Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganisms Despite Restrictive Antibiotic Policies in ICUs: A Prospective Observational Study

Abstract Background: Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin, and linezolid are frequently used in empirical treatment combinations in critically ill patients. Such inappropriate and unnecessary widespread use, leads to sub-optimal utilisation. However they are covered by the antibiotics restriction programme. This prospective observational study, evaluates gram-positive anti-bacterial utilisations in intensive care units (ICUs) with various evaluation criteria, to determine the frequency of inappropriate usage and the intervention targets required to ensure optimum use. Methods: This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital, Turkey. The total bed capacity was 55. Patients older than 18 years and who were prescribed gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid, and daptomycin) were included. Patients under this age or immunosuppressed patients (neutropenic,- HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. During the study period, 200 treatments were evaluated in 169 patients. The demographic and clinical features of the patients were recorded. Besides observations by the clinical staff, the treatments were recorded and evaluated by two infectious diseases specialists and two clinical pharmacists at 24-h intervals from the first day to the last day of treatment. SPSS software for Windows, (version 17, IBM, Armonk, NY) was used to analyse the data. Categorical variables were presented as number and percentage, and non-categorical variables were presented as mean ± standard deviation. Results: It was found that inappropriate gram-positive antibiotic use in ICUs was as high as 83% in terms of non-compliance with the selected quality parameters. Multivariate analysis was performed to evaluate the factors associated with inappropriate antibiotic use, increased creatinine levels were found to increase the risk of such use. Conclusions: In spite of the restricted antibiotics programme, inappropriate antibiotic use in ICUs is quite common. Thus, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation of such use and optimal treatment doses. Keywords: Antibiotic stewardship, rational antibiotic use, antibiotic resistance, gram positive microorganisms, inappropriate antibiotic use

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Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganism in Under Restrictive Antibiotic Policies in ICU; A Prospective Observational Study

10.21203/rs.2.21842/v2 ◽

2020 ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

ASLINUR ALBAYRAK ◽

Kenan Hızel

Keyword(s):

Risk Factors ◽

Antibiotic Use ◽

Quality Parameters ◽

Categorical Variables ◽

Solid Organ ◽

Gram Positive ◽

Inappropriate Use ◽

Positive Spectrum ◽

Surgical Icus ◽

Bed Capacity

Abstract Background Gram-positive spectrum antibiotics such as vancomycin, teicoplanin, daptomycin ,and linezolid are frequently used in empirical treatment combinations in critically ill patients Although they are included in the national antibiotic restriction program, thought to be inappropriate, unnecessary and suboptimal use is high due to their widespread use. In our study, in addition to their widespread use, gram-positive spectrum antibiotics were evaluated due to their use in more limited and clear clinical indications. This study aims to determine the frequency of inappropriate uses of gram-positive spectrum antibiotics and risk factors for inappropriate use according to different quality parameters. Methods This clinical study was conducted prospectively between 01.10.2018 and 01.10.2019 in the medical and surgical ICUs of Gazi University Faculty of Medicine Hospital with a total bed capacity of 55. Patients older than 18 years of age onset of gram-positive spectrum antibiotics (vancomycin, teicoplanin, linezolid ,and daptomycin) were included. Patients under the age of eighteen or immunosuppressed (neutropenic, HIV-infected patients with hematologic or solid organ malignancies) were not included in the study. The demographic and clinical features of the patients were recorded. The treatment was also evaluated and recorded by 2 infectious diseases specialists and 2 clinical pharmacists except for the clinical staff at 24-hour intervals from the first day to the last day of treatment. SPSS software for Windows, version 17 (IBM, Armonk, NY) was used to analyze the data. Categorical variables are presented as number and percentage, and non-categorical variables are presented as mean ± standard deviation. Results In the use of antibiotics, the incidence of non-compliance with at least one of the determined quality parameters was 83%. Multivariate analysis was performed to evaluate risk factors for inappropriate antibiotic use, and creatine values were found to increase the risk of inappropriate antibiotic use. Conclusions In spite of the restricted antibiotic program, inappropriate antibiotic use in ICUs is quite common. In particular, it is necessary to establish local guidelines in collaboration with different disciplines for the determination and follow-up of de-escalation and optimal treatment doses

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Inapropriate Use of Antibiotics Effective Against Gram Positive Microorganism in Under Restrictive Antibiotic Policies in ICU; A Prospective Observational Study

10.21203/rs.2.21842/v1 ◽

2020 ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

ASLINUR ALBAYRAK ◽

Kenan Hızel

Keyword(s):

Risk Factors ◽

Antibiotic Use ◽

Quality Parameters ◽

Categorical Variables ◽

Solid Organ ◽

Gram Positive ◽

Inappropriate Use ◽

Positive Spectrum ◽

Surgical Icus ◽

Bed Capacity

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Intravenous antibiotic use and exacerbation events in an adult cystic fibrosis centre: A prospective observational study

Respiratory Medicine ◽

10.1016/j.rmed.2019.06.017 ◽

2019 ◽

Vol 154 ◽

pp. 109-115 ◽

Cited By ~ 2

Author(s):

Zhe Hui Hoo ◽

Nicole R. Bramley ◽

Rachael Curley ◽

Frank P. Edenborough ◽

Stephen J. Walters ◽

...

Keyword(s):

Cystic Fibrosis ◽

Observational Study ◽

Prospective Observational Study ◽

Antibiotic Use ◽

Intravenous Antibiotic ◽

Cystic Fibrosis Centre

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Safety of early ambulation following blunt abdominal solid organ injury: A prospective observational study

The American Journal of Surgery ◽

10.1016/j.amjsurg.2017.05.014 ◽

2017 ◽

Vol 214 (3) ◽

pp. 402-406 ◽

Cited By ~ 2

Author(s):

Eugene Wang ◽

Kenji Inaba ◽

Saskya Byerly ◽

Ranan Mendelsberg ◽

Jack Sava ◽

...

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Organ Injury ◽

Solid Organ ◽

Solid Organ Injury ◽

Early Ambulation

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Inapropriate use of antibiotics effective against gram positive microorganisms despite restrictive antibiotic policies in ICUs: a prospective observational study

BMC Infectious Diseases ◽

10.1186/s12879-020-05005-7 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Hasan Selçuk Özger ◽

Dolunay Merve Fakıoğlu ◽

Kübra Erbay ◽

Aslınur Albayrak ◽

Kenan Hızel

Keyword(s):

Observational Study ◽

Prospective Observational Study ◽

Gram Positive

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Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

10.21203/rs.3.rs-67568/v1 ◽

2020 ◽

Author(s):

Ummara Altaf ◽

Muhammad Furqan Akhtar ◽

Bashir Ahmad ◽

Hassan Mehmood Yasir ◽

Brian Godman ◽

...

Keyword(s):

Observational Study ◽

Broad Spectrum ◽

Prospective Observational Study ◽

Inappropriate Prescribing ◽

Empirical Therapy ◽

Definitive Treatment ◽

Diffusion Method ◽

Gram Positive ◽

Gram Negative ◽

Culture Sensitivity

Abstract Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empirical therapy to be adjusted according to the result of culture sensitivity reports.Objective: To find the impact of culture sensitivity reports on the use of antibiotics and cost in a leading tertiary care hospital in Lahore.Methods: This prospective observational study was carried out in Ghurki trust teaching hospital. A total of 465 positive culture patients were taken over an 8 month study period using convenient sampling techniques and immediately sent to the microbiology laboratory for pathogen identification and susceptibility testing using the Kirby-Bauer disc diffusion method. Additional data was collected from the patient medical file which included demographic data, sample type, causative microbe, anti-microbial treatment given in empirical and definitive treatment as well as medicine costs. Results: Total of 497 isolates were detected from the 465 patient samples, which included 309 gram-negative rods and 188 gram-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was MSSA (28.4%) and Gram-negative was E. coli (23.8%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the A. baumannii isolates were resistant to carbapenems. Gram-positive microorganism showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics in empirical therapy were cefoperazone+sulbactam, ceftriaxone, amikacin, vancomycin and metronidazole whereas high use of linezolid, clindamycin, meropenem and piperacillin + tazobactam was evidenced in definitive treatment. Empiric therapy was adjusted in 222 (71.8%) cases of Gram-negative infections and 131 (69.6%) cases of gram-positive infections (p-value <0.0001). Compared with empirical therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average costs of antibiotics in definitive treatment was less than the empirical treatment (8.2%) and the length of hospitalization also decreased.Conclusion: Culture sensitivity reports helped reduce antibiotic utilization, hospital stay and costs as well as helping select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs and the development of hospital antibiotic guidelines within the hospital to reduce future unnecessary prescribing of broad-spectrum antibiotics.

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Effectiveness and Safety of a Single-Dose Ivermectin Treatment for Uncomplicated Strongyloidiasis in Immunosuppressed Patients (ImmunoStrong Study): The Study Protocol

Pathogens ◽

10.3390/pathogens10070812 ◽

2021 ◽

Vol 10 (7) ◽

pp. 812

Author(s):

Fernando Salvador ◽

Ana Lucas-Dato ◽

Silvia Roure ◽

Marta Arsuaga ◽

Asunción Pérez-Jacoiste ◽

...

Keyword(s):

Single Dose ◽

Observational Study ◽

Population Pharmacokinetics ◽

Prospective Observational Study ◽

Relevant Information ◽

Molecular Techniques ◽

Ivermectin Treatment ◽

Immunosuppressed Patients ◽

Immunocompetent Patients

Strongyloidiasis affects an estimated 600 million people worldwide, especially in tropical and subtropical areas. Single-dose ivermectin treatment has shown to be effective among immunocompetent patients with uncomplicated strongyloidiasis. Here, we present the protocol of the ImmunoStrong study, a prospective observational study aiming to evaluate the effectiveness and safety of a single-dose ivermectin for treatment of uncomplicated strongyloidiasis in immunosuppressed patients. The secondary objectives are to assess accuracy of molecular techniques for the follow-up of these patients and to determine the population pharmacokinetics of ivermectin. The information retrieved by this study will cover relevant information gaps in the strongyloidiasis management among immunosuppressed patients.

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Timely access to care for patients with critical burns in India: a prehospital prospective observational study

Emergency Medicine Journal ◽

10.1136/emermed-2018-207900 ◽

2019 ◽

Vol 36 (3) ◽

pp. 176-182 ◽

Cited By ~ 3

Author(s):

Jennifer A Newberry ◽

Corey B Bills ◽

Elizabeth A Pirrotta ◽

Michele Barry ◽

Govindaraju Venkata Ramana Rao ◽

...

Keyword(s):

Observational Study ◽

Medical Care ◽

Prospective Observational Study ◽

Total Body Surface Area ◽

Categorical Variables ◽

Continuous Variables ◽

Indian States ◽

Thermal Burns ◽

Low Middle Income Countries ◽

And Gender

BackgroundLow/middle-income countries carry a disproportionate burden of the morbidity and mortality from thermal burns. Nearly 70% of burn deaths worldwide are from thermal burns in India. Delays to medical care are commonplace and an important predictor of outcomes. We sought to understand the role of emergency medical services (EMS) as part of the healthcare infrastructure for thermal burns in India.MethodsWe conducted a prospective observational study of patients using EMS for thermal burns across five Indian states from May to August 2015. Our primary outcome was mortality at 2, 7 and 30 days. We compared observed mortality with expected mortality using the revised Baux score. We used Χ2 analysis for categorical variables and Wilcoxon two-sample test for continuous variables. ORs and 95% CIs are reported for all modelled predictor variables.ResultsWe enrolled 439 patients. The 30-day follow-up rate was 85.9% (n=377). The median age was 30 years; 56.7% (n=249) lived in poverty; and 65.6% (n=288) were women. EMS transported 94.3% of patients (n=399) to the hospital within 2 hours of their call. Median total body surface area (TBSA) burned was 60% overall, and 80% in non-accidental burns. Sixty-eight per cent of patients had revised Baux scores greater than 80. Overall 30-day mortality was 64.5%, and highest (90.2%) in women with non-accidental burns. Predictors of mortality by multivariate regression were TBSA (OR 7.9), inhalation injury (OR 5.5), intentionality (OR 4.7) and gender (OR 2.2).DiscussionAlthough EMS rapidly connects critically burned patients to care in India, mortality remains high, with women disproportionally suffering self-inflicted burns. To combat the burn epidemic in India, efforts must focus on rapid medical care and critical care services, and on a burn prevention strategy that includes mental health and gender-based violence support services.

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Validation of blood culture gram staining for the detection of Staphylococcus aureus by the ‘oozing sign’ surrounding clustered gram-positive cocci: a prospective observational study

BMC Infectious Diseases ◽

10.1186/s12879-018-3412-2 ◽

2018 ◽

Vol 18 (1) ◽

Author(s):

Yoshiro Hadano ◽

Miwako Isoda ◽

Kazushige Ishibashi ◽

Tatsuyuki Kakuma

Keyword(s):

Staphylococcus Aureus ◽

Blood Culture ◽

Observational Study ◽

Prospective Observational Study ◽

Gram Positive ◽

Gram Staining ◽

Gram Positive Cocci

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Independent Prognostic Indicators in the Elderly with Pneumonia: A Single-Center Prospective Observational Study

10.21203/rs.2.17883/v1 ◽

2019 ◽

Author(s):

Serkan Surme ◽

Ilker Inanc Balkan ◽

Osman Faruk Bayramlar ◽

Ritvan Kara Ali ◽

Bilgul Mete ◽

...

Keyword(s):

Renal Failure ◽

Acute Renal Failure ◽

Observational Study ◽

Mental Status ◽

Poor Prognosis ◽

Prospective Observational Study ◽

Pneumonia Severity Index ◽

The Elderly ◽

Antibiotic Use ◽

Prognostic Indicators

Abstract Background: The aim of this study was to investigate poor prognostic indicators in the elderly with pneumonia. Methods: In this prospective observational study, the patients with pneumonia were stratified into younger (18-64 years) and older (≥65 years) groups. The poor prognostic indicators were determined and compared. Results: There were 184 pneumonia episodes in 155 patients. The median age of the cases was 72 (range, 18-104) of whom 127 (69%) were ≥65 years old and 110 (59.8%) were male. Mental status changes were more common in the elderly group (p=0.04). Multivariate regression analysis determined three variables that could be potential independent risk factors for poor prognosis in the elderly: dyspnea at the onset (OR:5.85, CI:5.18-6.52, p=0.01), previous antibiotic use within the last 3 months (OR:2.97, CI:2.51-3.43, p=0.02), acute renal failure (OR:2.51, CI:2.06-2.96, p=0.04). A receiver operating characteristic (ROC) analysis showed that the area under the curves (AUC) of procalcitonin and C-reactive protein (CRP) as indicators of poor prognosis in the elderly were 0.846 (p<0.001) and 0.650 (p=0.008) respectively. In addition, mental status changes (p<0.001), the confusion, blood urea nitrogen, respiratory rate, blood pressure, and age ≥65 years (CURB-65) score (p<0.001), and the pneumonia severity index (PSI) (p<0.001) were associated with poor prognosis. Conclusion: Dyspnea at the onset, previous antibiotic use within the last 3 months, acute renal failure, serum CRP and procalcitonin levels along with the PSI and the CURB-65 scores should be carefully evaluated in terms of hospitalization, the need for intensive care unit admission and the initial antimicrobial therapy.

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