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Gruber MM, Weber A, Jung J, Strehlau A, Tsilimparis N, Draenert R. The impact of antibiotic stewardship interventions and patient related factors on antibiotic prescribing in a vascular surgical department. Infection 2024; 52:83-91. [PMID: 37289423 PMCID: PMC10810951 DOI: 10.1007/s15010-023-02056-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE The development of guidelines tailored to the departments' needs and counselling during ward rounds are important antibiotic stewardship (AS) strategies. The aim was to analyse the impact of AS ward rounds and institutional guidelines as well as patient-related factors on antibiotic use in vascular surgical patients. METHODS A retrospective prescribing-analysis of 3 months (P1, P2) before and after implementing weekly AS ward rounds and antimicrobial treatment guidelines was performed. Choice of systemic antibiotics, days of antibiotic therapy and clinical data were obtained from electronic patient records. RESULTS During P2, the overall antibiotic consumption as well as the use of last-resort compounds like linezolid and fluoroquinolones decreased distinctly (overall: 47.0 days of therapy (DOT)/100 patient days (PD) vs. 35.3 DOT/100PD, linezolid: 3.7 DOT/100PD vs. 1.0 DOT/100PD, fluoroquinolones: 7.0 DOT/100PD vs. 3.2 DOT/100PD) while narrow-spectrum beta-lactams increased by 48.4%. Courses of antibiotics were de-escalated more often during P2 (30.5% vs. 12.1%, p = 0.011). Only in P2, an antibiotic therapy was initiated in patients suffering from more comorbidities (i.e. higher Charlson Comorbidity Index) more frequently. Other patient factors had no distinct impact on antibiotic prescribing. CONCLUSION Weekly AS ward rounds improved adherence to institutional antibiotic treatment guidelines and antibiotic prescribing in vascular surgical patients. Clear patient-related determinants affecting choice of antibiotic therapies could not be identified.
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Affiliation(s)
- M M Gruber
- Stabsstelle Antibiotic Stewardship, LMU University Hospital, LMU Munich, Munich, Germany
- Hospital Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany
| | - A Weber
- Stabsstelle Antibiotic Stewardship, LMU University Hospital, LMU Munich, Munich, Germany
- Hospital Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany
| | - J Jung
- Stabsstelle Antibiotic Stewardship, LMU University Hospital, LMU Munich, Munich, Germany
- Max von Pettenkofer Institute, Faculty of Medicine, LMU Munich, Munich, Germany
| | - A Strehlau
- Hospital Pharmacy, LMU University Hospital, LMU Munich, Munich, Germany
| | - N Tsilimparis
- Division of Vascular Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - R Draenert
- Stabsstelle Antibiotic Stewardship, LMU University Hospital, LMU Munich, Munich, Germany.
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Tamblyn R, Moraga T, Girard N, Boulet J, Chan FKI, Habib B. Do clinical and communication skills scores on credentialing exams predict potentially inappropriate antibiotic prescribing? BMC MEDICAL EDUCATION 2023; 23:821. [PMID: 37915014 PMCID: PMC10621187 DOI: 10.1186/s12909-023-04817-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 10/29/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND There is considerable variation among physicians in inappropriate antibiotic prescribing, which is hypothesized to be attributable to diagnostic uncertainty and ineffective communication. The objective of this study was to evaluate whether clinical and communication skills are associated with antibiotic prescribing for upper respiratory infections and sinusitis. METHODS A cohort study of 2,526 international medical graduates and 48,394 U.S. Medicare patients diagnosed by study physicians with an upper respiratory infection or sinusitis between July 2014 and November 2015 was conducted. Clinical and communication skills were measured by scores achieved on the Clinical Skills Assessment examination administered by the Educational Commission for Foreign Medical Graduates (ECFMG) as a requirement for entry into U.S residency programs. Medicare Part D data were used to determine whether patients were dispensed an antibiotic following an outpatient evaluation and management visit with the study physician. Physician age, sex, specialty and practice region were retrieved from the ECFMG databased and American Medical Association (AMA) Masterfile. Multivariate GEE logistic regression was used to evaluate the association between clinical and communication skills and antibiotic prescribing, adjusting for other physician and patient characteristics. RESULTS Physicians prescribed an antibiotic in 71.1% of encounters in which a patient was diagnosed with sinusitis, and 50.5% of encounters for upper respiratory infections. Better interpersonal skills scores were associated with a significant reduction in the odds of antibiotic prescribing (OR per score decile 0.93, 95% CI 0.87-0.99), while greater proficiency in clinical skills and English proficiency were not. Female physicians, those practicing internal medicine compared to family medicine, those with citizenship from the US compared to all other countries, and those practicing in southern of the US were also more likely to prescribe potentially unnecessary antibiotics. CONCLUSIONS Based on this study, physicians with better interpersonal skills are less likely to prescribe antibiotics for acute sinusitis and upper respiratory infections. Future research should examine whether tailored interpersonal skills training to help physicians manage patient expectations for antibiotics could reduce unnecessary antibiotic prescribing.
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Affiliation(s)
- Robyn Tamblyn
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, H3A 1G1, Montreal, QC, Canada.
- Department of Medicine, McGill University Health Center, Montreal, QC, Canada.
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada.
| | - Teresa Moraga
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - Nadyne Girard
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - John Boulet
- Foundation for Advancement of International Medical Education and Research (FAIMER), Philadelphia, PA, USA
| | - Fiona K I Chan
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, 2001 McGill College Avenue, H3A 1G1, Montreal, QC, Canada
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
| | - Bettina Habib
- Clinical and Health Informatics Research Group, McGill University, Montreal, QC, Canada
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Poluektova O, Robertson DA, Rafferty A, Cunney R, Lunn PD. A scoping review and behavioural analysis of factors underlying overuse of antimicrobials. JAC Antimicrob Resist 2023; 5:dlad043. [PMID: 37168837 PMCID: PMC10164659 DOI: 10.1093/jacamr/dlad043] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 03/14/2023] [Indexed: 05/13/2023] Open
Abstract
Background Overuse of antimicrobials is a challenging global issue that contributes to antimicrobial resistance. Despite widespread awareness of the problem among members of the medical community and various attempts to improve prescription practices, existing antimicrobial stewardship programmes are not always effective. In our view, this may reflect limited understanding of factors that influence prescription of antimicrobials as empirical therapy, implying a need to address the psychological mechanisms behind some of the specific behaviours involved. Objectives To identify factors that influence the antimicrobials prescription as empirical therapy, and to relate these factors to findings from behavioural science. Methods We conducted a scoping review of the literature on the factors underlying antimicrobial prescription decisions, following the protocol designed using PRISMA guidelines. Results and conclusions From a final sample of 90 sources, we identified ten factors important in antimicrobial prescription decisions. In the second stage of our analysis, we grouped them into five final categories: (1) nature of the decision, (2) social influences, (3) individual differences, (4) characteristics of the patient, (5) context. We analyse these categories using a behavioural science perspective.
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Affiliation(s)
| | - Deirdre A Robertson
- Behavioural Research Unit, The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Ireland
- Trinity College Dublin, School of Psychology, Dublin, Ireland
| | - Aisling Rafferty
- Children’s Health Ireland, Department of Pharmacy, Dublin, Ireland
- University of Birmingham, School of Pharmacy, Institute of Clinical Sciences,Birmingham, UK
| | - Robert Cunney
- Children’s Health Ireland, Irish Meningitis and Sepsis Reference Laboratory, Dublin, Ireland
- Royal College of Surgeons in Ireland, Department of Microbiology, Dublin, Ireland
- Children’s Health Ireland, Department of Microbiology, Dublin, Ireland
| | - Peter D Lunn
- Behavioural Research Unit, The Economic and Social Research Institute, Whitaker Square, Sir John Rogerson’s Quay, Ireland
- Trinity College Dublin, Department of Economics, Dublin, Ireland
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Zhang C, Chen Y, Fan X, Jin P. Optimization of extraction process of 15 bioactive compounds from Qing Fei Yi Huo tablets using response surface methodology. J Chromatogr B Analyt Technol Biomed Life Sci 2023; 1223:123720. [PMID: 37159978 DOI: 10.1016/j.jchromb.2023.123720] [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: 03/02/2023] [Revised: 04/06/2023] [Accepted: 04/13/2023] [Indexed: 05/11/2023]
Abstract
Qing Fei Yi Huo tablets (QFYHT) can relieve the clinical symptoms of acute bronchitis, and is widely prescribed in China. However, the quality standard of QFTHT lacks quantitative assessment. Therefore, it is crucial to develop an effective method for the extraction and analyses of its bioactive components.This study aimed to optimize the ultrasonic extraction of QFYHT and establish a method for the simultaneous quantification of 15 components. Box-Behnken Design (BBD) experiment was employed with three factors (solvent volume, extraction time and ultrasonic power) to optimize the extraction conditions, and the total content of 15 components was measured by high-performance liquid chromatography-diode array detector (HPLC-DAD) method. The total extracted content of 15 components was the highest when 100% methanol was used as the solvent, and the solvent volume was 22 mL, extraction time was 30 min and ultrasonic power was 350 w. The 15 components showed a good linear relationship (r ≥ 0.9998) within a concentration range. The precision, stability and repeatability of this method were satisfactory, and the average recovery rates ranged from 98.08% ∼ 102.87%. These findings demonstrate that optimization of extraction conditions by RSM can significantly improve the ultrasonic extraction rate of the 15 bioactive components of QFYHT. The quantification method is simple, accurate, reliable and practical, and can provide reference for improving the quality control of QFYHT.
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Affiliation(s)
- Chun Zhang
- Department of Traditional Chinese Medicine, Jiaxing Institute for Food, Drug and Product Quality Control, Jiaxing 314001, China
| | - Yeqing Chen
- Department of Traditional Chinese Medicine, Jiaxing Institute for Food, Drug and Product Quality Control, Jiaxing 314001, China
| | - Xiaoliang Fan
- Department of Clinical Pharmacy, Zhejiang Chinese Medical University Affiliated Jiaxing TCM Hospital, Jiaxing 314001, China; Central Laboratory of Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing 314001, China.
| | - Peifen Jin
- Department of Traditional Chinese Medicine, Jiaxing Institute for Food, Drug and Product Quality Control, Jiaxing 314001, China
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Sun X, Ai L, Ran Y, Zhang Y, Zhang Q, Li Q, Cui Y, Sun L. Combined exploration of the mechanism of Sang Xing Decoction in the treatment of smoke-induced acute bronchitis from protein and metabolic levels. Biomed Pharmacother 2022; 152:113254. [PMID: 35691159 DOI: 10.1016/j.biopha.2022.113254] [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: 03/11/2022] [Revised: 05/21/2022] [Accepted: 06/03/2022] [Indexed: 11/02/2022] Open
Abstract
Sang Xing decoction (SXD) is a typical prescription for treating "warm dryness" in traditional Chinese medicine (TCM), which is equivalent to respiratory diseases such as acute bronchitis in modern medicine. However, its mechanism of action remains unclear. In this study, the representative components of SXD were characterized using liquid chromatography-tandem mass spectrometry (LC-MS). The key targets, signaling pathways, and metabolic pathways associated with SXD in the treatment of acute bronchitis were identified via network prediction and metabolomics. A rat model of acute bronchitis was also established using mixed smoke, systematic in vivo experiments such as histopathological analyses, enzyme-linked immunosorbent assay (ELISA), immunofluorescence, immunohistochemistry and western blotting were conducted to evaluate the network prediction results. An in-depth analysis of the targeted quantitative results was performed using the SIMCA software and MetaboAnalyst website. The results revealed that 50 active compounds and 45 key targets were screened and clustered with 20 approved drugs. The NF-κB signaling pathway, oxidative stress, and glutamine metabolism were associated with the therapeutic mechanism of SXD in acute bronchitis. In vivo experiments showed that SXD may maintain the production of inflammatory factors by regulating the PI3K/Akt/NF-κB signaling pathway, improving the metabolism of glutamine and glutamate to reduce oxidative stress, and inhibiting apoptosis. Simultaneously, the possibility of using SXD as an adjuvant drug for COVID-19 treatment was also revealed. This research will lay the foundation for the modern clinical application of SXD and promote the promotion and innovation of TCM.
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Affiliation(s)
- Xiaomeng Sun
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Lun Ai
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Yinfei Ran
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Yiwen Zhang
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Qian Zhang
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Qing Li
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Yan Cui
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
| | - Lixin Sun
- School of Pharmacy, Shenyang Pharmaceutical University, Wenhua Road 103, Shenyang 110016, Liaoning, China.
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Taylor A, Zerfas I, Le C, D'Amico F, Heath FR, Baumgartner M. Treatment of Acute Bronchitis and its Impact on Return Emergency Department Visits. J Emerg Med 2022; 63:10-16. [PMID: 35933264 DOI: 10.1016/j.jemermed.2022.01.020] [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: 09/30/2021] [Revised: 01/22/2022] [Accepted: 01/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Antibiotics are not recommended in healthy, uncomplicated adults for the treatment of acute bronchitis, yet are still often prescribed. No randomized studies have examined whether prescribing antibiotics in the emergency department (ED) impacts hospital return rates. OBJECTIVE Our aim was to compare hospital return rates between those who were prescribed an antibiotic vs. those who were not prescribed an antibiotic for the treatment of acute bronchitis. METHODS A retrospective cohort study was completed evaluating patients aged 18-64 years who presented to a community teaching hospital ED with acute bronchitis between January 2017 and December 2019. The primary outcomes were 30-day ED return and hospital admissions from initial ED visit. The rates of ED return or readmitted were compared for patients prescribed an antibiotic for treatment of acute bronchitis vs. those patients who were not prescribed an antibiotic. RESULTS Of the 752 patients included, 311 (41%) were prescribed antibiotics. Baseline demographics were similar between both groups. Of those prescribed an antibiotic, 26 of 311 (8.4%) returned to the hospital within 30 days compared with 33 of 441 patients (7.5%) who were not prescribed an antibiotic (odds ratio 1.13; 95% confidence interval 0.66-1.92). CONCLUSIONS There was no association found between antibiotic therapy for treatment of acute bronchitis and return to the hospital.
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Affiliation(s)
| | - Isabelle Zerfas
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Christina Le
- University of Pittsburgh School of Pharmacy, Pittsburgh, Pennsylvania
| | - Frank D'Amico
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - F Richard Heath
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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Outpatient Antibiotic Prescriptions in France: Patients and Providers Characteristics and Impact of the COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11050643. [PMID: 35625287 PMCID: PMC9137595 DOI: 10.3390/antibiotics11050643] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/05/2022] [Accepted: 05/09/2022] [Indexed: 02/04/2023] Open
Abstract
In France, despite several successive plans to control antimicrobial resistance, antibiotic use remains high in the outpatient setting. This study aims to better understand outpatient antibiotic use and prescription in order to identify tailored targets for future public health actions. Using data from the French National Health Data System, we described and compared the individual characteristics of patients with and without an antibiotic prescription. The prescribed antibiotics (ATC-J01) were detailed and compared between 2019 and 2020. Antibiotic prescribing indicators that take prescriber activity into account were estimated and compared. Patients who were female, advanced age, and the presence of comorbidities were associated with antibiotic prescriptions. The overall prescription rate was estimated at 134 per 1000 consultations and 326 per 1000 patients seen in 2019. General practitioners (GPs), dentists and paediatricians were associated with 78.0%, 12.2% and 2.2% of antibiotic prescriptions, respectively, with high prescription rates (391, 447, and 313 p. 1000 patients seen, respectively). In comparison with 2019, this rate decreased in 2020 for paediatricians (−30.4%) and GPs (−17.9%) whereas it increased among dentists (+17.9%). The reduction was twice as high among the male prescribers than among their female counterparts (−26.6 and −12.0, respectively). The reduction in prescriptions observed in 2020 (−18.2%) was more marked in children (−35.8%) but less so among individuals ≥65 years (−13.1%) and those with comorbidities (−12.5%). The decrease in penicillin prescriptions represents 67.3% of the overall reduction observed in 2020. The heterogeneous decrease in prescriptions by age and antibiotic class could be explained by the impact of COVID-19 control measures on the spread of respiratory viruses; thus, a substantial proportion of the prescriptions avoided in 2020 is likely inappropriate, particularly among children. In order to keep the rate of prescriptions comparable to that observed in 2020, male prescribers, paediatricians and GPs should be encouraged to maintain that level, while a campaign to raise awareness of the appropriate use of antibiotics should be aimed at dentists in particular.
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Xingrong S, Rui F, Jing C, Jing C, Oliver I, Lambert H, Wang D. Relationships Between Diagnosis, Bacterial Isolation, and Antibiotic Prescription in Out Patients With Respiratory Tract Infection Symptoms in Rural Anhui, China. Front Public Health 2022; 10:810348. [PMID: 35223737 PMCID: PMC8864097 DOI: 10.3389/fpubh.2022.810348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesThis paper aims to explore the direct associations of antibiotics prescription with clinical diagnosis and bacterial detection. It also analyses the relations of clinical diagnosis with symptoms and bacterial detection, with a hope of revealing indirect links to antibiotic prescription.MethodsThe study was implemented in one village clinic and one township health center in each of four rural residential areas in Anhui Province, China. Observations were conducted to record clinical diagnosis and antibiotic prescription. A semi-structured questionnaire survey was used to collected patients' sociodemographic information and reported symptoms. Sputum and throat swabs were collected for bacterial culture.ResultsAmong 1,068 patients presenting in the study settings who received a diagnosis of respiratory tract infection (RTI), 87.8% of prescriptions included an antibiotic and 35.8% included two or more antibiotics. Symptomatic RTI patients to the site clinics were diagnosed mainly as having upper respiratory tract infection (32.0%), bronchitis/tracheitis (23.4%), others (16.6%), pharyngitis (11.1%), common cold (8.0%), pneumonia/bronchopneumonia (4.6%) and tonsillitis (4.3%). These clinical diagnosis were associated with symptoms to a varied degree especially for upper respiratory tract infection and bronchitis/tracheitis. Prescription of any antibiotics was positively associated with diagnosis of bronchitis/tracheitis (OR: 5.00, 95% CI: 2.63–9.51), tonsillitis (OR: 4.63, 95% CI: 1.48–14.46), pneumonia/bronchopneumonia (OR: 4.28, 95% CI: 1.40–13.04), pharyngitis (OR: 3.22, 95% CI: 1.57–6.59) and upper respiratory tract infection (OR: 3.04, 95% CI: 1.75–5.27). Prescription of two or more antibiotics was statistically significant related to diagnosis of bronchitis/ tracheitis (OR: 2.20, 95% CI: 1.44–3.35) or tonsillitis (OR: 2.97, 95% CI: 1.47–6.00). About 30% of the patients were identified with some type of bacteria. Bacteria detection was linked with pharyngitis (OR: 0.50, 95% CI: 0.28–0.88) but not prescription of antibiotics.ConclusionsAntibiotics prescription were found with a strong relation to diagnosis of RTIs given by the clinician but was not associated with the presence of bacteria in patient samples. Part of the diagnosis may have been given by the clinician to justify their antibiotics prescription. There is clear need to use additional measures (e.g., symptoms) in conjunction with diagnosis to supervise or audit excessive antibiotics use.
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Affiliation(s)
- Shen Xingrong
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Feng Rui
- Department of Literature Review and Analysis, Library of Anhui Medical University, Hefei, China
| | - Chai Jing
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Cheng Jing
- School of Health Service Management, Anhui Medical University, Hefei, China
| | - Isabel Oliver
- National Infection Service, Public Health England, Bristol, United Kingdom
| | - Helen Lambert
- Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Debin Wang
- School of Health Service Management, Anhui Medical University, Hefei, China
- *Correspondence: Debin Wang
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