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Hinrichsen SL, de Lemos MC, Bernardino JM, Lima JA, Carrazone G, Vilella T, Trova G, Moura L, de Lima-Neto RG, Brink AJ. Assessing antimicrobial stewardship governance in Northeast Brazilian hospitals: a survey-based analysis. JAC Antimicrob Resist 2024; 6:dlae116. [PMID: 39104772 PMCID: PMC11299941 DOI: 10.1093/jacamr/dlae116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 06/20/2024] [Indexed: 08/07/2024] Open
Abstract
Background Effective governance of antimicrobial stewardship (AMS) and infection prevention control (IPC) in healthcare facilities is crucial for safeguarding patients against healthcare-associated infections and enhancing patient outcomes by optimizing antibiotic use and curbing the spread of antimicrobial-resistant (AMR) pathogens. Objectives To assess the current AMS governance in two public hospitals in Northeast of Brazil, specifically focusing on identifying institutional antibiotic policies and operational practices. Methods A survey was conducted by team leaders of both hospitals from 2020 to 2022 using a questionnaire adapted from the Pan American Health Organization (PAHO) recommendations for implementing AMS programmes (ASP) in Latin America and the Caribbean, alongside criteria from the National Health Surveillance Agency (ANVISA) and CDC. Results Fifty leaders, from senior management to coordinators, answered the questionnaire. Results indicate a lack of AMS process measures, specialist support, systematic antimicrobial utilization analysis and structured IPC programmes, especially in one hospital where patient records remain in paper format. Conclusions The empirical use of antimicrobials without local epidemiological or susceptibility data underscores the absence of logistical support for microbiological cultures in the region. These findings emphasize the urgent need for systematic AMS processes and multiprofessional teams to drive AMS and IPC practices, essential for patient care and safety.
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Affiliation(s)
- Sylvia Lemos Hinrichsen
- Centro de Ciências Médicas—Departamento Medicina Tropical, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
- Instituto Social Medianeiras da Paz (ISMEP), Infectious Disease Department—PSA Nordeste, Pernambuco, Brazil
| | - Marcela Coelho de Lemos
- Instituto Social Medianeiras da Paz (ISMEP), Infectious Disease Department—PSA Nordeste, Pernambuco, Brazil
| | | | - Juliana Andrade Lima
- Instituto Social Medianeiras da Paz (ISMEP), Infectious Disease Department—PSA Nordeste, Pernambuco, Brazil
| | - Genaro Carrazone
- Instituto Social Medianeiras da Paz (ISMEP), Infectious Disease Department—PSA Nordeste, Pernambuco, Brazil
| | - Tatiana Vilella
- Instituto Social Medianeiras da Paz (ISMEP), Infectious Disease Department—PSA Nordeste, Pernambuco, Brazil
| | - Gabriel Trova
- Laboratório Especial de Microbiologia Clínica (LEMC), Universidade Federal de São Paulo—UNIFESP, São Paulo, Brazil
| | - Libia Moura
- Centro de Ciências Médicas—Departamento Medicina Tropical, Universidade Federal de Pernambuco (UFPE), Pernambuco, Brazil
| | | | - Adrian John Brink
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- National Health Laboratory Services, Groote Schuur Hospital, Cape Town, South Africa
- Faculty of Health Sciences, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Raju R, Srinivas SC, Siddalingegowda SM, Vaidya R, Gharat M, Kumar TMP. Community pharmacists as antimicrobial resistance stewards: a narrative review on their contributions and challenges in low- and middle-income countries. JOURNAL OF PHARMACY & PHARMACEUTICAL SCIENCES : A PUBLICATION OF THE CANADIAN SOCIETY FOR PHARMACEUTICAL SCIENCES, SOCIETE CANADIENNE DES SCIENCES PHARMACEUTIQUES 2024; 27:12721. [PMID: 38939359 PMCID: PMC11208321 DOI: 10.3389/jpps.2024.12721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024]
Abstract
Antimicrobial resistance (AMR) is a global public health crisis that impedes the therapeutic effectiveness of available antimicrobial agents. Due to the high burden of infectious diseases and limited resources, especially trained healthcare professionals, low- and middle-income countries (LMICs) are particularly susceptible to the detrimental effects of AMR. Sometimes, as the first and last point of contact for patients seeking treatment for infections, community pharmacists can play a pivotal role in the stewardship required for AMR. This review aims to highlight the contributions made by community pharmacists in LMICs as AMR stewards. The review considers the challenges from the perspectives of limited resources, inadequate training, a lack of policies and regulations, and issues related to patient behavior. Community pharmacists in LMICs could optimize their advocacy contributions by focusing on One Health AMR stewardship. Transformational and actionable patient and population-centric antimicrobial stewardship (AMS) is feasible with the synergy of policymakers and other healthcare providers in the implementation of AMS policies and programs that support community pharmacists in their efforts to promote rational antimicrobial use.
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Affiliation(s)
- Rosy Raju
- JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | | | | | | | | | - T. M. Pramod Kumar
- JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
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Rashid MM, Ahmed S, Owens L, Hu N, Jaffe A, Homaira N. Asthma-community acquired pneumonia co-diagnosis in children: a scoping review. J Asthma 2024; 61:282-291. [PMID: 37943507 DOI: 10.1080/02770903.2023.2280843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/02/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE This scoping review investigated the existing literature and identified the evidence gaps related to diagnosis and management in children aged 2-18 years presenting to hospitals with a co-diagnosis of asthma and community-acquired pneumonia. DATA SOURCES We designed a scoping review following Arksey and O'Malley's scoping review framework and PRISMA extension for a scoping review. We searched literature using five electronic databases: PubMed, CINAHL, Scopus, Web of Science, and Embase from 2003 to June 2023. RESULTS A total of 1599 abstracts with titles were screened and 12 abstracts were selected for full review. Separate guidelines including Modified Global Initiative for Asthma (GINA) guidelines; modified Integrated Management of Childhood Illness (IMCI) guidelines; and a consensus guideline developed by the Pediatric Infectious Diseases Society (PIDS) and Infectious Diseases Society of America (IDSA) were used for diagnosing asthma and CAP individually. Chest X-rays were used in 83.3% (10/12) of studies to establish the co-diagnosis of asthma-CAP in children. Variations were observed in using different laboratory investigations across the studies. Infectious etiologies were detected in five (41.7%) studies. In 75% (9/12) of studies, children with asthma-CAP co-diagnosis were treated with antimicrobials, however, bacterial etiology was not reported in 44.4% (4/9) of the studies. CONCLUSIONS Our scoping review suggests that chest X-rays are commonly used to establish the co-diagnosis of asthma-CAP and antibiotics are often used without laboratory confirmation of a bacterial etiology. Clinical practice guidelines for the management of asthma and pneumonia in children who present with co-diagnosis may standardize clinical care and reduce variation.
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Affiliation(s)
- Md Mahbubur Rashid
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
| | - Shamim Ahmed
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Louisa Owens
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
- Respiratory Department, Sydney Children's Hospital, Sydney, Australia
| | - Nan Hu
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
| | - Adam Jaffe
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
- Respiratory Department, Sydney Children's Hospital, Sydney, Australia
| | - Nusrat Homaira
- Faculty of Medicine, School of Clinical Medicine, UNSW, Sydney, Australia
- Respiratory Department, Sydney Children's Hospital, Sydney, Australia
- James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh
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Pallares CJ, Porras J, De La Cadena E, García-Betancur JC, Restrepo-Arbeláez N, Viveros SMC, Cornistein W, Castañeda-Méndez P, Cuellar L, Boldim-Ferreira D, Chaverri-Murillo J, Labarca JA, Villegas MV. Antimicrobial stewardship programs in seven Latin American countries: facing the challenges. BMC Infect Dis 2023; 23:463. [PMID: 37434158 DOI: 10.1186/s12879-023-08398-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/13/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Studies have shown that more than 50% of the antibiotics used in hospitals are unnecessary or inappropriate and, that antimicrobial resistance may cost up to 20 billion USD in excess medical costs each year. On the other hand, Antimicrobial Stewardship Programs (ASP) significantly reduce inappropriate antimicrobial use, emergence of antimicrobial resistance, healthcare associated infections, and costs in hospital settings. OBJECTIVE To evaluate the development of ASP and antibiotic savings in 7 Latin American hospitals using standardized quantitative indicators in all the participating health care institutions. METHODS An interventional study was conducted, where pre- and post- evaluations were performed using a standardized score tool adapted from the Joint Commission International accreditation standards and, the Colombian Institute of Technical Standards and Certification. We evaluated ASP from 7 Latin American hospitals between 2019 and 2020. A pre-intervention evaluation was done in each hospital to quantify the degree of development of the ASP (ASP Development score). Based on these results, tailored on-site training was implemented in each hospital, followed by a post-intervention evaluation to quantify improvement of ASP-development indicators. In addition, monetary savings in antimicrobials derived from the ASP intervention were estimated. RESULTS In the pre-intervention evaluation, the average ASP development score for the 7 institutions was 65.8% (40-94.3%). The items with the lowest development score were those related to monitoring and communicating the ASP progress and success. For the post-intervention evaluation, 2 institutions couldn't participate due to the pressure imposed by the COVID-19 pandemic. For the remaining 5/7 hospitals, the average ASP development score was 82.3% with an increase of 12.0% when compared to the pre-intervention measurement of the same institutions (average pre-intervention score 70.3% (48.2%-94.3%) The items with a significant increase were key performance indicators, AMS education and training of the prescribers. Three of the seven (3/7) hospitals reported antibiotic monetary savings associated to the ASP intervention. CONCLUSIONS The use of the tool described shown to be useful to evaluate specific areas of ASP-development that were lacking and tailor interventions for the participating hospitals, consequently, it helped improve ASP-development in the institutions that underwent pre- intervention and post-intervention analysis. In addition, the strategies showed monetary savings on antimicrobial costs when measured.
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Affiliation(s)
- Christian José Pallares
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
- Clínica Imbanaco, Grupo Quirónsalud, Cali, Colombia
| | - Jessica Porras
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
| | - Elsa De La Cadena
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
| | - Juan Carlos García-Betancur
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
| | - Natalia Restrepo-Arbeláez
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
| | | | | | | | - Luis Cuellar
- Servicio de Infectología, Instituto Nacional de Enfermedades Neoplasicas, Lima, Perú
| | - Diogo Boldim-Ferreira
- Division of Infection Control and Hospital Epidemiology, Hospital São Paulo, Universidade Federal de São Paulo, São Paulo, Brazil
| | | | - Jaime A Labarca
- Department of Infectious Diseases, School of Medicine, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - María Virginia Villegas
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia.
- Clínica Imbanaco, Grupo Quirónsalud, Cali, Colombia.
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Otaigbe II, Elikwu CJ. Drivers of inappropriate antibiotic use in low- and middle-income countries. JAC Antimicrob Resist 2023; 5:dlad062. [PMID: 37265987 PMCID: PMC10230568 DOI: 10.1093/jacamr/dlad062] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Antimicrobial resistance (AMR) is a global security threat that accounts for about 700 000 deaths annually. Studies have shown that antimicrobial resistance could result in a 2% to 3.5% reduction in global Gross Domestic Product by 2050 and a loss of between 60 and 100 trillion US dollars, worth of economic output resulting in significant and widespread human suffering. Low- and middle-income countries (LMICs) will be worse hit by an unchecked rise of AMR. For example, it is predicted that AMR could kill about 4.1 million people in Africa by 2050 if it is not curbed. Similarly rising rates of AMR will lead to increased treatment costs and an inability to attain universal health coverage, in LMICs with fragile health systems. Sadly, AMR is driven by the inappropriate use of antimicrobials, especially antibiotics. Inappropriate antibiotic use is a pertinent problem in LMICs where regulatory frame works are weak. Inappropriate antibiotic use in LMICs is a multifaceted problem that cuts across clinical and veterinary medicine and agriculture. Therefore, efforts geared at curbing inappropriate antibiotic use in LMICs must identify the factors that drive this problem (i.e. inappropriate antibiotic use) in these countries. A clear knowledge of these factors will guide effective policy and decision making to curb inappropriate antibiotic use and ultimately AMR. The focus of this review is to discuss the factors that drive inappropriate antibiotic use in LMICs.
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Affiliation(s)
| | - Charles John Elikwu
- Department of Medical Microbiology, School of Basic Clinical Sciences, Benjamin Carson (Snr.) College of Health & Medical Sciences, Babcock University, Ilishan Remo, Ogun State, Nigeria
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Wade T, Roberts N, Ban JW, Waweru-Siika W, Winston H, Williams V, Heneghan CJ, Onakpoya IJ. Utility of healthcare-worker-targeted antimicrobial stewardship interventions in hospitals of low- and lower-middle-income countries: a scoping review of systematic reviews. J Hosp Infect 2023; 131:43-53. [PMID: 36130626 DOI: 10.1016/j.jhin.2022.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) initiatives in hospitals often include the implementation of clustered intervention components to improve the surveillance and targeting of antibiotics. However, impacts of the individual components of AMS interventions are not well known, especially in low- and lower-middle-income countries (LLMICs). OBJECTIVE A scoping review was conducted to summarize evidence from systematic reviews (SRs) on the impact of common hospital-implemented healthcare-worker-targeted components of AMS interventions that may be appropriate for LLMICs. METHODS Major databases were searched systematically for SRs of AMS interventions that were evaluated in hospitals. For SRs to be eligible, they had to report on at least one intervention that could be categorized according to the Effective Practice and Organisation of Care taxonomy. Clinical and process outcomes were considered. Primary studies from LLMICs were consulted for additional information. RESULTS Eighteen SRs of the evaluation of intervention components met the inclusion criteria. The evidence shows that audit and feedback, and clinical practice guidelines improved several clinical and process outcomes in hospitals. An unintended consequence of interventions was an increase in the use of antibiotics. There was a cumulative total of 547 unique studies, but only 2% (N=12) were conducted in hospitals in LLMICs. Two studies in LLMICs reported that guidelines and educational meetings were effective in hospitals. CONCLUSION Evidence from high- and upper-middle-income countries suggests that audit and feedback, and clinical practice guidelines have the potential to improve various clinical and process outcomes in hospitals. The lack of evidence in LLMIC settings prevents firm conclusions from being drawn, and highlights the need for further research.
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Affiliation(s)
- T Wade
- Department for Continuing Education, University of Oxford, Oxford, UK.
| | - N Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, UK
| | - J-W Ban
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - W Waweru-Siika
- Section of Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | - H Winston
- Department of Family Medicine, University of Pittsburgh Medical Center, McKeesport, PA, USA
| | - V Williams
- School of Nursing, Nipissing University, North Bay, Ontario, Canada
| | - C J Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - I J Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
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Lazure P, Augustyniak M, Goff DA, Villegas MV, Apisarnthanarak A, Péloquin S. Gaps and barriers in the implementation and functioning of antimicrobial stewardship programmes: results from an educational and behavioural mixed methods needs assessment in France, the United States, Mexico and India. JAC Antimicrob Resist 2022; 4:dlac094. [PMID: 36196443 PMCID: PMC9524477 DOI: 10.1093/jacamr/dlac094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/19/2022] [Indexed: 01/26/2023] Open
Abstract
Background Evidence shows limited adherence to antimicrobial stewardship (AMS) principles. Objectives To identify educational gaps and systemic barriers obstructing adherence to AMS principles. Methods A mixed-methods study combining a thematic analysis of qualitative interviews (January-February 2021) and inferential analysis of quantitative surveys (May-June 2021) was conducted. Participants from France, the USA, Mexico and India were purposively sampled from online panels of healthcare professionals to include infectious disease physicians, infection control specialists, clinical microbiologists, pharmacologists or pharmacists expected to apply AMS principles in their practice setting (e.g. clinic, academic-affiliated or community-based hospital). A gap analysis framework guided this study. Results The final sample included 383 participants (n = 33 interviews; n = 350 surveys). Mixed-methods findings indicated suboptimal knowledge and skills amongst participants to facilitate personal and collective application of AMS principles. Survey data indicated a gap in ideal versus current knowledge of AMS protocols, especially amongst pharmacologists (Δ0.95/4.00, P < 0.001). Gaps in ideal versus current skill levels were also measured and were highest amongst infectious control specialists (Δ1.15/4.00, P < 0.001), for convincing hospital executives to allocate resources to AMS programmes. Already existing systemic barriers (e.g. insufficient dedicated time/funding/training) were perceived as being aggravated during the COVID-19 pandemic (72% of survey participants agreed). Reported gaps were highest in India and France. Conclusions The educational needs of professionals and countries included in this study can inform future continuous professional development activities in AMS. Additional funding should be considered to address perceived systemic barriers. Local assessments are warranted to validate results and suitability of interventions.
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Affiliation(s)
| | | | - Debra A Goff
- The Ohio State University, College of Pharmacy, Columbus, OH, USA
| | - Maria Virginia Villegas
- Grupo de Investigación en Resistencia Antimicrobiana y Epidemiología Hospitalaria (RAEH), Universidad El Bosque, Bogotá, Colombia
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Lalithabai DS, Hababeh MO, Wani TA, Aboshaiqah AE. Knowledge, Attitude and Beliefs of Nurses Regarding Antibiotic use and Prevention of Antibiotic Resistance. SAGE Open Nurs 2022; 8:23779608221076821. [PMID: 35600006 PMCID: PMC9118425 DOI: 10.1177/23779608221076821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/04/2021] [Accepted: 01/11/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Resistance to antibiotics is a threat confronting health care system worldwide. Nurses play a significant role in combating this threat. Objectives The present study examined the knowledge and attitude of nurses towards antibiotic use and prevention of antibiotic resistance. Methods The research involved a cross-sectional study conducted in a multi-cultural tertiary healthcare setting. The participants were 341 nurses. A structured self-administered questionnaire with a good validity and reliability (α = 0.7) was used. Results The nurses surveyed showed moderate awareness of antibiotic resistance and a fair attitude towards its prevention. There was no significant correlation of demographic features with their overall knowledge and attitude ( p > 0.05). Conclusions Nurses perform a crucial part in infection control, but often lack knowledge of methods to prevent antibiotic resistance. This paucity highlights the importance of tailored interventions to help nurses improve their awareness of antibiotic resistance and create a favorable attitude towards its prevention.
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Monmaturapoj T, Scott J, Smith P, Watson MC. What influences the implementation and sustainability of antibiotic stewardship programmes in hospitals? A qualitative study of antibiotic pharmacists' perspectives across South West England. Eur J Hosp Pharm 2022; 29:e46-e51. [PMID: 33789988 PMCID: PMC8899653 DOI: 10.1136/ejhpharm-2020-002540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Antibiotic stewardship programmes (ASPs) are needed at every hospital as they can improve antibiotic use and address antibiotic resistance. Pharmacists are key agents and specialists in these programmes. This study explored antibiotic pharmacists' perceptions of factors that influence the implementation and sustainability of hospital-based ASPs. METHODS Semistructured interviews were conducted with hospital antibiotic pharmacists face-to-face or by telephone. NVivo V.12 software was used to collate and organise the data grouped within codes. Thematic analysis was undertaken using inductive and deductive approaches to produce overarching themes. RESULTS Thirteen pharmacists from 13 hospitals were interviewed. Four main themes were identified: (1) 'organisational culture' which highlighted the importance of strong local clinical leadership to help achieve organisational buy-in and address resistance among physicians or clinical hierarchies; (2) 'national influences' including networks, guidance and incentive schemes which were considered to be a driver to bring about changes across organisation; (3) 'continuous monitoring with feedback ASP data, preferably through direct communication' to demonstrate the impact of the programmes which then facilitated ongoing support from local leadership and improved engagement across organisation; and (4) 'resources' which indicated the need of information technology and dedicated personnel with protected time to support ASP activities. CONCLUSIONS Interventions and strategies should operate at different levels-individual, team, organisational and national-to help implement and sustain ASPs in hospital. This is also the first study to identify and highlight the importance of national initiatives in contributing to the implementation and sustainability of hospital-based ASPs.
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Affiliation(s)
| | - Jenny Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Paula Smith
- Department of Psychology, University of Bath, Bath, UK
| | - Margaret C Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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Assessing Knowledge, Beliefs, and Behaviors around Antibiotic Usage and Antibiotic Resistance among UK Veterinary Students: A Multi-Site, Cross-Sectional Survey. Antibiotics (Basel) 2022; 11:antibiotics11020256. [PMID: 35203857 PMCID: PMC8868437 DOI: 10.3390/antibiotics11020256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/06/2022] [Accepted: 02/09/2022] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) is a profound threat to human and animal health. Antimicrobial prescribing behaviours are influenced by psychological factors such as knowledge, beliefs, and emotions. As future antimicrobial prescribers, it is important to understand beliefs about AMR and stewardship among veterinary (vet) students. This cross-sectional online survey assessed vet students’ self-reported behavior, knowledge, and beliefs in specific relation to antibiotic resistance (ABR) and antibiotic usage. Participants were early years (first- and second-year; n = 460) and later-years (third- and fourth-year; n = 113) undergraduate vet students from three UK universities. Self-reported antibiotic-related behaviors were responsible among most students. Knowledge about ABR and stewardship was moderate among early years students and good among later years students. Vet students typically believed that vets had less responsibility for both causing and preventing ABR than other groups (animal owners, human medics, and the public). This study offers evidence that vet students (along with other groups) tend to lay greater responsibility for ABR/AMR outside of their own profession, which may impact their future prescribing behaviors. It is vital that AMR and antimicrobial stewardship are embedded across veterinary curricula, and that the One Health nature of the challenge posed by AMR is emphasized to encourage shared responsibility across all stakeholder groups, thereby helping to reduce ‘other-blaming’ for AMR.
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11
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Golding SE, Ogden J, Higgins HM. Examining the Effect of Context, Beliefs, and Values on UK Farm Veterinarians' Antimicrobial Prescribing: A Randomized Experimental Vignette and Cross-Sectional Survey. Antibiotics (Basel) 2021; 10:445. [PMID: 33921073 PMCID: PMC8071438 DOI: 10.3390/antibiotics10040445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/07/2021] [Accepted: 04/09/2021] [Indexed: 12/28/2022] Open
Abstract
Antimicrobial resistance (AMR) is a pressing threat to public and animal health. There is evidence that antimicrobial prescribing and stewardship behaviors by veterinarians (vets) are influenced by non-clinical factors, such as psychological, social, and environmental factors. This study explored the role of context, beliefs, and values on vets' antimicrobial prescribing decisions. UK-based practicing farm vets (n = 97) were recruited to an online study. Using an experimental vignette methodology, vets were randomly assigned across four conditions, to examine the effects of different contexts (pressure on farm economics, the farmer, or the vet-farmer relationship, compared to a control condition) on vets' likelihood of prescribing antibiotics. Vets' beliefs about different groups' responsibility for causing and preventing AMR and vets' values were also measured. Key findings were that context alone, values, and beliefs about groups' responsibilities for causing AMR were not predictive of vets' likelihood of prescribing antibiotics. However, vets' beliefs about groups' responsibilities for preventing AMR were predictive of an increased likelihood of prescribing antibiotics, when vets were exposed to the experimental condition of the vignette in which the vet-farmer relationship was under pressure. Farm vets also believed that different groups have different levels of responsibility for causing and preventing AMR. Results should be interpreted cautiously, given the smaller than planned for sample size, and the possibility for both false negatives and false positives. Further research is needed to explore how these findings could inform antimicrobial stewardship interventions in veterinary medicine.
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Affiliation(s)
- Sarah E. Golding
- School of Psychology, Faculty of Health and Medical Sciences, Stag Hill Campus, University of Surrey, Guildford GU2 7XH, UK;
| | - Jane Ogden
- School of Psychology, Faculty of Health and Medical Sciences, Stag Hill Campus, University of Surrey, Guildford GU2 7XH, UK;
| | - Helen M. Higgins
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston, Cheshire CH64 7TE, UK;
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12
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Impact of early carbapenemase notification on infection control management and antimicrobial stewardship. Infect Control Hosp Epidemiol 2021; 43:134-136. [PMID: 33455595 DOI: 10.1017/ice.2020.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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13
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Rost LM, Nguyen MH, Clancy CJ, Shields RK, Wright ES. Discordance Among Antibiotic Prescription Guidelines Reflects a Lack of Clear Best Practices. Open Forum Infect Dis 2020; 8:ofaa571. [PMID: 33447636 PMCID: PMC7793464 DOI: 10.1093/ofid/ofaa571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/18/2020] [Indexed: 11/23/2022] Open
Abstract
Background Antibiotics are among the most frequently administered drugs globally, yet they are often prescribed inappropriately. Guidelines for prescribing are developed by expert committees at international and national levels to form regional standards and by local experts to form hospital guidance documents. Our aim was to assess variability in antibiotic prescription guidelines for both regional standards and individual hospitals. Methods A search through 3 publicly accessible databases from February to June 2018 led to a corpus of English language guidance documents from 70 hospitals in 12 countries and regional standards from 7 academic societies. Results Guidelines varied markedly in content and structure, reflecting a paucity of rules governing their format. We compared recommendations for 3 common bacterial infections: community-acquired pneumonia, urinary tract infection, and cellulitis. Hospital guidance documents and regional standards frequently disagreed on preferable antibiotic classes for common infections. Where agreement was observed, guidance documents appeared to inherit recommendations from their respective regional standards. Several regional prescribing patterns were identified, including a greater reliance on penicillins over cephalosporins in the United Kingdom and fluoroquinolones in the United States. Regional prescribing patterns could not be explained by antibiotic resistance or costs. Additionally, literature that cited underlying recommendations did not support the magnitude of recommendation differences observed. Conclusions The observed discordance among prescription recommendations highlights a lack of evidence for superior treatments, likely resulting from a preponderance of noninferiority trials comparing antibiotics. In response, we make several suggestions for developing guidelines that support best practices of antibiotic stewardship.
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Affiliation(s)
- Lauren M Rost
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - M Hong Nguyen
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Cornelius J Clancy
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Ryan K Shields
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Antibiotic Management Program, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Erik S Wright
- Department of Biomedical Informatics, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Pittsburgh Center for Evolutionary Biology and Medicine, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Hegewisch-Taylor J, Dreser-Mansilla A, Romero-Mónico J, Levy-Hara G. Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review. Rev Panam Salud Publica 2020; 44:e68. [PMID: 32973908 PMCID: PMC7498295 DOI: 10.26633/rpsp.2020.68] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. METHODS This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included 'antibiotic' or 'antimicrobial' AND 'stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions' and 33 country names. RESULTS Selected articles totalled 147 studies published in 1985 - 2019; of those, 22% used 'antimicrobial stewardship' in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. CONCLUSIONS Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.
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Affiliation(s)
- Jennifer Hegewisch-Taylor
- Health Systems Research Center, National Institute of Public HealthCuernavacaMexicoHealth Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico.
| | - Anahí Dreser-Mansilla
- Health Systems Research Center, National Institute of Public HealthCuernavacaMexicoHealth Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico.
| | - Julián Romero-Mónico
- Health Systems Research Center, National Institute of Public HealthCuernavacaMexicoHealth Systems Research Center, National Institute of Public Health, Cuernavaca, Mexico.
| | - Gabriel Levy-Hara
- Infectious Diseases Unit, Hospital Carlos G. DurandBuenos AiresArgentinaInfectious Diseases Unit, Hospital Carlos G. Durand, Buenos Aires, Argentina.
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15
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Tripathi P, Tripathi R, Albarraq A, Makeen H, Alqahtani S, Pancholi S. Knowledge and perceptions of antimicrobial stewardship program among health-care students in Saudi Arabia. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_192_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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16
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Anthone J, Boldt D, Alexander B, Carroll C, Ased S, Schmidt D, Vivekanandan R, Destache CJ. Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE. PHARMACY 2019; 7:E156. [PMID: 31775246 PMCID: PMC6958401 DOI: 10.3390/pharmacy7040156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial Stewardship (AMS) Program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.
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Affiliation(s)
- Jennifer Anthone
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Dayla Boldt
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Bryan Alexander
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Cassara Carroll
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Sumaya Ased
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - David Schmidt
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Renuga Vivekanandan
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
- School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Christopher J. Destache
- School of Medicine, Creighton University, Omaha, NE 68178, USA
- School of Pharmacy & Health Professions, Creighton University, Omaha, NE 68178, USA
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Abubakar U, Tangiisuran B. Nationwide survey of pharmacists' involvement in antimicrobial stewardship programs in Nigerian tertiary hospitals. J Glob Antimicrob Resist 2019; 21:148-153. [PMID: 31628999 DOI: 10.1016/j.jgar.2019.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/01/2019] [Accepted: 10/08/2019] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES To evaluate the activities and barriers to hospital pharmacists' participation in antimicrobial stewardship programs (ASP) in Nigerian tertiary hospitals. METHODS A cross-sectional nationwide online survey was conducted over a 6-week period between May and June 2019. Invitation was sent to all the Heads of pharmacy department or pharmacists in charge of infectious diseases (ID) or antimicrobial pharmacists in tertiary hospitals in Nigeria. A validated questionnaire that consist of 24-items was used for data collection. RESULTS Forty-five hospitals were invited and 37 completed the survey (response rate, 82.2%). Five (13.5%) hospitals had a formal antimicrobial stewardship (AMS) team, with each of them having pharmacist representation. Regardless of the existence of an AMS team, hospital pharmacists have implemented AMS strategies, including evaluation of the appropriateness of antimicrobial prescriptions (54.1%) and monitoring of antimicrobial consumption (48.6%). The most common barriers to pharmacists' involvement in ASP were lack of training in AMS and ID (51.4%), lack of pharmacists with ID specialisation (40.5%) and lack of support from hospital administrators (37.8%). The majority of the pharmacists recommended training in AMS and ID (100%), participation on ward rounds (89.2%) and employment of more pharmacists (73%) as strategies to improve pharmacists' participation in ASP. CONCLUSIONS Hospital pharmacists are actively involved in AMS activities despite the lack of established AMS teams in most tertiary hospitals in Nigeria. However, lack of training and personnel were major barriers to pharmacist's involvement in ASP.
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Affiliation(s)
- Usman Abubakar
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia, 25200, Kuantan, Pahang, Malaysia; Pharmacy Department, IBB Specialist Hospital, Minna, Niger State, Nigeria.
| | - Balamurugan Tangiisuran
- National Poison Centre, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia; School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM, Pulau Pinang, Malaysia
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Kallen MC, Binda F, Ten Oever J, Tebano G, Pulcini C, Murri R, Beovic B, Saje A, Prins JM, Hulscher MEJL, Schouten JA. Comparison of antimicrobial stewardship programmes in acute-care hospitals in four European countries: A cross-sectional survey. Int J Antimicrob Agents 2019; 54:338-345. [PMID: 31200022 DOI: 10.1016/j.ijantimicag.2019.06.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 12/17/2022]
Abstract
Antimicrobial stewardship programmes (ASPs) are designed to improve antibiotic use. A survey was systematically developed to assess ASP prerequisites, objectives and improvement strategies in hospitals. This study assessed the current state of ASPs in acute-care hospitals throughout Europe. A survey containing 46 questions was disseminated to acute-care hospitals: all Dutch (n = 80) and Slovenian (n = 29), 215 French (25%, random stratified sampling) and 62 Italian (49% of hospitals with an infectious diseases department, convenience sampling) acute-care hospitals, for a Europe-wide assessment. Response rates for the Netherlands (Nl), Slovenia (Slo), France (Fr) and Italy (It) were 80%, 86%, 45% and 66%. There was variation between countries in the prerequisites met and the objectives and improvement strategies chosen. A formal ASP was present mainly in the Netherlands (90%) and France (84%) compared with Slovenia (60%) and Italy (60%). Presence of an antimicrobial stewardship (AMS) team ranged from 42% (Fr) to 94% (Nl). Salary support for AMS teams was provided in 68% (Fr), 51% (Nl), 33% (Slo) and 12% (It) of surveyed hospitals. Quantity of antibiotic use was monitored in the majority of hospitals, ranging from 72% (Nl) to 100% (Slo and Fr) of acute-care hospitals. Participating countries varied substantially in the use of 'prospective monitoring and advice' as a strategy to improve AMS objectives. ASP prerequisites, objectives and improvement activities vary considerably across Europe, with room for improvement. Stimulating appropriate system prerequisites throughout Europe, e.g. by introducing staffing standards and financial support for ASPs, seems a first priority.
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Affiliation(s)
- M C Kallen
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands.
| | - F Binda
- Université de Lorraine, APEMAC, Nancy, France; University of Milan, Department of Biomedical and Clinical Sciences 'Luigi Sacco', Milan, Italy
| | - J Ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - G Tebano
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, AP-PH, Paris, France; Sorbonne University, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - R Murri
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Beovic
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Saje
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J M Prins
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - M E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - J A Schouten
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Intensive Care Medicine, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
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19
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Weier N, Tebano G, Thilly N, Demoré B, Pulcini C, Zaidi STR. Pharmacist participation in antimicrobial stewardship in Australian and French hospitals: a cross-sectional nationwide survey. J Antimicrob Chemother 2019; 73:804-813. [PMID: 29237051 DOI: 10.1093/jac/dkx435] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Hospital pharmacists are an integral part of antimicrobial stewardship (AMS) programmes globally. Currently, little is known as to how hospital pharmacists see their role and involvement within the AMS framework. Objectives To assess the current level of involvement of Australian and French hospital pharmacists in AMS programmes and identify barriers limiting their involvement in AMS. Methods Hospital pharmacists throughout Australia and France were invited to participate in a nationwide online survey throughout March-May 2016. The survey was promoted through the national hospital pharmacists' association in Australia, while a stratified sampling method was used in France to invite pharmacists working in a variety of hospital settings. Results Invitations to participate in this survey were sent to 334 Australian pharmacists and 482 French pharmacists. Responses from 133 Australian and 126 French pharmacists were included for analysis. A total of 78.4% (203/259) of pharmacists reported the presence of an AMS programme. Pharmacists were most likely to be involved in AMS through assessing total antibiotic consumption and participating in AMS committee meetings. Barriers to participating in AMS included a lack of time and substantial non-clinical activities limiting involvement in AMS. Differences in responses were found between the two countries. Conclusions While the majority of pharmacists reported the presence of an AMS programme, multiple barriers to participation were identified by pharmacists in both countries. Further research should consider how to overcome the identified barriers to optimize the involvement of pharmacists in AMS.
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Affiliation(s)
- Naomi Weier
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Nathalie Thilly
- Université de Lorraine, EA 4360 APEMAC, Nancy, France.,Centre Hospitalier Régional Universitaire de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France
| | - Béatrice Demoré
- Centre Hospitalier Régional Universitaire de Nancy, Pharmacie Brabois, Nancy, France.,UMR 7565, SRSMC, CNRS-Lorraine University, Faculté de Pharmacie, Rue Albert Lebrun, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France.,Centre Hospitalier Régional Universitaire de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Syed Tabish R Zaidi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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20
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Malan L, Labuschagne Q, Brechtelsbauer E, Goff DA, Schellack N. Sustainable Access to Antimicrobials; A Missing Component to Antimicrobial Stewardship-A Tale of Two Countries. Front Public Health 2018; 6:324. [PMID: 30488031 PMCID: PMC6246712 DOI: 10.3389/fpubh.2018.00324] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 10/25/2018] [Indexed: 12/31/2022] Open
Abstract
Antimicrobial stewardship encompasses a wide range of processes and interventions designed to ensure that antimicrobials are used in the most effective manner. An important, but often neglected process to include is medicine procurement within hospitals, as the untimely administration of antimicrobials has a direct impact on patient care and antimicrobial resistance. A tender system (an open Request for Proposal, RFP) in South Africa is used in the procurement process to supply medicines and pharmaceutical supplies, whereas in the United States, each hospital is responsible for their own procurement processes. Possible key challenges facing countries to ensure a sustainable medical procurement are poor procurement practices, outdated information systems, and unavailability of human resources to support the current system. This article describes the need for adequate pharmacist–led inventory management systems, for sustainable antimicrobial delivery and the successful implementation of antimicrobial stewardship programs. Strategies to improve inventory control and medication delivery for public sector hospitals in South Africa include the development of national pharmaceutical data management standards. Pharmacist involvement in inventory management principles will ensure that antimicrobials are consistently in adequate supply for patient use, hence promoting safe and effective use while decreasing antimicrobial resistance.
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Affiliation(s)
- Lucille Malan
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | - Quinten Labuschagne
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
| | | | - Debra A Goff
- Department of Pharmacy, Wexner Medical Center, The Ohio State University, Columbus, OH, United States
| | - Natalie Schellack
- Division of Clinical Pharmacy, School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, South Africa
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21
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Beović B, Pulcini C, Dumartin C, Béraud G, Nerat B, Maurel C, Doušak M, Čižman M. Legal framework of antimicrobial stewardship in hospitals (LEASH): a European Society of Clinical Microbiology and Infectious Diseases (ESCMID) cross-sectional international survey. Int J Antimicrob Agents 2018; 52:616-621. [PMID: 30064000 DOI: 10.1016/j.ijantimicag.2018.07.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 05/27/2018] [Accepted: 07/18/2018] [Indexed: 10/28/2022]
Abstract
Antimicrobial stewardship (AMS) is the cornerstone activity in the combat against antimicrobial resistance. In order to ensure sustainable deployment and development of AMS, a strategic and regulatory framework needs to be provided by national healthcare authorities. Experts from 32 European countries, Israel and Turkey were invited to participate in a cross-sectional internet-based survey from October 2016 to May 2017 on the legal framework and mandatory components (structures, activities) of AMS in hospitals, i.e. components required by legislation or regulations. We collected data from 25 countries and two regions (in countries with federal health administration). Laws regulating AMS existed in seven countries and one region. Other health ministry regulations were applicable in 13 countries and one region. National strategies and/or action plans approved by ministries of health were in place in 13 countries and one region. Conversely, five countries and one region had no regulation of AMS in hospitals. Funding for AMS in hospitals was provided in five countries and one region. Eight countries and one region reported mandatory AMS structures and activities complying with the Transatlantic Taskforce on Antimicrobial Resistance (TATFAR) structure, policy and practice indicators. In 10/27 cases, however, the mandatory AMS activities were not being fully carried out. The survey showed heterogeneous legal frameworks for AMS in hospitals, and in many countries it was even lacking. The situation may be critical in countries with poor control of antimicrobial use and resistance. Recent international initiatives calling on policy-makers to address the threat of antimicrobial resistance could yield improvement.
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Affiliation(s)
- Bojana Beović
- University Medical Centre Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Slovenia; ESCMID Study Group for Antimicrobial Stewardship (ESGAP).
| | - Céline Pulcini
- ESCMID Study Group for Antimicrobial Stewardship (ESGAP); CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, and Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - Catherine Dumartin
- University of Bordeaux, INSERM, Bordeaux Population Health Research Center, UMR 1219, F-33000 Bordeaux, France; CHU de Bordeaux, Regional Centre for Prevention of Healthcare Associated Infections, F-33000 Bordeaux, France
| | - Guillaume Béraud
- ESCMID Study Group for Antimicrobial Stewardship (ESGAP); Centre de recherche du CHU de Québec-Université Laval, Hôpital Saint-Sacrement, 1050 Chemin Sainte-Foy (Québec), G1S 4L8 Canada; Médecine Interne et Maladies Infectieuses, CHU de Poitiers, France; Censtat, Interuniversity Institute for Biostatistics and statistical Bioinformatics, Hasselt University, Hasselt, Belgique
| | | | - Cristina Maurel
- Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - May Doušak
- Faculty of Social Sciences, University of Ljubljana, Slovenia
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Catho G, De Kraker M, Waldispühl Suter B, Valotti R, Harbarth S, Kaiser L, Elzi L, Meyer R, Bernasconi E, Huttner BD. Study protocol for a multicentre, cluster randomised, superiority trial evaluating the impact of computerised decision support, audit and feedback on antibiotic use: the COMPuterized Antibiotic Stewardship Study (COMPASS). BMJ Open 2018; 8:e022666. [PMID: 29950480 PMCID: PMC6042555 DOI: 10.1136/bmjopen-2018-022666] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Inappropriate use of antimicrobials in hospitals contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) interventions aim to improve antimicrobial prescribing, but they are often resource and personnel intensive. Computerised decision supportsystems (CDSSs) seem a promising tool to improve antimicrobial prescribing but have been insufficiently studied in clinical trials. METHODS AND ANALYSIS The COMPuterized Antibiotic Stewardship Study trial, is a publicly funded, open-label, cluster randomised, controlled superiority trial which aims to determine whether a multimodal CDSS intervention integrated in the electronic health record (EHR) reduces overall antibiotic exposure in adult patients hospitalised in wards of two secondary and one tertiary care centre in Switzerland compared with 'standard-of-care' AMS. Twenty-four hospital wards will be randomised 1:1 to either intervention or control, using a 'pair-matching' approach based on baseline antibiotic use, specialty and centre. The intervention will consist of (1) decision support for the choice of antimicrobial treatment and duration of treatment for selected indications (based on indication entry), (2) accountable justification for deviation from the local guidelines (with regard to the choice of molecules and duration), (3) alerts for self-guided re-evaluation of treatment on calendar day 4 of antimicrobial therapy and (4) monthly ward-level feedback of antimicrobial prescribing indicators. The primary outcome will be the difference in overall systemic antibiotic use measured in days of therapy per admission based on administration data recorded in the EHR over the whole intervention period (12 months), taking into account clustering. Secondary outcomes include qualitative and quantitative antimicrobial use indicators, economic outcomes and clinical, microbiological and patient safety indicators. ETHICS AND DISSEMINATION Ethics approval was obtained for all participating sites (Comission Cantonale d'Éthique de la Recherche (CCER)2017-00454). The results of the trial will be submitted for publication in a peer-reviewed journal. Further dissemination activities will be presentations/posters at national and international conferences. TRIAL REGISTRATION NUMBER NCT03120975; Pre-results.
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Affiliation(s)
- Gaud Catho
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlieke De Kraker
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Roberta Valotti
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Stephan Harbarth
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Luigia Elzi
- Division of Infectious Diseases, Ospedale San Giovanni, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Rodolphe Meyer
- Division of Informatics, Geneva University Hospitals, Geneva, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Ospedale Regionale di Lugano, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Benedikt D Huttner
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Context-sensitive antibiotic optimization: a qualitative interviews study of a remote Australian hospital setting. J Hosp Infect 2018; 100:265-269. [PMID: 29890182 DOI: 10.1016/j.jhin.2018.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 06/04/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Antibiotic optimization is an urgent international issue. Regulatory frameworks, including the requirement to have a functioning antimicrobial stewardship (AMS) programme, are now ubiquitous across the hospital sector nationally and internationally. However, healthcare is ultimately delivered in a diverse range of institutional settings and social contexts. There is emerging evidence that implementation of antibiotic optimization strategies may be inappropriate or even counterproductive to attempts to optimize in atypical healthcare settings. AIM To document the experiences and perspectives of clinical staff in a remote healthcare setting in Australia with respect to antimicrobial use, and strategies for optimization in that environment. METHODS Semi-structured qualitative interviews were conducted with 30 healthcare professionals, including doctors, nurses and pharmacists, from a remote hospital in Queensland, Australia. FINDINGS Four themes were identified from the analysis as key challenges to antibiotic optimization: (i) AMS as externally driven, and local knowledge sidelined; (ii) perceptions of heightened local population risks, treatment failure and the subsequent pressure to over-use of antimicrobials; (iii) interprofessional relationship dynamics including medical hierarchical structures perceived as a barrier to AMS; (iv) a clinical workforce dominated by transient locum staff and other process issues were perceived as significant barriers. CONCLUSION The perceptions of healthcare professionals in this site lead to the conclusion that antimicrobial regulations and practice improvement strategies more generally are unlikely to succeed if they fail to accommodate and respect the context of care, the resource and structural constraints of the setting, and the specificities of particular populations (and subsequent clinical 'know-how').
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Monnier AA, Eisenstein BI, Hulscher ME, Gyssens IC. Towards a global definition of responsible antibiotic use: results of an international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi3-vi16. [PMID: 29878216 PMCID: PMC5989615 DOI: 10.1093/jac/dky114] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project, this study aimed to identify key elements for a global definition of responsible antibiotic use based on diverse stakeholder input. Methods A three-step RAND-modified Delphi method was applied. First, a systematic review of antibiotic stewardship literature and relevant organization web sites identified definitions and synonyms of responsible use. Identified elements of definitions were presented by questionnaire to a multidisciplinary international stakeholder panel for appraisal of their relevance. Finally, questionnaire results were discussed in a consensus meeting. Results The systematic review and the web site search identified 17 synonyms (e.g. appropriate, correct) and 22 potential elements to include in a definition of responsible use. Elements were grouped into patient-level (e.g. Indication, Documentation) or societal-level elements (e.g. Education, Future Effectiveness). Forty-eight stakeholders with diverse backgrounds [medical community, public health, patients, antibiotic research and development (R&D), regulators, governments] from 18 countries across all continents participated in the questionnaire. Based on relevance scores, 21 elements were retained, 9 were rephrased and 1 was added. Together, the 22 elements and associated best-practice descriptions comprise an exhaustive list of elements to be considered when defining responsible use. Conclusions Combination of concepts from the literature and stakeholder opinion led to an international multidisciplinary consensus on a global definition of responsible antibiotic use. The widely diverging perspectives of stakeholders providing input should ensure the comprehensiveness and relevance of the definition for both individual patients and society. An aspirational goal would be to address all elements.
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Affiliation(s)
- Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | | | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
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Muller A, Bertrand X, Rogues AM, Péfau M, Alfandari S, Gauzit R, Dumartin C, Gbaguidi-Haore H. Higher third-generation cephalosporin prescription proportion is associated with lower probability of reducing carbapenem use: a nationwide retrospective study. Antimicrob Resist Infect Control 2018; 7:11. [PMID: 29387345 PMCID: PMC5778631 DOI: 10.1186/s13756-018-0302-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/12/2018] [Indexed: 12/22/2022] Open
Abstract
Background The ongoing extended spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) pandemic has led to an increasing carbapenem use, requiring release of guidelines for carbapenem usage in France in late 2010. We sought to determine factors associated with changes in carbapenem use in intensive care units (ICUs), medical and surgical wards between 2009 and 2013. Methods This ward-level multicentre retrospective study was based on data from French antibiotic and multidrug-resistant bacteria surveillance networks in healthcare facilities. Antibiotic use was expressed in defined daily doses per 1000 patient-days. Factors associated with the reduction in carbapenem use (yes/no) over the study period were determined from random-effects logistic regression model (493 wards nested within 259 healthcare facilities): ward characteristics (type, size…), ward antibiotic use (initial antibiotic use [i.e., consumption of a given antibiotic in 2009], initial antibiotic prescribing profile [i.e., proportion of a given antibiotic in the overall antibiotic consumption in 2009] and reduction in the use of a given antibiotic between 2009 and 2013) and regional ESBL-PE incidence rate in acute care settings in 2011. Results Over the study period, carbapenem consumption in ICUs (n = 85), medical (n = 227) and surgical wards (n = 181) was equal to 73.4, 6.2 and 5.4 defined daily doses per 1000 patient-days, respectively. Release of guidelines was followed by a significant decrease in carbapenem use within ICUs and medical wards, and a slowdown in use within surgical wards. The following factors were independently associated with a higher probability of reducing carbapenem use: location in Eastern France, higher initial carbapenem prescribing profile and reductions in consumption of fluoroquinolones, glycopeptides and piperacillin/tazobactam. In parallel, factors independently associated with a lower probability of reducing carbapenem use were ICUs, ward size increase, wards of cancer centres, higher initial third-generation cephalosporin (3GC) prescribing profile and location in high-risk regions for ESBL-PE. Conclusions Our study suggests that a decrease in 3GCs in the overall antibiotic use and the continuation of reduction in fluoroquinolone use, could allow reducing carbapenem use, given the well-demonstrated role of 3GCs and fluoroquinolones in the occurrence of ESBL-PE. Thus, antibiotic stewardship programs should target wards with higher 3GC prescription proportions to reduce them.
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Affiliation(s)
- Allison Muller
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France
| | - Xavier Bertrand
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France
| | - Anne-Marie Rogues
- 3University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Muriel Péfau
- 4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Serge Alfandari
- Gustave Dron Hospital, Infectious Diseases Department, F-59208 Tourcoing, France
| | - Rémy Gauzit
- 6AP-HP, Cochin University Hospital, Infectious Diseases Department, F-75014 Paris, France
| | - Catherine Dumartin
- 3University Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,4CHU Bordeaux, Southwestern Centre for Infection Prevention and Control, F-33000 Bordeaux, France
| | - Houssein Gbaguidi-Haore
- 1University Hospital of Besançon, Infection Control Department, F-25030 Besançon, France.,University Bourgogne-Franche-Comte, UMR 6249 Chrono-Environnement, F-25030 Besançon, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Hôpital Jean Minjoz, 3 Bd Fleming, 25030, Besançon, Cedex, France
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Dyar OJ, Tebano G, Pulcini C. Managing responsible antimicrobial use: perspectives across the healthcare system. Clin Microbiol Infect 2017; 23:441-447. [PMID: 28433726 DOI: 10.1016/j.cmi.2017.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 04/14/2017] [Accepted: 04/15/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Healthcare systems consist of building blocks. Shaping how these building blocks function and interact can promote responsible antimicrobial use, and this represents an important opportunity for managers at different points within healthcare systems to act upon. AIMS To review real-world examples of how healthcare systems can promote responsible antimicrobial use, focusing on the role of governance and managers. SOURCES We searched and reviewed existing literature and official documents, which mostly focused on antibiotics. We also drew on the diverse experiences of the ESGAP (the ESCMID (European Society of Clinical Microbiology and Infectious Diseases) Study Group for Antimicrobial stewardshiP) network. CONTENT First, we explored at the institution level the implementation of antimicrobial stewardship programmes, the need to embrace multidisciplinary approaches, the benefits of engaging with social sciences experts, and the role of governance and leadership. We look beyond individual institutions and highlight the urgent need for workforce capacity estimates for antimicrobial stewardship activities, how antimicrobial stewardship efforts can connect to form networks, and the importance of governance and regulation at national and international levels. IMPLICATIONS Managers in the healthcare system are in a strong position to look beyond individual prescriptions and to recognize the many ways in which different healthcare system building blocks can contribute to responsible use of antimicrobials. At the institution level this can be achieved by implementing antimicrobial stewardship programmes, ensuring they are adequately resourced, and driving buy-in across clinical leadership. At regional and national levels this includes facilitating the sharing of experiences and resources between institutions, and developing the standards and regulations needed to support responsible antimicrobial use.
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Affiliation(s)
- O J Dyar
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - G Tebano
- Service des maladies infectieuses, Groupe Hospitalier Sud Ile-de-France, Melun, France
| | - C Pulcini
- Service des maladies infectieuses et tropicales, Centre hospitalier régional universitaire (CHRU) de Nancy, and EA 4360 APEMAC, Université de Lorraine, Nancy, France.
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Plachouras D, Hopkins S. Antimicrobial stewardship: we know it works; time to make sure it is in place everywhere. Cochrane Database Syst Rev 2017; 2:ED000119. [PMID: 28211043 PMCID: PMC10284316 DOI: 10.1002/14651858.ed000119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Susan Hopkins
- Royal Free London NHS Foundation TrustLondonUK
- Public Health England
- University College LondonUK
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Abstract
Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.
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Cao H, Phe K, Laine GA, Russo HR, Putney KS, Tam VH. An institutional review of antimicrobial stewardship interventions. J Glob Antimicrob Resist 2016; 6:75-77. [DOI: 10.1016/j.jgar.2016.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/08/2016] [Accepted: 03/24/2016] [Indexed: 02/04/2023] Open
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Carlier M, Verstraete AG, De Waele JJ, Stove V. Stability of amoxicillin and amoxicillin/clavulanic acid reconstituted in isotonic saline. J Chemother 2016; 29:54-56. [PMID: 26032969 DOI: 10.1179/1973947815y.0000000052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- Mieke Carlier
- a Department of Clinical Chemistry, Microbiology and Immunology , Ghent University , Ghent , Belgium.,b Department of Critical Care Medicine , Ghent University Hospital , Ghent , Belgium
| | - Alain G Verstraete
- a Department of Clinical Chemistry, Microbiology and Immunology , Ghent University , Ghent , Belgium.,c Department of Laboratory Medicine , Ghent University Hospital , Ghent , Belgium
| | - Jan J De Waele
- b Department of Critical Care Medicine , Ghent University Hospital , Ghent , Belgium
| | - Veronique Stove
- a Department of Clinical Chemistry, Microbiology and Immunology , Ghent University , Ghent , Belgium.,c Department of Laboratory Medicine , Ghent University Hospital , Ghent , Belgium
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Broom J, Broom A, Adams K, Plage S. What prevents the intravenous to oral antibiotic switch? A qualitative study of hospital doctors' accounts of what influences their clinical practice. J Antimicrob Chemother 2016; 71:2295-9. [PMID: 27121400 DOI: 10.1093/jac/dkw129] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 03/18/2016] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Escalating antimicrobial resistance worldwide necessitates urgent optimization of antimicrobial prescribing to preserve antibiotics for future generations. Early intravenous (iv) to oral switch campaigns are one strategy that hospital-based antimicrobial stewardship programmes can incorporate to minimize inappropriate antibiotic use. Yet, iv antibiotics continue to be offered for longer than is clinically indicated, increasing hospital length of stay, increasing costs and placing patients at risk (e.g. cannula-related infections). This study aims to identify why this inappropriate prescribing trend continues. METHODS Twenty doctors (9 females and 11 males) working at a teaching hospital in north-east England participated in semi-structured interviews about their experiences of antibiotic use. NVivo10 software was used to conduct a thematic content analysis of the full interview transcripts driven by the framework approach. Results are reported according to COREQ guidelines. RESULTS Decisions around the choice of iv over oral antibiotics were influenced by three key issues: (i) consumerism, i.e. participants were concerned about the risk of litigation or complaints if patient expectations were not met; (ii) hierarchy of the medical team structure limited opportunities for de-escalation of antibiotics; and (iii) iv antibiotics were perceived as more potent and having significant mythical qualities, which participants acknowledged were not necessarily evidence based. CONCLUSIONS The iv to oral switch interventions should tailor strategies to demystify iv versus oral antibiotic efficacy, engage consumers around the negative effects of iv antibiotic overuse and examine strategies to streamline team decision-making. Addressing these issues has the potential to reduce inappropriate antibiotic use and resistance.
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Affiliation(s)
- Jennifer Broom
- Department of Medicine, Sunshine Coast Hospital and Health Service, PO Box 547, Nambour, QLD 5470, Australia The University of Queensland, Brisbane, QLD 4072, Australia
| | - Alex Broom
- School of Social Sciences, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Kate Adams
- Hull and East Yorkshire NHS Trust, Kingston upon Hull HU3 2JZ, UK
| | - Stefanie Plage
- School of Social Sciences, The University of New South Wales, Sydney, NSW 2052, Australia
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The Legislative Momentum of Antimicrobial Stewardship: the US Perspective. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0076-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Enani MA. The antimicrobial stewardship program in Gulf Cooperation Council (GCC) states: insights from a regional survey. J Infect Prev 2015; 17:16-20. [PMID: 28989448 DOI: 10.1177/1757177415611220] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Accepted: 09/19/2015] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The purpose of the current study is to describe the prevalence and characteristics of antimicrobial stewardship programs (ASP) in Gulf Cooperation Council (GCC) states to explore opportunities and overcome barriers to effective ASP implementation. METHODS A cross-sectional questionnaire survey was used to evaluate the current status of ASP: major stewardship components, barriers of implementation and program impact in acute care hospitals of GCC states. RESULTS Forty-seven healthcare professionals responded from four GCC states, the majority from Saudi Arabia (81%). Twenty-nine (62%) participating hospitals had ASP in place. Of these established programs, 35 (75%) reported lack of funding and personnel as major barriers to program implementation. The top three objectives cited for the hospital ASP were to reduce resistance (72.3%), improve clinical outcomes (70.2%) and reduce costs (44.7%). The reported impact of existing ASP was reduction of inappropriate prescribing (68%), reduction of broad spectrum antibiotic use (63.8%), reduction of healthcare-associated infections (61.7%), reduction of length of stay or mortality metrics (59.6%), reduction in direct antibiotic cost (57.4%) and reduction of reported antibiotic resistance (55.3%). CONCLUSION Survey participants from GCC states who have implemented ASP report significant impacts in the reduction of broad spectrum antibiotic use, hospital-acquired infection, inappropriate prescribing and antimicrobial resistance. These findings suggest a promising opportunity to enhance existing ASP through sharing of best practices and support the development of regional guidelines across GCC states.
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Affiliation(s)
- Mushira A Enani
- Infectious Diseases Section, Department of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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Banks TA, Ressner RA, Gada SM. Antibiotic reclamation: penicillin allergy, antibiotic stewardship, and the allergist. Ann Allergy Asthma Immunol 2015; 115:451-2. [PMID: 26386657 DOI: 10.1016/j.anai.2015.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/21/2015] [Accepted: 08/12/2015] [Indexed: 11/28/2022]
Affiliation(s)
| | - Roseanne A Ressner
- Infectious Disease Service, Walter Reed National Military Medical Center, Bethesda, Maryland
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Messina AP, van den Bergh D, Goff DA. Antimicrobial Stewardship with Pharmacist Intervention Improves Timeliness of Antimicrobials Across Thirty-three Hospitals in South Africa. Infect Dis Ther 2015; 4:5-14. [PMID: 26362291 PMCID: PMC4569642 DOI: 10.1007/s40121-015-0082-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Indexed: 11/16/2022] Open
Abstract
Introduction Ensuring timely administration of antimicrobials is critical in the management of patients with infections. Mortality increases by 7.6% for every hour of delay in the administration of antimicrobial therapy in patients with sepsis. The time elapsed from the written antibiotic order to actual intravenous administration or ‘hang-time’ can often be several hours due to logistics within the hospital. Our purpose is to evaluate the change in compliance with administering antimicrobials within an hour of prescription after implementation of a national antibiotic stewardship pharmacist-driven hang-time process improvement protocol. Methods This was a prospective multicenter study in 33 South African hospitals from 1 July 2013–30 August 2014. Two pilot sites established the mechanism for noninfectious disease pharmacists to make interventions and document hang-time data. Following this, a hang-time compliance assessment was initiated using the tools of healthcare improvement spread methodology. This consisted of five stages and an implementation toolkit was developed. The pharmacist study coordinator was responsible for implementation, the development of an implementation toolkit and real-time coordination of data with monthly feedback to all sites. Results A total of 32,985 patients who received intravenous antibiotics were assessed for hang-time compliance with first doses of new antibiotic orders. Over the 60-week period, 21,069 patients received antibiotics within an hour following prescription and were assessed as hang-time compliant. The change in improvement of hang-time compliance following implementation of a pharmacist-driven hang-time process improvement protocol was 41.2% pre-intervention week 1 (164/398) to 78.4% post-intervention week 60 (480/612; P < 0.0001). Pharmacists reviewed and evaluated twice as many patients during the final 4 weeks (1680) compared to the first 4 weeks (834; P < 0.0001). Conclusion Noninfectious disease pharmacists can significantly improve the timely administration of antimicrobials and contribute to low-hanging-fruit antimicrobial stewardship initiatives within a hospital system in a resource-limited country.
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Affiliation(s)
- Angeliki P Messina
- Department of Quality Leadership, Netcare Hospitals Ltd., Johannesburg, South Africa
| | - Dena van den Bergh
- Department of Quality Leadership, Netcare Hospitals Ltd., Johannesburg, South Africa
| | - Debra A Goff
- Department of Pharmacy, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
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A Simulation Study Reveals Lack of Pharmacokinetic/Pharmacodynamic Target Attainment in De-escalated Antibiotic Therapy in Critically Ill Patients. Antimicrob Agents Chemother 2015; 59:4689-94. [PMID: 26014946 DOI: 10.1128/aac.00409-15] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/19/2015] [Indexed: 01/08/2023] Open
Abstract
De-escalation of empirical antibiotic therapy is often included in antimicrobial stewardship programs in critically ill patients, but differences in target attainment when antibiotics are switched are rarely considered. The primary objective of this study was to compare the fractional target attainments of contemporary dosing of empirical broad-spectrum β-lactam antibiotics and narrower-spectrum antibiotics for a number pathogens for which de-escalation may be considered. The secondary objective was to determine whether alternative dosing strategies improve target attainment. We performed a simulation study using published population pharmacokinetic (PK) studies in critically ill patients for a number of broad-spectrum β-lactam antibiotics and narrower-spectrum antibiotics. Simulations were undertaken using a data set obtained from critically ill patients with sepsis without absolute renal failure (n = 49). The probability of target attainment of antibiotic therapy for different microorganisms for which de-escalation was applied was analyzed. EUCAST MIC distribution data were used to calculate fractional target attainment. The probability that therapeutic exposure will be achieved was lower for the narrower-spectrum antibiotics with conventional dosing than for the broad-spectrum alternatives and could drastically be improved with higher dosages and different modes of administrations. For a selection of microorganisms, the probability that therapeutic exposure will be achieved was overall lower for the narrower-spectrum antibiotics using conventional dosing than for the broad-spectrum antibiotics.
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