scholarly journals Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryuji Koizumi ◽  
Yoshiki Kusama ◽  
Yusuke Asai ◽  
Gu Yoshiaki ◽  
Yuichi Muraki ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Prediction Model ◽  
Broad Spectrum ◽  
Early Recognition ◽  
Antimicrobial Use ◽  
Appropriate Use ◽  
Sales Data ◽  
Defined Daily Doses ◽  
Before And After ◽  
Appropriate Antimicrobial Use

Abstract Background Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. Methods We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler’s sales databases. Using 2016–2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. Results DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. Conclusion The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required.

scholarly journals Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

2021 ◽  
Author(s):  
Ryuji KOIZUMI ◽  
Yoshiki KUSAMA ◽  
Yusuke ASAI ◽  
Yoshiaki GU ◽  
Yuichi MURAKI ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Prediction Model ◽  
Broad Spectrum ◽  
Early Recognition ◽  
Antimicrobial Use ◽  
Appropriate Use ◽  
Sales Data ◽  
Defined Daily Doses ◽  
Before And After ◽  
Appropriate Antimicrobial Use

Abstract Background Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. Methods We evaluated monthly defined daily doses/1,000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler’s sales databases. Using 2016–2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and non-government-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. Results DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. Conclusion The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required.

scholarly journals Longitudinal surveillance of outpatient β-lactam antimicrobial use in Canada, 1995 to 2010

2014 ◽  
Vol 25 (2) ◽  
pp. 107-112 ◽  
Author(s):  
Shiona K Glass-Kaastra ◽  
Rita Finley ◽  
Jim Hutchinson ◽  
David M Patrick ◽  
Karl Weiss ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Broad Spectrum ◽  
Population Data ◽  
Time Frame ◽  
Repeated Measurements ◽  
Antimicrobial Use ◽  
Defined Daily Doses ◽  
Canadian Provinces ◽  
Statistics Canada ◽  
Over Time

INTRODUCTION: β-lactam antimicrobials are the most commonly prescribed group of antimicrobials in Canada, and are categorized by the WHO as critically and highly important antimicrobials for human medicine. Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is highly important.OBJECTIVE: To assess the use of penicillin and cephalosporin antimicrobials within Canadian provinces over the 1995 to 2010 time frame according to two metrics: prescriptions per 1000 inhabitant-days and the average defined daily doses dispensed per prescription.METHODS: Antimicrobial prescribing data were acquired from the Canadian Integrated Program for Antimicrobial Resistance Surveillance and the Canadian Committee for Antimicrobial Resistance, and population data were obtained from Statistics Canada. The two measures developed were used to produce linear mixed models to assess differences among provinces and over time for the broad-spectrum penicillin and cephalosporin groups, while accounting for repeated measurements at the provincial level.RESULTS: Significant differences among provinces were found, as well as significant changes in use over time. A >28% reduction in broad-spectrum penicillin prescribing occurred in each province from 1995 to 2010, and a >18% reduction in cephalosporin prescribing occurred in all provinces from 1995 to 2010, with the exception of Manitoba, where cephalosporin prescribing increased by 18%.DISCUSSION: Significant reductions in the use of these important drugs were observed across Canada from 1995 to 2010. Newfoundland and Labrador and Quebec emerged as divergent from the remaining provinces, with high and low use, respectively.

scholarly journals Global Trends in Antimicrobial Use in Food Animals from 2017 to 2030

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 918
Author(s):  
Katie Tiseo ◽  
Laura Huber ◽  
Marius Gilbert ◽  
Timothy P. Robinson ◽  
Thomas P. Van Boeckel
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Multivariate Regression ◽  
Regression Models ◽  
Antimicrobial Use ◽  
Antimicrobial Consumption ◽  
Export Markets ◽  
Global Trends ◽  
Sales Data ◽  
Intensive Farming

Demand for animal protein is rising globally and has been facilitated by the expansion of intensive farming. However, intensive animal production relies on the regular use of antimicrobials to maintain health and productivity on farms. The routine use of antimicrobials fuels the development of antimicrobial resistance, a growing threat for the health of humans and animals. Monitoring global trends in antimicrobial use is essential to track progress associated with antimicrobial stewardship efforts across regions. We collected antimicrobial sales data for chicken, cattle, and pig systems in 41 countries in 2017 and projected global antimicrobial consumption from 2017 to 2030. We used multivariate regression models and estimated global antimicrobial sales in 2017 at 93,309 tonnes (95% CI: 64,443, 149,886). Globally, sales are expected to rise by 11.5% in 2030 to 104,079 tonnes (95% CI: 69,062, 172,711). All continents are expected to increase their antimicrobial use. Our results show lower global antimicrobial sales in 2030 compared to previous estimates, owing to recent reports of decrease in antimicrobial use, in particular in China, the world’s largest consumer. Countries exporting a large proportion of their production are more likely to report their antimicrobial sales data than countries with small export markets.

Perception, Attitude, and Knowledge Regarding Antimicrobial Resistance, Appropriate Antimicrobial Use, and Infection Control Among Future Medical Practitioners: A Multicenter Study

2016 ◽  
Vol 37 (5) ◽  
pp. 603-605 ◽  
Author(s):  
Nuttagarn Chuenchom ◽  
Visanu Thamlikitkul ◽  
Romanee Chaiwarith ◽  
Rawisut Deoisares ◽  
Pinyo Rattanaumpawan
Keyword(s):  
Medical Students ◽  
Antimicrobial Resistance ◽  
Infection Control ◽  
Multicenter Study ◽  
Control Unit ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Medical Practitioners ◽  
Stewardship Program ◽  
Appropriate Antimicrobial Use

A questionnaire-based study was conducted among final-year Thai medical students. The problem of antimicrobial resistance is well recognized, but their knowledge of antimicrobial resistance, appropriate antimicrobial use, and infection control was substantially limited. Only half of these students recognized existence of an antimicrobial stewardship program or infection control unit in their hospitals.Infect Control Hosp Epidemiol 2016;37:603–605

Impact of Different Methods of Feedback to Clinicians After Postprescription Antimicrobial Review Based on the Centers for Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults

2007 ◽  
Vol 28 (6) ◽  
pp. 641-646 ◽  
Author(s):  
Sara E. Cosgrove ◽  
Alpa Patel ◽  
Xiaoyan Song ◽  
Robert E. Miller ◽  
Kathleen Speck ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Disease Control ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Detection System ◽  
Tertiary Care ◽  
Clinical Event ◽  
Antimicrobial Use ◽  
12 Steps ◽  
Centers For Disease Control

Objectives.To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review.Design.Prospective intervention to identify and modify inappropriate antimicrobial therapy.Setting.A 1,000-bed, tertiary care teaching hospital.Patients.Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours.Interventions.We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and “reserve” antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC.Results.Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 (“target the pathogen”), 1% into step 4 (“access experts”), 3% into steps 7 and 8 (“treat infection, not colonization or contamination”), 18% into step 9 (“say ‘no’ to vancomycin”), and 26% into step 10 (“stop treatment when no infection”). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback.Conclusions.Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.

scholarly journals The Hospital Antimicrobial Use Process: From Beginning to End

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
William R Truong ◽  
Jason Yamaki
Keyword(s):  
Antimicrobial Resistance ◽  
Patient Outcomes ◽  
Adverse Drug Reactions ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Drug Reactions ◽  
Improve Patient ◽  
Appropriate Antimicrobial Use

Abstract Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient’s treatment course. Hence, approaching AMS through the framework of a hospital’s AUP is essential to improving appropriate antimicrobial use.

scholarly journals Informing Stewardship Measures in Canadian Food Animal Species through Integrated Reporting of Antimicrobial Use and Antimicrobial Resistance Surveillance Data—Part II, Application

Pathogens ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1491
Author(s):  
Agnes Agunos ◽  
Sheryl P. Gow ◽  
Anne E. Deckert ◽  
David F. Léger
Keyword(s):  
Antimicrobial Resistance ◽  
Animal Health ◽  
Surveillance Data ◽  
Integrated Analysis ◽  
Antimicrobial Use ◽  
Integrated Reporting ◽  
Farm Level ◽  
Antimicrobial Resistance Surveillance ◽  
Defined Daily Doses ◽  
The Impact

Using the methodology developed for integrated analysis and reporting of antimicrobial use (AMU) and antimicrobial resistance (AMR) data, farm-level surveillance data were synthesized and integrated to assess trends and explore potential AMU and AMR associations. Data from broiler chicken flocks (n = 656), grower–finisher pig herds (n = 462) and turkey flocks (n = 339) surveyed by the Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) at the farm-level (2015–2019) were used. The analyses showed a reduction in mean flock/herd level number of defined daily doses using Canadian standards (nDDDvetCA) adjusted for kg animal biomass that coincided with the decline in % resistance in the three species. This was noted in most AMU-AMR pairs studied except for ciprofloxacin resistant Campylobacter where resistance continued to be detected (moderate to high levels) despite limited fluoroquinolone use. Noteworthy was the significantly negative association between the nDDDvetCA/kg animal biomass and susceptible Escherichia coli (multispecies data), an early indication that AMU stewardship actions are having an impact. However, an increase in the reporting of diseases in recent years was observed. This study highlighted the value of collecting high-resolution AMU surveillance data with animal health context at the farm-level to understand AMR trends, enable data integration and measure the impact of AMU stewardship actions.

scholarly journals 920. Use of the Web by State and Territorial Health Departments to Promote the Dissemination of State Antimicrobial Resistance Surveillance Data, United States

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S494-S495
Author(s):  
Xin Yin ◽  
Keith W Hamilton ◽  
Heather Tate ◽  
Nkuchia M M’ikanatha
Keyword(s):  
Public Health ◽  
United States ◽  
Antimicrobial Resistance ◽  
Health Professionals ◽  
One Health ◽  
Antimicrobial Use ◽  
Web Survey ◽  
Related Information ◽  
Appropriate Antimicrobial Use ◽  
The Web

Abstract Background Antimicrobial resistant (AMR) bacteria pose a serious threat to public health. The national response to this threat includes calls for promoting judicious use of antibiotics in humans and animals and strengthening integrated One Health surveillance of AMR bacteria in humans, animals, and environment. However, the extent to which public health jurisdictions are disseminating surveillance findings to promote judicious use of antimicrobials is unclear. Methods We used a standardized web audit tool to manually review and document the presence of AMR-related information on the websites of all public health jurisdictions that participate in national notifiable disease surveillance in the United States. We also emailed a survey to representatives in the 54 jurisdictions that participate in the National Antimicrobial Resistance Monitoring System (NARMS) activities coordinated by the Centers for Disease Control and Prevention. The survey asked questions about AMR-related information on their public health department website. Results Of the 37 (68.5%) jurisdictions that responded to the email survey, 26 (70.3%) indicated that their websites have information on appropriate antibiotic use for health professionals, veterinarians and general public, compared to 89.3% from the web survey (Figure). Eleven (29.7%) indicated that they have data on antimicrobial susceptibility for pathogens, or antibiograms, on their websites, compared to 48.2% from the web survey. While 11 (29.7%) jurisdictions indicated that they have highlighted appropriate antimicrobial use on the homepage, the web survey found no reference on the homepage. Comparison of results from email and web survey on public health jurisdictions’ website, United States - 2020 Conclusion Public health jurisdictions have begun to use websites to increase awareness about the threat of antimicrobial resistance. However, the limited presence of information on appropriate antimicrobial use for the public, health professionals and veterinarians suggest the need for improvement. Gaps exist between the awareness of the epidemiologists and laboratorians and the information reported on public health jurisdictions’ websites. Websites can be expanded and better leveraged to increase visibility of AMR and appropriate antimicrobial prescribing across One Health domains. Disclosures All Authors: No reported disclosures

scholarly journals An Interprofessional Curriculum on Antimicrobial Stewardship Improves Knowledge and Attitudes Toward Appropriate Antimicrobial Use and Collaboration

2017 ◽  
Vol 4 (1) ◽  
Author(s):  
Conan MacDougall ◽  
Brian S. Schwartz ◽  
Lisa Kim ◽  
Mari Nanamori ◽  
Sharmin Shekarchian ◽  
...  
Keyword(s):  
Online Learning ◽  
Antimicrobial Stewardship ◽  
Interprofessional Collaboration ◽  
Pharmacy Students ◽  
Independent Learning ◽  
Antimicrobial Use ◽  
Knowledge And Attitudes ◽  
Learning Module ◽  
Before And After ◽  
Appropriate Antimicrobial Use

Abstract Background Inappropriate antimicrobial use can threaten patient safety and is the focus of collaborative physician and pharmacist antimicrobial stewardship teams. However, antimicrobial stewardship is not comprehensively taught in medical or pharmacy school curricula. Addressing this deficiency can teach an important concept as well as model interprofessional healthcare. Methods We created an antimicrobial stewardship curriculum consisting of an online learning module and workshop session that combined medical and pharmacy students, with faculty from both professions. Learners worked through interactive, branched-logic clinical cases relating to appropriate antimicrobial use. We surveyed participants before and after the curriculum using validated questions to assess knowledge and attitudes regarding antimicrobial stewardship and interprofessional collaboration. Results were analyzed using paired χ2 and t tests and mixed-effects logistic regression. Results Analysis was performed with the 745 students (425 medical students, 320 pharmacy students) who completed both pre- and postcurriculum surveys over 3 years. After completing the curriculum, significantly more students perceived that they were able to describe the role of each profession in appropriate antimicrobial use (34% vs 82%, P < .001), communicate in a manner that engaged the interprofessional team (75% vs 94%, P < .001), and describe collaborative approaches to appropriate antimicrobial use (49% vs 92%, P < .001). Student favorability ratings were high for the online learning module (85%) and small group workshop (93%). Conclusions A curriculum on antimicrobial stewardship consisting of independent learning and an interprofessional workshop significantly increased knowledge and attitudes towards collaborative antimicrobial stewardship among preclinical medical and pharmacy students.

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