scholarly journals Sustained Reduction in Third-generation Cephalosporin Usage in Adult Inpatients Following Introduction of an Antimicrobial Stewardship Program in a Large, Urban Hospital in Malawi

2020 ◽  
Author(s):  
Rebecca Lester ◽  
Kate Haigh ◽  
Alasdair Wood ◽  
Eleanor E MacPherson ◽  
Hendramoorthy Maheswaran ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Low Income ◽  
Regular Point ◽  
Case Fatality ◽  
Third Generation ◽  
Urban Hospital ◽  
Stewardship Program ◽  
Starting Point ◽  
First Choice ◽  
The Cost

Abstract Background Third-generation cephalosporins (3GC) remain the first-choice empiric antibiotic for severe infection in many sub-Saharan African hospitals. In Malawi, the limited availability of alternatives means that strategies to prevent the spread of 3GC resistance are imperative; however, suitable approaches to antimicrobial stewardship (AMS) in low-income settings are not well studied. Methods We introduced an AMS intervention to Queen Elizabeth Central Hospital in Blantyre. The intervention consisted of a prescribing application for smartphones and regular point-prevalence surveys with prescriber feedback. We evaluate the effects of the intervention on 3GC usage and on the cost of providing antibiotics. Using a thematic analysis of semi-structured interviews and participant observations, we additionally evaluate the acceptability of the stewardship program. Results The proportion of antibiotic prescriptions for a 3GC reduced from 193/241 (80.1%) to 177/330 (53.6%; percentage decrease, 26.5%; 95% confidence interval, 18.7–34.1) with no change in the case-fatality rate. The cost analysis estimated an annual savings of US$15 000. Qualitative research revealed trust in the guideline and found that its accessibility through smartphones helpful to guide clinical decisions. Operational health-system barriers and hierarchal clinical relationships lead to continued reliance on 3GC. Conclusions We report the successful introduction of an antimicrobial stewardship approach in Malawi. By focusing on pragmatic interventions and simple aims, we demonstrate the feasibility, acceptability, and cost savings of a stewardship program where resources are limited. In doing so, we provide a suitable starting point for expansions of AMS interventions in this and other low-income settings.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

scholarly journals Impact of Intervention by an Antimicrobial Stewardship Team on Rational Use of Antibiotics

2021 ◽  
Author(s):  
Ahmad Alikhani ◽  
Farhang Babamahmoudi ◽  
Alieh Khabbaz ◽  
Hamideh Abbaspour Kasgari ◽  
Sabzan Mohabbati
Keyword(s):  
Antimicrobial Stewardship ◽  
Intervention Group ◽  
Length Of Hospital Stay ◽  
Oral Antibiotics ◽  
Medication Costs ◽  
Stewardship Program ◽  
Intravenous Antibiotics ◽  
Rational Use Of Antibiotics ◽  
The Cost ◽  
The Impact

Background: An antimicrobial stewardship program can be defined as the set of actions performed in hospitals for the rational use of antibiotics. Early conversion from intravenous to oral antibiotics plays an important role in reducing the cost of treatment, shortening the length of hospital stay, and decreasing the workload of nurses. The purpose of this study was to evaluate the impact of the implementation of antimicrobial stewardship program on duration of hospitalization and medication costs. Methods: We performed an interventional study in Razi teaching hospital. All hospitalized patients aged 18 and older who met the inclusion criteria were included. This study comprised two groups. The interventional prospective group to assess the impact of intravenous to oral antibiotic conversion, and a retrospective group in which the intervention had not been applied, used as the comparator. Results: A total of 260 cases were enrolled; 47 in the interventional group and 213 in the retrospective one. The length of hospitalization was significantly shorter in the intervention group compared to the retrospective one (5.2 vs7.9 days, p<0.001). The cost of intravenous antibiotics and total medication costs significantly decreased in the intervention group. Conclusion: Our findings suggest that conversion from intravenous to oral antibiotics is effective for reducing the length of hospital stay, antibiotic cost, and excess use of intravenous antibiotics.

scholarly journals 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S138-S138
Author(s):  
Dong Hoon Shin ◽  
Hyung-sook kim ◽  
Eunjeong Heo ◽  
Myoung Jin Shin ◽  
Nak-Hyun Kim ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Antimicrobial Stewardship Program ◽  
The Core ◽  
Stewardship Program ◽  
National University

Abstract Background The U.S. Centers for Disease Control and Prevention released the core elements of antimicrobial stewardship program (ASP). In some countries, however, they may be difficult to apply in countries with limited resources. In this study, we evaluated the impact of successful ASP implementation on antibiotic use and resistance rates in an institution with limited infrastructural support. Methods A series of ASP activities were reviewed according to the core elements of ASP. The retrospective data of all hospitalized patients at a tertiary care teaching hospital was collected from January 2010 to December 2019, including antibiotic prescription data and culture results of all clinical specimens. The trends of the antibiotic-resistant rates were compared with nationwide data in Korea. The trend analyses were performed with 2-sided correlated seasonal Mann-Kendall nonparametric tests. Results The ASP activities over the past decade were summarized in Table. After activities such as preauthorization were achieved, other ASP activities were added one by one. Also, the infectious disease pharmacists, as ASP co-leaders, mainly carried out the following activities: reducing redundant anti-anaerobic antimicrobials and intravenous fluoroquinolones, and advised the physicians to discontinue the antibiotic prescription in cases when the intervention was plausible. After the ASP implementation, total antibacterial use significantly decreased (P &lt; 0.01; Figure). The use of glycopeptides (P &lt; 0.01) and fluoroquinolones (P &lt; 0.01) gradually decreased, while the use of third-generation cephalosporines did not significantly change (P=0.48). There was no significant change in total carbapenems use, but ertapenem use increased (P=0.02). Compared with the nationwide data, methicillin-resistant Staphylococcus aureus was on a decreasing trend consistently. Although third-generation cephalosporin-resistant Escherichia coli increased, third-generation cephalosporin resistant-Klebsiella pneumoniae and carbapenem resistant-Pseudomonas aeruginosa did not increase. Table. Antimicrobial stewardship activities for hospitalized patients over the past decade in Seoul National University Bundang Hospital. ASP: antimicrobial stewardship; ID: infectious disease; CDSS: Clinical decision support system Figure. DOT per 1,000 patient-days in Seoul National University Bundang Hospital and implemented actions of antimicrobial stewardship program. DOT: days of therapy; ID: infectious disease; PCR: polymerase chain reaction; GPC: gram positive cocci; Group 1 carbapenem: ertapenem Conclusion A stepwise implementation of the core ASP elements was effective in improving the appropriate use of antibiotics and reducing the antibiotic resistant organisms, even with limited human resources. Disclosures All Authors: No reported disclosures

scholarly journals Treatment of urinary tract infections in condition of growing antibiotic resistance: Antimicrobial Stewardship program

2019 ◽  
pp. 62-71
Author(s):  
O.I. Chub ◽  
O.V. Bilchenko ◽  
O.M. Godlevska ◽  
S.V. Teslenko
Keyword(s):  
Antibiotic Resistance ◽  
Urinary Tract ◽  
Urinary Tract Infections ◽  
Antimicrobial Stewardship ◽  
Third Generation ◽  
Antimicrobial Stewardship Program ◽  
E Coli ◽  
Stewardship Program ◽  
The Right ◽  
Tract Infections

 Resistance to common groups of antibiotics has been increasing in the treatment of urinary tract infections worldwide. In the United States, CDC has estimated that more thаn 2 million infections and 23,000 deaths are due to antibiotic resistance each year. In Europe, an еstimated 25,000 deaths are attributable to antibiotic-rеsistant infections. By 2050, it is estimated that antibiotic resistance will cause 10 million deaths every year.At the EU/EEA level, more than half (58.2%) of the E. coli isolates reported to EARS-Net for 2017 were resistant to at least one of the antimicrobial groups under regular surveillance, i.e. aminopenicillins, fluoroquinolones, third-generation cephalosporins, aminoglycosides and carbapenems. A majority (87.4%) of the third-generation cephalosporin-resistant E. coli isolates from 2017 were extended-spectrum beta-lactamase (ESBL)-positive. Use of broad-spectrum antimicrobials is a known risk factor for colonization and spread of resistant Enterobacteriaceae, including E. coli. The high levels of ESBLs and increasing resistance to key antimicrobial groups might also lead to an increased consumption of carbapenems, which in turn can increase the selection pressure and facilitated the spread of carbapenem-resistant Enterobacteriaceae. According to annual reports of CDC, WHO, EARS-Net and others,estimate that 30 percent of all antibiotics prescribed in outpatient clinics and 40 percent of all antibiotics prescribed in inpatient clinics were unnecessary. Improving the way we use antibiotics, often referred to as «antibiotic stewardship», is part of the National Action Plan. Appropriate antibiotic use means using the right antibiotic, at theright dose, for the right duration, and at the right time. The article reflects the recommendations of the European Association of Urology 2019 on the management and treatment of urinary tract infections in accordance with the principles of Antimicrobial Stewardship Program.

scholarly journals The Impact of Antimicrobial Stewardship Program on Injudicious Use of Cefuroxime

2021 ◽  
Vol 11 ◽  
Author(s):  
Ann L. Arulappen ◽  
Monica Danial ◽  
Norliza Haron ◽  
Lim Choo Hau ◽  
Amer Hayat Khan
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Prophylaxis ◽  
Cost Savings ◽  
Surgical Site Infections ◽  
Defined Daily Dose ◽  
Prescribing Pattern ◽  
Healthcare Settings ◽  
Stewardship Program ◽  
The Cost ◽  
The Impact

Antimicrobial stewardship (AMS) program promotes the judicious use of antimicrobials. Hence, this study was conducted to analyze the impact of stewardship on the prescribing pattern of cefuroxime injection among the surgeons as perioperative antimicrobial prophylaxis (PAP). This study was conducted retrospectively in Malaysia. Various outcomes were measured including cefuroxime usage, compliance with the guidelines, surgical site infections, and cost savings. A total of 1,601 patients were recruited in the study. In terms of usage, the total defined daily dose (DDD) prior to the intervention was 202 DDD/100 procedures compared to that after intervention which was 144 DDD/100 procedures (p &lt; 0.05). On the other hand, the excessively long administration of PAP dropped from 94.4 to 30.3% (p &lt; 0.001). Focusing on the compliance with the newly developed local guidelines, it has increased from 53 to 94.3% after the interventions were made (p &lt; 0.001), whereas the rate of surgical site infections was reduced from 17.0 to 9.0%. The cost of antibiotic being used has significantly reduced after the study intervention (p = 0.007). The quality of PAP directly impacts the antimicrobial usage, the surgical site infections, and the total cost involved. Thus, it is crucial to maintain the standard of PAP at all times in healthcare settings.

scholarly journals 1025. Inappropriate Aztreonam Usage – Antimicrobial Stewardship Strikes Back

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S361-S361
Author(s):  
Brandon J Smith ◽  
Bridget Batykefer ◽  
Christina Andrzejewski ◽  
Mohamed Yassin ◽  
Ricardo Arbulu
Keyword(s):  
Antimicrobial Stewardship ◽  
Alternative Therapy ◽  
Surrogate Marker ◽  
Cost Savings ◽  
Retrospective Chart Review ◽  
Pharmaceutical Expenditures ◽  
Stewardship Program ◽  
Therapy Cost ◽  
Clinical Surveillance ◽  
The Cost

Abstract Background Several studies have demonstrated that patients with reportedly β-lactam allergies (BLA) receive less efficacious and more toxic alternative antibiotics. A previous study at our institution utilizing aztreonam as a surrogate marker for BLA demonstrated nearly 50% of patients receiving aztreonam had previously tolerated an alternative β-lactam (BL). In response to those results, our Antimicrobial Stewardship Program (ASP) provided dedicated hospitalist, medical resident and pharmacist education on appropriate utilization of aztreonam and BLA. Additionally, members of the ASP team began receiving real-time clinical surveillance alerts for all aztreonam orders. Methods A retrospective chart review of inpatients >18 years old who received at least one dose of aztreonam between July 1, 2018 – December 31, 2018. Patients were excluded if they did not have a documented BLA or if they received aztreonam as de-escalation therapy. Cost of aztreonam therapy was compared with the cost of alternative BL agents based on prior and subsequently tolerated classes of BLs. Comparator agents included: piperacillin/tazobactam (penicillin), cefepime (cephalosporin) and meropenem (carbapenem). Comparisons of total number of aztreonam patients and doses, cost of aztreonam, and cost of alternative therapy were compared with the index population from 2017 Results Similar to our prior study, 43.7% (48.5% in 2017) had prior BL tolerance with an additional 31.3% (19.4% in 2017) demonstrated subsequent BL tolerance following aztreonam administration. Following the ASP interventions, orders, doses and cost of aztreonam was reduced. Forty-eight patients during the 6-month period received aztreonam, a 26.7% reduction. There was a 38.5% reduction in the number of aztreonam doses (P = 0.001), which yielded a cost savings of $14,067.67 (extrapolated to 1 year). Median aztreonam cost in 2017 $382.40 vs. $191.20 in 2018 (P = 0.004). In 2018, 41.7% of patient’s allergy profiles were appropriately updated compared with 3.3% in 2017. Conclusion Our study demonstrates that ASP interventions including increased education, allergy documentation and clinical surveillance alerts targeted at reducing aztreonam utilization can reduce pharmaceutical expenditures. Disclosures All authors: No reported disclosures.

Demonstrating Nutrient Cost Gradients: A Brooklyn Case Study

2014 ◽  
Vol 84 (5-6) ◽  
pp. 244-251 ◽  
Author(s):  
Robert J. Karp ◽  
Gary Wong ◽  
Marguerite Orsi
Keyword(s):  
Low Income ◽  
Energy Content ◽  
Food Selection ◽  
The United States ◽  
United States Department ◽  
Micronutrient Deficiencies ◽  
Caloric Density ◽  
Low Income Families ◽  
The Cost ◽  
The Impact

Abstract. Introduction: Foods dense in micronutrients are generally more expensive than those with higher energy content. These cost-differentials may put low-income families at risk of diminished micronutrient intake. Objectives: We sought to determine differences in the cost for iron, folate, and choline in foods available for purchase in a low-income community when assessed for energy content and serving size. Methods: Sixty-nine foods listed in the menu plans provided by the United States Department of Agriculture (USDA) for low-income families were considered, in 10 domains. The cost and micronutrient content for-energy and per-serving of these foods were determined for the three micronutrients. Exact Kruskal-Wallis tests were used for comparisons of energy costs; Spearman rho tests for comparisons of micronutrient content. Ninety families were interviewed in a pediatric clinic to assess the impact of food cost on food selection. Results: Significant differences between domains were shown for energy density with both cost-for-energy (p < 0.001) and cost-per-serving (p < 0.05) comparisons. All three micronutrient contents were significantly correlated with cost-for-energy (p < 0.01). Both iron and choline contents were significantly correlated with cost-per-serving (p < 0.05). Of the 90 families, 38 (42 %) worried about food costs; 40 (44 %) had chosen foods of high caloric density in response to that fear, and 29 of 40 families experiencing both worry and making such food selection. Conclusion: Adjustments to USDA meal plans using cost-for-energy analysis showed differentials for both energy and micronutrients. These differentials were reduced using cost-per-serving analysis, but were not eliminated. A substantial proportion of low-income families are vulnerable to micronutrient deficiencies.

Water supply and sanitation planning model: a management tool for large Brazilian cities

2003 ◽  
Vol 3 (1-2) ◽  
pp. 469-476
Author(s):  
S.R.A. Soares ◽  
R.S. Bernardes
Keyword(s):  
Water Supply ◽  
Low Income ◽  
Management Tool ◽  
Urban Water ◽  
Rapid Urbanization ◽  
Modeling Approach ◽  
Developing Cities ◽  
Starting Point ◽  
Water And Wastewater ◽  
Water Supply And Sanitation

The sanitary problems promoted by the rapid urbanization process in developing cities are usually resulted from the absence of planning, high population concentration and inadequate water and wastewater infrastructure for low income people. Because the provision and planning of water supply and is a complex task, a modeling approach was used to enhance the understanding of the process and the aspects involved. In the development of a model, not only the technical aspects were taken into account, but other aspects related to the provision of drinking water and the water resources protection were also analyzed, such as institutional, financial, socioeconomic, environmental and public health. In the modeling process two different methods of conceptualization were used to describe the urban water flow through the water and wastewater systems linked to various aspects related to their implementation in large developing cities. The urban water systems of five large metropolitan areas in Brazil were also evaluated for the complete model. It is expected that the modeling approach developed in this paper consists of a valuable methodology for water supply and sanitation planning in Brazilian cities, and other developing cities with the same characteristics. The suggested conceptual model could, at least, provide more than a starting point for a useful urban water management tool.

Sustainability Failure in the Antimicrobial Stewardship Program in a Secondary Care Hospital from Cuba: A Historical Review of 30 Years and 3 Shots

2020 ◽  
Vol 18 ◽  
Author(s):  
Humberto Guanche Garcell ◽  
Juan José Pisonero Socias ◽  
Gilberto Pardo Gómez
Keyword(s):  
Antimicrobial Stewardship ◽  
Historical Review ◽  
Original Data ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Continuous Quality ◽  
Stewardship Program ◽  
History Of ◽  
Health Organization

Background: During the last 30 years an antimicrobial stewardship program (ASP) was implemented in a facility with periods of weakness. We aim to describe the history of the sustainability failure in the local ASP. Methods: A historical review was conducted using original data from the facility library and papers published. An analysis of factors related to the failure was conducted based on the Doyle approach. Results: The first ASP was implemented from 1989 to 1996 based on the international experiences and contributes to the improvement in the quality of prescription, reduction of 52% in cost and in the incidence of nosocomial infection. The second program restarts in 2008 and decline in 2015, while the third program was guided by the Pan-American Health Organization from 2019. This program, in progress, is more comprehensive than previous ones and introduced as a novel measure the monitoring of antibiotic prophylaxis in surgery. The factors related to the sustainability were considered including the availability of antimicrobials, the leader´s support, safety culture, and infrastructure. Conclusions: The history behind thirty years of experiences in antimicrobial stewardship programs has allowed us to identify the gaps that require proactive strategies and actions to achieve sustainability and continuous quality improvement.

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