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Roger PM, Bastian S, Breurec S, Saliège M, Blanchet P, Brureau L. Simplified antibiotic guidelines in urology are associated with decreased multidrug-resistant Enterobacterales. Infect Dis Now 2023; 53:104763. [PMID: 37467843 DOI: 10.1016/j.idnow.2023.104763] [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: 12/01/2022] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE A simplified therapeutic guideline (STG) was established in our urology ward in 2019 for urinary infections. Our aim was to describe the level of physician adherence to STG and the impact of a limited number of antibiotic compounds on the rate of multidrug-resistant (MDR) bacteria. As guidelines should improve patient care, unfavorable outcomes were also reported. METHODS The STG for community-acquired and nosocomial urinary infections, including six antibiotics, was established in November 2019 and has been officially applied since January 2020. Treatment duration has to be ≤14 days. We conducted a before-after study to measure physician adherence to the STG for bacteremia treatment between January 2017 and December 2022. Adherence was defined as exclusive use of STG antibiotics. All isolated bacteria from blood cultures were recorded, including MDR Enterobacterales, defined as AmpC β-lactamase- or ESBL-producing strains. Unfavorable outcomes were defined as uncontrolled infection, a second surgical procedure, ICU requirement, and/or death. RESULTS Seventy-six cases of bacteremia occurred between January 2017 and December 2019, and ninety between January 2020 and December 2022. The main comorbid condition was urological cancer (46%). The main reason for surgery was ureteral stent (32%). Antibiotic management in accordance with STG increased from 18% to 52%, p < 0.001, and treatments > 14 days decreased from 53% to 28%, p < 0.001. MDR Enterobacterales bacteremia was reduced from 52% to 35%, p = 0.027. The rate of unfavorable outcomes was unchanged. CONCLUSION STG adherence in urology was satisfactory and associated with reduced MDR Enterobacterales bacteremia.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Centre Hospitalier Universitaire de Guadeloupe, France; Faculté de Médecine, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France.
| | - Sylvaine Bastian
- Service de Microbiologie, Centre Hospitalier Universitaire de Guadeloupe, France
| | - Sébastien Breurec
- Faculté de Médecine, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France; Service de Microbiologie, Centre Hospitalier Universitaire de Guadeloupe, France; Laboratoire Interaction des Ecosystèmes Microbiens, Institut Pasteur de Guadeloupe, France; Centre d'Investigation Clinique 1424, INSERM, France
| | - Marion Saliège
- Pharmacie, Centre Hospitalier Universitaire de Guadeloupe, France
| | - Pascal Blanchet
- Faculté de Médecine, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France; Urologie, Centre Hospitalier Universitaire de Guadeloupe, France; Institut de Recherche en Santé, Environnement et Travail, Université de Rennes, Inserm, EHESP, UMR-S 1085, F-97110 Pointe-à-Pitre, France
| | - Laurent Brureau
- Faculté de Médecine, Université des Antilles, Pointe-à-Pitre, Guadeloupe, France; Urologie, Centre Hospitalier Universitaire de Guadeloupe, France; Institut de Recherche en Santé, Environnement et Travail, Université de Rennes, Inserm, EHESP, UMR-S 1085, F-97110 Pointe-à-Pitre, France
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Stangl FP, Schneidewind L, Wagenlehner FM, Schultz-Lampel D, Baeßler K, Naumann G, Schönburg S, Anheuser P, Winkelhog-Gran S, Saar M, Hüsch T, Kranz J. Do or Don't: Results of a Multinational Survey on Antibiotic Prophylaxis in Urodynamics. Antibiotics (Basel) 2023; 12:1219. [PMID: 37508315 PMCID: PMC10376729 DOI: 10.3390/antibiotics12071219] [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: 05/30/2023] [Revised: 07/20/2023] [Accepted: 07/21/2023] [Indexed: 07/30/2023] Open
Abstract
Antibiotic prophylaxis contributes substantially to the increase in antibiotic resistance rates worldwide. This investigation aims to assess the current standard of practice in using antibiotic prophylaxis for urodynamics (UDS) and identify barriers to guideline adherence. An online survey using a 22-item questionnaire designed according to the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) was circulated among urologists and gynecologists in Austria, Germany, and Switzerland between September 2021 and March 2022. A total of 105 questionnaires were eligible for analysis. Out of 105 completed surveys, most responders (n = 99, 94%) regularly perform dipstick urine analysis prior to urodynamics, but do not perform a urine culture (n = 68, 65%). Ninety-eight (93%) participants refrain from using antibiotic prophylaxis, and sixty-eight (65%) use prophylaxis if complicating factors exist. If asymptomatic bacteriuria is present, approximately 54 (52%) participants omit UDS and reschedule the procedure until antimicrobial susceptibility testing is available. Seventy-eight (78%) participants do not have a standard procedure for antibiotic prophylaxis in their department. Part of the strategy against the development of bacterial resistance is the optimized use of antibiotics, including antibiotic prophylaxis in urodynamics. Establishing a standard procedure is necessary and purposeful to harmonize both aspects in the field of urological diagnostics.
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Affiliation(s)
- Fabian P Stangl
- Department of Urology, University Hospital of Bern, 3010 Bern, Switzerland
| | - Laila Schneidewind
- Department of Urology, University Medical Centre Rostock, 18057 Rostock, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus-Liebig-University Giessen, 35390 Giessen, Germany
| | - Daniela Schultz-Lampel
- Southwest Continence Center, Schwarzwald-Baar-Klinikum, 78052 Villingen-Schwenningen, Germany
| | - Kaven Baeßler
- Continence-and Pelvic-Floor-Centre, Franziskus-Hospital Berlin, 10787 Berlin, Germany
| | - Gert Naumann
- Women's Hospital, Helios Clinic Erfurt, 99089 Erfurt, Germany
- University Women's Clinic, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sandra Schönburg
- Department of Urology and Kidney Transplantation, Martin Luther University, 06108 Halle (Saale), Germany
| | - Petra Anheuser
- Klinik für Urologie, Asklepios Klinik Wandsbek, 22043 Hamburg, Germany
| | - Susanne Winkelhog-Gran
- Clinic for Urology and Pediatric Urology, St.-Antonius Hospital gGmbH, Academic Teaching Hospital of RWTH Aachen, 52249 Eschweiler, Germany
| | - Matthias Saar
- Department of Urology and Paediatric Urology, University Clinic RWTH Aachen, 52074 Aachen, Germany
| | - Tanja Hüsch
- Clinic for Urology and Pediatric Urology, University Medicine Johannes-Gutenberg-University Mainz, 55131 Mainz, Germany
| | - Jennifer Kranz
- Department of Urology and Kidney Transplantation, Martin Luther University, 06108 Halle (Saale), Germany
- Department of Urology and Paediatric Urology, University Clinic RWTH Aachen, 52074 Aachen, Germany
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Cicvarić A, Glavaš Tahtler J, Pavlović O, Mikić I, Kelrajter I, Kvolik S. CHARACTERISTICS AND TREATMENT OUTCOMES OF UROLOGIC PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT, OSIJEK UNIVERSITY HOSPITAL CENTER. Acta Clin Croat 2023; 62:14-20. [PMID: 38966029 PMCID: PMC11221221 DOI: 10.20471/acc.2023.62.s2.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Abstract
The postoperative care unit at the Department of Urology has significantly improved treatment of patients undergoing surgical procedures and reduced admission of urologic patients to the Intensive Care Unit (ICU). We examined the characteristics of urologic patients, time on mechanical ventilation, most common complications, and mortality in the period from January 2017 to March 2022. A total of 84 admissions to ICU were recorded, accounting for 1.5% of all patients having undergone surgical, therapeutic or diagnostic interventions under general or regional anesthesia at the Department of Urology. The most common reasons for admission to ICU were respiratory failure (79 patients), hemodynamic instability, and bleeding. The median time on mechanical ventilation was 9.7 [2.4-58.2] hours in urology patients vs. 6 [3-14.7] hours in the rest of surgical ICU patients (p=0.058). Hypertension and renal failure were more common in urologic than in the rest of surgical ICU patients (p<0.05). The overall mortality of urologic patients was lower than in the rest of surgical ICU patients (10.7% vs. 18.99%, p=0.08) but the difference did not reach statistical significance. Independently of the lower mortality, improvements in the outcome of urologic patients admitted to the ICU are feasible. Early identification of patients at risk of infections, postoperative respiratory failure, cardiovascular incidents, and bleeding may further reduce mortality and improve outcomes.
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Affiliation(s)
- Ana Cicvarić
- Department of Anesthesiology, Resuscitation, and ICU, Osijek University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Josipa Glavaš Tahtler
- Department of Anesthesiology, Resuscitation, and ICU, Osijek University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Oliver Pavlović
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Urology, Osijek University Hospital Center, Osijek, Croatia
| | - Ivana Mikić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ivan Kelrajter
- Department of Anesthesiology, Resuscitation, and ICU, Osijek University Hospital Center, Osijek, Croatia
| | - Slavica Kvolik
- Department of Anesthesiology, Resuscitation, and ICU, Osijek University Hospital Center, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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Jover-Sáenz A, Santos Rodríguez C, Ramos Gil MÁ, Palomera Fernández M, Invencio da Costa LF, Torres-Puig-Gros J, Castellana Perelló D, Montiu González E, Schoenenberger-Arnaiz JA, Bordalba Gómez JR, Galindo Ortego X, Ramirez-Hidalgo M. Impact of an Antimicrobial Stewardship Strategy on Surgical Hospital Discharge: Improving Antibiotic Prescription in the Transition of Care. Antibiotics (Basel) 2023; 12:antibiotics12050834. [PMID: 37237737 DOI: 10.3390/antibiotics12050834] [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: 03/24/2023] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial stewardship programs (AMSPs) are essential elements in reducing the unnecessary overprescription of antibiotics. Most of the actions of these programs have focused on actions during acute hospitalization. However, most prescriptions occur after hospital discharge, which represents a necessary and real opportunity for improvement in these programs. We present an AMSP multifaceted strategy implemented in a surgical department which was carried out by a multidisciplinary team to verify its reliability and effectiveness. Over a 1-year post-implementation period, compared to the pre-intervention period, a significant reduction of around 60% in antibiotic exposure occurred, with lower economic cost and greater safety.
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Affiliation(s)
- Alfredo Jover-Sáenz
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
| | - Carlos Santos Rodríguez
- Servicio de Farmacia, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain
| | - Miguel Ángel Ramos Gil
- Servicio de Farmacia, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain
| | | | | | | | - Dolors Castellana Perelló
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
| | - Elisa Montiu González
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
| | | | | | - Xavier Galindo Ortego
- Servicio de Otorrinolaringología, Hospital Universitari Arnau de Vilanova de Lleida (HUAV), 25198 Lleida, Spain
| | - María Ramirez-Hidalgo
- Unidad Territorial Infección Nosocomial (UTIN), Hospital Universitari Arnau de Vilanova de Lleida (HUAV), Institut de Recerca Biomèdica (IRBLleida), 25198 Lleida, Spain
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Clinical-pharmacological drug information center of Hannover Medical School: experiences and analysis from a tertiary care university hospital. Sci Rep 2022; 12:19409. [PMID: 36371467 PMCID: PMC9653451 DOI: 10.1038/s41598-022-24005-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022] Open
Abstract
Drug information centers (DICs) are institutions dedicated to provide objective, independent, and up-to-date information on drugs and their rational use. To overcome the lack of recent DIC reports from central Europe, we analyzed all queries (n = 594) submitted to the DIC run by the Institute for Clinical Pharmacology of Hannover Medical School between October 2018 and April 2022. Approximately one in three queries (31.1%; 185/594) was submitted by internists. 82.8% (492/594) of the queries were patient-specific, while the remaining 17.2% (102/594) were general queries. Adverse drug reactions (ADRs), indications/contraindications, and pharmacodynamic interactions (PDIs) represented the three most frequently addressed query categories, being involved in 44.8% (266/594), 43.3% (257/594), and 34.3% (204/594) of all queries, respectively (assignment of more than one category per query was possible). As compared to general queries, patient-specific queries were statistically significantly more often related to ADRs, PDIs, and pharmacokinetic interactions (PKIs) (ADRs: 35.3% vs. 46.7%, P = 0.034; PDIs: 14.7% vs. 38.4%, P < 0.001; PKIs: 20.6% vs. 31.5%, P = 0.028). To demonstrate the complexity of queries submitted to the clinical-pharmacological DIC, we present and comment on an illustrative selection of queries.
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Schneidewind L, Stangl FP, Dräger DL, Wagenlehner FME, Hakenberg OW, Kranz J. [What is the proportion of infectiology in the specialization urology? : A pilot study to underline the significance of Antibiotic Stewardship in urology]. UROLOGIE (HEIDELBERG, GERMANY) 2022; 61:1237-1242. [PMID: 35925110 PMCID: PMC9636103 DOI: 10.1007/s00120-022-01898-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/20/2022] [Indexed: 09/19/2023]
Abstract
BACKGROUND Urinary tract infections account for one of the most bacterial infectious diseases worldwide. OBJECTIVES The primary aim of this pilot project was to identify the relative percentage of antibiotic use in comparison to all patients in a university medical center for the better establishment of antibiotic stewardship (ABS) programs. MATERIAL AND METHODS This is an epidemiological pilot project. In the time period of three months it was evaluated which relative percentage of the patients was treated with antibiotics for bacterial urinary tract infection in comparison to all patients. RESULTS In summary, about 40% of all urological patients received an antibiotic treatment against urinary tract infections or as perioperative prophylaxis against bacterial infection in the operating room (OR). The antibiotic use at the urological ward is highest in comparison to ambulance or OR. CONCLUSION Infectious diseases, especially bacterial infections, account for a significant part of urology. This knowledge is essential to establish ABS programs and to tackle the progression of antibiotic resistance. Detailed studies are necessary to understand antibiotic prescription practice in urology to develop targeted ABS interventions.
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Affiliation(s)
- Laila Schneidewind
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland.
| | - Fabian P Stangl
- Universitätsklinik für Urologie, Inselspital Bern, Bern, Schweiz
| | - Desiree L Dräger
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland
| | - Florian M E Wagenlehner
- Klinik für Urologie, Kinderurologie und Andrologie, Justus-Liebig-Universität-Gießen, Gießen, Deutschland
| | - Oliver W Hakenberg
- Urologische Klinik und Poliklinik, Universitätsmedizin Rostock, Schillingallee 35, 18055, Rostock, Deutschland
| | - Jennifer Kranz
- Klinik für Urologie und Kinderurologie, Uniklinik RWTH Aachen, Aachen, Deutschland
- Universitätsklinik und Poliklinik für Urologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
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