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Xia H, Li J, Yang X, Zeng Y, Shi L, Li X, Qiu S, Yang S, Zhao M, Chen J, Yang L. Impacts of pharmacist-led multi-faceted antimicrobial stewardship on antibiotic use and clinical outcomes in urology department of a tertiary hospital in Guangzhou, China: an interrupted time-series study. J Hosp Infect 2024; 151:148-160. [PMID: 38795904 DOI: 10.1016/j.jhin.2024.05.003] [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: 01/17/2024] [Revised: 04/15/2024] [Accepted: 05/01/2024] [Indexed: 05/28/2024]
Abstract
BACKGROUND Research on the effectiveness of pharmacist-led antimicrobial stewardship programmes (ASPs) in the urology department is limited. AIM To evaluate the impact of pharmacist-led multi-faceted ASPs on antibiotic use and clinical outcomes. METHODS A prescription review of inpatients receiving one or more antibiotics in the urology department of a large teaching hospital in Guangzhou, China, was conducted from April 2019 to March 2023. The pharmacist-led multi-faceted ASP intervention included guideline development, training, medication consultation, review of medical orders, indicator monitoring, and consultation. The primary outcome was antibiotic consumption. The data were analysed using interrupted time-series (ITS) analysis. FINDINGS Following the implementation of ASPs, an immediate decrease was observed in total antibiotic consumption, antibiotic use rate, second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones, and WHO Watch category antibiotics. No differences were observed in mortality rate before and after the intervention, and no significant short- or long-term effects were found on length of hospital stay (LOS) using ITS. However, there was a significant short-term effect on average antibiotic cost. CONCLUSION The implementation of pharmacist-led multi-faceted ASPs had positive impacts on reducing antimicrobial consumption without increasing LOS, antibiotic cost, or mortality rate.
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Affiliation(s)
- H Xia
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - J Li
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - X Yang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Y Zeng
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - L Shi
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - X Li
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - S Qiu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - S Yang
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - M Zhao
- Department of Pulmonary and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - J Chen
- Department of Pharmacy, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
| | - L Yang
- School of Public Health, Sun Yat-sen University, Guangzhou, China; Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China; Institute for Global Health and Development, Peking University, Beijing, China.
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Freudenhammer M, Hufnagel M, Steib-Bauert M, Mansmann U, de With K, Fellhauer M, Kern WV. Antibiotic use in pediatric acute care hospitals: an analysis of antibiotic consumption data from Germany, 2013-2020. Infection 2024; 52:825-837. [PMID: 37917396 PMCID: PMC11143023 DOI: 10.1007/s15010-023-02112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/08/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) programs are effective tools for improving antibiotic prescription quality. Their implementation requires the regular surveillance of antibiotic consumption at the patient and institutional level. Our study captured and analyzed antibiotic consumption density (ACD) for hospitalized pediatric patients. METHOD We collected antibacterial drug consumption data for 2020 from hospital pharmacies at 113 pediatric departments of acute care hospitals in Germany. ACD was calculated as defined daily dose (DDD, WHO/ATC Index 2019) per 100 patient days (pd). In addition, we analyzed the trends in antibiotic use during 2013-2020. RESULTS In 2020, median ACD across all participating hospitals was 26.7 DDD/100 pd, (range: 10.1-79.2 DDD/100 pd). It was higher at university vs. non-university hospitals (38.6 vs. 25.2 DDD/100 pd, p < 0.0001). The highest use densities were seen on oncology wards and intensive care units at university hospitals (67.3 vs. 38.4 DDD/100 pd). During 2013-2020, overall ACD declined (- 10%) and cephalosporin prescriptions also decreased (- 36%). In 2020, cephalosporins nevertheless remained the most commonly dispensed class of antibiotics. Interhospital variability in cephalosporin/penicillin ratio was substantial. Antibiotics belonging to WHO AWaRe "Watch" and "Reserve" categories, including broad-spectrum penicillins (+ 31%), linezolid (+ 121%), and glycopeptides (+ 43%), increased over time. CONCLUSION Significant heterogeneity in ACD and prescription of different antibiotic classes as well as high prescription rates for cephalosporins and an increased use of reserve antibiotics indicate improvable antibiotic prescribing quality. AMS programs should urgently prioritize these issues to reduce antimicrobial resistance.
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Affiliation(s)
- Mirjam Freudenhammer
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany.
- Center for Chronic Immunodeficiency, Institute for Immunodeficiency, University Medical Center Freiburg, Freiburg, Germany.
| | - Markus Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, University Medical Center Freiburg, Freiburg, Germany
| | - Michaela Steib-Bauert
- Division of Infectious Diseases, Department of Internal Medicine II, University Medical Center Freiburg, Freiburg, Germany
| | - Ulrich Mansmann
- Institute for Medical Information Processing, Biometry and Epidemiology, Faculty of Medicine, LMU Munich, Munich, Germany
| | - Katja de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus Dresden at the TU Dresden, Dresden, Germany
| | - Matthias Fellhauer
- Pharmacy/Institute for Clinical Pharmacy, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Internal Medicine II, University Medical Center Freiburg, Freiburg, Germany
- Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Abdel Hadi H, Eltayeb F, Al Balushi S, Daghfal J, Ahmed F, Mateus C. Evaluation of Hospital Antimicrobial Stewardship Programs: Implementation, Process, Impact, and Outcomes, Review of Systematic Reviews. Antibiotics (Basel) 2024; 13:253. [PMID: 38534688 DOI: 10.3390/antibiotics13030253] [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: 01/20/2024] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/28/2024] Open
Abstract
Antimicrobial Stewardship Programs (ASP) were introduced in healthcare as a public health priority to promote appropriate prescribing of antimicrobials, to reduce adverse events related to antimicrobials, as well as to control the escalating challenges of antimicrobial resistance. To deliver aimed outcome objectives, ASPs involve multiple connected implementation process measures. A systematic review was conducted to evaluate both concepts of ASPs. Guided by PRISMA frames, published systematic reviews (SR) focusing on ASPs restricted to secondary and tertiary healthcare were evaluated over the past 10 years involving all age groups. Out of 265 identified SR studies, 63 met the inclusion criteria. The majority were conducted in Europe and North America, with limited studies from other regions. In the reviewed studies, all age groups were examined, although they were conducted mainly on adults when compared to children and infants. Both process and outcomes measures of ASPs were examined equally and simultaneously through 25 different concepts, dominated by efficacy, antimicrobial resistance, and economic impact, while information technology as well as role of pharmacy and behavioral factors were equally examined. The main broad conclusions from the review were that, across the globe, ASPs demonstrated effectiveness, proved efficacy, and confirmed efficiency, while focused evaluation advocated that developed countries should target medium- and small-sized hospitals while developing countries should continue rolling ASPs across healthcare facilities. Additionally, the future of ASPs should focus on embracing evolving information technology to bridge the gaps in knowledge, skills, and attitude, as well as to enhance appropriate decision making.
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Affiliation(s)
- Hamad Abdel Hadi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Faiha Eltayeb
- Division of Microbiology, Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Sara Al Balushi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Joanne Daghfal
- Communicable Diseases Centre, Hamad Medical Corporation, Doha P.O. Box 3050, Qatar
| | - Faraz Ahmed
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
| | - Ceu Mateus
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YW, UK
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Monnier A, Roy H, Blackburn J, Bussières JF. [Use of antimicrobials in a mother-child university hospital center in Canada: An observational study]. ANNALES PHARMACEUTIQUES FRANÇAISES 2024; 82:318-328. [PMID: 38160789 DOI: 10.1016/j.pharma.2023.12.012] [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: 10/16/2023] [Revised: 12/13/2023] [Accepted: 12/27/2023] [Indexed: 01/03/2024]
Abstract
INTRODUCTION The proper use of antimicrobials is a challenge in healthcare establishments. OBJECTIVES Describe the detailed antimicrobial consumption profile in 2021-2022. Describe the annual evolutionary profile of the use of antimicrobials in days of therapy/1000 patient days, antibiotic spectrum index/1000 patients days and according to the proportion of days of therapy administered by parenteral route from 2005-2006 to 2021-2022. METHOD Descriptive and retrospective study. All patients admitted to our mother-child hospital center between April 1, 2005 and March 31, 2022 were included. The study covers the consumption of all antimicrobials through the AWare classification of the World Health Organization and antibiotic spectrum index. RESULTS A total of 673.9 days of therapy/1000 patients days was calculated in 2021-2022, i.e. 550.8 for antibiotics, 46.5 for antivirals, 67.9 for antifungals and 8.7 for others. A total of 2436 ASI/1000 patient days was calculated in 2021-2021. According to the AWaRe classification, in 2021-2022, 52.1% (287/551) of days of therapy/1000 patients days referred to the "Access" group, 47.8% (263/551) to the "Watch" group and 0.2% (1/551) to the "Reserve" group. CONCLUSION This study aims to explore the use of antimicrobials in a mother-child hospital center. It puts into perspective a stable or even slightly decreasing use of a selection of antimicrobials and compares favorably with published data. Antibiotic governance is based in particular on the periodic evaluation of consumption. Our study illustrates different approaches to quantify and describe this use.
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Affiliation(s)
- A Monnier
- Unité de recherche en pratique pharmaceutique, département de pharmacie, centre hospitalier universitaire Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada
| | - H Roy
- Département de pharmacie, unité de recherche en pratique pharmaceutique, centre hospitalier universitaire Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada
| | - J Blackburn
- Département de microbiologie et maladies infectieuses, centre hospitalier universitaire Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada
| | - J-F Bussières
- Département de pharmacie, unité de recherche en pratique pharmaceutique, centre hospitalier universitaire Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal, QC, Canada; Faculté de pharmacie, université de Montréal, 2900, boulevard Édouard-Montpetit, H3T 1J4 Montréal, QC, Canada.
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Castagnola E, Lorenzi I, Barabino P, Pistorio A. Antibiotic defined daily dose in pediatrics. A single center study to proof the principle that a specific pediatric definition could be not needed. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2023; 41:559-562. [PMID: 36710161 DOI: 10.1016/j.eimce.2022.08.014] [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: 05/19/2022] [Accepted: 08/08/2022] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To evaluate if a specific pediatric defined daily dose (PeDDD) can be replaced with the defined daily dose (DDD) indicated by World Health Organization (WHO). METHODS The 50th percentile of body weight for age of children admitted from 2016 to 2020 at Istituto Giannina Gaslini, Genoa, Italy, was used to calculate PeDDD for vancomycin at 40mg/kg and meropenem at 60mg/kg. Data obtained were then used to calculate the PeDDD number based on the amount of drugs delivered quarterly from 2012 to 2016. Subsequently the DDD number was calculated for vancomycin at 2g and meropenem at 3g. With these results two curves were generated which were then compared for parallelism and area under the curve (AUC). RESULTS PeDDD was found to be 2.6 times DDD for both drugs, but both curves obtained were parallel and the AUCs were identical CONCLUSIONS: DDD according to WHO definition could be adopted in pediatrics to measure antibiotic consumption and therefore no specific PeDDD could be needed.
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Mimura W, Shinjo D, Shoji K, Fushimi K. Prescribed daily-dose-based metrics of oral antibiotic use for hospitalized children in Japan. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e24. [PMID: 36819770 PMCID: PMC9932642 DOI: 10.1017/ash.2023.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/24/2022] [Accepted: 12/28/2022] [Indexed: 06/18/2023]
Abstract
OBJECTIVE Defined daily-dose (DDD)-based metrics are frequently used to measure antibiotic consumption. However, they are unsuitable for the pediatric population because they are defined using the maintenance dose for 70-kg adults. Moreover, children have large body weight variations. We assessed the prescribed daily dose (PDD) and PDD-based metrics of oral antibiotics for children to develop an alternative to DDD-based metrics in Japan. DESIGN We performed observational study using data from the Japanese administrative claims database between April 2018 and March 2019. METHODS Of 453,001 patients (aged 1 month-15 years), 564,326 admissions to 1,159 hospitals were included. We showed the median PDD (mg/day and mg/kg/day) and PDD-based metrics for 8 antibiotics for each age category (1 month to <1 year old and 1-6, 7-12, and 13-15 years old). We also assessed the relationship between PDD-based metrics and days of therapy (DOT)-based metrics using a scatter plot and correlation. RESULTS In total, 86,389 patients (19.1%) were prescribed oral antibiotics; amoxicillin, macrolides, and third-generation cephalosporins were the most common. The PDD (mg/day) for each antibiotic increased with age to 7-12 years old, when an adult dose was reached. The PDD (mg/kg/day) decreased with age to 13-15 years old, due to increasing body weight. The relationship between PDD per 1,000 patient days and DOT per 1,000 patient days differed depending on the antibiotic. CONCLUSIONS PDD-based metrics stratified by age could characterize antibiotic consumption, even with body-weight variations. Therefore, PDD-based metrics, in addition to DOT-based metrics, are helpful benchmarks for antibiotic use in children.
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Affiliation(s)
- Wataru Mimura
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Daisuke Shinjo
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Kensuke Shoji
- Division of Infectious Diseases, National Center for Child Health and Development, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
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Antibiotic defined daily dose in pediatrics. A single center study to proof the principle that a specific pediatric definition could be not needed. Enferm Infecc Microbiol Clin 2022. [DOI: 10.1016/j.eimc.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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8
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Calle-Miguel L, Pérez-Méndez C, García-García E, Moreno-Pavón B, Solís-Sánchez G. Trends and Pattern of Antibiotic Use in Children in Northern Spain, Interpreting Data about Antibiotic Consumption in Pediatric Outpatients. CHILDREN 2022; 9:children9030442. [PMID: 35327815 PMCID: PMC8946892 DOI: 10.3390/children9030442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 03/01/2022] [Accepted: 03/18/2022] [Indexed: 11/16/2022]
Abstract
Monitoring of antibiotic prescription and consumption behavior is crucial. The Access, Watch, and Reserve (AWaRe) classification of antibiotics has been recently introduced in order to measure and improve patterns of antibiotic use. In this study, retrospective data about systemic antibiotic consumption (expressed in defined daily dose per 1000 inhabitants per day (DID)) in pediatric outpatients in a region in northern Spain (around 100,000 children up to 14 years old) from 2005 to 2018 were analyzed and compared with antibiotic consumption in general population in Spain. The pattern of use was analyzed by the percentage of the current AWaRe categories, the Access-to-Watch index, and the amoxicillin index. Data were calculated annually and compared into two periods. Mean antibiotic consumption in pediatric outpatients was 14.0 DID (CI 95% 13.38–14.62). It remained stable throughout the study and was lower than consumption in general population in Spain, particularly from 2016. Changes in the consumption of the main active principles have led to an improvement in the three metrics of the pattern of use. It is important to have a thorough knowledge of the methodology applied in studies about antibiotic consumption. There is a lack of an optimal standardized metric for the pediatric population.
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Affiliation(s)
- Laura Calle-Miguel
- Pediatrics Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Spain;
- Correspondence:
| | - Carlos Pérez-Méndez
- Pediatrics Department, Hospital Universitario de Cabueñes, Camino los Prados, 395, 33394 Gijón, Spain;
| | - Elisa García-García
- Pediatric Primary Health Care System, C/ Severo Ochoa s/n, 33208 Gijón, Spain; (E.G.-G.); (B.M.-P.)
| | - Belén Moreno-Pavón
- Pediatric Primary Health Care System, C/ Severo Ochoa s/n, 33208 Gijón, Spain; (E.G.-G.); (B.M.-P.)
| | - Gonzalo Solís-Sánchez
- Pediatrics Department, Hospital Universitario Central de Asturias, Av. Roma, s/n, 33011 Oviedo, Spain;
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Villanueva-Bueno C, Montecatine-Alonso E, Jiménez-Parrilla F, Fernández-Llamazares CM, Manrique-Rodríguez S, Zamora-Flores E, Dolz E, Fernández-Polo A, Catillo-Salinas F, Comuñas J, Gallego-Fernández C, González-López M, Gómez-Trevecedo Calvo MT, Gázquez-Pérez R, Álvarez Del Vayo-Benito C, Gil-Navarro MV. Antimicrobial defined daily dose in neonatal population. ENFERMEDADES INFECCIOSAS Y MICROBIOLOGIA CLINICA (ENGLISH ED.) 2022; 40:59-65. [PMID: 35120651 DOI: 10.1016/j.eimce.2021.05.012] [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: 02/11/2021] [Accepted: 05/11/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. METHODS Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. RESULTS A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). CONCLUSIONS A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.
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Affiliation(s)
- Cristina Villanueva-Bueno
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Elena Montecatine-Alonso
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Cecilia M Fernández-Llamazares
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Elena Zamora-Flores
- Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
| | - Elisenda Dolz
- Department of Pharmacy, Complejo hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canarias, Spain
| | - Aurora Fernández-Polo
- Department of Pharmacy, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, PROA-NEN Project, Barcelona, Spain
| | | | - Juanjo Comuñas
- Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Rocío Gázquez-Pérez
- Department of Pharmacy, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | | | - Maria-Victoria Gil-Navarro
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Dat VQ, Dat TT, Hieu VQ, Giang KB, Otsu S. Antibiotic use for empirical therapy in the critical care units in primary and secondary hospitals in Vietnam: a multicenter cross-sectional study. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2022; 18:100306. [PMID: 35024650 PMCID: PMC8669321 DOI: 10.1016/j.lanwpc.2021.100306] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/26/2021] [Accepted: 09/28/2021] [Indexed: 12/23/2022]
Abstract
Background The high rate of infections among patients admitted to critical care units (CCUs) is associated with high rate of antibiotic consumption, especially broad-spectrum antibiotics. This study is to describe the antibiotics use in CCUs in primary and secondary hospitals in Vietnam, a setting with high burden of antibiotic resistance. Methods This was a 7-day observational study in 51 CCUs in hospitals from 5 provinces in Vietnam from March to July 2019. Patients aged ≥ 18 years admitted to the participating CCUs was enrolled consecutively. We collected data on patient's demographics, initial diagnosis and antibiotic therapy within the first 24 hours. Antibiotic therapy was classified by the Anatomical Therapeutic Chemical (ATC) Index and the 2019 WHO Access, Watch, Reserve (AWaRe) groups. Findings Out of 1747 enrolled patients, empirical antibiotic treatments were initiated in 1112 (63.6%) patients. The most frequently prescribed antibiotics were cefotaxime (22.3%), levofloxacin (19%) and ceftazidime (10.8%). Antibiotics were given in 31.5% of patients without diagnosis of infection. Watch and/or Reserve group antibiotic were given in 87.3% of patients and associated with patient's age (aOR 1.01 per 1-year increment, 95%CI 1.00-1.02) and the presence of SIRS on admission (aOR 2.1, 95%CI 1.38-3.2). Interpretation We observed a high frequency use and a substantial variation in patterns of empirical antibiotic use in the CCUs in Vietnam. It highlights the importance of continuous monitoring antibiotic consumption in CCUs.
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Affiliation(s)
- Vu Quoc Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam).,Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Tran Tat Dat
- Department of Infectious Diseases, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Vu Quang Hieu
- Hanoi Medical University Hospital, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Kim Bao Giang
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam (No 1 Ton That Tung street, Dong Da district, Hanoi, Vietnam)
| | - Satoko Otsu
- World Health Organisation Viet Nam Country Office, Hanoi, VietNam (304 Kim Ma Street, Hanoi, VietNam).,Infectious Disease Department, Japanese Red Cross Wakayama Medical Centre, Wakayama City, Wakayama, Japan (4-20 Komatsubara-dori, Wakayama City 640-8558, Wakayama, Japan)
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11
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Evolution of antibiotic consumption in pediatric outpatients of Asturias, Spain (2005-2018). An Pediatr (Barc) 2021; 95:438-447. [PMID: 34785158 DOI: 10.1016/j.anpede.2020.11.010] [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: 08/25/2020] [Accepted: 11/13/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Data about consumption of antibiotics in Spain are worrisome. They are mainly prescribed in the community sector and there is a high exposure to antibiotics in the pediatric population. The aim of this study is to describe the evolution of antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. METHODS Retrospective and descriptive study using data about consumption of antibacterial agents for systemic use (J01 group of the Anatomical Therapeutic Chemical Classification) in pediatric outpatients in Asturias between 2005 and 2018. Data, expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID), in three periods were compared. RESULTS Mean antibiotic consumption in pediatric outpatients in Asturias (2005-2018) was 14 DID (CI95% 13.4-14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). Remarkable data along the study were: 1) increase in amoxicillin consumption (p = 0.027), that have exceeded that of amoxicillin-clavulanate since 2011; 2) steady consumption of macrolides, with an increase in azithromycin (p < 0.001) and a decrease in clarithromycin (p = 0.001); 3) reduction of cephalosporins consumption (p < 0.001); 4) increase in quinolones consumption (p = 0.002). CONCLUSIONS Global antibiotic consumption in pediatric outpatients in Asturias between 2005 and 2018 has experienced a constant decrease lately and an improvement in patterns of antibacterial use.
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Bleuse A, Chabut C, Roy H, Lebel D, Ovetchkine P, Blackburn J, Bussières JF. [Exploration of the evolution of antibiotic consumption according to the WHO AWaRe classification, in a mother-child university hospital]. ANNALES PHARMACEUTIQUES FRANÇAISES 2021; 80:576-583. [PMID: 34481782 DOI: 10.1016/j.pharma.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Different measures of antimicrobial are used to ensure proper usage, as part of structured antimicrobial stewardship programs. OBJECTIVE The main objective of this study is to describe the consumption of antibiotics in a mother-child teaching hospital using the AWaRe classification over a period of 15 years. METHODS This descriptive and retrospective study included all the data on antibiotic consumption of patients admitted to mother-child University Hospital from April 1st 2005 to March 31st, 2021. Of the 180 international non-proprietary names of antibiotics proposed by the World Health Organization (WHO), 54 were used. The number of days of treatment (DOT) per 1000 patient-days (PD) was calculated per year, per patientele (e.g. surgery, pediatrics, oncology, intensive care, neonatal intensive care, nursery, psychiatry, rehabilitation and obstetrics and gynecology) and globally. The data was classified per the WHO AWaRe classification. RESULTS A total of 10,489 DOT/1000PD were used globally in 15 years, corresponding to 53.9% of the "Access" group, 45.2% of the "Watch" group and 0.9% of the "Reserve" group. A reduction in the use of antibiotics was noted. The ratios of antibiotic consumptions in DOT/1000PD of 2020-2021 to 2005-2006 were 0.84 globally (1713/5653), 0.79 for the "Access" group (286/361), 0.89 for the "Watch" group (270/302) and 0.88 for the "Reserve" group (2.1/2.4). CONCLUSION The AWaRe classification was used to describe the consumption of antibiotics in a mother-child center. Our consumption compared favorably with international data and is in line with the WHO targets. This position may be linked to the presence of a structured anti-biogovernance program that has been in place for several years within our hospital. More work is needed to more precisely identify the antibiotics that should benefit from better supervision.
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Affiliation(s)
- A Bleuse
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - C Chabut
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - H Roy
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - D Lebel
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - P Ovetchkine
- Département de pédiatrie, CHU Sainte-Justine, Montréal, QC, Canada
| | - J Blackburn
- Département de pédiatrie, CHU Sainte-Justine, Montréal, QC, Canada
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, CHU Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada; Faculté de pharmacie, université de Montréal, Montréal, QC, Canada.
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Villanueva-Bueno C, Montecatine-Alonso E, Jiménez-Parrilla F, Fernández-Llamazares CM, Manrique-Rodríguez S, Zamora-Flores E, Dolz E, Fernández-Polo A, Catillo-Salinas F, Comuñas J, Gallego-Fernández C, González-López M, Gómez-Trevecedo Calvo MT, Gázquez-Pérez R, Álvarez Del Vayo-Benito C, Gil-Navarro MV. Antimicrobial defined daily dose in neonatal population. Enferm Infecc Microbiol Clin 2021; 40:S0213-005X(21)00191-9. [PMID: 34183175 DOI: 10.1016/j.eimc.2021.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/05/2021] [Accepted: 05/11/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antimicrobial defined daily dose (DDD), a standardized metric to assess antimicrobial consumption in adult population, has limitations hampering its use in neonatal patients. This study proposes an alternative DDD design applicable for neonates. METHODS Neonates (<1 month-old) from 6 Spanish hospitals during a 12-months period were included. Weight and weeks gestational age of each neonate were the variables collected. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication selected by the Delphi method. RESULTS A total of 4820 neonates were included. Mean age was 36.72 weeks of gestational age and Mean weight was 2.687kg. Standardized DDD (intravenous; oral route) for representative antimicrobials were: Amoxicillin (0.08; 0.08), amoxicillin-clavulanic acid (0.27; 0.08), ampicillin (0.27; x), cloxacillin (0.13; 0.13), penicillin G sodium (0.12), cefazolin (0.13), cefuroxime (0.27; x), cefotaxime (0.27), ceftazidime (0.27), ceftriaxone (0.13), cefepime (0.27) piperacillin-tazobactam (0.54), aztreonam (0.24), azithromycin (0.03; 0.03), clindamycin (0.04; 0.04), amikacin (0.04), gentamicin (0.01), metronidazole (0.04; 0.08), ciprofloxacin (0.04; 0.05), levofloxacin (x;x), fluconazole (0.02; 0.02), itraconazole (0.01; 0.01), fosfomycin (0.27). Restricted antimicrobials: meropenem (0.11), teicoplanin (0.02), vancomycin (0.08; 0.11), linezolid (0.08; 0.08), daptomycin (x), amphotericin B liposomal (0.01). CONCLUSIONS A useful method for antimicrobial DDD measurement in neonatology has been designed to monitor antimicrobial consumption in hospital settings. It should be validated in further studies and thereby included in the design for neonatal antimicrobial stewardship programs in the future.
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Affiliation(s)
- Cristina Villanueva-Bueno
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain.
| | - Elena Montecatine-Alonso
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | | | - Cecilia M Fernández-Llamazares
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Silvia Manrique-Rodríguez
- Department of Pharmacy, Hospital Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Research Network on Maternal and Child Health and Development II (Red SAMID II), Spanish Health Institute Carlos III, Madrid, Spain
| | - Elena Zamora-Flores
- Neonatology Division, Department of Pediatrics, Gregorio Marañon Biomedical Research Institute, Gregorio Marañon University Hospital, Complutense University, Madrid, Spain
| | - Elisenda Dolz
- Department of Pharmacy, Complejo hospitalario Universitario Insular-Materno Infantil, Las Palmas de Gran Canarias, Spain
| | - Aurora Fernández-Polo
- Department of Pharmacy, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, PROA-NEN Project, Barcelona, Spain
| | | | - Juanjo Comuñas
- Department of Neonatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | | | - Rocío Gázquez-Pérez
- Department of Pharmacy, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain
| | | | - Maria-Victoria Gil-Navarro
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Calle-Miguel L, Iglesias Carbajo AI, Modroño Riaño G, Pérez Méndez C, García García E, Rodríguez Nebreda S, Solís Sánchez G. [Evolution of antibiotic consumption in pediatric outpatients of Asturias, Spain (2005-2018)]. An Pediatr (Barc) 2021; 95:S1695-4033(20)30496-3. [PMID: 33637470 DOI: 10.1016/j.anpedi.2020.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/08/2020] [Accepted: 11/13/2020] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Data about consumption of antibiotics in Spain are worrisome. They are mainly prescribed in the community sector and there is a high exposure to antibiotics in the pediatric population. The aim of this study is to describe the evolution of antibiotic consumption in the pediatric population of Asturias during 2005-2018 period. MATERIAL AND METHODS Retrospective and descriptive study using data about consumption of antibacterial agents for systemic use (J01 group of the Anatomical Therapeutic Chemical Classification) in pediatric outpatients in Principado de Asturias between 2005 and 2018. Data, expressed as defined daily dose (DDD) per 1000 inhabitants per day (DID), in three periods were compared. RESULTS Mean antibiotic consumption in pediatric outpatients in Principado de Asturias (2005-2018) was 14 DID (CI95% 13.4-14.6). Consumption increased until 2009 (15.2 DID) and decreased from 2015 onwards (11.9 DID in 2018). Remarkable data along the study were: 1) increase in amoxicillin consumption (p=0.027), that have exceeded that of amoxicillin-clavulanate since 2011; 2) steady consumption of macrolides, with an increase in azithromycin (p<0.001) and a decrease in clarithromycin (p=0.001); 3) reduction of cephalosporins consumption (p<0.001); 4) increase in quinolones consumption (p=0.002). CONCLUSIONS Global antibiotic consumption in pediatric outpatients in Principado de Asturias between 2005 and 2018 has experienced a constant decrease lately and an improvement in patterns of antibacterial use.
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Affiliation(s)
- Laura Calle-Miguel
- Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | | | - Gracia Modroño Riaño
- Servicio de Farmacia Hospitalaria, Hospital de Cabueñes, Gijón, Asturias, España
| | | | - Elisa García García
- Pediatría de Atención Primaria, Centro de Salud Laviada, Gijón, Asturias, España
| | | | - Gonzalo Solís Sánchez
- Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Rahem LR, Franck B, Roy H, Lebel D, Ovetchkine P, Bussières JF. Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19. Can J Hosp Pharm 2021; 74:21-29. [PMID: 33487651 PMCID: PMC7801337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. OBJECTIVE To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. METHODS In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. RESULTS Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). CONCLUSIONS This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program.
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Affiliation(s)
- Lydia R Rahem
- is a candidate for the DPharm degree in the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec. She is also an intern with the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Bénédicte Franck
- is a candidate for the DPharm degree, Université Paul Sabatier, Toulouse, France. She is also a Research Assistant with the Pharmacy Practice Research Unit, CHU Sainte-Justine, Montréal, Quebec
| | - Hélène Roy
- , BPharm, MSc, is a Pharmacist with the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Denis Lebel
- , BPharm, MSc, FCSHP, is a Pharmacist and Assistant Director, Teaching and Research with the Pharmacy Practice Research Unit and the Department of Pharmacy, CHU Sainte-Justine, Montréal, Quebec
| | - Philippe Ovetchkine
- , MD, is a Pediatrician with the Department of Pediatrics, CHU Sainte-Justine, Montréal, Quebec
| | - Jean-François Bussières
- , BPharm, MSc, MBA, FCSHP, is a Pharmacist and Director with the Pharmacy Practice Research Unit and the Department of Pharmacy, CHU Sainte-Justine, and a Clinical Professor with the Faculty of Pharmacy, Université de Montréal, Montréal, Quebec
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Ahmed SN, Jhaj R, Patidar R, Dangi M, Malik S, Sadasivam B, Atal S. A Novel Metric System to Quantify Antibiotic Consumption in Paediatric Population: A Hospital Based, Biphasic Pilot Study. Discoveries (Craiova) 2020; 8:e119. [PMID: 33365385 PMCID: PMC7746476 DOI: 10.15190/d.2020.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: The Anatomical Therapeutic Chemical Classification / Defined Daily Dose (ATC/DDD) system recommended by World Health Organization is accepted worldwide as the standard method of quantification of drug consumption. However, owing to individual variation in body weight, the ATC/DDD system cannot be used for comparison across paediatric population.
OBJECTIVE: This study aimed to develop a novel metric system for standard quantification of antibiotic consumption in paediatric population.
METHOD: The standard unit of drug quantification in adult population is DDD/100 patient days (PD). We conceived a new unit of DDD/1000 kg-days (KD) where KD is the product of the body weight and length of hospital stay of an individual patient. We simulated the quantification and comparison of drugs in a computer model of five virtual paediatric hospitals (H1 to H5, n=100, 200, 100, 100, 100 respectively). We re-applied the metric system on two, real world, hospital-based, time cohorts (TC) (TC18, n=38 and TC19, n=47) of 2 weeks each, in two consecutive years.
RESULTS: The body weights (mean±SD) in H1-H5 were 5.7±3.0, 5.7±2.8, 25.3±8.5, 20.6±11.7 and 19.8±11.4 kg, respectively. The antibiotic consumption in terms of DDD/100 PD and DDD/1000 KD in the five hospitals was 1.26, 1.20, 5.52, 4.41 and 2.00, and 2.24, 2.14, 2.22, 2.17 and 1.06 respectively. In TC18 and TC19, the mean body weight, DDD/100 PD and DDD/1000 KD were 12.24±13.17, 30.93, 20.34 and 19.51±12.28, 11.99, 6.23, respectively.
CONCLUSION: DDD/1000 kg-days is a potential standard unit for drug quantification in paediatric population independent of weight distribution and size of the study sample. The universal application and comparison across diverse samples can generate useful information for resource allocation, anti-microbial stewardship, disease burden and drug use, and can help in taking policy decisions to improve healthcare delivery in the paediatric population.
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Affiliation(s)
- Shah Newaz Ahmed
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ratinder Jhaj
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Ritendra Patidar
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Mahendra Dangi
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shikha Malik
- Department of Paediatrics, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Shubham Atal
- Department of Pharmacology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
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Sadasivam B, Malik S, Atal S, Ahmed SN. Development and validation of a mathematical model to quantify antibiotic consumption in paediatric population: A hospital-based pilot study. J Clin Pharm Ther 2020; 45:1349-1356. [PMID: 32687605 DOI: 10.1111/jcpt.13216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/09/2020] [Accepted: 06/11/2020] [Indexed: 01/26/2023]
Abstract
WHAT IS KNOWN AND OBJECTIVES A standard drug classification system and a fundamental measurement unit of drug consumption are prerequisites in a healthcare information system for generating quality data on drug use. Globally, the ATC/DDD (Anatomical Therapeutic Chemical Classification/Defined Daily Dose) system recommended by WHO is accepted as the international standard. However, owing to variability in body weight, it cannot be used directly in paediatric population. In our work, we aimed to develop a standard method of quantification of antibiotic consumption in paediatric population using a modified approach of the ATC/DDD system. METHOD We developed a mathematical model in a simulated paediatric cohort (n = 1000) and calculated antibiotic consumption in units of days of therapy (DOT) and DDD/100 patient days (PD). We validated the model in an observational cohort (n = 38) of inpatients admitted in Paediatric Department of a tertiary care centre. RESULTS Model simulation showed near perfect positive correlation (R = .99-1.00) between DOT and DDD/100 PD in discrete weight based sub-cohorts (weight 1-10 kg). In the validation cohort, consumption of antibiotics was 121.76 and 33.16 in terms of DOT and DDD/100 PD respectively. Strong positive correlation between the two units (R = .73) was obtained. The correlation was better in predefined age and weight categories as compared to the uncategorised consumption (R = .78-.97). The model was proved validated when weight specific (in sub-cohorts of patients weighing 4, 5, 7 kg) DDD/100 PD and DOT also showed near perfect positive correlation (R = .96-.99). WHAT IS NEW AND CONCLUSION Weight specific DDD/100 PD can be explored further as a tool to standardise the quantification and comparison of consumption of drugs in paediatric population.
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Affiliation(s)
- Balakrishnan Sadasivam
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Shikha Malik
- Department of Paediatrics, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Shubham Atal
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
| | - Shah Newaz Ahmed
- Department of Pharmacology, All India Institute of Medical Sciences Bhopal, Bhopal, Madhya Pradesh, India
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Mostaghim M, Snelling T, Bajorek B. Agreement between units of measure for paediatric antibiotic utilisation surveillance using hospital pharmacy supply data. Pharm Pract (Granada) 2019; 17:1482. [PMID: 31592288 PMCID: PMC6763297 DOI: 10.18549/pharmpract.2019.3.1482] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 09/01/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Drug utilisation studies from paediatric hospitals that do not have access to
patient level data on medication use are limited by a lack of standardised
units of measures that reflect the varying daily dosage requirements among
patients. The World Health Organization’s defined daily dose is
frequently used in adult hospitals for benchmarking and longitudinal
analysis but is not endorsed for use in paediatric populations. Objective: Explore agreement between standard adult-based defined daily doses (DDD) and
paediatric estimates of daily injectable antibiotic use in a Paediatric
Intensive Care Unit that does not have access to individual patient-level
data. Methods: Hospital pharmacy antibiotic use reports and age-specific occupied bed-day
data from 1 January 2010 to 31 May 2016 were extracted. Paediatric reference
dosages and frequencies for antibiotics were defined and applied to three
paediatric units of measure. Measures were applied to extracted data,
agreement between antibiotic use measured in the adult DDD and each of the
paediatric measures was assessed visually via Bland-Altman plots and linear
regression for each antibiotic. Results: Thirty one different antibiotics were used throughout the study period.
Despite varying daily dosages in grams, the daily use of vials was unchanged
from birth to 18 years for thirteen antibiotics. Agreement between DDD and
vial-based measures was closer than the total recommended daily dose that
did not account for wastage during preparation and administration.
Vial-based measures were unaffected by vial size changes due to drug
shortage. Conclusions: Agreement between the DDD and vial-based measures of use supports the use of
DDD for select antibiotics that may be targeted by antimicrobial stewardship
programs. Vial based measures should be further explored in hospitals with
single vial policies; detailed understanding of hospital practice is needed
before inter-hospital comparisons are made.
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Affiliation(s)
- Mona Mostaghim
- Pharmacy Department, Sydney Children's Hospital; & Graduate School of Health, University of Technology Sydney, NSW (Australia).
| | - Tom Snelling
- Department of Infectious Diseases, Princess Margaret Hospital for Children; & Wesfarmers Centre of Vaccines & Infectious Diseases, Telethon Kids Institute, University of Western Australia, Subiaco (Australia).
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney, NSW (Australia).
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Goycochea-Valdivia WA, Montecatine-Alonso E, Gil-Navarro MV, Neth O. In reply to: “Antimicrobial defined daily dose adjusted by weight: A proposal for antibiotic consumption measurement in children”. Enferm Infecc Microbiol Clin 2019; 37:357-358. [DOI: 10.1016/j.eimc.2019.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 01/12/2019] [Accepted: 01/15/2019] [Indexed: 10/27/2022]
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Science M, Timberlake K, Morris A, Read S, Le Saux N. Quality Metrics for Antimicrobial Stewardship Programs. Pediatrics 2019; 143:peds.2018-2372. [PMID: 30926619 DOI: 10.1542/peds.2018-2372] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are targeted to optimize antimicrobial use. However, pediatric metrics used to measure outcomes of ASPs are not well established. Our aim for this project was to identify, refine, and develop consensus on standard metrics for pediatric ASPs. METHODS By using a modified Delphi process, 2 surveys were sent to experts and stakeholders to establish consensus on the utility of metrics. These were subdivided into 4 ASP domains: (1) antimicrobial consumption, (2) microbiologic outcomes, (3) clinical outcomes, and (4) process measures. Respondents were asked to rank the scientific merit, impact, feasibility, and accountability of each metric. Metrics with ≥75% agreement for scientific merit were included and metrics with ≤25% agreement were discarded. Consensus was finalized with a face-to-face meeting and final survey. RESULTS Thirty-eight participants from 15 pediatric hospitals across Canada completed all 3 rounds of the Delphi survey. In the domain of antimicrobial consumption, the 2 selected metrics were (1) days of therapy per 1000 patient-days and (2) total antimicrobial days. The clinical and process outcomes chosen were (1) 30-day readmission rate and (2) adherence to ASP recommendations, respectively. A microbiologic outcome was felt to be important and feasible, but consensus could not be obtained on a measure. Several barriers to implementation of the metrics were identified, including information technology limitations at various centers. CONCLUSIONS We obtained consensus on 4 metrics to evaluate pediatric antimicrobial stewardship activities in Canada. Adoption of these metrics by pediatric ASPs will facilitate measurement of outcomes nationally and internationally.
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Affiliation(s)
- Michelle Science
- Division of Infectious Diseases and .,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Kathryn Timberlake
- Department of Pharmacy, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Andrew Morris
- Division of Infectious Diseases, Sinai Health System, Toronto, Ontario, Canada.,Department of Medicine, University Health Network, Toronto, Ontario, Canada; and
| | - Stanley Read
- Division of Infectious Diseases and.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Le Saux
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Mostaghim M, Snelling T, McMullan B, Ewe YH, Bajorek B. Impact of clinical decision support on empirical antibiotic prescribing for children with community-acquired pneumonia. J Paediatr Child Health 2019; 55:305-311. [PMID: 30161269 DOI: 10.1111/jpc.14191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Revised: 06/08/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022]
Abstract
AIM To assess the impact of a computerised clinical decision support system (CDSS) on antibiotic use in hospitalised children with a presumptive diagnosis of uncomplicated community-acquired pneumonia (CAP). METHODS Codes associated with lower respiratory tract infection were used to identify cases of presumed uncomplicated CAP requiring admission to a tertiary paediatric hospital. Random sampling of the periods between 1 October 2010 and 30 September 2012 (pre-CDSS) and 1 October 2012 and 30 September 2014 (post-CDSS) determined the sequence of case assessment by two independent investigators. Initial antibiotic therapy, associated CDSS approvals and documented signs of clinical deterioration prior to antibiotic decision-making were recorded. RESULTS Statistically significant differences between cases pre- and post-CDSS implementation were minimal. High fever was observed in 57.5% (77/134) cases pre-CDSS and 45.8% (49/107) cases post-CDSS (P = 0.07). Supplemental oxygen was used in 30.6% pre-CDSS and 54.2% post-CDSS cases (P < 0.001). Narrow-spectrum penicillins were prescribed most often, with no statistically significant change post-CDSS implementation (81.3% pre-CDSS, 77.6% post-CDSS, P = 0.47). Macrolides were used consistently throughout the study period (53.7% pre-CDSS, 61.7% post-CDSS; P = 0.21). CONCLUSION CDSS implementation did not reduce already low rates of broad-spectrum antibiotic use for uncomplicated CAP.
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Affiliation(s)
- Mona Mostaghim
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Pharmacy Department, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Tom Snelling
- Department of Infectious Diseases, Princess Margaret Hospital for Children, Perth, Western Australia, Australia.,Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Brendan McMullan
- Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yean H Ewe
- Junior Medical Unit, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
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22
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Montecatine-Alonso E, Gil-Navarro MV, Fernández-Llamazares CM, Fernández-Polo A, Soler-Palacín P, Llorente-Gutiérrez J, Gómez-Travecedo Calvo MT, Esquivel-Mora MD, Pérez-Rodrigo I, Cisneros JM, Goycochea-Valdivia WA, Neth O. Antimicrobial defined daily dose adjusted by weight: a proposal for antibiotic consumption measurement in children. Enferm Infecc Microbiol Clin 2018; 37:301-306. [PMID: 30268590 DOI: 10.1016/j.eimc.2018.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 07/09/2018] [Accepted: 07/14/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Antimicrobial defined daily dose (DDD), has limitations for antimicrobial consumption measurement in paediatrics. An alternative DDD design applicable for children is proposed. METHODS Children (<16 years-old) from 10 Spanish hospitals during a 12-months period were included. Weight for age (50th percentile) was calculated for the median age of the cohort using standardized World Health Organization tables. DDD (g) for each antimicrobial was calculated by multiplying the obtained weight times the recommended dose (mg/kg) of the antimicrobial for the most common infectious indication. RESULTS A total of 40,575 children were included. Median age was 4.17 (IQR: 1.36-8.98) and 4.81 (IQR: 1.42-9.60) years for boys and girls, respectively. Mean weight for this age was 17.08kg. Standardized DDD for representative antimicrobials were calculated. CONCLUSIONS A useful method for antimicrobial DDD measurement in paediatrics has been proposed and should be validated in future studies for its use in paediatric antimicrobial stewardship programmes.
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Affiliation(s)
- Elena Montecatine-Alonso
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María-Victoria Gil-Navarro
- Department of Pharmacy, Institute of Biomedicine of Seville (IBIS), Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Cecilia M Fernández-Llamazares
- Department of Pharmacy, Hospital Gregorio Marañón. Instituto de Investigación Sanitaria Gregorio Marañón. Research Network on Maternal and Child Health and Development II (Red SAMID II). Spanish Health Institute Carlos III, Madrid, Spain
| | - Aurora Fernández-Polo
- Department of Pharmacy, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, PROA-NEN project, Barcelona, Spain
| | - Pere Soler-Palacín
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, PROA-NEN project, Barcelona, Spain
| | - Jesús Llorente-Gutiérrez
- Department of Pharmacy, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | | | | | | | - José M Cisneros
- Department of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBIS), University of Seville/CSIC/University Hospital Virgen del Rocío, Sevilla, Spain
| | - Walter-Alfredo Goycochea-Valdivia
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Sevilla, Institute of Biomedicine of Seville (IBIS), Spain.
| | - Olaf Neth
- Paediatric Infectious Diseases, Rheumatology and Immunology Unit, Hospital Universitario Virgen del Rocío, Sevilla, Institute of Biomedicine of Seville (IBIS), Spain
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23
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A new carbapenem drug dosage metric for carbapenem usage and correlation with carbapenem resistance of Pseudomonas aeruginosa. J Infect Chemother 2018; 24:949-953. [PMID: 30268412 DOI: 10.1016/j.jiac.2018.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/24/2018] [Accepted: 08/03/2018] [Indexed: 12/24/2022]
Abstract
The emergence and dissemination of antimicrobial resistance is a worldwide problem. Inappropriate antimicrobial use contributes to this resistance, and several metrics of drug usage have been used to monitor their consumption and rational use. We examined several existing drug metrics, and developed a new one, dose/duration-density (D/d2), for a the best correlation between carbapenem usage and carbapenem resistance of Pseudomonas aeruginosa. The annual changes of antimicrobial use density (AUD), days of therapy (DOT), daily dose (DD) and D/d2 for meropenem, imipenem and total carbapenems was analyzed for a correlation with carbapenem susceptibility of P. aeruginosa from 2006 through 2015 at a university hospital. The substitution of meropenem for imipenem usage, and an approximate 10% increase in carbapenem susceptibility of P. aeruginosa occurred over the study period. There were significant correlations of the meropenem susceptibility of P. aeruginosa and meropenem usage as measured by the meropenem DD, of imipenem susceptibility and imipenem AUD and DOT, and overall carbapenem susceptibility and imipenem DOT. The D/d2 for meropenem, imipenem and total carbapenems had significant correlations with individual and all carbapenem susceptibility of P. aeruginosa. These D/d2 is the best single carbapenem use metric for correlating carbapenem usage with P. aeruginosa resistance. Further studies are warranted to consider the value of D/d2 for other antimicrobials and bacteria.
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24
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Först G, de With K, Weber N, Borde J, Querbach C, Kleideiter J, Seifert C, Hagel S, Ambrosch A, Löbermann M, Schröder P, Steib-Bauert M, Kern WV. Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study. J Antimicrob Chemother 2018; 72:2931-2937. [PMID: 29091214 DOI: 10.1093/jac/dkx244] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/20/2017] [Indexed: 01/23/2023] Open
Abstract
Background The WHO/ATC (Anatomical Therapeutic Chemical) index DDD (WHO-DDD) is commonly used for drug consumption measurement. Discrepancies between WHO-DDD and actual prescribed daily doses (PDD) in hospitals have prompted alternative dose definitions adapted to doses recommended in hospital practice guidelines [recommended daily doses (RDD)]. Methods In order to validate RDD we performed modified point prevalence surveys in 24 acute care hospitals and recorded 20620 PDD of antibiotics given to 4226 adult patients on the day of the survey and the 6 preceding days. We calculated RDD and WHO-DDD and compared them with PDD. Results The rate of RDD corresponding to PDD was higher than the corresponding rate for WHO-DDD (pooled data, 55% versus 30%) and the differences were similar across the hospital sample, but varied according to drug/drug class, route of administration, indication and renal function. RDD underestimated actual consumption by 14% overall, while WHO-DDD overestimated total antibacterial consumption by 28% (pooled data; median values RDD -10% versus WHO-DDD +32%). The deviations of estimated from actual drug use volumes were largest for β-lactams (RDD -11% versus WHO-DDD +49%), in particular for penicillins (-11% versus +64%), if WHO-DDD were used. Conclusions Hospital antibiotic consumption surveillance systems using current WHO-DDD should address the uneven discrepancies between actual prescribing and consumption estimates according to drug class that may lead to misclassification in benchmark analyses. We recommend using validated RDD as a supplementary measure to the WHO-DDD for detailed analyses.
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Affiliation(s)
- Gesche Först
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Pharmacy Service, University Hospital and Medical Center, Freiburg, Germany
| | - Katja de With
- Clinical Infectious Disease Unit, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Nadine Weber
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Johannes Borde
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Infectious Diseases Section, Ortenau-Klinikum, Achern-Oberkirch, Germany
| | - Christiane Querbach
- Pharmacy, 'Rechts der Isar' Hospital of the Technical University, Munich, Germany
| | | | - Claudia Seifert
- Pharmacy Service, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Stefan Hagel
- Center for Infection and Infection Control, University Hospital, Jena, Germany
| | - Andreas Ambrosch
- Department of Laboratory Medicine, Microbiology and Infection Control, 'Barmherzige Brüder' Hospital, Regensburg, Germany
| | - Micha Löbermann
- Department of Infectious Diseases and Tropical Medicine, University Medical Center, Rostock, Germany
| | - Philipp Schröder
- Department of Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Michaela Steib-Bauert
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany
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25
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Huang PY, Shie SS, Ye JJ, Lin SP, Liu TP, Wu TS, Wu TL, Chuang SS, Cheng MH, Hsieh YC, Huang CT. Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship. BMC Infect Dis 2017; 17:598. [PMID: 28854887 PMCID: PMC5575946 DOI: 10.1186/s12879-017-2682-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 08/15/2017] [Indexed: 11/10/2022] Open
Abstract
Background Information is limited about the effect of restricted carbapenem use on clearance of multi-drug resistant Acinetobacter baumannii (MDRAB). We sought to determine the time effect of antibiotic exposure on multi-drug resistant Acinetobacter baumannii (MDRAB) acquisition and clearance. Methods We conducted a retrospective observational study at the intensive care units of a tertiary medical center. Forty-two of a cohort of previously healthy young adults who were concurrently burned by a dust explosion was included. Cases consisted of those from whom MDRAB was isolated during hospitalization. Controls consisted of patients from whom MDRAB was not isolated in the same period. Use of antimicrobial agents was compared based on days of therapy per 1,000 patient-days (DOT/1,000PD). A 2-state Markov multi-state model was used to estimate the risk of acquisition and clearance of MDRAB. Results MDRAB was discovered in 9/42 (21.4%) individuals. The cases had significantly higher use of carbapenem (652 DOT/1,000PD vs. 385 DOT/1,000PD, P < 0.001) before MDRAB isolation. For the cases, clearance of MDRAB was associated with lower use of carbapenem (469 DOT/1,000PD vs. 708 DOT/1,000PD, P = 0.003) and higher use of non-carbapenem beta-lactam (612 DOT/1,000PD vs. 246 DOT/1,000PD, P <0.001). In multi-state model, each additional DOT of carbapenem increased the hazard of acquiring MDRAB (hazard ratio (HR), 1.08; 95% confidence interval (CI) 1.01–1.16) and each additional DOT of non-carbapenem beta-lactam increased the protection of clearing MDRAB (HR, 1.25; 95% CI 1.07–1.46). Conclusions Both acquisition and clearance of MDRAB were related to antibiotic exposure in a homogeneous population. Our findings suggest that early discontinuation of carbapenem could be an effective measure in antibiotic stewardship for the control of MDRAB spreading.
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Affiliation(s)
- Po-Yen Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.,Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shian-Sen Shie
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan
| | - Jung-Jr Ye
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan
| | - Shih-Pin Lin
- Division of Biostatistics, Graduate Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.,Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Tsui-Ping Liu
- Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan.,Department of Laboratory Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ting-Shu Wu
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.,Infection Control Committee, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tsu-Lan Wu
- Department of Laboratory Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Shiow-Shuh Chuang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Ming-Huei Cheng
- Department of Anesthesiology, Taipei Veterans General Hospital and National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Yu-Chia Hsieh
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University College of Medicine, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.
| | - Ching-Tai Huang
- Division of Infectious Diseases, Department of Medicine, Chang Gung Memorial Hospital and Chang Gung University, 5 Fu-Shin St., Kweishan, 333, Taoyuan, Taiwan.
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26
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Gharbi M, Doerholt K, Vergnano S, Bielicki JA, Paulus S, Menson E, Riordan A, Lyall H, Patel SV, Bernatoniene J, Versporten A, Heginbothom M, Goossens H, Sharland M. Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK. BMJ Open 2016; 6:e012675. [PMID: 27810974 PMCID: PMC5129034 DOI: 10.1136/bmjopen-2016-012675] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance. METHODS We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates. RESULTS A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam. CONCLUSIONS We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.
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Affiliation(s)
- Myriam Gharbi
- NIHR Health Protection Research Unit Antimicrobial Resistance and Healthcare Associated Infection—Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Katja Doerholt
- Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
| | - Stefania Vergnano
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Julia Anna Bielicki
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
| | - Stéphane Paulus
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Esse Menson
- Department of General Paediatrics, Evelina London Children's Hospital, London, UK
| | - Andrew Riordan
- Paediatric Infectious Diseases and Immunology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Hermione Lyall
- Department of Infectious Diseases, St Mary's Hospital Imperial College Healthcare NHS Trust, London, UK
| | - Sanjay Valabh Patel
- Paediatric Infectious Diseases and Immunology, Southampton Children's Hospital, Southampton, UK
| | - Jolanta Bernatoniene
- Paediatric Infectious Disease and Immunology, University Hospitals Bristol NHS Foundation Trust, Bristol Royal Hospital for Children, Bristol, UK
| | - Ann Versporten
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
| | | | - Herman Goossens
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO) University of Antwerp, Antwerp, Belgium
| | - Mike Sharland
- Paediatric Infection Diseases, St George's Hospital NHS Trust, London, UK
- Institute for Infection and Immunity—Paediatric Infectious Diseases Research Group, St. George's University of London, London, UK
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27
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Johnson AP. Contribution of
JAC
to antimicrobial stewardship. J Antimicrob Chemother 2016; 71:3001-3007. [DOI: 10.1093/jac/dkw373] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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28
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Cotteret C, Vallières E, Roy H, Ovetchkine P, Longtin J, Bussières JF. [Antibiotic consumption and bacterial sensitivity in a teaching hospital: A 5-year study]. Arch Pediatr 2016; 23:1040-1049. [PMID: 27642149 DOI: 10.1016/j.arcped.2016.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 06/13/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION To reduce risks of antibiotic resistance, governmental and learned societies decreed the optimal use of antibiotics. The relation between antibiotic consumption and bacterial resistance increase has been clearly demonstrated over the last several years. Antibiotic consumption data and bacterial sensitivity data are regularly published, but very few publications have searched for a correlation between these two variables. This study focused on antibiotic use and consumption as well as bacterial sensitivity to these antibiotics. OBJECTIVES The main objective was to describe the changes in antibiotic consumption and bacterial sensitivity in a mother-child teaching hospital. The secondary objectives were to explore whether antibiotic use and bacterial sensitivity were correlated and to comment on the usefulness of these data for clinicians. METHODS This was a 5-year retrospective, descriptive, cross-sectional study. All samples from usually sterile biologic liquids of hospitalized pediatric patients were included in the study. The samples from outpatient clinics were excluded. All types of bacteria identified in more than 30 isolates were included in the study. The antibiotics usually used to treat these bacteria were included. To assess antibiotic consumption, we calculated the number of days of therapy per 1000 patient-days for hospitalized pediatric patients and we calculated the Pearson correlation coefficient between antibiotic consumption and sensitivity rates to these antibiotics. Two scenarios were explored: one with correlation by year and one with the next year for bacterial sensitivity. RESULTS During the study period (2010-2011 to 2014-2015), overall antibiotics consumption remained relatively stable. Concerning bacterial sensitivity, we noted important changes (sensitivity rates increased for 12 antibiotic-bacteria pairs, remained stable for five, and decreased for 15). We found three significant correlations for the first scenario: Pseudomonas aeruginos-ceftazidime (P=0.01), P. aeruginosa-ciprofloxacin and fluoroquinolone consumption (P=0.02), Enterococcus sp-ampicillin and penicillin consumption (P=0.04). For the second scenario, we found only two significant correlations: coagulase-negative Staphylococcus-oxacilline and penicillin consumption (P=0.02), P. aeruginosa/piperacillin (P=0.04). CONCLUSION This exploratory study allowed us to describe antibiotic consumption and bacterial sensitivity progression. To our knowledge, this is the first study exploring the correlation between antibiotic consumption and the bacterial sensitivity rate in pediatrics in Canada. It remains very difficult to show this correlation between these two variables because of the multiple sources of bacterial resistance. These data are particularly useful for the antimicrobial stewardship programs and for clinicians.
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Affiliation(s)
- C Cotteret
- Unité de recherche en pratique pharmaceutique, département de pharmacie, centre hospitalier Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal QC, Canada
| | - E Vallières
- Laboratoire de microbiologie, centre hospitalier Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal QC, Canada
| | - H Roy
- Unité de recherche en pratique pharmaceutique, département de pharmacie, centre hospitalier Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal QC, Canada
| | - P Ovetchkine
- Département de pédiatrie, centre hospitalier Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal QC, Canada
| | - J Longtin
- Laboratoire de santé du Québec, Institut national de santé publique du Québec, 190, Crémazie boulevard E, H2P 1E2 Montréal, QC, Canada; Centre de recherche en infectiologie, université de Laval, 2325, rue de l'Université, G1V 0A6 Québec, QC, Canada
| | - J-F Bussières
- Unité de recherche en pratique pharmaceutique, département de pharmacie, centre hospitalier Sainte-Justine, 3175, chemin de la Côte-Sainte-Catherine, H3T 1C5 Montréal QC, Canada; Faculté de pharmacie, université de Montréal, CP 6128, succursale Centre-ville, H3C 3J7 Montréal QC, Canada.
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29
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Collineau L, Belloc C, Stärk KDC, Hémonic A, Postma M, Dewulf J, Chauvin C. Guidance on the Selection of Appropriate Indicators for Quantification of Antimicrobial Usage in Humans and Animals. Zoonoses Public Health 2016; 64:165-184. [PMID: 27592024 DOI: 10.1111/zph.12298] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/28/2022]
Abstract
An increasing variety of indicators of antimicrobial usage has become available in human and veterinary medicine, with no consensus on the most appropriate indicators to be used. The objective of this review is therefore to provide guidance on the selection of indicators, intended for those aiming to quantify antimicrobial usage based on sales, deliveries or reimbursement data. Depending on the study objective, different requirements apply to antimicrobial usage quantification in terms of resolution, comprehensiveness, stability over time, ability to assess exposure and comparability. If the aim is to monitor antimicrobial usage trends, it is crucial to use a robust quantification system that allows stability over time in terms of required data and provided output; to compare usage between different species or countries, comparability must be ensured between the different populations. If data are used for benchmarking, the system comprehensiveness is particularly crucial, while data collected to study the association between usage and resistance should express the exposure level and duration as a measurement of the exerted selection pressure. Antimicrobial usage is generally described as the number of technical units consumed normalized by the population at risk of being treated in a defined period. The technical units vary from number of packages to number of individuals treated daily by adding different levels of complexity such as daily dose or weight at treatment. These technical units are then related to a description of the population at risk, based either on biomass or number of individuals. Conventions and assumptions are needed for all of these calculation steps. However, there is a clear lack of standardization, resulting in poor transparency and comparability. By combining study requirements with available approaches to quantify antimicrobial usage, we provide suggestions on the most appropriate indicators and data sources to be used for a given study objective.
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Affiliation(s)
- L Collineau
- SAFOSO AG, Bern, Liebefeld, Switzerland.,BIOEPAR, INRA, Oniris, Nantes, France
| | - C Belloc
- BIOEPAR, INRA, Oniris, Nantes, France
| | | | - A Hémonic
- IFIP - French Pork and Pig Institute, Le Rheu, France
| | - M Postma
- Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - J Dewulf
- Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - C Chauvin
- Anses - French Agency for Food, Environmental and Occupational Health and Safety, Ploufragan, France
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30
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Laine N, Hoppu K, Airaksinen M, Saxen H. Antimicrobial consumption in a tertiary children's hospital in Finland (2003-2013). Eur J Hosp Pharm 2016; 23:266-271. [PMID: 31156863 DOI: 10.1136/ejhpharm-2015-000766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 12/21/2015] [Accepted: 01/06/2016] [Indexed: 11/03/2022] Open
Abstract
Background Numbers of resistant pathogens are constantly increasing, and prudent use of antimicrobials is of paramount importance. In order to see whether any changes in the use of antimicrobials in recent years have occurred, we decided to monitor the consumption of these drugs at a single tertiary paediatric hospital. Materials and methods This single-centre retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical /DDD index) in a 130-bed paediatric tertiary hospital. The data on the consumption of antimicrobials were collected from years 2003-2013 by using electronic surveillance records provided by the local pharmacy. The consumption was related to days of hospital care. Results During 2003-2013, the use of penicillins, cephalosporins and carbapenems increased by 28%, 46% and 110%, respectively. The consumption of both aminoglycosides and vancomycin decreased by 61% and 41%, respectively. Amphotericin B use clearly decreased by 39% while the use of novel azoles and echinocandins increased. Conclusions Increased use of carbapenems was the most significant finding of our study. The year-to-year consumption of antibacterials was in general relatively stable and new antibacterials were taken into use conservatively. In contrast to antibacterials, novel antifungals were rapidly adopted into use despite scarce evidence on their safety in children.
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Affiliation(s)
- Niina Laine
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland.,Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Kalle Hoppu
- Poison Information Centre, Helsinki University Central Hospital, Helsinki, Finland
| | - Marja Airaksinen
- Department of Pharmacology and Pharmacotherapy, Faculty of Pharmacy, University of Helsinki, Helsinki, Finland
| | - Harri Saxen
- Children's Hospital, Helsinki University Central Hospital, University of Helsinki, Helsinki, Finland
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Dik JWH, Hendrix R, Poelman R, Niesters HG, Postma MJ, Sinha B, Friedrich AW. Measuring the impact of antimicrobial stewardship programs. Expert Rev Anti Infect Ther 2016; 14:569-75. [PMID: 27077229 DOI: 10.1080/14787210.2016.1178064] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Antimicrobial Stewardship Programs (ASPs) are being implemented worldwide to optimize antimicrobial therapy, and thereby improve patient safety and quality of care. Additionally, this should counteract resistance development. It is, however, vital that correct and timely diagnostics are performed in parallel, and that an institution runs a well-organized infection prevention program. Currently, there is no clear consensus on which interventions an ASP should comprise. Indeed this depends on the institution, the region, and the patient population that is served. Different interventions will lead to different effects. Therefore, adequate evaluations, both clinically and financially, are crucial. Here, we provide a general overview of, and perspective on different intervention strategies and methods to evaluate these ASP programs, covering before mentioned topics. This should lead to a more consistent approach in evaluating these programs, making it easier to compare different interventions and studies with each other and ultimately improve infection and patient management.
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Affiliation(s)
- Jan-Willem H Dik
- a Department of Medical Microbiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Ron Hendrix
- a Department of Medical Microbiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands.,b Medical Microbiology , Certe Laboratory for Infectious Diseases , Groningen , The Netherlands
| | - Randy Poelman
- a Department of Medical Microbiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Hubert G Niesters
- a Department of Medical Microbiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Maarten J Postma
- c Unit of PharmacoEpidemiology & PharmacoEconomics (PE2), Department of Pharmacy , University of Groningen , Groningen , The Netherlands.,d Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen , University of Groningen , Groningen , The Netherlands.,e Department of Epidemiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Bhanu Sinha
- a Department of Medical Microbiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
| | - Alexander W Friedrich
- a Department of Medical Microbiology, University Medical Center Groningen , University of Groningen , Groningen , The Netherlands
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Fortin É, Platt RW, Fontela PS, Buckeridge DL, Quach C. Predicting Antimicrobial Resistance Prevalence and Incidence from Indicators of Antimicrobial Use: What Is the Most Accurate Indicator for Surveillance in Intensive Care Units? PLoS One 2015; 10:e0145088. [PMID: 26710322 PMCID: PMC4692550 DOI: 10.1371/journal.pone.0145088] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Accepted: 11/26/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE The optimal way to measure antimicrobial use in hospital populations, as a complement to surveillance of resistance is still unclear. Using respiratory isolates and antimicrobial prescriptions of nine intensive care units (ICUs), this study aimed to identify the indicator of antimicrobial use that predicted prevalence and incidence rates of resistance with the best accuracy. METHODS Retrospective cohort study including all patients admitted to three neonatal (NICU), two pediatric (PICU) and four adult ICUs between April 2006 and March 2010. Ten different resistance/antimicrobial use combinations were studied. After adjustment for ICU type, indicators of antimicrobial use were successively tested in regression models, to predict resistance prevalence and incidence rates, per 4-week time period, per ICU. Binomial regression and Poisson regression were used to model prevalence and incidence rates, respectively. Multiplicative and additive models were tested, as well as no time lag and a one 4-week-period time lag. For each model, the mean absolute error (MAE) in prediction of resistance was computed. The most accurate indicator was compared to other indicators using t-tests. RESULTS Results for all indicators were equivalent, except for 1/20 scenarios studied. In this scenario, where prevalence of carbapenem-resistant Pseudomonas sp. was predicted with carbapenem use, recommended daily doses per 100 admissions were less accurate than courses per 100 patient-days (p = 0.0006). CONCLUSIONS A single best indicator to predict antimicrobial resistance might not exist. Feasibility considerations such as ease of computation or potential external comparisons could be decisive in the choice of an indicator for surveillance of healthcare antimicrobial use.
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Affiliation(s)
- Élise Fortin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec and Montréal, Québec, Canada
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Patricia S. Fontela
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, The Montréal Children's Hospital, McGill University, Montréal, Québec, Canada
| | - David L. Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Caroline Quach
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec and Montréal, Québec, Canada
- Department of Pediatrics, The Montréal Children's Hospital, McGill University, Montréal, Québec, Canada
- * E-mail:
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Fortin E, Quach C, Fontela PS, Buckeridge DL, Platt RW. A Simulation Study to Assess Indicators of Antimicrobial Use as Predictors of Resistance: Does It Matter Which Indicator Is Used? PLoS One 2015; 10:e0145761. [PMID: 26700185 PMCID: PMC4689584 DOI: 10.1371/journal.pone.0145761] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 12/08/2015] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Indicators of antimicrobial use have been described previously, but few studies have compared their accuracy in prediction of antimicrobial resistance in hospital settings. This study aimed to identify conditions under which significant differences would be observed in the predictive accuracy of indicators in the context of surveillance of intensive care units (ICUs). METHODS Ten resistance / antimicrobial use combinations were studied. We used simulation to determine if Québec's network of 81 ICUs or the National Healthcare Safety Network (NHSN) of 2952 ICUs are large enough to allow the detection of predetermined differences between the most accurate and 1) the second most accurate indicator, and 2) the least accurate indicator, in more than 80% of simulations. For each indicator, we simulated absolute errors in prediction for each ICU and each 4-week period, for surveillance lasting up to 5 years. Absolute errors were generated following a binomial distribution, using mean absolute errors (MAEs) observed in 9 ICUs as the average proportion; simulated MAEs were compared using t-tests. This was repeated 1000 times per scenario. RESULTS When comparing the two most accurate indicators, 80% power was reached less often with the Québec network versus the NHSN (0/20 versus 2/20 scenarios, with 5 years of surveillance data), a finding reinforced when comparing the most and least accurate indicators (3/20 versus 20/20 scenarios). When simulating 1 year of data, scenarios reaching an 80% power dropped to 0/20, comparing the two most accurate indicators with the larger network, and to 1/20, comparing the most and least accurate indicators with the smaller network. CONCLUSION Most of the time (72%), identifying an indicator of antimicrobial use predicting antimicrobial resistance with a better accuracy was not possible. The choice of an indicator for an eventual surveillance system should rely on criteria other that predictive accuracy.
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Affiliation(s)
- Elise Fortin
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec and Montréal, Québec, Canada
| | - Caroline Quach
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, Québec and Montréal, Québec, Canada
- Department of Pediatrics, The Montréal Children's Hospital, McGill University, Montréal, Québec, Canada
| | - Patricia S. Fontela
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- Department of Pediatrics, The Montréal Children's Hospital, McGill University, Montréal, Québec, Canada
| | - David L. Buckeridge
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
| | - Robert W. Platt
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Québec, Canada
- * E-mail:
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[Pilot study evaluating the ratio of adverse drug reactions related to antimicrobials over their consumption in 2012-2013]. ANNALES PHARMACEUTIQUES FRANÇAISES 2015; 74:165-72. [PMID: 26365553 DOI: 10.1016/j.pharma.2015.08.001] [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: 06/26/2015] [Revised: 08/10/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES As part of our antimicrobials stewardship program, we were interested in the use of antimicrobials and prevalence of adverse drug reactions associated with the use of these drugs. METHODS The retrospective and descriptive study was conducted over a one year-period between April 1st 2012 and March 31st 2013 in a mother-child Hospital. We determined the ratio: number of adverse drug reactions over 10,000 defined daily dose or 10,000days of therapy. We identified the ratios higher than average for which the confidence interval did not cross the calculated average. The severity of the adverse drug reactions was codified using the Common Terminology Criteria for Adverse Events. RESULTS We found 570 adverse drug reactions including 100 (17.5%) adverse drug reactions related to antimicrobials during the financial year 2012-2013. It represented 96 patients. Thus, five antimicrobials, for which the confidence interval does not cross the calculated average value, may be targeted in risk management because they have a higher ratio than average: piperacillin (290 [113-722]), valganciclovir (244 [43-1260]), ceftriaxone (114 [56-234]), acyclovir (76 [26-220]) and liposomal amphotericin B (72 [20-258]). CONCLUSION In a mother-child university hospital, we calculated a ratios of 19 [15-23] and 13 [10-15], it allows us targeting some antimicrobials in our approach to prevention and management of adverse drug reactions.
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