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Monnier AA, D'Onofrio V, Willemsen I, Kluytmans-van den Bergh MFQ, Kluytmans JAJW, Schuermans A, Leroux-Roels I, Gyssens IC. Practice testing of generic quality indicators for responsible antibiotic use in 9 hospitals in the Dutch-Belgian border area. J Hosp Infect 2022; 129:153-161. [PMID: 35998836 DOI: 10.1016/j.jhin.2022.07.030] [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: 05/23/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Inpatient quality indicators (IQIs) were previously developed to assess responsible antibiotic use. The aim of this study was the practice testing of these QIs in the hospital setting. METHOD This study was performed within a Dutch-Belgian border network of hospitals implementing the Infection Risk Scan (IRIS) point prevalence survey (PPS) as part of the I-4-1-Health project. Twenty out of 51 DRIVE-AB IQIs, including 13 structure and 7 process IQIs, were tested. Data on structure IQIs were obtained through a web-based questionnaire sent to the hospital medical microbiologists. PPS data from October-December 2018 were used to calculate performance scores for the process QIs. RESULTS Nine hospitals participated. Regarding structure IQIs: the lowest performance scores were observed for recommendations for microbiological investigations in the guidelines and the use of an approval system for restricted antibiotics. In addition, most hospitals reported that some antibiotics were out of stock due to shortages. Regarding process IQIs: 697 systemic antibiotic prescriptions were used to calculate performance scores. The lowest score was observed for documentation of an antibiotic plan in the medical file (58.8%). Performance scores for IQIs on guideline compliance varied between 74.1% and 82.3% for different aspects of the antibiotic regimen (duration, choice, route, timing). CONCLUSION This multicentre practice testing of IQIs identified improvement targets for stewardship efforts for both structure and process aspects of antibiotic care (approval system for restricted antibiotics, documentation of antibiotic plan). These results can guide the design of future PPS studies and a more extensive evaluation of the clinimetric properties of the IQIs.
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Affiliation(s)
- Annelie A Monnier
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine, And Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine, And Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Contrain infectiepreventiecoach, Breda, the Netherlands
| | - Marjolein F Q Kluytmans-van den Bergh
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Amphia Academy Infectious Disease Foundation, Amphia Hospital Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands
| | - Jan A J W Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands; Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands
| | - Annette Schuermans
- Department of Infection Control and epidemiology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | | | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine, And Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
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Ricchizzi E, Latour K, Kärki T, Buttazzi R, Jans B, Moro ML, Nakitanda OA, Plachouras D, Monnet DL, Suetens C, Kinross P. Antimicrobial use in European long-term care facilities: results from the third point prevalence survey of healthcare-associated infections and antimicrobial use, 2016 to 2017. ACTA ACUST UNITED AC 2019; 23. [PMID: 30458913 PMCID: PMC6247460 DOI: 10.2807/1560-7917.es.2018.23.46.1800394] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [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] [Indexed: 11/20/2022]
Abstract
Antimicrobials are commonly prescribed and contribute to the development of antimicrobial resistance in long-term care facilities (LTCFs). In 2010, the European Centre for Disease Prevention and Control initiated point prevalence surveys (PPS) of healthcare-associated infections and antimicrobial use in European LTCFs, performed by external contractors as the Healthcare-Associated infections in Long-Term care facilities (HALT) projects. Here, we investigated prevalence and characteristics of antimicrobial use and antimicrobial stewardship indicators in European LTCFs in 2016–17. Twenty-four European Union/European Economic Area (EU/EEA) countries, the former Yugoslav Republic of Macedonia and Serbia participated in the third PPS in European LTCFs. Overall, 4.9% (95% confidence interval: 4.8–5.1) of LTCF residents in the EU/EEA participating countries received at least one antimicrobial. The most commonly reported Anatomical Therapeutic Chemical (ATC) groups were beta-lactam antibacterials/penicillins (J01C), other antibacterials (J01X) (e.g. glycopeptide antibacterials, polymyxins), quinolones (J01M), sulfonamides and trimethoprim (J01E), and other beta-lactams (J01D). Urinary tract infections and respiratory tract infections were the main indications for antimicrobial prescription. This PPS provides updated and detailed information on antimicrobial use in LTCFs across the EU/EEA that can be used to identify targets for future interventions, follow-up of these interventions and promote prudent use of antimicrobials in European LTCFs.
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Affiliation(s)
- Enrico Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - Tommi Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Rossella Buttazzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | | | | | - Carl Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Pete Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
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Hufnagel M, Versporten A, Bielicki J, Drapier N, Sharland M, Goossens H. High Rates of Prescribing Antimicrobials for Prophylaxis in Children and Neonates: Results From the Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey. J Pediatric Infect Dis Soc 2019; 8:143-151. [PMID: 29579259 DOI: 10.1093/jpids/piy019] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND This study was conducted to assess the variation in prescription practices for systemic antimicrobial agents used for prophylaxis among pediatric patients hospitalized in 41 countries worldwide. METHODS Using the standardized Antibiotic Resistance and Prescribing in European Children Point Prevalence Survey protocol, a cross-sectional point-prevalence survey was conducted at 226 pediatric hospitals in 41 countries from October 1 to November 30, 2012. RESULTS Overall, 17693 pediatric patients were surveyed and 36.7% of them received antibiotics (n = 6499). Of 6818 inpatient children, 2242 (32.9%) received at least 1 antimicrobial for prophylactic use. Of 11899 prescriptions for antimicrobials, 3400 (28.6%) were provided for prophylactic use. Prophylaxis for medical diseases was the indication in 73.4% of cases (2495 of 3400), whereas 26.6% of prescriptions were for surgical diseases (905 of 3400). In approximately half the cases (48.7% [1656 of 3400]), a combination of 2 or more antimicrobials was prescribed. The use of broad-spectrum antibiotics (BSAs), which included tetracyclines, macrolides, lincosamides, and sulfonamides/trimethoprim, was high (51.8% [1761 of 3400]). Broad-spectrum antibiotic use for medical prophylaxis was more common in Asia (risk ratio [RR], 1.322; 95% confidence interval [CI], 1.202-1.653) and more restricted in Australia (RR, 0.619; 95% CI, 0.521-0.736). Prescription of BSA for surgical prophylaxis also varied according to United Nations region. Finally, a high percentage of surgical patients (79.7% [721 of 905]) received their prophylaxis for longer than 1 day. CONCLUSIONS A high proportion of hospitalized children received prophylactic BSAs. This represents a clear target for quality improvement. Collectively speaking, it is critical to reduce total prophylactic prescribing, BSA use, and prolonged prescription.
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Affiliation(s)
- Markus Hufnagel
- Division of Pediatric Infectious Diseases and Rheumatology, Department of Pediatrics and Adolescent Medicine, Medical Center, Faculty of Medicine, University of Freiburg, Germany
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Julia Bielicki
- Paediatric Infectious Disease Unit, St. George's Hospital, London, United Kingdom
| | - Nico Drapier
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
| | - Mike Sharland
- Paediatric Infectious Disease Unit, St. George's Hospital, London, United Kingdom
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, Belgium
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4
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Plachouras D, Kärki T, Hansen S, Hopkins S, Lyytikäinen O, Moro ML, Reilly J, Zarb P, Zingg W, Kinross P, Weist K, Monnet DL, Suetens C. Antimicrobial use in European acute care hospitals: results from the second point prevalence survey (PPS) of healthcare-associated infections and antimicrobial use, 2016 to 2017. Euro Surveill 2018; 23:1800393. [PMID: 30458917 PMCID: PMC6247463 DOI: 10.2807/1560-7917.es.23.46.1800393] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 07/18/2018] [Accepted: 10/16/2018] [Indexed: 01/22/2023] Open
Abstract
Antimicrobial agents used to treat infections are life-saving. Overuse may result in more frequent adverse effects and emergence of multidrug-resistant microorganisms. In 2016-17, we performed the second point-prevalence survey (PPS) of healthcare-associated infections (HAIs) and antimicrobial use in European acute care hospitals. We included 1,209 hospitals and 310,755 patients in 28 of 31 European Union/European Economic Area (EU/EEA) countries. The weighted prevalence of antimicrobial use in the EU/EEA was 30.5% (95% CI: 29.2-31.9%). The most common indication for prescribing antimicrobials was treatment of a community-acquired infection, followed by treatment of HAI and surgical prophylaxis. Over half (54.2%) of antimicrobials for surgical prophylaxis were prescribed for more than 1 day. The most common infections treated by antimicrobials were respiratory tract infections and the most commonly prescribed antimicrobial agents were penicillins with beta-lactamase inhibitors. There was wide variation of patients on antimicrobials, in the selection of antimicrobial agents and in antimicrobial stewardship resources and activities across the participating countries. The results of the PPS provide detailed information on antimicrobial use in European acute care hospitals, enable comparisons between countries and hospitals, and highlight key areas for national and European action that will support efforts towards prudent use of antimicrobials.
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Affiliation(s)
| | - Tommi Kärki
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Outi Lyytikäinen
- National Institute for Health and Welfare (THL), Department of Health Security, Helsinki, Finland
| | - Maria Luisa Moro
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | - Jacqui Reilly
- National Services Scotland, Health Protection Scotland, Glasgow, United Kingdom
- Glasgow Caledonian University, Glasgow, United Kingdom
| | | | | | - Pete Kinross
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | - Klaus Weist
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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Sviestina I, Usonis V, Gurksniene V, Burokiene S, Ivaskeviciene I, Mozgis D. Prescription of antibiotics in Riga and Vilnius tertiary children's hospitals. Eur J Hosp Pharm 2017; 25:189-194. [PMID: 31157017 DOI: 10.1136/ejhpharm-2016-001124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/03/2016] [Revised: 02/01/2017] [Accepted: 02/27/2017] [Indexed: 11/04/2022] Open
Abstract
Objectives The aim of this study was to compare the use of antibiotics among hospitalised children in Riga (Latvia) and in Vilnius (Lithuania) at two tertiary paediatric centres. Methods A point prevalence survey (PPS) was conducted using validated and standardised Antibiotic Resistance and Prescribing in European Children (ARPEC) project methodology during November 2012. All inpatients less than 18 years old were included in the study. All data were recorded for patients with active antimicrobial prescriptions at 8 am on the day of the survey. Data were entered into the ARPEC-webPPS programme and were validated online for accuracy. Results The proportion of patients receiving antimicrobial therapy was statistically different: 128 (37.0%) patients in Riga and 83 (26.3%) in Vilnius. The most common age group in Riga and Vilnius was 1-5 years. The most commonly used antibiotic classes for the treatment and prophylaxis of infection were third-generation cephalosporins (38; 25.5% prescriptions) in Riga and second-generation cephalosporins (16; 19.8%) in Vilnius. Parenteral use of antimicrobials was higher in Riga than in Vilnius: 111 (74.5%) prescriptions to paediatric patients in Riga and 45 (55.6%) prescriptions in Vilnius. Conclusions The PPS identified differences in antibiotic use in both hospitals and problem areas for improvement: high use of third-generation cephalosporins for paediatric patients (in Riga) and predominant use of parenteral antibiotics. Further collaboration between both centres is needed because sharing audit data and antimicrobial stewardship initiatives may encourage further changes in practice at both institutions.
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Affiliation(s)
- Inese Sviestina
- University Children's Hospital, Riga, Latvia.,Faculty of Pharmacy, Riga Stradins University, Riga, Latvia.,Faculty of Medicine, University of Latvia, Riga, Latvia
| | - Vytautas Usonis
- Vilnius University Faculty of Medicine, Clinic of Children's Diseases, Vilnius, Lithuania.,Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Vilija Gurksniene
- Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Sigita Burokiene
- Vilnius University Faculty of Medicine, Clinic of Children's Diseases, Vilnius, Lithuania.,Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Inga Ivaskeviciene
- Vilnius University Faculty of Medicine, Clinic of Children's Diseases, Vilnius, Lithuania.,Vilnius University Children's Hospital, Affiliate of Vilnius University Hospital, Vilnius, Lithuania
| | - Dzintars Mozgis
- Public Health and Epidemiology Department, Riga Stradins University, Riga, Latvia
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Abstract
INTRODUCTION Healthcare associated infections and antimicrobial use are common among residents of long-term care facilities. Faced to the lack of standardized data, the European Centre for Disease Prevention and Control funded a project with the aim of estimating prevalence of infections and antibiotic use in European long-term care facilities. AIM The aim of the authors was to present the results of the European survey which were obtained in Hungary. METHOD In Hungary, 91 long-term care facilities with 11,823 residents participated in the point-prevalence survey in May, 2013. RESULTS The prevalence of infections was 2.1%. Skin and soft tissues infections were the most frequent (36%), followed by infections of the respiratory (30%) and urinary tract (21%). Antimicrobials were mostly prescribed for urinary tract infections (40.3%), respiratory tract infections (38.4%) and skin and soft tissue infections (13.2%). The most common antimicrobials (97.5%) belonged to the ATC J01 class of "antibacterials for systemic use". CONCLUSIONS The results emphasise the need for a national guideline and education for good practice in long-term care facilities.
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Affiliation(s)
- Rita Szabó
- Országos Epidemiológiai Központ Kórházi-járványügyi Osztály Budapest Albert Flórián út 2-6. 1097
| | - Karolina Böröcz
- Országos Epidemiológiai Központ Kórházi-járványügyi Osztály Budapest Albert Flórián út 2-6. 1097
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