scholarly journals Trends of Adult Antimicrobial Hospital Consumption in Catalonia (Spain) from 2008 to 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s500-s501
Author(s):  
Santiago Grau ◽  
Sergi Hernández ◽  
Ariadna Padullés ◽  
Montserrat Gimenez ◽  
Lucía Boix-Palop ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Pearson Correlation ◽  
Acute Care Hospital ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Surgical Units ◽  
Amoxicillin Clavulanate ◽  
Bed Days ◽  
Hospital Consumption

Background: Antimicrobial resistance is a disturbing problem in the health system. A relationship between the use of certain antimicrobials and a resistance increase has been proposed. Since this phenomenon is not usually attributed to specific uses of antimicrobials but preferably to its evolution over the years, the analysis of the antimicrobial consumption over time can justify the epidemiological situation of a given region in terms of resistance and possible increases and decreases for specific microorganisms. The objective of this study was to analyze the evolution of the use of antimicrobials in Catalonia during 2008–2018 through the VINCat program (Infection Control and Antimicrobial Stewardship Catalonian Program). Methods: The number of hospitals participating in the VINCat increased from 46 in 2008 to 63 in 2018 (ie, 68.8% and 85.7% of all adult acute-care hospital beds in Catalonia, respectively). Hospitalization days recorded at the participating hospitals increased from 2,991,053 in 2008 to 3,714,938 in 2018. The Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index was used for monitoring antimicrobial consumption. Simple linear regressions were performed, the linear relationship was checked by ANOVA tests, and the Pearson correlation (Pc) coefficients were obtained. Values of P ≤ .05 were considered statistically significant. Results: From 2008 to 2018, there was a statistically significant increase of global antibacterial consumption (65.50 vs 71.73 DDD per 100 bed days; P = .001) and antimycotic consumption (3.09 vs 3.45 DDD per 100 bed days, P = .012) due to an increase of consumption in the surgical units. At the same time, there was a decrease in the consumption of antimycotics in the medical units (4.35 vs 3.90 DDD per 100 bed days; P =.029). Cephalosporins and carbapenem consumption increased both globally (10.88 vs 13.86 DDD per 100 bed days; P < .001) and in medical and surgical units (3.26 vs 5.38 DDD per 100 bed days; P < .001). This increase was mainly associated with ceftriaxone (3.45 vs 5.46 DDD per 100 bed days; P < .001) and meropenem (1.12 vs 3.08 DDD per 100 bed days; P < .001). There was a global decrease in the consumption of penicillins (26.10 vs 24.24 DDD per 100 bed days; P = .012) and quinolones (11.63 vs 9.61 DDD per 100 bed days; P = .004). This trend was observed also in ICUs and medical units but not in surgical units, for which only quinolones showed a significant decrease. Decreases in the use of amoxicillin/clavulanate acid (17.80 vs 14.24 DDD per 100 bed days; P < .001) and ciprofloxacin (5.68 vs 4.01 DDD per 100 bed days; P < .001) were observed. Conclusions: The increase in the use of antimicrobials in Catalonia is concerning. This increase is attributable to the use of these drugs in surgical units. Antibiotic stewardship measures should be aimed primarily at these units. The increasing use of carbapenems should be analyzed.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini as well as speaker honoraria from MSD, Pfizer, and Zambon.

scholarly journals Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 132
Author(s):  
Santiago Grau ◽  
Daniel Echeverria-Esnal ◽  
Silvia Gómez-Zorrilla ◽  
Maria Eugenia Navarrete-Rouco ◽  
Joan Ramon Masclans ◽  
...  
Keyword(s):  
Temporal Pattern ◽  
Tertiary Care Hospital ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Defined Daily Doses ◽  
Quasi Experimental ◽  
Bed Days ◽  
Hospital Consumption

Background: The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of antimicrobial consumption during this period. Methods: A retrospective quasi-experimental before–after study was conducted in a Spanish tertiary care hospital. The study compared two periods: pre-pandemic, from January 2018 to February 2020, and during the COVID-19 pandemic from March to June 2020. Antimicrobial consumption was analyzed monthly as defined daily doses (DDD)/100 bed-days and overall hospital and ICU consumption were evaluated. Results: An increase in the hospital consumption was noticed. Although only ceftaroline achieved statistical significance (p = 0.014), a rise was observed in most of the studied antimicrobials. A clear temporal pattern was detected. While an increase in ceftriaxone and azithromycin was observed during March, an increment in the consumption of daptomycin, carbapenems, linezolid, ceftaroline, novel cephalosporin/β-lactamase inhibitors or triazoles during April–May was noticed. In the ICU, these findings were more evident, namely ceftriaxone (p = 0.029), carbapenems (p = 0.002), daptomycin (p = 0.002), azithromycin (p = 0.030), and linezolid (p = 0.011) but followed a similar temporal pattern. Conclusion: An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Availability of updated protocols and antimicrobial stewardship programs are essential to optimize these outcomes.

scholarly journals Impact of changes in the WHO’s 2019 update of DDDs on the measurement of adult hospital antibacterial consumption in Catalonia (Spain), 2008–18

2020 ◽  
Vol 2 (4) ◽  
Author(s):  
Santiago Grau ◽  
Sergi Hernández ◽  
Enric Limón ◽  
Esther Calbo ◽  
Juan P Horcajada ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Temporal Trends ◽  
Accurate Assessment ◽  
Antimicrobial Consumption ◽  
National Program ◽  
Bed Days ◽  
Student’S T ◽  
Linear Regressions ◽  
Adult Hospital ◽  
Student’S T Test

Abstract Objectives In 2019 the WHO fully adopted new DDD values. The objective of this study is to analyse their impact on the measurement of consumption of antibacterials in hospitals participating in the Catalan Infection Control and Antimicrobial Stewardship National Program (VINCat-PROA) in Catalonia (Spain) between 2008 and 2018. Methods The anatomical therapeutic chemical/DDD system was used to monitor adult hospital antibacterial consumption expressed in DDD/100 bed-days. Consumption from 2008 to 2018 was calculated using both pre- and post-update DDD values. Differences were calculated as the percentage variation in DDD/100 bed-days and analysed with Student’s t-test. Simple linear regressions were performed to evaluate the trends in adult antimicrobial consumption over the study period. Results The overall consumption according to post-update DDD values decreased by 12.2% (P &lt; 0.001) compared with the pre-update DDD values. Penicillins (−19.6.%; P &lt; 0.001) and carbapenems (−19.0%; P = 0.023) showed the greatest reduction, followed by cephalosporins (−7.7%; P = 0.021) and quinolone antibacterials (−7.7%; P = 0.017). ICU services showed the greatest overall reduction (−13.1%; P &lt; 0.001). From 2008 to 2018 there was a statistically significant decrease in consumption of penicillins and quinolone antibacterials and a statistically significant increase in cephalosporin and carbapenem consumption with both pre- and post-update DDD values. There were no variations in the ranking of consumption between the pre- and post-update DDD values. Conclusions The WHO’s updates of DDDs have had a significant impact on the measurement of antibacterial consumption. In our region, they have corrected an overestimation of penicillin and carbapenem consumption amounting to 19%. It is essential to bear these findings in mind for an accurate assessment of temporal trends and benchmarking.

scholarly journals Drug utilization pattern among geriatrics according to anatomical therapeutic chemical and defined daily dose classification in a tertiary care hospital

2019 ◽  
Vol 8 (9) ◽  
pp. 1989
Author(s):  
T. Muneswar Reddy ◽  
Thammi Setty Durga Prasad ◽  
Allikesam Hemalatha ◽  
Vanam Chanukya ◽  
Bandi Lakshmi Sirisha
Keyword(s):  
Drug Utilization ◽  
Anatomical Therapeutic Chemical ◽  
Tertiary Care ◽  
Essential Medicines ◽  
World Health ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Utilization Pattern ◽  
Geriatric Population ◽  
Daily Dose

Background: This study was conducted to determine the drug utilization pattern among geriatric inpatients in general medicine department of the hospital.Methods: An observational, prospective study was conducted for a period of six months (November 2016 to April 2017) among 200 geriatric patients; demographic details, education, occupation, diagnosis and drug details were recorded. The drugs were categorized by anatomical therapeutic classification (ATC) and defined daily dose (DDD) was calculated. The World Health Organization (WHO) prescribing indicators were assessed.Results: The majority of the patients (59%) were in age group of 60-69 years. Cardiovascular diseases were common among geriatrics. Most commonly prescribed drug was Pantoprazole (81.7%). Drugs were assigned with ATC/DDD codes according to the guidelines of WHO. Drugs prescribed by their generic names were 56.64% and 43% of drugs that were included in the National Essential Medicines List.Conclusions: Clinical pharmacist have to collaborate and work together with physicians in selecting and adjusting the dose among geriatric population in order to reduce development of potential adverse drug reactions, serious drug related complications and drug interaction.

scholarly journals Antibiotic use on paediatric inpatients in a public hospital in Bangil, Indonesia

2021 ◽  
pp. 163-167
Author(s):  
Ika Norcahyanti ◽  
Malikatur Rosyidah ◽  
Abdul Kadir Jaelani ◽  
Antonius N.W. Pratama
Keyword(s):  
Public Hospital ◽  
Anatomical Therapeutic Chemical ◽  
Action Plan ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Cross Sectional ◽  
Pediatric Ward ◽  
Global Action ◽  
Bed Days ◽  
Cross Sectional Design

Introduction: The importance of antibiotic use in a clinical setting was evaluated in order to support the global action plan to decelerate the spreading speed of antimicrobial resistance. Objective: This study aimed to evaluate antibiotic use among pediatric inpatients in Bangil public hospital, East Java, Indonesia. Methods: This study used a cross-sectional design. The data were obtained from medical records of pediatric patients admitted to a pediatric ward in 2017. Data were analysed using the anatomical therapeutic chemical classification system (ATC)/defined daily dose (DDD) method in conjunction with data sources from a locally developed bacterial map. Results: The results showed the paediatric patients were dominantly male (n=218; 54.2%) and mostly diagnosed with diarrhoea (n=87; 15.3%). Ampicillin-sulbactam was the most commonly used antibiotic (16.3%). The total DDD value was 66.1 DDD/100 bed-days, and ceftriaxone demonstrated the highest DDD value (10.3 DDD/100 bed-days). Conclusion: In conclusion, the use of antibiotics in the pediatric ward in Bangil public hospital was comparable to other studies conducted in Indonesia.

scholarly journals DRUG UTILIZATION EVALUATION OF BENZODIAZEPINES IN A TERTIARY CARE HOSPITAL

2019 ◽  
pp. 6-9
Author(s):  
P. RAMA ◽  
R. MONISHA ◽  
SUSAN VARGHESE PAUL ◽  
VARSHA ELSA SCARIA ◽  
P. JANANI ◽  
...  
Keyword(s):  
Drug Utilization ◽  
Anatomical Therapeutic Chemical ◽  
Low Cost ◽  
Tertiary Care ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Probability Scale ◽  
Related Information ◽  
A Prospective Study ◽  
Drug Utilization Evaluation

Objective: To assess the rationale use of benzodiazepines among various departments in a multi-speciality hospital. Methods: A prospective study was conducted with a sample size of 200 for a period of six months. Data was collected from patients based on inclusion and exclusion criteria. Naranjo Adverse Drug Reaction Probability Scale and Drug Interaction Probability Scale (DIPS) were used as a study tool to measure the causality of adverse drug reactions and drug interactions. Based on the dosage of various benzodiazepines DDD was calculated and compared with WHO Anatomical Therapeutic Chemical (ATC) classification Defined Daily Dose (DDD). Results: BZD’s were mostly prescribed in males (74.5%) and married patients (86.5%) were more exposed to benzodiazepines compared to others. Lorazepam (70.1%) was found to be the most commonly used drug, mainly prescribed for sedation, followed by anxiety. DDD was calculated and majority of patients had DDD in accordance with WHO standard. Based on cost analysis, Clobazam was found to be the high cost and Lorazepam being the low-cost drug. The results of drug utilization evaluation of benzodiazepines study were compiled and reported to the respected department physician and their feedback was collected. Conclusion: The study showed a rational utilization of benzodiazepines and the negative outcomes of BZDs can be reduced by providing drug-related information to the prescribers and consumers.

Control of antibiotic use by a unit-dose drug distribution system

Open Medicine ◽  
2007 ◽  
Vol 2 (2) ◽  
pp. 168-179
Author(s):  
Karin Vasic ◽  
Zorica Jovic ◽  
Gordana Pesic
Keyword(s):  
Distribution System ◽  
Anatomical Therapeutic Chemical ◽  
Drug Distribution ◽  
Antibiotic Use ◽  
Drug Consumption ◽  
Direct Result ◽  
Defined Daily Dose ◽  
Total Drug ◽  
Unit Dose ◽  
Bed Days

AbstractThe aim of the study was to test a new model of drug distribution known as unit-dose drug distribution including the effects of implementing this system on total drug consumption, especially in curbing antimicrobial use.The study was carried out in the Department of Surgery at the University Clinical Center in Nis, Serbia. During the first six months of the study (comparative period), drugs were delivered directly from the pharmacy to the urology and orthopedic wards in the traditional way (ward stock system). During the next six months (study period), drugs were delivered directly from the pharmacy to the patients (unit-dose drug distribution system). Drug consumption was measured using the statistical unit defined daily dose (DDD) per 100 bed days according to the anatomical-therapeutic-chemical classification of drugs. Following implementation of the unit-dose drug distribution system, total drug consumption was reduced by 24.34% in the urology ward and by 21.43% in the orthopedic ward. During the comparative period, in the urology and orthopedic wards, systemic antiinfectives (group J) comprised 263.54 and 227.61 DDD/100 bed days or 43.05% and 25.52% of total drug consumption respectively, whereas, during the pilot study period this group of drugs comprised 191.63 and 173.52 DDD/100 bed days or 41.37% and 24.96% of total drug consumption respectively.The unit-dose distribution system of drugs in hospitals leads to a control of drug consumption and substantial savings. Also, the pharmacist-physician interaction began to emerge as an important factor as a direct result of the changes in the drug distribution system.

scholarly journals Impact of an antimicrobial stewardship programme on antimicrobial utilization and the prevalence of MDR Pseudomonas aeruginosa in an acute care hospital in Qatar

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Mazen A Sid Ahmed ◽  
Hamad Abdel Hadi ◽  
Sulieman Abu Jarir ◽  
Abdul Latif Al Khal ◽  
Muna A Al-Maslamani ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Significant Rise ◽  
Successful Implementation ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Healthcare Facilities

Abstract Background The excessive and inappropriate use of antibiotics is universal across all healthcare facilities. In Qatar there has been a substantial increase in antimicrobial consumption coupled with a significant rise in antimicrobial resistance (AMR). Antimicrobial stewardship programmes (ASPs) have become a standard intervention for effective optimization of antimicrobial prescribing. Methods A before–after study was conducted in Hamad General Hospital (603 bed acute care hospital): 1 year before implementation of a comprehensive ASP compared with the following 2 years. The ASP included a hospital-wide pre-authorization requirement by infectious diseases physicians for all broad-spectrum antibiotics. Prevalence of MDR Pseudomonas aeruginosa was compared with antimicrobial consumption, calculated as DDD per 1000 patient-days (DDD/1000 PD). Susceptibility was determined using broth microdilution, as per CLSI guidelines. Antibiotic use was restricted through the ASP, as defined in the hospital’s antibiotic policy. Results A total of 6501 clinical isolates of P. aeruginosa were collected prospectively over 3 years (2014–17). Susceptibility to certain antimicrobials improved after the ASP was implemented in August 2015. The prevalence of MDR P. aeruginosa showed a sustained decrease from 2014 (9%) to 2017 (5.46%) (P = 0.019). There was a significant 23.9% reduction in studied antimicrobial consumption following ASP implementation (P = 0.008). The yearly consumption of meropenem significantly decreased from 47.32 to 31.90 DDD/1000 PD (P = 0.012), piperacillin/tazobactam from 45.35 to 32.67 DDD/1000 PD (P &lt; 0.001) and ciprofloxacin from 9.71 to 5.63 DDD/1000 PD (P = 0.015) (from 2014 to 2017). Conclusions The successful implementation of the ASP led to a significant reduction in rates of MDR P. aeruginosa, pointing towards the efficacy of the ASP in reducing AMR.

Acute rehospitalisation during the first 3 months of in-patient rehabilitation for traumatic brain injury

2016 ◽  
Vol 40 (1) ◽  
pp. 114 ◽  
Author(s):  
Nalinda Andraweera ◽  
Richard Seemann
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Acute Care ◽  
Pearson Correlation ◽  
Acute Care Hospital ◽  
Functional Independence ◽  
Care Hospital ◽  
Injury Rehabilitation ◽  
Number Of Patients ◽  
Tract Infections

Objective Unplanned re-admission to acute care hospitals during in-patient rehabilitation causes disruption to the rehabilitation program and increases the cost of health care. The aims of the present study were to identify the frequency, reasons and duration of disruption to rehabilitation because of acute re-admissions during the first 3 months of in-patient rehabilitation for traumatic brain injury (TBI) and to investigate the correlation between the duration of acute rehospitalisation and the discharge functional independence measure (FIM) score. Methods A retrospective study was conducted on patients admitted for in-patient rehabilitation following TBI to a rehabilitation hospital in Auckland, New Zealand, between January 2009 and August 2013. Data on duration and reasons for acute rehospitalisation, as well as admission and discharge FIM scores, were obtained from electronic patient records. Pearson correlation was used to evaluate the relationship between the duration of acute rehospitalisation and the discharge FIM score. Results Of the 628 patients admitted for brain injury rehabilitation, 71 (11.3%) required acute rehospitalisation within the first 3 months. The main reasons for acute rehospitalisation were preventable medical causes (43.8%), including urinary tract infections, respiratory tract infections and coronary artery disease. Of the acute re-admissions, 76.6% were within the first month of admission to the rehabilitation centre and 46.6% needed in-patient treatment in the acute care hospital for >5 days. There was a moderately strong negative correlation between the duration of stay in the acute care hospital and the discharge FIM score (r = – 0.412; P = 0.0005). Conclusion A significant number of patients admitted for in-patient rehabilitation following TBI require acute rehospitalisation due to preventable medical causes. Because the duration of acute rehospitalisation has a negative impact on rehabilitation functional gain, preventive measures and surveillance need to be further investigated and optimised. What is known about the topic? The incidence of acute rehospitalisation of patients in the community following brain injury rehabilitation is 20%–25%, with approximately half the re-admissions being for elective reasons, including orthopaedic and reconstructive surgery. What does this paper add? Unplanned acute rehospitalisation during first 3 months of in-patient rehabilitation following TBI is due to preventable causes and results in lower FIM scores on discharge. What are the implications for practitioners? An uninterrupted rehabilitation programme is vital for achieving functional outcomes.

scholarly journals Prescribing pattern and utilization of selected antimicrobials in a tertiary hospital of Nepal

2019 ◽  
Vol 1 (2) ◽  
pp. 96-102
Author(s):  
Upasana Acharya ◽  
Ravi Mahat ◽  
Subhash Prasad Acharya ◽  
Bishnu Pahari ◽  
Prashant Tripathi
Keyword(s):  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Tertiary Hospital ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Prescribing Pattern ◽  
Empiric Treatment ◽  
Bed Days ◽  
One Year ◽  
Increasing Trends

 Introduction: This study was done to understand the purpose of using higher grade antimicrobials in a one year period and to compare the consumption of commonly prescribed parenteral antimicrobial agents in four consecutive years in a tertiary care hospital of Nepal. Materials & Methods: A retrospective observational study was carried out to collect the information on prescription of selected six classes of antimicrobial for all admitted patients aged 2 years or above for a one-year period. Further, the antimicrobial consumption tool 2016 was used to calculate defined daily dose (DDD) per 100 bed days of commonly dispensed parenteral antimicrobials for four consecutive years. Results: A total of 2568 antimicrobial supply forms prescribing higher grades antimicrobials were analyzed. The indications for use of antimicrobials were mainly for empiric treatment. Among the infections being treated, lower respiratory tract infection (LRTI) was the most frequent cause. Piperacillin-tazobactam was most frequently prescribed followed by Meropenem. Also, DDD for commonly used parenteral antimicrobials showed increasing trends over four consecutive years. Conclusion: The prescription of higher grades of antimicrobial for empiric treatment and surgical prophylaxis need to be monitored. The rate of consumption of such antimicrobials could not be assessed due to lack of similar studies but the increase in DDD/100 bed days each year suggested the rise in consumption of antimicrobial in the same institution.

Unit-Specific Rates of Hand Hygiene Opportunities in an Acute-Care Hospital

2016 ◽  
Vol 38 (4) ◽  
pp. 411-416 ◽  
Author(s):  
Angela Han ◽  
Laurie J. Conway ◽  
Christine Moore ◽  
Liz McCreight ◽  
Kelsey Ragan ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Temporal Variations ◽  
Time Of Day ◽  
Care Hospital ◽  
Adult Intensive Care Unit ◽  
Surgical Units ◽  
Wide Range ◽  
Step Down

OBJECTIVETo explore the frequency of hand hygiene opportunities (HHOs) in multiple units of an acute-care hospital.DESIGNProspective observational study.SETTINGThe adult intensive care unit (ICU), medical and surgical step-down units, medical and surgical units, and the postpartum mother–baby unit (MBU) of an academic acute-care hospital during May–August 2013, May–July 2014, and June–August 2015.PARTICIPANTSHealthcare workers (HCWs).METHODSHHOs were recorded using direct observation in 1-hour intervals following Public Health Ontario guidelines. The frequency and distribution of HHOs per patient hour were determined for each unit according to time of day, indication, and profession.RESULTSIn total, 3,422 HHOs were identified during 586 hours of observation. The mean numbers of HHOs per patient hour in the ICU were similar to those in the medical and surgical step-down units during the day and night, which were higher than the rates observed in medical and surgical units and the MBU. The rate of HHOs during the night significantly decreased compared with day (P<.0001). HHOs before an aseptic procedure comprised 13% of HHOs in the ICU compared with 4%–9% in other units. Nurses contributed >92% of HHOs on medical and surgical units, compared to 67% of HHOs on the MBU.CONCLUSIONSAssessment of hand hygiene compliance using product utilization data requires knowledge of the appropriate opportunities for hand hygiene. We have provided a detailed characterization of these estimates across a wide range of inpatient settings as well as an examination of temporal variations in HHOs.Infect Control Hosp Epidemiol2017;38:411–416

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