scholarly journals 209. Antibiotic Utilization During the COVID-19 Surge in Detroit

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S107-S108
Author(s):  
Anita Shallal ◽  
Rachel Kenney ◽  
Geehan Suleyman
Keyword(s):  
Hospital Admissions ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
National Health Care ◽  
Antibiotic Utilization ◽  
Days Of Therapy ◽  
Health Care Safety ◽  
Multiple Antibiotics

Abstract Background Antibiotic overutilization during the COVID-19 pandemic has been reported, despite relatively infrequent bacterial co-infection. We explored antibiotic utilization before, during and after the COVID-19 surge in Michigan. Methods Cross-sectional study at an 877-bed hospital in Detroit, Michigan from January 2019 through May 2020. Measures: Count of COVID-19 hospital admissions by day. Monthly antibiotic utilization for formulary agents used to treat pneumonia were measured using monthly days of therapy (DOT) per 1000 patient days present and the National Health Care Safety Network Standardized Antimicrobial Administration Ratio (SAAR). Descriptive analysis was utilized. Results The first COVID-19 case was detected March 11, 2020 and peaked in early April (Figure 1). Antibiotic utilization is demonstrated in Figure 2. The COVID-19 peak was associated with increased use of multiple antibiotics; notably, DOT per 1000 days present for ceftriaxone, cefepime and doxycycline were 85.43, 79.42 and 71.56, respectively in April. The institutional all-antibacterial SAAR was significantly reduced in May at 0.96, p=0.0022, after the COVID-19 surge. Figure 1 Figure 2 Conclusion We observed increased utilization of multiple antibiotics during the COVID-19 surge, and reduction in the all-antibacterial SAAR after the surge. More robust information is needed to promote optimal antibiotic use for patients with COVID-19 infections. Disclosures All Authors: No reported disclosures

Novel method of calculating adjusted antibiotic use by microbiological burden

2021 ◽  
pp. 1-6
Author(s):  
Hana R. Winders ◽  
Majdi N. Al-Hasan ◽  
Bruce M. Jones ◽  
Darrell T. Childress ◽  
Kayla R. Stover ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Resistant Bacteria ◽  
Bacterial Isolates ◽  
Sectional Study ◽  
Cross Sectional ◽  
Vancomycin Resistant Enterococci ◽  
Days Of Therapy ◽  
Novel Method ◽  
Vancomycin Resistant

Abstract Objective: To determine the usefulness of adjusting antibiotic use (AU) by prevalence of bacterial isolates as an alternative method for risk adjustment beyond hospital characteristics. Design: Retrospective, observational, cross-sectional study. Setting: Hospitals in the southeastern United States. Methods: AU in days of therapy per 1,000 patient days and microbiologic data from 2015 and 2016 were collected from 26 hospitals. The prevalences of Pseudomonas aeruginosa, extended-spectrum β-lactamase (ESBL)–producing bacteria, methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE) were calculated and compared to the average prevalence of all hospitals in the network. This proportion was used to calculate the adjusted AU (a-AU) for various categories of antimicrobials. For example, a-AU of antipseudomonal β-lactams (APBL) was the AU of APBL divided by (prevalence of P. aeruginosa at that hospital divided by the average prevalence of P. aeruginosa). Hospitals were categorized by bed size and ranked by AU and a-AU, and the rankings were compared. Results: Most hospitals in 2015 and 2016, respectively, moved ≥2 positions in the ranking using a-AU of APBL (15 of 24, 63%; 22 of 26, 85%), carbapenems (14 of 23, 61%; 22 of 25; 88%), anti-MRSA agents (13 of 23, 57%; 18 of 26, 69%), and anti-VRE agents (18 of 24, 75%; 15 of 26, 58%). Use of a-AU resulted in a shift in quartile of hospital ranking for 50% of APBL agents, 57% of carbapenems, 35% of anti-MRSA agents, and 75% of anti-VRE agents in 2015 and 50% of APBL agents, 28% of carbapenems, 50% of anti-MRSA agents, and 58% of anti-VRE agents in 2016. Conclusions: The a-AU considerably changes how hospitals compare among each other within a network. Adjusting AU by microbiological burden allows for a more balanced comparison among hospitals with variable baseline rates of resistant bacteria.

scholarly journals Efektifitas Antibiotik Pasien Demam Tifoid RSUP Dr. M. Djamil Padang

2019 ◽  
Vol 2 (2) ◽  
pp. 13-28
Author(s):  
Ayu Rahmawati ◽  
Husni Muchtar ◽  
Hansen Nasif
Keyword(s):  
Typhoid Fever ◽  
Pediatric Patients ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Adult Patients ◽  
Cross Sectional ◽  
Length Of Treatment ◽  
Number Of Patients ◽  
Analysis Design

To find out the effectiveness of antibiotics in typhoid fever patients at the SMF of Pediatric and SMF in Internal Medicine Dr. RSUP M. Djamil Padang. This study was a cross-sectional study with a retrospective type of data during 2012 and prospective from June to September 2013, with a descriptive analysis design. The number of patients who met the inclusion criteria were 11 patients. Percentage of antibiotic use in adult patients for ceftriaxone (60%) and chloramphenicol (40%). The percentage of antibiotic use in pediatric patients for ceftriaxone, chloramphenicol, and cefixim are 60%, 27%, and 13%, respectively. Fever free for ceftriaxone and chloramphenicol in pediatric and adult patients, each of which is 2-3 days and 4-6 days; 3-4 days and 4 days. To be free of cefixime fever in pediatric patients is 2 days. The length of treatment required is ceftriaxone and chloramphenicol (children and adults) antibiotics, 6 - 13 days and 9-13, respectively; 11-14 and 7 days. For the duration of cefixime antibiotic treatment for children is 13 days. The results of this study indicate that antibiotics that are used effectively against typhoid fever patients are seen from the time of free of fever and length of stay.

scholarly journals 142. Frequency of Short-course Empiric Antibiotic Use as an Antimicrobial Stewardship Metric

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S201-S201
Author(s):  
Jessina C McGregor ◽  
Caitlin M McCracken ◽  
Samuel F Hohmann ◽  
Amy L Pakyz
Keyword(s):  
Antimicrobial Stewardship ◽  
Full Range ◽  
Antibiotic Use ◽  
Empiric Therapy ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Short Course ◽  
Days Of Therapy ◽  
Empiric Antibiotic ◽  
Improve Hospital

Abstract Background Antimicrobial stewardship metrics that provide actionable guidance are needed to support efforts to improve hospital use of antibiotics. Antibiotics such as vancomycin and piperacillin/tazobactam are common empiric agents used frequently when the infectious process remains unknown. Thus short, incomplete courses of therapy are used more frequently for such agents. We aimed to evaluate the variability in short courses of vancomycin and piperacillin/tazobactam use across U.S. hospitals. Methods We performed a cross-sectional study among U.S. hospitals that contributed inpatient pharmacy data to the Vizient clinical database in 2016. We identified vancomycin and piperacillin-tazobactam courses initiated within the 48 hours of admission, measured as days of therapy received. We calculated the percent of patients that received 1, 2, 3, 4 or >4 days of therapy at each facility to describe short course empiric therapy use. To describe the variability across facilities, we then assessed the median, interquartile range (IQR), and total range of that percentage. Results We identified 145 hospitals representing approximately 3.7 million patient encounters for inclusion in this study. Within 48 hours of admission, 13.9% of encounters received vancomycin, 7.7% piperacillin/tazobactam, and 4.6% received both. The figure demonstrates the variability in the frequency of short course antibiotic use across hospitals; boxes indicate the IQR with the transecting line representing the median and whiskers representing the full range. The proportion of patients that received one day of therapy varied most across hospitals, with vancomycin ranging from 0–100%. In contrast, the frequency of patients that received greater than four days of therapy varied considerably less across hospitals; 0–33% for vancomycin. Conclusion The variability in use of short course empiric therapies suggests that use for non-infectious processes or infections not appropriately treated by these agents varies greatly across facilities. Measuring short course use for common empiric agents may serve as an important antimicrobial stewardship metric. Such a metric could inform antimicrobial stewardship efforts to reduce unnecessary initiation of empiric antimicrobial therapy. Disclosures All Authors: No reported disclosures

scholarly journals The Ontario Program To Improve AntiMIcrobial USE (OPTIMISE): A Descriptive Analysis of Dispensed Antibiotics

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S20-S21
Author(s):  
Kevin Schwartz ◽  
Camille Achonu ◽  
Kevin Brown ◽  
Gary Garber ◽  
Jennie Johnstone ◽  
...  
Keyword(s):  
Descriptive Analysis ◽  
Hospital Setting ◽  
Family Physicians ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Global Public Health ◽  
Cross Sectional ◽  
Health Crisis ◽  
Antibiotic Utilization

Abstract Background Antimicrobial resistant infections are an emerging global public health crisis. Antibiotic use is the largest modifiable risk factor for antimicrobial resistance. Greater than 90% of antibiotic use in Canada occurs outside of the hospital setting; however, there is a lack of data describing the patterns of community antibiotic use. Our objective was to describe outpatient antibiotic prescriptions for all of Ontario, Canada and to examine variability in antibiotic prescribing across physicians. Methods We conducted a cross-sectional study of antibiotics dispensed from community pharmacies in Ontario, Canada, between March 1, 2016 and February 28, 2017. Ontario has a population of 13.9 million people and over 30,000 physicians. We analyzed data from the Xponent™ database by QuintilesIMS. Xponent™ is based on data from 79% of retail pharmacies in Ontario. QuintilesIMS uses a geospatial extrapolation algorithm to project antibiotic utilization on 100% of the population. This analysis describes physician antibiotic prescribing patterns stratified by patient age and sex. Results There were 6,995,416 antibiotics dispensed or 501/1,000 population. The highest prescribing rate was for patients aged 65 and older at 702 antibiotic scripts/1,000 population, children 0–17 years received 477 antibiotic scripts/1,000 population and adults 18–64 years 446 antibiotics/1,000 population. Females aged 65 years and older received the highest number of antibiotics. Narrow spectrum penicillins, macrolides, first-generation cephalosporins, and second-generation fluoroquinolones (ciprofloxacin and norfloxacin) were the most common classes of antibiotics overall; however, the urinary antibiotics including ciprofloxacin, norfloxacin, and nitrofurantoin were the most common in older females (Figure 1). There was significant prescriber variability with 25% of all antibiotics being prescribed by 2.2% of physicians. Family physicians comprised 91% of these high prescribers. Conclusion This population-based study quantified community antibiotic utilization and demonstrated marked prescriber variability. Future antibiotic stewardship interventions should target the minority of family physicians that prescribe the majority of antibiotics. Disclosures All authors: No reported disclosures.

Frequency of Neck and Upper Extremity Musculoskeletal Disorders in Dentists

2020 ◽  
Vol 9 (3) ◽  
pp. 207-211
Author(s):  
Sidra Sarwar ◽  
Sara Khalid ◽  
Tahir Mahmood ◽  
Hadeeqa Jabeen ◽  
Shahid Imran
Keyword(s):  
Upper Extremity ◽  
Musculoskeletal Disorders ◽  
Health Care Professionals ◽  
Descriptive Analysis ◽  
Sampling Technique ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Dental Hospital ◽  
Upper Extremity Musculoskeletal Disorders ◽  
And Performance

Background: Musculoskeletal disorders are not only becoming prevalent among health care professionals in our country but are affecting their health and performance adversely. They are caused by poor ergonomics and awkward posture during work activities. The purpose of this study was to determine the frequency of neck and upper limb musculoskeletal disorders in dentists of Lahore, Pakistan. Material and Methods: This cross-sectional study was conducted during October 2017 to March 2018. The data was collected using convenient sampling technique from 162 Dentists including 52 males and 110 females of Children hospital Lahore, Punjab Dental hospital and Fatima Memorial Hospital, Lahore. Data was collected by using Mangalore Questionnaire for identification of musculoskeletal disorders. Descriptive analysis of the data was done using SPSS version 22.0. Results: Of 162 dentists, 115 (71%) suffered from musculoskeletal disorders. Shoulder was the most commonly affected region (30.9%) followed by neck (25.9%), arm (6.2%), wrist (4.3%), elbow (3.1%) and forearm (0.6%). Pain (45.7%) was found to be the most common complaint followed by muscle weakness (20.4%), paraesthesia (3.7%) and swelling (1.2%). Conclusions: It was concluded that majority of the dentists were suffering from musculoskeletal disorders with shoulder as the most affected region and pain as the most frequent complaint. Key words: Dentists, Musculoskeletal disorders, Neck pain, Upper extremity

scholarly journals Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 866
Author(s):  
Iltaf Hussain ◽  
Nisa Yousaf ◽  
Sana Haider ◽  
Pervisha Jalil ◽  
Muhammad Usman Saleem ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
University Students ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Dosing Regimen ◽  
Student Knowledge ◽  
Chi Square ◽  
Cross Sectional ◽  
Self Administered Questionnaire

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

scholarly journals Antibiotic Prescriptions among China Ambulatory Care Visits of Pregnant Women: A Nationwide Cross-Sectional Study

Antibiotics ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 601
Author(s):  
Houyu Zhao ◽  
Mei Zhang ◽  
Jiaming Bian ◽  
Siyan Zhan
Keyword(s):  
Pregnant Women ◽  
Ambulatory Care ◽  
National Level ◽  
Mainland China ◽  
Antibiotic Use ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Fetal Safety ◽  
First Trimester Of Pregnancy

Background: Antibiotic use in pregnant women at the national level has rarely been reported in China. Objectives: We aimed to investigate antibiotic prescriptions during pregnancy in ambulatory care settings in China. Methods: Data of 4,574,961 ambulatory care visits of pregnant women from October 2014 to April 2018 were analyzed. Percentages of Antibiotic prescriptions by different subgroups and various diagnosis categories and proportions of inappropriate antibiotic prescriptions for different subgroups were estimated. Food and Drug Administration (FDA) pregnancy categories were used to describe the antibiotic prescription patterns. The 95% confidence intervals (CIs) were estimated using the Clopper––Pearson method or Goodman method. Results: Among the 4,574,961 outpatient visits during pregnancy, 2.0% (92,514 visits; 95% CI, 2.0–2.0%) were prescribed at least one antibiotic. The percentage of antibiotic prescriptions for pregnant women aged >40 years was 4.9% (95% CI, 4.7–5.0%), whereas that for pregnant women aged 26–30 years was 1.5% (95% CI, 1.4–1.5%). In addition, percentages of antibiotic prescriptions varied among different trimesters of pregnancy, which were 5.4% (95% CI, 5.3–5.4%) for the visits in the first trimester of pregnancy and 0.5% (95% CI, 0.4–0.5%) in the third trimester of pregnancy. Furthermore, the percentages of antibiotic prescriptions substantially varied among different diagnosis categories and nearly three-quarters of antibiotic prescriptions had no clear indications and thus might be inappropriate. In total, 130,308 individual antibiotics were prescribed; among these, 60.4% (95% CI, 60.0–60.8%) belonged to FDA category B, 2.7% (95% CI, 2.1–3.5%) were classified as FDA category D and 16.8% (95% CI, 16.2–17.4%) were not assigned any FDA pregnancy category. Conclusions: Antibiotic prescriptions in ambulatory care during pregnancy were not highly prevalent in mainland China. However, a substantial proportion of antibiotics might have been prescribed without adequate indications. Antibiotics whose fetal safety has not been sufficiently illustrated were widely used in pregnant women.

scholarly journals SAT0082 FRAX AND DAS IN MOROCCAN RHEUMATOID ARTHRITIS PATIENTS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 975.1-975
Author(s):  
H. Azzouzi ◽  
O. Lamkhanat ◽  
I. Linda
Keyword(s):  
Rheumatoid Arthritis ◽  
Fracture Risk ◽  
Disease Activity ◽  
Descriptive Analysis ◽  
Cross Sectional Study ◽  
Fracture Probability ◽  
Mineral Density ◽  
Cross Sectional ◽  
Risk Probability ◽  
Fracture Assessment

Background:Rheumatoid Arthritis (RA) is one of the risk factors for the calculation of the 10 years fracture probability assessed by the FRAX tool.Objectives:The aim was to study the association of disease activity and the 10 year fracture risk probability by the FRAX tool in our RA patients and their impact on fracture prevalence.Methods:Cross-sectional study of the association FRAX and disease activity score (DAS 28 CRP) was designed. Patients with RA were included. Mean DAS was calculated for each patient adjusted on his follow-up duration. Data about patients (demographic, disease characteristics and fracture assessment) were collected. The 10 year fracture risk probability for major osteoporotic fracture was calculated with and without BMD (bone mineral density) using the FRAX tool for Morocco. Descriptive analysis and regressions were performed with SPSS.20. p<0.05 was considered significant.Results:One hundred and ninety nine RA patients were included with mean age of 55.5±12 years. Women represented 91% and 40.1% had osteoporosis. Remission was observed in 86.4% with 95.5% taking methotrexate. 17.1% had vertebral fractures. FRAX and DAS were associated (p=0.03), and both explained vertebral fracture (VF) prevalence. When adjusted on disease parameters, FRAX with and without BMD explained the vertebral prevalence (p=0.02, OR=1.09[1.01-1.19]). However, age remains the only predictor of VF when adjusted on osteoporosis factors (DAS28CRP, menopause, BMI, smoking, diabetes, gender, steroid use, HAQ) and FRAX BMD.Conclusion:Persistent disease activity was associated to high 10 year fracture risk probability calculated by the FRAX tool in RA.Disclosure of Interests:None declared

scholarly journals Empty shelves: selected essential medicines stockouts in South Africa

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Wolvaardt ◽  
R Nemuntandani ◽  
I Kamungoma-Dada
Keyword(s):  
South Africa ◽  
Urban Areas ◽  
Descriptive Analysis ◽  
Secondary Data ◽  
Treatment Interruption ◽  
Cross Sectional Study ◽  
Essential Medicines ◽  
Chi Square ◽  
Cross Sectional ◽  
Antiretroviral Medication

Abstract Background Access to essential medicines in South Africa has been compromised by stockouts in health facilities. This study describes the occurrence of stockouts for a selection of essential medicines. Methods This cross-sectional study used secondary data retrieved from the Stop Stock Outs Project (SSP). A descriptive analysis was conducted on data from the 2013-2015 SSP case management database of routinely reported stockouts. Chi square tests of independence was conducted on data from the SSP 2015 annual telephonic survey to investigate associations between the occurrence of stockouts, the level of health facility and the type of health professional. Results 231 facilities reported 609 stockouts. Antiretroviral medication had the most stockout reports (78%; n = 475/609), followed by anti-infectives (17.1%; n = 104/609) and tuberculosis medication (4.9%; n = 30/609). The highest number of stockout reports were received from Gauteng province and the majority (71.09%; n = 150/211) of facilities reporting stockouts were in urban areas. There were more stockouts at ambulatory, rather than inpatient care, facilities however, this was not statistically significant. Conclusions This study confirms that South Africa experiences medicine stockouts for many of the essential medicines, with antiretroviral medication being the category most affected. The stockouts vary between provinces and the urban-rural divide but are an equal threat to both ambulatory and inpatient facilities. Key messages The pattern of stockouts experienced over a three-year period suggest that stockouts are ‘normal’ despite the substantive effects of treatment interruption – especially patients with HIV and/or TB. Antiretroviral therapy is at risk as a result of stockouts.

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