scholarly journals 165. Decreased Antimicrobial Consumption and Decreased Rates of Multi-drug Resistant Organisms Following Onset of the COVID-19 Pandemic: Experience from an Australian Tertiary Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S192-S192
Author(s):  
Michael Moso ◽  
Kelly Cairns ◽  
Trisha Peel ◽  
Nenad Macesic
Keyword(s):  
Tertiary Hospital ◽  
Antimicrobial Treatment ◽  
Prescribing Patterns ◽  
World Health ◽  
Drug Resistant ◽  
Antimicrobial Consumption ◽  
Infection Level ◽  
Empiric Antibiotics ◽  
Antimicrobial Prescribing ◽  
Days Of Therapy

Abstract Background Current guidelines recommend empiric antibiotics be used only for severe cases of coronavirus disease 2019 (COVID-19) or in cases where there is high clinical suspicion for bacterial co-infection. Level of adherence to guideline-recommended prescribing is unknown and high rates of antimicrobial prescribing may lead to increased development of resistance. Methods We reviewed antimicrobial prescribing patterns for patients with COVID-19 managed at The Alfred Hospital in Melbourne, Australia in 2020. Adherence to World Health Organization (WHO) guideline-based prescribing was assessed by manual review of case notes. Monthly hospital-wide antibacterial consumption April-Dec 2020 (post-pandemic period) was compared to Jan 2019-Mar 2020 (pre-pandemic period), measured as days of therapy (DOT) per 1000 patient-days. Rates of multi-drug resistant organisms (MRO) (including MRSA, VRE, CPE, ESBL) were compared between months in 2019 and 2020 after pandemic onset (April 2020) and expressed as isolates per 1000 patient-days. Results 147 patients were managed for COVID-19 in 2020 at our centre. 101 patients required hospital admission and 58 (39%) were classified as either severe or critical in severity. 80 (54%) patients received empiric antimicrobial treatment, including 78/101 (77%) of hospital inpatients and 24/26 (92%) of ICU-admitted patients. 59 (73%) of antimicrobial prescriptions were adherent to WHO guidelines. Monthly antibacterial consumption was significantly lower post-pandemic than in the pre-pandemic period (mean 853 vs 902 DOT/1000 patient-days, P=0.0065). Antimicrobial use patterns varied, with significant decreases in commonly used antibiotics such as ceftriaxone, piperacillin-tazobactam, azithromycin and ciprofloxacin but no change in vancomycin or meropenem (Figure 1). There was a mean decrease of 0.77 MRO isolates/1000 patient-days (P=0.026) when each month in 2020 was compared with the corresponding month in 2019 (Figure 2). Antibacterial consumption in 2019 and 2020 by month, expressed as days of therapy/1000 patient-days. Rates of isolated multi-drug resistant organisms in 2019 and 2020 by month, expressed as isolates/1000 patient-days. Conclusion A high proportion of admitted patients with COVID-19 received empiric antibiotics. In spite of this, we observed a significant reduction in total antimicrobial consumption and reduced rates of MRO isolation in the post-pandemic period. Disclosures All Authors: No reported disclosures

scholarly journals 156. Evaluating Antibiotic Use and Developing a Tool to Optimize Prescribing in a Pediatric HIV Clinic in Eswatini

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S88-S88
Author(s):  
Ashish E Streatfield ◽  
Tara Ness ◽  
Tandzile T Simelane ◽  
Danielle Guffey ◽  
Bhekemusa Lukhele ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Initial Period ◽  
Antibiotic Use ◽  
Pediatric Hiv ◽  
Prescribing Patterns ◽  
World Health ◽  
Antimicrobial Use ◽  
Surveillance Systems ◽  
Antimicrobial Prescribing

Abstract Background Antibiotic resistance is an emerging global health issue, fueled by inadequate surveillance systems and the absence of antimicrobial stewardship. In resource-limited settings, antimicrobial use is often based on clinical evaluation rather than microbiologic evidence, making treatment guidelines and the education of healthcare providers paramount to ensuring appropriate antimicrobial prescribing. In a human immunodeficiency virus (HIV) clinic for children and their families in Eswatini, we sought to understand the use of antibiotics and identify specific areas for improvement. Methods We performed a retrospective patient chart review as part of a quality improvement (QI) initiative to assess antimicrobial use before and after implementation of a standardized antimicrobial guide. For each prescribing period, 100 random patient encounters were selected for review to observe if the indication for antibiotics, duration, and dose were consistent with World Health Organization (WHO) guidelines. Two physicians reviewed each encounter to determine the appropriateness of antibiotic use using a structured abstraction tool, with a third resolving discrepancies. Results were analyzed using a chi-square test of proportions and a structured survey was performed to assess perceptions of the guide. Results After the implementation of an antimicrobial guide, there was a significant decrease in the proportion of clinic visits with an antibiotic prescribed (p < 0.001). Incorrect indication for antimicrobial use decreased from 20.4% in the initial period, to 10.31% and 10.2% but did not reach significance (p=.0621) in the subsequent periods after implementation. Incorrect dose/duration decreased from 10.47% in the initial period to 7.37% and 3.1% in the subsequent periods, but this was also was not significant (p = 0.139). All prescribers who completed the survey used the antimicrobial guide and felt that it positively impacted their prescribing patterns. Conclusion Our study found that an antibiotic guide reduced and improved the prescription of antimicrobials. Antimicrobial stewardship is a global problem and this data demonstrates that practical solutions can have a lasting impact on antimicrobial prescribing in low resource settings. Disclosures All Authors: No reported disclosures

scholarly journals Antimicrobial prescribing patterns in a large tertiary hospital in Shanghai, China

2016 ◽  
Vol 48 (6) ◽  
pp. 666-673 ◽  
Author(s):  
Yuan-Yuan Wang ◽  
Ping Du ◽  
Fang Huang ◽  
Dong-Jie Li ◽  
Jun Gu ◽  
...  
Keyword(s):  
Tertiary Hospital ◽  
Prescribing Patterns ◽  
Antimicrobial Prescribing

IL-10-592 A/C Gene Polymorphism and Cytokine Levels are Associated with Susceptibility to Drug Resistance in Tuberculosis

2020 ◽  
Vol 8 (3) ◽  
pp. 103-112
Author(s):  
Atefeh SADEGHI SHERMEH ◽  
Majid KHOSHMIRSAFA ◽  
Ali-Akbar DELBANDI ◽  
Payam TABARSI ◽  
Esmaeil MORTAZ ◽  
...  
Keyword(s):  
Serum Levels ◽  
World Health ◽  
Control Group ◽  
Drug Resistant ◽  
Nucleotide Polymorphisms ◽  
Genotype Frequencies ◽  
Cytokine Levels ◽  
Ifn Γ ◽  
Health Organization ◽  
And Function

Introduction: Tuberculosis (TB) and especially resistant forms of it have a substantial economic burden on the community health system for diagnosis and treatment each year. Thus, investigation of this field is a priority for the world health organization (WHO). Cytokines play important roles in the relationship between the immune system and tuberculosis. Genetic variations especially single nucleotide polymorphisms (SNPs) impact cytokine levels and function against TB. Material and Methods: In this research SNPs in IFN-γ (+874 T/A) and IL-10 (-592 A/C) genes, and the effects of these SNPs on cytokine levels in a total of 87 tuberculosis patients and 100 healthy controls (HCs) were studied. TB patients divided into two groups: 1) 67 drug-sensitive (DS-TB) and 2) 20 drug-resistant (DR-TB) according to drug sensitivity test using polymerase chain reaction (PCR). For the genotyping of two SNPs, the PCR-based method was used and IFN-γ and IL-10 levels were measured by ELISA in pulmonary tuberculosis (PTB) and control group. Results: In -592A/C SNP, only two genotypes (AA, AC) were observed and both genotypes showed statistically significant differences between DR-TB and HCs (p=0.011). IL-10 serum levels in PTB patients were higher than HCs (p=0.02). The serum levels of IFN-γ were significantly higher in DS-TB patients than that of the other two groups (p<0.001); however, no significant differences were observed for allele and genotype frequencies in IFN-γ +874. Conclusions: Our results suggest that the SNP at -592 position of IL-10 gene may be associated with the susceptibility to DR-TB. However, further investigation is necessary. Keywords: Polymorphism, IFN-γ, IL-10, tuberculosis, drug-resistant tuberculosis

Evaluation of Drug Utilization Pattern Using WHO Prescribing Indicators in Endodontic Department at a Tertiary Hospital in Eastern Nepal

2020 ◽  
Vol 5 (3) ◽  
pp. 1191-1195
Author(s):  
Sushmita Shrestha ◽  
Navin Agrawal ◽  
Deependra Prasad Sarraf
Keyword(s):  
Drug Utilization ◽  
Inappropriate Prescribing ◽  
Systemic Infection ◽  
Tertiary Hospital ◽  
World Health ◽  
Utilization Pattern ◽  
Cross Sectional ◽  
Prescribing Indicators ◽  
Essential Drug List ◽  
Dental Practitioners

Introduction: Irrational or inappropriate prescribing practice is common in developing countries that can lead to ineffective treatment, prolonged hospitalization, harm to the patient, increased treatment cost and development of drug-resistant organisms. The prescription of antibiotics and other drugs in endodontics is limited to patients with progressive and diffuse swelling and with systemic infection. However, antibiotics continue to be over-prescribed by more than 66% dentists without a rational justification.Therefore, the periodic assessment of drug utilization pattern is important to know the existing pattern of drug use, decrease adverse effects and provide feedback to the prescribers. Objective: To evaluate the drug utilization pattern in endodontics using the World Health Organization prescribing indicators. Methodology: A cross-sectional prospective study was conducted among the patients visiting the outpatient department of Conservative Dentistry and Endodontics. After obtaining the informed consent, the relevant data were collected on a self-designed proforma by reviewing the health cards of the patients. The WHO prescribing indicators were calculated. Descriptive statistics were calculated using SPSS version 11.0. Results: Out of 187 patients, 101 (54%) were female. Mean age was 38.9±16.6 years. Majority of the patients suffered from acute apical periodontitis (30.5%). A total of 281 drugs were prescribed to 187 patients. Paracetamol+Ibuprofen (44.1%) was the most frequently prescribed drugs. Most of the patients were prescribed one drug (78.6%).  Average drug per prescription was 1.5. Majority of the drugs (89.0%) were prescribed from Essential drug list of Nepal. Conclusions: Analgesics were the most frequently prescribed drug. The prescription practice was rational. There is need to increase the number of medicine prescribed from National List of Essential medicines.Educational initiatives should be undertaken to further strengthen the rational prescription among dental practitioners.

Exploring patient-provider factors for risk of developing Multi-drug Resistance Tuberculosis in Southern Ethiopia: Qualitative Operation Research (Preprint)

2019 ◽  
Author(s):  
Yitagesu Habtu ◽  
Tesema Bereku ◽  
Girma Alemu ◽  
Ermias Abera
Keyword(s):  
Phenomenological Study ◽  
Treatment Success ◽  
World Health ◽  
Multi Drug Resistance ◽  
Southern Ethiopia ◽  
Drug Resistant ◽  
Related Factors ◽  
Drug Resistant Tuberculosis ◽  
Resistant Tuberculosis ◽  
Multi Drug Resistant Tuberculosis

BACKGROUND Ethiopia is one of among thirty high burden countries of multi-drug resistant tuberculosis (MDR-TB) in the regions of world health organization. Contextual evidence on the emergence of the disease is limited at a program level. OBJECTIVE The aim of the study is to explore patient-provider factors that may facilitate the emergence of multi-drug resistant tuberculosis. METHODS We used a phenomenological study design of qualitative approach from June to July, 2015. We conducted ten in-depth interviews and 4 focus group discussions with purposely selected patients and providers. We designed and used an interview guide to collect data. Verbatim transcribes were exported to open code 3.4 for emerging thematic analysis. Domain summaries were used to support core interpretation. RESULTS The study explored patient-provider factors facilitating the emergence of multi-drug resistant tuberculosis. These factors as underlying, health system and patient-related factors. Especially, the a shows conflicting finding between having a history of discontinuing drug-susceptible tuberculosis and emergence of multi-drug resistant tuberculosis. CONCLUSIONS The patient-provider factors may result in poor early case identification, adherence to and treatment success in drug sensitive or multi-drug resistant tuberculosis. Our study implies the need for awareness creation about multi-drug resistant tuberculosis for patients and further familiarization for providers. This study also shows that patients developed multi-drug resistant tuberculosis though they had never discontinued their drug-susceptible tuberculosis treatment. Therefore, further studies may require for this discording finding.

scholarly journals Effects of coronavirus disease 2019 (COVID-19) pandemic on antimicrobial prevalence and prescribing in a tertiary hospital in Singapore

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Tat Ming Ng ◽  
Sock Hoon Tan ◽  
Shi Thong Heng ◽  
Hui Lin Tay ◽  
Min Yi Yap ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Quality Indicators ◽  
Survey Methodology ◽  
Tertiary Hospital ◽  
Full Time ◽  
Full Time Equivalent ◽  
Prevalence Survey ◽  
Antimicrobial Prescribing ◽  
Point Prevalence Survey ◽  
Prescribing Quality

Abstract Background The deployment of antimicrobial stewardship (AMS) teams to deal with the COVID-19 pandemic can lead to a loss of developed frameworks, best practices and leadership resulting in adverse impact on antimicrobial prescribing and resistance. We aim to investigate effects of reduction in AMS resources during the COVID-19 pandemic on antimicrobial prescribing. Methods One of 5 full-time equivalent AMS pharmacists was deployed to support pandemic work and AMS rounds with infectious disease physicians were reduced from 5 to 2 times a week. A survey in acute inpatients was conducted using the Global Point Prevalence Survey methodology in July 2020 and compared with those in 2015 and 2017–2019. Results The prevalence of antimicrobial prescribing (55% in 2015 to 49% in 2019 and 47% in 2020, p = 0.02) and antibacterials (54% in 2015 to 45% in 2019 and 42% in 2020, p < 0.01) have been reducing despite the pandemic. Antimicrobial prescribing in infectious disease wards with suspected or confirmed COVID-19 cases was 29% in 2020. Overall, antimicrobial prescribing quality indicators continued to improve (e.g. reasons in notes, 91% in 2015 to 94% in 2019 and 97% in 2020, p < 0.01) or remained stable (compliance to guideline, 71% in 2015 to 62% in 2019 and 73% in 2020, p = 0.08). Conclusion During the COVID-19 pandemic, there was no increase in antimicrobial prescribing and no significant differences in antimicrobial prescribing quality indicators.

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