefficient < 0, P < 0.05). The utilization rate of hospital bed had a positive effect on the isolation proportion of methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococcus, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, cefotaxime or ceftriaxone resistant Escherichia coli, carbapenem-resistant Escherichia coli, cefotaxime or ceftriaxone resistant Klebsiella pneumoniae, carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (regression coefficient > 0, P < 0.05). The average hospital stay had a positive effect on the isolation proportion for several antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococcus, vancomycin-resistant Enterococcus faecalis, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, cefotaxime or ceftriaxone resistant Escherichia coli, carbapenem-resistant Escherichia coli, quinolone-resistant Escherichia coli, cefotaxime or ceftriaxone resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (regression coefficient > 0, P < 0.05). Bed allocation and utilization efficiency in healthcare institutions may affect the isolation proportion of MDROs in varying degrees.
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Affiliation(s)
- Xing-Tian Wang
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Hua Meng
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Dong-Feng Pan
- Department of Emergency Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Xiao-Yu Zheng
- Ningxia Chinese Medicine Research Center, Yinchuan, 750021, Ningxia Hui Autonomous Region, China
| | - Wen-Wen Lu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Chen Chen
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Ming Su
- Yinchuan Stomatology Hospital, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Xin-Ya Su
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Zhuo Liu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xiao-Juan Ma
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Pei-Feng Liang
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China.
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Dereje B, Yibabie S, Keno Z, Megersa A. Antibiotic utilization pattern in treatment of acute diarrheal diseases: the case of Hiwot Fana Specialized University Hospital, Harar, Ethiopia. J Pharm Policy Pract 2023; 16:62. [PMID: 37165415 PMCID: PMC10173574 DOI: 10.1186/s40545-023-00568-7] [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: 01/11/2023] [Accepted: 05/01/2023] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND The vast majority of acute diarrheal diseases are self-limiting and do not require treatment on a regular basis. Empirical antibiotics should only be used to treat dysenteric and invasive bacterial diarrhea. Antibiotic misuse in the treatment of acute diarrhea is widespread in clinical practice worldwide. Hence, the purpose of this study was to examine the pattern of antibiotic use for the acute diarrheal diseases at Hiwot Fana Specialized University Hospital, Harar, Ethiopia. METHODS A retrospective, institution-based cross-sectional study was conducted to investigate the antibiotic utilization pattern for the treatment of acute diarrheal diseases from September 1 to September 30, 2022. Data were obtained retrospectively from patient cards treated for diarrheal disorders from August 1, 2021 to August 31, 2022, using standardized questionnaires, and the analysis was performed using IBM SPSS Statistics version 27. RESULTS Among 332 patients in present study, 271 (81.63%) of them received nine different types of antibiotics, with the most commonly prescribed drugs were Cotrimoxazole (30.26%), Ciprofloxacin (19.19%), and Azithromycin (17.71%). Based on the presence of blood in the stools, 14.76% of the cases were invasive bacterial in nature. Antibiotics were prescribed about 2.55 times more frequently to patients under the age of 12 than to subjects 65 and older (AOR 2.55, 95% CI 1.45-3.87). Patients who received three or more medications were 2.77 times more likely to be prescribed antibiotics (AOR 2.77, 95% CI 1.84-7.56). For every unit increase in the number of drugs prescribed, the odds of prescribing antibiotics increased by 2.44 units (COR 2.44; 95% CI 2.06-4.32). CONCLUSIONS The current study found that antibiotics were overused in both adults and children with acute diarrheal diseases at Hiwot Fana Specialized University Hospital. The number of antibiotics prescribed was significantly associated with the patient's age and the number of medications prescribed. To reduce antibiotic overuse, health professionals have to follow the national standard treatment guidelines.
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Affiliation(s)
- Beyene Dereje
- Pharmacology Department, School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia.
| | - Shegaye Yibabie
- Medicine Department, School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
| | - Zenebe Keno
- Pharmacy Department, Hiwot Fana Specialized University Hospital, College of Health and Medical Science, Haramaya University, Harar, Ethiopia
| | - Alemayehu Megersa
- Pharmacology Department, School of Medicine, College of Medicine and Health Science, Dire Dawa University, Dire Dawa, Ethiopia
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Pédeboscq S, Issa N, Lahouati M, Labadie A, Pereyre S, Camou F. Impact of a 5-year antimicrobial stewardship program focusing on fluoroquinolone prescriptions. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2021; 29:616-621. [PMID: 34355739 DOI: 10.1093/ijpp/riab047] [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: 01/26/2021] [Accepted: 07/02/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Within the context of the wide use of fluoroquinolones (FQs) and the emergence of multidrug-resistant bacteria, French recommendations concerning the appropriate use of systemic FQs in adults were published in 2015. This study assessed the impact of antibiotic stewardship intervention on the use of FQs over a 5-year period. METHODS Five annual audits were performed to evaluate FQ prescriptions. Following the baseline audit, a campaign of appropriate antibiotic use was initiated with courses on antibiotics including FQs. All audits included quantitative and qualitative evaluations to calculate an index of therapeutic adequacy (ITA) with six criteria: indication, molecule type, dosage, duration, route of administration and association. These audits were performed annually from 2015 to 2019. KEY FINDINGS The number of prescriptions decreased substantially from 90 in 2015 to 17 in 2019. This reduction was consistent with consumption data, such that the defined daily dose for 1000 bed days diminished from 67 in 2015 to 42 in 2019. Between 2015 and 2016, the ITA decreased significantly from 3.27 to 1.79 (P = 0.001), corresponding to an improvement in prescription quality. The ITA stabilised between 2016 and 2019. Moreover, improvements were observed in the proportion of entirely conforming prescriptions, conformity of indications, choice of molecule type among FQs and proportion of prescriptions with non-conforming treatment durations. CONCLUSIONS Between 2015 and 2019, we observed quantitative and qualitative improvements in FQ prescriptions within the hospital. Prescription follow-up through annual audits, combined with training courses, contributed to consistent results.
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Affiliation(s)
- Stéphane Pédeboscq
- Pharmacy Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Nahema Issa
- Intensive Care and Infectious Disease Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Marin Lahouati
- Pharmacy Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Aurélie Labadie
- Pharmacy Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
| | - Sabine Pereyre
- Bacteriology Laboratory, University Hospital of Bordeaux, Bordeaux, France
| | - Fabrice Camou
- Intensive Care and Infectious Disease Department, Saint-André Hospital, University Hospital of Bordeaux, Bordeaux, France
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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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Jit M, Ng DHL, Luangasanatip N, Sandmann F, Atkins KE, Robotham JV, Pouwels KB. Quantifying the economic cost of antibiotic resistance and the impact of related interventions: rapid methodological review, conceptual framework and recommendations for future studies. BMC Med 2020; 18:38. [PMID: 32138748 PMCID: PMC7059710 DOI: 10.1186/s12916-020-1507-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/31/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Antibiotic resistance (ABR) poses a major threat to health and economic wellbeing worldwide. Reducing ABR will require government interventions to incentivise antibiotic development, prudent antibiotic use, infection control and deployment of partial substitutes such as rapid diagnostics and vaccines. The scale of such interventions needs to be calibrated to accurate and comprehensive estimates of the economic cost of ABR. METHODS A conceptual framework for estimating costs attributable to ABR was developed based on previous literature highlighting methodological shortcomings in the field and additional deductive epidemiological and economic reasoning. The framework was supplemented by a rapid methodological review. RESULTS The review identified 110 articles quantifying ABR costs. Most were based in high-income countries only (91/110), set in hospitals (95/110), used a healthcare provider or payer perspective (97/110), and used matched cohort approaches to compare costs of patients with antibiotic-resistant infections and antibiotic-susceptible infections (or no infection) (87/110). Better use of methods to correct biases and confounding when making this comparison is needed. Findings also need to be extended beyond their limitations in (1) time (projecting present costs into the future), (2) perspective (from the healthcare sector to entire societies and economies), (3) scope (from individuals to communities and ecosystems), and (4) space (from single sites to countries and the world). Analyses of the impact of interventions need to be extended to examine the impact of the intervention on ABR, rather than considering ABR as an exogeneous factor. CONCLUSIONS Quantifying the economic cost of resistance will require greater rigour and innovation in the use of existing methods to design studies that accurately collect relevant outcomes and further research into new techniques for capturing broader economic outcomes.
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Affiliation(s)
- Mark Jit
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK.
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK.
- School of Public Health, University of Hong Kong, Hong Kong, SAR, China.
| | - Dorothy Hui Lin Ng
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore
| | - Nantasit Luangasanatip
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Frank Sandmann
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK
| | - Katherine E Atkins
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Immunisation, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
- Centre for Global Health Research, The Usher Institute for Population Health Science and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Julie V Robotham
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London, UK
| | - Koen B Pouwels
- Modelling and Economics Unit, National Infections Service, Public Health England, London, UK
- The National Institute for Health Research (NIHR) Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, University of Oxford, Oxford, UK
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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Kaier K, Wolkewitz M, Hehn P, Mutters NT, Heister T. The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system. INTERNATIONAL JOURNAL OF HEALTH ECONOMICS AND MANAGEMENT 2020; 20:1-11. [PMID: 31165960 DOI: 10.1007/s10754-019-09267-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011-2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately - €4000). While controls on average also have a negative reimbursement-cost difference (approximately - €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (- 1500, p < 0.01). HAIs caused by vancomycin-resistant Enterococci have the most unfavorable reimbursement-cost difference (- €10,800), significantly higher (- €9100, p < 0.05) than controls. Among infection types, pneumonia is associated with highest losses (- €8400 and - €5700 compared with controls, p < 0.05), while cost-reimbursement relationship for Clostridium difficile-associated diarrhea is comparatively balanced (- €3200 and - €500 compared to controls, p = 0.198). From the hospital administration's perspective, it is not the additional costs of HAIs, but rather the cost-reimbursement relationship which guides decisions. Costs exceeding reimbursements for HAI may increase infection prevention and control efforts and can be used to show their cost-effectiveness from the hospital perspective.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Nico T Mutters
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Straße 115 b, 79106, Freiburg, Germany
| | - Thomas Heister
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
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Silva ML, Cargnello C, Aulois-Griot M, Dumartin C. Antibiotic misuse: How to evaluate the costs? Med Mal Infect 2019; 49:485-494. [PMID: 30954321 DOI: 10.1016/j.medmal.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/08/2018] [Accepted: 03/13/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Few studies have assessed the costs associated with the misuse of antibiotics in hospitals in France, despite the value of health economic data to inform antibiotic stewardship activities. We aimed to identify the methodological tools used to assess the cost of antibiotic misuse in hospitals. METHODS We performed a literature review using the major electronic medical databases. An index of relevance was developed to assess the intrinsic quality of selected articles. RESULTS Four hundred and three articles were retrieved, but 35 were selected for analysis. Most studies investigated the inadequate choice of the antibiotic molecule (n=17), the incorrect treatment duration (n=9), and the administration of an inappropriate dosage (n=7). Only three studies were medical/economic evaluations of specific interventions, such as prescription control by pharmacists or the implementation of a new diagnostic test. Considering our aim, the relevance of the studies was limited: few had defined the economic assessment as the primary objective or had detailed the method for calculating costs. Nevertheless, the misuse evaluation was usually better described. CONCLUSIONS Despite these limits, key factors for measuring antibiotic misuse (i.e., molecule choice, dosage) in relation to the costs (i.e., over/under prescription, hospital stay, staff remuneration) might serve as the basis for the development of a reference methodology to value the costs of misuse. The application of this methodology on identified situations of antibiotic misuse would help hospital decision-makers to justify resource allocation for implementing antimicrobial stewardship activities.
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Affiliation(s)
- M L Silva
- Unité Inserm 1219, UFR sciences pharmaceutiques- laboratoire de droit et économie pharmaceutiques, université de Bordeaux, 146, rue Léo-Saignat, case postale 81, 33076 Bordeaux, France.
| | - C Cargnello
- Unité Inserm 1219, UFR sciences pharmaceutiques- laboratoire de droit et économie pharmaceutiques, université de Bordeaux, 146, rue Léo-Saignat, case postale 81, 33076 Bordeaux, France
| | - M Aulois-Griot
- Unité Inserm 1219, UFR sciences pharmaceutiques- laboratoire de droit et économie pharmaceutiques, université de Bordeaux, 146, rue Léo-Saignat, case postale 81, 33076 Bordeaux, France
| | - C Dumartin
- Unité Inserm 1219, UFR sciences pharmaceutiques- laboratoire de droit et économie pharmaceutiques, université de Bordeaux, 146, rue Léo-Saignat, case postale 81, 33076 Bordeaux, France; CHU Bordeaux, CPIAS Nouvelle Aquitaine, hôpital Pellegrin - bâtiment Le Tondu, 33076 Bordeaux, France
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Kardaś-Słoma L, Lucet JC, Perozziello A, Pelat C, Birgand G, Ruppé E, Boëlle PY, Andremont A, Yazdanpanah Y. Universal or targeted approach to prevent the transmission of extended-spectrum beta-lactamase-producing Enterobacteriaceae in intensive care units: a cost-effectiveness analysis. BMJ Open 2017; 7:e017402. [PMID: 29102989 PMCID: PMC5722099 DOI: 10.1136/bmjopen-2017-017402] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE Several control strategies have been used to limit the transmission of multidrug-resistant organisms in hospitals. However, their implementation is expensive and effectiveness of interventions for the control of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) spread is controversial. Here, we aim to assess the cost-effectiveness of hospital-based strategies to prevent ESBL-PE transmission and infections. DESIGN Cost-effectiveness analysis based on dynamic, stochastic transmission model over a 1-year time horizon. PATIENTS AND SETTING Patients hospitalised in a hypothetical 10-bed intensive care unit (ICU) in a high-income country. INTERVENTIONS Base case scenario compared with (1) universal strategies (eg, improvement of hand hygiene (HH) among healthcare workers, antibiotic stewardship), (2) targeted strategies (eg, screening of patient for ESBL-PE at ICU admission and contact precautions or cohorting of carriers) and (3) mixed strategies (eg, targeted approaches combined with antibiotic stewardship). MAIN OUTCOMES AND MEASURES Cases of ESBL-PE transmission, infections, cost of intervention, cost of infections, incremental cost per infection avoided. RESULTS In the base case scenario, 15 transmissions and five infections due to ESBL-PE occurred per 100 ICU admissions, representing a mean cost of €94 792. All control strategies improved health outcomes and reduced costs associated with ESBL-PE infections. The overall costs (cost of intervention and infections) were the lowest for HH compliance improvement from 55%/60% before/after contact with a patient to 80%/80%. CONCLUSIONS Improved compliance with HH was the most cost-saving strategy to prevent the transmission of ESBL-PE. Antibiotic stewardship was not cost-effective. However, adding antibiotic restriction strategy to HH or screening and cohorting strategies slightly improved their effectiveness and may be worthy of consideration by decision-makers.
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Affiliation(s)
- Lidia Kardaś-Słoma
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Lucet
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Anne Perozziello
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Camille Pelat
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Gabriel Birgand
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infection Control Unit, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Etienne Ruppé
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Pierre-Yves Boëlle
- Pierre Louis Institute of Epidemiology and Public Health (IPLESPUMRS 1136), INSERM, UPMC University Paris 06, Sorbonne University, Paris, France
| | - Antoine Andremont
- Bacteriology Laboratory, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Yazdan Yazdanpanah
- IAME, UMR 1137, INSERM, Paris, France
- University of Paris Diderot, Sorbonne Paris Cité, Paris, France
- Infectious and Tropical Diseases Department, Bichat-Claude Bernard Hospital, AP-HP, Paris, France
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Fahs I, Shrayteh Z, Abdulkhalek R, Salameh P, Hallit S, Malaeb D. Professional practice evaluation of emergency department prescriptions for community-acquired infections in Lebanon. Int J Infect Dis 2017; 64:74-79. [PMID: 28941632 DOI: 10.1016/j.ijid.2017.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 09/02/2017] [Accepted: 09/05/2017] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Selecting the appropriate antibiotic regimen is extremely important in improving patient outcomes, minimizing antimicrobial resistance, and reducing costs. This study was conducted to evaluate current prescribing practices for empiric antibiotics at the time of admission to the emergency department (ED) and to assess their appropriateness in Lebanon. METHODS A retrospective observational study was conducted at three different Lebanese hospitals between June and December 2016. Adult patients who received antibiotics in the ED during the study period were included. The assessment of antibiotic therapy based on adherence to international guidelines, including the choice of antibiotic, dosing, or both, was considered for analysis. RESULTS A total of 258 patients who had a single diagnosis of an infectious disease were included. Adherence to international guidelines was noted in only 32.6% of cases; the frequency was highest for skin and soft tissue infections (50.0%), followed by urinary tract infections (40%). Among the different antibiotic classes, the highest percentage of drug incompatibility was for β-lactam prescriptions (70.8%). The percentage of incompatibility with guidelines for administered regimens on the basis of drug selection, dosing, or both was 53.4%, 10.3%, and 36.2%, respectively. CONCLUSIONS Inappropriate antibiotic use in the ED is prevalent, and physician adherence to international guidelines for empiric antibiotic prescriptions in the ED remains low. This emphasizes the importance of monitoring the use of antibiotics in the ED, as there is growing concern for antibiotic resistance and healthcare safety.
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Affiliation(s)
- Iqbal Fahs
- Department of Pharmaceutical Sciences, Lebanese International University, Mouseitbeh, Beirut, Lebanon.
| | - Zeina Shrayteh
- Department of Pharmaceutical Sciences, Lebanese International University, Mouseitbeh, Beirut, Lebanon.
| | - Rima Abdulkhalek
- Department of Pharmaceutical Sciences, Lebanese International University, Mouseitbeh, Beirut, Lebanon.
| | - Pascale Salameh
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon; Faculty of Medicine, Lebanese University, Hadath, Lebanon.
| | - Souheil Hallit
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon; Faculty of Pharmacy, Saint-Joseph University, Beirut, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Kaslik, Lebanon; Research Department, Psychiatric Hospital of the Cross, Jal El Dib, Lebanon.
| | - Diana Malaeb
- Department of Pharmaceutical Sciences, Lebanese International University, Mouseitbeh, Beirut, Lebanon.
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Leal JR, Conly J, Henderson EA, Manns BJ. How externalities impact an evaluation of strategies to prevent antimicrobial resistance in health care organizations. Antimicrob Resist Infect Control 2017; 6:53. [PMID: 28588766 PMCID: PMC5457558 DOI: 10.1186/s13756-017-0211-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 05/25/2017] [Indexed: 01/21/2023] Open
Abstract
Background The rates of antimicrobial-resistant organisms (ARO) continue to increase for both hospitalized and community patients. Few resources have been allocated to reduce the spread of resistance on global, national and local levels, in part because the broader economic impact of antimicrobial resistance (i.e. the externality) is not fully considered when determining how much to invest to prevent AROs, including strategies to contain antimicrobial resistance, such as antimicrobial stewardship programs. To determine how best to measure and incorporate the impact of externalities associated with the antimicrobial resistance when making resource allocation decisions aimed to reduce antimicrobial resistance within healthcare facilities, we reviewed the literature to identify publications which 1) described the externalities of antimicrobial resistance, 2) described approaches to quantifying the externalities associated with antimicrobial resistance or 3) described macro-level policy options to consider the impact of externalities. Medline was reviewed to identify published studies up to September 2016. Main body An externality is a cost or a benefit associated with one person’s activity that impacts others who did not choose to incur that cost or benefit. We did not identify a well-accepted method of accurately quantifying the externality associated with antimicrobial resistance. We did identify three main methods that have gained popularity to try to take into account the externalities of antimicrobial resistance, including regulation, charges or taxes on the use of antimicrobials, and the right to trade permits or licenses for antimicrobial use. To our knowledge, regulating use of antimicrobials is the only strategy currently being used by health care systems to reduce antimicrobial use, and thereby reduce AROs. To justify expenditures on programs that reduce AROs (i.e. to formally incorporate the impact of the negative externality of antimicrobial resistance associated with antimicrobial use), we propose an alternative approach that quantifies the externalities of antimicrobial use, combining the attributable cost of AROs with time-series analyses showing the relationship between antimicrobial utilization and incidence of AROs. Conclusion Based on the findings of this review, we propose a methodology that healthcare organizations can use to incorporate the impact of negative externalities when making resource allocation decisions on strategies to reduce AROs. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0211-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jenine R Leal
- Infection Prevention and Control, Alberta Health Services, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Cumming School of Medicine, University of Calgary, Calgary, Canada.,Health Sciences Centre, Room G236, 3330 Hospital Drive NW, Calgary, AB T2N 4N1 Canada
| | - John Conly
- Departments of Medicine, University of Calgary, Calgary, Canada.,Departments of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Canada.,Departments of Pathology and Laboratory Medicine, University of Calgary, Calgary, Canada.,Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Canada.,Foothills Medical Centre, AGW5, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
| | - Elizabeth Ann Henderson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Infection Prevention and Control, Alberta Health Services, Calgary, Canada.,Foothills Medical Centre, AGW5, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
| | - Braden J Manns
- Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Departments of Medicine, University of Calgary, Calgary, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.,Foothills Medical Centre, AGW5, 1403 29th Street NW, Calgary, AB T2N 2T9 Canada
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11
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Varankovich NV, Nickerson MT, Korber DR. Probiotic-based strategies for therapeutic and prophylactic use against multiple gastrointestinal diseases. Front Microbiol 2015; 6:685. [PMID: 26236287 PMCID: PMC4500982 DOI: 10.3389/fmicb.2015.00685] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Accepted: 06/22/2015] [Indexed: 12/18/2022] Open
Abstract
Probiotic bacteria offer a number of potential health benefits when administered in sufficient amounts that in part include reducing the number of harmful organisms in the intestine, producing antimicrobial substances and stimulating the body's immune response. However, precisely elucidating the probiotic effect of a specific bacterium has been challenging due to the complexity of the gut's microbial ecosystem and a lack of definitive means for its characterization. This review provides an overview of widely used and recently described probiotics, their impact on the human's gut microflora as a preventative treatment of disease, human/animal models being used to help show efficacy, and discusses the potential use of probiotics in gastrointestinal diseases associated with antibiotic administration.
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Affiliation(s)
| | | | - Darren R. Korber
- Department of Food and Bioproduct Sciences, University of Saskatchewan, SaskatoonSK, Canada
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12
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Bernard L, Dinh A, Ghout I, Simo D, Zeller V, Issartel B, Le Moing V, Belmatoug N, Lesprit P, Bru JP, Therby A, Bouhour D, Dénes E, Debard A, Chirouze C, Fèvre K, Dupon M, Aegerter P, Mulleman D. Antibiotic treatment for 6 weeks versus 12 weeks in patients with pyogenic vertebral osteomyelitis: an open-label, non-inferiority, randomised, controlled trial. Lancet 2015; 385:875-82. [PMID: 25468170 DOI: 10.1016/s0140-6736(14)61233-2] [Citation(s) in RCA: 271] [Impact Index Per Article: 30.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Duration of treatment for patients with vertebral osteomyelitis is mainly based on expert recommendation rather than evidence. We aimed to establish whether 6 weeks of antibiotic treatment is non-inferior to 12 weeks in patients with pyogenic vertebral osteomyelitis. METHODS In this open-label, non-inferiority, randomised controlled trial, we enrolled patients aged 18 years or older with microbiologically confirmed pyogenic vertebral osteomyelitis and typical radiological features from 71 medical care centres across France. Patients were randomly assigned to either 6 weeks or 12 weeks of antibiotic treatment (physician's choice in accordance with French guidelines) by a computer-generated randomisation list of permuted blocks, stratified by centre. The primary endpoint was the proportion of patients who were classified as cured at 1 year by a masked independent validation committee, analysed by intention to treat. Non-inferiority would be declared if the proportion of cured patients assigned to 6 weeks of treatment was not less than the proportion of cured patients assigned to 12 weeks of treatment, within statistical variability, by an absolute margin of 10%. This trial is registered with EudraCT, number 2006-000951-18, and Clinical Trials.gov, number NCT00764114. FINDINGS Between Nov 15, 2006, and March 15, 2011, 359 patients were randomly assigned, of whom six in the 6-week group and two in the 12-week group were excluded after randomisation. 176 patients assigned to the 6-week treatment regimen and 175 to the 12-week treatment regimen were analysed by intention to treat. 160 (90·9%) of 176 patients in the 6-week group and 159 (90·9%) of 175 of those in the 12-week group met the criteria for clinical cure. The difference between the groups (0·05%, 95% CI -6·2 to 6·3) showed the non-inferiority of the 6-week regimen when compared with the 12-week regimen. 50 patients in the 6-week group and 51 in the 12-week group had adverse events, the most common being death (14 [8%] in the 6-week group vs 12 [7%] in the 12-week group), antibiotic intolerance (12 [7%] vs 9 [5%]), cardiorespiratory failure (7 [4%] vs 12 [7%]), and neurological complications (7 [4%] vs 3 [2%]). INTERPRETATION 6 weeks of antibiotic treatment is not inferior to 12 weeks of antibiotic treatment with respect to the proportion of patients with pyogenic vertebral osteomyelitis cured at 1 year, which suggests that the standard antibiotic treatment duration for patients with this disease could be reduced to 6 weeks. FUNDING French Ministry of Health.
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Affiliation(s)
- Louis Bernard
- Division of Infectious Diseases, University Hospital Bretonneau, Tours, France; Division of Infectious Diseases, Bretonneau University Hospital, Tours, France.
| | - Aurélien Dinh
- Division of Infectious Diseases, University Hospital Raymond Poincaré, Garches, France
| | - Idir Ghout
- Clinical Research Unit, University Hospital Ambroise Paré, Boulogne, France
| | - David Simo
- Clinical Research Unit, University Hospital Ambroise Paré, Boulogne, France
| | - Valerie Zeller
- Referral Centre for Bone and Joint Infections, Hospital Diaconesses Croix Saint-Simon, Paris, France
| | | | - Vincent Le Moing
- Maladies Infectieuses et Tropicales, University Hospital, Montpellier, France
| | - Nadia Belmatoug
- Division of Internal Medicine, University Hospital, Beaujon-Clichy, France
| | - Philippe Lesprit
- Mobile Infectious Diseases Unit, University Hospital, Créteil, France
| | - Jean-Pierre Bru
- Division of Infectious Diseases, Regional Hospital, Annecy, France
| | - Audrey Therby
- Division of Infectious Diseases, General Hospital of Versailles, Le Chesnay, France
| | - Damien Bouhour
- Division of Infectious Diseases, General Hospital, Bourg en Bresse, France
| | - Eric Dénes
- Division of Infectious Diseases, Limoges University Hospital, Limoges, France
| | - Alexa Debard
- Division of Infectious Diseases, University Hospital, Toulouse, France
| | | | - Karine Fèvre
- Division of Infectious Diseases, Bretonneau University Hospital, Tours, France
| | - Michel Dupon
- Division of Infectious Diseases, Bordeaux University Hospital, Bordeaux, France
| | - Philippe Aegerter
- Clinical Research Unit, AP-HP, Ambroise Paré University Hospital, Boulogne, France
| | - Denis Mulleman
- Division of Rheumatology, University Hospitals of Tours, Tours, France
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13
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Borde JP, Kern WV, Hug M, Steib-Bauert M, de With K, Busch HJ, Kaier K. Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department. Emerg Med J 2014; 32:509-15. [PMID: 25261006 DOI: 10.1136/emermed-2014-204067] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/29/2014] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Early initiation of antimicrobial treatment for acute infection is an important task in the emergency department (ED) with a likely impact on the hospital-wide antibiotic use pattern. We implemented an antibiotic stewardship (ABS) programme focused on non-trauma emergency patients at a large university hospital centre targeting broad-spectrum cephalosporin and fluoroquinolone use. METHODS Guidelines and focused discussion groups emphasised reduced prescription of third-generation cephalosporins and fluoroquinolones and encouraged penicillins. Antibiotic consumption expressed as monthly drug density in WHO-Anatomical Therapeutic Chemical defined and locally recommended daily doses (DDD and RDD) per 100 patient days was analysed before (January 2008 to October 2011) and after starting the intervention (January 2012 to October 2013). We performed a before-and-after uncontrolled interventional study using interrupted time-series (ITS) analysis in one ED to investigate ABS intervention-related effects in a quasiexperimental research setting. RESULTS The mean monthly total antibiotic use density declined from 111 RDD (138 DDD) per 100 patient days before the intervention to 86 RDD (128 DDD) per 100 patient days after starting the intervention. Among the different antibacterial drug classes, the consumption of third-generation cephalosporins showed the largest reduction and dropped significantly by -68% between preintervention and postintervention periods. Using the RDD dataset, ITS confirmed a highly significant postintervention change in level of third-generation cephalosporins (-15.2, 95% CI (-24.08 to -6.311)) and a corresponding increase in the use of aminopenicillin/betalactamase inhibitor formulations (+6.6, 95% CI (4.169 to 9.069)). The drug use densities for fluoroquinolones and for overall antibiotics declined, however, the postinterventional level changes missed statistical significance--overall (95% CI (-39.99 to 0.466), fluoroquinolones 95% CI (-11.72 to 4.333)). CONCLUSIONS An intensified ABS programme using non-restrictive tools targeting third-generation cephalosporin and fluoroquinolone use in the setting of a large academic hospital emergency medicine department is feasible and effective. The intervention may serve as a model for other emergency medicine departments at hospitals with a similar structure and baseline situation.
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Affiliation(s)
- Johannes P Borde
- Department of Medicine, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany
| | - Winfried V Kern
- Department of Medicine, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany
| | - Martin Hug
- Pharmacy Service, University Medical Center, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany
| | - Michaela Steib-Bauert
- Department of Medicine, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany
| | - Katja de With
- Department of Medicine, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Hans-Jörg Busch
- Department of Medicine, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany Department of Emergency Medicine, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany
| | - Klaus Kaier
- Institute of Medical Biometry and Informatics, Universitätsklinikum Freiburg i.Br., Freiburg i.Br., Germany
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14
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Borde JP, Kaier K, Steib-Bauert M, Vach W, Geibel-Zehender A, Busch H, Bertz H, Hug M, de With K, Kern WV. Feasibility and impact of an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a tertiary care university medical center. BMC Infect Dis 2014; 14:201. [PMID: 24731220 PMCID: PMC3999502 DOI: 10.1186/1471-2334-14-201] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 04/09/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Restricted use of third-generation cephalosporins and fluoroquinolones has been linked to a reduced incidence of hospital-acquired infections with multidrug-resistant bacteria. We implemented an intensified antibiotic stewardship (ABS) programme in the medical service of a university hospital center aiming at a reduction by at least 30% in the use of these two drug classes. METHODS The ABS programme was focused on the 300-bed medical service. Prescription of third-generation cephalosporins was discouraged, whereas the use of penicillins was encouraged. Monthly drug use density was measured in WHO-ATC defined and locally recommended daily doses (DDD and RDD) per 100 patient days, to evaluate trends before (01/2008 to 10/2011) and after starting the intervention (1/2012 to 3/2013). The effect was analysed using interrupted time-series analysis with six non-intervention departments as controls. RESULTS Following initiation of the ABS intervention, overall antibiotic use in the medical service declined (p < 0.001). There was a significant intervention-related decrease in the use of cephalosporins and fluoroquinolones (p < 0.001) outperforming the decreasing baseline trend. Trend changes observed in some of the control departments were smaller, and the difference between trend changes in the medical service and those in control departments were highly significant for overall use and cephalosporin use reductions (p < 0.001) as well as for the increasing use of penicillins (p < 0.001). Mean use density levels (in RDD per 100 patient days) dropped for cephalosporins from 16.3 to 10.3 (-37%) and for fluoroquinolones from 17.7 to 10.1 (-43%), respectively. During the same period, the use of penicillins increased (15.4 to 18.2; 18%). The changes in expenditures for antibiotics in the medical service compared to control services minus programme costs indicated initial net cost savings likely to be associated with the programme. CONCLUSION An intensified ABS programme targeting cephalosporin und fluoroquinolone use in the setting of a large academic hospital is feasible and effective. The intervention may serve as a model for other services and hospitals with a similar structure and baseline situation.
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Affiliation(s)
- Johannes P Borde
- Department of Medicine, Abteilung Infektiologie, Universitätsklinikum Freiburg, Hugstetter Straße 55, D-79106 Freiburg i,Br, Germany.
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15
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Manzoor S, Moncayo S, Navarro-Villoslada F, Ayala JA, Izquierdo-Hornillos R, de Villena FJM, Caceres JO. Rapid identification and discrimination of bacterial strains by laser induced breakdown spectroscopy and neural networks. Talanta 2014; 121:65-70. [PMID: 24607111 DOI: 10.1016/j.talanta.2013.12.057] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Revised: 12/16/2013] [Accepted: 12/24/2013] [Indexed: 01/27/2023]
Abstract
Identification and discrimination of bacterial strains of same species exhibiting resistance to antibiotics using laser induced breakdown spectroscopy (LIBS) and neural networks (NN) algorithm is reported. The method has been applied to identify 40 bacterial strains causing hospital acquired infections (HAI), i.e. Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Salmonella typhimurium, Salmonella pullurum and Salmonella salamae. The strains analyzed included both isolated from clinical samples and constructed in laboratory that differ in mutations as a result of their resistance to one or more antibiotics. Small changes in the atomic composition of the bacterial strains, as a result of their mutations and genetic variations, were detected by the LIBS-NN methodology and led to their identification and classification. This is of utmost importance because solely identification of bacterial species is not sufficient for disease diagnosis and identification of the actual strain is also required. The proposed method was successfully able to discriminate strains of the same bacterial species. The optimized NN models provided reliable bacterial strain identification with an index of spectral correlation higher than 95% for the samples analyzed, showing the potential and effectiveness of the method to address the safety and social-cost HAI-related issue.
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Affiliation(s)
- S Manzoor
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense, 28040 Madrid, Spain
| | - S Moncayo
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense, 28040 Madrid, Spain
| | - F Navarro-Villoslada
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense, 28040 Madrid, Spain
| | - J A Ayala
- Centro de Biología Molecular "Severo Ochoa", CSIC. C/Nicolás Cabrera, 1, Cantoblanco, 28049 Madrid, Spain
| | - R Izquierdo-Hornillos
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense, 28040 Madrid, Spain
| | - F J Manuel de Villena
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense, 28040 Madrid, Spain
| | - J O Caceres
- Departamento de Química Analítica, Facultad de Ciencias Químicas, Universidad Complutense, 28040 Madrid, Spain.
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Vandijck D, Cleemput I, Hellings J, Vogelaers D. Infection prevention and control strategies in the era of limited resources and quality improvement: a perspective paper. Aust Crit Care 2013; 26:154-7. [PMID: 23969192 DOI: 10.1016/j.aucc.2013.07.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 02/08/2023] Open
Abstract
This paper aims to describe, using an evidence-based approach, the importance of and the resources necessary for implementing effective infection prevention and control (IPC) programmes. The intrinsic and explicit values of such strategies are presented from a clinical, health-economic and patient safety perspective. Policy makers and hospital managers are committed to providing comprehensive, accessible, and affordable healthcare of high quality. Changes in the healthcare system over time accompanied with variations in demographics and case-mix have considerably affected the availability, quality and ultimately the safety of healthcare. The main goal of an IPC programme is to prevent and control healthcare-associated infections (HAI). Many patient-, healthcare provider-, and organizational factors are associated with an increased risk for acquiring HAIs and may impact both the quality and outcome of patient care. Evidence has been published in support of having an effective IPC programme. It has been estimated that about one-third of HAIs could be prevented if key elements of the evidence-based recommendations for IPC are adequately introduced and followed. However, several healthcare agencies from over the world have reported deficits in the essential resources and components of current IPC programmes. To meet its main goal, staffing, training, and infrastructure requirements are needed. Nevertheless, and given the economic crisis, policy makers and hospital managers may be tempted to not increase or even to reduce the budget as it consumes resources and does not generate sufficient visible revenue. IPC is a critical issue in patient safety, as HAIs are by far the most common complication affecting admitted patients. The significant clinical and health-economic burden HAIs place on the healthcare system speak to the importance of getting introduced effective IPC programmes.
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Affiliation(s)
- Dominique Vandijck
- Ghent University, Faculty of Medicine and Health Sciences, Ghent, Belgium; Hasselt University, Faculty of Business Economics, Diepenbeek, Belgium.
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Kaier K, Mutters NT, Frank U. Bed occupancy rates and hospital-acquired infections--should beds be kept empty? Clin Microbiol Infect 2012; 18:941-5. [PMID: 22757765 DOI: 10.1111/j.1469-0691.2012.03956.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
There is growing evidence that bed occupancy (BO) rates, overcrowding and understaffing influence the spread of hospital-acquired infections (HAIs). In this article, a systematic review of the literature is presented, summarizing the evidence on the adverse effects of high BO rates and overcrowding in hospitals on the incidence of HAIs. A Pubmed database search identified 179 references, of which 44 were considered to be potentially relevant for full-text review. The majority (62.9%) focused on methicillin-resistant Staphylococcus aureus-associated infection or colonization. Only 12 studies were found that provided a statistical analysis of the impact of BO on HAI rates. The median BO rate of the analysed studies was 81.2%. The majority of studies (75%) indicated that BO rates and understaffing directly influence the incidence of HAIs. Only three studies showed no significant association between BO rates and the incidence of HAIs. Interestingly, only one of the included studies detected a seasonal trend in the BO rate. The present review shows an association between BO rates and the spread of HAIs in various settings. Because the evidence on this topic is limited, we conclude that further research is needed in order to analyse the rationale of a threshold BO rate, because keeping beds empty is comparatively costly.
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Affiliation(s)
- K Kaier
- Department of Environmental Health Sciences, University Medical Centre Freiburg, Freiburg, Germany.
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