Point prevalence survey of healthcare-associated infections and antimicrobial use in Kosovo hospitals

Establishing obstetrics-specific metrics and interventions for antimicrobial stewardship

Background

To describe baseline antimicrobial stewardship (AMS) metrics and apply AMS interventions in an inpatient obstetrical population.

Methods

From October 2018 to October 2019, our tertiary-care obstetrical center reviewed components of our AMS program, which included: (1) antimicrobial consumption data, (2) point prevalence surveys (PPS), and (3) prospective audit and feedback. We reviewed institutional data for antimicrobial consumption from the pharmacy database. Detailed point prevalence surveys were conducted for all antimicrobial prescriptions on two predefined dates each month. Daily audits and feedback assessed the appropriateness of all non-protocolized antimicrobials.

Results

Our average antimicrobial length of therapy (LOT) was 12 days per 100 patient-days, where erythromycin (2.33), amoxicillin (2.28), and ampicillin (1.81) were the greatest contributors. Point prevalence surveys revealed that 28.8% of obstetrical inpatients were on antimicrobials, of which 11.2% were inappropriate. Protocolized antimicrobials were 62% less likely (p = 0.027) to be inappropriate. From 565 audited prescriptions, 110 (19.5%) resulted in feedback, where 90% of recommendations were accepted and implemented. The most common reasons for interventions include incorrect dosage, recommending a diagnostic test before continuing antimicrobials, and changing antimicrobials based on specific culture and sensitivity.

Conclusions

Antimicrobial use in obstetrics is unique compared to general inpatients. We provide a baseline set of metrics for AMS at our obstetrical center intending to lay the groundwork for AMS programming in our discipline. Antimicrobial protocolization, as well as audit and feedback, are feasible interventions to improve antimicrobial prescribing patterns.

Enoxacin-based derivatives: antimicrobial and antibiofilm agent: a biology-oriented drug synthesis (BIODS) approach

Background: To find alternative molecules against Klebsiella pneumonia, Proteus mirabilis and methicillin-resistant Staphylococcus aureus, new enoxacin derivatives were synthesized and screened. Methods: All derivatives exhibited promising antibacterial activities as compared to standard enoxacin (2 μg/ml) and standard cefixime (82 μg/ml). Compounds 2, 3 and 5 significantly downregulated the gene expression of biofilm-forming genes. Conclusion: Based on our results, these molecules may serve as potential drug candidates to cure several bacterial infections in the future.

COVID-19: Development and implementation of a video-conference-based educational concept to improve the hygiene skills of health and nursing professionals in the Republic of Kosovo

INTRODUCTION

The COVID-19 pandemic caught the health care systems of all countries unprepared. For the further education of healthcare personnel in the Republic of Kosovo, it became necessary to implement a concept for practical training in hygienic working. A video-conference-based educational concept to bridge the physical distance between Germany and Kosovo enabled the rapid, theoretical and practical transfer of knowledge.

METHODS

Current evidence on COVID-19 and Standard Operation Procedures (SOP) were researched. Healthcare staff in Pristina were advised and trained in ten online sessions on hygienic working under pandemic conditions via the "Logitech Rally for DFNconf" video conferencing system. The seminars were interpreted consecutively (Albanian). The Situational Judgement Test (HygiKo-SJT) should describe changes in participants' hygiene knowledge.

RESULTS

A total of 25 people were trained in hygiene-related knowledge in terms of basic and specific hygiene for COVID-19. The weekly training sessions made it possible to address questions and subsequently provide practical knowledge. The HygiKo-SJT did not show a generalizable, measurable improvement in hygiene competence.

CONCLUSION

Participants benefited from the concept and rapid implementation of a live video-conference-based seminar on "Hygiene under Pandemic Conditions". The positive experience in terms of guidance, advice and training provides the basis for implementing a dedicated "Hygiene" module in Kosovo.

Point prevalence survey of antibiotic use in hospitals in Latin American countries

BACKGROUND

Point prevalence surveys (PPSs) on antibiotic use are useful for understanding different aspects related to prescription patterns in hospitals.

METHODS

An adaptation of the WHO methodology for a PPS on antibiotic use was applied. Hospital wards were divided into medical (MED), surgical (SUR), ICUs, gynaecology and obstetrics (GO), high-risk (HR) and mixed wards (MIX). A web application (RedCap©) through a mobile device was used for data collection.

RESULTS

Between December 2018 and August 2019, 5444 patients in 33 hospitals in five countries were included (10 hospitals in Cuba, 7 in Paraguay, 6 in El Salvador, 5 in Mexico and 5 in Peru). Of these patients, 54.6% received at least one antibiotic, with variations between and within hospitals and countries. Antibiotics were more frequently used in ICUs (67.2%), SUR (64.5%) and MED wards (54.2%), with 51.2% of antibiotics prescribed for community-acquired infections (CAIs), 22.9% for healthcare-associated infections (HAIs), 11.1% for surgical prophylaxis and 6.1% for unknown reasons. Adherence to guidelines was observed in 68.6% of cases (72.8% for CAIs, 72.4% for HAIs and 44.3% for prophylaxis). Third-generation cephalosporins were the class of antibiotics most frequently used (26.8%), followed by carbapenems (10.3%) and fluoroquinolones (8%). Targeted treatments were achieved in 17.3% of cases.

CONCLUSIONS

Antibiotic use was generally higher than that published in other studies. There is an urgent need to promote and strengthen the antimicrobial stewardship programmes in Latin America.

Administration of Systemic Antibiotics for Dental Treatment in Kosovo Major Dental Clinics: A National Survey

OBJECTIVE

 Antibiotics misuse and a high level of antibiotics resistance is observed worldwide, but particularly in developing countries. Kosovo in the last decade is facing challenges regarding antimicrobial resistance. The purpose of the present study was to investigate patterns of antibiotics prescriptions of dentists in Kosovo's major dental clinics.

MATERIALS AND METHODS

 For Kosovo's prescribing pattern, data collection was obtained from 10 Regional Dental Clinics and a Tertiary Health Center regarding patients who were prescribed antibiotics in the years 2015 to 2019. Data analysis was performed by using descriptive statistics and was processed by using MS Excel.

RESULTS

 Most prescribed antibiotic during the observed period from 2015 to 2019 in Kosovo was amoxicillin, although a drastic increase of amoxicillin with clavulanic acid-as a broad-spectrum antibiotic-is observed. The trend of antibiotics use in tertiary health institutions is in an overall decrease in Kosovo with an exception in the year 2017. Despite this overall decrease, inconsistency in prescribing is observed when the pattern is analyzed for each region separately. The highest number of patients in health care dental clinics received antibiotics for maxilla-related health conditions and the lowest number of them for oncologic ones.

CONCLUSION

 The patterns of antibiotics prescriptions by dental practitioners in Kosovo during the years 2015 to 2019 are fluctuating. Compared with the global health care standards, the irrational use of antibiotics in dental health care clinics in Kosovo still exist and this issue should be further addressed by respective actors.

High multidrug resistance in urinary tract infections in a tertiary hospital, Kathmandu, Nepal

SETTING:

Tribhuvan University Teaching Tertiary Care Hospital, Kathmandu, Nepal, May–October 2019.

OBJECTIVE:

1) To describe the bacteriological profile, 2) to identify the antimicrobial resistance (AMR) pattern, and 3) to find the demographic characteristics associated with the presence of bacterial growth and multidrug resistance (MDR) in adult urine samples undergoing culture and drug susceptibility testing.

DESIGN:

This was a hospital-based, cross-sectional study using routine laboratory records.

RESULTS:

Among 11,776 urine samples, 16% (1,865/11,776) were culture-positive, predominantly caused by Escherichia coli (1,159/1,865; 62%). We found a high prevalence of resistance to at least one antibiotic (1,573/1,865; 84%) and MDR (1,000/1,865; 54%). Resistance to commonly used antibiotics for urinary tract infections (UTIs) such as ceftazidime, levofloxacin, cefepime and ampicillin was high. Patients aged ⩾60 years (adjusted prevalence ratio [aPR] 1.6, 95% CI 1.4–1.7) were more likely to have culture positivity. Patients with age ⩾45 years (45–59 years: aPR 1.5, 95% CI 1.3–1.7; ⩾60 years: aPR 1.4, 95% CI 1.2–1.6), male sex (aPR 1.3, 95% CI 1.2–1.5) and from inpatient settings (aPR 1.4, 95% CI 1.2–1.7) had significantly higher prevalence of MDR.

CONCLUSION:

Urine samples from a tertiary hospital showed high prevalence of E. coli and MDR to routinely used antibiotics, especially among inpatients. Regular surveillance and application of updated antibiograms are crucial to monitor the AMR situation in Nepal.

Hospital-acquired infections caused by enterococci: a systematic review and meta-analysis, WHO European Region, 1 January 2010 to 4 February 2020

BackgroundHospital-acquired infections (HAI) caused by Enterococcus spp., especially vancomycin-resistant Enterococcusspp. (VRE), are of rising concern.AimWe summarised data on incidence, mortality and proportion of HAI caused by enterococci in the World Health Organization European Region.MethodsWe searched Medline and Embase for articles published between 1 January 2010 and 4 February 2020. Random-effects meta-analyses were performed to obtain pooled estimates.ResultsWe included 75 studies. Enterococcus spp. and VRE accounted for 10.9% (95% confidence interval (CI): 8.7-13.4; range: 6.1-17.5) and 1.1% (95% CI: 0.21-2.7; range: 0.39-2.0) of all pathogens isolated from patients with HAI. Hospital wide, the pooled incidence of HAI caused by Enterococcus spp. ranged between 0.7 and 24.8 cases per 1,000 patients (pooled estimate: 6.9; 95% CI: 0.76-19.0). In intensive care units (ICU), pooled incidence of HAI caused by Enterococcus spp. and VRE was 9.6 (95% CI: 6.3-13.5; range: 0.39-36.0) and 2.6 (95% CI: 0.53-5.8; range: 0-9.7). Hospital wide, the pooled vancomycin resistance proportion among Enterococcus spp. HAI isolates was 7.3% (95% CI: 1.5-16.3; range: 2.6-11.5). In ICU, this proportion was 11.5% (95% CI: 4.7-20.1; range: 0-40.0). Among patients with hospital-acquired bloodstream infections with Enterococcus spp., pooled all-cause mortality was 21.9% (95% CI: 15.7-28.9; range: 14.3-32.3); whereas all-cause mortality attributable to VRE was 33.5% (95% CI: 13.0-57.3; range: 14.3-41.3).ConclusionsInfections caused by Enterococcus spp. are frequently identified among hospital patients and associated with high mortality.

Healthcare-associated infections over an eight year period in a large university hospital in Sicily (Italy, 2011-2018)

Background

Up to 7% of hospitalised patients acquire at least one healthcare-associated infection (HAI). The aim of the present study was to quantify the burden of HAIs in an Italian hospital, identifying involved risk factors.

Methods

Prevalence point study carried out from 2011 to 2018. For each recruited patient, a data entry form was compiled including information on demographics, hospital admission, risk factors, antimicrobial treatment, and infection if present.

Results

A total of 2844 patients were included and 218 (7.03%) reported an infection. HAI prevalence rates showed a significant increase (average annual per cent change (AAPC) +33.9%; p=0.018) from 2011 to 2014 whereas from 2014 to 2018 a gradual decline was observed (AAPC -6.15%; p=0.35). Urinary tract infection was the most common HAI (25.2%) and a total of 166 (76.1%) pathogens were isolated from 218 infections. Enterococcus and Klebsiella species were the most prevalent pathogens, causing 15.1% and 14.5% of HAIs, respectively. A significant higher risk of HAIs was found in patients exposed to central catheter (adjusted odds ratio (adj-OR)=5.40), peripheral catheter (adj-OR=1.89), urinary catheter (adj-OR=1.46), National Healthcare Safety Network surgical intervention (adj-OR=1.48), ultimately fatal disease (adj-OR=2.19) or rapidly fatal disease (adj-OR=2.09) and in patients with longer hospital stay (adj-OR=1.01).

Conclusion

Intervention programmes based on guidelines dissemination and personnel training can contribute to reduce the impact of HAI. Moreover, McCabe score can be a very powerful and efficient predictor of risk for HAI. Finally, an unexpected very high burden of disease due to Enterobacteriaceae and Gram positive cocci that could be related to the frequent use of carbapenems and third generation cephalosporins in this hospital was found.

Point prevalence survey of health-care associated infections and their risk factors in the tertiary-care referral hospitals of Southern Tunisia

BACKGROUND

Health-care associated infections (HAI) are considered a public health problem and have substantial effect on mortality and morbidity. This study aimed to determine the prevalence of HAI in South Tunisian University Hospitals (UH) and to identify their risk factors.

METHODS

We performed a point prevalence study, in the UH of Southern Tunisia in February 2019, including all hospitalized patients for at least 48 hours.

RESULTS

Overall, 898 patients were included in this survey, among whom 480 participants (53.5%) were males. There were 81 HAIs, accounting for a prevalence of HAI of 9.02%. Urinary tract infections (28.4%) were the most common HAI, followed by respiratory tract infections (22.2%). The main identified microorganisms among HAI patients were Klebsiella pneumonia (22.7%) and Escherichia coli (20.7%). Independent intrinsic risk factors of high prevalence of HAI were diabetes (Adjusted Odds Ratio (AOR)=3.5;p=0.016) having a rapidly fatal disease (AOR=4;p=0.024) and an ASA scores ≥2 (AOR=2.8;p=0.045). As for extrinsic risk factors, admission in ICU (AOR=11.1;p= 0.04), a length of hospital stay ≥ 7 days (AOR=4.1;p=0.04), previous hospitalization within 90 days prior to the admission (AOR=4.2;p=0.01) and having a peripheral vascular catheter (AOR=6.7; p=0.039) were independently associated with higher prevalence of HAI. Lower prevalence of HAI was independently associated with prescription of antimicrobial preoperative prophylaxis (AOR= 0.1; p=0.02).

CONCLUSION

Our findings illustrated high prevalence of HAI in South Tunisian Hospitals, affecting principally fragilized patients who may require special needs. Therefore, promoting hygiene programs for health professionals to establish patient safety's culture is urgently needed.

Point-Prevalence Survey for the Hospital-Acquired Infections in Intensive Care Units of Trauma Center in a Tertiary Care Hospital of Northern India

Background  The burden of hospital-acquired infections (HAIs) is all assumption based, and the true burden remains unknown in most countries, particularly in the developing countries where healthcare facilities are suboptimal and knowledge is limited.

Methodology  This cross-sectional study was conducted at the trauma center of a tertiary care institute from August to September 2019, to assess the burden of HAI and antibiotic resistance pattern of HAI. The total sample size in our study was 105. Our objective was to estimate the point prevalence of HAI and study the associated factors in a tertiary care hospital.

Result  In this study, the point prevalence of HAI was five to six times higher when compared with that of developed countries. Gram-negative organisms were the predominant bacteria; with Acinetobacter baumannii the most common among them.

Conclusion  Point-prevalence survey is an important objective of the antimicrobial stewardship program; it will be helpful in controlling antimicrobial resistance and this tool plays a significant role in hospital settings. Our study is quite pertinent to assess the point prevalence of HAI. It will help in knowing the current prevalence and pattern of the HAI. Therefore, as healthcare administrators, we can further decrease the HAI for better patient outcomes in the future.

Antibiotic usage in hospitalized patients: a one-day point prevalence study

Measurements are one of the most important means of evaluating the quality of antibiotic consumption. This study has evaluated the antibiotic consumption using one-day point prevalence study data collected from different hospitals in Turkey. This research was planned as a multicenter point surveillance study which aimed demonstrating the use of antibiotics among inpatients in Turkey. On the day of surveillance, demographic data from 21,920 inpatients, names of antibiotics used by the inpatients, number of antibiotics approved by infectious disease specialist (IDS), and the length of antibiotic use were recorded. These results showed that 30.3% of patients were using antibiotics and 57.7% of those were IDS-approved. The rate of IDS-approved antibiotic consumption was higher for internal medicine wards and in intensive care units, whereas non-IDS-approved antibiotics were used among inpatients of surgical wards.