1
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Jambo A, Edessa D, Adem F, Gashaw T. Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study. SAGE Open Med 2023; 11:20503121231163792. [PMID: 37065976 PMCID: PMC10102944 DOI: 10.1177/20503121231163792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/27/2023] [Indexed: 04/18/2023] Open
Abstract
Objective Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021. Methods A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval. Results Of the total participants, 116 (16.74%, 95% confidence interval: 14.1-19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00-2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64-6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07-2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10-2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14-2.84) were associated with an initial inappropriate antimicrobial use. Conclusion Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.
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Affiliation(s)
- Abera Jambo
- Clinical Pharmacy Department, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
- Abera Jambo, Clinical Pharmacy Department,
School of Pharmacy, College of Health and Medical Sciences, Haramaya University,
Harar, Ethiopia.
| | - Dumessa Edessa
- Clinical Pharmacy Department, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Fuad Adem
- Clinical Pharmacy Department, School of
Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar,
Ethiopia
| | - Tigist Gashaw
- Department of Pharmacology and
Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya
University, Harar, Ethiopia
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2
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Önal U, Akyol D, Mert M, Başkol D, Memetali SC, Şanlıdağ G, Kenanoğlu B, Uyan-Önal A, Quliyeva G, Avşar CB, Akdağ D, Demir M, Erdem HA, Kahraman Ü, Bozbıyık O, Özgiray E, Bozkurt D, Akarca FK, Demirağ K, Çankayalı İ, Uyar M, Çilli F, Arda B, Yamazhan T, Pullukçu H, Taşbakan MI, Sipahi H, Ulusoy S, Sipahi OR. Carbapenem-resistant Gram-negative pathogens associated with septic shock: a review of 120 cases. J Chemother 2022; 34:436-445. [PMID: 35446235 DOI: 10.1080/1120009x.2022.2064703] [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: 10/18/2022]
Abstract
This study aimed to evaluate the influencing variables for outcomes in patients with septic shock having culture-proven carbapenem-resistant Gram-negative pathogens. It included 120 patients (mean age 64.29 ± 1.35 years and 58.3% female). The mean Sequential Organ Failure Assessment score during septic shock diagnosis was found to be 11.22 ± 0.43 and 9 ± 0.79 among the patients with mortality and among the survivors, respectively (P = 0.017). The logistic regression analysis showed that empirical treatment as mono Gram-negative bacteria-oriented antibiotic therapy (P = 0.016, odds ratio (OR) = 17.730, 95% confidence interval (CI): 1.728-182.691), Charlson Comorbidity Index >2 (P = 0.032, OR = 7.312, 95% CI: 5.7-18.3), and systemic inflammatory response syndrome score 3 or 4 during septic shock diagnosis (P = 0.014, OR = 5.675, 95% CI: 1.424-22.619) were found as independent risk factors for day 30 mortality. Despite early diagnosis and effective management of patients with septic shock, the mortality rates are quite high in CRGNP-infected patients.
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Affiliation(s)
- Uğur Önal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey.,Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Uludag University, Bursa, Turkey
| | - Deniz Akyol
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Merve Mert
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Dilşah Başkol
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Seichan Chousein Memetali
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Gamze Şanlıdağ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Buse Kenanoğlu
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Ayşe Uyan-Önal
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey.,Yüksek İhtisas Research and Teaching Hospital, Department of Infectious Diseases and Clinical Microbiology, Bursa, Turkey
| | - Günel Quliyeva
- Bona Dea International Hospital, Infectious Diseases Clinic, Baku, Azerbaijan
| | - Cansu Bulut Avşar
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Damla Akdağ
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Melike Demir
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Hüseyin Aytaç Erdem
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Ümit Kahraman
- Faculty of Medicine, Department of Cardiovascular Surgery, Ege University, Bornova, Izmir, Turkey
| | - Osman Bozbıyık
- Faculty of Medicine, Department of General Surgery, Ege University, Bornova, Izmir, Turkey
| | - Erkin Özgiray
- Faculty of Medicine, Department of Neurosurgery, Ege University, Bornova, Izmir, Turkey
| | - Devrim Bozkurt
- Faculty of Medicine, Department of Internal Medicine, Ege University, Bornova, Izmir, Turkey
| | - Funda Karbek Akarca
- Faculty of Medicine, Department of Emergency Medicine, Ege University, Bornova, Izmir, Turkey
| | - Kubilay Demirağ
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ege University, Bornova, Izmir, Turkey
| | - İlkin Çankayalı
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ege University, Bornova, Izmir, Turkey
| | - Mehmet Uyar
- Faculty of Medicine, Department of Anaesthesiology and Reanimation, Ege University, Bornova, Izmir, Turkey
| | - Feriha Çilli
- Faculty of Medicine, Department of Medical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Bilgin Arda
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Tansu Yamazhan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Hüsnü Pullukçu
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Meltem Işıkgöz Taşbakan
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Hilal Sipahi
- Department of Medical Microbiology, Bornova Directorate of Health, Bornova, Izmir, Turkey
| | - Sercan Ulusoy
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
| | - Oguz Resat Sipahi
- Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Ege University, Bornova, Izmir, Turkey
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3
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DERİN O, ŞEKER F, AKSOY N, YIGIT P, YILMAZ M, MERT A. The Effect of Antimicrobial Policy Implementation on Carbapenem Resistance: A University Hospital Experience. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2022. [DOI: 10.33808/clinexphealthsci.1010571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective: The resistance of Gram-negative bacteria to antibiotics is a global issue that leads to increased mortality and treatment costs. The aim of this study is to see how a newly formed carbapenem control team affected the prevalence of carbapenem-resistant Gram-negative rods and antibiotic consumption expenses in 2017 compared to the year before.
Methods: The rate of carbapenem antibiotic usage in Intensive Care Units and Bone Marrow Transplantation services, as well as the findings of culture materials obtained from various body parts of the same patients, between January 1, 2016, and December 31, 2017 were assessed.
Results: While there was an ordinary restriction on carbapenem consumption in 2016, carbapenem consumption has been more restricted in 2017. The carbapenem-resistant Gram-negative bacteria patterns of culture materials are examined and compared with Defined Daily Dose data of carbapenems. After the restriction, a significant decrease in the consumption of carbapenems was detected. The decline in carbapenem-resistant Gram-negative bacteria and decreasing antibiotic consumption were found to have a moderately positive correlation (r=0.641, p=0.02). A 60.9% decrease was observed in carbapenem costs after carbapenem restriction, on the other hand, an increase in other unrestricted antibiotics was apparent.
Conclusion: Antimicrobial restriction policies can help minimize the rate of carbapenem-resistant Gram-negative rods, which is a serious problem in healthcare. We demonstrated that a decrease in carbapenem-resistant Gram-negative rods isolation rates can lead to a decrease in healthcare-associated infections. Although there is no decrease in the direct antibiotics cost, a drop in carbapenem-resistant may lower the expenses of drastic consequences of infections with carbapenem-resistant and its cost. we can conclude that the Antibiotic Control Policy should be modified based on this new information.
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4
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Hur B, Hardefeldt LY, Verspoor K, Baldwin T, Gilkerson JR. Overcoming challenges in extracting prescribing habits from veterinary clinics using big data and deep learning. Aust Vet J 2022; 100:220-222. [DOI: 10.1111/avj.13145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 01/02/2022] [Indexed: 11/27/2022]
Affiliation(s)
- B Hur
- Asia‐Pacific Centre for Animal Health, Melbourne Veterinary School University of Melbourne Melbourne Victoria Australia
- School of Computing and Information Systems University of Melbourne Melbourne Victoria Australia
| | - LY Hardefeldt
- Asia‐Pacific Centre for Animal Health, Melbourne Veterinary School University of Melbourne Melbourne Victoria Australia
| | - K Verspoor
- School of Computing and Information Systems University of Melbourne Melbourne Victoria Australia
- School of Computing Technologies RMIT University Melbourne Victoria Australia
| | - T Baldwin
- School of Computing and Information Systems University of Melbourne Melbourne Victoria Australia
| | - JR Gilkerson
- Asia‐Pacific Centre for Animal Health, Melbourne Veterinary School University of Melbourne Melbourne Victoria Australia
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5
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Smith DR, Temime L, Opatowski L. Microbiome-pathogen interactions drive epidemiological dynamics of antibiotic resistance: A modeling study applied to nosocomial pathogen control. eLife 2021; 10:68764. [PMID: 34517942 PMCID: PMC8560094 DOI: 10.7554/elife.68764] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 08/31/2021] [Indexed: 12/16/2022] Open
Abstract
The human microbiome can protect against colonization with pathogenic antibiotic-resistant bacteria (ARB), but its impacts on the spread of antibiotic resistance are poorly understood. We propose a mathematical modeling framework for ARB epidemiology formalizing within-host ARB-microbiome competition, and impacts of antibiotic consumption on microbiome function. Applied to the healthcare setting, we demonstrate a trade-off whereby antibiotics simultaneously clear bacterial pathogens and increase host susceptibility to their colonization, and compare this framework with a traditional strain-based approach. At the population level, microbiome interactions drive ARB incidence, but not resistance rates, reflecting distinct epidemiological relevance of different forces of competition. Simulating a range of public health interventions (contact precautions, antibiotic stewardship, microbiome recovery therapy) and pathogens (Clostridioides difficile, methicillin-resistant Staphylococcus aureus, multidrug-resistant Enterobacteriaceae) highlights how species-specific within-host ecological interactions drive intervention efficacy. We find limited impact of contact precautions for Enterobacteriaceae prevention, and a promising role for microbiome-targeted interventions to limit ARB spread.
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Affiliation(s)
- David Rm Smith
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France.,Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France
| | - Laura Temime
- Modélisation, épidémiologie et surveillance des risques sanitaires (MESuRS), Conservatoire national des arts et métiers, Paris, France.,PACRI unit, Institut Pasteur, Conservatoire national des arts et métiers, Paris, France
| | - Lulla Opatowski
- Institut Pasteur, Epidemiology and Modelling of Antibiotic Evasion (EMAE), Paris, France.,Université Paris-Saclay, UVSQ, Inserm, CESP, Anti-infective evasion and pharmacoepidemiology team, Montigny-Le-Bretonneux, France
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6
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Selcuk A. The point prevalence and inappropriateness of antibiotic use at hospitals in Turkey: a systematic review and meta-analysis. J Chemother 2021; 33:390-399. [PMID: 33618610 DOI: 10.1080/1120009x.2021.1888031] [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] [Indexed: 10/22/2022]
Abstract
Inappropriate antimicrobial use is a key problem causing antimicrobial resistance and increased health care costs. Although global point prevalence surveys on antimicrobial prescribing in hospitals were described, there is lack of data from Turkish hospitals. Here, we aimed to perform systematic review and meta-analysis for the point prevalence surveys on antimicrobial prescribing in Turkish hospitals. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guideline was used to identify studies for the review. Articles published between January 2004 and September 2020 by Turkish investigators were included if they used the point prevalence survey method. The Joanna Briggs Institute's critical appraisal tool and the World Health Organization's point prevalence survey tool were used to the evaluate studies. Results were combined using random effects meta-analysis. The pooled point prevalence of antimicrobial use in Turkish hospitals was 48% (95% confidence interval 43-54). There was considerable heterogeneity in prevalence among the studies (I2= 98.75 %, 95 % CI 98.49-98-97). The most commonly prescribed antimicrobial and indication for antimicrobial use were third generation cephalosporins (36%) and respiratory tract infections (88%), respectively. More than two thirds of the antimicrobials were prescribed empirically (median: 71% [interquartile range: 56-80]) in hospitals. The point prevalence and inappropriateness of antimicrobial use are high in Turkish hospitals. Turkey is one of the biggest consumers of antimicrobials. There is an urgent need for antimicrobial stewardship programmes at Turkish hospitals to improve antimicrobial prescribing. Our study findings can contribute to improving antimicrobial prescribing, and thereby control antimicrobial resistance.
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Affiliation(s)
- Aysu Selcuk
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ankara University, Yenimahalle, Ankara, Turkey
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7
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Schuts EC, Boyd A, Muller AE, Mouton JW, Prins JM. The Effect of Antibiotic Restriction Programs on Prevalence of Antimicrobial Resistance: A Systematic Review and Meta-Analysis. Open Forum Infect Dis 2021; 8:ofab070. [PMID: 33880388 PMCID: PMC8043261 DOI: 10.1093/ofid/ofab070] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background In hospital settings, restriction of selected classes of antibiotics is usually believed to contribute to containment of resistance development. We performed a systematic review and meta-analysis to assess the effect of restricting the use of specific antibiotic classes on the prevalence of resistant bacterial pathogens. Methods We conducted a systematic literature search in Embase and PubMed/OVID MEDLINE. We included studies until June 4, 2020 in which a restrictive antibiotic policy was applied and prevalence of resistance and use of antibiotics were reported. We calculated the overall effect of antimicrobial resistance between postintervention versus preintervention periods using pooled odds ratios (ORs) from a mixed-effects model. We stratified meta-analysis by antibiotic-pathogen combinations. We assessed heterogeneity between studies using the I2 statistic and sources of heterogeneity using meta-regression. Results We included 15 individual studies with an overall low quality of evidence. In meta-analysis, significant reductions in resistance were only observed with nonfermenters after restricting fluoroquinolones (OR = 0.77, 95% confidence interval [CI] = 0.62–0.97) and piperacillin-tazobactam (OR = 0.81, 95% CI = 0.72–0.92). High degrees of heterogeneity were observed with studies restricting carbapenem (Enterobacterales, I2 = 70.8%; nonfermenters, I2 = 81.9%), third-generation cephalosporins (nonfermenters, I2 = 63.3%), and fluoroquiolones (nonfermenters, I2 = 64.0%). Results were comparable when excluding studies with fewer than 50 bacteria. There was no evidence of publication bias for any of the antibiotic-pathogen combinations. Conclusions We could not confirm that restricting carbapenems or third-generation cephalosporins leads to decrease in prevalence of antibiotic resistance among Enterobacterales, nonfermenters, or Gram-positive bacteria in hospitalized patients. Nevertheless, reducing fluoroquinolone and piperacilline-tazobactam use may decrease resistance in nonfermenters.
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Affiliation(s)
- Emelie C Schuts
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anders Boyd
- Department of Infectious Diseases, Public Health Service Amsterdam, Amsterdam, the Netherlands.,Stichting HIV Monitoring, Amsterdam, Netherlands
| | - Anouk E Muller
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands.,Department of Medical Microbiology, Haaglanden Medical Centre, The Hague, the Netherlands
| | - Johan W Mouton
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Jan M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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8
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Gashaw T, Sisay M, Tesfa T, Baye Y, Amare F. Amoxicillin Utilization Pattern at Governmental Hospitals in Eastern Ethiopia. Infect Drug Resist 2021; 14:193-203. [PMID: 33505162 PMCID: PMC7829130 DOI: 10.2147/idr.s288387] [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: 10/23/2020] [Accepted: 01/01/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Penicillin is among the highly used antibiotics in most parts of the world, with amoxicillin being the most frequently utilized drug in the category. However, amoxicillin use has been found to deviate from standard treatment guidelines (STGs). OBJECTIVE This study aimed to evaluate amoxicillin utilization patterns based on Ethiopian STGs criteria at four governmental hospitals in Harar town: Hiwot Fana Specialized University Hospital, Jugel Hospital, South East Command III Hospital, and Federal Harar Police Hospital in Eastern Ethiopia in 2016. METHODS A hospital-based retrospective cross-sectional study was employed using medication records of patients who received amoxicillin in 2016 at four governmental hospitals from May 15 to June 30, 2018. A total of 502 medication records were proportionally allocated based on the ratio of consumption data of each hospital. Simple random sampling was employed to collect the required sample from the sampling frame. The collected data were entered into SPSS version 21 and analyzed using descriptive analysis. RESULTS Amoxicillin was used in all age groups, including pregnant and lactating women. The majority (96.2%) of patients were from the outpatient departments. Complete blood count was the most laboratory investigation carried out in 24.9% whereas microbiological culture was not recorded at all. Top three indications include nonspecific upper respiratory tract infections (15.1%), pneumonia (13.5%) and dental problems (10.6%). Non-steroidal anti-inflammatory drugs (56.2%) were frequently co-administered agents. An appropriate utilization was made considering indication, dose, frequency and therapy duration in 23.9% as per the Ethiopian STG. The wrong indication (65.4%) was the prime reason for inappropriateness, followed by dose (14.6%) and duration of therapy (12.2%). CONCLUSION Amoxicillin utilization was appropriate in less than a quarter of patients. The wrong indication was the main reason for inappropriateness, predisposing to resistance development. Further studies identifying factors related to misuse and sensitivity tests should be the next steps.
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Affiliation(s)
- Tigist Gashaw
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Mekonnen Sisay
- Department of Pharmacology and Toxicology, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Tewodros Tesfa
- Microbiology Unit, Medical Laboratory Sciences, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Yohannes Baye
- Department of Pediatrics and Neonatal Nursing, School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Firehiwot Amare
- Department of Clinical Pharmacy, School of Pharmacy, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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9
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Hur B, Hardefeldt LY, Verspoor KM, Baldwin T, Gilkerson JR. OUP accepted manuscript. JAC Antimicrob Resist 2021; 4:dlab194. [PMID: 35156027 PMCID: PMC8827557 DOI: 10.1093/jacamr/dlab194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 11/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background As antimicrobial prescribers, veterinarians contribute to the emergence of MDR pathogens. Antimicrobial stewardship programmes are an effective means of reducing the rate of development of antimicrobial resistance. A key component of antimicrobial stewardship programmes is selecting an appropriate antimicrobial agent for the presenting complaint and using an appropriate dose rate for an appropriate duration. Objectives To describe antimicrobial usage, including dose, for common indications for antimicrobial use in companion animal practice. Methods Natural language processing (NLP) techniques were applied to extract and analyse clinical records. Results A total of 343 668 records for dogs and 109 719 records for cats administered systemic antimicrobials from 1 January 2013 to 31 December 2017 were extracted from the database. The NLP algorithms extracted dose, duration of therapy and diagnosis completely for 133 046 (39%) of the records for dogs and 40 841 records for cats (37%). The remaining records were missing one or more of these elements in the clinical data. The most common reason for antimicrobial administration was skin disorders (n = 66 198, 25%) and traumatic injuries (n = 15 932, 19%) in dogs and cats, respectively. Dose was consistent with guideline recommendations in 73% of cases where complete clinical data were available. Conclusions Automated extraction using NLP methods is a powerful tool to evaluate large datasets and to enable veterinarians to describe the reasons that antimicrobials are administered. However, this can only be determined when the data presented in the clinical record are complete, which was not the case in most instances in this dataset. Most importantly, the dose administered varied and was often not consistent with guideline recommendations.
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Affiliation(s)
- Brian Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
- Corresponding author. E-mail:
| | - Laura Y. Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - Karin M. Verspoor
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
- School of Computing Technologies, RMIT University, Melbourne, Victoria, Australia
| | - Timothy Baldwin
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - James R. Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
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10
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Özger HS, Fakıoğlu DM, Erbay K, Albayrak A, Hızel K. Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study. BMC Infect Dis 2020; 20:289. [PMID: 32306946 PMCID: PMC7169036 DOI: 10.1186/s12879-020-05005-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 03/31/2020] [Indexed: 12/12/2022] Open
Abstract
Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation. Results It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use. Conclusions In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses.
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Affiliation(s)
- Hasan Selçuk Özger
- Faculty of Medicine, Department of Infectious Diseases, Gazi University, Ankara, Turkey
| | | | - Kübra Erbay
- Faculty of Medicine, Department of Infectious Diseases, Gazi University, Ankara, Turkey
| | - Aslınur Albayrak
- Faculty of Pharmacy, Department of Clinical Pharmacy, Gazi University, Ankara, Turkey.
| | - Kenan Hızel
- Faculty of Medicine, Department of Infectious Diseases, Gazi University, Ankara, Turkey
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11
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Hur BA, Hardefeldt LY, Verspoor KM, Baldwin T, Gilkerson JR. Describing the antimicrobial usage patterns of companion animal veterinary practices; free text analysis of more than 4.4 million consultation records. PLoS One 2020; 15:e0230049. [PMID: 32168354 PMCID: PMC7069610 DOI: 10.1371/journal.pone.0230049] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 02/20/2020] [Indexed: 01/30/2023] Open
Abstract
Antimicrobial Resistance is a global crisis that veterinarians contribute to through their use of antimicrobials in animals. Antimicrobial stewardship has been shown to be an effective means to reduce antimicrobial resistance in hospital environments. Effective monitoring of antimicrobial usage patterns is an essential part of antimicrobial stewardship and is critical in reducing the development of antimicrobial resistance. The aim of this study is to describe how frequently antimicrobials were used in veterinary consultations and identify the most frequently used antimicrobials. Using VetCompass Australia, Natural Language Processing techniques, and the Australian Strategic Technical Advisory Group’s (ASTAG) Rating system to classify the importance of antimicrobials, descriptive analysis was performed on the antimicrobials prescribed in consultations from 137 companion animal veterinary clinics in Australia between 2013 and 2017 (inclusive). Of the 4,400,519 consultations downloaded there were 595,089 consultations where antimicrobials were prescribed to dogs or cats. Antimicrobials were dispensed in 145 of every 1000 canine consultations; and 38 per 1000 consultations involved high importance rated antimicrobials. Similarly with cats, 108 per 1000 consultations had antimicrobials dispensed, and in 47 per 1000 consultations an antimicrobial of high importance rating was administered. The most common antimicrobials given to cats and dogs were cefovecin and amoxycillin clavulanate, respectively. The most common topical antimicrobial and high-rated topical antimicrobial given to dogs and cats was polymyxin B. This study provides a descriptive analysis of the antimicrobial usage patterns in Australia using methods that can be automated to inform antimicrobial use surveillance programs and promote antimicrobial stewardship.
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Affiliation(s)
- Brian A. Hur
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
- * E-mail:
| | - Laura Y. Hardefeldt
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
| | - Karin M. Verspoor
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
- Centre for the Digital Transformation of Health, University of Melbourne, Parkville, Victoria, Australia
| | - Timothy Baldwin
- School of Computing and Information Systems, University of Melbourne, Parkville, Victoria, Australia
| | - James R. Gilkerson
- Asia-Pacific Centre for Animal Health, Melbourne Veterinary School, University of Melbourne, Parkville, Victoria, Australia
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Vazin A, Mirjalili M, Asadi S. Evaluation of aminoglycosides utilization in intensive care units of a teaching hospital in southern Iran. Pharm Pract (Granada) 2019; 17:1523. [PMID: 31592293 PMCID: PMC6763303 DOI: 10.18549/pharmpract.2019.3.1523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/08/2019] [Indexed: 11/16/2022] Open
Abstract
Background: Inappropriate use of antimicrobial agents is one of the most important factors in inducing resistance and prolonged hospitalization as well as increase in patient mortality rate. Objective: The aim of this study was to evaluate aminoglycosides (AGs) usage pattern at intensive care units (ICUs) of Nemazee hospital Shiraz, Iran. Methods: In this cross-sectional study, the usage pattern of AGs was evaluated during 32 months. Guidelines for AGs usage were approved by the drug and therapeutic committee of the hospital, and criteria were developed to assess 11 parameters involving AGs therapy, such as proper indication for the use of the drug, dosage and duration of therapy. Clinical parameters, such as microbial culture and sensitivity, serum creatinine (SCr) and creatinine clearance, and white blood cell count were evaluated. Results: Ninety-five patients were recruited, 50 male and 45 females. In most patients (64%) the origin of infection was hospital and only in 36% of them, community was the source. Ventilator associated pneumonia (27%), central nervous system (25%) and urinary tract infection (10%) were the most important indications for AGs prescription. Scores of AGs usage at Nemazee hospital was calculated as 5.9 out of 11, which meant that in only 54% of cases AGs prescription was based on guideline proposed by the Department of Clinical Pharmacy of Nemazee Hospital. Conclusions: Non-adherence to the guidelines occurred frequently in the ICUs of Nemazee hospital. Prescription of loading dose, and AGs level measurement were not done and evaluating microbiological data was often neglected. Incorporating pharmacists in the health care team and holding training programs for physicians and nurses with the goal of raising awareness about the proposed guideline.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz (Iran).
| | - Mahtabalsadat Mirjalili
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz (Iran).
| | - Sara Asadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences. Shiraz (Iran).
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Mahi-Birjand M, Ziaee M, Bijari B, Khalvati R, Abedini MR, Golboei Mousavi H, Ziaee A. Evaluation of vancomycin use in university-affiliated hospitals in Southern Khorasan Province (East Iran) based on HICPAC guidelines. DRUG HEALTHCARE AND PATIENT SAFETY 2019; 11:29-35. [PMID: 31040721 PMCID: PMC6459150 DOI: 10.2147/dhps.s187732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Vancomycin resistance has raised concerns about its effectiveness prospect in the treatment of patients with Gram-positive infections. The Healthcare Infection Control Practices Advisory Committee (HICPAC) has recently established guidelines to delineate improper use of vancomycin. In this light, we sought out to determine the appropriateness of vancomycin prescription using the HICPAC guidelines. Setting The study was carried out in two university-affiliated hospitals, Valiasr and Imam Reza, with 297 and 234 beds, respectively, from May 2012 to May 2013. Methods This retrospective study evaluated the vancomycin prescription and usage in the hospitals. Total vancomycin use was determined and expressed as vancomycin courses per 298 admitted patients. The patient information was collected on a data collection sheet as follows: demographic variables, etiology and localization of infection, microbiological data, duration of vancomycin treatment, reasons for vancomycin prescription, prescribed antibiotic dosing, and patient regimen. Results The average age of the patients and vancomycin treatment duration were 55.965 years and 10.5 days, respectively. Septicemia (15.7%) was the most common cause of vancomycin administration. Vancomycin use was documented to be appropriate and inappropriate in 236 (89.4%) and 28 (10.6%) patients, respectively. No statistically significant differences were found among the wards and hospitals (P values =0.66 and 0.54, respectively) in terms of appropriateness of vancomycin use based on the HICPAC criteria. In addition, 29.21% and 62% of all patients exhibited complete and partial recovery, respectively. We found that 90% of the cases showed compliance with the HICPAC recommendations. Conclusion Comprehensive programs are required to improve the vancomycin use in the hospitals. Vancomycin use should be monitored due to its large-scale empiric use. The rate of improper use of vancomycin in the infection and intensive care unit services may be high, and pharmacists must take appropriate action to optimize the use of the drug.
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Affiliation(s)
- Motahare Mahi-Birjand
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran,
| | - Masood Ziaee
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran,
| | - Bita Bijari
- Infectious Disease Research Center, Birjand University of Medical Sciences, Birjand, Iran,
| | - Reza Khalvati
- Food and Drug Administration, Mazandaran University of Medical Sciences, Mazandaran, Iran
| | - Mohammad Reza Abedini
- Department of Pharmacology, Cellular and Molecular Research Center, School of Medicine, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Arash Ziaee
- Mashhad University of Medical Sciences, Mashhad, Iran
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Ertürk Şengel B, Bilgin H, Ören Bilgin B, Gidener T, Saydam S, Pekmezci A, Ergönül Ö, Korten V. The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system. Int J Infect Dis 2019; 82:40-43. [PMID: 30844518 DOI: 10.1016/j.ijid.2019.02.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP. METHODS A prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use ≥72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use ≥72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods. RESULTS A total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095). CONCLUSIONS This study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback.
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Affiliation(s)
- Buket Ertürk Şengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Hüseyin Bilgin
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Beyza Ören Bilgin
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tolga Gidener
- Marmara University School of Medicine, Istanbul, Turkey
| | - Simge Saydam
- Marmara University School of Medicine, Istanbul, Turkey
| | | | - Önder Ergönül
- Department of Infectious Disease and Clinical Microbiology, Koc University, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1310-1361. [DOI: 10.1007/s00103-018-2811-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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16
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Implementation and outcomes of hospital-wide computerized antimicrobial approval system and on-the-spot education in a traumatic intensive care unit in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:672-680. [PMID: 29167061 DOI: 10.1016/j.jmii.2017.10.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 09/20/2017] [Accepted: 10/09/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND/PURPOSE Inappropriate prescribing of antibiotics is a major health-care problem in intensive care units (ICUs). This study evaluates the impact of a direct hospital-wide computerized antimicrobial approval system (HCAAS) and on-the-spot education for practitioners in a neurosurgical ICU in Taiwan. METHODS We retrospectively analyzed the medical records monthly of patients who were admitted to the neurosurgical ICU during a period of 7 years and 7 months. A pretest-post-test time series analysis, comparing the three periods: period I (no infectious disease (ID) physician), period II (part-time ID physicians), and period III (full-time ID physician). Antimicrobial consumption and expenditure, incidence of hospital-associated infections, prevalence of healthcare-associated bacterial isolates, in-hospital mortality rates, and indication of antibiotics usage were analyzed. RESULTS Full-time ID physician can increase the consumption of narrow-spectrum antimicrobials (cefazolin, and cefuroxime), and decrease the consumptions of broad-spectrum antimicrobials (ceftazidime, cefepime, and vancomycin) compared to part-time ID physicians. From period I to period III, the expenditure of antimicrobials, incidence of hospital-associated pneumonia, and the in-hospital mortality rates (crude, sepsis-related, and overall infection-related mortality) decreased statistically. The prevalence of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae, and Carbapenems-resistant Pseudomonas aeruginosa remained at low level after HCAAS implementation. From 2007 to 2009, the rational antibiotics usage continued to increase, resulting from to more prophylaxis and appropriate microbiologic proof, but less empiric antimicrobial therapy. CONCLUSION Implementation of HCAAS and long-term on-the-spot education by full-time ID physician can reduce antimicrobial consumption, cost, and improve inappropriate antibiotic usage whilst not compromising healthcare quality.
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Vazin A, Karimzadeh I, Zand A, Hatami-Mazinani N, Firouzabadi D. Evaluating Adherence of Health-Care Team to Standard Guideline of Colistin Use at Intensive Care Units of a Referral Hospital in Shiraz, Southwest of Iran. Adv Pharm Bull 2017; 7:391-397. [PMID: 29071221 PMCID: PMC5651060 DOI: 10.15171/apb.2017.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 12/01/2022] Open
Abstract
Purpose: To evaluate colistin use according to global standard drug consumption in intensive care units of a referral hospital in Shiraz, Iran Methods: A prospective, interventional study was performed during an 11 month period on 100 patients admitted to ICUs of a teaching hospital being treated with colistin for at least 3 subsequent doses. Required demographic, clinical, and paraclinical data were gathered by a pharmacist. Fifteen indexes were considered to evaluate colistin use. A clinical pharmacist reviewed indication and dose of colistin at the time of prescribing this agent. Results: In our study population, pneumonia (69%) was the main indication of colistin. In 87% of patients, colistin administration was based on microbiological laboratory evidence. Continuation of therapy was inappropriate in 5% of cases. By the intervention of the clinical pharmacist, colistin was discontinued in all patients in whom empirical therapy was continued incorrectly. None of the patients received loading dose of colistin. The maintenance dose, dose interval, and duration of treatment of colistin were appropriate in 76%, 71%, and 100% of patients, respectively. For none of the patients, the pharmacokinetic dosing method was used. In all patients, serum creatinine and WBC count were evaluated on daily basis. The sum indexes of colistin use were relevant to standard guidelines in 67.33% of the cases. Conclusion: The results of this study highlight the necessity of the pharmaceutical care team participation in all stages of treatment with antibiotics. After pharmacist interventions, some criteria of colistin utilization were corrected and brought closer to standard values.
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Affiliation(s)
- Afsaneh Vazin
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Iman Karimzadeh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Atiyeh Zand
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nazafarin Hatami-Mazinani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Dena Firouzabadi
- Department of Clinical Pharmacy, Faculty of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Sipahi OR, Uysal S, Aydemir SŞ, Pullukçu H, Taşbakan M, Tünger A, Çilli FF, Yamazhan T, Arda B, Sipahi H, Ulusoy S. Antibacterial resistance patterns and incidence of hospital-acquired Staphylococcus aureus bacteremia in a tertiary care educational hospital in Turkey: a perspective from 2001 to 2013. Turk J Med Sci 2017; 47:1210-1215. [PMID: 29156865 DOI: 10.3906/sag-1607-63] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Staphylococcus aureus is an important nosocomial pathogen and a successful antimicrobial-resistance developer. In this study we retrospectively evaluated the resistance patterns and incidence of microbiologically confirmed nosocomial bacteremia (MCNB) related S. aureus strains between 2001 and 2013. Materials and methods: Any patient in whom S. aureus was isolated in at least one set of blood cultures (sent to the bacteriology laboratory 72 h after hospital admission) was considered to have MCNB. Results: The methicillin-resistant S. aureus (MRSA) rate in 2001 was 73.8% whereas it was 36.2% in 2013. When the 2001-2003 and 2011?2013 periods were compared, resistance to oxacillin, levofloxacin, gentamicin, erythromycin, and clindamycin decreased significantly (P < 0.05). When we evaluated the total S. aureus, MRSA, and methicillin-sensitive S. aureus (MSSA) bacteremia rates per 1000 days and 1000 patients, there was an increase in the 2004?2005 period, which was followed by a slight decrease until 2013 (P < 0.05). There was a plateau in MCNB-related S. aureus rates between 2008 and 2011. Conclusion: There was a decrease in overall S. aureus and MRSA bacteremia incidence as well as MRSA rates except for a plateau between 2008 and 2011. This steady decrease in the resistance rates is most probably due to the 2003 budget application and application of antimicrobial stewardship.
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Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. THE LANCET. INFECTIOUS DISEASES 2017. [PMID: 28629876 DOI: 10.1016/s1473-3099(17)30325-0] [Citation(s) in RCA: 442] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Antibiotic stewardship programmes have been shown to reduce antibiotic use and hospital costs. We aimed to evaluate evidence of the effect of antibiotic stewardship on the incidence of infections and colonisation with antibiotic-resistant bacteria. METHODS For this systematic review and meta-analysis, we searched PubMed, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and Web of Science for studies published from Jan 1, 1960, to May 31, 2016, that analysed the effect of antibiotic stewardship programmes on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infections in hospital inpatients. Two authors independently assessed the eligibility of trials and extracted data. Studies involving long-term care facilities were excluded. The main outcomes were incidence ratios (IRs) of target infections and colonisation per 1000 patient-days before and after implementation of antibiotic stewardship. Meta-analyses were done with random-effect models and heterogeneity was calculated with the I2 method. FINDINGS We included 32 studies in the meta-analysis, comprising 9 056 241 patient-days and 159 estimates of IRs. Antibiotic stewardship programmes reduced the incidence of infections and colonisation with multidrug-resistant Gram-negative bacteria (51% reduction; IR 0·49, 95% CI 0·35-0·68; p<0·0001), extended-spectrum β-lactamase-producing Gram-negative bacteria (48%; 0·52, 0·27-0·98; p=0·0428), and meticillin-resistant Staphylococcus aureus (37%; 0·63, 0·45-0·88; p=0·0065), as well as the incidence of C difficile infections (32%; 0·68, 0·53-0·88; p=0·0029). Antibiotic stewardship programmes were more effective when implemented with infection control measures (IR 0·69, 0·54-0·88; p=0·0030), especially hand-hygiene interventions (0·34, 0·21-0·54; p<0·0001), than when implemented alone. Antibiotic stewardship did not affect the IRs of vancomycin-resistant enterococci and quinolone-resistant and aminoglycoside-resistant Gram-negative bacteria. Significant heterogeneity between studies was detected, which was partly explained by the type of interventions and co-resistance patterns of the target bacteria. INTERPRETATION Antibiotic stewardship programmes significantly reduce the incidence of infections and colonisation with antibiotic-resistant bacteria and C difficile infections in hospital inpatients. These results provide stakeholders and policy makers with evidence for implementation of antibiotic stewardship interventions to reduce the burden of infections from antibiotic-resistant bacteria. FUNDING German Center for Infection Research.
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de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, Fellhauer M, Geiss HK, Janata O, Krause R, Lemmen S, Meyer E, Mittermayer H, Porsche U, Presterl E, Reuter S, Sinha B, Strauß R, Wechsler-Fördös A, Wenisch C, Kern WV. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection 2017; 44:395-439. [PMID: 27066980 PMCID: PMC4889644 DOI: 10.1007/s15010-016-0885-z] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute. Materials and methods A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development. Conclusion The guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.
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Affiliation(s)
- K de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - F Allerberger
- Division Public Health, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - S Amann
- Hospital Pharmacy, Munich Municipal Hospital, Munich, Germany
| | - P Apfalter
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - H-R Brodt
- Department of Infectious Disease Medical Clinic II, Goethe-University Frankfurt, Frankfurt, Germany
| | - T Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Fellhauer
- Hospital Pharmacy, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - H K Geiss
- Department of Hospital Epidemiology and Infectiology, Sana Kliniken AG, Ismaning, Germany
| | - O Janata
- Department for Hygiene and Infection Control, Danube Hospital, Vienna, Austria
| | - R Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - S Lemmen
- Division of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Aachen, Germany
| | - E Meyer
- Institute of Hygiene and Environmental Medicine, Charité, University Medicine Berlin, Berlin, Germany
| | - H Mittermayer
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - U Porsche
- Department for Clinical Pharmacy and Drug Information, Landesapotheke, Landeskliniken Salzburg (SALK), Salzburg, Austria
| | - E Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - S Reuter
- Clinic for General Internal Medicine, Infectious Diseases, Pneumology and Osteology, Klinikum Leverkusen, Leverkusen, Germany
| | - B Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Strauß
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - A Wechsler-Fördös
- Department of Antibiotics and Infection Control, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - C Wenisch
- Medical Department of Infection and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - W V Kern
- Division of Infectious Diseases, Department of Medicine, Freiburg University Medical Center, Freiburg, Germany
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Jabri FF. Antimicrobial Consumption and Multidrug Resistant Organisms in Intensive Care Units. Biometrics 2017. [DOI: 10.4018/978-1-5225-0983-7.ch004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Improper antimicrobial use and bacterial resistance can affect an entire community, threaten public health and create economic burdens and ecological consequences on societies. This chapter discusses the importance of counteracting this public health issue. In Saudi Arabia, the appropriate use of antimicrobial agents is of particular concern. The prescribing of broad-spectrum antimicrobials in hospital settings is not highly restricted, and antimicrobials are available over the counters in pharmacies. This unwise use provides a scenario for the emergence of bacterial resistance and subsequent public health concerns. In addition, there is a lack of representative epidemiological research on antimicrobial consumption and quantitative data linking consumption to the incidence of resistance. This chapter illustrates that the implementation and the success of the strategies that monitor and control antimicrobial consumption depend on the availability of information about the extent and patterns of antimicrobial consumption. It demonstrates the potentials and recommendations on obtaining antimicrobial consumption data using defined daily dose as a unit of measurement in Saudi hospital settings.
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Guclu E, Ogutlu A, Karabay O, Demirdal T, Erayman I, Hosoglu S, Turhan V, Erol S, Oztoprak N, Batirel A, Altay FA, Kaya G, Karahocagil M, Sozen H, Yildirim M, Kocak F, Teker B. Antibiotic consumption in Turkish hospitals; a multi-centre point prevalence study. J Chemother 2016; 29:19-24. [PMID: 27238248 DOI: 10.1080/1120009x.2016.1156893] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This multi-centre study aimed to determine the antibiotic consumption in Turkish hospitals by point prevalence. Antibiotic consumption of 14 centres was determined using the DDD method. Among hospitalized patients, 44.8% were using antibiotics and the total antibiotic consumption was 674.5 DDD/1000 patient-days (DPD). 189.6 (28%) DPD of the antibiotic consumption was restricted while 484.9 (72%) DPD was unrestricted. Carbapenems (24%) and beta lactam/beta lactamase inhibitors (ampicillin-sulbactam or amoxicillin-clavulanate; 22%) were the most commonly used restricted and unrestricted antibiotics. Antibiotics were most commonly used in intensive care units (1307.7 DPD). Almost half of the hospitalized patients in our hospitals were using at least one antibiotic. Moreover, among these antibiotics, the most commonly used ones were carbapenems, quinolones and cephalosporins, which are known to cause collateral damage. We think that antibiotic resistance, which is seen at considerably high rates in our hospitals, is associated with this level of consumption.
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Affiliation(s)
- Ertugrul Guclu
- a Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Sakarya University , Sakarya , Turkey
| | - Aziz Ogutlu
- a Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Sakarya University , Sakarya , Turkey
| | - Oguz Karabay
- a Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Sakarya University , Sakarya , Turkey
| | - Tuna Demirdal
- b Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Izmir Katip Celebi University , Izmir , Turkey
| | - Ibrahim Erayman
- c Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Necmettin Erbakan University , Konya , Turkey
| | - Salih Hosoglu
- d Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology , Dicle University , Diyarbakır , Turkey
| | - Vedat Turhan
- e Department of Infectious Diseases and Clinical Microbiology , GATA Haydarpasa Training and Research Hospital , Istanbul , Turkey
| | - Serpil Erol
- f Department of Infectious Diseases and Clinical Microbiology , Haydarpasa Numune Training and Research Hospital , Istanbul , Turkey
| | - Nefise Oztoprak
- g Department of Infectious Diseases and Clinical Microbiology , Antalya Training and Research Hospital , Antalya , Turkey
| | - Ayse Batirel
- h Department of Infectious Diseases and Clinical Microbiology , Dr. Lutfi Kirdar Kartal Training and Research Hospital , Istanbul , Turkey
| | - Fatma Aybala Altay
- i Department of Infectious Diseases and Clinical Microbiology , Ankara Diskapi Yildirim Beyazit Education and Research Hospital , Ankara , Turkey
| | - Gulsum Kaya
- j Health Science Institute, Sakarya University , Sakarya , Turkey
| | - Mustafa Karahocagil
- k Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Yuzuncuyıl University , Van , Turkey
| | - Hamdi Sozen
- l Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Mugla Sıtkı Kocman University , Mugla , Turkey
| | - Mustafa Yildirim
- m Department of Infectious Diseases and Clinical Microbiology , Umraniye Training and Research Hospital , Istanbul , Turkey
| | - Funda Kocak
- n Division of Infectious Diseases and Clinical Microbiology , Health Ministry Basaksehir State Hospital , Istanbul , Turkey
| | - Bahri Teker
- o Division of Infectious Diseases and Clinical Microbiology , Nisa Private Hospital , Istanbul , Turkey
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[Impact of an infectious diseases consultation service on the quality of care and the survival of patients with infectious diseases]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2015; 109:500-10. [PMID: 26593765 DOI: 10.1016/j.zefq.2015.09.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 09/03/2015] [Accepted: 09/03/2015] [Indexed: 11/20/2022]
Abstract
While trained infectious diseases (ID) specialists are regularly involved in inpatient and outpatient care in the United States and Canada, these specialized services are only rarely established in Germany. This article aims to summarize the findings of numerous studies that investigated the impact of ID consultation services on patient care and outcome in patients suffering from infectious diseases. The strongest evidence for a clinical benefit is found in the context of Staphylococcus aureus bacteremia (SAB), where in-hospital- and day-30 mortality was significantly and consistently reduced by about 40% in patients that were evaluated and treated in cooperation with an ID physician. Furthermore, studies revealed that this effect was associated with an improved adherence to standards of care. Newer studies show a reduced length of hospital stay due to ID consultations, especially if patients are evaluated early in the course of their hospital stay. Of note, informal or curbside consultations do not seem to be equivalent to a formal ID consultation with bedside patient evaluation. Studies in other patient groups (solid organ transplant recipients or intensive care unit patients) or in the context of other infections (infective endocarditis, pneumonia, other bloodstream infections) also revealed positive effects of ID consultations. Higher rates of appropriate empirical and targeted antimicrobial treatments and de-escalation strategies due to successful pathogen identification were documented. These modifications resulted in lower treatment costs and decreased antimicrobial resistance development. Although there are methodological limitations in single studies, we consider the consistent and reproducible positive effects of ID consultations shown in studies in different countries and health care systems as convincing evidence for the improved quality of care and treatment outcomes in patients with infectious diseases. Thus, strong consideration should be given to establish ID consultation services in small and medium sized hospitals as well.
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Veličković - Radovanović R, Stefanović N, Damnjanović I, Kocić B, Antić S, Dinić M, Petrović J, Mitić R, Catić - Djordjević A. Monitoring of antibiotic consumption and development of resistance by enterobacteria in a tertiary care hospital. J Clin Pharm Ther 2015; 40:426-30. [DOI: 10.1111/jcpt.12283] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 04/15/2015] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | - B. Kocić
- Faculty of Medicine; University of Nis; Nis Serbia
- Institute for Public Health Nis; Nis Serbia
| | - S. Antić
- Institute for Public Health Nis; Nis Serbia
| | - M. Dinić
- Faculty of Medicine; University of Nis; Nis Serbia
- Institute for Public Health Nis; Nis Serbia
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Evaluation of restricted antibiotic use in a hospital in Romania. Int J Clin Pharm 2015; 37:452-6. [PMID: 25832678 DOI: 10.1007/s11096-015-0096-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Accepted: 03/04/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Antibiotics are the most frequently used drugs among hospitalised patients. Antimicrobial resistance is a major health issue and therefore antibiotic consumption should be under strict surveillance. OBJECTIVE To evaluate the use of restricted antibiotics in an academic hospital in Romania. METHODS Retrospective evaluation of the use of 11 restricted antibiotics issued based on the antibiotics formularies for the year 2012. Therapeutic guidelines and the summary of product characteristics were used for the evaluation. The appropriateness antibiotics use was verified, according to three main criteria: appropriate indication (type of treatment, localization and type of infection), dose and duration of treatment. Descriptive statistics and multiple logistic regression analysis were performed. Results 664 prescribing formularies were analyzed, of these 319 were from the intensive care unit (48.04 %). The most prescribed antibiotics were vancomycin (171, 25.75 %), imipenem (151, 22.74 %) and meropenem (116, 17.47 %). Overall, 285 prescriptions (42.92 %) were considered inappropriate. Vancomycin, meropenem and imipenem were prescribed inappropriate in 49.71, 46.55 and 44.06 % of such cases. Of the total 285 prescriptions deemed as inappropriate, for 49.82 % the dose was incorrect, 20 % were inadequate in terms of treatment duration and 15.44 % were wrongly indicated. Inappropriate use was significantly higher among empirical prescriptions than the documented ones (69.75 vs. 30.25 %, p < 0.001). Multiple stepwise logistic regression identified that the duration of the treatment was significant for inappropriate antibiotic use (p < 0.05). The risk of inappropriate use in the case of empirical prescriptions is higher than for documented prescriptions (OR 5.78, p < 0.001, CI 3.65-9.15). CONCLUSIONS the results suggest the need to intensify the control of the use of restricted antibiotics. The implementation of drug formularies in hospitals and the involvement of the clinical pharmacist may ensure rational antibiotic therapy.
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Pulcini C, Botelho-Nevers E, Dyar OJ, Harbarth S. The impact of infectious disease specialists on antibiotic prescribing in hospitals. Clin Microbiol Infect 2014; 20:963-72. [PMID: 25039787 DOI: 10.1111/1469-0691.12751] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given the current bacterial resistance crisis, antimicrobial stewardship programmes are of the utmost importance. We present a narrative review of the impact of infectious disease specialists (IDSs) on the quality and quantity of antibiotic use in acute-care hospitals, and discuss the main factors that could limit the efficacy of IDS recommendations. A total of 31 studies were included in this review, with a wide range of infections, hospital settings, and types of antibiotic prescription. Seven of 31 studies were randomized controlled trials, before/after controlled studies, or before/after uncontrolled studies with interrupted time-series analysis. In almost all studies, IDS intervention was associated with a significant improvement in the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input, and with decreased antibiotic consumption. Variability in the antibiotic prescribing practices of IDSs, informal (curbside) consultations and the involvement of junior IDSs are among the factors that could have an impact on the efficacy of IDS recommendations and on compliance rates, and deserve further investigation. We also discuss possible drawbacks of IDSs in acute-care hospitals that are rarely reported in the published literature. Overall, IDSs are valuable to antimicrobial stewardship programmes in hospitals, but their impact depends on many human and organizational factors.
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Affiliation(s)
- C Pulcini
- Service de Maladies Infectieuses, CHU de Nancy, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France
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Martins HSI, Bomfim MRQ, França RO, Farias LM, Carvalho MAR, Serufo JC, Santos SG. Resistance markers and genetic diversity in Acinetobacter baumannii strains recovered from nosocomial bloodstream infections. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:1465-78. [PMID: 24477210 PMCID: PMC3945548 DOI: 10.3390/ijerph110201465] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/09/2014] [Accepted: 01/18/2014] [Indexed: 01/25/2023]
Abstract
In this study, phenotypic and genotypic methods were used to detect metallo-β-lactamases, cephalosporinases and oxacillinases and to assess genetic diversity among 64 multiresistant Acinetobacter baumannii strains recovered from blood cultures in five different hospitals in Brazil from December 2008 to June 2009. High rates of resistance to imipenem (93.75%) and polymyxin B (39.06%) were observed using the disk diffusion (DD) method and by determining the minimum inhibitory concentration (MIC). Using the disk approximation method, thirty-nine strains (60.9%) were phenotypically positive for class D enzymes, and 51 strains (79.6%) were positive for cephalosporinase (AmpC). Using the E-test, 60 strains (93.75%) were positive for metallo-β-lactamases (MβLs). All strains were positive for at least one of the 10 studied genes; 59 (92.1%) contained blaVIM-1, 79.6% contained blaAmpC, 93.7% contained blaOXA23 and 84.3% contained blaOXA51. Enterobacteria Repetitive Intergenic Consensus (ERIC)-PCR analysis revealed a predominance of certain clones that differed from each other. However, the same band pattern was observed in samples from the different hospitals studied, demonstrating correlation between the genotypic and phenotypic results. Thus, ERIC-PCR is an appropriate method for rapidly clustering genetically related isolates. These results suggest that defined clonal clusters are circulating within the studied hospitals. These results also show that the prevalence of MDR A. baumannii may vary among clones disseminated in specific hospitals, and they emphasize the importance of adhering to appropriate infection control measures.
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Affiliation(s)
- Hanoch S I Martins
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Antônio Carlos 6627, Pampulha 31207-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Rosa Q Bomfim
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Antônio Carlos 6627, Pampulha 31207-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Rafaela O França
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Antônio Carlos 6627, Pampulha 31207-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Luiz M Farias
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Antônio Carlos 6627, Pampulha 31207-901, Belo Horizonte, Minas Gerais, Brazil.
| | - Maria Auxiliadora R Carvalho
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Antônio Carlos 6627, Pampulha 31207-901, Belo Horizonte, Minas Gerais, Brazil.
| | - José Carlos Serufo
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal de Minas Gerais, Professor Alfredo Balena 190, Santa Efigênia 30130-100, Belo Horizonte, MG, Brazil.
| | - Simone G Santos
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Antônio Carlos 6627, Pampulha 31207-901, Belo Horizonte, Minas Gerais, Brazil.
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Surveillance and correlation of antimicrobial usage and resistance of Pseudomonas aeruginosa: a hospital population-based study. PLoS One 2013; 8:e78604. [PMID: 24250801 PMCID: PMC3826718 DOI: 10.1371/journal.pone.0078604] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/23/2013] [Indexed: 12/31/2022] Open
Abstract
This retrospective study evaluated trends and association between resistance of Pseudomonas aeruginosa isolated from patients with hospital-acquired infections (HAIs) and hospital antimicrobial usage from 2003 through 2011 in a tertiary care hospital in northeast China. HAI was defined as occurrence of infection after hospital admission, without evidence that infection was present or incubating (≦48 h) on admission. In vitro susceptibilities were determined by disk diffusion test and susceptibility profiles were determined using zone diameter interpretive criteria, as recommended by Clinical and Laboratory Standards Institute (CLSI). Data on usage of various antimicrobial agents, expressed as defined daily dose (DDD) per 1,000 patients-days developed by WHO Anatomical Therapeutical Chemical (ATC)/DDD index 2011, were collected from hospital pharmacy computer database. Most of 747 strains of P. aeruginosa were collected from respiratory samples (201 isolates, 26.9%), blood (179, 24.0%), secretions and pus (145, 19.4%) over the years. Time series analysis demonstrated a significant increase in resistance rates of P. aeruginosa to ticarcillin/clavulanic acid, piperacillin/tazobactam, cefoperazone/sulbactam, piperacillin, imipenem, meropenem, ceftazidime, cefepime, ciprofloxacin, and levofloxacin except aminoglycosides over time in the hospital (P<0.001). The rates of carbapenem-resistant P. aeruginosa (CRPA) isolated from patients with HAIs were 14.3%, 17.1%, 21.1%, 24.6%, 37.0%, 48.8%, 56.4%, 51.2%, and 54.1% over time. A significant increase in usage of anti-pseudomonal carbapenems (P<0.001) was seen. ARIMA models demonstrated that anti-pseudomonal carbapenems usage was strongly correlated with the prevalence of imipenem and meropenem-resistant P. aeruginosa (P<0.001). Increasing of quarterly CRPA was strongly correlated at one time lag with quarterly use of anti-pseudomonal carbapenems (P<0.001). Our data demonstrated positive correlation between anti-pseudomonal antimicrobial usage and P. aeruginosa resistance to several classes of antibiotics, but not all antimicrobial agents in the hospital.
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Xu J, Sun Z, Li Y, Zhou Q. Surveillance and correlation of antibiotic consumption and resistance of Acinetobacter baumannii complex in a tertiary care hospital in northeast China, 2003-2011. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:1462-73. [PMID: 23571451 PMCID: PMC3709328 DOI: 10.3390/ijerph10041462] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2013] [Revised: 03/28/2013] [Accepted: 03/29/2013] [Indexed: 11/16/2022]
Abstract
This study investigated the changes in resistance of Acinetobacter baumannii complex and the association of carbapenem-resistant A. baumannii complex (CRAB) infection and hospital antimicrobial usage from 2003 to 2011 in a tertiary care hospital in northeast China. In vitro susceptibilities were determined by disk diffusion test and susceptibility profiles were determined using zone diameter interpretive criteria, as recommended by the Clinical and Laboratory Standards Institute (CLSI). Data on consumption of various antimicrobial agents, expressed as defined daily dose/1,000 patients/day, were collected retrospectively from hospital pharmacy computer database. Most of 2,485 strains of A. baumannii complex were collected from respiratory samples (1,618 isolates, 65.1%), secretions and pus (465, 18.7%) over the years. The rates of antimicrobial resistance in A. baumannii complex increased significantly over the years. The rates of CRAB were between 11.3% and 59.1% over the years. The quarterly use of anti-pseudomonal carbapenems, but not other classes of antibiotics, was strongly correlated with the increase of quarterly CRAB (β = 1.661; p < 0.001). Dedicated use of anti-pseudomonal carbapenems would be an important intervention to control the increase of CRAB.
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Affiliation(s)
- Jiancheng Xu
- Department of Laboratory Medicine, First Hospital of Jilin University, Changchun 130021, China; E-Mail:
| | - Zhihui Sun
- Department of Pharmacy, First Hospital of Jilin University, Changchun 130021, China; E-Mails: (Z.S.); (Y.L.)
| | - Yanyan Li
- Department of Pharmacy, First Hospital of Jilin University, Changchun 130021, China; E-Mails: (Z.S.); (Y.L.)
| | - Qi Zhou
- Department of Pediatrics, First Hospital of Jilin University, Changchun 130021, China
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +86-431-8878-3458; Fax: +86-431-8565-4528
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Okay OS, Li K, Yediler A, Karacik B. Determination of selected antibiotics in the Istanbul strait sediments by solid-phase extraction and high performance liquid chromatography. JOURNAL OF ENVIRONMENTAL SCIENCE AND HEALTH. PART A, TOXIC/HAZARDOUS SUBSTANCES & ENVIRONMENTAL ENGINEERING 2012; 47:1372-1380. [PMID: 22571525 DOI: 10.1080/10934529.2012.672303] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Surface sediments from 12 different locations of the Istanbul Strait and Marmara Sea, Turkey were analysed for five antibiotics belonging to two different groups of widely used pharmaceuticals, tetracyclines (TCs) and fluoroquinolones (FQs), by solid-phase extraction and high performance liquid chromatography. These two groups of antibiotics, mainly used to prevent or treat illness for humans as well as for animals, are frequently detected in the effluent of municipal sewage plants, in the aquatic environments and in soils after being spread by liquid manure. The results of analysis revealed that measured concentrations of individual antibiotics were significantly different depending on sampling location. Chlortetracycline (CTC) was not detected in any of the samples. High concentrations were mainly found in urbanized regions of the Strait. The concentrations of the two tetracyclines ranged from not detectable to 27.3 μg kg(-1) in freeze-dried marine sediments. Comparable results were obtained for the two fluoroquinolones with concentration levels from 1.3 μg kg(-1) up 34.1 μg kg(-1). This study is the first attempt to show the contamination degree of the Istanbul Strait sediments by emerging contaminants. Particular concern should be given concerning their potential side effects caused by the frequent consumption of mussels and fishes captured in the Istanbul Strait.
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Affiliation(s)
- Oya S Okay
- Istanbul Technical University, Faculty of Naval Architecture and Ocean Engineering, Maslak, Istanbul, Turkey.
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Sipahi OR, Bardak S, Turhan T, Arda B, Pullukcu H, Ruksen M, Aydemir S, Dalbasti T, Yurtseven T, Zileli M, Ulusoy S. Linezolid in the treatment of methicillin-resistant staphylococcal post-neurosurgical meningitis: A series of 17 cases. ACTA ACUST UNITED AC 2011; 43:757-64. [DOI: 10.3109/00365548.2011.585177] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lee B. Editorial Commentary:Digital Decision Making: Computer Models and Antibiotic Prescribing in the Twenty‐First Century. Clin Infect Dis 2008; 46:1139-41. [DOI: 10.1086/529441] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Buijs J, Dofferhoff ASM, Mouton JW, Wagenvoort JHT, van der Meer JWM. Concentration-dependency of beta-lactam-induced filament formation in Gram-negative bacteria. Clin Microbiol Infect 2008; 14:344-9. [PMID: 18261128 DOI: 10.1111/j.1469-0691.2007.01940.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Ceftazidime and cefotaxime are beta-lactam antibiotics with dose-related affinities for penicillin-binding protein (PBP)-3 and PBP-1. At low concentrations, these antibiotics inhibit PBP-3, leading to filament formation. Filaments are long strands of non-dividing bacteria that contain enhanced quantities of endotoxin molecules. Higher concentrations of ceftazidime or cefotaxime cause inhibition of PBP-1, resulting in rapid bacterial lysis, which is associated with low endotoxin release. In the present study, 37 isolates of Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa and Acinetobacter spp. were studied over a 4-h incubation period in the presence of eight concentrations of ceftazidime or cefotaxime. As resistance of Gram-negative bacteria is an emerging problem in clinical practice, 14 isolates of E. coli and Klebsiella pneumoniae that produced extended-spectrum beta-lactamases (ESBLs) were also investigated. Morphological changes after exposure to the beta-lactam antibiotics revealed recognisable patterns in various bacterial families, genera and isolates. In general, all isolates of Enterobacteriaceae produced filaments within a relatively small concentration range, with similar patterns for E. coli and K. pneumoniae. Pseudomonas and Acinetobacter spp. produced filaments in the presence of clinically-relevant concentrations of both antibiotics as high as 50 mg/L. In all genera, filament-producing capacity was clearly related to the MIC. Ceftazidime induced filament production in more isolates and over wider concentration ranges than did cefotaxime. Interestingly, ESBL-producing isolates were not protected against filament induction. The induction of filament production may lead to additional risks during empirical treatment of severe infections.
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Affiliation(s)
- J Buijs
- Department of Medical Microbiology and Infectious Diseases, Atrium Medical Centre, Heerlen, The Netherlands.
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