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Detrimental Effect of Ozone on Pathogenic Bacteria. Microorganisms 2021; 10:microorganisms10010040. [PMID: 35056489 PMCID: PMC8779011 DOI: 10.3390/microorganisms10010040] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/11/2021] [Accepted: 12/19/2021] [Indexed: 12/13/2022] Open
Abstract
(1) Background: Disinfection of medical devices designed for clinical use associated or not with the growing area of tissue engineering is an urgent need. However, traditional disinfection methods are not always suitable for some biomaterials, especially those sensitive to chemical, thermal, or radiation. Therefore, the objective of this study was to evaluate the minimal concentration of ozone gas (O3) necessary to control and kill a set of sensitive or multi-resistant Gram-positive and Gram-negative bacteria. The cell viability, membrane permeability, and the levels of reactive intracellular oxygen (ROS) species were also investigated; (2) Material and Methods: Four standard strains and a clinical MDR strain were exposed to low doses of ozone at different concentrations and times. Bacterial inactivation (cultivability, membrane damage) was investigated using colony counts, resazurin as a metabolic indicator, and propidium iodide (PI). A fluorescent probe (H2DCFDA) was used for the ROS analyses; (3) Results: No reduction in the count colony was detected after O3 exposure compared to the control group. However, the cell viability of E. coli (30%), P. aeruginosa (25%), and A. baumannii (15%) was reduced considerably. The bacterial membrane of all strains was not affected by O3 but presented a significant increase of ROS in E. coli (90 ± 14%), P. aeruginosa (62.5 ± 19%), and A. baumanni (52.6 ± 5%); (4) Conclusion: Low doses of ozone were able to interfere in the cell viability of most strains studied, and although it does not cause damage to the bacterial membrane, increased levels of reactive ROS are responsible for causing a detrimental effect in the lipids, proteins, and DNA metabolism.
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Alsenani F, Tupally KR, Chua ET, Eltanahy E, Alsufyani H, Parekh HS, Schenk PM. Evaluation of microalgae and cyanobacteria as potential sources of antimicrobial compounds. Saudi Pharm J 2020; 28:1834-1841. [PMID: 33424272 PMCID: PMC7783216 DOI: 10.1016/j.jsps.2020.11.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 11/21/2020] [Indexed: 12/12/2022] Open
Abstract
Three microalgal extracts show antimicrobial activity against gram-positive bacteria. Different purification techniques were used to reveal the bioactive compounds. Linoleic acid, oleic acid, DHA and EPA inhibited the growth of gram-positive bacteria.
In recent decades, marine microorganisms have become known for their ability to produce a wide variety of secondary bioactive metabolites. Several compounds have been isolated from marine microorganisms for the development of novel bioactives for the food and pharmaceutical industries. In this study, a number of microalgae were evaluated for their antimicrobial activity against gram-positive and gram-negative bacteria, including food and plant pathogens, using various extraction techniques and antimicrobial assays. Disc diffusion and spot-on-lawn assays were conducted to confirm the antimicrobial activity. To measure the potency of the extracts, minimum inhibition concentrations (MIultCs) were measured. Three microalgae, namely Isochrysis galbana, Scenedesmus sp. NT8c, and Chlorella sp. FN1, showed strong inhibitory activity preferentially against gram-positive bacteria. These microalgal species were then selected for further purification and analysis, leading to compound identification. By using a mixture of different chromatography techniques gas chromatography–mass spectrometry (GC–MS) and high-performance liquid chromatography (HPLC) and ultra-high performance liquid chromatography-quadrupole time-of-flight mass spectrometry (UHPLC-Q-TOF-MS), we were able to separate and identify the dominant compounds that are responsible for the inhibitory activity. Additionally, nuclear magnetic resonance (NMR) was used to confirm the presence of these compounds. The dominant compounds that were identified and purified in the extracts are linoleic acid, oleic acid, docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA). These compounds are the potential candidates that inhibit the growth of gram-positive bacteria. This indicates the potential use of microalgae and their antimicrobial compounds as biocontrol agents against food and plant pathogens.
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Affiliation(s)
- Faisal Alsenani
- Department of Pharmacognosy, Faculty of Pharmacy, Umm Al-Qura University, Makkah 21955, Saudi Arabia.,School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Brisbane, QLD 4072, Australia.,Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Karnaker R Tupally
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Brisbane, QLD 4072, Australia
| | - Elvis T Chua
- Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Eladl Eltanahy
- Phycology Laboratory, Botany Department, Faculty of Science, Mansoura University, Egypt
| | - Hamed Alsufyani
- Department of Biology, Faculty of Science and Arts, University of Jeddah, Khulais 21921, Saudi Arabia
| | - Harendra S Parekh
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Brisbane, QLD 4072, Australia
| | - Peer M Schenk
- Algae Biotechnology Laboratory, School of Agriculture and Food Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
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Kim YA, Park YS, Youk T, Lee H, Lee K. Trends in South Korean antimicrobial use and association with changes in Escherichia coli resistance rates: 12-year ecological study using a nationwide surveillance and antimicrobial prescription database. PLoS One 2018; 13:e0209580. [PMID: 30596704 PMCID: PMC6312334 DOI: 10.1371/journal.pone.0209580] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/07/2018] [Indexed: 12/04/2022] Open
Abstract
The purpose of this study is to determine the correlation between use of antimicrobials, such as fluoroquinolone, cefoxitin, and cefotaxime, and Escherichia coli resistance using a nationwide database. Nationwide data on antimicrobial consumption for 12 years (2002 to 2013) were acquired from a database of subjects (n = 1,025,340) included in the National Health Insurance Service-National Sample Cohort. National antimicrobial resistance rates of E. coli were obtained from the Korean Antimicrobial Resistance Monitoring System, which has been administered by the Korean Centers for Disease Control and Prevention since 2002. Fluoroquinolone-resistance rates of E. coli isolated from general hospitals have continuously increased since 2002 and were correlated with nationwide fluoroquinolone use (r = 0.82, P = 0.0012) or ciprofloxacin use (r = 0.90, P<0.0001). Cefotaxime-resistance rates of E. coli isolated from general hospitals markedly increased since 2008 and were correlated with nationwide cefotaxime use (r = 0.94, P<0.0001) or third-generation cephalosporin use (r = 0.96, P<0.0001). Cefoxitin-resistance rates of E. coli isolated from general hospitals peaked in 2010 and significantly correlated with cephamycin use at a two-year interval (r = 0.64, P = 0.0256). In conclusion, consumption of antimicrobials such as fluoroquinolone, cefoxitin, and cefotaxime is well correlated with the resistance rates of E. coli to these agents. This study provides background data for national antimicrobial management policies to reduce antimicrobial resistance.
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Affiliation(s)
- Young Ah Kim
- Department of Laboratory Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Yoon Soo Park
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
- * E-mail: (YSP); (HL)
| | - Taemi Youk
- Research Institute, National Health Insurance Service Ilsan Hospital, Goyang, South Korea
| | - Hyukmin Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
- * E-mail: (YSP); (HL)
| | - Kyungwon Lee
- Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea
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Lamba M, Graham DW, Ahammad SZ. Hospital Wastewater Releases of Carbapenem-Resistance Pathogens and Genes in Urban India. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2017; 51:13906-13912. [PMID: 28949542 DOI: 10.1021/acs.est.7b03380] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Increasing antibiotic resistant hospital-acquired infections and limited new antibiotic discovery are jeopardizing human health at global scales, although how hospitals themselves fuel antimicrobial resistance (AMR) in the wider environment is largely unknown. Antibiotic resistance (AR) in hospitals in countries such as India is potentially problematic because of high antibiotic use, overcrowding, and inadequate wastewater containment. Here we quantified fecal coliforms (FC), carbapenem-resistant Enterobacteriaceae (CRE), blaNDM-1, and selected extended-spectrum β-lactam (ESBL) resistant bacteria and genes in 12 hospital wastewater outfalls and five background sewer drains across New Delhi over two seasons. Hospital wastewaters had up to 9 orders of magnitude greater concentrations of CRE bacteria and blaNDM-1 than local sewers (depending on the hospital), implying hospitals contribute high concentrations of AR relative to community sources in Delhi, especially during the winter. Significant correlations were found between FC levels (a fecal indictor), and CRE (r = 0.924; p = 0.005), blaNDM-1 (r = 0.934, p = 0.009), and ESBL-resistant bacteria (r = 0.913, p = 0.010) levels across hospital wastewaters, respectively, implying that elevated CRE and blaNDM-1 are of patient origin. However, of greater importance to global health, microbial culturing found 18 to 41% of wastewater CRE isolates (n = 1447) were on the WHO "critical pathogen" list in urgent need of new antibiotics, and 55% of CRE isolates from larger hospitals carried at least one blaNDM-1 gene. Wastewater releases from New Delhi hospitals may pose a greater AR exposure risk to residents than believed, implying in-hospital antibiotic use must be better controlled and more effective waste treatment is needed for hospital wastewaters.
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Affiliation(s)
- Manisha Lamba
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi , Hauz Khas, New Delhi, 110016, India
| | - David W Graham
- School of Civil Engineering & Geosciences, Newcastle University , Newcastle upon Tyne, NE1 7RU, United Kingdom
| | - S Z Ahammad
- Department of Biochemical Engineering and Biotechnology, Indian Institute of Technology Delhi , Hauz Khas, New Delhi, 110016, India
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Bosso JA, Sieg A, Mauldin PD. Comparison of Hospitalwide and Custom Antibiograms for Clinical Isolates of Pseudomonas aeruginosa. Hosp Pharm 2014; 48:295-301. [PMID: 24421478 DOI: 10.1310/hpj4804-295] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospital antibiograms, which are commonly used to determine empiric antibiotic therapy and as a tool in stewardship in a given institution, are open to bias when combining susceptibility results from various sources, hospital locations, and patient groups. METHODS We assessed such differences, using Pseudomonas aeruginosa as a test case, with susceptibility data from 2008 through 2010 in our institution. Each year's data were analyzed separately. A variety of specific or subcategorical antibiograms were compared with each other as well as with versions including all tested isolates and those with results from inpatients and outpatients only. Statistical significance was determined at the .01 level using either chi-square or Fisher exact test, and clinical significance was defined as ≥10 percentage points. RESULTS A variety of clinically significant differences were found that illustrated important differences within the intensive care unit environment and based on population, specifically adult versus pediatric. Concordance between statistically significant and clinically significant differences was poor. CONCLUSION These results corroborate and extend previous similar observations and point to the potential importance of subanalyses in preparing the annual hospital antibiogram.
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Affiliation(s)
- John A Bosso
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina ; Department of Medicine, Medical University of South Carolina College of Medicine, Charleston, South Carolina. Corresponding author: John A. Bosso, PharmD, South Carolina College of Pharmacy, 280 Calhoun Street, Charleston, SC 29435; phone: 843-792-8501; fax: 843-884-2929; e-mail:
| | - Adam Sieg
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina
| | - Patrick D Mauldin
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina ; Department of Medicine, Medical University of South Carolina College of Medicine, Charleston, South Carolina. Corresponding author: John A. Bosso, PharmD, South Carolina College of Pharmacy, 280 Calhoun Street, Charleston, SC 29435; phone: 843-792-8501; fax: 843-884-2929; e-mail:
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Bosso JA, Sieg A, Mauldin PD. Comparison of Hospitalwide and Custom Antibiograms for Clinical Isolates of Pseudomonas aeruginosa. Hosp Pharm 2014. [PMID: 24421478 DOI: 10.1310/hpj4804-295.test] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hospital antibiograms, which are commonly used to determine empiric antibiotic therapy and as a tool in stewardship in a given institution, are open to bias when combining susceptibility results from various sources, hospital locations, and patient groups. METHODS We assessed such differences, using Pseudomonas aeruginosa as a test case, with susceptibility data from 2008 through 2010 in our institution. Each year's data were analyzed separately. A variety of specific or subcategorical antibiograms were compared with each other as well as with versions including all tested isolates and those with results from inpatients and outpatients only. Statistical significance was determined at the .01 level using either chi-square or Fisher exact test, and clinical significance was defined as ≥10 percentage points. RESULTS A variety of clinically significant differences were found that illustrated important differences within the intensive care unit environment and based on population, specifically adult versus pediatric. Concordance between statistically significant and clinically significant differences was poor. CONCLUSION These results corroborate and extend previous similar observations and point to the potential importance of subanalyses in preparing the annual hospital antibiogram.
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Affiliation(s)
- John A Bosso
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina ; Department of Medicine, Medical University of South Carolina College of Medicine, Charleston, South Carolina. Corresponding author: John A. Bosso, PharmD, South Carolina College of Pharmacy, 280 Calhoun Street, Charleston, SC 29435; phone: 843-792-8501; fax: 843-884-2929; e-mail:
| | - Adam Sieg
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina
| | - Patrick D Mauldin
- Department of Clinical Pharmacy and Outcome Sciences, South Carolina College of Pharmacy, Charleston, South Carolina ; Department of Medicine, Medical University of South Carolina College of Medicine, Charleston, South Carolina. Corresponding author: John A. Bosso, PharmD, South Carolina College of Pharmacy, 280 Calhoun Street, Charleston, SC 29435; phone: 843-792-8501; fax: 843-884-2929; e-mail:
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Yoshida J, Kikuchi T, Matsubara N, Asano I, Ogami N. Association between ward-specific antimicrobial use density and methicillin-resistant Staphylococcu aureus surveillance: a 60-month study. Infect Drug Resist 2013; 6:59-66. [PMID: 23901286 PMCID: PMC3726436 DOI: 10.2147/idr.s45843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
It is not known whether or not ward-specific antimicrobial use density (AUD) affects the ratio of methicillin-resistant Staphylococcus aureus (MRSA) in culture-positive S. aureus. A 60-month study was attempted to ascertain the association between inpatient MRSA ratio and ward-specific AUDs as well as the former and latter study intervals, specimen types, and ward specialty. During the study, the professionals in infection control regulated the use of broad-spectrum antimicrobials and those for MRSA. By both month and ward, the ratio of inpatients positive for MRSA to those positive for S. aureus was calculated. Factors associated with MRSA ratio included AUDs averaged for the sampling month and its previous month, outpatient MRSA ratio by age, ward specialty, specimen type, and half intervals to represent historical changes. Of a total of 4,245 strains of S. aureus isolated during the 5-year study, 2,232 strains (52.6%) were MRSA. By year, outpatient MRSA ratio at age ≥15 decreased in later years, as did inpatient MRSA ratio. Multivariate analysis for inpatient MRSA ratio revealed a positive risk in AUDs for meropenem (odds ratio [OR] 1.761; 95% confidence interval [CI] 1.761–2.637, P = 0.01), imipenem-cilastatin (OR 1.583; 95% CI 1.087–2.306, P = 0.02), ampicillin-sulbactam (OR 1.623; 95% CI 1.114–2.365, P = 0.01), and minocycline (OR 1.680; CI 1.135–2.487, P = 0.01), respiratory care ward (OR 2.292; 95% CI 1.085–4.841, P = 0.03), and outpatient MRSA ratio (OR 1.536; 95% CI 1.070–2.206, P = 0.02). Use of broad-spectrum antimicrobials, such as meropenem, imipenem-cilastatin, and ampicillin-sulbactam may increase inpatient MRSA ratio. Ward factor should be included in MRSA surveillance because of the possible effect on AUD and considering patients’ backgrounds.
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Affiliation(s)
- Junichi Yoshida
- Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Yamaguchi, Japan
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Isaiah IN, Nche BT, Nwagu IG, Nwagu II. Incidence of temonera, sulphuhydryl variables and cefotaximase genes associated with β-lactamase producing escherichia coli in clinical isolates. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2012; 3:557-61. [PMID: 22363078 PMCID: PMC3271419 DOI: 10.4297/najms.2011.3554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: the occurrence of the different types of Extended spectrum beta Lactamase producing Escherichia coli with the, Sulphurhydryl variable, Temonera and the Cefotaximase have been on the rise Aim: The study was to determine the prevalence of extended spectrum beta lactamase gene resistance across the clinical isolates of hospitalized patients. Materials and Method: Three hundred and fifty isolates of Escherichia coli were received from different clinical specimens. The susceptibility profile of the isolates against 10 different antibiotics was examined, the MICs (Minimum Inhibitory Concentration) for ceftazidime were also determined using micro-broth dilution assay. Isolates showing MIC ≥ 6 μg/ml for ceftazidime were screened for ESBL (PCT)phenotypic confirmatory test and subjected to PCR (polymerase chain reaction) to further. Results: By disk diffusion test, there was resistance to ceftazidime and cefotaxime were 180(51.4%) and 120 (34.2%) respectively. However, all strains were susceptible to imipenem. 250 isolates showed MICs≥ 6 μg/ml for ceftazidime of which 180 (72%) were positive for extended spectrum beta lactamase. The prevalence of Sulphurhydryl variable, Temonera and the Cefotaximase among these isolates were 17.1%, 6.6% and 17%, respectively. Conclusion: For the identification of extended spectrum beta lactamase producing isolates it is recommended that clinical laboratories adopt simple test based on Cinical laboratory standard institute recommendation for confirming extended spectrum beta lactamase production in enterobacteriacea species.
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Affiliation(s)
- Ibeh Nnana Isaiah
- Department of Medical Microbiology, Federal Medical Centre Yola Adamawa State, Nigeria
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Schwartz DN, Evans RS, Camins BC, Khan YM, Lloyd JF, Shehab N, Stevenson K. Deriving measures of intensive care unit antimicrobial use from computerized pharmacy data: methods, validation, and overcoming barriers. Infect Control Hosp Epidemiol 2011; 32:472-80. [PMID: 21515978 DOI: 10.1086/659760] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To outline methods for deriving and validating intensive care unit (ICU) antimicrobial utilization (AU) measures from computerized data and to describe programming problems that emerged. DESIGN Retrospective evaluation of computerized pharmacy and administrative data. SETTING ICUs from 4 academic medical centers over 36 months. INTERVENTIONS Investigators separately developed and validated programming code to report AU measures in selected ICUs. Use of antibacterial and antifungal drugs for systemic administration was categorized and expressed as antimicrobial-days (each day that each antimicrobial drug was given to each patient) and patient-days receiving antimicrobials (each day that any antimicrobial drug was given to each patient). Monthly rates were compiled and analyzed centrally, with ICU patient-days as the denominator. Results were validated against data collected from manual review of medical records. Frequent discussion among investigators aided identification and correction of programming problems. RESULTS AU data were successfully programmed though a reiterative process of computer code revision. After identifying and resolving major programming errors, comparison of computerized patient-level data with data collected by manual review of medical records revealed discrepancies in antimicrobial-days and patient-days receiving antimicrobials that ranged from less than 1% to 17.7%. The hospital from which numerator data were derived from electronic records of medication administration had the least discrepant results. CONCLUSIONS Computerized AU measures can be derived feasibly, but threats to validity must be sought out and corrected. The magnitude of discrepancies between computerized AU data and a gold standard based on manual review of medical records varies, with electronic records of medication administration providing maximal accuracy.
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Affiliation(s)
- David N Schwartz
- Division of Infectious Diseases, John H. Stroger, Jr. Hospital of Cook County, Rush Medical College, Chicago, Illinois, USA.
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Microbiological surveillance and parenteral antibiotic use in a critical care unit. Can J Infect Dis 2010; 11:107-11. [PMID: 18159274 DOI: 10.1155/2000/672340] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/1999] [Accepted: 09/07/1999] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To evaluate parenteral antibiotic utilization and bacterial resistance patterns in a critical care unit (CrCU). DESIGN Descriptive, prospective audit of infection site, culture and antimicrobial susceptibility test results, parenteral antibiotic usage and duration, total antibiotic acquisition costs, and length of stay. SETTING A 17-bed medical-surgical CrCU in a tertiary care teaching hospital in Metropolitan Toronto. PATIENTS Two hundred and fifty-eight patients admitted to the CrCU between May 1995 and April 1996 who received antimicrobial therapy. RESULTS The most frequently prescribed antibiotics were cefazolin (47%, 1098 g), gentamicin (33%,141 g) and ceftriaxone (20%, 255 g). The most common indications for antimicrobial therapy included surgical prophylaxis (34%) and pneumonia (35%). The following organisms were isolated from patients treated with antibiotics: Staphylococcus aureus (26%), Pseudomonas aeruginosa (13%), enterococci (12%), Haemophilus influenzae (11%), Escherichia coli (11%), Enterobacter cloacae (8%) and other Gram-negative bacilli (19%). Only 9% of Gram-negative bacilli were resistant to aminoglycosides, 3% were resistant to ciprofloxacin and no extended-spectrum beta-lactamases or imipenem-resistance were detected. No vancomycin-resistant enterococci and only two methicillin-resistant Staphylococcus aureus isolates were identified. CONCLUSIONS Antibiotic use during the audit appeared appropriate for the specific clinical indications. Low levels of bacterial resistance were detected during the audit.
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Mulvey MR, Simor AE. Antimicrobial resistance in hospitals: how concerned should we be? CMAJ 2009; 180:408-15. [PMID: 19221354 DOI: 10.1503/cmaj.080239] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Michael R Mulvey
- Department of Nosocomial Infections, National Microbiology Laboratory, Public Health Agency of Canada, University of Manitoba, Winnipeg, Man
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Messadi AA, Lamia T, Kamel B, Salima O, Monia M, Saida BR. Association between antibiotic use and changes in susceptibility patterns of Pseudomonas aeruginosa in an intensive care burn unit: a 5-year study, 2000-2004. Burns 2008; 34:1098-102. [PMID: 18619737 DOI: 10.1016/j.burns.2008.03.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2007] [Accepted: 03/06/2008] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the relationship between antimicrobial resistance in Pseudomonas aeruginosa and annual antibiotic use in a burn unit. From 1 January 2000 to 31 December 2004, 203 non-repetitive strains of Ps. aeruginosa were recovered from various clinical specimens. Antimicrobial susceptibility testing was performed using the disc diffusion method, and susceptibility data were interpreted according to break points recommended by the French Society of Microbiology. The antibiotic consumption for imipenem, ceftazidime, cefotaxime, piperacillin-tazobactam, ofloxacin, ciprofloxacin, gentamicin and amikacin was calculated with antimicrobial density. The relationship between antibiotic use and the resistance of Ps. aeruginosa was analysed. The consumption of ceftazidime and amikacin showed no association with resistance. A statistically significant relationship was observed between increasing use of ciprofloxacin and the incidence of resistant Ps. aeruginosa to this antibiotic (rs=0.89, p=0.05), and a significant correlation between ciprofloxacin consumption and resistance to imipenem was noted (rs=0.89, p=0.043). Restricted use of ciprofloxacin during 2003 and 2004 was followed by a significant decrease of resistance in Ps. aeruginosa. Our report illustrates the major role of ciprofloxacin in the emergence of resistant Ps. aeruginosa.
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Lee SS, Kim HS, Kang HJ, Kim JK, Chung DR. Rapid spread of methicillin-resistant Staphylococcus aureus in a new hospital in the broad-spectrum antibiotic era. J Infect 2007; 55:358-62. [PMID: 17692383 DOI: 10.1016/j.jinf.2007.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2007] [Revised: 05/28/2007] [Accepted: 06/26/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES It has been known that it takes a long time for methicillin-resistant Staphylococcus aureus (MRSA) to introduce and become endemic within a hospital. During the last decade, widespread use of broad-spectrum antibiotics might have affected the time required for MRSA to spread and become endemic in hospitals. However, there has been no report on this issue. We investigated how fast MRSA has spread and become endemic in a hospital opened in the broad-spectrum antibiotic era. METHODS The study was performed at a Korean hospital, which opened in 1999. We examined the change of antimicrobial susceptibility and antimicrobial use density (AUD) for 6 years since hospital opening. RESULTS S. aureus susceptibility to oxacillin decreased from 64% in the first month to 33% in the second month (P=.05), and then has maintained around 30%. AUD was remarkably high from the first year, in which total AUD and those of aminopenicillins, second-generation cephalosporins, fluoroquinolones, and macrolides were 4674.6, 1444.6, 1700.9, 421.3, and 520.0 DDD/1000 patient-days, respectively. CONCLUSIONS MRSA has spread within a few months in a hospital opened in the broad-spectrum antibiotic era. Excessively high use of broad-spectrum antibiotics seems to be responsible for rapid spread of MRSA in the hospital.
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Affiliation(s)
- S S Lee
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, 896 Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, South Korea
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Petrikkos G, Markogiannakis A, Papaparaskevas J, Papapareskevas J, Daikos GL, Stefanakos G, Zissis NP, Avlamis A. Differences in the changes in resistance patterns to third- and fourth-generation cephalosporins and piperacillin/tazobactam among Klebsiella pneumoniae and Escherichia coli clinical isolates following a restriction policy in a Greek tertiary care hospital. Int J Antimicrob Agents 2007; 29:34-8. [PMID: 17189092 DOI: 10.1016/j.ijantimicag.2006.08.042] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2006] [Revised: 08/10/2006] [Accepted: 08/10/2006] [Indexed: 11/19/2022]
Abstract
The aim of the present study was to investigate whether replacement of broad-spectrum cephalosporins (CEPs) by piperacillin/tazobactam (TZP) as first-line empirical therapy may have an effect on beta-lactam resistance among Klebsiella pneumoniae and Escherichia coli in a tertiary care hospital. Data regarding CEP and TZP consumption and resistance were collected on a bimonthly basis during an open-label 2-year (1 year observational and 1 year interventional) study. Consumption of ceftazidime was reduced by 64.5%. In contrast, consumption of the other third-generation CEPs (cefotaxime and ceftriaxone) remained almost stable, whereas an increase in consumption of TZP by 2.8-fold was observed. A significant decrease in resistance to third-generation cephalosporins among K. pneumoniae isolates was observed, and the incidence of extended-spectrum beta-lactamase-producing isolates was notably reduced. These findings were less evident among E. coli isolates. Despite the significant increase in TZP consumption, the respective resistance rates of both bacterial species examined have remained almost unchanged.
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Affiliation(s)
- George Petrikkos
- First Department of Propaedeutic Medicine, Infectious Diseases Laboratory, G.K. Daikos, Laikon General Hospital, Aghiou Thoma 17, Goudi, Athens 11527, Greece.
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15
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Monnet DL. Measuring antimicrobial use: the way forward. Clin Infect Dis 2007; 44:671-3. [PMID: 17278057 DOI: 10.1086/511649] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2006] [Accepted: 11/20/2006] [Indexed: 11/03/2022] Open
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16
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Brahmi N, Blel Y, Kouraichi N, Ben Hamouda R, Thabet H, Amamou M. [Impact of antibiotic use and prescribing policy in a Tunisian intensive care unit]. Med Mal Infect 2006; 36:460-5. [PMID: 17027213 DOI: 10.1016/j.medmal.2006.07.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2006] [Accepted: 07/21/2006] [Indexed: 12/18/2022]
Abstract
OBJECTIVE The aim of this study was to assess the efficacy of local antibiotic policy in a Tunisian ICU. The predefined primary efficacy objectives were the decrease of antibiotic consumption, reduction of inappropriate antibiotic (ATB) use and antimicrobial resistance. DESIGN This prospective intervention study lasted from January 2002 to December 2004. In the first study period or the baseline phase (from January to December 2002) we focused on physician education for ATB prescription practice. The second period concerned intervention (control of all ATB use). RESULTS The number of infection episodes significantly decreased from 2002 to 2004; 198 infection episodes in 2002 (1.63+/-1.15 episodes/patient) versus 124 in 2003 (1.22+/-0.93) (P<0.0008) versus 121 in 2004 (1.23+/-0.8) (P1<0.0008). The number of ATB/prescription also significantly decreased from 1.85+/-1.3 in 2002 to 1.5+/-0.9 in 2003 (P=0.02) and 1.5+/-1.4 in 2004 (P1=0.05). Appropriateness of antibiotherapy improved during the intervention period: 65% in 2002 versus 86% in 2003 (P=0.0003) and 81% in 2004 (P1=0.02). The length of antibiotherapy in survivors was considerably reduced: 14.1+/-2.9 days in 2002 versus 11.9+/-1.2 days in 2003 (P<10(-5)) and 10.9+/-2.5 days in 2004 (P1<10(-5)) with a significant reduction of antibiotherapy cost and length of stay (20.4+/-9 days in 2002 versus 18.3+/-6 days in 2003 and 16.9+/-8 days in 2004; P=0.05; P1=0.02). There was a significant decrease of carbapenem resistant Enterobacteriaceae esbeta, Pseudomonas aeruginosa and Acinetobacter baumannii.
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Affiliation(s)
- N Brahmi
- Service de Réanimation Médicale Polyvalente CAMU, 2, rue Raspail, 1008 Montfleury, Tunis, Tunisie.
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17
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Samy RP, Gopalakrishnakone P, Houghton P, Ignacimuthu S. Purification of antibacterial agents from Tragia involucrata--a popular tribal medicine for wound healing. JOURNAL OF ETHNOPHARMACOLOGY 2006; 107:99-106. [PMID: 16600546 DOI: 10.1016/j.jep.2006.02.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 02/22/2006] [Indexed: 05/08/2023]
Abstract
Tragia involucrata has been widely used in traditional systems of medicine for a variety of diseases. In the present study, in vitro antibacterial properties of nine different compounds including vinyl hexylether, shellsol, 2,4-dimethyl hexane, 2-methylnonane and 2,6-dimethyl heptane were isolated from the leaf of Tragia involucrata studied against Escherichia coli, Proteus vulgaris and Staphylococcus aureus using the disc-diffusion method at 50 microg/ml concentrations. The compound vinyl hexylether showed a broad spectrum of activity. The highest activity was found in shellsol (50 microg/ml) against Proteusvulgaris and Staphylococcus aureus. Minimum inhibitory concentrations were determined for the effective compounds (MICs 2.5-40 microg/ml), shellsol and vinyl hexylether showed inhibitory action at the lowest dilution (10 microg/ml) than 2-methylnanone. Shellsol inhibited the growth of Staphylococcus aureus very effectively than the other compounds. These compounds showed bactericidal effects against all the tested bacteria (MBC, 12.25 microg/ml). However, the compound shellsol showed effective killing of wound causing bacteria (Staphylococcus aureus). So, the study was focused on the constituent to evaluate wound healing in rat model. Rats that received 50 microg/kg, b.w. of shellsol showed complete healing after 24 days. Histological examination revealed an increase in the fibroblast, neovascularization, granulation and thickness of scar tissue after the treatment of shellsol as compared to control. The topical application of shellsol did not cause any toxic response on rat skin. Thus, the antibacterial properties of the constituents give some scientific basis to its usage in traditional medicine.
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Affiliation(s)
- Ramar Perumal Samy
- Venom and Toxin Research Programme, Department of Anatomy, National University of Singapore, Singapore
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18
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de With K, Meyer E, Steib-Bauert M, Schwab F, Daschner FD, Kern WV. Antibiotic use in two cohorts of German intensive care units. J Hosp Infect 2006; 64:231-7. [PMID: 16891039 DOI: 10.1016/j.jhin.2006.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 05/23/2006] [Indexed: 11/18/2022]
Abstract
Antibiotic use was evaluated in two cohorts of intensive care units (ICUs) in Germany. One cohort included ICUs participating in a surveillance programme (N=34) collecting antibiotic use and bacterial resistance data, with quarterly feedback. The second ICU cohort was from a cross-sectional study and represented a sample from hospitals in South-west Germany (N=58). Two dose definitions were used. These were the World Health Organization/Anatomical Therapeutic Chemical Classification (ATC) 2001 definition of defined daily dose (DDD), and a definition of recommended daily dose (RDD) that better reflected the currently prescribed dosages of parenteral drugs for hospitalized patients. Data were expressed as DDD or RDD per 100 patient-days. It was determined whether hospital size and affiliation, year of study and ICU type had an influence on overall use of antibiotics. Overall use differed between the two ICU cohorts irrespective of the dose definitions used. High use of antibiotics was primarily associated with hospital affiliation (university vs non-university) and hospital size. Mean overall use of antibiotics in non-university hospital ICUs ranged between 106 and 111 DDD/100 (59 and 67 RDD/100) for different hospital size categories, compared with 140 DDD/100 (87 RDD/100) in university hospital ICUs. In conclusion, in order to compare the use of antibiotics between ICU cohorts and to assess trends over time, data adjustment is required for hospital affiliation and size.
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Affiliation(s)
- K de With
- Centre for Infectious Diseases and Travel Medicine, Department of Medicine, University Hospital, Freiburg, Germany
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19
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Abstract
Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources.
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Affiliation(s)
- Conan MacDougall
- Department of Pharmacy, School of Pharmacy, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Virginia 23298, USA.
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20
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Filius PMG, Gyssens IC, Kershof IM, Roovers PJE, Ott A, Vulto AG, Verbrugh HA, Endtz HP. Colonization and resistance dynamics of gram-negative bacteria in patients during and after hospitalization. Antimicrob Agents Chemother 2005; 49:2879-86. [PMID: 15980364 PMCID: PMC1168677 DOI: 10.1128/aac.49.7.2879-2886.2005] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
The colonization and resistance dynamics of aerobic gram-negative bacteria in the intestinal and oropharyngeal microfloras of patients admitted to intensive care units (ICU) and general wards were investigated during and after hospitalization. A total of 3,316 specimens were obtained from patients upon admission, once weekly during hospitalization, at discharge from the ICU, at discharge from the hospital, and 1 and 3 months after discharge from the hospital. Five colonies per specimen were selected for identification and susceptibility testing. In both patient populations, the gram-negative colonization rates in oropharyngeal specimens increased during hospitalization and did not decrease in the 3 months after discharge. In rectal specimens, colonization rates decreased during hospitalization and increased after discharge. There was a change in species distribution among the dominant microfloras during hospitalization. Klebsiella spp., Enterobacter spp., Serratia marcescens, and Pseudomonas aeruginosa were isolated more often, whereas the frequency of Escherichia coli declined. The percentage of ICU patients colonized with ampicillin- and/or cephalothin-resistant fecal E. coli was significantly increased at discharge from the hospital and did not change in the 3 months after discharge. The emergence of multidrug resistance was observed for E. coli during patient stays in the ICU. Resistance frequencies in E. coli significantly increased with the length of stay in the ICU. For the general ward population, no significant changes in resistance frequencies were found during hospitalization. From a population perspective, the risk of dissemination of resistant gram-negative bacteria into the community through hospitalized patients appears to be low for general ward patients but is noticeably higher among ICU patients.
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Affiliation(s)
- P Margreet G Filius
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
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21
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de With K, Bergner J, Bühner R, Dörje F, Gonnermann C, Haber M, Hartmann M, Rothe U, Strehl E, Steib-Bauert M, Kern WV. Antibiotic use in German university hospitals 1998-2000 (Project INTERUNI-II). Int J Antimicrob Agents 2005; 24:213-8. [PMID: 15325423 DOI: 10.1016/j.ijantimicag.2004.03.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2004] [Accepted: 03/11/2004] [Indexed: 11/24/2022]
Abstract
In a pilot study we established a hospital antibiotic use database from which estimates for antibiotic consumption in German hospitals (expressed as defined daily doses per 100 patient days, DDD/100) can be retrieved for both benchmarking and antibiotic use and resistance research purposes. Data from eight university hospitals (1998-2000) showed a mean antibiotic use density of 60.1 DDD/100 in the surgical and 79.3 DDD/100 in the medical services. Antibiotic use was higher in the intensive care units (surgery: 146 DDD/100, medicine: 187 DDD/100) than in haematology-oncology services (110.8 DDD/100) or in other surgical (51.6 DDD/100) and medical (66 DDD/100) service areas. There were major differences in the use of specific antibacterial drug classes between service areas. The established database allows detailed analysis in antibacterial drug use and can be linked to bacterial resistance surveillance databases.
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Affiliation(s)
- Katja de With
- Center for Infectious Diseases and Travel Medicine, University Hospital, Hugstetter Strass 55, D-79106 Freiburg, Germany
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22
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Wattal C, Joshi S, Sharma A, Oberoi JK, Prasad KJ. Prescription auditing and antimicrobial resistance at a tertiary care hospital in New Delhi, India. J Hosp Infect 2005; 59:156-8. [PMID: 15620451 DOI: 10.1016/j.jhin.2004.09.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Accepted: 09/19/2004] [Indexed: 11/27/2022]
Abstract
This paper reports the antibiotic consumption data of Sir Ganga Ram Hospital, New Delhi and bacterial resistance over a seven-year period. Cephalosporins, penicillins and fluoroquinolones were the most widely prescribed antibiotics. A correlation was seen between Escherichia coli resistance to third-generation cephalosporins and increased cephalosporin use, as well as resistance to co-amoxyclav and its use.
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Affiliation(s)
- C Wattal
- Department of Clinical Microbiology, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi 110061, India.
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23
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Shulman L, Ost D. Managing infection in the critical care unit: how can infection control make the ICU safe? Crit Care Clin 2005; 21:111-28, ix. [PMID: 15579356 DOI: 10.1016/j.ccc.2004.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The goal of this article is to use ventilator-associated pneumonia (VAP) as a prototype for nosocomial infections to explore the issues of patient safety and infection control. To do this, we review disease-specific aspects of VAP, develop a brief working definition of patient safety, and then determine how the concepts of infection control fit into the broader context of patient safety.
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Affiliation(s)
- Lawrence Shulman
- Division of Pulmonary and Critical Care Medicine, North Shore University Hospital, 300 Community Drive, Manhasset, NY 11030, USA
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24
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Tiemersma EW, Bronzwaer SLAM, Lyytikäinen O, Degener JE, Schrijnemakers P, Bruinsma N, Monen J, Witte W, Grundman H. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004; 10:1627-34. [PMID: 15498166 PMCID: PMC3320277 DOI: 10.3201/eid1009.040069] [Citation(s) in RCA: 376] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
European Antimicrobial Resistance Surveillance System shows large variations in methicillin-resistant S. aureus. We explored the variation in proportions of methicillin-resistant Staphylococcus aureus (MRSA) between and within countries participating in the European Antimicrobial Resistance Surveillance System and temporal trends in its occurrence. This system collects routine antimicrobial susceptibility tests for S. aureus. We examined data collected from January 1999 through December 2002 (50,759 isolates from 495 hospitals in 26 countries). MRSA prevalence varied almost 100-fold, from <1% in northern Europe to >40% in southern and western Europe. MRSA proportions significantly increased in Belgium, Germany, Ireland, the Netherlands, and the United Kingdom, and decreased in Slovenia. Within countries, MRSA proportions varied between hospitals with highest variance in countries with a prevalence of 5% to 20%. The observed trends should stimulate initiatives to control MRSA at national, regional, and hospital levels. The large differences between hospitals indicate that efforts may be most effective at regional and hospital levels.
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Affiliation(s)
- Edine W Tiemersma
- National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
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25
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Rogues AM, Placet-Thomazeau B, Parneix P, Vincent I, Ploy MC, Marty N, Merillou B, Labadie JC, Gachie JP. Use of antibiotics in hospitals in south-western France. J Hosp Infect 2004; 58:187-92. [PMID: 15501332 DOI: 10.1016/j.jhin.2004.07.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2003] [Accepted: 07/26/2004] [Indexed: 11/17/2022]
Abstract
Data on the use of antibiotics were collected by means of a questionnaire from 49 hospitals in south-western France. Use was expressed as a usage density rate: number of defined daily doses (DDDs) per 1000 patient-days. The average use of antibiotics amounted to 402 DDDs per 1000 patient-days and varied between 60 and 734. In acute-care wards, the amount of antibiotic use increased with the size of the hospital: 461 DDDs per 1000 patient-days for group A (<100 beds), 510 DDDs per 1000 patient-days for group B (more than 100 and less then 300 beds) and 676 DDDs per 1000 patient-days for group C (>300 beds). The rate of use differed among different types of hospital areas and varied from 58 for psychiatry departments to more than 1273 DDDs per 1000 patient-days for the infectious diseases departments. Broad-spectrum penicillins were the most frequently prescribed antibiotics. Fluoroquinolone and third-generation cephalosporin use were relatively uniform in the three size categories. This study shows that it is possible for a hospital to benchmark its consumption with other hospitals that are similar in size. In this way, surveillance of antibiotic use can aid hospitals in targeting infection control efforts.
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Affiliation(s)
- A M Rogues
- Service d'Hygiène Hospitalière, Hôpital Pellegrin, CHU de Bordeaux, Place Amélie Raba-Léon, 33076 Bordeaux, France.
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26
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Berger P, Pascal L, Sartor C, Delorme J, Monge P, Ragon CP, Charbit M, Sambuc R, Drancourt M. Generalized additive model demonstrates fluoroquinolone use/resistance relationships for Staphylococcus aureus. Eur J Epidemiol 2004; 19:453-60. [PMID: 15233318 DOI: 10.1023/b:ejep.0000027348.92979.94] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Mathematical models currently used to study the relationship between the prevalence of the resistance to an antibiotic and the amount of drug may not be adequate because they do not integrate temporal and area analyses simultaneously. Furthermore, the forms of such relationship are unknown. We applied the Generalized Additive Model (GAM) to study fluoroquinolone use and the incidence of fluoroquinolone-resistance in Staphylococcus aureus in our institution over a 3-year period. Overall institution and individual hospital unitrestricted analyses were performed. Relative risk (RR) observed for increasing fluoroquinolone use with a 4-month lag from the 25th percentile to the 75th percentile was 1.27 (95% CI: 1.13-1.42). In the surgery units, RR was 1.23 (95% CI: 1.01-1.50) for fluoroquinolone use with a 2-months lag. GAM enabled us to observe for the first time a significant temporal relationship between fluoroquinolone use and the incidence of fluoroquinolone-resistant nosocomial S. aureus isolates.
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Affiliation(s)
- Pierre Berger
- Laboratoire d'Evaluation Hospitalière-Mesure de la Santé Perçue, Faculté de Médecine, Marseilles, France
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27
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Solano T, Matthews Z. Comparison of antibiotic dispensing data with administration data in intensive care. J Hosp Infect 2004; 58:87-8. [PMID: 15350721 DOI: 10.1016/j.jhin.2004.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2004] [Indexed: 12/01/2022]
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28
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Bertin M, Muller A, Bertrand X, Cornette C, Thouverez M, Talon D. Relationship between glycopeptide use and decreased susceptibility to teicoplanin in isolates of coagulase-negative staphylococci. Eur J Clin Microbiol Infect Dis 2004; 23:375-9. [PMID: 15112071 DOI: 10.1007/s10096-004-1129-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To investigate the relationship between glycopeptide use and decreased susceptibility to teicoplanin in coagulase-negative staphylococci (CNS) isolates, data on teicoplanin susceptibility and glycopeptide use from existing microbiology laboratory and pharmacy databases were collected for the period between July 2000 and March 2001. Pooled data for the entire study period were first used to analyse associations. Univariate analysis showed that the incidence of CNS with decreased susceptibility to teicoplanin was significantly correlated with the use of glycopetides, particularly with vancomycin use. This association was confirmed by multivariate analysis. This study suggests that variations in antimicrobial resistance are related to variations in antimicrobial use in the model of CNS with decreased susceptibility to teicoplanin, thus confirming the usefulness of restricting antimicrobial prescribing as a means of controlling resistance.
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Affiliation(s)
- M Bertin
- Service d'Hygiène Hospitalière et d'Epidémiologie Moléculaire, CHU Jean Minjoz, 25030 Besançon, France
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29
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Meyer E, Schroeren-Boersch B, Schwab F, Jonas D, Rüden H, Gastmeier P, Daschner FD. [Quality assurance in intensive care medicine. SARI-surveillance on antibiotic use and bacterial resistance in intensive care units]. Anaesthesist 2004; 53:427-33. [PMID: 15004690 DOI: 10.1007/s00101-004-0668-2] [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: 10/26/2022]
Abstract
Intensive care units (ICUs) are high risk areas for emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, or on the correlation between antibiotic use and emergence of resistance. Supported by the German Ministry of Science and Education, project SARI (Surveillance on antibiotic use and bacterial resistance in ICUs) started in 02/2000 and now includes data on antibiotic use and resistance rates in 35 medical, surgical and interdisciplinary ICUs. To date (2/2000-12/2002), a total of 939 participant months, 339,461 patient days and 452,282 defined daily doses (DDD) have been covered with a mean antibiotic usage density (AD) of 1,332 DDDs/1,000 patient days and resistance data on 31,189 isolates from ICUs. The design of the project and first results of SARI are presented. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).
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Affiliation(s)
- E Meyer
- Institut für Umweltmedizin und Krankenhaushygiene, Universitätsklinikum Freiburg.
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30
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Thuong M, Zahar JR, Cohen Y. [Control scale of antibiotic prescriptions in intensive care]. Presse Med 2004; 33:130-6. [PMID: 15026709 DOI: 10.1016/s0755-4982(04)98502-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
UNLABELLED THE PROBLEM TO BE SOLVED: The improvement in the prescription of antibiotics (PA) is currently one of the stages necessary for the management of bacterial resistances. Patients admitted to intensive care, because of an acute affection or fragile territory, are frequently administered an antibiotic. The inappropriate nature of the PA is noted in 30 to 50% of cases. The inadequacy of the initial antibiotic therapy leads to an excessive increase in mortality and morbidity. THE DEVELOPMENT OF A CONTROL TOOL In order to improve our habits and help the prescribers, a panel of experts discussed the subject of the prescription of antibiotics during the 3rd day of the Outcomerea Group. At the end of this meeting, practical guidelines together with a scale for the control of the prescription of antibiotics had been established. COMMENTS We targeted our discussion on the importance of empirical treatment and the need to document the infectious episode. Moreover, we discussed the choice of the antibiotic molecule and the crucial need to reassess the treatment set-up. We also approach the place of combinations of antibiotics and their indications in our units as well as the optimal duration of the treatments.
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Affiliation(s)
- Marie Thuong
- Service de réanimation polyvalente, Hôpital Delafontaine, Saint-Denis (93)
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31
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Madaras-Kelly K. Optimizing Antibiotic Use in Hospitals: The Role of Population-Based Antibiotic Surveillance in Limiting Antibiotic Resistance. Pharmacotherapy 2003; 23:1627-33. [PMID: 14695042 DOI: 10.1592/phco.23.15.1627.31967] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
To minimize antibiotic resistance, pharmacists increasingly are becoming involved in antibiotic surveillance, formulation of antibiotic use policies, and day-to-day control of problematic antibiotic use. Population-based antibiotic surveillance has become common with the proliferation of electronic databases. The most widely applied measure of antibiotic consumption is the defined daily dose/1000 patient days. Most studies correlating antibiotic consumption with resistance have focused on antibiogram-related end points; antibiogram data generally reflect institutional nosocomial infection patterns. Most study designs have been derived from traditional epidemiology such as case-control with regression modeling or simple linear regression; however, these methods have limitations. Several experimental designs show promise. Many historical-control studies, including a multicentered study, suggest that population-based antibiotic surveillance and policy intervention can decrease antibiotic resistance in hospitals. Further research on the relationships among antibiotic surveillance, structured antibiotic policy interventions, and other microbiologic, patient-oriented, and economic end points is needed.
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Affiliation(s)
- Karl Madaras-Kelly
- Department of Pharmacy Practice, College of Pharmacy, Idaho State University, Pocatello, Idaho, USA.
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32
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Muller A, Thouverez M, Talon D, Bertrand X. Contribution de la pression de sélection antibiotique dans l’acquisition de Staphylococcus aureus résistant à la méticilline (SARM) dans un centre hospitalier universitaire. ACTA ACUST UNITED AC 2003; 51:454-9. [PMID: 14568589 DOI: 10.1016/s0369-8114(03)00146-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen, which causes severe morbidity and mortality in hospitals. Antibiotic pressure is recognised as an individual risk factor in the acquisition of MRSA, however, some authors suggest that antibiotic use must be considered as an ecological and collective problem on a unit or hospital scale. The objective of our study was to determine whether antibiotic pressure affects the acquisition of MRSA. The study was conducted during 1 year (from October 2000 to September 2001) at Besançon hospital. The analysis was based on the research of a correlation between incidence of MRSA acquisition, the colonisation pressure exerted by imported MRSA and use of antimicrobials ineffective against MRSA at the unit level. Univariate analysis showed that acquired MRSA cases were significantly correlated with the use of all antimicrobials, as well as with the use of each class of antimicrobial and with colonisation pressure. In multivariate analysis, the stratification of the units into consumer classes allowed us to eliminate the scale effect of each antimicrobial class and to characterise the impact of high antimicrobial use compared to weak antimicrobial. The highest risks of MRSA acquisition were observed for beta-lactams and quinolones. This study shows that "MRSA acquisition" is correlated to antibiotic use and highlights the need to improve antibiotic usage in the control of MRSA.
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Affiliation(s)
- A Muller
- Service d'hygiène hospitalière et d'épidémiologie moléculaire, centre hospitalier universitaire Jean-Minjoz, Besançon 25030, France
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Jarvis WR. Epidemiology and Control of Pseudomonas Aeruginosa Infections in the Intensive Care Unit. SEVERE INFECTIONS CAUSED BY PSEUDOMONAS AERUGINOSA 2003. [DOI: 10.1007/978-1-4615-0433-7_10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Lepper PM, Grusa E, Reichl H, Högel J, Trautmann M. Consumption of imipenem correlates with beta-lactam resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother 2002; 46:2920-5. [PMID: 12183248 PMCID: PMC127431 DOI: 10.1128/aac.46.9.2920-2925.2002] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
It is generally assumed that the antibiotic prescription policy of a hospital has a significant impact on bacterial resistance rates; however, few studies are available to support this concept with valid statistical data. During a 3-year period from 1997 to 2000, we monitored the consumption of beta-lactam and other antibiotics with known activity against Pseudomonas aeruginosa in a 600-bed community hospital. Monthly isolations of P. aeruginosa were assessed, and resistance rates were recorded. Partial correlation coefficients between consumption and resistance rates were determined, taking into account possible associations with other variables such as seasonal effects and transfers from other hospitals. A total of 30 +/- 7 novel P. aeruginosa strains per month were isolated without epidemic clustering. Prescriptions of imipenem varied significantly during the study period, while prescriptions of other antipseudomonal agents were stable, with the exception of an increase in piperacillin-tazobactam prescriptions. Rates of resistance of P. aeruginosa to the antimicrobial agents used showed a time course similar to figures for imipenem consumption. Monthly rates of resistance to imipenem (partial correlation coefficient [cc], 0.63), piperacillin-tazobactam (cc, 0.57), and ceftazidime (cc, 0.56) were significantly associated with imipenem prescription rates in the same or the preceding month, while consumption of ceftazidime or piperacillin-tazobactam had no apparent association with resistance. Among the variables investigated, imipenem consumption was identified as the major factor associated with both carbapenem and beta-lactam resistance in endemic P. aeruginosa. Periods of extensive imipenem use were associated with significant increases in resistance. Our data support the concept that a written antibiotic policy which balances the use of various antibiotic classes may help to avoid disturbances of a hospital's microbial sensitivity patterns.
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Affiliation(s)
- Philipp M Lepper
- Section of Hospital Hygiene, Department of Medical Microbiology and Hygiene, Ulm University Hospital, Germany
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35
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Asseray N, Mallaret MR, Sousbie M, Liberelle B, Schaerer L, Borrel E, Rieussec MO, Walter B, Guimier C, Buffet X, Soule H, Croizé J, Stahl JP. Antibiothérapie à l’hôpital : évaluation des pratiques de prescription dans le cadre d’un réseau interhospitalier. Med Mal Infect 2002. [DOI: 10.1016/s0399-077x(02)00404-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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36
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Curtis C, Fitzpatrick R, Marriott JF. An evaluation of quinolone prescribing in a group of acute hospitals: development of an objective measure of usage. PHARMACY WORLD & SCIENCE : PWS 2002; 24:61-6. [PMID: 12061135 DOI: 10.1023/a:1015563416551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To develop an objective measure to enable hospital Trusts to compare their use of antibiotics. DESIGN Self-completion, postal questionnaire with telephone follow up. SAMPLE 4 hospital trusts in the English Midlands. RESULTS The survey showed that it was possible to collect data concerning the number of Defined Daily Doses (DDD's) of quinolone antibiotic dispensed per Finished Consultant Episode (FCE) in each Trust. In the 4 trusts studied the mean DDD/FCE was 0.197 (range 0.117 to 0.258). This indicates that based on a typical course length of 5 days, 3.9% of patient episodes resulted in the prescription of a quinolone antibiotic. Antibiotic prescribing control measures in each Trust were found to be comparable. CONCLUSION The measure will enable Trusts to objectively compare their usage of quinolone antibiotics and use this information to carry out clinical audit should differences be recorded. This is likely to be applicable to other groups of antibiotics.
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Affiliation(s)
- C Curtis
- Queen's Hospital, Burton upon Trent, Straffordshire, UK.
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37
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Lesch CA, Itokazu GS, Danziger LH, Weinstein RA. Multi-hospital analysis of antimicrobial usage and resistance trends. Diagn Microbiol Infect Dis 2001; 41:149-54. [PMID: 11750169 DOI: 10.1016/s0732-8893(01)00296-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
We report a pilot study comparing antimicrobial usage and antimicrobial resistance trends for prominent nosocomial pathogens between 1994-1996. A convenience sample of ten hospitals participated in this retrospective review. We found a large variation in antimicrobial use and resistance trends and that many hospitals did not have data readily available to evaluate drug usage and resistance rates. A significant strong positive correlation was observed between the usage of ceftazidime and the prevalence of ceftazidime resistant Pseudomonas aeruginosa (r = 0.8, p = 0.005) and of ceftazidime resistant Enterobacter species (r = 0.8, p = 0.02). The presence of antibiotic control policies correlated with lower rates of some resistant strains and less antibiotic use. Our findings can be a useful starting point for hospitals that want to systematically measure antimicrobial use and resistance. Hospital laboratories, pharmacies, and infection control departments must work together to develop databases that will facilitate such measurements.
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Affiliation(s)
- C A Lesch
- University of Illinois at Chicago, Department of Pharmacy Practice, Chicago, Illinois, USA
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38
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Talon D, Bertrand X, Thouverez M. [Risk factors and prevention of the acquisition and transmission of glycopeptide resistant enterococci]. PATHOLOGIE-BIOLOGIE 2001; 49:641-8. [PMID: 11692752 DOI: 10.1016/s0369-8114(01)00225-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We reviewed the literature concerning the role of antibiotic use as a risk factor for glycopeptide-resistant enterococci (VRE) infection/colonisation, to enable us to develop measures for preventing the acquisition and transmission of VRE. We found that the length of stay, the number of stays in hospital and the transfer of patients between hospitals and units were all risk factors for acquiring VRE infection. However, analysis of group and individual data showed that there was also a clear link between vancomycin and third-generation cephalosporin use and the prevalence of VRE colonisation/infection. Evidence for this link was provided by the consistent association and dose-effect relationship observed, and from the frequently consistent variations observed over time. However, it is difficult to give precise recommendations because very few studies have investigated both intrinsic bacterial factors making specific strains more epidemic and the precise characteristics of the conditions determining antibiotic selection pressure. In the absence of this information, and maintaining the prevention measures against cross-contamination which remain a priority, these results suggest that programs aimed at improving the prescription of antibiotics should be initiated in hospitals.
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Affiliation(s)
- D Talon
- Service d'hygiène hospitalière et d'épidémiologie moléculaire, centre hospitalier universitaire Jean Minjoz, 25030, Besançon, France.
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39
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Abstract
Antimicrobial resistance is a growing problem in nearly every infectious disease, but the extent and rate of increase of the problem varies widely with different pathogen-drug combinations. The rate of increase of resistance depends primarily on the availability of resistant variants and the intensity of selection imposed by antimicrobial treatment (appropriately measured). Declines in resistance following antimicrobial control measures are typically faster in hospital-acquired infections than in community-acquired ones, probably owing to the dependence in the latter case on the fitness cost of resistance. Open questions and approaches for testing the hypotheses proposed here are outlined.
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Affiliation(s)
- M Lipsitch
- Dept of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA.
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40
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Abstract
While there is a growing concern about increasing antimicrobial resistance and international spread of resistant microorganisms, we are still lacking timely multinational, good-quality susceptibility data to guide our decisions on controlling such resistance. This review describes and compares current sources of multicentric antimicrobial susceptibility data, identifies problems responsible for the postponing of the implementation of epidemiological antimicrobial resistance surveillance systems and finally presents requirements for such systems.
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Affiliation(s)
- D L Monnet
- Department of Research and Development, Division of Microbiology, Statens Serum Institut, Artillerivej 5, DK-2300, Copenhagen, Denmark.
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41
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Monnet DL. [Antibiotic use and bacterial resistance]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2000; 19:409-17. [PMID: 10874442 DOI: 10.1016/s0750-7658(00)90211-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
The relationships between antibiotic use and bacterial resistance are not so easy to demonstrate. However, the evidence is abundant and mostly consistent. In this review, we will consider and discuss the different levels of evidence models: biological, consistent associations, dose-effect relationship, and concomitant variations. Decision-making is dependent of the local conditions. In the hospital, establishing an epidemiological diagnosis is a prerequisite to any decision, including restriction of antibiotic use.
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Affiliation(s)
- D L Monnet
- Department of Research and Development, Statens Serum Institut, Copenhague, Danemark
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42
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Lipsitch M, Bergstrom CT, Levin BR. The epidemiology of antibiotic resistance in hospitals: paradoxes and prescriptions. Proc Natl Acad Sci U S A 2000; 97:1938-43. [PMID: 10677558 PMCID: PMC26540 DOI: 10.1073/pnas.97.4.1938] [Citation(s) in RCA: 309] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/1999] [Indexed: 11/18/2022] Open
Abstract
A simple mathematical model of bacterial transmission within a hospital was used to study the effects of measures to control nosocomial transmission of bacteria and reduce antimicrobial resistance in nosocomial pathogens. The model predicts that: (i) Use of an antibiotic for which resistance is not yet present in a hospital will be positively associated at the individual level (odds ratio) with carriage of bacteria resistant to other antibiotics, but negatively associated at the population level (prevalence). Thus inferences from individual risk factors can yield misleading conclusions about the effect of antibiotic use on resistance to another antibiotic. (ii) Nonspecific interventions that reduce transmission of all bacteria within a hospital will disproportionately reduce the prevalence of colonization with resistant bacteria. (iii) Changes in the prevalence of resistance after a successful intervention will occur on a time scale of weeks to months, considerably faster than in community-acquired infections. Moreover, resistance can decline rapidly in a hospital even if it does not carry a fitness cost. The predictions of the model are compared with those of other models and published data. The implications for resistance control and study design are discussed, along with the limitations and assumptions of the model.
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Affiliation(s)
- M Lipsitch
- Department of Biology, Emory University, 1510 Clifton Road, Atlanta, GA 30322, USA.
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43
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López-Lozano JM, Monnet DL, Yagüe A, Burgos A, Gonzalo N, Campillos P, Saez M. Modelling and forecasting antimicrobial resistance and its dynamic relationship to antimicrobial use: a time series analysis. Int J Antimicrob Agents 2000; 14:21-31. [PMID: 10717497 DOI: 10.1016/s0924-8579(99)00135-1] [Citation(s) in RCA: 147] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
To investigate the relationship between antimicrobial use and resistance in our hospital, we collected antimicrobial susceptibility and use data from existing microbiology laboratory and pharmacy databases for the period July 1st, 1991-December 31, 1998. The data was analyzed as time series and autoregressive integrated moving average (Box-Jenkins) and transfer function models were built. By using this method, we were able to demonstrate a temporal relationship between antimicrobial use and resistance, to quantify the effect of use on resistance and to estimate the delay between variations of use and subsequent variations in resistance. The results obtained for two antimicrobial-microorganism combinations: ceftazidime-gram-negative bacilli and imipenem-Pseudomonas aeruginosa, are shown as examples.
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Affiliation(s)
- J M López-Lozano
- Investigation Unit, Microbiology Laboratory and Pharmacy, Hospital Vega Baja, 03314, Orihuela, Spain.
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44
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45
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Hubert SK, Mohammed JM, Fridkin SK, Gaynes RP, McGowan JE, Tenover FC. Glycopeptide-intermediate Staphylococcus aureus: evaluation of a novel screening method and results of a survey of selected U.S. hospitals. J Clin Microbiol 1999; 37:3590-3. [PMID: 10523558 PMCID: PMC85700 DOI: 10.1128/jcm.37.11.3590-3593.1999] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Isolates of Staphylococcus aureus with decreased susceptibilities to glycopeptide antimicrobial agents, such as vancomycin and teicoplanin, have emerged in the United States and elsewhere. Commercially prepared brain heart infusion agar (BHIA) supplemented with 6 microg of vancomycin per ml was shown in a previous study to detect glycopeptide-intermediate S. aureus (GISA) with high sensitivity and specificity; however, this medium, when prepared in-house, occasionally showed growth of vancomycin-susceptible control organisms. This limitation could significantly impact laboratories that prepare media in-house, particularly if they wished to conduct large surveillance studies for GISA. Therefore, a pilot study to detect GISA was performed with vancomycin-containing Mueller-Hinton agar (MHA) prepared in-house in place of commercially prepared BHIA. MHA was selected for this study because this medium is widely available and well standardized. The results of the pilot study showed that supplementation of MHA with 5 microg of vancomycin per ml was both a sensitive and a specific method for screening for GISA isolates. This method was used to screen for GISA among 630 clinical isolates of methicillin-resistant S. aureus collected during 1997 from 33 U.S. hospitals. Although 14 S. aureus isolates grew on the screening agar, all were vancomycin susceptible (MICs were </=1 microg/ml) by broth microdilution testing. Population analyses of five isolates revealed two with a subpopulation for which vancomycin MICs were 8 microg/ml. In summary, the MHA screen plate containing 5 microg of vancomycin per ml prepared in-house provides a sensitive and cost-effective method for large-scale screening for GISA for which vancomycin MICs are 8 microg/ml. However, confirmation of isolates as vancomycin resistant is critical. This study suggests that GISA was not a widespread problem in the United States in 1997.
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Affiliation(s)
- S K Hubert
- Department of Epidemiology, Rollins School of Public Health of Emory University, Atlanta, Georgia 30322, USA
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46
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McDonald LC, Banerjee SN, Jarvis WR. Seasonal variation of Acinetobacter infections: 1987-1996. Nosocomial Infections Surveillance System. Clin Infect Dis 1999; 29:1133-7. [PMID: 10524953 DOI: 10.1086/313441] [Citation(s) in RCA: 100] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
To determine whether nosocomial infections due to Acinetobacter species have increased over the past 10 years and whether infections continue to have a pronounced seasonal variation, we analyzed infections reported by hospitals in the National Nosocomial Infections Surveillance System that performed adult and pediatric intensive care unit surveillance from 1987 through 1996. Overall, 3447 nosocomial acinetobacter infections were reported during 5,596, 156 patient-days. There was a yearly median of 7.2 infections (range, 5.0-10.5) per 10,000 patient-days and a downward trend in the rate of acinetobacter infections overall (P<.05) and of 2 major types of infection (P<.05): bloodstream infections (yearly median, 1.6 per 10, 000 central venous catheter-days; range, 1.3-2.9) and pneumonia (yearly median, 7.6 per 10,000 ventilator-days; range, 6.5-12.0). Throughout this period, average rates were significantly higher during July-October than during November-June for acinetobacter infections overall (8.0 vs. 5.2; P<.01) and for bloodstream infections (2.0 vs. 1.2; P<.01) and pneumonia (9.7 vs. 6.6; P<.01).
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Affiliation(s)
- L C McDonald
- Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services,Atlanta, Georgia 30333, USA.
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47
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Burke JP, Pestotnik SL. Antibiotic resistance-systems thinking, chaos and complexity theory. Curr Opin Infect Dis 1999; 12:317-9. [PMID: 17035792 DOI: 10.1097/00001432-199908000-00001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Intensive Care Antimicrobial Resistance Epidemiology (ICARE) Surveillance Report, data summary from January 1996 through December 1997: A report from the National Nosocomial Infections Surveillance (NNIS) System. Am J Infect Control 1999; 27:279-84. [PMID: 10358233 DOI: 10.1053/ic.1999.v27.a98878] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The Intensive Care Antimicrobial Resistance Epidemiology project has established laboratory-based surveillance for antimicrobial resistance and antimicrobial use at a subset of hospitals participating in the National Nosocomial Infections Surveillance system. These data illustrate that, for most antimicrobial resistant organisms studied, rates of resistance were highest in the intensive care unit areas and lowest in the outpatient areas. For most of the antimicrobial agents, the rate of use was highest in the intensive care unit areas in parallel to the pattern seen for resistance. These comparative data on antimicrobial use and resistance among similar areas (ie, intensive care unit or other inpatient areas) can be used as a benchmark by participating hospitals to focus their efforts at addressing antimicrobial resistance.
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49
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Steward CD, Stocker SA, Swenson JM, O'Hara CM, Edwards JR, Gaynes RP, McGowan JE, Tenover FC. Comparison of agar dilution, disk diffusion, MicroScan, and Vitek antimicrobial susceptibility testing methods to broth microdilution for detection of fluoroquinolone-resistant isolates of the family Enterobacteriaceae. J Clin Microbiol 1999; 37:544-7. [PMID: 9986809 PMCID: PMC84460 DOI: 10.1128/jcm.37.3.544-547.1999] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/1998] [Accepted: 12/01/1998] [Indexed: 11/20/2022] Open
Abstract
Fluoroquinolone resistance appears to be increasing in many species of bacteria, particularly in those causing nosocomial infections. However, the accuracy of some antimicrobial susceptibility testing methods for detecting fluoroquinolone resistance remains uncertain. Therefore, we compared the accuracy of the results of agar dilution, disk diffusion, MicroScan Walk Away Neg Combo 15 conventional panels, and Vitek GNS-F7 cards to the accuracy of the results of the broth microdilution reference method for detection of ciprofloxacin and ofloxacin resistance in 195 clinical isolates of the family Enterobacteriaceae collected from six U.S. hospitals for a national surveillance project (Project ICARE [Intensive Care Antimicrobial Resistance Epidemiology]). For ciprofloxacin, very major error rates were 0% (disk diffusion and MicroScan), 0.9% (agar dilution), and 2.7% (Vitek), while major error rates ranged from 0% (agar dilution) to 3.7% (MicroScan and Vitek). Minor error rates ranged from 12.3% (agar dilution) to 20.5% (MicroScan). For ofloxacin, no very major errors were observed, and major errors were noted only with MicroScan (3.7% major error rate). Minor error rates ranged from 8.2% (agar dilution) to 18.5% (Vitek). Minor errors for all methods were substantially reduced when results with MICs within +/-1 dilution of the broth microdilution reference MIC were excluded from analysis. However, the high number of minor errors by all test systems remains a concern.
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Affiliation(s)
- C D Steward
- Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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50
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Bhavnani SM. Antimicrobial usage and resistance problems: Surveillance issues and a strategy for the future. ACTA ACUST UNITED AC 1998. [DOI: 10.1016/s1069-417x(00)88356-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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