scholarly journals Evolution of Antimicrobial Consumption During the First Wave of COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 132
Author(s):  
Santiago Grau ◽  
Daniel Echeverria-Esnal ◽  
Silvia Gómez-Zorrilla ◽  
Maria Eugenia Navarrete-Rouco ◽  
Joan Ramon Masclans ◽  
...  
Keyword(s):  
Temporal Pattern ◽  
Tertiary Care Hospital ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Defined Daily Doses ◽  
Quasi Experimental ◽  
Bed Days ◽  
Hospital Consumption

Background: The first wave of COVID-19 pandemic may have significantly impacted antimicrobial consumption in hospitals. The objective of this study was to assess the evolution of antimicrobial consumption during this period. Methods: A retrospective quasi-experimental before–after study was conducted in a Spanish tertiary care hospital. The study compared two periods: pre-pandemic, from January 2018 to February 2020, and during the COVID-19 pandemic from March to June 2020. Antimicrobial consumption was analyzed monthly as defined daily doses (DDD)/100 bed-days and overall hospital and ICU consumption were evaluated. Results: An increase in the hospital consumption was noticed. Although only ceftaroline achieved statistical significance (p = 0.014), a rise was observed in most of the studied antimicrobials. A clear temporal pattern was detected. While an increase in ceftriaxone and azithromycin was observed during March, an increment in the consumption of daptomycin, carbapenems, linezolid, ceftaroline, novel cephalosporin/β-lactamase inhibitors or triazoles during April–May was noticed. In the ICU, these findings were more evident, namely ceftriaxone (p = 0.029), carbapenems (p = 0.002), daptomycin (p = 0.002), azithromycin (p = 0.030), and linezolid (p = 0.011) but followed a similar temporal pattern. Conclusion: An increase in the antimicrobial consumption during the first wave of COVID-19 pandemic was noticed, especially in the ICU. Availability of updated protocols and antimicrobial stewardship programs are essential to optimize these outcomes.

scholarly journals Increase of Antimicrobial Consumption in a Tertiary Care Hospital during the First Phase of the COVID-19 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 778
Author(s):  
Alexandre Castro-Lopes ◽  
Sofia Correia ◽  
Cátia Leal ◽  
Inês Resende ◽  
Pedro Soares ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Age Groups ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Lengths Of Stay ◽  
Defined Daily Doses ◽  
Before And After ◽  
Amoxicillin Clavulanic Acid ◽  
Admission Type

Background: The COVID-19 pandemic poses novel challenges in antimicrobial consumption metrics and stewardship strategies. COVID-19 patients became the major cause of hospital admission during the first wave of the pandemic, often leading to an antimicrobial prescription upon admission or treatment for superinfections. The aim of this study was to understand how antimicrobial consumption was impacted at the beginning of the pandemic in a tertiary care hospital, a reference center for COVID-19. Materials and Methods: A retrospective before-and-after study was done. Descriptive statistics of discharges, patient-days, and antimicrobial use indicators (defined daily doses (DDD)/100 discharges, DDD/100 patient-days) for various groups were calculated for the first three months of the pandemic (March, April, and May 2020) as a quarterly value, and for each year in 2011–2019, and their annual percentage changes were used to estimate 95% confidence intervals. The indicators were compared to patient type (medical/surgical), type of admission (urgent/elective), and age groups using Spearman’s correlation coefficient. Results: Statistically significant increases occurred in 2020 for total antibacterials, macrolides, cephalosporins, amoxicillin/clavulanic acid, carbapenems, meropenem, and third-generation cephalosporins, while a reduction was seen in cefazolin/cefoxitin. A correlation was found between antibacterial consumption and patient or admission type. In 2020, unlike in pre-pandemic years, there was a different impact in DDD/100 discharges and DDD/100 patient-days due to increased lengths-of-stay and longer antimicrobial therapy. Conclusions: The COVID-19 pandemic led to an increase in antimicrobial consumption with a different impact in DDD/100 discharges and DDD/100 patient-days. This highlights the need to use both indicators simultaneously to better understand the causes of antimicrobial consumption variation and improve the design of effective antimicrobial stewardship interventions.

A Study on prescribing pattern of drugs in orthopaedic in-patient department at a tertiary care hospital in Guntur region

2020 ◽  
Vol 8 (2) ◽  
pp. 60-70
Author(s):  
Anjani Teja Ch ◽  
Ramesh babu K ◽  
Leela subramanyam S ◽  
Janani Y ◽  
Eswar Sai Kiran K ◽  
...  
Keyword(s):  
Tertiary Care Hospital ◽  
Care Delivery ◽  
Tertiary Care ◽  
Essential Medicine ◽  
Care Hospital ◽  
Age Group ◽  
Common Condition ◽  
Prescribing Pattern ◽  
Prescribing Indicators ◽  
Bed Days

The descriptive observational study was conducted over six months among inpatients of the orthopaedics department. The aim is to observe the prescribing pattern of drugs, to find out the percentage of analgesics given and most commonly prescribed analgesic, to compare the prescribed drugs whether they are in NLEM, WHO list and calculate DDD/100 Bed-days and to analyze the drugs for WHO prescribing drugs. A total of 250 patients were included in the study. Out of this, 168 were male, and 82 were female. Most of the patients were in the age group of 31-40[45 in number with 18%]. The most common condition was found to fracture [113 in number with 95.2%]. Commonly prescribed drugs were analgesics 447 with 26.76%. Among all the NSAID's, PCM was most commonly prescribed analgesic with 34.4%. The highest no, of drugs was found to be 4drugs/prescription with 24%. Monthly one analgesic was prescribed per prescription with 38.8%. Utilization of analgesics in term of DDD/100 Bed-days was 55.26; Drugs will be evaluated per prescription as per prescribing indicators of WHO was done, the average no. of drugs per prescription was found to be 0.45, percentage of drugs prescribed by generic name was found to be 13.3%, percentage of encounters with antibiotics prescribed were found to be 94.4%, In ratio percentage of drugs prescribed from the national list of essential medicine was found to be 92.6%. This study would help to facilitate better health care delivery.

scholarly journals The effect of care transition pathway implementation on patients undergoing joint replacement during the COVID-19 pandemic: a quasi-experimental study from a tertiary care hospital orthopedic department in Beijing, China

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ya-ping Xu ◽  
Pei-yu Zhao ◽  
Yi-tong Bai ◽  
Shuang Li
Keyword(s):  
Joint Replacement ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Transition ◽  
Control Group ◽  
Care Hospital ◽  
Quasi Experimental ◽  
And Control ◽  
Beijing China

Abstract Background The coronavirus disease (COVID-19) pandemic has had a massive impact on individuals globally. The Chinese government has formulated effective response measures, and medical personnel have been actively responding to challenges associated with the epidemic prevention and control strategies. This study aimed to evaluate the effect of the implementation of a care transition pathway on patients that underwent joint replacement during the COVID-19 pandemic. Methods A quasi-experimental study was designed to evaluate the effect of implementing a care transition pathway for patients who underwent joint replacement during the COVID-19 pandemic in the orthopedic department of a tertiary care hospital in Beijing, China. Using a convenient sampling method, a total of 96 patients were selected. Of these, 51 patients who had undergone joint replacement in 2019 and received treatment via the routine nursing path were included in the control group. The remaining 45 patients who underwent joint replacement during the COVID-19 epidemic in 2020 and received therapy via the care transition pathway due to the implementation of epidemic prevention and control measures were included in the observation group. The quality of care transition was assessed by the Care Transition Measure (CTM), and patients were followed up 1 week after discharge. Results The observation group was determined to have better general self-care preparation, written planning materials, doctor-patient communication, health monitoring, and quality of care transition than the control group. Conclusions A care transition pathway was developed to provide patients with care while transitioning through periods of treatment. It improved the patient perceptions of nursing quality. The COVID-19 pandemic is a huge challenge for health professionals, but we have the ability to improve features of workflows to provide the best possible patient care.

scholarly journals Trends of Adult Antimicrobial Hospital Consumption in Catalonia (Spain) from 2008 to 2018

2020 ◽  
Vol 41 (S1) ◽  
pp. s500-s501
Author(s):  
Santiago Grau ◽  
Sergi Hernández ◽  
Ariadna Padullés ◽  
Montserrat Gimenez ◽  
Lucía Boix-Palop ◽  
...  
Keyword(s):  
Anatomical Therapeutic Chemical ◽  
Pearson Correlation ◽  
Acute Care Hospital ◽  
Defined Daily Dose ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Surgical Units ◽  
Amoxicillin Clavulanate ◽  
Bed Days ◽  
Hospital Consumption

Background: Antimicrobial resistance is a disturbing problem in the health system. A relationship between the use of certain antimicrobials and a resistance increase has been proposed. Since this phenomenon is not usually attributed to specific uses of antimicrobials but preferably to its evolution over the years, the analysis of the antimicrobial consumption over time can justify the epidemiological situation of a given region in terms of resistance and possible increases and decreases for specific microorganisms. The objective of this study was to analyze the evolution of the use of antimicrobials in Catalonia during 2008–2018 through the VINCat program (Infection Control and Antimicrobial Stewardship Catalonian Program). Methods: The number of hospitals participating in the VINCat increased from 46 in 2008 to 63 in 2018 (ie, 68.8% and 85.7% of all adult acute-care hospital beds in Catalonia, respectively). Hospitalization days recorded at the participating hospitals increased from 2,991,053 in 2008 to 3,714,938 in 2018. The Anatomical Therapeutic Chemical Classification (ATC) defined daily dose (DDD) index was used for monitoring antimicrobial consumption. Simple linear regressions were performed, the linear relationship was checked by ANOVA tests, and the Pearson correlation (Pc) coefficients were obtained. Values of P ≤ .05 were considered statistically significant. Results: From 2008 to 2018, there was a statistically significant increase of global antibacterial consumption (65.50 vs 71.73 DDD per 100 bed days; P = .001) and antimycotic consumption (3.09 vs 3.45 DDD per 100 bed days, P = .012) due to an increase of consumption in the surgical units. At the same time, there was a decrease in the consumption of antimycotics in the medical units (4.35 vs 3.90 DDD per 100 bed days; P =.029). Cephalosporins and carbapenem consumption increased both globally (10.88 vs 13.86 DDD per 100 bed days; P < .001) and in medical and surgical units (3.26 vs 5.38 DDD per 100 bed days; P < .001). This increase was mainly associated with ceftriaxone (3.45 vs 5.46 DDD per 100 bed days; P < .001) and meropenem (1.12 vs 3.08 DDD per 100 bed days; P < .001). There was a global decrease in the consumption of penicillins (26.10 vs 24.24 DDD per 100 bed days; P = .012) and quinolones (11.63 vs 9.61 DDD per 100 bed days; P = .004). This trend was observed also in ICUs and medical units but not in surgical units, for which only quinolones showed a significant decrease. Decreases in the use of amoxicillin/clavulanate acid (17.80 vs 14.24 DDD per 100 bed days; P < .001) and ciprofloxacin (5.68 vs 4.01 DDD per 100 bed days; P < .001) were observed. Conclusions: The increase in the use of antimicrobials in Catalonia is concerning. This increase is attributable to the use of these drugs in surgical units. Antibiotic stewardship measures should be aimed primarily at these units. The increasing use of carbapenems should be analyzed.Funding: NoneDisclosures: Juan Pablo Horcajada reports consulting fees from MSD, Pfizer, and Menarini as well as speaker honoraria from MSD, Pfizer, and Zambon.

scholarly journals Significance of Immunohistochemical Biomarker in Breast Carcinoma from a Single Tertiary Care Hospital of Southern Assam

2021 ◽  
Author(s):  
Naiding Momota ◽  
Choudhury Biswadeep ◽  
Bezbaruah Babul ◽  
Nivedita Dasgupta ◽  
Deuri Biman ◽  
...  
Keyword(s):  
Lymph Node ◽  
Breast Carcinoma ◽  
Tumor Size ◽  
Tertiary Care Hospital ◽  
Histological Grade ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Tumor Grade ◽  
Lymph Node Status ◽  
Care Hospital

Abstract Background: Breast carcinoma is the most common malignancy in female worldwide, leading cause of death in women.immunohistochemistry plays a very important role in the prognostication and treatment determination of breast carcinoma patients. Objective: To analyze the immunohistochemical markers in invasive carcinoma of breast and to correlate the expression of hormonal receptors with age of the patient, tumor size, histological grade and lymph node metastasis.Materials and method: The study was conducted on 88 infiltrating ductal breast carcinoma sample in a tertiary care hospital of Southern Assam for a period of two year (January2018- December 2019). Data including age, tumor size, and histologic grade and lymph node status retrieved from pathology department. Chi- square was used to determine the statistical significance between ER/PR status HER2/neu status along with their correlation with various clinicopathological parametres with respect to infiltrating ductal breast carcinoma.Result: The mean age of the patients was 56.6 years. We observed correlation between ER and PR expression with age, tumor size, tumor grade. There was correlation between HER2/neu expression and age only. None of the markers showed correlation with lymph node involvement (P>0.05).Conclusion: Our findings showed the importance of biomarkers (ER, PR, HER2/neu) expression as prognostic factors for therapeutic decision.

scholarly journals Post-operative hypocalcemia in patients undergoing thyroid surgeries in tertiary care hospital: an observational study

2021 ◽  
Vol 7 (8) ◽  
pp. 1293
Author(s):  
Tabish Maqbool ◽  
Showkat Ahmad Showkat ◽  
Kulvinder Singh Mehta
Keyword(s):  
Thyroid Surgery ◽  
Tertiary Care Hospital ◽  
Statistical Significance ◽  
Tertiary Care ◽  
Perioperative Period ◽  
Female Gender ◽  
Care Hospital ◽  
Thyroid Resection ◽  
Strong Risk Factor ◽  
Permanent Hypocalcemia

<p><strong>Background: </strong>Post-operative hypocalcaemia is one of the most common complications of thyroid and parathyroid surgery. Temporary hypocalcaemia has been reported to occur in 1.6-50% of the patients undergoing bilateral thyroid resection. Permanent hypoparathyroidism results in 0-13% of patients after bilateral thyroid surgery.</p><p><strong>Method: </strong>We have analyzed the data of 34 patients undergoing total thyroid surgery (with or without neck dissection) and completion thyroidectomy at the department of ENT and HNS, SMHS hospital over a period of 1.5 years between May 2019 to November 2020.</p><p><strong>Results:</strong> Hypocalcemia was found in a total of 15 patients out of 34 patients in the post-op period. Among the total patients who developed hypocalcemia 5 (14.7%) were males and 10 (29.4%) were females. Among the patients who developed post-op hypocalcemia 14 patients developed transient hypocalcemia (p&gt;0.01) which is not statistically significant and 1 patient developed permanent hypocalcemia (p&gt;0.01) which also has no statistical significance.</p><p><strong>Conclusions: </strong>The study suggests that female gender is a strong risk factor for developing post-operative hypocalcemia, other factors that play a role include difference in serum calcium levels in the perioperative period and type of surgery.</p>

Differential Correlation Between Rates of Antimicrobial Drug Consumption and Prevalence of Antimicrobial Resistance in a Tertiary Care Hospital in Greece

2008 ◽  
Vol 29 (7) ◽  
pp. 615-622 ◽  
Author(s):  
Elias Iosifidis ◽  
Charalampos Antachopoulos ◽  
Maria Tsivitanidou ◽  
Aspasia Katragkou ◽  
Evagelia Farmaki ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antimicrobial Drug ◽  
Drug Consumption ◽  
Care Hospital ◽  
Antimicrobial Consumption ◽  
Consumption Rates ◽  
Imipenem Resistance ◽  
Rate Of Consumption

Objective.To investigate whether there is a correlation between the rates of antimicrobial drug consumption in hospital departments and the prevalence of antimicrobial resistance among clinically important bacteria recovered in the hospital.Design.Retrospective study.Setting.Tertiary care hospital in Greece.Methods.Data on antimicrobial consumption (from January 2001 through December 2004) were expressed as defined daily doses per 100 bed-days. The prevalence of antimicrobial resistance among isolates of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterococcusfaecium recovered during the same time period were calculated by the microbiology department. We then performed the following analyses: (1) a comparison of the consumption rates for different antimicrobial groups in individual hospital departments, (2) a comparison of the prevalence of resistance to different antimicrobials, and (3) a correlation analysis of antimicrobial consumption rates and the prevalence of antimicrobial resistance.Results.The rates of antimicrobial consumption and the prevalence of resistance varied substantially among the hospital's departments. The annual rate of consumption for carbapenems correlated with the rate of consumption for glycopeptides and third-generation cephalosporins (P < .05). Among P. aeruginosa isolates, the prevalence of imipenem resistance correlated with the prevalence of resistance to amikacin, ciprofloxacin, and ceftazidime (P < .05). The rate of carbapenem consumption correlated with the prevalence of imipenem resistance among P. aeruginosa and A. baumannii isolates (P < .05). The rate of aminoglycoside consumption correlated with the prevalence of amikacin resistance among P. aeruginosa, K. pneumoniae, and E. coli isolates (P < .05). However, the rate of consumption for fluoroquinolones and glycopeptides had no correlation with the prevalence of ciprofloxacin resistance among gram-negative bacteria or vancomycin resistance among E. faecium isolates.Conclusions.These data are suggestive of a differential relationship between antimicrobial consumption and the prevalence of antimicrobial resistance among various species and for various antimicrobial agents. These findings may help to optimize antimicrobial prescription policies in the hospital, especially in departments that have both high rates of antimicrobial consumption and a high prevalence of antimicrobial resistance.

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