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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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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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Crosby M, von den Baumen TR, Chu C, Gomes T, Schwartz KL, Tadrous M. Interprovincial variation in antibiotic use in Canada, 2019: a retrospective cross-sectional study. CMAJ Open 2022; 10:E262-E268. [PMID: 35318250 PMCID: PMC8946648 DOI: 10.9778/cmajo.20210095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Geographic trends in antibiotic prescribing show regional variation in antibiotic overuse and antimicrobial resistance, posing a threat to global health care systems. This study's objective was to examine interprovincial variation in outpatient antibiotic dispensing in Canada in 2019. METHODS We conducted a cross-sectional study of antibiotic prescriptions dispensed in Canadian provinces in 2019, leveraging the IQVIA Geographic Prescription Monitor database. We report annual rates of overall antibiotic dispensing, broad-spectrum antibiotic dispensing and age-specific antibiotic dispensing as prescriptions per 1000 population in each province and nationally. RESULTS A total of 23 406 640 antibiotic prescriptions were dispensed nationally in 2019, at a rate of 627.3 prescriptions per 1000 population. Overall antibiotic dispensing rates in Newfoundland and Labrador (920.5 prescriptions per 1000 population) and Saskatchewan (713.7 prescriptions per 1000 population) significantly exceeded the national rate, whereas the rate in British Columbia (543.3 prescriptions per 1000 population) was significantly below the national rate. We observed additional variation when provincial rates of antibiotic dispensing were stratified by drug class and age group. INTERPRETATION We identified interprovincial variation in antibiotic use in Canadian provinces in 2019. These findings highlight the need for provincial targets for antibiotic use to reduce overuse and antimicrobial resistance.
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Affiliation(s)
- Michael Crosby
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Teagan Rolf von den Baumen
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Cherry Chu
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Tara Gomes
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Kevin L Schwartz
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont
| | - Mina Tadrous
- Leslie Dan Faculty of Pharmacy (Crosby, Rolf von den Baumen, Gomes, Tadrous), University of Toronto; Institute for Health System Solutions and Virtual Care (Chu), Women's College Hospital; Li Ka Shing Knowledge Institute (Gomes), St. Michael's Hospital; ICES Central (Gomes, Schwartz, Tadrous); Public Health Ontario (Schwartz); Dalla Lana School of Public Health (Schwartz), University of Toronto; Women's College Research Institute (Tadrous), Toronto, Ont.
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Boone CG, Antoniou T, Juurlink DN, von den Baumen TR, Kitchen SA, Richards GC, Tadrous M, Gomes T. The impact of proposed regulatory changes and rescheduling on low-dose codeine purchasing in Canada: a time-series analysis. CMAJ Open 2021; 9:E1181-E1186. [PMID: 34906994 PMCID: PMC8687488 DOI: 10.9778/cmajo.20210173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Low-dose codeine products can be purchased without a prescription in most of Canada. We explored trends in the purchasing of these products across the Canadian provinces from 2014 to 2019, evaluating the impact of Health Canada's 2016 announcement of a proposed regulatory change and the 2017 opening of a 60-day public comment period, as well as the impact of Manitoba's 2016 policy change requiring a prescription for the purchase of all codeine products in that province. METHODS We evaluated population-adjusted monthly purchasing of codeine products from January 2014 to October 2019 using the IQVIA Canadian Drug Store and Hospital Purchases Audit database, stratified by province and over-the-counter (OTC) status. The primary outcomes were change in the monthly volume of low-dose codeine purchased after the 2016 federal regulatory proposal and the 2017 period of public comment across the provinces. Our secondary analysis was the impact of Manitoba's policy change in February 2016 requiring a prescription for low-dose codeine. We conducted a time-series analysis using interventional autoregressive integrated moving average models. RESULTS Over the study period, 24 120 kg of codeine (3.025 billion units) and 937 867 kg of acetaminophen were sold as OTC, low-dose codeine products across the Canadian provinces. Health Canada's 2016 announcement did not significantly affect OTC codeine purchasing (p = 0.57). The initiation of a 60-day public comment period was associated with a roughly 44% decrease in OTC codeine purchasing (p = 0.03). In Manitoba, purchasing of the same codeine formulations decreased after rescheduling in February 2016 (p < 0.001). We observed no significant change in the rate of purchasing of higher dose codeine formulations in response to scheduling changes in Manitoba (p = 0.22). INTERPRETATION Although Health Canada's 2016 announcement of a proposed regulatory change did not appear to have an effect on OTC codeine purchasing nationally, the 60-day comment period was associated with a decrease in purchasing. Further, Manitoba's 2016 policy change was associated with a significant and sustained decrease in the overall volume of codeine purchased. Given the potential risks of codeine dependence and acetaminophen toxicity with these products, a national rescheduling strategy should be considered.
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Affiliation(s)
- Charlotte G Boone
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tony Antoniou
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - David N Juurlink
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Teagan Rolf von den Baumen
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Sophie A Kitchen
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Georgia C Richards
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Mina Tadrous
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont
| | - Tara Gomes
- Centre for Addiction and Mental Health (Boone); Li Ka Shing Knowledge Institute (Antoniou, Kitchen, Gomes), St. Michael's Hospital; ICES Central (Antoniou, Juurlink, Tadrous, Gomes); Department of Family and Community Medicine (Antoniou), University of Toronto, Toronto, Ont.; London Health Sciences Centre (Rolf von den Baumen), London, Ont.; Nuffield Department of Primary Care Health Sciences (Richards), University of Oxford, Oxford, UK; Women's College Hospital (Tadrous); Institute for Health Policy, Management, and Evaluation (Gomes), University of Toronto, Toronto, Ont.
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Trinh NTH, Chalumeau M, Bruckner TA, Levy C, Bessou A, Milic D, Cohen R, Lemaitre M, Cohen JF. Monitoring outpatient antibiotic utilization using reimbursement and retail sales data: a population-based comparison in France, 2012-17. J Antimicrob Chemother 2021; 76:2446-2452. [PMID: 34120188 DOI: 10.1093/jac/dkab185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 04/26/2021] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES To assess whether a retail sales database could be used to monitor antibiotic utilization in the outpatient setting at the national level. METHODS We extracted 2012-17 outpatient antibiotic extrapolated retail sales (IQVIA's Xponent) and reimbursement data from the National Health Insurance (SNDS) in metropolitan France. We compared estimates of antibiotic use and consumption [number of antibiotic drug deliveries (DrID) and defined daily doses (DID) per 1000 inhabitants per day]. We relied on relative differences, Pearson's r statistics and time series using autoregressive integrated moving average (ARIMA) modelling to study: (i) differences in point estimates, (ii) correlation, and (iii) consistency in time trends between Xponent and SNDS. The analysis was conducted overall and in subgroups (age groups, therapeutic classes, major antimicrobial agents and regions). RESULTS We analysed approximately 377 million antibiotic drug deliveries, comprising nearly 3.4 billion DDDs. Overall, Xponent slightly overestimated SNDS point estimates with yearly relative differences of +3.5% for DrID and +3.3% for DID. Peaks in relative differences were observed for July and August months. Relative differences were <5% in most subgroups, except for fosfomycin and three French regions. Overall and across most subgroups, the correlation between Xponent and SNDS monthly aggregated estimates was almost perfect (r ≥ 0.992 for all subgroups, except for one region). ARIMA modelling showed high consistency between Xponent's and SDNS's DrID time series, but detected timepoints where the series significantly diverged. CONCLUSIONS IQVIA's Xponent and SNDS data were highly consistent. Xponent database seems suitable for monitoring outpatient antibiotic utilization in France.
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Affiliation(s)
- Nhung T H Trinh
- Université de Paris, Epidemiology and Statistics Research Center-CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004, Paris, France.,IQVIA, La Défense, France
| | - Martin Chalumeau
- Université de Paris, Epidemiology and Statistics Research Center-CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004, Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
| | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, CA, USA
| | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France.,Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | | | | | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | | | - Jérémie F Cohen
- Université de Paris, Epidemiology and Statistics Research Center-CRESS, INSERM, Obstetrical, Perinatal and Pediatric Epidemiology research team, F-75004, Paris, France.,Department of General Pediatrics and Pediatric Infectious Diseases, AP-HP, Hôpital Necker-Enfants malades, Université de Paris, Paris, France
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Fernandez-Lazaro CI, Brown KA, Langford BJ, Daneman N, Garber G, Schwartz KL. Late-career Physicians Prescribe Longer Courses of Antibiotics. Clin Infect Dis 2020; 69:1467-1475. [PMID: 30615108 DOI: 10.1093/cid/ciy1130] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 01/04/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antibiotic duration is often longer than necessary. Understanding the reasons for variability in antibiotic duration can inform interventions to reduce prolonged antibiotic use. We aim to describe patterns of interphysician variability in prescribed antibiotic treatment durations and determine physician predictors of prolonged antibiotic duration in the community setting. METHODS We performed a retrospective cohort analysis of family physicians in Ontario, Canada, between 1 March 2016 and 28 February 2017, using the Xponent dataset from IQVIA. The primary outcome was proportion of prolonged antibiotic course prescribed, defined as >8 days of therapy. We used multivariable logistic regression models, with generalized estimating equations to account for physician-level clustering to evaluate predictors of prolonged antibiotic courses. RESULTS There were 10 616 family physicians included in the study, prescribing 5.6 million antibiotic courses. There was substantial interphysician variability in the proportion of prolonged antibiotic courses (median, 33.3%; interdecile range, 13.5%-60.3%). In the multivariable regression model, later physician career stage, rural location, and a larger pediatric practice were significantly associated with greater use of prolonged courses. Prolonged courses were more likely to be prescribed by late-career physicians (adjusted odds ratio [aOR], 1.48; 95% confidence interval, 1.38-1.58) and mid-career physicians (aOR, 1.25; 1.16-1.34) when compared to early-career physicians. CONCLUSIONS We observed substantial variability in prescribed antibiotic duration across family physicians, with durations particularly long among late-career physicians. These findings highlight opportunities for community antimicrobial stewardship interventions to improve antibiotic use by addressing practice differences in later-career physicians.
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Affiliation(s)
- Cesar I Fernandez-Lazaro
- Infection Prevention and Control, Public Health Ontario, Toronto, Canada.,Department of Biomedical and Diagnostic Sciences, University of Salamanca, Spain
| | - Kevin A Brown
- Infection Prevention and Control, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada
| | - Bradley J Langford
- Infection Prevention and Control, Public Health Ontario, Toronto, Canada
| | - Nick Daneman
- Infection Prevention and Control, Public Health Ontario, Toronto, Canada.,Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Gary Garber
- Infection Prevention and Control, Public Health Ontario, Toronto, Canada.,Department of Medicine, Ottawa Hospital Research Institute, Canada
| | - Kevin L Schwartz
- Infection Prevention and Control, Public Health Ontario, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Canada.,Department of Medicine, St. Joseph's Health Centre, Toronto, Canada
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Validating a popular outpatient antibiotic database to reliably identify high prescribing physicians for patients 65 years of age and older. PLoS One 2019; 14:e0223097. [PMID: 31557249 PMCID: PMC6762161 DOI: 10.1371/journal.pone.0223097] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/13/2019] [Indexed: 12/14/2022] Open
Abstract
Objective Many jurisdictions lack comprehensive population-based antibiotic use data and rely on third party companies, most commonly IQVIA. Our objective was to validate the accuracy of the IQVIA Xponent antibiotic database in identifying high prescribing physicians compared to the reference standard of a highly accurate population-wide database of outpatient antimicrobial dispensing for patients ≥65 years. Methods We conducted this study between 1 March 2016 and 28 February 2017 in Ontario, Canada. We evaluated the agreement and correlation between the databases using kappa statistics and Bland-Altman plots. We also assessed performance characteristics for Xponent to accurately identify high prescribing physicians with sensitivity, specificity, positive predictive value (PPV), and negative predictive value. Results We included 9,272 physicians. The Xponent database has a specificity of 92.4% (95%CI 92.0%-92.8%) and PPV of 77.2% (95%CI 76.0%-78.4%) for correctly identifying the top 25th percentile of physicians by antibiotic volume. In the sensitivity analysis, 94% of the top 25th percentile physicians in Xponent were within the top 40th percentile in the reference database. The mean number of antibiotic prescriptions per physician were similar with a relative difference of -0.4% and 2.7% for female and male patients, respectively. The error was greater in rural areas with a relative difference of -8.4% and -5.6% per physician for female and male patients, respectively. The weighted kappa for quartile agreement was 0.68 (95%CI 0.67–0.69). Conclusion We validated the IQVIA Xponent antibiotic database to identify high prescribing physicians for patients ≥65 years, and identified some important limitations. Collecting accurate population-based antibiotic use data will remain vital to global antimicrobial stewardship efforts.
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Schwartz KL, Achonu C, Brown KA, Langford B, Daneman N, Johnstone J, Garber G. Regional variability in outpatient antibiotic use in Ontario, Canada: a retrospective cross-sectional study. CMAJ Open 2018; 6:E445-E452. [PMID: 30381321 PMCID: PMC6208056 DOI: 10.9778/cmajo.20180017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Regional variability in antibiotic use is associated with both antibiotic overuse and antimicrobial resistance. Our objectives were to benchmark outpatient antibiotic use and to evaluate geographic variability among health regions in the province of Ontario, Canada. METHODS This was a cross-sectional study of antibiotics dispensed from outpatient retail pharmacies in Ontario between March 2016 and February 2017. We analyzed variability in the number of antibiotic prescriptions dispensed per 1000 population among Ontario's 14 health regions with crude and adjusted Poisson regression models. Adjusted models controlled for rurality, 4 physician characteristics and 6 population characteristics. RESULTS There were 8 352 578 antibiotics dispensed during the 1-year study period or 621 per 1000 population. The most commonly prescribed antibiotic classes were narrow-spectrum penicillins, macrolides, first-generation cephalosporins and second-generation fluoroquinolones, with adult women receiving the highest rate of prescriptions: 985 antibiotic prescriptions per 1000 population. There was geographic variability in total and class-specific antibiotic use. In the health region with the highest use 778 antibiotics were dispensed per 1000 population whereas in the health region with the lowest use 534 antibiotics were dispensed per 1000 population. The adjusted marginal standardized antibiotic prescription rates for the health regions with the highest and lowest use were 787 (95% confidence interval [CI] 658-934) and 546 (95% CI 494-606) antibiotic prescriptions per 1000 population, respectively. INTERPRETATION We described baseline antibiotic usage in Ontario over a 12-month period, noting variability among some health regions. Our findings highlight the need for interventions to optimize antibiotic use and slow the emergence of antimicrobial resistance.
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Affiliation(s)
- Kevin L Schwartz
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont.
| | - Camille Achonu
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont
| | - Kevin Antoine Brown
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont
| | - Bradley Langford
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont
| | - Nick Daneman
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont
| | - Jennie Johnstone
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont
| | - Gary Garber
- Public Health Ontario (Schwartz, Achonu, Brown, Langford, Daneman, Johnstone, Garber); Dalla Lana School of Public Health (Schwartz, Brown, Johnstone); Sunnybrook Health Sciences Centre (Daneman); Department of Medicine (Daneman, Garber), University of Toronto, Toronto, Ont.; Ottawa Hospital Research Institute (Garber), Ottawa, Ont
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Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study. Infect Control Hosp Epidemiol 2018; 39:941-946. [PMID: 29893654 DOI: 10.1017/ice.2018.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities. DESIGN Observational study of acute-care hospitals in Ontario, Canada METHODS: A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest. RESULTS Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75-0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67-0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64-0·99) were associated with lower risk-adjusted antibiotic use. CONCLUSIONS Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.
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Tsutsui A, Yahara K, Shibayama K. Trends and patterns of national antimicrobial consumption in Japan from 2004 to 2016. J Infect Chemother 2018; 24:414-421. [PMID: 29428566 DOI: 10.1016/j.jiac.2018.01.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 12/18/2017] [Accepted: 01/09/2018] [Indexed: 12/19/2022]
Abstract
Frequent use of broad-spectrum antimicrobial classes has been reported in Japan; however, little is known about the long-term trend of national antimicrobial consumption, and that of individual agents. This study analyzed the national sales data of systemic antimicrobials from 2004 to 2016, derived from the IMS Japan Pharmaceutical Market database, to assess the consumption patterns of antimicrobial classes and agents in Japan. The number of defined daily doses per 1000 inhabitants per day (DID) was calculated for each antimicrobial agent. During the last 13 years, total antimicrobial consumption fluctuated by only 5% around the average of 14.41 DID. In 2016, the most used class was macrolides (32%), followed by cephalosporins (28%) and fluoroquinolones (19%). Oral agents comprised a large proportion (93%) of antimicrobial consumption. The most used agent, clarithromycin, accounted for 25% of all oral compounds used in 2016. The consumption of oral agents with high bioavailability, such as fluoroquinolones, amoxicillin, and sulfamethoxazole/trimethoprim increased, whereas that of cephalosporins decreased. In 2016, ceftriaxone was the most consumed parenteral agent, followed by cefazolin. The consumption of parenteral agents increased after 2009 when high-dose regimens of piperacillin/tazobactam, meropenem, and ampicillin/sulbactam were approved by the health insurance system. National antimicrobial consumption has been stable over the last 13 years. Moreover, shifts in the use of agents with high bioavailability and those approved for high-dose regimens were observed. However, the increased use of broad-spectrum agents is worrisome. A multifaceted approach is required to reduce overall antimicrobial consumption.
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Affiliation(s)
- Atsuko Tsutsui
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan.
| | - Koji Yahara
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan
| | - Keigo Shibayama
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Higashimurayama, Tokyo 189-0002, Japan
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Evaluating the Relationship Between Hospital Antibiotic Use and Antibiotic Resistance in Common Nosocomial Pathogens. Infect Control Hosp Epidemiol 2017; 38:1457-1463. [PMID: 29072150 DOI: 10.1017/ice.2017.222] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The relationship between hospital antibiotic use and antibiotic resistance is poorly understood. We evaluated the association between antibiotic utilization and resistance in academic and community hospitals in Ontario, Canada. METHODS We conducted a multicenter observational ecological study of 37 hospitals in 2014. Hospital antibiotic purchasing data were used as an indicator of antibiotic use, whereas antibiotic resistance data were extracted from hospital indexes of resistance. Multivariate regression was performed, with antibiotic susceptibility as the primary outcome, antibiotic consumption as the main predictor, and additional covariates of interest (ie, hospital type, laboratory standards, and patient days). RESULTS With resistance data representing more than 90,000 isolates, we found the increased antibiotic consumption in defined daily doses per 1,000 patient days (DDDs/1,000 PD) was associated with decreased antibiotic susceptibility for Pseudomonas aeruginosa (-0.162% per DDD/1,000 PD; P=.119). However, increased antibiotic consumption predicted increased antibiotic susceptibility significantly for Escherichia coli (0.173% per DDD/1,000 PD; P=.005), Klebsiella spp (0.124% per DDD/1,000 PD; P=.004), Enterobacter spp (0.194% per DDD/1,000 PD; P=.003), and Enterococcus spp (0.309% per DDD/1,000 PD; P=.001), and nonsignificantly for Staphylococcus aureus (0.012% per DDD/1,000 PD; P=.878). Hospital type (P=.797) and laboratory standard (P=.394) did not significantly predict antibiotic susceptibility, while increased hospital patient days generally predicted increased organism susceptibility (0.728% per 10,000 PD; P<.001). CONCLUSIONS We found that hospital-specific antibiotic usage was generally associated with increased, rather than decreased hospital antibiotic susceptibility. These findings may be explained by community origins for many hospital-diagnosed infections and practitioners choosing agents based on local antibiotic resistance patterns. Infect Control Hosp Epidemiol 2017;38:1457-1463.
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12
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Fitzpatrick MA, Suda KJ, Evans CT, Hunkler RJ, Weaver F, Schumock GT. Influence of drug class and healthcare setting on systemic antifungal expenditures in the United States, 2005-15. Am J Health Syst Pharm 2017; 74:1076-1083. [PMID: 28522642 DOI: 10.2146/ajhp160943] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Overall and specific class trends in systemic antifungal expenditures in various U.S. healthcare settings from 2005 through 2015 were evaluated. METHODS Systemic antifungal expenditures from January 1, 2005, through December 31, 2015, were obtained from the QuintilesIMS National Sales Perspective database, which provides a statistically valid projection of medication purchases from multiple markets throughout the United States. Summary data for total antifungal expenditures over the entire period are reported, as are growth and the percentage change in expenditures from one year to the next. Expenditures were also assessed specifically by year, class, and healthcare setting. Expenditure trends over the study period were assessed using simple linear trend regression models. RESULTS Overall expenditures for the 11-year period were $9.37 billion. The greatest proportion of expenditures occurred in nonfederal hospitals (47.2%) and for triazoles (57.6%). From 2005 through 2015, total expenditures decreased from $1.1 billion to $894 million (-18.8%, p = 0.09); however, expenditures in clinics and retail pharmacies increased (202%, p < 0.01, and 13.8%, p = 0.04, respectively), a trend most pronounced after 2012. Expenditures for flucytosine also increased (968.1%, p < 0.01), particularly in clinics where there was a dramatic 6,640.9% increase (p < 0.01). CONCLUSION From 2005 through 2015, an increase in systemic antifungal expenditures was observed in community settings, despite an overall decrease in total antifungal expenditures in the United States. Large increases in flucytosine expenditures were observed, particularly in the community.
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Affiliation(s)
- Margaret A Fitzpatrick
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Medicine, Division of Infectious Diseases, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Katie J Suda
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL
| | - Charlesnika T Evans
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Preventive Medicine, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Frances Weaver
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, and Department of Public Health Sciences, Loyola University Chicago Stritch School of Medicine, Maywood, IL
| | - Glen T Schumock
- Department of Pharmacy Practice, University of Illinois at Chicago College of Pharmacy, Chicago, IL
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13
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Tan C, Vermeulen M, Wang X, Zvonar R, Garber G, Daneman N. Variability in antibiotic use across Ontario acute care hospitals. J Antimicrob Chemother 2016; 72:554-563. [PMID: 27856724 DOI: 10.1093/jac/dkw454] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 09/08/2016] [Accepted: 09/27/2016] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. METHODS Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. RESULTS There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). CONCLUSIONS There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts.
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Affiliation(s)
- Charlie Tan
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Marian Vermeulen
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Xuesong Wang
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Rosemary Zvonar
- Infection Prevention and Control, Public Health Ontario, Ontario, Canada
| | - Gary Garber
- Infection Prevention and Control, Public Health Ontario, Ontario, Canada
| | - Nick Daneman
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada .,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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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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