An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan

Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This study aimed at measuring changes and patterns of national antimicrobial use for one year preceding and one year during the COVID-19 pandemic. Annual national antimicrobial consumption for 2019 and 2020 was obtained from the Jordan Food and Drug Administration (JFDA) following the WHO surveillance methods. The WHO Access, Watch, and Reserve (AWaRe) classification was used. Total antibiotic consumption in 2020 (26.8 DDD per 1000 inhabitants per day) decreased by 5.5% compared to 2019 (28.4 DDD per 1000 inhabitants per day). There was an increase in the use of several antibiotics during 2020 compared with 2019 (third generation cephalosporins (19%), carbapenems (52%), macrolides (57%), and lincosamides (106%)). In 2020, there was a marked reduction in amoxicillin use (−53%), while the use of azithromycin increased by 74%. National antimicrobial consumption of the Access group decreased by 18% from 2019 to 2020 (59.1% vs. 48.1% of total consumption). The use of the Watch group increased in 2020 by 26%. The study highlighted an increase in the use of certain antibiotics during the pandemic period that are known to be associated with increasing resistance. Efforts to enhance national antimicrobial stewardship are needed to ensure rational use of antimicrobials.

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Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz490 ◽

2019 ◽

Vol 75 (3) ◽

pp. 747-755

Author(s):

Pierre-Marie Roger ◽

Ingrid Peyraud ◽

Michel Vitris ◽

Valérie Romain ◽

Laura Bestman ◽

...

Keyword(s):

Clavulanic Acid ◽

Odds Ratio ◽

Adjusted Odds Ratio ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Third Generation ◽

Therapeutic Guidelines ◽

Amoxicillin Clavulanic Acid ◽

The Impact ◽

Third Generation Cephalosporins

Abstract Objectives We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. Methods Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. Results We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82–5.92 and 2.18, 95% CI 1.38–3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06–0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34–0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was −16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). Conclusions STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.

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Trends in Antibiotic Consumption and Resistance in France Over 20 Years: Large and Continuous Efforts but Contrasting Results

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa452 ◽

2020 ◽

Vol 7 (11) ◽

Author(s):

Jean Carlet ◽

Vincent Jarlier ◽

Jacques Acar ◽

Olivier Debaere ◽

Patrick Dehaumont ◽

...

Keyword(s):

Antibiotic Consumption ◽

Third Generation ◽

Antimicrobial Consumption ◽

Information Campaign ◽

Gram Negative ◽

E Coli ◽

Public Campaign ◽

Third Generation Cephalosporins ◽

Positive Effect ◽

Gram Positive Cocci

Abstract Background Antimicrobial resistance (AMR) is a serious threat to humanity. This paper describes the French efforts made since 2001 and presents data on antimicrobial consumption (AC) and AMR. Methods We gathered all data on AC and AMR recorded since 2001 from different national agencies, transferred on a regular basis to standardized European data on AC and resistance in both humans and animals. Results After a large information campaign implemented in France from 2001 to 2005 in humans, AC in the community decreased significantly (18% to 34% according to the calculation method used). It remained at the same level from 2005 to 2010 and increased again from 2010 to 2018 (8%). Contrasting results were observed for AMR. The resistance of Staphylococcus aureus decreased significantly. For gram-negative bacilli, the results were variable according to the microorganism. The resistance of Enterobacteriaceae to third-generation cephalosporins increased, remaining moderate for Escherichia coli (12% in 2017) but reaching 35% in the same year for Klebsiella pneumoniae. Resistance to carbapenems in those 2 microorganisms remained below 1%. Both global AC and resistance to most antibiotics decreased significantly in animals. Conclusions Antibiotic consumption decreased significantly in France after a large public campaign from 2001 to 2005, but this positive effect was temporary. The effect on AMR varied according to the specific microorganism: The effect was very impressive for gram-positive cocci, variable for gram-negative bacilli, and moderate for E. coli, but that for K. pneumoniae was of concern. The consumption of and resistance to antibiotics decreased significantly in animals.

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Two Time-Series Analyses of the Impact of Antibiotic Consumption and Alcohol-Based Hand Disinfection on the Incidences of Nosocomial Methicillin-ResistantStaphylococcus aureusInfection andClostridium difficileInfection

Infection Control and Hospital Epidemiology ◽

10.1086/596605 ◽

2009 ◽

Vol 30 (4) ◽

pp. 346-353 ◽

Cited By ~ 70

Author(s):

Klaus Kaier ◽

Christian Hagist ◽

Uwe Frank ◽

Andreas Conrad ◽

Elisabeth Meyer

Keyword(s):

Time Series ◽

Multivariate Analysis ◽

Multivariate Time Series ◽

Antibiotic Consumption ◽

Third Generation ◽

Hand Disinfection ◽

Mrsa Infection ◽

Time Series Analyses ◽

The Impact ◽

Third Generation Cephalosporins

Objective.To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistantStaphylococcus aureus(MRSA) infection andClostridium difficileinfection (CDI).Methods.Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month.Results.The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P<.001). The multivariate analysis (R2= 0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P= .023), third-generation cephalosporins (P= .05), fluoroquinolones (P= .01), and lincosamides (P= .05). The multivariate analysis (R2= 0.55) showed that a higher level of consumption of third-generation cephalosporins (P= .008), fluoroquinolones (P= .084), and/or macrolides (P= .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected.Conclusion.In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI.

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Ambulantna poraba antibiotikov pri otrocih v Sloveniji

Slovenian Medical Journal ◽

10.6016/zdravvestn.2474 ◽

2017 ◽

Vol 86 (5-6) ◽

Author(s):

Milan Čižman ◽

Tina Plankar Srovin ◽

Maja Sočan ◽

Aleš Korošec ◽

Jerneja Ahčan ◽

...

Keyword(s):

Antibiotic Use ◽

Antibiotic Consumption ◽

Upper Respiratory Tract ◽

Total Consumption ◽

Family Doctors ◽

Nitrofuran Derivatives ◽

Gender And Health ◽

Tract Infections ◽

Outpatient Settings ◽

Third Generation Cephalosporins

Background: Antibiotics are among the most common drugs prescribed in outpatient settings. It is estimated that up to 50 % are prescribed unnecessarily or inappropriately. To plan the actions for optimizing the use of antibiotics, we conducted a national antibiotic consumption study in children aged 0–18 years in the period between 2003 and 2015.Methods: In this national retrospective research we analyzed outpatient antibiotic consumption using ATC/DDD classification. The use of antibiotics was recorded in relation to the pattern of prescription, age, gender and health region.Results: The total consumption of antibiotics decreased by 35 % from 979 to 636 prescriptions per 1000 children/year (PTY) during the whole study period. Te use of all antibiotic classes decreased (except for quinolones and nitrofuran derivatives) by 12.5 %–81 %. In all those years we recorded the highest consumption in children aged 1 to 4 years (2184–1160 PTY). Amoxicillin was the most commonly prescribed antibiotic in children aged 0 to 4 years, penicillin V among 5 to 14 years and co-amoxiclav among adolescents aged 15 to 19 years. In health regions in the northeastern part of Slovenia much more antibiotics were prescribed than in other regions. In 2015, 65 % of prescriptions were prescribed by pediatricians and school medicine specialists, 16 % by physicians without specialization, 14 % by GPs/family doctors and 5 % by other specialists.Conclusions: Despite the decrease in outpatient antibiotic use in children and adolescents in Slovenia, the overall and especially broad-spectrum antibiotic consumption (amoxicillin with clavulanic acid, azithromycin and second/third generation cephalosporins) is still too high. It is necessary to strengthen activities to reduce prescribing, particularly for acute (upper) respiratory tract infections.

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Geographical distribution of Enterobacterales with a carbapenemase IMP-6 phenotype and its association with antimicrobial use: An analysis using comprehensive national surveillance data on antimicrobial resistance

PLoS ONE ◽

10.1371/journal.pone.0243630 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243630

Author(s):

Aki Hirabayashi ◽

Koji Yahara ◽

Toshiki Kajihara ◽

Motoyuki Sugai ◽

Keigo Shibayama

Keyword(s):

Geographical Distribution ◽

Surveillance Data ◽

Antimicrobial Use ◽

Third Generation ◽

National Surveillance ◽

Mixed Effect ◽

Bacteriological Test ◽

Geographical Regions ◽

Carbapenemase Gene ◽

Third Generation Cephalosporins

Enterobacterales resistant to carbapenems, a class of last-resort antimicrobials, are ranked as an “urgent” and “critical” public health hazard by CDC and WHO. IMP-type carbapenemase-containing Enterobacterales are endemic in Japan, and blaIMP-6 is one of the notable carbapenemase genes responsible for the resistance. The gene is plasmid-encoded and confers resistance to meropenem, but not to imipenem. Therefore, IMP-6-producing Enterobacterales isolates are occasionally overlooked in clinical laboratories and are referred to as ‘stealth-type’. Since previous reports in Japan were confined only to some geographical regions, their distribution across prefectures and the factors affecting the distribution remain unclear. Here, we revealed the dynamics of the geographical distribution of Enterobacterales with IMP-6 phenotype associated with antimicrobial use in Japan. We utilized comprehensive national surveillance data of all routine bacteriological test results from more than 1,400 hospitals in 2015 and 2016 to enumerate Escherichia coli and Klebsiella pneumoniae isolates with the antimicrobial susceptibility pattern (phenotype) characteristic of IMP-6 (imipenem susceptible, meropenem resistant), and to tabulate the frequency of isolates with the phenotype for each prefecture. Isolates were detected in approximately half of all prefectures, and combined analysis with the national data of antimicrobial usage revealed a statistically significant association between the frequency and usage of not carbapenems but third-generation cephalosporins (p = 0.006, logistic mixed-effect regression) and a weaker association between the frequency and usage of fluoroquinolones (p = 0.043). The usage of third-generation cephalosporins and fluoroquinolones may select the strains with the IMP-6 phenotype, and contribute to their occasional spread. We expect the findings will promote antimicrobial stewardship to reduce the spread of the notable carbapenemase gene.

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Antimicrobial point prevalence surveys in two Ghanaian hospitals: opportunities for antimicrobial stewardship

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlaa001 ◽

2020 ◽

Vol 2 (1) ◽

Cited By ~ 4

Author(s):

Daniel Kwame Afriyie ◽

Israel A Sefah ◽

Jacqueline Sneddon ◽

William Malcolm ◽

Rachel McKinney ◽

...

Keyword(s):

Antibiotic Use ◽

Point Prevalence ◽

Antimicrobial Use ◽

Third Generation ◽

Surgical Prophylaxis ◽

Duration Of Treatment ◽

Prevalence Studies ◽

Guideline Compliance ◽

Almost All ◽

Third Generation Cephalosporins

Abstract Background Improved knowledge regarding antimicrobial use in Ghana is needed to reduce antimicrobial resistance (AMR). This includes point prevalence studies (PPSs) in hospitals. Objectives were to: (i) provide baseline data in two hospitals [Keta Municipal Hospital (KMH) and Ghana Police Hospital (GPH)] and identify priorities for improvement; (ii) assess the feasibility of conducting PPSs; and (iii) compare results with other studies. Methods Standard PPS design using the Global PPS paper forms, subsequently transferred to their template. Training undertaken by the Scottish team. Quality indicators included: rationale for use; stop/review dates; and guideline compliance. Results Prevalence of antibiotic use was 65.0% in GPH and 82.0% in KMH. Penicillins and other β-lactam antibiotics were the most frequently prescribed in both hospitals, with third-generation cephalosporins mainly used in GPH. Antibiotic treatment was mainly empirical and commonly administered intravenously, duration was generally short with timely oral switching and infections were mainly community acquired. Encouragingly, there was good documentation of the indications for antibiotic use in both hospitals and 50.0%–66.7% guideline compliance (although for many indications no guideline existed). In addition, almost all prescribed antibiotics had stop dates and there were no missed doses. The duration of use for surgical prophylaxis was generally more than 1 day (69.0% in GPH and 77.0% in KMH). Conclusions These two hospitals were the first in Ghana to use the Global PPS system. We found the PPS was feasible, relatively rapid and achieved with limited training. Targets for improvement identified included reduction of broad-spectrum antibiotics and duration of treatment.

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Policies to Reduce Antibiotic Consumption: The Impact in the Basque Country

Antibiotics ◽

10.3390/antibiotics9070423 ◽

2020 ◽

Vol 9 (7) ◽

pp. 423

Author(s):

Paula Rojas ◽

Fernando Antoñanzas

Keyword(s):

Bacterial Resistance ◽

Moving Average ◽

Basque Country ◽

Arima Model ◽

Antibiotic Consumption ◽

Line Treatment ◽

Autoregressive Integrated Moving Average ◽

Drug Packaging ◽

One Year ◽

The Impact

In 2013, a change in copayment rate was introduced in the Basque Country (one year later than in the other regions in Spain), and improvements were made to drug packaging. In 2014, a National Program Against Bacterial Resistance (Spanish abbreviation: PRAN) was approved. The aim of this study is to analyze the impact of change to the copayment rate, the adjustment of drug packaging, and the approval of PRAN on the consumption of antibiotics. Raw monthly data on the consumption of antibiotics (costs, packages, and daily defined doses per thousand people (DID)) were collected from January 2009 to December 2018 in the Basque Country. Counterfactual and intervention analysis (Autoregressive integrated moving average (ARIMA) model) was performed for the total series, disaggregated by group of antibiotics (2019 WHO Access, Watch, and Reserve (AWaRe) Classification) and active substances with the highest cost per prescription (cefditoren and moxifloxacin), the lowest cost per prescription (doxycycline and cloxacillin), and the most prescribed active ingredients (amoxicillin, azithromycin, and levofloxacin). Introduction of copayment led to a ‘stockpiling effect’ one month before its implementation, equal to 8% in the three consumption series analyzed. Only the adjustment of drug packaging significantly reduced the number of packages dispensed (−12.19%). PRAN approval reduced consumption by 0.779 DID (−4.51%), representing a significant decrease for both ’access’ and ’watch’ group antibiotics. Despite the delay in implementing changes to copayment, there was a ‘stockpiling effect’. With the adjustment of packaging, fewer packs were prescribed but with a higher drug load and price. PRAN approval reduced both the consumption of ’access group antibiotics’ (first-line treatment) and ’watch group antibiotics’ (second-line treatment).

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Occurrence of clinical isolates ofKlebsiella pneumoniaeharboring chromosomally mediated and plasmid-mediated CTX-M-15 β-lactamase in a Tunisian hospital

Canadian Journal of Microbiology ◽

10.1139/w2012-089 ◽

2012 ◽

Vol 58 (9) ◽

pp. 1099-1103 ◽

Cited By ~ 4

Author(s):

Chedly Chouchani ◽

Allaaeddin El Salabi ◽

Rim Marrakchi ◽

Nader Abouelkacem ◽

Timothy R. Walsh

Keyword(s):

Health Care Professionals ◽

Resistance Mechanism ◽

Multidrug Resistant ◽

Clinical Isolates ◽

Third Generation ◽

Chain Reaction ◽

Resistant Strains ◽

Polymerase Chain ◽

The Impact ◽

Third Generation Cephalosporins

The spread of multidrug-resistant strains of Klebsiella pneumoniae in hospitals is of concern to clinical microbiologists, health care professionals, and physicians because of the impact infections caused by these bacteria have in causing morbidity and mortality. Clinical isolates of K. pneumoniae have been found to show resistance to third-generation cephalosporins as a result of acquiring extended-spectrum β-lactamase-producing genes, such as blaCTX-M. Since little is known about the mechanisms of antibiotic resistance observed in Kasserine hospital, Tunisia, this study was undertaken to investigate the mechanisms by which clinical isolates of K. pneumoniae resist β-lactam antibiotics. Twelve strains of K. pneumoniae were collected from patients admitted to Kasserine hospital; these isolates showed multiresistance phenotypes. Molecular genetics investigations using polymerase chain reaction, S1 digestion, and pulsed-field gel electrophoresisshowed that blaCTX-M-15in association with ISEcp1 is responsible for the resistance of these strains to third-generation cephalosporins. It has been determined that blaCTX-M-15is chromosomally mediated and plasmid mediated, which alarming need for infection control to prevent the outbreak of such a resistance mechanism.

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Antimicrobial Use Prior to the Acquisition of Multiresistant Bacteria

Infection Control and Hospital Epidemiology ◽

10.1086/502029 ◽

2002 ◽

Vol 23 (3) ◽

pp. 155-158 ◽

Cited By ~ 8

Author(s):

Matthieu Eveillard ◽

Jean-Luc Schmit ◽

François Eb

Keyword(s):

Staphylococcus Aureus ◽

Prospective Study ◽

Clavulanic Acid ◽

Antimicrobial Therapy ◽

Antimicrobial Agents ◽

Antimicrobial Use ◽

Third Generation ◽

Multiresistant Bacteria ◽

Amoxicillin Clavulanic Acid ◽

Third Generation Cephalosporins

AbstractWe assessed whether patients who acquired methicillin-resistantStaphylococcus aureus(MRSA) had less exposure to antimicrobial agents than did those who acquired Enterobacteriaceae that produced extended-spectrum β-lactamase (ESβL). In a 6-month, prospective study, ESβL carriers had received antimicrobial therapy more often than had MRSA carriers. Amoxicillin-clavulanic acid, fluoroquinolones, and third-generation cephalosporins, especially ceftazidime, had been prescribed more often for ESβL carriers than for MRSA carriers.

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Incidence of healthcare-associated Clostridioides difficile infections and association with ward-level antibiotic consumption in a German university hospital: an ecological study

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkz195 ◽

2019 ◽

Vol 74 (8) ◽

pp. 2400-2404 ◽

Cited By ~ 1

Author(s):

Marina Kipnis ◽

Frank Schwab ◽

Tobias S Kramer ◽

Miriam S Stegemann ◽

Caroline Isner ◽

...

Keyword(s):

Risk Factor ◽

Generation Cephalosporin ◽

Antibiotic Consumption ◽

University Hospital ◽

Incidence Density ◽

Third Generation ◽

Antimicrobial Consumption ◽

Clostridioides Difficile ◽

Ward Level ◽

Healthcare Associated

Abstract Objectives Clostridioides difficile infection (CDI) is one of the most important healthcare-associated infections. We aimed to describe the incidence density of healthcare-associated CDI (HA-CDI) in Germany’s largest hospital and to identify associations with ward-level antimicrobial consumption. Methods We used surveillance data on CDI and antimicrobial consumption from 2014 to 2017 and analysed a potential association by means of multivariable regression analysis. Results We included 77 wards with 404998 admitted patients and 1850862 patient-days. Six hundred and seventy-one HA-CDI cases were identified, resulting in a pooled mean incidence density of 0.36/1000 patient-days (IQR = 0.34–0.39). HA-CDI incidence density on ICU and haematological–oncological wards was about three times higher than on surgical wards [incidence rate ratio (IRR) = 3.00 (95% CI = 1.96–4.60) and IRR = 2.78 (95% CI = 1.88–4.11), respectively]. Ward-level consumption of third-generation cephalosporins was the sole antimicrobial risk factor for HA-CDI. With each DDD/100 patient-days administered, a ward’s HA-CDI incidence density increased by 2% [IRR = 1.02 (95% CI = 1.01–1.04)]. Other risk factors were contemporaneous community-associated CDI cases [IRR = 1.32 (95% CI = 1.07–1.63)] and CDI cases in the previous month [IRR = 1.27 (95% CI = 1.07–1.51)]. Furthermore, we found a significant decrease in HA-CDI in 2017 compared with 2014 [IRR = 0.68 (95% CI = 0.54–0.86)]. Conclusions We confirmed that ward-level antimicrobial use influences HA-CDI and specifically identified third-generation cephalosporin consumption as a risk factor.

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