1
|
Espona M, Echeverria-Esnal D, Hernandez S, Almendral A, Gómez-Zorrilla S, Limon E, Ferrandez O, Grau S. Impact of Generic Entry on Hospital Antimicrobial Use: A Retrospective Quasi-Experimental Interrupted Time Series Analysis. Antibiotics (Basel) 2021; 10:antibiotics10101149. [PMID: 34680730 PMCID: PMC8532699 DOI: 10.3390/antibiotics10101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background: The impact of antimicrobials generic entry (GE) is controversial. Their introduction could provide an economic benefit yet may also increase their consumption, leading to a higher risk of resistance. Our aim was to analyze the impact of GE on trends of antimicrobial consumption in an acute-care hospital. Methods: A retrospective quasi-experimental interrupted time series analysis was conducted at a 400-bed tertiary hospital in Barcelona, Spain. All antimicrobials for systemic use for which a generic product entered the hospital from January 2000 to December 2019 were included. Antimicrobial consumption was expressed as DDD/100 bed days. Results: After GE, the consumption of cefotaxime (0.09, p < 0.001), meropenem (0.54, p < 0.001), and piperacillin-tazobactam (0.13, p < 0.001) increased, whereas the use of clindamycin (−0.03, p < 0.001) and itraconazole (−0.02, p = 0.01) was reduced. An alarming rise in cefepime (0.004), daptomycin (1.02), and cloxacillin (0.05) prescriptions was observed, despite not achieving statistical significance. On the contrary, the use of amoxicillin (−0.07), ampicillin (−0.02), cefixime (−0.06), fluconazole (−0.13), imipenem–cilastatin (−0.50) and levofloxacin (−0.35) decreased. These effects were noticed beyond the first year post GE. Conclusions: GE led to an increase in the consumption of broad-spectrum molecules. The potential economic benefit of generic antibiotics could be diluted by an increase in resistance. Antimicrobial stewardship should continue to monitor these molecules despite GE.
Collapse
Affiliation(s)
- Mercè Espona
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Daniel Echeverria-Esnal
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
| | - Sergi Hernandez
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08097 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Alexander Almendral
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08097 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Silvia Gómez-Zorrilla
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Department of Infectious Diseases, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
| | - Enric Limon
- VINCat Program Surveillance of Healthcare Related Infections in Catalonia, 08097 Barcelona, Spain; (S.H.); (A.A.); (E.L.)
| | - Olivia Ferrandez
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
| | - Santiago Grau
- Department of Pharmacy, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain; (M.E.); (D.E.-E.); (O.F.)
- Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain;
- Department of Pharmacology, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
- Correspondence: ; Tel.: +34-932-483-151
| |
Collapse
|
2
|
Horcajada JP, Grau S, Paño-Pardo JR, López A, Oliver A, Cisneros JM, Rodriguez-Baño J. Antimicrobial stewardship in Spain: Programs for Optimizing the use of Antibiotics (PROA) in Spanish hospitals. Germs 2018; 8:109-112. [PMID: 30250829 DOI: 10.18683/germs.2018.1137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Juan P Horcajada
- MD, PhD, Service of Infectious Diseases, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autónoma de Barcelona, Passeig Marítim 25, Barcelona, 08003, Spain
| | - Santiago Grau
- PharmD, PhD, Service of Pharmacy, Hospital del Mar, Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autónoma de Barcelona, Passeig Marítim 25, Barcelona, 08003, Spain
| | - José Ramón Paño-Pardo
- MD, PhD, Infectious Diseases Service, Hospital Clínico Universitario Lozano Blesa, IIS Aragón, Avda. San Juan Bosco, 15, Zaragoza, 50009, Spain
| | - Antonio López
- PharmD, MSc, Spanish Agency of Medicines and Health Products (AEMPS), Calle Campezo 1, Madrid, 28022, Spain
| | - Antonio Oliver
- PhD, Service of Microbiology, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdiSBa), Ctra Valldemossa 79, Palma de Mallorca, 07120, Spain
| | - José M Cisneros
- MD, PhD, Department of Infectious Diseases, Microbiology, and Preventive Medicine, Infectious Diseases Research Group, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, Avda. Manuel Siurot s/n, Sevilla, 41013, Spain
| | - Jesús Rodriguez-Baño
- MD, PhD, Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Avda. Dr. Fedriani nº 3, Sevilla, 41009, Spain
| |
Collapse
|
3
|
Vancomycin and daptomycin minimum inhibitory concentrations as a predictor of outcome of methicillin-resistant Staphylococcus aureus bacteraemia. J Glob Antimicrob Resist 2018; 14:141-144. [PMID: 29601996 DOI: 10.1016/j.jgar.2018.03.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 01/09/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES The aim of this study was to determine the persistence of the adverse prognostic effect of elevated vancomycin minimum inhibitory concentration (MIC) in methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in a setting with low vancomycin use. METHODS A retrospective study focusing on episodes of bacteraemia due to MRSA diagnosed from January 2010 through December 2015 was designed. The main outcome measures were 30-day mortality and treatment failure. Multivariate logistic regression analysis was used to identify variables associated with patient mortality and treatment outcome. RESULTS In total, 79 MRSA bacteraemia episodes were included. The vancomycin MIC was >1.0μg/mL in 53 episodes (67.1%). The presence of high vancomycin MIC was not associated with a higher mortality rate or treatment success. A daptomycin MIC≥0.5μg/mL was present in 16 (26.2%) of 61 episodes for which the daptomycin MIC was obtained and was associated with 30-day mortality in the multivariate analysis (odds ratio=4.72, 95% confidence interval 1.19-18.71). None of the antimicrobials used were associated with a lower risk of treatment failure or mortality. CONCLUSIONS The pernicious effect of high vancomycin MIC disappears in the absence of a predominant use of this antibiotic. However, a high daptomycin MIC in MRSA bacteraemia is associated with higher mortality in patients with bacteraemia, irrespective of antimicrobial treatment choice.
Collapse
|
4
|
Gladstone BP, Cona A, Shamsrizi P, Vilken T, Kern WV, Malek N, Tacconelli E. Antimicrobial resistance rates in gram-positive bacteria do not drive glycopeptides use. PLoS One 2017; 12:e0181358. [PMID: 28727741 PMCID: PMC5519079 DOI: 10.1371/journal.pone.0181358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 06/15/2017] [Indexed: 11/25/2022] Open
Abstract
Surveillance data are considered essential to appropriate empiric antibiotic therapy and stewardship. The objective of this study was to determine if a change in the rates of antibiotic resistance impacts antibiotic use in European hospitals. Glycopeptides use was selected to study the correlation between resistance rates and antibiotic use because of the restricted spectrum against resistant gram positive bacteria. PubMed, ECDC databases and national/regional surveillance systems were searched to identify glycopeptides´ consumption in defined daily dose per 1000 inhabitant-days (DID) and rate of methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase negative staphylococci (MRCoNS), and vancomycin-resistant enterococci (VRE) in bloodstream infections (BSIs) in European countries between 1997 and 2015. Time trends were studied and associations between DID and BSI resistance rates were tested using multi-level mixed effect models. To account for the gap in the publication and dissemination of the yearly resistance data, a 2-year lag in the resistance rates was applied. Data on glycopeptides´ DID and resistance rates of target microorganisms in blood cultures were identified among 31 countries over a 19-year period. Glycopeptides use significantly increased (p<0·0001) while rates of MRSA BSIs decreased in majority of the countries (p<0·0001) and MRCoNS and VRE BSIs remained stable. Variation in glycopeptides' DID was not associated with variation in BSIs due to MRSA (p = 0·136) and VRE (p = 0·613). After adjusting for MRCoNS and VRE resistance rates, among 21 countries, 11 (52%) had a concordant and 10 (48%) a discordant trend in yearly glycopeptides´ DID and MRSA BSI rates. No correlation was found between resistance rates and DID data even among 8 countries with more than 5% decrease in MRSA rates over time. (RC -0·009, p = 0·059). Resistance rate of MRSA, MRCoNS, and VRE BSIs does not impact DID of glycopeptides in European hospitals. This finding is key to redefining the role and structure of antimicrobial surveillance and stewardship programmes.
Collapse
Affiliation(s)
- Beryl Primrose Gladstone
- Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany
| | - Andrea Cona
- Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany
- Infectious Diseases and Tropical Medicine, San Paolo Hospital, University of Milan, Milan, Italy
| | - Parichehr Shamsrizi
- Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany
| | - Tuba Vilken
- Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany
| | - Winfred V. Kern
- Infectious Diseases, Department of Medicine, University Hospital and Medical Center and Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany
| | - Nisar Malek
- Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany
| | - Evelina Tacconelli
- Infectious Diseases, Department of Internal Medicine I, DZIF Partner, Tübingen University Hospital, Tübingen, Germany
| |
Collapse
|
5
|
Absence of Correlation Between Vancomycin Consumption and Minimum Inhibitory Concentration of Methicillin-Resistant Staphylococcus aureus Isolates. Infect Control Hosp Epidemiol 2017; 38:751-753. [DOI: 10.1017/ice.2017.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
6
|
Correlation between antibiotic consumption and resistance of bloodstream bacteria in a University Hospital in North Eastern Italy, 2008-2014. Infection 2017; 45:459-467. [PMID: 28265870 DOI: 10.1007/s15010-017-0998-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 02/18/2017] [Indexed: 01/31/2023]
Abstract
PURPOSE The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. METHODS Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year. Potential correlations between antibiotic consumption and bacteria resistance rates were investigated through the Pearson's correlation. RESULTS The overall consumption of antibiotic grew from 80 to 97 DDD 100 patient/days (p = 0.005) during the study period. The increased consumption of amoxicillin/clavulanate and piperacillin/tazobactam was associated with the reduction of MRSA rate from 48.5 to 25.9% (p = 0.007 and p = 0.04, respectively). The increased consumption of piperacillin/tazobactam was associated with the reduction of ESBL-positive Enterobacteriaceae rate from 28.9 to 20.9% (p = 0.01). The increased consumption of carbapenems was associated with the increased rate of carbapenem-resistant Acinetobacter baumannii from 0 to 96.4% (p = 0.03). No carbapenem-resistant Enterobacteriaceae isolates were reported. The consumption of vancomycin grew significantly (p = 0.005). A dramatic spread of vancomycin-resistant Enterococcus faecium occurred in 2014. The consumption of fluoroquinolones and extended-spectrum cephalosporins remained stable. CONCLUSIONS An antibiotic stewardship program targeted to limit the consumption of extended-spectrum cephalosporins and fluoroquinolones in favor of amoxicillin/clavulanate and piperacillin/tazobactam correlates with a decreasing rate of MRSA and ESBL-positive Enterobacteriaceae. The analysis of correlations between antibiotic consumption and bacterial resistance rates is a useful tool to orient antimicrobial stewardship policies at local level.
Collapse
|
7
|
Assessment of linezolid prescriptions in three French hospitals. Eur J Clin Microbiol Infect Dis 2017; 36:1133-1141. [PMID: 28127641 DOI: 10.1007/s10096-017-2900-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/04/2017] [Indexed: 12/15/2022]
Abstract
The use of linezolid to treat gram-positive cocci infections is increasing in France. Linezolid is approved in pneumonia and complicated skin and soft tissue infections. Overuse and misuse of linezolid can favor the emergence and spreading of linezolid-resistant strains. We aimed to assess the appropriateness of linezolid use in French hospitals. This is a multicenter, retrospective study conducted in three tertiary care hospitals. Appropriateness of linezolid indications and adequacy (composite score concerning dosage, route of administration and blood monitoring) were assessed. Over a three-month period, all prescriptions of linezolid were extracted and analyzed by two independent infectious disease experts. Among the 81 initial prescriptions that were evaluated, indication was appropriate in 48% of cases. Among those, 51% complied with international guidelines. Fifty-seven percent of the prescriptions were adequate regarding dosage, route of administration and blood monitoring. Overall, 23% of prescriptions combined both appropriateness and adequacy. The most frequent reasons for inappropriateness were the possibility of choosing narrower-spectrum antibiotics and the empirical use of linezolid in severe sepsis or septic shock. Initial treatment was the most frequently appropriate in bone and joint infection cases (p = 0.001). Our study shows that even if modalities of use were mostly correct, appropriateness of linezolid indications is low. Educational programs are mandatory to improve practices, as well as clinical studies to better assess the efficacy and safety of linezolid in clinical situations other than pneumonia or complicated skin and soft tissue infections.
Collapse
|
8
|
Ruiz J, Villarreal E, Gordon M, Frasquet J, Castellanos A, Ramirez P. From MIC creep to MIC decline: Staphylococcus aureus antibiotic susceptibility evolution over the last 4 years. Clin Microbiol Infect 2016; 22:741-2. [PMID: 27184873 DOI: 10.1016/j.cmi.2016.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 02/29/2016] [Accepted: 05/04/2016] [Indexed: 10/21/2022]
Affiliation(s)
- J Ruiz
- Hospital Universitario y Politecnico la Fe, Intensive Care Unit, IIS La Fe, Valencia, Spain
| | - E Villarreal
- Hospital Universitario y Politecnico la Fe, Intensive Care Unit, IIS La Fe, Valencia, Spain
| | - M Gordon
- Hospital Universitario y Politecnico la Fe, Intensive Care Unit, Valencia, Spain
| | - J Frasquet
- Hospital Universitario y Politecnico la Fe, Microbiology Department, Valencia, Spain
| | - A Castellanos
- Hospital Universitario y Politecnico la Fe, Intensive Care Unit, Valencia, Spain
| | - P Ramirez
- Hospital Universitario y Politecnico la Fe, Intensive Care Unit, Valencia, Spain.
| |
Collapse
|