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Gobezie MY, Tesfaye NA, Faris AG, Hassen M. Surveillance of antimicrobial utilization in Africa: a systematic review and meta-analysis of prescription rates, indications, and quality of use from point prevalence surveys. Antimicrob Resist Infect Control 2024; 13:101. [PMID: 39256804 PMCID: PMC11389494 DOI: 10.1186/s13756-024-01462-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 09/04/2024] [Indexed: 09/12/2024] Open
Abstract
BACKGROUND Antimicrobial resistance (AMR) is a global public health concern that is fueled by the overuse of antimicrobial agents. Low- and middle-income countries, including those in Africa,. Point prevalence surveys (PPS) have been recognized as valuable tools for assessing antimicrobial utilization and guiding quality improvement initiatives. This systematic review and meta-analysis aimed to evaluate the prescription rates, indications, and quality of antimicrobial use in African health facilities. METHODS A comprehensive search was conducted in multiple databases, including PubMed, Scopus, Embase, Hinari (Research4Life) and Google Scholar. Studies reporting the point prevalence of antimicrobial prescription or use in healthcare settings using validated PPS tools were included. The quality of the studies was assessed using the Joanna Briggs Institute (JBI) critical appraisal checklist. A random-effects meta-analysis was conducted to combine the estimates. Heterogeneity was evaluated using Q statistics, I² statistics, meta-regression, and sensitivity analysis. Publication bias was assessed using a funnel plot and Egger's regression test, with a p-value of < 0.05 indicating the presence of bias. RESULTS Out of 1790 potential studies identified, 32 articles were included in the meta-analysis. The pooled prescription rate in acute care hospitals was 60%, with significant heterogeneity (I2 = 99%, p < 0.001). Therapeutic prescriptions constituted 62% of all the prescribed antimicrobials. Prescription quality varied: documentation of reasons in notes was 64%, targeted therapy was 10%, and parenteral prescriptions were 65%, with guideline compliance at 48%. Hospital-acquired infections comprised 20% of all prescriptions. Subgroup analyses revealed regional disparities in antimicrobial prescription prevalence, with Western Africa showing a prevalence of 65% and 44% in Southern Africa. Publication bias adjustment estimated the prescription rate at 54.8%, with sensitivity analysis confirming minor variances among studies. CONCLUSION This systematic review and meta-analysis provide valuable insights into antimicrobial utilization in African health facilities. The findings highlight the need for improved antimicrobial stewardship and infection control programs to address the high prevalence of irrational antimicrobial prescribing. The study emphasizes the importance of conducting regular surveillance through PPS to gather reliable data on antimicrobial usage, inform policy development, and monitor the effectiveness of interventions aimed at mitigating AMR.
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Affiliation(s)
- Mengistie Yirsaw Gobezie
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Nuhamin Alemayehu Tesfaye
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Abebe Getie Faris
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Minimize Hassen
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
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Legros S, Vanoverschelde A, van Krieken J, Debaveye Y, Versporten A, Huis In 't Veld D, Westelinck V, Briquet C, Vercheval C, Spriet I, Denis O, Magerman K, De Schepper M, Buyle F. Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND - modified Delphi procedure. Acta Clin Belg 2024; 79:77-86. [PMID: 38146874 DOI: 10.1080/17843286.2023.2297123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/15/2023] [Indexed: 12/27/2023]
Abstract
INTRODUCTION Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. OBJECTIVES The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. METHODS A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. RESULTS A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. CONCLUSION Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.
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Affiliation(s)
- Sylvie Legros
- Pharmacy Department, Europe Hospitals, Brussels, Belgium
- Department of Antimicrobial Stewardship, Antimicrobial Stewardship, Europe Hospitals, Brussels, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Ghent University, Ghent, Belgium
| | | | - Yves Debaveye
- Department of Intensive Care Medicine, KU Leuven, University Hospitals Leuven, Leuven, Belgium
| | - Ann Versporten
- Belgian Antibiotic Policy Coordination Commission (BAPCOC), Quality and Patient Safety, Direction General Healthcare, Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Diana Huis In 't Veld
- Department of Internal Medicine and Infectious Diseases, University Hospital Ghent, Ghent, Belgium
| | - Veerle Westelinck
- Department of Pharmacy, AZ Sint-Maarten, Mechelen, Belgium
- Antimicrobial Stewardship, AZ Sint-Maarten, Mechelen, Belgium
| | - Caroline Briquet
- Antimicrobial Stewardship, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
- Pharmacy Department, Cliniques Universitaires, Saint-Luc, UCLouvain, Brussels, Belgium
| | - Christelle Vercheval
- Department of Antimicrobial Stewardship, Hospital Outbreak Support Team (HOST), H.uni network, Brussels, Belgium
| | - Isabel Spriet
- Pharmacy Department, University Hospitals Leuven, Leuven, Belgium
- Clinical Pharmacology and Pharmacotherapy, Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Olivier Denis
- Laboratory of microbiology, CHU UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Koen Magerman
- Department of Laboratory Medicine, Jessa Ziekenhuis vwz, Hasselt, Belgium
| | | | - Franky Buyle
- Pharmacy Department, Ghent University Hospital, Ghent, Belgium
- Antimicrobial Stewardship, Ghent University Hospital, Ghent, Belgium
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Ayhan M, Coşkun B, Kayaaslan B, Hasanoğlu İ, Kalem AK, Eser F, Bilir YA, Ünlü S, Güner R. Point prevalence of antibiotic usage in major referral hospital in Turkey. PLoS One 2024; 19:e0296900. [PMID: 38295065 PMCID: PMC10830045 DOI: 10.1371/journal.pone.0296900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 12/21/2023] [Indexed: 02/02/2024] Open
Abstract
INTRODUCTION The most important and undesirable consequence of inappropriate antibiotic use is the spread of antibiotic resistance, increased adverse effects, increased mortality and healthcare costs. We aimed to assess antibiotic usage characteristics in inpatient setting in our center. MATERIALS AND METHODS A one-day, single center point-prevalence study was carried out on June 9th 2021, in Ankara City Hospital in Turkey. Data of antibiotic consumption, appropriateness of usage and predictors of inappropriate use in adult patients were evaluated. RESULTS Out of 2640 adult patients, 893 (33.8%) were receiving at least one antibiotic. A total of 1212 antibiotic prescriptions with an average of 1.44±0.64 were found. Antibiotics were most commonly used for therapeutic purpose (84.7%), followed by surgical prophylaxis (11.6%). Majority of therapeutically used antibiotics were empirical (67.9%). Infectious diseases consultation was present in 68.3% with a compliance rate of 95.7%. Rate of inappropriate use was 20%. The most frequent cause of inappropriateness was unnecessary use (52.5%). Most commonly and most inappropriately used antibiotics were carbapenems (17.5%) and first generation cephalosporins (38.7%), respectively. Most of the inappropriateness observed in first-generation cephalosporins was due to inappropriate longer surgical prophylaxis. While age is an independent risk factor for inappropriate antibiotic use (p = 0.042), COVID-19 unit admission, use for therapeutic purpose and infectious diseases consultation were protective factors (p<0.001, p<0.001, p<0.001). CONCLUSION Rate of inappropriate use was low, but inappropriate surgical prophylaxis remains an important problem in surgical units. There is a considerable need to implement an antimicrobial stewardship program that focuses on surgical prophylaxis practices.
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Affiliation(s)
- Müge Ayhan
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Belgin Coşkun
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Bircan Kayaaslan
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - İmran Hasanoğlu
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Fatma Eser
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
| | - Yeşim Aybar Bilir
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Serpil Ünlü
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Rahmet Güner
- Department of Infectious Diseases and Clinical Microbiology, Ankara Yıldırım Beyazıt University, Ankara City Hospital, Ankara, Turkey
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So M, Nakamachi Y, Thursky K. Auditing tools for antimicrobial prescribing in solid organ transplant recipients: The why, the how, and an assessment of current options. Transpl Infect Dis 2022; 24:e13905. [DOI: 10.1111/tid.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 01/15/2023]
Affiliation(s)
- Miranda So
- Sinai Health‐University Health Network Antimicrobial Stewardship Program, University Health Network Toronto Ontario Canada
- Leslie Dan Faculty of Pharmacy University of Toronto Toronto Ontario Canada
| | - Yoshiko Nakamachi
- Sinai Health‐University Health Network Antimicrobial Stewardship Program, University Health Network Toronto Ontario Canada
| | - Karin Thursky
- National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity University of Melbourne Melbourne Victoria Australia
- Royal Melbourne Hospital Melbourne Victoria Australia
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Mbyemeire H, Ssekatawa K, Kato CD, Wampande EM. Molecular characterization and distribution of cephalosporin resistance determinants in Escherichia coli and Klebsiella pneumoniae isolated from patients attending Kampala International University Teaching Hospital in Bushenyi, Western Uganda. ALEXANDRIA JOURNAL OF MEDICINE 2021. [DOI: 10.1080/20905068.2021.1952821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Herbert Mbyemeire
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western, Bushenyi, Uganda
- African Center of Excellence in Materials Product Development and Nanotechnology (MAPRONANO ACE, College of Engineering Design Art and Technology Makerere University, Kampala, Uganda, Africa
| | - Kenneth Ssekatawa
- Department of Biochemistry, Faculty of Biomedical Sciences, Kampala International University-Western, Bushenyi, Uganda
- African Center of Excellence in Materials Product Development and Nanotechnology (MAPRONANO ACE, College of Engineering Design Art and Technology Makerere University, Kampala, Uganda, Africa
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
| | - Charles D. Kato
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
- Department of Microbiology and Immunology, Faculty of Biomedical Sciences, Kampala International University-Western Campus, Bushenyi, Uganda
| | - Eddie M. Wampande
- College of Veterinary Medicine, Animal Resources and Biosecurity, Makerere University, Kampala, Uganda
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Seni J, Mapunjo SG, Wittenauer R, Valimba R, Stergachis A, Werth BJ, Saitoti S, Mhadu NH, Lusaya E, Konduri N. Antimicrobial use across six referral hospitals in Tanzania: a point prevalence survey. BMJ Open 2020; 10:e042819. [PMID: 33323448 PMCID: PMC7745526 DOI: 10.1136/bmjopen-2020-042819] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/15/2020] [Accepted: 11/13/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To delineate the prevalence and factors associated with antimicrobial use across six referral hospitals in Tanzania using WHO point prevalence survey (PPS) methodology to inform hospital-specific antimicrobial stewardship programmes. DESIGN Cross-sectional analytical study. SETTING Six referral hospitals in Tanzania. PARTICIPANTS Patients irrespective of age and gender (n=948) admitted in the six referral hospital wards before 8:00 hours on each day of the survey were included in December 2019. Using the WHO PPS methodology, data on hospitals, wards, patients, antibiotics, and indications for antibiotics were collected. OUTCOME MEASURES We analysed the prevalence of antibiotic use by referral hospital, ward, indication and patient characteristics as the main outcomes. We also described adherence to the Tanzania Standard Treatment Guidelines (STG) and WHO's AWaRe categorisation of antibiotics. RESULTS Approximately 62.3% of inpatients were prescribed antibiotics, predominantly from the Access group of antibiotics (ceftriaxone, metronidazole or ampicillin-cloxacillin). The overall adherence of antibiotic prescriptions to the Tanzania STG was high (84.0%), with the exception of Sekou Toure Regional Referral Hospital (68.0%) and Maweni Regional Referral Hospital (57.8%). The most common indication for antibiotic prescriptions was community-acquired infections (39.8%). Children less than 2 years of age (OR 1.73, 95% CI 1.02 to 2.92, p=0.039); admission to surgical wards (OR 4.90, 95% CI 2.87 to 8.36, p <0.001); and admission to paediatric wards (OR 3.93, 95% CI 2.16 to 7.15, p <0.001) were associated with increased odds of antibiotic use. Only 2 of 591 patients were prescribed antibiotics based on culture and antimicrobial susceptibility testing results. CONCLUSIONS Empirical use of antibiotics is common, and the Access group of antibiotics is predominantly prescribed in children less than 2 years and patients admitted to surgical and paediatric wards. Lack of utilisation of antimicrobial susceptibility testing services in these hospitals requires urgent interventions. Routine monitoring of antibiotic use is recommended to be part of antibiotic stewardship programmes in Tanzania.
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Affiliation(s)
- Jeremiah Seni
- Weill Bugando School of Medicine, Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Siana G Mapunjo
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Rachel Wittenauer
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Richard Valimba
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health (MSH), Dar es Salaam, Tanzania
| | - Andy Stergachis
- Department of Global Health, University of Washington, Seattle, Washington, USA
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | - Brian J Werth
- School of Pharmacy, University of Washington, Seattle, Washington, USA
| | | | - Noel H Mhadu
- Ministry of Health, Community Development, Gender, Elderly and Children, Dodoma, Tanzania
| | - Edgar Lusaya
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program, Management Sciences for Health (MSH), Dar es Salaam, Tanzania
| | - Niranjan Konduri
- USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS), Management Sciences for Health (MSH), Arlington, Virginia, USA
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Horumpende PG, Mshana SE, Mouw EF, Mmbaga BT, Chilongola JO, de Mast Q. Point prevalence survey of antimicrobial use in three hospitals in North-Eastern Tanzania. Antimicrob Resist Infect Control 2020; 9:149. [PMID: 32894182 PMCID: PMC7487761 DOI: 10.1186/s13756-020-00809-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial resistance (AMR) is one of the most urgent global health threats with low-resource countries being disproportionately affected. Targeted interventions require insight in antibiotic prescription practices. A point prevalence survey (PPS) is a well-known tool to get insight in antibiotic dispensing practices in hospitals and identify areas for improvement. Here, we describe the results of a PPS performed in a tertiary, regional and district hospital in Kilimanjaro region in Tanzania. Methods A PPS was performed in the Kilimanjaro Christian Medical Centre (KCMC; tertiary hospital), Mawenzi (regional) and St. Joseph (district) hospital in November and December 2016. Antibiotic use in all patients admitted more than 24 h and those undergoing surgery was recorded. All clinical wards were included except the pediatrics. Data from a single ward were collected on the same day. Results A total of 399 patients were included in the PPS: 232 patients from KCMC, 94 from Mawenzi hospital and 73 patients from St. Joseph hospital. Overall prevalence of antibiotic use was 44.0%: 38% in KCMC, 59% in Mawenzi and 63% in St. Joseph. Ceftriaxone (n = 94, 29.8%), metronidazole (n = 79, 23.9%) and other antibiotics belonging to the penicillin class (n = 89, 28.3%) were most commonly prescribed. Antibiotics prescribed for surgical prophylaxis were continued for more than 3 days in 57% of cases. Conclusion Our study shows a rate of broad-spectrum antibiotic use in Tanzanian hospitals and prolonged surgical antibiotic prophylaxis being a common practice. PPS is an important tool to improve future antibiotic use in Tanzania hospitals.
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Affiliation(s)
- Pius G Horumpende
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania. .,Kilimanjaro Clinical Research Institute, Moshi, Tanzania. .,Institute of Infectious Diseases, Military College of Medical Sciences (MCMS) and General Military Hospital (GMH), Lugalo, Dar es Salaam, Tanzania.
| | - Stephen E Mshana
- Catholic University of Health and Allied Sciences (CUHAS), Mwanza, Tanzania
| | - Elise F Mouw
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Blandina T Mmbaga
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Jaffu O Chilongola
- Kilimanjaro Christian Medical University College, P.O. BOX 2240, Moshi, Tanzania.,Kilimanjaro Clinical Research Institute, Moshi, Tanzania
| | - Quirijn de Mast
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
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Stordeur F, Miliani K, Lacavé L, Rogues AM, Dumartin C, Alfandari S, Astagneau P, L'Hériteau F. How to measure hospital antibiotic consumption: comparison of two methods from data surveillance in France. JAC Antimicrob Resist 2020; 2:dlaa059. [PMID: 34223016 PMCID: PMC8210307 DOI: 10.1093/jacamr/dlaa059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 06/18/2020] [Accepted: 06/24/2020] [Indexed: 11/23/2022] Open
Abstract
Background Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. Objectives To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. Methods The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman’s correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. Results A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. Conclusions Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement.
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Affiliation(s)
- Florence Stordeur
- Centre hospitalier intercommunal de Poissy St Germain, 10 rue du champ Gaillard, 78100 Poissy, France
| | - Katiuska Miliani
- Centre d'appui pour la prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France
| | - Ludivine Lacavé
- Assistance Publique - Hôpitaux de Paris (AP-HP), délégation à la recherche clinique et à l'innovation (DRCI), Paris, France
| | - Anne-Marie Rogues
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,CHU Bordeaux, Hygiène hospitalière, F-33000 Bordeaux, France
| | - Catherine Dumartin
- Université Bordeaux, Inserm, Bordeaux Population Health Research Center, Team Pharmacoepidemiology, UMR 1219, F-33000 Bordeaux, France.,CHU Bordeaux, CPias Nouvelle Aquitaine, F-33000 Bordeaux, France
| | | | - Pascal Astagneau
- Centre d'appui pour la prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France.,Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, F-75013 Paris, France
| | - François L'Hériteau
- Centre d'appui pour la prévention des infections associées aux soins (CPias) Ile-de-France, Paris, France
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Wathne JS, Skodvin B, Charani E, Harthug S, Blix HS, Nilsen RM, Kleppe LKS, Vukovic M, Smith I. Identifying targets for antibiotic stewardship interventions through analysis of the antibiotic prescribing process in hospitals - a multicentre observational cohort study. Antimicrob Resist Infect Control 2020; 9:114. [PMID: 32693826 PMCID: PMC7374853 DOI: 10.1186/s13756-020-00749-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 06/04/2020] [Indexed: 01/10/2023] Open
Abstract
Background In order to change antibiotic prescribing behaviour, we need to understand the prescribing process. The aim of this study was to identify targets for antibiotic stewardship interventions in hospitals through analysis of the antibiotic prescribing process from admission to discharge across five groups of infectious diseases. Methods We conducted a multi-centre, observational cohort study, including patients with lower respiratory tract infections, exacerbation of chronic obstructive pulmonary disease, skin- and soft tissue infections, urinary tract infections or sepsis, admitted to wards of infectious diseases, pulmonary medicine and gastroenterology at three teaching hospitals in Western Norway. Data was collected over a 5-month period and included antibiotics prescribed and administered during admission, antibiotics prescribed at discharge, length of antibiotic therapy, indication for treatment and discharge diagnoses, estimated glomerular filtration rate (eGFR) on admission, antibiotic allergies, place of initiation of therapy, admittance from an institution, patient demographics and outcome data. Primary outcome measure was antibiotic use throughout the hospital stay, analysed by WHO AWaRe-categories and adherence to guideline. Secondary outcome measures were a) antibiotic prescribing patterns by groups of diagnoses, which were analysed using descriptive statistics and b) non-adherence to the national antibiotic guidelines, analysed using multivariate logistic regression. Results Through analysis of 1235 patient admissions, we identified five key targets for antibiotic stewardship interventions in our population of hospital inpatients; 1) adherence to guideline on initiation of treatment, as this increases the use of WHO Access-group antibiotics, 2) antibiotic prescribing in the emergency room (ER), as 83.6% of antibiotic therapy was initiated there, 3) understanding prescribing for patients admitted from other institutions, as this was significantly associated with non-adherence to guideline (OR = 1.44 95% CI 1.04, 2.00), 4) understanding cultural and contextual drives of antibiotic prescribing, as non-adherent prescribing differed significantly between the sites of initiation of therapy (between hospitals and ER versus ward) and 5) length of therapy, as days of antibiotic therapy was similar across a wide range of diagnoses and with prolonged therapy after discharge. Conclusions Analysing the process of antibiotic prescribing in hospitals with patient-level data identified important targets for antibiotic stewardship interventions in hospitals.
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Affiliation(s)
- Jannicke Slettli Wathne
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway. .,Norwegian Advisory Unit for Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway. .,Department of Quality and Development, Hospital Pharmacies Enterprise in Western Norway, Møllendalsbakken 9, 5021, Bergen, Norway.
| | - Brita Skodvin
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway.,Norwegian Advisory Unit for Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Esmita Charani
- NHIR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Hammersmith Hospital Campus, Du Cane Road, London, W12 0NN, UK
| | - Stig Harthug
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, 5021, Bergen, Norway.,Norwegian Advisory Unit for Antibiotic Use in Hospitals, Department of Research and Development, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, Marcus Thranes gate 6, 0473, Oslo, Norway.,School of Pharmacy, University of Oslo, Sem Sælandsvei 3, 0371, Oslo, Norway
| | - Roy M Nilsen
- Western Norway University of Applied Sciences, Inndalsveien 28, 5063, Bergen, Norway
| | - Lars Kåre Selland Kleppe
- Department of Infectious Diseases and Unit for Infection Prevention and Control, Department of Research and Education, Stavanger University Hospital, Armauer Hansens vei 20, 4011, Stavanger, Norway
| | - Marta Vukovic
- Department of Pharmaceutical Services, Oslo Hospital Pharmacy, Kirkeveien 166, 0450, Oslo, Norway
| | - Ingrid Smith
- Innovation, Access and Use, Department of Essential Medicines and Health Products, World Health Organization (WHO), Avenue Appia 20, 1211, Geneva 27, Switzerland.
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Saleem Z, Hassali MA, Godman B, Versporten A, Hashmi FK, Saeed H, Saleem F, Salman M, Rehman IU, Khan TM. Point prevalence surveys of antimicrobial use: a systematic review and the implications. Expert Rev Anti Infect Ther 2020; 18:897-910. [PMID: 32394754 DOI: 10.1080/14787210.2020.1767593] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: In view of increasing concerns with antimicrobial resistance (AMR), the World Health Organization (WHO) instituted a Global Action Plan (GAP) to address this. Area covered: One of the strategies to achieve the goals of GAP is to conduct regular surveillance of antimicrobial use through point prevalence surveys (PPS). In this review, PubMed, EBSCO, Proquest, Cinahl, and Scopus were searched for PPS of antimicrobial use published in English between January 2000 and December 2019. After systematic database screening of 2,893 articles, 60 PPS met the inclusion criteria and consequently were incorporated in this systematic review. Expert opinion: This review highlighted that most of the PPS were conducted in upper-middle and high-income countries. Prevalence of antimicrobial use was significantly higher in non-European hospitals compared with European hospitals. The domination of third-generation cephalosporin and fluoroquinolones use across all the regions suggests substantial use of broad-spectrum antimicrobials across countries. Among all identified regions around the world, India was the region where the highest use of antimicrobials was observed. Although PPS is a useful tool to assess the pattern of antimicrobial use and provides a robust baseline; however, a standardized surveillance method is needed. In order to optimize antimicrobial use, more efforts are required to improve antimicrobial use.
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Affiliation(s)
- Zikria Saleem
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia.,Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Mohamed Azmi Hassali
- School of Pharmaceutical Sciences, Universiti Sains Malaysia , George Town, Malaysia
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School , Liverpool, UK.,Department of Clinical Pharmacology, Karolinska Institute , Stockholm, Sweden.,Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University , Glasgow, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp , Antwerp, Belgium
| | | | - Hamid Saeed
- University College of Pharmacy, University of the Punjab , Lahore, Pakistan
| | - Fahad Saleem
- Faculty of Pharmacy and Health Sciences, University of Balochistan , Quetta, Pakistan
| | - Muhammad Salman
- Faculty of Pharmacy, The University of Lahore , Lahore, Pakistan
| | - Inayat Ur Rehman
- Department of Pharmacy, Abdul Wali Khan University Mardan , Mardan, Pakistan.,School of Pharmacy, Monash University Malaysia , Bandar Sunway, Malaysia
| | - Tahir Mehmood Khan
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore, Pakistan
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11
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Wilke M, Hübner C, Kämmerer W. Calculated parenteral initial treatment of bacterial infections: Economic aspects of antibiotic treatment. GMS INFECTIOUS DISEASES 2020; 8:Doc03. [PMID: 32373428 PMCID: PMC7186923 DOI: 10.3205/id000047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
This is the seventeenth chapter of the guideline "Calculated initial parenteral treatment of bacterial infections in adults - update 2018" in the 2nd updated version. The German guideline by the Paul-Ehrlich-Gesellschaft für Chemotherapie e.V. (PEG) has been translated to address an international audience. This chapter analyses economic aspects of antiinfective therapy. Any treatment decision is also a cost decision. In this chapter the authors particularly analyse whether or not there is evidence that certain clinically effective strategies as Antimicrobial Stewardship programs (AMS), guideline adherent initial therapy, early diagnostics, De-escalation, sequence therapy or therapeutic drug monitoring also have benficial economic effects. These can be direct savings or shortening of length of stay to free resources.
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Affiliation(s)
| | - Claudia Hübner
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Universität Greifswald, Germany
| | - Wolfgang Kämmerer
- Klinische Pharmazie, Apotheke des Universitätsklinikums Augsburg, Germany
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12
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Dlamini NN, Meyer JC, Kruger D, Kurdi A, Godman B, Schellack N. Feasibility of using point prevalence surveys to assess antimicrobial utilisation in public hospitals in South Africa: a pilot study and implications. Hosp Pract (1995) 2019; 47:88-95. [PMID: 30963821 DOI: 10.1080/21548331.2019.1592880] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES There is currently a lack of data regarding antimicrobial use among public hospitals in South Africa. This is a concern given their growing use and increasing antimicrobial resistance rates in South Africa. Consequently, the objectives of this study were to firstly determine the appropriateness of point prevalence survey (PPS) data collection instruments for performing antimicrobial utilization studies among public sector hospitals in South Africa; secondly, to determine current antimicrobial utilization in a public sector hospital, and thirdly evaluate the prescribing of antimicrobials with those contained within the national Essential Medicines List and Standard Treatment Guidelines (EML/STGs). The findings will be used to guide future activities in South Africa. METHODS A PPS was conducted in Dr George Mukhari Academic Hospital. For each in-patient ward, all patients' files were completely surveyed on a single day. The number of patients who were on antimicrobials served as the numerator and the denominator comprised the total number of patients in the ward. RESULTS 39 wards and 512 patient files were surveyed. The overall prevalence of antimicrobial use was 37.7%, highest in the ICUs. Beta lactamase inhibitors and antimicrobials for tuberculosis were the most prevalent antimicrobials. More than two thirds (83%) of antimicrobial treatment was modified following culture sensitivity test results when requested, and 98% of antimicrobials prescribed were contained within the current EML/STGs. In 10.8% of occasions, antimicrobials appear to have been prescribed other than for treatment, i.e. no systemic infection. There were concerns though with the lack of IV to oral switching. CONCLUSION The PPS method offers a standardized tool that can be used to identify targets for quality improvement. However, there were concerns with the time taken to conduct PPS studies, which is an issue in resource limited settings. This is being addressed alongside concerns with the lack of IV to oral switching.
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Affiliation(s)
- Nokuthula N Dlamini
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Johanna C Meyer
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
| | - Danie Kruger
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,b Pharmacy , Private Hospital , Pretoria , South Africa
| | - Amanj Kurdi
- c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa.,c Department of Pharmacoepidemiology, Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK.,d Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institutet , Karolinska University Hospital Huddinge , Stockholm , Sweden.,e Health Economics Centre , Liverpool University Management School , Liverpool , UK
| | - Natalie Schellack
- a School of Pharmacy , Sefako Makgatho Health Sciences University , Ga-Rankuwa , Pretoria , South Africa
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13
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Elhajji FD, Al-Taani GM, Anani L, Al-Masri S, Abdalaziz H, Qabba'h SH, Al Bawab AQ, Scott M, Farren D, Gilmore F, Versporten A, Goossens H, Aldeyab MA. Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan. BMC Health Serv Res 2018; 18:849. [PMID: 30419895 PMCID: PMC6233602 DOI: 10.1186/s12913-018-3656-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 10/28/2018] [Indexed: 12/04/2022] Open
Abstract
Background To assess antimicrobial prescribing in a Northern Ireland hospital (Antrim Area Hospital (AAH)) and compare them with those of a hospital in Jordan (Specialty Hospital). Methods Using the Global-PPS approach, the present study surveyed patients admitted to the hospital in 2015, the prescribed antibiotics, and a set of quality control indicators related to antibiotics. Results Ultimately, 444 and 112 inpatients in the AAH and the Specialty Hospital, respectively, were surveyed. For the medical group, 165 inpatients were prescribed 239 antibiotics in the AAH, while 44 patients in the Specialty Hospital were prescribed 65 antibiotics. In relation to the surgical group, 34 inpatients treated for infection were prescribed 66 antibiotics in the AAH, while 41 patients in the Specialty Hospital treated for infection were prescribed 56 antibiotics. For the medical patients, the most frequently prescribed antibiotics in the AAH were a combination of penicillins (18.8%) and penicillins with extended spectrum (18.8%). For the surgical patients, the most frequently prescribed antibiotics in the AAH were imidazole derivatives (24.2%). For the medical and surgical patients in the Specialty Hospital, the most frequently prescribed antibiotics were third-generation cephalosporins (26.2 and 37.5%, respectively). In medical patients, compliance to guidelines was 92.2% in the Specialty Hospital compared to 72.0% in the AAH (p < 0.001). In surgical patients, compliance to guidelines was 92.7% in the Specialty Hospital compared to 81.8% in the AAH (p = 0.012). Conclusions The present study highlighted differences in the utilisation of antimicrobials between two hospitals in two distinct regions and benchmarked antibiotic prescriptions across two hospitals.
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Affiliation(s)
- Feras Darwish Elhajji
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | | | - Lana Anani
- The Pharmacy Department, The Specialty Hospital, Amman, Jordan
| | - Sahar Al-Masri
- Quality & Medication Management, The Specialty Hospital, Amman, Jordan
| | - Haneen Abdalaziz
- Department of Clinical Pharmacy & Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | | | | | - Michael Scott
- Northern Health and Social Care Trust, Antrim, Ballymena, Northern Ireland, UK
| | - David Farren
- Northern Health and Social Care Trust, Antrim, Ballymena, Northern Ireland, UK
| | - Fiona Gilmore
- Northern Health and Social Care Trust, Antrim, Ballymena, Northern Ireland, UK
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Mamoon A Aldeyab
- School of Pharmacy and Pharmaceutical Sciences, Ulster University, Coleraine, Northern Ireland, UK
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14
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Okoth C, Opanga S, Okalebo F, Oluka M, Baker Kurdi A, Godman B. Point prevalence survey of antibiotic use and resistance at a referral hospital in Kenya: findings and implications. Hosp Pract (1995) 2018; 46:128-136. [PMID: 29652559 DOI: 10.1080/21548331.2018.1464872] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/10/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND AIMS A substantial amount of antibiotic use in hospitals may be inappropriate, potentially leading to the development and spread of antibiotic resistance, adverse effects, mortality and increased hospital costs. The objective was to assess current patterns of antibiotic use in a leading referral hospital in Western Kenya. This would lead to the identification of opportunities for quality improvement in this hospital and others across Kenya. METHODOLOGY A point prevalence survey was carried out with data abstracted principally from patient medical records supplemented by interviews from physicians when needed. The pattern of antibiotic use was analyzed by descriptive methods. Differences in antibiotic use and indications between the selected wards were compared using the Chi-square test or Fisher's exact tests. RESULTS Among the patients surveyed, 67.7% were on antibiotics. The most common classes of antibiotics prescribed were third generation cephalosporins (55%), imidazole derivatives like metronidazole (41.8%) and broad spectrum penicillins (41.8%). The most common indication for antibiotic use was medical prophylaxis (29%), with local guidelines advocating antibiotic prophylaxis in mothers after delivery of their child as well as in neonates with birth asphyxia and low weight at birth. Dosing of antibiotics was seen as generally optimal when assessed against current recommendations. CONCLUSION Whilst the dosing of antibiotics seemed adequate, there was high use of antibiotics in this hospital. This needs to be urgently reviewed with currently appreciable empiric antibiotic use. Programmes are being instigated to address these concerns. This includes developing antibiotic guidelines and formularies especially for empiric use as well as implementing antimicrobial stewardship activities.
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Affiliation(s)
- Caleb Okoth
- a Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Sylvia Opanga
- a Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy , University of Nairobi , Nairobi , Kenya
| | - Faith Okalebo
- b Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Kenya
| | - Margaret Oluka
- b Department of Pharmacology and Pharmacognosy, School of Pharmacy , University of Nairobi , Kenya
| | - Amanj Baker Kurdi
- c Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
| | - Brian Godman
- c Strathclyde Institute of Pharmacy and Biomedical Sciences , University of Strathclyde , Glasgow , UK
- d Division of Clinical Pharmacology , Karolinska Institute , Stockholm , Sweden
- e Health Economics Centre , Liverpool University Management School, Liverpool University , UK
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15
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Leung V, Li M, Wu JHC, Langford B, Zvonar R, Powis J, Longpre J, Béïque L, Gill S, Ho G, Garber G. Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study. Open Forum Infect Dis 2018; 5:ofy110. [PMID: 29977965 DOI: 10.1093/ofid/ofy110] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 05/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Antimicrobial stewardship, a key component of an overall strategy to address antimicrobial resistance, has been recognized as a global priority. The ability to track and benchmark antimicrobial use (AMU) is critical to advancing stewardship from an organizational and provincial perspective. As there are few comprehensive systems in Canada that allow for benchmarking, Public Health Ontario conducted a pilot in 2016/2017 to assess the feasibility of using a point prevalence methodology as the basis of a province-wide AMU surveillance program. Methods Three acute care hospitals of differing sizes in Ontario, Canada, participated. Adults admitted to inpatient acute care beds on the survey date were eligible for inclusion; a sample size of 170 per hospital was targeted, and data were collected for the 24-hour period before and including the survey date. Debrief sessions at each site were used to gather feedback about the process. Prevalence of AMU and the Antimicrobial Spectrum Index (ASI) was reported for each hospital and by indication per patient case. Results Participants identified required improvements for scalability including streamlining ethics, data sharing processes, and enhancing the ability to compare with peer organizations at a provincial level. Of 457 patients, 172 (38%) were receiving at least 1 antimicrobial agent. Beta-lactam/beta-lactamase inhibitors were the most common (18%). The overall mean ASI per patient was 6.59; most cases were for treatment of infection (84%). Conclusions This pilot identified factors and features required for a scalable provincial AMU surveillance program; future efforts should harmonize administrative processes and enable interfacility benchmarking.
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Affiliation(s)
- Valerie Leung
- Infection Prevention and Control, Public Health Ontario
| | - Michael Li
- Leslie Dan Faculty of Pharmacy, University of Toronto
| | | | | | - Rosemary Zvonar
- Department of Pharmacy, The Ottawa Hospital and Ottawa Hospital Research Institute
| | - Jeff Powis
- Department of Medicine, Michael Garron Hospital, Toronto
| | | | - Lizanne Béïque
- Department of Pharmacy, The Ottawa Hospital and Ottawa Hospital Research Institute
| | - Suzanne Gill
- Department of Pharmaceutial Services, Michael Garron Hospital, Toronto
| | - Grace Ho
- Department of Pharmaceutial Services, Michael Garron Hospital, Toronto
| | - Gary Garber
- Division of Infectious Diseases, The Ottawa Hospital.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, University of Ottawa, Canada
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16
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Longitudinal point prevalence survey of antibacterial use in Northern Ireland using the European Surveillance of Antimicrobial Consumption (ESAC) PPS and Global-PPS tool. Epidemiol Infect 2018; 146:985-990. [PMID: 29690946 DOI: 10.1017/s095026881800095x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Antimicrobial resistance is a limiting factor for the success of the treatment of infectious diseases and is associated with increased morbidity and cost. The present study aims to evaluate prescribing patterns of antimicrobials and quantify progress in relation to targets for quality improvement in the prescription of antimicrobials in Northern Ireland's secondary care sector using three repetitive point prevalence surveys (PPS) over a 6-year period: the European Surveillance of Antimicrobial Consumption (ESAC-PPS) in 2009 and 2011 and the Global-PPS on Antimicrobial Consumption and Resistance in 2015. Out of 3605 patients surveyed over the three time points, 1239 (34.4%) were treated with an antibiotic, the most frequently prescribed antibiotic groups were a combination of penicillins, including β-lactamase inhibitors. Compliance with hospital antibiotic policies in 2009, 2011 and 2015 were 54.5%, 71.5% and 79.9%, respectively. Likewise, an indication for treatment was recorded in patient notes 88.5%, 87.7% and 90.6% in 2009, 2011 and 2015, respectively, and surgical prophylactic antibiotic prescriptions for >24 h was 3.9%, 3.2% and 0.7% in 2009, 2011 and 2015, respectively. Treatment based on biomarker data was used in 61.5% of cases. In conclusion, a general trend in the improvement of key antimicrobial-related quality indicators was noted. The PPS tool provided a convenient, inexpensive surveillance system of antimicrobial consumption and should be considered an essential component to establish and maintain informed antibiotic stewardship in hospitals.
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17
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Mas-Morey P, Valle M. A systematic review of inpatient antimicrobial stewardship programmes involving clinical pharmacists in small-to-medium-sized hospitals. Eur J Hosp Pharm 2017; 25:e69-e73. [PMID: 31157071 DOI: 10.1136/ejhpharm-2017-001381] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/05/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023] Open
Abstract
Objective Antimicrobial stewardship programmes (ASPs) have been widely implemented in large hospitals but little is known regarding small-to-medium-sized hospitals. This literature review evaluates outcomes described for ASPs participated in by clinical pharmacists and implemented in small-to-medium-sized hospitals (<500 beds). Methods Following PRISMA principles, PubMed and Cochrane Library databases were searched in early 2016 for English language articles describing implementation and outcomes for inpatient ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. Each included study was required to include at least one of the following outcomes: microbiological outcomes, quality of care and clinical outcomes or antimicrobial use and cost outcomes. Results We included 28 studies from 26 hospitals, mostly American or Canadian. Most cases (23 studies) consisted of time-series comparisons of pre-and post-intervention periods. Of the 28 studies analysed, 8 reported microbiological outcomes, 21 reported quality of care and clinical outcomes, and 27 reported antimicrobial use and cost outcomes. Interventions were not generally associated with significant changes in mortality or readmission rates but were associated with substantial cost savings, mainly due to reduced use of antibiotics or the use of cheaper antibiotics. Conclusion As far as we are aware, ours is the first systematic review that evaluates ASPs participated in by clinical pharmacists in small-to-medium-sized hospitals. ASPs appear to be an effective strategy for reducing antimicrobial use and cost. However, the limited association with better microbiological, care quality and clinical outcomes would highlight the need for further studies and for standardised methods for evaluating ASP outcomes.
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Affiliation(s)
- Pedro Mas-Morey
- Department of Pharmacy, Hospital Quirónsalud Palmaplanas, Palma de Mallorca, Balearic Islands, Spain.,Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Valle
- Department of Pharmacology, Therapeutics and Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain.,Pharmacokinetic/Pharmacodynamic Modelling and Simulation, Sant Pau Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain
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18
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Krasniqi S, Versporten A, Jakupi A, Raka D, Daci A, Krasniqi V, Deva Z, Rashiti A, Brajshori N, Hajdari S, Bytyqi J, Neziri B, Goossens H, Raka L. Antibiotic utilisation in adult and children patients in Kosovo hospitals. Eur J Hosp Pharm 2017; 26:146-151. [PMID: 31428322 DOI: 10.1136/ejhpharm-2017-001363] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/05/2017] [Accepted: 09/12/2017] [Indexed: 01/21/2023] Open
Abstract
Objectives There are no reliable data on antibiotic use in Kosovo hospitals. The aim of this survey was to monitor volumes and patterns of antibiotic use in hospitalised patients in order to identify targets for quality improvement. Methods Data on antimicrobial use were collected from seven hospitals in Kosovo during 2013 using the standardised point prevalence survey (PPS) methodology as developed by the ESAC (European Surveillance of Antimicrobial Consumption) and ARPEC (Antibiotic Resistance and Prescribing in European Children). The survey included all inpatients receiving an antimicrobial agent on the day of the PPS. Results Overall, 1667 patients were included in the study: adults 1345 (81%) and children 322 (19%). Of the hospital inpatients, 579/1345 (43%) adults and 188/322 (58%) children received at least one antibiotic during a hospital stay. The top three antibacterial subgroups (ATC level 3) were β-lactam antibiotics, cephalosporins and aminoglycosides. In all hospital centres, the most commonly prescribed antibiotic was ceftriaxone (39% for adult and 36% for children). Antibiotics were administered mainly parenterally in 74% of adults and 94% of children. Empirical prescribing was higher in adults 498/579 (86%) and children 181/188 (96%), compared with targeted treatment based on susceptibility testing-81 (14%) and 8 (4%), respectively. Conclusions Antibiotic use in Kosovo's hospitals is very high. Gathered data will be an important tool to identify targets for quality improvement and will support preparation of guidelines and protocols for the prudent use of antibiotics.
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Affiliation(s)
- Shaip Krasniqi
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Ann Versporten
- Faculty of Medicine and Health Science, Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Arianit Jakupi
- Kosovo Medicine Agency, Ministry of Health of Kosovo, Prishtina, Kosovo
| | - Denis Raka
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Armond Daci
- Department of Pharmacy, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Valon Krasniqi
- Department of Pharmacology, Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Zana Deva
- Institute of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo
| | - Albiona Rashiti
- Institute of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo
| | - Naime Brajshori
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Shefqet Hajdari
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Jetëmira Bytyqi
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Burim Neziri
- Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
| | - Herman Goossens
- Faculty of Medicine and Health Science, Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Lul Raka
- Institute of Microbiology, National Institute of Public Health of Kosovo, Prishtina, Kosovo.,Faculty of Medicine, University of Prishtina, Prishtina, Kosovo
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19
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Al-Maliky GR, Al-Ward MM, Taqi A, Balkhair A, Al-Zakwani I. Evaluation of antibiotic prescribing for adult inpatients at Sultan Qaboos University Hospital, Sultanate of Oman. Eur J Hosp Pharm 2017; 25:195-199. [PMID: 31157018 DOI: 10.1136/ejhpharm-2016-001146] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 04/01/2017] [Accepted: 04/03/2017] [Indexed: 11/04/2022] Open
Abstract
Objective Little is known into the prudent use of antibiotics in hospitals in Oman. This study is to evaluate antibiotic prescribing by measuring the overall compliance with the local antibiotic prescribing guidelines. Methods An observational study involving 366 patients' admission episodes as determined by power analysis on patients (≥18 years) on oral and/or parenteral antibiotic during admission, in the period of 10 weeks (1 February-15 April, 2014). The adapted audit tool of the Barking, Havering and Redbridge University Hospitals NHS Trust was used for this study. Analyses were performed using descriptive statistics. Main outcome measures: antibiotic prescribing compliance with the local guidelines as well as the overall restricted antibiotic policy adherence at Sultan Qaboos University Hospital (SQUH). Results The number of prescribed and audited antibiotics totalled 825, compliance with local guidelines was suboptimal at 63% (n=520), and of 211 restricted antibiotics prescribed, the overall adherence to restricted antibiotic policy was inadequate at 46% (n=98). The majority of the antibiotics prescribed were broad spectrum at 90% (n=739), mainly penicillins at 31% (n=256) and cephalosporins at 17% (n=139). Conclusion The study has provided valuable baseline details of antibiotic prescribing patterns in SQUH. The diagnosis was documented in 89% (n=327) of the admission episodes. However, the compliance with SQUH antibiotic prescribing guidelines was suboptimal, and the overall compliance with SQUH restricted antibiotic guidelines was in 46% of the prescriptions. Further studies are required to address the reasons behind the non-compliance with local guidelines.
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Affiliation(s)
| | | | - Aqila Taqi
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Al Khoudh, Oman
| | - Abdullah Balkhair
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Al Khoud, Oman
| | - Ibrahim Al-Zakwani
- Department of Pharmacy, Sultan Qaboos University Hospital, Muscat, Al Khoudh, Oman.,Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, Al Khoudh, Oman
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20
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Fukunaga BT, Sumida WK, Taira DA, Davis JW, Seto TB. Hospital-Acquired Methicillin-resistant Staphylococcus aureus Bacteremia Related to Medicare Antibiotic Prescriptions: A State-Level Analysis. HAWAI'I JOURNAL OF MEDICINE & PUBLIC HEALTH : A JOURNAL OF ASIA PACIFIC MEDICINE & PUBLIC HEALTH 2016; 75:303-309. [PMID: 27738564 PMCID: PMC5056633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) results in almost half of all deaths caused by antibiotic resistant organisms. Current evidence suggests that MRSA infections are associated with antibiotic use. This study examined state-level data to determine whether outpatient antibiotic use was associated with hospital-acquired MRSA (HA-MRSA) infections. The 2013 Centers for Disease Control and Prevention (CDC) Healthcare-Associated Infections Progress Report was used to obtain HA-MRSA infection rates. Data on the number of antibiotic prescriptions with activity towards methicillin-sensitive Staphylococcus aureus (MSSA) at the state level were obtained from the 2013 Medicare Provider Utilization and Payment Data: Part D Prescriber Public Use File. Pearson's correlation coefficient was used to analyze the relationship between the number of antibiotic prescriptions and HA-MRSA infection rates. The average number of HA-MRSA infections was 0.026 per 1000 persons with the highest rates concentrated in Southeastern and Northeastern states. The average number of outpatient prescriptions per capita was 0.74 with the highest rates in Southeastern states. A significant correlation (ρ = 0.64, P <.001) between infections and prescriptions was observed, even after adjusting for non-reporting hospitals. This association provides evidence of the importance of appropriate antibiotic prescribing. Prescriber and heat map data may be useful for targeting antimicrobial stewardship programs in an effort to manage appropriate antibiotic use to help stop antibiotic resistance.
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Affiliation(s)
- Bryce T Fukunaga
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT)
| | - Wesley K Sumida
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT)
| | - Deborah A Taira
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT)
| | - James W Davis
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT)
| | - Todd B Seto
- Daniel K. Inouye College of Pharmacy, University of Hawai'i at Hilo, Hilo, HI (BTF, WKS, DAT)
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Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H. The Worldwide Antibiotic Resistance and Prescribing in European Children (ARPEC) point prevalence survey: developing hospital-quality indicators of antibiotic prescribing for children. J Antimicrob Chemother 2016; 71:1106-17. [DOI: 10.1093/jac/dkv418] [Citation(s) in RCA: 186] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 11/05/2015] [Indexed: 01/19/2023] Open
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Scott MG, Scullin C, Hogg A, Fleming GF, McElnay JC. Integrated medicines management to medicines optimisation in Northern Ireland (2000–2014): a review. Eur J Hosp Pharm 2015. [DOI: 10.1136/ejhpharm-2014-000512] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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James R, Upjohn L, Cotta M, Luu S, Marshall C, Buising K, Thursky K. Measuring antimicrobial prescribing quality in Australian hospitals: development and evaluation of a national antimicrobial prescribing survey tool. J Antimicrob Chemother 2015; 70:1912-8. [PMID: 25724986 DOI: 10.1093/jac/dkv047] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/04/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship (AMS) programmes have been developed with the intention of reducing inappropriate and unnecessary use of antimicrobials, while improving the quality of patient care and locally helping prevent the development of antimicrobial resistance. An important aspect of AMS programmes is the qualitative assessment of prescribing through antimicrobial prescribing surveys (APS), which are able to provide information about the prescribing behaviour within institutions. Owing to lack of standardization of audit tools and the resources required, qualitative methods for the assessment of antimicrobial use are not often performed. The aim of this study was to design an audit tool that was appropriate for use in all Australian hospitals, suited to local user requirements and included an assessment of the overall appropriateness of the prescription. METHODS In November 2011, a pilot APS was conducted across 32 hospitals to assess the usability and generalizability of a newly designed audit tool. Following participant feedback, this tool was revised to reflect the requirements of the respondents. A second pilot study was then performed in November 2012 across 85 hospitals. RESULTS These surveys identified several areas that can be targets for quality improvement at a national level, including: documentation of indication; surgical prophylaxis prescribed for >24 h; compliance with prescribing guidelines; and the appropriateness of the prescription. CONCLUSIONS By involving the end users in the design and evaluation, we have been able to provide a practical and relevant APS tool for quantitative and qualitative data collection in a wide range of Australian hospital settings.
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Affiliation(s)
- Rodney James
- Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Lydia Upjohn
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Menino Cotta
- Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Susan Luu
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Caroline Marshall
- Department of Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Kirsty Buising
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
| | - Karin Thursky
- Victorian Infectious Disease Service, Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria 3010, Australia
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Sabaté M, Ferrer P, Ballarín E, Rottenkolber M, Amelio J, Schmiedl S, Reynolds R, Klungel O, Ibáñez L. Inpatient Drug Utilization in Europe: Nationwide Data Sources and a Review of Publications on a Selected Group of Medicines (PROTECT Project). Basic Clin Pharmacol Toxicol 2014; 116:201-11. [DOI: 10.1111/bcpt.12358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 11/19/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Mònica Sabaté
- Fundació Institut Català de Farmacologia; Barcelona Spain
- Department of Clinical Pharmacology; University Hospital Vall d'Hebron; Barcelona Spain
- Department of Pharmacology, Toxicology and Clinical Therapeutics; Hospital Universitari Vall d'Hebron; Univ Autònoma de Barcelona; Barcelona Spain
| | - Pili Ferrer
- Fundació Institut Català de Farmacologia; Barcelona Spain
| | - Elena Ballarín
- Fundació Institut Català de Farmacologia; Barcelona Spain
- Department of Clinical Pharmacology; University Hospital Vall d'Hebron; Barcelona Spain
| | - Marietta Rottenkolber
- Institute for Medical Information Sciences, Biometry and Epidemiology; Ludwig-Maximilians Universitaet- Muenchen; Munich Germany
| | | | - Sven Schmiedl
- Philipp Klee-Institute for Clinical Pharmacology; Helios Klinik Wuppertal; Wuppertal Germany
- Department of Clinical Pharmacology; School of Medicine; Faculty of Health; Witten-Herdecke University; Witten Germany
| | - Robert Reynolds
- Epidemiology; Pfizer Research & Development; New York NY USA
| | - Olaf Klungel
- Division of Pharmacoepidemiology and Clinical Pharmacology; Utrecht University; Utrecht The Netherlands
| | - Luisa Ibáñez
- Fundació Institut Català de Farmacologia; Barcelona Spain
- Department of Clinical Pharmacology; University Hospital Vall d'Hebron; Barcelona Spain
- Department of Pharmacology, Toxicology and Clinical Therapeutics; Hospital Universitari Vall d'Hebron; Univ Autònoma de Barcelona; Barcelona Spain
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Radošević Quadranti N, Popović B, Škrobonja I, Skočibušić N, Vlahović-Palčevski V. Assessment of adherence to printed guidelines for antimicrobial drug use in a university hospital. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2014-000533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Antibacterial usage in English NHS hospitals as part of a national Antimicrobial Stewardship Programme. Public Health 2014; 128:693-7. [PMID: 25132393 DOI: 10.1016/j.puhe.2014.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2014] [Indexed: 11/22/2022]
Abstract
Antimicrobial resistance (AMR) has become a global problem for health care services, with fewer antimicrobials entering the market and some pathogenic organisms becoming resistant to commonly used antimicrobials. Antimicrobial stewardship (AS), including evidence-based standard setting, education and communication, and audits of practice, has become a key method of preventing the rise in the rise in AMR. Data on antibiotic consumption are often obtained through prospective and retrospective point prevalence audits of antibiotic usage, but such studies are very resource intensive and only provide a snapshot of consumption. The objective of the study reported here was to examine longitudinal total antibacterial usage at a national level and cross-sectional usage at an individual hospital trust level using a commercial database that captures antimicrobial prescribing from at least 99% of English hospital Trusts.
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Chaudhary P, Bahl A, Kumar A. Trends of prescribing and utilisation of antibiotics in the paediatric out-patient population of a secondary care hospital in Gurgaon, India. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2014. [DOI: 10.7713/ijms.2014.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Maripuu H, Aldeyab MA, Kearney MP, McElnay JC, Conlon G, Magee FA, Scott MG. An audit of antimicrobial treatment of lower respiratory and urinary tract infections in a hospital setting. Eur J Hosp Pharm 2014. [DOI: 10.1136/ejhpharm-2013-000394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Abstract
In an interview in March 2013, the Chief Medical Officer described antibiotic resistance as a 'ticking time bomb' and ranked it along with terrorism on a list of threats to the nation. Her report Infections and the Rise of Antimicrobial Resistance (Department of Health, 2011) highlighted that, while a new infectious disease has been discovered nearly every year over the past three decades, there have been very few new antibiotics developed, leaving our armoury nearly empty. Antibiotic resistance is a universal problem that needs to be tackled by a wide variety of strategies and players. Our approach to tackling resistance to antibiotic agents must therefore also be dynamic. As well as reducing environmental use, we also need to lower antibiotic use in the healthcare setting. Healthcare workers have a huge role to play in combating antibiotic resistance. This article focuses on several issues related to antibiotic resistance, including antibiotic modes of action and the properties that confer resistance on bacteria. It includes information on antibiotic usage and describes current healthcare strategies we can adopt to help reduce the development of resistance.
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Affiliation(s)
- Ann-Marie Aziz
- Clinical Lead: Infection Prevention and Control, Pennine Care NHS Foundation Trust
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Aldeyab MA, McElnay JC, Scott MG, Lattyak WJ, Darwish Elhajji FW, Aldiab MA, Magee FA, Conlon G, Kearney MP. A modified method for measuring antibiotic use in healthcare settings: implications for antibiotic stewardship and benchmarking. J Antimicrob Chemother 2013; 69:1132-41. [PMID: 24222612 DOI: 10.1093/jac/dkt458] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES To determine whether adjusting the denominator of the common hospital antibiotic use measurement unit (defined daily doses/100 bed-days) by including age-adjusted comorbidity score (100 bed-days/age-adjusted comorbidity score) would result in more accurate and meaningful assessment of hospital antibiotic use. METHODS The association between the monthly sum of age-adjusted comorbidity and monthly antibiotic use was measured using time-series analysis (January 2008 to June 2012). For the purposes of conducting internal benchmarking, two antibiotic usage datasets were constructed, i.e. 2004-07 (first study period) and 2008-11 (second study period). Monthly antibiotic use was normalized per 100 bed-days and per 100 bed-days/age-adjusted comorbidity score. RESULTS Results showed that antibiotic use had significant positive relationships with the sum of age-adjusted comorbidity score (P = 0.0004). The results also showed that there was a negative relationship between antibiotic use and (i) alcohol-based hand rub use (P = 0.0370) and (ii) clinical pharmacist activity (P = 0.0031). Normalizing antibiotic use per 100 bed-days contributed to a comparative usage rate of 1.31, i.e. the average antibiotic use during the second period was 31% higher than during the first period. However, normalizing antibiotic use per 100 bed-days per age-adjusted comorbidity score resulted in a comparative usage rate of 0.98, i.e. the average antibiotic use was 2% lower in the second study period. Importantly, the latter comparative usage rate is independent of differences in patient density and case mix characteristics between the two studied populations. CONCLUSIONS The proposed modified antibiotic measure provides an innovative approach to compare variations in antibiotic prescribing while taking account of patient case mix effects.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast BT9 7BL, Northern Ireland , UK
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HLA alleles influence the clinical signature of amoxicillin-clavulanate hepatotoxicity. PLoS One 2013; 8:e68111. [PMID: 23874514 PMCID: PMC3706603 DOI: 10.1371/journal.pone.0068111] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/25/2013] [Indexed: 12/13/2022] Open
Abstract
Background and Aim The genotype-phenotype interaction in drug-induced liver injury (DILI) is a subject of growing interest. Previous studies have linked amoxicillin-clavulanate (AC) hepatotoxicity susceptibility to specific HLA alleles. In this study we aimed to examine potential associations between HLA class I and II alleles and AC DILI with regards to phenotypic characteristics, severity and time to onset in Spanish AC hepatotoxicity cases. Methods High resolution genotyping of HLA loci A, B, C, DRB1 and DQB1 was performed in 75 AC DILI cases and 885 controls. Results The distributions of class I alleles A*3002 (P/Pc = 2.6E-6/5E-5, OR 6.7) and B*1801 (P/Pc = 0.008/0.22, OR 2.9) were more frequently found in hepatocellular injury cases compared to controls. In addition, the presence of the class II allele combination DRB1*1501-DQB1*0602 (P/Pc = 5.1E-4/0.014, OR 3.0) was significantly increased in cholestatic/mixed cases. The A*3002 and/or B*1801 carriers were found to be younger (54 vs 65 years, P = 0.019) and were more frequently hospitalized than the DRB1*1501-DQB1*0602 carriers. No additional alleles outside those associated with liver injury patterns were found to affect potential severity as measured by Hy’s Law criteria. The phenotype frequencies of B*1801 (P/Pc = 0.015/0.42, OR 5.2) and DRB1*0301-DQB1*0201 (P/Pc = 0.0026/0.07, OR 15) were increased in AC DILI cases with delayed onset compared to those corresponding to patients without delayed onset, while the opposite applied to DRB1*1302-DQB1*0604 (P/Pc = 0.005/0.13, OR 0.07). Conclusions HLA class I and II alleles influence the AC DILI signature with regards to phenotypic expression, latency presentation and severity in Spanish patients.
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Rajmokan M, Morton A, Marquess J, Playford EG, Jones M. Development of a risk-adjustment model for antimicrobial utilization data in 21 public hospitals in Queensland, Australia (2006-11). J Antimicrob Chemother 2013; 68:2400-5. [PMID: 23689029 DOI: 10.1093/jac/dkt175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES Making valid comparisons of antimicrobial utilization between hospitals requires risk adjustment for each hospital's case mix. Data on individual patients may be unavailable or difficult to process. Therefore, risk adjustment for antimicrobial usage frequently needs to be based on a hospital's services. This study evaluated such a strategy for hospital antimicrobial utilization. METHODS Data were obtained on five broad subclasses of antibiotics [carbapenems, β-lactam/β-lactamase inhibitor combinations (BLBLIs), fluoroquinolones, glycopeptides and third-generation cephalosporins] from the Queensland pharmacy database (MedTrx) for 21 acute public hospitals (2006-11). Eleven clinical services and a variable for hospitals from the tropical region were employed for risk adjustment. Multivariable regression models were used to identify risk and protective services for these antibiotics. Funnel plots were used to display hospitals' antimicrobial utilization. RESULTS Total inpatient antibiotic utilization for these antibiotics increased from 130.6 defined daily doses (DDDs)/1000 patient-days in 2006 to 155.8 DDDs/1000 patient-days in 2011 (P < 0.0001). Except for third-generation cephalosporins, the average utilization rate was higher for intensive care, renal/nephrology, cardiac, burns/plastic surgery, neurosurgery, transplant and acute spinal services than for the respective reference group (no service). In addition, oncology, high-activity infectious disease and coronary care services were associated with higher utilization of carbapenems, BLBLIs and glycopeptides. CONCLUSIONS Our model predicted antimicrobial utilization rates by hospital services. The funnel plots displayed hospital utilization data after adjustment for variation among the hospitals. However, the methodology needs to be validated in other populations, ideally using a larger group of hospitals.
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Affiliation(s)
- M Rajmokan
- Centre for Healthcare Related Infection Surveillance and Prevention (CHRISP), Queensland Health, Herston, QLD 4006, Australia
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Sviestina I, Aston J, Mozgis D. Comparison of antimicrobial prescribing between two specialist paediatric centres in the UK and Latvia. Eur J Hosp Pharm 2013. [DOI: 10.1136/ejhpharm-2012-000179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Aldeyab MA, Harbarth S, Vernaz N, Kearney MP, Scott MG, Darwish Elhajji FW, Aldiab MA, McElnay JC. The impact of antibiotic use on the incidence and resistance pattern of extended-spectrum beta-lactamase-producing bacteria in primary and secondary healthcare settings. Br J Clin Pharmacol 2012; 74:171-9. [PMID: 22150975 DOI: 10.1111/j.1365-2125.2011.04161.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • The emergence and spread of bacteria producing extended-spectrum beta-lactamases (ESBLs) has important therapeutic and epidemiologic implications. • A key target for the establishment of hospital antibiotic stewardship is reducing the occurrence of additional antibiotic resistance. • Further research is needed to accumulate supporting evidence that reducing antibiotic use will result in a parallel reduction in antibiotic resistance. WHAT THIS STUDY ADDS • Fluoroquinolone restriction reversed ciprofloxacin resistance in primary and secondary healthcare settings. • Fluoroquinolone restriction reduced ESBL-producing bacteria incidence rates in both the primary and secondary healthcare settings. • This study highlights the value of time-series analysis in designing efficient antibiotic stewardship. AIMS The objective of the present study was to study the relationship between hospital antibiotic use, community antibiotic use and the incidence of extended-spectrum beta-lactamase (ESBL)-producing bacteria in hospitals, while assessing the impact of a fluoroquinolone restriction policy on ESBL-producing bacteria incidence rates. METHODS The study was retrospective and ecological in design. A multivariate autoregressive integrated moving average (ARIMA) model was built to relate antibiotic use to ESB-producing bacteria incidence rates and resistance patterns over a 5 year period (January 2005-December 2009). RESULTS Analysis showed that the hospital incidence of ESBLs had a positive relationship with the use of fluoroquinolones in the hospital (coefficient = 0.174, P= 0.02), amoxicillin-clavulanic acid in the community (coefficient = 1.03, P= 0.03) and mean co-morbidity scores for hospitalized patients (coefficient = 2.15, P= 0.03) with various time lags. The fluoroquinolone restriction policy was implemented successfully with the mean use of fluoroquinolones (mainly ciprofloxacin) being reduced from 133 to 17 defined daily doses (DDDs)/1000 bed days (P < 0.001) and from 0.65 to 0.54 DDDs/1000 inhabitants/day (P= 0.0007), in both the hospital and its surrounding community, respectively. This was associated with an improved ciprofloxacin susceptibility in both settings [ciprofloxacin susceptibility being improved from 16% to 28% in the community (P < 0.001)] and with a statistically significant reduction in ESBL-producing bacteria incidence rates. DISCUSSION This study supports the value of restricting the use of certain antimicrobial classes to control ESBL, and demonstrates the feasibility of reversing resistance patterns post successful antibiotic restriction. The study also highlights the potential value of the time-series analysis in designing efficient antibiotic stewardship.
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Affiliation(s)
- Mamoon A Aldeyab
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, BT9 7BL Belfast, Northern Ireland, UK.
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A point prevalence survey of antibiotic use in four acute-care teaching hospitals utilizing the European Surveillance of Antimicrobial Consumption (ESAC) audit tool. Epidemiol Infect 2011; 140:1714-20. [PMID: 22115422 DOI: 10.1017/s095026881100241x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The objective of this research was to assess current patterns of hospital antibiotic prescribing in Northern Ireland and to determine targets for improving the quality of antibiotic prescribing. A point prevalence survey was conducted in four acute teaching hospitals. The most commonly used antibiotics were combinations of penicillins including β-lactamase inhibitors (33·6%), metronidazole (9·1%), and macrolides (8·1%). The indication for treatment was recorded in 84·3% of the prescribing episodes. A small fraction (3·9%) of the surgical prophylactic antibiotic prescriptions was for >24 h. The results showed that overall 52·4% of the prescribed antibiotics were in compliance with the hospital antibiotic guidelines. The findings identified the following indicators as targets for quality improvement: indication recorded in patient notes, the duration of surgical prophylaxis and compliance with hospital antibiotic guidelines. The results strongly suggest that antibiotic use could be improved by taking steps to address the identified targets for quality improvement.
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Polk RE, Hohmann SF, Medvedev S, Ibrahim O. Benchmarking risk-adjusted adult antibacterial drug use in 70 US academic medical center hospitals. Clin Infect Dis 2011; 53:1100-10. [PMID: 21998281 DOI: 10.1093/cid/cir672] [Citation(s) in RCA: 115] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship programs are advised to measure and risk-adjust antimicrobial use to facilitate interhospital comparisons, a process called benchmarking. The purpose of this investigation was to evaluate a new benchmarking strategy for antibacterials. METHODS Hospital-wide adult antibacterial drug use in 2009 was measured as days of therapy (DOT) and length of therapy (LOT) from billing records in 70 US academic medical centers (AMCs). Patients were assigned to 1 of 35 clinical service lines (CSL) based on their Medicare Severity Diagnosis Related Group. Expected (E) use was determined by indirect standardization and compared with observed (O) use. RESULTS Of 1,791 ,180 discharged adults, 63.7% received antibacterial drugs; the range by CSL was 14.3% (psychiatry) to 99.7% (lung transplant). Mean ± SD hospital-wide use was 839 ± 106 DOTs (range, 594-1109) and 536 ± 53.0 LOT (range, 427-684) per 1000 patient-days. The ventilator support CSL had the most DOT per discharge, 39.4 ± 9.4 days; the LOT was 21.5 ± 4.5 days. The hospital-wide O/E ratio range was 0.7-1.45; in 5 AMCs the ratio exceeded the 90% confidence interval (CI) and was below the 90% CI in 6. Variability in use was explained by the proportion of treated patients within each CSL and mean LOT and DOT per discharge. CONCLUSIONS Adult antibacterial drug use was benchmarked to expected use adjusted for patient mix, and outlier hospitals were identified. Differences between expected and observed use reflect usage patterns that were benchmarked and are targets for evaluation and intervention.
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Affiliation(s)
- Ron E Polk
- Department of Pharmacotherapy and Outcome Science, School of Pharmacy, Virginia Commonwealth University, Richmond, USA.
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Zarb P, Goossens H. European Surveillance of Antimicrobial Consumption (ESAC): value of a point-prevalence survey of antimicrobial use across Europe. Drugs 2011; 71:745-55. [PMID: 21504250 DOI: 10.2165/11591180-000000000-00000] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
All 27 EU member states and another seven countries participate in the European Surveillance of Antimicrobial Consumption (ESAC) project. ESAC carried out three hospital point-prevalence surveys on antimicrobial use. Point-prevalence surveys linked antimicrobial use to indication and also assessed dosing using a standardized methodology for data collection and online data submission with feedback capability using a dedicated web-based tool. The objectives of the ESAC hospital point-prevalence surveys were to first determine the feasibility of a pan-European survey and identify targets for quality improvement. Hospitals were voluntarily selected by the lead national or hospital representatives for each country. The WHO Anatomical Therapeutic Chemical Classification of drugs was used for classification of antimicrobials. The three surveys were carried out during a maximum of 2 weeks in the second quarter of 2006, 2008 and 2009. Each department had to be surveyed in 1 day. All systemic antibacterials (J01), rifampicin (J04AB), oral vancomycin (A07AA) and oral/rectal metronidazole (P01AB) were the antimicrobials surveyed, including the prescribed regimen. The number of participating hospitals increased from 20 to 172 from 2006 to 2009. The patient demographics and indications for treatment were similar throughout the three point-prevalence surveys. 'Reason in notes' and 'surgical prophylaxis >24 hours' were also similar. Guideline compliance (51%) was only introduced in the 2009 point-prevalence survey, replacing 'sample for culture and sensitivity' (<50% in 2006 and 2008) since samples were either not taken or no information was available for the majority (>50%) of patients. The use of combination therapy, although exhibiting a wide range within each category, was related to hospital type, with teaching and tertiary hospitals having a significantly higher use of combination therapy (teaching : non-teaching hospitals [p < 0.0001]; and primary : tertiary hospitals [p < 0.0001]). Point-prevalence surveys are useful when time and resources do not allow for continuous surveillance. Repeated point-prevalence surveys within the same institution(s) can be used to monitor trends and effectiveness of antimicrobial-stewardship initiatives. Targets should be set as quality indicators for the individual hospital(s) and effectiveness of any intervention monitored through repeated point-prevalence surveys. Spin-off initiatives, such as the Antibiotic Resistance and Prescribing in European Children, and the European Centre for Disease Prevention and Control point-prevalence survey on healthcare-associated infections and antimicrobial use, will utilize adapted versions of WebPPS, the point-prevalence survey software developed by ESAC. WebPPS will also be made available for non-commercial use to third parties. Interest has been shown from three continents outside Europe, namely North America, Australia and Africa.
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Affiliation(s)
- Peter Zarb
- Infection Control Unit, Mater Dei Hospital, Msida, Malta
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