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Kanda N, Ohbe H, Jo T, Matsui H, Fushimi K, Hatakeyama S, Yasunaga H. Trends in inpatient antimicrobial consumption using days of therapy and days of antibiotic spectrum coverage: A nationwide claims database study in Japan. J Infect Chemother 2024; 30:228-235. [PMID: 37852373 DOI: 10.1016/j.jiac.2023.10.012] [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: 09/01/2023] [Revised: 10/09/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Days of antibiotic spectrum coverage (DASC), a novel metric for both antimicrobial volume and spectrum, was proposed to measure inpatient antimicrobial consumption in 2022. The DASC may better reflect efforts toward antimicrobial stewardship; however, no previous study has described the distribution of trends in DASC in hospitals or the association between the trend in DASC and days of therapy (DOT). This study assessed trends in antimicrobial consumption for inpatients at acute care hospitals in Japan using the DOT and DASC. METHODS This retrospective observational study used the nationwide administrative inpatient claims database of Japanese acute care hospitals between 2014 and 2018. The prescriptions of all antibiotics were identified to calculate DOT/1000 patient-days, DASC/1000 patient-days, and DASC/DOT. We described the five-year trend in these metrics and examined the association between the trends in DOT and DASC. RESULTS In total, 26,301,685 admissions from 634 hospitals were included. The DOT/1000 patient-days and DASC/1000 patient-days increased significantly by 6.1% and 5.6%, respectively. The DASC/DOT ratio did not change significantly (P = 0.35). Moreover, there was little correlation between DOT/1000 patient-days and DASC/DOT (R2 = 0.01). There was also little correlation between the five-year changes in DOT/1000 patient-days and those in DASC/DOT (R2 = 0.02). CONCLUSIONS It may be difficult to assess trends in the antibiotic spectrum using DASC alone. However, the combination of DOT as a quantity indicator and DASC/DOT as a spectrum indicator may allow for a more appropriate evaluation of stewardship efforts.
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Affiliation(s)
- Naoki Kanda
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan; Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan.
| | - Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Shuji Hatakeyama
- Division of General Internal Medicine, Jichi Medical University Hospital, Tochigi, Japan; Division of Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, 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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Park YS, Kim SY, Kim H, Jang SY, Park EC. Impact of financial incentives for infection prevention and management on antibiotic use: A Korea National Health Insurance cohort study. J Infect Public Health 2024; 17:362-369. [PMID: 38198969 DOI: 10.1016/j.jiph.2023.12.015] [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: 08/29/2023] [Revised: 12/10/2023] [Accepted: 12/17/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND The Korean government implemented financial incentives to enhance infection prevention and management within general hospital settings. This study aimed to evaluate the impact of infection control compensation on antibiotic usage using a controlled interrupted time series analysis. METHODS The main unit of analysis was 270,901 inpatient episodes extracted from the Korean National Health Insurance Service Cohort Database from 2013 to 2019. The 96-month period was examined before and after the intervention, which was set to September 1, 2017, by applying a 1-year lag time after the incentive was introduced. Segmented regression was used to estimate the effects of interventions in a controlled interrupted time series. Hospitals that received nationwide financial incentives for infection prevention and management were included in the analysis. The study's primary outcome was the use of antibiotics based on the WHO Access, Watch, and Reserve (AWaRe) classification of antibiotics, and the secondary outcome was the number of days of antibiotic use as days of therapy (DOTs) per patient day (PD). RESULTS The probability of overall antibiotic use decreased between incentivized and unincentivized hospitals (odds ratio [OR], 0.922; 95% confidence interval [CI], 0.859-1.000). The difference in level change in the use of third-generation cephalosporins (OR,0.894; 95% CI, 0.817-0.977) and carbapenem (OR,0.790; 95% CI, 0.630-0.992) was significantly reduced between incentivized and unincentivized hospitals. The difference in slope change on DOTs/PD of glycopeptides was - 0.005 DOT/PDs, and that of carbapenem was - 0.003 between incentivized and unincentivized hospitals. CONCLUSION We observed that incentives for infection prevention and management have had a positive impact on some aspects of antibiotic usage. A partial decrease was observed in antibiotic use, accompanied by a modest reduction in DOTs/PD, particularly for antibiotics aimed at addressing multidrug-resistant pathogens. Further investigation is necessary to establish evidence for extending these incentives.
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Affiliation(s)
- Yu Shin Park
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Soo Young Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea; Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Hyunkyu Kim
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Yong Jang
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Healthcare Management, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea; Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Zirpe KG, Kapse US, Gurav SK, Tiwari AM, Deshmukh AM, Suryawanshi PB, Bhoyar AP, Wankhede PP, Desai D, Suryawanshi R, John R, Bhagat S. Impact of an Antimicrobial Stewardship Program on Broad Spectrum Antibiotics Consumption in the Intensive Care Setting. Indian J Crit Care Med 2023; 27:737-742. [PMID: 37908433 PMCID: PMC10613868 DOI: 10.5005/jp-journals-10071-24543] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023] Open
Abstract
Background and objectives Antibiotics are the most commonly exploited agents in intensive care units. An antimicrobial stewardship program (ASP) helps in the optimal utilization of antibiotics and prevents the development of antibiotic resistance. The aim of this study was to assess the impact of ASP on broad-spectrum antibiotic consumption in terms of defined daily dose (DDD) and days of therapy (DOT) before and after the implementation of an ASP. Materials and methods It was a prospective, quasi-experimental, pre- and post-study. Group A consisted of 5 months of ASP data, ASP activities were implemented during the next 2 months and continued. Group B (post-ASP) data was collected for the next 5 months. Total and individual DDDs and DOTs of broad-spectrum antibiotics utilized were compared between group A and group B. Results Total DDDs used per 100 patient bed days were reduced by 18.72% post-ASP implementation (103.46 to 84.09 grams). The total DOT per 100 patient bed days used was 90.91 vs 71.25 days (21.62% reduction). As per the WHO classification of antibiotics use, the watch category (43.4% vs 43.04%) as well as reserve category (56.6% vs 56.97%) used between the two groups were found similar. The average length of stay (8.9 ± 2 days) after ASP was found significantly lesser than baseline (10.8 ± 3.4 days) (p < 0.05), however, there was no significant change in mortality between the two groups. Conclusion Antimicrobial stewardship program implementation may reduce overall antibiotic consumption both in terms of DDD and DOT. How to cite this article Zirpe KG, Kapse US, Gurav SK, Tiwari AM, Deshmukh AM, Suryawanshi PB, et al. Impact of an Antimicrobial Stewardship Program on Broad Spectrum Antibiotics Consumption in the Intensive Care Setting. Indian J Crit Care Med 2023;27(10):737-742.
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Affiliation(s)
- Kapil Gangadhar Zirpe
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Upendrakumar S Kapse
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Sushma Kirtikumar Gurav
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Anand Mohanlal Tiwari
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Abhijit Manikrao Deshmukh
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | | | - Abhaya Pramodrao Bhoyar
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Prajkta Prakash Wankhede
- Department of Neurotrauma Unit, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Devashish Desai
- Department of Infectious Diseases Specialist, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rupali Suryawanshi
- Department of Laboratory, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Rebecca John
- Medical Director Office, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
| | - Soniya Bhagat
- Department of Quality Assurance, Grant Medical Foundation's Ruby Hall Clinic, Pune, Maharashtra, India
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Chen J, Ekaney I, Shah PJ. Comparison of antimicrobial utilization metrics: Food for thought for an antimicrobial stewardship programme. Int J Antimicrob Agents 2022; 60:106681. [PMID: 36279975 DOI: 10.1016/j.ijantimicag.2022.106681] [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: 03/11/2021] [Revised: 03/31/2022] [Accepted: 10/17/2022] [Indexed: 11/05/2022]
Abstract
Given the overuse of antimicrobials and increasing antimicrobial resistance, the World Health Organization and Centers for Disease Control and Prevention recommend antimicrobial stewardship programmes to measure and assess the use of antimicrobials. Several antimicrobial use metrics have been described, including days of therapy, defined daily doses and standardized antimicrobial administration ratio. Understanding these metrics, including the advantages and disadvantages, can help antimicrobial stewardship programmes to monitor antimicrobial use at their institution, and assess the impact of antimicrobial stewardship efforts. This review discusses the three commonly used antimicrobial use metrics, their pros and cons, and how antimicrobial stewardship programmes can use these metrics to help assess the use of antimicrobials.
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Affiliation(s)
- Jingshi Chen
- Department of Pharmacy, Houston Methodist Hospital, Houston, TX, USA
| | - Irene Ekaney
- Department of Infectious Diseases, Houston Methodist Sugar Land Hospital, Sugar Land, TX, USA
| | - Punit J Shah
- Department of Pharmacy, Houston Methodist Sugar Land Hospital, Sugar Land, TX, USA.
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Nakamura S, Arima T, Tashiro R, Yasumizu S, Aikou H, Watanabe E, Nakashima T, Nagatomo Y, Kakimoto I, Motoya T. Impact of an antimicrobial stewardship in a 126-bed community hospital with close communication between pharmacists working on post-prescription audit, ward pharmacists, and the antimicrobial stewardship team. J Pharm Health Care Sci 2021; 7:25. [PMID: 34332639 PMCID: PMC8325832 DOI: 10.1186/s40780-021-00206-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 04/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Antimicrobial stewardship (AS) is defined as coordinated interventions to improve and measure the appropriate use of antimicrobial agents. However, available resources for AS differ depending on the size of the clinical setting. Therefore, AS programs based on guidelines need to be selected in order to implement AS in small- to medium-sized hospitals. The present study compared the impact of AS in a 126-bed community hospital between pre- and post-AS periods. Methods The present study was retrospectively performed by selecting data on eligible patients from electronic medical records stored in the central database of the hospital. The roles of the AS team included weekly rounds and recommendations on the appropriate use of antimicrobials, and pharmacists working on post-prescription audits and pharmaceutical care at the bedside closely communicated with the AS team to assist with its implementation. As process measurements, the order rate of culture examinations, the conducting rate of de-escalation, antimicrobial use density (AUD), days of therapy (DOT), and the AUD/DOT ratio of carbapenems and tazobactam-piperacillin (TAZ/PIPC) were measured. Thirty-day mortality and recurrence rates were examined as clinical outcomes. Results A total of 535 patients (288 in the pre-AS period and 247 in the post-AS period) were enrolled in the present study. The recommendation rate to prescribers significantly increased (p < 0.01) from 10.4% in the pre-AS period to 21.1% in the post-AS period. The order rate of culture examinations increased from 56.3 to 73.3% (p < 0.01). The conducting rate of de-escalation increased from 10.2 to 30.8% (p < 0.05). The AUD of carbapenems and TAZ/PIPC significantly decreased (p < 0.05). The DOT of carbapenems (p < 0.01) and TAZ/PIPC (p < 0.05) also significantly decreased. The AUD/DOT ratio of carbapenem significantly increased from 0.37 to 0.60 (p < 0.01). Thirty-day mortality rates were 11.2 and 14.2%, respectively, and were not significantly different. The 30-day recurrence rate significantly decreased (p < 0.05) from 14.7 to 7.5%. Conclusions The implementation of AS in this hospital improved the appropriate use of antimicrobials without negatively affecting clinical outcomes. These results may be attributed to close communication between pharmacists working on post-prescription audits and pharmaceutical care at the bedside and the AS team.
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Affiliation(s)
- Satoshi Nakamura
- Infection Control Team and Antimicrobial Stewardship Team, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan.,Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Takashi Arima
- Infection Control Team and Antimicrobial Stewardship Team, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan.,Division of Urology, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Ryoichi Tashiro
- Infection Control Team and Antimicrobial Stewardship Team, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan.,Department of Nursing, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Satomi Yasumizu
- Infection Control Team and Antimicrobial Stewardship Team, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan.,Division of Clinical Laboratory, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Hayato Aikou
- Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Emi Watanabe
- Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Takashi Nakashima
- Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Yuho Nagatomo
- Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Ikuyo Kakimoto
- Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan
| | - Toshiro Motoya
- Division of Pharmacy, Tarumizu Chuo Hospital, Tarumizu Municipal Medical Center, Tarumizu, Japan.
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Kazzaz YM, AlTurki H, Aleisa L, Alahmadi B, Alfattoh N, Alattas N. Evaluating antimicrobial appropriateness in a tertiary care pediatric ICU in Saudi Arabia: a retrospective cohort study. Antimicrob Resist Infect Control 2020; 9:173. [PMID: 33143749 PMCID: PMC7640689 DOI: 10.1186/s13756-020-00842-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Background Inappropriate antibiotic utilization is associated with the emergence of antimicrobial resistance (AMR) and a decline in antibiotic susceptibility in many pathogenic organisms isolated in intensive care units. Antibiotic stewardship programs (ASPs) have been recommended as a strategy to reduce and delay the impact of AMR. A crucial step in ASPs is understanding antibiotic utilization practices and quantifying the problem of inappropriate antibiotic use to support a targeted solution. We aim to characterize antibiotic utilization and determine the appropriateness of antibiotic prescription in a tertiary care pediatric intensive care unit. Methods A retrospective cohort study was conducted at King Abdullah Specialized Children’s Hospital, Riyadh, Saudi Arabia, over a 6-month period. Days of therapy (DOT) and DOT per 1000 patient-days were used as measures of antibiotic consumption. The appropriateness of antibiotic use was assessed by two independent pediatric infectious disease physicians based on the Centers for Disease Control and Prevention 12-step Campaign to prevent antimicrobial resistance among hospitalized children. Results During the study period, 497 patients were admitted to the PICU, accounting for 3009 patient-days. A total of 274 antibiotic courses were administered over 2553 antibiotic days. Forty-eight percent of antibiotic courses were found to be nonadherent to at least 1 CDC step. The top reasons were inappropriate antibiotic choice (empirical or definitive) and inappropriate prophylaxis durations. Cefazolin and vancomycin contributed to the highest percentage of inappropriate DOTs. Conclusions Antibiotic consumption was high with significant inappropriate utilization. These data could inform decision-making in antimicrobial stewardship programs and strategies. The CDC steps provide a more objective tool and limit biases when assessing antibiotic appropriateness
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Affiliation(s)
- Yasser M Kazzaz
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia. .,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.
| | - Haneen AlTurki
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Lama Aleisa
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Bashaer Alahmadi
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Nora Alfattoh
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Nadia Alattas
- Department of Pediatrics, Ministry of National Guards - Health Affairs, Riyadh, Kingdom of Saudi Arabia.,College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
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8
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Le Saux NMA, Bowes J, Viel-Thériault I, Thampi N, Blackburn J, Buba M, Harrison MA, Barrowman N. Combined influence of practice guidelines and prospective audit and feedback stewardship on antimicrobial treatment of community-acquired pneumonia and empyema in children: 2012 to 2016. Paediatr Child Health 2020; 26:234-241. [PMID: 34136053 DOI: 10.1093/pch/pxaa066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/12/2019] [Accepted: 02/20/2020] [Indexed: 01/15/2023] Open
Abstract
Background Aminopenicillins are recommended empiric therapy for community-acquired pneumonia (CAP). The aim of the study was to assess treatment over a 5-year period after CAP guideline publication and introduction of an antimicrobial stewardship program (ASP). Methods Using ICD-10 discharge codes for pneumonia, children less than 18 years admitted to the Children's Hospital of Eastern Ontario January 1, 2012 and December 31, 2016 were identified. Children ≥ 2 months with consolidation were included. One day of therapy (DOT) was one or more doses of an antimicrobial given for 1 day. Results Of 1,707 patients identified, 713 met inclusion criteria. Eighteen (2.5%) had bacteria identified by culture and 79 of 265 (29.8%) had Mycoplasma pneumoniae detected. Mean DOT/1,000 patient days of aminopenicillins/penicillin (AAP) increased by 18.1% per year (95% confidence interval [CI] -0.2, 39.9%) and decreased by 37.6% per year (95% CI -56.1, -11.3%) for second- and third-generation cephalosporins in the post-ASP period. The duration of discharge antimicrobials decreased. Of 74 (10.4%) patients who had pleural fluid drained, 35 (47.3%) received more than 5 days of AAP and ≤ 5 days of second-/third-generation cephalosporins with no difference in median length of stay nor mean duration of antimicrobials. Conclusions Implementation of CAP management guidelines followed by prospective audit and feedback stewardship was associated with a sustained decrease in the use of broad-spectrum antibiotics in childhood CAP. Use of AAP should also be strongly considered in patients with effusions (even if no pathogen is identified), as clinical outcome appears similar to patients treated with broad-spectrum antimicrobials.
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Affiliation(s)
- Nicole M A Le Saux
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Jennifer Bowes
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Service d'Infectiologie, Département de Pédiatrie, Centre hospitalier université Laval et Centre mère-enfant Soleil, Québec, Québec
| | - Nisha Thampi
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Julie Blackburn
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario.,Services de microbiologie et de maladies infectieuses, CHU Sainte-Justine, Montréal, Québec
| | - Melanie Buba
- Division of Infectious Diseases, Children's Hospital of Eastern Ontario, Ottawa, Ontario
| | - Mary-Ann Harrison
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
| | - Nick Barrowman
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario
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9
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Balkhy HH, El-Saed A, AlShehri A, Alshaalan M, Hijazi O, El-Metwally A, Aljohany SM, Al Saif S. Antimicrobial consumption in three pediatric and neonatal intensive care units in Saudi Arabia: 33-month surveillance study. Ann Clin Microbiol Antimicrob 2019; 18:20. [PMID: 31269955 PMCID: PMC6607581 DOI: 10.1186/s12941-019-0320-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 06/21/2019] [Indexed: 01/21/2023] Open
Abstract
Background Despite their critical role in antimicrobial stewardship programs, data on antimicrobial consumption among the pediatric and neonatal population is limited internationally and lacking in Saudi Arabia. The current study was done as part of our antimicrobial stewardship activities. Objectives To calculate overall and type-specific antimicrobial consumption. Methods A prospective surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in two pediatric and one neonatal intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as days of therapy (DOT) per 1000 patient-days and as frequency of daily consumption. Results During the 33 months of the study, a total of 30,110 DOTs were monitored during 4921 admissions contributing 62,606 patient-days. Cephalosporins represented 38.0% of monitored antimicrobials in pediatric ICUs followed by vancomycin (21.9%), carbapenems (14.0%), aminoglycosides (8.8%), and piperacillin/tazobactam (8.8%). Their consumption rates were 265.1, 152.6, 97.6, 61.4, and 61.4 DOTs per 1000 patient-days (respectively). Aminoglycosides represented 45.4% of monitored antimicrobials in neonatal ICU followed by cephalosporins (30.4%) vancomycin (13.6%), and carbapenems (8.3%). Their consumption rates were 147.5, 98.7, 44.3, and 27 DOTs per 1000 patient-days (respectively). Conclusion Cephalosporins are frequently used in pediatric ICU while aminoglycosides are frequently used in neonatal ICU. The local consumption of cephalosporins and carbapenems in both ICUs is probably higher than international levels. Such data can help in establishing and monitoring the functions of antimicrobial stewardship activities aiming to ensure judicious consumption of antimicrobials.
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Affiliation(s)
- Hanan H Balkhy
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. .,King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. .,Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426, Saudi Arabia.
| | - Aiman El-Saed
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426, Saudi Arabia.,Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ali AlShehri
- Pediatric Intensive Care, King Abdullah Specialized Children's Hospital, MNGHA, Riyadh, Saudi Arabia
| | - Mohammad Alshaalan
- Department of Pediatrics, Infectious Disease Division, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Omar Hijazi
- Pediatric Cardiothoracic Intensive Care Unit, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Ashraf El-Metwally
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Sameera M Aljohany
- Pathology and Laboratory Medicine Department, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Saif Al Saif
- Neonatal Intensive Care, King Abdullah Specialized Children's Hospital, MNGHA, Riyadh, Saudi Arabia
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10
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Ertürk Şengel B, Bilgin H, Ören Bilgin B, Gidener T, Saydam S, Pekmezci A, Ergönül Ö, Korten V. The need for an antibiotic stewardship program in a hospital using a computerized pre-authorization system. Int J Infect Dis 2019; 82:40-43. [PMID: 30844518 DOI: 10.1016/j.ijid.2019.02.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 02/25/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVES Antimicrobial stewardship programs (ASPs) have an important role in the appropriate utilization of antibiotics. Some of the core strategies recommended for ASPs are pre-authorization and prospective audit and feedback. In Turkey, a unique nationwide antibiotic restriction program (NARP) has been in place since 2003. The aim of this study was to measure the effect of a prospective audit and feedback strategy system along with the NARP. METHODS A prospective quasi-experimental study was designed and implemented between March and June 2017. A computerized pre-authorization system was used as an ASP strategy to approve the antibiotics. During the baseline period, patients with intravenous (IV) antibiotic use ≥72 h were monitored without intervention. In the second period, feedback and treatment recommendations were given to attending physicians in the case of IV antibiotic use ≥72 h. The modified criteria of Kunin et al. and Gyssens et al. were followed for appropriateness of prescribing. Days of therapy (DOT) and length of stay (LOS) were calculated and compared between the two study periods. RESULTS A total of 866 antibiotic episodes among 519 patients were observed. A significant reduction in systemic antibiotic consumption was observed in the intervention period (575 vs. 349 DOT per 1000 patient-days; p < 0.001). On multivariate analysis, prospective audit and feedback (odds ratio 1.5, 95% confidence interval 1.09-2.04; p = 0.011) and pre-authorization of restricted antibiotics (odds ratio 1.7; 95% confidence interval 1.2-2.31; p = 0.002) were the predictors of appropriate antimicrobial use. Mean LOS was decreased by 2.9 days (p = 0.095). CONCLUSIONS This study showed that the antimicrobial restriction program alone was effective, but the system should be supported by a tailored ASP, such as prospective audit and feedback.
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Affiliation(s)
- Buket Ertürk Şengel
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey.
| | - Hüseyin Bilgin
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
| | - Beyza Ören Bilgin
- Department of Internal Medicine, Marmara University School of Medicine, Istanbul, Turkey
| | - Tolga Gidener
- Marmara University School of Medicine, Istanbul, Turkey
| | - Simge Saydam
- Marmara University School of Medicine, Istanbul, Turkey
| | | | - Önder Ergönül
- Department of Infectious Disease and Clinical Microbiology, Koc University, Istanbul, Turkey
| | - Volkan Korten
- Department of Infectious Disease and Clinical Microbiology, Marmara University School of Medicine, Istanbul, Turkey
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11
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Balkhy HH, El-Saed A, El-Metwally A, Arabi YM, Aljohany SM, Al Zaibag M, Baharoon S, Alothman AF. Antimicrobial consumption in five adult intensive care units: a 33-month surveillance study. Antimicrob Resist Infect Control 2018; 7:156. [PMID: 30598819 PMCID: PMC6302414 DOI: 10.1186/s13756-018-0451-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/11/2018] [Indexed: 12/16/2022] Open
Abstract
Background Estimating the baseline antimicrobial consumption is extremely important to monitor the impact of antimicrobial stewardship activities that aim to reduce the burden and cost of antimicrobial consumption. Objectives To quantify service-specific antimicrobial consumption using different metrics. Methods A surveillance study was conducted at King Abdulaziz Medical City, Riyadh, Saudi Arabia, between October 2012 and June 2015 in five adult intensive care units (ICUs). Consumption data were collected manually on a daily basis by infection control practitioners. Data were presented as defined daily dose (DDD), days of therapy (DOT) per 1000 patient days, and frequency of daily consumption. Results A total of 43,970 DDDs and 46,940 DOTs were monitored during 54,116 patient-days. For the most frequently consumed antimicrobials, the consumption of carbapenems, piperacillin/tazobactam, vancomycin, and colistin (respectively) in all ICUs combined were 255.9, 134.3, 98.2, and 13.6 DDDs per 1000 patient-days and 235.7, 145.9, 129.5, and 117.5 DOTs per 1000 patient-days. For the frequency of daily consumption, carbapenems were the most frequently consumed antimicrobial group in medical/surgical, burn, and step-down ICUs while piperacillin/tazobactam was the most frequently consumed antimicrobial in neuro-surgical and cardio-thoracic ICUs. Conclusion High consumption of broad-spectrum antimicrobial agents such as meropenem and piperacillin/tazobactam is observed in multiple ICUs in a tertiary care hospital. Meropenem consumption is considerably higher than similar ICUs internationally. Future studies focusing on concurrent monitoring of antimicrobial resistance and identifying patient and physician characteristics associated with specific prescription patterns may help in improving judicious antimicrobial consumption.
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Affiliation(s)
- Hanan H Balkhy
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,2Infectious Diseases, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia
| | - Aiman El-Saed
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,3Infection Prevention and Control Department, King Abdulaziz Medical City (KAMC), Ministry of National Guard Health Affairs (MNGHA), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia.,4Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ashraf El-Metwally
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,2Infectious Diseases, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.,Intensive Care Department, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Sameera M Aljohany
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Pathology and Laboratory Medicine Department, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Muayed Al Zaibag
- Cardiac Center & Cardiac Sciences, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Salim Baharoon
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Internal Medicine Department, Infectious Disease Division, KAMC, MNGHA, Riyadh, Saudi Arabia
| | - Adel F Alothman
- 1King Saud bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia.,Internal Medicine Department, Infectious Disease Division, KAMC, MNGHA, Riyadh, Saudi Arabia
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12
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Kallen MC, Natsch S, Opmeer BC, Hulscher MEJL, Schouten JA, Prins JM, van der Linden P. How to measure quantitative antibiotic use in order to support antimicrobial stewardship in acute care hospitals: a retrospective observational study. Eur J Clin Microbiol Infect Dis 2018; 38:347-355. [PMID: 30478815 DOI: 10.1007/s10096-018-3434-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 08/28/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
A cornerstone of antimicrobial stewardship programs (ASPs) is monitoring quantitative antibiotic use. Frequently used metrics are defined daily dose (DDD) and days of therapy (DOT). The purpose of this study was (1) to explore for the hospital setting the possibilities of quantitative data retrieval on the level of medical specialty and (2) to describe factors affecting the usability and interpretation of these quantitative metrics. We performed a retrospective observational study, measuring overall systemic antibiotic use at specialty level over a 1-year period, from December 1st 2014 to December 1st 2015, in one university and 13 non-university hospitals in the Netherlands. We distinguished surgical and non-surgical adult specialties. The association between DDDs, calculated from aggregated dispensing data, and DOTs, calculated from patient-level prescription data, was explored descriptively and related to organizational factors, data sources (prescription versus dispensing data), data registration, and data extraction. Twelve hospitals were able to extract dispensing data (DDD), three of which on the level of medical specialty; 13 hospitals were able to extract prescription data (DOT), 11 of which by medical specialty. A large variation in quantitative antibiotic use was found between hospitals and the correlation between DDDs and DOTs at specialty level was low. Differences between hospitals related to organizational factors, data sources, data registration, and data extraction procedures likely contributed to the variation in quantitative use and the low correlation between DDDs and DOTs. The differences in healthcare organization, data sources, data registration, and data extraction procedures contributed to the variation in reported quantitative use between hospitals. Uniform registration and extraction procedures are necessary for appropriate measurement and interpretation and benchmarking of quantitative antibiotic use.
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Affiliation(s)
- Marlot C Kallen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - S Natsch
- Department of Clinical Pharmacy, Radboud University Medical Center, Comeniuslaan 4, 6525 HP, Nijmegen, The Netherlands
| | - B C Opmeer
- Clinical Research Unit, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - M E J L Hulscher
- Scientific Center for Quality of healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Comeniuslaan 4, 6525 HP, Nijmegen, The Netherlands
| | - J A Schouten
- Department of Intensive Care Medicine, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands.,Department of Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Comeniuslaan 4, 6525 HP, Nijmegen, The Netherlands
| | - J M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Paul van der Linden
- Department of Clinical Pharmacy, Tergooi Hospital, Van Riebeeckweg 212, 1213 XZ, Hilversum, The Netherlands.
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13
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Marins TA, Marra AR, Edmond MB, Martino MDV, Yokota PKO, Mafra ACCN, Durão Junior MS. Evaluation of Candida bloodstream infection and antifungal utilization in a tertiary care hospital. BMC Infect Dis 2018; 18:187. [PMID: 29669521 PMCID: PMC5907302 DOI: 10.1186/s12879-018-3094-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 04/12/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Candida bloodstream infections carry a significant mortality risk, justifying the importance of adequate antifungal therapy. This study describes trends in antifungal consumption using the Defined Daily Dose (DDD) and Days of Therapy (DOT) metrics, identifies the microbiological profile, the time to initiation of empirical therapy, the adjustment after positive blood culture results for Candida, and the impact on in-hospital mortality rate in patients with candidemia. METHODS An analysis of antifungal consumption from 2008 to 2016, and of candidemia cases from 2012 to 2016 was carried out in a private tertiary hospital. RESULTS A total of 11,273 admissions were identified with a prescription for at least one type of antifungal therapy. Fluconazole was the most prescribed antifungal drug in terms of general consumption. Through the DDD and DOT metrics, we observed that over time, there was an increase in the consumption of liposomal amphotericin B, micafungin and voriconazole. Candida albicans was the most isolated species in blood cultures. Regarding candidemia, we analyzed samples from 115 patients. Empirical therapy was started within 24 h of blood culture in 44.3% of the cases, and in 81.7% of the cases, the antifungal was deemed to be adequate based in antifungal susceptibility testing, both of which were not associated with the in-hospital mortality rate. CONCLUSIONS Our study reinforces the importance of monitoring the consumption of antifungal agents, which helps in proposing actions that lead to their rational use and, consequently, reduces the appearance of resistant strains.
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Affiliation(s)
| | - Alexandre R. Marra
- Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
| | - Michael B. Edmond
- Office of Clinical Quality, Safety and Performance Improvement, University of Iowa Hospitals and Clinics, Iowa City, IA USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA USA
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14
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Momattin H, Al-Ali AY, Mohammed K, Al-Tawfiq JA. Benchmarking of antibiotic usage: An adjustment to reflect antibiotic stewardship program outcome in a hospital in Saudi Arabia. J Infect Public Health 2017; 11:310-313. [PMID: 28864362 PMCID: PMC7102737 DOI: 10.1016/j.jiph.2017.08.008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 08/11/2017] [Accepted: 08/12/2017] [Indexed: 12/05/2022] Open
Abstract
Antimicrobial stewardship program aims to reduce antibiotic use. Periodic measurement and monitoring of antibiotic use and comparison within the institution as well as with other organizations are important indicators. We analyzed antibiotic usage in a general hospital in Saudi Arabia. Antibiotic data were collected retrospectively for 2011 and from 2013 to 2015, and only adult patients (>15 year of age) were included in the study. Data were presented as days of therapy (DOT) and defined daily dose (DDD). DDD was adjusted per 100 bed-days and according to the case mix index (CMI). The total DDD was 37,557 in 2013, 36,550 in 2014 and 38,738 in 2015. The DDD per 100 patient-days was 90.7–94.5. There was a discordant findings of antibiotic measurements based on the DDD compared to DOT, and DDD/100 bed-days compared to DOT/100 bed-days. There was a negative correlation between CMI and DDD per 100 bed days (r −0.696), but a positive correlation of CMI with DOT (r +0.93). Adjusted DDD/100 bed-days showed decrease in the usage of antibiotics, reflecting activities of the antibiotic stewardship program. The increase in DOT/100 bed-days may indicate the favorable utilization of combination therapy. Antibiotic usage needs to be adjusted per 100 bed-days and correlated with CMI for better reflection of optimal antibiotic utilization, activities of the antibiotic stewardship program, and to allow benchmarking.
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Affiliation(s)
- Hisham Momattin
- Pharmacy Services Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Anfal Y Al-Ali
- Department of Pharmacy Services, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
| | - Khurram Mohammed
- Pharmacy Services Division, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.
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15
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Bérard C, Cerruti L, Cotteret C, Lebel D, Bussières JF. [Pilot study evaluating the ratio of adverse drug reactions related to antimicrobials over their consumption in 2012-2013]. Ann Pharm Fr 2016; 74:165-72. [PMID: 26365553 DOI: 10.1016/j.pharma.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 08/10/2015] [Accepted: 08/16/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVES As part of our antimicrobials stewardship program, we were interested in the use of antimicrobials and prevalence of adverse drug reactions associated with the use of these drugs. METHODS The retrospective and descriptive study was conducted over a one year-period between April 1st 2012 and March 31st 2013 in a mother-child Hospital. We determined the ratio: number of adverse drug reactions over 10,000 defined daily dose or 10,000days of therapy. We identified the ratios higher than average for which the confidence interval did not cross the calculated average. The severity of the adverse drug reactions was codified using the Common Terminology Criteria for Adverse Events. RESULTS We found 570 adverse drug reactions including 100 (17.5%) adverse drug reactions related to antimicrobials during the financial year 2012-2013. It represented 96 patients. Thus, five antimicrobials, for which the confidence interval does not cross the calculated average value, may be targeted in risk management because they have a higher ratio than average: piperacillin (290 [113-722]), valganciclovir (244 [43-1260]), ceftriaxone (114 [56-234]), acyclovir (76 [26-220]) and liposomal amphotericin B (72 [20-258]). CONCLUSION In a mother-child university hospital, we calculated a ratios of 19 [15-23] and 13 [10-15], it allows us targeting some antimicrobials in our approach to prevention and management of adverse drug reactions.
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16
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Dalton BR, MacTavish SJ, Bresee LC, Rajapakse N, Vanderkooi O, Vayalumkal J, Conly J. Antimicrobial use over a four-year period using days of therapy measurement at a Canadian pediatric acute care hospital. Can J Infect Dis Med Microbiol 2015; 26:253-8. [PMID: 26600813 PMCID: PMC4644008 DOI: 10.1155/2015/835209] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Antimicrobial resistance is a concern that is challenging the ability to treat common infections. Surveillance of antimicrobial use in pediatric acute care institutions is complicated because the common metric unit, the defined daily dose, is problematic for this population. OBJECTIVE During a four-year period in which no specific antimicrobial stewardship initiatives were conducted, pediatric antimicrobial use was quantified using days of therapy (DOT) per 100 patient days (PD) (DOT/100 PD) at the Alberta Children's Hospital (Calgary, Alberta) for benchmarking purposes. METHODS Drug use data for systemic antimicrobials administered on wards at the Alberta Children's Hospital were collected from electronic medication administration records. DOT were calculated and rates were determined using 100 PD as the denominator. Changes over the surveillance period and subgroup proportions were represented graphically and assessed using linear regression. RESULTS Total antimicrobial use decreased from 93.6 DOT/100 PD to 75.7 DOT/100 PD (19.1%) over the 2010/2011 through to the 2013/2014 fiscal years. During this period, a 20.0% increase in PD and an essentially stable absolute count of DOT (2.9% decrease) were observed. Overall, antimicrobial use was highest in the pediatric intensive care and oncology units. DISCUSSION The exact changes in prescribing patterns that led to the observed reduction in DOT/100 PD with associated increased PD are unclear, but may be a topic for future investigations. CONCLUSION Antimicrobial use data from a Canadian acute care pediatric hospital reported in DOT/100 PD were compiled for a four-year time period. These data may be useful for benchmarking purposes.
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Affiliation(s)
- Bruce R Dalton
- Department of Pharmacy Services, Alberta Health Services, Calgary
- O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Sandra J MacTavish
- Department of Pharmacy Services, Alberta Health Services, Calgary
- School of Pharmacy, University of Waterloo, Waterloo, Ontario
| | - Lauren C Bresee
- Department of Pharmacy Services, Alberta Health Services, Calgary
- School of Pharmacy, University of Waterloo, Waterloo, Ontario
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary
| | - Nipunie Rajapakse
- Department of Pediatrics, Section of Infectious Diseases, University of Calgary
- Department of Medicine, Cumming School of Medicine, University of Calgary
- Alberta Children’s Hospital Research Institute, Alberta Health Services, University of Calgary, Calgary, Alberta
| | - Otto Vanderkooi
- Department of Pediatrics, Section of Infectious Diseases, University of Calgary
- Department of Medicine, Cumming School of Medicine, University of Calgary
- Alberta Children’s Hospital Research Institute, Alberta Health Services, University of Calgary, Calgary, Alberta
| | - Joseph Vayalumkal
- Department of Pediatrics, Section of Infectious Diseases, University of Calgary
- Department of Medicine, Cumming School of Medicine, University of Calgary
- Alberta Children’s Hospital Research Institute, Alberta Health Services, University of Calgary, Calgary, Alberta
| | - John Conly
- Alberta Children’s Hospital Research Institute, Alberta Health Services, University of Calgary, Calgary, Alberta
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Synder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta
- Department of Microbiology, Immunology and Infectious Diseases, Cumming School of Medicine, University of Calgary, Calgary, Alberta
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17
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Abstract
Antimicrobial stewardship is a new field that struggles to find the right balance between meaningful and useful metrics to study the impact of antimicrobial stewardship programs (ASPs). ASP metrics primarily measure antimicrobial use, although microbiological resistance and clinical outcomes are also important measures of the impact an ASP has on a hospital and its patient population. Antimicrobial measures looking at consumption are the most commonly used measures, and are focused on defined daily doses, days of therapy, and costs, usually standardized per 1,000 patient-days. Each measure provides slightly different information, with their own upsides and downfalls. Point prevalence measurement of antimicrobial use is an increasingly used approach to understanding consumption that does not entirely rely on sophisticated electronic information systems, and is also replicable. Appropriateness measures hold appeal and promise, but have not been developed to the degree that makes them useful and widely applicable. The primary reason why antimicrobial stewardship is necessary is the growth of antimicrobial resistance. Accordingly, antimicrobial resistance is an important metric of the impact of an ASP. The most common approach to measuring resistance for ASP purposes is to report rates of common or important community- or nosocomial-acquired antimicrobial-resistant organisms, such as methicillin-resistant Staphylococcus aureus and Clostridium difficile. Such an approach is dependent on detection methods, community rates of resistance, and co-interventions, and therefore may not be the most accurate or reflective measure of antimicrobial stewardship interventions. Development of an index to reflect the net burden of resistance holds theoretical promise, but has yet to be realized. Finally, programs must consider patient outcome measures. Mortality is the most objective and reliable method, but has several drawbacks. Disease- or organism-specific mortality, or cure, are increasingly used metrics.
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Affiliation(s)
- Andrew M. Morris
- Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, ON Canada
- Faculty of Medicine, Department of Medicine, University of Toronto, Toronto, ON Canada
- Mount Sinai Hospital, 415-600 University Avenue, Toronto, ON M5G 1X5 Canada
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