Antibacterial agents and the fight against antibiotic resistance: A real-world evidence analysis of consumption and spending by an Italian healthcare company

INTRODUCTION

The escalating bacterial resistance stands as an increasingly pertinent concern, particularly in the post-pandemic era where the use of antibiotics appears to be relentlessly surging, giving rise to profound apprehensions. The substantial utilization of last-generation penicillins and cephalosporins is anticipated to imminently result in the emergence of superbugs for which therapeutic solutions will be scarce.

METHODS

An analysis of antibiotic consumption in the hospital setting has been conducted in an Italian healthcare organization. Querying the internal management system facilitated the calculation of indicators and assessment of prescription trends.

RESULTS

A comparison has been made between the first half of 2023 and the first half of 2022, to highlight the exponential growth in the consumption of beta-lactam antibiotics, with consumption doubling compared to the previous year's semester. Overall, considering the prescription averages, there is a prescribing growth of +29% concerning hospitalization and +28% concerning hospital discharge. However, it should be noted that the consumption of certain antibiotics such as sulphonamides and trimethoprim (-103.00%), tetracyclines (-54.00%), macrolides, lincosamides and streptogramins (-50.00%) and colistin (-13.00%) decreased.

CONCLUSION

This real-world evidence analysis aimed to support the justified and comprehensible global concerns regarding bacterial resistance. The extensive consumption of antibiotics will inevitably lead to the development of increasingly drug-resistant bacteria for which no antibiotic may be efficacious. National programs addressing antibiotic resistance and the awareness of all healthcare personnel must be accorded the utmost priority to enhance consumption data and, consequently, safeguard future human survival.

["Red code" C-sections: A new tool developed with Delphi method is enabling analysis of practices]

OBJECTIVE

In France, C-sections are classified through a color code according to their degree of urgency. A red-classified C-section is triggered when life of mother or fetus is immediately threatened These cases happen very rarely and represent less than 1% of total deliveries. Many French maternity hospitals are above this rate. This risky procedure should remain an exception. The main purpose of this study is to develop a new tool enabling to determine the relevance of red C-sections in order to improve obstetrical practices.

METHODS

Eleven national obstetrical experts were submitted with relevant-estimated indications of red C-sections. A two-round Delphi methodology was then used to reach a consensus on a new table of relevance.

RESULTS

Five different groups of indications were proposed to the panel of experts. After two rounds, four groups achieved a consensus by being qualified "very relevant" or "relevant" by more than 80% of the 11 experts.

CONCLUSION

The aim of this new consensual table of relevance is to improve quality of care. It allows to evaluate the relevance of red C-sections and determine when red C-sections are non-relevant but it particularly helps teams to identify ways of improvements. Finally, this tool enables a reproductible analysis that can be further intra- or inter-hospitals developed towards harmonization of practices.

SARS-CoV-2 caused a surge in antibiotic consumption causing a silent pandemic inside the pandemic. A retrospective analysis of Italian data in the first half of 2022

BACKGROUND

The phenomenon of antibiotic resistance shows no sign of stopping, despite global policies to combat it that have been in place for several years. The risk of forms of pathogenic microorganisms that are increasingly resistant to common antibiotics has led health authorities around the world to pay greater attention to the phenomenon. The worrying situation, has led to further recommendations from the World Health Organization (WHO) and national recommendations in Italy through the new National Plan against Antibiotic Resistance 2022-2025 (PNCAR 2022-2025).

AIM

This manuscript aims to raise the awareness of all health professionals to follow what is suggested by regulatory agencies and scientific societies.

METHOD

We conducted a retrospective study of antibiotic pharmacoutilization in Italy, in the Campania region at the Azienda Sanitaria Locale (ASL) Napoli 3 Sud, on consumption in the first half of 2022 in a population of more than 1 million people.

RESULT

The results indicate that consumption, based on defined daily doses (DDDs), is above the national average. Probably the COVID-19 pandemic has influenced this growth in prescriptions.

CONCLUSIONS

Our study suggests an informed and appropriate use of antibiotics, so as to embark on a virtuous path in the fight against antibiotic resistance.

Towards more relevance in forensic science research and development

Many different issues have been identified in forensic science for more than 10 years. While quality management has often been suggested as a path forward, research is generally considered as an essential part of the solution. Through an overview of current forensic science research, this paper aims at evaluating if and how research answer the challenges forensic science is currently facing. While forensic related publications have massively increased over the years, approximately half of the publications were published in non-forensic sources, indicating that forensic science research tends to be led by other disciplines. Over the years, forensic science research has remained largely oriented towards methodological and technological development rather than relevance to the forensic science discipline and practice. Practical implementation of the techniques is rarely discussed from a forensic perspective, and thus research rarely move from the "proof-of-concept" stage to its utilisation in case investigation. The digital transformation also generated a massive increase of data, making it challenging to find the relevant pieces of information in the mass of "forensic" publications available on-line. Thus, we propose to refocus forensic science research on forensic fundamental and practical questions to strengthen the discipline and its impact on crime investigation and security issues. Our propositions represent an incentive to further discuss forensic science research and knowledge transmission through the definition of a common culture within the community, focusing on common fundamental knowledge such as a better understanding of the concept of trace and its case-based information content.

[Certification of health establishments: the changing perspective on transfusion risk]

The HAS certification for healthcare organisation has gradually introduced the concepts of risk and relevance of care. Related to quality and safety of care, the transfusion act has early been part of the referential, and it seemed interesting to us to observe the changes in the requirements on this topic. After taking into account the regulations and the organization of haemovigilance in the establishment, it is now the search for the factual result for the patient which is the objective of the two main criteria devoted to transfusion. At the same time as the referential, the investigation methods have also evolved: the targeted tracer for Labile Blood Products and Blood-Derived Medicines allows a more detailed analysis geared towards the effective implementation of good transfusion practices. In conclusion, certification has moved from organizing and auditing the process to directly measuring transfusion safety for the patient.

[Antibiotic therapy in hospitals: Evaluation of antibiotic prescriptions and determination of factors influencing relevance]

OBJECTIVES

To evaluate the relevance and compliance of antibiotic prescriptions made in a Tunisian hospital and study the factors likely to influence them.

METHODS

This is a cross-sectional, monocentric study of antibiotic prescriptions belonging to the Watch and Reserve Groups of the World Health Organization's AWaRe classification, between January 1 and February 29, 2020.

RESULTS

A total of 310 antibiotic prescriptions were analyzed. Monotherapy represented 89,7 % of prescriptions. The most prescribed molecule was cefotaxime (42,8%). Antibiotic therapy was documented in 13% of cases. The antibiotic prescriptions were rational in 14,5% of cases. One third of prescriptions were irrelevant and 4,8% not justified. The dominant ground for non-compliance was unsuitable duration. The status of the prescriber and the prescribing service were factors influencing the relevance of prescriptions.

CONCLUSION

Irrational use of antibiotics was common in this study. As a result, the establishment of an antibiotic therapy guide and a computerized decision-support tool seem essential to guarantee the quality of antibiotic prescriptions.

Évaluation médico-economique de l’impact de mesures d’adaptation au virage de la chirurgie robot-assistée en urologie

INTRODUCTION

The development of robot-assisted urological surgery is held back by the lack of robust medico-economic analyses and their heterogeneity. We conducted a medico-economic study to evaluate the implementation of measures to optimize the transition to robotic surgery.

METHOD

We carried out a single-center, controlled study from the point of view of the public healthcare establishment for 4 years. Economic data collection was based on a micro-costing method and revenues from stay-related groups. Clinical data corresponded to mean lengths of stay, operating duration, complications and stays in intensive care. The measures to optimize the transition to robotic, implemented mid-study period, enabled before/after comparison.

RESULTS

Altogether, 668 patients undergoing robotic surgery were included. Robotic activity increased significantly from periods 1 to 2 to 256% (P=<0.001) as did the overall proportion of robotic by 45% to 85% (P=<0.001). The mean lengths of stay fell significantly, 6.8 d vs. 5.1 d (P<0.001). Costs and revenues increased significantly, resulting in a persistent deficit for the activity €226K vs. €382K (P=<0.001). With increased volume of activity, the deficit per operation and the cost per minute of robotic operating room fell significantly, €3,284 vs. €1,474/procedure (P=<0.001) and €27 vs €24/min (P=<0.029), tending towards a break-even point (=zero deficit) at 430 operations per year.

CONCLUSIONS

Robotic-assisted surgery can be significantly optimized by implementing measures for the robotic turn to reach a break-even point at 430 operations per year. A better multidisciplinary case mix could lower the break-even volume of activity in short term.

LEVEL OF EVIDENCE

3.

[Contribution of meb to endometriosis patients' diagnosis and treatment]

OBJECTIVES

Diagnosis and treatment of endometriosis may be complex and therefore justify the discussion of therapeutic decisions in a multidisciplinary endometriosis board (MEB). The development of endometriosis regional expert centers requires an assessment of the quality and relevance of MEB.

METHODS

Qualitiative retrospective study on patients whose management was discussed in Centre Hospitalier Lyon-Sud between June 2013 and December 2017.

RESULTS

Among 376 patients presented in MEB, 309 (80.2%) were painful and 184 (59.5%) had complex endometriosis. A complete clinical evaluation was performed in 120 (38.8%) patients. MRI was performed for 370 (98.4%) patients including 303 (81.9%) with a second reading by an expert radiologist. These second readings allowed a diagnosis correction in 88 (60.7 %) patients with complex endometriosis. MR enterography (27.8 %) and rectal endoscopic sonography (14.4%) were the most frequently used third-line exams to complete the initial imaging of digestive lesion in patients with rectal endometriosis. Surgery was proposed for 199 (52,9%) patients including 108 (58,7%) with complex endometriosis.

CONCLUSION

One of the major interests of MEB in endometriosis is the second reading of MRI, which, by identifying complex endometriosis initially undiagnosed or underestimated, enabled to better discuss the benefits/risks of therapeutic choices, and to organize complex surgeries when those were retained. The development of MEB in regional expert centers will contribute to optimizing the relevance of care for patients with endometriosis.

[Relevance of fluoroquinolones prescriptions in medical service]

INTRODUCTION

Fluoroquinolones (FQ) are antibiotics which favour the emergence of resistance and remain widely prescribed in the French hospital environment. A focus of prescription recommendation was published by the French Infectious Diseases Society (SPILF) in 2015 in order to preserve their use. The pneumology-oriented medical service of Salon de Provence's hospital had high FQ consumption for the year 2015; thus a relevant assessment of prescriptions was carried out.

METHODS

This retrospective study was conducted between January 1 and December 31, 2015 and concerned patients who received at least one FQ administration during their hospitalization.

RESULTS

Thirty-eight per cent of the prescriptions were justified, 37 % were inappropriate and 25 % unjustified. The majority of unjustified prescriptions were for lung infections. Only 35 % of the patients received bacteriological documentation and 53 % of the prescriptions were reassessed at 48-72hours. Twenty-two per cent of the justified prescriptions showed non-conformities concerning the duration of prescriptions, the dosage or an association with another antibiotic.

CONCLUSION

The diffusion of these results, combined with the implementation of corrective actions, should make it possible to improve the relevance of the FQ prescription.

Definition of indicators of the appropriateness of oral anticoagulant prescriptions in hospitalized adults: Literature review and consensus (PACHA study)

BACKGROUND

Indicators of the appropriateness of oral anticoagulant prescriptions are lacking, despite the major contribution they could make to improve quality of care.

AIM

To identify and select such indicators according to their utility and operational implementation.

METHODS

A literature review was conducted to identify indicators of the appropriateness of oral anticoagulant prescriptions according to the guidelines of health authorities and European learned societies. A first list of indicators was identified from guidelines related to general or targeted clinical situations. A two-round Delphi consensus process, completed by a synthesis meeting, was then set up to ask European experts to rate the utility and operational implementation of the indicators on a qualitative binary scale. An indicator was selected if ≥80% of the experts judged it both useful and implementable (strong consensus).

RESULTS

We selected 32 references, from which 84 indicators were identified. Nineteen indicators were short-listed for submission to expert judgment. Twenty-two experts participated in the Delphi process. Sixteen indicators obtained strong consensus for selection; three indicators did not achieve consensus. Two-thirds of the selected indicators focused on the appropriateness of oral anticoagulant prescriptions in general or in patients with atrial fibrillation; the other third focused on the appropriateness of prescriptions in patients with a prosthetic heart valve, venous thromboembolism or trauma.

CONCLUSION

This work addresses the current lack of indicators of the appropriateness of oral anticoagulant prescriptions. The selected indicators will be implemented from the hospital information system to assess their metrological properties to detect inappropriate prescriptions.