Dedicated time for antimicrobial stewardship—How much and why? Lessons learned from South Korea

2020 ◽  
Vol 41 (12) ◽  
pp. 1436-1437
Author(s):  
Payal K. Patel ◽  
Arjun Srinivasan
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
South Korea ◽  
Antimicrobial Stewardship ◽  
Large Scale ◽  
The United States ◽  
Lessons Learned ◽  
Joint Commission ◽  
Antimicrobial Use ◽  
Institutional Level

AbstractAntimicrobial resistance is a global and pressing problem that requires large-scale, federal coordination of efforts and tailored local interventions and surveillance. Given the urgency of the threat, many countries now have national policies to reduce inappropriate antimicrobial use. However, few countries have followed this with resources at the institutional level to support the implementation of practices to achieve this goal. In the United States, accreditation bodies such as Centers for Medicare and Medicaid Services and The Joint Commission have added antimicrobial stewardship standards to encourage uptake of antimicrobial stewardship programs (ASPs).

Biodefense and Emergency Use Authorization: Different Originations, Purposes, and Evolutionary Paths of Institutions in the United States and South Korea

2022 ◽  
Author(s):  
HyunJung Kim
Keyword(s):  
Public Health ◽  
United States ◽  
South Korea ◽  
Driving Forces ◽  
The United States ◽  
Lessons Learned ◽  
Post Exposure Prophylaxis ◽  
Meso Level ◽  
Public Health Emergencies ◽  
Level Analysis

Abstract Background: Historical institutionalism (HI) determines that institutions have been transformed by a pattern of punctuated evolution due to exogenous shocks. Although scholars frequently emphasize the role of agency - endogenous factors – when it comes to institutional changes, but the HI analytic narratives still remain in the meso-level analysis in the context of structure and agency. This article provides domestic and policy-level accounts of where biodefense institutions of the United States and South Korea come from, seeing through emergency-use-authorization (EUA) policy, and how the EUA policies have evolved by employing the policy-learning concepts through the Event-related Policy Change Model. Results: By employing the Birkland’s model, this article complements the limitation of the meso-level analysis in addressing that the 2001 Amerithrax and the 2015 Middle East Respiratory Syndrome (MERS) outbreak rooted originations and purposes of the biodefense respectively. Since the crisis, a new post-crisis agenda in society contributed to establishing new domestic coalition, which begin to act as endogenous driving forces that institutionalize new biodefense institutions and even reinforce them through path dependent way when the institutions evolved. Therefore, EUA policy cores (Post-Exposure Prophylaxis (PEP) in the United States and Non-Pharmaceutical Intervention (NPI) in South Korea keep strengthened during the policy revisions. Conclusions: The United States and South Korea have different originations and purposes of biodefense, which are institutions evolving through self-reinforce dependent way based on the lessons learned from past crises. In sum, under the homeland security biodefense institution, the US EUA focuses on the development of specialized, unlicensed PEP in response to public health emergencies; on the other hand, under the disease containment-centric biodefense institution, the Korean EUA is specialized to conduct NPI missions in response to public health emergencies.

scholarly journals 2004. Impact of Procalcitonin Roll-out Without Antimicrobial Stewardship Guidance in a Community Hospital Emergency Department

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S672-S672
Author(s):  
Alfredo J Mena Lora ◽  
Samah Qasmieh ◽  
Eric Wenzler ◽  
Scott Borgetti ◽  
Naman Jhaveri ◽  
...  
Keyword(s):  
United States ◽  
Emergency Department ◽  
Length Of Stay ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
The United States ◽  
Healthcare Research ◽  
Antimicrobial Use ◽  
Tract Infections ◽  
The Impact

Abstract Background Lower respiratory tract infections (LRTIs) are one of the most common infectious disease-related emergency department (ED) visits in the United States. The ID Society of America and the Agency for Healthcare Research and Quality support the use of procalcitonin (PCT) for antimicrobial stewardship (ASP) in LRTI. Though not widely available, awareness and access to PCT is rising. At our facility, PCT became available in February 2018. The aim of our study is to assess the impact of PCT at an urban community hospital and identify possible targets for ASP interventions. Methods Retrospective review of cases from February to August 2018. Cases from the ED were selected for review. Appropriateness of testing was assessed, defined as guideline-based use for cessation of antibiotics in uncomplicated LRTIs without critical illness or immunosuppression. Demographic variables and clinical characteristics, such as, diagnosis, antimicrobial use and PCT levels were obtained. Results PCT was ordered 268 times hospital-wide, of which 160 (60%) were in the ED. Ages ranged from 0–90, with an average of 47. Most cases were male (51%). Appropriate testing for LRTI occurred in 33 (29%) cases. Antimicrobials were used in 75% of cases with low (< 0.5) PCT levels (Figure 1). Length of stay (LOS) was higher in groups that received antimicrobials (Figure 2). Testing was not appropriate in 127 cases (71%), with upper respiratory (21%), soft-tissue (17%), genitourinary (15%) and abdominal (13%) infections as the most common reasons for testing. Other diagnosis included alcohol withdrawal, seizures and altered mental status. Cumulative cost of PCT testing was $24000, of which $19050 was not consistent with guidelines. Conclusion Clinicians routinely ordered PCT in the ED. Antimicrobials were used for LRTIs despite low PCT levels. This may have contributed to higher LOS and excess antimicrobial use. Unwarranted PCT testing had a cost of $19050. As PCT becomes widely available in hospitals across the United States, education and decision support by ASP to clinicians may be needed to enhance guideline-appropriate evidence-based use of PCT. Targeted ASP interventions in the ED may have cost savings by reducing excess testing, length of stay and improving antimicrobial use. Disclosures All authors: No reported disclosures.

scholarly journals Effectiveness of Corona Lockdowns: Evidence for a Number of Countries

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Stefan Homburg
Keyword(s):  
United States ◽  
South Korea ◽  
Large Scale ◽  
The United States ◽  
Research Strategy ◽  
United States South

AbstractThe paper assesses the effectiveness of the large-scale lockdowns that took place during the SARS-CoV-2 (corona) pandemic. Countries considered include the United States, South Korea, Germany, Austria, Switzerland, Italy, Spain, and Sweden. Our research strategy utilizes the fact that fatal outcomes follow infections with a delay of 23 days. Therefore, the dates of the actual infections can be inferred from the data. The results suggest that lockdowns were superfluous and ineffective.

scholarly journals Automated data-intensive forecasting of plant phenology throughout the United States

2019 ◽  
Author(s):  
Shawn D. Taylor ◽  
Ethan P. White
Keyword(s):  
United States ◽  
Large Scale ◽  
The United States ◽  
Plant Phenology ◽  
Lessons Learned ◽  
Phenological Data ◽  
Data Intensive ◽  
Potential Applications ◽  
Near Term ◽  
Automated Forecasting

AbstractPhenology - the timing of cyclical and seasonal natural phenomena such as flowering and leaf out - is an integral part of ecological systems with impacts on human activities like environmental management, tourism, and agriculture. As a result, there are numerous potential applications for actionable predictions of when phenological events will occur. However, despite the availability of phenological data with large spatial, temporal, and taxonomic extents, and numerous phenology models, there has been no automated species-level forecasts of plant phenology. This is due in part to the challenges of building a system that integrates large volumes of climate observations and forecasts, uses that data to fit models and make predictions for large numbers of species, and consistently disseminates the results of these forecasts in interpretable ways. Here we describe a new near-term phenology forecasting system that makes predictions for the timing of budburst, flowers, ripe fruit, and fall colors for 78 species across the United States up to 6 months in advance and is updated every four days. We use the lessons learned in developing this system to provide guidance developing large-scale near-term ecological forecast systems more generally, to help advance the use of automated forecasting in ecology.

Otitis Media—Principles of Judicious Use of Antimicrobial Agents

PEDIATRICS ◽  
1998 ◽  
Vol 101 (Supplement_1) ◽  
pp. 165-171 ◽  
Author(s):  
Scott F. Dowell ◽  
S. Michael Marcy ◽  
William R. Phillips ◽  
Michael A. Gerber ◽  
Benjamin Schwartz
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Otitis Media ◽  
Antibiotic Treatment ◽  
Antimicrobial Agents ◽  
Otitis Media With Effusion ◽  
Antimicrobial Prophylaxis ◽  
Acute Otitis Media ◽  
The United States ◽  
Antimicrobial Use

Otitis media is the leading indication for outpatient antimicrobial use in the United States. Overdiagnosis of and unnecessary prescribing for this condition has contributed to the spread of antimicrobial resistance. A critical step in reducing unnecessary prescribing is to identify the subset of patients who are unlikely to benefit from antibiotics. Conscientiously distinguishing acute otitis media (AOM) from otitis media with effusion (OME), and deferring antibiotics for OME will accomplish this goal, and will avoid up to 8 million unnecessary courses of antibiotics annually. Criteria for defining these conditions are presented, as well as the evidence supporting deferring antibiotic treatment. Discussions of shortened courses of antibiotics for AOM and restricted indications for antimicrobial prophylaxis are also presented.

scholarly journals Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS)

2012 ◽  
Vol 33 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Neil Fishman ◽  
◽  
◽  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Safety Issue ◽  
The United States ◽  
Position Statement ◽  
Policy Statement ◽  
Antimicrobial Use ◽  
Patient Safety Issue ◽  
Healthcare Epidemiology

Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States.

scholarly journals 408. Impact of the COVID-19 Pandemic on Antimicrobial Use and Resistance in the United States and the Dominican Republic

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S305-S306
Author(s):  
Alfredo J Mena Lora ◽  
Rita Alexandra Rojas-Fermin ◽  
Stephanie L Echeverria ◽  
Katia Castro ◽  
Anel E Guzman ◽  
...  
Keyword(s):  
United States ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Dominican Republic ◽  
The United States ◽  
Antimicrobial Use ◽  
E Coli ◽  
The Us ◽  
Tract Infections ◽  
The Impact

Abstract Background The disease caused by SARS-CoV-2, COVID-19, has caused a global public health crisis. Lower respiratory tract infections (LRTIs) caused by COVID-19 has led to an increase in hospitalizations. Disease severity and concerns for bacterial co-infections can increase antimicrobial pressure. Our aim is to define and compare the impact of COVID-19 on antimicrobial use (AU) and antimicrobial resistance (AMR) in the Dominican Republic (DR) and the United States (US). Methods We performed a retrospective review of AU and antimicrobial susceptibility patterns from 2019-20 at a hospital in the US (H-US) and the DR (H-DR). Our sites are community teaching hospitals with 151 beds in H-US and 295 beds in H-DR. After AU was tabulated, percent changes between 2019-20 were calculated. Resistance patterns for extended-spectrum beta-lactamase producing (ESBL) E coli, ESBL Klebsiella pneumoniae (ESBL-Kp), carbapenem resistant Pseudomonas aeruginosa (CR-PSAR) and Klebsiella pneumoniae (CR-Kp) were tabulated and percent changes between 2019-20 were calculated. Results AU increased by 10% in H-US and 25% in H-DR, with carbapenem use increasing by 268% and 144% respectively. Ceftriaxone use increased by 30% in H-US and 33% in H-DR. Azithromycin increased 54% in H-US and 338% in the H-DR. Resistance increased from 10% to 28% for ESBL-Kp and from 10% to 12% for ESBL E coli at H-US. CR-PSAR decreased from 20% to 12%, while cefepime and piperacillin resistance increased from 5% to 20% and 3% to 16% respectively (Figure 1). At H-DR, ESBL-Kp resistance decreased from 68% to 64% and increased from 58% to 59% for ESBL E coli. CR-PSAR and cefepime resistance increased from 5% to 19% and from 9% to 29% respectively (Figure 2). Figure 1. Antimicrobial resistance (%) for select organisms at H-US in 2019 and 2020 Figure 2. Antimicrobial resistance (%) for select organisms at H-DR in 2019 and 2020 Conclusion COVID-19 had a major impact on antimicrobial consumption and resistance in the US and DR. A greater impact was seen on ESBL rates in the US whilst a greater impact on carbapenem resistance was seen in the DR. The rise in carbapenem use in H-US reflected a rise in ESBL rates. In the DR, ESBL producing organisms were common prior to COVID-19 and carbapenem use was more widespread. The impact of the COVID-19 pandemic on AU may accelerate AMR worldwide. The scale up of antimicrobial stewardship across the globe is urgently needed to curb AMR. Disclosures All Authors: No reported disclosures

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