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Trzebucki AM, Davis MR, McCreary EK, Cuccaro S, Bariola JR, Khadem T. Impact of a pharmacy-driven MRSA nares screening protocol on vancomycin discontinuation in a tele-antimicrobial stewardship model. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e56. [PMID: 38655024 PMCID: PMC11036443 DOI: 10.1017/ash.2024.43] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 03/01/2024] [Accepted: 03/03/2024] [Indexed: 04/26/2024]
Abstract
A pharmacist-driven protocol for methicillin-resistant Staphylococcus aureus nares screening and empiric vancomycin discontinuation was instituted in a community healthcare system utilizing a tele-antimicrobial stewardship program to reduce inappropriate use of vancomycin. The protocol and associated intervention resulted in a significant decrease in both vancomycin utilization and the rate of acute kidney injury.
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Affiliation(s)
- Alex M. Trzebucki
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Matthew R. Davis
- Department of Clinical Pharmacy, Infectious Disease Connect, Inc., Pittsburgh, PA, USA
| | - Erin K. McCreary
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Clinical Pharmacy, Infectious Disease Connect, Inc., Pittsburgh, PA, USA
| | - Susan Cuccaro
- Department of Clinical Pharmacy, Heritage Valley Health System, Beaver, PA, USA
| | - J. Ryan Bariola
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Tina Khadem
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Abejew AA, Wubetu GY, Fenta TG. Relationship between Antibiotic Consumption and Resistance: A Systematic Review. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2024; 2024:9958678. [PMID: 38476862 PMCID: PMC10932619 DOI: 10.1155/2024/9958678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 11/20/2023] [Accepted: 02/24/2024] [Indexed: 03/14/2024]
Abstract
Background Unreserved use of antibiotics exerted selective pressure on susceptible bacteria, resulting in the survival of resistant strains. Despite this, the relationship between antibiotic resistance (ABR) and antibiotic consumption (ABC) is rarely studied. This systematic review aims to review the relationship between ABC and ABR from 2016 to 2022. Methods Articles published over 7 years (2016-2022) were searched from December 23 to 31, 2022. The search strategy was developed by using keywords for ABC and ABR. From 3367 articles, 58 eligible articles were included in the final review. Results The pooled ABC was 948017.9 DPDs and 4108.6 DIDs where over 70% of antibiotics were from the Watch and Reserve category based on the WHO AWaRe classification. The average pooled prevalence of ABR was 38.4%. Enterococcus faecium (59.4%), A. baumannii (52.6%), and P. aeruginosa (48.6%) were the most common antibiotic-resistant bacteria. Cephalosporins (76.8%), penicillin (58.3%), and aminoglycosides (52%) were commonly involved antibiotics in ABR. The positive correlation between ABR and consumption accounted for 311 (81%). The correlation between ABR P. aeruginosa and ABC accounted for 87 (22.7%), followed by 78 (20.3%) and 77 (20.1%) for ABR E. coli and K. pneumoniae with ABCs, respectively. Consumption of carbapenems and fluoroquinolones was most commonly correlated with resistance rates of P. aeruginosa, K. pneumoniae, E. coli, and A. baumannii. Conclusion There is a positive correlation between ABC and the rate of ABR. The review also revealed a cross-resistance between the consumption of different antibiotics and ABR. Optimizing antibiotic therapy and reducing unnecessary ABC will prevent the emergence and spread of ABR. Thus, advocating the implementation of stewardship programs plays a pivotal role in containing ABR.
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Affiliation(s)
- Asrat Agalu Abejew
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Department of Pharmacy, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | | | - Teferi Gedif Fenta
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Martinez YG, Tran M, Roduta T, Lam S, Price T, Stramel S. The Impact of an Antimicrobial Stewardship Clinical Pharmacy Specialist on Antimicrobial Days of Therapy through Education Driven Policies, Procedures, and Interventions. PHARMACY 2023; 11:137. [PMID: 37736909 PMCID: PMC10514815 DOI: 10.3390/pharmacy11050137] [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: 05/14/2023] [Revised: 07/31/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
The primary goal of antimicrobial stewardship is to improve patient outcomes and minimize the consequences of antibiotic use. Prospective audit and feedback cannot always be performed by an antimicrobial stewardship program member which is where policies, procedures and education can aid interventions. The purpose of this study was to evaluate the impact on antimicrobial days of therapy due to a dedicated clinical pharmacy specialist primarily responsible for developing policies and procedures and providing education. A pre-intervention and post-intervention retrospective analysis of antimicrobial days of therapy from September 2019-May 2020 and July 2020-March 2021 was performed. Inclusion criteria consisted of adults receiving IV vancomycin, azithromycin, meropenem, ciprofloxacin, and/or levofloxacin. Excluded criteria consisted of documented interventions that were not related to implemented policies and procedures or performed education and patients receiving antimicrobial surgical prophylaxis. The primary outcome was antimicrobial days of therapy. An average of 3.47 ± 2.46 days (pre-intervention, n = 203) and 3.21 ± 2.52 days (post-intervention, n = 203) were observed for the primary outcome (p < 0.04182). Pharmacists performed 75 interventions pre-intervention and 102 interventions post-intervention (p = 0.0092). The implementation of a dedicated antimicrobial stewardship clinical pharmacy specialist responsible for developing policies, procedures, and education successfully reduced antimicrobial days of therapy and documented interventions.
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Affiliation(s)
- Yolanda G. Martinez
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - MaiCuc Tran
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - Thomas Roduta
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - Susan Lam
- Memorial Hermann Health System, Houston, TX 77024, USA;
| | - Todd Price
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
| | - Stefanie Stramel
- Memorial Hermann Memorial City Medical Center, Houston, TX 77024, USA (T.R.); (T.P.)
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Pereira TC, Flores EMM, Abramova AV, Verdini F, Calcio Gaudino E, Bucciol F, Cravotto G. Simultaneous hydrodynamic cavitation and glow plasma discharge for the degradation of metronidazole in drinking water. ULTRASONICS SONOCHEMISTRY 2023; 95:106388. [PMID: 37011519 PMCID: PMC10457580 DOI: 10.1016/j.ultsonch.2023.106388] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/17/2023] [Accepted: 03/26/2023] [Indexed: 06/19/2023]
Abstract
In this study, a novel hydrodynamic cavitation unit combined with a glow plasma discharge system (HC-GPD) was proposed for the degradation of pharmaceutical compounds in drinking water. Metronidazole (MNZ), a commonly used broad-spectrum antibiotic, was selected to demonstrate the potential of the proposed system. Cavitation bubbles generated by hydrodynamic cavitation (HC) can provide a pathway for charge conduction during glow plasma discharge (GPD). The synergistic effect between HC and GPD promotes the production of hydroxyl radicals, emission of UV light, and shock waves for MNZ degradation. Sonochemical dosimetry provided information on the enhanced formation of hydroxyl radicals during glow plasma discharge compared to hydrodynamic cavitation alone. Experimental results showed a MNZ degradation of 14% in 15 min for the HC alone (solution initially containing 300 × 10-6 mol L-1 MNZ). In experiments with the HC-GPD system, MNZ degradation of 90% in 15 min was detected. No significant differences were observed in MNZ degradation in acidic and alkaline solutions. MNZ degradation was also studied in the presence of inorganic anions. Experimental results showed that the system is suitable for the treatment of solutions with conductivity up to 1500 × 10-6 S cm-1. The results of sonochemical dosimetry showed the formation of oxidant species of 0.15 × 10-3 mol H2O2 L-1 in the HC system after 15 min. For the HC-GPD system, the concentration of oxidant species after 15 min reached 13 × 10-3 molH2O2L-1. Based on these results, the potential of combining HC and GPD systems for water treatment was demonstrated. The present work provided useful information on the synergistic effect between hydrodynamic cavitation and glow plasma discharge and their application for the degradation of antibiotics in drinking water.
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Affiliation(s)
| | | | - Anna V Abramova
- Kurnakov Institute of General and Inorganic Chemistry of the Russian Academy of Sciences, Moscow, Russia
| | - Federico Verdini
- Department of Drug Science and Technology, Turin University, Turin, Italy
| | | | - Fabio Bucciol
- Department of Drug Science and Technology, Turin University, Turin, Italy
| | - Giancarlo Cravotto
- Department of Drug Science and Technology, Turin University, Turin, Italy
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Keshavarzi F. Practical Concerns about the Metrics and Methods of Financial Outcome Measurement in Antimicrobial Stewardship Programs: A Narrative Review. IRANIAN JOURNAL OF MEDICAL SCIENCES 2022; 47:394-405. [PMID: 36117584 PMCID: PMC9445868 DOI: 10.30476/ijms.2021.92213.2343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/23/2021] [Accepted: 09/28/2021] [Indexed: 11/13/2022]
Abstract
Emerging pathogens in the meantime of paucity of new antibiotics discovery, put antimicrobial stewardship in the center of attention, to preserve the existing antimicrobial effect. Implementation of antimicrobial stewardship programs, however, needs approval from healthcare system managers. The approval process can be enhanced, when the beneficial effects of stewardship programs are supported by both clinical and financial evidence. Focusing on the financial outcome evaluation, the practitioners who run the stewardship programs, may choose certain methods and metrics, depending on the clinical setting scale and type, available human resources, and budget. The wise selection of the methods and metrics warrants a comprehensive insight of the existing methods and metrics, deployed by typically published works that set good examples to follow. This review is an attempt to provide such an insight along with typical relevant examples for each metric and method.
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Affiliation(s)
- Fazlollah Keshavarzi
- Department of Clinical Pharmacy, School of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
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Alammari KM, Thabit AK. Characteristics of patients infected with Clostridioides difficile at a Saudi Tertiary Academic Medical Center and assessment of antibiotic duration. Gut Pathog 2021; 13:10. [PMID: 33593421 PMCID: PMC7887815 DOI: 10.1186/s13099-021-00405-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 02/10/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Clostridioides difficile infection (CDI) is a common hospital-associated diarrhea. Several antibiotics commonly associate with CDI; however, limited data are available on the duration of exposure prior to CDI. Moreover, studies on the characteristics of CDI patients in Saudi Arabia are limited. Therefore, this study aimed to characterize CDI patients identified over 10 years and assess antibiotic days of therapy (DOT) prior to CDI. METHODS This was a retrospective descriptive analysis of CDI patients at a Saudi tertiary academic medical center between December 2007 and January 2018. Patients characteristics, prior exposure to known CDI risk factors, and DOT of antibiotics prior to CDI incidence were assessed. RESULTS A total of 159 patients were included. Median age was 62 years. Most cases were hospital-acquired (71.1%), non-severe (44.7%), and admitted to medical wards (81.1%). Prior exposure to antibiotics and acid suppression therapy were reported with the majority (76.1 and 75.5%, respectively). The most frequently prescribed antibiotics were piperacillin/tazobactam, ceftriaxone, meropenem, and ciprofloxacin with median DOTs prior to CDI incidence of 14 days for the β-lactams and 26 days for ciprofloxacin. The distribution of DOT was significantly different for piperacillin/tazobactam in different units (P = 0.003) where its median DOT was the shortest in medical wards (11 days), and for ciprofloxacin among different severity groups (P = 0.013), where its median DOT was the shortest in severe CDI patients (11 days). CONCLUSION Most patients in this study had hospital-acquired non-severe CDI and were largely exposed to antibiotics and acid suppression therapy. Therefore, such therapies should be revised for necessity.
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Affiliation(s)
- Khadijah M Alammari
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265, Saudi Arabia
| | - Abrar K Thabit
- Pharmacy Practice Department, Faculty of Pharmacy, King Abdulaziz University, 7027 Abdullah Al-Sulaiman Rd, Jeddah, 22254-2265, Saudi Arabia.
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