Antimicrobial Use in a Swedish Pediatric Hospital (original) (raw)
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Longitudinal surveillance of antibiotic use in the hospital
QJM, 2001
We evaluated antimicrobial use in our hospital by department, including indications for use, source of infections, use of the microbiology laboratory, and appropriateness of prescribing, in a prospective, comparative, non-interventional study of all patients receiving antimicrobial agents. We excluded departments where antimicrobial use was negligible. The other 19 departments were followed for 3 (n = 4) or 4 (n=15) months, including 2 consecutive months in the spring-summer and either 1 or 2 in the autumn-winter. Antimicrobial therapy was followed from initiation, through possible adaptations, and possible change from intravenous to oral therapy, until discontinuation of treatment. Overall, 6376 antibiotics were given to 2306 patients. Of the surveyed hospitalized patients, 62%"22% received antibiotics, with a range of 4±100% per department. Antibiotics were prescribed for infections acquired in the community (3037 instances, 47%), in the hospital (2182, 34%), in a nursing home (575, 9%), and for prophylaxis continued post-operatively (582, 9%). The most common indications for antimicrobial use were: respiratory tract infection (1729, 27%), urinary tract infection (955, 15%), sepsis (701, 11%), intra-abdominal infections (663, 10%), prophylaxis 582 (9%), soft-tissue infection (572, 9%), and surgical site infection (319, 5%). Univariate indicators for appropriateness of treatment were: age, department, site of infection, source of infection, antimicrobial drug and serum creatinine (all p-0.001). Forty-nine antimicrobials were prescribed in 279 combinations, 58% as single agent and 42% as drug combinations. Half of all antimicrobial use consisted of four agents: cefuroxime (19.1%), metronidazole (11.3%), gentamicin (10.6%) and ampicillin (10.2%), which together accounted for 20% of expenditure on antibiotics. Although use of as many as 53% of antimicrobials (26/49) surveyed was restricted, use in this category accounted for only 29% of all antimicrobial courses. Of 6376 antibiotic courses, 4101 (64%) were given intravenously and 2275 (36%) orally. Appropriateness of use of restricted drugs was lower (70%) than of unrestricted ones (84%, p-0.001). Of 24 571 defined daily doses (DDD) given orally, 4587 (19%) were restricted, compared to 7264 (34%) of 21 602 DDDs given intravenously (p-0.001). Antibiotic treatment in our hospital appears to be substantial and increasing, justifying efforts to improve appropriateness of therapy and improve clinical and financial results.
Prescribing trends before and after implementation of an antimicrobial stewardship program
The Medical Journal of Australia, 2013
p to 50% of antimicrobial agents prescribed to hospital inpatients are considered to be inappropriate, 1,2 and this excess use has been associated with increased mortality, adverse drug reactions and the development of resistant bacteria. 3,4 The Australian Commission on Safety and Quality in Health Care recently published recommendations for hospital-based antimicrobial stewardship programs. 2 A variety of approaches are available to implem ent these rec om mendations, including dissemination of guidelines, education, restricting antimicrobial availability and postprescribing audit and review. We aimed to evaluate changes in antimicrobial prescribing after the implementation of an antimicrobial stewardship program in a specialist tertiary referral hospital. Methods Setting Alfred Health is a health service comprising three hospitals in metropolitan Melbourne. The largest campus, the Alfred Hospital, is a 430-bed tertiary teaching hospital with medicine, surgery and trauma services. It includes immunocompromised populations (including patients with HIV, cystic fibrosis and heart/lung transplantation, and haematology and bone marrow transplantation) and is supported by a 35-bed intensive care unit (ICU). Antimicrobial stewardship program Prescribing trends before and after implementation of an antimicrobial stewardship program U Research Objectives: Antimicrobial stewardship programs are recommended to reduce antimicrobial resistance by reducing inappropriate use of antimicrobials. We implemented an antimicrobial stewardship program and aimed to evaluate its effect on broad-spectrum antimicrobial use. Design, setting and participants: Observational study with historical control using interrupted time series analysis conducted in a tertiary referral hospital. Hospital inpatients prescribed restricted antimicrobials for non-standard indications, where approval had expired or without approval. Intervention: Baseline period of 30 months immediately followed by an 18-month intervention period commencing January 2011. Main outcome measures: Number and type of interventions made by antimicrobial stewardship team; monthly rate of use of broad-spectrum antimicrobial agents (in defined daily doses/1000 occupied bed-days). Results: The antimicrobial stewardship team made 1104 recommendations in 779 patients during the 18-month intervention period. In 64% of cases, the recommendation was made to cease or de-escalate the antimicrobial therapy, or to change from intravenous to oral therapy. The introduction of the intervention resulted in an immediate 17% (95% CI, 13%-20%) reduction in broad-spectrum antimicrobial use in the intensive care unit and a 10% (95% CI, 4%-16%) reduction in broad-spectrum antimicrobial use outside the intensive care unit. Reductions were particularly seen in cephalosporin and glycopeptide use, although these were partially offset by increases in the use of -lactam-lactamase inhibitors. Conclusions: The introduction of an antimicrobial stewardship program, including postprescription review, resulted in an immediate reduction in broadspectrum antimicrobial use in a tertiary referral centre. However, the effect of this intervention reduced over time.
Antimicrobial consumption in a tertiary children’s hospital in Finland (2003–2013)
European Journal of Hospital Pharmacy, 2016
Background Numbers of resistant pathogens are constantly increasing, and prudent use of antimicrobials is of paramount importance. In order to see whether any changes in the use of antimicrobials in recent years have occurred, we decided to monitor the consumption of these drugs at a single tertiary paediatric hospital. Materials and methods This single-centre retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical /DDD index) in a 130-bed paediatric tertiary hospital. The data on the consumption of antimicrobials were collected from years 2003-2013 by using electronic surveillance records provided by the local pharmacy. The consumption was related to days of hospital care. Results During 2003-2013, the use of penicillins, cephalosporins and carbapenems increased by 28%, 46% and 110%, respectively. The consumption of both aminoglycosides and vancomycin decreased by 61% and 41%, respectively. Amphotericin B use clearly decreased by 39% while the use of novel azoles and echinocandins increased. Conclusions Increased use of carbapenems was the most significant finding of our study. The year-to-year consumption of antibacterials was in general relatively stable and new antibacterials were taken into use conservatively. In contrast to antibacterials, novel antifungals were rapidly adopted into use despite scarce evidence on their safety in children.
Reduction in broad-spectrum antimicrobial use associated with no improvement in hospital antibiogram
Journal of Antimicrobial Chemotherapy, 2004
Objective: To evaluate the effect of an antimicrobial management programme on broad-spectrum antimicrobial use and antimicrobial susceptibilities of common nosocomial pathogens at a tertiary-care teaching hospital. Methods: Review of hospital charts of patients who had been prescribed broad-spectrum antimicrobials 48 h earlier. Recommendations to streamline or discontinue antimicrobials were made based on results of available microbiology data, radiography studies, as well as the working diagnosis at the time of review. The charts were reviewed again on the following day to assess acceptance or rejection of the recommendations. Antimicrobial use, measured as defined daily dose per 1000 patient days (DDD/1000 PD), was determined before and after the antimicrobial management programme was started and was assessed as the mean quarterly use in the six quarters preceding implementation of the programme compared to the most recent six quarters that the programme has been in existence. Antibiotic susceptibilities were obtained from the clinical microbiology laboratory. Results: Compared to the six quarters before the programme, broad-spectrum antibiotic use decreased by 28% (693 DDD/1000 PD to 502 DDD/1000 PD, P = 0.003). Total antifungal agent use decreased by a similar amount, i.e. 28% (144 DDD/1000 PD to 103 DDD/1000 PD, P = 0.02). Total antimicrobial use decreased by 27% (1461 DDD/1000 PD to 1069 DDD/1000 PD, P = 0.0007). Susceptibilities of common nosocomial Gramnegative organisms to commonly prescribed antibiotics did not change significantly over the 3 years of the programme. The rate of methicillin-resistant Staphylococcus aureus increased significantly in the nonintensive care areas of the hospital (P = 0.02) and decreased significantly in the intensive care areas of the hospital (P = 0.009) over the 4 year period from 2000 to 2003. Conclusion: Implementation of an antibiotic management programme resulted in substantial reductions in both broad-spectrum and total antimicrobial consumption without having a significant impact on antibiotic susceptibilities of common Gram-negative microorganisms within the institution. The changes in MRSA rate in the non-ICU and ICU settings may reflect infection control measures that were in place during the study period.
Euro surveillance : bulletin Européen sur les maladies transmissibles = European communicable disease bulletin, 2016
This study sought to analyse antimicrobial pressure, indications for treatment, and compliance with treatment recommendations and to identify possible problem areas where inappropriate use could be improved through interventions by the network of the local Swedish Strategic Programme Against Antibiotic Resistance (Strama) groups. Five point-prevalence surveys were performed in between 49 and 72 participating hospitals from 2003 to 2010. Treatments were recorded for 19 predefined diagnosis groups and whether they were for community-acquired infection, hospital-acquired infection, or prophylaxis. Approximately one-third of inpatients were treated with antimicrobials. Compliance with guidelines for treatment of community-acquired pneumonia with narrow-spectrum penicillin was 17.0% during baseline 2003-2004, and significantly improved to 24.2% in 2010. Corresponding figures for quinolone use in uncomplicated cystitis in women were 28.5% in 2003-2004, and significantly improved, decreasi...
Research Square (Research Square), 2024
Background. Healthcare-associated infections (HAIs) represent a major threat in Europe. Infection prevention and control (IPC) measures are crucial to lower their occurrence, as well as antimicrobial stewardship to ensure appropriate use of antibiotics. Starting from Italian national data, this study aimed at describing IPC indicators and outcomes related to HAIs and antimicrobial use in Italy, and estimating effects of IPC variables on HAI prevalence and on the proportion of antibiotics without speci c reason. Methods. Based on data collected for Italy during the ECDC PPS-2 Point Prevalence Survey, descriptive statistics were computed at national and macro-regional level. Causal assumption-informed regression models were then built to estimate the impact of structural determinants, sta ng parameters and IPC-related variables on HAI prevalence and percentage of antibiotic prescriptions with no reason detailed on medical records, after adjusting for relevant confounders. Results. The Italian frame showed substantial heterogeneity for both outcomes between macro-regions. The percentage of single-bed rooms was the only structural determinant with signi cant, positive impact on HAI prevalence (OR = 0.91 for every + 5%, p < 0.001), while the prevalence of antimicrobial agents without speci ed reason was lower in the presence of one more IPC nurse (OR = 0.78, p < 0.001) or one more antibiotic consultant (OR = 0.67, p < 0.001) per 100 beds. Both outcomes were reduced in the presence of routinely led IPC plans and reports (p < 0.001), HAI prevention measures (p < 0.001) and post-prescription review (p < 0.01). Conclusions. Our model con rmed the pivotal role of IPC measures and antimicrobial stewardship in contrasting HAIs and inappropriate antibiotic prescriptions. Post-prescription review appeared to be a valuable indicator of antimicrobial stewardship policies.
Study to assess quality of antimicrobial use by point prevalence survey at a tertiary care centre
IP innovative publication pvt. ltd, 2019
Knowledge and perception of rational Antimicrobial Use (AU) help in developing interventions to improve AU. Data to target AU surveillance and interventions are provided by Point Prevalence surveys, which are a resource-effective alternative to prospective surveillance. Point Prevalence Survey (PPS) on AU provides a snapshot of antibiotic use at a given point of time and can be repeated at regular intervals to monitor trends. It provides data that can be fed back to front line clinicians and used to inform discussions about stewardship. In Our 670 bedded tertiary care Hospital, we did the PPS during last week of Jan 2019 in the identified wards and ICU’s. A survey team reviewed patients’ case sheet and noted antibiotics prescriptions on the date of the survey. Other important details such as admitting ward, age, sex, total number of patients on admissions, administered antibiotics and its route, their dosages, dosing intervals, patients’ clinical diagnosis and indications for antibiotic use, Hospital-acquired infections (HAI) or Communityacquired (CAI) and surgical antibiotic prophylaxis (SAP) or Medical antibiotics prophylaxis(MAP). Of 502 patients admitted in the hospital, 325(64.7%) received 1 Antimicrobial orders (AO) on the date of the survey. Of 325 total AOs, 98 (30.2 %) were administered for (SAP) surgical prophylaxis, 19(5.84%) for Medical prophylaxis, (MAP), 23(7%) for reasons not documented in the medical record, i.e., Unknown- (UK), 167 (51.38%) were for CAI and 18(5.3%) for HAI. Parenteral Cefotaxim was the most prevalent antibiotic generally used and for all types of infection onset category.51% of all prescriptions for CAI was for respiratory infections. Broad spectrum AO treatment was prevalent, for both SAP and CAI infections. Understanding common reasons for Antibiotic use (e.g., Lower respiratory infection) can help focus education and stewardship efforts on areas in which improved use may have the greatest impact.