RESUMEN
OBJECTIVE: The quality of care and safety for Telemedicine-discharged patients with suspected respiratory infections are closely related to low rates of prescriptions of unjustified and high-risk medications. This retrospective study aimed to assess adherence to the current COVID-19 guidelines in direct-to-consumer telemedicine encounters at a large center using multidrug stewardship protocols. METHODS: A quarterly electronic survey utilizing medical records of individual physician care assessed various quality indicators. Physicians received ongoing adaptive feedback based on personal metrics, with Telemedicine Center recommendations derived from the 2020 Infectious Diseases Society of America guidelines. The study included all consecutive adults with new respiratory symptoms in the last 14 days who sought spontaneous Telemedicine consultations between March 2020 and August 2021. This study analyzed patients with suspected or confirmed COVID-19 and other airway infections. RESULTS: Of the 221,128 evaluated patients, 42,042 (19%) had confirmed COVID-19; 104,021 (47%) were suspected to have COVID-19; and, 75,065 (33%) had other diagnoses. Patients with suspected or confirmed COVID-19 had a mean (+DP) age of 35±12 years. A total of 125,107 (85.65%) patients were managed at home, 2,552 (1.74%) were referred for non-urgent in-office reassessment, and 17,185 (11.7%) were referred to the emergency department for whom there was no further treatment recommendation. The antibiotic rate in confirmed or suspected COVID-19 cases was 0.46%/0.65% and that for non-evidence-based prescriptions was 0.01%/0.005%. CONCLUSION: Guideline training and Telemedicine consultation feedback may lead to lower antibiotic and antimicrobial prescriptions in suspected and confirmed COVID-19 cases. Multidrug stewardship protocols may improve guideline adherence and reinforce the quality of care and safety in Telemedicine encounters.
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COVID-19 , Adhesión a Directriz , Telemedicina , Humanos , Estudios Retrospectivos , Adhesión a Directriz/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Telemedicina/normas , Adulto , Femenino , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , SARS-CoV-2 , Tratamiento Farmacológico de COVID-19 , Programas de Optimización del Uso de los Antimicrobianos/normasRESUMEN
The identification of antimicrobial use patterns is essential for determining key targets for antimicrobial stewardship interventions and evaluating the effectiveness thereof. Accurately identifying antimicrobial use patterns requires quantitative evaluation, which focuses on measuring the quantity and frequency of antimicrobial use, and qualitative evaluation, which assesses the appropriateness, effectiveness, and potential side effects of antimicrobial prescriptions. This paper summarizes the quantitative and qualitative methods used to evaluate antimicrobials, drawing insights from overseas and domestic cases.
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Programas de Optimización del Uso de los Antimicrobianos , Pautas de la Práctica en Medicina , Humanos , Antibacterianos/uso terapéutico , Antibacterianos/efectos adversos , Antiinfecciosos/uso terapéutico , Antiinfecciosos/efectos adversos , Programas de Optimización del Uso de los Antimicrobianos/normas , Prescripciones de Medicamentos , Revisión de la Utilización de Medicamentos , Pautas de la Práctica en Medicina/normas , Investigación CualitativaRESUMEN
INTRODUCTION: Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. OBJECTIVES: The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. METHODS: A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. RESULTS: A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. CONCLUSION: Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.
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Programas de Optimización del Uso de los Antimicrobianos , Técnica Delphi , Indicadores de Calidad de la Atención de Salud , Bélgica , Programas de Optimización del Uso de los Antimicrobianos/normas , Humanos , Antibacterianos/uso terapéutico , Hospitales/normas , Encuestas y CuestionariosRESUMEN
BACKGROUND: The growth of antimicrobial resistance worldwide has led to increased focus on antimicrobial stewardship (AMS) and infection prevention and control (IPC) measures, although primarily in high-income countries (HIC). We aimed to compare pediatric AMS and IPC resources/activities between low- and middle-income countries (LMIC) and HIC and to determine the barriers and priorities for AMS and IPC in LMIC as assessed by clinicians in those settings. METHODS: An online questionnaire was distributed to clinicians working in HIC and LMIC healthcare facilities in 2020. RESULTS: Participants were from 135 healthcare settings in 39 LMIC and 27 HIC. Formal AMS and IPC programs were less frequent in LMIC than HIC settings (AMS 42% versus 76% and IPC 58% versus 89%). Only 47% of LMIC facilities conducted audits of antibiotic use for pediatric patients, with less reliable availability of World Health Organization Access list antibiotics (29% of LMIC facilities). Hand hygiene promotion was the most common IPC intervention in both LMIC and HIC settings (82% versus 91%), although LMIC hospitals had more limited access to reliable water supply for handwashing and antiseptic hand rub. The greatest perceived barrier to pediatric AMS and IPC in both LMIC and HIC was lack of education: only 17% of LMIC settings had regular/required education on antimicrobial prescribing and only 25% on IPC. CONCLUSIONS: Marked differences exist in availability of AMS and IPC resources in LMIC as compared with HIC. A collaborative international approach is urgently needed to combat antimicrobial resistance, using targeted strategies that address the imbalance in global AMS and IPC resource availability and activities.
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Programas de Optimización del Uso de los Antimicrobianos/normas , Conocimientos, Actitudes y Práctica en Salud , Control de Infecciones/métodos , Pediatría/normas , Países Desarrollados , Países en Desarrollo , Instituciones de Salud/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Humanos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Antimicrobial stewardship (AMS) is central to the World Health Organisation Global Action Plan against antimicrobial resistance (AMR). If antibiotics are used without restraint, morbidity and mortality from AMR will continue to increase. In resource-rich settings, AMS can safely reduce antibiotic consumption. However, for children in low- and middle-income countries (LMIC), the impact of different AMS interventions is unknown. AIM: To determine the impact of different AMS interventions on antibiotic use and clinical and microbiologic outcomes in children in LMIC. METHODS: MEDLINE, Embase and PubMed were searched for studies of AMS interventions in pediatric population in LMIC settings. Controlled trials, controlled before-and-after studies and interrupted time series studies were included. Outcomes assessed were antibiotic use, multidrug-resistant organism (MDRO) rates, clinical outcomes and cost. RESULTS: Of 1462 studies, 34 met inclusion criteria including a total population of >5,000,000 in 17 countries. Twenty were in inpatients, 2 in ED, 10 in OPD and 2 in both. Seven studies were randomized controlled trials. All types of interventions reported a positive impact on antibiotic prescribing. AMS bundles with education, and clinical decision tools appeared more effective than guidelines alone. AMS interventions resulted in significantly decreased clinical infections (4/4 studies) and clinical failure (2/2) and reduced MDRO colonization rate (4/4). There was no concomitant increase in mortality (4/4 studies) or length of stay (2/2). CONCLUSION: Multiple effective strategies exist to reduce antibiotic consumption in LMIC. However, marked heterogeneity limit conclusions regarding the most effective approach, particularly regarding clinical outcomes. Overall, AMS strategies are important tools in the reduction of MDRO-related morbidity in children in LMIC.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Programas de Optimización del Uso de los Antimicrobianos/normas , Países en Desarrollo , Niño , Preescolar , Análisis Costo-Beneficio , Sistemas de Apoyo a Decisiones Clínicas , Guías como Asunto , Política de Salud , Humanos , Lactante , Evaluación de Resultado en la Atención de Salud , Paquetes de Atención al Paciente/métodos , Paquetes de Atención al Paciente/normasRESUMEN
Though antimicrobial stewardship (AMS) programmes are the cornerstone of Uganda's national action plan (NAP) on antimicrobial resistance, there is limited evidence on AMS attitude and practices among healthcare providers in health facilities in Uganda. We determined healthcare providers' AMS attitudes, practices, and associated factors in selected health facilities in Uganda. We conducted a cross-sectional study among nurses, clinical officers, pharmacy technicians, medical officers, pharmacists, and medical specialists in 32 selected health facilities in Uganda. Data were collected once from each healthcare provider in the period from October 2019 to February 2020. Data were collected using an interview-administered questionnaire. AMS attitude and practice were analysed using descriptive statistics, where scores of AMS attitude and practices for healthcare providers were classified into high, fair, and low using a modified Blooms categorisation. Associations of AMS attitude and practice scores were determined using ordinal logistic regression. This study reported estimates of AMS attitude and practices, and odds ratios with 95% confidence intervals were reported. We adjusted for clustering at the health facility level using clustered robust standard errors. A total of 582 healthcare providers in 32 healthcare facilities were recruited into the study. More than half of the respondents (58%,340/582) had a high AMS attitude. Being a female (aOR: 0.66, 95% CI: 0.47-0.92, P < 0.016), having a bachelor's degree (aOR: 1.81, 95% CI: 1.24-2.63, P < 0.002) or master's (aOR: 2.06, 95% CI: 1.13-3.75, P < 0.018) were significant predictors of high AMS attitude. Most (46%, 261/582) healthcare providers had fair AMS practices. Healthcare providers in the western region's health facilities were less likely to have a high AMS practice (aOR: 0.52, 95% CI 0.34-0.79, P < 0.002). In this study, most healthcare providers in health facilities had a high AMS attitude and fair AMS practice.
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Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/normas , Actitud del Personal de Salud , Infecciones Bacterianas/tratamiento farmacológico , Instituciones de Salud/normas , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Adulto , Infecciones Bacterianas/epidemiología , Estudios Transversales , Femenino , Humanos , Prescripción Inadecuada , Masculino , Persona de Mediana Edad , Farmacéuticos/psicología , Encuestas y Cuestionarios , Uganda/epidemiología , Adulto JovenRESUMEN
Severe pneumonia is associated with high mortality (short and long term), as well as pulmonary and extrapulmonary complications. Appropriate diagnosis and early initiation of adequate antimicrobial treatment for severe pneumonia are crucial in improving survival among critically ill patients. Identifying the underlying causative pathogen is also critical for antimicrobial stewardship. However, establishing an etiological diagnosis is challenging in most patients, especially in those with chronic underlying disease; those who received previous antibiotic treatment; and those treated with mechanical ventilation. Furthermore, as antimicrobial therapy must be empiric, national and international guidelines recommend initial antimicrobial treatment according to the location's epidemiology; for patients admitted to the intensive care unit, specific recommendations on disease management are available. Adherence to pneumonia guidelines is associated with better outcomes in severe pneumonia. Yet, the continuing and necessary research on severe pneumonia is expansive, inviting different perspectives on host immunological responses, assessment of illness severity, microbial causes, risk factors for multidrug resistant pathogens, diagnostic tests, and therapeutic options.
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Antiinfecciosos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/normas , Cuidados Críticos/métodos , Neumonía/terapia , Antiinfecciosos/farmacología , Cuidados Críticos/normas , Enfermedad Crítica/terapia , Resistencia a Múltiples Medicamentos , Adhesión a Directriz/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/normas , Neumonía/diagnóstico , Neumonía/epidemiología , Neumonía/microbiología , Guías de Práctica Clínica como Asunto , Factores de Riesgo , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
ABSTRACT: This study aimed to assess the impact of the pharmacist-led intervention on perioperative antibiotic prophylaxis by standardizing the cephalosporin intradermal skin test in the orthopedic department.A pre-and postintervention study was conducted among patients in the Orthopedics Department at the Beijing Chao-Yang Hospital in China. Use of intradermal skin test, perioperative antibacterial prophylaxis, and cost of care were compared between the preintervention population (admitted from 6/1/2018 to 8/31/2018) and postintervention population (admitted from 1/1/2019 to 3/31/2019). Logistic regression and generalized linear regression were used to assess the intervention impact.425 patients from the preintervention period and 448 patients from the postintervention period were included in the study. After the implementation of the pharmacist intervention program, there was a decrease in the utilization of intradermal skin tests, from 95.8% to 16.5% (Pâ<â.001). Patients were more likely to have cephalosporin as prophylactic antimicrobials (ORâ=â5.28, Pâ<â.001) after the implementation. The cost of antimicrobials was significantly reduced by $150.21 (Pâ<â.001) for each patient.Pharmacist-involved intervention can reduce the utilization of cephalosporins skin tests and decrease the prescription of unnecessary high-cost antimicrobials.
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Antibacterianos/uso terapéutico , Profilaxis Antibiótica/métodos , Programas de Optimización del Uso de los Antimicrobianos/normas , Cefalosporinas/uso terapéutico , Pruebas Intradérmicas/normas , Procedimientos Ortopédicos , Farmacéuticos , China , Hospitales , Humanos , Persona de Mediana Edad , OrtopediaRESUMEN
BACKGROUND: Respiratory tract infections (RTI) are the second most frequent diagnosis after Malaria amongst Outpatients in Uganda. Majority are Non pneumonia cough and flu which are self-limiting and often do not require antibacterials. However, antibiotics are continuously prescribed for these conditions and are a major contributor to antimicrobial resistance and wastage of health resources. Little is known about this problem in Uganda hence the impetus for the study. OBJECTIVES: To determine the antibacterial prescribing rate and associated factors among RTI outpatients in Mbarara municipality METHODOLOGY: This was a retrospective cross-sectional study on records of RTI outpatients from 1st April 2019 to 31st March 2020 (prior to the novel corona virus disease pandemic) in four selected public health facilities within Mbarara municipality. A pretested data caption tool was used to capture prescribing patterns using WHO/INRUD prescribing indicators. We used logistic regression to determine factors associated to antibacterial prescribing. RESULTS: A total of 780 encounters were studied with adults (18-59 years) forming the largest proportion of age categories at (337, 43.15%) and more females (444, 56.85%) than men (337, 43.15%). The antibacterial prescribing rate was 77.6% (606) with Amoxicillin the most prescribed 80.4% (503). The prescribing pattern showed an average of 2.47 (sd 0.72) drugs per encounter and the percentage of encounters with injection at 1.5% (24). Drugs prescribed by generic (1557, 79%) and drugs prescribed from essential medicine list (1650, 84%) both not conforming to WHO/INRUD standard; an indicator of possible irrational prescribing. Female gender (adjusted odds ratio [aOR] = 1.51, 95% confidence interval [CI]: (1.06-2.16); 18-59 years age group (aOR = 1.66, 95% CI: 1.09-2.33) and Individuals prescribed at least three drugs were significantly more likely to have an antibacterial prescribed (aOR= 2.72, 95% CI: 1.86-3.98). CONCLUSION: The study found a high antibacterial prescribing rate especially among patients with URTI, polypharmacy and non-conformity to both essential medicine list and generic name prescribing. This prescribing pattern does not comply with rational drug use policy and needs to be addressed through antimicrobial stewardship interventions, prescriber education on rational drug use and carrying out more research to determine the appropriateness of antibacterial prescribed.
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Atención Ambulatoria/estadística & datos numéricos , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Adhesión a Directriz/estadística & datos numéricos , Prescripción Inadecuada/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Infecciones del Sistema Respiratorio/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Atención Ambulatoria/normas , Programas de Optimización del Uso de los Antimicrobianos/normas , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Prescripción Inadecuada/prevención & control , Lactante , Recién Nacido , Modelos Logísticos , Masculino , Persona de Mediana Edad , Polifarmacia/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Estudios Retrospectivos , Uganda , Adulto JovenRESUMEN
INTRODUCTION: Carbapenems, last-resort antibiotics, are widely used as first-line treatment in patients carrying extended-spectrum beta-lactamases (ESBL) Enterobacteriaceae, including in a pediatric setting. We aimed to implement an antibiotic stewardship program (ASP) to improve the use of carbapenems. METHODS: We implemented an ASP at the Bordeaux Children's University Hospital with 6-month audits on prescribing practice before and after an intervention (revision of antibiotic treatment protocols, a half-day educational session with feedback of the first study period). The number of carbapenem prescriptions was analyzed and two criteria were used to assess conformity of the indication for carbapenem prescription and conformity of the reassessment. A logistic regression was used to assess the overall compliance of carbapenem prescriptions over the two periods adjusted for ESBL carriage. RESULTS: A total of 57 patients were included with 37 carbapenem prescriptions before the intervention and 23 after. Overall carbapenem consumption decreased from 0.54 prescriptions per 100 admissions to 0.32 (p = 0.06). Conformity increased during the study for indication (46-87%, p = 0.004) and for reassessment (48-78%, p = 0.04) and was significantly associated with the second study period, after adjustment for ESBL carriage. CONCLUSION: Our intervention contributed to a significant improvement in the compliance to indications for carbapenem indication and in the reassessment of the prescription.
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Programas de Optimización del Uso de los Antimicrobianos/métodos , Carbapenémicos/administración & dosificación , Adolescente , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/normas , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Carbapenémicos/uso terapéutico , Niño , Preescolar , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Femenino , Francia , Hospitales Pediátricos/organización & administración , Hospitales Pediátricos/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Masculino , Desarrollo de Programa/métodos , Estudios RetrospectivosRESUMEN
OBJECTIVE: To evaluate if decreasing postop abx prophylaxis affects UTI and wound infection rates in patients following urethroplasty. METHODS: A retrospective review of patients who underwent urethroplasty from 9/2017 - 3/2020 by a single surgeon was performed. All patients received urine culture specific perioperative IV abx prior to urethroplasty and kept a urethral catheter for 3 weeks postop. Patients undergoing a urethroplasty from 9/2017 to 12/2018 received extended postop abx prophylaxis for 3 weeks until catheter removal (Group 1). Patients from 12/2018 to 3/2020 received abx for 3 days around catheter removal (Group 2). UTIs, abx complications, and wound infections between groups were evaluated. UTIs were defined as a positive urine culture or reported lower urinary tract symptoms/fevers treated with empiric abx. RESULTS: 120 patients underwent urethroplasty. Group 1 consisted of 60 patients with mean age of 51.9 years and mean stricture length of 3.6 cm. Group 2 had 60 patients with mean age of 53.1 years and mean stricture length of 3.8 cm. 10 patients had UTIs after urethroplasty. There was no significant difference in UTI (6.7% vs 11.7%; P = 0.529) or wound infection rates (3.3% vs 1.7%;' P = 1.000) between the two groups. CONCLUSION: Extended postoperative antibiotic prophylaxis does not appear to significantly affect UTI or wound infection rates following urethroplasty. The retrospective nature of the study has limitations, however, this is the first comparison of two different antibiotic administration protocols to our knowledge.
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Antibacterianos/administración & dosificación , Profilaxis Antibiótica , Programas de Optimización del Uso de los Antimicrobianos/normas , Duración de la Terapia , Complicaciones Posoperatorias/prevención & control , Uretra/cirugía , Estrechez Uretral/cirugía , Infecciones Urinarias/prevención & control , Adulto , Anciano , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Procedimientos Quirúrgicos Urológicos Masculinos/métodosRESUMEN
BACKGROUND: Historically, amoxicillin (Amoxil) has been used as a first-line agent to treat pediatric urinary tract infections (UTIs). However, emerging antibiotic resistance in urinary pathogens has led to broader treatment options, such as cefdinir (Omnicef). This shift in prescribing practices is predicted to vary among place of service and gender due to differing institutional protocols and antimicrobial stewardship practices. OBJECTIVE: This study aimed to describe the antibiotic utilization patterns associated with treating pediatric UTIs in Texas Medicaid patients and to assess the real-world efficacy of the antibiotics that were prescribed. METHODS: Texas Medicaid prescription and medical claims data for patients under 1 year of age were included in the analysis if they presented with a UTI to the healthcare practitioner's office or the emergency department (ED) and were treated with an outpatient antibiotic. Treatment efficacy was assessed by whether a patient received a second (different) antibiotic within 7 days of their initial antibiotic fill. RESULTS: A total of 12,795 visits met inclusion criteria; 12,561 visits included prescriptions for the top 4 antibiotics prescribed: cefdinir (50%), amoxicillin (25%), cephalexin (Keflex; 13%), and amoxicillin-clavulanate (Augmentin; 12%). Cefdinir utilization predominated in both places of service [office (50%) and ED (55%)], and gender [males (47%) and females (52%)]. Controlling for gender and place of service, initial treatment with amoxicillin when compared with cefdinir (OR = 2.54; 95% confidence intervals: 1.843.54; P < 0.001) was associated with a greater rate of treatment failure. CONCLUSIONS: In this study of Texas Medicaid patients, the widespread utilization of cefdinir may be appropriate for the empiric treatment of uncomplicated UTIs because of its low rate of treatment failure compared to other commonly used antibiotics.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Utilización de Medicamentos/normas , Infecciones Urinarias/tratamiento farmacológico , Amoxicilina/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/normas , Cefdinir/uso terapéutico , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pacientes Ambulatorios/estadística & datos numéricos , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Estudios Retrospectivos , TexasRESUMEN
Antibiotic consumption rates were quite high in number, although the bacterial coinfection rates were low in coronavirus disease 2019 pneumonia. Generally, empirical antibiotic treatment is not recommended for uncomplicated coronavirus disease 2019 mild to moderate pneumonia cases. On the other hand, antibiotic treatment and de-escalation are recommended for intubated intensive care unit patients or critical patients with sepsis, septic shock, or acute respiratory distress syndrome. The presentation of patients with severe coronavirus disease 2019 pneumonia can direct the clinicians to use antibiotics. We believe that wait and watch strategy can be preferred in such cases without sepsis, secondary bacterial infection findings, or procalcitonin < 0.5 ng/ mL. We think that a new wave of resistance will occur inevitably if we cannot perform the antibiotic stewardship properly.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos , Tratamiento Farmacológico de COVID-19 , COVID-19 , Selección de Paciente , Programas de Optimización del Uso de los Antimicrobianos/métodos , Programas de Optimización del Uso de los Antimicrobianos/normas , COVID-19/diagnóstico , Humanos , Uso Excesivo de los Servicios de Salud/prevención & control , Índice de Severidad de la EnfermedadRESUMEN
BACKGROUND: Urinary tract infection (UTI) is frequently encountered in the emergency department (ED). We assessed an antibiotic stewardship intervention tailored for the ED. The primary objective was improving overall adherence to agent choice and treatment duration. The secondary objective was a decrease in fluoroquinolone prescription. METHODS: This pre-post study included patients discharged from the ED with a UTI diagnosis. The intensive intervention period lasted three months and involved dissemination of guidelines, short lectures, incorporation of order sets into electronic ED charts and weekly personal audit and feedback. The following 11-month phase was a booster period consisting of monthly text messages of the treatment protocol. Assessment of adherence to the protocol was compared between the three-month pre-intervention period and the last two months of the intensive intervention period, as well as with the last two months of the booster period. RESULTS: A total of 177 patients were included in the pre-intervention period, 156 in the intervention period, and 94 in the late follow-up assessing the booster period. Median age was 49 (18-94) years, 78.2% were female, 84.8% had cystitis. During the intervention period, protocol adherence with antibiotic selection and duration increased from 41% to 84% (p < 0.001). Adherence remained high in the late follow-up period (73.4% vs. 41%, p < 0.001). Fluoroquinolone use decreased from 19.1% pre-intervention, to 5% in the intervention and 7.4% in the late follow-up periods (p < 0.001). CONCLUSIONS: An antibiotic stewardship intervention in a busy ED resulted in adherence to treatment protocols, including a decrease in fluoroquinolone use. A monthly reminder preserved most of the effect for a year.
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Programas de Optimización del Uso de los Antimicrobianos/normas , Infecciones Urinarias/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/métodos , Programas de Optimización del Uso de los Antimicrobianos/estadística & datos numéricos , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/normas , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud/métodosRESUMEN
BACKGROUND: Impetigo is a contagious bacterial infection that affects the superficial skin layers. Increasing worldwide antimicrobial resistance (AMR) to existing topical agents commonly prescribed to treat impetigo is central to treatment failure. The Worldwide Health Organization developed a global action plan on AMR, but omitted information about AMR stewardship programs for topical antibiotics. OBJECTIVES: The review aims to provide information to clinicians and stakeholders regarding AMR and antimicrobial stewardship on topical antimicrobial drugs for impetigo treatment. METHODS: The literature searches reviewed the status of AMR to current topical antibiotics in impetigo, current therapeutic behavior, and concordance with antimicrobial stewardship principles. Two international panels convened to discuss the output of the searches, and the results of the panel discussions were used in the development of the manuscript. RESULTS: The literature search included clinical trials, research studies, clinical guidelines, consensus papers, and reviews (if they provided original data), published between January 2008 and May 2019. The articles were selected based on clinical relevancy of impetigo management, clinical efficacy, and safety of the treatment and antimicrobial resistance. The searches resulted in one-hundred and ninety-eight articles. After applying the eligibility criteria, nineteen articles met inclusion criteria and were considered in the present review. CONCLUSIONS: While published antimicrobial stewardship guidelines have focused on systemic antibiotics, few studies have attempted to evaluate topical antibiotic prescribing practices for impetigo treatment. Many of the topical impetigo treatments currently in use have developed resistance. The appropriate use of topical ozenoxacin can help eradicate impetigo while minimizing AMR.J Drugs Dermatol. 20(4):366-372. doi:10.36849/JDD.5795.
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Antibacterianos/farmacología , Programas de Optimización del Uso de los Antimicrobianos/normas , Impétigo/tratamiento farmacológico , Staphylococcus aureus/efectos de los fármacos , Administración Cutánea , Aminopiridinas/farmacología , Aminopiridinas/normas , Aminopiridinas/uso terapéutico , Antibacterianos/normas , Antibacterianos/uso terapéutico , Prescripciones de Medicamentos/normas , Farmacorresistencia Bacteriana , Humanos , Pruebas de Sensibilidad Microbiana , Guías de Práctica Clínica como Asunto , Quinolonas/farmacología , Quinolonas/normas , Quinolonas/uso terapéutico , Staphylococcus aureus/aislamiento & purificación , Resultado del TratamientoRESUMEN
INTRODUCTION: All major international guidelines for the management of infective endocarditis (IE) have undergone major revisions, recommending antibiotic prophylaxis (AP) restriction to high-risk patients or foregoing AP completely. We performed a systematic review to investigate the effect of these guideline changes on the global incidence of IE. METHODS: Electronic database searches were performed using Ovid Medline, EMBASE and Web of Science. Studies were included if they compared the incidence of IE prior to and following any change in international guideline recommendations. Relevant studies fulfilling the predefined search criteria were categorized according to their inclusion of either adult or pediatric patients. Incidence of IE, causative microorganisms and AP prescription rates were compared following international guideline updates. RESULTS: Sixteen studies were included, reporting over 1.3 million cases of IE. The crude incidence of IE following guideline updates has increased globally. Adjusted incidence increased in one study after European guideline updates, while North American rates did not increase. Cases of IE with a causative pathogen identified ranged from 62% to 91%. Rates of streptococcal IE varied across adult and pediatric populations, while the relative proportion of staphylococcal IE increased (range pre-guidelines 16-24.8%, range post-guidelines 26-43%). AP prescription trends were reduced in both moderate and high-risk patients following guideline updates. DISCUSSION: The restriction of AP to only high-risk patients has not resulted in an increase in the incidence of streptococcal IE in North American populations. The evidence of the impact of AP restriction on IE incidence is still unclear for other populations. Future population-based studies with adjusted incidence of IE, AP prescription rates and accurate pathogen identification are required to delineate findings further in these other regions.
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Profilaxis Antibiótica/normas , Programas de Optimización del Uso de los Antimicrobianos/normas , Endocarditis Bacteriana/epidemiología , Adolescente , Anciano , Anciano de 80 o más Años , Profilaxis Antibiótica/efectos adversos , Niño , Preescolar , Toma de Decisiones Clínicas , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/mortalidad , Endocarditis Bacteriana/terapia , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. METHODS: A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. RESULTS: The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1-6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. CONCLUSIONS: We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.
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Antibacterianos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/normas , Indicadores de Calidad de la Atención de Salud , Profilaxis Antibiótica , Técnica Delphi , Humanos , Pacientes Internos , Pacientes Ambulatorios , República de CoreaRESUMEN
Quantification of antibiotic utilization is an essential component of antibiotic stewardship programs. In this multicentric study, we used different metrics to evaluate inpatient antibiotic use in children. The study objectives were to describe point prevalence of antibiotic use by indication and patient characteristics, to evaluate DOTs, LOTs and PDDs, and to compare PDDs to DDDs, which assume average maintenance dose per day in adults. All children hospitalized on the days of the study were included. Trained personnel collected demographic and clinical data from patients' clinical records. We recorded information about antibiotics administered on the date of data collection, and in the previous 30 days of hospitalization. Of 810 patients, 380 (46.9%; CI 95%: 43.4-50.4) received one or more antibiotics; prevalence of use was 27.0% for prophylaxis (219/810), and 20.7% (168/810) for treatment. Overall, 587 drugs were issued to the 380 patients receiving antibiotics (1.5 antibiotic per patient). When considering treatments, DOT and LOT per 100 patient-days were 30.5 and 19.1, respectively, resulting in a DOT/LOT ratio of 1.6. PDDs increased with age and approached DDDs only in children aged ≥ 10 years; the ratio between PDDs estimated in children aged ≥ 10 years and in 0-11 month-old infants ranged from 2 for sulfamethoxazole and trimethoprim, to 25 for meropenem. Our results confirm that DOT, LOT and PDD are better alternatives to DDD in children.
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Antibacterianos/uso terapéutico , Programas de Optimización del Uso de los Antimicrobianos/normas , Utilización de Medicamentos/normas , Antibacterianos/efectos adversos , Antibacterianos/normas , Benchmarking , Niño , Preescolar , Femenino , Hospitales Pediátricos , Humanos , Lactante , Recién Nacido , Pacientes Internos , Italia/epidemiología , Masculino , PediatríaRESUMEN
BACKGROUND: The goals of the National Action Plan on Antimicrobial Resistance (AMR) of Japan include "implementing appropriate infection prevention and control" and "appropriate use of antimicrobials," which are relevant to healthcare facilities. Specifically, linking efforts between existing infection control teams and antimicrobial stewardship programs was suggested to be important. Previous studies reported that human resources, such as full-time equivalents of infection control practitioners, were related to improvements in antimicrobial stewardship. METHODS: We posted questionnaires to all teaching hospitals (n = 1017) regarding hospital countermeasures against AMR and infections. To evaluate changes over time, surveys were conducted twice (1st survey: Nov 2016, 2nd survey: Feb 2018). A latent transition analysis (LTA) was performed to identify latent statuses, which refer to underlying subgroups of hospitals, and effects of the number of members in infection control teams per bed on being in the better statuses. RESULTS: The number of valid responses was 678 (response rate, 66.7%) for the 1st survey and 559 (55.0%) for the 2nd survey. More than 99% of participating hospitals had infection control teams, with differences in activity among hospitals. Roughly 70% had their own intervention criteria for antibiotics therapies, whereas only about 60 and 50% had criteria established for the use of anti-methicillin-resistant Staphylococcus aureus antibiotics and broad-spectrum antibiotics, respectively. Only 50 and 40% of hospitals conducted surveillance of catheter-associated urinary tract infections and ventilator-associated pneumonia, respectively. Less than 50% of hospitals used maximal barrier precautions for central line catheter insertion. The LTA identified five latent statuses. The membership probability of the most favorable status in the 2nd study period was slightly increased from the 1st study period (23.6 to 25.3%). However, the increase in the least favorable status was higher (26.3 to 31.8%). Results of the LTA did not support a relationship between increasing the number of infection control practitioners per bed, which is reportedly related to improvements in antimicrobial stewardship, and being in more favorable latent statuses. CONCLUSIONS: Our results suggest the need for more comprehensive antimicrobial stewardship programs and increased surveillance activities for healthcare-associated infections to improve antimicrobial stewardship and infection control in hospitals.