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Ohashi K, Matsuoka T, Shinoda Y, Takahashi T, Shikano H, Kagajo M, Yagi T, Usami E. Evaluation of long-term pharmacist-led prospective audit and feedback in antimicrobial stewardship: An 8-year study. Am J Infect Control 2024; 52:670-677. [PMID: 38142775 DOI: 10.1016/j.ajic.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Limited research has evaluated the long-term outcomes of prospective audit and feedback (PAF) led by pharmacists. We assessed pharmacist-led PAF processes and outcome measures over 8 years. METHODS This study was conducted at a single public hospital in Japan. Between 2014 and 2021, pharmacists conducted weekday PAFs for hospitalized patients and annually evaluated the process and outcome measures. The endpoints included detection of drug-resistant bacteria, drug susceptibility rates, duration of antimicrobial therapy, and proportion of long-term administration. RESULTS Among inpatients, methicillin-resistant Staphylococcus aureus significantly decreased from 50.9% in 2014 to 32.8% in 2021 (P < .001). The susceptibility rate of Pseudomonas aeruginosa to meropenem significantly increased from 91.2% in 2014 to 94.4% in 2021 (P < .001) and levofloxacin increased from 84.9% in 2014 to 89.3% in 2021 (P < .001). Antimicrobial therapy duration did not differ significantly between 2014 and 2016, but decreased significantly from 2017 onwards (P < .001), except in 2018. The number of patients receiving intravenous antimicrobials for >10 days decreased significantly between 2014 and 2021 (P < .001). CONCLUSIONS Long-term continuous PAF interventions by pharmacists contribute to improving and maintaining process and outcome indicators and prevent the spread of drug-resistant bacteria.
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Affiliation(s)
- Kengo Ohashi
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan; The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan.
| | - Tomoko Matsuoka
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan; The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan
| | - Yasutaka Shinoda
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan; The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan
| | - Takamasa Takahashi
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Surgery, Ogaki Municipal Hospital, Gifu, Japan
| | - Hiroaki Shikano
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Pediatrics, Ogaki Municipal Hospital, Gifu, Japan
| | - Michiko Kagajo
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Respiratory Medicine, Ogaki Municipal Hospital, Gifu, Japan
| | - Tetsuya Yagi
- The Team for Antimicrobial Stewardship, Ogaki Municipal Hospital, Gifu, Japan; Department of Infectious Diseases, Nagoya, University Hospital, Nagoya, Japan
| | - Eiseki Usami
- Department of Pharmacy, Ogaki Municipal Hospital, Gifu, Japan
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Murakami Y, Nozaki Y, Morosawa M, Toyama M, Ogashiwa H, Ueda T, Nakajima K, Tanaka R, Takesue Y. Difference in the impact of coinfections and secondary infections on antibiotic use in patients hospitalized with COVID-19 between the Omicron-dominant period and the pre-Omicron period. J Infect Chemother 2024:S1341-321X(24)00067-9. [PMID: 38428674 DOI: 10.1016/j.jiac.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/14/2024] [Accepted: 02/26/2024] [Indexed: 03/03/2024]
Abstract
INTRODUCTION This study evaluated the effect of coinfections and/or secondary infections on antibiotic use in patients hospitalized with coronavirus disease 2019 (COVID-19). METHOD Days of therapy per 100 bed days (DOT) in a COVID-19 ward were compared between 2022 (Omicron period) and 2021 (pre-Omicron period). Antibiotics were categorized as antibiotics predominantly used for community-acquired infections (CAIs) and antibiotics predominantly used for health care-associated infections (HAIs). Bacterial and/or fungal infections which were proved or assumed on admission were defined as coinfections. Secondary infections were defined as infections that occurred following COVID-19. RESULTS Patients with COVID-19 during the Omicron period were older and had more comorbidities. Coinfections were more common in the Omicron period than in the pre-Omicron period (44.4% [100/225] versus 0.8% [2/257], respectively, p < 0.001), and the mean DOT of antibiotics for CAIs was significantly increased in the Omicron period (from 3.60 to 17.84, p < 0.001). Secondary infection rate tended to be higher in the Omicron period (p = 0.097). Mean DOT of antibiotics for HAIs were appeared to be lower in the COVID-19 ward than in the general ward (pre-Omicron, 3.33 versus 6.37, respectively; Omicron, 3.84 versus 5.22, respectively). No multidrug-resistant gram-negative organisms were isolated in the COVID-19 ward. CONCLUSION Antibiotic use for CAIs was limited in the pre-Omicron period but increased in the Omicron period because of a high coinfection rate on admission. With the antimicrobial stewardship, excessive use of antibiotics for HAIs was avoided in the COVID-19 ward during both periods.
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Affiliation(s)
- Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Mika Morosawa
- Department of Respiratory Medicine, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Masanobu Toyama
- Department of Pharmacy, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Hitoshi Ogashiwa
- Department of Clinical Technology, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, Aichi, 479-8510, Japan.
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan.
| | - Ryoya Tanaka
- Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan; Department of Clinical Infectious Diseases, Tokoname City Hospital, 3-3-3 Asukadai, Tokoname, 479-8510, Japan.
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Kurabayashi M, Yamada T, Tomita M, Matsumoto M, Mizutani R, Uesugi K, Niino H, Yamada H, Isobe T, Edagawa S. Impact of antimicrobial stewardship implementation on the antibiotic use and susceptibility in a Japanese long-term care hospital. J Infect Chemother 2024; 30:134-140. [PMID: 37793545 DOI: 10.1016/j.jiac.2023.09.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 09/15/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Antimicrobial use (AMU) is closely related to the emergence of antimicrobial-resistant (AMR) bacteria. Meanwhile, long-term care hospitals (LTCHs) have been pointed out to be important reservoirs for AMR. However, evidence illustrating the association between AMU and AMR in LTCHs is lacking compared to that of acute care hospitals. METHODS We evaluated the impact of an antimicrobial stewardship (AS) program implementation, in a LTCH on AMU and antibiotic susceptibility between three periods: the pre-AS-period (pre-AS); the first period after AS implementation (post-AS 1), in which initiated recommendation the blood culture collection and definitive therapy by AS team; and the second period (post-AS 2), implementation of a balanced use of antibiotics was added. RESULTS After the AS implementation, a significant increase in the number of blood cultures collected was observed. Conversely, the AMU of piperacillin-tazobactam (PIPC/TAZ), which has activity against Pseudomonas aeruginosa, was increased and occupied 43.0% of all injectable AMU in post-AS 1 compared with that in pre-AS (35.5%). In the post-AS 2 period, we analyzed the %AUD and recommended hospital-wide PIPC/TAZ sparing; this resulted in the significant reduction in %AUD of PIPC/TAZ, which was associated with improved susceptibility of P. aeruginosa to PIPC/TAZ. CONCLUSIONS These results suggest that AS programs aimed at implementing antibiotic sparing may lead to improve AMR, highlighting the necessity of correcting overuse of a single class of antibiotics and usefulness of AMU monitoring in the LTCH setting.
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Affiliation(s)
- Makoto Kurabayashi
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Takehiro Yamada
- Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo, 006-8585, Japan.
| | - Masashi Tomita
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Minami Matsumoto
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Ryunosuke Mizutani
- Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo, 006-8585, Japan.
| | - Koichi Uesugi
- Department of Pharmacotherapy, Faculty of Pharmaceutical Sciences, Hokkaido University of Science, 15-4-1, Maeda 7-jo, Teine-ku, Sapporo, 006-8585, Japan.
| | - Hideki Niino
- Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Clinical Laboratory, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Hidetoshi Yamada
- Department of Pharmacy, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Takeshi Isobe
- Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Medical, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
| | - Shunji Edagawa
- Department of Infection Control and Prevention, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Infectious Diseases, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan; Department of Neurology, Sapporo Nishimaruyama Hospital, 4-7-25, Maruyamanishimachi, Chuo-ku, Sapporo, 064-8557, Japan.
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Fieldman T, Mossialos E, Anderson M. Enhancing global insight into AMR spread and generation: prospects and limitations of the WHO and quadripartite research agendas. J Antimicrob Chemother 2024; 79:207-210. [PMID: 38153237 DOI: 10.1093/jac/dkad393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023] Open
Abstract
In Summer 2023, the World Health Organisation (WHO) and the Food and Agriculture Organization of the United Nations (FAO)-United Nations Environment Programme (UNEP) WHO-World Organisation for Animal Health (OIE) Quadripartite published two separate research agendas on antimicrobial resistance (AMR). While the publication of these research agendas on AMR creates a significant opportunity to align research priorities internationally, we emphasize a number of limitations. Firstly, the production of two separate AMR research agendas, in human health and One Health, rather than one integrated research agenda, risks the continued deprioritization of the One Health agenda. Furthermore, neither research agenda addressed the need to study the relationship between climate change and AMR despite growing evidence to suggest this may be significant. Finally, there are also missed opportunities in directing the study of appropriate treatment regimens and in clarifying the overall most resource-efficient path to combatting AMR. Moving forward, the international research agenda for AMR needs to be continually redefined in an inclusive, transparent and independent manner. This could be the task of the proposed, but so far not realized, Independent Panel on Evidence for Action against AMR.
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Affiliation(s)
- Thomas Fieldman
- Department of Clinical Microbiology, Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
| | - Michael Anderson
- Department of Health Policy, London School of Economics and Political Science, London WC2A 2AE, UK
- Health Organisation, Policy, Economics (HOPE), Centre for Primary Care & Health Services Research, The University of Manchester, Manchester M13 9PL, UK
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Shi T, Xie L. Distribution and antimicrobial resistance analysis of gram-negative bacilli isolated from a tertiary hospital in Central China: a 10-year retrospective study from 2012 to 2021. Front Microbiol 2023; 14:1297528. [PMID: 38111644 PMCID: PMC10726009 DOI: 10.3389/fmicb.2023.1297528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023] Open
Abstract
Background Gram-negative bacilli are one of the most common causes of various infections in clinical. The emergence and global spread of multi-drug resistant gram-negative bacilli has become a major challenge in the global public health field. Methods A total of 51,189 non-repetitive strains of gram-negative bacilli were isolated in clinical settings. The antimicrobial susceptibility testing was conducted by using the automated VITEK 2 compact system and the matched AST susceptibility test card, complemented by the disk diffusion method. The antimicrobial susceptibility results were interpreted by CLSI. Rates of MDR and XDR in Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa were investigated. Used the chi-square test to determine whether the antimicrobial resistance rates of four major gram-negative bacilli isolated from ICU and non-ICU department have statistical differences. Results Escherichia coli (31.4%), Klebsiella spp. (21.2%), Acinetobacter spp. (13.8%), and P. aeruginosa (11.0%) were the most frequently isolated gram-negative bacilli. Escherichia coli was the top one organism isolated from urinary tract (68.4%), bloodstream (39.9%), body fluid (33.2%), wound and pus (37%), except for respiratory tract (8.8%). Whereas Acinetobacter baumannii and K. pneumoniae were the major isolated organisms from respiratory tract. Acinetobacter baumannii showed high resistance to fluoroquinolones, β-lactam/β-lactamase inhibitor combinations class, ceftazidime, cefepime, imipenem, and meropenem, the resistance rates reached more than 70%. Ceftazidime showed a lower resistance rate to E. coli than ceftriaxone. For E. coli, fluoroquinolones showed a high resistance rate (ciprofloxacin 61.36% and levofloxacin 53.97%), whereas amikacin, carbapenems exhibited a lower resistance rate fluctuating at 2%. Acinetobacter baumannii and K. pneumoniae showed rapid increases in carbapenem resistance whereas E. coli had the lowest resistance rate and remain stable at 2%. Acinetobacter baumannii exhibited the highest rate of MDR and XDR, reaching 60-80 and 45-55%, respectively. Compared to non-ICU departments, the resistance rates of four major gram-negative bacilli in the ICU department were much higher and the differences were statistically significant (p < 0.05). Conclusion Amikacin, carbapenems, and piperacillin/tazobactam exhibited relatively high sensitivity, whereas fluoroquinolones showed high resistance rate whether they can be the first-line antimicrobials for empirical treatment of UTI should take more consideration. The gram-negative bacilli in ICU were more resistance than that in non-ICU. These findings are helpful for clinicians using antimicrobials reasonably.
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Affiliation(s)
| | - Liangyi Xie
- Department of Clinical Laboratory, Hunan Provincial People’s Hospital (The First Affiliated Hospital of Hunan Normal University), Changsha, Hunan, China
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Upadhyyaya GK, Tewari S. Enhancing Surgical Outcomes: A Critical Review of Antibiotic Prophylaxis in Orthopedic Surgery. Cureus 2023; 15:e47828. [PMID: 38022210 PMCID: PMC10679787 DOI: 10.7759/cureus.47828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
The postoperative burden remains significant due to the possibility of prolonged hospitalization, escalated healthcare costs, and patient distress caused by postorthopedic surgical site infections (SSIs). Orthopedic surgery is likewise faced with a significant challenge posed by these conditions. A positive association has been observed between the presence of postorthopedic SSIs and heightened susceptibility to adverse health outcomes, along with elevated rates of morbidity and mortality. Systemic antibiotic prophylaxis (SAP) reduces the risk of acquiring an SSI. Closed fractures, open fractures, arthroplasty, and percutaneous fixation each possess distinct attributes that impact the data and antimicrobial therapy. When implementing SAP, it is crucial to strike a delicate equilibrium between maintaining effective antibiotic stewardship protocols and preventing the occurrence of SSIs. This practice effectively prevents both the incidence of negative consequences and the emergence of antibiotic resistance. The objective of this study was to examine the existing literature on the use of surgical antibiotic prophylaxis in orthopedic surgery and explore the potential consequences associated with the inappropriate administration of antibiotics.
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Affiliation(s)
- Gaurav K Upadhyyaya
- Department of Orthopedics, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Sachchidanand Tewari
- Department of Pharmacology, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
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Cheerala VSK, Akhir A, Saxena D, Maitra R, Chopra S, Neelakantan SC. Discovery of benzoxazole-thiazolidinone hybrids as promising antibacterial agents against Staphylococcus aureus and Enterococcus species. RSC Med Chem 2023; 14:1712-1721. [PMID: 37731699 PMCID: PMC10507814 DOI: 10.1039/d3md00290j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 07/17/2023] [Indexed: 09/22/2023] Open
Abstract
Antibiotic resistance is rapidly exacerbating the unceasing rise in nosocomial infections caused by drug-resistant bacterial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE). Therefore, there is a dire need for new therapeutic agents that can mitigate the unbridled emergence of drug-resistant pathogens. In the present study, several benzoxazole-thiazolidinone hybrids (BT hybrids) were synthesized and evaluated for their antibacterial activity against the ESKAP pathogen panel. The preliminary screening revealed the selective and potent inhibitory activity of hydroxy BT hybrids against S. aureus with MIC ≤ 4 μg mL-1. Hydroxy compounds (BT25, BT26, BT18, BT12, and BT11) exhibited a good selectivity index (SI > 20), which were determined to be non-toxic to Vero cells. An engaging fact is that two compounds BT25 and BT26 showed potent activity against various clinically-relevant and highly drug resistant S. aureus (MRSA & VRSA) and Enterococcus (VRE) isolates. These hybrids showed concentration-dependent bactericidal activity that is comparable to vancomycin. These experimental results were corroborated with docking, molecular dynamics, and free energy studies to discern the antibacterial mechanisms of hydroxy BT hybrids with three bacterial enzymes DNA gyrase B, MurB, and penicillin binding protein 4 (PBP4). The reassuring outcome of the current investigation confirmed that the aforementioned BT hybrids could be used as very promisingly potent antibacterial agents for the treatment of Staphylococcus aureus and Enterococcus infections.
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Affiliation(s)
- Vijay Sai Krishna Cheerala
- Department of Chemistry, Sri Sathya Sai Institute of Higher Learning Brindavan Campus Bengaluru 560067 Karnataka India +91 7975943998
| | - Abdul Akhir
- Division of Molecular Microbiology and Immunology, CSIR-Central Drug Research Institute Sector 10, Sitapur Road Lucknow - 226031 Uttar Pradesh India +91 7652032958
| | - Deepanshi Saxena
- Division of Molecular Microbiology and Immunology, CSIR-Central Drug Research Institute Sector 10, Sitapur Road Lucknow - 226031 Uttar Pradesh India +91 7652032958
| | - Rahul Maitra
- Division of Molecular Microbiology and Immunology, CSIR-Central Drug Research Institute Sector 10, Sitapur Road Lucknow - 226031 Uttar Pradesh India +91 7652032958
| | - Sidharth Chopra
- Division of Molecular Microbiology and Immunology, CSIR-Central Drug Research Institute Sector 10, Sitapur Road Lucknow - 226031 Uttar Pradesh India +91 7652032958
- Academy of Scientific and Innovative Research (AcSIR) Ghaziabad 201002 India
| | - Sundaresan Chittor Neelakantan
- Department of Chemistry, Sri Sathya Sai Institute of Higher Learning Brindavan Campus Bengaluru 560067 Karnataka India +91 7975943998
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Morosawa M, Ueda T, Nakajima K, Inoue T, Toyama M, Ogasiwa H, Doi M, Nozaki Y, Murakami Y, Ishii M, Takesue Y. Comparison of antibiotic use and antibiotic resistance between a community hospital and tertiary care hospital for evaluation of the antimicrobial stewardship program in Japan. PLoS One 2023; 18:e0284806. [PMID: 37093821 PMCID: PMC10124824 DOI: 10.1371/journal.pone.0284806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 04/06/2023] [Indexed: 04/25/2023] Open
Abstract
Assessment of risk-adjusted antibiotic use (AU) is recommended to evaluate antimicrobial stewardship programs (ASPs). We aimed to compare the amount and diversity of AU and antimicrobial susceptibility of nosocomial isolates between a 266-bed community hospital (CH) and a 963-bed tertiary care hospital (TCH) in Japan. The days of therapy/100 bed days (DOT) was measured for four classes of broad-spectrum antibiotics predominantly used for hospital-onset infections. The diversity of AU was evaluated using the modified antibiotic heterogeneity index (AHI). With 10% relative DOT for fluoroquinolones and 30% for each of the remaining three classes, the modified AHI equals 1. Multidrug resistance (MDR) was defined as resistance to ≥ 3 anti-Pseudomonas antibiotic classes. The DOT was significantly higher in the TCH than in the CH (10.85 ± 1.32 vs. 3.89 ± 0.93, p < 0.001). For risk-adjusted AU, the DOT was 6.90 ± 1.50 for acute-phase medical wards in the CH, and 8.35 ± 1.05 in the TCH excluding the hematology department. In contrast, the DOT of antibiotics for community-acquired infections was higher in the CH than that in the TCH. As quality assessment of AU, higher modified AHI was observed in the TCH than in the CH (0.832 ± 0.044 vs. 0.721 ± 0.106, p = 0.003), indicating more diverse use in the TCH. The MDR rate in gram-negative rods was 5.1% in the TCH and 3.4% in the CH (p = 0.453). No significant difference was demonstrated in the MDR rate for Pseudomonas aeruginosa and Enterobacteriaceae species between hospitals. Broad-spectrum antibiotics were used differently in the TCH and CH. However, an increased antibiotic burden in the TCH did not cause poor susceptibility, possibly because of diversified AU. Considering the different patient populations, benchmarking AU according to the facility type is promising for inter-hospital comparisons of ASPs.
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Affiliation(s)
- Mika Morosawa
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Respiratory Medicine, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Takashi Ueda
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazuhiko Nakajima
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
| | - Tomoko Inoue
- Department of Pharmacy, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Masanobu Toyama
- Department of Pharmacy, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Hitoshi Ogasiwa
- Department of Clinical Technology, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Miki Doi
- Department of Clinical Technology, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Yasuhiro Nozaki
- Department of Respiratory Medicine, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Yasushi Murakami
- Department of Respiratory Medicine, Tokoname City Hospital, Tokoname, Aichi, Japan
| | - Makoto Ishii
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshio Takesue
- Department of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Japan
- Department of Clinical Infectious Diseases, Tokoname City Hospital, Tokoname, Japan
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