Trend analysis of antimicrobial consumption and development of resistance in non-fermenters in a tertiary care hospital in Delhi, India

Background: The COVID-19 pandemic poses novel challenges in antimicrobial consumption metrics and stewardship strategies. COVID-19 patients became the major cause of hospital admission during the first wave of the pandemic, often leading to an antimicrobial prescription upon admission or treatment for superinfections. The aim of this study was to understand how antimicrobial consumption was impacted at the beginning of the pandemic in a tertiary care hospital, a reference center for COVID-19. Materials and Methods: A retrospective before-and-after study was done. Descriptive statistics of discharges, patient-days, and antimicrobial use indicators (defined daily doses (DDD)/100 discharges, DDD/100 patient-days) for various groups were calculated for the first three months of the pandemic (March, April, and May 2020) as a quarterly value, and for each year in 2011–2019, and their annual percentage changes were used to estimate 95% confidence intervals. The indicators were compared to patient type (medical/surgical), type of admission (urgent/elective), and age groups using Spearman’s correlation coefficient. Results: Statistically significant increases occurred in 2020 for total antibacterials, macrolides, cephalosporins, amoxicillin/clavulanic acid, carbapenems, meropenem, and third-generation cephalosporins, while a reduction was seen in cefazolin/cefoxitin. A correlation was found between antibacterial consumption and patient or admission type. In 2020, unlike in pre-pandemic years, there was a different impact in DDD/100 discharges and DDD/100 patient-days due to increased lengths-of-stay and longer antimicrobial therapy. Conclusions: The COVID-19 pandemic led to an increase in antimicrobial consumption with a different impact in DDD/100 discharges and DDD/100 patient-days. This highlights the need to use both indicators simultaneously to better understand the causes of antimicrobial consumption variation and improve the design of effective antimicrobial stewardship interventions.

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Seroprevalence of Blood-borne Viral Infections in Post HAART Era at a Tertiary Care Hospital in South India: A Five Year Trend Analysis (2008-2012) and a Comprehensive Review

British Journal of Medicine and Medical Research ◽

10.9734/bjmmr/2013/3759 ◽

2013 ◽

Vol 3 (4) ◽

pp. 1929-1937

Author(s):

K. Ramana

Keyword(s):

Trend Analysis ◽

South India ◽

Viral Infections ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Comprehensive Review

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Antimicrobial resistance patterns of WHO priority pathogens isolated in children from a tertiary care hospital in Southern India: A descriptive and time trend analysis

10.21203/rs.3.rs-30293/v1 ◽

2020 ◽

Author(s):

Vijayalaxmi V Mogasale ◽

Prakash Saldanha ◽

Vidya Pai ◽

Rekha PD ◽

Vittal Mogasale

Keyword(s):

Staphylococcus Aureus ◽

Antimicrobial Resistance ◽

Trend Analysis ◽

Time Trend ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

World Health ◽

Care Hospital ◽

E Coli ◽

Resistance Patterns

Abstract Background There is global consensus that Antimicrobial Resistance (AMR) poses an unprecedented challenge to modern medicine as we know it today; and the lack of new antibiotics in the pipeline is compounding the threat to contain emerging drug-resistant infections. In 2017, the World Health Organization (WHO) has articulated a priority pathogens list (PPL) to provide strategic direction to research and development of new anti-microbials. Anti-microbial resistance patterns of selected ‘drug-bug’ combinations based on the WHO-PPL in one tertiary health care facility in India are explored in this paper. Methods Culture reports of laboratory specimens, collected between 1st January 2014 and 31st October 2019 from paediatric patients in a tertiary care hospital in India, were retrospectively extracted. The antimicrobial susceptibility patterns for selected antimicrobials based on the WHO-PPL are analysed and reported. Results Of 12,256 culture specimens screened, 2,335 (19%) showed culture positivity; of which 1,556 were organisms from the WHO-PPL. E. coli was the most common organism isolated (37%) followed by Staphylococcus aureus (16%). Total 72% of E. coli were extended-spectrum beta-lactamases producers, 55% of Enterobacteriaceae were resistant to 3rd generation cephalosporins, and 53% of Staphylococcus aureus were Methicillin resistant. Time-trend analysis of the data showed continued high resistance to carbapenem in E coli, Klebsiella pneumoniae and Enterobacter cloacae. Conclusions The AMR trends and prevalence patterns are likely to be different, across various local settings, than as defined at the national level or the WHO-PPL. This difference needs to be recognised in decision and policy making. It is critical, that the evidence used at national and global levels, have reasonable geographical and population representation through standardised and more granular AMR surveillance, in order to improve the effectiveness of the overall national AMR response.

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Differential Correlation Between Rates of Antimicrobial Drug Consumption and Prevalence of Antimicrobial Resistance in a Tertiary Care Hospital in Greece

Infection Control and Hospital Epidemiology ◽

10.1086/589333 ◽

2008 ◽

Vol 29 (7) ◽

pp. 615-622 ◽

Cited By ~ 29

Author(s):

Elias Iosifidis ◽

Charalampos Antachopoulos ◽

Maria Tsivitanidou ◽

Aspasia Katragkou ◽

Evagelia Farmaki ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Antimicrobial Drug ◽

Drug Consumption ◽

Care Hospital ◽

Antimicrobial Consumption ◽

Consumption Rates ◽

Imipenem Resistance ◽

Rate Of Consumption

Objective.To investigate whether there is a correlation between the rates of antimicrobial drug consumption in hospital departments and the prevalence of antimicrobial resistance among clinically important bacteria recovered in the hospital.Design.Retrospective study.Setting.Tertiary care hospital in Greece.Methods.Data on antimicrobial consumption (from January 2001 through December 2004) were expressed as defined daily doses per 100 bed-days. The prevalence of antimicrobial resistance among isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcusfaecium recovered during the same time period were calculated by the microbiology department. We then performed the following analyses: (1) a comparison of the consumption rates for different antimicrobial groups in individual hospital departments, (2) a comparison of the prevalence of resistance to different antimicrobials, and (3) a correlation analysis of antimicrobial consumption rates and the prevalence of antimicrobial resistance.Results.The rates of antimicrobial consumption and the prevalence of resistance varied substantially among the hospital's departments. The annual rate of consumption for carbapenems correlated with the rate of consumption for glycopeptides and third-generation cephalosporins (P < .05). Among P. aeruginosa isolates, the prevalence of imipenem resistance correlated with the prevalence of resistance to amikacin, ciprofloxacin, and ceftazidime (P < .05). The rate of carbapenem consumption correlated with the prevalence of imipenem resistance among P. aeruginosa and A. baumannii isolates (P < .05). The rate of aminoglycoside consumption correlated with the prevalence of amikacin resistance among P. aeruginosa, K. pneumoniae, and E. coli isolates (P < .05). However, the rate of consumption for fluoroquinolones and glycopeptides had no correlation with the prevalence of ciprofloxacin resistance among gram-negative bacteria or vancomycin resistance among E. faecium isolates.Conclusions.These data are suggestive of a differential relationship between antimicrobial consumption and the prevalence of antimicrobial resistance among various species and for various antimicrobial agents. These findings may help to optimize antimicrobial prescription policies in the hospital, especially in departments that have both high rates of antimicrobial consumption and a high prevalence of antimicrobial resistance.

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