Effect of population inflow and outflow between rural and urban areas on regional antimicrobial use surveillance

Purpose Regional-level measures can complement national antimicrobial stewardship programs. In Japan, sub-prefectural regions called secondary medical areas (SMAs) provide general inpatient care within their borders, and regional antimicrobial stewardship measures are frequently implemented at this level. There is therefore a need to conduct antimicrobial use (AMU) surveillance at this level to ascertain antimicrobial consumption. However, AMU estimates are generally standardized to residence-based nighttime populations, which do not account for population mobility across regional borders. We examined the impact of population in/outflow on SMA-level AMU estimates by comparing the differences between standardization using daytime and nighttime populations. Methods We obtained AMU information from the National Database of Health Insurance Claims and Specific Health Checkups of Japan. AMU was quantified at the prefectural and SMA levels using the number of defined daily doses (DDDs) divided by (a) 1,000 nighttime population per day or (b) 1,000 daytime population per day. We identified and characterized the discrepancies between the two types of estimates at the prefectural and SMA levels. Results The national AMU was 17.21 DDDs per 1,000 population per day. The mean (95% confidence interval) prefectural-level DDDs per 1,000 nighttime and daytime population per day were 17.27 (14.10, 20.44) and 17.41 (14.30, 20.53), respectively. The mean (95% confidence interval) SMA-level DDDs per 1,000 nighttime and daytime population per day were 16.12 (9.84, 22.41) and 16.41 (10.57, 22.26), respectively. The nighttime population-standardized estimates were generally higher than the daytime population-standardized estimates in urban areas, but lower in the adjacent suburbs. Large differences were observed in the main metropolitan hubs in eastern and western Japan. Conclusion Regional-level AMU estimates, especially of smaller regions such as SMAs, are susceptible to the use of different populations for standardization. This finding indicates that AMU standardization based on population values is not suitable for AMU estimates in small regions.

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The first national survey of antimicrobial use among dentists in Japan from 2015 to 2017 based on the national database of health insurance claims and specific health checkups of Japan

PLoS ONE ◽

10.1371/journal.pone.0244521 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0244521

Author(s):

Akane Ono ◽

Masahiro Ishikane ◽

Yoshiki Kusama ◽

Chika Tanaka ◽

Sachiko Ono ◽

...

Keyword(s):

Health Insurance ◽

Antimicrobial Stewardship ◽

Population Based ◽

National Database ◽

Antimicrobial Use ◽

Insurance Claims ◽

Population Based Study ◽

Defined Daily Doses ◽

Health Insurance Claims ◽

Specific Health

Purpose To counter the global health threat of antimicrobial resistance, effective antimicrobial stewardship programs are needed to improve antimicrobial use (AMU) among dentists in addition to physicians. This study aimed to investigate the nationwide epidemiology of AMU among Japanese dentists to facilitate the development of dentist-centered programs. Methods We conducted a retrospective population-based study using the National Database of Health Insurance Claims and Specific Health Checkups of Japan to analyze the AMU among Japanese dentists between 2015 and 2017. AMU was quantified as the defined daily doses per 1,000 inhabitants per day (DID). The trends in dentist-prescribed AMU were examined according to antimicrobial category and administration route. We also compared outpatient oral AMU between dentists and physicians as well as between on-site and off-site dispensing. Results The DID values of dentist-prescribed AMU were 1.23 in 2015, 1.22 in 2016, and 1.21 in 2017. During this study period, outpatient oral antimicrobials comprised the majority (approximately 99%) of dentist-prescribed AMU, and cephalosporins were the most frequently prescribed antimicrobials (>60% of all antimicrobials). The DID values of outpatient oral AMU were 1.21 for dentists and 12.11 for physicians. The DID value for on-site dispensing was 0.89 in 2017, in which cephalosporins were the predominantly used antimicrobials (DID: 0.60). Conclusions Interventions that target dentists in Japan should focus on on-site dispensing of oral antimicrobials (especially cephalosporins) for outpatients. Further studies are needed to ascertain the underlying factors of oral cephalosporin prescriptions to guide the development of effective antimicrobial stewardship programs.

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Onchocerciasis control in Ghana (1974–2016)

Parasites & Vectors ◽

10.1186/s13071-020-04507-2 ◽

2021 ◽

Vol 14 (1) ◽

Author(s):

Nana-Kwadwo Biritwum ◽

Dziedzom K. de Souza ◽

Odame Asiedu ◽

Benjamin Marfo ◽

Uche Veronica Amazigo ◽

...

Keyword(s):

Confidence Interval ◽

Vector Control ◽

Control Strategy ◽

Financial Support ◽

Control Programme ◽

Ivermectin Treatment ◽

Mobile Community ◽

The Mean ◽

The Impact ◽

Onchocerciasis Control

Abstract Background The control of onchocerciasis in Ghana started in 1974 under the auspices of the Onchocerciasis Control Programme (OCP). Between 1974 and 2002, a combination of approaches including vector control, mobile community ivermectin treatment, and community-directed treatment with ivermectin (CDTI) were employed. From 1997, CDTI became the main control strategy employed by the Ghana OCP (GOCP). This review was undertaken to assess the impact of the control interventions on onchocerciasis in Ghana between 1974 and 2016, since which time the focus has changed from control to elimination. Methods In this paper, we review programme data from 1974 to 2016 to assess the impact of control activities on prevalence indicators of onchocerciasis. This review includes an evaluation of CDTI implementation, microfilaria (Mf) prevalence assessments and rapid epidemiological mapping of onchocerciasis results. Results This review indicates that the control of onchocerciasis in Ghana has been very successful, with a significant decrease in the prevalence of infection from 69.13% [95% confidence interval) CI 60.24–78.01] in 1975 to 0.72% (95% CI 0.19–1.26) in 2015. Similarly, the mean community Mf load decreased from 14.48 MF/skin snip in 1975 to 0.07 MF/skin snip (95% CI 0.00–0.19) in 2015. Between 1997 and 2016, the therapeutic coverage increased from 58.50 to 83.80%, with nearly 100 million ivermectin tablets distributed. Conclusions Despite the significant reduction in the prevalence of onchocerciasis in Ghana, there are still communities with MF prevalence above 1%. As the focus of the GOCP has changed from the control of onchocerciasis to its elimination, both guidance and financial support are required to ensure that the latter goal is met.

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152. Applying A Difference-in-Difference Analysis to Assess Effect of Antimicrobial Stewardship Strategies on Changes in Antimicrobial Use

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.197 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S86-S86

Author(s):

Ann F Chou ◽

Yue Zhang ◽

Makoto M Jones ◽

Christopher J Graber ◽

Matthew B Goetz ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Clinical Pharmacist ◽

Antibiotic Use ◽

Feedback Mechanism ◽

Health Care Facilities ◽

Antimicrobial Use ◽

Time Points ◽

The Difference ◽

The Impact ◽

Over Time

Abstract Background About 30–50% of inpatient antimicrobial therapy is sub-optimal. Health care facilities have utilized various antimicrobial stewardship (AS) strategies to optimize appropriate antimicrobial use, improve health outcomes, and promote patient safety. However, little evidence exists to assess relationships between AS strategies and antimicrobial use. This study examined the impact of changes in AS strategies on antimicrobial use over time. Methods This study used data from the Veterans Affairs (VA) Healthcare Analysis & Informatics Group (HAIG) AS survey, administered at 130 VA facilities in 2012 and 2015, and antimicrobial utilization from VA Corporate Data Warehouse. Four AS strategies were examined: having an AS team, feedback mechanism on antimicrobial use, infectious diseases (ID) attending physicians, and clinical pharmacist on wards. Change in AS strategies were computed by taking the difference in the presence of a given strategy in a facility between 2012–2015. The outcome was the difference between antimicrobial use per 1000 patient days in 2012–2013 and 2015–2016. Employing multiple regression analysis, changes in antimicrobial use was estimated as a function of changes in AS strategies, controlling for ID human resources in and organizational complexity. Results Of the 4 strategies, only change in availability of AS teams had an impact on antimicrobial use. Compared to facilities with no AS teams at both time points, antibiotic use decreased by 63.9 uses per 1000 patient days in facilities that did not have a AS team in 2012 but implemented one in 2015 (p=0.0183). Facilities that had an AS team at both time points decreased use by 62.2 per 1000 patient days (p=0.0324). Conclusion The findings showed that AS teams reduced inpatient antibiotic use over time. While changes in having feedback on antimicrobial use and clinical pharmacist on wards showed reduced antimicrobial use between 2012–2015, the differences were not statistically significant. These strategies may already be a part of a comprehensive AS program and employed by AS teams. In further development of stewardship programs within healthcare organizations, the association between AS teams and antibiotic use should inform program design and implementation. Disclosures All Authors: No reported disclosures

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Promoting Antimicrobial Stewardship Education Among Pediatricians Through a Maintenance of Certification Part 4 Quality Impro

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.53 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s29-s29

Author(s):

Prachi Singh ◽

Brian Lee ◽

Jenna Holmen

Keyword(s):

Antimicrobial Stewardship ◽

Transition Period ◽

Surgical Patients ◽

Antimicrobial Use ◽

Maintenance Of Certification ◽

Stewardship Program ◽

Surgical Antibiotic Prophylaxis ◽

Baseline Knowledge ◽

Initial Survey ◽

The Impact

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None

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Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.121 ◽

2018 ◽

Vol 39 (8) ◽

pp. 941-946 ◽

Cited By ~ 2

Author(s):

Bradley J. Langford ◽

Julie Hui-Chih Wu ◽

Kevin A. Brown ◽

Xuesong Wang ◽

Valerie Leung ◽

...

Keyword(s):

Observational Study ◽

Acute Care ◽

Antimicrobial Stewardship ◽

Acute Care Hospitals ◽

Antibiotic Use ◽

Audit And Feedback ◽

Prospective Audit ◽

Defined Daily Doses ◽

Prospective Audit And Feedback ◽

The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

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The impact of digital interventions on antimicrobial stewardship in hospitals: A qualitative synthesis of systematic reviews (Preprint)

10.2196/preprints.27959 ◽

2021 ◽

Author(s):

Bethany A Van Dort ◽

Jonathan Penm ◽

Angus Ritchie ◽

Melissa T Baysari

Keyword(s):

Systematic Reviews ◽

Antimicrobial Stewardship ◽

Digital Health ◽

Hospital Setting ◽

Antimicrobial Use ◽

Qualitative Synthesis ◽

Large Variability ◽

Antimicrobial Prescribing ◽

Digital Interventions ◽

The Impact

BACKGROUND Antimicrobial stewardship (AMS) programs aim to optimize antimicrobial use by utilizing a suite of coordinated strategies. With the increased use of health information technology in hospitals, AMS processes that were traditionally paper-based are becoming computerized and streamlined. A number of reviews on digital interventions supporting AMS have been performed, so we performed a review of reviews to consolidate findings OBJECTIVE To provide a systematic overview and synthesis of evidence on the effectiveness of digital interventions to improve antimicrobial prescribing and monitoring in hospitals. METHODS Databases: Medline, Embase, Scopus, CINAHL and the Cochrane Database of Systematic Reviews were searched from 2010 onwards. Papers were eligible if they included studies that examined the effectiveness of digital health interventions related to antimicrobial prescribing and monitoring, in an inpatient hospital setting. Papers were excluded if they did not include a clearly defined search strategy, if they were limited to a pediatric setting, or they were not in English. RESULTS Seven systematic reviews were included for data extraction. Five reviews were of moderate quality and two of low quality. A large number of digital interventions were evaluated, with a strong focus on clinical decision support. There was a large variability in outcome measures used. Six reviews reported that digital interventions reduced antimicrobial use and improved antimicrobial appropriateness. The impact of digital interventions on clinical outcomes was inconsistent. CONCLUSIONS The results of this review indicate digital interventions, regardless of type, reduce antimicrobial use and improve antimicrobial appropriateness in hospitals. We recommend hospitals consider implementing one or more digital interventions to facilitate AMS programs.

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Application of an antibiotic spectrum index in the neonatal intensive care unit

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2019.221 ◽

2019 ◽

Vol 40 (10) ◽

pp. 1181-1183 ◽

Cited By ~ 1

Author(s):

Alexandra C. Lahart ◽

Christopher C. McPherson ◽

Jeffrey S. Gerber ◽

Barbara B. Warner ◽

Brian R. Lee ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Stewardship ◽

Neonatal Intensive Care ◽

Very Low Birth Weight ◽

Antimicrobial Use ◽

Low Birth Weight Infants ◽

Antimicrobial Spectrum ◽

Days Of Therapy ◽

The Impact

AbstractAntimicrobial stewardship programs typically use days of therapy to assess antimicrobial use. However, this metric does not account for the antimicrobial spectrum of activity. We applied an antibiotic spectrum index to a population of very-low-birth-weight infants to assess its utility to evaluate the impact of antimicrobial stewardship interventions.

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Development of an antimicrobial stewardship program in an integrated healthcare system

American Journal of Health-System Pharmacy ◽

10.1093/ajhp/zxy002 ◽

2018 ◽

Vol 76 (1) ◽

pp. 34-43 ◽

Cited By ~ 1

Author(s):

Michael A Lane ◽

Amanda J Hays ◽

Helen Newland ◽

Jeanne E Zack ◽

Rebecca M Guth ◽

...

Keyword(s):

Healthcare System ◽

Antimicrobial Stewardship ◽

Gap Analysis ◽

System Level ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Integrated Healthcare ◽

Stewardship Program ◽

Regulatory Mandates ◽

The Impact

Abstract Purpose The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. Summary With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4–8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. Conclusion BJC’s ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.

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Provincial and Temporal Variation in Macrolide and Lincosamide Antimicrobial Use by Outpatients in Canada, 1995 to 2010

Canadian Journal of Infectious Diseases and Medical Microbiology ◽

10.1155/2014/904053 ◽

2014 ◽

Vol 25 (2) ◽

pp. 103-106 ◽

Cited By ~ 2

Author(s):

Shiona K Glass-Kaastra ◽

Rita Finley ◽

Jim Hutchinson ◽

David M Patrick ◽

Karl Weiss ◽

...

Keyword(s):

Mixed Models ◽

Repeated Measures ◽

Secular Trend ◽

Time Frame ◽

Antimicrobial Use ◽

Patterns Of Use ◽

Defined Daily Doses ◽

The Mean ◽

Canadian Provinces ◽

Over Time

INTRODUCTION: Because antimicrobial use is commonly associated with the development of antimicrobial resistance, monitoring the volume and patterns of use of these agents is very important.OBJECTIVE: To assess the use of macrolide and lincosamide (ML) antimicrobials within Canadian provinces over time, and to compare use rates with those reported by European countries.METHODS: Antimicrobial prescribing data were used to develop two yearly metrics: prescriptions per 1000 inhabitant-days (PrIDs) and the mean defined daily doses (DDDs) per prescription, which were then used to build linear mixed models to assess differences among provinces over time.RESULTS: After accounting for repeated measures over time, prescribing rates (PrIDs) varied significantly according to province and year (P<0.001). However, little change occurred within each province over the time frame studied; from 1995 to 2010, each province had a PrID change <0.01. Quebec and British Columbia had significantly lower prescribing rates than all other provinces. No overall secular trend was apparent. In contrast, the DDDs per prescription did not vary significantly according to province, but showed a significant year-to-year increase.DISCUSSION: ML prescribing varied among provinces in Canada between 1995 and 2010, but remained relatively stable within each province. The average DDDs per ML prescription did not vary according to province, but increased linearly over time. These increases are likely to indicate that fewer prescriptions are being written for children over time, a practice supported by good antimicrobial stewardship principles.

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The impact of stroke on people living in central Uganda: A descriptive study

African Journal of Disability ◽

10.4102/ajod.v7i0.438 ◽

2018 ◽

Vol 7 ◽

Cited By ~ 1

Author(s):

Julius T. Kamwesiga ◽

Lena K. Von Kock ◽

Gunilla M. Eriksson ◽

Susanne G.E. Guidetti

Keyword(s):

Everyday Life ◽

Urban Areas ◽

Clinical Characteristics ◽

Hand Function ◽

Chronic Phase ◽

Mulago Hospital ◽

Stroke Severity ◽

Cross Sectional ◽

The Mean ◽

The Impact

Background: Knowledge about perceived impact of stroke on everyday life as well as rehabilitation needs after stroke in Uganda is necessary to identify and develop rehabilitation interventions.Objectives: To explore and describe clinical characteristics and functioning during the acute or subacute phase and chronic phase, as well as the impact of stroke on everyday life during the chronic phase in stroke survivors in central Uganda.Method: A cross-sectional observational study was conducted on a consecutively included acute or subacute (n = 58) sample and a chronic (n = 62) sample. Face-to-face interviews were conducted to collect demographic information and clinical characteristics. The Scandinavian Stroke Scale (SSS) was used to collect clinical characteristics, assess neurological impairment and define stroke severity. The Barthel Index was used to assess the level of dependence in activities of daily living. In addition, the Stroke Impact Scale (SIS) 3.0 Uganda version was used to assess the impact of stroke in everyday life as perceived by the individuals in the chronic sample receiving rehabilitation.Results: The mean age of the acute/subacute sample was 49 years and 81% had moderate or severe stroke. The mean age of the chronic rehabilitation group was 53 years and 58% had mild stroke. Time since onset in the acute sample was between 2 days and 3 weeks, and time since onset for the chronic sample varied between 3 months and 3 years. Strength, hand function and participation were the most impacted SIS domains in the chronic sample.Conclusion: People with severe and moderate stroke were more likely to be admitted to Mulago Hospital. The mean age in the study sample was lower than that in high-income countries. Further knowledge is needed regarding the impact of stroke to develop guidelines for stroke rehabilitation interventions feasible in the Ugandan healthcare context in both rural and urban areas.

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