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Karimi G, Kabir K, Farrokhi B, Abbaszadeh E, Esmaeili ED, Khodamoradi F, Sarbazi E, Azizi H. Prescribing pattern of antibiotics by family physicians in primary health care. J Pharm Policy Pract 2023; 16:11. [PMID: 36658638 PMCID: PMC9854067 DOI: 10.1186/s40545-023-00515-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
PURPOSE Irrational prescription of antibiotics is an ongoing global public health concern, leading to antibiotic resistance. Understanding the prescribing pattern of antibiotics is important to tackling mal-prescription and antibiotic resistance. We aimed to investigate the pattern and factors affecting outpatients' antibiotic prescribing by family physicians in Primary Health Care (PHC). METHODS A cross-sectional study was conducted in 19 PHC facilities in Alborz province. Prescribing pattern of antibiotics was evaluated among 1068 prescriptions by family physicians. Prescribing pattern of antibiotics included prescriptions containing antibiotics, the number of antibiotics per prescription, type, name of antibiotic, and mal-prescription. Multiple logistic regression analysis was used to estimate the adjusted odds ratios and 95% confidence intervals. RESULTS Overall, 57% of the prescriptions had ≥ 1 antibiotic and the average number of antibiotics per prescription was 1.27. Amoxicillin was the commonly prescribed antibiotic. There was a significant relationship between age, sex, type of health insurance, work experience of the physician, and seasons with antibiotic prescribing (P < 0.05). In 59.31% of antibiotic prescriptions at least one of the scientific criteria was not fulfilled. In the final analysis, after adjusting for the potential confounders, field experts of physicians (OR = 1.59; 95% CI: 1.08-6.17), female sex (OR = 2.23; 95% CI: 1.18-4.21), and winter season (OR = 3.34; 95% CI: 1.26-8.15) were found associated factors with antibiotic prescribing. CONCLUSION The average number of antibiotics per prescription and the percentage of irrational prescriptions were relatively high in this study. There is need to improve antibiotic prescribing patterns among family physicians working in primary health care.
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Affiliation(s)
- Gholamali Karimi
- grid.449129.30000 0004 0611 9408Student Research Committee, Department of Epidemiology, School of Public Health, Ilam University of Medical Sciences, Ilam, Iran ,grid.411705.60000 0001 0166 0922Savojbolagh Health Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Kourosh Kabir
- grid.411705.60000 0001 0166 0922Department of Community Medicine , School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Babak Farrokhi
- Executive Deputy National Director for Family Medicine, Health Network Administration Center, Undersecretary for Health Affairs, Ministry of Health, Tehran, Iran
| | - Effat Abbaszadeh
- grid.411705.60000 0001 0166 0922Savojbolagh Health Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Elham Davtalab Esmaeili
- grid.412888.f0000 0001 2174 8913Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Farzad Khodamoradi
- grid.411230.50000 0000 9296 6873Department of Social Medicine, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ehsan Sarbazi
- grid.412888.f0000 0001 2174 8913Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Azizi
- grid.412888.f0000 0001 2174 8913Women’s Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran ,grid.411705.60000 0001 0166 0922Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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2
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Ngan TTD, Quan TA, Quang LM, Vinh VH, Duc CM, Nguyet HT, Tu NTC, Khanh NH, Long LB, Hue NH, Hung DT, Thanh ND, Ve NV, Giang TT, Tung LT, Tuan TT, Kesteman T, Dodds Ashley E, Anderson DJ, Van Doorn HR, Huong VTL. Review of antibiotic prescriptions as part of antimicrobial stewardship programmes: results from a pilot implementation at two provincial-level hospitals in Viet Nam. JAC Antimicrob Resist 2023; 5:dlac144. [PMID: 36686271 PMCID: PMC9847554 DOI: 10.1093/jacamr/dlac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Accepted: 12/26/2022] [Indexed: 01/19/2023] Open
Abstract
Objectives To investigate the feasibility of retrospective prescription-based review and to describe the antibiotic prescribing patterns to provide information for an antimicrobial stewardship programme in Viet Nam. Methods This study was conducted in two provincial-level hospitals between February and April 2020. Reviews were done by a clinical team consisting of leaders/senior doctors of each ward to assess the optimal level (optimal/adequate/suboptimal/inadequate/not assessable) of antibiotic prescriptions. Mixed-effect logistic regression at prescription level was used to explore factors associated with optimal antibiotic use. Results The retrospective prescription-based review was accepted by study clinical wards with varied levels of participants. One hundred and eighty-three patients (326 prescriptions) in Hospital 1 and 200 patients (344 prescriptions) in Hospital 2 were included. One hundred and nineteen of the 326 (36.5%) antibiotic prescriptions in Hospital 1 and 51/344 (14.8%) antibiotic prescriptions in Hospital 2 were determined to be optimal by the review teams. The number of adequate antibiotic prescriptions were 179/326 (54.9%) and 178 (51.7%) in Hospital 1 and Hospital 2, respectively. The optimal level was lower for surgical prophylaxis antibiotics than for empirical therapy (OR = 0.06; 95% CI 0.01-0.45), higher in prescriptions in the ICU (OR = 12.00; 95% CI 3.52-40.92), higher in definitive antibiotic therapy (OR = 48.12; 95% CI 7.17-322.57) and higher in those with an indication recorded in medical records (OR = 3.46; 95% CI 1.13-10.62). Conclusions This study provides evidence on the feasibility of retrospective prescription-based review, with adaption to the local situation. High and varying levels of optimal antibiotic prescriptions in clinical wards in hospitals were observed in Viet Nam.
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Affiliation(s)
| | | | - Le Minh Quang
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Vu Hai Vinh
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Chau Minh Duc
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Huynh Thi Nguyet
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Nguyen Thi Cam Tu
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Nguyen Hong Khanh
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Le Ba Long
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Hong Hue
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Dinh The Hung
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Duc Thanh
- Viet Tiep Hospital, 1 Nha Thuong, Cat Dai, Le Chan, Hai Phong, Viet Nam
| | - Nguyen Van Ve
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Tran Thanh Giang
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Le Thanh Tung
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Truong Thanh Tuan
- Dong Thap Hospital, 144 Mai Van Khai, My Tan, Cao Lanh City, Đong Thap
| | - Thomas Kesteman
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam
| | - Elizabeth Dodds Ashley
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, USA
| | - Deverick J Anderson
- Duke Antimicrobial Stewardship Outreach Network, Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University, Durham, NC 27710, USA
| | - H Rogier Van Doorn
- Hanoi Group, Oxford University Clinical Research Unit, 78 Giai Phong, Viet Nam,Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Vu Thi Lan Huong
- Corresponding author. E-mail: @Quan_Truong_Anh, @Nguyencamtu, @hrogier, @Deverick_A, @HuongVu03531589, @The_Real_LDA
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3
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Rodríguez-Baño J, Rossolini GM, Schultsz C, Tacconelli E, Murthy S, Ohmagari N, Holmes A, Bachmann T, Goossens H, Canton R, Roberts AP, Henriques-Normark B, Clancy CJ, Huttner B, Fagerstedt P, Lahiri S, Kaushic C, Hoffman SJ, Warren M, Zoubiane G, Essack S, Laxminarayan R, Plant L. Key considerations on the potential impacts of the COVID-19 pandemic on antimicrobial resistance research and surveillance. Trans R Soc Trop Med Hyg 2021; 115:1122-1129. [PMID: 33772597 PMCID: PMC8083707 DOI: 10.1093/trstmh/trab048] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 01/08/2023] Open
Abstract
Antibiotic use in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients during the COVID-19 pandemic has exceeded the incidence of bacterial coinfections and secondary infections, suggesting inappropriate and excessive prescribing. Even in settings with established antimicrobial stewardship (AMS) programmes, there were weaknesses exposed regarding appropriate antibiotic use in the context of the pandemic. Moreover, antimicrobial resistance (AMR) surveillance and AMS have been deprioritised with diversion of health system resources to the pandemic response. This experience highlights deficiencies in AMR containment and mitigation strategies that require urgent attention from clinical and scientific communities. These include the need to implement diagnostic stewardship to assess the global incidence of coinfections and secondary infections in COVID-19 patients, including those by multidrug-resistant pathogens, to identify patients most likely to benefit from antibiotic treatment and identify when antibiotics can be safely withheld, de-escalated or discontinued. Long-term global surveillance of clinical and societal antibiotic use and resistance trends is required to prepare for subsequent changes in AMR epidemiology, while ensuring uninterrupted supply chains and preventing drug shortages and stock outs. These interventions present implementation challenges in resource-constrained settings, making a case for implementation research on AMR. Knowledge and support for these practices will come from internationally coordinated, targeted research on AMR, supporting the preparation for future challenges from emerging AMR in the context of the current COVID-19 pandemic or future pandemics.
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Affiliation(s)
- Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain
- Departamento de Medicina, Universidad de Sevilla, Sevilla, Spain
- Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy
| | - Constance Schultsz
- Department of Global Health - AIGHD Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Srinivas Murthy
- BC Children's Hospital, University of British Columbia, Vancouver, Canada
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Alison Holmes
- Department of Medicine, Faculty of Medicine, Imperial College London, London, UK
| | - Till Bachmann
- The University of Edinburgh, Edinburgh Medical School, Division of Infection and Pathway Medicine, UK
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Rafael Canton
- Servicio de Microbiología. Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
- Red Española de Investigación en Patología Infecciosa (REIPI), Instituto de Salud Carlos III, Madrid, Spain
| | - Adam P Roberts
- Department of Tropical Disease Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Birgitta Henriques-Normark
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | | | - Benedikt Huttner
- Division of Infectious Diseases, Geneva, University Hospitals, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Shawon Lahiri
- JPIAMR Secretariat, Swedish Research Council, Stockholm, Sweden
| | - Charu Kaushic
- Institute of Infection and Immunity, Canadian Institutes of Health Research
- McMaster Immunology Research Center, Dept Pathology and Mol. Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Steven J Hoffman
- Global Strategy Lab, Dahdaleh Institute for Global Health Research, Faculty of Health and Osgoode Hall Law School, York University, Toronto, Canada
| | - Margo Warren
- Access to Medicine Foundation, Amsterdam, the Netherlands
| | - Ghada Zoubiane
- International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark
| | - Sabiha Essack
- International Centre for Antimicrobial Resistance Solutions (ICARS), Copenhagen, Denmark
- Antimicrobial Research Unit, University of KwaZulu-Natal, Durban, South Africa
| | | | - Laura Plant
- Institute of Infection and Immunity, Canadian Institutes of Health Research
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Mijović G, Čizmović L, Vuković MN, Stamatović S, Lopičić M. Antibiotic Consumption in Hospitals and Resistance Rate of Klebsiella pneumoniae and Escherichia coli in Montenegro. Acta Clin Croat 2020; 59:469-479. [PMID: 34177057 PMCID: PMC8212642 DOI: 10.20471/acc.2020.59.03.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Inappropriate use of antibiotics leads to an increase in antibiotic resistance. Infections caused by antibiotic-resistant gram-negative bacteria are a serious threat to public health. This study aimed to compare data on inpatient antibiotic consumption with antimicrobial resistance (AMR) rate of Klebsiella pneumoniae and Escherichia coli invasive strains in Montenegro and provide targets for improving antibiotic use. We used the national data on antibiotic consumption from 2009 to 2015, Point Prevalence Survey data on inpatient antibiotic consumption from 2015, and national AMR data on 79 Klebsiella pneumoniae and 68 Escherichia coli isolates collected from 8 hospitals from 2016 to 2018. The most commonly used antibiotics were third-generation cephalosporins with a median annual consumption of 0.66 DDD/1000/day. Ceftriaxone was the most frequently prescribed antibiotic in the treatment of community/hospital acquired infections and surgical/medical prophylaxis. The highest resistance rates were recorded for Klebsiella pneumoniae to ceftriaxone, ceftazidime and gentamicin (93.59%, 90.79% and 89.87%, respectively), and Escherichia coli to aminopenicillins, ceftriaxone and ceftazidime (89.06%, 70.15% and 61.54%, respectively). High consumption of broad-spectrum antibiotics in Montenegro is accompanied by the high rate of resistance of Klebsiella pneumoniae and Escherichia coli to these agents. Antibiotic misuse demands the introduction of an antimicrobial stewardship program in Montenegrin hospitals.
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Affiliation(s)
| | - Lidija Čizmović
- 1Institute of Public Health of Montenegro, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro; 4Faculty of Science and Mathematics, University of Montenegro, Podgorica, Montenegro
| | - Mirjana Nedović Vuković
- 1Institute of Public Health of Montenegro, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro; 4Faculty of Science and Mathematics, University of Montenegro, Podgorica, Montenegro
| | - Siniša Stamatović
- 1Institute of Public Health of Montenegro, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro; 4Faculty of Science and Mathematics, University of Montenegro, Podgorica, Montenegro
| | - Milena Lopičić
- 1Institute of Public Health of Montenegro, Podgorica, Montenegro; 2Faculty of Medicine, University of Montenegro, Podgorica, Montenegro; 3Agency for Medicines and Medical Devices of Montenegro, Podgorica, Montenegro; 4Faculty of Science and Mathematics, University of Montenegro, Podgorica, Montenegro
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5
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Alharbi HA. Antibiotic Skin Testing in the Intensive Care Unit: A Systematic Review. Crit Care Nurse 2020; 39:e1-e9. [PMID: 31961941 DOI: 10.4037/ccn2019207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Recent research has shown that a large majority of patients with a history of penicillin allergy are acutely tolerant of penicillins and that there is no clinically significant immunologic cross-reactivity between penicillins and cephalosporins or other β-lactams. The standard test to confirm acute tolerance is challenge with a therapeutic dose. Skin testing is useful only when the culprit antibiotic can haptenate serum proteins and induce an immunoglobulin E-mediated reaction and the clinical history demonstrates such high risk that a direct oral challenge may result in anaphylaxis. OBJECTIVE To review and evaluate the current practice of skin testing for antibiotics (other than penicillin) in critically ill patients by means of a systematic literature review. METHODS This systematic review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines. Several electronic databases were searched using the following terms: antibiotics, skin test (tests, testing), intensive care, intensive care unit, ICU, critical care, critical care unit. RESULTS Twenty-three articles were identified for inclusion in this review. The results indicate a lack of standardized skin testing for all antibiotics in critical care settings. Oral challenge with nonirritating concentrations of antibiotics can be helpful in determining allergy to these drugs. CONCLUSIONS Critical care providers should evaluate antibiotic allergy using nonirritating concentrations before administering antibiotics to patients. Introduction of a standardized skin test for all antibiotics in intensive care unit patients to help select the most appropriate antibiotic treatment regimen might help save lives and reduce costs.
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Affiliation(s)
- Homood A Alharbi
- Homood A. Alharbi is an assistant professor, College of Nursing, King Saud University, Riyadh, Saudi Arabia
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Langford BJ, Wu JHC, Lo J, Leung V, Daneman N, Schwartz K, Garber G. Pilot study of an online hospital antibiotic use tracking and reporting system. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2019; 4:233-240. [PMID: 36339286 PMCID: PMC9612809 DOI: 10.3138/jammi.2019-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/19/2019] [Indexed: 06/16/2023]
Abstract
BACKGROUND Antimicrobial use (AMU) varies widely among hospitals, suggesting a need to better monitor usage and evaluate the effectiveness of antimicrobial stewardship programs (ASPs). Our objective was to assess the feasibility of implementing an online voluntary hospital antibiotic use tracking and reporting system. METHODS An online survey was sent to ASP clinicians representing hospitals across Ontario. Hospitals that tracked total hospital-wide inpatient antibiotic use in 2017 were asked to submit either days of therapy (DOT) or defined daily doses (DDD), along with separate inpatient days (PD), which were used as the denominator. Respondents who indicated no hospital-wide AMU tracking were asked to describe the barriers to its use. Antibiotic use was displayed on a public website for consenting hospitals. RESULTS Of 201 eligible hospitals, 66 (33%) provided AMU data representing 10,634 of 25,208 (43%) eligible inpatient beds in the province. DOT and DDD data were provided by 36 hospitals, each. Weighted average antibiotic use was highest in acute teaching hospitals (513 DOT/1,000 PD, 709 DDD/1,000 PD) and lowest in complex continuing care and rehabilitation facilities (158 DOT/1,000 PD, 159 DDD/1,000 PD). Barriers cited for providing hospital-wide AMU data include lack of time and resources to collect and evaluate AMU data and technological limitations preventing data collection. CONCLUSION Integrating hospital AMU tracking and reporting as part of a voluntary initiative is feasible, with relatively broad participation. Short of a legislative mandate for participation, opportunities still exist to increase representation, including provision of guidance and technical support to help hospitals track and share AMU.
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Affiliation(s)
- Bradley J Langford
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
- Pharmacy, Unity Health Network, Toronto, Ontario, Canada
| | - Julie Hui-Chih Wu
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Jennifer Lo
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
- Pharmacy, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Valerie Leung
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
| | - Nick Daneman
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
- Infectious Disease, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Populations & Public Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kevin Schwartz
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
- Populations & Public Health Research Program, Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Infectious Disease, Unity Health Network, Toronto, Ontario, Canada
| | - Gary Garber
- Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada
- School of Medicine, University of Toronto, Toronto, Ontario, Canada
- School of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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7
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Avedissian SN, Scheetz MH, Zembower TR, Silkaitis C, Maxwell R, Jenkins C, Postelnick MJ, Sutton SH, Rhodes NJ. Measuring the impact of varying denominator definitions on standardized antibiotic consumption rates: implications for antimicrobial stewardship programmes. J Antimicrob Chemother 2019; 73:2876-2882. [PMID: 30085084 DOI: 10.1093/jac/dky275] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/15/2018] [Indexed: 02/01/2023] Open
Abstract
Objectives To quantify the impact of varying the at-risk days definition on the overall report of at-risk days and on the calculated standardized consumption rates (SCRs) for piperacillin/tazobactam, amikacin, daptomycin and vancomycin. Methods Data were evaluated for two system hospitals, an 894 bed academic centre and a 114 bed community hospital. Aggregate inpatient antibiotic administration and occupancy data were extracted from electronic databases at the facility-wide level. Occupancy data were reported from admission-discharge-transfer systems. At-risk days were defined as hospital days present (DP), patient days (PD), persons present (PP) and billing days (BD). Inpatient antimicrobial days of therapy (DOT) across four major antimicrobial agents were used to calculate facility-wide SCRs using each denominator and were evaluated by least-squares regression and R2 values. Results Within the 894 bed academic hospital, the average monthly facility-wide days were 28 424, 22 198, 15 957 and 14 789 by the DP, PP, PD and BD definitions, respectively. Within the 114 bed community hospital, the average monthly facility-wide days were 5175, 3523 and 2816 by the DP, PP and PD definitions, respectively. Strong concordance was observed between facility-wide SCRs using the DP and PP definitions in both the academic (R2 = 0.99, y = 0.78x - 0.001) and community (R2 = 0.99, y = 0.68x - 0.03) centres across all four inpatient antibiotics evaluated. In an analysis of piperacillin/tazobactam SCRs, rates were over-predicted by 28%-93% at the facility-wide level across centres using alternative denominators. Conclusions We found that data source and definitions of at-risk denominator days meaningfully impact antibiotic SCRs. Centres should carefully consider these potential sources of variation when setting consumption benchmarks and internally evaluating use.
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Affiliation(s)
- Sean N Avedissian
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA.,Midwestern University Pharmacometrics Center of Excellence, Downers Grove, IL, USA
| | - Marc H Scheetz
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA.,Midwestern University Pharmacometrics Center of Excellence, Downers Grove, IL, USA
| | - Teresa R Zembower
- Department of Internal Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, IL, USA
| | - Christina Silkaitis
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Medicine, Chicago, IL, USA
| | - Robert Maxwell
- Department of Pharmacy, Northwestern Memorial Hospital, Chicago, IL, USA
| | - Charles Jenkins
- Department of Analytics, NM HealthCare (NMHC), Northwestern Medicine, Chicago, IL, USA
| | | | - Sarah H Sutton
- Department of Internal Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nathaniel J Rhodes
- Department of Pharmacy Practice, Midwestern University, Chicago College of Pharmacy, Downers Grove, IL, USA.,Midwestern University Pharmacometrics Center of Excellence, Downers Grove, IL, USA
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8
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Shaver AL, Jacobs DM, LaMonte MJ, Noyes K. Antibiotic prescribing for acute respiratory tract infections in the United States outpatient setting. BMC FAMILY PRACTICE 2019; 20:91. [PMID: 31266449 PMCID: PMC6607511 DOI: 10.1186/s12875-019-0980-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 06/16/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute respiratory tract infections (ARIs) are common in the outpatient setting. Although they are predominantly viral, antibiotics are often prescribed for the treatment of ARIs. METHODS Using the U.S. Medical Expenditure Panel Survey (MEPS; 2010-2015), we estimated the national prevalence and predictors of outpatient antibiotic prescribing for ARIs by provider type. We categorized the trends of antibiotic prescriptions (overall or broad-spectrum) for ARIs by provider type (physician and advanced practice provider [APP] which includes nurse practitioner [NP], and physician assistant [PA]). The outcome variable was defined as receipt of an antibiotic prescription during a consultation with a provider for an ARI (including outpatient clinic visit or doctor's office visit). RESULTS There were 64,081,892 ARI antibiotic prescriptions written, with a decrease from 10.9 (2010) to 9.7 million (2015) during the study interval (p < 0.0001). Associations of patient- and provider-level variables with antibiotics prescription were examined using binary logistic regression. Blacks were more likely to receive antibiotics than whites (OR 1.51; 95% CI 1.25, 1.84; p < 0.001), and antibiotic prescription was more likely if the patient-provider race was concordant (OR 5.41; 95% CI 4.65, 6.29, p < 0.0001). Although the majority of patients with ARI were cared for by physicians, APPs were seeing an increasing number of ARI patients. CONCLUSIONS Antibiotic prescribing for ARIs though declining, remains high. More research is needed to better understand the drivers of ARI antibiotic prescribing and to develop targeted interventions for both patients and providers.
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Affiliation(s)
- Amy L Shaver
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 272 Farber Hall, South Campus, Buffalo, NY, 14260, USA.
| | - David M Jacobs
- Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Michael J LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 272 Farber Hall, South Campus, Buffalo, NY, 14260, USA
| | - Katia Noyes
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, 272 Farber Hall, South Campus, Buffalo, NY, 14260, USA
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9
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Zheng B, Li N, Hu Z, Liu M. From population to individuals: a new indicator for evaluating the appropriateness of clinical application of antibiotics. BMC Pharmacol Toxicol 2018; 19:55. [PMID: 30185217 PMCID: PMC6126037 DOI: 10.1186/s40360-018-0245-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 08/28/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aims to establish a new indicator based on the anatomical therapeutic chemical/defined daily dose (ATC/DDD) system. METHODS Utilization data of antibiotics of inpatients in a university hospital were used to calculate the indicators of use rate (UR), use density (UD), and ratio of use density to use rate (UD/UR). According to the professional characteristics, the recommended values of UD/UR in different departments were established respectively. Crosswise comparison and appropriateness evaluation between different treatment groups with the same profession were performed. For individual inpatients with abnormally increased drug utilization index (DUI) and ratios of antimicrobial course to length of stay (C/S), detailed analysis was performed to examine whether any irrational drug utilization occurred. RESULTS The indicator UD/UR combines both dose and duration of treatment, which were the two main factors affecting the appropriateness of clinical application of antibiotics. Thus, it can more sensitively reveal the drug utilization of inpatients receiving antibiotics. UD/UR is also more suitable for evaluating the clinical appropriateness of antibiotic application than the macroscopic indicator, total UD, and could be applied at the macroscopic and microscopic levels. CONCLUSIONS The ratio UD/UR has great practical value and can serve as a reference for evaluating the appropriateness of clinical application of antibiotics.
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Affiliation(s)
- Bin Zheng
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Na Li
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Zhijian Hu
- Department of Information, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
| | - Maobai Liu
- Department of Pharmacy, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou District, Fuzhou City, 350001 Fujian Province China
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10
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Bielicki JA, Sharland M, Versporten A, Goossens H, Cromwell DA. Using risk adjustment to improve the interpretation of global inpatient pediatric antibiotic prescribing. PLoS One 2018; 13:e0199878. [PMID: 29979795 PMCID: PMC6034826 DOI: 10.1371/journal.pone.0199878] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 06/15/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives Assessment of regional pediatric last-resort antibiotic utilization patterns is hampered by potential confounding from population differences. We developed a risk-adjustment model from readily available, internationally used survey data and a simple patient classification to aid such comparisons. Design We investigated the association between pediatric conserve antibiotic (pCA) exposure and patient / treatment characteristics derived from global point prevalence surveys of antibiotic prescribing, and developed a risk-adjustment model using multivariable logistic regression. The performance of a simple patient classification of groups with different expected pCA exposure levels was compared to the risk model. Setting 226 centers in 41 countries across 5 continents. Participants Neonatal and pediatric inpatient antibiotic prescriptions for sepsis/bloodstream infection for 1281 patients. Results Overall pCA exposure was high (35%), strongly associated with each variable (patient age, ward, underlying disease, community acquisition or nosocomial infection and empiric or targeted treatment), and all were included in the final risk-adjustment model. The model demonstrated good discrimination (c-statistic = 0.83) and calibration (p = 0.38). The simple classification model demonstrated similar discrimination and calibration to the risk model. The crude regional pCA exposure rates ranged from 10.3% (Africa) to 67.4% (Latin America). Risk adjustment substantially reduced the regional variation, the adjusted rates ranging from 17.1% (Africa) to 42.8% (Latin America). Conclusions Greater comparability of pCA exposure rates can be achieved by using a few easily collected variables to produce risk-adjusted rates.
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Affiliation(s)
- Julia A. Bielicki
- Paediatric Infectious Diseases Research Group, Infection and Immunity, St George’s University of London, London, United Kingdom
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Paediatric Pharmacology Group, University of Basel Children’s Hospital, Basel, Switzerland
- * E-mail:
| | - Mike Sharland
- Paediatric Infectious Diseases Research Group, Infection and Immunity, St George’s University of London, London, United Kingdom
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - David A. Cromwell
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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11
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Först G, de With K, Weber N, Borde J, Querbach C, Kleideiter J, Seifert C, Hagel S, Ambrosch A, Löbermann M, Schröder P, Steib-Bauert M, Kern WV. Validation of adapted daily dose definitions for hospital antibacterial drug use evaluation: a multicentre study. J Antimicrob Chemother 2018; 72:2931-2937. [PMID: 29091214 DOI: 10.1093/jac/dkx244] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/20/2017] [Indexed: 01/23/2023] Open
Abstract
Background The WHO/ATC (Anatomical Therapeutic Chemical) index DDD (WHO-DDD) is commonly used for drug consumption measurement. Discrepancies between WHO-DDD and actual prescribed daily doses (PDD) in hospitals have prompted alternative dose definitions adapted to doses recommended in hospital practice guidelines [recommended daily doses (RDD)]. Methods In order to validate RDD we performed modified point prevalence surveys in 24 acute care hospitals and recorded 20620 PDD of antibiotics given to 4226 adult patients on the day of the survey and the 6 preceding days. We calculated RDD and WHO-DDD and compared them with PDD. Results The rate of RDD corresponding to PDD was higher than the corresponding rate for WHO-DDD (pooled data, 55% versus 30%) and the differences were similar across the hospital sample, but varied according to drug/drug class, route of administration, indication and renal function. RDD underestimated actual consumption by 14% overall, while WHO-DDD overestimated total antibacterial consumption by 28% (pooled data; median values RDD -10% versus WHO-DDD +32%). The deviations of estimated from actual drug use volumes were largest for β-lactams (RDD -11% versus WHO-DDD +49%), in particular for penicillins (-11% versus +64%), if WHO-DDD were used. Conclusions Hospital antibiotic consumption surveillance systems using current WHO-DDD should address the uneven discrepancies between actual prescribing and consumption estimates according to drug class that may lead to misclassification in benchmark analyses. We recommend using validated RDD as a supplementary measure to the WHO-DDD for detailed analyses.
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Affiliation(s)
- Gesche Först
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Pharmacy Service, University Hospital and Medical Center, Freiburg, Germany
| | - Katja de With
- Clinical Infectious Disease Unit, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Nadine Weber
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Johannes Borde
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Infectious Diseases Section, Ortenau-Klinikum, Achern-Oberkirch, Germany
| | - Christiane Querbach
- Pharmacy, 'Rechts der Isar' Hospital of the Technical University, Munich, Germany
| | | | - Claudia Seifert
- Pharmacy Service, Medical Center of the Carl Gustav Carus Technical University, Dresden, Germany
| | - Stefan Hagel
- Center for Infection and Infection Control, University Hospital, Jena, Germany
| | - Andreas Ambrosch
- Department of Laboratory Medicine, Microbiology and Infection Control, 'Barmherzige Brüder' Hospital, Regensburg, Germany
| | - Micha Löbermann
- Department of Infectious Diseases and Tropical Medicine, University Medical Center, Rostock, Germany
| | - Philipp Schröder
- Department of Medicine, Federal Armed Forces Hospital, Ulm, Germany
| | - Michaela Steib-Bauert
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine, University Hospital and Medical Center, Freiburg, Germany
- Albert-Ludwigs-University Faculty of Medicine, Freiburg, Germany
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12
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Stanić Benić M, Milanič R, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Zanichelli V, Le Maréchal M, Huttner B, Tebano G, Hulscher ME, Pulcini C, Schouten J, Vlahović-Palčevski V. Metrics for quantifying antibiotic use in the hospital setting: results from a systematic review and international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi50-vi58. [PMID: 29878222 PMCID: PMC5989607 DOI: 10.1093/jac/dky118] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Quantifying antibiotic use is an essential element of antibiotic stewardship since it allows comparison between different settings and time windows, and measurement of the impact of interventions. However, quantity metrics (QMs) and methods have not been standardized. Objectives To propose a set of QMs for antibiotic use in inpatients (IQMs) that are accepted globally by professionals in a range of disciplines. The study was conducted within the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project. Methods A systematic literature review using MEDLINE identified articles on measuring inpatient antibiotic use, published up to 29 January 2015. A consensually selected list of national and international web sites was screened for additional IQMs. IQMs were classified according to the type of numerator used and presented to a multidisciplinary panel of stakeholders. A RAND-modified Delphi consensus procedure, which consisted of two online questionnaires and a face-to-face meeting, was performed. Results The systematic literature review and web site search identified 168 eligible articles from which an initial list of 20 IQMs, composed of 20 different numerators and associated denominators was developed. The consensus procedure resulted in a final set of 12 IQMs. Among this final set, DDDs per 100(0) patient-days and days of therapy per patient-days were most frequently found in the review. The panel recommended that antibiotic use should be expressed in at least two metrics simultaneously. Conclusions Our consensus procedure identified a set of IQMs that we propose as an evidence-based global standard.
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Affiliation(s)
- Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka Medical Faculty, Rijeka, Croatia
| | | | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
- University of Antwerp, Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Antwerp, Belgium
| | - Ann Versporten
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
| | - Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000 Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka Medical Faculty, Rijeka, Croatia
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13
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Collineau L, Belloc C, Stärk KDC, Hémonic A, Postma M, Dewulf J, Chauvin C. Guidance on the Selection of Appropriate Indicators for Quantification of Antimicrobial Usage in Humans and Animals. Zoonoses Public Health 2016; 64:165-184. [PMID: 27592024 DOI: 10.1111/zph.12298] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Indexed: 11/28/2022]
Abstract
An increasing variety of indicators of antimicrobial usage has become available in human and veterinary medicine, with no consensus on the most appropriate indicators to be used. The objective of this review is therefore to provide guidance on the selection of indicators, intended for those aiming to quantify antimicrobial usage based on sales, deliveries or reimbursement data. Depending on the study objective, different requirements apply to antimicrobial usage quantification in terms of resolution, comprehensiveness, stability over time, ability to assess exposure and comparability. If the aim is to monitor antimicrobial usage trends, it is crucial to use a robust quantification system that allows stability over time in terms of required data and provided output; to compare usage between different species or countries, comparability must be ensured between the different populations. If data are used for benchmarking, the system comprehensiveness is particularly crucial, while data collected to study the association between usage and resistance should express the exposure level and duration as a measurement of the exerted selection pressure. Antimicrobial usage is generally described as the number of technical units consumed normalized by the population at risk of being treated in a defined period. The technical units vary from number of packages to number of individuals treated daily by adding different levels of complexity such as daily dose or weight at treatment. These technical units are then related to a description of the population at risk, based either on biomass or number of individuals. Conventions and assumptions are needed for all of these calculation steps. However, there is a clear lack of standardization, resulting in poor transparency and comparability. By combining study requirements with available approaches to quantify antimicrobial usage, we provide suggestions on the most appropriate indicators and data sources to be used for a given study objective.
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Affiliation(s)
- L Collineau
- SAFOSO AG, Bern, Liebefeld, Switzerland.,BIOEPAR, INRA, Oniris, Nantes, France
| | - C Belloc
- BIOEPAR, INRA, Oniris, Nantes, France
| | | | - A Hémonic
- IFIP - French Pork and Pig Institute, Le Rheu, France
| | - M Postma
- Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - J Dewulf
- Department of Reproduction, Obstetrics and Herd Health, Veterinary Epidemiology Unit, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium
| | - C Chauvin
- Anses - French Agency for Food, Environmental and Occupational Health and Safety, Ploufragan, France
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14
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Gu J, Zhao J, Huang Y, Yang W, Ren Z, Li W, Fan Y, Zhang Q, Zhang F, Fu Y. Use of antibiotics by urban and rural residents in Heilongjiang Province, China: cross-sectional study. Trop Med Int Health 2015; 20:1815-22. [PMID: 26376187 DOI: 10.1111/tmi.12602] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify and compare the factors affecting the knowledge of, attitude towards and use of antibiotics between urban and rural residents in China. METHODS A total of 3631 urban and rural residents in Heilongjiang Province, China, were selected using random sampling. Questionnaires recorded demographic characteristics and participant knowledge of, attitude towards and use of antibiotics. The responses of rural and urban residents were compared, and logistic regression analysis was applied to identify the factors that may contribute to the knowledge of, attitude towards and use of antibiotics. RESULTS The majority of the participants (>60%) were aware that antibiotics could be used to treat bacterial infections and that bacteria could be resistant to antibiotics. However, only roughly half (40-60%) of the participants were aware that bacterial resistance to antibiotics had become a problem in China. Urban participants reported a more adequate knowledge of, attitude towards and use of antibiotics than rural participants. Logistic regression analysis indicated that urban residency, female gender and level of education were associated with knowledge of, attitude towards and use of antibiotics. CONCLUSIONS Within our sample in Heilongjiang Province, the knowledge of, attitude towards and use of antibiotics were suboptimal in roughly half of all urban and rural residents, but better in urban than in rural residents. Targeted interventions to educate rural residents in particular may reduce the misuse of antibiotics.
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Affiliation(s)
- Jiarui Gu
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Jizi Zhao
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Ying Huang
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Weidong Yang
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Zheng Ren
- The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Wenjing Li
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Yuzhuo Fan
- Department of Microbiology, Harbin Medical University, Harbin, China
| | - Qiao Zhang
- Harbin Medical University, Harbin, China
| | - Fengmin Zhang
- Department of Microbiology, Harbin Medical University, Harbin, China.,Wu Lien-Teh Institute, Harbin Medical University, Harbin, China.,Heilongjiang Provincial Key Laboratory of Infection and Immunity, Harbin Medical University, Harbin, China
| | - Yingmei Fu
- Department of Microbiology, Harbin Medical University, Harbin, China.,Wu Lien-Teh Institute, Harbin Medical University, Harbin, China.,Heilongjiang Provincial Key Laboratory of Infection and Immunity, Harbin Medical University, Harbin, China
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15
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Hopkins CJ. Inpatient antibiotic consumption in a regional secondary hospital in New Zealand. Intern Med J 2014; 44:185-90. [PMID: 24528814 DOI: 10.1111/imj.12345] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/03/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Reporting of antibiotic consumption in hospitals is a crucial component of antibiotic stewardship, but data from Australasian secondary hospitals are scarce. The hypothesis of this audit is that antibiotic consumption in secondary hospitals would be lower than in tertiary centres. AIMS The study aims to present the first published audit of antibiotic consumption from a secondary hospital in New Zealand compared with two tertiary centres. METHODS Hospital population-level data were retrospectively accessed to identify all systemic antibiotics dispensed to adult inpatients at Taranaki District Health Board during 2011. Consumption was calculated in defined daily doses per 100 inpatient-days and per 100 admissions, stratified by drug class. Comparison was against published data from two tertiary centres. RESULTS Total consumption was lower, but that of high-risk antibiotic classes was higher than both tertiary centres. The relative consumption of lincosamides was 4.0 and 2.6 times higher than the two tertiary centres, with an associated 14% incidence of Clostridium difficile associated diarrhoea within 3 months. CONCLUSION Our secondary hospital appears to consume the wrong types of antibiotic rather than too much. Data from all Australasian hospitals, stratified by clinical service area and hospital level, are required for clinically relevant benchmarking.
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Affiliation(s)
- C J Hopkins
- Department of Medicine, Taranaki Base Hospital, New Plymouth, New Zealand
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16
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Pristaš I, Baršić B, Butić I, Zarb P, Goossens H, Andrašević AT. Point prevalence survey on antibiotic use in a Croatian Infectious Disease Hospital. J Chemother 2013; 25:222-8. [PMID: 23906076 DOI: 10.1179/1973947812y.0000000065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Antibiotic use is the driving force for increasing antibiotic resistance. A large proportion of antibiotics in hospitals are used inadequately. The objective of this study was to evaluate antibiotic use at the Hospital for Infectious Diseases through point-prevalence surveys conducted in 2006, 2008, and 2009. Point prevalence surveys were part of the European Surveillance on Antimicrobial Consumption (ESAC) Hospital Care Subproject and patients' data were collected following ESAC protocol. Additionally, the adequacy of antimicrobial therapy and administration of the first line antibiotic according to the local guidelines were assessed by an infectious disease doctor and a clinical microbiologist. In the study period among the 599 patients admitted to hospital, 352 (58·8%) received antibiotics. Out of 448 antimicrobial treatments, 313 (69·9%) were administered parenterally and 135 (30·1%) orally. Altogether in years 2006, 2008, and 2009 the most commonly prescribed antibiotics were ceftriaxone (19·9%), co-amoxiclav (15·4%), ciprofloxacin (12·3%), narrow spectrum penicillins (6·5%), and penicillinase resistant penicillins (5·6%). Most (82·6%) of the treated infections were community acquired infections. The predominating diagnoses were urinary tract infections and infections with no primary site defined, followed by skin, soft tissue and bone and joint infections. The overall adequacy of antimicrobial therapy was 82% and the first line antibiotic according to the local guidelines was administered with high frequency for central nervous system and cardiovascular infections (100%), and low for ear, nose, and throat infections, urinary tract infections, lower respiratory tract and bone and joint infections (23·0%, 51·6%, 52·5%, 65·0%, respectively) which indicates a significant overuse of antibiotics for diagnoses listed. The results of an individual point prevalence survey provided reliable and representative data for the hospital. Point-prevalence surveys proved to be a valuable method for detecting targets for antibiotic prescribing improvement and they clearly showed that our local hospital guidelines offered too many choices of antibiotic treatment for each clinical indication and needed revision.
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Affiliation(s)
- Irina Pristaš
- University Hospital for Infectious Diseases, Zagreb, Croatia.
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17
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Unger NR, Gauthier TP, Cheung LW. Penicillin Skin Testing: Potential Implications for Antimicrobial Stewardship. Pharmacotherapy 2013; 33:856-67. [DOI: 10.1002/phar.1288] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Nathan R. Unger
- Department of Pharmacy Practice; Nova Southeastern University College of Pharmacy; Palm Beach Gardens Florida
| | - Timothy P. Gauthier
- Department of Pharmacy Practice; Nova Southeastern University College of Pharmacy; Fort Lauderdale Florida
| | - Linda W. Cheung
- Pharmacy Service, James A. Haley Veterans' Hospital; Tampa Florida
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18
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Ashiru-Oredope D, Sharland M, Charani E, McNulty C, Cooke J. Improving the quality of antibiotic prescribing in the NHS by developing a new Antimicrobial Stewardship Programme: Start Smart--Then Focus. J Antimicrob Chemother 2012; 67 Suppl 1:i51-63. [DOI: 10.1093/jac/dks202] [Citation(s) in RCA: 172] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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19
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Pathak A, Mahadik K, Dhaneria SP, Sharma A, Eriksson B, Lundborg CS. Surveillance of antibiotic consumption using the "focus of infection" approach in 2 hospitals in Ujjain, India. PLoS One 2012; 7:e38641. [PMID: 22715402 PMCID: PMC3371041 DOI: 10.1371/journal.pone.0038641] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Accepted: 05/08/2012] [Indexed: 11/24/2022] Open
Abstract
Antibiotic surveillance initiatives are limited in resource-constrained settings. In the present study, a quantitative comparison of antibiotic use rates for suspected infections in 2 hospitals in India was performed using the “focus of infection” approach to identify targets for quality improvement in antibiotic prescription patterns in hospitalized patients.
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Affiliation(s)
- Ashish Pathak
- Division of Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
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20
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Boussat S, Demoré B, Lozniewski A, Aissa N, Rabaud C. How to improve the collection and analysis of hospital antibiotic consumption: preliminary results of the ConsoRes software experimental implementation. Med Mal Infect 2012; 42:154-60. [PMID: 22424796 DOI: 10.1016/j.medmal.2012.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 12/05/2011] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The online software ConsoRes is used to collect and analyze data on antibiotic consumption and evolution of bacterial resistance in healthcare institutions in every hospital ward (HW). We report the first results of ConsoRes implementation in the northeast hospitals of France. METHODOLOGY ConsoRes was implemented in January 2011, in nine volunteer hospitals after performing an onsite assessment. Five of these hospitals were already monitoring antibiotic consumption with a network such as Raisin ATB or Antibiolor, providing feedback on the various evaluation tools. RESULTS The ConsoRes data collection import function meets expectations of pharmacists, bacteriologists, or clinicians since it is user friendly, prevents redundant data input, and allows data transfer to the national databases. Importing the hospital organizational structure prevents mistakes on consumption allocation, which was noted in the previous databases, and makes comparison and benchmark analysis reliable. ConsoRes also provides a rapid consumption data feedback to all registered users within the hospital, whether in charge of a ward (clinician) or having a transversal function (pharmacist, bacteriologist). The availability of an automatic standard report or of an online customized report is another major feature of ConsoRes. CONCLUSION Besides providing surveillance, the concomitant analysis of local antibiotic consumption and bacterial resistance should have an educational impact by allowing each user to implement actions within the framework of antibiotic stewardship.
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Affiliation(s)
- S Boussat
- Centre de coordination de lutte contre les infections nosocomiales de l'Est, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, Vandœuvre-lès-Nancy, France.
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21
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Haug JB, Myhr R, Reikvam A. Pharmacy sales data versus ward stock accounting for the surveillance of broad-spectrum antibiotic use in hospitals. BMC Med Res Methodol 2011; 11:166. [PMID: 22166018 PMCID: PMC3252256 DOI: 10.1186/1471-2288-11-166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2011] [Accepted: 12/13/2011] [Indexed: 11/17/2022] Open
Abstract
Background Antibiotic consumption in hospitals is commonly measured using the accumulated amount of drugs delivered from the pharmacy to ward held stocks. The reliability of this method, particularly the impact of the length of the registration periods, has not been evaluated and such evaluation was aim of the study. Methods During 26 weeks, we performed a weekly ward stock count of use of broad-spectrum antibiotics - that is second- and third-generation cephalosporins, carbapenems, and quinolones - in five hospital wards and compared the data with corresponding pharmacy sales figures during the same period. Defined daily doses (DDDs) for antibiotics were used as measurement units (WHO ATC/DDD classification). Consumption figures obtained with the two methods for different registration intervals were compared by use of intraclass correlation analysis and Bland-Altman statistics. Results Broad-spectrum antibiotics accounted for a quarter to one-fifth of all systemic antibiotics (ATC group J01) used in the hospital and varied between wards, from 12.8 DDDs per 100 bed days in a urological ward to 24.5 DDDs in a pulmonary diseases ward. For the entire study period of 26 weeks, the pharmacy and ward defined daily doses figures for all broad-spectrum antibiotics differed only by 0.2%; however, for single wards deviations varied from -4.3% to 6.9%. The intraclass correlation coefficient, pharmacy versus ward data, increased from 0.78 to 0.94 for parenteral broad-spectrum antibiotics with increasing registration periods (1-4 weeks), whereas the corresponding figures for oral broad-spectrum antibiotics (ciprofloxacin) were from 0.46 to 0.74. For all broad-spectrum antibiotics and for parenteral antibiotics, limits of agreement between the two methods showed, according to Bland-Altman statistics, a deviation of ± 5% or less from average mean DDDs at 3- and 4-weeks registration intervals. Corresponding deviation for oral antibiotics was ± 21% at a 4-weeks interval. Conclusions There is a need for caution in interpreting pharmacy sales data aggregated over short registration intervals, especially so for oral formulations. Even a one-month registration period may be too short.
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Affiliation(s)
- Jon B Haug
- Department of Infectious Diseases, Oslo University Hospital Aker, Trondheimsveien 235, NO-0514 Oslo, Norway.
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22
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Plüss-Suard C, Pannatier A, Kronenberg A, Mühlemann K, Zanetti G. Hospital antibiotic consumption in Switzerland: comparison of a multicultural country with Europe. J Hosp Infect 2011; 79:166-71. [DOI: 10.1016/j.jhin.2011.05.028] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 05/13/2011] [Indexed: 12/31/2022]
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23
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McNeil V, Cruickshank M, Duguid M. Safer use of antimicrobials in hospitals: the value of antimicrobial usage data. Med J Aust 2010; 193:S114-7. [PMID: 20955139 DOI: 10.5694/j.1326-5377.2010.tb04026.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2010] [Accepted: 08/11/2010] [Indexed: 11/17/2022]
Abstract
The National Antimicrobial Utilisation Surveillance Program (NAUSP) collects aggregate data from hospitals in all Australian states and provides reports of monthly hospital inpatient antimicrobial usage to contributing hospitals. These data provide an Australian peer-group benchmark; hospitals can compare their usage with similar hospitals and identify areas of antimicrobial use that require more in-depth analysis. Overall high usage has been used by hospitals and area health services as a stimulus for initiation or expansion of antimicrobial stewardship programs. High use of particular classes of antimicrobials has triggered individual drug audits and been used to tailor interventions. Longitudinal antimicrobial usage data have been used by hospitals to measure the effects of antimicrobial stewardship strategies and provide feedback to prescribers.
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Affiliation(s)
- Vicki McNeil
- Antimicrobial Utilisation Surveillance Programs, Infection Control Service, Communicable Disease Control Branch, SA Health, Adelaide, SA, Australia.
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24
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Ansari F, Molana H, Goossens H, Davey P, Davey P, Ansari F, Goossens H, Ferech M, Metz S, Jansens H, Andrašević AT, Cazin I, Mach R, Vlcek J, Molstad B, Jamieson C, Mitt P, Elomaa N, Patry I, Bertrand X, Antoniadou A, Giamarellou H, Pujate E, Filius M, van Nispen tot Pennerden C, Syrrist C, Ansari F, Hill K, Cizman M, Erntell M, Gur D, Heginbothom M. Development of standardized methods for analysis of changes in antibacterial use in hospitals from 18 European countries: the European Surveillance of Antimicrobial Consumption (ESAC) longitudinal survey, 2000–06. J Antimicrob Chemother 2010; 65:2685-91. [DOI: 10.1093/jac/dkq378] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- F. Ansari
- Quality, Safety and Informatics Research Group, Division of Clinical and Population Sciences and Education, University of Dundee, Dundee DD2 4BF, UK
| | - H. Molana
- Department of Economic Studies, University of Dundee, Dundee DD1 4HN, UK
| | - H. Goossens
- Vaccine and Infectious Diseases Institute, Laboratory of Microbiology, University of Antwerp, Antwerp, Belgium
| | - P. Davey
- Quality, Safety and Informatics Research Group, Division of Clinical and Population Sciences and Education, University of Dundee, Dundee DD2 4BF, UK
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25
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Kritsotakis EI, Christidou A, Roumbelaki M, Tselentis Y, Gikas A. The dynamic relationship between antibiotic use and the incidence of vancomycin-resistant Enterococcus: time-series modelling of 7-year surveillance data in a tertiary-care hospital. Clin Microbiol Infect 2008; 14:747-54. [PMID: 18727798 DOI: 10.1111/j.1469-0691.2008.02026.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of antibiotics in the epidemiology of vancomycin-resistant Enterococcus (VRE) has been studied extensively, but controversies remain as to which, and to what extent, antibiotics facilitate the emergence and dissemination of VRE in hospitals. Aggregate data on the use of several antibiotic classes in terms of defined daily doses (DDD) per 100 patient-days (PD), and VRE incidence rates in terms of clinical isolates per 1000 PD, were evaluated during a 7-year period at a tertiary-care hospital. Time-series analysis (autoregressive integrated moving average (ARIMA) and transfer function models) was used to quantify the temporal effect of antibiotic use on VRE incidence and estimate effect-delays. The incidence rate of VRE observed in a specific bimester was found to be a function of its value during the preceding bimester and of prior changes in the volume of use of four antibiotic classes. In particular, an increase of one DDD/100 PD in the use of glycopeptides, fluoroquinolones, extended-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations resulted, independently, in average changes of +0.024, +0.015, + 0.020 and -0.010 isolates per 1000 PD in the incidence of VRE, with average delays of 2, 4, 2 and 6 months, respectively, which explained 56% of the observed variation in VRE rates over time. Efforts to reduce VRE cross-transmission should be supplemented by targeted antibiotic control policies. The use of glycopeptides, broad-spectrum cephalosporins and fluoroquinolones in high amounts should be the targets of such policies. Penicillin-beta-lactamase inhibitor combinations might be suitable substitutes for extended-spectrum cephalosporins.
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Affiliation(s)
- E I Kritsotakis
- Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Crete, Greece
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26
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CHAUVIN C, QUERREC M, PEROT A, GUILLEMOT D, SANDERS P. Impact of antimicrobial drug usage measures on the identification of heavy users, patterns of usage of the different antimicrobial classes and time-trends evolution. J Vet Pharmacol Ther 2008; 31:301-11. [DOI: 10.1111/j.1365-2885.2008.00960.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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27
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Declercq P, Petré D, Gordts B, Voss A. Complicated Community-Acquired Soft Tissue Infection by MRSA from Porcine Origin. Infection 2007; 36:590-2. [DOI: 10.1007/s15010-007-7029-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Accepted: 06/14/2007] [Indexed: 01/04/2023]
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28
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Cooke J. Report of the Prescribing Subgroup of the Specialist Advisory Committee on Antimicrobial Resistance (SACAR). J Antimicrob Chemother 2007; 60 Suppl 1:i9-13. [PMID: 17656393 DOI: 10.1093/jac/dkm152] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This report describes the work of the Human Prescribing Subgroup of the Department of Health (DH) Specialist Advisory Committee on Antimicrobial Resistance over a period of 3 years from 2003. It describes the coordination and outputs from the DH Pharmacy Initiative for promoting prudent use of antibiotics in hospitals. The production and dissemination of a template have supported this and have provided a format for acute hospitals to develop antimicrobial guidelines. Engagement with key stakeholders has enabled antimicrobial use and resistance to be highlighted as an important policy issue. Work with the Healthcare Commission has informed the development of high-level indicators that have been incorporated into national audits of acute hospitals and recommendations in a national report 'The Best Medicine'. The development of a quantitative database of antimicrobial usage has been an important feature of this work. Three annual national multidisciplinary conferences have been organized where work has been presented.
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Affiliation(s)
- Jonathan Cooke
- Pharmacy and Medicines Management, University Hospital of South Manchester NHS Foundation Trust, Manchester M23 9LT, UK.
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29
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Curcio D, Fernández F. What is the best denominator with which to measure antibiotic consumption? Clin Microbiol Infect 2007; 13:553. [PMID: 17331120 DOI: 10.1111/j.1469-0691.2007.01696.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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