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Yu XL, Zhou LY, Huang X, Li XY, Pan QQ, Wang MK, Yang JS. Urgent call for attention to diabetes-associated hospital infections. World J Diabetes 2024; 15:1683-1691. [PMID: 39192868 PMCID: PMC11346093 DOI: 10.4239/wjd.v15.i8.1683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/25/2024] Open
Abstract
In this editorial, we discuss the recent article by Zhao et al published in the World Journal of Diabetes, which highlights the importance of recognizing the risk indicators associated with diabetes mellitus (DM). Given the severe implications of healthcare-associated infections (HAIs) in hospitalized individuals- such as heightened mortality rates, prolonged hospitalizations, and increased costs- we focus on elucidating the connection between DM and nosocomial infections. Diabetic patients are susceptible to pathogenic bacterial invasion and subsequent infection, with some already harboring co-infections upon admission. Notably, DM is an important risk factor for nosocomial urinary tract infections and surgical site infections, which may indirectly affect the occurrence of nosocomial bloodstream infections, especially in patients with DM with poor glycemic control. Although evidence regarding the impact of DM on healthcare-associated pneumonias remains inconclusive, attention to this potential association is warranted. Hospitalized patients with DM should prioritize meticulous blood glucose management, adherence to standard operating procedures, hand hygiene pra-ctices, environmental disinfection, and rational use of drugs during hospitalization. Further studies are imperative to explore the main risk factors of HAIs in patients with DM, enabling the development of preventative measures and mitigating the occurrence of HAIs in these patients.
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Affiliation(s)
- Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xiao Huang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xin-Yue Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Qing-Qing Pan
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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Xiao Y, Xin X, Chen Y, Yan Q. Antimicrobial use, healthcare-associated infections, and bacterial resistance in general hospitals in China: the first national pilot point prevalence survey report. Eur J Clin Microbiol Infect Dis 2023; 42:715-726. [PMID: 37067662 DOI: 10.1007/s10096-023-04602-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/11/2023] [Indexed: 04/18/2023]
Abstract
The purpose of this study is to implement point prevalence survey (PPS), assess antimicrobial prescribing and resistance in general hospitals and clinical specialties in China, and compare them with similar data from other parts of the world. Twenty general hospitals in China were surveyed in October or November, 2019. A standardized surveillance protocol was used to collect data on patient demographics, diagnosis of infection, the prevalence and intensity of antimicrobial use, prescribing quality, bacterium type and resistance spectrum, and the prevalence and type of healthcare-associated infections (HAIs). Overall, 10,881 beds and 10,209 inpatients were investigated. The overall prevalence of antibiotic use was 37.00%, the use of antibiotic prophylaxis in surgical patients was high (74.97%). The intensity of antimicrobial use was 61.25 DDDs/100 patient days. Only 11.62% of antimicrobial prescriptions recorded the reason for prescribing. Intravenous or combination treatments comprised 92.02% and 38.07%, respectively, and only 30.65% of prescriptions referred to a microbiological or biomarker tests. The incidence of HAIs in all patients was 3.79%. The main associated factors for HAIs included more frequent invasive procedures (27.34%), longer hospital stay (> 1-week stay accounting for 51.47%), and low use of alcohol hand rubs (only 29.79% placed it bedside). Most of the resistant bacteria declined; only carbapenem-resistant Enterobacter is higher than previously reported. The prevalence of antibiotic use in general hospitals fell significantly, the overall bacterial resistance declined, and the incidence of HAI was low. However, the low quality of antimicrobial use requires urgent attention.
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Affiliation(s)
- Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
- Research Units of Infectious Disease and Microecology, Chinese Academy of Medical Sciences, Beijing, China.
| | - Xing Xin
- Department of Infection Control, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunbo Chen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Yan
- National Institute of Hospital Administration, National Health Commission of China, Beijing, China
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Spernovasilis N, Kritsotakis EI, Mathioudaki A, Vouidaski A, Markaki I, Psaroudaki D, Ioannou P, Kofteridis DP. Antimicrobial Prescribing before and after the Implementation of a Carbapenem-Focused Antimicrobial Stewardship Program in a Greek Tertiary Hospital during the COVID-19 Pandemic. Antibiotics (Basel) 2022; 12:antibiotics12010039. [PMID: 36671240 PMCID: PMC9854477 DOI: 10.3390/antibiotics12010039] [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: 11/20/2022] [Revised: 12/19/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. METHODS All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. RESULTS Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. CONCLUSIONS Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing.
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Affiliation(s)
- Nikolaos Spernovasilis
- School of Medicine, University of Crete, 71500 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
- Department of Infectious Diseases, German Oncology Center, 4108 Limassol, Cyprus
- Correspondence: (N.S.); (D.P.K.)
| | - Evangelos I. Kritsotakis
- School of Medicine, University of Crete, 71500 Heraklion, Greece
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Anna Mathioudaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Alexandra Vouidaski
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Ioulia Markaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Despoina Psaroudaki
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Petros Ioannou
- School of Medicine, University of Crete, 71500 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
| | - Diamantis P. Kofteridis
- School of Medicine, University of Crete, 71500 Heraklion, Greece
- Department of Internal Medicine and Infectious Diseases, University Hospital of Heraklion, 71500 Heraklion, Greece
- Correspondence: (N.S.); (D.P.K.)
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Patel PK, Satoh N, Narita M, Cho Y, Oshiro Y, Suzuki T, Fowler KE, Greene MT, Tokuda Y, Kaye KS. Inpatient antibiotic prescribing patterns using the World Health Organization (WHO) Access Watch and Reserve (AWaRe) classification in Okinawa, Japan: A point-prevalence survey. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e155. [PMID: 36483349 PMCID: PMC9726586 DOI: 10.1017/ash.2022.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/08/2022] [Accepted: 06/10/2022] [Indexed: 06/17/2023]
Abstract
Using point-prevalence methodology and the World Health Organization (WHO) Access, Watch, and Reserve Classification, we measured antibiotic use in 5 hospitals in Okinawa, Japan, on October 1, 2020. Overall, 29% of patients were prescribed an antibiotic on the survey date and the 3 most used antibiotics in the "Watch" category were cefazolin, ampicillin-sulbactam, and ampicillin.
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Affiliation(s)
- Payal K. Patel
- Division of Infectious Diseases, Veterans’ Affairs Ann Arbor Healthcare System and University of Michigan, Ann Arbor, Michigan, United States
| | - Naoyuki Satoh
- Division of Hospital Medicine, Heartlife Hospital, Okinawa, Japan
| | - Masashi Narita
- Division of Infectious Diseases, Okinawa Chubu Hospital, Okinawa, Japan
| | - Yoshiaki Cho
- Division of Pediatric Infectious Diseases, Okinawa Prefectural Nanbu Medical Center and Children’s Medical Center, Okinawa, Japan
| | - Yusuke Oshiro
- Division of Hospital Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Tomoharu Suzuki
- Division of Hospital Medicine, Urasoe General Hospital, Okinawa, Japan
| | - Karen E. Fowler
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - M. Todd Greene
- Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, United States
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Okinawa, Japan
| | - Keith S. Kaye
- Division of Infectious Diseases, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
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Morioka H, Iguchi M, Tetsuka N, Kinoshita F, Tomita Y, Kato D, Hirabayashi A, Matsumoto A, Oka K, Kato H, Inagaki T, Kato Y, Kitagawa K, Ichikawa K, Kouyama Y, Kawamura N, Toyodome Y, Adachi N, Ito Y, Yagi T. Five-year point prevalence survey of healthcare-associated infections and antimicrobial use in a Japanese university hospital. Infect Prev Pract 2021; 3:100151. [PMID: 34647007 PMCID: PMC8498696 DOI: 10.1016/j.infpip.2021.100151] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 05/28/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Periodic point prevalence surveys (PPSs) provide a method for assessing changes in healthcare-associated infections (HAIs) and antimicrobial use over time. Following the introduction of an antimicrobial stewardship programme at Nagoya University Hospital (Aichi, Japan) a five-year PPS study was performed to highlight any epidemiological changes. METHODS One-day PPSs were performed annually in July at Nagoya University Hospital. Data on patient characteristics, medical devices, active HAIs and antimicrobial use were collected using a standard data-collection form. RESULTS A total of 4339 patients were included. Over the five-year study period the median patient age was 62 years, median duration of hospital admission was nine days, 9% of patients had an HAI and 35.2% received at least one antimicrobial. Overall there were 406 HAIs (95% confidence interval, 369-447) with surgical site infection, pneumonia and febrile neutropenia occurring most frequently. Enterobacterales were the most common pathogens (N = 78, 28.6%) and 32.1% were third-generation cephalosporin-resistant. Meropenem was the most frequently prescribed antimicrobial for HAIs. Surgical antimicrobial prophylaxis changed drastically, with shorter durations and a marked reduction in oral cephalosporin use. However, antimicrobials for medical prophylaxis gradually increased. CONCLUSIONS This five-year PPS study shows consistent data for patient background, HAIs and causative pathogens and highlights changes in antimicrobial use during the era of the National Action Plan on Antimicrobial Resistance. To describe the epidemiology of Japanese hospitals by PPS, multicentre PPSs including in community hospitals should be performed annually.
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Affiliation(s)
- H. Morioka
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
| | - M. Iguchi
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
| | - N. Tetsuka
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
| | - F. Kinoshita
- Department of Advanced Medicine, Nagoya University Hospital, Aichi, Japan
| | - Y. Tomita
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
- Department of Internal Medicine, Japanese Red Cross Nagoya Daini Hospital, Aichi, Japan
| | - D. Kato
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
- Department of Orthopedic Surgery, Okazaki City Hospital, Aichi, Japan
| | - A. Hirabayashi
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
- Antimicrobial Resistance Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - A. Matsumoto
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
| | - K. Oka
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
| | - H. Kato
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
- Department of Infectious Diseases, Toyota Memorial Hospital, Aichi, Japan
| | - T. Inagaki
- Department of Hospital Pharmacy, Nagoya University Hospital, Aichi, Japan
| | - Y. Kato
- Department of Hospital Pharmacy, Nagoya University Hospital, Aichi, Japan
| | - K. Kitagawa
- Department of Hospital Pharmacy, Nagoya University Hospital, Aichi, Japan
| | - K. Ichikawa
- Department of Hospital Pharmacy, Nagoya University Hospital, Aichi, Japan
- Department of Pharmacy, NHO Mie Chuo Medical Center, Mie, Japan
| | - Y. Kouyama
- Department of Hospital Pharmacy, Nagoya University Hospital, Aichi, Japan
- Department of Pharmacy, Fujita Health University Hospital, Aichi, Japan
| | - N. Kawamura
- Department of Nursing, Nagoya University Hospital, Aichi, Japan
| | - Y. Toyodome
- Department of Nursing, Nagoya University Hospital, Aichi, Japan
| | - N. Adachi
- Department of Nursing, Nagoya University Hospital, Aichi, Japan
| | - Y. Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - T. Yagi
- Department of Infectious Diseases, Nagoya University Hospital, Aichi, Japan
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Obeid WMN, Abdoon IH, Osman B, Osman WJA, Suliman HM, Mohamed EM, Mothana RAA. Drug use evaluation of cefepime at Khartoum North Teaching Hospital in Sudan. Int J Clin Pract 2021; 75:e13882. [PMID: 33277753 DOI: 10.1111/ijcp.13882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cefepime is essentially used for life-threatening infections. Although overutilisation of antibiotics is strongly discouraged around the world, they are still overused in developing countries including Sudan. OBJECTIVES This study aims to evaluate the rational use of cefepime at Khartoum North Teaching Hospital-Sudan. METHODS A retrospective cross-sectional, hospital-based study was conducted in the internal medicine ward at Khartoum North Teaching Hospital from August/2018 to April/2019. The study covered medical records of adult patients receiving cefepime during the study period. Patient's data were analysed using simple descriptive statistics (frequency and percentage) and inferential statistics (logistic regression) to describe the relationship between dependent and independent variables. P ≤ .05 was considered statistically significant. RESULTS Out of 90 patients, only 16.7% of patients were tested for antibiotic sensitivity. Cefepime was prescribed to 50% and 23.3% of patients for the treatment of UTIs/post-dialysis and sepsis, respectively. Although the majority of patients (72.2%) received cefepime with appropriate indication, only 21.1% and 15.6% received the drug with appropriate dose and duration, respectively. Cefepime had been prescribed appropriately in a correct dose, duration, and indications for only 7.8% of patients. The vast majority of patients tested for kidney functions had elevated creatinine levels (96.1%); however, cefepime dose had been adjusted for only 4.1% of them. CONCLUSION This study highlighted the irrational use of cefepime regarding inappropriate dose, duration, and inadequate antibiotic sensitivity tests. A lack of attention to dosage adjustment in patients with renal impairment had been observed. Positive clinical outcome was significantly associated with antibiotic sensitivity test.
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Affiliation(s)
| | - Iman Hassan Abdoon
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Bashier Osman
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Wadah J A Osman
- Department of Pharmacognosy, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Hayat Mohamed Suliman
- Department of Pharmacology, Faculty of Pharmacy, University of Khartoum, Khartoum, Sudan
| | - Elwasila M Mohamed
- Department of Agricultural Extension and Rural Development, Faculty of Agriculture, University of Khartoum, Khartoum, Sudan
| | - Ramzi A A Mothana
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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7
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Loftus MJ, Curtis SJ, Naidu R, Cheng AC, Jenney AWJ, Mitchell BG, Russo PL, Rafai E, Peleg AY, Stewardson AJ. Prevalence of healthcare-associated infections and antimicrobial use among inpatients in a tertiary hospital in Fiji: a point prevalence survey. Antimicrob Resist Infect Control 2020; 9:146. [PMID: 32859255 PMCID: PMC7456377 DOI: 10.1186/s13756-020-00807-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/19/2020] [Indexed: 12/03/2022] Open
Abstract
Background Healthcare-associated infections (HAIs) and antimicrobial use (AMU) are important drivers of antimicrobial resistance, yet there is minimal data from the Pacific region. We sought to determine the point prevalence of HAIs and AMU at Fiji’s largest hospital, the Colonial War Memorial Hospital (CWMH) in Suva. A secondary aim was to evaluate the performance of European Centre for Diseases Prevention and Control (ECDC) HAI criteria in a resource-limited setting. Methods We conducted a point prevalence survey of HAIs and AMU at CWMH in October 2019. Survey methodology was adapted from the ECDC protocol. To evaluate the suitability of ECDC HAI criteria in our setting, we augmented the survey to identify patients with a clinician diagnosis of a HAI where diagnostic testing criteria were not met. We also assessed infection prevention and control (IPC) infrastructure on each ward. Results We surveyed 343 patients, with median (interquartile range) age 30 years (16–53), predominantly admitted under obstetrics/gynaecology (94, 27.4%) or paediatrics (83, 24.2%). Thirty patients had one or more HAIs, a point prevalence of 8.7% (95% CI 6.0% to 12.3%). The most common HAIs were surgical site infections (n = 13), skin and soft tissue infections (7) and neonatal clinical sepsis (6). Two additional patients were identified with physician-diagnosed HAIs that failed to meet ECDC criteria due to insufficient investigations. 206 (60.1%) patients were receiving at least one antimicrobial. Of the 325 antimicrobial prescriptions, the most common agents were ampicillin (58/325, 17.8%), cloxacillin (55/325, 16.9%) and metronidazole (53/325, 16.3%). Use of broad-spectrum agents such as piperacillin/tazobactam (n = 6) and meropenem (1) was low. The majority of prescriptions for surgical prophylaxis were for more than 1 day (45/76, 59.2%). Although the number of handwashing basins throughout the hospital exceeded World Health Organization recommendations, availability of alcohol-based handrub was limited and most concentrated within high-risk wards. Conclusions The prevalence of HAIs in Fiji was similar to neighbouring high-income countries, but may have been reduced by the high proportion of paediatric and obstetrics patients, or by lower rates of inpatient investigations. AMU was very high, with duration of surgical prophylaxis an important target for future antimicrobial stewardship initiatives.
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Affiliation(s)
- M J Loftus
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - S J Curtis
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia
| | - R Naidu
- Colonial War Memorial Hospital, Suva, Fiji
| | - A C Cheng
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - A W J Jenney
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia.,Fiji National University, Suva, Fiji
| | - B G Mitchell
- School of Nursing and Midwifery, University of Newcastle, Callaghan, Australia
| | - P L Russo
- Department of Nursing Research, Cabrini Institute, Malvern, Australia.,Department of Nursing and Midwifery, Monash University, Frankston, Australia
| | - E Rafai
- Fiji Ministry of Health and Medical Services, Suva, Fiji
| | - A Y Peleg
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia. .,Infection and Immunity Program, Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, Australia.
| | - A J Stewardson
- Department of Infectious Diseases, The Alfred Hospital and Central Clinical School, Monash University, Melbourne, Australia.
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Takamatsu A, Yao K, Murakami S, Tagashira Y, Hasegawa S, Honda H. Barriers to Adherence to Antimicrobial Stewardship Postprescription Review and Feedback For Broad-Spectrum Antimicrobial Agents: A Nested Case-Control Study. Open Forum Infect Dis 2020; 7:ofaa298. [PMID: 32832576 PMCID: PMC7434090 DOI: 10.1093/ofid/ofaa298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/13/2020] [Indexed: 12/17/2022] Open
Abstract
Background Postprescription review and feedback (PPRF) is one of the most common strategies in antimicrobial stewardship program (ASP) intervention. However, disagreements between the prescribers and ASP personnel can occur. The aim of the present study was to identify the factors associated with nonadherence to PPRF intervention. Methods The present retrospective nested case-control study was performed at a tertiary care center, which has been conducting a once-weekly PPRF for carbapenems and piperacillin/tazobactam since 2014. Nonadherence to ASP recommendations was defined as the failure of the primary care team to modify or stop antimicrobial therapy 72 hours after the issuance of PPRF recommendations. Factors associated with nonadherence to PPRF intervention were identified using multivariate logistic regression analysis. Results In total, 2466 instances of PPRF in 1714 cases between April 2014 and September 2019 were found. The nonadherence rate was 5.9%, and 44 cases were found in which carbapenems or piperacillin/tazobactam continued to be used against PPRF recommendations. Factors associated with nonadherence to PPRF recommendations were a previous history of hospitalization within 90 days (adjusted odds ratio [aOR], 2.62; 95% confidence interval [CI], 1.18-5.81) and a rapidly fatal McCabe score at the time of PPRF intervention (aOR, 2.87; 95% CI, 1.18-6.98). A review of the narrative comments in the electronic medical records indicated that common reasons for nonadherence were "the patient was sick" (n = 12; 27.3%) and "the antimicrobial seemed to be clinically effective" (n = 9; 20.5%). Conclusions Nonadherence to PPRF recommendations was relatively uncommon at the study institution. However, patients with a severe disease condition frequently continued to receive broad-spectrum antimicrobials against PPRF recommendations. Understanding physicians' cognitive process in nonadherence to ASP recommendations and ASP interventions targeting medical subspecialties caring for severely ill patients is needed to improve ASP.
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Affiliation(s)
- Akane Takamatsu
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Kenta Yao
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shutaro Murakami
- Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Yasuaki Tagashira
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Shinya Hasegawa
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Hitoshi Honda
- Division of Infectious Diseases, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.,Department of Infection Control, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
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9
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Huang G, Huang Q, Zhang G, Jiang H, Lin Z. Point-prevalence surveys of hospital-acquired infections in a Chinese cancer hospital: From 2014 to 2018. J Infect Public Health 2020; 13:1981-1987. [PMID: 32280033 DOI: 10.1016/j.jiph.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/27/2020] [Accepted: 03/08/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Both hospital-acquired infection (HAI) and cancer represents major health concerns worldwide, but there is a paucity of data describing HAI in Chinese cancer patients. The objective of this study is to demonstrate the prevalence, causative agents, antimicrobial use and risk factors for HAI in a cancer hospital in Southwestern China. METHODS We use the criteria of the Ministry of Health of the People's Republic of China to define hospital-acquired infections. One-day cross-sectional surveys were annually conducted from 2014 to 2018. Trained staff collected hospital-acquired infections, antimicrobial use and clinical characteristics data of inpatients. Multivariate logistic regression was used to determine the potential risk factors associated with HAIs. RESULTS Of the 6717 patients surveyed, there were 140 patients (2.1%, 95% confidence interval, 1.7-2.4%) with 144 distinct HAIs. Lower respiratory tract infections (47, 32.6%) and surgical-site infections (29, 20.1%) were the most common HAIs. Escherichia coli was the most common pathogen (29.6%). Risk factors for HAI included younger age (<18 years) or older age (>65 years), hospitalization in the intensive care unit, presence of central catheter and undergoing surgery in the previous 30 days. The overall prevalence of patients receiving antimicrobial agents was 15.2%. CONCLUSION To control hospital-acquired infections in cancer patients, surveillance and prevention strategies to infections associated with central catheters or related to surgery should be augmented.
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Affiliation(s)
- Guyu Huang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Qianqian Huang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Guoqiang Zhang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Hu Jiang
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China
| | - Zhen Lin
- Department of Hospital Infection Prevention and Control, Affiliated Cancer Hospital of Guangxi Medical University, Nanning, China.
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10
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Komagamine J, Yabuki T, Hiraiwa T. A trend in prevalence of antimicrobial use and appropriateness of antimicrobial therapy in an acute care hospital from 2018 to 2019: repeated prevalence surveys in Japan. BMC Res Notes 2019; 12:811. [PMID: 31849341 PMCID: PMC6918669 DOI: 10.1186/s13104-019-4849-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 12/08/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES The supply of cefazolin has been reduced dramatically since March 2019 in Japan. However, no studies have evaluated the effects of cefazolin shortage on the appropriateness of antimicrobial use. Therefore, we compared the appropriateness of inpatient antimicrobial drug use between the two surveys conducted in August 2018 and August 2019 in a Japanese hospital with no supply of cefazolin since the cefazolin shortage. RESULTS In the 2019 survey, a total of 275 patients were included, and 256 patients were included in the 2018 survey. The prevalence of antimicrobial drug use did not change from 2018 to 2019 (28.5% versus 28.7%; p = 0.96). The proportion of cefazolin in all antimicrobial drugs used on the survey date significantly decreased from 2018 to 2019 (24.1% versus 0.0%; p < 0.001). The proportion of appropriate antimicrobial use in all antimicrobial therapies tended to be lower in 2019 than in 2018 (41.2% versus 60.6%; p = 0.06), and the proportion of unnecessary use of a broader spectrum of antimicrobial drugs significantly increased from 2018 to 2019 (4.7% versus 37.3%; p = 0.002). The shortage of cefazolin might lead to inappropriate use of other antimicrobial drugs.
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Affiliation(s)
- Junpei Komagamine
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi, Japan.
| | - Taku Yabuki
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi, Japan
| | - Taku Hiraiwa
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, 1-10-37, Nakatomatsuri, Utsunomiya, Tochigi, Japan
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