P2096 Are recommendations for antibiotic use related to antibiotic consumption in hospital? Results from a French surveillance network

Abstract Background Antibiotic use (ABU) surveillance in healthcare facilities (HCFs) is essential to guide stewardship. Two methods are recommended: antibiotic consumption (ABC), expressed as the number of DDD/1000 patient-days; and prevalence of antibiotic prescription (ABP) measured through point prevalence surveys. However, no evidence is provided about whether they lead to similar conclusions. Objectives To compare ABC and ABP regarding HCF ranking and their ability to identify outliers. Methods The comparison was made using 2012 national databases from the antibiotic surveillance network and prevalence study. HCF rankings according to each method were compared with Spearman’s correlation coefficient. Analyses included the ABU from entire HCFs as well as according to type, clinical ward and by antibiotic class and specific molecule. Results A total of 1076 HCFs were included. HCF rankings were strongly correlated in the whole cohort. The correlation was stronger for HCFs with a higher number of beds or with a low or moderate proportion of acute care beds. ABU correlation between ABC or ABP was globally moderate or weak in specific wards. Furthermore, the two methods did not identify the same outliers, whichever HCF characteristics were analysed. Correlation between HCF ranking varied according to the antibiotic class. Conclusions Both methods ranked HCFs similarly overall according to ABC or ABP; however, major differences were observed in ranking of clinical wards, antibiotic classes and detection of outliers. ABC and ABP are two markers of ABU that could be used as two complementary approaches to identify targets for improvement.

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Informing the development of a standardised approach to measure antibiotic use in secondary care: a systematic review protocol

BMJ Open ◽

10.1136/bmjopen-2018-026792 ◽

2019 ◽

Vol 9 (5) ◽

pp. e026792

Author(s):

Selina Patel ◽

Arnoupe Jhass ◽

Susan Hopkins ◽

Laura Shallcross

Keyword(s):

Secondary Care ◽

Scale Up ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Antibiotic Usage ◽

Prescribing Patterns ◽

Primary Data ◽

Antibiotic Prescribing ◽

Cochrane Central Register ◽

Antibiotic Consumption Surveillance

IntroductionEcological and individual-level evidence indicates that there is an association between level of antibiotic exposure and the emergence and spread of antibiotic resistance. The Global Point Prevalence Survey in 2015 estimated that 34.4% of hospital inpatients globally received at least one antimicrobial. Antimicrobial stewardship to optimise antibiotic use in secondary care can reduce the high risk of patients acquiring and transmitting drug-resistant infections in this setting. However, differences in the availability of data on antibiotic use in this context make it difficult to develop a consensus of how to comparably monitor antibiotic prescribing patterns across secondary care. This review will aim to document and critically evaluate methods and measures to monitor antibiotic use in secondary care.Methods and analysisWe will search Medline (Ovid), Embase (Ovid), Cumulative Index to Nursing and Allied Health Literature, Cochrane Central Register of Controlled Trials and websites of key organisations for published reports where an attempt to measure antibiotic usage among adult inpatients in high-income hospital settings has been made. Two independent reviewers will screen the studies for eligibility, extract data and assess the study quality using the Newcastle-Ottawa scale. A description of the methods and measures used in antibiotic consumption surveillance will be presented. An adaptation of the Affordability, Practicability, Effectiveness, Acceptability, Side-effects Equity framework will be used to consider the practicality of implementing different approaches to measuring antibiotic usage in secondary care settings. A descriptive comparison of definitions and estimates of (in)appropriate antibiotic usage will also be carried out.Ethics and disseminationEthical approval is not required for this study as no primary data will be collected. The results will be published in relevant peer-reviewed journals and presented at relevant conferences or meetings where possible. This review will inform future approaches to scale up antibiotic consumption surveillance strategies to attempt to maximise impact through standardisation.PROSPERO registration numberCRD42018103375

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Staphylococcus aureus - selective reporting of antibiogram results and its impact on antibiotic use: Interventional study with a reference group on the effect of switching from non-selective to selective antibiotic reporting

Antimicrobial Resistance and Infection Control ◽

10.1186/s13756-021-01021-7 ◽

2021 ◽

Vol 10 (1) ◽

Author(s):

Franka Lestin-Bernstein ◽

Ramona Harberg ◽

Ingo Schumacher ◽

Lutz Briedigkeit ◽

Oliver Heese ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Selective Reporting ◽

Beta Lactams ◽

Interventional Study ◽

Patient Level ◽

Narrow Spectrum ◽

Bed Days ◽

The Impact

Abstract Background Antimicrobial stewardship (AMS) strategies worldwide focus on optimising the use of antibiotics. Selective susceptibility reporting is recommended as an effective AMS tool although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use. The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections. Methods This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin, instead of reporting all tested antibiotics. The impact of implementing selective reporting was analysed by monitoring total monthly antibiotic consumption in our hospital and in a reference hospital (recommended daily dose/100 occupied bed days: RDD/100 BD), as well as on an individual patient level by analysing days of therapy adjusted for bed days (DOT/ 100 BD) for patients with S. aureus bacteremia (SAB) and respectively skin and soft tissue infections (SSTI). Results MSSA-antibiograms were acquired for 2836 patients. The total use of narrow-spectrum beta-lactams more than doubled after implementing selective reporting (from 1.2 to 2.8 RDD/100 BD, P < 0.001). The use of intravenous flucloxacillin/cefazolin for SAB rose significantly from 52 to 75 DOT/100 BD (plus 42%), just as the use of oral cefalexin for SSTI (from 1.4 to 9.4 DOT/100 BD, from 3 to 17 of 85/88 patients). Considering the overall consumption, there was no decrease in antibiotics omitted from the antibiogram. This was probably due to their wide use for other infections. Conclusions As narrow-spectrum beta-lactams are not widely used for other infections, their increase in the overall consumption of the entire hospital was a strong indicator that selective reporting guided clinicians to an optimised antibiotic therapy of S. aureus infections. On a patient level, this assumption was verified by a significant improved treatment of S. aureus infections in the subgroups of SAB and SSTI. As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

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Staphylococcus Aureus: Selective Reporting of Antibiogram Results and Its Impact on Antibiotic Use. Interventional Study with a Reference Group on the Effect of Switching from Non-Selective to Selective Antibiotic Reporting

10.21203/rs.3.rs-41131/v1 ◽

2020 ◽

Author(s):

Franka Lestin-Bernstein ◽

Ramona Harberg ◽

Ingo Schumacher ◽

Lutz Briedigkeit ◽

Oliver Heese ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Antibiotic Therapy ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Selective Reporting ◽

Care Hospital ◽

Beta Lactams ◽

Interventional Study ◽

Narrow Spectrum ◽

The Impact

Abstract Background:Antimicrobial stewardship (AMS) strategies worldwide focus on optimised antibiotic use. Selective susceptibility reporting is recommended as an effective AMS tool, although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use.The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections.Methods:This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period, susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/oral cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin; instead of reporting all tested antibiotics during the year before the intervention and in the reference clinic. The impact of the intervention was analysed by monitoring antibiotic consumption (recommended daily dose/100 occupied bed days: RDD/100 BD).Results:MSSA-antibiograms were reported for 2836 patients. Total use of narrow-spectrum beta-lactams more than doubled during the intervention (from 1.2 to 2.8 RDD/100 BD, P<0.001; P<0.001 compared to the reference clinic); the percentage of total antibiotic use increased from 2.6% to 6.2%. A slight, but significant increase in the use of trimethoprim-sulfamethoxazole was also observed (+ 0.37 RDD/100 BD).There was no decrease in antibiotics withdrawn from the antibiogram, probably as a consequence of their wide use for indications other than S. aureus infections.Conclusions:As narrow-spectrum beta-lactams are not widely used for other infections, there is a strong indication that selective reporting guided clinicians to optimised antibiotic therapy of S. aureus infections.As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

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Antibiotics stewardship in Ghana: a cross-sectional study of public knowledge, attitudes, and practices

10.21203/rs.2.19809/v1 ◽

2020 ◽

Author(s):

Tamara Jimah ◽

Ama P. Fenny ◽

Oladele Ogunseitan

Keyword(s):

Antibiotic Resistance ◽

Inappropriate Medication ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

Individual Knowledge ◽

Knowledge Attitudes And Practices

Abstract Background Antibiotic resistance is a major contributing factor to global morbidity and mortality and is associated with inappropriate medication use. However, the level of antibiotic consumption and knowledge about antibiotic resistance in Ghana is inadequately quantified. Our study identifies strategies for improved stewardship of antibiotics to prevent the proliferation of resistant pathogens by assessing the level of antibiotic knowledge, attitudes, and consumption behaviors by region, gender, age, and education in rural and urban Ghana. Methods A cross-sectional study was conducted in 12 communities in the urban Greater Accra and rural Upper West regions of Ghana. A questionnaire survey was administered to 400 individuals aged 18 years and older in selected locations during September-October 2018 to gather data on individual knowledge, attitudes, and practices concerning antibiotics and antibiotic resistance. Multivariate analysis was used to investigate the association between demographic characteristics and knowledge, attitudes, and related behaviors. Results Over 30% (125/400) had not received a doctor’s prescription during their last illness. Seventy percent (278/400) had taken at least one antibiotic in the year prior to the survey. The top five frequently used antibiotics were Amoxicillin , Amoxicillin-clavulanic acid , Ampicillin , Ciprofloxacin , and Metronidazole . Women and older adults had higher knowledge compared to their respective counterparts (p<0.01). Furthermore, prudent antibiotic use was significantly more prevalent in women than men (p<0.05). Although no regional differences were found in overall knowledge, compared to urban residents, individuals residing in rural settings exhibited higher knowledge about the ineffectiveness of antibiotics for viruses like the cold and HIV/AIDS (p<0.001). Two hundred and fifty-two (63%) respondents were unaware of antibiotic resistance. There was generally a low level of self-efficacy among participants regarding their role in preserving the effectiveness of antibiotics. Conclusion Antibiotic knowledge, attitudes, and use varied significantly across demographics, suggesting a context-specific approach to developing effective community interventions.

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Impact of Outpatient Antibiotic Use on Carriage of Ampicillin-ResistantEscherichia coli

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01708-09 ◽

2010 ◽

Vol 55 (3) ◽

pp. 1135-1141 ◽

Cited By ~ 11

Author(s):

Matthew H. Samore ◽

Claude Tonnerre ◽

Elizabeth Lyon Hannah ◽

Gregory J. Stoddard ◽

Robert J. Borotkanics ◽

...

Keyword(s):

Drug Class ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Clinic Visit ◽

Individual Risk ◽

Competitive Balance ◽

Household Level ◽

E Coli ◽

Group 2 ◽

Group 1

ABSTRACTStudies about the relationship between antibiotic consumption and carriage of antibiotic-resistantEscherichia coliin individual patients have yielded conflicting results. The goal of this study was to identify individual- and household-level factors associated with carriage of ampicillin (AMP)-resistantE. coliduring consumption of a course of oral antibiotics. We enrolled outpatients and their families in a prospective household study of AMP-resistant or AMP-susceptibleE. colicarriage. Two kinds of index patients were identified. Group 1 consisted of outpatients who were being initiated on a new antibiotic course at the time of a clinic visit, and group 2 consisted of outpatients not starting antibiotics. Each participant was asked to submit three stool swab samples (at baseline, week 1, and week 4) and to complete a questionnaire. Antimicrobial susceptibility testing was performed on each phenotypically distinctE. colicolony. The study included 149 group 1 households (total, 570 participants) and 38 group 2 households (total, 131 participants). AMP-resistantE. coliwas recovered from 29% of stool samples. Observed associations with antibiotic exposure varied by drug class. Penicillins, which were the most frequently prescribed drug class, were associated with a modest increase in AMP-resistantE. colicarriage and a modest decrease in AMP-susceptibleE. colicarriage. Neither change by itself was statistically significant. Macrolides were associated with reduced carriage of both AMP-resistantE. coliand AMP-susceptibleE. coli(P< 0.05). Both AMP-resistant and AMP-susceptibleE. colidemonstrated household clustering (P< 0.001). In summary, the overall effect of antibiotics on individual risk of carriage of AMP-resistantE. coliwas small. However, even a modest alteration of the competitive balance between AMP-resistant and AMP-susceptibleE. colimay promote population spread of resistantE. coli. Examining changes in both resistant and susceptible organisms in antibiotic-treated individuals and their close contacts improves understanding of antibiotic selection pressure.

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Use of the World Health Organization Access, Watch, and Reserve Classification to Follow Trends in Prescription of Antibiotic Use in Two Pediatric Intensive Care Units in Rio de Janeiro, Brazil

Journal of Pediatric Infectious Diseases ◽

10.1055/s-0040-1701648 ◽

2020 ◽

Vol 15 (03) ◽

pp. 155-160

Author(s):

André Ricardo Araujo da Silva ◽

Cristina Vieira de Souza Oliveira ◽

Cristiane Henriques Teixeira ◽

Izabel Alves Leal

Keyword(s):

Time Series ◽

Intensive Care ◽

Time Series Analysis ◽

World Health Organization ◽

Pediatric Intensive Care ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

World Health ◽

The World ◽

Health Organization

Abstract Objective The recommended percentage of antibiotic use in pediatric intensive care units (PICUs) using the World Health Organization (WHO) Access, Watch, and Reserve (AWaRE) classification is not known. Methods We have conducted an interrupted time series analysis in two PICUs in Rio de Janeiro, Brazil, over a period of 18 months. The type of antibiotics used was evaluated using the WHO AWaRE classification, and the amount of antibiotic was measured using days of therapy/1,000 patient-days (DOT/1000PD) after implementation of an antimicrobial stewardship program (ASP). The first and last semesters were compared using medians and the Mann–Whitney's test. The trends of antibiotic consumption were performed using time series analysis in three consecutive 6-month periods. Results A total of 2,205 patients were admitted, accounting for 12,490 patient-days. In PICU 1, overall antibiotic consumption (in DOT/1000PD) was 1,322 in the first 6 months of analysis and 1,264.5 in the last 6 months (p = 0.81). In PICU 2, the consumption for the same period was 1,638.5 and 1,344.5, respectively (p = 0.031). In PICU 1, the antibiotics classified in the AWaRE groups were used 33.2, 57.9, and 8.4% of the time, respectively. The remaining 0.5% of antibiotics used were not classified in any of these groups. In PICU 2, the AWaRE groups corresponded to 30.2, 60.5, and 9.3% of all antibiotics used, respectively. There was no use of unclassified antibiotics in this unit. The use of all three groups of WHO AWaRE antibiotics was similar in the first and the last semesters, with the exception of Reserve group in PICU 2 (183.5 × 92, p = 0.031). Conclusion A significant reduction of overall antibiotic use and also in the Reserve group was achieved in one of the PICU units studied. The antibiotics classified in the Watch group were the most used in both units, representing ∼60% of all the antibiotics consumed.

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Evaluation of antibiotic usage in swine reproduction farms in Umbria region based on the quantitative analysis of antimicrobial consumption

Italian Journal of Food Safety ◽

10.4081/ijfs.2017.6886 ◽

2017 ◽

Vol 6 (3) ◽

Cited By ~ 2

Author(s):

Fausto Scoppetta ◽

Marco Sensi ◽

Maria Pia Franciosini ◽

Marinella Capuccella

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Diagnostic Methods ◽

Antibiotic Administration ◽

Oral Antibiotic ◽

Defined Daily Doses ◽

Umbria Region ◽

Antimicrobial Susceptibility Tests ◽

Critical Aspects

Antibiotic use in food-producing animals has considerable impact on public health, especially with respect to the development and spread of antibiotic resistance. Pigs represent one of the main species in which antibiotics are frequently used for different purposes. Surveillance of antibiotic consumption and dose appropriateness, through novel approaches based on defined daily doses, is strongly needed to assess farms’ antibiotic risk, in terms of spread of antibiotic resistance and possibile presence of residues in meat. In this study, antibiotic consumption was monitored in 14 swine reproduction farms, together with managerial, structural, and health aspects. Most of the controlled farms (65%) were classified as at medium antibiotic risk, 21% at high antibiotic risk, and 14% at low antibiotic risk. Critical aspects of antibiotic administration concerned treatments for suckling and weaner piglets, oral antibiotic administration, treatment and diagnosis of gastroenteric infections, and use of critically important antimicrobials for human medicine, especially colistin. These aspects could be considered critical aspects of antibiotic use in from-farrow-to-wean/finish swine farms in the Umbria region and must be controlled to minimize risks. Even though a small number of farms in Umbria region are at high antibiotic risk, the risk of antibiotic resistance should be minimized, and management and biosecurity of the farms should be improved by extending the use of antimicrobial susceptibility tests and optimizing the diagnostic methods for infectious diseases. Furthermore, farmers’ and veterinarians’ knowledge of antibiotic resistance should be improved and the prudent use of antibiotics encouraged to prevent the development and spread of resistant microorganisms.

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Impact of national interventions to promote responsible antibiotic use: a systematic review

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz348 ◽

2019 ◽

Vol 75 (1) ◽

pp. 14-29 ◽

Cited By ~ 7

Author(s):

Jane Mingjie Lim ◽

Shweta Rajkumar Singh ◽

Minh Cam Duong ◽

Helena Legido-Quigley ◽

Li Yang Hsu ◽

...

Keyword(s):

Systematic Review ◽

National Level ◽

Public Health Problem ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Middle Income ◽

Middle Income Countries ◽

Policy Interventions ◽

The Impact

Abstract Background Global recognition of antimicrobial resistance (AMR) as an urgent public health problem has galvanized national and international efforts. Chief among these are interventions to curb the overuse and misuse of antibiotics. However, the impact of these initiatives is not fully understood, making it difficult to assess the expected effectiveness and sustainability of further policy interventions. We conducted a systematic review to summarize existing evidence for the impact of nationally enforced interventions to reduce inappropriate antibiotic use in humans. Methods We searched seven databases and examined reference lists of retrieved articles. To be included, articles had to evaluate the impact of national responsible use initiatives. We excluded studies that only described policy implementations. Results We identified 34 articles detailing interventions in 21 high- and upper-middle-income countries. Interventions addressing inappropriate antibiotic access included antibiotic committees, clinical guidelines and prescribing restrictions. There was consistent evidence that these were effective at reducing antibiotic consumption and prescription. Interventions targeting inappropriate antibiotic demand consisted of education campaigns for healthcare professionals and the general public. Evidence for this was mixed, with several studies showing no impact on overall antibiotic consumption. Conclusions National-level interventions to reduce inappropriate access to antibiotics can be effective. However, evidence is limited to high- and upper-middle-income countries, and more evidence is needed on the long-term sustained impact of interventions. There should also be a simultaneous push towards standardized outcome measures to enable comparisons of interventions in different settings.

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Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz490 ◽

2019 ◽

Vol 75 (3) ◽

pp. 747-755

Author(s):

Pierre-Marie Roger ◽

Ingrid Peyraud ◽

Michel Vitris ◽

Valérie Romain ◽

Laura Bestman ◽

...

Keyword(s):

Clavulanic Acid ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Third Generation ◽

Therapeutic Guidelines ◽

Amoxicillin Clavulanic Acid ◽

The Impact ◽

Third Generation Cephalosporins

Abstract Objectives We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. Methods Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. Results We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82–5.92 and 2.18, 95% CI 1.38–3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06–0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34–0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was −16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). Conclusions STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.

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