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Mthombeni TC, Burger JR, Lubbe MS, Julyan M. Antibiotic prescribing to inpatients in Limpopo, South Africa: a multicentre point-prevalence survey. Antimicrob Resist Infect Control 2023; 12:103. [PMID: 37717012 PMCID: PMC10505321 DOI: 10.1186/s13756-023-01306-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Electronic continuous surveillance databases are ideal for monitoring antibiotic use (ABU) in hospitalised patients for antibiotic stewardship programmes (ASP). However, such databases are scarce in low-resource settings. Point prevalence surveys (PPS) are viable alternatives. This report describes ABU and identifies ASP implementation improvement areas in Limpopo Province, South Africa. METHODS This cross-sectional descriptive study extracted patient-level ABU data from patients' files using a modified global PPS tool. Data were collected between September and November 2021 at five regional hospitals in Limpopo Province, South Africa. All patients in the wards before 8 a.m. on study days with an antibiotic prescription were included. Antibiotic use was stratified by Anatomic Therapeutic Chemical and Access, Watch, Reserve classifications and presented as frequencies and proportions with 95% confidence intervals (CI). Associations between categorical variables were assessed using the chi-square test. Cramér's V was used to assess the strength of these associations. RESULTS Of 804 inpatients surveyed, 261 (32.5%) (95% CI 29.2-35.7) were prescribed 416 antibiotics, 137 were female (52.5%) and 198 adults (75.9%). One hundred and twenty-two (46.7%) patients received one antibiotic, 47.5% (124/261) received two, and 5.7% (15/261) received three or more antibiotics. The intensive care units had a higher ABU (68.6%, 35/51) compared to medical (31.3%, 120/384) and surgical (28.5%, 105/369) wards (p = 0.005, Cramér's V = 0.2). Lower respiratory tract infection (27.4%, 104/379), skin and soft tissue infections (SST) (23.5%, 89/379), and obstetrics and gynaecology prophylaxis (14.0%, 53/379) were the common diagnoses for antibiotic prescriptions. The three most prescribed antibiotic classes were imidazoles (21.9%, 91/416), third-generation cephalosporins (20.7%, 86/416) and combination penicillin (18.5%, 79/416). Access antibiotics accounted for 70.2% (292/416) of prescriptions and Watch antibiotics for 29.6% (123/416) (p = 0.110, Cramér's V = 0.1). Reasons for prescribing and treatment plans were documented in 64.9% (270/416) (95% CI 60.3-69.5) and 21.4% (89/416) (95% CI 17.3-25.3) of prescriptions, respectively. CONCLUSIONS The study serves as a baseline for ABU surveillance at the five regional hospitals in Limpopo Province. Lack of documentation indicates poor prescribing practices; ASP should address gaps by deploying evidence-based, multifaceted and stepwise interventions.
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Affiliation(s)
- Tiyani Comfort Mthombeni
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa
| | - Johanita Riétte Burger
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa.
| | - Martha Susanna Lubbe
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa
| | - Marlene Julyan
- Medicine Usage in South Africa (MUSA), North-West University Potchefstroom Campus, Potchefstroom, South Africa
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VanScoy BD, Jones S, Conde H, Friedrich LV, Cotroneo N, Bhavnani SM, Ambrose PG. Evaluation of Oral Tebipenem as a Step-Down Therapy following Intravenous Ertapenem against Extended-Spectrum β-Lactamase-Producing Escherichia coli in a Hollow-Fiber In Vitro Infection Model. Antimicrob Agents Chemother 2023; 67:e0090822. [PMID: 36757190 PMCID: PMC10019163 DOI: 10.1128/aac.00908-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 10/31/2022] [Indexed: 02/10/2023] Open
Abstract
Tebipenem is an orally bioavailable carbapenem in development for the treatment of patients with complicated urinary tract infections. Herein, we describe the results of studies designed to evaluate tebipenem's potential as an oral (p.o.) transition therapy from intravenous (i.v.) ertapenem therapy for the most common uropathogen, Escherichia coli. These studies utilized a 7-day hollow-fiber in vitro infection model and 5 extended-spectrum β-lactamase-producing E. coli challenge isolates. Human free-drug serum concentration-time profiles for tebipenem 600 mg p.o. every 8 h and ertapenem 1 g i.v. every 24 h were simulated in the hollow-fiber in vitro infection model. Samples were collected for bacterial density and drug concentration determination over the 7-day study period. Generally, ertapenem monotherapy resulted in a greater reduction in bacterial density than did tebipenem monotherapy. In the treatment arms in which ertapenem dosing was stopped following dosing for 1 or 3 days, immediate bacterial regrowth occurred and matched that of the growth control. Finally, in the treatment arms in which ertapenem dosing was stopped following dosing for 1 or 3 days and tebipenem dosing was initiated for the remainder of the 7-day study, the intravenous-to-oral transition regimen reduced bacterial burdens and prevented regrowth. Given that transition from intravenous to oral antibiotic therapy has been shown to reduce hospital length of stay, nosocomial infection risk, and cost, and improve patient satisfaction, these data demonstrate tebipenem's potential role as an oral transition agent from intravenous antibiotic regimens within the antibiotic stewardship paradigm.
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Affiliation(s)
- B. D. VanScoy
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - S. Jones
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - H. Conde
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | | | - N. Cotroneo
- Spero Therapeutics, Inc., Cambridge, Massachusetts, USA
| | - S. M. Bhavnani
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
| | - P. G. Ambrose
- Institute for Clinical Pharmacodynamics, Inc., Schenectady, New York, USA
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3
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Van Swol JM, Myers WK, Beall JA, Atteya MM, Blice JP. Post-traumatic endophthalmitis prophylaxis: a systematic review and meta-analysis. J Ophthalmic Inflamm Infect 2022; 12:39. [DOI: 10.1186/s12348-022-00317-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/05/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Purpose
The goal of this study is to determine if certain aspects of endophthalmitis prophylaxis strategies are superior to others.
Design
This investigation is a systematic review and meta-analysis.
Methods
All studies specifying a type of prophylaxis strategy and resulting rates of endophthalmitis were included. Time course, method of administration, and antibiotic regimen, and confounding factors were collected and included for meta-regression.
Results
Time courses greater than 24 h did not significantly improve outcomes. Likewise, intraocular and/or intravenous antibiotic administration methods did not significantly outperform oral administration. No antibiotic regimens performed differently from vancomycin/ ≥ 3rd generation cephalosporin except for ciprofloxacin monotherapy which yielded significantly worse outcomes.
Conclusions
Future antibiotic strategies should strongly consider the risks of antibiotic treatment > 24 h and administration methods other than the oral antibiotic forms. In addition, providers should be wary of using ciprofloxacin monotherapy for endophthalmitis prophylaxis when treating open globe injuries.
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4
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Lee IR, Tong SYC, Davis JS, Paterson DL, Syed-Omar SF, Peck KR, Chung DR, Cooke GS, Libau EA, Rahman SNBA, Gandhi MP, Shi L, Zheng S, Chaung J, Tan SY, Kalimuddin S, Archuleta S, Lye DC. Early oral stepdown antibiotic therapy versus continuing intravenous therapy for uncomplicated Gram-negative bacteraemia (the INVEST trial): study protocol for a multicentre, randomised controlled, open-label, phase III, non-inferiority trial. Trials 2022; 23:572. [PMID: 35854360 PMCID: PMC9295110 DOI: 10.1186/s13063-022-06495-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022] Open
Abstract
Background The incidence of Gram-negative bacteraemia is rising globally and remains a major cause of morbidity and mortality. The majority of patients with Gram-negative bacteraemia initially receive intravenous (IV) antibiotic therapy. However, it remains unclear whether patients can step down to oral antibiotics after appropriate clinical response has been observed without compromising outcomes. Compared with IV therapy, oral therapy eliminates the risk of catheter-associated adverse events, enhances patient quality of life and reduces healthcare costs. As current management of Gram-negative bacteraemia entails a duration of IV therapy with limited evidence to guide oral conversion, we aim to evaluate the clinical efficacy and economic impact of early stepdown to oral antibiotics. Methods This is an international, multicentre, randomised controlled, open-label, phase III, non-inferiority trial. To be eligible, adult participants must be clinically stable / non-critically ill inpatients with uncomplicated Gram-negative bacteraemia. Randomisation to the intervention or standard arms will be performed with 1:1 allocation ratio. Participants randomised to the intervention arm (within 72 h from index blood culture collection) will be immediately switched to an oral fluoroquinolone or trimethoprim-sulfamethoxazole. Participants randomised to the standard arm will continue to receive IV therapy for at least 24 h post-randomisation before clinical re-assessment and decision-making by the treating doctor. The recommended treatment duration is 7 days of active antibiotics (including empiric therapy), although treatment regimen may be longer than 7 days if clinically indicated. Primary outcome is 30-day all-cause mortality, and the key secondary outcome is health economic evaluation, including estimation of total healthcare cost as well as assessment of patient quality of life and number of quality-adjusted life years saved. Assuming a 30-day mortality of 8% in the standard and intervention arms, with 6% non-inferiority margin, the target sample size is 720 participants which provides 80% power with a one-sided 0.025 α-level after adjustment for 5% drop-out. Discussion A finding of non-inferiority in efficacy of oral fluoroquinolones or trimethoprim-sulfamethoxazole versus IV standard of care antibiotics may hypothetically translate to wider adoption of a more cost-effective treatment strategy with better quality of life outcomes. Trial registration ClinicalTrials.govNCT05199324. Registered 20 January 2022. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06495-3.
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Affiliation(s)
- I Russel Lee
- National Centre for Infectious Diseases, Singapore, Singapore.
| | - Steven Y C Tong
- Department of Infectious Diseases, University of Melbourne, at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Joshua S Davis
- School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women's Hospital Campus, Brisbane, Australia
| | | | | | | | - Graham S Cooke
- Department of Infectious Diseases, Imperial College London, London, UK
| | | | - Siti-Nabilah B A Rahman
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, Singapore
| | - Mihir P Gandhi
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, Singapore
| | - Luming Shi
- Singapore Clinical Research Institute, Consortium for Clinical Research and Innovation, Singapore, Singapore
| | - Shuwei Zheng
- Department of Infectious Disease, Sengkang General Hospital, Singapore, Singapore
| | - Jenna Chaung
- Division of Infectious Diseases, Ng Teng Fong General Hospital, Singapore, Singapore
| | - Seow Yen Tan
- Department of Infectious Diseases, Changi General Hospital, Singapore, Singapore
| | - Shirin Kalimuddin
- Department of Infectious Diseases, Singapore General Hospital, Singapore, Singapore.,Programme in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore, Singapore
| | - Sophia Archuleta
- Division of Infectious Diseases, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - David C Lye
- National Centre for Infectious Diseases, Singapore, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore. .,Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore, Singapore.
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5
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Quintens C, Coenen M, Declercq P, Casteels M, Peetermans WE, Spriet I. From basic to advanced computerised intravenous to oral switch for paracetamol and antibiotics: an interrupted time series analysis. BMJ Open 2022; 12:e053010. [PMID: 35396281 PMCID: PMC8995958 DOI: 10.1136/bmjopen-2021-053010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES Early switch from intravenous to oral therapy of bioequivalent drugs has major advantages but remains challenging. At our hospital, a basic clinical rule was designed to automatically alert the physician to review potential intravenous to oral switch (IVOS). A rather low acceptance rate was observed. In this study, we aimed to develop, validate and investigate the effect of more advanced clinical rules for IVOS, as part of a centralised pharmacist-led medication review service. DESIGN AND SETTING A quasi-experimental study was performed in a large teaching hospital in Belgium using an interrupted time series design. INTERVENTION A definite set of 13 criteria for IVOS, focusing on the ability of oral absorption and type of infection, was obtained by literature search and validated by a multidisciplinary expert panel. Based on these criteria, we developed a clinical rule for paracetamol and one for ten bioequivalent antibiotics to identify patients with potentially inappropriate intravenous prescriptions (PIVs). Postintervention, the clinical rule alerts were reviewed by pharmacists, who provided recommendations to switch in case of eligibility. PRIMARY AND SECONDARY OUTCOME MEASURES A regression model was used to assess the impact of the intervention on the number of persistent PIVs between the preintervention and the postintervention period. The total number of recommendations, acceptance rate and financial impact were recorded for the 8-month postintervention period. RESULTS At baseline, a median number of 11 (range: 7-16) persistent PIVs per day was observed. After the intervention, the number reduced to 3 (range: 1-7) per day. The advanced IVOS clinical rules showed an immediate relative reduction of 79% (incidence rate ratio=0.21, 95% CI 0.13 to 0.32; p<0.01) in the proportion of persistent PIVs. No significant underlying time trends were observed during the study. Postintervention, 1091 recommendations were provided, of which 74.1% were accepted, resulting in a total 1-day cost saving of €4648.35. CONCLUSIONS We showed the efficacy of advanced clinical rules combined with a pharmacist-led medication review for IVOS of bioequivalent drugs.
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Affiliation(s)
- Charlotte Quintens
- Pharmacy department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Marie Coenen
- Pharmacy department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Peter Declercq
- Pharmacy department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Minne Casteels
- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Willy E Peetermans
- Department of General Internal Medicine, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
| | - Isabel Spriet
- Pharmacy department, Universitaire Ziekenhuizen Leuven, Leuven, Belgium
- Department of Pharmaceutical and Pharmacological Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
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6
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Mazdeyasna H, Nori P, Patel P, Doll M, Godbout E, Lee K, Noda AJ, Bearman G, Stevens MP. Antimicrobial Stewardship at the Core of COVID-19 Response Efforts: Implications for Sustaining and Building Programs. Curr Infect Dis Rep 2020; 22:23. [PMID: 32834785 PMCID: PMC7332741 DOI: 10.1007/s11908-020-00734-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We describe traditional antimicrobial stewardship program (ASP) activities with a discussion of how these activities can be refocused in the setting of the COVID-19 pandemic. Additionally, we discuss possible adverse consequences of ASP attention diversion on COVID-19 response efforts and overall implications for future pandemic planning. We also discuss ASP in collaboration with other groups within health systems and how COVID-19 may affect these relationships long term. Despite the paucity of literature on Antimicrobial Stewardship and COVID-19, the potential contributions of ASPs during a pandemic are numerous. ASPs can develop strategies to identify patients with COVID-19-like-illness; this is particularly useful when these patients are missed at the time of health system entry. ASPs can also play a critical role in the management of potential drug shortages, developing local treatment guidelines, optimizing the use of antibiotics, and in the diagnostic stewardship of COVID-19 testing, among other roles. Importantly, it is often difficult to ascertain whether critically ill patients who are hospitalized with COVID-19 have concurrent or secondary bacterial infections—ASPs are ideally situated to help optimize antimicrobial use for these patients via a variety of mechanisms. ASPs are uniquely positioned to aid in pandemic response planning and relief efforts. ASPs are already integrated into health systems and play a key role in optimizing antimicrobial prescribing. As ASPs assist in COVID-19 response, understanding the role of ASPs in pandemic relief efforts may mitigate damage from future outbreaks.
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Affiliation(s)
- Hasti Mazdeyasna
- Virginia Commonwealth University School of Medicine, Richmond, VA USA
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Avenue 4H, Bronx, NY 10467 USA
| | - Payal Patel
- Infectious Diseases Section, Ann Arbor VA Medical Center (111-i), 2215 Fuller Road, Ann Arbor, MI 48105 USA
| | - Michelle Doll
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Emily Godbout
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Kimberly Lee
- Virginia Commonwealth University Health System, Richmond, VA USA
| | - Andrew J Noda
- Virginia Commonwealth University Health System, Richmond, VA USA
| | - Gonzalo Bearman
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Michael P Stevens
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
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Abstract
Intravenous antibiotics are overused in hospitals. Many infections can be managed with oral antibiotics Oral antibiotics avoid the adverse effects of intravenous administration. They are also usually less expensive When intravenous antibiotics are indicated, it may be possible to switch to oral therapy after a short course. There are guidelines to aid the clinician with the timing of the switch so that there is no loss of efficacy Infections that may be suitable for a short course of intravenous antibiotic include pneumonia, complicated urinary tract infections, certain intra-abdominal infections, Gram-negative bacteraemia, acute exacerbations of chronic lung disease, and skin and soft tissue infections Bone and joint infections and infective endocarditis are managed with prolonged courses of intravenous antibiotics. However, there is research looking at the feasibility of an earlier switch to oral antibiotics in these conditions
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Affiliation(s)
- Kate McCarthy
- Royal Brisbane and Women's Hospital, Brisbane.,Pathology Queensland, Brisbane.,Queensland Statewide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR, University of Queensland, Brisbane
| | - Minyon Avent
- Royal Brisbane and Women's Hospital, Brisbane.,Pathology Queensland, Brisbane.,Queensland Statewide Antimicrobial Stewardship Program, Infection and Immunity Theme, UQCCR, University of Queensland, Brisbane
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8
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Mahatumarat T, Pinmanee N, Injai W, Chaiwarith R. Inappropriateness of Intravenous Antibiotic Prescriptions at Hospital Discharge at a Tertiary Care hospital in Thailand. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:125-129. [PMID: 31908542 PMCID: PMC6929924 DOI: 10.2147/dhps.s221430] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/30/2019] [Indexed: 11/23/2022]
Abstract
Background Intravenous antibiotics, either as outpatient parenteral antimicrobial therapy (OPAT) or transition of care to community-based management, is a common practice in tertiary care hospitals to minimize hospital stays. However, infectious disease consultation was not mandated for those prescriptions. Therefore, we conducted this study to evaluate the appropriateness of intravenous antibiotic prescriptions at hospital discharge. Methods This retrospective cross-sectional study was conducted among patients receiving care at the internal medicine units of the Maharaj Nakorn Chiang Mai Hospital from November 1, 2015, to April 30, 2016. Intravenous antibiotics at hospital discharge were reviewed by an infectious diseases (ID) specialist. Results One hundred and twenty-nine prescriptions for 117 patients were reviewed. The most common diagnoses requiring intravenous antibiotics at hospital discharge were upper urinary tract infection (34.2%) and hepatobiliary tract infections (15.4%). The most common intravenous antibiotic was ceftriaxone (36.4%), followed by ertapenem (20.1%). Overall, the inappropriateness of prescriptions was 85.3%. The most common reason for inappropriateness was a failure to switch to oral antibiotics (52.7%), followed by incorrect duration (16.3%). Conclusion Antimicrobial stewardship should be considered for intravenous antibiotics at hospital discharge to reduce the inappropriateness of those prescriptions.
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Affiliation(s)
- Tuanjai Mahatumarat
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Napaporn Pinmanee
- Division of Pharmacy, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wichchulada Injai
- Division of Pharmacy, Maharaj Nakorn Chiang Mai Hospital, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Division of Infectious Diseases, Department of Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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9
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Papp-Wallace KM. The latest advances in β-lactam/β-lactamase inhibitor combinations for the treatment of Gram-negative bacterial infections. Expert Opin Pharmacother 2019; 20:2169-2184. [PMID: 31500471 PMCID: PMC6834881 DOI: 10.1080/14656566.2019.1660772] [Citation(s) in RCA: 82] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/23/2019] [Indexed: 12/21/2022]
Abstract
Introduction: Antimicrobial resistance in Gram-negative pathogens is a significant threat to global health. β-Lactams (BL) are one of the safest and most-prescribed classes of antibiotics on the market today. The acquisition of β-lactamases, especially those which hydrolyze carbapenems, is eroding the efficacy of BLs for the treatment of serious infections. During the past decade, significant advances were made in the development of novel BL-β-lactamase inhibitor (BLI) combinations to target β-lactamase-mediated resistant Gram-negatives.Areas covered: The latest progress in 20 different approved, developing, and preclinical BL-BLI combinations to target serine β-lactamases produced by Gram-negatives are reviewed based on primary literature, conference abstracts (when available), and US clinical trial searches within the last 5 years. The majority of the compounds that are discussed are being evaluated as part of a BL-BLI combination.Expert opinion: The current trajectory in BLI development is promising; however, a significant challenge resides in the selection of an appropriate BL partner as well as the development of resistance linked to the BL partner. In addition, dosing regimens for these BL-BLI combinations need to be critically evaluated. A revolution in bacterial diagnostics is essential to aid clinicians in the appropriate selection of novel BL-BLI combinations for the treatment of serious infections.
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Affiliation(s)
- Krisztina M. Papp-Wallace
- Louis Stokes Cleveland Department of Veterans Affairs, Research Service, Cleveland, OH, USA
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Department of Biochemistry, Case Western Reserve University, Cleveland, OH, USA
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10
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Gasparetto J, Tuon FF, Dos Santos Oliveira D, Zequinao T, Pipolo GR, Ribeiro GV, Benincá PD, Cruz JAW, Moraes TP. Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC Infect Dis 2019; 19:650. [PMID: 31331272 PMCID: PMC6647098 DOI: 10.1186/s12879-019-4280-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 07/11/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the oral switch (OS) stewardship intervention in the intensive care unit (ICU). METHODS This was a retrospective study with a convenience sample in two Brazilian ICUs from different hospitals in patients with sepsis receiving antibiotic therapy. The stewardship intervention included OS in patients diagnosed with sepsis when clinical stability was achieved. The primary outcome was overall mortality. Other variables evaluated were as follows: cost of antimicrobial treatment, daily costs of intensive care, acute kidney injury, and length of stay. RESULTS There was no difference in mortality between the OS and non-OS groups (p = 0.06). Length of stay in the ICU (p = 0.029) was shorter and acute kidney injury incidence (p = 0.032) and costs of antimicrobial therapy (p < 0.001) were lower in the OS group. CONCLUSION OS stewardship programs in the ICU may be considered a safe strategy. Switch therapy reduced the cost and shortened the length of stay in ICUs.
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Affiliation(s)
- Juliano Gasparetto
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | - Felipe Francisco Tuon
- Laboratory of Emerging Infectious Diseases, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil.
| | - Dayana Dos Santos Oliveira
- Laboratory of Emerging Infectious Diseases, Escola de Medicina, Pontifícia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Curitiba, PR, 80215-901, Brazil
| | - Tiago Zequinao
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | | | - Paola Delai Benincá
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
| | | | - Thyago Proenca Moraes
- School of Medicine, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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11
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Tefera GM, Feyisa BB, Kebede TM. Antimicrobial use-related problems and their costs in surgery ward of Jimma University Medical Center: Prospective observational study. PLoS One 2019; 14:e0216770. [PMID: 31100088 PMCID: PMC6524801 DOI: 10.1371/journal.pone.0216770] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 04/30/2019] [Indexed: 02/04/2023] Open
Abstract
Introduction Antibiotics are among the most commonly misused of all drugs, which results in antibiotic resistance and waste of resources and it has not been studied in Ethiopia. Therefore, this study was carried out to assess antibiotic use–related problems and their costs among patients hospitalized at the surgical ward of Jimma University Medical Center. Methods Hospital-based prospective observational study was used to assess the prevalence, cost, and determinants of antibiotic use–related problems; multiple stepwise backward logistic regression analysis was done for a P value of < 0.25 to look for predictors of antibiotic use-related problems. Written informed consent was obtained and confidentiality was secured. Results Among 300 participants, antibiotic use–related problems (ABURPs) were found in 69.3% of the study participants. The direct total cost attributed to these problems was approximated to a minimum of 2230.15 US$. Independent predictors for antibiotic use–related problems were: indication for antibiotic use like: use of antibiotic for prophylaxis; p < 0.0001, antibiotic use for both therapeutic & prophylaxis; p < 0.0001, CDC wound class I and II; p = 0.016 and; p = 0.002 respectively, overall poly-pharmacy and greater than 2 antibiotic exposure during hospital stay; p = 0.019and p = 0.006 respectively and hospital stay for ≥21 days; p = 0.007. Conclusion The prevalence of antibiotic use-related problems was high and resulted in extra cost. Antibiotic use for prophylaxis, prophylaxis, and treatment, poly-pharmacy, greater than 2 antibiotic exposures during the hospital stay, CDC wound class I and II, and duration of hospital stay of ≥ 21 days was found to be independent predictors of antibiotic use–related problems.
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Affiliation(s)
- Gosaye Mekonen Tefera
- Department of Pharmacy, Clinical pharmacy course unit, Ambo University, Ambo, Ethiopia
- * E-mail:
| | | | - Tsegaye Melaku Kebede
- School of Pharmacy, Department of clinical pharmacy, Jimma University, Jimma, Ethiopia
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Tamma PD, Conley AT, Cosgrove SE, Harris AD, Lautenbach E, Amoah J, Avdic E, Tolomeo P, Wise J, Subudhi S, Han JH. Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia. JAMA Intern Med 2019; 179:316-323. [PMID: 30667477 PMCID: PMC6439703 DOI: 10.1001/jamainternmed.2018.6226] [Citation(s) in RCA: 79] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
IMPORTANCE Conversion to oral therapy for Enterobacteriaceae bacteremia has the potential to improve the quality of life of patients by improving mobility, eliminating catheter-associated discomfort, decreasing the risk for noninfectious and infectious catheter-associated adverse events, and decreasing health care costs. OBJECTIVE To compare the association of 30-day mortality with early oral step-down therapy vs continued parenteral therapy for the treatment of Enterobacteriaceae bloodstream infections. DESIGN, SETTING, AND PARTICIPANTS This retrospective multicenter cohort study included a 1:1 propensity score-matched cohort of 4967 unique patients hospitalized with monomicrobial Enterobacteriaceae bloodstream infection at 3 academic medical centers from January 1, 2008, through December 31, 2014. Eligibility criteria included appropriate source control measures, appropriate clinical response by day 5, active antibiotic therapy from day 1 until discontinuation of therapy, availability of an active oral antibiotic option, and ability to consume other oral medications or feeding. Statistical analysis was performed from March 2, 2018, to June 2, 2018. EXPOSURES Oral step-down therapy within the first 5 days of treatment of Enterobacteriaceae bacteremia. MAIN OUTCOMES AND MEASURES The main outcome was 30-day all-cause mortality. RESULTS Of the 2161 eligible patients, 1185 (54.8%) were male and 1075 (49.7%) were white; the median (interquartile range [IQR]) age was 59 (48-68) years. One-to-one propensity-score matching yielded 1478 patients, with 739 in each study arm. Sources of bacteremia included urine (594 patients [40.2%]), gastrointestinal tract (297 [20.1%]), central line-associated (272 [18.4%]), pulmonary (58 [3.9%]), and skin and soft tissue (41 [2.8%]). There were 97 (13.1%) deaths in the oral step-down group and 99 (13.4%) in the intravenous (IV) group within 30 days (hazard ratio [HR], 1.03; 95% CI, 0.82-1.30). There were no differences in recurrence of bacteremia within 30 days between the groups (IV, 6 [0.8%]; oral, 4 [0.5%]; HR, 0.82 [0.33-2.01]). Patients transitioned to oral step-down therapy were discharged from the hospital an average of 2 days (IQR, 1-6) sooner than patients who continued to receive IV therapy (5 days [IQR, 3-8 days] vs 7 days [IQR, 4-14 days]; P < .001). CONCLUSIONS AND RELEVANCE In this study, 30-day mortality was not different among hospitalized patients who received oral step-down vs continued parenteral therapy for the treatment of Enterobacteriaceae bloodstream infections. The findings suggest that transitioning to oral step-down therapy may be an effective treatment approach for patients with Enterobacteriaceae bacteremia who have received source control and demonstrated an appropriate clinical response. Early transition to oral step-down therapy may be associated with a decrease in the duration of hospital stay for patients with Enterobacteriaceae bloodstream infections.
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Affiliation(s)
- Pranita D Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Anna T Conley
- Medical Student, Department of Medicine, University of Maryland School of Medicine, Baltimore
| | - Sara E Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore
| | - Anthony D Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - Ebbing Lautenbach
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Joe Amoah
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Edina Avdic
- Department of Pharmacy, The Johns Hopkins Hospital, Baltimore
| | - Pam Tolomeo
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Jacqueleen Wise
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
| | - Sonia Subudhi
- Medical Student, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore
| | - Jennifer H Han
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania
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Marsh N, Webster J, Larsen E, Genzel J, Cooke M, Mihala G, Cadigan S, Rickard CM. Expert versus generalist inserters for peripheral intravenous catheter insertion: a pilot randomised controlled trial. Trials 2018; 19:564. [PMID: 30333063 PMCID: PMC6192347 DOI: 10.1186/s13063-018-2946-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Accepted: 09/26/2018] [Indexed: 11/10/2022] Open
Abstract
Background Peripheral intravenous catheters (PVCs) are essential invasive devices, with 2 billion PVCs sold each year. The comparative efficacy of expert versus generalist inserter models for successful PVC insertion and subsequent reliable vascular access is unknown. Methods A single-centre, parallel-group, pilot randomised controlled trial (RCT) of 138 medical/surgical patients was conducted in a large tertiary hospital in Australia to compare PVC insertion by (1) a vascular access specialist (VAS) or (2) any nursing or medical clinician (generalist model). The primary outcome was the feasibility of a larger RCT as established by predetermined criteria (eligibility, recruitment, retention, protocol adherence). Secondary outcomes were PVC failure: phlebitis, infiltration/extravasation, occlusion, accidental removal or partial dislodgement, local infection or catheter-related bloodstream infection; dwell time; insertion success, insertion attempts; patient satisfaction; and procedural cost-effectiveness. Results Feasibility outcomes were achieved: 92% of screened patients were eligible; two patients refused participation; there was no attrition or missing outcome data. PVC failure was higher with generalists (27/50, 54%) than with VASs (33/69, 48%) (228 versus 217 per 1000 PVC days; incidence rate ratio 1.05, 95% confidence interval 0.61–1.80). There were no local or PVC-related infections in either group. All PVCs (n = 69) were successfully inserted in the VAS group. In the generalist group, 19 (28%) patients did not have a PVC inserted. There were inadequate data available for the cost-effectiveness analysis, but the mean insertion procedure time was 2 min in the VAS group and 11 min in the generalist group. Overall satisfaction with the PVC was measured on an 11-point scale (0 = not satisfied and 10 = satisfied) and was higher in the VAS group (n = 43; median = 7) compared to the generalist group (n = 20; median = 4.5). The multivariable model identified medical diagnosis and bed-bound status as being significantly associated with higher PVC failure, and securement with additional non-sterile tape was significantly associated with lower PVC failure. Conclusion This pilot trial confirmed the feasibility and need for a large, multicentre RCT to test these PVC insertion models. Trial registration Australian New Zealand Clinical Trials Registry, ACTRN12616001675415. Registered on 6 December 2016.
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Affiliation(s)
- Nicole Marsh
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Joan Webster
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,School of Nursing, Queensland University of Technology, Kelvin Grove, QLD, Australia
| | - Emily Larsen
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Jodie Genzel
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia.,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Marie Cooke
- School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia.,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Gabor Mihala
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Centre for Applied Health Economics, Menzies Health Institute Queensland, Brisbane, QLD, Australia
| | - Sue Cadigan
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Claire M Rickard
- Royal Brisbane and Women's Hospital, Herston, QLD, Australia. .,School of Nursing and Midwifery, Griffith University, Nathan, QLD, Australia. .,Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Brisbane, QLD, Australia.
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Mok M, Kinkade A, Tung A, Tejani AM. Identification of Patients Eligible for IV-to-PO Conversion: A Cost-Minimization Study. Can J Hosp Pharm 2016; 69:301-5. [PMID: 27621490 DOI: 10.4212/cjhp.v69i4.1584] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Merisa Mok
- , BSc(Pharm), was, at the time of writing, a student in the Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia. She is now a resident with the Lower Mainland Pharmacy Services Pharmacy Practice Residency Program, Vancouver, British Columbia
| | - Angus Kinkade
- , BSc(Pharm), ACPR, PharmD, MSc, BCPS, is with Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Anthony Tung
- , BSc(Pharm), ACPR, BCPS, MBA, is with Lower Mainland Pharmacy Services, Vancouver, British Columbia
| | - Aaron M Tejani
- , BSc(Pharm), PharmD, ACPR, is with Lower Mainland Pharmacy Services, Vancouver, British Columbia
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