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Fonseca Medeiros A, Margotto Bertollo C, Moreira Reis AM, Costa MA, Meireles Leite EM, da Silva Gonçalves S, Nogueira Guimarães de Abreu MH, Pedra de Souza R, Parreiras Martins MA. Building an antimicrobial stewardship program: A narrative of six years under the Donabedian perspective. Front Pharmacol 2023; 14:1074389. [PMID: 37025495 PMCID: PMC10070795 DOI: 10.3389/fphar.2023.1074389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023] Open
Abstract
Introduction: Antimicrobial resistance (AMR) is increasing and represents one of the world's major challenges. AMR increase morbimortality, length of hospital stay and costs. Antimicrobial Stewardship Programs (ASP) are one of the key strategies to promote the rational use of antimicrobials since AMR is mostly driven by antimicrobial consumption. Objective: To describe the ASP implementation in a teaching hospital from the perspective of Donabedian quality assessment and the Brazilian regulatory requirements. Method: This was a descriptive study with secondary data collection, including document review of the ASP. The study setting was a general public 392-bed hospital. The ASP activities were performed by the hospital infection control committee (HICC), hospital pharmacy (HP) and diagnostic support laboratory (DSL). The description of the three services mainly involved in the ASP was based on a quality assessment model involving the dimensions of "structure", "process" and "result" proposed by Donabedian. The distribution among dimensions was guided by the checklist of essential elements of the ASP that compose the Brazilian regulatory requirements. The checklist was applied in July, 2022, and the ASP results described from 2016 to 2021. Results: ASP actions have been gradually implemented since 2008 with the implementation of HICC and improved over the years. Regarding structure, the investments in technology were mapped, quantifying 26 computers and three software programs employed to computerize the ASP processes performed in specific physical areas by HICC, HP and DSL. Institutional guidelines used by HICC, HP and DSL guided clinical practices to operationalize ASP. The evaluation metrics improved for 10 indicators and worsened for four indicators. From the 60 items composing the checklist, the hospital met the requirements in 73.3% of the items (n = 44). Conclusion: This study described the implementation of ASP in a teaching hospital, applying the Donabedian perspective. Although the hospital still does not have a classic ASP model, there were investments to improve structure, processes and results, aiming to comply with international guidelines. A high proportion of key elements of ASP in the hospital were followed according to the Brazilian regulatory requirements. Aspects related to antimicrobial consumption and the emergence of microbial resistance deserve further investigations.
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Affiliation(s)
- Amanda Fonseca Medeiros
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
| | - Caryne Margotto Bertollo
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Adriano Max Moreira Reis
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Monica Aparecida Costa
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Renan Pedra de Souza
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biológicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria Auxiliadora Parreiras Martins
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Hospital Risoleta Tolentino Neves, Rua das Gabirobas, Belo Horizonte, Minas Gerais, Brazil
- Hospital das Clínicas da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- *Correspondence: Maria Auxiliadora Parreiras Martins,
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Poran I, Elbaz M, Turjeman A, Huberman Samuel M, Eliakim-Raz N, Nashashibi J, Paul M, Leibovici L. Predicting In-Hospital Antibiotic Use in the Medical Department: Derivation and Validation Study. Antibiotics (Basel) 2022; 11:antibiotics11060813. [PMID: 35740219 PMCID: PMC9219723 DOI: 10.3390/antibiotics11060813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/12/2022] [Accepted: 06/13/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The rise of multi-drug-resistant pathogens and nosocomial infections among hospitalized patients is partially attributed to the increased use of antibiotic therapy. A prediction model for in-hospital antibiotic treatment could be valuable to target preventive strategies. Methods: This was a retrospective cohort study, including patients admitted in 2018 to medical departments and not treated with antibiotics during the first 48 h. Data available at hospital admission were used to develop a logistic model to predict the probability of antibiotic treatment during hospitalization. The performance of the model was evaluated in two independent validation cohorts. Results: In the derivation cohort, antibiotic treatment was initiated in 454 (8.1%) out of 5592 included patients. Male gender, lower functional capacity, prophylactic antibiotic treatment, medical history of atrial fibrillation, peripheral vascular disease, solid organ transplantation, chronic use of a central venous catheter, urinary catheter and nasogastric tube, albumin level, mental status and vital signs at presentation were identified as predictors for antibiotic use during hospitalization and were included in the prediction model. The area under the ROC curve (AUROC) was 0.72 (95% CI 0.70–0.75). In the highest probability group, the percentage of antibiotic treatment was 18.2% (238/1,307). In the validation cohorts, the AUROC was 0.73 (95% CI 0.68–0.77) and 0.75 (95% CI 0.72–0.78). In the highest probability group, the percentage of antibiotic treatment was 12.5% (66/526) and 20.7% (244/1179) of patients. Conclusions: Our prediction model performed well in the validation cohorts and was able to identify a subgroup of patients at high risk for antibiotic treatment.
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Affiliation(s)
- Itamar Poran
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Correspondence: ; Tel.: +972-524881870; Fax: +972-3-9376512
| | - Michal Elbaz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Adi Turjeman
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Maayan Huberman Samuel
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
| | - Noa Eliakim-Raz
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Infectious Diseases Unit, Rabin Medical Center, Beilinson Hospital, Petah Tikva 4941492, Israel
| | - Jeries Nashashibi
- Department of Medicine D, Rambam Health Care Campus, Haifa 3436212, Israel;
| | - Mical Paul
- Infectious Diseases Institute, Rambam Health Care Campus, Haifa 3436212, Israel;
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa 3436212, Israel
| | - Leonard Leibovici
- Department of Medicine E, Rabin Medical Center, Beilinson Hospital, Petach Tikva 4941492, Israel; (M.E.); (A.T.); (M.H.S.); (N.E.-R.); (L.L.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Sjövall F, Edström M, Walther S, Hanberger H. A nationwide evaluation of antibiotics consumption in Swedish intensive care units. Infect Dis (Lond) 2022; 54:713-721. [PMID: 35638173 DOI: 10.1080/23744235.2022.2081717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Around 70% of all ICU patients are treated with antibiotics whereas up to 30% are suggested as unnecessary. Measuring antibiotic consumption is a prerequisite to improving its use and the purpose of the present investigation was to explore the use of antibiotics in Swedish ICUs. MATERIAL AND METHODS Daily Defined Doses (DDDs) of antimicrobials delivered to Swedish ICUs, 2016-2018, were retrieved from Swedish pharmacies. From the Swedish Intensive Care Registry, we extracted data on a number of patient admissions, occupied bed days and Simplified Acute Physiology Score (SAPS)3. RESULTS There was a similar annual rate of total DDDs per admission of 3.7, 3.5, 3.8 and total DDDs per 100 occupied bed days of 111, 111, and 115 but with an approximately 6-fold difference of DDDs per occupied bed days (61-366) between the ICUs. The most frequently used antibiotics were isoxazolyl penicillins (J01CF), penicillins with betalactamase-inhibitors, mainly piperacillin/tazobactam (J01CR), 3rd and 4th generation cephalosporins (J01DD + DE) and carbapenems (J01DH). Together these four classes accounted for a median of 52% of all antibiotic use. The use of carbapenems had a moderate positive correlation with the mean SAPS3 score (r = 0.6, p = .01). The use of other broad-spectrum antibiotics showed no such correlation. CONCLUSION Overall antibiotic use remained similar in Swedish ICUs during the years 2016-2018. Broad-spectrum antibiotics accounted for 50% of all DDDs but with a large inter-ICU variation which only partly can be explained by differences in patient case mix and microbial resistance. Presumably, it also reflects varying local prescribing practices.
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Affiliation(s)
- Fredrik Sjövall
- Intensive and Perioperative Care, Skane University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Morgan Edström
- Department of Clinical Pharmacology, Region Östergötland, Linköping, Sweden
| | - Sten Walther
- Department of Cardio-thoracic and vascular surgery, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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The Overlooked Issue of Outpatient Combination Antibiotic Prescribing in Low- and Middle-Income Countries: An Example from Syria. Antibiotics (Basel) 2022; 11:antibiotics11010074. [PMID: 35052951 PMCID: PMC8772973 DOI: 10.3390/antibiotics11010074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 01/02/2022] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
This study aimed to determine and describe the prevalence of combination antibiotics dispensed in outpatients with health insurance in Syria. Data on all dispensed medicines between June 2018 and May 2019 for 81,314 adults were obtained, and medicines belonging to the J01 group of the World Health Organization (WHO) anatomical therapeutic classification (ATC) were included in the analysis. Prescriptions were stratified according to the number of antibiotics, age, and sex. Antibiotic utilization was expressed as the number of prescriptions per 1000 persons per year. Out of 59,404 prescriptions for antibiotics, 14.98% contained antibiotic combinations, distributed to 22.49% of the patients. The prevalence of dispensing antibiotic combinations was higher in female patients (23.00%), and the youngest (18–30 years, 26.19%) and oldest age groups (>70 years, 25.19%). The antibiotics most commonly combined were co-amoxiclav, second- and third-generation cephalosporins, and macrolides. Over 60% of the combinations contained ceftriaxone alone or in combination with sulbactam. The present study shows an alarmingly widespread prescription of antibiotic combinations, posing a risk to global health by promoting resistance development.
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Baral P, Hann K, Pokhrel B, Koirala T, Thapa R, Bijukchhe SM, Khogali M. Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study. Public Health Action 2021; 11:52-57. [PMID: 34778016 PMCID: PMC8575388 DOI: 10.5588/pha.21.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 08/10/2021] [Indexed: 11/11/2022] Open
Abstract
SETTING Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal. OBJECTIVES To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019. DESIGN This was a cross-sectional study. RESULTS Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories. CONCLUSION We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.
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Affiliation(s)
- P Baral
- Department of Pharmacy, Modern Technical College, Sanepa, Lalitpur, Nepal
| | - K Hann
- Sustainable Health System, Freetown, Sierra Leone
| | - B Pokhrel
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - T Koirala
- Dasharathpur Primary Health Centre, Department of Health Services, Ministry of Health and Population, Surkhet, Nepal
| | - R Thapa
- Department of Pharmacy, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - S M Bijukchhe
- Department of Paediatrics, Patan Academy of Health Sciences, Lalitpur, Nepal
| | - M Khogali
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), World Health Organization, Geneva, Switzerland
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Singh P, Gupta DK, Bindra A, Trikha A, Lathwal A, Malhotra R, Walia K, Mathur P. Antimicrobial consumption in intensive care unit patients at level 1 trauma centre in India. Indian J Med Microbiol 2021; 40:86-90. [PMID: 34602292 DOI: 10.1016/j.ijmmb.2021.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/29/2021] [Accepted: 09/13/2021] [Indexed: 11/05/2022]
Abstract
PURPOSE Increase in the antimicrobial resistance causes a concern globally. To mitigate the rapidly rising antimicrobial resistance in the health system globally antimicrobial stewardship programs (AMSP) have been advocated. Therefore, we aim to measure aggregate antibiotic consumption by both Defined Daily Dosage (DDD) and Days of Therapy (DOT) methods. METHODS As a part of Indian Council of Medical Research initiative to develop local AMSP, this prospective study of six months was conducted at a level -1 Trauma Centre of AIIMS, New Delhi. In this, we have included all the patients of polytrauma and neurosurgical Intensive care units between April to October 2019. Consumption of antibiotics data were collected manually daily by infection control practitioners. Data were presented as Days of Therapy (DOT) and Defined Daily Dose (DDD). RESULTS During the six months of study, antimicrobial consumption of ICU was compared with empirical therapy v/s culture-based therapy. Overall average antimicrobial consumption for the six months for both empirical therapy and culture-based therapy DDD/1000 patient days was 531.8 and 460.7 whereas DOT/1000 patient days 489.9 and 426.04 respectively. CONCLUSIONS Antimicrobial Stewardship activities aim to ensure judicious consumption of antimicrobials. Such data will be of value in establishing, evaluating and monitoring the function of the AMSP in the healthcare settings.
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Affiliation(s)
- Parul Singh
- Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Deepak Kumar Gupta
- Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Ashish Bindra
- Department of Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Anjan Trikha
- Department of Anaesthesia, All India Institute of Medical Sciences, New Delhi, India.
| | - Amit Lathwal
- Department of Hospital Administration, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences New Delhi, India.
| | - Kamini Walia
- Indian Council of Medical Research, New Delhi, India.
| | - Purva Mathur
- Department of Microbiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India.
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Kallen MC, Hulscher MEJL, Elzer B, Geerlings SE, van der Linden PD, Teerenstra S, Natsch S, Opmeer BC, Prins JM. A multicentre cluster-randomized clinical trial to improve antibiotic use and reduce length of stay in hospitals: comparison of three measurement and feedback methods. J Antimicrob Chemother 2021; 76:1625-1632. [PMID: 33638644 PMCID: PMC8120330 DOI: 10.1093/jac/dkab035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/20/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Various metrics of hospital antibiotic use might assist in guiding antimicrobial stewardship (AMS). OBJECTIVES To compare patient outcomes in association with three methods to measure and feedback information on hospital antibiotic use when used in developing an AMS intervention. METHODS Three methods were randomly allocated to 42 clusters from 21 Dutch hospitals: (1) feedback on quantity of antibiotic use [DDD, days-of-therapy (DOT) from hospital pharmacy data], versus feedback on (2) validated, or (3) non-validated quality indicators from point prevalence studies. Using this feedback together with an implementation tool, stewardship teams systematically developed and performed improvement strategies. The hospital length of stay (LOS) was the primary outcome and secondary outcomes included DOT, ICU stay and hospital mortality. Data were collected before (February-May 2015) and after (February-May 2017) the intervention period. RESULTS The geometric mean hospital LOS decreased from 9.5 days (95% CI 8.9-10.1, 4245 patients) at baseline to 9.0 days (95% CI 8.5-9.6, 4195 patients) after intervention (P < 0.001). No differences in effect on LOS or secondary outcomes were found between methods. Feedback on quality of antibiotic use was used more often to identify improvement targets and was preferred over feedback on quantity of use. Consistent use of the implementation tool seemed to increase effectiveness of the AMS intervention. CONCLUSIONS The decrease in LOS versus baseline likely reflects improvement in the quality of antibiotic use with the stewardship intervention. While the outcomes with the three methods were otherwise similar, stewardship teams preferred data on the quality over the quantity of antibiotic use.
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Affiliation(s)
- M C Kallen
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
| | - M E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - B Elzer
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
| | - S E Geerlings
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
| | - P D van der Linden
- Tergooi Hospital, Department of Clinical Pharmacy, Van Riebeeckweg 212, Hilversum, The Netherlands
| | - S Teerenstra
- Radboud University Medical Center, Radboud Institute for Health Sciences, Department for Health Evidence, Group Biostatistics, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - S Natsch
- Radboud University Medical Center, Department of Pharmacy, Geert Grooteplein Zuid 10, Nijmegen, The Netherlands
| | - B C Opmeer
- Amsterdam UMC, University of Amsterdam, Clinical Research Unit, Meibergdreef 9, Amsterdam, The Netherlands
| | - J M Prins
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, The Netherlands
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Hopman NEM, Wagenaar JA, van Geijlswijk IM, Broens EM. Development and Pilot of an Interactive Online Course on Antimicrobial Stewardship in Companion Animals. Antibiotics (Basel) 2021; 10:antibiotics10050610. [PMID: 34065607 PMCID: PMC8161360 DOI: 10.3390/antibiotics10050610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/06/2021] [Accepted: 05/17/2021] [Indexed: 11/28/2022] Open
Abstract
A holistic approach to antimicrobial use (AMU) and prescribing is needed to combat the problem of antimicrobial resistance (AMR). Previously, an antimicrobial stewardship programme (ASP) was developed, introduced, and evaluated in 44 Dutch companion animal clinics, which resulted in an optimization of AMU. As a follow-up to this, an online course was developed to promote awareness of AMU, AMR, and responsible antimicrobial prescribing. The aim of this paper is to describe the development and pilot, including evaluation, of this course, which will be disseminated more widely among Dutch companion animal veterinarians. The interactive programme consists of a major e-learning component and two online, face-to-face meetings. The course comprises five different parts corresponding with five consecutive weeks. Theory on several topics is offered, for example on AMU and AMR in general, Dutch regulations and guidelines on veterinary AMU, behavioural change, and possible methods to quantify AMU. Additionally, several assignments are offered, for example to reflect upon one’s own current antimicrobial prescribing behaviour. Interactive discussion and peer-to-peer learning are promoted. Since September 2020, the course has been offered in a pilot phase, and the feedback is promising. Evaluation of the pilot phase will result in recommendations for further optimization and dissemination.
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Affiliation(s)
- Nonke E. M. Hopman
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Yalelaan 1, 3584 CL Utrecht, The Netherlands; (J.A.W.); (E.M.B.)
- Correspondence:
| | - Jaap A. Wagenaar
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Yalelaan 1, 3584 CL Utrecht, The Netherlands; (J.A.W.); (E.M.B.)
- Wageningen Bioveterinary Research, Houtribweg 39, 8221 RA Lelystad, The Netherlands
| | - Ingeborg M. van Geijlswijk
- IRAS Veterinary Pharmacology and Therapeutics Group, Department Population Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 106, 3584 CM Utrecht, The Netherlands;
| | - Els M. Broens
- Department Biomolecular Health Sciences, Faculty of Veterinary Medicine, Utrecht University, Utrecht, Yalelaan 1, 3584 CL Utrecht, The Netherlands; (J.A.W.); (E.M.B.)
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Namugambe JS, Delamou A, Moses F, Ali E, Hermans V, Takarinda K, Thekkur P, Nanyonga SM, Koroma Z, Mwoga JN, Akello H, Imi M, Kitutu FE. National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda. Trop Med Infect Dis 2021; 6:83. [PMID: 34069434 PMCID: PMC8163196 DOI: 10.3390/tropicalmed6020083] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/02/2021] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.
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Affiliation(s)
- Juliet Sanyu Namugambe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, P.O. Box 1410 Mbarara, Uganda
| | - Alexandre Delamou
- Africa Centre of Excellence for Prevention and Control of Transmissible Diseases (CEA-PCMT), University Gamal Abdel Nasser, Conakry, PB: 4099 Maferinyah, Guinea;
- Centre National de Formation et de Recherche en Santé Rurale (CNFRSR) de Maferinyah, PB: 4099 Maferinyah, Guinea
| | - Francis Moses
- Ministry of Health and Sanitation, 00232 Freetown, Sierra Leone; (F.M.); (Z.K.)
- College of Medicine & Allied Health Sciences, University of Sierra Leone, 00232 Freetown, Sierra Leone
| | - Engy Ali
- Médecins Sans Frontières–Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg De Manstraat 6, 2100 Deurne, Brussels, Belgium; (E.A.); (V.H.)
| | - Veerle Hermans
- Médecins Sans Frontières–Operational Centre Brussels, Medical Department, Operational Research Unit (LuxOR), Luxembourg De Manstraat 6, 2100 Deurne, Brussels, Belgium; (E.A.); (V.H.)
| | - Kudakwashe Takarinda
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (K.T.); (P.T.)
| | - Pruthu Thekkur
- Centre for Operational Research, International Union Against Tuberculosis and Lung Disease, 75006 Paris, France; (K.T.); (P.T.)
| | - Stella Maris Nanyonga
- Clinical Epidemiology Unit, College of Health Sciences, Makerere University, P.O. Box 7072 Kampala, Uganda;
| | - Zikan Koroma
- Ministry of Health and Sanitation, 00232 Freetown, Sierra Leone; (F.M.); (Z.K.)
| | - Joseph Ngobi Mwoga
- World Health Organisation County Office, P.O. Box 24578 Kampala, Uganda;
| | - Harriet Akello
- Ministry of Health Uganda, P.O. Box 7272 Kampala, Uganda;
| | - Monica Imi
- Enabel, The Belgian Development Agency, P.O. Box 40131 Kampala, Uganda;
| | - Freddy Eric Kitutu
- Sustainable Pharmaceutical Systems (SPS) Unit, Pharmacy Department, School of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda;
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10
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Rees GM, Barrett DC, Sánchez-Vizcaíno F, Reyher KK. Measuring antimicrobial use on dairy farms: A method comparison cohort study. J Dairy Sci 2021; 104:4715-4726. [PMID: 33612227 DOI: 10.3168/jds.2020-18690] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 11/19/2020] [Indexed: 11/19/2022]
Abstract
Antimicrobial use on UK dairy farms is measured for surveillance purposes, with veterinary sales data as a proxy for use. Two other methods of recording use have been used commonly on-farm: medicine waste bins and farm medicine records. However, none of these methods has been validated to measure antimicrobial use. The objective of this research was to assess agreement between the 3 most common methods for measuring on-farm antimicrobial use with a predetermined reference method on UK dairy farms. Antimicrobial use was measured prospectively on 26 UK dairy farms using medicine waste bins into which participants placed all discarded medicine packaging for a 12-mo period. At the end of 12 mo, farm medicine records and veterinary sales data were obtained retrospectively for participating farms. The reference method used was based on pre- and poststudy inventories combined with veterinary sales data. We investigated the systematic difference between the mean on-farm antimicrobial use measured by each of the 3 methods and a reference method, using one-way repeated-measures ANOVA models. Reliability and clinical relevance of the agreement between each pair of methods was quantified using the concordance correlation coefficient (CCC) and the Bland-Altman method, respectively. When compared with the reference method, veterinary sales data had excellent reliability for injectable antimicrobials and intramammary antimicrobials [95% confidence interval (CI) of CCC > 0.90] and moderate to excellent reliability for other antimicrobials (95% CI of CCC: 0.68-0.97). Medicine waste bins had good to excellent reliability for injectable (95% CI of CCC: 0.84-0.99), and intramammary products (95% CI of CCC: 0.78-0.94) and no agreement for other forms of antimicrobial. Farm medicine records did not agree for any form of antimicrobial when compared with the reference method. The use of veterinary sales data as a proxy for on-farm antimicrobial use in the UK represented excellent statistical reliability and offered clinically good agreement with the reference method when used to measure injectable antimicrobials. This study applies to the UK context and included a relatively small number of farms. However, these results have research and policy implications, both nationally and internationally, and are essential in accurately quantifying agricultural antimicrobial use to inform both animal and human health.
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Affiliation(s)
- G M Rees
- Bristol Veterinary School, University of Bristol, Langford House, Langford, North Somerset BS40 5DU, United Kingdom.
| | - D C Barrett
- Bristol Veterinary School, University of Bristol, Langford House, Langford, North Somerset BS40 5DU, United Kingdom
| | - F Sánchez-Vizcaíno
- Bristol Veterinary School, University of Bristol, Langford House, Langford, North Somerset BS40 5DU, United Kingdom
| | - K K Reyher
- Bristol Veterinary School, University of Bristol, Langford House, Langford, North Somerset BS40 5DU, United Kingdom
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11
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Vest TA, Gazda NP, Schenkat DH, Eckel SF. Practice-enhancing publications about the medication-use process in 2019. Am J Health Syst Pharm 2021; 78:141-153. [PMID: 33119100 DOI: 10.1093/ajhp/zxaa355] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE This article identifies, prioritizes, and summarizes published literature on the medication-use process (MUP) from calendar year 2019 that can impact health-system pharmacy daily practice. The MUP is the foundational system that provides the framework for safe medication utilization within the healthcare environment. The MUP is defined in this article as having the following components: prescribing/transcribing, dispensing, administration, and monitoring. Articles that evaluated one of the steps were gauged for their usefulness in promoting daily practice change. SUMMARY A PubMed search was conducted in January 2020 for calendar year 2019 using targeted Medical Subject Headings keywords; in addition, searches of the table of contents of selected pharmacy journals were conducted. A total of 4,317 articles were identified. A thorough review identified 66 potentially practice-enhancing articles: 17 for prescribing/transcribing, 17 for dispensing, 7 for administration, and 25 for monitoring. Ranking of the articles for importance by peers led to the selection of key articles from each category. The highest-ranked articles are briefly summarized, with a mention of why each article is important within health-system pharmacy. The other articles are listed for further review and evaluation. CONCLUSION It is important to routinely review the published literature and to incorporate significant findings into daily practice; this article assists in identifying and summarizing the most impactful recently published literature in this area. Health-system pharmacists have an active role in improving the MUP in their institution, and awareness of the significant published studies can assist in changing practice at the institutional level.
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Affiliation(s)
- Tyler A Vest
- Duke University Hospital, Durham, NC.,University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC
| | | | | | - Stephen F Eckel
- University of North Carolina at Chapel Hill Eshelman School of Pharmacy, Chapel Hill, NC.,University of North Carolina Medical Center, Chapel Hill, NC
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12
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Ababneh MA, Jaber M, Rababa'h A, Alabweny E. Prevalence of antimicrobial use in a tertiary academic hospital: a venue for antimicrobial stewardship programs. Expert Rev Anti Infect Ther 2020; 19:1047-1051. [PMID: 33307895 DOI: 10.1080/14787210.2021.1863789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To quantify antimicrobial use in inpatients setting as part of antimicrobial stewardship program surveillance. METHOD Antimicrobial use was obtained using a pre-designed data collection form in this point prevalence study. Setting: The study was conducted in a tertiary academic hospital in the North of Jordan on 13 August 2018. Main outcome measures: antimicrobial use was determined using two methods: defined daily use (DDD) and days of therapy (DOT). RESULTS This study identified antimicrobial use in 144 patients. Carbapenems, glycopeptides, and piperacillin-tazobactam were the most utilized antimicrobials in the inpatients' setting in both measures DDD and DOT. The highest prescription rate of antibiotics was in the internal medicine wards (49.8 DDD/100 admissions), followed by surgery wards (33.2 DDD/100 admissions) and intensive care unit (20.6 DDD/100 admissions). CONCLUSION This surveillance study addressed patterns of antimicrobial usage in inpatients settings in a tertiary care hospital in Jordan. This practice is feasible and could be adopted routinely by antimicrobial stewardship programs.
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Affiliation(s)
- Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mutaz Jaber
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Abeer Rababa'h
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Eshraq Alabweny
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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13
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Amaya-Villar R. Adequate antibiotic monitoring to improve what needs to be improved. Med Intensiva 2020; 44:265-266. [DOI: 10.1016/j.medin.2019.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 12/02/2019] [Indexed: 11/15/2022]
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14
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Abstract
PURPOSE OF REVIEW To provide an update on the current landscape of antimicrobial stewardship in solid organ transplant (SOT) recipients. RECENT FINDINGS Constructing personalized antimicrobial prescribing approaches to avoid untoward consequences of antimicrobials while improving outcomes is an emerging and critical aspect of transplant medicine. Stewardship activities encompassing the specialized interests of transplant patients and programs are evolving. New literature evaluating strategies to optimize antimicrobial agent selection, dosing, and duration have been published. Additionally, consensus guidance for certain infectious clinical syndromes is available and should inform institutional clinical practice guidelines. Novel metrics for stewardship-related outcomes in transplantation are desperately needed. Though exciting new molecular diagnostic technologies will likely be pivotal in the care of immunocompromised patients, optimal clinical adaptation and appropriate integration remains unclear. Important studies understanding the behaviors influencing antimicrobial prescribing in organizational transplant cultures are needed to optimize interventions. SUMMARY Consequences of antimicrobial use, such as Clostridiodes difficile and infections with multidrug-resistant organisms disproportionately affect SOT recipients and are associated with poor allograft and patient outcomes. Application of ASP interventions tailored to SOT recipients is recommended though further studies are needed to provide guidance for best practice.
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15
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Resman F. Antimicrobial stewardship programs; a two-part narrative review of step-wise design and issues of controversy Part I: step-wise design of an antimicrobial stewardship program. Ther Adv Infect Dis 2020; 7:2049936120933187. [PMID: 32612826 PMCID: PMC7307277 DOI: 10.1177/2049936120933187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 05/11/2020] [Indexed: 12/27/2022] Open
Abstract
Regardless of one's opinion of antimicrobial stewardship programs (ASPs), it is hardly possible to work in hospital care and not be exposed to the term or its practical effects. Despite the term being relatively new, the number of publications in the field is vast, including several excellent reviews of general and specific aspects. Work in antimicrobial stewardship is complex, and includes not only aspects of infectious disease and microbiology, but also of epidemiology, genetics, behavioural psychology, systems science, economics and ethics, to name a few. This review aims to take several of these aspects and the scientific evidence of antimicrobial stewardship studies and merge them into two questions: How should we design ASPs based on what we know today? And which are the most essential unanswered questions regarding antimicrobial stewardship on a broader scale? This narrative review is written in two separate parts aiming to provide answers to the two questions. This first part is written as a step-wise approach to designing a stewardship intervention based on the pillars of unmet need, feasibility, scientific evidence and necessary core elements. It is written mainly as a guide to someone new to the field. It is sorted into five distinct steps: (a) focusing on designing aims; (b) assessing performance and local barriers to rational antimicrobial use; (c) deciding on intervention technique; (d) practical, tailored design including core element inclusion; and (e) evaluation and sustainability. The second part, published separately, formulates ten critical questions on controversies in the field of antimicrobial stewardship. It is aimed at clinicians and researchers with stewardship experience and strives to promote discussion, not to provide answers.
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Affiliation(s)
- Fredrik Resman
- Department of Translational Medicine, Clinical
Infection Medicine, Lund University, Rut Lundskogs Gata 3, Plan 6, Malmö, 20502,
Sweden
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16
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Araujo da Silva AR, Jaszkowski E, Schober T, von Both U, Meyer-Buehn M, Marques AF, Farkas B, de Abreu BS, di Biase CB, Takahashi JM, de Castro LD, Leal IA, Teixeira CH, Nussbaum CF, Hoffmann F, Hübner J. Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil. Eur J Clin Microbiol Infect Dis 2019; 39:249-255. [PMID: 31673879 DOI: 10.1007/s10096-019-03714-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
Abstract
Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.
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Affiliation(s)
- André Ricardo Araujo da Silva
- Materno-Infantil Departament, Faculdade de Medicina, Universidade Federal Fluminense, Rua Marquês do Paraná 303, Niterói, RJ, 24033-900, Brazil.
| | - Elena Jaszkowski
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Tilmann Schober
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Ulrich von Both
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Melanie Meyer-Buehn
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Amanda Fáris Marques
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Beatriz Farkas
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Bernardo Silva de Abreu
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Clara Biscaia di Biase
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Jully Miyoshi Takahashi
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Luisa Dutra de Castro
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Izabel Alves Leal
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | - Cristiane Henriques Teixeira
- Teaching Laboratory of Prevention and Control of Healthcare-Associated Infections, Faculdade de Medicina, Universidade Federal Fluminense, Niterói, RJ, 24033-900, Brazil
| | | | - Florian Hoffmann
- Intensive Care Medicine service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
| | - Johannes Hübner
- Infectiology Service, Dr. von Hauner Children's Hospital, LMU Munich, 80337, Munich, Germany
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17
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Dammeyer AH, Heinze S, Adler AC, Nasri L, Schomacher L, Zamfir M, Heigl K, Karlin B, Franitza M, Hörmansdorfer S, Tuschak C, Valenza G, Ochmann U, Herr C. Clinical relevance of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin susceptible Staphylococcus aureus (MSSA) for mothers during pregnancy. Arch Gynecol Obstet 2019; 300:1303-1316. [PMID: 31531777 DOI: 10.1007/s00404-019-05287-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 09/03/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated. METHODS From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included. RESULTS Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p < 0.05). MSSA colonization was significantly associated with self-reported respiratory diseases during pregnancy (p < 0.05), but AMRB/MSSA colonization was not statistically associated with other types of infection. CONCLUSION Our results demonstrate a low overall rate of colonization with AMRB/MSSA, as well as a low percentage of colonized pregnant women who developed infections. Multiparous women are at higher risk for colonization with MSSA/MRSA or ESBL. Because the prevalence of AMRB/MSSA is low, this study suggests that general screening of pregnant women without risk factors is not recommended.
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Affiliation(s)
- A H Dammeyer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.
| | - S Heinze
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - A C Adler
- Bavarian State Ministry of Public Health and Care Services, Munich, Germany
| | - L Nasri
- Klinikum Augsburg, Women's Clinic, Augsburg, Germany
| | - L Schomacher
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - M Zamfir
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - K Heigl
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - B Karlin
- Rotkreuzklinikum München, Women's Clinic, Munich, Germany
| | - M Franitza
- Klinikum Augsburg, Women's Clinic, Augsburg, Germany
| | - S Hörmansdorfer
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - C Tuschak
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - G Valenza
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany
| | - U Ochmann
- Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
| | - C Herr
- Bavarian Health and Food Safety Authority, Munich/Oberschleißheim/Erlangen, Germany.,Institute and Outpatient Clinic of Occupational, Social and Environmental Medicine, Clinic of the University of Munich, Munich, Germany
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