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Zanichelli V, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Pulcini C, Le Maréchal M, Tebano G, Vlahović-Palčevski V, Stanić Benić M, Milanič R, Harbarth S, Hulscher ME, Huttner B. Variation in antibiotic use among and within different settings: a systematic review. J Antimicrob Chemother 2018; 73:vi17-vi29. [PMID: 29878219 PMCID: PMC5989604 DOI: 10.1093/jac/dky115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Variation in antibiotic use may reflect inappropriate use. We aimed to systematically describe the variation in measures for antibiotic use among settings or providers. This study was conducted as part of the innovative medicines initiative (IMI)-funded international project DRIVE-AB. Methods We searched for studies published in MEDLINE from January 2004 to January 2015 reporting variation in measures for systemic antibiotic use (e.g. DDDs) in inpatient and outpatient settings. The ratio between a study's reported maximum and minimum values of a given measure [maximum:minimum ratio (MMR)] was calculated as a measure of variation. Similar measures were grouped into categories and when possible the overall median ratio and IQR were calculated. Results One hundred and forty-three studies were included, of which 85 (59.4%) were conducted in Europe and 12 (8.4%) in low- to middle-income countries. Most studies described the variation in the quantity of antibiotic use in the inpatient setting (81/143, 56.6%), especially among hospitals (41/81, 50.6%). The most frequent measure was DDDs with different denominators, reported in 23/81 (28.4%) inpatient studies and in 28/62 (45.2%) outpatient studies. For this measure, we found a median MMR of 3.7 (IQR 2.6-5.0) in 4 studies reporting antibiotic use in ICUs in DDDs/1000 patient-days and a median MMR of 2.3 (IQR 1.5-3.2) in 18 studies reporting outpatient antibiotic use in DDDs/1000 inhabitant-days. Substantial variation was also identified in other measures. Conclusions Our review confirms the large variation in antibiotic use even across similar settings and providers. Data from low- and middle-income countries are under-represented. Further studies should try to better elucidate reasons for the observed variation to facilitate interventions that reduce unwarranted practice variation. In addition, the heterogeneity of reported measures clearly shows that there is need for standardization.
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Affiliation(s)
- Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Université de Lorraine, APEMAC, F-54000 Nancy, France
| | | | | | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey. Infect Control Hosp Epidemiol 2016; 37:647-54. [PMID: 26905338 DOI: 10.1017/ice.2016.26] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.
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Tang J, Wang L, Xi Y, Liu G. A three-year survey of the antimicrobial resistance of microorganisms at a Chinese hospital. Exp Ther Med 2016; 11:731-736. [PMID: 26997986 PMCID: PMC4774333 DOI: 10.3892/etm.2016.2983] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 10/13/2015] [Indexed: 11/06/2022] Open
Abstract
The present retrospective study aimed to investigate the antibiotic susceptibility of bacteria at Shanghai First People's Hospital (Shanghai, China) between 2009 and 2011. An increasing trend of antibiotic resistance was observed in this hospital between 2009 and 2011. Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus were the most prevalent resistant strains. Antimicrobial susceptibility was detected using standard Kirby-Bauer disk diffusion and analyzed using World Health Organization software. E. coli was demonstrated to be the most prevalent bacterium in the present survey between 2009 and 2011 (16.2, 20.0 and 19.6%, respectively); followed by A. baumannii (13.5, 13.3 and 10.6%, respectively) and S. aureus. Notably, >70% of E. coli and 70% of S. aureus were resistant to common antibiotics; whereas 60% of A. baumannii and 20% of Pseudomonas aeruginosa were resistant to the majority of the antibiotics investigated. In 2011, Enterococcus faecalis exhibited a resistance rate of 55.6% against levofloxacin and E. faecium exhibited a 53.2% resistance rate. The present survey demonstrated an increasing trend in bacterial resistance against antibiotics; therefore, more stringent guidelines for antibiotics should be advocated.
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Affiliation(s)
- Jing Tang
- Department of Clinical Pharmacy, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, P.R. China
| | - Lili Wang
- Department of Blood Transfusion, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, P.R. China
| | - Yufei Xi
- Department of Clinical Pharmacy, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, P.R. China
| | - Gaolin Liu
- Department of Clinical Pharmacy, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200080, P.R. China
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Saunders L, Perennec-Olivier M, Jarno P, L’Hériteau F, Venier AG, Simon L, Giard M, Thiolet JM, Viel JF. Improving prediction of surgical site infection risk with multilevel modeling. PLoS One 2014; 9:e95295. [PMID: 24835189 PMCID: PMC4023946 DOI: 10.1371/journal.pone.0095295] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 03/25/2014] [Indexed: 11/19/2022] Open
Abstract
Background Surgical site infection (SSI) surveillance is a key factor in the elaboration of strategies to reduce SSI occurrence and in providing surgeons with appropriate data feedback (risk indicators, clinical prediction rule). Aim To improve the predictive performance of an individual-based SSI risk model by considering a multilevel hierarchical structure. Patients and Methods Data were collected anonymously by the French SSI active surveillance system in 2011. An SSI diagnosis was made by the surgical teams and infection control practitioners following standardized criteria. A random 20% sample comprising 151 hospitals, 502 wards and 62280 patients was used. Three-level (patient, ward, hospital) hierarchical logistic regression models were initially performed. Parameters were estimated using the simulation-based Markov Chain Monte Carlo procedure. Results A total of 623 SSI were diagnosed (1%). The hospital level was discarded from the analysis as it did not contribute to variability of SSI occurrence (p = 0.32). Established individual risk factors (patient history, surgical procedure and hospitalization characteristics) were identified. A significant heterogeneity in SSI occurrence between wards was found (median odds ratio [MOR] 3.59, 95% credibility interval [CI] 3.03 to 4.33) after adjusting for patient-level variables. The effects of the follow-up duration varied between wards (p<10−9), with an increased heterogeneity when follow-up was <15 days (MOR 6.92, 95% CI 5.31 to 9.07]). The final two-level model significantly improved the discriminative accuracy compared to the single level reference model (p<10−9), with an area under the ROC curve of 0.84. Conclusion This study sheds new light on the respective contribution of patient-, ward- and hospital-levels to SSI occurrence and demonstrates the significant impact of the ward level over and above risk factors present at patient level (i.e., independently from patient case-mix).
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Affiliation(s)
- Lauren Saunders
- Coordination Centre for Nosocomial Infection Control, Western Regions, Rennes, France
- Department of Public Health, Faculty of Medicine, Rennes, France
| | | | - Pascal Jarno
- Coordination Centre for Nosocomial Infection Control, Western Regions, Rennes, France
| | - François L’Hériteau
- Coordination Centre for Nosocomial Infection Control, Northern Regions, Paris, France
| | - Anne-Gaëlle Venier
- Coordination Centre for Nosocomial Infection Control, South-Western Regions, Bordeaux, France
| | - Loïc Simon
- Coordination Centre for Nosocomial Infection Control, Eastern Regions, Nancy, France
| | - Marine Giard
- Coordination Centre for Nosocomial Infection Control, South-Eastern Regions, Lyon, France
| | | | - Jean-François Viel
- Department of Public Health, Faculty of Medicine, Rennes, France
- * E-mail:
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Behnke M, Hansen S, Leistner R, Diaz LAP, Gropmann A, Sohr D, Gastmeier P, Piening B. Nosocomial infection and antibiotic use: a second national prevalence study in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:627-33. [PMID: 24133543 PMCID: PMC3796357 DOI: 10.3238/arztebl.2013.0627] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/29/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2011, seventeen years after the first national study on the prevalence of nosocomial infections and antibiotic use in German hospitals, a second national prevalence study was carried out according to the specifications of the European Centre for Disease Prevention and Control (ECDC). METHODS The ECDC protocol, containing uniform surveillance definitions and ascertainment methods, was implemented. The only infections counted were those that were active or under treatment with antibiotics on the day of the study. In addition to the representative sample required by the ECDC, which consisted of 46 hospitals, further hospitals participated on a voluntary basis. RESULTS Data on 41 539 patients in 132 hospitals were analyzed. The prevalence of infections that had arisen during the current hospital stay was 3.8% in the overall group and 3.4% in the representative sample of 9626 patients in 46 hospitals. The prevalence of all nosocomial infections, including those acquired before the current hospital stay and still present upon admission, was 5.1% in both the overall group and the representative sample. The prevalence of antibiotic use on the day of the study was 25.5% and 23.3% in the two groups, respectively. CONCLUSION The prevalence of nosocomial infection has not changed since 1994, but the prevalence of antibiotic use has increased. In interpreting these findings, one should bear in mind that confounders may have influenced them in different directions: The mean length of hospital stay is now shorter than in 1994, but the mean age of hospitalized patients is higher.
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Affiliation(s)
- Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | | | - Alexander Gropmann
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Dorit Sohr
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Brar Piening
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
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Kanerva M, Ollgren J, Lyytikainen O, Agthe N, Mottonen T, Kauppinen M, Laurila K, Suomalainen P, Vuorela R, Ryhta I, Vastamaki R, Helen M, Hietaniemi K, Varis T, Eliin L, Nieminen J, Skogberg K, Salminen R, Yrjonsalo ML, Kimmo AM, Sandberg K, Tuppurainen T, Mattila K, Aalto A, Anttila VJ, Estlander C, Hamalainen M, Jalkanen M, Kanerva M, Kuutamo T, Lappalainen T, Mattila P, Pipping D, Ratia M, Sammalkorpi K, Simons L, Tommila P, Totterman I, Lehtinen P, Torvinen S, Eklund M, Fellman M, Mikkola J, Haapaniemi L, Junka A, Jakobsson A, Leppaaho-Lakka J, Patsi S, Rummukainen M, Tiitinen T, Liikka M, Hamalainen S, Koivula I, Rissanen AM, Ruotsalainen E, Terasvirta H, Hannola K, Marttinen T, Palosara J, Pietikainen R, Kaukoniemi U, Nurkkala-Pitko T, Broas M, Isojarvi J, Jagerroos H, Jankala E, Niemi P, Poyry S, Raisanen L, Leukka M, Dahl S, Ijas P, Karkkainen P, Vuorinen S, Heikkila H, Kaija T, Teirila I, Haapala J, Harkonen M, Reiman A, Salonen J, Sarkkinen H, Sihvola H, Turunen P, Taskila H, Virranniemi L, Huttunen S, Rintala E, Uusitalo-Seppala R, Pulli T, Sistonen A, Panttila A, Saikku J, Tapanainen M, Lumio J, Sinkkonen J, Routamaa M, Terho K, Elomaa N, Eriksen-Neuman B. Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment. J Antimicrob Chemother 2011; 66:2651-4. [DOI: 10.1093/jac/dkr333] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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