scholarly journals Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

2016 ◽  
Vol 21 (32) ◽  
Author(s):  
Ajay Oza ◽  
Fionnuala Donohue ◽  
Howard Johnson ◽  
Robert Cunney
Keyword(s):  
Administrative Data ◽  
Risk Adjustment ◽  
Antibiotic Consumption ◽  
Factors Affecting ◽  
Defined Daily Doses ◽  
Acute Hospitals ◽  
Consumption Rates ◽  
Hospital Antibiotic Consumption ◽  
Bed Days ◽  
The Impact

As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed.

scholarly journals Antibiotic Consumption and Stewardship at a Hospital outside of an Early Coronavirus Disease 2019 Epicenter

2020 ◽  
Vol 64 (11) ◽  
Author(s):  
Deanna J. Buehrle ◽  
Brooke K. Decker ◽  
Marilyn M. Wagener ◽  
Amesh Adalja ◽  
Nina Singh ◽  
...  
Keyword(s):  
Antibiotic Consumption ◽  
Days Of Therapy ◽  
Hospital Antibiotic Consumption ◽  
Bed Days ◽  
The Impact

ABSTRACT There are scant data on the impact of coronavirus disease 2019 (COVID-19) on hospital antibiotic consumption, and no data from outside epicenters. At our nonepicenter hospital, antibiotic days of therapy (DOT) and bed days of care (BDOC) were reduced by 151.5/month and 285/month, respectively, for March to June 2020 compared to 2018–2019 (P = 0.001 and P < 0.001). DOT per 1,000 BDOC was increased (8.1/month; P = 0.001). COVID-19 will impact antibiotic consumption, stewardship, and resistance in ways that will likely differ temporally and by region.

scholarly journals Antibiotic Consumption in the Latvian Teaching Hospital 2000-2008

2009 ◽  
Vol 63 (4-5) ◽  
pp. 253-256
Author(s):  
Elīna Dimiņa ◽  
Mārtiņš Akermanis ◽  
Uga Dumpis
Keyword(s):  
Teaching Hospital ◽  
Enzyme Inhibitor ◽  
Antibiotic Use ◽  
Educational Interventions ◽  
Antibiotic Consumption ◽  
Resistance Selection ◽  
Defined Daily Doses ◽  
Multiresistant Bacteria ◽  
Bed Days ◽  
The Impact

Antibiotic Consumption in the Latvian Teaching Hospital 2000-2008 Antibiotics are one of the most commonly used drugs in hospital care and significantly contribute to healthcare costs. Recently, there has been significant interest raised on the environmental impact of antibiotic use, in particular on how it effects resistance selection pressure. Rapid global spread of multiresistant bacteria requires improved understanding on how changes in antibiotic use affect resistance selection. We present a unique study on antibiotic consumption and its trends over an eight-year period. Data were obtained from the pharmaceutical database system. The study period extended from January 2000 through December 2008. Antibiotic use was expressed as a rate — defined daily doses (DDD) per 100 patient days (DDD/100) in a quarter year. The total amount of antibiotics used for systemic treatment at the beginning of the period (first quarter of 2000) was 38.7 DDD per 100 bed days and increased to 72.6 DDD per 100 bed days (r = 0.81) by the 4th quarter of 2008. Despite variability during the study period, a significant trend was observed with an average increase of 0.97 (95% CI: 1.2; 3.2) per quarter. Penicillin was the most common antibiotic group used at the hospital in the study period and demonstrated the greatest increase in consumption (r = 0.92). The consumption rates of fluoroquinolones were high and also showed a significant increase (r = 0.76). We observed a significant increase of antibiotic consumption in our hospital during the study period, which lacked a clear explanation. This increase was mostly due to increased use of amoxicillinum/enzyme inhibitor and ceftriaxone. Analysis of consumption should be continued to assess the impact of educational interventions.

scholarly journals Antimicrobial Consumption among 66 Acute Care Hospitals in Catalonia: Impact of the COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (8) ◽  
pp. 943
Author(s):  
Santiago Grau ◽  
Sergi Hernández ◽  
Daniel Echeverría-Esnal ◽  
Alexander Almendral ◽  
Ricard Ferrer ◽  
...  
Keyword(s):  
Amphotericin B ◽  
Acute Care ◽  
Antimicrobial Consumption ◽  
Trend Pattern ◽  
Defined Daily Doses ◽  
Bed Days ◽  
Antifungal Consumption ◽  
Antibacterial And Antifungal ◽  
Antifungal Use ◽  
The Impact

Background: Antimicrobials have been widely used during the COVID-19 pandemic. This study aimed to analyze the impact of the COVID-19 pandemic on the antimicrobial consumption of 66 hospitals in Catalonia. Methods: Adult antibacterial and antimycotic consumption was calculated as defined daily doses (DDD)/100 bed-days and DDD/100 discharges. Firstly, overall and ICU consumption in 2019 and 2020 were compared. Secondly, observed ICU 2020 consumptions were compared with non-COVID-19 2020 estimated consumptions (based on the trend from 2008–2019). Results: Overall, antibacterial consumption increased by 2.31% and 4.15% DDD/100 bed-days and DDD/100 discharges, respectively. Azithromycin (105.4% and 109.08% DDD/100 bed-days and DDD/100 discharges, respectively) and ceftriaxone (25.72% and 27.97% DDD/100 bed-days and DDD/100 discharges, respectively) mainly accounted for this finding. Likewise, antifungal consumption increased by 10.25% DDD/100 bed-days and 12.22% DDD/100 discharges, mainly due to echinocandins or amphotericin B. ICU antibacterial and antimycotic consumption decreased by 1.28% and 4.35% DDD/100 bed-days, respectively. On the contrary, antibacterial and antifungal use, expressed in DDD/100 discharges, increased by 23.42% and 19.58%. Azithromycin (275.09%), ceftriaxone (55.11%), cefepime (106.35%), vancomycin (29.81%), linezolid (31.28%), amphotericin B (87.98%), and voriconazole (96.17%) use changed the most. Observed consumption of amphotericin B, azithromycin, caspofungin, ceftriaxone, vancomycin, and voriconazole were higher than estimated values. Conclusions: The consumption indicators for most antimicrobials deviated from the expected trend pattern. A worrisome increase in antibacterial and antifungal consumption was observed in ICUs in Catalonia.

scholarly journals Staphylococcus aureus - selective reporting of antibiogram results and its impact on antibiotic use: Interventional study with a reference group on the effect of switching from non-selective to selective antibiotic reporting

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Beta Lactams ◽  
Interventional Study ◽  
Patient Level ◽  
Narrow Spectrum ◽  
Bed Days ◽  
The Impact

Abstract Background Antimicrobial stewardship (AMS) strategies worldwide focus on optimising the use of antibiotics. Selective susceptibility reporting is recommended as an effective AMS tool although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use. The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections. Methods This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin, instead of reporting all tested antibiotics. The impact of implementing selective reporting was analysed by monitoring total monthly antibiotic consumption in our hospital and in a reference hospital (recommended daily dose/100 occupied bed days: RDD/100 BD), as well as on an individual patient level by analysing days of therapy adjusted for bed days (DOT/ 100 BD) for patients with S. aureus bacteremia (SAB) and respectively skin and soft tissue infections (SSTI). Results MSSA-antibiograms were acquired for 2836 patients. The total use of narrow-spectrum beta-lactams more than doubled after implementing selective reporting (from 1.2 to 2.8 RDD/100 BD, P < 0.001). The use of intravenous flucloxacillin/cefazolin for SAB rose significantly from 52 to 75 DOT/100 BD (plus 42%), just as the use of oral cefalexin for SSTI (from 1.4 to 9.4 DOT/100 BD, from 3 to 17 of 85/88 patients). Considering the overall consumption, there was no decrease in antibiotics omitted from the antibiogram. This was probably due to their wide use for other infections. Conclusions As narrow-spectrum beta-lactams are not widely used for other infections, their increase in the overall consumption of the entire hospital was a strong indicator that selective reporting guided clinicians to an optimised antibiotic therapy of S. aureus infections. On a patient level, this assumption was verified by a significant improved treatment of S. aureus infections in the subgroups of SAB and SSTI. As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals Plant defences limit herbivore population growth by changing predator–prey interactions

2017 ◽  
Vol 284 (1862) ◽  
pp. 20171120 ◽  
Author(s):  
Mônica F. Kersch-Becker ◽  
André Kessler ◽  
Jennifer S. Thaler
Keyword(s):  
Population Growth ◽  
Plant Resistance ◽  
Prey Availability ◽  
Factors Affecting ◽  
Low Resistance ◽  
Plant Volatile ◽  
Natural Predator ◽  
Consumption Rates ◽  
The Impact ◽  
Predator Community

Plant quality and predators are important factors affecting herbivore population growth, but how they interact to regulate herbivore populations is not well understood. We manipulated jasmonate-induced plant resistance, exposure to the natural predator community and herbivore density to test how these factors jointly and independently affect herbivore population growth. On low-resistance plants, the predator community was diverse and abundant, promoting high predator consumption rates. On high-resistance plants, the predator community was less diverse and abundant, resulting in low predator consumption rate. Plant resistance only directly regulated aphid population growth on predator-excluded plants. When predators were present, plant resistance indirectly regulated herbivore population growth by changing the impact of predators on the herbivorous prey. A possible mechanism for the interaction between plant resistance and predation is that methyl salicylate, a herbivore-induced plant volatile attractive to predators, was more strongly induced in low-resistance plants. Increased plant resistance reduced predator attractant lures, preventing predators from locating their prey. Low-resistance plants may regulate herbivore populations via predators by providing reliable information on prey availability and increasing the effectiveness of predators.

scholarly journals Measuring the impact of varying denominator definitions on standardized antibiotic consumption rates: implications for antimicrobial stewardship programmes

2018 ◽  
Vol 73 (10) ◽  
pp. 2876-2882 ◽  
Author(s):  
Sean N Avedissian ◽  
Marc H Scheetz ◽  
Teresa R Zembower ◽  
Christina Silkaitis ◽  
Robert Maxwell ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Consumption ◽  
Consumption Rates ◽  
The Impact

scholarly journals Measuring patient safety in New Zealand public hospitals

2021 ◽  
Author(s):  
◽  
Nicholas Bowden
Keyword(s):  
Patient Safety ◽  
Quality Of Care ◽  
New Zealand ◽  
Administrative Data ◽  
Risk Adjustment ◽  
Public Hospitals ◽  
Hospital Administrative ◽  
The Impact ◽  
Hospital Administrative Data

<p>In New Zealand the Ministry of Health recognises quality of care as an integral part of a high performing health system and identifies patient safety as one of the key dimensions of quality. Over recent years a greater emphasis has been placed on improving patient safety mostly as a result of increased awareness around the frequency of medical error and resulting economic cost. However tools used to measure patient safety are limited. In particular the use of hospital administrative data to measure patient safety is scarce and existing safety measures often ignore one of the major issues confronting comparative analyses of hospital safety, risk adjustment to control for the differences in populations hospitals serve.   The objective of this research is to develop comparable measures of patient safety for New Zealand public hospitals. It uses risk adjustment strategies applied to the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) with New Zealand hospital administrative data, the National Minimum Dataset 2001 to 2009. The research employs econometric techniques to address risk adjustment of the PSIs, utilising existing AHRQ models but adapting and re-estimating them with New Zealand administrative data.   The findings from the research indicate that to use the AHRQ PSIs as measures of hospital patient safety in New Zealand, risk adjustment should first be employed to ensure measures are comparable across hospitals and over time. Overall, although the impact of risk adjustment appears to be minor, it has relevance and this should be recognised. Relative hospital performance is affected by risk adjustment. In particular, it has the greatest impact on those hospitals with poor rankings. The research takes us a step closer to being able to confidently measure patient safety and quality of care in New Zealand public hospitals in an innovative way.</p>

scholarly journals Antibiotic Utilization Trends in Two State Hospitals of Mongolia from 2013 to 2017

2019 ◽  
Vol 2019 ◽  
pp. 1-8
Author(s):  
Gereltuya Dorj ◽  
Hege Salvesen Blix ◽  
Bruce Sunderland ◽  
Badamkhand Gankhulug ◽  
Otgonbileg Tegshee ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
The State ◽  
Public Hospitals ◽  
Antibiotic Utilization ◽  
Parametric Data ◽  
Consumption Rates ◽  
Bed Days ◽  
The Government ◽  
Very High

Background. The study aimed to evaluate inpatient antibiotic use in both the State Second Hospital and State Third Hospital in Mongolia, using the WHO developed and standardized ATC/DDD methodology. Methods. Data were collected from the State Second Hospital and State Third Hospital which are major public hospitals that provide health care for approximately one fifth of the Mongolian population. Antibiotic utilization was monitored retrospectively for five years (2013–2017) using the ATC/DDD methodology and data were presented in DDD/ admission and DDD/100 bed days. Statistical analysis was performed using a Student’s t-test for parametric data. A P value of ≤0.05 was considered to be statistically significant. Results. The annual consumption rates in the State Second Hospital were stable over time while in the State Third Hospital consumption rates varied considerately between years. Overall, the total antibiotic consumption rate was very high, but has decreased in both hospitals. The rate of consumption of all antibiotics was approximately twice that in the State Third Hospital (421.7 DDD/100 bed days) between 2013 and 2017 when compared with the State Second Hospital (199.7 DDD/ 100 bed days), P<0.001). The seven most frequently used antibiotics comprised approximately 75% of all DDDs in both hospitals, in the period 2013–2017; being: amoxicillin, cefazolin, cefotaxime, ceftriaxone, clarithromycin, ciprofloxacin, and nitroxoline. However, this was not consistent when considering the individual years, since in 2015 and 2016, these seven active agents represented approximately 50%. Conclusion. This is the first hospital-based study of antibiotic consumption rates reported in Mongolia. In addition to very high consumption rates, large differences occurred between the hospitals investigated. Inappropriate and high levels of antibiotic use lead to increased costs and also increased nosocomial infection rates with potentially resistant species. The Government and health professionals need to take more active roles in improving and promoting quality antibiotic use among inpatients.

scholarly journals Impact of Antibiotic Use on Carbapenem Resistance in Pseudomonas aeruginosa: Is There a Role for Antibiotic Diversity?

2013 ◽  
Vol 57 (4) ◽  
pp. 1709-1713 ◽  
Author(s):  
C. Plüss-Suard ◽  
A. Pannatier ◽  
A. Kronenberg ◽  
K. Mühlemann ◽  
G. Zanetti
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Broad Spectrum ◽  
Carbapenem Resistance ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Content Type ◽  
Defined Daily Doses ◽  
Consumption Data ◽  
Resistance Rates ◽  
The Impact

ABSTRACTIn this study, we aimed to evaluate the relationship between the rates of resistance ofPseudomonas aeruginosato carbapenems and the levels and diversity of antibiotic consumption. Data were retrospectively collected from 20 acute care hospitals across 3 regions of Switzerland between 2006 and 2010. The main outcome of the present study was the rate of resistance to carbapenems amongP. aeruginosa. Putative predictors included the total antibiotic consumption and carbapenem consumption in defined daily doses per 100 bed days, the proportion of very broad-spectrum antibiotics used, and the Peterson index. The present study confirmed a correlation between carbapenem use and carbapenem resistance rates at the hospital and regional levels. The impact of diversifying the range of antibiotics used againstP. aeruginosaresistance was suggested by (i) a positive correlation in multivariate analysis between the above-mentioned resistance and the proportion of consumed antibiotics having a very broad spectrum of activity (coefficient = 1.77; 95% confidence interval, 0.58 to 2.96;P< 0.01) and (ii) a negative correlation between the resistance and diversity of antibiotic use as measured by the Peterson homogeneity index (coefficient = −0.52;P< 0.05). We conclude that promoting heterogeneity plus parsimony in the use of antibiotics appears to be a valuable strategy for minimizing the spread of carbapenem resistance inP. aeruginosain hospitals.

scholarly journals Global increase and geographic convergence in antibiotic consumption between 2000 and 2015

2018 ◽  
Vol 115 (15) ◽  
pp. E3463-E3470 ◽  
Author(s):  
Eili Y. Klein ◽  
Thomas P. Van Boeckel ◽  
Elena M. Martinez ◽  
Suraj Pant ◽  
Sumanth Gandra ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antibiotic Consumption ◽  
Bacterial Disease ◽  
Antibiotic Prescribing ◽  
Middle Income ◽  
Defined Daily Doses ◽  
Resistance Patterns ◽  
Consumption Rates ◽  
Per Capita ◽  
Global Increase

Tracking antibiotic consumption patterns over time and across countries could inform policies to optimize antibiotic prescribing and minimize antibiotic resistance, such as setting and enforcing per capita consumption targets or aiding investments in alternatives to antibiotics. In this study, we analyzed the trends and drivers of antibiotic consumption from 2000 to 2015 in 76 countries and projected total global antibiotic consumption through 2030. Between 2000 and 2015, antibiotic consumption, expressed in defined daily doses (DDD), increased 65% (21.1–34.8 billion DDDs), and the antibiotic consumption rate increased 39% (11.3–15.7 DDDs per 1,000 inhabitants per day). The increase was driven by low- and middle-income countries (LMICs), where rising consumption was correlated with gross domestic product per capita (GDPPC) growth (P = 0.004). In high-income countries (HICs), although overall consumption increased modestly, DDDs per 1,000 inhabitants per day fell 4%, and there was no correlation with GDPPC. Of particular concern was the rapid increase in the use of last-resort compounds, both in HICs and LMICs, such as glycylcyclines, oxazolidinones, carbapenems, and polymyxins. Projections of global antibiotic consumption in 2030, assuming no policy changes, were up to 200% higher than the 42 billion DDDs estimated in 2015. Although antibiotic consumption rates in most LMICs remain lower than in HICs despite higher bacterial disease burden, consumption in LMICs is rapidly converging to rates similar to HICs. Reducing global consumption is critical for reducing the threat of antibiotic resistance, but reduction efforts must balance access limitations in LMICs and take account of local and global resistance patterns.

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