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Pandak N, Al Sidairi H, Al-Zakwani I, Al Balushi Z, Chhetri S, Ba’Omar M, Al Lawati S, Al-Abri SS, Khamis F. The Outcome of Antibiotic Overuse before and during the COVID-19 Pandemic in a Tertiary Care Hospital in Oman. Antibiotics (Basel) 2023; 12:1665. [PMID: 38136699 PMCID: PMC10740960 DOI: 10.3390/antibiotics12121665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/15/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Antimicrobial resistance (AMR), a serious global public health challenge, may have accelerated development during the COVID-19 pandemic because antibiotics were prescribed for COVID-19. This study aimed to assess antibiotics use before and during the pandemic and correlate the results with the rate of resistant microorganisms detected in hospitalized patients during the study period. This single-center study looked retrospectively at four years of data (2018-2021) from Royal Hospital, Muscat, which is the biggest hospital in Oman with approximately 60,000 hospital admissions yearly. The consumption rate of ceftriaxone, piperacillin tazobactam, meropenem, and vancomycin was presented as the antibiotic consumption index, the ratio of defined daily dose (DDD) per 100 bed days. Analyses were performed using the nonparametric test for trend across the study period. Correlation between antibiotic consumption indexes and the isolated microorganisms in the four-year study period was performed using Spearman's rank correlation coefficient. We compared data from the pre-COVID-19 to the COVID-19 period. Though more patients were admitted pre-COVID-19 (132,828 versus 119,191 during COVID-19), more antibiotics were consumed during the pandemic (7350 versus 7915); vancomycin and ceftriaxone had higher consumption during than before the pandemic (p-values 0.001 and 0.036, respectively). Vancomycin-resistant Enterococcus (VRE) and Candida auris were detected more during the COVID-19 period with p-values of 0.026 and 0.004, respectively. Carbapenem-resistant Enterobacterales (CRE), vancomycin-resistant Enterococcus spp., and C. auris were detected more often during the pandemic with p-values of 0.011, 0.002, and 0.03, respectively. Significant positive correlations between antibiotic consumption and drug-resistant isolates were noted. This study confirms that the overuse of antibiotics triggers the development of bacterial resistance; our results emphasize the importance of antibiotic control.
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Affiliation(s)
- Nenad Pandak
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
| | - Hilal Al Sidairi
- Department of Microbiology, Royal Hospital, P.O. Box 1331, Muscat 111, Oman;
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 1331, Muscat 111, Oman;
| | - Zakariya Al Balushi
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
| | - Shabnam Chhetri
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
| | - Muna Ba’Omar
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
| | - Sultan Al Lawati
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
| | - Seif S. Al-Abri
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
| | - Faryal Khamis
- Department of Infectious Diseases, Royal Hospital, P.O. Box 1331, Muscat 111, Oman; (Z.A.B.); (S.C.); (M.B.); (S.A.L.); (S.S.A.-A.); (F.K.)
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Costantine JK, Bwire GM, Myemba DT, Sambayi G, Njiro BJ, Kilipamwambu A, Ching’oro N, Shungu RS, Mganga M, Majigo MV. WHO/INRUD prescribing indicators among tertiary regional referral hospitals in Dar es Salaam, Tanzania: a call to strengthen antibiotic stewardship programmes. JAC Antimicrob Resist 2023; 5:dlad093. [PMID: 37546545 PMCID: PMC10400121 DOI: 10.1093/jacamr/dlad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 07/17/2023] [Indexed: 08/08/2023] Open
Abstract
Background Antibiotic prescribing should be guided by national essential medicines lists (NEMLs) and treatment guidelines; however, there are inadequate data on antibiotic utilization patterns in tertiary hospitals in Tanzania. This study aimed to determine antibiotic prescribing patterns in tertiary hospitals in Dar es Salaam, Tanzania. Methods A retrospective cross-sectional study was conducted in three regional referral hospitals. About 200 prescription records from 2020 to 2022 were analysed at each hospital for prescribing patterns using WHO/ International Network of Rational Use of Drugs (INRUD) indicators (1993) and the AWaRe 2021 classification. Factors associated with receiving an antibiotic prescription were assessed using a logistic regression model. Facilities were ranked on prescribing practices using the index of rational drug prescribing (IRDP). Results A total of 2239 drugs were prescribed, of which 920 (41.1%) were antibiotics. An average of 3.7 ± 1.5 (optimal: 1.6-1.8) total medicines and 1.53 ± 0.78 antibiotics were prescribed per patient. About 88.0% (528) of the prescriptions contained antibiotics (optimal: 20.0%-26.8%), while 78.2% (413) of all antibiotic prescriptions contained injections (optimal: 13.4%-24.1%). Furthermore, 87.5% (462) of the antibiotics were prescribed in generic names (optimal: 100%), while 98.7% (521) conformed to the NEML (optimal: 100%). Metronidazole was the most frequently prescribed antibiotic (39.2%; n = 134), followed by ceftriaxone (37.1%, n = 127) and amoxicillin/clavulanic acid (8.5%, n = 29). Conclusions We found substantial empirical prescribing and overuse of antibiotics exceeding WHO recommendations. Antibiotic overuse varied across the hospitals. Being male, having underlying conditions such as diabetes mellitus, and/or being treated at Temeke hospital were associated with receiving an antibiotic prescription. We recommend strengthening antibiotic stewardship programmes in the studied facilities.
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Affiliation(s)
- Judith K Costantine
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - George M Bwire
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | | | - Godfrey Sambayi
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Belinda J Njiro
- Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Amosi Kilipamwambu
- Department of Pediatrics, School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Novatus Ching’oro
- Department of Pharmacognosy, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Rehema S Shungu
- Department of Pharmaceutical Microbiology, School of Pharmacy, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
| | - Mathew Mganga
- Department of Health, Social Welfare, and Nutrition, President’s Office, Regional Administration and Local Government, PO Box 1923, Dodoma, Tanzania
| | - Mtebe V Majigo
- Department of Microbiology and Immunology, School of Medicine, Muhimbili University of Health and Allied Sciences, PO Box 65001, Dar es Salaam, Tanzania
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Al Awaidy S, Al Salmi Z, Zayed B. Antimicrobial Stewardship Opportunities: An Example from Oman. Oman Med J 2023; 38:e498. [PMID: 37496865 PMCID: PMC10367181 DOI: 10.5001/omj.2023.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 06/25/2023] [Indexed: 07/28/2023] Open
Affiliation(s)
- Faryal khamis1
- Adult Infectious Diseases, Department of Medicine, Royal Hospital, Muscat, Oman
- Office of Health Affairs, Ministry of Health, Muscat, Oman
- Department of Pharmaceutical Care, Royal Hospital, Muscat, Oman
- Antimicrobial Resistance, Jordan Office, World Health Organization
| | | | - Zaher Al Salmi
- Department of Pharmaceutical Care, Royal Hospital, Muscat, Oman
| | - Bassem Zayed
- Department of Pharmaceutical Care, Royal Hospital, Muscat, Oman
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Haseeb A, Saleem Z, Maqadmi AF, Allehyani RA, Mahrous AJ, Elrggal ME, Kamran SH, AlGethamy M, Naji AS, AlQarni A, Alhariqi KW, Khan MA, Ibrahim K, Raees F, Azmat A, Cook A, Campbell SM, Lorenzetti G, Meyer JC, Godman B, Moore CE. Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications. Antibiotics (Basel) 2023; 12:827. [PMID: 37237730 PMCID: PMC10215537 DOI: 10.3390/antibiotics12050827] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/22/2023] [Accepted: 04/23/2023] [Indexed: 05/28/2023] Open
Abstract
Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East.
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Affiliation(s)
- Abdul Haseeb
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan 60800, Pakistan
| | - Aseel Fayk Maqadmi
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Roaa Abdulrahman Allehyani
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
- Batterjee Medical College, Jeddah 21442, Saudi Arabia
| | - Ahmad J. Mahrous
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Mahmoud E. Elrggal
- Department of Clinical Pharmacy, College of Pharmacy, Umm Al-Qura University, Makkah 24382, Saudi Arabia; (A.H.); (A.F.M.); (R.A.A.); (A.J.M.); (M.E.E.)
| | - Sairah Hafeez Kamran
- Institute of Pharmacy, Lahore College for Women University, Lahore 54000, Pakistan;
| | - Manal AlGethamy
- Department of Infection Prevention and Control Program, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia;
| | - Asem Saleh Naji
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | - Abdullmoin AlQarni
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | - Khalid W. Alhariqi
- Infectious Diseases Department, Alnoor Specialist Hospital, Makkah 24241, Saudi Arabia; (A.S.N.); (A.A.); (K.W.A.)
| | | | - Kiran Ibrahim
- Primary and Secondary Healthcare Department, DHQ Hospital Khushab, Khushab 41200, Pakistan;
| | - Fahad Raees
- Department of Medical Microbiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Aisha Azmat
- Department of Physiology, Faculty of Medicine, Umm Al-Qura University, Makkah 24382, Saudi Arabia;
| | - Aislinn Cook
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
| | - Stephen M. Campbell
- Centre for Epidemiology and Public Health, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
| | - Giulia Lorenzetti
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
| | - Johanna C. Meyer
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Molotlegi Street, Garankuwa, Pretoria 0208, South Africa
| | - Brian Godman
- School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria 0208, South Africa;
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow G4 0RE, UK
- Centre of Medical and Bio-Allied Health Sciences Research, Ajman University, Ajman 346, United Arab Emirates
| | - Catrin E. Moore
- Centre for Neonatal and Paediatric Infection, St. George’s University of London, London SW17 0RE, UK; (A.C.); (G.L.); (C.E.M.)
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Rahbi FA, Salmi IA, Khamis F, Balushi ZA, Pandak N, Petersen E, Hannawi S. Physicians' attitudes, knowledge, and practices regarding antibiotic prescriptions. J Glob Antimicrob Resist 2023; 32:58-65. [PMID: 36584969 DOI: 10.1016/j.jgar.2022.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 12/06/2022] [Accepted: 12/17/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Inappropriate and overuse of antimicrobials, incorrect dosing, and extended duration are some of the leading causes of antibiotic-resistance that have led to the development of antimicrobial resistance (AMR). We aimed to evaluate knowledge, attitudes, and practices regarding rational antibiotic prescribing among physicians in a teaching hospital in Oman, with the goal of identifying knowledge gaps and interventions that could lead to judicious use of antimicrobials and reduce the emergence of resistant organisms METHODS: A cross-sectional study assessing physicians' knowledge of and attitudes towards prescribing antibiotics was conducted at the Royal Hospital from 15 January to 31 March 2020. Likert scales were used to evaluate physicians' awareness and perception of personal performance regarding the care of patients with infections and rational use of antibiotics. RESULTS Inadequate hand washing was regarded as the most important factor contributing to AMR (51.6%), followed by widespread use of antibiotics (49%), prescribing broad-spectrum antibiotics (47.3%), lack of effective narrow-spectrum antibiotics (47.3%), inappropriate duration of antibiotic therapy (46.2%), inappropriate empirical choice of antibiotics (45.1%), poor access to information on local antibiotic resistance patterns (40.8%), and inadequate restrictions on antibiotic prescribing (34.4%). Other factors contributing to AMR such as lack of local hospital guidelines on antibiotic usage, random mutations in microbes, patient demands and expectations for antibiotics, and the role of pharmaceutical companies in advertising and promoting use of antibiotics were deemed important by 33.3%, 26.8%, 22.5% and 20.4%, respectively. CONCLUSIONS AMR is a global health threat with significant effect on the health system and the economy. Misuse and overuse of antimicrobials remain the main drivers for the development of drug-resistant pathogens. Identifying knowledge gaps and planning interventions that could lead to judicious use of antimicrobials including establishing an Antimicrobial Stewardship Program are of paramount importance in reducing AMR in the twenty-first century and beyond.
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Affiliation(s)
| | - Issa Al Salmi
- Renal Medicine, The Royal Hospital, Muscat, Oman; Internal Medicine, Oman Medical Specialty Board, Muscat, Oman.
| | - Faryal Khamis
- Infectious Disease Unit, Department of Medicine , The Royal Hospital, Muscat, Oman
| | - Zakaria Al Balushi
- Infectious Disease Unit, Department of Medicine , The Royal Hospital, Muscat, Oman
| | - Nenad Pandak
- Infectious Disease Unit, Department of Medicine , The Royal Hospital, Muscat, Oman
| | - Eskild Petersen
- European Society for Clinical Microbiology and Infectious Diseases, Basel, Switzerland; Department of Molecular Medicine, The University of Pavia, Pavia, Italy; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Suad Hannawi
- Internal Medicine Department, Ministry of Health and Prevention, Dubai, UAE
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Prayitno L, Yuniar Y. Trends in Using Antibiotics in the Era of National Health Insurance in the City of Manado. JOURNAL OF HEALTH MANAGEMENT 2022. [DOI: 10.1177/09720634221128728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Introduction: Antibiotic use needs to be monitored. Its irrational use causes resistance. Research aims to determine trends in antibiotic use. Methods: Observational research with retrospective data collection. Cross-sectional research design. Data about the availability of antibiotics from 2014 to 2017 in hospitals, health offices and PHCs in the city of Manado. Results: Trends of antibiotics used in PHC and health office in 2014–2017 were betalactam, macrolide, sulfamethoxazole-trimethoprim, and quinolone groups. Trends in secondary hospital were betalactam, sulfamethoxazole-trimethoprim, and quinolone groups. Trends in tertiary hospital are betalactam, quinolones, and other groups. Conclusion: Based on the data of five major antibiotics use in Manado City, there was a change in the pattern of antibiotic use, and this pattern tended to increase.
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Affiliation(s)
- Lukman Prayitno
- National Institute of Health Policy Development, Indonesian Health Ministry, Indonesia
| | - Yuyun Yuniar
- National Research and Innovation Agency, Indonesia
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7
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Light E, Baker-Austin C, Card RM, Ryder D, Alves MT, Al-Sarawi HA, Abdulla KH, Stahl H, Al-Ghabshi A, Alghoribi MF, Balkhy HH, Joseph A, Hughes A, Quesne WJL, Verner-Jeffreys DW, Lyons BP. Establishing a marine monitoring programme to assess antibiotic resistance: A case study from the Gulf Cooperation Council (GCC) region. ENVIRONMENTAL ADVANCES 2022; 9:None. [PMID: 36466197 PMCID: PMC9710716 DOI: 10.1016/j.envadv.2022.100268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 05/29/2023]
Abstract
The World Health Organization considers antimicrobial resistance as one of the most pressing global issues which poses a fundamental threat to human health, development, and security. Due to demographic and environmental factors, the marine environment of the Gulf Cooperation Council (GCC) region may be particularly susceptible to the threat of antimicrobial resistance. However, there is currently little information on the presence of AMR in the GCC marine environment to inform the design of appropriate targeted surveillance activities. The objective of this study was to develop, implement and conduct a rapid regional baseline monitoring survey of the presence of AMR in the GCC marine environment, through the analysis of seawater collected from high-risk areas across four GCC states: (Bahrain, Oman, Kuwait, and the United Arab Emirates). 560 Escherichia coli strains were analysed as part of this monitoring programme between December 2018 and May 2019. Multi-drug resistance (resistance to three or more structural classes of antimicrobials) was observed in 32.5% of tested isolates. High levels of reduced susceptibility to ampicillin (29.6%), nalidixic acid (27.9%), tetracycline (27.5%), sulfamethoxazole (22.5%) and trimethoprim (22.5%) were observed. Reduced susceptibility to the high priority critically important antimicrobials: azithromycin (9.3%), ceftazidime (12.7%), cefotaxime (12.7%), ciprofloxacin (44.6%), gentamicin (2.7%) and tigecycline (0.5%), was also noted. A subset of 173 isolates was whole genome sequenced, and high carriage rates of qnrS1 (60/173) and bla CTX-M-15 (45/173) were observed, correlating with reduced susceptibility to the fluoroquinolones and third generation cephalosporins, respectively. This study is important because of the resistance patterns observed, the demonstrated utility in applying genomic-based approaches to routine microbiological monitoring, and the overall establishment of a transnational AMR surveillance framework focussed on coastal and marine environments.
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Affiliation(s)
- Edel Light
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
- UK FAO Reference Centre for Antimicrobial Resistance, Veterinary Medicines Directorate, Woodham Lane, New Haw, Addlestone, Surrey, UK
| | - Craig Baker-Austin
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
| | - Roderick M. Card
- UK FAO Reference Centre for Antimicrobial Resistance, Veterinary Medicines Directorate, Woodham Lane, New Haw, Addlestone, Surrey, UK
- Department of Bacteriology, Animal and Plant Health Agency, Woodham Lane, New Haw, Addlestone, Surrey, UK
| | - David Ryder
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
| | - Mickael Teixeira Alves
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
| | - Hanan A. Al-Sarawi
- Kuwait Environment Public Authority (KEPA), P.O. Box: 24395, Safat 13104, Kuwait
| | | | - Henrik Stahl
- Zayed University, Academic City, 192 82 Dubai, United Arab Emirates
| | - Aliya Al-Ghabshi
- Al-Khabourah Vocational College for Marine Sciences, Ministry of Higher Education, Scientific Research and Innovation, Oman
| | - Majed F. Alghoribi
- King Abdullah International Medical Research Centre, KAIMRC, Saudi Arabia
| | | | - Andrew Joseph
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
| | - Alexandra Hughes
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
| | - Will J.F. Le Quesne
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Suffolk, Lowestoft NR33 0HT, United Kingdom
| | - David W. Verner-Jeffreys
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
- UK FAO Reference Centre for Antimicrobial Resistance, Veterinary Medicines Directorate, Woodham Lane, New Haw, Addlestone, Surrey, UK
| | - Brett P. Lyons
- Centre for Environment, Fisheries and Aquaculture Science (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
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Al-Hashimy ZS, Conway BR, Al-Yaqoobi M, Khamis F, Al Mawali GZ, Al Maashani AM, Al Hadhrami YS, Al Alawi SS, Al Mamari MS, Lattyak WJ, Lattyak EA, Aldiab M, Gould I, López-Lozano JM, Aldeyab MA. Identifying Targets for Antibiotic Use for the Management of Carbapenem-Resistant Acinetobacter baumannii (CRAb) in Hospitals-A Multi-Centre Nonlinear Time-Series Study. Antibiotics (Basel) 2022; 11:775. [PMID: 35740181 PMCID: PMC9220031 DOI: 10.3390/antibiotics11060775] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/03/2022] [Accepted: 06/05/2022] [Indexed: 01/21/2023] Open
Abstract
Solutions are needed to inform antimicrobial stewardship (AMS) regarding balancing the access to effective antimicrobials with the need to control antimicrobial resistance. Theoretical and mathematical models suggest a non-linear relationship between antibiotic use and resistance, indicating the existence of thresholds of antibiotic use beyond which resistance would be triggered. It is anticipated that thresholds may vary across populations depending on host, environment, and organism factors. Further research is needed to evaluate thresholds in antibiotic use for a specific pathogen across different settings. The objective of this study is to identify thresholds of population antibiotic use associated with the incidence of carbapenem-resistant Acinetobacter baumannii (CRAb) across six hospital sites in Oman. The study was an ecological, multi-centre evaluation that involved collecting historical antibiotic use and CRAb incidence over the period from January 2015 to December 2019. By using non-linear time-series analysis, we identified different thresholds in the use of third-generation cephalosporins, piperacillin-tazobactam, aminoglycoside, and fluoroquinolones across participating hospitals. The identification of different thresholds emphasises the need for tailored analysis based on modelling data from each hospital. The determined thresholds can be used to set targets for each hospital AMS, providing a balance between access to these antibiotics versus controlling CRAb incidence.
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Affiliation(s)
- Zainab Said Al-Hashimy
- Directorate of Pharmacy and Medical Stores, Khawlah Hospital, Muscat P.O. Box 90, Oman;
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Mubarak Al-Yaqoobi
- Directorate of Laboratories, Department of Microbiology, Khawlah Hospital, Muscat P.O. Box 90, Oman;
| | - Faryal Khamis
- Adult Infectious Disease, Department of Medicine, Royal Hospital, Muscat P.O. Box 1331, Oman;
| | | | - Aisha Mahad Al Maashani
- Department of Pharmacy and Medical Store, As Sultan Qaboos Hospital, Salalah P.O. Box 98, Oman;
| | | | - Said Salim Al Alawi
- Department of Pharmacy and Medical Store, Sur Hospital, Sur P.O. Box 966, Oman;
| | | | - William J. Lattyak
- Scientific Computing Associates Corp., River Forest, IL 60305, USA; (W.J.L.); (E.A.L.)
| | - Elizabeth A. Lattyak
- Scientific Computing Associates Corp., River Forest, IL 60305, USA; (W.J.L.); (E.A.L.)
| | - Motasem Aldiab
- Department of Computing, British Columbia Institute of Technology, Vancouver, BC V6B 3H6, Canada;
| | - Ian Gould
- Medical Microbiology Department, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, UK;
| | - José-María López-Lozano
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), 30120 Murcia, Spain;
- Research Group on Health Sciences Data Analysis, Universidad de Murcia, 30003 Murcia, Spain
| | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK;
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9
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Ambusaidi A, Taylor N, Quinn F, Rizk N, Taylor S. Omani senior secondary school students’ knowledge of and attitudes to antibiotic resistance. PLoS One 2022; 17:e0264500. [PMID: 35213650 PMCID: PMC8880815 DOI: 10.1371/journal.pone.0264500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022] Open
Abstract
Antibiotic resistance is a worldwide problem that is increasing largely due to the misuse of antibiotics in human health and agriculture. This situation is further exacerbated by a dearth of new antibiotic development, the focus of pharmaceutical companies having shifted to more lucrative treatments for chronic conditions such as elevated blood pressure. To conserve the efficacy of the current crop of antibiotics, it is vital that they are used appropriately by individuals. Effective education may be a means to achieve such appropriate use. This paper reports on a large-scale, mixed methods study, which employed a survey and oral questionnaires, undertaken with senior secondary Omani students. The study explored students’ understanding of antibiotic resistance as well as their attitudes to the issue of antibiotic resistance. The study findings indicated that, although some students had a reasonably clear understanding of antibiotic resistance, many had serious misconceptions that could result in misuse of antibiotics. The article concludes with suggestions for amending secondary school pedagogy in Oman to address the misconceptions.
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Affiliation(s)
| | - Neil Taylor
- University of New England, Armidale, NSW, Australia
- * E-mail:
| | | | - Nadya Rizk
- University of New England, Armidale, NSW, Australia
| | - Subhashni Taylor
- College of Arts, Society & Education, James Cook University, Smithfield, Cairns, QLD, Australia
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10
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Mahmood RK, Gillani SW, Alzaabi MJ, Gulam SM. Evaluation of inappropriate antibiotic prescribing and management through pharmacist-led antimicrobial stewardship programmes: a meta-analysis of evidence. Eur J Hosp Pharm 2021; 29:2-7. [PMID: 34848531 PMCID: PMC8717790 DOI: 10.1136/ejhpharm-2021-002914] [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: 05/31/2021] [Accepted: 06/28/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose This meta-analysis aims to evaluate inappropriate antibiotic prescribing in the Gulf region and determine the effect of pharmacist-led antimicrobial stewardship (AMS) programmes on reducing inappropriateness. Method Articles were searched, analysed, and quality assessed through the risk of bias (ROB) quality assessment tool to select articles with a low level of bias. In step 1, 515 articles were searched, in step 2, 2360 articles were searched, and ultimately 32 articles were included by critical analysis. Statistical analysis used to determine risk ratio and standard mean differences were calculated using Review manager 5.4; 95% confidence intervals were calculated using the fixed-effect model. The I2 statistic assessed heterogeneity. In statistical heterogeneity, subgroup and sensitivity analyses, a random effect model was performed. The α threshold was 0.05. The primary outcome was inappropriateness in antibiotic prescribing in the Gulf region and reduction of inappropriateness through AMS. Result Detailed review and analysis of 18 studies of inappropriate antibiotic prescribing in the Gulf region showed the risk of inappropriateness was 43 669/100 846=43.3% (pooled RR 1.31, 95% CI 1.30 to 1.32). Test with overall effect was 58.87; in the second step 28 AMS programmes led by pharmacists showed reduced inappropriateness in AMS with pharmacist versus pre-AMS without pharmacist (RR 0.36, 95% CI 0.32 to 0.39). Conclusion Inappropriate antibiotic prescribing in the Gulf region is alarming and needs to be addressed through pharmacist-led AMS programmes.
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Affiliation(s)
- Rana Kamran Mahmood
- Gulf Medical University Ajman UAE, Ajman, UAE.,Pharmacy, Response Plus medical, Abu Dhabi, UAE
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11
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Baraka MA, AlLehaibi LH, AlSuwaidan HN, Alsulaiman D, Islam MA, Alotaibi BS, Alboghdadly A, Homoud AH, Al-Ghamdi FH, Al Ghamdi MS, Babar ZUD. Patterns of infections and antimicrobial drugs' prescribing among pregnant women in Saudi Arabia: a cross sectional study. J Pharm Policy Pract 2021; 14:9. [PMID: 33441164 PMCID: PMC7807808 DOI: 10.1186/s40545-020-00292-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022] Open
Abstract
Background Antimicrobial agents are among the most commonly prescribed drugs in pregnancy due to the increased susceptibility to infections during pregnancy. Antimicrobials can contribute to different maternal complications. Therefore, it is important to study their patterns in prescription and utilization. The data regarding this issue is scarce in Saudi Arabia. Therefore, the aim of this study is to generate data on the antimicrobial agents that are most commonly prescribed during pregnancy as well as their indications and safety. Methods This is a retrospective study focusing on pregnant women with a known antimicrobial use at Johns Hopkins Aramco Healthcare (JHAH). The sample included 344 pregnant women with a total of 688 antimicrobial agents prescribed. Data was collected on the proportion of pregnant women who received antimicrobial agents and on the drug safety during pregnancy using the risk categorization system of the U.S. Food and Drug Administration (FDA). Results The results showed that urinary tract infections (UTIs) were the most reported (59%) infectious diseases. Around 48% of pregnant women received antimicrobial medications at some point during pregnancy. The top two antimicrobial agents based on prescription frequency were B-lactams (44.6%) and azole anti-fungals (30%). The prescribed drugs in the study were found to be from classes B, C and D under the FDA risk classification system. Conclusion The study revealed a high proportion of antimicrobials prescribed during pregnancy that might pose risks to mothers and their fetuses. Future multicenter studies are warranted to evaluate the rational prescription of antimicrobial medications during pregnancy.
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Affiliation(s)
- Mohamed A Baraka
- Clinical Pharmacy Department, College of Pharmacy, Al Ain University, Al Ain Campus, Al Ain, United Arab Emirates. .,Clinical Pharmacy Department, College of Pharmacy, Al-Azhar University, Cairo, Egypt.
| | - Lina Hussain AlLehaibi
- First Health Cluster in Eastern Province, Dammam Medical Complex, Dammam, 32245, Saudi Arabia
| | - Hind Nasser AlSuwaidan
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, P.O. Box. 1982, Dammam, 31441, Saudi Arabia
| | - Duaa Alsulaiman
- King Fahd Hospital of the University (KFHU), Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Md Ashraful Islam
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Badriyah Shadid Alotaibi
- Department of Pharmaceutical Sciences, College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Amany Alboghdadly
- College of Pharmacy, Princess Nourah Bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ali H Homoud
- Clinical Pharmacy Service, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Fuad H Al-Ghamdi
- Pharmacy Department at Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Mastour S Al Ghamdi
- Department of Pharmacology, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Zaheer-Ud-Din Babar
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK
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12
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Jain M, Kakkar S, Bansal A, Kapadia R. A cross-sectional study of prescribing pattern of antimicrobial agents among inpatients of a tertiary Healthcare Centre. SCRIPTA MEDICA 2020. [DOI: 10.5937/scriptamed51-28092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Background: Antimicrobial agents are the mainstay of treatment in modern medicine. In view of emerging threat of Antimicrobial Resistance (AMR), there was a requirement aimed at identifying patterns of antimicrobial prescribing. The prescribing pattern of antimicrobial agents (AMAs) among the medicine inpatients of SMS Medical College & Hospital, Jaipur, India was studied. The objectives were to evaluate, monitor and suggest rational prescribing practices. Methods: This was a cross-sectional study that was done for a period of one year from July 2016 to June 2017. The rationality of antimicrobial drug use was evaluated by analysing the prescriptions. Results: A total of 400 patients were included in the study. Percentage of indoor patients with one or more AMAs prescribed was 48.75 %. The average number of AMAs prescribed was 1.67. Percentage of AMAs prescribed consistent with the National List of Essentials Medicines (NLEM) was 89.73 %. The average AMAs duration prescribed was found to be 4.24 days. The most commonly prescribed antibacterial agent in medicine in patients was a beta-lactam AMA with 57.29 % of all prescriptions. Conclusion: AMR is strongly linked to improper antimicrobial use. This study suggests that certain interventions are required to minimise toxicity and lessen the chances of emergence of resistance. It is therefore proposed that there should be continuous education on rational use of drugs among healthcare professionals.
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13
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Le Quesne WJF, Baker-Austin C, Verner-Jeffreys DW, Al-Sarawi HA, Balkhy HH, Lyons BP. Antimicrobial resistance in the Gulf Cooperation Council region: A proposed framework to assess threats, impacts and mitigation measures associated with AMR in the marine and aquatic environment. ENVIRONMENT INTERNATIONAL 2018; 121:1003-1010. [PMID: 29980310 DOI: 10.1016/j.envint.2018.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 06/24/2018] [Accepted: 06/24/2018] [Indexed: 06/08/2023]
Abstract
It is becoming increasingly clear that the genetic diversity and abundance of antimicrobial resistance (AMR) in non-clinical settings has been underestimated and that the environment plays an integral role in enabling the development of AMR. Due to specific demographic and environmental factors the Gulf Cooperation Council (GCC) region may be particularly susceptible to the threat of AMR, with the marine and aquatic environment potentially playing a specific role in its development and propagation. The demographic factors include rapid population growth, significant international population movements, heavy antibiotic use and insufficient antibiotic stewardship. Environmental factors leading to susceptibility include notable inputs of untreated sewage effluent, high ambient water temperatures, elevated concentrations of heavy metals, and poorly regulated use of antimicrobials in veterinary settings. However, to date there is only a limited understanding of the role that this environment plays in enabling the emergence and propagation AMR in this region. This article provides an overview of the risk associated with AMR in the marine and aquatic environment in the GCC region and proposes a framework for understanding how such environments interact with the wider development and propagation of resistance. It identifies priority actions aligned with the World Health Organisation AMR Global Action Plan and associated national action plans to evaluate the role of marine and aquatic systems relative to the wider factors driving AMR emergence and propagation. The proposed framework and actions to evaluate the role of marine and aquatic environments in driving propagation and emergence of AMR are equally applicable at the regional and national level beyond the GCC.
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Affiliation(s)
- William J F Le Quesne
- Centre for Environment, Fisheries and Aquaculture (CEFAS), Lowestoft, Suffolk NR33 0HT, United Kingdom
| | - Craig Baker-Austin
- Centre for Environment, Fisheries and Aquaculture (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom.
| | - David W Verner-Jeffreys
- Centre for Environment, Fisheries and Aquaculture (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
| | - Hanan A Al-Sarawi
- School of Biological Sciences, Plymouth University, Drake Circus, Plymouth, PL4 8AA, United Kingdom; Department of Earth & Environmental Sciences, Kuwait University, Faculty of Science, P.O. Box 5969, Safat 13060, Kuwait; Kuwait Environment Public Authority (KEPA), P.O. Box: 24395, Safat 13104, Kuwait
| | - Hanan H Balkhy
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; GCC Centre for Infection Control, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia
| | - Brett P Lyons
- Centre for Environment, Fisheries and Aquaculture (CEFAS), Weymouth, Dorset DT4 8UB, United Kingdom
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14
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Abstract
Lemierre's syndrome is a rare, life-threatening condition, which may be fatal if not properly treated. This disease refers to thrombophlebitis of the internal jugular vein, which is the result of bacterial sore throat infection (usually in the form of pharyngitis) that extends into the parapharyngeal space. However, it can result from other infective foci in the ear, nose, parotid glands, and paranasal sinuses. The bacteria typically responsible is Fusobacterium necrophorum. Here, we describe a case of Lemierre's syndrome that occurred in a 20-year-old female who presented with neurological deficits following a two-week history of upper respiratory tract infection. Our case displayed typical findings of this rare condition with a review of the previous literature and also to emphasize the importance of high index of suspicion to reduce the mortality of this disease.
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Affiliation(s)
| | | | - Sawsan Taif
- Radiology Department, Khoula Hospital, Muscat, Oman
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15
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Balkhair A. Antibiotics Resistance: When the Armamentarium Gets to the Verge of Being Empty. Oman Med J 2017; 32:267-268. [PMID: 28804577 DOI: 10.5001/omj.2017.53] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Abdullah Balkhair
- Infectious Diseases Unit, Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
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16
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Garcell HG, Arias AV, Sandoval CAP, García EG, Gamboa MEV, Sado AB, Serrano RNA. Incidence and Etiology of Surgical Site Infections in Appendectomies: A 3-Year Prospective Study. Oman Med J 2017; 32:31-35. [PMID: 28042400 DOI: 10.5001/omj.2017.06] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Surgical site infections (SSIs) constitute a threat, especially in complicated appendicitis, and are commonly due to gram-negative organisms. We sought to describe the incidence of SSIs in appendectomies performed during a three-year period (January 2013 to December 2015) in a community hospital in Qatar, and compare this with external benchmarks. METHODS We conducted a longitudinal study at The Cuban Hospital, Qatar. We used the standardized surveillance criteria to define SSI developed by the Centers for Disease Control. Information about age, sex, smoking habits, diabetes mellitus status, body mass index, and the result of bacteriologic studies were collected. RESULTS Of a total 603 patients, 22 (3.6%) cases of SSI were reported, with an infection rate of 13.6%, 4.5%, and 1.0% in 2013, 2014, and 2015, respectively. SSIs were observed more frequently in patients with contaminated/dirty wounds (6.6%). About 65% of isolates from the surgical site were multidrug-resistant organisms (Escherichia coli and Klebsiella spp.). CONCLUSIONS This study describes the incidence of SSI in appendectomy, which could be used as a benchmark for the facility improvement program. The high frequency of multidrug-resistant organisms in SSIs requires additional studies focused on evaluating the effectiveness of the current preventive practices with a particular reference to antimicrobial prophylaxis.
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Affiliation(s)
| | | | | | | | | | - Adam Bode Sado
- Surgical Department, The Cuban Hospital, Hamad Medical Corporation, Qatar
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17
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Garcell HG, Arias AV, Fernandez EA, Guerrero YB, Serrano RNA. Antibiotic Consumption During a 4-year Period in a Community Hospital with an Antimicrobial Stewardship Program. Oman Med J 2016; 31:352-6. [PMID: 27602189 DOI: 10.5001/omj.2016.70] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES We sought to evaluate the trend of antibiotic consumption in patients admitted to a community hospital in Qatar with an antimicrobial stewardship program. METHODS This observational study was carried out in a 75-bed facility in Western Qatar over a 4-year period (2012-2015). The monitoring of antimicrobial consumption from inpatient wards was performed from the pharmacy records and presented as defined daily dose (DDD) divided by the patient days and expressed as 100 bed-days (DBD). RESULTS The consumption of antimicrobials in 2012 was 171.3 DBD, and increased to 252.7 DBD in 2013, 229.1 DBD in 2014, and 184.7 DBD in 2015. Cephalosporins use reduced from 98.2 DBD in 2013 to 51.5 DBD in 2015 while the consumption of penicillins increased during the beginning of 2014 with a slight decrease in 2015. Carbapenems consumption during 2014-2015 was lower than previous years, and vice-versa for aminoglycosides. Fluoroquinolones had a sustained increase with 37.1% increased consumption in 2015 compared to the two previous years. There was an increase in the use of intravenous (IV) (108.5%) and oral azithromycin (55.1%) and the use of oral (152.8%) and IV moxifloxacin (22.9%). CONCLUSIONS We observed a decrease in antibiotic use in patients admitted to a community hospital with an antimicrobial stewardship program, but the increase in fluoroquinolones consumption is a concern that requires focused strategies.
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