scholarly journals Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance

2015 ◽  
Vol 2 (1) ◽  
Author(s):  
Neil M. Vora ◽  
Christine J. Kubin ◽  
E. Yoko Furuya
Keyword(s):  
New York ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Categorical Variables ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Gram Negative ◽  
Stewardship Program

Abstract Background.  Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods.  We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results.  A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions.  Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

scholarly journals High Prevalence of Antimicrobial Resistance Among Gram-Negative Isolated Bacilli in Intensive Care Units at a Tertiary-Care Hospital in Yucatán Mexico

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 588 ◽  
Author(s):  
Andrés H. Uc-Cachón ◽  
Carlos Gracida-Osorno ◽  
Iván G. Luna-Chi ◽  
Jonathan G. Jiménez-Guillermo ◽  
Gloria M. Molina-Salinas
Keyword(s):  
Escherichia Coli ◽  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Intensive Care Units ◽  
High Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Gram Negative ◽  
Resistance Rates

Background and Objectives: Antimicrobial resistance (AMR) is increasing worldwide and imposes significant life-threatening risks to several different populations, especially to those in intensive care units (ICU). The most commonly isolated organisms in ICU comprise gram-negative bacilli (GNB), and these represent a leading cause of serious infections. This study was conducted to describe the prevalence of resistance in GNB isolated from patients in adults, pediatric, and neonatal ICU in a tertiary-care hospital in Mérida, Mexico. Materials and Methods: A retrospective study was done on samples collected in Neonatal (NICU), Pediatric (PICU) and Adult (AICU) ICU of Unidad Médica de Alta Especialidad, Instituto Mexicano del Seguro Social in Mérida, México. The identification of isolates and antimicrobial susceptibility testing were performed using an automated system. Results: A total of 517 GNB strains were isolated. The most common positive culture was bronchial secretions. Pseudomonas aeruginosa was the prevalent pathogen in NICU and PICU, whereas Escherichia coli was common in the AICU. Overall, GNB exhibited a high resistance rates for Ampicillin (95.85%), Cefuroxime (84.17%), Piperacillin (82.93%), Cefotaxime (78.07%), Ceftriaxone (77.41%), Aztreonam (75.23%), Cefazolin (75.00%), and Ceftazidime (73.19%). There are significant differences in the resistance rates of GNB from different ICUs for penicillins, cephalosporins, carbapenems and fluoroquinolones drugs. Escherichia coli (multidrug-resistant [MDR] = 91.57%, highly resistant microorganisms [HRMO] = 90.36%) and Acinetobacter baumannii (MDR = 86.79%, HRMO = 83.02%) exhibited the highest percentage of MDR and HRMO profiles. The prevalence of the extended-spectrum beta-lactamases (ESBL)-producing isolates was 83.13% in E. coli, 78.84% in Klebsiella pneumoniae, and 66.67% in Proteus mirabilis, respectively. Conclusions: The high resistance rates to drugs were exhibited by our GNB isolates. Continuous surveillance and control of the use of antimicrobials are urgently needed to reduce the emergence and spreading of MDR, HRMO, and/or ESBL-producing bacilli.

scholarly journals 244. The Double-Edged Sword of Cost Effectiveness in Evaluating Antimicrobial Stewardship Interventions

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S121-S122
Author(s):  
Omar Zmerli ◽  
Amanda Chamieh ◽  
Sanaa Saliba ◽  
Claude Afif ◽  
Eid Azar
Keyword(s):  
Cost Effectiveness ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Tertiary Care ◽  
High Price ◽  
Gram Negative ◽  
Stewardship Program ◽  
Yearly Average ◽  
The Impact

Abstract Background The multiple classical benefits of reducing antimicrobial consumption extend beyond the impact on rates of antimicrobial resistance and infections to include a cost-saving effect of 100,000$-300,000$ per intervention as estimated by the CDC. However, the recent introduction of novel antimicrobial molecules with a high price tag and the fall in the prices of older agents presents a substantial challenge in maintaining cost-effectiveness. Methods We retrieved from the antimicrobial stewardship program(ASP) database the consumption of the Gram-negative broad-spectrum antibacterial agents (GNBS): imipenem, meropenem, ertapenem, piperacillin-tazobactam, amikacin, colistin, ceftazidime, ceftolozane-tazobactam and cefepime from January 2015-August 2019 at Saint George Hospital(SGH), a 333-bed tertiary care center in Lebanon. The yearly cost of all antibacterials consumed during this period were obtained from SGH billing records. GNBS consumption was calculated as Daily Defined Doses (DDD)/1000 Patient Days(PD) per WHO guidelines. Results The carbapenem consumption significantly dropped from a peak of 205 DDD/1000PD in 2015 to 33 DDD/1000PD in 2019. This drop was not accompanied by an increase in the consumption of other GNBS. The total use of GNBS dropped by 54% from 288 DDD/1000PD in 2015 to 132 DDD/1000PD by August 2019. Currently, SGH serves a yearly average of 82,000 patient-days. Hence, this reduction in total GNBS consumption corresponds to 12,792 fewer daily defined doses of antimicrobial therapy per year. The average annual cost of all antibacterials at SGH is 1,100,000 $ (U.S. Dollars), ranging from 955679 $ to 1340109 $ for the period 2015–2019. (Table 1) Consumption of Gram-negative Broad-Spectrum Antimicrobial Agents and Cost of Antibiotics at Saint George Hospital, Lebanon Conclusion The striking decrease in GNBS consumption, namely carbapenems, was not mirrored with a reduction of total antibacterial cost. Although novel antimicrobials carry great potential, they come at a significant increase in overall cost. Modeling ASP interventions solely around cost-effectiveness will limit the better placement of these new agents in institutional therapeutic guidelines. Strict continuous analysis of consumption, antimicrobial resistance, and cost within an ASP provides a proactive and vigilant approach to navigate through the complexity of difficult to treat bacterial infections. Disclosures All Authors: No reported disclosures

scholarly journals To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center

2015 ◽  
Vol 3 (1) ◽  
pp. 13-24
Author(s):  
YK Gupta ◽  
Shakti Kumar Gupta ◽  
Madhav Madhusudan Singh ◽  
DK Sharma ◽  
Aarti Kapil
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Tertiary Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Prescribing Practices ◽  
Care Teaching ◽  
Stewardship Program ◽  
Large Tertiary Care

ABSTRACT Introduction As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects. Aim To study the antimicrobial stewardship program in a large tertiary care teaching center. Objectives • To study the antibiotic prescribing practices in a tertiary care government hospital • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital • To make recommendation if any for rational use of antibiotics. Materials and methods • Review of literature • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients. • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients. • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription. • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program. Results The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices. Conclusion Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used. How to cite this article Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

scholarly journals Antimicrobial resistance surveillance, intensive care units of a tertiary care hospital, Islamabad

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
N Noreen ◽  
S Dil ◽  
N Ullah Khan ◽  
I Naveed
Keyword(s):  
Intensive Care ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Clinical Specimen ◽  
Health Care Facilities ◽  
Care Hospital ◽  
Stepping Stone ◽  
Hospital Acquired

Abstract Background Hospital Acquired Infections (HAIs) are the emerging threat in the health care facilities around the globe. Most of Intensive Care Unit(ICU)patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. Objective was to study the occurrence of different types of HAIs in patients admitted to various ICUs of and the AMR pattern of the bacterial pathogens isolated from them. Methods It was a retrospective descriptive study based on culture reports of the patients admitted to surgical, Medical ICU of tertiary care hospital during period from March 2019 to October 2019. Results Most common culture positive clinical specimen received was tracheal aspirate(35.3%) followed by exudate(22.7%).Pseudomonas from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 25% infections were HAIs, out of which pneumonia(7.24%)was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli(GNB) was Multi Drug Resistant(MDR) resistant to three or more class of antibiotics such as cephalosporins, aminoglycosides, tetracyclines and fluoroquinolones. Conclusions Increasing trend of AMR among hospital acquired pathogens such as MDR-GNBs,MRSA and VRE pose a great threat to critically ill patients of ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future Key messages Study on AMR surveillance is the need of the hour. such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial resistance in future.

Sign in / Sign up

Export Citation Format

Share Document