Correlation between antibiotic consumption and bacterial resistance as quality indicator of proper use of these drugs in inpatients

Relationship Between Antimicrobial Prescribing and Antimicrobial Resistance Among UTI Patients at Buraidah Central Hospital, Saudi Arabia

Introduction:

Most of the decisions regarding diagnosis and treatment are based on laboratory test results. Urinary tract infections (UTIs) are among the most common infections in humans. The changing antimicrobial sensitivity in UTI requires appropriate antibiotics. Antimicrobial resistance is an emerging problem in the Kingdom of Saudi Arabia where the complete reversal of antimicrobial resistance is difficult due to irrational use of antibiotics.

Objectives:

This study aimed to determine the most common bacterial agents causing UTI in different seasons among patients who were admitted to Buraidah Central Hospital (BCH), Saudi Arabia. The study also evaluated the link between prescribing and resistance toward antimicrobials.

Materials and Methods:

A 6-month retrospective study was conducted among adult patients who were admitted to the inpatient department at BCH. A total of 379 files were collected from microbiological laboratory for inpatients.

Results:

Most UTI-causing bacteria prevailed in the same season. Of 15 bacterial strains, 12 were significantly correlated with 20 (of a total of 40) antibiotics that were used. Most bacteria were gram-negative. Gram-negative bacilli including Escherichia coli, Klebsiella spp., and Pseudomonadaceae and gram-positive Enterococcus faecalis were most frequently causing UTIs.

Conclusion:

Overall prevalence of antibiotic resistance was negative in bacterial isolates. However, the relationship between antimicrobial prescribing and antimicrobial resistance was significantly negative among UTI patients in BCH, Saudi Arabia.

Patterns of Antibiotic Prescription in Children: Tirana, Albania Region

BACKGROUND

Antibiotics (abx) constitute the most prescribed therapeutic agent in the world. There is little data regarding antibiotic consumption by young children in Albania.

AIM

This study aims to evaluate antibiotic prescription in children in quantitative and qualitative terms, and therefore, propose recommendations to improve overall clinical outcomes.

METHODS

A retrospective, cross-sectional drug utilisation study was conducted based on unreimbursed prescriptions collected in 25 pharmacies, randomly selected within the district of Tirana, during the period beginning December 2015 to January 2016. They contain at least one antibacterial therapeutic agent prescribed for children 0-15 years old, for systemic use. The data were analysed using SPSS 20.

RESULTS

A group of 904 prescriptions meet inclusion criteria, 54.1% patient were female, and 45.9% were male. The most exposed age group were 2-6 years old. The most common diagnosis was respiratory tract infections: bronchitis (59.2%), tonsillitis (17%) followed by bronchopneumonia (9.6%). The most prescribed antibiotic classes are Penicillins (33%), Cephalosporins (33.2%) and Macrolides (21,5%). Amoxicillin (19.4%), Azithromycin (14.7%), the combination of Amoxicillin and Clavulanic acid (13.5%) and Cefaclor (11.7%) were the most commonly prescribed. We observed short duration therapies, with a mean duration of 5.21 days and in 17.4 % of cases with a duration of ≤ 2 days.

CONCLUSIONS

We observed a large use of broad-spectrum antibiotics for common respiratory tract infection in children less than 6 years old. We would recommend the creation of an electronic database of patient's record in order to monitor the quality of prescription and education of the healthcare professionals and patient of risks related to antibiotic resistance.

Systematic review of antibiotic consumption in acute care hospitals

Antibiotic consumption is an easily quantifiable performance measure in hospitals and might be used for monitoring. We conducted a review of published studies and online surveillance reports reporting on antibiotic consumption in acute care hospitals between the years 1997 and 2013. A pooled estimate of antibiotic consumption was calculated using a random effects meta-analysis of rates with 95% confidence intervals. Heterogeneity was assessed through subgroup analysis and metaregression. Eighty studies, comprising data from 3130 hospitals, met the inclusion criteria. The pooled rate of hospital-wide consumption was 586 (95% confidence interval 540 to 632) defined daily doses (DDD)/1000 hospital days (HD) for all antibacterials. However, consumption rates were highly heterogeneous. Antibacterial consumption was highest in intensive care units, at 1563 DDD/1000 HD (95% confidence interval 1472 to 1653). Hospital-wide antibacterial consumption was higher in Western Europe and in medium-sized, private and university-affiliated hospitals. The methods of data collection were significantly associated with consumption rates, including data sources, dispensing vs. purchase vs. usage data, counting admission and discharge days and inclusion of low-consumption departments. Heterogeneity remained in all subgroup analyses. Major heterogeneity currently precludes defining acceptable antibiotic consumption ranges in acute care hospitals. Guidelines on antibiotic consumption reporting that will account for case mix and a minimal set of hospital characteristics recommending standardized methods for monitoring and reporting are needed.