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Di Lorenzo A, Campogiani L, Iannetta M, Iannazzo R, Imeneo A, Alessio G, D’Aquila V, Massa B, Fato I, Rindi LV, Malagnino V, Teti E, Andreoni M, Sarmati L. The Impact of Viral and Bacterial Co-Infections and Home Antibiotic Treatment in SARS-CoV-2 Hospitalized Patients at the Policlinico Tor Vergata Hospital, Rome, Italy. Antibiotics (Basel) 2023; 12:1348. [PMID: 37760645 PMCID: PMC10525365 DOI: 10.3390/antibiotics12091348] [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: 07/27/2023] [Revised: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 09/29/2023] Open
Abstract
Co-infections during COVID-19 may worsen patients' outcomes. This study reports the results of a screening assessing the presence of co-infections among patients hospitalized for SARS-CoV-2 infection in the Infectious Diseases-Ward of the Policlinico Tor Vergata Hospital, Rome, Italy, from 1 January to 31 December 2021. Data on hepatitis B and C virus, urinary antigens for legionella pneumophila and streptococcus pneumoniae, pharyngeal swab for respiratory viruses, QuantiFERON®-TB Gold Plus assay (QFT-P), blood cultures and pre-hospitalization antibiotic prescription were recorded. A total of 482 patients were included, 61% males, median age of 65 years (IQR 52-77), median Charlson comorbidity index of 4 (IQR 2-5). The mortality rate was 12.4%; 366 patients needed oxygen supply. In total, 151 patients (31.3%) received home antibiotics without any association with the outcome. No significant association between mortality and the positivity of viral hepatitis markers was found. Out of 442 patients, 125 had an indeterminate QFT-P, associated with increased mortality. SARS-CoV-2 was the only respiratory virus detected among 389 pharyngeal swabs; 15/428 patients were positive for S. pneumoniae; none for L. pneumophila. In total, 237 blood cultures were drawn within 48 h from hospital admission: 28 were positive and associated with increased mortality. In our cohort, bacterial and viral co-infections in COVID-19 hospitalized patients were rare and not associated with higher mortality.
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Affiliation(s)
- Andrea Di Lorenzo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Laura Campogiani
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Marco Iannetta
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Roberta Iannazzo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Alessandra Imeneo
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Grazia Alessio
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Veronica D’Aquila
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Barbara Massa
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Ilenia Fato
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Lorenzo Vittorio Rindi
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
| | - Vincenzo Malagnino
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Elisabetta Teti
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Massimo Andreoni
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
| | - Loredana Sarmati
- Department of System Medicine, Tor Vergata University, 00133 Rome, Italy; (A.D.L.); (L.C.); (M.I.); (R.I.); (A.I.); (G.A.); (V.D.); (B.M.); (I.F.); (L.V.R.); (V.M.); (E.T.); (M.A.)
- Infectious Disease Clinic, Policlinico Tor Vergata, 00133 Rome, Italy
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Bauer KA, Puzniak LA, Yu KC, Klinker KP, Watts JA, Moise PA, Finelli L, Gupta V. Association of SARS-CoV-2 status and antibiotic-resistant bacteria with inadequate empiric therapy in hospitalized patients: a US multicenter cohort evaluation (July 2019 - October 2021). BMC Infect Dis 2023; 23:490. [PMID: 37488478 PMCID: PMC10367264 DOI: 10.1186/s12879-023-08453-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 07/10/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Antibiotic usage and antibiotic resistance (ABR) patterns changed during the COVID-19 pandemic. Inadequate empiric antibiotic therapy (IET) is a significant public health problem and contributes to ABR. We evaluated factors associated with IET before and during the COVID-19 pandemic to determine the impact of the pandemic on antibiotic management. METHODS This multicenter, retrospective cohort analysis included hospitalized US adults who had a positive bacterial culture (specified gram-positive or gram-negative bacteria) from July 2019 to October 2021 in the BD Insights Research Database. IET was defined as antibacterial therapy within 48 h that was not active against the bacteria. ABR results were based on susceptibility testing and reports from local facilities. Multivariate analysis was used to identify risk factors associated with IET in patients with any positive bacterial culture and ABR-positive cultures, including multidrug-resistant (MDR) bacteria. RESULTS Of 278,344 eligible patients in 269 hospitals, 56,733 (20.4%) received IET; rates were higher in patients with ABR-positive (n = 93,252) or MDR-positive (n = 39,000) cultures (34.9% and 45.0%, respectively). Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)-positive patients had significantly higher rates of IET (25.9%) compared with SARS-CoV-2-negative (20.3%) or not tested (19.7%) patients overall and in the ABR and MDR subgroups. Patients with ABR- or MDR-positive cultures had more days of therapy and longer lengths of stay. In multivariate analyses, ABR, MDR, SARS-CoV-2-positive status, respiratory source, and prior admissions were identified as key IET risk factors. CONCLUSIONS IET remained a persistent problem during the COVID-19 pandemic and occurred at higher rates in patients with ABR/MDR bacteria or a co-SARS-CoV-2 infection.
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Affiliation(s)
| | | | - Kalvin C Yu
- Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ, USA
| | | | - Janet A Watts
- Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ, USA
| | | | | | - Vikas Gupta
- Becton, Dickinson and Company, 1 Becton Drive, Franklin Lakes, NJ, USA.
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FRATONI AJ, KOIS AK, COLMERAUER JL, LINDER KE, NICOLAU DP, KUTI JL. Impact of a Pharmacist Managed Procalcitonin Program on COVID-19 Respiratory Tract Infection Outcomes and Healthcare Resource Utilization. Open Forum Infect Dis 2022; 9:ofac468. [PMID: 36176570 PMCID: PMC9494375 DOI: 10.1093/ofid/ofac468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Patients hospitalized with coronavirus disease 2019 (COVID-19) often receive empiric antibiotic coverage. Procalcitonin (PCT) is a biomarker with Food and Drug Administration–approved guidance cutoffs for antibiotic use in lower respiratory tract infections. Herein we describe the implementation and impact of a pharmacist-managed PCT monitoring program in hospitalized patients with COVID-19. In this quasi-experimental, single-center, retrospective study of a prospective antimicrobial stewardship pharmacist-managed program, inpatients who were severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction positive were reviewed during weekday working hours and evaluated for appropriateness of antibiotic treatment by utilizing the PCT biomarker. As needed, the infectious diseases pharmacist offered feedback around antibiotic discontinuation in patients with PCT values ≤0.25 ng/mL. Adherence to PCT cutoffs, clinical outcomes, and utilization of health care resources were quantified and compared with a time frame immediately preceding the program's implementation. A total of 772 patients hospitalized with COVID-19 were analyzed. The pre-intervention cohort was comprised of 519 patients, and 253 patients were included after program implementation. Antibiotics were prescribed within 72 hours of admission to 232 (44.7%) and 108 (42.7%) patients during the control and intervention phases, respectively. There was no difference in the primary outcome of percentage of patients who received >1 day of antibiotic therapy (23.5% vs 21.7%; P = .849) or in any secondary outcome including hospital length of stay, 30-day readmission rates, or discharge disposition. In a hospital where the majority of COVID-19 patients did not receive empiric antibiotics, the implementation of a pharmacist-managed PCT monitoring program did not significantly decrease antibiotic use or health care resource utilization.
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Affiliation(s)
- Andrew J FRATONI
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT , USA
| | - Abigail K KOIS
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT , USA
| | | | - Kristin E LINDER
- Department of Pharmacy Services, Hartford Hospital , Hartford, CT , USA
| | - David P NICOLAU
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT , USA
| | - Joseph L KUTI
- Center for Anti-Infective Research and Development, Hartford Hospital , Hartford, CT , USA
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Wolk DM, Lanyado A, Tice AM, Shermohammed M, Kinar Y, Goren A, Chabris CF, Meyer MN, Shoshan A, Abedi V. Prediction of Influenza Complications: Development and Validation of a Machine Learning Prediction Model to Improve and Expand the Identification of Vaccine-Hesitant Patients at Risk of Severe Influenza Complications. J Clin Med 2022; 11:jcm11154342. [PMID: 35893436 PMCID: PMC9332321 DOI: 10.3390/jcm11154342] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/11/2022] [Accepted: 07/14/2022] [Indexed: 12/02/2022] Open
Abstract
Influenza vaccinations are recommended for high-risk individuals, but few population-based strategies exist to identify individual risks. Patient-level data from unvaccinated individuals, stratified into retrospective cases (n = 111,022) and controls (n = 2,207,714), informed a machine learning model designed to create an influenza risk score; the model was called the Geisinger Flu-Complications Flag (GFlu-CxFlag). The flag was created and validated on a cohort of 604,389 unique individuals. Risk scores were generated for influenza cases; the complication rate for individuals without influenza was estimated to adjust for unrelated complications. Shapley values were used to examine the model’s correctness and demonstrate its dependence on different features. Bias was assessed for race and sex. Inverse propensity weighting was used in the derivation stage to correct for biases. The GFlu-CxFlag model was compared to the pre-existing Medial EarlySign Flu Algomarker and existing risk guidelines that describe high-risk patients who would benefit from influenza vaccination. The GFlu-CxFlag outperformed other traditional risk-based models; the area under curve (AUC) was 0.786 [0.783−0.789], compared with 0.694 [0.690−0.698] (p-value < 0.00001). The presence of acute and chronic respiratory diseases, age, and previous emergency department visits contributed most to the GFlu-CxFlag model’s prediction. When higher numerical scores were assigned to more severe complications, the GFlu-CxFlag AUC increased to 0.828 [0.823−0.833], with excellent discrimination in the final model used to perform the risk stratification of the population. The GFlu-CxFlag can better identify high-risk individuals than existing models based on vaccination guidelines, thus creating a population-based risk stratification for individual risk assessment and deployment in vaccine hesitancy reduction programs in our health system.
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Affiliation(s)
- Donna M. Wolk
- Department of Laboratory Medicine, Diagnostic Medicine Institute, Geisinger, Danville, PA 17822, USA;
- Geisinger Commonwealth School of Medicine, Scranton, PA 18509, USA
- Correspondence:
| | - Alon Lanyado
- Medial EarlySign, 6 Hangar Road, Hod Hasharon 4527703, Israel; (A.L.); (Y.K.); (A.S.)
| | - Ann Marie Tice
- Department of Laboratory Medicine, Diagnostic Medicine Institute, Geisinger, Danville, PA 17822, USA;
| | - Maheen Shermohammed
- Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger, Danville, PA 17822, USA; (M.S.); (A.G.); (C.F.C.); (M.N.M.)
| | - Yaron Kinar
- Medial EarlySign, 6 Hangar Road, Hod Hasharon 4527703, Israel; (A.L.); (Y.K.); (A.S.)
| | - Amir Goren
- Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger, Danville, PA 17822, USA; (M.S.); (A.G.); (C.F.C.); (M.N.M.)
| | - Christopher F. Chabris
- Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger, Danville, PA 17822, USA; (M.S.); (A.G.); (C.F.C.); (M.N.M.)
| | - Michelle N. Meyer
- Behavioral Insights Team, Steele Institute for Health Innovation, Geisinger, Danville, PA 17822, USA; (M.S.); (A.G.); (C.F.C.); (M.N.M.)
| | - Avi Shoshan
- Medial EarlySign, 6 Hangar Road, Hod Hasharon 4527703, Israel; (A.L.); (Y.K.); (A.S.)
| | - Vida Abedi
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA;
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Şencan İ, Çağ Y, Karabay O, Kurtaran B, Güçlü E, Öğütlü A, Demirbaş Z, Bulut D, Karlıdağ GE, Sefa Sayar M, Şibar EG, Eren Kutsoylu OÖ, Kul G, Erol S, Bektaş B, Ünver Ulusoy T, Kuzi S, Tasbakan M, Yiğit Ö, Ceran N, İnal AS, Ergen P, Yamazhan T, Uzar H, Ağalar C. Antibiotic use and Influencing Factors Among Hospitalized Patients with COVID-19: A Multicenter Point-Prevalence Study from Turkey. Balkan Med J 2022; 39:209-217. [PMID: 35611705 PMCID: PMC9136543 DOI: 10.4274/balkanmedj.galenos.2022.2021-11-62] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background Broad-spectrum empirical antimicrobials are frequently prescribed for patients with coronavirus disease 2019 (COVID-19) despite the lack of evidence for bacterial coinfection. Aims We aimed to cross-sectionally determine the frequency of antibiotics use, type of antibiotics prescribed, and the factors influencing antibiotics use in hospitalized patients with COVID-19 confirmed by polymerase chain reaction. Study Design The study was a national, multicenter, retrospective, and single-day point prevalence study. Methods This was a national, multicenter, retrospective, and single-day point-prevalence study, conducted in the 24-h period between 00:00 and 24:00 on November 18, 2020, during the start of the second COVID-19 peak in Turkey. Results A total of 1500 patients hospitalized with a diagnosis of COVID-19 were included in the study. The mean age ± standard deviation of the patients was 65.0 ± 15.5, and 56.2% (n = 843) of these patients were men. Of these hospitalized patients, 11.9% (n = 178) were undergoing invasive mechanical ventilation or ECMO. It was observed that 1118 (74.5%) patients were receiving antibiotics, of which 416 (37.2%) were prescribed a combination of antibiotics. In total, 71.2% of the patients had neither a clinical diagnosis nor microbiological evidence for prescribing antibiotics. In the multivariate logistic regression analysis, hospitalization in a state hospital (p < 0.001), requiring any supplemental oxygen (p = 0.005), presence of moderate/diffuse lung involvement (p < 0.001), C-reactive protein > 10 ULT coefficient (p < 0.001), lymphocyte count < 800 (p = 0.007), and clinical diagnosis and/or confirmation by culture (p < 0.001) were found to be independent factors associated with increased antibiotic use. Conclusion The necessity of empirical antibiotics use in patients with COVID-19 should be reconsidered according to their clinical, imaging, and laboratory findings.
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Affiliation(s)
- İrfan Şencan
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Health Practice and Research Center, İstanbul, Turkey
| | - Yasemin Çağ
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Oğuz Karabay
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Behice Kurtaran
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University, Adana, Turkey
| | - Ertuğrul Güçlü
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Aziz Öğütlü
- Department of Infectious Diseases and Clinical Microbiology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Zehra Demirbaş
- Department of Infectious Diseases and Clinical Microbiology, Elbistan State Hospital, Kahramanmaraş, Turkey
| | - Dilek Bulut
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Gülden Eser Karlıdağ
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Elazığ City Hospital, Elazığ, Turkey
| | - Merve Sefa Sayar
- Department of Infectious Diseases and Clinical Microbiology, Van Training and Research Hospital, Van, Turkey
| | - Ezgi Gizem Şibar
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Health Practice and Research Center, İstanbul, Turkey
| | - Oya Özlem Eren Kutsoylu
- Department of Infectious Diseases and Clinical Microbiology, Dokuz Eylül University Faculty of Medicine, Izmir, Turkey
| | - Gülnur Kul
- Department of Infectious Diseases and Clinical Microbiology, Dörtyol State Hospital, Hatay, Turkey
| | - Serpil Erol
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Haydarpaşa Training and Research Hospital Health Practice and Research Center, İstanbul, Turkey
| | - Begüm Bektaş
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Tülay Ünver Ulusoy
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Dışkapı Yıldırım Beyazıt Health Practice and Research Center, İstanbul, Turkey
| | - Semanur Kuzi
- Department of Infectious Diseases and Clinical Microbiology, Ünye State Hospital, Ordu, Turkey
| | - Meltem Tasbakan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Özge Yiğit
- Department of Infectious Diseases and Clinical Microbiology, Ünye State Hospital, Ordu, Turkey
| | - Nurgül Ceran
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences Turkey, Haydarpaşa Training and Research Hospital Health Practice and Research Center, İstanbul, Turkey
| | - Ayşe Seza İnal
- Department of Infectious Diseases and Clinical Microbiology, Çukurova University, Adana, Turkey
| | - Pınar Ergen
- Department of Infectious Diseases and Clinical Microbiology, İstanbul Medeniyet University Faculty of Medicine, İstanbul, Turkey
| | - Tansu Yamazhan
- Department of Infectious Diseases and Clinical Microbiology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hanife Uzar
- Department of Infectious Diseases and Clinical Microbiology, Viranşehir State Hospital, Şanlıurfa, Turkey
| | - Canan Ağalar
- Department of Infectious Diseases and Clinical Microbiology, Fenerbahçe University, Medicana Ataşehir Hospital, İstanbul, Turkey
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de Courville C, Cadarette SM, Wissinger E, Alvarez FP. The economic burden of influenza among adults aged 18 to 64: A systematic literature review. Influenza Other Respir Viruses 2022; 16:376-385. [PMID: 35122389 PMCID: PMC8983919 DOI: 10.1111/irv.12963] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
While the economic burden of influenza infection is well described among adults aged 65 and older, less is known about younger adults. A systematic literature review was conducted to describe the economic burden of seasonal influenza in adults aged 18 to 64 years, to identify the main determinants of direct and indirect costs, and to highlight any gaps in the existing published evidence. MEDLINE and Embase were searched from 2007 to February 7, 2020, for studies reporting primary influenza-related cost data (direct or indirect) or absenteeism data. Of the 2613 publications screened, 51 studies were included in this review. Half of them were conducted in the United States, and 71% of them described patients with influenza-like illness rather than laboratory-confirmed disease. Only 12 studies reported cost data specifically for at-risk populations. Extracted data highlighted that within the 18- to 64-year-old group, up to 88% of the economic burden of influenza was attributable to indirect costs, and up to 75% of overall direct costs were attributable to hospitalizations. Furthermore, within the 18- to 64-year-old group, influenza-related costs increased with age and underlying medical conditions. The reported cost of influenza-related hospitalizations was found to be up to 2.5 times higher among at-risk populations compared with not-at-risk populations. This review documents the considerable economic impact of influenza among adults aged 18 to 64. In this age group, most of the influenza costs are indirect, which are generally not recognized by decision makers. Future studies should focus on at-risk subgroups, lab-confirmed cases, and European countries.
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Affiliation(s)
| | | | - Erika Wissinger
- Evidence Synthesis & ModelingXcenda, L.L.C.CarrolltonTexasUSA
| | - Fabián P. Alvarez
- Global Health Economics and Value AssessmentSanofi PasteurLyonFrance
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Gupta SD, Nandy M, Song DG, Pan CH. Present therapeutic and diagnostic approaches for SARS-CoV-2 infection. COMPUTATIONAL APPROACHES FOR NOVEL THERAPEUTIC AND DIAGNOSTIC DESIGNING TO MITIGATE SARS-COV-2 INFECTION 2022. [PMCID: PMC9300475 DOI: 10.1016/b978-0-323-91172-6.00025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The novel Coronavirus (nCoV), severe acute respiratory syndrome-Coronavirus-2 (SARS-CoV-2), has shaken the whole world and posed significant challenges to the global healthcare system for more than a year. The scientific community across the globe is trying to combat this virus by developing a safe vaccine that can provide long-term immunity against the virus. The other means of overcoming its pathogenicity is to treat the infected people with available drugs and/or novel therapeutic strategies. The available drugs were previously designed to combat viral infections and come with tested safety. This appears to be the most practical approach as a quick response to the highly infectious pandemic with high morbidity and mortality. Although many repurposed drugs like favipiravir and hydroxychloroquine have been tried, they have been proven toxic and/or less efficacious. This has led the world to find urgent therapeutic interventions (traditional and novel), to help decrease the severity of COVID-19 infection and aim towards recovery. This chapter of the book will discuss the most up-to-date published data with respect to prevention and treatment of COVID-19 infection. Diagnosis also plays an important part in controlling the pandemic caused by the virus. A cheap, accurate and fast identification test for the virus is the need of the hour. This chapter will also throw light on the various diagnostic procedures available for the identification of SARS-CoV-2, till date, along with their advantages and disadvantages.
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Antibiotic prescribing in patients with COVID-19: rapid review and meta-analysis. Clin Microbiol Infect 2021; 27:520-531. [PMID: 33418017 PMCID: PMC7785281 DOI: 10.1016/j.cmi.2020.12.018] [Citation(s) in RCA: 433] [Impact Index Per Article: 144.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 02/07/2023]
Abstract
Background The proportion of patients infected with SARS-CoV-2 that are prescribed antibiotics is uncertain, and may contribute to patient harm and global antibiotic resistance. Objective The aim was to estimate the prevalence and associated factors of antibiotic prescribing in patients with COVID-19. Data Sources We searched MEDLINE, OVID Epub and EMBASE for published literature on human subjects in English up to June 9 2020. Study Eligibility Criteria We included randomized controlled trials; cohort studies; case series with ≥10 patients; and experimental or observational design that evaluated antibiotic prescribing. Participants The study participants were patients with laboratory-confirmed SARS-CoV-2 infection, across all healthcare settings (hospital and community) and age groups (paediatric and adult). Methods The main outcome of interest was proportion of COVID-19 patients prescribed an antibiotic, stratified by geographical region, severity of illness and age. We pooled proportion data using random effects meta-analysis. Results We screened 7469 studies, from which 154 were included in the final analysis. Antibiotic data were available from 30 623 patients. The prevalence of antibiotic prescribing was 74.6% (95% CI 68.3–80.0%). On univariable meta-regression, antibiotic prescribing was lower in children (prescribing prevalence odds ratio (OR) 0.10, 95% CI 0.03–0.33) compared with adults. Antibiotic prescribing was higher with increasing patient age (OR 1.45 per 10 year increase, 95% CI 1.18–1.77) and higher with increasing proportion of patients requiring mechanical ventilation (OR 1.33 per 10% increase, 95% CI 1.15–1.54). Estimated bacterial co-infection was 8.6% (95% CI 4.7–15.2%) from 31 studies. Conclusions Three-quarters of patients with COVID-19 receive antibiotics, prescribing is significantly higher than the estimated prevalence of bacterial co-infection. Unnecessary antibiotic use is likely to be high in patients with COVID-19.
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Mayi BS, Mainville M, Altaf R, Lanspa M, Vaniawala S, Ollerhead TA, Raja A. A Crucial Role for Antimicrobial Stewardship in the Midst of COVID-19. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2021; 22:jmbe-22-69. [PMID: 33953821 PMCID: PMC8060144 DOI: 10.1128/jmbe.v22i1.2285] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 02/15/2021] [Indexed: 05/04/2023]
Abstract
As the world deals with a pandemic, there remains another global challenge that cannot be ignored. Use of broad-spectrum antibiotics may be justified as we are trying to treat a novel disease condition, which in turn could lead to an increase in antimicrobial resistance. We can decrease morbidity, mortality, and health care costs by controlling antimicrobial resistance, but it requires antimicrobial stewardship. Major components of effective and timely antimicrobial stewardship are diagnostic stewardship, infection prevention and control, and integration of COVID-19 specific flags into electronic health records, all of which may be integrated into current strategies of COVID-19 mitigation and management. Going through the influenza season of 2020, implementation of antimicrobial stewardship education efforts in the United States can help us contend with influenza in addition to COVID-19 and any bacterial co-infections or secondary infections. Additional solutions include the development of vaccines, alternative therapies such as antibodies, and advanced diagnostics using advances in genomics and computer science.
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Affiliation(s)
- Bindu S. Mayi
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Clearwater, FL 33759
- Corresponding author. Mailing address: Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, 3400 Gulf to Bay Blvd., Clearwater, FL 33759. E-mail:
| | - Manda Mainville
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Rida Altaf
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Michelle Lanspa
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Sheel Vaniawala
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Thomas A. Ollerhead
- Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, FL 33328
| | - Aarti Raja
- Department of Biological Sciences, Halmos College of Arts and Sciences, Nova Southeastern University, Fort Lauderdale, FL 33314
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Karami Z, Knoop BT, Dofferhoff ASM, Blaauw MJT, Janssen NA, van Apeldoorn M, Kerckhoffs APM, van de Maat JS, Hoogerwerf JJ, Ten Oever J. Few bacterial co-infections but frequent empiric antibiotic use in the early phase of hospitalized patients with COVID-19: results from a multicentre retrospective cohort study in The Netherlands. Infect Dis (Lond) 2020; 53:102-110. [PMID: 33103530 DOI: 10.1080/23744235.2020.1839672] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Knowledge on bacterial co-infections in COVID-19 is crucial to use antibiotics appropriately. Therefore, we aimed to determine the incidence of bacterial co-infections, antibiotic use and application of antimicrobial stewardship principles in hospitalized patients with COVID-19. METHODS We performed a retrospective observational study in four hospitals (1 university, 2 non-university teaching, 1 non-teaching hospital) in the Netherlands from March to May 2020 including consecutive patients with PCR-confirmed COVID-19. Data on first microbiological investigations obtained at the discretion of the physician and antibiotic use in the first week of hospital admission were collected. RESULTS Twelve (1.2%) of the 925 patients included had a documented bacterial co-infection (75.0% pneumonia) within the first week. Microbiological testing was performed in 749 (81%) patients: sputum cultures in 105 (11.4%), blood cultures in 711 (76.9%), pneumococcal urinary antigen testing in 202 (21.8%), and Legionella urinary antigen testing in 199 (21.5%) patients, with clear variation between hospitals. On presentation 556 (60.1%; range 33.3-73.4%) patients received antibiotics for a median duration of 2 days (IQR 1-4). Intravenous to oral switch was performed in 41 of 413 (9.9%) patients who received intravenous treatment >48 h. Mean adherence to the local guideline on empiric antibiotic therapy on day 1 was on average 60.3% (range 45.3%-74.7%). CONCLUSIONS On presentation to the hospital bacterial co-infections are rare, while empiric antibiotic use is abundant. This implies that in patients with COVID-19 empiric antibiotic should be withheld. This has the potential to dramatically reduce the current overuse of antibiotics in the COVID-19 pandemic.
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Affiliation(s)
- Zara Karami
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands
| | - Bram T Knoop
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands
| | | | - Marc J T Blaauw
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands.,Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.,Bernhoven University, Uden, The Netherlands
| | - Nico A Janssen
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands
| | | | | | - Josephine S van de Maat
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands
| | - Jacobien J Hoogerwerf
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands
| | - Jaap Ten Oever
- Radboud University Medical Center, Nijmegen, The Netherlands.,Radboud Center for Infectious diseases, Nijmegen, The Netherlands
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Pulia MS, Wolf I, Schulz LT, Pop-Vicas A, Schwei RJ, Lindenauer PK. COVID-19: An Emerging Threat to Antibiotic Stewardship in the Emergency Department. West J Emerg Med 2020; 21:1283-1286. [PMID: 32970587 PMCID: PMC7514390 DOI: 10.5811/westjem.2020.7.48848] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/07/2020] [Indexed: 02/07/2023] Open
Abstract
While current research efforts focus primarily on identifying patient level interventions that mitigate the direct impact of COVID-19, it is important to consider the collateral effects of COVID-19 on antimicrobial resistance. Early reports suggest high rates of antibiotic utilization in COVID-19 patients despite their lack of direct activity against viral pathogens. The ongoing pandemic is exacerbating known barriers to optimal antibiotic stewardship in the ED, representing an additional direct threat to patient safety and public health. There is an urgent need for research analyzing overall and COVID-19 specific antibiotic prescribing trends in the ED. Optimizing ED stewardship during COVID-19 will likely require a combination of traditional stewardship approaches (e.g. academic detailing, provider education, care pathways) and effective implementation of host response biomarkers and rapid COVID-19 diagnostics. Antibiotic stewardship interventions with demonstrated efficacy in mitigating the impact of COVID-19 on ED prescribing should be widely disseminated and inform the ongoing pandemic response.
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Affiliation(s)
- Michael S. Pulia
- University of Wisconsin Madison, School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin
| | - Ian Wolf
- University of Wisconsin Madison, School of Medicine and Public Health, Madison, Wisconsin
| | - Lucas T. Schulz
- University of Wisconsin Madison, School of Medicine and Public Health, Department of Pharmacy, Madison, Wisconsin
| | - Aurora Pop-Vicas
- University of Wisconsin Madison, School of Medicine and Public Health, Department of Medicine, Madison, Wisconsin
| | - Rebecca J. Schwei
- University of Wisconsin Madison, School of Medicine and Public Health, Department of Emergency Medicine, Madison, Wisconsin
| | - Peter K. Lindenauer
- University of Massachusetts Medical School - Baystate, Department of Medicine, Springfield, Massachusetts
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12
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Anthone J, Boldt D, Alexander B, Carroll C, Ased S, Schmidt D, Vivekanandan R, Destache CJ. Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE. PHARMACY 2019; 7:E156. [PMID: 31775246 PMCID: PMC6958401 DOI: 10.3390/pharmacy7040156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial Stewardship (AMS) Program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.
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Affiliation(s)
- Jennifer Anthone
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Dayla Boldt
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Bryan Alexander
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Cassara Carroll
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Sumaya Ased
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - David Schmidt
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Renuga Vivekanandan
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
- School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Christopher J. Destache
- School of Medicine, Creighton University, Omaha, NE 68178, USA
- School of Pharmacy & Health Professions, Creighton University, Omaha, NE 68178, USA
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Kuti JL, Nicolau DP. Critique of prevention of pneumococcal disease in high risk adults: A pharmacist‐based assessment of adult immunization protocols in clinical practice. JOURNAL OF THE AMERICAN COLLEGE OF CLINICAL PHARMACY 2019. [DOI: 10.1002/jac5.1145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Joseph L. Kuti
- Center for Anti‐Infective Research and Development Hartford Hospital Hartford Connecticut
| | - David P. Nicolau
- Center for Anti‐Infective Research and Development Hartford Hospital Hartford Connecticut
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14
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Role of rapid diagnostics for viral respiratory infections in antibiotic prescribing decision in the emergency department. Infect Control Hosp Epidemiol 2019; 40:974-978. [DOI: 10.1017/ice.2019.166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
AbstractObjective:To describe the frequency of antibiotic prescriptions in patients with known viral respiratory infections (VRIs) diagnosed by polymerase chain reaction (PCR) in 3 emergency departments (EDs) and to identify patient characteristics that influence the prescribing of antibiotics by ED physicians despite PCR confirmation of viral cause.Design:Retrospective, observational analysis of patients with PCR-diagnosed VRI discharged from 3 acute-care hospital EDs within 1 health system.Results:In total, 323 patients were discharged from the ED with a VRI diagnosis, of whom 68 were prescribed antibiotics (21.1%). These patients were older (median, 59.5 vs 43 years; P = .04), experienced symptoms longer (median, 4 vs 2 days; P = .002), were more likely to have received antibiotics in the preceding 7 days (27.9% vs 9.8%; P < .001), and had higher proportions of abnormal chest X-rays (64.5% vs 28.4%; P < .001). Patients were more likely to receive antibiotics for a diagnosis of pneumonia (39.7% vs 1.6%; P < .001) or otitis media (7.4% vs 0.4%; P = .002), and were less likely with diagnosis of upper respiratory infection (2.9% vs 13.7%; P = .02) or influenza (20.6% vs 44.3%; P < .001).Conclusions:Despite a diagnosis of VRI, one-fifth of ED patients were prescribed antibiotics. Patient characteristics including age, duration of symptoms, abnormal chest X-rays, and specific diagnosis may increase provider concern for concurrent bacterial infections. Opportunities exist for antimicrobial stewardship strategies to incorporate rapid diagnostics in promoting judicious antibiotic usage in the ED.
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16
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Lesho EP, Laguio-Vila M. The Slow-Motion Catastrophe of Antimicrobial Resistance and Practical Interventions for All Prescribers. Mayo Clin Proc 2019; 94:1040-1047. [PMID: 30922694 DOI: 10.1016/j.mayocp.2018.11.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Revised: 10/26/2018] [Accepted: 11/05/2018] [Indexed: 01/29/2023]
Abstract
All medical and surgical specialties depend on the pool of effective antibiotics that continues to evaporate because of the increasing prevalence of drug-resistant bacteria. Antimicrobial-resistant infections kill 700,000 patients every year. By 2050, they are projected to cause 10 million deaths per year at a cumulative global cost of $100 trillion. Professional societies and international health agencies, including the United Nations, have declared escalating antimicrobial resistance as one of the gravest and most urgent threats to global public health and issued calls for action. The propensity of bacteria to mobilize and share genetic resistance determinants across species and genera, record levels of conflict-driven human population displacement, and the dearth of new antibiotics and rapid diagnostic tests, along with climate change and the epidemic of opioid addiction, exacerbate the antimicrobial resistance crisis. The predominant cause of antibiotic resistance is exposure to antibiotics through appropriate and inappropriate use. Mindfulness, nudging by peers, and adjuncts and alternatives to antibiotics, such as phage therapies, microbiome-based therapies, and novel medical informatics applications, could help reduce antibiotic use. This article describes the antimicrobial resistance crisis and highlights points in the continuum of care in which clinicians can readily implement practical, no-cost changes to minimize antibiotic exposure.
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Affiliation(s)
- Emil P Lesho
- Infectious Diseases Unit, Rochester Regional Health, Rochester, NY.
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17
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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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Abstract
INTRODUCTION Abuse and misuse of available antimicrobial drugs have increased antimicrobial resistance (AMR), with relevant adverse health and economic impacts. Several factors suggest that the influenza vaccine is a possible effective measure to control AMR through a significant reduction in antibiotic consumption. In this paper, aspects related will be discussed. AREAS COVERED Although the effectiveness of influenza immunization can significantly vary according to the study design, the circulating influenza viruses, the type of vaccine, the age of the enrolled subjects, the outcome measured and the season of the study, all experts agree that the influenza vaccine can significantly reduce the risk of contracting influenza in subjects of any age. Consequently, influenza vaccination may reduce the number of bacterial superimposed infections that can complicate influenza and require antibiotic prescriptions EXPERT COMMENTARY Several indirect and direct observations seem to indicate that influenza vaccines can play an important role in reducing influenza-related antibiotic prescriptions. This finding can lead to at least two undeniable advantages, reductions in drug expenditure and limitations of the risk of favoring AMR development. However, only when universal vaccination is accepted and implemented will the true advantages of the influenza vaccine in reducing AMR development be completely known and exploited.
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Affiliation(s)
- Susanna Esposito
- a Pediatric Clinic, Department of Surgical and Biomedical Sciences , Università degli Studi di Perugia , Perugia , Italy
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Walter JM, Wunderink RG. Testing for Respiratory Viruses in Adults With Severe Lower Respiratory Infection. Chest 2018; 154:1213-1222. [PMID: 29908153 PMCID: PMC6224704 DOI: 10.1016/j.chest.2018.06.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/29/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022] Open
Abstract
Viral pathogens are a common cause of severe lower respiratory tract infection in adults. Our ability to rapidly and accurately identify viral infections has dramatically improved as slow culture-based techniques have been largely replaced by multiplex high-throughput systems. Given these advances, reevaluation of the role of respiratory viral testing in adults presenting with lower respiratory tract infection is important. This article reviews the potential benefits of testing, provides an overview of the most commonly used diagnostic techniques, and considers whether current evidence supports routine testing.
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Affiliation(s)
- James M Walter
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Richard G Wunderink
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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20
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Donmez S, Gungor K, Gov P. Knowledge, Attitude and Practice of Self-Medication with Antibiotics Among Nursing Students. INT J PHARMACOL 2017. [DOI: 10.3923/ijp.2018.136.143] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Lowe CF, Payne M, Puddicombe D, Mah A, Wong D, Kirkwood A, Hull MW, Leung V. Antimicrobial stewardship for hospitalized patients with viral respiratory tract infections. Am J Infect Control 2017; 45:872-875. [PMID: 28526309 DOI: 10.1016/j.ajic.2017.03.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 03/22/2017] [Accepted: 03/22/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The purpose of this study was to implement a targeted antimicrobial stewardship intervention for patients with a viral respiratory tract infection. METHODS This was a quasi-experimental before and after audit and feedback intervention of adult inpatients with a positive polymerase chain reaction for a respiratory virus in 2 acute care hospitals in Vancouver, Canada. Audit and feedback was implemented based on 2 criteria: microbiology (no positive bacterial cultures) and chest imaging (absence of pneumonia or consolidation on radiology dictation). A chart review was conducted to assess for days of antibiotics postviral diagnosis. Outcomes including length of stay, intensive care unit admission within 14 days, mechanical ventilation within 14 days, antibiotics prescribed within 14 days, Clostridium difficile infection diagnosed within 30 days, and readmission within 30 days were also reviewed in comparison with the previous year. RESULTS Antimicrobial stewardship recommendations for hospitalized patients with viral respiratory tract infections were accepted for 77% of cases. This targeted approach based on easily assessed parameters translated into a 1.3-day (95% confidence interval, 0.3-2.3; P < .01) decrease in mean days of antibiotics postviral diagnosis compared with the previous year without systematic interventions. Compared with the previous year, no differences were identified for adverse outcomes associated with the intervention. CONCLUSIONS A targeted antimicrobial stewardship intervention integrating virology testing with the treating physician facilitated a reduction in duration of antibiotic treatment for viral respiratory tract infections.
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Abstract
Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.
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