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Gilham EL, Pearce-Smith N, Carter V, Ashiru-Oredope D. Assessment of global antimicrobial resistance campaigns conducted to improve public awareness and antimicrobial use behaviours: a rapid systematic review. BMC Public Health 2024; 24:396. [PMID: 38321479 PMCID: PMC10848528 DOI: 10.1186/s12889-024-17766-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 01/13/2024] [Indexed: 02/08/2024] Open
Abstract
INTRODUCTION Public health campaigns with a well-defined outcome behaviour have been shown to successfully alter behaviour. However, the complex nature of antimicrobial resistance (AMR) creates challenges when evaluating campaigns aimed at raising awareness and changing behaviour. AIMS To determine what campaigns have been conducted and which reported being effective at improving awareness of antimicrobial resistance and changing behaviour around antimicrobial use in members of the public. It also sought to determine the outcome measures studies have used to assess campaign effectiveness. METHODS A systematic search of Ovid MEDLINE and Embase, was conducted in October 2022 using a predefined search strategy. Studies which were published between 2010 and September 2022 that outlined a campaign or invention aimed at the public and focusing on AMR or antibiotic usage were eligible for inclusion and studies which solely targeted healthcare professionals (HCP) were excluded. RESULTS Literature searches retrieved 6961 results. De-duplication and screening removed 6925 articles, five articles from grey literature and reference screening were included, giving a total of 41 studies and 30 unique interventions. There was a distribution of campaigns globally with the majority run in Europe (n = 15) with most campaigns were conducted nationally (n = 14). Campaigns tended to focus on adult members of the public (n = 14) or targeted resources towards both the public and HCPs (n = 13) and predominately assessed changes in knowledge of and/or attitudes towards AMR (n = 16). Campaigns where an improvement was seen in their primary outcome measure tended to use mass media to disseminate information, targeted messaging towards a specific infection, and including the use of HCP-patient interactions. DISCUSSION This review provides some evidence that campaigns can significantly improve outcome measures relating to AMR and antibiotic usage. Despite a lack of homogeneity between studies some common themes emerged between campaigns reported as being effective. However, the frequent use of observational study designs makes it difficult to establish causation between the campaign and changes seen in the studies outcome measures. It is important that clear evaluation processes are embedded as part of the design process for future campaigns; a campaign evaluation framework for use by campaign developers may facilitate this.
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Affiliation(s)
- Ellie L Gilham
- HCAI and AMR Division, Health Security Agency, London, UK
| | | | | | - Diane Ashiru-Oredope
- HCAI and AMR Division, Health Security Agency, London, UK.
- School of Pharmacy, University of Nottingham, Nottingham, UK.
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2
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Baudet A, Guillaso M, Grimmer L, Regad M, Florentin A. Microbiological Contamination of the Office Environment in Dental and Medical Practice. Antibiotics (Basel) 2021; 10:antibiotics10111375. [PMID: 34827313 PMCID: PMC8614722 DOI: 10.3390/antibiotics10111375] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/03/2021] [Accepted: 11/08/2021] [Indexed: 12/19/2022] Open
Abstract
The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0–1280) and 26 (range: 0–188) CFU/100 cm2, respectively. In indoor air, those concentrations were 403 (range: 118–732) and 327 (range: 32–806) CFU/m3, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms.
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Affiliation(s)
- Alexandre Baudet
- Faculté d’Odontologie, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France
- Service d’Odontologie, CHRU-Nancy, F-54000 Nancy, France
- APEMAC, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France;
- Correspondence:
| | - Monique Guillaso
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
| | - Léonie Grimmer
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
| | | | - Marie Regad
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
- Département Territorial d’Hygiène et de Prévention du Risque Infectieux, CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France
| | - Arnaud Florentin
- APEMAC, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France;
- Département d’Hygiène, des Risques Environnementaux et Associés aux Soins, Faculté de Médecine, Université de Lorraine, F-54505 Vandœuvre-lès-Nancy, France; (M.G.); (L.G.); (M.R.)
- Département Territorial d’Hygiène et de Prévention du Risque Infectieux, CHRU-Nancy, F-54505 Vandœuvre-lès-Nancy, France
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3
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Yaacoub S, Lanoy E, Hider-Mlynarz K, Saleh N, Maison P. Trend of antibiotic consumption and its association with influenza-like illnesses in France between 2004 and 2018. Eur J Public Health 2021; 31:1137-1143. [PMID: 34534281 DOI: 10.1093/eurpub/ckab143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Antibiotic consumption has been reported to be driven by the treatment of respiratory tract infections. Our objectives were to describe the trend of antibiotic consumption in France compared with that of other European countries; to describe the evolution of each antibiotic class in France; and to explore the relationship between antibiotic consumption and incidence of influenza-like illnesses. METHODS In this observational study, antibiotic consumption was reported as defined daily doses per 1000 inhabitants per day in the community and hospital sectors in descriptive and graphical formats, using data from the European Surveillance of Antimicrobial Consumption Network database. The total consumption and the consumption of different classes of antibiotics in France according to time and influenza-like illnesses were studied using multiple linear regression models. RESULTS The total consumption of antibiotics in France was constant over the 15 years. It was driven by the community sector (92.8%) and was higher than the consumption of other European Union countries (P-value < 0.001). The beta-lactam penicillins were the most consumed antibiotic class and the only class that increased with time. The multiple linear regression models showed a positive correlation between antibiotic consumption in the community sector and incidence of influenza-like illnesses [B = 0.170, 95% CI (0.088-0.252)]. Similar significant results were shown between other antibiotic classes used in the management of influenza-like illnesses (other beta-lactams, and macrolides, lincosamides and streptogramins) and influenza-like illnesses. CONCLUSION Our results suggest that antibiotics used in the management of respiratory tract infections might be involved in the irrational use of antibiotics.
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Affiliation(s)
- Sally Yaacoub
- EA 7379 EpiDermE Group, Paris-Est Creteil University, Creteil, France
| | - Emilie Lanoy
- Biostatistics and Epidemiology Unit, Gustave-Roussy, Villejuif, France.,Biostatistics and Epidemiology Unit, Paris-Saclay University, Paris-Sud Univ., UVSQ, CESP, INSERM, Villejuif, France
| | | | - Nadine Saleh
- Faculty of Public Health, Lebanese University, Fanar, Lebanon.,INSPECT-LB: Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie, Beirut, Lebanon.,Faculty of Public Health, CERIPH (Center for Research in Public Health), Lebanese University, Fanar, Lebanon
| | - Patrick Maison
- EA 7379 EpiDermE Group, Paris-Est Creteil University, Creteil, France.,ANSM, Saint Denis, France.,CHI Creteil, Creteil, France
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Smith DR, Temime L, Opatowski L. Microbiome-pathogen interactions drive epidemiological dynamics of antibiotic resistance: A modeling study applied to nosocomial pathogen control. eLife 2021; 10:68764. [PMID: 34517942 PMCID: PMC8560094 DOI: 10.7554/elife.68764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
The human microbiome can protect against colonization with pathogenic antibiotic-resistant bacteria (ARB), but its impacts on the spread of antibiotic resistance are poorly understood. We propose a mathematical modeling framework for ARB epidemiology formalizing within-host ARB-microbiome competition, and impacts of antibiotic consumption on microbiome function. Applied to the healthcare setting, we demonstrate a trade-off whereby antibiotics simultaneously clear bacterial pathogens and increase host susceptibility to their colonization, and compare this framework with a traditional strain-based approach. At the population level, microbiome interactions drive ARB incidence, but not resistance rates, reflecting distinct epidemiological relevance of different forces of competition. Simulating a range of public health interventions (contact precautions, antibiotic stewardship, microbiome recovery therapy) and pathogens (Clostridioides difficile, methicillin-resistant Staphylococcus aureus, multidrug-resistant Enterobacteriaceae) highlights how species-specific within-host ecological interactions drive intervention efficacy. We find limited impact of contact precautions for Enterobacteriaceae prevention, and a promising role for microbiome-targeted interventions to limit ARB spread.
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Affiliation(s)
- David Rm Smith
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France.,Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France.,PACRI unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
| | - Lulla Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
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5
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Serena TE, Bowler PG, Schultz GS, D’souza A, Rennie MY. Are Semi-Quantitative Clinical Cultures Inadequate? Comparison to Quantitative Analysis of 1053 Bacterial Isolates from 350 Wounds. Diagnostics (Basel) 2021; 11:1239. [PMID: 34359322 PMCID: PMC8303231 DOI: 10.3390/diagnostics11071239] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 01/22/2023] Open
Abstract
Early awareness and management of bacterial burden and biofilm is essential to wound healing. Semi-quantitative analysis of swab or biopsy samples is a relatively simple method for measuring wound microbial load. The accuracy of semi-quantitative culture analysis was compared to 'gold standard' quantitative culture analysis using 428 tissue biopsies from 350 chronic wounds. Semi-quantitative results, obtained by serial dilution of biopsy homogenates streaked onto culture plates divided into 4 quadrants representing occasional, light, moderate, and heavy growth, were compared to total bacterial load quantified as colony-forming units per gram (CFU/g). Light growth, typically considered an insignificant finding, averaged a clinically significant 2.5 × 105 CFU/g (SE = 6.3 × 104 CFU/g). Occasional growth (range: 102-106 CFU/g) and light growth (103-107 CFU/g) corresponded to quantitative values that spanned a 5-log range; moderate and heavy growth corresponded to a range of 4-log and 6-log, respectively, with a high degree of overlap in range of CFU/g per category. Since tissue biopsy and quantitative culture cannot be widely practiced and semi-quantitative analysis is unreliable, other clinically relevant approaches are required to determine wound bioburden and guide best management practices. Fluorescence imaging is a point-of-care technology that offers great potential in this field.
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Affiliation(s)
| | | | - Gregory S. Schultz
- Department of Obstetrics and Gynecology, University of Florida, Gainesville, FL 32610, USA;
| | - Anna D’souza
- MolecuLight Inc., Toronto, ON M5G 1T6, Canada; (A.D.); (M.Y.R.)
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Waleekhachonloet O, Rattanachotphanit T, Limwattananon C, Thammatacharee N, Limwattananon S. Effects of a national policy advocating rational drug use on decreases in outpatient antibiotic prescribing rates in Thailand. Pharm Pract (Granada) 2021; 19:2201. [PMID: 33628347 PMCID: PMC7886315 DOI: 10.18549/pharmpract.2021.1.2201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/24/2021] [Indexed: 11/15/2022] Open
Abstract
Objective: This study examined the effects of a national policy advocating rational drug
use (RDU), namely, the ‘RDU Service Plan’, starting in fiscal
year 2017 and implemented by the Thai Ministry of Public Health (MOPH), on
trends in antibiotic prescribing rates for outpatients. The policy was
implemented subsequent to a voluntary campaign involving 136 hospitals,
namely, the ‘RDU Hospital Project’, which was implemented
during fiscal years 2014-2016. Methods: Hospital-level antibiotic prescribing rates in fiscal years 2014-2019 for
respiratory infections, acute diarrhea, and fresh wounds were aggregated for
two hospital groups using equally weighted averages: early adopters of RDU
activities through the RDU Hospital Project and late adopters under the RDU
Service Plan. Pre-/post-policy annual changes in the prescribing levels and
trends were compared between the two groups using an interrupted time-series
analysis. Results: In fiscal years 2014-2016, decreases in antibiotic prescribing rates for
respiratory infections and acute diarrhea in both groups reflected a trend
that existed before the RDU Service Plan was implemented. The immediate
effect of the RDU Service Plan policy occurred in fiscal year 2017, when the
prescribing level among the late adopters dropped abruptly for all three
conditions with a greater magnitude than in the decrease among the early
adopters, despite nonsignificant differences. The medium-term effect of the
RDU Service Plan was identified through a further decreasing trend during
fiscal years 2017-2019 for all conditions in both groups, except for acute
diarrhea among the early adopters. Conclusions: The national policy on rational drug use effectively reduced antibiotic
prescribing for common but questionable outpatient conditions.
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Affiliation(s)
| | | | | | | | - Supon Limwattananon
- PhD. Faculty of Pharmaceutical Sciences, Khon Kaen University. Khon Kaen (Thailand).
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7
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Saliba-Gustafsson EA, Nyberg A, Borg MA, Rosales-Klintz S, Stålsby Lundborg C. Barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections: A qualitative study with general practitioners in Malta. PLoS One 2021; 16:e0246782. [PMID: 33571265 PMCID: PMC7877739 DOI: 10.1371/journal.pone.0246782] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antibiotic resistance is a leading global public health concern and antibiotic use is a key driver. Effective interventions are needed to target key stakeholders, including general practitioners (GPs). In Malta, little is known about factors that influence GPs' antibiotic prescribing, making it challenging to implement targeted interventions. We therefore aimed to explore GPs' understanding of antibiotic use and resistance, and describe their perceived barriers and facilitators to prudent antibiotic prescribing for acute respiratory tract infections in Malta. METHODS Face-to-face individual semi-structured interviews were held with a quota sample of 20 GPs in 2014. Interviews were audio recorded and transcribed verbatim, and later analysed iteratively using manifest and latent content analysis. Findings were collated in a socioecological model to depict how GPs as individuals are embedded within larger social systems and contexts, and how each component within this system impacts their prescribing behaviour. FINDINGS We found that GPs' antibiotic prescribing decisions are complex and impacted by numerous barriers and facilitators at the individual, interpersonal, organisational, community, and public policy level. Predominant factors found to impact GPs' antibiotic prescribing included not only intrinsic GP factors such as knowledge, awareness, experience, and misconceptions, but also several external factors. At the interpersonal level, GPs' perceived patient demand and behaviour to be a persistent issue that impacts their prescribing decisions. Similarly, some GPs found pressure from drug reps to be concerning despite being considered an important source of information. Organisational and public policy-level issues such as lack of access to relevant antibiotic prescribing guidelines and current antibiotic resistance data from the community, were also considered major barriers to appropriate antibiotic prescribing. Utilisation of diagnostic testing was found to be low and GPs' perceptions on the introduction of rapid point-of-care tests to support antibiotic prescription decisions, were mixed. CONCLUSION This study revealed the complexity of the antibiotic prescribing decision and the numerous barriers and facilitators that impact it, visualised through a socioecological model. Addressing GPs' antibiotic prescribing practices will require targeted and coordinated implementation activities at all levels to change behaviour and address misconceptions, whilst also improving the physical and social environment. TRIAL REGISTRATION NUMBER NCT03218930; https://clinicaltrials.gov/ct2/show/NCT03218930.
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Affiliation(s)
- Erika A. Saliba-Gustafsson
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California, United States of America
| | - Anna Nyberg
- Faculty of Social Sciences, Stockholm University, Stockholm, Sweden
| | - Michael A. Borg
- Department of Infection Prevention and Control, Mater Dei Hospital, Msida, Malta
- Faculty of Medicine and Surgery, University of Malta, Msida, Malta
| | - Senia Rosales-Klintz
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
- Unit of Surveillance and Response Support (SRS), European Centre for Disease Prevention and Control, Solna, Sweden
| | - Cecilia Stålsby Lundborg
- Department of Global Public Health, Health Systems and Policy (HSP): Improving Use of Medicines, Karolinska Institutet, Stockholm, Sweden
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8
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Lin L, Alam P, Fearon E, Hargreaves JR. Public target interventions to reduce the inappropriate use of medicines or medical procedures: a systematic review. Implement Sci 2020; 15:90. [PMID: 33081791 PMCID: PMC7574316 DOI: 10.1186/s13012-020-01018-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 07/06/2020] [Indexed: 01/08/2023] Open
Abstract
Background An epidemic of health disorders can be triggered by a collective manifestation of inappropriate behaviors, usually systematically fueled by non-medical factors at the individual and/or societal levels. This study aimed to (1) landscape and assess the evidence on interventions that reduce inappropriate demand of medical resources (medicines or procedures) by triggering behavioral change among healthcare consumers, (2) map out intervention components that have been tried and tested, and (3) identify the “active ingredients” of behavior change interventions that were proven to be effective in containing epidemics of inappropriate use of medical resources. Methods For this systematic review, we searched MEDLINE, EMBASE, the Cochrane Library, and PsychINFO from the databases’ inceptions to May 2019, without language restrictions, for behavioral intervention studies. Interventions had to be empirically evaluated with a control group that demonstrated whether the effects of the campaign extended beyond trends occurring in the absence of the intervention. Outcomes of interest were reductions in inappropriate or non-essential use of medicines and/or medical procedures for clinical conditions that do not require them. Two reviewers independently screened titles, abstracts, and full text for inclusion and extracted data on study characteristics (e.g., study design), intervention development, implementation strategies, and effect size. Data extraction sheets were based on the checklist from the Cochrane Handbook for Systematic Reviews. Results Forty-three studies were included. The behavior change technique taxonomy v1 (BCTTv1), which contains 93 behavioral change techniques (BCTs), was used to characterize components of the interventions reported in the included studies. Of the 93 BCTs, 15 (16%) were identified within the descriptions of the selected studies targeting healthcare consumers. Interventions consisting of education messages, recommended behavior alternatives, and a supporting environment that incentivizes or encourages the adoption of a new behavior were more likely to be successful. Conclusions There is a continued tendency in research reporting that mainly stresses the effectiveness of interventions rather than the process of identifying and developing key components and the parameters within which they operate. Reporting “negative results” is likely as critical as reporting “active ingredients” and positive findings for implementation science. This review calls for a standardized approach to report intervention studies. Trial registration PROSPERO registration number CRD42019139537
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Affiliation(s)
- Leesa Lin
- London School of Hygiene & Tropical Medicine, London, UK.
| | - Prima Alam
- London School of Hygiene & Tropical Medicine, London, UK
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Ouldali N, Cohen R, Levy C, Gelbert-Baudino N, Seror E, Corrard F, Vie Le Sage F, Michot AS, Romain O, Bechet S, Bonacorsi S, Angoulvant F, Varon E. Pneumococcal susceptibility to antibiotics in carriage: a 17 year time series analysis of the adaptive evolution of non-vaccine emerging serotypes to a new selective pressure environment. J Antimicrob Chemother 2020; 74:3077-3086. [PMID: 31280295 DOI: 10.1093/jac/dkz281] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/21/2019] [Accepted: 06/03/2019] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Pneumococcal conjugate vaccine (PCV) implementations led to major changes in serotype distribution and antibiotic resistance in carriage, accompanied by changes in antibiotic consumption. OBJECTIVES To assess the dynamic patterns of antimicrobial non-susceptibility across non-PCV13 serotypes following PCV implementations. METHODS We conducted a quasi-experimental interrupted time series analysis based on a 17 year French nationwide prospective cohort. From 2001 to 2018, 121 paediatricians obtained nasopharyngeal swabs from children with acute otitis media who were aged 6 months to 2 years. The main outcome was the rate of penicillin-non-susceptible pneumococci (PNSP), analysed by segmented regression. RESULTS We enrolled 10 204 children. After PCV13 implementation, the PNSP rate decreased (-0.5% per month; 95% CI -0.9 to -0.1), then, after 2014, the rate slightly increased (+0.7% per month; 95% CI +0.2 to +1.2). Global antibiotic use within the previous 3 months decreased over the study period (-22.2%; 95% CI -33.0 to -11.3), but aminopenicillin use remained high. Among the main non-PCV13 serotypes, four dynamic patterns of penicillin susceptibility evolution were observed, including unexpected patterns of serotypes emerging while remaining or even becoming penicillin susceptible. In contrast to PNSP strains, for these latter patterns, the rate of co-colonization with Haemophilus influenzae increased concomitant with their emergence. CONCLUSIONS In a context of continuing high antibiotic selective pressure, a progressive increase in PNSP rate was observed after 2014. However, we highlighted an unexpected variability in dynamic patterns of penicillin susceptibility among emerging non-PCV13 serotypes. Antibiotic resistance may not be the only adaptive mechanism to antimicrobial selective pressure, and co-colonization with H. influenzae may be involved.
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Affiliation(s)
- Naim Ouldali
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Unité d'épidémiologie clinique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, ECEVE INSERM UMR 1123, Paris, France.,Urgences pédiatriques, hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Robert Cohen
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, Créteil, France.,Unité Court Séjour, Petits nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, France
| | - Corinne Levy
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France.,Clinical Research Center (CRC), Centre Hospitalier Intercommunal de Créteil, Créteil, Créteil, France
| | - Nathalie Gelbert-Baudino
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Elisa Seror
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,Hématologie pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France
| | - François Corrard
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - François Vie Le Sage
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,AFPA, Association Française de Pédiatrie Ambulatoire, Saint-Germain-en-Laye, France
| | - Anne-Sylvestre Michot
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France
| | - Olivier Romain
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Réanimation et pédiatrie néonatales, Hôpitaux Universitaires Paris-Sud, Hôpital Antoine Béclère, Clamart, France
| | - Stéphane Bechet
- ACTIV, Association Clinique et Thérapeutique Infantile du Val-de-Marne, Saint Maur-des-Fossés, France.,GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Stéphane Bonacorsi
- Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Microbiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Robert-Debré, Paris, France
| | - François Angoulvant
- GPIP, Groupe de Pathologie Infectieuse Pédiatrique, Paris, France.,Urgences pédiatriques, hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France.,Centre de recherche des Cordeliers, INSERM UMR 1138, Paris, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, Centre Hospitalier Intercommunal de Créteil, Créteil, France
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10
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Fletcher-Miles H, Gammon J, Williams S, Hunt J. A scoping review to assess the impact of public education campaigns to affect behavior change pertaining to antimicrobial resistance. Am J Infect Control 2020; 48:433-442. [PMID: 31444097 DOI: 10.1016/j.ajic.2019.07.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Years of global antibiotic misuse has led to the progression of antimicrobial resistance (AMR), posing a direct threat to public health. To impact AMR and maintain antimicrobial viability, educational interventions toward fostering positive AMR behavior change have been employed with some success. METHODS This scoping review sought to identify research-supporting use of public educational AMR campaigns, and their efficacy toward informing positive AMR behaviors to inform current debate. To enable credible and reflexive examination of a wide variety of literature, Arksey and O'Malley's (2005) methodological framework was used. RESULTS Three primary themes were identified: (1) behavior change and theoretical underpinnings, (2) intervention paradigm, and (3) educational engagement. From 94 abstracts identified, 31 articles were chosen for review. More attention is required to identify elements of intervention design that inform and sustain behavior change, and the impact of how an intervention is delivered and targeted is needed to limit assumptions of population homogeneity, which potentially limits intervention efficacy. Moreover, research on the impact of hospital-based inpatient interventions is needed. CONCLUSIONS The existing body of research fails to provide robust evidence to support sound evidential interventions supported by theoretical justifications. Furthermore, interventions to ensure long-term sustained behavior change are unclear and not addressed.
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Affiliation(s)
| | - John Gammon
- College of Human and Health Sciences, Swansea University, Wales, United Kingdom
| | - Sharon Williams
- College of Human and Health Sciences, Swansea University, Wales, United Kingdom
| | - Julian Hunt
- College of Human and Health Sciences, Swansea University, Wales, United Kingdom
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11
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Association between National Treatment Guidelines for Upper Respiratory Tract Infections and Outpatient Pediatric Antibiotic Use in France: An Interrupted Time-Series Analysis. J Pediatr 2020; 216:88-94.e4. [PMID: 31610933 DOI: 10.1016/j.jpeds.2019.09.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/13/2019] [Accepted: 09/10/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To test whether updated clinical practice guidelines for managing upper respiratory tract infections released in France in November 2011 were associated with changes in national outpatient pediatric antibiotic use. STUDY DESIGN We performed an interrupted time-series analysis using national antibiotic dispensation data in French children from January 2009 to December 2017 (IQVIA Suivi de la Dispensation Médicale database). We described the overall evolution of antibiotic prescription rates and modeled the changes in the proportion of amoxicillin and the proportion of broad-spectrum antibiotics following the guidelines in 2 age groups (0-5 and 6-14 years old). RESULTS We analyzed 123 million pediatric antibiotic prescriptions. The most commonly prescribed individual antibiotic agent was amoxicillin (37.7%). Over the study period, the annual antibiotic prescription rate decreased by 33.1% (from 1387 to 928 per 1000 pediatric inhabitants per year), consistently across age groups and major antibiotic agents except for amoxicillin (+14.4%). After the release of the guidelines, we observed a gradual increase in the proportion of amoxicillin (relative change 5 years postintervention of +64.3% [95% CI 51.6-80.1] and +28.4% [21.1-36.2] for children 0-5 and 6-14 years, respectively) concomitantly with a gradual decrease in the proportion of broad-spectrum antibiotics (relative change 5 years postintervention of -26.1% [-29.3, -23.7] and -19.8% [-22.1, -16.0] for children 0-5 and 6-14 years old, respectively). CONCLUSIONS The 2011 guidelines for upper respiratory tract infections preceded changes in outpatient pediatric antibiotic use at the national level, with a replacement of broad-spectrum antibiotics by amoxicillin.
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12
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Lim JM, Singh SR, Duong MC, Legido-Quigley H, Hsu LY, Tam CC. Impact of national interventions to promote responsible antibiotic use: a systematic review. J Antimicrob Chemother 2020; 75:14-29. [PMID: 31834401 PMCID: PMC6910191 DOI: 10.1093/jac/dkz348] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 07/02/2019] [Accepted: 07/11/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. METHODS We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. RESULTS We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. CONCLUSIONS National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.
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Affiliation(s)
- Jane Mingjie Lim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549
| | - Shweta Rajkumar Singh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549
| | - Minh Cam Duong
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Li Yang Hsu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549
| | - Clarence C Tam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System (NUHS), Singapore 117549
- London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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13
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Dylis A, Boureau AS, Coutant A, Batard E, Javaudin F, Berrut G, de Decker L, Chapelet G. Antibiotics prescription and guidelines adherence in elderly: impact of the comorbidities. BMC Geriatr 2019; 19:291. [PMID: 31664914 PMCID: PMC6819552 DOI: 10.1186/s12877-019-1265-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/29/2019] [Indexed: 11/29/2022] Open
Abstract
Background Although the interest of antibiotics is well known, antibiotics prescription is associated with side effect, especially in patients with multiples comorbidities. One way to reduce the incidence of side effects is to respect antibiotics prescriptions guidelines. Our objective was to investigated the factors associated with guidelines adherence in elderly patients with multiples comorbidities. Methods From October 2015 to December 2016, antibiotics prescription and guidelines adherence were analyzed in two post-acute care and rehabilitation services of a 2600-bed, university-affiliated center. Results One hundred and twenty-eight patients were included, fifty-nine (46%) patients had antibiotics prescription according to guidelines. In Multivariable logistic regression analysis, prescription of 2 antibiotics or more (OR = 0.168, 95% IC = 0.037–0.758, p < 0.05), 85 years of age and more (OR = 0.375, 95% IC = 0.151–0.931, p < 0.05) and the Charlson comorbidity index score (OR = 0.750, 95% IC = 0.572–0.984, p < 0.05) were negatively associated with antibiotics prescriptions according to guidelines. Conclusions High comorbidity in the elderly was negatively associated with the guidelines adherence of antibiotiсs prescriptions. These criteria should be considered to optimize antibiotics prescriptions in elderly patients. Electronic supplementary material The online version of this article (10.1186/s12877-019-1265-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anthony Dylis
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Anne Sophie Boureau
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Audrey Coutant
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Eric Batard
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - François Javaudin
- Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France.,Emergency Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Gilles Berrut
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France
| | - Laure de Decker
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France.,Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France
| | - Guillaume Chapelet
- Clinical Gerontology Department, Centre Hospitalier Universitaire de Nantes, 1 place Alexis-Ricordeau, F-44000, Nantes, France. .,Université de Nantes, EE MiHAR (Microbiotes, Hôtes, Antibiotiques et Résistance bacterienne), Institut de Recherche en Santé (IRS2), 22 Boulevard bénoni-Goullin, F-44200, Nantes, France.
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14
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Rogers Van Katwyk S, Grimshaw JM, Nkangu M, Nagi R, Mendelson M, Taljaard M, Hoffman SJ. Government policy interventions to reduce human antimicrobial use: A systematic review and evidence map. PLoS Med 2019; 16:e1002819. [PMID: 31185011 PMCID: PMC6559631 DOI: 10.1371/journal.pmed.1002819] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 05/03/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Growing political attention to antimicrobial resistance (AMR) offers a rare opportunity for achieving meaningful action. Many governments have developed national AMR action plans, but most have not yet implemented policy interventions to reduce antimicrobial overuse. A systematic evidence map can support governments in making evidence-informed decisions about implementing programs to reduce AMR, by identifying, describing, and assessing the full range of evaluated government policy options to reduce antimicrobial use in humans. METHODS AND FINDINGS Seven databases were searched from inception to January 28, 2019, (MEDLINE, CINAHL, EMBASE, PAIS Index, Cochrane Central Register of Controlled Trials, Web of Science, and PubMed). We identified studies that (1) clearly described a government policy intervention aimed at reducing human antimicrobial use, and (2) applied a quantitative design to measure the impact. We found 69 unique evaluations of government policy interventions carried out across 4 of the 6 WHO regions. These evaluations included randomized controlled trials (n = 4), non-randomized controlled trials (n = 3), controlled before-and-after designs (n = 7), interrupted time series designs (n = 25), uncontrolled before-and-after designs (n = 18), descriptive designs (n = 10), and cohort designs (n = 2). From these we identified 17 unique policy options for governments to reduce the human use of antimicrobials. Many studies evaluated public awareness campaigns (n = 17) and antimicrobial guidelines (n = 13); however, others offered different policy options such as professional regulation, restricted reimbursement, pay for performance, and prescription requirements. Identifying these policies can inform the development of future policies and evaluations in different contexts and health systems. Limitations of our study include the possible omission of unpublished initiatives, and that policies not evaluated with respect to antimicrobial use have not been captured in this review. CONCLUSIONS To our knowledge this is the first study to provide policy makers with synthesized evidence on specific government policy interventions addressing AMR. In the future, governments should ensure that AMR policy interventions are evaluated using rigorous study designs and that study results are published. PROTOCOL REGISTRATION PROSPERO CRD42017067514.
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Affiliation(s)
- Susan Rogers Van Katwyk
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Jeremy M. Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Miriam Nkangu
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ranjana Nagi
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Monica Taljaard
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Steven J. Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Ontario, Canada
- Department of Health Research Methods, Evidence, and Impact, and McMaster Health Forum, McMaster University, Hamilton, Ontario, Canada
- Department of Global Health & Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
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15
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Huttner B, Saam M, Moja L, Mah K, Sprenger M, Harbarth S, Magrini N. How to improve antibiotic awareness campaigns: findings of a WHO global survey. BMJ Glob Health 2019; 4:e001239. [PMID: 31179029 PMCID: PMC6528771 DOI: 10.1136/bmjgh-2018-001239] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/15/2019] [Accepted: 01/19/2019] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION We aimed to examine the characteristics of antibiotic awareness campaigns (AAC) conducted on a national or regional level since 2010. METHODS In October 2016, the WHO invited stakeholders involved in the planning or conduct of AACs to answer a web questionnaire. We solicited general information about the characteristics of the AAC, with a particular focus on key messages supporting optimal use of antibiotics. RESULTS Stakeholders in 93 countries were contacted and 55 countries responded. Overall, 60 AACs from 16 low/middle-income countries (LMIC) and 31 high-income countries were identified. Forty-five campaigns (75%) were conducted on a national level and most of them (47/60; 78%) were organised by public health authorities and publicly funded. There were no major differences between LMICs and high-income countries in the types of key messages. The scientifically questionable 'Finish your prescription' slogan was used by 31 AACs (52%). A One Health approach was mentioned in 13/60 AACs (22%). Most messages were universally applicable; adaptation to locally prevalent public misconceptions was not systematic. The evaluation of the impact of campaigns was still incomplete, as only 18 AACs (30%) assessed their impact on antibiotic use. CONCLUSION For future AACs, it seems essential to base messages more rigorously on scientific evidence, context specificities and behavioural change theory. A new generation of messages that encourage first-choice use of narrow spectrum antibiotics is needed, reflecting international efforts to preserve broad spectrum antibiotic classes. Evaluation of the impact of AACs remains suboptimal.
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Affiliation(s)
- Benedikt Huttner
- Infection Control Program and Division of Infectious Diseases, World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
- World Health Organization, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Mirko Saam
- Communications in Science, Geneva, Switzerland
| | - Lorenzo Moja
- World Health Organization, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Karen Mah
- World Health Organization, Antimicrobial Resistance Secretariat, Geneva, Switzerland
| | - Marc Sprenger
- World Health Organization, Antimicrobial Resistance Secretariat, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program and Division of Infectious Diseases, World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Nicola Magrini
- World Health Organization, Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
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16
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Kristensen PK, Johnsen SP, Thomsen RW. Decreasing trends, and geographical variation in outpatient antibiotic use: a population-based study in Central Denmark. BMC Infect Dis 2019; 19:337. [PMID: 31014280 PMCID: PMC6480614 DOI: 10.1186/s12879-019-3964-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 04/08/2019] [Indexed: 12/25/2022] Open
Abstract
Background Antimicrobial overuse and misuse of broad-spectrum antibiotics increases the risk for antimicrobial resistance. Investigating unwarranted variation in antibiotic prescription has therefore gained global priority. Methods We examined recent time trends in the utilization of narrow- and broad-spectrum antibiotics as well as the variation in antibiotic use by sex, age, and municipality of residence. Complete individual-level data on all redeemed out-of hospital prescriptions for antibiotics in the entire adult population of Central Denmark (1.3 million inhabitants) was obtained for the period 2006–2015. Results Following an initial increase of 2% between 2006 and 2011, the overall rate of redeemed prescriptions for antibiotics per 1000 person years declined by 17% between 2011 and 2015. Among persons aged over 65 years, the decline in use began later (from 2013) and was less pronounced. Antibiotic use in 2015 remained substantially higher among females (289/1000 person-years) vs. males (182/1000 person-years) and among the very old (520/1000 person-years in >85y old) vs. middle-aged (204/1000 person-years in 45-65y old). A decreasing trend in antibiotic use over time was observed in all municipalities, mainly due to a decrease in narrow-spectrum antibiotics. However, a striking and unexplained 1.6-fold geographical variation in antibiotic use, including tetracyclines, macrolides and fluoroquinolones remained in 2015. Of concern, among females aged ≥65 years and males aged ≥85 years, a continuous increasing trend in broad-spectrum antibiotic use was observed. Conclusions Antibiotic use has decreased almost 20% in Central Denmark after 2011, possibly related to a nationwide antibiotic stewardship program in Denmark. However, substantial geographical variation in antibiotic prescription remains and the use of broad-spectrum antibiotics has increased in adults of older age. Continuous focus on avoiding unnecessary use of broad-spectrum antibiotics is requested. Electronic supplementary material The online version of this article (10.1186/s12879-019-3964-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pia Kjær Kristensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark. .,Department of Orthopedic Surgery, Regional Hospital Horsens, Sundvej 30, DK-8700, Horsens, Denmark.
| | - Søren Paaske Johnsen
- Department of Clinical Medicine, Aalborg University, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark
| | - Reimar Wernich Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, DK-8200, Aarhus N, Denmark
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17
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Fortanier AC, Venekamp RP, Stellato RK, Sanders EAM, Damoiseaux RAMJ, Hoes AW, Schilder AM. Outpatient antibiotic use in Dutch infants after 10-valent pneumococcal vaccine introduction: a time-series analysis. BMJ Open 2018; 8:e020619. [PMID: 29961011 PMCID: PMC6042577 DOI: 10.1136/bmjopen-2017-020619] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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
OBJECTIVE This population-based cohort study assesses the impact of switching from a 7-valent pneumococcal conjugate vaccine (PCV) to a 10-valent PCV on outpatient antibiotic use in Dutch infants, and whether geographical vaccination coverage modifies this association. SETTING AND PARTICIPANTS We extracted 2006-2013 anonymised antibiotic purchase data of 255 154 Dutch infants aged below 2 years from Achmea Health, a health insurance fund covering 28% of the national population. DESIGN AND MAIN OUTCOME MEASURE Changes in monthly antibiotic use from 2006-2011 (PCV7) to 2011-2013 (PCV10) were estimated using time-series analysis accounting for seasonality and autocorrelation. Interaction terms for vaccination coverage (categorised into seven groups) and period were added to the model to test whether this association was vaccination coverage-dependent. RESULTS 275 337 antibiotic courses were used by 119 078 infants (461 352 person-years). PCV10 introduction was associated with a modest 1.6% overall reduction in antibiotic use (purchase rate ratio: 0.98, 95% CI: 0.98 to 0.99). Our model showed a significant difference in time trend in antibiotic use after PCV10 introduction (p=0.0084) with an increase in prescriptions in the PCV7 period (slope: 0.0023/month, 95% CI: -0.0001 to 0.0047) versus a decline in the PCV10 period (slope: -0.0089/month, 95% CI: -0.0150 to -0.0029). There was no evidence that PCV vaccination coverage affected this association, but since the largest rate ratios were observed in municipalities with the lowest vaccine coverage and had very wide accompanying CIs, our study might have insufficient power to detect such an association. CONCLUSIONS Switching from PCV7 to PCV10 was associated with a modest decline in outpatient antibiotic use in Dutch infants.
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Affiliation(s)
- Alexandre C Fortanier
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Roderick P Venekamp
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Rebecca K Stellato
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Elisabeth A M Sanders
- Department of Paediatric Immunology and Infectious Disease, University Medical Center, Utrecht University, Utrecht, The Netherlands
- Centre for Infectious Disease Control, National Institute of Public Health and the Environ-ment (RIVM), Bilthoven, The Netherlands
| | - Roger A M J Damoiseaux
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Arno W Hoes
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
| | - Anne M Schilder
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands
- evidENT, Ear Institute, University College London, London, UK
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18
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Cheysson F, Vibet MA, Guillemot D, Watier L. Estimation of exposure-attributable fractions from time series: A simulation study. Stat Med 2018; 37:3437-3454. [PMID: 29938833 DOI: 10.1002/sim.7818] [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] [Received: 07/12/2017] [Revised: 04/17/2018] [Accepted: 04/22/2018] [Indexed: 11/06/2022]
Abstract
Burden analysis in public health often involves the estimation of exposure-attributable fractions from observed time series. When the entire population is exposed, the association between the exposure and outcome must be carefully modelled before the attributable fractions can be estimated. This article derives asymptotic convergences for the estimation of attributable fractions for commonly used time series models (ARMAX, Poisson, negative binomial, and Serfling), using for the most part the delta method. For the Poisson regression, the estimation of the attributable fraction is achieved by a Monte Carlo algorithm, taking into account both an estimation and a prediction error. A simulation study compares these estimations in the case of an epidemic exposure and highlights the importance of thorough analysis of the data: When the outcome is generated under an additive model, the additive models are satisfactory, and the multiplicative models are poor, and vice versa. However, the Serfling model performs poorly in all cases. Of note, a misspecification in the form or delay of the association between the exposure and the outcome leads to mediocre estimation of the attributable fraction. An application to the fraction of French outpatient antibiotic use attributable to influenza between 2003 and 2010 illustrates the asymptotic convergences. This study suggests that the Serfling model should be avoided when estimating attributable fractions while the model of choice should be selected after careful investigation of the association between the exposure and outcome.
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Affiliation(s)
- Felix Cheysson
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Marie-Anne Vibet
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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19
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Trinh NTH, Chahwakilian P, Bruckner TA, Sclison S, Levy C, Chalumeau M, Milic D, Cohen R, Cohen JF. Discrepancies in national time trends of outpatient antibiotic utilization using different measures: a population-based study in France. J Antimicrob Chemother 2018; 73:1395-1401. [DOI: 10.1093/jac/dky018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/03/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Nhung T H Trinh
- Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Research Centre for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
| | | | - Tim A Bruckner
- Program in Public Health, University of California, Irvine, CA, USA
| | | | - Corinne Levy
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France
- Clinical Research Centre, Centre Hospitalier Intercommunal de Créteil, Créteil, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
| | - Martin Chalumeau
- Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Research Centre for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
- Department of General Paediatrics and Paediatric Infectious Disease, Necker—Enfants malades hospital, Assistance Publique—Hôpitaux de Paris, Paris Descartes University, Paris, France
| | | | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val-de-Marne (ACTIV), Saint-Maur-des-Fossés, France
- Université Paris Est, IMRB-GRC GEMINI, Créteil, France
- Unité Court Séjour, Petits Nourrissons, Service de Néonatalogie, Centre Hospitalier Intercommunal de Créteil, Créteil, France
| | - Jérémie F Cohen
- Inserm UMR 1153, Obstetrical, Perinatal and Paediatric Epidemiology Research Team, Research Centre for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), Paris Descartes University, Paris, France
- Department of General Paediatrics and Paediatric Infectious Disease, Necker—Enfants malades hospital, Assistance Publique—Hôpitaux de Paris, Paris Descartes University, Paris, France
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Ritchie SR, Jayanatha KJ, Duffy EJ, Chancellor J, Allport Z, Thomas MG. Previous antibiotic-related adverse drug reactions do not reduce expectations for antibiotic treatment of upper respiratory tract infections. J Glob Antimicrob Resist 2017; 10:256-260. [PMID: 28732785 DOI: 10.1016/j.jgar.2017.05.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/12/2017] [Accepted: 05/15/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Patients' expectations may influence prescribers' decisions about antibiotic prescribing for upper respiratory tract infection (URTI). We examined whether a history of an antibiotic related adverse drug reaction (aADR) influenced a person's perception about the safety of antibiotics or their expectation of receiving an antibiotic prescription for an URTI. METHODS We developed a questionnaire and surveyed 103 hospital inpatients, 38 of whom (37%) reported past experience of aADR. RESULTS Of the 88 participants who reported recent antibiotic use, participants with a history of aADR reported increased perception of harm from their last antibiotic treatment (P<0.05). Overall, 41/103 (40%) participants expected their doctors to prescribe antibiotics to treat an URTI. Participants' perceptions of antibiotic safety or expectation of antibiotic treatment for an URTI did not differ between those who had personal experience of an aADR compared with those with no history of aADR. CONCLUSIONS The almost universal belief that antibiotics are safe, beneficial medications, even among people with prior aADR, helps to explain the strong patient expectations for antibiotic treatment in a range of conditions. Educational campaigns about the prescription of antibiotics for viral URTI should include information that the risk of harm far outweighs any potential benefits.
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Affiliation(s)
- Stephen R Ritchie
- Department of Infectious Disease, Auckland City Hospital, New Zealand; Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand.
| | - Kalpa J Jayanatha
- Department of Infectious Disease, Auckland City Hospital, New Zealand
| | - Eamon J Duffy
- Department of Infectious Disease, Auckland City Hospital, New Zealand
| | - James Chancellor
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Zarah Allport
- Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | - Mark G Thomas
- Department of Infectious Disease, Auckland City Hospital, New Zealand; Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Cross ELA, Tolfree R, Kipping R. Systematic review of public-targeted communication interventions to improve antibiotic use. J Antimicrob Chemother 2017; 72:975-987. [PMID: 27999058 PMCID: PMC7263825 DOI: 10.1093/jac/dkw520] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 10/19/2016] [Accepted: 11/07/2016] [Indexed: 01/14/2023] Open
Abstract
Background Excessive use of antibiotics accelerates the acquisition/spread of antimicrobial resistance. A systematic review was conducted to identify the components of successful communication interventions targeted at the general public to improve antibiotic use. Methods The databases MEDLINE, EMBASE, CINAHL, Web of Science and Cochrane Library were searched. Search terms were related to the population (public, community), intervention (campaign, mass media) and outcomes (antibiotic, antimicrobial resistance). References were screened for inclusion by one author with a random subset of 10% screened by a second author. No date restrictions were applied and only articles in the English language were considered. Studies had to have a control group or be an interrupted time-series. Outcomes had to measure change in antibiotic-related prescribing/consumption and/or the public's knowledge, attitudes or behaviour. Two reviewers assessed the quality of studies. Narrative synthesis was performed. Results Fourteen studies were included with an estimated 74-75 million participants. Most studies were conducted in the United States or Europe and targeted both the general public and clinicians. Twelve of the studies measured changes in antibiotic prescribing. There was quite strong ( P < 0·05 to ≥ 0·01) to very strong ( P < 0·001) evidence that interventions that targeted prescribing for RTIs were associated with decreases in antibiotic prescribing; the majority of these studies reported reductions of greater than -14% with the largest effect size reaching -30%. Conclusion Multi-faceted communication interventions that target both the general public and clinicians can reduce antibiotic prescribing in high-income countries but the sustainability of reductions in antibiotic prescribing is unclear.
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Affiliation(s)
| | - Robert Tolfree
- Public Health Team, Somerset Council, County Hall, Taunton, TA1 4DY, UK
| | - Ruth Kipping
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, Bristol, BS8 2PS, UK
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Alari A, Chaussade H, Domenech De Cellès M, Le Fouler L, Varon E, Opatowski L, Guillemot D, Watier L. Impact of pneumococcal conjugate vaccines on pneumococcal meningitis cases in France between 2001 and 2014: a time series analysis. BMC Med 2016; 14:211. [PMID: 27998266 PMCID: PMC5175381 DOI: 10.1186/s12916-016-0755-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 11/23/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pneumococcal meningitis (PM) is a major invasive pneumococcal disease. Two pneumococcal conjugate vaccines (PCVs) have been introduced in France: PCV7 was recommended in 2003 and replaced in 2010 by PCV13, which has six additional serotypes. The impact of introducing those vaccines on the evolution of PM case numbers and serotype distributions in France from 2001 to 2014 is assessed herein. METHODS Data on 5166 Streptococcus pneumoniae strains isolated from cerebrospinal fluid between 2001 and 2014 in the 22 regions of France were obtained from the National Reference Center for Pneumococci. The effects of the different vaccination campaigns were estimated using time series analyses through autoregressive moving-average models with exogenous variables ("flu-like" syndromes incidence) and intervention functions. Intervention functions used 11 dummy variables representing each post vaccine epidemiological period. The evolution of serotype distributions was assessed for the entire population and the two most exposed age groups (<5 and > 64 years old). RESULTS For the first time since PCV7 introduction in 2003, total PM cases decreased significantly after starting PCV13 use: -7.1 (95% CI, -10.85 to -3.35) cases per month during 2013-2014, and was confirmed in children < 5 years old (-3.5; 95% CI, -4.81 to -2.13) and adults > 64 years old (-2.0; 95% CI, -3.36 to -0.57). During 2012-2014, different non-vaccine serotypes emerged: 12F, 24F in the entire population and children, 6C in the elderly; serotypes 3 and 19F persisted in the entire population. CONCLUSIONS Unlike other European countries, the total PM cases in France declined only after introduction of PCV13. This suggests that vaccine pressure alone does not explain pneumococcal epidemiological changes and that other factors could play a role. Serotype distribution had changed substantially compared to the pre-vaccine era, as in other European countries, but very differently from the US. A highly reactive surveillance system is thus necessary not only to monitor evolutions due to vaccine pressure and to verify the local serotypic appropriateness of new higher-valent pneumococcal vaccines, but also to recognise and prevent unexpected changes due to other internal or external factors.
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Affiliation(s)
- Anna Alari
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Hélène Chaussade
- Service de Médecine Interne et Maladies Infectieuses, Hôpital Bretonneau CHRU de Tours, Tours, France
| | - Matthieu Domenech De Cellès
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Lénaig Le Fouler
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Emmanuelle Varon
- National Reference Center for Pneumococci, APHP, Paris, France
- Hôpital Européen Georges-Pompidou, Laboratoire de Microbiologie Clinique, APHP, Paris, France
| | - Lulla Opatowski
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - Didier Guillemot
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- APHP, Hôpital Raymond-Poincaré, Unité Fonctionnelle de Santé Publique (D.G.), Garches, France
| | - Laurence Watier
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), Inserm, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
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Maltezou HC, Adamis G, Tsonou P, Moustaka E, Katerelos P, Gargalianos P. Consumption of antibiotics for community-acquired infections by adults in Greece: A cross-sectional study. Am J Infect Control 2016; 44:1741-1743. [PMID: 27424304 DOI: 10.1016/j.ajic.2016.04.242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 11/28/2022]
Abstract
We studied the rates and characteristics of antibiotics consumption for community-acquired infections in 309 adult patients. Of them, 293 (94.8%) had received at least 1 course of antibiotics during the past year. In total, 419 courses of antibiotics were consumed during the past year, including 285 (68%) following medical examination, 72 (17.2%) following telephone consultation, 30 (7.2%) following suggestion by a pharmacist, and in 16 (3.8%) the antibiotic was available at home. Older age and asthma were significantly associated with a higher risk for antibiotics consumption.
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Affiliation(s)
- Helena C Maltezou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece.
| | - Georgios Adamis
- First Department of Medicine and Infectious Diseases Unit, Athens General Hospital "G. Gennimatas", Athens, Greece
| | - Paraskeui Tsonou
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Eleni Moustaka
- Seventh Department of Pulmonary Medicine, Athens Chest General Hospital "Sotiria", Athens, Greece
| | - Panos Katerelos
- Department for Interventions in Health-Care Facilities, Hellenic Center for Disease Control and Prevention, Athens, Greece
| | - Panagiotis Gargalianos
- First Department of Medicine and Infectious Diseases Unit, Athens General Hospital "G. Gennimatas", Athens, Greece
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Schröder W, Sommer H, Gladstone BP, Foschi F, Hellman J, Evengard B, Tacconelli E. Gender differences in antibiotic prescribing in the community: a systematic review and meta-analysis. J Antimicrob Chemother 2016; 71:1800-6. [DOI: 10.1093/jac/dkw054] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Accepted: 02/10/2016] [Indexed: 01/24/2023] Open
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Harbarth S, Balkhy HH, Goossens H, Jarlier V, Kluytmans J, Laxminarayan R, Saam M, Van Belkum A, Pittet D. Antimicrobial resistance: one world, one fight! Antimicrob Resist Infect Control 2015. [PMCID: PMC4652432 DOI: 10.1186/s13756-015-0091-2] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The lack of new antibiotic classes calls for a cautious use of existing agents. Yet, every 10 min, almost two tons of antibiotics are used around the world, all too often without any prescription or control. The use, overuse and misuse of antibiotics select for resistance in numerous species of bacteria which then renders antimicrobial treatment ineffective. Almost all countries face increased antimicrobial resistance (AMR), not only in humans but also in livestock and along the food chain. The spread of AMR is fueled by growing human and animal populations, uncontrolled contamination of fresh water supplies, and increases in international travel, migration and trade. In this context of global concern, 68 international experts attending the fifth edition of the World HAI Resistance Forum in June 2015 shared their successes and failures in the global fight against AMR. They underlined the need for a “One Health” approach requiring research, surveillance, and interventions across human, veterinary, agricultural and environmental sectors. This strategy involves concerted actions on several fronts. Improved education and increased public awareness are a well-understood priority. Surveillance systems monitoring infections need to be expanded to include antimicrobial use, as well as the emergence and spread of AMR within clinical and environmental samples. Adherence to practices to prevent and control the spread of infections is mandatory to reduce the requirement of antimicrobials in general care and agriculture. Antibiotics need to be banned as growth promoters for farm animals in countries where it has not yet been done. Antimicrobial stewardship programmes in animal husbandry have proved to be efficient for minimising AMR, without compromising productivity. Regarding the use of antibiotics in humans, new tools to provide highly specific diagnoses of pathogens can decrease diagnostic uncertainty and improve clinical management. Finally, infection prevention and control measures – some of them as simple as hand hygiene – are essential and should be extended beyond healthcare settings. Aside from regulatory actions, all people can assist in AMR reduction by limiting antibiotic use for minor illnesses. Together, we can all work to reduce the burden of AMR.
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van der Mee-Marquet NL, Blanc DS, Gbaguidi-Haore H, Dos Santos Borges S, Viboud Q, Bertrand X, Quentin R. Marked increase in incidence for bloodstream infections due to Escherichia coli, a side effect of previous antibiotic therapy in the elderly. Front Microbiol 2015; 6:646. [PMID: 26175721 PMCID: PMC4485226 DOI: 10.3389/fmicb.2015.00646] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/15/2015] [Indexed: 01/04/2023] Open
Abstract
We conducted a survey including 3334 bloodstream infections (BSIs) due to E. coli diagnosed in 2005–2014 at a stable cohort of hospitals. Marked increases in incidence were observed for community-acquired (CA) BSIs in patients aged >75 years, CA-BSIs of digestive origin in patients aged 60–74 years, healthcare-associated BSIs, and BSIs associated with ESBL (extended-spectrum B-lactamase)-producing E. coli (ESBLEc). Using MLST, we studied the genetic diversity of 412 BSI isolates recovered during the 2014 survey: 7 major sequence type complexes (STCs) were revealed in phylogenetic group B2, 3 in group A/B1 and 2 in group D. Among the 31 ESBLEc isolates, 1/3 belonged to STC 131. We searched for possible associations between clonal groups, clinical determinants and characteristics of BSIs: isolates from groups B2 (except STC 131) and D were susceptible to antibiotics and associated with BSIs of urinary origin in patients <60 years. STC 131 and group A/B1 isolates were multi-drug resistant and associated with CA-BSIs of digestive origin in patients aged 60–74 with a recent history of antibiotic treatment. STC 131 isolates were associated with HCA-BSIs in patients with recent/present hospitalization in a long-stay unit. We provide a unique population-based picture of the epidemiology of E. coli BSI. The aging nature of the population led to an increase in the number of cases caused by the B2 and D isolates generally implicated in BSIs. In addition, the association of a trend toward increasing rates of gut colonization with multi drug-resistant isolates revealed by the rise in the incidence of BSIs of digestive origin caused by STC 131 and A/B1 (STCs 10, 23, and 155) isolates, and a significant increase in the frequency of BSIs in elderly patients with recent antibiotic treatment suggested that antibiotic use may have contributed to the growing incidence of BSI.
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Affiliation(s)
- Nathalie L van der Mee-Marquet
- Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire de Tours, UMR 1282 Tours, France ; Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire de Tours France
| | - Dominique S Blanc
- Service of Hospital Preventive Medicine, Lausanne University Hospital Lausanne, Switzerland
| | - Houssein Gbaguidi-Haore
- Service d'Hygiéne Hospitaliére, Centre Hospitalier Universitaire de Besançon, UMR CNRS 6249, Chrono-environnement, Université Bourgogne Framche-Comté Besançon, France
| | - Sandra Dos Santos Borges
- Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire de Tours, UMR 1282 Tours, France
| | - Quentin Viboud
- Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire de Tours, UMR 1282 Tours, France
| | - Xavier Bertrand
- Service d'Hygiéne Hospitaliére, Centre Hospitalier Universitaire de Besançon, UMR CNRS 6249, Chrono-environnement, Université Bourgogne Framche-Comté Besançon, France
| | - Roland Quentin
- Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire de Tours, UMR 1282 Tours, France
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Huttner B, Harbarth S, Nathwani D. Success stories of implementation of antimicrobial stewardship: a narrative review. Clin Microbiol Infect 2014; 20:954-62. [PMID: 25294340 DOI: 10.1111/1469-0691.12803] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Revised: 08/12/2014] [Accepted: 08/12/2014] [Indexed: 01/19/2023]
Abstract
It has been increasingly recognized that antimicrobial stewardship (AMS) has to be a key component of any efforts that aim to mitigate the current global antimicrobial resistance (AMR) crisis. It has also become evident that AMR is a problem that cannot be tackled by single institutions or physicians, but needs concerted actions at regional, national and supra-national levels. However, it is easy to become discouraged, given the problems that are often encountered when implementing AMS. The aim of this review is to highlight some of the success stories of AMS strategies, and to describe the actions that have been taken, the outcomes that have been obtained, and the obstacles that have been met. Although the best approach to effective AMS remains elusive and may vary significantly among settings, these diverse examples from a range of healthcare contexts demonstrate that effective AMS is possible. Such examples will inform others and encourage them to formally evaluate and share their results with the global stewardship community.
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Affiliation(s)
- B Huttner
- Infection Control Programme and Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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