scholarly journals Antimicrobial Use Over a Four-Year Period Using Days of Therapy Measurement at a Canadian Pediatric Acute Care Hospital

2015 ◽  
Vol 26 (5) ◽  
pp. 253-258 ◽  
Author(s):  
Bruce R Dalton ◽  
Sandra J MacTavish ◽  
Lauren C Bresee ◽  
Nipunie Rajapakse ◽  
Otto Vanderkooi ◽  
...  
Keyword(s):  
Acute Care ◽  
Medication Administration ◽  
Prescribing Patterns ◽  
Antimicrobial Use ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Surveillance Period ◽  
Children's Hospital ◽  
Days Of Therapy ◽  
Children’S Hospital

BACKGROUND: Antimicrobial resistance is a concern that is challenging the ability to treat common infections. Surveillance of antimicrobial use in pediatric acute care institutions is complicated because the common metric unit, the defined daily dose, is problematic for this population.OBJECTIVE: During a four-year period in which no specific antimicrobial stewardship initiatives were conducted, pediatric antimicrobial use was quantified using days of therapy (DOT) per 100 patient days (PD) (DOT/100 PD) at the Alberta Children’s Hospital (Calgary, Alberta) for benchmarking purposes.METHODS: Drug use data for systemic antimicrobials administered on wards at the Alberta Children’s Hospital were collected from electronic medication administration records. DOT were calculated and rates were determined using 100 PD as the denominator. Changes over the surveillance period and subgroup proportions were represented graphically and assessed using linear regression.RESULTS: Total antimicrobial use decreased from 93.6 DOT/100 PD to 75.7 DOT/100 PD (19.1%) over the 2010/2011 through to the 2013/2014 fiscal years. During this period, a 20.0% increase in PD and an essentially stable absolute count of DOT (2.9% decrease) were observed. Overall, antimicrobial use was highest in the pediatric intensive care and oncology units.DISCUSSION: The exact changes in prescribing patterns that led to the observed reduction in DOT/100 PD with associated increased PD are unclear, but may be a topic for future investigations.CONCLUSION: Antimicrobial use data from a Canadian acute care pediatric hospital reported in DOT/100 PD were compiled for a four-year time period. These data may be useful for benchmarking purposes.

scholarly journals 2892. The Relationship Between Inpatient and Post-discharge Antimicrobial Use at the Hospital-level Across an Integrated Healthcare Network

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S79-S80
Author(s):  
Daniel J Livorsi ◽  
Jade Feller ◽  
Brian Lund ◽  
Bruce Alexander ◽  
Rajeshwari Nair ◽  
...  
Keyword(s):  
Hospital Discharge ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Health Administration ◽  
Hospital Level ◽  
Post Discharge ◽  
Antimicrobial Prescribing ◽  
Days Of Therapy

Abstract Background Hospital-based antimicrobial stewardship interventions and metrics have typically focused only on inpatient antimicrobial exposure. However, single-center studies have found a large portion of antimicrobial exposure occurs immediately after hospital discharge. We sought to describe antimicrobial-prescribing upon hospital discharge across the Veterans Health Administration (VHA) and to compare inpatient and post-discharge antimicrobial use at the hospital-level. Methods This retrospective study used national VHA administrative data to identify all acute-care admissions from January 1, 2014 to December 31, 2016. Post-discharge antimicrobials were defined as oral outpatient antimicrobials prescribed at the time of hospital discharge. We measured inpatient-days of therapy (DOT) and post-discharge DOTs. At the hospital-level, inpatient DOTs per 100 admissions were compared with post-discharge DOTs per 100 admissions using Spearman’s rank-order correlation. Results Among 1.7 million acute-care admissions across 122 VHA hospitals, 46.1% were administered inpatient antimicrobials and 19.9% were prescribed an oral antimicrobial at discharge. Fluoroquinolones were the most common antimicrobial prescribed at discharge among 335,396 antimicrobial prescriptions (38.3%). At the hospital-level, median inpatient antimicrobial use was 331.3 DOTs per 100 admissions (interquartile range (IQR) 284.9–367.9) and median post-discharge use was 209.5 DOTs per 100 admissions (IQR 181.5–239.6). Thirty-nine percent of the total duration of antimicrobial exposure occurred after hospital discharge. The metrics of inpatient DOTs per 100 admissions and post-discharge DOTs per 100 admissions were weakly correlated at the hospital-level (rho = 0.44, P < 0.0001). Conclusion Antimicrobial-prescribing at hospital discharge was common and contributed substantially to the total antimicrobial exposure associated with an acute-care hospital stay. A hospital’s inpatient antimicrobial use was only weakly correlated with its post-discharge antimicrobial use. Antimicrobial stewardship interventions should specifically target antimicrobial-prescribing at discharge. Disclosures All Authors: No reported Disclosures.

scholarly journals 109. Develop and Implement a Novel Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital Located in an Adult-Centered Community Hospital in San Joaquin Valley, California

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S168-S169
Author(s):  
Tsung-Chi Lien ◽  
Laurie Covarrubias ◽  
Alice Ip ◽  
Harlan Husted ◽  
Emi Suzuki ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Medical Center ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospital ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Children’S Hospital

Abstract Background A pediatric-specific antimicrobial stewardship program (Ped ASP) has been shown to optimize antimicrobial use, improve patient outcomes, and reduce healthcare expenditures in this population. Opportunities and challenges exist when developing a Ped ASP for a children’s hospital within an adult-centered medical center primarily due to mixed infrastructure. The objective of this study is to provide process and outcome data of a new Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital. Methods A pediatric infectious disease physician and four pediatric pharmacists designed a Ped ASP utilizing direct and indirect patient care activities to optimize pediatric antimicrobial use in 21 bed-pediatric services within a 685-bed, adult-centered medical center. Implemented in 2020, Ped ASP activities include thrice weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The Ped ASP team also developed policies, education, and other resources to further guide appropriate antimicrobial use, in collaboration with the adult team. Results Ped ASP was initiated on general pediatric (PED) and pediatric intensive care (PICU) units. In 2020, a total of 286 charts were reviewed with 199 antibiotic interventions provided, including optimization of antimicrobial selection (23%), IV-to-PO conversion (15%), and antimicrobial dosage adjustment (13%). Annual average antibiotic length and days of therapy per 1000 patient-days were 241 and 290 respectively in PED, and 388 and 432 in PICU. The overall trend from 2020 to 2021 decreased in PED but increased in PICU (Fig. 1). The ratio of narrow to broad spectrum antibiotic use increased for both PED and PICU (Fig. 2). Simultaneously, a pediatric-specific antibiogram, extended-infusion protocol of beta-lactams, and neonatal sepsis treatment algorithm were developed and implemented. Antibiotic Days of Therapy per 1000 Patient Days Ratio of Narrow: Broad Spectrum Antibiotic Usage Conclusion A Ped ASP was successfully developed in a non-freestanding children’s hospital. Continual metrics served as an important tool to identify areas for improvement. Future goals include expansion of Ped ASP to other service lines, enhanced ASP education and development of additional pediatric antimicrobial treatment pathways. Disclosures All Authors: No reported disclosures

scholarly journals Prospective Audit for Antimicrobial Use and Stewardship Practices in Intensive Care Unit at a Tertiary-Care Center in India

2021 ◽  
Vol 1 (S1) ◽  
pp. s40-s40
Author(s):  
Parul Singh ◽  
Purva Mathur ◽  
Kamini Walia ◽  
Anjan Trikha
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Empirical Therapy ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Defined Daily Dose ◽  
Survey Form ◽  
Specimen Collection ◽  
Days Of Therapy

Background: Antimicrobial decision making in the ICU is challenging. Injudicious use of antimicrobials contributes to the development of resistant pathogens and drug-related adverse events. However, inadequate antimicrobial therapy is associated with mortality in critically ill patients. Antimicrobial stewardship programs are increasingly being implemented to improve prescribing. Methods: This prospective study was conducted over 11 months, during which the pharmacist used a standardized survey form to collect data on antibiotic use. Evaluation of antimicrobial use and stewardship practices in a 12-bed polytrauma ICU and a 20-bed neurosurgery ICU of the 248-bed AIIMS Trauma Center in Delhi, India. Antimicrobial consumption was measured using WHO-recommended defined daily dose (DDD) of given antimicrobials and days of therapy (DOT). Results: Antibiotics were ranked by frequency of use over the 11-month period based on empirical therapy and culture-based therapy. The 11-month DDD and DOT averages when empiric antibiotics were used were 532 of 1,000 patient days and 484 per 1,000 patient days, respectively (Figure 1). When cultures were available, DDD was 486 per 1,000 patient days and DOT was 442 per 1,000 patient days (Figure). Conclusions: The quantity and frequency of antibiotics used in the ICUs allowed the AMSP to identify areas to optimize antibiotic use such as educational initiatives, early specimen collection, and audit and feedback opportunities.Funding: NoDisclosures: None

scholarly journals A trend in prevalence of antimicrobial use and appropriateness of antimicrobial therapy in an acute care hospital from 2018 to 2019: repeated prevalence surveys in Japan

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Junpei Komagamine ◽  
Taku Yabuki ◽  
Taku Hiraiwa
Keyword(s):  
Drug Use ◽  
Acute Care ◽  
Antimicrobial Therapy ◽  
Acute Care Hospital ◽  
Antimicrobial Drug ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Antimicrobial Drugs ◽  
Inappropriate Use ◽  
Appropriate Antimicrobial Use

Abstract Objectives The supply of cefazolin has been reduced dramatically since March 2019 in Japan. However, no studies have evaluated the effects of cefazolin shortage on the appropriateness of antimicrobial use. Therefore, we compared the appropriateness of inpatient antimicrobial drug use between the two surveys conducted in August 2018 and August 2019 in a Japanese hospital with no supply of cefazolin since the cefazolin shortage. Results In the 2019 survey, a total of 275 patients were included, and 256 patients were included in the 2018 survey. The prevalence of antimicrobial drug use did not change from 2018 to 2019 (28.5% versus 28.7%; p = 0.96). The proportion of cefazolin in all antimicrobial drugs used on the survey date significantly decreased from 2018 to 2019 (24.1% versus 0.0%; p < 0.001). The proportion of appropriate antimicrobial use in all antimicrobial therapies tended to be lower in 2019 than in 2018 (41.2% versus 60.6%; p = 0.06), and the proportion of unnecessary use of a broader spectrum of antimicrobial drugs significantly increased from 2018 to 2019 (4.7% versus 37.3%; p = 0.002). The shortage of cefazolin might lead to inappropriate use of other antimicrobial drugs.

scholarly journals Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19

2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Lydia R Rahem ◽  
Bénédicte Franck ◽  
Hélène Roy ◽  
Denis Lebel ◽  
Philippe Ovetchkine ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Pediatric Population ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Defined Daily Dose ◽  
Centre Hospitalier ◽  
Stewardship Program ◽  
Centre Hospitalier Universitaire ◽  
Days Of Therapy

Background: Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. Objective: To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. Methods: In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. Results: Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/ maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). Conclusions: This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program. RÉSUMÉ Contexte : La gestion des antimicrobiens est une pratique courante dans les centres hospitaliers afin de réduire l’utilisation inappropriée des antimicrobiens et le risque de résistance. Objectif : Décrire l’évolution de l’utilisation des antimicrobiens dans un centre hospitalier universitaire de 2015-16 à 2018-19. Méthodes : Dans cette étude rétrospective, descriptive et transversale, les dossiers pharmacologiques ont servi à déterminer le nombre de jours de traitement (NJT) et la dose définie journalière (DDD) par 1000 jours-présence (JP) pour chaque antimicrobien et pour chaque unité de soins par année de l’étude. Pour chaque mesure, on a également comparé le ratio de 2018-19 à celui de 2015-16, qui est exprimé en proportion; lorsque la valeur de cette proportion était ≤ 0,8 ou ≥ 1,2, ce qui indiquait un changement important durant la période de l’étude, une note explicative a été attribuée par consensus. Résultats : Durant la période à l’étude, 94 antimicrobiens ont été disponibles dans notre centre : 70 antibiotiques (dont les antiparasitaires et les antituberculeux), 14 antiviraux et 10 antifongiques. Le nombre total de NJT par 1000 JP a diminué de 904 en 2015-16 à 867 en 2018-19. Les cinq antimicrobiens utilisés le plus fréquemment et présentés en minimum / maximum de NJT par 1000 JP étaient les suivants : piperacilline-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicilline (51/69), vancomycine (53/68) et cefotaxime (55/58). Pendant la même période, les unités de soins qui faisaient la plus grande utilisation d’antimirobiens (exprimée en minimum / maximum de NJT par 1000 JP) étaient hématologie-oncologie (2529/2723), pédiatrie (1006/1408) et soins intensifs pédiatriques (1328/1717). Conclusions : Cette étude démontre une consommation stable d’antimicrobiens entre 2015-16 et 2018-19 dans un centre hospitalier universitaire mère-enfant canadien. Malgré le fait que la consommation entre les groupes d’antimicrobiens (antibiotiques, antiviraux, antifongiques) était stable, on a constaté d’importantes variations concernant certains médicaments individuels. Plusieurs facteurs peuvent expliquer cette variation, notamment des ruptures d’approvisionnement, des changements de pratique et des changements dans la prévalence d’infections. La surveillance de la consommation des antimicrobiens est une partie essentielle de tout programme d’antibiogouvernance.

Impact of the Use of Procalcitonin Assay in Hospitalized Adult Patients with Pneumonia at a Community Acute Care Hospital

2012 ◽  
Vol 33 (4) ◽  
pp. 424-426 ◽  
Author(s):  
Janet L. Kook ◽  
Stephanie R. Chao ◽  
Jennifer Le ◽  
Philip A. Robinson
Keyword(s):  
Cohort Study ◽  
Acute Care ◽  
Acute Care Hospital ◽  
Antibiotic Use ◽  
Adult Patients ◽  
Care Hospital ◽  
Days Of Therapy ◽  
Before And After ◽  
Quasi Experimental

A retrospective, quasi-experimental cohort study compared antibiotic use before and after implementation of a procalcitonin assay at a community acute care hospital. This study demonstrated that the implementation of the procalcitonin assay was associated with a decrease in antibiotic days of therapy in adult patients with pneumonia.

scholarly journals Impact of the COVID-19 pandemic on neonatal admissions in a tertiary children’s hospital in southwest China: An interrupted time-series study

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0262202
Author(s):  
Weiqin Liu ◽  
Qifen Yang ◽  
Zhen-e Xu ◽  
Ya Hu ◽  
Yongming Wang ◽  
...  
Keyword(s):  
Time Series ◽  
Southwest China ◽  
Interrupted Time Series ◽  
Care Hospital ◽  
Health Seeking ◽  
Health Seeking Behavior ◽  
Children's Hospital ◽  
Children’S Hospital ◽  
Seeking Behavior ◽  
The Impact

Background The unprecedented coronavirus disease 2019 (COVID-19) pandemic has caused millions of infections worldwide and represents a significant challenge facing modern health care systems. This study was conducted to investigate the impact of lockdown measures in a tertiary Children’s Hospital in southwest China, which might be used to predict long-term effects related to health-seeking behavior of parents/caregivers. Methods This study included newborns enrolled over a span of 86 weeks between January 4, 2019, and August 27, 2020. We designated two time periods for analysis purposes: a stable pre-COVID period(55 weeks between January 4, 2019, and January 23, 2020) and a COVID-impacted period (31 weeks between January 24, 2020, and August 27, 2020). An interrupted time-series analysis was employed to compare changes and trends in hospital admissions and disease spectra before and after the period of nonpharmaceutical interventions (NPIs). Furthermore, this study was conducted to evaluate whether the health-seeking behavior of parents/caregivers was influenced by pandemic factors. Results Overall, 16,640 infants were admitted to the neonatology department during the pre-COVID period (n = 12,082) and the COVID-impacted period (n = 4,558). The per week neonatal admissions consistently decreased following the first days of NPIs (January 24, 2020). The average weekly admission rates of 220/week pre-COVID period and 147/week COVID-impacted period. There was an evident decrease in the volume of admissions for all disease spectra after the intervention, whereas the decrease of patients complaining about pathological jaundice-related conditions was statistically significant (p<0.05). In the COVID-impacted period, the percentage of patients who suffered from respiratory system diseases, neonatal encephalopathy, and infectious diseases decreased, while the percentage of pathological jaundice-related conditions and gastrointestinal system diseases increased. The neonatal mortality rates (NMRs) increased by 8.7% during the COVID-impacted period compared with the pre-COVID period. Conclusions In summary, there was a significant decline in neonatal admissions in a tertiary care hospital during the COVID-19 Pandemic and the associated NPIs. Additionally, this situation had a remarkable impact on disease spectra and health-seeking behavior of parents/caregivers. We, therefore, advise continuing follow-ups and monitoring the main health indicators in vulnerable populations affected by this Pandemic over time.

scholarly journals Antimicrobial use trends, Israel, 2012 to 2017

2019 ◽  
Vol 24 (34) ◽  
Author(s):  
Yaakov Dickstein ◽  
Elizabeth Temkin ◽  
Debby Ben-David ◽  
Yehuda Carmeli ◽  
Mitchell J Schwaber
Keyword(s):  
Acute Care ◽  
Acute Care Hospital ◽  
Acute Care Hospitals ◽  
Study Data ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Hospital Data ◽  
Surgical Intensive Care ◽  
Health Maintenance ◽  
Defined Daily Doses

Background In 2012, Israel’s National Center for Infection Control initiated a national stewardship programme that included mandatory annual reporting of antimicrobial use. Here we present nationwide Israeli data for the period 2012 to 2017. Aim The goal of this study was to detect trends in antimicrobial use in Israel following the introduction of the stewardship programme, as part of an assessment of the programme’s impact. Methods In this retrospective observational study, data were collected from Israel’s health maintenance organisations (HMOs), acute care hospitals and post-acute care hospitals (PACHs). Acute care hospital data were collected for general medical and surgical wards, and medical/surgical intensive care units (ICUs). Data were converted into defined daily doses (DDD), with use rates presented as DDD per 1,000 insured/day in the community and DDD per 100 patient-days in hospitals and PACHs. Trends were analysed using linear regression. Results Antimicrobial use decreased across sectors between 2012 and 2017. In the community, the decrease was modest, from 22.8 to 21.8 DDD per 1,000 insured per day (4.4%, p = 0.004). In acute care hospitals, antibiotic DDDs per 100 patient-days decreased from 100.0 to 84.0 (16.0%, p = 0.002) in medical wards, from 112.8 to 94.2 (16.5%, p = 0.004) in surgical wards and from 154.4 to 137.2 (11.1%, p = 0.04) in ICUs. Antimicrobial use decreased most markedly in PACHs, from 29.1 to 18.1 DDD per 100 patient-days (37.8%, p = 0.005). Conclusion Between 2012 and 2017, antimicrobial use decreased significantly in all types of healthcare institutions in Israel, following the introduction of the nationwide antimicrobial stewardship programme.

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