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Boal NS, Chiou CA, Sadlak N, Sarmiento VA, Lefebvre DR, Distefano AG. Antibiotic utilization in endoscopic dacryocystorhinostomy: a multi-institutional study and review of the literature. Orbit 2024; 43:183-189. [PMID: 37395439 DOI: 10.1080/01676830.2023.2227705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 06/15/2023] [Indexed: 07/04/2023]
Abstract
PURPOSE Utilization of antibiotics for endoscopic dacryocystorhinostomy (endo-DCR) is largely dependent on individual surgeon preference. This study aimed to investigate prescribing practices of pre-, peri-, and postoperative antibiotics and effects on postoperative infection rates in patients who underwent endo-DCR. METHODS A retrospective chart review of institutional data at two academic centers of endo-DCR cases from 2015-2020 was performed. Postoperative infection rates for patients who received pre-, peri-, and postoperative antibiotics, individually or in combination, and those who did not, were compared via odds ratio and ANOVA linear regression. RESULTS 331 endo-DCR cases were included; 22 cases (6.6%) had a postoperative infection. There was no significant difference in the infection rates between patients without an active preoperative dacryocystitis who received different permutations of peri- and postoperative antibiotics. Patients who received preoperative antibiotics within two weeks of surgery for preexisting acute dacryocystitis, but did not receive peri- or postoperative antibiotics, had a higher rate of postoperative infections (p = 008). CONCLUSIONS Our data suggest antibiotics may be beneficial only when patients have a recent or active dacryocystitis prior to surgery. Otherwise, our data do not support the routine use of antibiotic prophylaxis in endo-DCR.
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Affiliation(s)
- Nina S Boal
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Carolina A Chiou
- Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Sadlak
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - V Adrian Sarmiento
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Daniel R Lefebvre
- Division of Ophthalmic Plastic Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
- Division of Ophthalmology, Surgical Service, Boston Veterans Affairs HealthCare System, Boston, Massachusetts, USA
- Dedham Ophthalmic Consultants and Surgeons / Lexington Eye Associates, Dedham, Massachusetts, USA
| | - Alberto G Distefano
- Department of Ophthalmology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
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2
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Nickel KB, Durkin MJ, Olsen MA, Sahrmann JM, Neuner E, O’Neil CA, Butler AM. Utilization of broad- versus narrow-spectrum antibiotics for the treatment of outpatient community-acquired pneumonia among adults in the United States. Pharmacoepidemiol Drug Saf 2024; 33:e5779. [PMID: 38511244 PMCID: PMC11016291 DOI: 10.1002/pds.5779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/22/2024]
Abstract
PURPOSE To characterize antibiotic utilization for outpatient community-acquired pneumonia (CAP) in the United States. METHODS We conducted a cohort study among adults 18-64 years diagnosed with outpatient CAP and a same-day guideline-recommended oral antibiotic fill in the MarketScan® Commercial Database (2008-2019). We excluded patients coded for chronic lung disease or immunosuppressive disease; recent hospitalization or frequent healthcare exposure (e.g., home wound care, patients with cancer); recent antibiotics; or recent infection. We characterized utilization of broad-spectrum antibiotics (respiratory fluoroquinolone, β-lactam + macrolide, β-lactam + doxycycline) versus narrow-spectrum antibiotics (macrolide, doxycycline) overall and by patient- and provider-level characteristics. Per 2007 IDSA/ATS guidelines, we stratified analyses by otherwise healthy patients and patients with comorbidities (coded for diabetes; chronic heart, liver, or renal disease; etc.). RESULTS Among 263 914 otherwise healthy CAP patients, 35% received broad-spectrum antibiotics (not recommended); among 37 161 CAP patients with comorbidities, 44% received broad-spectrum antibiotics (recommended). Ten-day antibiotic treatment durations were the most common for all antibiotic classes except macrolides. From 2008 to 2019, broad-spectrum antibiotic use substantially decreased from 45% to 19% in otherwise healthy patients (average annual percentage change [AAPC], -7.5% [95% CI -9.2%, -5.9%]), and from 55% to 29% in patients with comorbidities (AAPC, -5.8% [95% CI -8.8%, -2.6%]). In subgroup analyses, broad-spectrum antibiotic use varied by age, geographic region, provider specialty, and provider location. CONCLUSIONS Real-world use of broad-spectrum antibiotics for outpatient CAP declined over time but remained common, irrespective of comorbidity status. Prolonged duration of therapy was common. Antimicrobial stewardship is needed to aid selection according to comorbidity status and to promote shorter courses.
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Affiliation(s)
- Katelin B. Nickel
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Michael J. Durkin
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Margaret A. Olsen
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - John M. Sahrmann
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Elizabeth Neuner
- Department of Pharmacy, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Caroline A. O’Neil
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
| | - Anne M. Butler
- Department of Medicine, Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, USA
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO, USA
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Wawrzoniak T, Romańska J. Effect of Serial Clinical Observation Complemented by Point-of-Care Blood Culture Volume Verification on Antibiotic Exposure in Newborns. Glob Pediatr Health 2024; 11:2333794X231226057. [PMID: 38269318 PMCID: PMC10807344 DOI: 10.1177/2333794x231226057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Objective. This study evaluated the effects of serial clinical observation strategy complemented by point-of-care verification of blood culture volume in managing term and near-term newborns at risk for early-onset sepsis. Methods. We used a "before-and-after" approach. Infants born at ≥35 0/7 weeks' gestation were eligible. Our strategy was based on serial clinical observation complemented with point-of-care verification of blood culture volume. Two separate 12-month periods were analyzed. The number of infants exposed to antibiotics started during the first 3 days of life was compared before and after introducing the strategy. Results. During the post-intervention period, 0.6% of infants received antibiotic therapy, compared to 4.1% during the pre-intervention period (P < .001; relative risk [RR]: 0.15; 95% CI: 0.08-0.28). Conclusion. Serial clinical observation complemented with verification of blood culture volume might reduce antibiotic utilization in newborns in the early postnatal period.
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Sarkhi KA, Eljaaly K, Kaki R, Bahamdan R, Alghamdi SA, Baharith MO, Thabit AK. Impact of a multidisciplinary antimicrobial stewardship program on antibiotic utilization and clinical outcomes at a tertiary hospital in Saudi Arabia: a quasi-experimental study. Expert Rev Anti Infect Ther 2024; 22:115-120. [PMID: 37974376 DOI: 10.1080/14787210.2023.2285425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/25/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND This study aims to assess the impact of a multidisciplinary antimicrobial stewardship program (ASP) intervention on various metrics. METHODS A quasi-experimental study was performed on non-ICU patients for whom a restricted antibiotic was ordered. In September 2020, a prospective audit and feedback was implemented involving infectious disease clinical pharmacists, utilization of electronic resources, and improved documentation. Outcomes included defined daily dose and days of therapy per 100-patient days (DDD/100PD and DOT/100PD) and patient clinical outcomes. RESULTS 402 episodes were evaluated for 167 and 190 unique patients in the pre- and post-intervention phases, respectively. DDD/100PD and DOT/100PD were lower in the post-phase than in the pre-phase (1.75 vs. 2.54 and 16.13 vs. 44.93). Antibiotic de-escalation and clinical cure rates were significantly higher in the post-phase than in the pre-phase (62% vs. 40.6% and 83.5% vs. 65.8%; P < 0.001 for both comparisons). Hospital and ICU stays were significantly shorter in the post-phase (14 vs. 22 and 3 vs. 9, respectively; P < 0.001 for both comparisons). In-hospital mortality and 30-day readmission rates were lower in the post-phase (13% vs. 20.8%; P = 0.037 and 20.5% vs. 33.8%; P = 0.003, respectively). CONCLUSION The implemented multidisciplinary ASP intervention was associated with a significant improvement in antibiotic utilization and patient clinical outcomes.
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Affiliation(s)
- Khadijah A Sarkhi
- Department of Pharmaceutical Care Services, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
- Department of Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Khalid Eljaaly
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reham Kaki
- Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Infectious Disease and Infection Control and Environmental Health, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Rahaf Bahamdan
- Department of Pharmaceutical Care Services, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Sultan A Alghamdi
- Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Abrar K Thabit
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
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Dowling J, Arscott-Mills T, Bayani O, Boustany M, Moorad B, Richard-Greenblatt M, Tlhako N, Zalot M, Steenhoff AP, Gezmu AM, Nakstad B, Strysko J, Coffin SE, McGann C. Antibiotic Use for Sepsis in Hospitalized Neonates in Botswana: Factors Associated with Guideline-Divergent Prescribing. Microorganisms 2023; 11:2641. [PMID: 38004653 PMCID: PMC10673292 DOI: 10.3390/microorganisms11112641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
In low- and middle-income countries, where antimicrobial access may be erratic and neonatal sepsis pathogens are frequently multidrug-resistant, empiric antibiotic prescribing practices may diverge from the World Health Organization (WHO) guidelines. This study examined antibiotic prescribing for neonatal sepsis at a tertiary referral hospital neonatal unit in Gaborone, Botswana, using data from a prospective cohort of 467 neonates. We reviewed antibiotic prescriptions for the first episode of suspected sepsis, categorized as early-onset (EOS, days 0-3) or late-onset (LOS, >3 days). The WHO prescribing guidelines were used to determine whether antibiotics were "guideline-synchronous" or "guideline-divergent". Logistic regression models examined independent associations between the time of neonatal sepsis onset and estimated gestational age (EGA) with guideline-divergent antibiotic use. The majority (325/470, 69%) were prescribed one or more antibiotics, and 31 (10%) received guideline-divergent antibiotics. Risk factors for guideline-divergent prescribing included neonates with LOS, compared to EOS (aOR [95% CI]: 4.89 (1.81, 12.57)). Prematurity was a risk factor for guideline-divergent prescribing. Every 1-week decrease in EGA resulted in 11% increased odds of guideline-divergent antibiotics (OR [95% CI]: 0.89 (0.81, 0.97)). Premature infants with LOS had higher odds of guideline-divergent prescribing. Studies are needed to define the causes of this differential rate of guideline-divergent prescribing to guide future interventions.
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Affiliation(s)
- Jameson Dowling
- College of Public Health, Temple University, Philadelphia, PA 19122, USA;
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
| | - Tonya Arscott-Mills
- Department of Pediatrics, Wake Forest School of Medicine, Winston Salem, NC 27101, USA
| | - One Bayani
- Faculties of Medicine & Health Sciences, Department of Paediatric & Adolescent Health, University of Botswana, Gaborone P.O. Box 00701, Botswana
| | - Mickael Boustany
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
| | - Banno Moorad
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
| | - Melissa Richard-Greenblatt
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A1, Canada
- Public Health Ontario, Toronto, ON M5G 1M1, Canada
| | - Nametso Tlhako
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
| | - Morgan Zalot
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
| | - Andrew P. Steenhoff
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Alemayehu M. Gezmu
- Faculties of Medicine & Health Sciences, Department of Paediatric & Adolescent Health, University of Botswana, Gaborone P.O. Box 00701, Botswana
| | - Britt Nakstad
- Faculties of Medicine & Health Sciences, Department of Paediatric & Adolescent Health, University of Botswana, Gaborone P.O. Box 00701, Botswana
| | - Jonathan Strysko
- Botswana-UPenn Partnership, University of Pennsylvania & University of Botswana, Gaborone P.O. Box 45498, Botswana
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
| | - Susan E. Coffin
- Division of Infectious Diseases, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA (S.E.C.)
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Carolyn McGann
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Neonatology, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Pathan SR, Bhende VV, Sharma TS, Kumar A, Patel VA, Sharma KB, Pandya SB. Antibiotic Utilization and Prophylaxis in Paediatric Cardiac Surgery: A Retrospective Observational Study at a Rural Tertiary Care Hospital in India. Cureus 2023; 15:e45107. [PMID: 37842391 PMCID: PMC10569353 DOI: 10.7759/cureus.45107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2023] [Indexed: 10/17/2023] Open
Abstract
Introduction Antimicrobial prophylaxis, involving short antibiotic courses preceding surgical procedures, is recommended to minimize postoperative infections. Paediatric cardiac surgeries are classified as clean procedures, though infection challenges persist due to illness severity and extended ICU stays. Antimicrobial prophylaxis varies, ranging from single doses to extended administration until catheters are removed. Typically lasting 24 to 48 hours, it has proven infection-reduction benefits. Despite these practices, uncertainties surround the optimal nature, timing, and duration of administration. This concern is amplified by escalating antimicrobial resistance driven by antibiotic overuse. Vulnerable paediatric populations bear heightened consequences of irrational antimicrobial use, contributing to global resistance trends. Yet, a defined optimal prophylaxis schedule for paediatric cardiac surgery is lacking. Importing adult guidelines may be inadequate due to paediatric research complexities and population diversity. Developing effective prophylaxis protocols is crucial for children undergoing cardiac surgery, given global antibiotic overuse and evolving drug resistance. Establishing an optimal prophylactic strategy remains a challenge, necessitating further research for evidence-based protocols to mitigate infections in this vulnerable patient cohort. Methods This study investigates antibiotic use in paediatric cardiac surgery. A retrospective analysis of 100 patients from a rural Indian hospital (2017-2018) assesses antibiotic patterns, including type, dose, duration, and adherence to prophylaxis protocols. Results In the studied cohort of paediatric cardiac surgery patients, complete compliance (100%) with antibiotic prophylaxis was observed. However, deviations were identified: 30% received antibiotics prematurely, and 30% did not align with institutional protocol criteria. Concerning antibiotic selection, 87% followed hospital policy with the recommended cefoperazone and sulbactam combination plus amikacin, while 9% received piperacillin/tazobactam + amikacin due to sepsis. Irregular use (22%) based on clinical records occurred. Furthermore, 4% received piperacillin/tazobactam + teicoplanin, with one instance of inappropriate higher antibiotic use. Regarding prophylaxis duration, only 27% adhered to the appropriate timeline, with 40% exceeding 48 hours, indicating extended use. Upon discharge, a notable proportion (45 patients) received antibiotic prescriptions. Among them, 73% were prescribed rationally, while 27% exhibited irrational antibiotic use. Conclusion The findings of this study shed a significant light on the issue of antibiotic misuse within the context of paediatric cardiac surgery. It underscores the pressing need for more stringent measures to regulate and address this concerning trend. The study underscores the pivotal importance of adhering rigorously to established protocols and guidelines for antibiotic prophylaxis. This adherence not only holds the potential to elevate the overall quality of patient care but also plays a critical role in combating the escalating challenge of antibiotic resistance. Through a concerted effort to optimize antibiotic usage, we can simultaneously enhance patient outcomes and contribute to the ongoing fight against the emergence of antibiotic-resistant strains, thus preserving the efficacy of these vital medications for future generations.
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Affiliation(s)
- Sohilkhan R Pathan
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Vishal V Bhende
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Tanishq S Sharma
- Pediatric Cardiac Surgery, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Amit Kumar
- Pediatric Cardiac Intensive Care, Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Vishal A Patel
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Kruti B Sharma
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
| | - Shivangi B Pandya
- Clinical Research Services (CRS), Bhanubhai and Madhuben Patel Cardiac Centre, Bhaikaka University, Karamsad, IND
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Hambalek H, Matuz M, Ruzsa R, Engi Z, Visnyovszki Á, Papfalvi E, Hajdú E, Doró P, Viola R, Soós G, Csupor D, Benko R. Impact of the COVID-19 Pandemic on Ambulatory Care Antibiotic Use in Hungary: A Population-Based Observational Study. Antibiotics (Basel) 2023; 12:970. [PMID: 37370289 DOI: 10.3390/antibiotics12060970] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 05/25/2023] [Indexed: 06/29/2023] Open
Abstract
The COVID-19 pandemic and related restrictions have potentially impacted the use of antibiotics. We aimed to analyze the use of systemic antibiotics (J01) in ambulatory care in Hungary during two pandemic years, to compare it with pre-COVID levels (January 2015-December 2019), and to describe trends based on monthly utilization. Our main findings were that during the studied COVID-19 pandemic period, compared to the pre-COVID level, an impressive 23.22% decrease in the use of systemic antibiotics was detected in ambulatory care. A significant reduction was shown in the use of several antibacterial subgroups, such as beta-lactam antibacterials, penicillins (J01C, -26.3%), and quinolones (J01M, -36.5%). The trends of antibiotic use moved in parallel with the introduction or revoking of restriction measures with a nadir in May 2020, which corresponded to a 55.46% decrease in use compared to the previous (pre-COVID) year's monthly means. In general, the systemic antibiotic use (J01) was lower compared to the pre-COVID periods' monthly means in almost every studied pandemic month, except for three months from September to November in 2021. The seasonal variation of antibiotic use also diminished. Active agent level analysis revealed an excessive use of azithromycin, even after evidence of ineffectiveness for COVID-19 emerged.
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Affiliation(s)
- Helga Hambalek
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Mária Matuz
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Roxána Ruzsa
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Zsófia Engi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Ádám Visnyovszki
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Erika Papfalvi
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Edit Hajdú
- Department of Internal Medicine Infectiology Unit, Albert Szent-Györgyi Health Centre, University of Szeged, Állomás Street 1-3, 6725 Szeged, Hungary
| | - Péter Doró
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Réka Viola
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
| | - Gyöngyvér Soós
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
| | - Dezső Csupor
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Institute for Translational Medicine, Medical School, University of Pécs, 7624 Pécs, Hungary
| | - Ria Benko
- Institute of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, 6725 Szeged, Hungary
- Central Pharmacy Department, Albert Szent-Györgyi Health Center, University of Szeged, 6725 Szeged, Hungary
- Emergency Department, Albert Szent-Györgyi Health Centre, University of Szeged, Semmelweis Street 6, 6725 Szeged, Hungary
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Robertson J, Vlahović-Palčevski V, Iwamoto K, Högberg LD, Godman B, Monnet DL, Garner S, Weist K. Corrigendum: Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications From ESAC-Net and WHO Europe. Front Pharmacol 2021; 12:765748. [PMID: 34658897 PMCID: PMC8515024 DOI: 10.3389/fphar.2021.765748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 09/09/2021] [Indexed: 11/13/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fphar.2021.639207.].
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Affiliation(s)
- Jane Robertson
- World Health Organization Regional Office for Europe, Copenhagen, Denmark.,Department of Clinical Pharmacology, The University of Newcastle, Callaghan, NSW, Australia
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka/Medical Faculty and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Kotoji Iwamoto
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom.,Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Sarah Garner
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Klaus Weist
- European Centre for Disease Prevention and Control, Solna, Sweden
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9
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Gradl G, Werning J, Enners S, Kieble M, Schulz M. Quality Appraisal of Ambulatory Oral Cephalosporin and Fluoroquinolone Use in the 16 German Federal States from 2014-2019. Antibiotics (Basel) 2021; 10:831. [PMID: 34356753 PMCID: PMC8300794 DOI: 10.3390/antibiotics10070831] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/02/2021] [Accepted: 07/05/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Despite concerns about causing bacterial resistance and serious side effects, oral cephalosporins and fluoroquinolones are still frequently prescribed in Germany. We aimed to test a method for the detection of regional quality differences in the use of oral cephalosporins and fluoroquinolones and to apply this to the German federal states. METHODS Use of antibiotics from 2014-2019 was analyzed using dispensing data from community pharmacies claimed to the statutory health insurance (SHI) funds. Quality of regional antibiotic use in 2019 was assessed by calculating indicators based on defined daily doses per 1000 SHI-insured persons per day (DID). Oral cephalosporin and fluoroquinolone use was followed by linear regression analyses. RESULTS The method used was suitable to find meaningful quality differences in ambulatory oral cephalosporin and fluoroquinolone use between the German federal states. In 2019, DID varied from 1.62 in Brandenburg to 3.17 in Rhineland-Palatinate for cephalosporins and from 0.47 in Brandenburg to 0.89 in Saarland for fluoroquinolones. The city-states Hamburg, Bremen, and Berlin showed highest quality with the applied indicator set. From 2014-2019, a significant decrease in utilization of oral cephalosporins was found in all federal states. During 2017-2019, all states showed a significant decline of fluoroquinolone use.
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Affiliation(s)
- Gabriele Gradl
- German Institute for Drug Use Evaluation (DAPI), 10557 Berlin, Germany; (J.W.); (S.E.); (M.K.); (M.S.)
| | - Johanna Werning
- German Institute for Drug Use Evaluation (DAPI), 10557 Berlin, Germany; (J.W.); (S.E.); (M.K.); (M.S.)
| | - Salka Enners
- German Institute for Drug Use Evaluation (DAPI), 10557 Berlin, Germany; (J.W.); (S.E.); (M.K.); (M.S.)
| | - Marita Kieble
- German Institute for Drug Use Evaluation (DAPI), 10557 Berlin, Germany; (J.W.); (S.E.); (M.K.); (M.S.)
| | - Martin Schulz
- German Institute for Drug Use Evaluation (DAPI), 10557 Berlin, Germany; (J.W.); (S.E.); (M.K.); (M.S.)
- Department of Medicine, ABDA–Federal Union of German Associations of Pharmacists, 10557 Berlin, Germany
- Institute of Pharmacy, Freie Universität Berlin, 12169 Berlin, Germany
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Robertson J, Vlahović-Palčevski V, Iwamoto K, Högberg LD, Godman B, Monnet DL, Garner S, Weist K. Variations in the Consumption of Antimicrobial Medicines in the European Region, 2014-2018: Findings and Implications from ESAC-Net and WHO Europe. Front Pharmacol 2021; 12:639207. [PMID: 34220495 PMCID: PMC8248674 DOI: 10.3389/fphar.2021.639207] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Surveillance of antimicrobial consumption (AMC) is important to address inappropriate use. AMC data for countries in the European Union (EU) and European Economic Area (EEA) and Eastern European and Central Asian countries were compared to provide future guidance. Methods: Analyses of 2014-2018 data from 30 EU/EEA countries of the European Surveillance of Antibiotic Consumption network (ESAC-Net) and 15 countries of the WHO Regional Office for Europe (WHO Europe) AMC Network were conducted using the Anatomical Therapeutic Chemical (ATC) classification and Defined Daily Dose (DDD) methodology. Total consumption (DDD per 1000 inhabitants per day) of antibacterials for systemic use (ATC group J01), relative use (percentages), trends over time, alignment with the WHO Access, Watch, Reserve (AWaRe) classification, concordance with the WHO global indicator (60% of total consumption should be Access agents), and composition of the drug utilization 75% (DU75%) were calculated. Findings: In 2018, total consumption of antibacterials for systemic use (ATC J01) ranged from 8.9 to 34.1 DDD per 1000 inhabitants per day (population-weighted mean for ESAC-Net 20.0, WHO Europe AMC Network 19.6, ESAC-Net Study Group, and WHO Europe AMC Network Study Group). ESAC-Net countries consumed more penicillins (J01C; 8.7 versus 6.3 DDD per 1000 inhabitants per day), more tetracyclines (J01A; 2.2 versus 1.2), less cephalosporins (J01D; 2.3 versus 3.8) and less quinolones (J01M; 1.7 versus 3.4) than WHO Europe AMC Network countries. Between 2014 and 2018, there were statistically significant reductions in total consumption in eight ESAC-Net countries. In 2018, the relative population-weighted mean consumption of Access agents was 57.9% for ESAC-Net and 47.4% for the WHO Europe AMC Network. For each year during 2014-2018, 14 ESAC-Net and one WHO Europe AMC Network countries met the WHO global monitoring target of 60% of total consumption being Access agents. DU75% analyses showed differences in the choices of agents in the two networks. Interpretation: Although total consumption of antibacterials for systemic use was similar in the two networks, the composition of agents varied substantially. The greater consumption of Watch group agents in WHO Europe AMC Network countries suggests opportunities for improved prescribing. Significant decreases in consumption in several ESAC-Net countries illustrate the value of sustained actions to address antimicrobial resistance.
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Affiliation(s)
- Jane Robertson
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
- Department of Clinical Pharmacology, The University of Newcastle, Callaghan, NSW, Australia
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka/Medical Faculty and Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
| | - Kotoji Iwamoto
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | | | - Sarah Garner
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Klaus Weist
- European Centre for Disease Prevention and Control, Solna, Sweden
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11
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Graber CJ, Jones MM, Goetz MB, Madaras-Kelly K, Zhang Y, Butler JM, Weir C, Chou AF, Youn SY, Samore MH, Glassman PA. Decreases in Antimicrobial Use Associated With Multihospital Implementation of Electronic Antimicrobial Stewardship Tools. Clin Infect Dis 2021; 71:1168-1176. [PMID: 31673709 DOI: 10.1093/cid/ciz941] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/02/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antimicrobial stewards may benefit from comparative data to inform interventions that promote optimal inpatient antimicrobial use. METHODS Antimicrobial stewards from 8 geographically dispersed Veterans Affairs (VA) inpatient facilities participated in the development of antimicrobial use visualization tools that allowed for comparison to facilities of similar complexity. The visualization tools consisted of an interactive web-based antimicrobial dashboard and, later, a standardized antimicrobial usage report updated at user-selected intervals. Stewards participated in monthly learning collaboratives. The percent change in average monthly antimicrobial use (all antimicrobial agents, anti-methicillin-resistant Staphylococcus aureus [anti-MRSA] agents, and antipseudomonal agents) was analyzed using a pre-post (January 2014-January 2016 vs July 2016-January 2018) design with segmented regression and external comparison with uninvolved control facilities (n = 118). RESULTS Intervention sites demonstrated a 2.1% decrease (95% confidence interval [CI], -5.7% to 1.6%) in total antimicrobial use pre-post intervention vs a 2.5% increase (95% CI, 0.8% to 4.1%) in nonintervention sites (absolute difference, 4.6%; P = .025). Anti-MRSA antimicrobial use decreased 11.3% (95% CI, -16.0% to -6.3%) at intervention sites vs a 6.6% decrease (95% CI, -9.1% to -3.9%) at nonintervention sites (absolute difference, 4.7%; P = .092). Antipseudomonal antimicrobial use decreased 3.4% (95% CI, -8.2% to 1.7%) at intervention sites vs a 3.6% increase (95% CI, 0.8% to 6.5%) at nonintervention sites (absolute difference, 7.0%; P = .018). CONCLUSIONS Comparative data visualization tool use by stewards at 8 VA facilities was associated with significant reductions in overall antimicrobial and antipseudomonal use relative to uninvolved facilities.
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Affiliation(s)
- Christopher J Graber
- Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA.,Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Makoto M Jones
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Matthew Bidwell Goetz
- Department of Medicine, David Geffen School of Medicine at the University of California-Los Angeles, Los Angeles, California, USA.,Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Karl Madaras-Kelly
- Department of Pharmacy Boise VA Medical Center, Boise, Idaho.,College of Pharmacy, Idaho State University, Meridian, Idaho
| | - Yue Zhang
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Jorie M Butler
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah, Salt Lake City, Utah, USA.,Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Charlene Weir
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Biomedical Informatics, University of Utah, Salt Lake City, Utah, USA
| | - Ann F Chou
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Sarah Y Youn
- Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Matthew H Samore
- IDEAS Center, VA Salt Lake City Healthcare System, Salt Lake City, Utah, USA.,Department of Medicine, University of Utah, Salt Lake City, Utah, USA.,Division of Epidemiology, University of Utah, Salt Lake City, Utah, USA
| | - Peter A Glassman
- Center for Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.,VA Pharmacy Benefits Management Services, Veterans Health Administration, Washington, D.C., USA
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12
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Giacomini E, Perrone V, Alessandrini D, Paoli D, Nappi C, Degli Esposti L. Evidence of Antibiotic Resistance from Population-Based Studies: A Narrative Review. Infect Drug Resist 2021; 14:849-858. [PMID: 33688220 PMCID: PMC7937387 DOI: 10.2147/idr.s289741] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 02/11/2021] [Indexed: 12/23/2022] Open
Abstract
The 20th century witnessed the dawn of the antibiotic revolution and is now facing the rising phenomenon of antibiotic resistance. In this narrative review, we aim to describe antibiotic resistance in clinical practice settings through population-based studies from different countries reporting the role of misuse of antibiotics in the development of resistance and the clinical and economic burden associated. The misuse of antibiotics was documented in the wide population as well as in hospitals and care facilities. It was mainly reported as over-use and inappropriate prescribing. Improper dosage regimens and longer treatment duration were regarded as pivotal factors related to antibiotic resistance; the emerging strategy of "antibiotic-de-escalation" could be the key to overcome these issues. The investigation of the self-medication attitude revealed widespread antibiotic use without following medical instructions or medical consultation. Moreover, several studies established the association of antibiotic resistance with increased risk of longer hospitalizations and mortality, highlighting the heavy clinical and economic burden of this phenomenon. In this narrative review, the widespread inappropriate use of antibiotics emerged as one of the main causes of antibiotic resistance, which negative outcomes call for the development of antibiotic stewardship programs and global surveillance networks.
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Affiliation(s)
- Elisa Giacomini
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | | | | | - Daniela Paoli
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
| | - Carmela Nappi
- CliCon S.r.l. Health, Economics & Outcomes Research, Ravenna, Italy
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13
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Xu S, Yuan S, Kabba JA, Chen C, Liu W, Chang J, Fang Y. Analysis of Antibiotic Use Patterns and Trends Based on Procurement Data of Healthcare Institutions in Shaanxi Province, Western China, 2015-2018. Int J Environ Res Public Health 2020; 17:E7536. [PMID: 33081253 DOI: 10.3390/ijerph17207536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 10/10/2020] [Accepted: 10/14/2020] [Indexed: 11/23/2022]
Abstract
Overuse of antibiotics has caused a series of global problems, especially in the underdeveloped western regions where healthcare systems are fragile. We used antibiotic procurement data of all healthcare institutions to analyze the total amount, patterns and trends of antibiotic use in Shaanxi Province, western China between 2015 and 2018. Antibiotic utilization was quantified using the standard Anatomical Therapeutic Chemical (ATC)/Defined daily dose (DDD) methodology. The World Health Organization’s “Access, Watch and Reserve” (AWaRe) classification and European Surveillance of Antimicrobial Consumption (ESAC) drug-specific quality indicators were also adopted to evaluate the appropriateness and quality of antibiotic utilization. Overall, antibiotic consumption decreased from 11.20 DID in 2015 to 10.13 DID (DDDs per 1000 inhabitants per day) in 2016, then increased to 12.99 DID in 2018. The top three antibiotic categories consumed in 2018 were J01C (penicillins) 33.58%, J01D (cephalosporins) 29.76%, and J01F (macrolides) 19.14%. Parenteral antibiotics accounted for 27.41% of the total consumption. The largest proportion of antibiotic use was observed in primary healthcare institutions in rural areas, which accounts for 51.67% of total use. Consumption of the Access group, the Watch group, the Reserve group of antibiotics was 40.31%, 42.28% and 0.11%, respectively. Concurrently, the consumption of J01D and the percentage of J01 (DD + DE) (third and fourth generation cephalosporins) were at a poor level according to the evaluation of ESAC quality indicators. The total antibiotic consumption in Shaanxi Province had been on an upward trend, and the patterns of antibiotic use were not justified enough to conclude that it was rational. This is partly because there was high preference for the third and fourth generation cephalosporins and for the Watch group antibiotics.
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14
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Knight J, Michal J, Milliken S, Swindler J. Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System. Pharmacy (Basel) 2020; 8:E41. [PMID: 32188001 DOI: 10.3390/pharmacy8010041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 03/11/2020] [Accepted: 03/11/2020] [Indexed: 11/25/2022] Open
Abstract
While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.
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15
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Al-Hasan MN, Winders HR, Bookstaver PB, Justo JA. Direct Measurement of Performance: A New Era in Antimicrobial Stewardship. Antibiotics (Basel) 2019; 8:E127. [PMID: 31450576 DOI: 10.3390/antibiotics8030127] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 01/23/2023] Open
Abstract
For decades, the performance of antimicrobial stewardship programs (ASPs) has been measured by incidence rates of hospital-onset Clostridioides difficile and other infections due to multidrug-resistant bacteria. However, these represent indirect and nonspecific ASP metrics. They are often confounded by factors beyond an ASP’s control, such as changes in diagnostic testing methods or algorithms and the potential of patient-to-patient transmission. Whereas these metrics remain useful for global assessment of healthcare systems, antimicrobial use represents a direct metric that separates the performance of an ASP from other safety and quality teams within an institution. The evolution of electronic medical records and healthcare informatics has made measurements of antimicrobial use a reality. The US Centers for Disease Control and Prevention’s initiative for reporting antimicrobial use and standardized antimicrobial administration ratio in hospitals is highly welcomed. Ultimately, ASPs should be evaluated based on what they do best and what they can control, that is, antimicrobial use within their own institution. This narrative review critically appraises existing stewardship metrics and advocates for adopting antimicrobial use as the primary performance measure. It proposes novel formulas to adjust antimicrobial use based on quality of care and microbiological burden at each institution to allow for meaningful inter-network and inter-facility comparisons.
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16
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Robertson J, Iwamoto K, Hoxha I, Ghazaryan L, Abilova V, Cvijanovic A, Pyshnik H, Darakhvelidze M, Makalkina L, Jakupi A, Dzhakubekova A, Carp A, Cizmovic L, Rachina S, Radonjic V, Yusufi S, Aksoy M, Ibragimova M, Godman B, Kluge H, Pedersen HB. Antimicrobial Medicines Consumption in Eastern Europeand Central Asia - An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action. Front Pharmacol 2019; 9:1156. [PMID: 30890943 PMCID: PMC6411709 DOI: 10.3389/fphar.2018.01156] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/24/2018] [Indexed: 12/16/2022] Open
Abstract
Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network. Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action. Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes. Findings: Total J01 consumption in 2015 ranged 8.0-41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4-42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2-56.6, 9.4-28.8, and 7.5-24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3-49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7-38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3-35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest. Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.
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Affiliation(s)
- Jane Robertson
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
- Department of Clinical Pharmacology, The University of Newcastle, Callaghan, NSW, Australia
| | - Kotoji Iwamoto
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Iris Hoxha
- Department of Pharmacy, University of Medicine, Tirana, Tirana, Albania
| | - Lilit Ghazaryan
- Scientific Centre of Drug and Medical Technology Expertise, Ministry of Health, Yerevan, Armenia
| | - Vafa Abilova
- Department of Import Medicines and Medical Devices, Analytical Expertise Center, Ministry of Health, Baku, Azerbaijan
| | - Ana Cvijanovic
- Sector for Providing Information on Drugs and Medical Products, Agency for Medicinal Products and Medical Devices of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
| | - Halina Pyshnik
- Department of Pharmaceutical Inspection and Organization of Medicinal Supply, Ministry of Health of the Republic of Belarus, Minsk, Belarus
| | - Marina Darakhvelidze
- Health Care Department, Ministry of IDPs, Labour, Health and Social Affairs of Georgia, Tbilisi, Georgia
| | - Larissa Makalkina
- Department of Cardiology and Internal Medicine with a Course of Clinical Pharmacology and Pharmacy Astana Medical University, Astana, Kazakhstan
| | - Arianit Jakupi
- A2 – Pharmaceutical Consulting and UBT – Higher Education Institution, Pristina, Kosovo†
| | - Aigul Dzhakubekova
- Specialized Expertise of Medicines Unit, Department of Drug Provision and Medical Devices, Ministry of Health, Bishkek, Kyrgyzstan
| | - Angela Carp
- P.I. Coordination, Implementation and Monitoring Unit of the Health System Projects, Chişinãu, Moldova
| | - Lidija Cizmovic
- Department for Establishing Maximum Prices and Monitoring Consumption of Medicines, Agency for Medicines and Medical Devices, Podgorica, Montenegro
| | - Svetlana Rachina
- Internal Medicine Department with Cardiology and Functional Diagnostics Course, Russian Friendship University, Moscow, Russia
| | - Vesela Radonjic
- National Centre for Information on Medicines and Medical Device, Medicines and Medical Devices Agency of Serbia, Belgrade, Serbia
- Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Salomudin Yusufi
- Vice-Rector for Science, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
| | - Mesil Aksoy
- Turkish Medicines and Medical Devices Agency, Department of Rational Use of Medicines, Ministry of Health, Ankara, Turkey
| | - Muhabbat Ibragimova
- Head of the Information and Analytical Department, The State Center for Expertise and Standardization of Medicines, Medical Devices and Medical Equipment of the Agency for the Development of the Pharmaceutical Industry under the Ministry of Health of the Republic of Uzbekistan, Tashkent, Uzbekistan
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Liverpool Health Economics, University of Liverpool, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Department of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Hans Kluge
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Hanne Bak Pedersen
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
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Bojanić L, Marković-Peković V, Škrbić R, Stojaković N, Ðermanović M, Bojanić J, Fürst J, Kurdi AB, Godman B. Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications. Front Pharmacol 2018; 9:442. [PMID: 29896100 PMCID: PMC5987173 DOI: 10.3389/fphar.2018.00442] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/16/2018] [Indexed: 11/30/2022] Open
Abstract
Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29-40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7-11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities.
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Affiliation(s)
- Ljubica Bojanić
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Vanda Marković-Peković
- Ministry of Health and Social Welfare, Banja Luka, Bosnia and Herzegovina
- Department of Social Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Ranko Škrbić
- Department of Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Nataša Stojaković
- Department of Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Mirjana Ðermanović
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Janja Bojanić
- Public Health Institute, Banja Luka, Bosnia and Herzegovina
- Department of Epidemiology, Faculty of Medicine, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Jurij Fürst
- Health Insurance Institute of Slovenia, Ljubljana, Slovenia
| | - Amanj B. Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Department of pharmacology and toxicology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, United Kingdom
- Liverpool Health Economics Centre, Liverpool University, Liverpool, United Kingdom
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital Huddinge, Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Kota Bharu, Malaysia
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18
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Abstract
Appropriate antimicrobial therapy is essential to ensuring positive patient outcomes. Inappropriate or suboptimal utilization of antibiotics can lead to increased length of stay, multidrug-resistant infections, and mortality. Critically ill intensive care patients, particularly those with severe sepsis and septic shock, are at risk of antibiotic failure and secondary infections associated with incorrect antibiotic use. Through the initiation of active empiric antibiotic therapy based upon local susceptibilities, daily evaluation of signs and symptoms of infection and narrowing of antibiotic therapy when feasible, providers can streamline the treatment of common intensive care unit (ICU) infections. Optimizing antibiotic dosing through prolonged infusions can be beneficial in intensive care populations with altered pharmacokinetics. Antimicrobial stewardship teams can assist ICU providers in managing and implementing these tactics. This review will discuss the current literature on antibiotic use in the ICU applying antimicrobial stewardship strategies. Based upon the most recent evidence, ICUs would benefit from employing empiric guidelines for antibiotic use, collecting appropriate specimens and implementing molecular diagnostics, optimizing the dosing of antibiotics, and reducing the duration of total therapy. These strategies for antibiotic use have the potential to enhance patient care while preventing adverse outcomes.
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Affiliation(s)
- Maureen Campion
- 1 Division of Infectious Disease, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
| | - Gail Scully
- 1 Division of Infectious Disease, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA
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Berry GJ, Miller CR, Prats MM, Marquez C, Oladipo OO, Loeffelholz MJ, Petersen JR. Comparison of the Alere i Strep A Test and the BD Veritor System in the Detection of Group A Streptococcus and the Hypothetical Impact of Results on Antibiotic Utilization. J Clin Microbiol 2018; 56:e01310-17. [PMID: 29305539 DOI: 10.1128/JCM.01310-17] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 12/21/2017] [Indexed: 11/20/2022] Open
Abstract
Rapid detection of group A Streptococcus (GAS) is an integral component of treatment decisions in the clinic, especially in the pediatric population. We prospectively collected 216 specimens from symptomatic, predominantly pediatric patients and evaluated the performance of the Alere i Strep A test (Alere i; Alere Inc., Scarborough, ME) and the BD Veritor system (BD Veritor; Becton, Dickinson and Company, Sparks, MD), with culture results being used as a comparator. Real-time PCR (RT-PCR) was performed as an arbiter in discordant cases. Comprehensive chart review was also done to determine the hypothetical impact of the results on antibiotic use. Alere i had a sensitivity and a specificity of 100% and 91.3%, respectively, and BD Veritor had a sensitivity and a specificity of 76.2% and 93.6%, respectively, when the results were compared to those of GAS culture. Further analysis of discordant results using RT-PCR revealed that while BD Veritor missed 13 confirmed positive cases, Alere i detected 100% (n = 13) of the same cases. Analysis of assay agreement showed that Alere i and BD Veritor had only moderate agreement (agreement = 0.888 [95% confidence interval {CI}, 0.838 to 0.927]; kappa index = 0.689 [95% CI, 0.91 to 0.974]). We also found both the underutilization and the overutilization of antibiotics based on the results of molecular testing. Overall, Alere i showed superior performance over BD Veritor in the detection of GAS pharyngitis and could potentially assist in better antibiotic utilization.
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Sacco KA, Bates A, Brigham TJ, Imam JS, Burton MC. Clinical outcomes following inpatient penicillin allergy testing: A systematic review and meta-analysis. Allergy 2017; 72:1288-1296. [PMID: 28370003 DOI: 10.1111/all.13168] [Citation(s) in RCA: 167] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND A documented penicillin allergy is associated with increased morbidity including length of hospital stay and an increased incidence of resistant infections attributed to use of broader-spectrum antibiotics. The aim of the systematic review was to identify whether inpatient penicillin allergy testing affected clinical outcomes during hospitalization. METHODS We performed an electronic search of Ovid MEDLINE/PubMed, Embase, Web of Science, Scopus, and the Cochrane Library over the past 20 years. Inpatients having a documented penicillin allergy that underwent penicillin allergy testing were included. RESULTS Twenty-four studies met eligibility criteria. Study sample size was between 24 and 252 patients in exclusively inpatient cohorts. Penicillin skin testing (PST) with or without oral amoxicillin challenge was the main intervention described (18 studies). The population-weighted mean for a negative PST was 95.1% [CI 93.8-96.1]. Inpatient penicillin allergy testing led to a change in antibiotic selection that was greater in the intensive care unit (77.97% [CI 72.0-83.1] vs 54.73% [CI 51.2-58.2], P<.01). An increased prescription of penicillin (range 9.9%-49%) and cephalosporin (range 10.7%-48%) antibiotics was reported. Vancomycin and fluoroquinolone use was decreased. Inpatient penicillin allergy testing was associated with decreased healthcare cost in four studies. CONCLUSIONS Inpatient penicillin allergy testing is safe and effective in ruling out penicillin allergy. The rate of negative tests is comparable to outpatient and perioperative data. Patients with a documented penicillin allergy who require penicillin should be tested during hospitalization given its benefit for individual patient outcomes and antibiotic stewardship.
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Affiliation(s)
- K. A. Sacco
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
| | - A. Bates
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
| | - T. J. Brigham
- Winn-Dixie Foundation Medical Library; Mayo Clinic; Jacksonville FL USA
| | - J. S. Imam
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
| | - M. C. Burton
- Department of Internal Medicine; Mayo Clinic; Jacksonville FL USA
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Mladenovic-Antic S, Kocic B, Velickovic-Radovanovic R, Dinic M, Petrovic J, Randjelovic G, Mitic R. Correlation between antimicrobial consumption and antimicrobial resistance of Pseudomonas aeruginosa in a hospital setting: a 10-year study. J Clin Pharm Ther 2016; 41:532-7. [PMID: 27511808 DOI: 10.1111/jcpt.12432] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/16/2016] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Antimicrobial resistance is one of the greatest threats to human health. One of the most important factors leading to the emergence of resistant bacteria is overuse of antibiotics. The purpose of this study was to investigate the correlation between antimicrobial usage and bacterial resistance of Pseudomonas aeruginosa (P. aeruginosa) over a 10-year period in the Clinical Center Niš, one of the biggest tertiary care hospitals in Serbia. We focused on possible relationships between the consumption of carbapenems and beta-lactam antibiotics and the rates of resistance of P. aeruginosa to carbapenems. METHODS We recorded utilization of antibiotics expressed as defined daily doses per 100 bed days (DBD). Bacterial resistance was reported as the percentage of resistant isolates (percentage of all resistant and intermediate resistant strains) among all tested isolates. RESULTS AND DISCUSSION A significant increasing trend in resistance was seen in imipenem (P < 0·05, Spearman ρ = 0·758) and meropenem (P < 0·05, ρ = 0·745). We found a significant correlation between aminoglycoside consumption and resistance to amikacin (P < 0·01, Pearson r = 0·837) and gentamicin (P < 0·01, Pearson r = 0·827). The correlation between the consumption of carbapenems and resistance to imipenem in P. aeruginosa shows significance (P < 0·01, Pearson r = 0·795), whereas resistance to meropenem showed a trend towards significance (P > 0·05, Pearson r = 0·607). We found a very good correlation between the use of all beta-lactam and P. aeruginosa resistance to carbapenems (P < 0·01, Pearson r = 0·847 for imipenem and P < 0·05, Pearson r = 0·668 for meropenem). WHAT IS NEW AND CONCLUSION Our data demonstrated a significant increase in antimicrobial resistance to carbapenems, significant correlations between the consumption of antibiotics, especially carbapenems and beta-lactams, and rates of antimicrobial resistance of P. aeruginosa to imipenem and meropenem.
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Affiliation(s)
| | - B Kocic
- Institute for Public Health Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | | | - M Dinic
- Institute for Public Health Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | | | - G Randjelovic
- Institute for Public Health Nis, Nis, Serbia.,Faculty of Medicine, University of Nis, Nis, Serbia
| | - R Mitic
- Clinical Centre Nis, Nis, Serbia
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