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Maruyama K, Sekiya K, Yanagida N, Yasuda S, Fukumoto D, Hosoya S, Moriya H, Kawabe M, Mori T. The impact of meropenem shortage and post-prescription review and feedback on broad-spectrum antimicrobial use: An interrupted time-series analysis. Infect Prev Pract 2024; 6:100380. [PMID: 39044941 PMCID: PMC11263744 DOI: 10.1016/j.infpip.2024.100380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 06/13/2024] [Indexed: 07/25/2024] Open
Abstract
Background Meropenem (MEPM) holds significance in treating severe infections and drug-resistant bacteria. There are concerns that antimicrobial shortages may lead to the use of alternative antimicrobials that are less effective and safer. We have responded to the MEPM shortage with post-prescription monitoring and feedback (PPRF) with no restrictions on MEPM initiation. We aimed to assess the impact of the MEPM shortage and the PPRF on broad-spectrum antimicrobial use and mortality. Methods This retrospective study was conducted in a single hospital in Japan. The period from October 2021 to August 2022 was defined as the period before the MEPM shortage, and the period from September 2022 to March 2023 was defined as the period during the MEPM shortage. To support the appropriate use of antimicrobials during MEPM shortages, the antimicrobial stewardship team (AST) developed a list of alternatives to MEPM. An interrupted time series analysis was used to assess changes in use and mortality among patients receiving broad-spectrum antimicrobials over the study period. Discussion The shortage of MEPM and PPRF temporarily increased the use of alternative cefepime; however, the subsequent change in days of therapy and days of coverage of broad-spectrum antimicrobials suggests a decrease in the use of these antimicrobials. Despite these shifts, the mortality rates remained stable, suggesting that the response to the shortage did not adversely affect treatment outcomes. Conclusion In the context of antimicrobial shortages, AST support plays an important role in enabling physicians to make optimal use of antimicrobials.
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Affiliation(s)
- Kohei Maruyama
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Pharmacy, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Kiyoshi Sekiya
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Allergy and Respirology, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Noriyuki Yanagida
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Pediatrics, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Shuhei Yasuda
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Clinical Laboratory, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Daisuke Fukumoto
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Nursing, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Satoshi Hosoya
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Emergency, Critical Care Medicine, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hiromitsu Moriya
- Division of Antimicrobial Stewardship Program, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
- Department of Surgery, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Motoko Kawabe
- Department of Pharmacy, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Tatsuya Mori
- Department of Pharmacy, NHO Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
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Saitoh A, Nishiya K, Miyairi I, Shoji K, Ishiwada N, Katayose M, Hoshino T, Ohga S, Moriuchi H, Ouchi K. Launch of Board Certification in Pediatric Infectious Diseases in Japan. Pediatr Infect Dis J 2024; 43:e270-e274. [PMID: 38717154 DOI: 10.1097/inf.0000000000004388] [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: 07/19/2024]
Abstract
To cultivate specialists in pediatric infectious diseases (ID) in Japan, the Japanese Society for Pediatric Infectious Diseases initiated board certification for pediatric ID in 2017. Previously, in 2014, we had formed a committee for board certification in pediatric ID and discussed the fundamentals of the board certification system, including the goals, requirements for designated training institutions, provisional certification of pediatric ID specialists and eligibility for and content of the board certification examination. After approval from 31 programs, the pediatric ID programs started in 2017 with 8 fellows in 7 programs. The first 6 graduates received board certification in 2020. To date, 61 pediatricians have been board certified as pediatric ID specialists. In parallel, we introduced board certification for pediatricians who work mainly in primary care settings and have a special interest in pediatric ID. This system has certified 338 pediatricians. During and after the development of the programs, we achieved substantial progress in highlighting the pivotal role of pediatric ID specialists, including the establishment and maintenance of antimicrobial stewardship programs, pediatric ID consultations and introduction of viral diagnosis by polymerase chain reaction at institutions. However, several issues need to be addressed, including the establishment of independent pediatric ID departments in institutions, payment of consultation fees, program site visits, maintenance of certification and cultivation of physician-scientists. These challenges will be the focus of future efforts.
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Affiliation(s)
- Akihiko Saitoh
- From the Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Katsumi Nishiya
- Center for Health Professions Education, Kansai Medical University, Osaka, Japan
| | - Isao Miyairi
- Department of Pediatrics, Hamamatsu University School of Medicine, Shizuoka, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan
| | - Naruhiko Ishiwada
- Department of Infectious Diseases, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | | | - Tadashi Hoshino
- Division of Infectious Diseases, Chiba Children's Hospital, Chiba, Japan
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Moriuchi
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazunobu Ouchi
- Department of Medical Welfare for Children, Kawasaki University of Medical Welfare, Okayama, Japan
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Tverdek FP, Aitken SL, Mulanovich VE, Adachi J, Wu C, Cantu SS, McDaneld PM, Chemaly RF. Implementation of an Automated Antibiotic Time-out at a Comprehensive Cancer Center. Open Forum Infect Dis 2024; 11:ofae235. [PMID: 38798895 PMCID: PMC11127483 DOI: 10.1093/ofid/ofae235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/23/2024] [Indexed: 05/29/2024] Open
Abstract
Background Antimicrobial stewardship programs can optimize antimicrobial use and have been federally mandated in all hospitals. However, best stewardship practices in immunocompromised patients with cancer are not well established. Methods An antimicrobial time out, in the form of an email, was sent to physicians caring for hospitalized patients reaching 5 days of therapy for targeted antimicrobials (daptomycin, linezolid, tigecycline, vancomycin, imipenem/cilastatin, meropenem) in a comprehensive cancer center. Physicians were to discontinue the antimicrobial if unnecessary or document a rationale for continuation. This is a quasi-experimental, interrupted time series analysis assessing antimicrobial use during the following times: period 1 (before time-out: January 2007-June 2010) and period 2 (after time-out: July 2010-March/2015). The primary antimicrobial consumption metric was mean duration of therapy. Days of therapy per 1000 patient-days were also assessed. Results Implementation of the time-out was associated with a significant decrease in mean duration of therapy for the following antimicrobials; daptomycin: -0.89 days (95% confidence interval [CI], -1.38 to -.41); linezolid: -0.89 days (95% CI, -1.27 to -.52); meropenem: -0.97 days (95% CI, -1.39 to -.56); tigecycline: -1.41 days (95% CI, -2.19 to -.63); P < .001 for each comparison. Days of therapy/1000 patient-days decreased significantly for meropenem (-43.49; 95% CI, -58.61 to -28.37; P < .001), tigecycline (-35.47; 95% CI, -44.94 to -26.00; P < .001), and daptomycin (-9.47; 95% CI, -15.25 to -3.68; P = .002). Discussion A passive day 5 time-out was associated with reduction in targeted antibiotic use in a cancer center and could potentially be successfully adopted to several settings and electronic health records.
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Affiliation(s)
- Frank P Tverdek
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Samuel L Aitken
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Center for Antimicrobial Resistance and Microbial Genomics, UTHealth McGovern Medical School, Houston, Texas, USA
| | - Victor E Mulanovich
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Javier Adachi
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Cai Wu
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sherry S Cantu
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Patrick M McDaneld
- Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Wushouer H, Du K, Chen S, Li H, Zhang W, Yang Y, Hu L, Zhou Y, Sun H, Zheng B, Guan X, Shi L. Evaluation of prescription review and feedback policy on rational antibiotic use in primary healthcare settings in Beijing, China: a qualitative study using the Theoretical Domains Framework and the behaviour change wheel. JAC Antimicrob Resist 2023; 5:dlad128. [PMID: 38046566 PMCID: PMC10691747 DOI: 10.1093/jacamr/dlad128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/14/2023] [Indexed: 12/05/2023] Open
Abstract
Objectives To decelerate antibiotic resistance driven by inappropriate antibiotic prescribing, a prescription review and feedback (PRF) policy is implemented in primary healthcare institutions (PHIs) in Beijing, China. However, evaluation of PRF implementation in PHIs is scarce. This study aims to systematically identify the barriers and facilitators of PRF policy implementation to provide evidence for antimicrobial stewardship. Methods We conducted key informant interviews with 40 stakeholders engaged in the implementation of PRF in Beijing, including physicians, pharmacists and administrators. Interviews were audio recorded and transcribed verbatim. We coded the interview transcripts and mapped informant views to domains of the Theoretical Domains Framework. We then used a behaviour change wheel to suggest possible behavioural interventions. Results Procedural knowledge (Knowledge) and skills (Skill) of PRF were possessed by stakeholders. They felt responsible to promote the appropriate use of antibiotics (Social/professional role and identity) and believed that PRF could help to change inappropriate provider behaviours (Behavioural regulation) in prescribing antibiotics (Beliefs about consequences) under increased intention on antibiotic use (Stages of change). Moreover, informants called for a more unified review standard to enhance PRF implementation (Goals). Frequently identified barriers to PRF included inadequate capacity (Skill), using punishment mechanism (Behaviour regulation), reaching consistently lower antibiotic prescription rates (Goals), lack of resources (Environmental context and resources) and perceived pressure coming from patients (Social influences). Conclusions Stakeholders believed that PRF implementation promoted the rational use of antibiotics at PHIs in Beijing. Still, PRF was hampered by inconsistencies in review process and resources needed for PRF implementation.
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Affiliation(s)
- Haishaerjiang Wushouer
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Kexin Du
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Shicai Chen
- Department of Clinical Pharmacology, National Institute on Drug Dependence, Peking University, Beijing 100191, China
| | - Huangqianyu Li
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Wanmeng Zhang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yaoyao Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Lin Hu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
| | - Yue Zhou
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- Department of Pharmacy, Peking University People’s Hospital, Beijing 100044, China
| | - Hui Sun
- United Nations Children’s Fund, China Office, Beijing 100600, China
| | - Bo Zheng
- Institute of Clinical Pharmacology, Peking University First Hospital, Beijing 100034, China
| | - Xiaodong Guan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
| | - Luwen Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University, 38 Xueyuan Road, Haidian District, Beijing 100191, China
- International Research Center for Medicinal Administration, Peking University, Beijing 100191, China
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Kouyama Y, Uehara Y, Takamatsu A, Suzuki R, Nishida R, Inuzuka K, Muramatsu E, Ohyama K, Doi Y, Yamada S, Honda H. The impact of carbapenem shortage and stewardship countermeasures on antimicrobial practice at a tertiary care center. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e173. [PMID: 38028913 PMCID: PMC10644165 DOI: 10.1017/ash.2023.460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 12/01/2023]
Abstract
We evaluated the impact of carbapenem shortage on antimicrobial practice and patient outcome at a tertiary care center. During the shortage, hospital antimicrobial practice could be safely managed through additional antimicrobial stewardship measures including treatment guidance and mandatory preauthorization. Antimicrobial shortage may present a unique opportunity for promoting antimicrobial stewardship.
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Affiliation(s)
- Yuichi Kouyama
- Division of Antimicrobial Stewardship Program, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Yuki Uehara
- Division of Antimicrobial Stewardship Program, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Akane Takamatsu
- Graduate School of Public Health, St. Luke’s International University, Tokyo, Japan
| | - Ryota Suzuki
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Rie Nishida
- Division of Antimicrobial Stewardship Program, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Katsumasa Inuzuka
- Division of Antimicrobial Stewardship Program, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Eriko Muramatsu
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Koji Ohyama
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Yohei Doi
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Shigeki Yamada
- Department of Pharmacy, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Hitoshi Honda
- Department of Infectious Diseases, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
- Division of Infection Control, Department of Quality and Safety in Healthcare, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
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Tan SY, Khan RA, Khalid KE, Chong CW, Bakhtiar A. Correlation between antibiotic consumption and the occurrence of multidrug-resistant organisms in a Malaysian tertiary hospital: a 3-year observational study. Sci Rep 2022; 12:3106. [PMID: 35210515 PMCID: PMC8873402 DOI: 10.1038/s41598-022-07142-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/14/2022] [Indexed: 01/28/2023] Open
Abstract
Inappropriate use of antibiotics has been shown to contribute to the occurrence of multidrug-resistant organisms (MROs). A surveillance study was performed in the largest tertiary care hospital in Kuala Lumpur, Malaysia, from 2018 to 2020 to observe the trends of broad-spectrum antibiotics (beta-lactam/beta-lactamases inhibitors (BL/BLI), extended-spectrum cephalosporins (ESC), and fluoroquinolones (FQ)) and antibiotics against MRO (carbapenems, polymyxins, and glycopeptides) usage and the correlation between antibiotic consumption and MROs. The correlation between 3-year trends of antibiotic consumption (defined daily dose (DDD)/100 admissions) with MRO infection cases (per 100 admissions) was determined using a Jonckheere-Terpstra test and a Pearson's Correlation coefficient. The antimicrobial resistance trend demonstrated a positive correlation between ESC and FQ towards the development of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase (ESBL)-producing Klebsiella spp, ESBL-producing Escherichia coli (E. coli), and MRO Acinetobacter baumannii (A. baumannii). Increasing carbapenem consumption was positively correlated with the occurrence of ESBL-producing Klebsiella spp and E. coli. Polymyxin use was positively correlated with ESBL-producing Klebsiella spp, MRO A. baumannii, and carbapenem-resistant Enterobacteriaceae. The findings reinforced concerns regarding the association between MRO development, especially with a surge in ESC and FQ consumption. Stricter use of antimicrobials is thus crucial to minimise the risk of emerging resistant organisms.
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Affiliation(s)
- Sin Yee Tan
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Rahela Ambaras Khan
- Pharmacy Department, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Khairil Erwan Khalid
- Medical Department, Hospital Kuala Lumpur, Ministry of Health, Kuala Lumpur, Malaysia
| | - Chun Wie Chong
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
| | - Athirah Bakhtiar
- School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia.
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Xie L, Du Y, Wang X, Zhang X, Liu C, Liu J, Peng X, Guo X. Effects of Regulation on Carbapenem Prescription in a Large Teaching Hospital in China: An Interrupted Time Series Analysis, 2016-2018. Infect Drug Resist 2021; 14:3099-3108. [PMID: 34408453 PMCID: PMC8364849 DOI: 10.2147/idr.s322938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/14/2021] [Indexed: 01/22/2023] Open
Abstract
Purpose Carbapenem resistance due to the overuse of carbapenems has become a public health problem worldwide, particularly in low- and middle-income countries (LMICs). However, there are few policies guiding carbapenem prescription, and their effectiveness is still unclear. A regulation targeting carbapenem prescription was implemented in March 2017 in China. This study aimed to assess the effects of the regulation for providing evidence on the prudent use of carbapenems. Patients and Methods This was an interventional, retrospective study started in January 2017. The intervention covered establishing performance appraisal indicators, special authorisation, strict prescribing restrictions, and dedicated supervision, particularly in the intensive care unit (ICU). Data on adult inpatients who received at least one carbapenems were extracted from January 2016 to December 2018. Segmented regression analysis was performed to evaluate the effect of the regulation. Results A total of 2005 inpatients received carbapenems. Segmented regression models showed an immediate decline in the intensity of antibiotic consumption (IAC) of carbapenems (coefficient = −9.65, p < 0.001), particularly imipenem (coefficient = −6.82, p = 0.002), and the antibiotic consumption of carbapenems (coefficient = −133.60, p = 0.003) in the ICU. And there is a decreasing trend in the IAC of meropenem (coefficient = −0.03, p = 0.008) in all departments. Furthermore, the IAC of carbapenems and imipenem (coefficient = −0.36, p = 0.035; coefficient = −0.49, p = 0.025, respectively), and the average length of stay (ALoS) (coefficient = −0.73, p < 0.001) showed downward trends in the ICU. Conclusion The intervention effectively reduced the IAC of carbapenems and imipenem, carbapenem consumption and the ALoS in the ICU, and the IAC of meropenem in all departments. The effects of the intervention were significant in the ICU, which indicated an urgent need for stronger regulations focusing on critical departments in the future.
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Affiliation(s)
- Lewei Xie
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Yaling Du
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xuemei Wang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Chenxi Liu
- School of Medicine and Health Management, Tongji Medical School, Huazhong University of Science and Technology, Wuhan, Hubei, People's Republic of China
| | - Junjie Liu
- School of Statistics and Mathematics, Central University of Finance and Economics, Beijing, People's Republic of China
| | - Xi Peng
- First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China
| | - Xinhong Guo
- First Affiliated Hospital, School of Medicine, Shihezi University, Xinjiang, Shihezi, People's Republic of China
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Poline J, Postaire M, Parize P, Pilmis B, Bille E, Zahar JR, Frange P, Cohen JF, Lortholary O, Toubiana J. Stewardship program on carbapenem prescriptions in a tertiary hospital for adults and children in France: a cohort study. Eur J Clin Microbiol Infect Dis 2021; 40:1039-1048. [PMID: 33389261 PMCID: PMC7778866 DOI: 10.1007/s10096-020-04103-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/05/2020] [Indexed: 01/31/2023]
Abstract
Antimicrobial stewardship programs aim at reducing the overuse of broad-spectrum antibiotics such as carbapenems, but their impact remains unclear. We compared the use of carbapenems between paediatric and adult subjects admitted to a French tertiary hospital and described the intervention of an antibiotic stewardship team (AST). As part of AST routine activity, all adult and paediatric patients receiving carbapenems are identified in real time using a computer-generated alert system and reviewed by the AST. Data associated with carbapenem prescriptions were extracted for 2 years (2014-2015) and were compared between paediatric and adult wards. Prescription appropriateness (i.e. no clinically suitable narrower spectrum alternative to carbapenem for de-escalation) and AST intervention were analysed. In total, 775 carbapenem prescriptions for 291 children and 262 adults were included. Most patients (95%) had a comordity and 52% had known recent carriage of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBLE). Most carbapenem prescriptions came from intensive care units (n = 269, 35%) and were initiated for urinary tract (n = 200, 27%), sepsis (n = 181, 25%), and lung (n = 153, 21%) infections. Carbapenems were initiated empirically in 537 (70%) cases, and an organism was isolated in 523 (67%) cases. Among the isolated organisms, 47% (n = 246) were ESBLE and 90% (n = 468) were susceptible to carbapenems, but an alternative existed in 61% (n = 320) of cases according to antibiotic susceptibility testing. Among prescriptions reviewed by the AST, 39% (n = 255) were considered non-appropriate and led to either antibiotic discontinuation (n = 47, 7%) or de-escalation (n = 208, 32%). Non-appropriate prescriptions were more frequent in paediatric wards (p = 0.01) and in microbiologically documented infections (p = 0.013), and less observed in immunocompromised patients (p = 0.009) or with a known ESBLE carriage (p < 0.001). Tailored stewardship programs are essential to better control carbapenem use and subsequent antimicrobial resistance.
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Affiliation(s)
- Julie Poline
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015 Paris, France ,Department of Gut Inflammation, Center for Research on Inflammation CRI, INSERM 1149, Université de Paris, 75006 Paris, France
| | - Martine Postaire
- Department of Pharmacy, Hôpital Necker–Enfants Malades, APHP, Université de Paris, Paris, France
| | - Perrine Parize
- Department of Infectious Diseases and Tropical Medicine, Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université de Paris, IHU Imagine, Paris, France
| | - Benoit Pilmis
- Department of Infectious Diseases and Tropical Medicine, Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université de Paris, IHU Imagine, Paris, France
| | - Emmanuelle Bille
- Department of Microbiology, Necker Enfants-Malades Hospital, APHP, Université de Paris, Paris, France
| | - Jean Ralph Zahar
- Department of Microbiology, Necker Enfants-Malades Hospital, APHP, Université de Paris, Paris, France ,Infection Control Unit, IAME, UMR 1137, Université Paris 13, Sorbonne Paris Cité, Paris, France
| | - Pierre Frange
- Department of Microbiology, Necker Enfants-Malades Hospital, APHP, Université de Paris, Paris, France
| | - Jérémie F. Cohen
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015 Paris, France
| | - Olivier Lortholary
- Department of Infectious Diseases and Tropical Medicine, Necker Enfants-Malades Hospital, Necker-Pasteur Infectious Diseases Center, Université de Paris, IHU Imagine, Paris, France
| | - Julie Toubiana
- Department of General Paediatrics and Paediatric Infectious Diseases, Hôpital Necker–Enfants Malades, APHP, Université de Paris, 149 rue de Sèvres, 75015 Paris, France ,Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
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