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Albayrak A, Akkuzu E, Karahalil B. The impact of antimicrobial use on potential major drug-drug interactions in the pediatric Intensive Care Unit patients at University Hospital in Türkiye. Minerva Pediatr (Torino) 2024; 76:388-394. [PMID: 33858128 DOI: 10.23736/s2724-5276.21.06173-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Antimicrobials, especially antibiotics, are among the most widely used drugs in the pediatric intensive care unit. Pediatrics patients in intensive care unit are exposed to potential drug-drug interactions (PDDIs) and suffered from their adverse and side effects. The aim of this study is to evaluate the impact of antimicrobial use on PDDIs, as well as to examine the rate and the risk factors PDDIs, furthermore the management of PDDIs. METHODS The present retrospective cohort study included 179 patients under 18 years of age who were hospitalized in Pediatric Intensive Care Unit in Türkiye. Drug interactions were evaluated using the Lexicomp® (Macedonia, OH, USA) drug interaction tool which provides evidence-based drug information. RESULTS Our study results showed that the frequency of the use of antimicrobial drugs (antibiotic, antifungal, antiviral) was found to be statistically significantly higher (P<0.05) in the group with PDDIs compared to the group without PDDIs. Especially, the use of carbapenem, cephalosporin among the antibiotic groups significantly increased the frequency of PDDIs (P<0.05). While the probability PDDIs statistically significantly increased 3.73 times (OR [odds ratio] = 3.73; 95% CI=1.47-9.50) in patients who used a single antibiotic compared to patients who did not use antibiotics (P=0.006), the probability of the occurrence of PDDIs by using more than one antibiotic was statistically significantly 8.5 times (95% CI=3.30-21.89) (P<0.001). CONCLUSIONS Our study results showed that the use of antimicrobial drugs (antibiotic, antifungal, antiviral) was found to be statistically significantly higher (P<0.05) in the group with PDDIs.
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Affiliation(s)
- Aslınur Albayrak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Gazi University, Ankara, Türkiye -
| | - Emine Akkuzu
- Department of Pediatric Intensive Care, Medical Faculty, Gazi University, Ankara, Türkiye
| | - Bensu Karahalil
- Department of Pharmaceutical Toxicology, Faculty of Pharmacy, Gazi University, Ankara, Türkiye
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2
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Gatti M, Cojutti PG, Campoli C, Caramelli F, Corvaglia LT, Lanari M, Pession A, Ramirez S, Viale P, Pea F. A Proof of Concept of the Role of TDM-Based Clinical Pharmacological Advices in Optimizing Antimicrobial Therapy on Real-Time in Different Paediatric Settings. Front Pharmacol 2021; 12:755075. [PMID: 34646143 PMCID: PMC8502823 DOI: 10.3389/fphar.2021.755075] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 09/13/2021] [Indexed: 01/14/2023] Open
Abstract
Introduction: Antimicrobial treatment is quite common among hospitalized children. The dynamic age-associated physiological variations coupled with the pathophysiological alterations caused by underlying illness and potential drug-drug interactions makes the implementation of appropriate antimicrobial dosing extremely challenging among paediatrics. Therapeutic drug monitoring (TDM) may represent a valuable tool for assisting clinicians in optimizing antimicrobial exposure. Clinical pharmacological advice (CPA) is an approach based on the correct interpretation of the TDM result by the MD Clinical Pharmacologist in relation to specific underlying conditions, namely the antimicrobial susceptibility of the clinical isolate, the site of infection, the pathophysiological characteristics of the patient and/or the drug-drug interactions of cotreatments. The aim of this study was to assess the role of TDM-based CPAs in providing useful recommendations for the real-time personalization of antimicrobial dosing regimens in various paediatric settings. Materials and methods: Paediatric patients who were admitted to different settings of the IRCCS Azienda Ospedaliero-Universitaria of Bologna, Italy (paediatric intensive care unit [ICU], paediatric onco-haematology, neonatology, and emergency paediatric ward), between January 2021 and June 2021 and who received TDM-based CPAs on real-time for personalization of antimicrobial therapy were retrospectively assessed. Demographic and clinical features, CPAs delivered in relation to different settings and antimicrobials, and type of dosing adjustments were extracted. Two indicators of performance were identified. The number of dosing adjustments provided over the total number of delivered CPAs. The turnaround time (TAT) of CPAs according to a predefined scale (optimal, <12 h; quasi-optimal, between 12-24 h; acceptable, between 24-48 h; suboptimal, >48 h). Results: Overall, 247 CPAs were delivered to 53 paediatric patients (mean 4.7 ± 3.7 CPAs/patient). Most were delivered to onco-haematological patients (39.6%) and to ICU patients (35.8%), and concerned mainly isavuconazole (19.0%) and voriconazole (17.8%). Overall, CPAs suggested dosing adjustments in 37.7% of cases (24.3% increases and 13.4% decreases). Median TAT was 7.5 h (IQR 6.1-8.8 h). Overall, CPAs TAT was optimal in 91.5% of cases, and suboptimal in only 0.8% of cases. Discussion: Our study provides a proof of concept of the helpful role that TDM-based real-time CPAs may have in optimizing antimicrobial exposure in different challenging paediatric scenarios.
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Affiliation(s)
- Milo Gatti
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pier Giorgio Cojutti
- SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Caterina Campoli
- Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Fabio Caramelli
- Pediatric Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Tommaso Corvaglia
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Neonatal Intensive Care Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Marcello Lanari
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Pediatric Emergency Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Andrea Pession
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Pediatric Oncology & Hematology Unit 'Lalla Seràgnoli', IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Pierluigi Viale
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,Infectious Diseases Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Federico Pea
- Department of Medical and Surgical Sciences, Alma Mater Studiorum University of Bologna, Bologna, Italy.,SSD Clinical Pharmacology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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3
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Hartman SJF, Brüggemann RJ, Orriëns L, Dia N, Schreuder MF, de Wildt SN. Pharmacokinetics and Target Attainment of Antibiotics in Critically Ill Children: A Systematic Review of Current Literature. Clin Pharmacokinet 2021; 59:173-205. [PMID: 31432468 PMCID: PMC7007426 DOI: 10.1007/s40262-019-00813-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Pharmacokinetics (PK) are severely altered in critically ill patients due to changes in volume of distribution (Vd) and/or drug clearance (Cl). This affects the target attainment of antibiotics in critically ill children. We aimed to identify gaps in current knowledge and to compare published PK parameters and target attainment of antibiotics in critically ill children to healthy children and critically ill adults. METHODS Systematic literature search in PubMed, EMBASE and Web of Science. Articles were labelled as relevant when they included information on PK of antibiotics in critically ill, non-neonatal, pediatric patients. Extracted PK-parameters included Vd, Cl, (trough) concentrations, AUC, probability of target attainment, and elimination half-life. RESULTS 50 relevant articles were identified. Studies focusing on vancomycin were most prevalent (17/50). Other studies included data on penicillins, cephalosporins, carbapenems and aminoglycosides, but data on ceftriaxone, ceftazidime, penicillin and metronidazole could not be found. Critically ill children generally show a higher Cl and larger Vd than healthy children and critically ill adults. Reduced target-attainment was described in critically ill children for multiple antibiotics, including amoxicillin, piperacillin, cefotaxime, vancomycin, gentamicin, teicoplanin, amikacin and daptomycin. 38/50 articles included information on both Vd and Cl, but a dosing advice was given in only 22 articles. CONCLUSION The majority of studies focus on agents where TDM is applied, while other antibiotics lack data altogether. The larger Vd and higher Cl in critically ill children might warrant a higher dose or extended infusions of antibiotics in this patient population to increase target-attainment. Studies frequently fail to provide a dosing advice for this patient population, even if the necessary information is available. Our study shows gaps in current knowledge and encourages future researchers to provide dosing advice for special populations whenever possible.
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Affiliation(s)
- Stan J F Hartman
- Department of Pharmacology-Toxicology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | | | - Lynn Orriëns
- Department of Pharmacology-Toxicology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Nada Dia
- Department of Pharmacology-Toxicology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Michiel F Schreuder
- Division of Pediatric Nephrology, Department of Pediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Saskia N de Wildt
- Department of Pharmacology-Toxicology, Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Department of Intensive Care Medicine, Radboudumc, Nijmegen, The Netherlands.,Intensive Care and Department of Pediatric Surgery, Erasmus MC-Sophia Children's Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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4
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Abdel-Qader DH, Ismael NS, Albassam A, El-Shara’ AA, Aljamal MS, Ismail R, Abdel-Qader HA, Hamadi S, Al Mazrouei N, Ibrahim OM. Antibiotics use and appropriateness in two Jordanian children hospitals: a point prevalence study. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Background
Although inappropriate antibiotics prescribing in hospitals is a key factor in accelerating antibiotic resistance, inadequate data are available about antibiotics prescribing rate and appropriateness. Our study aimed to measure antibiotics prescribing rate, indications, appropriateness and predictors.
Methods
The study was conducted in two public children hospitals (five wards) in Jordan using one-week point prevalence survey to prospectively collect the data. Appropriateness of antibiotics therapy was assessed by a multidisciplinary committee and predictors of inappropriate prescribing were studied through multivariate logistic regression.
Key findings
The overall antibiotics prescribing rate was 75.6% (n = 501/663), where the highest rate of antibiotics prescribing was in the Pediatrics ward (82.2%, n = 222/270). However, the lowest rate was in the Pediatric Intensive Care Unit (30.0%, 9/30). The most common antibiotics classes prescribed were: Beta-lactams (57.5%, n = 492/855). The most common underlying condition for antibiotics prescribing was upper respiratory tract infections (25.5%, n = 128/501) followed by pneumonia (20.6%, n = 103/501). Around half of antibiotics were prescribed upon appropriate decision (49.5%, n = 423/855). However, 22.0% (n = 188/855) of antibiotics were wrongly chosen, and 9.5% (n = 81/855) were wrongly applied. Initially inappropriate decision for prescription occurred in 15.3% (n = 131/855) of antibiotics. Ceftriaxone (OR 3.1; 95% CI 2.6–4.1; P = 0.03) and patients with ≥3 medication orders (OR 2.6; 95% CI 1.7–3.5; P = 0.001) significantly predicted inappropriate antibiotics prescribing.
Conclusions
The incidence of antibiotics prescribing in Jordanian children hospitals was high compared to other countries. Further multi-centric studies are required to enhance the generalisability of results and better develop effective and efficient antibiotic stewardship programmes.
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Affiliation(s)
| | | | - Abdullah Albassam
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Kuwait, Kuwait
| | | | | | - Rami Ismail
- Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Hasan A Abdel-Qader
- Consultant Pediatrician and Neonatologist, Ministry of Health, Amman, Jordan
| | - Salim Hamadi
- Faculty of Pharmacy & Medical Sciences, University of Petra, Amman, Jordan
| | - Nadia Al Mazrouei
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah., Sharjah, UAE
| | - Osama Mohamed Ibrahim
- Department of Pharmacy Practice and Pharmacotherapeutics, College of Pharmacy, University of Sharjah., Sharjah, UAE
- Department of Clinical Pharmacy, Faculty of Pharmacy, Cairo University, Cairo, Egypt
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5
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Clements MN, Russell N, Bielicki JA, Ellis S, Gastine S, Hsia Y, Standing JF, Walker AS, Sharland M. Global antibiotic dosing strategies in hospitalised children: Characterising variation and implications for harmonisation of international guidelines. PLoS One 2021; 16:e0252223. [PMID: 34043696 PMCID: PMC8159011 DOI: 10.1371/journal.pone.0252223] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 05/11/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Paediatric global antibiotic guidelines are inconsistent, most likely due to the limited pharmacokinetic and efficacy data in this population. We investigated factors underlying variation in antibiotic dosing using data from five global point prevalence surveys. METHODS & FINDINGS Data from 3,367 doses of the 16 most frequent intravenous antibiotics administered to children 1 month-12 years across 23 countries were analysed. For each antibiotic, we identified standard doses given as either weight-based doses (in mg/kg/day) or fixed daily doses (in mg/day), and investigated the pattern of dosing using each strategy. Factors underlying observed variation in weight-based doses were investigated using linear mixed effects models. Weight-based dosing (in mg/kg/day) clustered around a small number of peaks, and all antibiotics had 1-3 standard weight-based doses used in 5%-48% of doses. Dosing strategy was more often weight-based than fixed daily dosing for all antibiotics apart from teicoplanin, which had approximately equal proportions of dosing attributable to each strategy. No strong consistent patterns emerged to explain the historical variation in actual weight-based doses used apart from higher dosing seen in central nervous system infections, and lower in skin and soft tissue infections compared to lower respiratory tract infections. Higher dosing was noted in the Americas compared to the European region. CONCLUSIONS Antibiotic dosing in children clusters around a small number of doses, although variation remains. There is a clear opportunity for the clinical, scientific and public health communities to consolidate behind a consistent set of global antibiotic dosing guidelines to harmonise current practice and prioritise future research.
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Affiliation(s)
| | - Neal Russell
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University, London, United Kingdom
| | - Julia A. Bielicki
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University, London, United Kingdom
| | - Sally Ellis
- Global Antibiotic Research & Development Partnership, Geneva, Switzerland
| | - Silke Gastine
- Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | - Yingfen Hsia
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University, London, United Kingdom
| | - Joseph F. Standing
- Infection, Immunity and Inflammation, Institute of Child Health, University College London, London, United Kingdom
| | | | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Institute for Infection and Immunity, St George’s University, London, United Kingdom
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6
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Barbieri E, Donà D, Cantarutti A, Lundin R, Scamarcia A, Corrao G, Cantarutti L, Giaquinto C. Antibiotic prescriptions in acute otitis media and pharyngitis in Italian pediatric outpatients. Ital J Pediatr 2019; 45:103. [PMID: 31420054 PMCID: PMC6697973 DOI: 10.1186/s13052-019-0696-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Acute otitis media (AOM) and pharyngitis are very common infections in children and adolescents. Italy is one of the European countries with the highest rate of antibiotic prescriptions. The aim of this study is to describe first-line treatment approaches for AOM and pharyngitis in primary care settings in Italy over six years, including the prevalence of ‘wait and see’ for AOM, where prescription of antibiotics is delayed 48 h from presentation, and differences in prescribing for pharyngitis when diagnostic tests are used. Methods The study is a secondary data analysis using Pedianet, a database including data at outpatient level from children aged 0–14 in Italy. Prescriptions per antibiotic group, per age group and per calendar year were described as percentages. “Wait and see” approach rate was described for AOM and pharyngitis prescriptions were further grouped according to the diagnostic test performed and test results. Results We identified 120,338 children followed by 125 family pediatricians between January 2010 and December 2015 for a total of 923,780 person-years of follow-up. Among them 30,394 (mean age 44 months) had at least one AOM diagnosis (n = 54,943) and 52,341 (mean age 5 years) had at least one pharyngitis diagnosis (n = 126,098). 82.5% of AOM diagnoses were treated with an antibiotic within 48 h (mainly amoxicillin and amoxicillin/clavulanate) and the “wait and see” approach was adopted only in 17.5% of cases. The trend over time shows an increase in broad spectrum antibiotic prescriptions in the last year (2015). 79,620 (63%) cases of pharyngitis were treated and among GABHS pharyngitis confirmed by rapid test 56% were treated with amoxicillin. The ones not test confirmed were treated mainly with broad spectrum antibiotics. Conclusions Despite guidance to use the ‘wait and see’ approach in the age group analyzed, this strategy is not often used for AOM, as previously noted in other studies in hospital settings. Broad-spectrum antibiotic prescription was more frequent when pharyngitis was not confirmed by rapid test, in keeping with evidence from other studies that diagnostic uncertainty leads to overuse of antibiotics. Electronic supplementary material The online version of this article (10.1186/s13052-019-0696-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E Barbieri
- Department for Woman and Child Health, University of Padua, Padua, Italy.
| | - D Donà
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy
| | - A Cantarutti
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | | | - G Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Department of Statistics and Quantitative Methods, Unit of Biostatistics Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | | | - C Giaquinto
- Division of Paediatric Infectious Diseases, Department for Woman and Child Health, University of Padua, Via Giustiniani 3, 35141, Padua, Italy.,PENTA Foundation, Padua, Italy.,National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.,Pedianet Project, Padua, Italy
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7
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Mali NB, Deshpande SP, Tullu MS, Deshmukh CT, Gogtay NJ, Thatte UM. A Prospective Antibacterial Utilization Study in Pediatric Intensive Care Unit of a Tertiary Referral Center. Indian J Crit Care Med 2018; 22:422-426. [PMID: 29962742 PMCID: PMC6020630 DOI: 10.4103/ijccm.ijccm_365_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Purpose: Antibacterials are commonly prescribed to Pediatric Intensive Care Unit (PICU) patients. However, inappropriate antibacterial prescriptions lead to increases in antibacterial resistance, treatment cost, duration of treatment, and poor clinical outcome. The antibacterial utilization study assesses the prescription patterns and if necessary recommends the interventions to improve antibacterial prescriptions. Hence, the present prospective groundwork was conducted. Materials and Methods: The study was conducted over the period of 6 months (April 18 to October 20, 2014). The demographics and drug use details were captured daily from patients admitted to PICU to assess World Health Organization indicators. Results: A total of 200 patients enrolled, among them 119 males and 81 females. There were 12.46 (±6.16) drugs prescribed per patient, of which 2.38 (±1.48) were antibacterials. Among the total drug prescribed, 18.49% were antibacterials and 97% patients received at least one antibacterial. Ceftriaxone (49.48%) was the most commonly prescribed antibacterial, while imipenem (2.58%) and colistin (2.06%) use was very low. A total of 80.95% antibacterials were prescribed by generic name, 94.88% were administered intravenously, and 80.76% were prescribed from hospital pharmacy. The average length of PICU stay was 6.15 days (±6.20), the average length of antibacterial treatment was 6.08 days (±6.27), and the average length of empirical antibacterial treatment was 5.50 days (±5.40). The cost of antibacterial therapy per patient was Indian rupees 824.64 (±235.35). In 27 patients, bacterial culture test was positive and of whom 21 received antibacterials as per sensitivity pattern. Conclusions: The use of antibacterials was not indiscriminately high but more prescriptions per sensitivity pattern are required.
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Affiliation(s)
- Nitin B Mali
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Siddharth P Deshpande
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Milind S Tullu
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Chandrahas T Deshmukh
- Department of Pediatrics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Nithya J Gogtay
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
| | - Urmila M Thatte
- Department of Clinical Pharmacology, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
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8
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Goycochea-Valdivia WA, Moreno-Ramos F, Paño-Pardo JR, Aracil-Santos FJ, Baquero-Artigao F, del Rosal-Rabes T, Mellado-Peña MJ, Escosa-García L. Identifying priorities to improve paediatric in-hospital antimicrobial use by cross-sectional evaluation of prevalence and appropriateness of prescription. Enferm Infecc Microbiol Clin 2017; 35:556-562. [DOI: 10.1016/j.eimc.2017.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 11/27/2022]
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9
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Krasniqi S, Versporten A, Jakupi A, Raka D, Daci A, Krasniqi V, Deva Z, Rashiti A, Brajshori N, Hajdari S, Bytyqi J, Neziri B, Goossens H, Raka L. Antibiotic utilisation in adult and children patients in Kosovo hospitals. Eur J Hosp Pharm 2017; 26:146-151. [PMID: 31428322 DOI: 10.1136/ejhpharm-2017-001363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 01/21/2023] Open
Abstract
Objectives There are no reliable data on antibiotic use in Kosovo hospitals. The aim of this survey was to monitor volumes and patterns of antibiotic use in hospitalised patients in order to identify targets for quality improvement. Methods Data on antimicrobial use were collected from seven hospitals in Kosovo during 2013 using the standardised point prevalence survey (PPS) methodology as developed by the ESAC (European Surveillance of Antimicrobial Consumption) and ARPEC (Antibiotic Resistance and Prescribing in European Children). The survey included all inpatients receiving an antimicrobial agent on the day of the PPS. Results Overall, 1667 patients were included in the study: adults 1345 (81%) and children 322 (19%). Of the hospital inpatients, 579/1345 (43%) adults and 188/322 (58%) children received at least one antibiotic during a hospital stay. The top three antibacterial subgroups (ATC level 3) were β-lactam antibiotics, cephalosporins and aminoglycosides. In all hospital centres, the most commonly prescribed antibiotic was ceftriaxone (39% for adult and 36% for children). Antibiotics were administered mainly parenterally in 74% of adults and 94% of children. Empirical prescribing was higher in adults 498/579 (86%) and children 181/188 (96%), compared with targeted treatment based on susceptibility testing-81 (14%) and 8 (4%), respectively. Conclusions Antibiotic use in Kosovo's hospitals is very high. Gathered data will be an important tool to identify targets for quality improvement and will support preparation of guidelines and protocols for the prudent use of antibiotics.
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Affiliation(s)
- Shaip Krasniqi
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Ann Versporten
- Faculty of Medicine and Health Science, Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Arianit Jakupi
- Kosovo Medicine Agency, Ministry of Health of Kosovo, Prishtina, Kosovo
| | - Denis Raka
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Armond Daci
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Valon Krasniqi
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Zana Deva
- Institute of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo
| | - Albiona Rashiti
- Institute of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo
| | - Naime Brajshori
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Shefqet Hajdari
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Jetëmira Bytyqi
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Burim Neziri
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Herman Goossens
- Faculty of Medicine and Health Science, Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Lul Raka
- Institute of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo.,Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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Gucwa AL, Dolar V, Ye C, Epstein S. Correlations between quality ratings of skilled nursing facilities and multidrug-resistant urinary tract infections. Am J Infect Control 2016; 44:1256-1260. [PMID: 27810066 DOI: 10.1016/j.ajic.2016.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/08/2016] [Accepted: 03/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to determine risk factors for the acquisition of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) in residents of skilled nursing facilities (SNFs). METHODS Using the informational database provided by the Centers for Medicare and Medicaid Services (CMS), a retrospective logistic regression was performed on 1,523 urine cultures from 12 SNFs located in Long Island, New York. RESULTS Of the 1,142 positive urine cultures, Escherichia coli was most prevalent. Additionally, 164 (14.4%) of the UTIs were attributed to an MDRO. In multivariate logistic regression, sex and overall quality rating predicted the occurrence of UTIs, whereas identification of MDROs was dependent on the level of nursing care received. The mean predicted probability of UTIs and receipt of contaminated samples was inversely dependent on the facility's rating, where the likelihood increased as overall quality ratings decreased. CONCLUSIONS The CMS's quality rating system may provide some insight into the status of infection control practices in SNFs. The results of this study suggest that potential consumers should focus on the overall star ratings and the competency of the nursing staff in these facilities rather than on individual quality measures.
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Abbas Q, Ul Haq A, Kumar R, Ali SA, Hussain K, Shakoor S. Evaluation of antibiotic use in Pediatric Intensive Care Unit of a developing country. Indian J Crit Care Med 2016; 20:291-4. [PMID: 27275078 PMCID: PMC4876651 DOI: 10.4103/0972-5229.182197] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Pediatric Intensive Care Unit (PICU) patients are often prescribed antibiotics with a low threshold in comparison to patients elsewhere. Irrational antibiotics use can lead to rapid emergence of drug resistance, so surveillance of their use is important. Objectives: To evaluate the use of antibiotics in relation to bacteriological findings in PICU of a Tertiary Hospital. Methods: Retrospective review of medical records of all children (age 1 month–16 years) admitted in our closed multidisciplinary-cardiothoracic PICU from January to June 2013 was performed, after approval from Ethical Review Committee. For each antibiotic, indication (prophylactic, empiric, therapeutic) and duration of use were recorded. All diagnoses of infections were recorded according to diagnostic criteria of IPSCC 2005. Results are presented as frequency and percentages and median with inter quartile range using SPSS version 19. Results: All of the total 240 patients admitted in PICU during the study period received antibiotics: 43% (n = 104) prophylactically, 42% (n = 102) empirically, and 15% (n = 15) therapeutically. Median number of antibiotic use per patient in PICU was 3, with range of 1–7. 25% received 1 antibiotic, 23% received 2 antibiotics, 29% received 3 antibiotics, and rest received ≥4 antibiotics. Most commonly used antibiotics were cefazolin, meropenem, vancomycin and ceftriaxone, and most frequently used combination was meropenem and vancomycin. In majority of the cases, (70%) empiric antibiotic combinations were stopped in 72 h. Conclusion: This is the first report of antibiotics use in PICU from our country, which shows that antibiotics are prescribed universally in our PICU. Strategies to assess the need for antibiotic use are needed.
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Affiliation(s)
- Qalab Abbas
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Anwar Ul Haq
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Raman Kumar
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Syed Asad Ali
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
| | - Kashif Hussain
- Department of Pharmacy, Aga Khan University, Karachi, Sindh, Pakistan
| | - Sadia Shakoor
- Department of Pediatric and Child Health, Aga Khan University, Karachi, Sindh, Pakistan
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Rashed AN, Wong ICK, Wilton L, Tomlin S, Neubert A. Drug Utilisation Patterns in Children Admitted to a Paediatric General Medical Ward in Five Countries. Drugs Real World Outcomes 2015; 2:397-410. [PMID: 26690854 PMCID: PMC4674526 DOI: 10.1007/s40801-015-0049-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate and compare drug prescription patterns in children admitted to a paediatric general medical ward in five countries. Methods A prospective cohort study conducted on paediatric medical wards in the UK, Germany, Australia, Hong Kong (HK) and Malaysia. Data were collected over 3 months in each country except in Australia (1 month). All medications prescribed were classified according to the WHO Anatomical Therapeutic Chemical (ATC) classification. For each drug, frequency of prescriptions and patient exposures were calculated for ATC anatomical and therapeutic levels overall and by country. Results One thousand two hundred and seventy-eight patients were included (Australia 146, Germany 376, UK 313, HK 143 and Malaysia 300); 89.2 % of patients (1140) received medications, median 3 (interquartile range 2–5) drugs per patient. 5367 drugs were prescribed. The most frequently prescribed therapeutic groups in all countries were: systemic antibacterials (1355; 25.2 %), analgesics/non-steroidal anti-inflammatory drugs (NSAIDs) (1173; 21.8 %) and drugs for obstructive airway diseases (472; 8.8 %). Overall, 65.1 % (742) of patients received at least one systemic antibacterial, 63.7 % (726) received one or more analgesic/NSAIDs, and 23.6 % (269) received ‘drugs for obstructive airway diseases’. The number of patients exposed to these groups differed significantly between countries (p < 0.05). Paracetamol was the most frequently prescribed in all countries, but metamizole was only used in Germany. Morphine was mainly prescribed in the UK. Conclusion This study provides an overview of drug use patterns in five culturally and ethnically diverse countries. The most frequently used therapeutic groups were similar, but the proportion of patients treated differed between countries. Also within a therapeutic group the specific drug used varied between countries.
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Affiliation(s)
- Asia N Rashed
- Institute of Pharmaceutical Science, King's College London, King's Health Partners, 150 Stamford Street, London, SE1 9NH UK ; Pharmacy Department, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, Westminster Bridge Road, London, SE1 7EH UK
| | - Ian C K Wong
- Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China ; UCL School of Pharmacy, London, UK
| | | | - Stephen Tomlin
- Institute of Pharmaceutical Science, King's College London, King's Health Partners, 150 Stamford Street, London, SE1 9NH UK ; Pharmacy Department, Evelina London Children's Hospital, Guy's and St. Thomas' NHS Foundation Trust, King's Health Partners, Westminster Bridge Road, London, SE1 7EH UK
| | - Antje Neubert
- Department of Paediatric and Adolescent Medicine, University Hospital Erlangen, Erlangen, Germany
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Buccellato E, Melis M, Biagi C, Donati M, Motola D, Vaccheri A. Use of Antibiotics in Pediatrics: 8-Years Survey in Italian Hospitals. PLoS One 2015; 10:e0139097. [PMID: 26405817 PMCID: PMC4584004 DOI: 10.1371/journal.pone.0139097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 09/09/2015] [Indexed: 11/21/2022] Open
Abstract
Objectives To evaluate antibiotic consumption in the pediatric wards of Emilia-Romagna Region, from 2004 to 2011, with a focus on the antibiotics reserved to the most serious infections, and to analyse the ADRs reported for antibiotics by the pediatric wards of Emilia-Romagna hospitals. Methods Reference population was represented by all the patients (0–14 years old) admitted to the pediatric wards of all the hospitals of Emilia-Romagna Region. Drug consumption was expressed as number of DDDs per 100 Bed-Days (BD) and data were analysed by active substance, by therapeutic subgroups or by ward type. The time trends of antibiotic consumption were statistically analysed by linear regression. All the suspected ADR reports associated with antibiotics, reported between January 2004 and December 2011 were drawn by the Italian Spontaneous Reporting Database. Results Overall antibiotic consumption showed only a slight increase (p = 0.224). Among the pediatric wards, pediatric surgery showed the highest increase from 2004 to 2011 (p = 0.011). Penicillins and β-lactamase inhibitors was the first therapeutic group with a statistically significant increase over years (p = 0.038), whereas penicillins with extended spectrum presented a statistically significant reduction (p = 0.008). Moreover, only 5 drugs out of the 8 antibiotics reserved to the most serious infections were used. Pharmacovigilance data showed 27 spontaneous ADR reports associated to ATC J01 drugs. Amoxicillin/clavulanic acid had the highest number of ADR reports (n = 7). Conclusions The steadily increasing consumption in penicillins and β-lactamase inhibitors, in association with a considerable decrease of plain penicillins, raises a serious concern. Pharmacovigilance reports seem to suggest a safe use of antibiotics in the hospital setting of Emilia-Romagna. Further studies to investigate the reason for prescribing antibiotics in children inpatients are needed.
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Affiliation(s)
- Elena Buccellato
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Mauro Melis
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Chiara Biagi
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Monia Donati
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Domenico Motola
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
| | - Alberto Vaccheri
- Unit of Pharmacology, Department of Medical and Surgical Sciences, University of Bologna, Via Irnerio 48, 40126, Bologna, Italy
- * E-mail:
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Raastad R, Tvete IF, Abrahamsen TG, Berild D, Leegaard TM, Walberg M, Müller F. A worrying trend in weight-adjusted paediatric antibiotic use in a Norwegian tertiary care hospital. Acta Paediatr 2015; 104:687-92. [PMID: 25753620 DOI: 10.1111/apa.12994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/29/2014] [Accepted: 03/05/2015] [Indexed: 11/28/2022]
Abstract
AIM The World Health Organization recommends the defined daily dose (DDD) as the standard unit of measurement for antibiotic use, but this is not applicable in children. We aimed to assess paediatric antibiotic use in a Norwegian tertiary care hospital using a novel weight-adjusted method. METHODS We obtained antibiotic purchase data from the hospital pharmacy and administrative data for all admissions from 2002 to 2009 to the paediatric wards at Oslo University Hospital, Rikshospitalet. Recommended daily doses per 100 kg days (RDDs/kg days) were calculated based on national guidelines for paediatric antibiotic use, length of stay and estimated weight for sex and age using national growth references. RESULTS Total antibiotic use increased significantly from 51.8 to 65.5 RDDs/100 kg days. We found statistically significant annual increases in the consumption of carbapenems (18.0%), third-generation cephalosporins (6.0%) and imidazole derivatives (6.6%) and a considerable difference between total antibiotic use measured in RDDs/100 kg days and DDDs/100 bed days for neonates. CONCLUSION Weight-adjusted antibiotic use provided a more meaningful description of the quantities of antibiotics consumed than DDDs/100 bed days, particularly for neonates. Total antibiotic use, use of meropenem, third-generation cephalosporins and imidazole derivatives increased significantly despite low prevalence of antibiotic-resistant pathogens.
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Affiliation(s)
- Ragnhild Raastad
- Department of Infectious Diseases; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | | | - Tore G. Abrahamsen
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Pediatrics; Oslo University Hospital; Oslo Norway
| | - Dag Berild
- Department of Infectious Diseases; Oslo University Hospital; Oslo Norway
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
| | - Truls M. Leegaard
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology and Infection Control; Akershus University Hospital; Lørenskog Norway
| | - Mette Walberg
- Microbiology Section; Laboratory Centre; Vestre Viken Hospital Trust; Rud Norway
| | - Fredrik Müller
- Institute of Clinical Medicine; University of Oslo; Oslo Norway
- Department of Microbiology; Oslo University Hospital; Oslo Norway
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Implementation of Hospital’s Antibiotic Policy Decreases Antimicrobial Use in the General Pediatric Ward. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 857:67-74. [DOI: 10.1007/5584_2015_124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Al-Balushi K, Al-Ghafri F, Al-Sawafi F, Al-Zakwani I. Antibiotic prescribing trends in an omani paediatric population. Sultan Qaboos Univ Med J 2014; 14:e495-e499. [PMID: 25364552 PMCID: PMC4205061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 03/05/2014] [Accepted: 05/01/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES This study aimed to evaluate antibiotic prescribing patterns for paediatric patients at Sultan Qaboos University Hospital (SQUH), a tertiary care hospital in Muscat, Oman. METHODS This retrospective cross-sectional study included all 1,186 prescriptions issued for 499 patients at the paediatric outpatient clinic and paediatric inpatient ward at SQUH between March and May 2012. RESULTS Of the 499 patients, 138 (27.6%) were prescribed a total of 28 different antibiotics. A total of 185 (15.6%) antibiotic prescriptions were issued among the total drug prescriptions. Preschool children aged 0-6 years were prescribed antibiotics most frequently (n = 110). Co-amoxiclav was the most commonly prescribed antibiotic in both inpatients and outpatients (27.0% and 33.9%, respectively), followed by cefuroxime in inpatients (13.5%) and azithromycin in outpatients (18.6%). Co-amoxiclav was the most commonly prescribed antibiotic in both 0-6 (31.3%) and 7-11 (23.3%) year-olds, while cefuroxime was most commonly prescribed in children ≥12 years old (25.0%). CONCLUSION Antibiotic prescription patterns in this population were similar to those in North America, Europe and Asia. To confirm the findings of this study, further research on antibiotic prescription trends across the wider paediatric population of Oman should be initiated.
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Affiliation(s)
- Khalid Al-Balushi
- Department of Pharmacology & Clinical Pharmacy, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al-Ghafri
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Fatma Al-Sawafi
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, Sultan Qaboos University, Muscat, Oman
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Oman
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Brett A, Bielicki J, Newland JG, Rodrigues F, Schaad UB, Sharland M. Neonatal and pediatric antimicrobial stewardship programs in Europe-defining the research agenda. Pediatr Infect Dis J 2013; 32:e456-65. [PMID: 23958812 DOI: 10.1097/inf.0b013e31829f0460] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The relationship between suboptimal use of antimicrobials and antimicrobial resistance has become increasingly clear. Despite significant international effort aimed at reducing inappropriate antimicrobial prescribing in hospitals, antimicrobial resistance remains a major public health threat. Antimicrobial Stewardship Programs (ASPs) comprise a series of measures aimed at optimizing the use of antimicrobials, while improving the quality of patient care and promoting cost-effectiveness. This discussion article aims to summarize some of the approaches that have been used in neonatal and pediatric ASPs, with a particular focus on the European healthcare setting. Current evidence demonstrates neonatal and pediatric ASPs to be safe, practical to implement, generally cost-effective and possibly associated with a reduction in antimicrobial resistance rates. This review identified that, despite the recognized need for additional evidence and information on implementation, published data on pediatric ASPs derives mainly from the United States, with very few published reports on formal ASPs in European children's hospitals. Consequently, the optimal method of implementation remains unknown within a European setting. Future research needs to include novel study designs on how best to introduce ASPs, monitoring of clinically relevant outcomes and cost-effectiveness with improved measurement of the impact on antimicrobial resistance.
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Affiliation(s)
- Ana Brett
- From the *Infectious Diseases Unit and Emergency Service, Hospital Pediátrico, Centro, Hospitalar e Universitário de Coimbra, Coimbra, Portugal; †Paediatric Infectious Diseases Research Group, St George's University London, London, United Kingdom; ‡Division of Pediatric Infectious Diseases, Children's Mercy Hospital and Clinics, University of Missouri-Kansas City, MO; and §Paediatric Infectious Diseases Division, University Children's Hospital, Basel, Switzerland
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Aseeri MA. The impact of a pediatric antibiotic standard dosing table on dosing errors. J Pediatr Pharmacol Ther 2013; 18:220-6. [PMID: 24052785 DOI: 10.5863/1551-6776-18.3.220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The goal of this study was to compare the rate of dosing errors for antibiotic orders in pediatric patients before and after the implementation of an antibiotic standard dosing table with precalculated dosage for different weight ranges at a tertiary care hospital. METHODS A retrospective study of 300 antibiotic prescriptions for pediatric patients in three different settings (ambulatory care, inpatient, and emergency department) at a tertiary care hospital assessed the appropriateness of antibiotic dosing. The need for an antibiotic dosing standardization policy was identified after finding that more than 30% of patients experienced a dose variation of ±10% of the recommended daily dose. An antibiotic dosing standardization policy was implemented with an antibiotic standard dosing table for different weight ranges, and a hospital wide-education program was conducted to increase awareness of this new practice and its benefits. Three months after implementation, a random sampling of 300 antibiotic prescriptions collected from the same settings as the pre-intervention period was evaluated for compliance with the new policy and its effect on the number of antibiotic dosing errors. RESULTS Six hundred prescriptions were included in this study (300 in the pre-implementation phase and 300 in the post-implementation phase). Patient characteristics were similar in both groups in terms of sex, age, and weight. Physician compliance with the antibiotic dosing standardization policy after its implementation was 62%. The dosing standardization policy reduced the rate of dosing errors from 34.3% to 5.06% (p=0.0001), and weight documentation on the antibiotic prescription improved from 65.8% to 85.7% (p=0.0001). CONCLUSIONS Implementation of an antibiotic dosing standardization policy significantly reduced the incidence of dosing errors in antibiotics prescribed for pediatric patients in our hospital.
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Affiliation(s)
- Mohammed A Aseeri
- Pharmacy Department, King Saud bin Abdul Aziz University for Health Sciences, King Abdul Aziz Medical City/ National Guard Health Affairs, Jeddah, Saudi Arabia
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Balciunas EM, Castillo Martinez FA, Todorov SD, Franco BDGDM, Converti A, Oliveira RPDS. Novel biotechnological applications of bacteriocins: A review. Food Control 2013. [DOI: 10.1016/j.foodcont.2012.11.025] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Point prevalence survey of antimicrobial utilization in the cardiac and pediatric critical care unit. Pediatr Crit Care Med 2013; 14:e280-8. [PMID: 23823209 DOI: 10.1097/pcc.0b013e31828a846d] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine the rate of documented infections and prevalence of antimicrobial use among pediatric patients admitted to the PICU. To assess the appropriateness of antimicrobial prescribing according to clinical and microbiological findings, Infectious Disease Consult recommendations, and formulary guidelines. DESIGN Prospective point prevalence study. SETTING Cardiac and medical-surgical critical care units (CCCU-PICU) in a tertiary care pediatric teaching hospital in Toronto, Canada. PATIENTS All patients admitted to the CCCU-PICU during the week of October 27, 2008 (period A) and February 9, 2009 (period B) were followed until completion of their antimicrobial course(s). Data were collected on infection types and indications, frequency, and types of antimicrobials used. Appropriateness of antimicrobial prescribing was assessed according to predefined criteria by four blinded clinician assessors. MEASUREMENT AND MAIN RESULTS Forty-two of 60 patients (70%) received antimicrobials in period A and 42 of 53 patients (79%) received antimicrobials in period B. Of the patients on antimicrobials, 45% in period A and 52% in period B had a definitive diagnosis of infection. Pneumonia and sepsis were the most common infections in period A, whereas pneumonia and other respiratory tract infections were the most common in period B. Antimicrobials were commonly prescribed for documented infection (38%) during period A and empiric therapy (47%) during period B. Cefazolin, cefuroxime, vancomycin, and gentamicin were the commonly used antimicrobials during both periods. Inappropriate antimicrobial use ranged from 16.7% to 61.9%, depending on assessors and surveillance period. The most common reasons for inappropriate use were overly broad spectrum, wrong dosage, and unwarranted overlap of spectrum. CONCLUSIONS There was a high prevalence of antimicrobial use in CCCU-PICU patients. Because a significant proportion of antimicrobial use was deemed inappropriate, interventions are required to optimize antimicrobial use in critically ill children.
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The antibiotic resistance and prescribing in European Children project: a neonatal and pediatric antimicrobial web-based point prevalence survey in 73 hospitals worldwide. Pediatr Infect Dis J 2013; 32:e242-53. [PMID: 23838740 DOI: 10.1097/inf.0b013e318286c612] [Citation(s) in RCA: 122] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The neonatal and pediatric antimicrobial point prevalence survey (PPS) of the Antibiotic Resistance and Prescribing in European Children project (http://www.arpecproject.eu/) aims to standardize a method for surveillance of antimicrobial use in children and neonates admitted to the hospital within Europe. This article describes the audit criteria used and reports overall country-specific proportions of antimicrobial use. An analytical review presents methodologies on antimicrobial use. METHODS A 1-day PPS on antimicrobial use in hospitalized children was organized in September 2011, using a previously validated and standardized method. The survey included all inpatient pediatric and neonatal beds and identified all children receiving an antimicrobial treatment on the day of survey. Mandatory data were age, gender, (birth) weight, underlying diagnosis, antimicrobial agent, dose and indication for treatment. Data were entered through a web-based system for data-entry and reporting, based on the WebPPS program developed for the European Surveillance of Antimicrobial Consumption project. RESULTS There were 2760 and 1565 pediatric versus 1154 and 589 neonatal inpatients reported among 50 European (n = 14 countries) and 23 non-European hospitals (n = 9 countries), respectively. Overall, antibiotic pediatric and neonatal use was significantly higher in non-European (43.8%; 95% confidence interval [CI]: 41.3-46.3% and 39.4%; 95% CI: 35.5-43.4%) compared with that in European hospitals (35.4; 95% CI: 33.6-37.2% and 21.8%; 95% CI: 19.4-24.2%). Proportions of antibiotic use were highest in hematology/oncology wards (61.3%; 95% CI: 56.2-66.4%) and pediatric intensive care units (55.8%; 95% CI: 50.3-61.3%). CONCLUSIONS An Antibiotic Resistance and Prescribing in European Children standardized web-based method for a 1-day PPS was successfully developed and conducted in 73 hospitals worldwide. It offers a simple, feasible and sustainable way of data collection that can be used globally.
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Irwin A, Sharland M. Measuring antibiotic prescribing in hospitalised children in resource-poor countries: a systematic review. J Paediatr Child Health 2013; 49:185-92. [PMID: 21679337 DOI: 10.1111/j.1440-1754.2011.02126.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Antibiotic resistance represents a significant threat to global health. Widespread exposure to antibiotics drives the development of antibiotic resistance. Little is known about the exposure to antibiotics of hospitalised children, particularly in resource-poor countries where the burden of infectious disease is highest. The review sought to identify original research quantifying antibiotic use in hospitalised children in resource countries. The methods used were: A systematic search of the MEDLINE, CINAHL, EMBASE, LILACS and African Index Medicus databases. Eighteen papers were identified and the methodology varied considerably. Only seven used a recognised defined daily dose (DDD) methodology. The studies reveal a high exposure of hospitalised children to antibiotics. With the exception of data from China, the studies were limited by their design. Limited evidence of the variation in drug, dose and total exposure to antibiotic use in hospitalised children in resource-poor countries exists. An international network of surveillance of both antimicrobial prescribing and resistance using a simple standardised methodology in this context remains an important goal. A simplified paediatric version of the adult DDD methodology is required to allow international comparison between populations.
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Affiliation(s)
- Adam Irwin
- Institute of Child Health, Alder Hey Children's Hospital NHS Foundation Trust, Department of Women's and Children's Health, Institute of Translational Medicine, University of Liverpool, Liverpool, UK.
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Borrás Novell C, Hernández Bou S, García García JJ. [Prescribing of antibiotics in patients admitted from Emergency Departments: a multicenter study]. An Pediatr (Barc) 2012; 79:15-20. [PMID: 23084406 DOI: 10.1016/j.anpedi.2012.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 08/02/2012] [Accepted: 09/03/2012] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION The infectious disease is the main source of care demand in Pediatric Emergency Departments (PED) and is a frequent cause of hospital admission with antibiotics. Our objectives are: 1) to determine the diseases that are seen in PED that required admission with antibiotics; 2) to determine the microbiological methods used and, 3) to analyze the characteristics of the indicated treatment. MATERIAL AND METHODS A prospective multicenter study was conducted in 22 Spanish hospitals. We included patients younger than 18 years seen in PED on day 14 of each month between June 2009 and May 2010 who required hospitalization with systemic antibiotics. Patients admitted to Intensive Care Unit were excluded. RESULTS There were 30,632 consultations in the PED during the study period. A total of 1,446 (4.7%) patients were hospitalized, 395 (27.3%) of them with antibiotics. Ninety-five patients (24.1%) had received antibiotics before admission. Three hundred twenty (81%) children underwent at least one microbiological test, with blood culture (69.9%) and urine culture (30.9%) being the most requested ones. The main diagnoses at admission were pneumonia (29.4%), urinary tract infection (15.4%), and fever without source (12.1%). Twenty five different antibiotics were prescribed, with cefotaxime (27.8%) and amoxicillin-clavulanate (23.4%) being the most prescribed ones. A single antibiotic was prescribed to 80.8% of patients, and parenteral administration was the most indicated (93.7%). CONCLUSIONS Antibiotic therapy was prescribed in one in every 4 patients who required admission to hospital. Pneumonia was the most common source. Blood culture was the most frequent microbiological test requested in the PED. A limited number of beta-lactam antibiotics represented the majority of antibiotic prescriptions.
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Affiliation(s)
- C Borrás Novell
- Servicio de Urgencias, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues de Llobregat, Barcelona, España
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Chen YS, Liu PY, Huang YF, Chen CS, Chiu LH, Huang NY, Hsieh KS, Chen YS. Comparison of diagnostic tools with multiplex polymerase chain reaction for pediatric lower respiratory tract infection: a single center study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2012; 46:413-8. [PMID: 23031535 DOI: 10.1016/j.jmii.2012.07.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 07/02/2012] [Accepted: 07/26/2012] [Indexed: 11/18/2022]
Abstract
BACKGROUND/PURPOSE Acute respiratory tract infections are a leading cause of morbidity and mortality in children worldwide. Most have a viral etiology, with pneumococcus as an important pathogen. This single-center study compared the use of conventional diagnostic tools and two multiplex polymerase chain reaction (PCR) examinations for determining pathogens in lower respiratory tract infections (LRTIs) among children aged <5 years. METHODS From July to October 2010, 45 patients aged 2 months to 60 months and diagnosed as having LRTIs were enrolled. Their nasopharyngeal aspirates were evaluated through viral culture and two multiplex PCR examinations. The patients' clinical course, symptoms, signs, and laboratory findings were recorded and analyzed. RESULTS Among the 45 patients, 38 (84.4%) had detectable pathogens. Conventional viral and blood cultures had 35.6% positive rate, which increased to 51.1% when the quick antigen tests (Influenza A+B test and respiratory syncytial virus) and urine pneumococcal antigen test were combined. The positive rate further increased to 84.4% when the two multiplex PCR methods were combined. Twelve patients had co-infection, including 10 detected by the multiplex PCR methods. The co-infection rate was 26.7% (12/45). CONCLUSION Most LRTIs in children have a viral etiology. Multiplex PCR tests are rapid assays that can increase the diagnostic yield rate and detect slow-growing viruses and can detect more pathogens than conventional viral culture to enable, thereby helping clinicians to provide appropriate and timely treatment.
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Affiliation(s)
- Yu-Shen Chen
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Po-Yen Liu
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Yung-Feng Huang
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Chiao-Shan Chen
- Section of Clinical Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Ling-Hui Chiu
- Section of Clinical Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Nuan-Ya Huang
- Section of Clinical Microbiology, Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Yao-Shen Chen
- Section of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
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Recent trends in the use of antibiotic prophylaxis in pediatric surgery. J Pediatr Surg 2011; 46:366-71. [PMID: 21292089 DOI: 10.1016/j.jpedsurg.2010.11.016] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Accepted: 11/04/2010] [Indexed: 11/20/2022]
Abstract
AIMS The use of surgical antibiotic prophylaxis (AP) in children is poorly characterized. The aims of this study were to examine (1) trends in the use of AP for commonly performed operations, (2) appropriateness in the context of available guidelines, and (3) adverse events potentially attributable to AP. METHODS We conducted a 5-year retrospective analysis of 22 children's hospitals (January 2005-March 2009) for all patients younger than 18 years who underwent 1 of the 40 commonly performed general and urological procedures. Indications for AP were defined by published specialty-specific guidelines. Clostridium difficile infection and surrogate events for drug allergy (diphenhydramine and epinephrine administrations) were examined as potential antibiotic-associated adverse events. RESULTS Procedures of 246,316 were identified, of which 25% met criteria for AP. Eighty-two percent of the children received antibiotics during procedures when AP was indicated (range, 60%-96% by hospital), and 40% of the patients received antibiotics when there was no indication (range, 10%-83%). The likelihood of receiving AP was significantly different between hospitals for all procedures examined (P < .0001 for each procedure). Adverse events were significantly more frequent in children receiving AP than in those who did not (odds ratio [95% confidence interval] C difficile: 18.8 [6.9-51.5], P < .0001; epinephrine: 1.8 [1.7-2.0], P < .0001; diphenhydramine: 6.0 [5.6-6.5], P < .0001). CONCLUSIONS Significant variation exists in the use of AP in the pediatric surgical population. Many children do not receive AP when indicated, and an even greater proportion may receive antibiotics when there is no indication. These findings may have profound implications from a public health perspective when extrapolated to all children undergoing surgical procedures.
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Agwu A, Lee C, Jain S, Murray K, Topolski J, Miller R, Townsend T, Lehmann C. A World Wide Web–Based Antimicrobial Stewardship Program Improves Efficiency, Communication, and User Satisfaction and Reduces Cost in a Tertiary Care Pediatric Medical Center. Clin Infect Dis 2008; 47:747-53. [DOI: 10.1086/591133] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ahern JW, Corriveau M, Raszka WV. Development of a pediatric pocket-sized guide for antimicrobial therapy. Am J Health Syst Pharm 2008; 65:203-5. [DOI: 10.2146/ajhp070346] [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] Open
Affiliation(s)
| | - Michele Corriveau
- Department of Pharmacy
Fletcher Allen Health Care
111 Colchester Avenue
Burlington, VT 05401
| | - William V. Raszka
- Department of Pediatrics
College of Medicine
University of Vermont
Burlington, VT 05405
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Salas AA, Aranda E. Antibiotic prescribing patterns as empirical therapy among hospitalized patients in a Bolivian paediatric teaching hospital. Acta Paediatr 2007; 96:1533-5. [PMID: 17714538 DOI: 10.1111/j.1651-2227.2007.00454.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ariel A Salas
- Department of Postgraduate Education and Research, Children's Hospital Dr. Ovidio Aliaga Uria, La Paz, Bolivia.
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Hajdu A, Samodova OV, Carlsson TR, Voinova LV, Nazarenko SJ, Tjurikov AV, Petrova EG, Tulisov AV, Andresen S, Eriksen HM. A point prevalence survey of hospital-acquired infections and antimicrobial use in a paediatric hospital in north-western Russia. J Hosp Infect 2007; 66:378-84. [PMID: 17573155 DOI: 10.1016/j.jhin.2007.04.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2006] [Accepted: 04/26/2007] [Indexed: 11/19/2022]
Abstract
We carried out a one-day prevalence survey of hospital-acquired infections (HAIs) and antimicrobial use in February 2006 in a paediatric hospital in Arkhangelsk, north-western Russia. A total 472 patients aged less than 18 years old were included in the study, of which 395 (84%) had been inpatients in the hospital for at least 48 h on the study day. The overall prevalence of HAI amongst the latter group of patients was 17% [67/395; 95% confidence interval (CI): 13.8-21.2] with upper respiratory tract infections being most frequently diagnosed (45%), followed by lower respiratory tract infections (19%) and urinary tract infections (12%). The highest proportion of HAI was found in patients less than one year old and in those with hospital stays of longer than 10 days. Antimicrobial agents were given to 39% of all hospitalized patients (183/472; 95% CI: 34.5-43.2). Cephalosporins accounted for 39% (82/211) of all antimicrobial prescriptions, followed by the penicillins (22%; 46/211). This study established a baseline for surveillance of HAI and antimicrobial use within the hospital, and facilitated the adoption of targeted infection control measures.
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Affiliation(s)
- A Hajdu
- Norwegian Institute of Public Health, Oslo, Norway.
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von Gunten V, Reymond JP, Beney J. Clinical and economic outcomes of pharmaceutical services related to antibiotic use: a literature review. ACTA ACUST UNITED AC 2007; 29:146-63. [PMID: 17273907 DOI: 10.1007/s11096-006-9042-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2005] [Accepted: 06/20/2006] [Indexed: 10/23/2022]
Abstract
AIM OF THE REVIEW To identify and review the clinical and economic impact of pharmacists' interventions on antibiotic use. METHOD A literature search was conducted on Medline (1966-2003) to identify original articles measuring the impact of pharmacists' interventions on antimicrobial therapy at patient's or prescriber's level. RESULTS Forty-three articles were included: 20 uncontrolled before-after studies, four controlled before-after studies, five controlled trials, 12 randomized controlled trials and two interrupted time series (ITS). The described interventions were grouped into four categories: patient-specific recommendations (pharmacists' interventions concerning patient-specific drug therapy), implementation of policies, education, and therapeutic drug monitoring. These interventions were often combined to provide a multifaceted intervention, making it difficult to isolate the impact of one specific intervention. Measured outcomes were: appropriateness of prescribing (evaluated in 17 studies, 16 showing significant improvement), costs (analysed in 22 studies, nine showing a statistically significant reduction in costs after or with the intervention), and length of hospital stay (mixed results). Other measured outcomes were: drug use, prescriptions, length of treatment, dose intervals, switch to oral route, mortality rate, and treatment failure. CONCLUSION Over the years, the number of studies and quality of methodology has increased. The most frequently observed outcomes with a positive impact were appropriateness of prescribing and cost savings. The vast majority of studies used multiple interventions, in conjunction with pharmacists' recommendations to physicians. Coupled with the use of practice guidelines or educational strategies, these interventions demonstrated a positive impact on economic or clinical outcomes. However, the data are still sparse and sometimes contradictory; therefore, further studies with randomized controlled designs are needed.
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Affiliation(s)
- Vera von Gunten
- Division of Pharmacy, Institut Central des Hôpitaux Valaisans, Sion, Switzerland.
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Voit SB, Todd JK, Nelson B, Nyquist AC. Electronic surveillance system for monitoring surgical antimicrobial prophylaxis. Pediatrics 2005; 116:1317-22. [PMID: 16322153 DOI: 10.1542/peds.2004-1969] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Antimicrobial surgical prophylaxis comprises one third of all antibiotic use in pediatric hospitals and 80% of all antibiotic use in surgery. Previous studies reported that antimicrobial surgical prophylaxis is often inconsistent with recommended guidelines. An electronic surveillance system was developed to measure antimicrobial utilization and to identify opportunities to improve and monitor the administration of antibiotics for surgical prophylaxis. METHODS A retrospective cohort study was conducted on patients with selected inpatient surgical procedures performed from May 1999 to April 2000 at 4 US children's hospitals. International Classification of Diseases, Ninth Revision surgical procedure codes were divided into clean or unclean categories, and an electronic surveillance system was designed using antibiotic and microbiologic culture utilization data to measure appropriate antimicrobial use associated with the surgical procedure. A medical chart review was conducted to validate the electronic system. RESULTS Ninety percent of cases were classified properly by the electronic surveillance system as confirmed by medical chart review. Surgical antibiotic prophylaxis was not in accordance with the American Academy of Pediatrics (AAP) guidelines for almost half of all procedures. Prolonged antimicrobial administration in clean surgical procedures was the most frequent deviation from guidelines. Statistical differences between the index hospital and the comparison hospitals reflect both over- and underutilization of surgical prophylaxis with significant opportunity to improve prophylaxis for all hospitals. CONCLUSIONS Antimicrobial surgical prophylaxis at the children's hospitals studied is not always consistent with published AAP guidelines. This electronic surveillance system provides a rapid, reproducible, and validated tool to measure easily the efforts to improve adherence to AAP surgical prophylaxis guidelines.
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Affiliation(s)
- Sara Bornstein Voit
- Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado, USA
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Ufer M, Radosević N, Vogt A, Palcevski G, Francetić I, Reinalter SC, Seyberth HW, Vlahović-Palcevski V. Antimicrobial drug use in hospitalised paediatric patients: a cross-national comparison between Germany and Croatia. Pharmacoepidemiol Drug Saf 2005; 14:735-9. [PMID: 15880392 DOI: 10.1002/pds.1108] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE To compare the utilisation of systemic antimicrobials at the paediatric units of the university hospitals in Marburg (Germany) and Rijeka (Croatia). METHODS A prospective, observational analysis of hospital records from 300 incident users of antimicrobials in each study centre that were younger than 19 years. Antimicrobial utilisation was analysed in six gender-specific age groups with respect to drug choice, duration of treatment and hospital stay, indication and route of administration. The extent of antimicrobial drug use was assessed by the number of treatment courses. RESULTS In each hospital, more than 1/3 of the patients were younger than 1 year. The duration of hospital stay was about two-fold longer in Rijeka (18.5 +/- 5.8 days) than in Marburg (8.6 +/- 3.8 days). Pneumonia and other respiratory tract infections were the most common indications in Marburg (38.6%) and Rijeka (58.7%). The cumulative percentage of patients treated with an equal number of different antimicrobials was lower in Rijeka than in Marburg. The most commonly used antimicrobials were ampicillin (40.3%) and cefuroxim (35.9%) in Marburg, but ceftriaxone (43.3%) and cefotaxim (14.0%) in Rijeka. CONCLUSIONS A shorter treatment duration, less variation in the prescribing pattern and a greater adherence to the use of recommended antimicrobials argue for a more rational antimicrobial drug use in Marburg than in Rijeka. However, a further identification of drug choice determinants is warranted.
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Affiliation(s)
- M Ufer
- Division of Clinical Pharmacology, Department of Laboratory Medicine, WHO Collaborating Centre for Drug Utilisation Research and Clinical Pharmacological Services, Karolinska University Hospital, Stockholm, Sweden.
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Gillor O, Kirkup BC, Riley MA. Colicins and microcins: the next generation antimicrobials. ADVANCES IN APPLIED MICROBIOLOGY 2004; 54:129-46. [PMID: 15251279 DOI: 10.1016/s0065-2164(04)54005-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Osnat Gillor
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06520-8106, USA
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Affiliation(s)
- Alberto Yagüe
- Laboratorio de Microbiología, Hospital Vega Baja, Orihuela, Alicante, Spain.
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Abstract
Antimicrobial use is the major determinant in the development of resistance. Many parameters of importance for optimal quality of antimicrobial therapy have already been defined. Maximal efficacy of the treatment should be combined with minimal toxicity at the lowest cost. Quality of antimicrobial drug use is dependent on knowledge of many aspects of infectious diseases. Considering efficacy, many of our indications for antimicrobial use need critical evaluation. Irrational use should be discouraged. Avoidance of the development of resistance is a quality parameter that will need increasing attention. This paper reviews the well-established factors that may influence the appropriateness of pharmacotherapy with antimicrobial drugs. It cites recent evidence supporting principles of prudent prescribing and gives an overview of audits that have addressed these parameters. Measures relating to resistance are discussed.
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Affiliation(s)
- I C Gyssens
- Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
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