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Jin J, Zhu J, Tang J. The impact of antimicrobial management by clinical pharmacists in obstetrics and gynecology on antimicrobial indicators, bacterial resistance and drug costs from 2011 to 2021 in China. Heliyon 2023; 9:e16851. [PMID: 37389079 PMCID: PMC10300213 DOI: 10.1016/j.heliyon.2023.e16851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023] Open
Abstract
Objectives The goal of our study is to analyze the effectiveness and role of clinical pharmacists in antibiotic management through retrospective research from 2011 to 2021, depending on the current scenario of the antibiotic application in China. Methods We formed a team of pharmacists to carry out multifaceted intervention measures, such as forming a working group, developing a plan, establishing management rules via the pre-trial system, prescription comments, collaborating with the administrative department, implementing training and publicity, and so on. Antibiotic use was studied, bacterial drug resistance was determined, and antibiotic costs were computed. Results The pharmacist intervention and rectification of inappropriate antibacterial drug orders considerably enhanced the rational use rate of antibiotics and reduced the cost of antibiotics. Antibiotic use in clean surgery decreased from 90.22% to 11.14%, the use rate of antibiotics decreased from 63.82% to 30.26%, and antibiotic use intensity decreased from 42.75DDDs to 30.04DDDs. The types, timing, and course of antibacterials used in wards were all improved to varying degrees. Bacterial drug resistance improved noticeably, with resistance of Escherichia coli to cephalosporins, ciprofloxacin and carbapenems decreased in varying degrees. The use of antibacterial drugs has decreased significantly. Conclusions It is feasible and effective for pharmacists in gynecology and obstetrics to control antibiotic use, which plays a positive role in promoting the safe, effective, and cost-effective use of antibiotics and serves as a valuable reference for the antibiotic management.
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Shen L, Wei X, Yin J, Haley DR, Sun Q, Lundborg CS. Interventions to optimize the use of antibiotics in China: A scoping review of evidence from humans, animals, and the environment from a One Health perspective. One Health 2022; 14:100388. [PMID: 35686150 PMCID: PMC9171522 DOI: 10.1016/j.onehlt.2022.100388] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 04/02/2022] [Accepted: 04/03/2022] [Indexed: 12/28/2022] Open
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Setiawan E, Abdul-Aziz MH, Roberts JA, Cotta MO. Hospital-Based Antimicrobial Stewardship Programs Used in Low- and Middle-Income Countries: A Scoping Review. Microb Drug Resist 2022; 28:566-584. [PMID: 35333607 DOI: 10.1089/mdr.2021.0363] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The burden of antimicrobial resistance (AMR) is considerable in many low- and middle-income countries (LMICs), and it is important to describe the antimicrobial stewardship program (ASP) activities found in these countries and report their impact. Importantly, as these programs target prescribing behavior, the factors influencing prescription of antimicrobials must also be taken into account. This scoping review aimed to (1) describe hospital-based ASP activities, (2) report methods used to measure the impact of ASPs, and (3) explore factors influencing antimicrobial prescribing behavior in LMICs. PubMed was searched from database inception until April 2021. Factors influencing antimicrobial prescribing behavior were canvassed using the Capability-Opportunity-Motivation and Behavior framework. Most of ASP studies in LMICs were predominantly conducted in tertiary care and university-based hospitals. Audit of antimicrobial prescriptions with feedback and restrictive-based strategies was the main reported activity. Total antimicrobial consumption was the main method used to measure the impact of ASPs. Positive outcomes were observed for both clinical and microbiological outcomes; however, these were measured from nonrandomized controlled trials. Dominant factors identified through the behavioral framework were a limited awareness of AMR as a local problem, a perception that overprescription of antimicrobials had limited consequences and was mainly driven by a motivation to help improve patient outcomes. In addition, antimicrobial prescribing practices were largely influenced by existing hierarchy among prescribers. Our scoping review suggests that LMICs need to evaluate antimicrobial appropriateness as an added measure to assess impact. Furthermore, improvements in the access of microbiology and diagnostic facilities and ensuring ASP champions are recruited from senior prescribers will positively influence antimicrobial prescribing behavior, helping improve stewardship of antimicrobials in these countries.
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Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Clinical and Community Pharmacy; and Center for Medicines Information and Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, Surabaya, Indonesia
| | - Mohd-Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia.,Department of Pharmacy and Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | - Menino Osbert Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Xu J, Huang J, Yu Y, Zhou D, Wang Y, Xue S, Shang E, Sun J, Ding X, Shi L, Duan L, Tang L, Zhou Q, Li X. The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital. Front Pharmacol 2022; 13:832078. [PMID: 35295325 PMCID: PMC8919369 DOI: 10.3389/fphar.2022.832078] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 01/13/2022] [Indexed: 11/13/2022] Open
Abstract
Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies. Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay. Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, -0.271 to -0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, -0.288 to -0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, -0.115 to -0.022); p = 0.003]. Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.
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Affiliation(s)
- Jinhui Xu
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jian Huang
- Department of Vascular and Interventional Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - YanXia Yu
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Dayong Zhou
- Department of Vascular and Interventional Radiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Ying Wang
- Department of Education and Training, The First Affiliated Hospital of SooChow University, SuZhou, China
| | - Sudong Xue
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Erning Shang
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Jiantong Sun
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xinyuan Ding
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lu Shi
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lufen Duan
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Lian Tang
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Qin Zhou
- Department of Pharmacy, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, China
| | - Xin Li
- Department of Clinical Pharmacy, School of Pharmacy, Nanjing Medical University, Nanjing, China.,Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, China
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Monmaturapoj T, Scott J, Smith P, Abutheraa N, Watson MC. Pharmacist-led education-based antimicrobial stewardship interventions and their effect on antimicrobial use in hospital inpatients: a systematic review and narrative synthesis. J Hosp Infect 2021; 115:93-116. [PMID: 34144096 DOI: 10.1016/j.jhin.2021.06.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/06/2021] [Accepted: 06/07/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Antimicrobial stewardship (AMS) programmes optimize antimicrobial use and address antimicrobial resistance. Pharmacists are often key agents of these programmes. The effectiveness of hospital-based AMS interventions when they are led by pharmacists, however, has not previously been reported. AIM To evaluate the effectiveness of pharmacist-led AMS interventions in improving antimicrobial use for hospital inpatients. METHODS Standard systematic review methods were used. The search strategies and databases used in a previous Cochrane review were applied. Studies that reported pharmacist-led AMS interventions were included. Narrative synthesis was used to report the findings. PRISMA guidelines were followed. FINDINGS From 6971 records retrieved and screened, 52 full-text articles were included. Most studies were undertaken in teaching hospitals (N = 45) and many were conducted in North America (N = 27). Most interventions targeted junior or ward physicians and lasted between one and six months. All studies evaluated educational interventions often in combination with other interventions and reported improvements 'in compliance with target AMS practice'. Greater compliance was achieved with multiple interventions. Pharmacist-led interventions reduced the duration of antimicrobial therapy without increasing mortality. No consistency of evidence was achieved in relation to interventions and reduced duration of hospital stay, nor infections due to antimicrobial resistance or occurrence of Clostridium difficile. CONCLUSION This is the first systematic review to evaluate the effectiveness of pharmacist-led AMS interventions in hospital inpatients. Education-based interventions were effective in increasing guideline compliance and reducing duration of antimicrobial therapy. Future hospital-based AMS programmes should consider the involvement of pharmacists to deliver and promote AMS interventions and programmes.
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Affiliation(s)
- T Monmaturapoj
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK.
| | - J Scott
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - P Smith
- Department of Psychology, University of Bath, Bath, UK
| | - N Abutheraa
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
| | - M C Watson
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK
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Niu J, Chen H, Chen K, Liu Y, Ju F, Xue T, Yin D, Li C, Yin C, Jiao L, Zhao G, Huang J. Effect of pharmaceutical care on the treatment of COVID-19: A protocol for systematic review and meta analysis. Medicine (Baltimore) 2020; 99:e23377. [PMID: 33235111 PMCID: PMC7710203 DOI: 10.1097/md.0000000000023377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 10/28/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND We aimed to conduct a meta-analysis to assess the effect of pharmaceutical care on the treatment of coronavirus disease 2019 (COVID-19). METHODS All case-controlled studies related to pharmaceutical care on the treatment of COVID-19 will be included in this review. We will use index words related to pharmaceutical care and COVID-19 to perform literature searches in PubMed, Embase, MEDLINE, CNKI, and Wanfang databases, to include articles indexed as of October 20, 2020 in English and Chinese language. Two reviewers will select trials independently for inclusion and assess trial quality. Two pairs of review authors will independently extract information for each included trials. Primary outcomes are clinical outcomes, average hospital stays, costs, patient satisfaction, and incidence of adverse drug reactions. We will evaluate the risk of bias of the included studies based on Cochrane assessment tool. Revman 5.3 (the Cochrane collaboration, Oxford, UK) will be used for heterogeneity assessment, generating funnel-plots, data synthesis, subgroup analysis, and sensitivity analysis. RESULTS We will provide targeted and practical results assessing the effect of pharmaceutical care on the treatment of COVID-19. CONCLUSION The stronger evidence about the effect of pharmaceutical care on the treatment of COVID-19 will be provided for clinicians. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42020214223 ETHICS AND DISSEMINATION:: There is no need for ethical approval, and the review will be reported in a peer-reviewed journal.
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Affiliation(s)
| | - Hongjun Chen
- Department of Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, Jiangsu, China
| | - Kaixia Chen
- Department of Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, Jiangsu, China
| | - Yin Liu
- Department of Clinical Pharmacy
| | - Feng Ju
- Department of Clinical Pharmacy
| | | | | | | | | | | | | | - Jixun Huang
- Department of Pharmacy, Jingjiang People's Hospital, the Seventh Affiliated Hospital of Yangzhou University, Jingjiang, Jiangsu, China
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Li XY, Qi X, Tian SH, He R, Jiang S, Li HJ. Impact of dedicated infectious disease teamwork on the treatment and prognosis of patients with diabetic foot infection. Int J Infect Dis 2020; 100:133-138. [PMID: 32916250 DOI: 10.1016/j.ijid.2020.08.085] [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: 05/29/2020] [Revised: 07/10/2020] [Accepted: 08/23/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE The aim was to develop and evaluate the impact of a new model in which the infectious disease (ID) physician and pharmacist work together to treat diabetic foot infections (DFIs). METHODS A quasi-experimental before-after study was conducted. The medical charts of inpatients with DFI admitted between April 1, 2017 and March 31, 2018 were reviewed retrospectively (control group, n = 30). Inpatients diagnosed with DFI between April 1, 2018 and March 31, 2019 were enrolled prospectively as the intervention group and received treatment through dedicated ID teamwork (intervention group, n = 35). RESULTS The distribution of infection severity and levels of metabolic criteria were similar in the two groups. Compared with the control group, the intervention group received adequate initial empirical treatment more frequently (96.8% vs 43.5%, p < 0.001) and had a shorter median duration of fever (1 day vs 7.5 days, p < 0.001). Rates of healing and relapse within 6 months were similar in the two groups, although the intervention group showed more sites of osteomyelitis (p = 0.036) and a higher percentage of polymicrobial infections (48.6% vs 10.0%, p = 0.001). CONCLUSION The early and full participation of ID physicians and pharmacists in the treatment of DFI facilitated targeted antimicrobial treatment and improved patient outcomes.
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Affiliation(s)
- Xiang-Yan Li
- Department of Anti-infection, Institute of Clinical Pharmacology, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Xin Qi
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Shuo-Han Tian
- Department of Pharmacy, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Rui He
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Shan Jiang
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
| | - Hui-Juan Li
- Department of Plastic Surgery and Burns, Peking University First Hospital, No. 8, Xishiku Street, Xicheng District, Beijing 100034, China.
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Wang R, Dong X, Zhang X, Gan S, Kong L, Lu X, Rao Y. Pharmacist-driven multidisciplinary initiative continuously improves postoperative nausea and vomiting in female patients undergoing abdominal surgery. J Clin Pharm Ther 2020; 45:959-967. [PMID: 32022296 DOI: 10.1111/jcpt.13110] [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: 11/12/2019] [Revised: 11/12/2019] [Accepted: 01/03/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The incorrect or insufficient prophylaxis of postoperative nausea and vomiting (PONV) is common in practice. A clinical pharmacist-led guidance team (CPGT) was established and included in general surgery teams. OBJECTIVE This study aimed to evaluate the effects of the CPGT on the improvement of PONV and prophylaxis administration. METHODS A prospective before-after study was conducted on 156 female patients undergoing abdominal surgery at a Chinese tertiary teaching hospital from December 2016 to December 2017. A total of 82 patients were enrolled in the preintervention period, and 74 patients were included in the post-intervention period. The CPGT established the evidence-based criteria for prophylactic anti-emetic administration and conducted interventions, including a review of medical records, provision of feedback, educational outreach, and dedicated support. Primary outcomes included the incidence of PONV within 24 hours of surgery, administered number of prophylactic anti-emetics, and accuracy of the timing for prophylactic anti-emetics. Outcomes were analysed by logistic regression or multivariable linear regression. RESULTS AND DISCUSSION After intervention, patients reported significantly less PONV (33.78% vs 56.10%; odds ratio [OR]: 0.29; numbers needed to treat [NNT]: 3.47), vomiting (29.73% vs 45.12%; OR: 0.42; NNT: 5.16) and nausea (31.08% vs 56.10%; OR: 0.24; NNT: 3.19) within 24 hours of surgery. The accuracy of the timing for prophylactic anti-emetics significantly increased (OR: 3.66; P: .003). Anaesthesiologists administered increased numbers of prophylactic anti-emetics (OR: 5.82; P < .001). The improvement of PONV did not decrease during the four-month period after intervention (P: .639). WHAT IS NEW AND CONCLUSION The CPGT is a valuable service model to continuously improve PONV and optimize prophylaxis administration.
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Affiliation(s)
- Rongrong Wang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xihao Dong
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xuan Zhang
- Northern Jiangsu People's Hospital, Yangzhou, China
| | - Shuyuan Gan
- Department of Anesthesiology, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Limin Kong
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyang Lu
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Yuefeng Rao
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Effect of clinical pharmacist intervention on the treatment of acute pancreatitis. Int J Clin Pharm 2019; 41:1652-1657. [PMID: 31696422 DOI: 10.1007/s11096-019-00931-2] [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: 01/18/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
Background The participation of clinical pharmacists in the treatment of acute pancreatitis has rarely been reported. Objective The aim of this study was to retrospectively evaluate the impact of intervention of clinical pharmacists on the treatment of acute pancreatitis. Setting An academic teaching hospital in Taizhou, Jiangsu, China. Method Two hundred and twenty-eight patients with acute pancreatitis were retrospectively enrolled from July 2017 to July 2018 and divided into an intervention group (n = 119) and a control group (n = 109) according to whether a clinical pharmacist was involved. No significant differences in the baseline clinical characteristics were found between the groups. Clinical pharmacists participated in drug formulation and adjustment, pharmaceutical care, and follow-up. Main outcome measure Clinical outcomes, average hospital stays, costs, incidence of adverse drug reactions, 1-month subsequent visit rate, and patient satisfaction between the two groups were measured. Results The clinical symptoms of patients in both groups were relieved after treatment. There were no significant differences between the groups in computed tomography grades after treatment, incidence of adverse drug reactions, or average hospital stays. However, the intervention group had lower total costs of hospitalization, drugs and antibiotics but higher rates of 1-month subsequent visits and satisfaction compared with the control group. Conclusion The intervention of clinical pharmacists in the treatment of acute pancreatitis can effectively reduce costs of hospitalization, drug and antibiotics and improve follow-up compliance and patient satisfaction.
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Wang R, Yang Q, Zhang S, Hong Y, Zhang M, Jiang S. Trends and correlation of antibiotic susceptibility and antibiotic consumption at a large teaching hospital in China (2007-2016): a surveillance study. Ther Clin Risk Manag 2019; 15:1019-1027. [PMID: 31692506 PMCID: PMC6708394 DOI: 10.2147/tcrm.s210872] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 08/02/2019] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the trends and correlation between the antibiotic consumption and susceptibility of eight most frequent isolates in the First Affiliated Hospital of Zhejiang University (2007-2016). METHOD This study was based on the yearly surveillance data in a 2500-bed capacity tertiary-care teaching hospital. Trends and correlation were, respectively, analyzed by linear regression and Pearson's correlation coefficient. RESULTS The consumption of all antibiotics decreased by 10.8% over time, especially first-generation cephalosporins (p=0.001), fourth-generation cephalosporins (p=0.01), aminoglycosides (p<0.001), and fluoroquinolones (p<0.001), but increased remarkably in linezolid, carbapenems, glycopeptides, and third-generation cephalosporins (3GCs). 72.7% of trend analyses indicated increased susceptibility to antibiotics with remarkably decreased consumption. In particular, susceptibility to aminoglycosides and fluoroquinolones remarkably increased in seven of eight pathogens and negatively correlated with the corresponding antibiotic consumption (p<0.05). Isolation density significantly declined in methicillin-resistant Staphylococcus aureus (54.9-41.3%, p=0.009) and in extended-spectrum β-lactamase producing Klebsiella pneumoniae (42.4-15.6%, p=0.007), which positively correlated with the consumption of fluoroquinolones. The susceptibility to antibiotics with increased consumption was almost stable. Decreased trends were only found in K. pneumoniae to imipenem (81-71.3%, p=0.046) and cefoperazone/sulbactam (70.8-61.0%, p=0.014) and in Acinetobacter baumannii to cefoperazone/sulbactam (59-28%, p=0.007), which negatively correlated with the consumption of carbapenems (r=-0.649, p=0.042) and 3GCs/β-lactamase inhibitors (p<0.05), respectively. The consumption of glycopeptides even positively correlated with the growing susceptibility to vancomycin in Enterococcus faecium (r=0.633, p=0.049) and Enterococcus faecalis (r=0.752, p=0.012). CONCLUSION The susceptibility to antibiotics with decreased consumption increased remarkably, but maintained stable to those with growing consumption. The stricter management of carbapenems and 3GCs is necessary.
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Affiliation(s)
- Rongrong Wang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Qing Yang
- Department of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Shaojun Zhang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yun Hong
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - MeiHua Zhang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Saiping Jiang
- Department of Pharmacy, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
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