Antibiotic stewardship in Norway: are strategies for rational use of antibiotics followed in Norwegian healthcare system?

AbstractObjectiveResistance has been a major challenge since the development of antibiotics and countries have been working to curb it. As part of this effort, Norway has been striving to maintain low consumption of antibiotics and drug resistance. This paper aims to review the findings of studies in this regard as an attempt to investigate if the impacts of the country’s antibiotic stewardship strategies are in line with the intention.MethodA literature review was performed by searching MEDLINE/PubMed to identify peer reviewed articles which dealt with antibiotic use and resistance in Norway. Studies conducted after the year 2000, when a comprehensive national action plan against antibiotic resistance was initiated, were included and the search terms were antibiotic, antimicrobials, resistance and Norway.ResultsA total of 229 articles were identified of which 75 were included in the review. In primary healthcare settings, hospitals and nursing homes, research themes like adherence to specific institutional guidelines, consumption of antibiotics, patterns of antibiotic resistance, infection prevention/control, as well as resistance profiling were taken up by investigators. Most of the findings highlighted that healthcare facilities are striving to adhere to guidelines and implement strategies outlined in the national strategic plan, despite some challenges. This has resulted in restricting the use of antibiotics thereby maintaining favorable environment to promote their prudent use.ConclusionBy and large, the findings affirm that the Norwegian healthcare system is characterized by a conservative use of antibiotics that has a positive impact on resistance containment. The authorities need to work further on issues such as adherence to guidelines and infection prevention/control so as to further maximize the prevailing good conditions.

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Survey of knowledge and perceptions of antibiotic resistance and antibiotic stewardship among doctors and pharmacists in a tertiary hospital: a pilot study

10.21203/rs.3.rs-25984/v1 ◽

2020 ◽

Author(s):

Mary Akpan ◽

Idong Imo Kingsley ◽

Agantem Ekuma ◽

Arit Udoh

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Action Plan ◽

Antibiotic Use ◽

Tertiary Hospital ◽

Global Public Health ◽

Chi Square ◽

Significant Difference ◽

Global Action ◽

Chi Square Analysis

Abstract Background: Antibiotic resistance poses a serious global public health threat and results in prolonged illness, increased mortality and cost. The WHO global action plan on antibiotic resistance emphasizes five strategic objectives, including improved awareness of antibiotic resistance and optimization of antibiotic use. The objectives of this study were to assess doctors’ and pharmacists’ knowledge and perceptions of antibiotic resistance and stewardship, and hospital’s preparedness to implement antibiotic stewardship programs (ASPs).Methods: One hundred and twenty-four doctors and 61 pharmacists were surveyed in University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria. Descriptive and Pearson chi-square analysis were carried out to compare knowledge and perceptions between the two groups. Results: Both doctors and pharmacists perceived antibiotic resistance as a global and national problem (98% vs 97%), respectively. Both groups perceived excessive use of broad-spectrum antibiotics and antibiotics for common cold and cough increase resistance (84% vs 75%, 71% vs 82%, respectively). Only 47% of doctors and 53% of pharmacists correctly defined antibiotic stewardship with 77% and 85%, respectively, agreeing that restriction of certain antibiotics reduces resistance. There was with no significant difference in knowledge between the two groups in majority of questions/statements; however, there was association between length of practice and knowledge of causes of antibiotic resistance (F = 2.586; p = 0.028).Conclusion: Participants in this study showed good knowledge of the prevalence and causes of antibiotic resistance, as well as antibiotic stewardship strategies. There was however little awareness of the hospital’s plan to implement ASPs. Hospital management needs to emphasize optimizing antibiotic use through stewardship programs.

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Development and pilot evaluation of an educational programme on infection prevention and antibiotics with English and Scottish youth groups, informed by COM-B

Journal of Infection Prevention ◽

10.1177/17571774211012463 ◽

2021 ◽

pp. 175717742110124

Author(s):

Catherine V Hayes ◽

Charlotte V Eley ◽

Diane Ashiru-Oredope ◽

Magda Hann ◽

Cliodna AM McNulty

Keyword(s):

Primary Schools ◽

Infection Prevention ◽

Action Plan ◽

Antibiotic Use ◽

Educational Programme ◽

Youth Group ◽

Youth Groups ◽

Hygiene Behaviour ◽

Programme Content ◽

The Uk

Background: The UK 5-year antimicrobial resistance (AMR) National Action Plan highlights the need to prevent community infections through education of children. Activities around infection prevention (IP) and antibiotics were piloted by UK youth groups in 2016–2018, prompting Public Health England (PHE) to develop a standardised programme. The aim of the study was to develop and pilot an educational programme on IP and antibiotics for use by community youth groups in the UK. Methods: A working group, including youth group volunteers interested in IP and AMR, agreed on the programme content through consensus, informed by the Capability, Opportunity, Motivation, Behaviour model (COM-B). The Antibiotic Guardian Youth Badge (AGYB) included learning through interactive e-Bug activities on IP and prudent antibiotic use, action setting through Antibiotic Guardian pledges and consolidation through poster development. The programme was piloted and evaluated with conveniently recruited youth groups in 2019, including quantitative and qualitative questionnaire feedback from community leaders and children. Results: Fourteen youth group leaders and 232 children from uniformed Girlguiding/Scout groups in England and Scotland participated in the pilot evaluation, as well as two primary schools. Leaders reported alignment to the themes of their youth organisation, but struggled to teach antibiotics and antibiotic resistance. Children reported enjoyment and intentions to improve hygiene behaviour. Conclusion: Community youth groups are a suitable setting for IP and antibiotics education. The AGYB was officially launched in March 2020 and promoted for use with home-schooling children and remote youth group meetings to educate about IP during the coronavirus disease 2019 (COVID-19) pandemic.

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The impact of a multimodel approach to designing a new orthopedic department

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1345 ◽

2020 ◽

pp. 1-6

Author(s):

Elad Keren ◽

Abraham Borer ◽

Lior Nesher ◽

Tali Shafat ◽

Rivka Yosipovich ◽

...

Keyword(s):

Hand Hygiene ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Tertiary Care ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Prevention Measures ◽

Orthopedic Department ◽

Before And After ◽

The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

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A UK-based survey of cat owners’ perceptions and experiences of antibiotic usage

Journal of Feline Medicine and Surgery ◽

10.1177/1098612x19826353 ◽

2019 ◽

Vol 22 (2) ◽

pp. 69-76 ◽

Cited By ~ 1

Author(s):

Jennifer Stallwood ◽

Alex Shirlow ◽

Angie Hibbert

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Diagnostic Tests ◽

Bacterial Infections ◽

Viral Infections ◽

Diagnostic Testing ◽

Antibiotic Use ◽

Good Communication ◽

Long Acting ◽

Veterinary Antibiotic

Objectives The aim of this study was to explore owners’ knowledge of antibiotics, experience of antibiotic use in their cats and involvement in decision-making regarding antibiotic prescriptions. Methods Cat owners were recruited via social media and veterinary practices to complete a survey designed to evaluate general knowledge of antibiotics, attitudes to antibiotic stewardship and experiences of antibiotic use in their own cat between November 2017 and March 2018. Data were analysed descriptively. Results A total of 1436 surveys were completed; 247 respondents (17.2%) had a veterinary background. The majority of the remaining respondents correctly identified that antibiotics treat bacterial infections (84.0%; n = 999) but do not treat viral infections (72.8%; n = 865). A minority (n = 338; 28.4%) agreed that antibiotic resistance was a problem in cats in the UK; 92.3% (n = 1097) identified that resistance was a problem in human medicine. Seventy percent (n = 832) of the respondents’ cats had received antibiotics; 29.6% (n = 246) received a long-acting injectable antibiotic (14 days’ duration). Diagnostic tests were performed before antibiotic prescription in 38.7% (n = 322) of cats; 1.4% (n = 7) of respondents reported declining suggested tests and 65.8% (n = 778) indicated that they would be happy to pay for diagnostic tests to allow selection of the most appropriate antibiotic. Most respondents (95.8%; n = 792) indicated that they were happy to follow their veterinarian’s advice and recommendations; however, 49.2% (n = 405) had expected antibiotics to be prescribed. Conclusions and relevance Cat owners demonstrated good knowledge of antibiotic action; however, greater owner education regarding the potential for veterinary antibiotic resistance, requirement for diagnostic testing and training in the administration of oral medication with first-line antibiotics, as well as the use of veterinary antibiotic guidelines, will improve antibiotic stewardship. Good communication between veterinarians and owners is necessary for rational antibiotic use.

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Infection Prevention and Control Policies and Staffing: A National Survey of Home Health Agencies in the United States

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.882 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s301-s301

Author(s):

Jingjing Shang ◽

Ashley Chastain ◽

U. Gayani Perera ◽

Monika Pogorzelska-Maziarz ◽

Patricia Stone

Keyword(s):

Quality Improvement ◽

Influenza Vaccination ◽

Staff Member ◽

Antibiotic Stewardship ◽

Prevention And Control ◽

Infection Prevention ◽

Infection Prevention And Control ◽

For Profit ◽

Healthcare Settings ◽

And Control

Background: Infection prevention and control (IPC) is a national priority in all healthcare settings, and IPC staffing characteristics have been linked to patient safety outcomes. However, there is a lack of knowledge about IPC in home healthcare (HHC), the fastest growing healthcare sector. Our aim was to better understand the current state of IPC in HHC, as well as the HHC staff involved with IPC policy implementation. Methods: A national survey was conducted between October 2018 and November 2019. The participants included (1) agencies recruited from a national HHC conference and (2) a national random sample of 1,501 agencies stratified by census region, ownership status, and rural or urban location. Survey items included staff influenza vaccination policies, antibiotic stewardship, infection surveillance, and IPC staffing. Descriptive statistics were computed, and differences by ownership were calculated using 2 and Student t tests. Results: Of the 535 HHC agencies that responded to the survey (response rate, 33%), 64% were for-profit agencies. Overall, 30.8% of the agencies (17.9% for-profit, 57.6% nonprofit; P < .01) required staff influenza vaccination. Most nonprofit agencies (84.1%) and about half of the for-profit agencies (48.1%) offered free influenza vaccinations to staff (P < .01). During the past influenza season, 62.6% of agencies (81.5% nonprofit vs 51.6% for-profit; P < .01) had 75% of their employees vaccinated for influenza, and 9.3% (2% nonprofit vs 13.5% for-profit; P < .01) reported that they did not track this data. Only 17.9% of HHC agencies used antibiotic prescribing guidelines, and 33.3% reported that they reviewed cases to assess the appropriateness of antibiotic administration and/or indication. Most HHC agencies (86%) reported collecting and reviewing infection data to identify trends, which was often done quarterly or more frequently. Almost every responding agency reported that the staff member in charge of IPC had other responsibilities including administrative, education/training, or quality improvement, and 33.5% of those personnel had received no specific IPC training. Also, ~6% of agencies (12.5% of government-owned agencies) reported that they currently did not have a staff member in charge of IPC. Conclusions: This is the first national study of IPC in HHC, which can be used as a benchmark for quality improvement initiatives in the home care environment. Compared to other healthcare settings, HHC agencies have substantial challenges related to IPC. Most HHC agencies do not have a staff member exclusively dedicated to IPC, and staff training is inadequate. Furthermore, a significant number of agencies have no staff influenza vaccination or antibiotic stewardship policies in place. The situation is worse at for-profit agencies, which dominate the current US HHC industry.Funding: NoneDisclosures: None

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1007. A novel approach to evaluate antibiotic utilization across the spectrum of inpatient and ambulatory care and implications for prioritization of antibiotic stewardship efforts

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.871 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S354-S354

Author(s):

Holly M Frost ◽

Bryan C Knepper ◽

Katherine C Shihadeh ◽

Timothy C Jenkins

Keyword(s):

Ambulatory Care ◽

Healthcare System ◽

Antibiotic Stewardship ◽

Antibacterial Agent ◽

Antibiotic Use ◽

Urgent Care ◽

Outpatient Clinics ◽

Integrated Healthcare ◽

Adult Outpatient ◽

Systemic Antibacterial

Abstract Background Antibiotic overuse remains a significant problem in inpatient and outpatient settings. The objective of this study was to develop a methodology to evaluate antibiotic use across inpatient and ambulatory care sites in an integrated healthcare system in order to prioritize antibiotic stewardship efforts. Methods We conducted an epidemiologic study of antibiotic use across an integrated healthcare system on 12 randomly-selected days between October 1, 2017 and September 30, 2018. Inpatients and perioperative patients were recorded as having received an antibiotic if they were administered ≥1 dose of a systemic antibacterial agent. Outpatients were recorded as having received an antibiotic if they were prescribed ≥1 systemic antibacterial agent. Results On the study days, 10.9% (95% CI 10.6–11.3%) of patients received an antibiotic. Of all antibiotics administered or prescribed, 54.1% were from ambulatory care (95% CI 52.6–55.7%), 38.0% were from the hospital, (95% CI 36.6–39.5%), and 7.8% (95% CI 7.1–7.8%) were perioperative. The emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards accounted for 26.4% (95% CI: 25.0–27.7%), 23.8% (95% CI: 22.6–25.2), and 23.9% (95% CI 22.7–25.3) of antibiotic use, respectively. Only 9.2% (95% CI: 8.3–10.1%) of all antibiotics were administered in critical care units. Antibiotics with a broad spectrum of Gram-negative activity accounted for 30.4% (95% CI: 29.0–31.9%) of all antibiotics prescribed. Infections of the respiratory tract were the leading indication for antibiotic use. Conclusion In an integrated healthcare system, nearly three-quarters of antibiotic use occurred in the emergency department/urgent care centers, adult outpatient clinics, and adult noncritical care inpatient wards. Antibiotics with a broad spectrum of Gram-negative activity accounted for a large portion of antibiotic use. Analysis of antibiotic utilization across the spectrum of inpatient and ambulatory care is useful to prioritize antibiotic stewardship efforts. Disclosures All authors: No reported disclosures.

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Antibiotic resistance in European wastewater treatment plants mirrors the pattern of clinical antibiotic resistance prevalence

Science Advances ◽

10.1126/sciadv.aau9124 ◽

2019 ◽

Vol 5 (3) ◽

pp. eaau9124 ◽

Cited By ~ 83

Author(s):

Katariina M. M. Pärnänen ◽

Carlos Narciso-da-Rocha ◽

David Kneis ◽

Thomas U. Berendonk ◽

Damiano Cacace ◽

...

Keyword(s):

Antibiotic Resistance ◽

Wastewater Treatment ◽

Wastewater Treatment Plants ◽

Action Plan ◽

Quantitative Polymerase Chain Reaction ◽

Antibiotic Use ◽

Control Measures ◽

World Health ◽

Global Action ◽

Health Organization

Integrated antibiotic resistance (AR) surveillance is one of the objectives of the World Health Organization global action plan on antimicrobial resistance. Urban wastewater treatment plants (UWTPs) are among the most important receptors and sources of environmental AR. On the basis of the consistent observation of an increasing north-to-south clinical AR prevalence in Europe, this study compared the influent and final effluent of 12 UWTPs located in seven countries (Portugal, Spain, Ireland, Cyprus, Germany, Finland, and Norway). Using highly parallel quantitative polymerase chain reaction, we analyzed 229 resistance genes and 25 mobile genetic elements. This first trans-Europe surveillance showed that UWTP AR profiles mirror the AR gradient observed in clinics. Antibiotic use, environmental temperature, and UWTP size were important factors related with resistance persistence and spread in the environment. These results highlight the need to implement regular surveillance and control measures, which may need to be appropriate for the geographic regions.

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2070. Assessing Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A National Survey

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1750 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S698-S698

Author(s):

Rachel M Zetts ◽

Andrea Garcia ◽

Jason Doctor ◽

Jeffrey Gerber ◽

Jeffrey A Linder ◽

...

Keyword(s):

United States ◽

Primary Care ◽

Antibiotic Resistance ◽

National Survey ◽

Antibiotic Stewardship ◽

Primary Care Physicians ◽

Antibiotic Use ◽

The United States ◽

Incentive Program ◽

Data Feedback

Abstract Background At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship can improve prescribing and minimize the threat of antibiotic resistance. We assessed primary care physicians’ (PCPs) perceptions of antibiotic resistance, inappropriate antibiotic use, and the need for and impact of antibiotic stewardship activities. Methods We conducted a national survey of 1,550 internal and family medicine physicians and pediatricians recruited from a medical market research panel. Quotas were established to recruit participants by geographic region and specialty. For sample representativeness, survey weights were generated according to these characteristics using the American Medical Association’s Masterfile. Results Among respondents, 94% agreed that resistance is a problem in the United States, but only 55% felt it was a problem for their practice; 65% of respondents agreed they had seen an increase in resistant infections in their patients over the past 5 years. Responses about inappropriate antibiotic use were similar: 91% agreed that it was a problem, but 37% agreed that it is a problem in their practice. Additionally, 60% felt they prescribed antibiotics more appropriately than their peers. For antibiotic stewardship, 91% felt it was appropriate for office-based practices, but 53% believed that discussions with patients on the appropriate use of antibiotics is sufficient to address the problem. The majority of respondents indicated they were likely, very likely, or extremely likely to implement stewardship interventions in response to feedback or incentives from payers or health departments. The activities with the strongest likelihood to spur stewardship adoption included the state health department publishing local resistance patterns (82%), a payer creating a stand-alone incentive program for stewardship (80%), or a payer including it in a broader quality incentive program (76%). Conclusion PCPs feel that antibiotic resistance, inappropriate prescribing, and stewardship are important in the United States, but not for their own practices. This disconnect poses a challenge for the success of outpatient stewardship programs. Incentive or data feedback activities may help encourage stewardship uptake. Disclosures All authors: No reported disclosures.

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The role of “spillover” in antibiotic resistance

10.1101/536714 ◽

2019 ◽

Cited By ~ 1

Author(s):

Scott W. Olesen ◽

Marc Lipsitch ◽

Yonatan H. Grad

Keyword(s):

Mathematical Modeling ◽

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Dynamical Models ◽

Modeling And Analysis ◽

Us States ◽

Key Driver ◽

Resistance Data

ABSTRACTAntibiotic use is a key driver of antibiotic resistance. Understanding the quantitative association between antibiotic use and resulting resistance is important for predicting future rates of antibiotic resistance and for designing antibiotic stewardship policy. However, the use-resistance association is complicated by “spillover”, in which one population’s level of antibiotic use affects another population’s level of resistance via the transmission of bacteria between those populations. Spillover is known to have effects at the level of families and hospitals, but it is unclear if spillover is relevant at larger scales. We used mathematical modeling and analysis of observational data to address this question. First, we used dynamical models of antibiotic resistance to predict the effects of spillover. Whereas populations completely isolated from one another do not experience any spillover, we found that if even 1% of interactions are between populations, then spillover may have large consequences: the effect of a change in antibiotic use in one population on antibiotic resistance in that population could be reduced by as much as 50%. Then, we quantified spillover in observational antibiotic use and resistance data from US states and European countries for 3 pathogen-antibiotic combinations, finding that increased interactions between populations were associated with smaller differences in antibiotic resistance between those populations. Thus, spillover may have an important impact at the level of states and countries, which has ramifications for predicting the future of antibiotic resistance, designing antibiotic resistance stewardship policy, and interpreting stewardship interventions.

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Potential impact of outpatient stewardship interventions on antibiotic exposures of common bacterial pathogens

eLife ◽

10.7554/elife.52307 ◽

2020 ◽

Vol 9 ◽

Author(s):

Christine Tedijanto ◽

Yonatan H Grad ◽

Marc Lipsitch

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Pathogenic Bacteria ◽

Selective Pressure ◽

Bacterial Pathogens ◽

Antibiotic Use ◽

Infection Incidence ◽

Potential Impact ◽

The Relationship

The relationship between antibiotic stewardship and population levels of antibiotic resistance remains unclear. In order to better understand shifts in selective pressure due to stewardship, we use publicly available data to estimate the effect of changes in prescribing on exposures to frequently used antibiotics experienced by potentially pathogenic bacteria that are asymptomatically colonizing the microbiome. We quantify this impact under four hypothetical stewardship strategies. In one scenario, we estimate that elimination of all unnecessary outpatient antibiotic use could avert 6% to 48% (IQR: 17% to 31%) of exposures across pairwise combinations of sixteen common antibiotics and nine bacterial pathogens. All scenarios demonstrate that stewardship interventions, facilitated by changes in clinician behavior and improved diagnostics, have the opportunity to broadly reduce antibiotic exposures across a range of potential pathogens. Concurrent approaches, such as vaccines aiming to reduce infection incidence, are needed to further decrease exposures occurring in ‘necessary’ contexts.

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