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Abejew AA, Wubetu GY, Fenta TG. Assessment of challenges and opportunities in antibiotic stewardship program implementation in Northwest Ethiopia. Heliyon 2024; 10:e32663. [PMID: 38912506 PMCID: PMC11193037 DOI: 10.1016/j.heliyon.2024.e32663] [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: 10/31/2023] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024] Open
Abstract
Background Indiscriminate use of antibiotics leads to antibiotic resistance (AMR) and results in mortality, morbidity, and financial burden. Antibiotic stewardship programs (ASPs) with education can resolve a number of barriers recognized in the implementation of successful ASPs. The aim of this study was to assess health professionals' perceptions and status of ASPs in hospitals in 2022. Methods A cross-sectional study was conducted from September 1, 2022 to October 30, 2022. A total of 181 health professionals were included, and a self-administered questionnaire was used to collect data. The status of hospitals was assessed using a checklist. The data were analyzed using SPSS version 23, and descriptive statistics and Chi-square tests (X2) at a P-value of <0.05 were used. Results Of the 181 respondents, 163 (90.1 %), and 161 (89.0 %) believed that AMR is a significant problem in Ethiopia and globally, respectively. Easy access to antibiotics 155 (85.6 %), and inappropriate use 137 (75.7 %) were perceived as key contributors to AMR. Antibiotics were believed to be prescribed/dispensed without laboratory results 86 (47.5 %), and antibiotic susceptibility patterns were not considered to guide empiric therapy 81 (44.8 %). ASP was believed to reduce the duration of hospital stays and associated costs 137 (75.7 %), and improve the quality of patient care 133 (73.5 %), whereas 151 (83.4 %), 143 (79 %), and 142 (78.5 %) suggested education, institutional guidelines, and prospective audits with feedback interventions to combat AMR in their hospitals, respectively. There were significant differences in perception among professionals based on professional category and attempts by hospitals to implement ASPs. Although ASPs were not functioning according to standard, there have been attempts to implement it in three hospitals. The issue of ASP had never been heard in general hospitals. Currently, it is feasible to implement ASPs in four hospitals. Conclusion The status of ASP in hospitals was very poor. Despite a lack of prior knowledge on ASPs, most respondents do have a positive perception of AMR and the implementation of ASPs. Pharmacist-led prospective audits and feedback with education and institutional guidelines for empiric antibiotic use can be better implemented in hospitals. Involvement of representatives from infection prevention and control, and collaboration among hospitals in ASP implementation will help establish a strong ASP in the area.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Vicentini C, Libero G, Cugudda E, Gardois P, Zotti CM, Bert F. Barriers to the implementation of antimicrobial stewardship programmes in long-term care facilities: a scoping review. J Antimicrob Chemother 2024:dkae146. [PMID: 38870077 DOI: 10.1093/jac/dkae146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) present specific challenges for the implementation of antimicrobial stewardship (AMS) programmes. A growing body of literature is dedicated to AMS in LTCFs. OBJECTIVES We aimed to summarize barriers to the implementation of full AMS programmes, i.e. a set of clinical practices, accompanied by recommended change strategies. METHODS A scoping review was conducted through Ovid-MEDLINE, CINAHL, Embase and Cochrane Central. Studies addressing barriers to the implementation of full AMS programmes in LTCFs were included. Implementation barriers described in qualitative studies were identified and coded, and main themes were identified using a grounded theory approach. RESULTS The electronic search revealed 3904 citations overall. Of these, 57 met the inclusion criteria. All selected studies were published after 2012, and the number of references per year progressively increased, reaching a peak in 2020. Thematic analysis of 13 qualitative studies identified three main themes: (A) LTCF organizational culture, comprising (A1) interprofessional tensions, (A2) education provided in silos, (A3) lack of motivation and (A4) resistance to change; (B) resources, comprising (B1) workload and staffing levels, (B2) diagnostics, (B3) information technology resources and (B4) funding; and (C) availability of and access to knowledge and skills, including (C1) surveillance data, (C2) infectious disease/AMS expertise and (C3) data analysis skills. CONCLUSIONS Addressing inappropriate antibiotic prescribing in LTCFs through AMS programmes is an area of growing interest. Hopefully, this review could be helpful for intervention developers and implementers who want to build on the most recent evidence from the literature.
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Affiliation(s)
- Costanza Vicentini
- Department of Public Health Sciences and Pediatrics, University of Turin, Torino, Italy
| | - Giulia Libero
- Department of Public Health Sciences and Pediatrics, University of Turin, Torino, Italy
| | - Eleonora Cugudda
- Department of Public Health Sciences and Pediatrics, University of Turin, Torino, Italy
| | - Paolo Gardois
- Department of Public Health Sciences and Pediatrics, Medical Library 'Ferdinando Rossi', University of Turin, Torino, Italy
| | - Carla Maria Zotti
- Department of Public Health Sciences and Pediatrics, University of Turin, Torino, Italy
| | - Fabrizio Bert
- Department of Public Health Sciences and Pediatrics, University of Turin, Torino, Italy
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Facilitators and barriers to implementing antimicrobial stewardship programs in public South African hospitals. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e34. [PMID: 36865702 PMCID: PMC9972532 DOI: 10.1017/ash.2022.355] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/15/2022] [Accepted: 11/15/2022] [Indexed: 02/25/2023]
Abstract
Objective The South African National Department of Health released guidelines and recommendations for antimicrobial stewardship (AMS) programs to be established in public healthcare facilities. Their implementation remains challenged, especially in North West Province, where the public health system functions under severe strain. This research explored and interpreted the facilitators that strengthen and barriers that hinder the implementation of the national AMS program in public hospitals in North West Province. Design A qualitative design and interpretive descriptive approach enabled insight into the realities of AMS program implementation. Setting Public hospitals in North West Province, sampled through criterion sampling (n = 5). Participants Purposive criterion sampling of healthcare practitioners (n = 30) actively participating in AMS programs in the 5 sampled public hospitals. Method Qualitative, interpretive description with semi-structured individual interviews that were digitally recorded and transcribed. The ATLAS.ti version 8 software facilitated content analysis, followed by second-level analysis. Results In total, 4 themes, 13 categories, and 25 subcategories emerged. We detected dissonance between government AMS ideals and the realities of AMS program implementation in public hospitals. A multilevel AMS leadership and governance vacuum exists in a dysfunctional health ecosystem in which AMS must operate. Healthcare practitioners agreed on the importance of AMS despite different understandings of AMS and ineffective multidisciplinary teams. Discipline-specific education and training are essential for all AMS participants. Conclusions AMS is essential yet complex, and its contextualization and implementation are underestimated in public hospitals. Recommendations are focused on a supportive organizational culture, contextualized AMS program implementation plans, and changes in management.
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Haseeb A, Saleem Z, Altaf U, Batool N, Godman B, Ahsan U, Ashiq M, Razzaq M, Hanif R, E-Huma Z, Amir A, Hossain MA, Raafat M, Radwan RM, Iqbal MS, Kamran SH. Impact of Positive Culture Reports of E. coli or MSSA on De-Escalation of Antibiotic Use in a Teaching Hospital in Pakistan and the Implications. Infect Drug Resist 2023; 16:77-86. [PMID: 36636371 PMCID: PMC9831081 DOI: 10.2147/idr.s391295] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
Background Antibiotic de-escalation is a key element of antimicrobial stewardship programs that restrict the spread and emergence of resistance. This study was performed to evaluate the impact of positive culture sensitivity reports of E. coli or Methicillin sensitive Staphylococcus aureus (MSSA) on de-escalation of antibiotic therapy. Methods This prospective observational study was performed on 256 infected patients. The samples were obtained principally from the pus of infected sites for the identification of pathogens and culture-sensitivity testing. The data were collected from patient medical files, which included their demographic data, sample type, causative microbe and antimicrobial treatment as empiric or definitive treatment based on cultures. Data were analyzed using SPSS. Results Of 256 isolated microbes, 138 (53.9%) were MSSA and 118 were E. coli (46.1%). MSSA showed 100% sensitivity to cefoxitin, oxacillin, vancomycin, fosfomycin, colistin and more than 90% to linezolid (95.3%), tigecycline (93.1%), chloramphenicol (92.2%) and amikacin (90.2%). E. coli showed 100% sensitivity to only fosfomycin and more than 90% to colistin (96.7%), polymyxin-B (95.1%) and tigecycline (92.9%). The high use of cefoperazone+sulbactam (151), amikacin (149), ceftriaxone (33), metronidazole (30) and piperacillin + tazobactam (22) was seen with empiric prescribing. Following susceptibility testing, the most common antibiotics prescribed for E. coli were meropenem IV (34), amikacin (34), ciprofloxacin (29) and cefoperazone+sulbactam (25). For MSSA cases, linezolid (48), clindamycin (30), cefoperazone+ sulbactam IV (16) and amikacin (15) was used commonly. Overall, there was 23% reduction in antibiotic use in case of E. coli and 43% reduction in MSSA cases. Conclusion Culture sensitivity reports helped in the de-escalation of antimicrobial therapy, reducing the prescribing of especially broad-spectrum antibiotics. Consequently, it is recommended that local hospital guidelines be developed based on local antimicrobial susceptibility patterns while preventing the unnecessary use of broad-spectrum antibiotics for empiric treatment.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan,Correspondence: Zikria Saleem, Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan, Email
| | - Ummara Altaf
- Department of Pharmacy, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - Narjis Batool
- Australian Institute of Health Innovation, Center of Health Systems and Safety Research, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW, Australia
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK,School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa,Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates
| | - Umar Ahsan
- Department of Infection Prevention and Control, Al Noor Specialist Hospital, Ministry of health, Makkah, Kingdom of Saudi Arabia
| | - Mehreen Ashiq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Mutiba Razzaq
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Rabia Hanif
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Zill E-Huma
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Afreenish Amir
- Department of Microbiology, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Mohammad Akbar Hossain
- Department of Pharmacology and Toxicology, Faculty of Medicine in Al-Qunfudah, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Mohamed Raafat
- Department of Pharmacology and Toxicology, College of Pharmacy, Umm AL-Qura University, Makkah, Saudi Arabia
| | - Rozan Mohammad Radwan
- Pharmaceutical Care Department, Al Noor Specialist Hospital, Ministry of Health, Makkah, Saudi Arabia
| | - Muhammad Shahid Iqbal
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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Weier N, Thilly N, Howard P, Demore B, Patel R, Pulcini C, Zaidi STR. Development of an international survey tool to measure confidence and current antimicrobial stewardship practices of hospital pharmacists. J Antimicrob Chemother 2022; 77:3466-3474. [PMID: 36227627 DOI: 10.1093/jac/dkac343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 09/16/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Pharmacists are identified as key members of hospital antimicrobial stewardship (AMS) teams in international guidelines. Developing an international standardized tool to measure hospital pharmacists' confidence and practices of AMS will encourage knowledge sharing and better networking between hospital pharmacists internationally. OBJECTIVES To develop a survey tool that can be used internationally to assess pharmacists' knowledge, confidence, perceived barriers and current AMS practices. METHODS A project team was formed to refine the survey tool that was initially used in a previous survey study. Following revision by the project team, a revised survey tool was sent to the ESCMID Study Group for Antimicrobial Stewardship (ESGAP). Feedback from the ESGAP members was considered by the project team to finalize the survey tool. RESULTS A total of 88 changes were made to the survey tool after revision by the project team. A total of 43/216 (19.9%) of ESGAP members provided feedback on the survey tool, which led to a further 19 revisions. ESGAP members were agreeable to the questions in the survey tool, with >50% agreeing that each question was suitable. The final survey tool consisted of 42 questions, reduced from 72 questions in the original survey. CONCLUSIONS An international survey tool to measure hospital pharmacists' confidence and practices of AMS was developed. This tool will help the wider hospital pharmacy community in conducting local studies on current AMS practices and to identify areas where further support is needed. Use of a standardized survey tool will also allow individual regions/countries to compare their data with other countries to identify potential quality improvement programmes.
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Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention. Aten Primaria 2022; 54:102493. [PMID: 36270205 PMCID: PMC9586853 DOI: 10.1016/j.aprim.2022.102493] [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: 07/10/2022] [Revised: 09/19/2022] [Accepted: 09/27/2022] [Indexed: 11/21/2022] Open
Abstract
Objective We assessed the impact of the implementation of a simple multifaceted intervention aimed at improving management of cystitis in primary care. Design Quality control before and after study. Site Primary care centres in Barcelona city provided by the Catalonian Institute of Health. Participants The multifaceted intervention consisted of (1) creation of a group with a leader in each of the primary care centres, out of hours services, sexual and reproductive centres, and home visit service, (2) session on management of cystitis in each centre, (3) result feedback for professionals, and (4) provision of infographics for professionals and patients with urinary tract infections. Interventions started in November 2020 and ended in the summer of 2021. Main measurements Variation in the prescription of first-line antibiotics, usage of antibiotics, and request for urine cultures before and after this intervention. Results Training sessions took place in 93% of the centres. The use of first-line therapies cystitis increased by 6.4% after the intervention (95% confidence interval [CI], 5.7–7.1%). The use of nitrofurantoin in recurrent cystitis increased, mainly in out of hours service (8.7%; 95% CI, 5.2–12.2%). Urine cultures were more frequently requested after the intervention for recurrent cystitis in both primary care centres and out of hours services, with a 7.2% increase [95% CI, 5.9–8.5%), but also for uncomplicated urinary tract infections (3.1%; 95% CI, 1.8–4.4%). Conclusions A low-intensity multifaceted intervention on management of cystitis, with strong institutional support, resulted in a better choice of antibiotic in antibiotic prescribing, but the intervention had less impact on the adequacy of urine cultures.
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Araújo BCD, Melo RCD, Bortoli MCD, Bonfim JRDA, Toma TS. Prevenção e controle de resistência aos antimicrobianos na Atenção Primária à Saúde: evidências para políticas. CIENCIA & SAUDE COLETIVA 2022; 27:299-314. [DOI: 10.1590/1413-81232022271.22202020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 11/18/2020] [Indexed: 11/21/2022] Open
Abstract
Resumo A resistência aos antimicrobianos é um problema mundial que põe em risco a segurança da saúde da população. O objetivo deste artigo é identificar e avaliar estratégias para prevenção e controle de resistência microbiana, bem como barreiras para sua implementação em serviços de Atenção Primária à Saúde (APS). Realizou-se uma síntese de evidências para políticas. As buscas de evidências foram realizadas entre novembro/dezembro de 2018, em 13 bases de dados. Um diálogo deliberativo foi realizado para validação dos resultados e levantamento de barreiras e facilitadores para implementação das estratégias. As 13 revisões sistemáticas incluídas mostraram que intervenções com foco em educação, uso de sistemas eletrônicos e biomarcadores reduziram o consumo e prescrição de antimicrobianos. É um obstáculo à implementação a expectativa de usuários/cuidadores em receber prescrição de antibióticos, e são facilitadores as ações educativas que envolvem profissionais de saúde. O uso racional de medicamentos se impõe na APS com vistas à prevenção da resistência dos microrganismos aos antibióticos. As intervenções identificadas neste estudo podem ser implementadas isoladamente ou em conjunto, conforme o contexto local.
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Schneidewind L, Kranz J, Tandogdu Z. Rising significance of antibiotic stewardship in urology and urinary tract infections - a rapid review. Curr Opin Urol 2021; 31:285-290. [PMID: 34009175 DOI: 10.1097/mou.0000000000000897] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW To give an overview of the significance as well as recent developments in antibiotic stewardship (ABS) in urology and for the treatment of urinary tract infections (UTI). This rapid review is focused on recent publications during the past 18 months. RECENT FINDINGS Despite the evidence to support the use of ABS interventions in the treatment of UTIs, there remains considerable inappropriate use of antibiotics, up to 68%, especially concerning the treatment of asymptomatic bacteriuria and the overuse of fluoroquinolones. Emerging evidence indicate that ABS programs can improve patient outcome and reduce multidrug-resistant pathogens.Interestingly, in this past 18 months new targets for ABS have been developed, e.g. involvement of a pharmacist, strict adherence to guidelines, improvement of the guidelines itself and understanding the prescription process in the emergency room as well as the analysis of own surveillance data. SUMMARY ABS programs in urology are essential and their significance has become more apparent than ever before. New targets for ABS interventions should be evaluated in prospective controlled clinical trials of their effectiveness to reduce further inappropriate antibiotic use without hindering the treatment of UTIs.
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Affiliation(s)
| | - Jennifer Kranz
- St. Antonius Hospital Eschweiler, Department of Urology, Eschweiler
- Martin-Luther-University, Department of Urology and Kidney Transplantation, Halle (Saale), Germany
| | - Zafer Tandogdu
- University College London Hospitals, Department of Urology, London
- University College London, Division of Surgery and Interventional Science, London, UK
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Saleh D, Abu-Farha R, Mukattash TL, Barakat M, Alefishat E. Views of Community Pharmacists on Antimicrobial Resistance and Antimicrobial Stewardship in Jordan: A Qualitative Study. Antibiotics (Basel) 2021; 10:antibiotics10040384. [PMID: 33916855 PMCID: PMC8067308 DOI: 10.3390/antibiotics10040384] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/19/2021] [Accepted: 04/01/2021] [Indexed: 12/18/2022] Open
Abstract
The Center for Disease Control and Prevention and the World Health Organization issued a practical approach and Global Action Plan to control the threatening emerging antibacterial resistance. One of the main bases of this plan is the Antimicrobial Stewardship Program (ASPs). This study aimed to evaluate community pharmacists’ awareness and perception towards antimicrobial resistance and ASPs in Jordan. Thus, a qualitative study was conducted through in-depth interviews with twenty community pharmacists. Convenience sampling was used in the study. Qualitative analysis of the data yielded four themes and eleven sub-themes. All the respondents showed a good understanding of the causes of antimicrobial resistance. The most important cause reported by them was the non-restricted prescription of antimicrobials. Most of the pharmacists believed that they are competent to provide ASPs, however, they believed that there are several barriers against the implementation of ASPs in community pharmacies in Jordan. Barriers demonstrated by the pharmacists, included organizational obstacles, resources obstacles, and personal obstacles. In conclusion, this study revealed several barriers against the implementation of ASPs in community pharmacies in Jordan. Incorporating ASPs in the community pharmacy settings requires proper pharmacist training, several academic disciplines team efforts, and good pharmacy practice of antimicrobial guidelines.
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Affiliation(s)
- Doaa Saleh
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan; (D.S.); (R.A.-F.); (M.B.)
| | - Rana Abu-Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan; (D.S.); (R.A.-F.); (M.B.)
| | - Tareq L. Mukattash
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan;
| | - Muna Barakat
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11937, Jordan; (D.S.); (R.A.-F.); (M.B.)
| | - Eman Alefishat
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman 11937, Jordan
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi 127788, United Arab Emirates
- Correspondence: ; Tel.: +971-5018466
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Alghamdi S, Berrou I, Aslanpour Z, Mutlaq A, Haseeb A, Albanghali M, Hammad MA, Shebl N. Antimicrobial Stewardship Programmes in Saudi Hospitals: Evidence from a National Survey. Antibiotics (Basel) 2021; 10:193. [PMID: 33671401 PMCID: PMC7923167 DOI: 10.3390/antibiotics10020193] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/15/2021] [Indexed: 12/16/2022] Open
Abstract
Saudi hospitals and healthcare facilities are facing increasing rates of antimicrobial resistance and the emergence of new multi-drug resistant strains. This is placing an unprecedented threat to successful treatments and outcomes of patients accessing those facilities. The inappropriate use of antimicrobials is fueling this crisis, warranting urgent implementation of interventions to preserve antimicrobials and reduce resistance rates. Antimicrobial stewardship programmes (ASPs) can improve antimicrobial use, treatment success rates and reduce the levels of antimicrobial resistance. The Saudi Ministry of Health (MOH) devised a national antimicrobial stewardship plan to implement ASPs in hospitals, but little is known about the progress of implementation and the factors affecting it. This study aims to assess the level and the factors affecting the adoption and implementation of ASPs in Saudi hospitals at a national level. A nationwide cross-sectional survey was conducted in 2017 using an online questionnaire sent to all MOH hospitals. Overall, 147 out 247 MOH hospitals responded to the survey (54%). Only 26% of the hospitals reported the implementation of ASPs. Hospitals lack the knowledge, technological and staff resources to adopt and implement ASPs. Alternative models of ASP adoption could be explored to improve the rates of implementation of ASPs.
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Affiliation(s)
- Saleh Alghamdi
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Albaha University, Albaha, Saudi Arabia; (S.A.); (M.A.H.)
| | - Ilhem Berrou
- School of Health and Wellbeing, Faculty of Health and Applied Sciences, University of the West of England, Bristol BS16 1DD, UK
| | - Zoe Aslanpour
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (Z.A.); (N.S.)
| | - Alaa Mutlaq
- General Department of Pharmaceutical Care, Ministry of Health, Riyadh, Saudi Arabia;
| | - Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al Qura University, Makkah, Saudi Arabia;
| | - Mohammad Albanghali
- Department of Public Health, Faculty of Applied Medical Sciences, Albaha University, Albaha, Saudi Arabia;
| | - Mohamed Anwar Hammad
- Department of Clinical Pharmacy, Faculty of Clinical Pharmacy, Albaha University, Albaha, Saudi Arabia; (S.A.); (M.A.H.)
| | - Nada Shebl
- Department of Clinical, Pharmaceutical and Biological Sciences, School of Life and Medical Sciences, University of Hertfordshire, Hatfield AL10 9AB, UK; (Z.A.); (N.S.)
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Soucy JPR, Low M, Acharya KR, Ellen M, Hulth A, Löfmark S, Garber GE, Watson W, Moran-Gilad J, Fisman DN, MacFadden DR. Evaluation of an automated feedback intervention to improve antimicrobial prescribing among primary care physicians (OPEN Stewardship): protocol for an interrupted time-series and usability analysis in Ontario, Canada and Southern Israel. BMJ Open 2021; 11:e039810. [PMID: 33441352 PMCID: PMC7812099 DOI: 10.1136/bmjopen-2020-039810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Antimicrobial resistance undermines our ability to treat bacterial infections, leading to longer hospital stays, increased morbidity and mortality, and a mounting burden to the healthcare system. Antimicrobial stewardship is increasingly important to safeguard the efficacy of existing drugs, as few new drugs are in the developmental pipeline. While significant progress has been made with respect to stewardship in hospitals, relatively little progress has been made in the primary care setting, where the majority of antimicrobials are prescribed. OPEN Stewardship is an international collaboration to develop an automated feedback platform to improve responsible antimicrobial prescribing among primary care physicians and capable of being deployed across heterogeneous healthcare settings. We describe the protocol for an evaluation of this automated feedback intervention with two main objectives: assessing changes in antimicrobial prescribing among participating physicians and determining the usability and usefulness of the reports. METHODS AND ANALYSIS A non-randomised evaluation of the automated feedback intervention (OPEN Stewardship) will be conducted among approximately 150 primary care physicians recruited from Ontario, Canada and Southern Israel, based on a series of targeted stewardship messages sent using the platform. Using a controlled interrupted time-series analysis and multilevel negative binomial modelling, we will compare the antimicrobial prescribing rates of participants before and after the intervention, and also to the prescribing rates of non-participants (from the same healthcare network) during the same period. We will examine outcomes targeted by the stewardship messages, including prescribing for antimicrobials with duration longer than 7 days and prescribing for indications where antimicrobials are typically unnecessary. Participants will also complete a series of surveys to determine the usability and usefulness of the stewardship reports. ETHICS AND DISSEMINATION All sites have obtained ethics committee approval to recruit providers and access anonymised prescribing data. Dissemination will occur through open-access publication, stakeholder networks and national/international meetings.
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Affiliation(s)
- Jean-Paul R Soucy
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Marcelo Low
- Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel
| | - Kamal Raj Acharya
- Department of Population Medicine, University of Guelph Ontario Veterinary College, Guelph, Ontario, Canada
| | - Moriah Ellen
- Department of Health Services Management, Guilford Glazer Faculty of Business and Management, University of the Negev, Beer Sheva, Israel
| | - Anette Hulth
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Sonja Löfmark
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - Gary E Garber
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
- Infectious Diseases, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - William Watson
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- St Michael's Hospital, Toronto, Ontario, Canada
| | - Jacob Moran-Gilad
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - David N Fisman
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Derek R MacFadden
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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12
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de Melo RC, de Araújo BC, de Bortoli MC, Toma TS. [Prevention and control of antimicrobial stewardship: a review of evidenceGestión de las intervenciones en materia de prevención y control de la resistencia a los antimicrobianos en los hospitales: revisión de la evidencia]. Rev Panam Salud Publica 2020; 44:e35. [PMID: 32973894 PMCID: PMC7498289 DOI: 10.26633/rpsp.2020.35] [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: 11/20/2019] [Accepted: 02/04/2020] [Indexed: 11/24/2022] Open
Abstract
Objective To identify effective interventions to manage antimicrobial resistance in hospital settings and potential barriers to their implementation. Method A synthesis of evidence for health policy was performed using SUPPORT tools. Literature searches were performed in November and December 2018 in 14 databases. A face-to-face deliberative dialogue workshop to identify implementation barriers was performed with 23 participants (manager, researchers, and health care professionals) and 14 listeners divided into three groups. Researchers with experience in deliberative dialogue acted as facilitators. Results Twenty-seven systematic reviews focusing on antimicrobial stewardship using combined or individual strategies were identified. The interventions included education, electronic systems, use of biomarkers, and several strategies of antimicrobial management. The main barriers to the implementation of interventions, identified in the literature and deliberative dialogue workshop, were poor infrastructure and insufficient human resources, patient complaints regarding the treatment received, cultural differences within the multidisciplinary team, work overload, and lack of financing/planning. Conclusion Most of the strategies identified were effective for antimicrobial stewardship in hospital settings. The reliability of results may be strengthened with the performance of additional research of higher methodological quality.
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Affiliation(s)
- Roberta Crevelário de Melo
- Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS São Paulo (SP) Brasil Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS, São Paulo (SP), Brasil
| | - Bruna Carolina de Araújo
- Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS São Paulo (SP) Brasil Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS, São Paulo (SP), Brasil
| | - Maritsa Carla de Bortoli
- Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS São Paulo (SP) Brasil Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS, São Paulo (SP), Brasil
| | - Tereza Setsuko Toma
- Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS São Paulo (SP) Brasil Secretaria de Estado de Saúde, Instituto de Saúde, Centro de Tecnologias de Saúde para o SUS, São Paulo (SP), Brasil
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13
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Scheuplein NJ, Bzdyl NM, Kibble EA, Lohr T, Holzgrabe U, Sarkar-Tyson M. Targeting Protein Folding: A Novel Approach for the Treatment of Pathogenic Bacteria. J Med Chem 2020; 63:13355-13388. [PMID: 32786507 DOI: 10.1021/acs.jmedchem.0c00911] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infectious diseases are a major cause of morbidity and mortality worldwide, exacerbated by increasing antibiotic resistance in many bacterial species. The development of drugs with new modes of action is essential. A leading strategy is antivirulence, with the aim to target bacterial proteins that are important in disease causation and progression but do not affect growth, resulting in reduced selective pressure for resistance. Immunophilins, a superfamily of peptidyl-prolyl cis-trans isomerase (PPIase) enzymes have been shown to be important for virulence in a broad-spectrum of pathogenic bacteria. This Perspective will provide an overview of the recent advances made in understanding the role of each immunophilin family, cyclophilins, FK506 binding proteins (FKBPs), and parvulins in bacteria. Inhibitor design and medicinal chemistry strategies for development of novel drugs against bacterial FKBPs will be discussed. Furthermore, drugs against human cyclophilins and parvulins will be reviewed in their current indication as antiviral and anticancer therapies.
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Affiliation(s)
- Nicolas J Scheuplein
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Nicole M Bzdyl
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, 6009 Perth, Australia
| | - Emily A Kibble
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, 6009 Perth, Australia.,School of Veterinary and Life Sciences, Murdoch University, 6150 Murdoch, Australia
| | - Theresa Lohr
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Ulrike Holzgrabe
- Institute of Pharmacy and Food Chemistry, University of Würzburg, Am Hubland, 97074 Würzburg, Germany
| | - Mitali Sarkar-Tyson
- Marshall Centre for Infectious Diseases Research and Training, School of Biomedical Sciences, University of Western Australia, 6009 Perth, Australia
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14
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Keizer J, Beerlage-De Jong N, Al Naiemi N, van Gemert-Pijnen JEWC. Finding the match between healthcare worker and expert for optimal audit and feedback on antimicrobial resistance prevention measures. Antimicrob Resist Infect Control 2020; 9:125. [PMID: 32758300 PMCID: PMC7405438 DOI: 10.1186/s13756-020-00794-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
Abstract
Background The potentials of audit and feedback (AF) to improve healthcare are currently not exploited. To unlock the potentials of AF, this study focused on the process of making sense of audit data and translating data into actionable feedback by studying a specific AF-case: limiting antimicrobial resistance (AMR). This was done via audit and feedback of AMR prevention measures (APM) that are executed by healthcare workers (HCW) in their day-to-day contact with patients. This study’s aim was to counterbalance the current predominantly top-down, expert-driven audit and feedback approach for APM, with needs and expectations of HCW. Methods Qualitative semi-structured interviews were held with sixteen HCW (i.e. physicians, residents and nurses) from high-risk AMR departments at a regional hospital in The Netherlands. Deductive coding was succeeded by open and axial coding to establish main codes, subcodes and variations within codes. Results HCW demand insights from audits into all facets of APM in their working routines (i.e. diagnostics, treatment and infection control), preferably in the form of simple and actionable feedback that invites interdisciplinary discussions, so that substantiated actions for improvement can be implemented. AF should not be seen as an isolated ad-hoc intervention, but as a recurrent, long-term, and organic improvement strategy that balances the primary aims of HCW (i.e. improving quality and safety of care for individual patients and HCW) and AMR-experts (i.e. reducing the burden of AMR). Conclusions To unlock the learning and improvement potentials of audit and feedback, HCW’ and AMR-experts’ perspectives should be balanced throughout the whole AF-loop (incl. data collection, analysis, visualization, feedback and planning, implementing and monitoring actions). APM-AF should be flexible, so that both audit (incl. collecting and combining the right data in an efficient and transparent manner) and feedback (incl. persuasive and actionable feedback) can be tailored to the needs of various target groups. To balance HCW’ and AMR-experts’ perspectives a participatory holistic AF development approach is advocated.
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Affiliation(s)
- J Keizer
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, The Netherlands.
| | - N Beerlage-De Jong
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, The Netherlands
| | - N Al Naiemi
- Department of Infection Prevention, Hospital Group Twente, Almelo/Hengelo, The Netherlands.,LabMicTA, Hengelo, The Netherlands
| | - J E W C van Gemert-Pijnen
- Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, P.O. Box 217, Enschede, 7500AE, The Netherlands
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Fernández-Urrusuno R, Meseguer Barros CM, Benavente Cantalejo RS, Hevia E, Serrano Martino C, Irastorza Aldasoro A, Limón Mora J, López Navas A, Pascual de la Pisa B. Successful improvement of antibiotic prescribing at Primary Care in Andalusia following the implementation of an antimicrobial guide through multifaceted interventions: An interrupted time-series analysis. PLoS One 2020; 15:e0233062. [PMID: 32413054 PMCID: PMC7228088 DOI: 10.1371/journal.pone.0233062] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 04/27/2020] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Most effective strategies designed to improve antimicrobial prescribing have multiple approaches. We assessed the impact of the implementation of a rigorous antimicrobial guide and subsequent multifaceted interventions aimed at improving antimicrobial use in Primary Care. METHODS A quasi-experimental study was designed. Interventions aimed at achieving a good implementation of the guide consisted of the development of electronic decision support tools, local training meetings, regional workshops, conferences, targets for rates of antibiotic prescribing linked to financial incentives, feedback on antibiotic prescribing, and the implementation of a structured educational antimicrobial stewardship program. Interventions started in 2011, and continued until 2018. Outcomes: rates of antibiotics use, calculated into defined daily doses per 1,000 inhabitants-day (DID). An interrupted time-series analysis was conducted. The study ran from January 2004 until December 2018. RESULTS Overall annual antibiotic prescribing rates showed increasing trends in the pre-intervention period. Interventions were followed by significant changes on trends with a decline over time in antibiotic prescribing. Overall antibiotic rates dropped by 28% in the Aljarafe Area and 22% in Andalusia between 2011 and 2018, at rates of -0.90 DID per year (95%CI:-1.05 to -0.75) in Aljarafe, and -0.78 DID (95%CI:-0.95 to -0.60) in Andalusia. Reductions occurred at the expense of the strong decline of penicillins use (33% in Aljarafe, 25% in Andalusia), and more precisely, amoxicillin clavulanate, whose prescription plummeted by around 50%. Quinolones rates decreased before interventions, and continued to decline following interventions with more pronounced downward trends. Decreasing cephalosporins trends continued to decline, at a lesser extent, following interventions in Andalusia. Trends of macrolides rates went from a downward trend to an upward trend from 2011 to 2018. CONCLUSIONS Multifaceted interventions following the delivering of a rigorous antimicrobial guide, maintained in long-term, with strong institutional support, could led to sustained reductions in antibiotic prescribing in Primary Care.
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Affiliation(s)
- Rocío Fernández-Urrusuno
- Clinical Unit Primary Care Pharmacy Sevilla, Aljarafe-Sevilla Norte Primary Health Care Area, Andalusian Public Health Care Service, Seville, Spain
| | | | | | - Elena Hevia
- Promotion and Rational Use of Drugs Service, General Direction of Pharmacy, Andalusian Public Health Care Service, Seville, Spain
| | | | | | - Juan Limón Mora
- General Direction of Health Care and Health Outcomes, Andalusian Public Health Care Service, Seville, Spain
| | - Antonio López Navas
- Coordination Unit of the Spanish National Action Plan on Antimicrobial Resistance, Spanish Medicines Agency and Health Products, Madrid, Spain
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Tavakoli M, Hashemi A, Vaezjalali M, Mohammadzadeh M, Goudarzi H. Inhibition of growth and gene expression in Staphylococcus aureus by anti- gyrA peptide nucleic acid. Future Microbiol 2020; 14:1123-1132. [PMID: 31512520 DOI: 10.2217/fmb-2019-0103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Multidrug-resistant Staphylococcus aureus isolates have become a serious concern in clinical microbiology. Antisense strategy, which specifically targets essential genes, could be helpful. Materials & methods: S. aureus cultures were treated with peptide conjugate-peptide nucleic acid (PPNA) specific for the gyrA gene. In addition, antimicrobial synergy with ciprofloxacin was tested. Results: The results indicated anti-gyrA-PPNA dramatically inhibited the growth of S. aureus isolates in Mueller Hinton Broth with complete elimination of bacteria observed on cell cultures. Specifically, PPNA reduced the gyrA transcripts up to 50%. With antisense interference, growth inhibition was augmented through combination with ciprofloxacin. Conclusion: This study suggested that anti-gyrA-PPNAs could be introduced as a novel candidate for developing antisense antibiotic to treat all S. aureus infections.
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Affiliation(s)
- Mahnaz Tavakoli
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Hashemi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Maryam Vaezjalali
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Mohammadzadeh
- Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Alborz, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gentry EM, Kester S, Fischer K, Davidson LE, Passaretti CL. Bugs and Drugs: Collaboration Between Infection Prevention and Antibiotic Stewardship. Infect Dis Clin North Am 2019; 34:17-30. [PMID: 31836329 DOI: 10.1016/j.idc.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Overall goals of antibiotic stewardship and infection prevention programs are to improve patient safety as it pertains to risk of infection or multidrug-resistant organism (MDRO) acquisition. Although the focus of day-to-day activities may differ, the themes of surveillance, education, clinician engagement, and multidisciplinary interactions are prevalent in both programs. Synergistic work between programs has yielded benefits in prevention of MDROs, surgical site infections, Clostridioides difficile infection, and reducing inappropriate testing and treatment for asymptomatic bacteriuria. Collaboration between programs can help maximize resources and minimize redundant work to keep issues related to bugs and drugs at bay.
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Affiliation(s)
- Erin M Gentry
- Antimicrobial Support Network, Carolinas Medical Center, Department of Pharmacy Services, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
| | - Shelley Kester
- Infection Prevention, Division of Quality, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA
| | - Kristin Fischer
- Department of Medicine, Division of Infectious Diseases, Atrium Health, 1540 Garden Terrace, Suite 209, Charlotte, NC 28203, USA
| | - Lisa E Davidson
- Antimicrobial Support Network, Internal Medicine, Division of Infectious Diseases, Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA
| | - Catherine L Passaretti
- Health System Infection Prevention, Internal Medicine, Division of Infectious Diseases, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA
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Capoor MR, Subudhi CP, Collier A, Bal AM. Antifungal stewardship with an emphasis on candidaemia. J Glob Antimicrob Resist 2019; 19:262-268. [DOI: 10.1016/j.jgar.2019.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 05/23/2019] [Accepted: 05/31/2019] [Indexed: 12/28/2022] Open
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19
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Al-Qahtani SM, Baffoe-Bonnie H, El-Saed A, Alshamrani M, Algwizani A, Alaklabi A, AlJoudi K, Albaalharith N, Mohammed A, Hussain S, Balkhy HH. Appropriateness of antimicrobial use among septic patients managed by the critical care response team: an opportunity for improvement through de-escalation. Antimicrob Resist Infect Control 2019; 8:186. [PMID: 31832186 PMCID: PMC6869254 DOI: 10.1186/s13756-019-0609-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 09/21/2019] [Indexed: 01/09/2023] Open
Abstract
Background Most septic patients managed by critical care response teams (CCRT) are prescribed antimicrobials. Nevertheless, data evaluating their appropriateness are lacking both locally and internationally. The objective was to assess antimicrobial use among septic and non-septic patients managed by CCRT. Setting Case-control design was used to compare septic (cases) and non-septic (controls) CCRT patients at tertiary care setting. The frequency of antimicrobial use was assessed before and after CCRT activation. The appropriateness of antimicrobial use was assessed at day four post-CCRT, based on standard recommendations, clinical assessment, and culture results. Main results A total of 157 cases and 158 controls were included. The average age was 61.1 ± 20.4 years, and 54.6% were males, with minor differences between groups. The use of any antimicrobial was 100.0% in cases and 87.3% in controls (p < 0.001). The use of meropenem (68.2% versus 34.8%, p < 0.001) and vancomycin (56.7% versus 25.9%, p < 0.001) were markedly higher in cases than controls. The overall appropriateness was significantly lower in cases than controls (50.7% versus 59.6%, p = 0.047). Individual appropriateness was lowest with meropenem (16.7%) and imipenem (25.0%), and highest with piperacillin/tazobactam (87.1%) and colistin (78.3%). Only 48.5% of antimicrobials prescribed by CCRT were de-escalated by a primary team within four days. Individual appropriateness and de-escalations were not different between groups. Conclusions Empiric use and inadequate de-escalation of broad-spectrum antimicrobials were major causes for inappropriate antimicrobial use in CCRT patients. Our findings highlight the necessity of urgent implementation of an antimicrobial stewardship program, including training and auditing of antimicrobial prescriptions.
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Affiliation(s)
- Saad M Al-Qahtani
- 1Intensive Care Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Henry Baffoe-Bonnie
- 3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Aiman El-Saed
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Majid Alshamrani
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | | | - Ali Alaklabi
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,5Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Khuloud AlJoudi
- 6Pharmacy Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nahlah Albaalharith
- 1Intensive Care Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Azzam Mohammed
- 3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Sajid Hussain
- 1Intensive Care Medicine Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.,7King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Kaljee LM, Prentiss T, Zervos M. Physician barriers to implementation of hospital-based antimicrobial stewardship programs (ASPs): a global perspective. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2019. [DOI: 10.1007/s40506-019-0183-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhuo A, Labbate M, Norris JM, Gilbert GL, Ward MP, Bajorek BV, Degeling C, Rowbotham SJ, Dawson A, Nguyen KA, Hill-Cawthorne GA, Sorrell TC, Govendir M, Kesson AM, Iredell JR, Dominey-Howes D. Opportunities and challenges to improving antibiotic prescribing practices through a One Health approach: results of a comparative survey of doctors, dentists and veterinarians in Australia. BMJ Open 2018; 8:e020439. [PMID: 29602857 PMCID: PMC5884343 DOI: 10.1136/bmjopen-2017-020439] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To explore and compare the knowledge, attitudes and experiences of doctors, dentists and veterinarians (as prescribers) in relation to antibiotic use and antibiotic resistance (AbR), and to consider the implications of these for policy-making that support a One Health approach. DESIGN A cross-sectional survey conducted online. SETTING Doctors, dentists and veterinarians practising in primary, secondary or tertiary care in Australia. PARTICIPANTS 547 doctors, 380 dentists and 403 veterinarians completed the survey. MAIN OUTCOME MEASURES Prescribers' knowledge, attitudes and perceptions of AbR, the extent to which a range of factors are perceived as barriers to appropriate prescribing practices, and perceived helpfulness of potential strategies to improve antibiotic prescribing in practice. RESULTS There was substantial agreement across prescriber groups that action on AbR is required by multiple sectors and stakeholders. However, prescribers externalised responsibility to some extent by seeing the roles of others as more important than their own in relation to AbR. There were common and context-specific barriers to optimal prescribing across the prescriber groups. Prescriber groups generally perceived restrictive policies as unhelpful to supporting appropriate prescribing in their practice. CONCLUSIONS The results have implications for implementing a One Health approach that involves doctors, dentists and veterinarians as key players to tackling the crisis of AbR. The findings are that (1) prescribers understand and are likely receptive to a One Health policy approach to AbR, (2) policy development should be sensitive to barriers that are specific to individual prescriber groups and (3) the development and introduction of interventions that might be perceived as reducing prescriber autonomy will need to be carefully designed and implemented.
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Affiliation(s)
- Annie Zhuo
- School of Geosciences, The University of Sydney, Sydney, NSW, Australia
| | - Maurizio Labbate
- School of Life Sciences, University of Technology Sydney, Sydney, New South Wales, Australia
- The ithree Institute, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Jacqueline M Norris
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Gwendolyn L Gilbert
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Michael P Ward
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
| | - Beata V Bajorek
- Graduate School of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Degeling
- Faculty of Social Science, University of Wollongong, Wollongong, NSW, Australia
| | - Samantha J Rowbotham
- Menzies Centre for Health Policy, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
- The Australian Prevention Partnership Centre, The Sax Institute, Sydney, New South Wales, Australia
| | - Angus Dawson
- Sydney Health Ethics, University of Sydney, Sydney, New South Wales, Australia
| | - Ky-Anh Nguyen
- Faculty of Dentistry, University of Sydney, Sydney, New South Wales, Australia
- Institute of Dental Research, Westmead Centre for Oral Health, Sydney, New South Wales, Australia
| | - Grant A Hill-Cawthorne
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tania C Sorrell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
| | - Merran Govendir
- Sydney School of Veterinary Science, University of Sydney, Sydney, New South Wales, Australia
| | - Alison M Kesson
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Infectious Disease and Microbiology, The Children’s Hospital at Westmead, Sydney, NSW, Australia
| | - Jonathan R Iredell
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
- Westmead Institute for Medical Research, Sydney, New South Wales, Australia
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Dale Dominey-Howes
- School of Geosciences, The University of Sydney, Sydney, NSW, Australia
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, New South Wales, Australia
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Xu B, Ding X, Wu Y, Cui L, Qian P, Wang D, Zhao Y. Synthesis and antibacterial activity of oxazolidinone derivatives containing nitro heteroaromatic moiety. Chem Res Chin Univ 2018. [DOI: 10.1007/s40242-018-7302-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Bonsignore M, Balamitsa E, Nobis C, Tafelski S, Geffers C, Nachtigall I. Antibiotic stewardship an einem Krankenhaus der Grund- und Regelversorgung. Anaesthesist 2018; 67:47-55. [DOI: 10.1007/s00101-017-0399-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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López-Cortés LE, Rosso-Fernández C, Núñez-Núñez M, Lavín-Alconero L, Bravo-Ferrer J, Barriga Á, Delgado M, Lupión C, Retamar P, Rodríguez-Baño J. Targeted simplification versus antipseudomonal broad-spectrum beta-lactams in patients with bloodstream infections due to Enterobacteriaceae (SIMPLIFY): a study protocol for a multicentre, open-label, phase III randomised, controlled, non-inferiority clinical trial. BMJ Open 2017; 7:e015439. [PMID: 28601833 PMCID: PMC5734512 DOI: 10.1136/bmjopen-2016-015439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 04/04/2017] [Accepted: 04/27/2017] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Within the context of antimicrobial stewardship programmes, de-escalation of antimicrobial therapy is one of the proposed strategies for reducing the unnecessary use of broad-spectrum antibiotics (BSA). The empirical treatment of nosocomial and some healthcare-associated bloodstream infections (BSI) frequently includes a beta-lactam with antipseudomonal activity as monotherapy or in combination with other drugs, so there is a great opportunity to optimise the empirical therapy based on microbiological data. De-escalation is assumed as standard of care for experts in infectious diseases. However, it is less frequent than it would desirable. METHODS AND ANALYSIS The SIMPLIFY trial is a multicentre, open-label, non-inferiority phase III randomised controlled clinical trial, designed as a pragmatic 'real-practice' trial. The aim of this trial is to demonstrate the non-inferiority of de-escalation from an empirical beta-lactam with antipseudomonal activity to a targeted narrow-spectrum antimicrobial in patients with BSI due to Enterobacteriaceae. The primary outcome is clinical cure, which will be assessed at the test of cure visit. It will be conducted at 19 Spanish public and university hospitals. ETHICS AND DISSEMINATION Each participating centre has obtained the approval of the ethics review committee, the agreement of the directors of the institutions and authorisation from the Spanish Regulatory Agency (Agencia Española del Medicamento y Productos Sanitarios). Data will be presented at international conferences and published in peer-reviewed journals. DISCUSSION Strategies to reduce the use of BSA should be a priority. Most of the studies that support de-escalation are observational, retrospective and heterogeneous. A recent Cochrane review stated that well-designed clinical trials should be conducted to assess the safety and efficacy of de-escalation. TRIAL REGISTRATION NUMBER The European Union Clinical Trials Register: EudraCT number 2015-004219-19. Clinical trials.gov: NCT02795949. Protocol version: V.2.0, dated 16 May 2016. All items from the WHO Trial Registration Data Set are included in the registry.
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Affiliation(s)
- Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Clara Rosso-Fernández
- Unidad de Investigación Clínica y Ensayos Clínicos (UICEC-HUVR), Hospitales Universitario Virgen del Rocío y Virgen Macarena, Sevilla, Spain
- Farmacología Clínica, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - María Núñez-Núñez
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
- Unidad Clínica de Farmacia. Hospitales Universitarios Virgen Macarena, Sevilla, Spain
| | - Lucía Lavín-Alconero
- Unidad de Investigación Clínica y Ensayos Clínicos (UICEC-HUVR), Hospitales Universitario Virgen del Rocío y Virgen Macarena, Sevilla, Spain
| | - José Bravo-Ferrer
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Ángel Barriga
- Unidad de Investigación Clínica y Ensayos Clínicos (UICEC-HUVR), Hospitales Universitario Virgen del Rocío y Virgen Macarena, Sevilla, Spain
| | - Mercedes Delgado
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Carmen Lupión
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Pilar Retamar
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas y Microbiología Clínica, Instituto de Biomedicina de Sevilla (IBiS)/Hospital Universitario Virgen Macarena /CSIC/Universidad de Sevilla, Sevilla, Spain
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Adeniji F. Global analysis of strategies to tackle antimicrobial resistance. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2017; 26:85-89. [PMID: 28544416 DOI: 10.1111/ijpp.12365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 02/10/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global public health issue driven by inappropriate use of antimicrobials resulting in decreased efficacy on the background of an extremely limited pipeline for new antibiotics. We sought to analyse the effectiveness of key policies and strategies in tackling AMR globally and identify gaps in these. METHOD The scope, magnitude, history and drivers of AMR were reviewed using supporting evidence. Our methodology included a literature review and semi-structured survey, whilst the analyses process was guided by an adapted health policy analyses framework. RESULTS Six key policies of global, UK and Nigerian origin were identified along with supporting literature. Seven respondents from key organisations were identified and interviewed. Their responses were analysed using framework analyses principles. CONCLUSIONS Antimicrobial resistance is driven by several factors, ranging from poverty to poor implementation of inadequate policies. The UK AMR strategy is the most comprehensive with room for improvement. Nigeria lacks a specific AMR policy, but has other policies which address health system drivers of AMR. Similarly, the UK's surveillance system is extensive with recent findings corresponding to global findings. Nigeria's surveillance system is focused on detecting and tackling epidemics as indicated by its recent success with Ebola, but there is room for improvement and it could be expanded to cover AMR. Global policies do not add much value to the UK strategy and provide little guidance on how low-income countries, for example Nigeria can fill current gaps in surveillance and policies as key drivers are not fully addressed.
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Affiliation(s)
- Funke Adeniji
- London School of Hygiene & Tropical Medicine, London, UK
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Reynolds-Campbell G, Nicholson A, Thoms-Rodriguez CA. Oral Bacterial Infections: Diagnosis and Management. Dent Clin North Am 2017; 61:305-318. [PMID: 28317568 DOI: 10.1016/j.cden.2016.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The human oral cavity contains more than 500 different bacterial species. These organisms belong to several phyla including Bacteroidetes, Firmicutes, Tenericutes, Actinobacteria, Proteobacteria, Euryarchaeota, Chlamydiae, and Spirochaetes. Many of these have the ability to colonize the gingival crevices and the outer surface of the tooth forming biofilms often leading to dental plaque formation. These bacteria produce acid that erode teeth causing cavities or infections. The diagnosis of these infections is often clinical and antibiotics are used empirically to treat some infections or as prophylaxis. The characterization, definitive diagnosis, and susceptibility testing of oral bacterial infections are valuable in guiding appropriate therapy and in prevention of disease.
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Affiliation(s)
| | - Alison Nicholson
- Department of Microbiology, The University of the West Indies, Mona, KGN 7, Jamaica, West Indies
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Liu P, Ohl C, Johnson J, Williamson J, Beardsley J, Luther V. Frequency of empiric antibiotic de-escalation in an acute care hospital with an established Antimicrobial Stewardship Program. BMC Infect Dis 2016; 16:751. [PMID: 27955625 PMCID: PMC5153830 DOI: 10.1186/s12879-016-2080-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Accepted: 12/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Expanding antimicrobial resistance patterns in the face of stagnant growth in novel antibiotic production underscores the importance of antibiotic stewardship in which de-escalation remains an integral component. We measured the frequency of antibiotic de-escalation in a tertiary care medical center with an established antimicrobial stewardship program to provide a plausible benchmark for de-escalation. METHODS A retrospective, observational study was performed by review of randomly selected electronic medical records of 240 patients who received simultaneous piperacillin/tazobactam and vancomycin from January to December 2011 at an 885-bed tertiary care medical center. Patient characteristics including antibiotic regimen, duration and indication, culture results, length of stay, and hospital mortality were evaluated. Antibiotic de-escalation was defined as the use of narrower spectrum antibiotics or the discontinuation of antibiotics after initiation of piperacillin/tazobactam and vancomycin therapy. Subjects dying within 72 h of antibiotic initiation were considered not de-escalated for subsequent analysis and were subtracted from the study population in determining a modified mortality rate. RESULTS The most commonly documented indications for piperacillin/tazobactam and vancomycin therapy were pneumonia and sepsis. Of the 240 patients studied, 151 (63%) had their antibiotic regimens de-escalated by 72 h. The proportion of patients de-escalated by 96 h with positive vs. negative cultures was similar, 71 and 72%, respectively. Median length of stay was 4 days shorter in de-escalated patients, and the difference in adjusted mortality was not significant (p = 0.82). CONCLUSIONS The empiric antibiotic regimens of approximately two-thirds of patients were de-escalated by 72 h in an institution with a well-established antimicrobial stewardship program. While this study provides one plausible benchmark for antibiotic de-escalation, further studies, including evaluations of antibiotic appropriateness and patient outcomes, are needed to inform decisions on potential benchmarks for antibiotic de-escalation.
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Affiliation(s)
- Peter Liu
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Christopher Ohl
- Wake Forest School of Medicine, Section on Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - James Johnson
- Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - John Williamson
- Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - James Beardsley
- Wake Forest Baptist Health, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Vera Luther
- Wake Forest School of Medicine, Section on Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
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Avent ML, Hall L, Davis L, Allen M, Roberts JA, Unwin S, McIntosh KA, Thursky K, Buising K, Paterson DL. Antimicrobial stewardship activities: a survey of Queensland hospitals. AUST HEALTH REV 2016; 38:557-63. [PMID: 25376911 DOI: 10.1071/ah13137] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 08/20/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE In 2011, the Australian Commission on Safety and Quality in Health Care (ACSQHC) recommended that all hospitals in Australia must have an Antimicrobial Stewardship (AMS) program by 2013. Nevertheless, little is known about current AMS activities. This study aimed to determine the AMS activities currently undertaken, and to identify gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. METHODS The AMS activities of 26 facilities from 15 hospital and health services in Queensland were surveyed during June 2012 to address strategies for effective AMS: implementing clinical guidelines, formulary restriction, reviewing antimicrobial prescribing, auditing antimicrobial use and selective reporting of susceptibility results. RESULTS The response rate was 62%. Nineteen percent had an AMS team (a dedicated multidisciplinary team consisting of a medically trained staff member and a pharmacist). All facilities had access to an electronic version of Therapeutic Guidelines: Antibiotic, with a further 50% developing local guidelines for antimicrobials. One-third of facilities had additional restrictions. Eighty-eight percent had advice for restricted antimicrobials from in-house infectious disease physicians or clinical microbiologists. Antimicrobials were monitored with feedback given to prescribers at point of care by 76% of facilities. Deficiencies reported as barriers to establishing AMS programs included: pharmacy resources, financial support by hospital management, and training and education in antimicrobial use. CONCLUSIONS Several areas for improvement were identified: reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use. There also appears to be a lack of resources to support AMS programs in some facilities. WHAT IS KNOWN ABOUT THE TOPIC?: The ACSQHC has recommended that all hospitals implement an AMS program by 2013 as a requirement of Standard 3 (Preventing and Controlling Healthcare-Associated Infections) of the National Safety and Quality Health Service Standards. The intent of AMS is to ensure appropriate prescribing of antimicrobials as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections, and improve patient safety and quality of care. This criterion also aligns closely with Standard 4: Medication Safety. Despite this recommendation, little is known about what AMS activities are undertaken in these facilities and what additional resources would be required in order to meet these national standards. WHAT DOES THE PAPER ADD?: This is the first survey that has been conducted of public hospital and health services in Queensland, a large decentralised state in Australia. This paper describes what AMS activities are currently being undertaken, identifies practice gaps, barriers to implementation and opportunities for improvement in Queensland hospitals. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: Several areas for improvement such as reviewing antimicrobial prescribing with feedback to the prescriber, auditing, and training and education in antimicrobial use have been identified. In addition, there appears to be a lack of resources to support AMS programs in some facilities.
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Affiliation(s)
- Minyon L Avent
- Infection and Immunity Theme, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Qld 4006, Australia.
| | - Lisa Hall
- Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia.
| | - Louise Davis
- Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia.
| | - Michelle Allen
- Centre for Healthcare Related Infection Surveillance and Prevention, Communicable Diseases Unit, Queensland Health, Herston, Qld 4006, Australia.
| | - Jason A Roberts
- Burns Trauma and Critical Care Research Centre, The University of Queensland, Level 3 Ned Hanlon Building, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Qld 4029, Australia.
| | - Sean Unwin
- Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia.
| | - Kylie A McIntosh
- Department of Health, 50 Lonsdale Street, Melbourne, Victoria 3000.
| | - Karin Thursky
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Melbourne, Vic. 3000, Australia.
| | - Kirsty Buising
- Victorian Infectious Diseases Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, Melbourne, Vic. 3000, Australia.
| | - David L Paterson
- Infection and Immunity Theme, UQ Centre for Clinical Research (UQCCR), Level 8, Building 71/918 Royal Brisbane and Women's Hospital, Herston, Qld 4006, Australia.
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Shashikala N, Joseph NM, Karnam AHF, Rasitha D, Kanungo R. Failure of educational interventions to reduce use of carbapenems in the intensive care unit of a tertiary care hospital. J Hosp Infect 2016; 94:130-1. [PMID: 27301953 DOI: 10.1016/j.jhin.2016.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/12/2016] [Indexed: 10/21/2022]
Affiliation(s)
- N Shashikala
- Pondicherry Institute of Medical Sciences, Puducherry, Pondicherry, India.
| | - N M Joseph
- Pondicherry Institute of Medical Sciences, Puducherry, Pondicherry, India
| | - A H F Karnam
- Pondicherry Institute of Medical Sciences, Puducherry, Pondicherry, India
| | - D Rasitha
- Pondicherry Institute of Medical Sciences, Puducherry, Pondicherry, India
| | - R Kanungo
- Pondicherry Institute of Medical Sciences, Puducherry, Pondicherry, India
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The Role of Mathematical Modeling in Designing and Evaluating Antimicrobial Stewardship Programs. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0074-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Impact of different cell penetrating peptides on the efficacy of antisense therapeutics for targeting intracellular pathogens. Sci Rep 2016; 6:20832. [PMID: 26860980 PMCID: PMC4748415 DOI: 10.1038/srep20832] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Accepted: 01/08/2016] [Indexed: 12/20/2022] Open
Abstract
There is a pressing need for novel and innovative therapeutic strategies to address infections caused by intracellular pathogens. Peptide nucleic acids (PNAs) present a novel method to target intracellular pathogens due to their unique mechanism of action and their ability to be conjugated to cell penetrating peptides (CPP) to overcome challenging delivery barriers. In this study, we targeted the RNA polymerase α subunit (rpoA) using a PNA that was covalently conjugated to five different CPPs. Changing the conjugated CPP resulted in a pronounced improvement in the antibacterial activity observed against Listeria monocytogenes in vitro, in cell culture, and in a Caenorhabditis elegans (C. elegans) infection model. Additionally, a time-kill assay revealed three conjugated CPPs rapidly kill Listeria within 20 minutes without disrupting the bacterial cell membrane. Moreover, rpoA gene silencing resulted in suppression of its message as well as reduced expression of other critical virulence genes (Listeriolysin O, and two phospholipases plcA and plcB) in a concentration-dependent manner. Furthermore, PNA-inhibition of bacterial protein synthesis was selective and did not adversely affect mitochondrial protein synthesis. This study provides a foundation for improving and developing PNAs conjugated to CPPs to better target intracellular pathogens.
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Adherence to European Association of Urology Guidelines on Prophylactic Antibiotics: An Important Step in Antimicrobial Stewardship. Eur Urol 2016; 69:276-83. [PMID: 26001610 DOI: 10.1016/j.eururo.2015.05.010] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 05/07/2015] [Indexed: 11/24/2022]
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"Choosing Wisely Canada" and antimicrobial stewardship: A shared focus on reducing unnecessary care. ACTA ACUST UNITED AC 2015; 41:9-13. [PMID: 29769967 DOI: 10.14745/ccdr.v41is4a03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
There is a growing movement in medicine which recognizes that some tests, treatments or procedures do not add value for patients, and may even cause harm. The "Choosing Wisely Canada" campaign is a grassroots, physician-led campaign to engage physicians and patients in conversations about overuse of unnecessary tests, treatments and procedures to improve the quality of health care. This article reviews the underlying principles of this campaign and its spread across Canada. It also highlights the alignment between the principles of Choosing Wisely Canada with those of antimicrobial stewardship, which share similar motivations, challenges and opportunities.
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Zhang YZ, Singh S. Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us. World J Crit Care Med 2015; 4:13-28. [PMID: 25685719 PMCID: PMC4326760 DOI: 10.5492/wjccm.v4.i1.13] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/21/2014] [Accepted: 12/17/2014] [Indexed: 02/06/2023] Open
Abstract
Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include “standard” control of antibiotic prescribing such as “de-escalation strategies”through to interventional approaches utilising biomarker-guided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 non-protocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.
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Howard P, Pulcini C, Levy Hara G, West RM, Gould IM, Harbarth S, Nathwani D. An international cross-sectional survey of antimicrobial stewardship programmes in hospitals. J Antimicrob Chemother 2014; 70:1245-55. [PMID: 25527272 DOI: 10.1093/jac/dku497] [Citation(s) in RCA: 165] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES To report the extent and components of global efforts in antimicrobial stewardship (AMS) in hospitals. METHODS An Internet-based survey comprising 43 questions was disseminated worldwide in 2012. RESULTS Responses were received from 660 hospitals in 67 countries: Africa, 44; Asia, 50; Europe, 361; North America, 72; Oceania, 30; and South and Central America, 103. National AMS standards existed in 52% of countries, 4% were planning them and 58% had an AMS programme. The main barriers to implementing AMS programmes were perceived to be a lack of funding or personnel, a lack of information technology and prescriber opposition. In hospitals with an existing AMS programme, AMS rounds existed in 64%; 81% restricted antimicrobials (carbapenems, 74.3%; quinolones, 64%; and cephalosporins, 58%); and 85% reported antimicrobial usage, with 55% linking data to resistance rates and 49% linking data to infection rates. Only 20% had electronic prescribing for all patients. A total of 89% of programmes educated their medical, nursing and pharmacy staff on AMS. Of the hospitals, 38% had formally reviewed their AMS programme: reductions were reported by 96% of hospitals for inappropriate prescribing, 86% for broad-spectrum antibiotic use, 80% for expenditure, 71% for healthcare-acquired infections, 65% for length of stay or mortality and 58% for bacterial resistance. CONCLUSIONS The worldwide development and implementation of AMS programmes varies considerably. Our results should inform and encourage the further evaluation of this with a view to promoting a worldwide stewardship framework. The prospective measurement of well-defined outcomes of the impact of these programmes remains a significant challenge.
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Affiliation(s)
- P Howard
- Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX, UK
| | - C Pulcini
- CHU de Nancy, Service de Maladies Infectieuses, Nancy, France Université de Lorraine, Université Paris Descartes, EA 4360 Apemac, Nancy, France
| | - G Levy Hara
- Infectious Diseases Unit, Hospital Carlos G Durand, Buenos Aires, Argentina
| | - R M West
- Leeds Institute for Health Sciences, University of Leeds, Leeds LS2 9LJ, UK
| | - I M Gould
- Microbiology, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - D Nathwani
- Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
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Brooks BD, Brooks AE. Therapeutic strategies to combat antibiotic resistance. Adv Drug Deliv Rev 2014; 78:14-27. [PMID: 25450262 DOI: 10.1016/j.addr.2014.10.027] [Citation(s) in RCA: 207] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Revised: 10/20/2014] [Accepted: 10/22/2014] [Indexed: 12/16/2022]
Abstract
With multidrug resistant bacteria on the rise, new antibiotic approaches are required. Although a number of new small molecule antibiotics are currently in the development pipeline with many more in preclinical development, the clinical options and practices for infection control must be expanded. Biologics and non-antibiotic adjuvants offer this opportunity for expansion. Nevertheless, to avoid known mechanisms of resistance, intelligent combination approaches for multiple simultaneous and complimentary therapies must be designed. Combination approaches should extend beyond biologically active molecules to include smart controlled delivery strategies. Infection control must integrate antimicrobial stewardship, new antibiotic molecules, biologics, and delivery strategies into effective combination therapies designed to 1) fight the infection, 2) avoid resistance, and 3) protect the natural microbiome. This review explores these developing strategies in the context of circumventing current mechanisms of resistance.
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Affiliation(s)
| | - Amanda E Brooks
- Department of Pharmaceutics and Pharmaceutical Chemistry, University of Utah, Salt Lake City, UT 84112, USA; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, ND58108, USA.
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Hasanin A, Eladawy A, Mohamed H, Salah Y, Lotfy A, Mostafa H, Ghaith D, Mukhtar A. Prevalence of extensively drug-resistant gram negative bacilli in surgical intensive care in Egypt. Pan Afr Med J 2014; 19:177. [PMID: 25815098 PMCID: PMC4366122 DOI: 10.11604/pamj.2014.19.177.4307] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 10/09/2014] [Indexed: 11/11/2022] Open
Abstract
Introduction The prevalence of extensively drug resistant gram negative bacilli (XDR-GNB) is rapidly progressing; however in Egypt data are sparse. We conducted the present study to quantify the incidence, risk factors and outcome of patients harboring XDR-GNB. Methods A one year prospective study was done by collecting all the bacteriological reports for cultures sent from the surgical intensive care unit, Cairo university teaching hospital. XDR-GNB were defined as any gram negative bacilli resistant to three or more classes of antimicrobial agents. Patients with XDR-GNB compared with those sustaining non extensively drug-resistant infection. A multivariate logistic regression model was created to identify independent predictors of multi-resistance. Results During one-year study period, a total of 152 samples (65%) out of 234 gram negative bacilli samples developed extensively drug resistant infection. XDR strains were significantly higher in Acinetobacterspp (86%), followed by Pseudomonas (63%), then Proteus (61%), Klebsiella (52%), and E coli (47%). Fourth generation cephalosporine (Cefipime) had the lowest susceptibility (10%) followed by third generation cephalosporines (11%), Quinolones (31%), Amikacin (42%), Tazobactam (52%), Carbapinems (52%), and colistin (90%). Relaparotomy was the only significant risk factor for acquisition of XDR infection. Conclusion Extensively drug-resistant gram negative infections are frequent in our ICU. This is an alarming health care issue in Egypt which emphasizes the need to rigorously implement infection control practices.
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Affiliation(s)
- Ahmed Hasanin
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Akram Eladawy
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hossam Mohamed
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmin Salah
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Lotfy
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hanan Mostafa
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Doaa Ghaith
- Department of clinical pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Mukhtar
- Department of anesthesia, Faculty of Medicine, Cairo University, Cairo, Egypt
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Carroll SP, Jørgensen PS, Kinnison MT, Bergstrom CT, Denison RF, Gluckman P, Smith TB, Strauss SY, Tabashnik BE. Applying evolutionary biology to address global challenges. Science 2014; 346:1245993. [PMID: 25213376 PMCID: PMC4245030 DOI: 10.1126/science.1245993] [Citation(s) in RCA: 153] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Two categories of evolutionary challenges result from escalating human impacts on the planet. The first arises from cancers, pathogens, and pests that evolve too quickly and the second, from the inability of many valued species to adapt quickly enough. Applied evolutionary biology provides a suite of strategies to address these global challenges that threaten human health, food security, and biodiversity. This Review highlights both progress and gaps in genetic, developmental, and environmental manipulations across the life sciences that either target the rate and direction of evolution or reduce the mismatch between organisms and human-altered environments. Increased development and application of these underused tools will be vital in meeting current and future targets for sustainable development.
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Affiliation(s)
- Scott P Carroll
- Department of Entomology, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA. Institute for Contemporary Evolution, Davis, CA 95616, USA.
| | - Peter Søgaard Jørgensen
- Center for Macroecology, Evolution and Climate, Department of Biology, University of Copenhagen, 2100 Copenhagen, Denmark. Center for Macroecology, Evolution and Climate, Natural History Museum of Denmark, University of Copenhagen, 2100 Copenhagen, Denmark.
| | - Michael T Kinnison
- School of Biology and Ecology, University of Maine, Orono, ME 04469, USA
| | - Carl T Bergstrom
- Department of Biology, University of Washington, Seattle, WA 98195, USA
| | - R Ford Denison
- Department of Ecology, Evolution, and Behavior, University of Minnesota, Minneapolis, MN 55108, USA
| | - Peter Gluckman
- Centre for Human Evolution, Adaptation and Disease, Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Thomas B Smith
- Department of Ecology and Evolutionary Biology, University of California, Los Angeles, CA 90095, USA. Center for Tropical Research, Institute of the Environment and Sustainability, University of California, Los Angeles, 619 Charles E. Young Drive East, Los Angeles, 90095-1496, CA
| | - Sharon Y Strauss
- Department of Evolution and Ecology and Center for Population Biology, University of California, Davis, One Shields Avenue, CA 95616, USA
| | - Bruce E Tabashnik
- Department of Entomology, University of Arizona, Tucson, AZ 85721, USA
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Trivedi KK, Dumartin C, Gilchrist M, Wade P, Howard P. Identifying Best Practices Across Three Countries: Hospital Antimicrobial Stewardship in the United Kingdom, France, and the United States. Clin Infect Dis 2014; 59 Suppl 3:S170-8. [DOI: 10.1093/cid/ciu538] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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López-Medrano F, Moreno-Ramos F, de Cueto M, Mora-Rillo M, Salavert M. How to assist clinicians in improving antimicrobial prescribing: tools and interventions provided by stewardship programs. Enferm Infecc Microbiol Clin 2014; 31 Suppl 4:38-44. [PMID: 24129288 DOI: 10.1016/s0213-005x(13)70131-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In the last decade, there has been an exponential increase in the microorganisms resistant to antimicrobials and a significant increase in the cost of these types of drugs. This phenomenon has increased interest in the development of interventions for counseling on and control of the use of antimicrobials, referred to as stewardship programs. In this article we review, from various points of view, the tools that have been developed with this purpose. First, we highlight the value of locally adapted guidelines and clinical pathways as an essential part of the operational process. Then we emphasize the importance of the relationship between microbiologists and clinicians for the accurate transmission of the information provided by blood cultures to make the most appropriate choice of antimicrobial for the patient's treatment. We also review the computerized tools that have facilitated the correct use of antimicrobials according to the controls established by the departments of pharmacy. Based on the previous tools, some programs based on "bedside recommendations" provided by multidisciplinary teams have been developed for optimizing the rational use of antimicrobials (PROA programs). Finally, we comment on the peculiarities of the programs targeting antifungals that have been developed in recent years.
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Affiliation(s)
- Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Fundación de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Morhard R, Katz R. Legal and Regulatory Capacity to Support the Global Health Security Agenda. Biosecur Bioterror 2014; 12:254-62. [DOI: 10.1089/bsp.2014.0023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Pawluk S, Black E, El-Awaisi A. Strategies for improving antibiotic use in Qatar: a survey of pharmacists' perceptions and experiences. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:77-9. [PMID: 24650133 DOI: 10.1111/ijpp.12108] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Accepted: 01/18/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The objectives of this study were to identify antimicrobial stewardship activities in Qatar, identify pharmacist involvement in activities and summarize perceived barriers for implementation of antimicrobial stewardship programs (ASPs). METHODS A cross-sectional survey was developed based on study objectives and completed by pharmacists in Qatar. KEY FINDINGS Most hospital settings have implemented components of ASP. Lack of infectious disease specialists and training of healthcare providers was the most common barrier to implementation or expansion of ASP identified in the hospital and community settings respectively. CONCLUSION Pharmacists report some components of ASP have been implemented; however, barriers must be overcome to further expand ASPs.
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Affiliation(s)
- Shane Pawluk
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
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Moro ML, Gagliotti C. Antimicrobial resistance and stewardship in long-term care settings. Future Microbiol 2014; 8:1011-25. [PMID: 23902147 DOI: 10.2217/fmb.13.75] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Infections and antimicrobial resistance (AMR) in long-term care facilities (LTCFs) are a public health challenge and a future infectious disease threat. More and more data show the dimension and impact of AMR and of inappropriate use of antimicrobials in this setting. Recently, the spread of carbapenemase-producing Enterobacteriaceae has provided new insights into the dangerous role the long-term care sector may play in the AMR problem in a community. Implementation of effective infection and surveillance control programs in LTCFs is challenging, due to scarce resources (personnel, expertise, diagnostic and supportive services), and no or poor coordination of medical care. However, interventions in LTCFs have been proven to be effective: inappropriate use of antibiotics for asymptomatic bacteriuria may be reduced; hand hygiene compliance may be improved; and the transmission of multidrug-resistant organisms may be halted. This paper reviews the most recent epidemiological information on this issue, providing references to valuable intervention programs.
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Affiliation(s)
- Maria Luisa Moro
- Infectious Risk Unit, Agenzia Sanitaria e Sociale Regione Emilia-Romagna, Bologna, Italy.
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Sridharan P, Chamberlain RS. The efficacy of procalcitonin as a biomarker in the management of sepsis: slaying dragons or tilting at windmills? Surg Infect (Larchmt) 2013; 14:489-511. [PMID: 24274059 DOI: 10.1089/sur.2012.028] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Sepsis is defined as systemic inflammatory response syndrome (SIRS) in the context of an underlying infectious process, and is associated with high rates of morbidity and mortality, particularly when initial therapy is delayed. Numerous biomarkers, including but not limited to cytokines (interleukins-2 and -6 [IL-2, IL-6] and tumor necrosis factor-α [TNF-α]), leukotrienes, acute-phase proteins (C-reactive protein [CRP]), and adhesion molecules, have been evaluated and rejected as unsuitable for the diagnosis of sepsis, predicting its severity, and guiding its treatment. Most recently, procalcitonin (PCT) has been suggested as a novel biomarker that may be useful in guiding therapeutic decision making in the management of sepsis. This article assesses critically the published literature on the clinical utility of PCT concentrations for guiding the treatment of sepsis in adult patients. METHODS A comprehensive search of all published studies of the use of serum concentrations of PCT to guide the treatment of sepsis in adult patients (1996 to 2011) was conducted with PubMed and Google Scholar. The search focused on the value of PCT concentrations to guide the diagnosis, prognosis, monitoring, and escalation and de-escalation of antbiotic therapy in these patients. Keywords searched included "procalcitonin," "sepsis," "sepsis biomarker," "sepsis diagnosis," "sepsis prognosis," "sepsis mortality," "antibiotic escalation," "antibiotic de-escalation," "antibiotic duration," and "antimicrobial stewardship." RESULTS Forty-six trials evaluating the efficacy of PCT concentrations in diagnosing sepsis have been published, with 39 of these trials yielding positive results and 7 yielding negative results. Wanner et al. published the largest study (n=405) demonstrating that peak PCT concentrations occur early after injury in both patients with sepsis and those with multiple organ dysfunction syndrome (MODS). Among 17 trials assessing the prognostic value of PCT concentrations with regard to clinical outcome and morbidity, 12 trials yielded positive results and five showed negative or equivocal results. Reith et al. published the largest study of the prognostic use of PCT concentrations (n=246), demonstrating that median PCT values on post-operative days (POD) one, four, and 10 were predictive of mortality in patients with abdominal sepsis (p<0.01). Among 14 trials of the utility of PCT concentrations for establishing an infectious cause of sepsis, 13 yielded positive results and only one yielded negative results. The largest study of this use of PCT concentrations, conducted by Baykut et al. (n=400), evaluated these concentrations in post-operative patients with infection, and demonstrated that concentrations of PCT remained elevated until POD 4, with a second increase observed between POD 4 and POD 6. In uninfected patients, PCT concentrations began to decrease on POD 2. Only a single study has assessed the utility of PCT concentrations in guiding the escalation of antibiotic therapy, and its results were negative. Specifically, Jensen et al. (n=1,200) compared a PCT-guided antibiotic escalation strategy with the standard of care for sepsis and found no difference in outcomes. They also found that the PCT group had a longer average stay in the intensive care unit (ICU), greater rates of mechanical ventilation, and a decreased estimated glomerular filtration rate (eGFR). Among four trials focusing on PCT concentrations and antibiotic de-escalation, all showed positive results with the measurement of PCT concentrations. The largest such study, by Bouadma et al. (n=621), demonstrated a four-day decrease in antibiotic duration when PCT concentrations were used to guide therapy relative to the study arm given the standard of care, with no increase in mortality (p=0.003). CONCLUSIONS The diagnostic value of serum PCT concentrations for discriminating among SIRS, sepsis, severe sepsis, and septic shock remains to be established. Although higher PCT concentrations suggest a systemic bacterial infection as opposed to a viral, fungal, or inflammatory etiology of sepsis, serum PCT concentrations do not correlate with the severity of sepsis or with mortality. At present, PCT concentrations are solely investigational with regard to determining the timing and appropriateness of escalation of antimicrobial therapy in sepsis. Nevertheless, serum PCT concentrations have established utility in monitoring the clinical response to medical and surgical therapy for sepsis, and in surveillance for the development of sepsis in burn and ICU patients, and may have a role in guiding the de-escalation of antibiotic therapy.
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Affiliation(s)
- Prasanna Sridharan
- 1 Department of Surgery, Saint Barnabas Medical Center , Livingston, New Jersey
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Affiliation(s)
- Jordi Rello
- Critical Care Department, Vall d'Hebron Institute of Research, CIBERES, Universitat Autònoma de Barcelona, Barcelona, Spain.
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Abbo L, Lo K, Sinkowitz-Cochran R, Burke AC, Hopkins RS, Srinivasan A, Hooton TM. Antimicrobial stewardship programs in Florida's acute care facilities. Infect Control Hosp Epidemiol 2013; 34:634-7. [PMID: 23651897 DOI: 10.1086/670632] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We surveyed acute care facilities in Florida to assess components of and barriers to sustained antimicrobial stewardship programs (ASPs). Most respondents with and without ASPs are doing some stewardship-related activities to improve antimicrobial use. Collaborative efforts between facilities and health departments are important to providing better resources for ASPs.
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Affiliation(s)
- Lilian Abbo
- University of Miami Miller School of Medicine, Department of Medicine, Division of Infectious Diseases, Miami, Florida 33136, USA.
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Bateman VM, Gould IM. Measures to prevent antimicrobial resistance. Microb Drug Resist 2013. [DOI: 10.2217/ebo.13.126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Vhairi M Bateman
- After graduating from Dundee University (UK) in 2003 and completing a rotation in general medical specialties, Vhairi M Bateman has been working as a specialty trainee in infectious diseases and medical microbiology at Aberdeen Royal Infirmary (UK) since 2008. She has previously worked as a clinical research fellow with an interest in Clostridium difficile infection
| | - Ian M Gould
- Ian M Gould is Consultant Clinical Microbiologist and Director of Medical Microbiology at Aberdeen Royal Infirmary (UK), and Honorary Professor of Public Health, Epidemiology and Microbiology at the University of Trnava (Slovakia). He has trained in clinical microbiology and infectious diseases in the UK, Canada and Africa. He is an editor or board member of several international journals and chairman of various national/international working parties, learned societies and advisory boards on antibiotic
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Trivedi KK, Rosenberg J. The state of antimicrobial stewardship programs in California. Infect Control Hosp Epidemiol 2013; 34:379-84. [PMID: 23466911 DOI: 10.1086/669876] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess antimicrobial stewardship programs (ASPs) and strategies in California general acute care hospitals and to describe the effect of state legislation (Senate Bill 739) requiring hospitals to develop processes for evaluating the judicious use of antimicrobials. DESIGN Web-based survey of general acute care hospitals. PARTICIPANTS All 422 general acute care hospital campuses in California were invited to participate. RESULTS Responses from 223 (53%) of California's general acute care hospital campuses were included and were statistically representative of all acute care hospital campuses by region but not bed size or rurality. Community hospitals represented 73% of respondents. Fifty percent of hospitals described a current ASP and 30% reported planning an ASP; of these, 51% reported measuring outcomes. Twenty percent of hospitals reported no planned ASP or uncertainty whether an ASP existed and described barriers including staffing constraints (47%), lack of funding (42%), and lack of initiation of a formal proposal to start an ASP (42%). Of 135 responding hospitals, 22% reported that Senate Bill 739 influenced initiation of their ASP. CONCLUSIONS Although many studies have been published that describe hospital-specific ASPs, most have been described within academic centers, and there are limited assessments of ASP strategies across hospital systems. Our study verifies that many ASPs exist in California, particularly in community settings where a scarcity of antimicrobial restriction was thought to exist. Additionally, Senate Bill 739 appears to have played a role in initiating many hospital ASPs, which supports the adoption of similar legislation in other states and nationally.
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Affiliation(s)
- Kavita K Trivedi
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, CA 94804, USA.
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Gould IM, Bal AM. New antibiotic agents in the pipeline and how they can help overcome microbial resistance. Virulence 2013; 4:185-91. [PMID: 23302792 PMCID: PMC3654619 DOI: 10.4161/viru.22507] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bacterial resistance is a growing threat and yet few new antibiotics active against multi-resistant bacteria are being explored. A combination of falling profits, regulatory mechanisms and irrational and injudicious use of antibiotics has led to an alarming situation where some infections have no cure. In this article, we summarize the new developments that have been suggested to incentivize the pharmaceutical industries toward the field of infections. We also briefly mention the new compounds on the horizon and some newly approved compounds that might help us tide over this crisis.
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