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So JSP, Capule FR, Peña IG, Nacabuan SMJ, Ngo FLU, Robles YR, Ouano NNM, del Mar RR. Drug Utilization Review of Monitored Parenteral Antimicrobials in a Tertiary Care Private Hospital in Cebu City. ACTA MEDICA PHILIPPINA 2024; 58:35-48. [PMID: 38939423 PMCID: PMC11199354 DOI: 10.47895/amp.vi0.7249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Abstract
Background Based on the 2017-2020 annual report of the Department of Health-Antimicrobial Resistance Surveillance Program, significant resistance patterns have been observed for common disease-causing pathogens. In the hospital setting, antimicrobial stewardship programs have been implemented to optimize the use of antimicrobials. Drug utilization review studies provide essential feedback to improve prescribing and use of medications. Objectives This study aimed to review drug utilization of monitored parenteral antimicrobials among patients admitted from January to December 2019. Methods The study employed a retrospective, cross-sectional, descriptive research design. A retrospective chart review of drugs administered to patients was conducted. Results A total of 821 patients charts met the inclusion criteria. The patients' ages ranged from 18 to 98 years old and 52% were females. General Internal Medicine practitioners (28%) were the top prescribers of monitored parenteral antimicrobials primarily for the management of moderate-risk community-acquired pneumonia (39%). They were mostly indicated for empirical treatment of infections (94%) and were given for an average of 5.73 days.Only 58% of the total cases had orders for culture and sensitivity testing. Of which, principally 47% had colony cultures. Blood (29%) and sputum (27%) were the most common specimens taken for culture and sensitivity testing. The microorganisms often isolated were Escherichia coli (19%), Klebsiella pneumoniae (18%), and Staphylococcus aureus (9%). In addition, extended-spectrum beta lactamase-producing gram-negative pathogens (4%) and methicillin-resistant S. aureus (1%) were also isolated. All the microorganisms isolated showed most resistance to ampicillin (81%) and most susceptibility to colistin (100%). There were drug therapy-related problems encountered. There was one case of an adverse drug reaction (0.1%) and two cases of contraindications (0.2%). Therapeutic duplication was also observed in 5% of the cases. Moreover, 39% had instances of drug-drug interactions.Piperacillin-tazobactam had the highest consumption (79.50 defined daily doses/1,000-patient days) among the monitored parenteral antimicrobials.Some prescriptions were deemed inappropriate upon evaluation. 12% of cases were inappropriate based on the justification indicator. As for the critical indicators, duration of therapy (78%) was the main reason. Only four components of the DUE criteria indicators have met or exceeded the established threshold level.The cost analysis indicated that the total actual cost of therapy with the monitored parenteral antimicrobials amounted to ₱17,645,601.73. Considering Department of Health National Antibiotic Guidelines recommendations, ideal total cost of treatment was ₱14,917,214.29. Potential cumulative cost savings of ₱2,728,387.44 could have been achieved for patients admitted last 2019. Conclusion Consumption of piperacillin-tazobactam was relatively high as compared to the other monitored parenteral antimicrobials covered in this study. Physicians at the study site seldom prescribe monitored parenteral antimicrobials as recommended by the National Antibiotic Guidelines. This is evidenced in the incidence of inappropriate therapy regimens, with inapt duration of therapy as the leading explanation.From the patient's perspective, the main economic implication was on the direct medical costs, particularly the increased cost of the actual antimicrobial therapy prescribed to manage various infections. Adherence of physicians to the established guidelines and selection of the most cost-effective therapy could have resulted in considerable cost savings.
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Affiliation(s)
- Jan Steven P. So
- Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Francis R. Capule
- Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Imelda G. Peña
- Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Shiela May J. Nacabuan
- Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Frances Lois U. Ngo
- Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | - Yolanda R. Robles
- Department of Pharmacy, College of Pharmacy, University of the Philippines Manila, Manila, Philippines
| | | | - Ron R. del Mar
- AppleOne Medical Group, VisayasMed City Center, Cebu City, Cebu, Philippines
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2
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Moon SM, Kim B, Kim HB. Quantitative and qualitative evaluation of antimicrobial usage: the first step for antimicrobial stewardship. Korean J Intern Med 2024; 39:383-398. [PMID: 38715229 PMCID: PMC11076899 DOI: 10.3904/kjim.2023.506] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 12/19/2023] [Indexed: 05/12/2024] Open
Abstract
The identification of antimicrobial use patterns is essential for determining key targets for antimicrobial stewardship interventions and evaluating the effectiveness thereof. Accurately identifying antimicrobial use patterns requires quantitative evaluation, which focuses on measuring the quantity and frequency of antimicrobial use, and qualitative evaluation, which assesses the appropriateness, effectiveness, and potential side effects of antimicrobial prescriptions. This paper summarizes the quantitative and qualitative methods used to evaluate antimicrobials, drawing insights from overseas and domestic cases.
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Affiliation(s)
- Song Mi Moon
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam,
Korea
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3
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Lee SJ, Lee R, Cho SY, Nho D, Ahn HL, Lee DG. Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea. Korean J Intern Med 2024; 39:399-412. [PMID: 38715230 PMCID: PMC11076883 DOI: 10.3904/kjim.2023.504] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 05/12/2024] Open
Abstract
Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.
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Affiliation(s)
- Soo Jin Lee
- Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul,
Korea
| | - Raeseok Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Sung-Yeon Cho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dukhee Nho
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Hye Lim Ahn
- Department of Pharmacy, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
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4
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He J, You E, Zhong Q, Huang F. Trends and seasonal variation of antibiotic consumption by community residents in Hefei, China, 2012-2016. Public Health 2023; 220:27-32. [PMID: 37229945 DOI: 10.1016/j.puhe.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 02/13/2023] [Accepted: 04/19/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the trends and seasonal variations of antibiotic consumption by community residents in Hefei, China, over a 5-year period. STUDY DESIGN This was an ecological study. METHODS Data on antibiotic consumption by community residents in Hefei between 2012 and 2016 were collected from the Hefei Center for Disease Control and Prevention. Statistical analysis was carried out using Microsoft Excel 2021, SPSS 26.0 and R4.1.3. An interrupted time series (ITS) analysis was modelled to assess the impact of policies on antibiotic consumption trends. RESULTS Amoxicillin and cephalosporins accounted for 63.64% and 30.48%, respectively, of the total defined daily dose per 1000 inhabitant-days (DID) of antibiotics in 2016. The total consumption of antibiotics decreased from 6.92 DID in 2012 to 5.61 DID in 2016 (Ptrend = 0.017). Seasonal analysis showed an average of 34.24% antibiotic consumption in the winter over the 5 years. The equation constructed by the ITS analysis was Y = 5.530 + 0.323X1 - 7.574X2 - 0.323X3 + ε. CONCLUSION Between 2012 and 2016, overall antibiotic consumption by community residents in Hefei decreased significantly. The impact of antibiotic policies, implemented between 2011 and 2013, started to appear in 2014 when the consumption of antibiotics decreased. This study has important policy implications for the use of antibiotics at the community level. Further studies on the trends of antibiotic consumption are required, and strategies should be designed to promote appropriate use of antibiotics.
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Affiliation(s)
- J He
- School of Public Health, Anhui Medical University, Hefei, Anhui, PR China
| | - E You
- Hefei Center for Disease Control and Prevention, Hefei, Anhui, PR China
| | - Q Zhong
- School of Public Health, Anhui Medical University, Hefei, Anhui, PR China.
| | - F Huang
- School of Public Health, Anhui Medical University, Hefei, Anhui, PR 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: 0] [Impact Index Per Article: 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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6
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Lee HJ, Lee DG. Urgent need for novel antibiotics in Republic of Korea to combat multidrug-resistant bacteria. Korean J Intern Med 2022; 37:271-280. [PMID: 35272440 PMCID: PMC8925957 DOI: 10.3904/kjim.2021.527] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 01/21/2022] [Indexed: 11/27/2022] Open
Abstract
Multidrug resistance in bacteria is an important issue and is increasing in frequency worldwide because of the limitations of therapeutic agents. From 2010 to 2019, 14 new systemic antibiotics received regulatory approval in the United States. However, few new antibiotics have been introduced in Republic of Korea to combat multidrug-resistant pathogens. Here, we introduce six novel antibiotics for Gram-positive bacteria and five for Gram-negative bacteria approved by the United States Food and Drug Administration and the European Medicines Agency from 2009 to October 2021, and recommend that they be approved for use in Republic of Korea at the earliest possible date.
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Affiliation(s)
- Hyo-Jin Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
| | - Dong-Gun Lee
- Division of Infectious Diseases, Department of Internal Medicine, The Catholic University of Korea, Seoul,
Korea
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul,
Korea
- Catholic Hematology Hospital, The Catholic University of Korea, Seoul,
Korea
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7
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Kim YC, Park JY, Kim B, Kim ES, Ga H, Myung R, Park SY, Lee MJ, Moon SM, Park SH, Song KH, Kim HB. Prescriptions patterns and appropriateness of usage of antibiotics in non-teaching community hospitals in South Korea: a multicentre retrospective study. Antimicrob Resist Infect Control 2022; 11:40. [PMID: 35193679 PMCID: PMC8861602 DOI: 10.1186/s13756-022-01082-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/12/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although non-teaching community hospitals form the majority of healthcare providers in South Korea, there is limited data on antibiotic usage in them. To evaluate the pattern of antibiotic usage and its appropriateness in hospitals with < 400 beds in South Korea. Methods A multicentre retrospective study was conducted in 10 hospitals (six long-term care hospitals, three acute care hospitals, and one orthopaedic hospital), with < 400 beds in South Korea. We analysed patterns of antibiotic prescription in 2019, and their appropriateness in the participating hospitals. For the evaluation of the appropriateness of the prescription, 25 patients under antibiotic therapy were randomly selected at each hospital, over two separate periods. Due to the heterogeneity of their characteristics, the orthopaedics hospital was excluded from the analysis. Results The most commonly prescribed antibiotics in long-term care hospitals was fluoroquinolone, followed by beta-lactam/beta-lactamase inhibitor (anti-pseudomonal). In acute care hospitals, these were third generation cephalosporin, followed by first generation cephalosporin, and second generation cephalosporin. The major antibiotics that were prescribed in the orthopedics hospital was first generation cephalosporin Only 2.3% of the antibiotics were administered inappropriately. In comparison, 15.3% of patients were prescribed an inappropriate dose. The proportion of inappropriate antibiotic prescriptions was 30.6% of the total antibiotic prescriptions. Conclusions The antibiotic usage patterns vary between non-teaching community hospitals in South Korea. The proportion of inappropriate prescriptions exceeded 30% of the total antibiotic prescriptions. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01082-2.
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Affiliation(s)
- Yong Chan Kim
- Department of Internal Medicine, Division of Infectious Diseases, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul, 04763, Korea.
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam, 13620, Gyeonggi-do, Korea.
| | - Hyuk Ga
- Incheon Eun-Hye Hospital, Incheon, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science and Economics, Korea University, Seoul, Korea
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Korea
| | - Myung Jin Lee
- Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea
| | - Song Mi Moon
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam, 13620, Gyeonggi-do, Korea
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam, 13620, Gyeonggi-do, Korea
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Skender K, Singh V, Stalsby-Lundborg C, Sharma M. Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study. PLoS One 2021; 16:e0245902. [PMID: 33503028 PMCID: PMC7840031 DOI: 10.1371/journal.pone.0245902] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 01/09/2021] [Indexed: 11/24/2022] Open
Abstract
Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.
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Affiliation(s)
- Kristina Skender
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Vivek Singh
- Department of Orthopedic, Ruxmaniben Deepchand Medical College, Ujjain, India
| | - Cecilia Stalsby-Lundborg
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
| | - Megha Sharma
- Department of Global Public Health, Health Systems and Policy, Karolinska Institutet, Stockholm, Sweden
- Department of Pharmacology, Ruxmaniben Deepchand Gardi Medical College, Ujjain, India
- * E-mail:
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Kim B, Myung R, Lee MJ, Kim J, Pai H. Trend of Antibiotic Usage for Hospitalized Community-acquired Pneumonia Cases in Korea Based on the 2010-2015 National Health Insurance Data. J Korean Med Sci 2020; 35:e390. [PMID: 33289366 PMCID: PMC7721565 DOI: 10.3346/jkms.2020.35.e390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/14/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND This study is to describe the changes in prescribing practices of antibiotics to treat community-acquired pneumonia (CAP) in Korea during 2010-2015. METHODS The claim database of the Health Insurance Review and Assessment Service in Korea was used to select adult patients (≥ 18 years of age) admitted between 2010 and 2015, with the International Classification of Diseases, Tenth Revision codes relevant to all-cause pneumonia for the first or second priority discharge diagnosis. The episodes with hospital-acquired or healthcare-associated pneumonia were excluded. Consumption of each antibiotic was converted to defined daily dose (DDD) per episode. The amount of antibiotic consumption was compared between patients with CAP aged < 65 years and those aged ≥ 65 years. RESULTS The average amount of antibiotic consumption per episode was 15.5 DDD, which remained stable throughout the study period (P = 0.635). Patients aged ≥ 65 years received more antibiotics than those aged < 65 years (15.7 vs. 15.3 DDD). Third-generation cephalosporin (4.9 DDD/episode, 31.4%) was the most commonly prescribed, followed by macrolide (2.7 DDD/episode, 17.1%) and beta-lactam/beta-lactamase inhibitor (BL/BLI) (2.1 DDD/episode, 13.6%). The consumption amount of fourth-generation cephalosporin (4th CEP) (P = 0.001), BL/BLI (P = 0.003) and carbapenem (P = 0.002) increased each year during the study period. The consumption of 4th CEP and carbapenem was doubled during 2010-2015. CONCLUSION The prescription of broad-spectrum antibiotics such as 4th CEP and carbapenem to treat CAP increased in Korea during 2010-2015.
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Affiliation(s)
- Bongyoung Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Rangmi Myung
- Department of Economics, College of Political Science & Economics, Korea University, Seoul, Korea
| | - Myoung Jae Lee
- Department of Economics, College of Political Science & Economics, Korea University, Seoul, Korea.
| | - Jieun Kim
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Hyunjoo Pai
- Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea.
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10
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Human resources required for antimicrobial stewardship activities for hospitalized patients in Korea. Infect Control Hosp Epidemiol 2020; 41:1429-1435. [PMID: 33100246 DOI: 10.1017/ice.2020.1234] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We calculated the human resources required for an antimicrobial stewardship program (ASP) in Korean hospitals. DESIGN Multicenter retrospective study. SETTING Eight Korean hospitals ranging in size from 295 to 1,337 beds. METHODS The time required for performing ASP activities for all hospitalized patients under antibiotic therapy was estimated and converted into hours per week. The actual time spent on patient reviews of each ASP activity was measured with a small number of cases, then the total time was estimated by applying the determined times to a larger number of cases. Full-time equivalents (FTEs) were measured according to labor laws in Korea (52 hours per week). RESULTS In total, 225 cases were reviewed to measure time spent on patient reviews. The median time spent per patient review for ASP activities ranged from 10 to 16 minutes. The total time spent on the review for all hospitalized patients was estimated using the observed number of ASP activities for 1,534 patients who underwent antibiotic therapy on surveillance days. The most commonly observed ASP activity was 'review of surgical prophylactic antibiotics' (32.7%), followed by 'appropriate antibiotics recommendations for patients with suspected infection without a proven site of infection but without causative pathogens' (28.6%). The personnel requirement was calculated as 1.20 FTEs (interquartile range [IQR], 1.02-1.38) per 100 beds and 2.28 FTEs (IQR, 1.93-2.62) per 100 patients who underwent antibiotic therapy, respectively. CONCLUSION The estimated time required for human resources performing extensive ASP activities on all hospitalized patients undergoing antibiotic therapy in Korean hospitals was ~1.20 FTEs (IQR, 1.02-1.38) per 100 beds.
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Sosa-Hernández O, Vázquez-Zamora C, Gutiérrez-Muñoz VH, Lugo-Zamudio GE, Cureño-Díaz MA. [Results of the Program for the Rational Use of Antimicrobials in a Mexican hospital, 2013-2018Resultados de um programa para o uso racional de antimicrobianos num hospital no México, 2013-2018]. Rev Panam Salud Publica 2020; 44:e45. [PMID: 32973898 PMCID: PMC7498298 DOI: 10.26633/rpsp.2020.45] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/09/2020] [Indexed: 12/22/2022] Open
Abstract
Objetivo. Describir los resultados del Programa de Uso Racional de Antimicrobianos en el Hospital Juárez de México. Métodos. Se diseñó un estudio de tipo observacional, transversal, retrospectivo y descriptivo. Se analizó el consumo de antimicrobianos de enero de 2013 a diciembre de 2018 a través del cálculo de la dosis diaria definida (DDD); para el análisis de costos se realizó un cálculo de costeo tradicional. Resultados. En el grupo de los carbapenémicos, es notable la reducción en el consumo de imipenem/cilastina: se pasó de una DDD en el 2013 de 2,3 a 0,7 en el 2018, con una reducción de 70%. En cambio, en los otros dos fármacos, se ha observado un incremento. En meropenem se registró de 2% (de 2,4 en 2013 a 2,5 en 2018); en el consumo de ertapenem el incremento es de 75% (de 1 en 2013 a 1,8 en 2018). En total, el gasto de antimicrobianos durante 2013 fue de $930 556,46, mientras que en 2018 fue de $856 079,10, con una diferencia de 8%, lo que equivale a $74 905,61 del gasto total (los valores se expresan en dólares estadounidenses). Conclusiones. Se necesita evaluar de manera constante los programas para el uso racional de antimicrobianos, mediante el monitoreo del consumo y el gasto derivado.
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Affiliation(s)
- Oscar Sosa-Hernández
- Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Secretaría de Salud Ciudad de México México Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Secretaría de Salud, Ciudad de México, México
| | - Claudia Vázquez-Zamora
- Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Secretaría de Salud Ciudad de México México Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Secretaría de Salud, Ciudad de México, México
| | - Víctor Hugo Gutiérrez-Muñoz
- Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Secretaría de Salud Ciudad de México México Unidad de Vigilancia Epidemiológica Hospitalaria, Hospital Juárez de México, Secretaría de Salud, Ciudad de México, México
| | - Gustavo Esteban Lugo-Zamudio
- Dirección Médica, Hospital Juárez de México, Secretaría de Salud Ciudad de México México Dirección Médica, Hospital Juárez de México, Secretaría de Salud, Ciudad de México, México
| | - Mónica Alethia Cureño-Díaz
- Dirección de Planeación Estratégica, Hospital Juárez de México, Secretaría de Salud Ciudad de México México Dirección de Planeación Estratégica, Hospital Juárez de México, Secretaría de Salud, Ciudad de México, México
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Changes in Clinical Characteristics of Community-Acquired Acute Pyelonephritis and Antimicrobial Resistance of Uropathogenic Escherichia coli in South Korea in the Past Decade. Antibiotics (Basel) 2020; 9:antibiotics9090617. [PMID: 32961887 PMCID: PMC7559700 DOI: 10.3390/antibiotics9090617] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 09/10/2020] [Accepted: 09/17/2020] [Indexed: 12/04/2022] Open
Abstract
This study examined changes in the clinical characteristics of community-acquired acute pyelonephritis (CA-APN) in South Korea between the period 2010–2011 and 2017–2018. We recruited all CA-APN patients aged ≥19 years who visited eight hospitals in South Korea from September 2017 to August 2018, prospectively. Data collected were compared with those from the previous study in 2010–2012, with the same design and participation from 11 hospitals. A total of 617 patients were enrolled and compared to 818 patients’ data collected in 2010–2011. Escherichia coli was the most common causative pathogen of CA-APN in both periods (87.3% vs. 86.5%, p = 0.680). E. coli isolates showed significantly higher antimicrobial resistance against fluoroquinolone (32.0% vs. 21.6%, p < 0.001), cefotaxime (33.6% vs. 8.3%, p < 0.001), and trimethoprim/sulfamethoxazole (37.5% vs. 29.2%, p = 0.013) in 2017–2018 than in 2010–2011. Total duration of antibiotic treatment increased from 16.55 ± 9.68 days in 2010–2011 to 19.12 ± 9.90 days in 2017–2018 (p < 0.001); the duration of carbapenem usage increased from 0.59 ± 2.87 days in 2010–2011 to 1.79 ± 4.89 days in 2010–2011 (p < 0.001). The median hospitalization was higher for patients in 2017–2018 than in 2010–2011 (9 vs. 7 days, p < 0.001). In conclusion, antimicrobial resistance of E. coli to almost all antibiotic classes, especially third generation cephalosporin, increased significantly in CA-APN in South Korea. Consequently, total duration of antibiotic treatment, including carbapenem usage, increased.
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Bento Talizin T, Dantas de Maio Carrilho CM, Magalhães Carvalho Grion C, Tibery Queiroz Cardoso L, Toshiyuki Tanita M, Boll KM, Moro Kauss IA, Festti J, Ribeiro Lopes C, Alves da Silva LM, Patruceli de Azevedo I, Paes K, Medeiros EA. Polymyxin for treatment of ventilator-associated pneumonia in a setting of high carbapenem resistance. PLoS One 2020; 15:e0237880. [PMID: 32813749 PMCID: PMC7437913 DOI: 10.1371/journal.pone.0237880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/04/2020] [Indexed: 12/16/2022] Open
Abstract
Objectives To analyse the use of polymyxins for the treatment of ventilator-associated pneumonia (VAP) at a teaching hospital where carbapenem-resistant gram-negative bacteria are endemic. Patients and methods This was a historical cohort study of patients receiving polymyxins to treat VAP in ICUs at a public university hospital in southern Brazil between January 1, 2017 and January 31, 2018. Results During the study period, 179 cases of VAP were treated with polymyxins. Of the 179 patients, 158 (88.3%) were classified as having chronic critical illness. Death occurred in 145 cases (81.0%). Multivariate analysis showed that the factors independently associated with mortality were the presence of comorbidities (P<0.001) and the SOFA score of the day of polymyxin prescription (P<0.001). Being a burn patient was a protective factor for mortality (P<0.001). Analysis of the 14-day survival probability showed that mortality was higher among the patients who had sepsis or septic shock at the time of polymyxin prescription (P = 0.028 and P<0.001, respectively). Acinetobacter baumannii was identified as the etiological agent of VAP in 121 cases (67.6%). In our cohort, polymyxin consumption and the incidence density of VAP were quite high. Conclusions In our study, comprised primarily of chronically critically ill patients, there was a high prevalence of VAP caused by multidrug-resistant bacteria, consistent with healthcare-associated infections in low- and middle-income countries. Presence of comorbidities and the SOFA score at the time of polymyxin prescription were predictors of mortality in this cohort. Despite aggressive antimicrobial treatment, mortality was high, stressing the need for antibiotic stewardship.
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Affiliation(s)
- Thalita Bento Talizin
- Comissão de Epidemiologia Hospitalar, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
- Medical School, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
- * E-mail:
| | | | | | | | - Marcos Toshiyuki Tanita
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Karine Maria Boll
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Ivanil Aparecida Moro Kauss
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Josiane Festti
- Hospital Universitário da Universidade Estadual de Londrina, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | | | | | | | - Késia Paes
- Medical School, Universidade Estadual de Londrina, Londrina, Paraná, Brazil
| | - Eduardo Alexandrino Medeiros
- Comissão de Epidemiologia Hospitalar, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, São Paulo, Brazil
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