Antibiotic use in a Clinical Department of a University Hospital in Vietnam

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

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Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211035827 ◽

2021 ◽

pp. 175717742110358

Author(s):

Sailesh Kumar Shrestha ◽

Swarup Shrestha ◽

Sisham Ingnam

Keyword(s):

Prevention And Control ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

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Antibiotic Prophylaxis in Orbital Fractures

The Open Ophthalmology Journal ◽

10.2174/1874364101711010011 ◽

2017 ◽

Vol 11 (1) ◽

pp. 11-16 ◽

Cited By ~ 5

Author(s):

Benjamin Reiss ◽

Lamise Rajjoub ◽

Tamer Mansour ◽

Tony Chen ◽

Aisha Mumtaz

Keyword(s):

Prophylactic Antibiotic ◽

Antibiotic Use ◽

University Hospital ◽

Orbital Fracture ◽

Number Needed To Treat ◽

Orbital Fractures ◽

Oral Antibiotics ◽

George Washington ◽

Amoxicillin Clavulanate ◽

Trauma Teams

Purpose: To determine whether prophylactic antibiotic use in patients with orbital fracture prevent orbital infection. Design: Retrospective cohort study. Participants: All patients diagnosed with orbital fracture between January 1, 2008 and March 1, 2014 at The George Washington University Hospital and Clinics. Main Outcome Measures: Development of orbital infection. Results: One hundred seventy-two patients with orbital fracture met our inclusion and exclusion criteria. No orbital infections were documented. Twenty subjects (12%) received no prophylactic antibiotic, and two (1%) received only one dose of antibiotics pre-operatively for surgery. For primary antibiotic, 136 subjects (79%) received oral antibiotics, and 14 (8%) received intravenous (IV) antibiotics (excluding cefazolin). Cephalexin and amoxicillin-clavulanate were the most prescribed oral antibiotics that are equally effective. Five-to-seven day courses of antibiotics had no increased infections compared to ten-to-fourteen day courses. Calculated boundaries for effectiveness of prophylactic antibiotics ranged from a Number Needed to Treat (NNT) of 75 to a Number Needed to Harm (NNH) of 198. Conclusion: Antibiotics for prevention of orbital infection in patients with orbital fractures have become widely used. Coordination between trauma teams and specialists is needed to prevent patient overmedication and antibiotic resistance. Should antibiotics be used, shorter courses and avoidance of broad spectrum agents are recommended. Additional studies are needed.

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Relationship between Antibiotic Use and Antibiotic Resistance in Major Nosocomial Pathogens at a University Hospital

Chonnam Medical Journal ◽

10.4068/cmj.2008.44.3.137 ◽

2008 ◽

Vol 44 (3) ◽

pp. 137 ◽

Cited By ~ 8

Author(s):

Young A Song ◽

Sook-In Jung ◽

Mi Ok Chang ◽

Hee-Jung Ban ◽

Nam Chul Jin ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

University Hospital ◽

Nosocomial Pathogens

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Can We Optimize Antibiotic Use in Norwegian Neonates? A Prospective Comparison Between a University Hospital and a District Hospital

Frontiers in Pediatrics ◽

10.3389/fped.2019.00440 ◽

2019 ◽

Vol 7 ◽

Author(s):

Christian Magnus Thaulow ◽

Dag Berild ◽

Hege Salvesen Blix ◽

Anne Karin Brigtsen ◽

Tor Åge Myklebust ◽

...

Keyword(s):

District Hospital ◽

Antibiotic Use ◽

University Hospital ◽

Prospective Comparison

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Ecological Study of the Effectiveness of Isolation Precautions in the Management of Hospitalized Patients Colonized or Infected WithAcinetobacter baumannii

Infection Control and Hospital Epidemiology ◽

10.1086/592697 ◽

2008 ◽

Vol 29 (12) ◽

pp. 1118-1123 ◽

Cited By ~ 20

Author(s):

Houssein Gbaguidi-Haore ◽

Sophie Legast ◽

Michelle Thouverez ◽

Xavier Bertrand ◽

Daniel Talon

Keyword(s):

Ecological Study ◽

Hospital Setting ◽

Acute Care Hospital ◽

Antibiotic Use ◽

Annual Incidence ◽

University Hospital ◽

Outcome Variable ◽

Care Hospital ◽

Aggregated Data ◽

The Impact

Objective.To assess the impact of isolation precautions on the incidence of patients colonized or infected withAcinetobacter baumannii(case patients) in a university hospital during the period from 1999 to 2006.Design.Ecological study.Setting.The Besançon University Hospital in France, a 1,200-bed acute care hospital with approximately 50,000 admissions per year.Methods.Using Poisson regression analysis, we evaluated a total of 350,000 patient-days to determine the annual incidence of case patients. This annual incidence was used as the outcome variable, and infection control practices, antibiotic use, and other aggregated data regarding patients' age, sex, McCabe score, and immune status were used as covariates.Results.The implementation of isolation precautions was independently and negatively associated with the incidence of patients colonized or infected withA. baumannii(relative risk, 0.50 [95% confidence interval, 0.40–0.64];P< .001).Conclusions.Our study suggests that the implementation of isolation precautions, in addition to standard precautions, effectively prevents the spread ofA. baumanniiin a hospital setting.

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How Does Antimicrobial Stewardship Affect Inappropriate Antibiotic Therapy in Urological Patients?

Antibiotics ◽

10.3390/antibiotics9020063 ◽

2020 ◽

Vol 9 (2) ◽

pp. 63 ◽

Cited By ~ 3

Author(s):

Atsushi Uda ◽

Katsumi Shigemura ◽

Koichi Kitagawa ◽

Kayo Osawa ◽

Kenichiro Onuma ◽

...

Keyword(s):

Infectious Disease ◽

Disease Management ◽

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Retrospective Review ◽

Antibiotic Use ◽

University Hospital ◽

Annual Changes ◽

Inappropriate Medications

Antimicrobial stewardship teams (ASTs) have been well-accepted in recent years; however, their clinical outcomes have not been fully investigated in urological patients. The purpose of this study was to evaluate the outcomes of intervention via a retrospective review of urological patients, as discussed in the AST meetings, who were treated with broad-spectrum antibiotics between 2014 and 2018 at the Department of Urology, Kobe University Hospital in Japan. Interventions were discussed in AST meetings for patients identified by pharmacists as having received inappropriate antibiotic therapy. The annual changes in numbers of inappropriate medications and culture submissions over five years at the urology department were statistically analyzed. Among 1,033 patients audited by pharmacists, inappropriate antibiotic therapy was found in 118 cases (11.4%). The numbers of inappropriate antibiotic use cases and of interventions for indefinite infections had significantly decreased during the study period (p = 0.012 and p = 0.033, respectively). However, the number of blood and drainage culture submissions had significantly increased (p = 0.009 and p = 0.035, respectively). Our findings suggest that urologists have probably become more familiar with infectious disease management through AST intervention, leading to a decrease in inappropriate antibiotic use and an increase in culture submissions.

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Chlorhexidine versus Tincture of Iodine for Reduction of Blood Culture Contamination Rates: a Prospective Randomized Crossover Study

Journal of Clinical Microbiology ◽

10.1128/jcm.01457-16 ◽

2016 ◽

Vol 54 (12) ◽

pp. 3007-3009 ◽

Cited By ~ 6

Author(s):

Elizabeth Story-Roller ◽

Melvin P. Weinstein

Keyword(s):

Blood Culture ◽

Crossover Study ◽

Clinical Care ◽

Bloodstream Infections ◽

Antibiotic Use ◽

University Hospital ◽

Contamination Rate ◽

Nursing Unit ◽

Skin Antisepsis ◽

Randomized Crossover Study

Blood cultures (BCs) are the standard method for diagnosis of bloodstream infections (BSIs). However, the average BC contamination rate (CR) in U.S. hospitals is 2.9%, potentially resulting in unnecessary antibiotic use and excessive therapy costs. Several studies have compared various skin antisepsis agents without a clear consensus as to which agent is most effective in reducing contamination. A prospective, randomized crossover study directly comparing blood culture contamination rates using chlorhexidine versus iodine tincture for skin antisepsis was performed at Robert Wood Johnson University Hospital (RWJUH). Eight nursing units at RWJUH were provided with blood culture kits containing either chlorhexidine (CH) or iodine tincture (IT) for skin antisepsis prior to all blood culture venipunctures, which were obtained by nurses or clinical care technicians. At quarterly intervals, the antiseptic agent used on each nursing unit was switched. Analyses of positive BCs were performed to distinguish true BSIs from contaminants. Of the 6,095 total BC sets obtained from the participating nursing units, 667 (10.94%) were positive and 238 (3.90%) were judged by the investigators to be contaminated. Of the 3,130 BCs obtained using IT, 340 (10.86%) were positive and 123 (3.93%) were contaminated. Of 2,965 BCs obtained using CH, 327 (11.03%) were positive and 115 (3.88%) were contaminated. The rates of contaminated BCs were not statistically significant between the two antiseptic agents (P= 1.0). We conclude that CH and IT are equivalent agents for blood culture skin antisepsis.

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