Evaluation of Adult Outpatient Antibiotics Use at Jimma Medical Center (with Defined Daily Doses for Usage Metrics)

Abstract Background Klebsiella pneumoniae liver abscess (KPLA) is an endemic disease in East Asia. KPLA is usually caused by hypervirulent strains that are susceptible to all kinds of antibiotics except ampicillin. Patients with KPLA are commonly treated with β-lactams and need prolonged duration of intravenous therapy. Fluoroquinolone has high oral bioavailability and has the potential to shorten the duration of intravenous therapy, but studies regarding fluoroquinolone use in KPLA are limited. We aimed to compare the outcomes of patients with KPLA treated with β-lactams and fluoroquinolone. Methods Consecutive patients with KPLA in a tertiary medical center of Taiwan between 2011 and 2018 were enrolled retrospectively. Clinical characteristics and treatment outcomes were compared between cases treated with β-lactams and fluoroquinolones. Logistic regression was performed to identify risk factors of prolonged hospitalization (defined as > 30 days). Capsular genotypes and presence of rmpA or rmpA2 genes were analyzed among K. pneumoniae strains collected after July 2012. Hypervirulent strains were defined as those had rmpA or rmpA2 genes. Results A total of 330 KPLA patients identified, and the in-hospital mortality was 0.9% (n = 3). Nearly all K. pneumoniae strains were hypervirulent strains (97.1%). Capsular type K1 (n = 176) and K2 (n = 63) were the most common capsular types. Most patients received β-lactams (n = 296, 89.7%), and only 34 (10.3%) patients received fluoroquinolones as the main antibiotics (levofloxacin = 17; moxifloxacin = 10; ciprofloxacin = 7). The duration of intravenous antibiotics use in fluoroquinolones group was shorter than β-lactams group (20.12 ± 9.21 vs. 26.81 ± 16.10, P = 0.001). Prolonged hospitalization was more common in β-lactams group than fluoroquinolones group (32.1% vs. 11.8%, P = 0.014). The in-hospital mortality, duration of antibiotic use, and recurrence rate were similar between the two groups. Fluoroquinolones was independent protective factor for prolonged hospitalization (hazard ratio, 0.28; P = 0.026). Conclusion Fluoroquinolone is able to shorten the duration of intravenous antibiotic use and beneficial in prolonged hospitalization in patients with KPLA. Disclosures All authors: No reported disclosures.

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Correlation between antibiotic consumption and bacterial resistance as quality indicator of proper use of these drugs in inpatients

Vojnosanitetski pregled ◽

10.2298/vsp0904307v ◽

2009 ◽

Vol 66 (4) ◽

pp. 307-312 ◽

Cited By ~ 6

Author(s):

Radmila Velickovic-Radovanovic ◽

Jasmina Petrovic ◽

Branislava Kocic ◽

Snezana Antic ◽

Gordana Randjelovic

Keyword(s):

Bacterial Resistance ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

E Coli ◽

Defined Daily Doses ◽

Clinical Center ◽

Rational Drug ◽

Antibiotics Use ◽

Amoxicillin Clavulanic Acid ◽

Investigation Period

Background/Aim. Antibiotics are the most frequently used medications in Serbian hospitalized patients. Information about antibiotic utilization and sensitivity among inpatients in Serbia is scanty, and there are no available publications on the topic. The aim of this study was to investigate the correlation between antibiotic use and bacterial resistance in the Clinical Center Nis, one of the biggest hospitals in Serbia. Methods. The data on antibiotics use in inpatients were obtained from the database of the Department of Pharmacotherapy and expressed as defined daily doses per 100 bed-days (DBD), during 2003-2007. Bacterial resistances were given as percentages of resistant isolates. Results. During the investigation period, the overall consumption of antibiotics had a significant decrease in 2007, by 22.99% (62.23 : 47.92 DBD; p < 0.05). The most frequently used antibiotics were cephalosporins, followed by penicillin's, aminoglycosides and quinolones. Hospital aminoglycosides consumption was reduced in 2007 to 59.9% (13.4 : 5.53 DBD) while the resistance to amikacin was reduced from 40.88% to 32.1%. However, utilization of ciprofloxacin had a significant increase in 2007 (120.7%). There was an alarming increase in the level of resistance to ciprofloxacin in our hospital (from 13.5% to 28.3 % in Escherichia coli and from 11.1 to 30.09% in Proteus mirabilis). Reduction of E coli resistant to amoxicillin+clavulanic acid correlated significantly with their utilization, while the resistance for all isolates decreased from 52.16% to 24.40%. Conclusions. These results confirm an association between the use of antibiotics and the prevalence of resistance. This methodology could provide good quality indicators of rational drug use and serve for local monitoring of antibiotics use and resistance, as well as for external comparison.

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Retrospective single-center analysis of the reasons and serious complications of peritoneal-related peritonitis in patients with end-stage renal disease undergoing peritoneal dialysis treatment

Polish Journal of Public Health ◽

10.2478/pjph-2018-0019 ◽

2018 ◽

Vol 128 (3) ◽

pp. 103-106

Author(s):

Agnieszka M. Grzebalska ◽

Anna Steć ◽

Izabela Ławnicka ◽

Anna Bednarek-Skublewska ◽

Andrzej Książek

Keyword(s):

Peritoneal Dialysis ◽

Medical Center ◽

Gram Positive ◽

Dialysis Treatment ◽

Gram Negative ◽

Antibiotics Use ◽

Stage Renal Disease ◽

End Stage ◽

Culture Negative ◽

Dialysis Discontinuation

Abstract Introduction. Peritonitis is still a serious complication of peritoneal dialysis (PD). Consequences of peritonitis can be severe. The most severe are peritoneal dialysis discontinuation and patient’s death. In majority, peritonitis is bacterial in the origin. Mainly there is a gram-positive infection, less commonly gram-negative one. Some peritonitis are culture-negative, because of former antibiotics use. In minority, fungal, tuberculous or even viral peritonitis are observed. Aim. The aim of the present study is to analyze the number, origin and serious complications of peritoneal-related peritonitis cases found in our PD center. Material and methods. We performed a retrospective five-years evaluation of medical records. The total number of peritonitis episodes was 56 cases, underwent by 30 adult patients on chronic peritoneal dialysis. Peritonitis was diagnosed according to ISPD recommendations. Causes and serious complications of peritoneal-related peritonitis were analyzed in every single year. Etiology of peritonitis was classified on the basis of the result of effluent dialysate culture as: gram-positive, gram-negative and culture negative. Peritoneal dialysis discontinuation or patient’s death were defined as serious complications. Results. Among 56 cases of peritoneal-related peritonitis 44.6% were gram-positive, 26.8% gram-negative and 28.6% culture-negative. No fungal or tuberculosis peritonitis were found. Because of the peritonitis complications in the evaluated period, six patients discontinued peritoneal dialysis and were switched to hemodialysis (20%), two others died (6.7%). Conclusion. The further improvement in peritonitis’ causes identification and treatment is needed in order to reduce number of serious complications in our medical center.

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Procalcitonin Uptake and Effect on Antibiotics Stewardship: A Single Institution Experience

International Journal of Innovative Research in Medical Science ◽

10.23958/ijirms/vol05-i09/947 ◽

2020 ◽

Vol 5 (09) ◽

pp. 395-399

Author(s):

Hycienth Ahaneku, MD DrPH ◽

Chukwuemeka A. Umeh, MD DrPH ◽

Mike Cao, MD ◽

Bradley Kapten, MD ◽

Baher Elhalwagi, MD ◽

...

Keyword(s):

Logistic Regression ◽

Respiratory Infections ◽

Medical Center ◽

Demographic Data ◽

Public Health Problem ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Antibiotics Resistance ◽

Cross Sectional ◽

Antibiotics Use

Background: In the face of antibiotics resistance and adverse effects, emerging evidence suggests that procalcitonin guided therapy can help enhance appropriate use of antibiotics especially in patients with respiratory infections and sepsis. We seek to assess the uptake of procalcitonin among clinicians in a US hospital and assess its correlation with amount and duration of antibiotics use. We also seek to identify factors significantly associated with antibiotic use. Methodology: Retrospective cross-sectional study of patients with sepsis and COPD at a Medical Center in Texas USA. A total 48 COPD and 62 Sepsis patients were assessed. We collected demographic data such as age, weight, height, gender, and race/ethnicity. We also collected data on procalcitonin, number of antibiotics used, duration of antibiotics, and WBC levels at admission. We conducted bivariate analyses and logistic regression analyses to assess factor associated with procalcitonin, number of antibiotics used and duration of antibiotics. Results: We had 48 COPD patients and 62 sepsis patients in this study. Overall physicians ordered Procalcitonin on only 11.8% of patients. Procalcitonin was not significantly associated with antibiotics use. However, patients who had procalcitonin ordered had significantly lower WBC count than those without procalcitonin (10.1 vs. 12.9, p:0.026). Number of antibiotics was significantly associated with type of diagnosis (Sepsis 66.7% vs. COPD 50.7%, p = 0.001). In the logistic regression analysis, after adjusting for other variables patients with sepsis were significantly more likely to be on higher number antibiotics (OR 6.08, p <0.001) and longer duration of antibiotics (OR 7.44, p < 0.001). Conclusion: Inappropriate use of antibiotics is a public health problem. Procalcitonin has been touted as a biomarker that is effective in reducing use of antibiotics. Our study showed a low utilization of Procalcitonin by physicians and that patients with lower WBC counts were more likely to have procalcitonin ordered. However, our study did not find any association between procalcitonin and the number and duration of antibiotics use.

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Long-Term Surveillance of Antibiotic Prescriptions and the Prevalence of Antimicrobial Resistance in Non-Fermenting Gram-Negative Bacilli

Microorganisms ◽

10.3390/microorganisms8030397 ◽

2020 ◽

Vol 8 (3) ◽

pp. 397 ◽

Cited By ~ 2

Author(s):

Chia-Huei Chou ◽

Yi-Ru Lai ◽

Chih-Yu Chi ◽

Mao-Wang Ho ◽

Chao-Ling Chen ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Nosocomial Infections ◽

Antimicrobial Agents ◽

Medical Center ◽

Acinetobacter Calcoaceticus ◽

Multidrug Resistant ◽

Research Database ◽

Gram Negative ◽

Defined Daily Doses ◽

Acinetobacter Baumannii Complex

The increasing emergence of multidrug-resistant (MDR) bacteria has been recognized as a public health threat worldwide. Hospitalized patients and outpatients are commonly infected by non-fermenting Gram-negative bacilli (NFGNB), particularly the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB) and Pseudomonas aeruginosa. Antimicrobial agents are critical for treating the nosocomial infections caused by NFGNB. The aim of this study was to assess antimicrobial resistance and the use of antimicrobial agents. The bacterial isolates of 638,152 specimens from both inpatients and outpatients, retrieved from 2001 to 2008 at a medical center in central Taiwan, were examined for their susceptibility to various antimicrobial agents, including cefepime, imipenem, ciprofloxacin, gentamicin, amikacin, meropenem, and levofloxacin. Administrated prescriptions of the monitored antibiotics were analyzed using the Taiwan National Health Insurance Research Database (NHIRD). Our results show that the defined daily doses (DDDs) for cefepime, imipenem, and ciprofloxacin increased with time, and a trend toward reduced antimicrobial sensitivities of both ACB and P. aeruginosa was noticeable. In conclusion, the antimicrobial sensitivities of ACB and P. aeruginosa were reduced with the increased use of antibiotics. Continuous surveillance of antibiotic prescriptions and the prevalence of emerging resistance in nosocomial infections is warranted.

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Medicaid & Medicare: D.C. Appellate Court Denies Claim for Medicare Reimbursement of GME Cost

The Journal of Law Medicine & Ethics ◽

10.1017/s1073110500012997 ◽

1999 ◽

Vol 27 (2) ◽

pp. 205-205

Author(s):

choeffel Amy

Keyword(s):

Medical Center ◽

Federal District ◽

Federal Court ◽

University Of Pennsylvania ◽

District Court ◽

Appellate Court ◽

Court Of Appeals ◽

Department Of Health ◽

Administrative Proceedings ◽

Summary Judgment

The U.S. Court of Appeals for the District of Columbia upheld, in Presbyterian Medical Center of the University of Pennsylvania Health System v. Shalala, 170 F.3d 1146 (D.C. Cir. 1999), a federal district court ruling granting summary judgment to the Department of Health and Human Services (DHHS) in a case in which Presbyterian Medical Center (PMC) challenged Medicare's requirement of contemporaneous documentation of $828,000 in graduate medical education (GME) expenses prior to increasing reimbursement amounts. DHHS Secretary Donna Shalala denied PMC's request for reimbursement for increased GME costs. The appellants then brought suit in federal court challenging the legality of an interpretative rule that requires requested increases in reimbursement to be supported by contemporaneous documentation. PMC also alleged that an error was made in the administrative proceedings to prejudice its claims because Aetna, the hospital's fiscal intermediary, failed to provide the hospital with a written report explaining why it was denied the GME reimbursement.

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