Impact of an antibiotic stewardship programme in a surgical setting

Background: Antibiotics are miracles of science and critical for many surgical procedures. However, the emergence of multidrug resistant pathogens resulting from inappropriate antibiotic use is a threat to modern medicine. This study aimed to determine the appropriateness of antibiotic use, cost, consumption and impact of an antibiotic stewardship intervention round in a surgical ward setting.Methods: Baseline antibiotic utilisation was determined with a retrospective cross-sectional study in two surgical wards in a tertiary academic hospital in South Africa where medical records of 264 patients who received antibiotics were reviewed. In the second stage of the study, records of 212 patients who received antibiotics were reviewed during a weekly antibiotic stewardship intervention round. The volume of antibiotics consumed was determined using defined daily doses (DDDs)/1000 patients’ days, and the appropriateness of the antibiotic prescription for treatment was also determined using a quality-of-use algorithm.Results: There was a reduction in the volume of antibiotic consumption from a total 739.30 DDDs/1000 to 564.93 DDDs/1000 patient days, with reduction in inappropriate antibiotic use from 35% to 26% from baseline to antibiotic stewardship programme stages, respectively. There was an overall increase in culture targeted therapy in both wards in the antibiotic stewardship programme stage.Conclusion: The implementation of an antibiotic stewardship programme led to a reduction in antibiotic consumption and improvement in appropriate use of antibiotics.

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Trends and patterns of antibiotic prescribing at orthopedic inpatient departments of two private-sector hospitals in Central India: A 10-year observational study

PLoS ONE ◽

10.1371/journal.pone.0245902 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245902

Author(s):

Kristina Skender ◽

Vivek Singh ◽

Cecilia Stalsby-Lundborg ◽

Megha Sharma

Keyword(s):

Design Patterns ◽

Central India ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Prescribing Patterns ◽

Essential Medicines ◽

World Health ◽

Antibiotic Prescribing ◽

Cross Sectional ◽

Defined Daily Doses

Background Frequent antibiotic prescribing in departments with high infection risk like orthopedics prominently contributes to the global increase of antibiotic resistance. However, few studies present antibiotic prescribing patterns and trends among orthopedic inpatients. Aim To compare and present the patterns and trends of antibiotic prescription over 10 years for orthopedic inpatients in a teaching (TH) and a non-teaching hospital (NTH) in Central India. Methods Data from orthopedic inpatients (TH-6446; NTH-4397) were collected using a prospective cross-sectional study design. Patterns were compared based on the indications and corresponding antibiotic treatments, mean Defined Daily Doses (DDD)/1000 patient-days, adherence to the National List of Essential Medicines India (NLEMI) and the World Health Organization Model List of Essential Medicines (WHOMLEM). Antibiotic prescriptions were analyzed separately for the operated and the non-operated inpatients. Linear regression was used to analyze the time trends of antibiotic prescribing; in total through DDD/1000 patient-days and by antibiotic groups. Results Third generation cephalosporins were the most prescribed antibiotic class (TH-39%; NTH-65%) and fractures were the most common indications (TH-48%; NTH-48%). Majority of the operated inpatients (TH-99%; NTH-97%) were prescribed pre-operative prophylactic antibiotics. The non-operated inpatients were also prescribed antibiotics (TH-40%; NTH-75%), although few of them had infectious diagnoses (TH-8%; NTH-14%). Adherence to the NLEMI was lower (TH-31%; NTH-34%) than adherence to the WHOMLEM (TH-65%; NTH-62%) in both hospitals. Mean DDD/1000 patient-days was 16 times higher in the TH (2658) compared to the NTH (162). Total antibiotic prescribing increased over 10 years (TH-β = 3.23; NTH-β = 1.02). Conclusion Substantial number of inpatients were prescribed antibiotics without clear infectious indications. Adherence to the NLEMI and the WHOMLEM was low in both hospitals. Antibiotic use increased in both hospitals over 10 years and was higher in the TH than in the NTH. The need for developing and implementing local antibiotic prescribing guidelines is emphasized.

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Antibiotics stewardship in Ghana: a cross-sectional study of public knowledge, attitudes, and practices

10.21203/rs.2.19809/v1 ◽

2020 ◽

Author(s):

Tamara Jimah ◽

Ama P. Fenny ◽

Oladele Ogunseitan

Keyword(s):

Antibiotic Resistance ◽

Inappropriate Medication ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

Individual Knowledge ◽

Knowledge Attitudes And Practices

Abstract Background Antibiotic resistance is a major contributing factor to global morbidity and mortality and is associated with inappropriate medication use. However, the level of antibiotic consumption and knowledge about antibiotic resistance in Ghana is inadequately quantified. Our study identifies strategies for improved stewardship of antibiotics to prevent the proliferation of resistant pathogens by assessing the level of antibiotic knowledge, attitudes, and consumption behaviors by region, gender, age, and education in rural and urban Ghana. Methods A cross-sectional study was conducted in 12 communities in the urban Greater Accra and rural Upper West regions of Ghana. A questionnaire survey was administered to 400 individuals aged 18 years and older in selected locations during September-October 2018 to gather data on individual knowledge, attitudes, and practices concerning antibiotics and antibiotic resistance. Multivariate analysis was used to investigate the association between demographic characteristics and knowledge, attitudes, and related behaviors. Results Over 30% (125/400) had not received a doctor’s prescription during their last illness. Seventy percent (278/400) had taken at least one antibiotic in the year prior to the survey. The top five frequently used antibiotics were Amoxicillin , Amoxicillin-clavulanic acid , Ampicillin , Ciprofloxacin , and Metronidazole . Women and older adults had higher knowledge compared to their respective counterparts (p<0.01). Furthermore, prudent antibiotic use was significantly more prevalent in women than men (p<0.05). Although no regional differences were found in overall knowledge, compared to urban residents, individuals residing in rural settings exhibited higher knowledge about the ineffectiveness of antibiotics for viruses like the cold and HIV/AIDS (p<0.001). Two hundred and fifty-two (63%) respondents were unaware of antibiotic resistance. There was generally a low level of self-efficacy among participants regarding their role in preserving the effectiveness of antibiotics. Conclusion Antibiotic knowledge, attitudes, and use varied significantly across demographics, suggesting a context-specific approach to developing effective community interventions.

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Understanding of Pharmacy Students towards Antibiotic Use, Antibiotic Resistance and Antibiotic Stewardship Programs: A Cross-Sectional Study from Punjab, Pakistan

Antibiotics ◽

10.3390/antibiotics10010066 ◽

2021 ◽

Vol 10 (1) ◽

pp. 66

Author(s):

Khezar Hayat ◽

Shazia Jamshed ◽

Meagen Rosenthal ◽

Noman Ul Haq ◽

Jie Chang ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Pharmacy Students ◽

Cross Sectional ◽

Adequate Understanding ◽

Self Administered Questionnaire ◽

And Training ◽

Insight Into

Antibiotic resistance (ABR) is a significant issue for public health globally. An adequate understanding of ABR and the approaches used to tackle ABR, including antibiotic stewardship programs, are vital. This study aimed to get an insight into antibiotic use, ABR, and antibiotic stewardship programs among pharmacy students of Punjab, Pakistan. This multicenter study was undertaken among final (fifth) year undergraduate pharmacy students of 7 universities of Punjab, Pakistan. A paper-based self-administered questionnaire comprising 48-items was utilized for data collection. Descriptive and inferential statistics were employed for data analysis. This study included a total of 296 respondents with a response rate of 85.8%. Most of the students had an average understanding of antibiotic use (59.8%), ABR (42.6%), ABR mechanisms (48.0%), and factors of ABR (51.7%). Only 21.6% of students have heard about antibiotic stewardship programs. More than half of the students believed that educating and training healthcare professionals (53.4%) and medical students (57.8%) about the prescribing and judicial usage of antibiotics could reduce the ABR burden. The awareness of most of the pharmacy students about certain aspects of antibiotic use, ABR, and stewardship programs was suboptimal.

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Trends and Drivers of Inpatient Antibiotic Consumption among 89 China Tertiary General Hospitals from 2011Q1 to 2015Q4

BioMed Research International ◽

10.1155/2018/5968653 ◽

2018 ◽

Vol 2018 ◽

pp. 1-7

Author(s):

Jiangyun Chen ◽

Rui Min ◽

He Wang ◽

Shengwen Zhao ◽

Haomiao Li ◽

...

Keyword(s):

Antibiotic Stewardship ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Panel Regression ◽

General Hospitals ◽

Policy Interventions ◽

Defined Daily Doses ◽

Stewardship Program ◽

Program Policy ◽

Made In

Antibacterial surveillance is an essential measure for strengthening the management of clinical antibiotic use. This study aimed to determine the trends and drivers of inpatient antibiotic consumption in China. A sample of 89 hospitals with complete data from 2011Q1 to 2015Q4 was included. Accumulative defined daily doses (DDDs), antibiotic use density (AUD), and drug variety were calculated to evaluate antibiotic consumption. From 2011Q1 to 2015Q4, the median values of DDDs, AUD, and drug variety dropped by 10.49%, 39.19%, and 27.96%, respectively. Panel regression results showed, for each additional quarter, DDDs reduced by 6.714 DDDs, AUD reduced by 0.013 DDDs per 100 inpatients per day, and drug variety reduced by 0.012 types (p < 0.001). National hospitals were more likely to use antibiotics, with the highest number of DDDs (106 709 DDDs) and AUD (60 DDDs per 100 inpatients per day) and a large number of drug variety (71 types of drug) all reported from national hospitals. Overall, a downward trend of inpatient antibiotic consumption was observed in competitive tertiary general hospitals in China. However, antibiotic use in China, especially in national hospitals, continues to exceed the guidelines set forth by the nationwide antibiotic stewardship program. China must continue to improve surveillance of antibiotic consumption by constructing a more comprehensive, continuous, and targeted stewardship program. Policy interventions in China should be made in consideration of unbalanced regional development and the consequences this may have on antibiotic consumption.

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Point prevalence survey of antibiotic consumption across three hospitals in Ghana

JAC-Antimicrobial Resistance ◽

10.1093/jacamr/dlab008 ◽

2021 ◽

Vol 3 (1) ◽

Author(s):

Obed Kwabena Offe Amponsah ◽

Kwame Ohene Buabeng ◽

Alex Owusu-Ofori ◽

Nana Kwame Ayisi-Boateng ◽

Katri Hämeen-Anttila ◽

...

Keyword(s):

Susceptibility Testing ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Cross Sectional Study ◽

Point Prevalence ◽

Prevalence Survey ◽

Cross Sectional ◽

Exact Test ◽

Susceptibility Data ◽

Chi Squared

Abstract Background Actionable data on antimicrobial use is important when planning strategic interventions such as antimicrobial stewardship to address the challenge of drug resistance, particularly in resource-constrained settings. Objectives To assess the prevalence of antibiotic use, the pattern of commonly used antibiotics and patient factors that may be associated with the increased use of antibiotics in the study hospitals. Methods This was a cross-sectional study conducted using the WHO Methodology for Point Prevalence Surveys in hospitals. Chi-squared analysis, Fisher’s exact test and logistic regression were employed to analyse statistically the data obtained. Results The overall prevalence of antibiotic use in the hospitals was 60.5%. The commonest indications for antibiotic recommendations were community-acquired infections (36.5%), surgical prophylaxis (26.1%) and hospital-acquired infections (15.7%), among others. Very few (2.7%) of the patients had their samples taken for culture and susceptibility testing to guide therapy. Penicillins (48.7%), cephalosporins (23.5%) and fluoroquinolones (17.4%) were the most commonly prescribed antibiotics. Concurrent malaria infection [adjusted OR (AOR) 0.33, 95% CI 0.11–0.94, P = 0.04] and increasing age (AOR 0.98, 95% CI 0.96–1.00, P = 0.02) were associated with lower risk of antibiotic use. Conclusions The prevalence of antibiotic consumption in the hospitals was lower than that reported in similar studies in Ghana, but high relative to some reports from high-income countries. Most antibiotic therapy was empirical and not guided by culture and susceptibility testing. There is the need for application of the WHO AWaRe classification for the selection of antibiotics and increased use of culture and susceptibility data to guide infectious disease therapy.

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Diversity and Distribution of Spa types among Methicillin Resistant Staphylococcus Aureus Isolated from Humans and Livestock in Kabale District - South Western Uganda

10.21203/rs.3.rs-1055610/v1 ◽

2021 ◽

Author(s):

Andrew Baguma ◽

Benson Musinguzi ◽

Patrick Orikiriza ◽

Joel Bazira

Keyword(s):

Antibiotic Use ◽

Multidrug Resistant ◽

Cross Sectional Study ◽

Multi Drug Resistance ◽

Typing Method ◽

Cross Sectional ◽

Effective Prevention ◽

Household Contacts ◽

Western Uganda ◽

Spa Types

Abstract Background: S. aureus is a skin and mucosal bacterial commensal of both humans and animals which has evolved as an important pathogen implicated to cause various infections. High levels of antibiotic use have resulted into multi-drug resistance MRSA, especially among HA-MRSA, CA-and LA - MRSA. Awareness on coexistence and diversity of MRSA clones among humans and household Livestock particularly cattle and swine in our region is limited. We used spa typing method to determine spa diversity, distribution and coexistence in outpatients, household contacts and respective livestock (cattle and swine) in Kabale region, south western Uganda. Methods: This was a cross sectional study by design consisting of outpatients, household contacts and livestock. Outpatients (n =100) colonized with MRSA were traced back to their respective homesteads where household members, domestic cattle, and, swine were tested for S. aureus and subsequently MRSA colonization. High-resolution DNA melting analysis was used to determine spa types among MRSA isolates. Overlap of MRSA isolates among humans and livestock was based on the presence of similar spa types.Results: A total of 3371 S.aureus isolates were collected from outpatients (n =376), household contacts (n = 1531), Cattle (n = 1159) and Swine (n = 305), among which 482 had mecA gene where 27% (100/376) and 8% (123/1531) were outpatients and household contacts respectively while 11% (132/1159) and 42% (127/305) were cattle and swine respectively. Twenty different spa types were identified; t034, t4677, t108, t1451, t9377, t1081, t040, t701, t041, t002, t044, t037,t121, t127, t922, t032, t019, t018, t012 and t030, among which t034 (109/482), t4677 (53/482), t9377 (63/482) and t1081 (53/482) were most prevalent and distributed among human and livestock. All the MRSA isolates were multidrug resistant to antibiotics tested. Conclusion: In Kabale region, there is high diversity of spa types among MRSA. Presence of similar spa types was found circulating among humans and their respective livestock which demonstrates a possible bidirectional transmission. Presence of MDR - MRSA highlights the need for effective prevention and control of MRSA among livestock and in the community using One Health approach.

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Antibiotics stewardship in Ghana: a cross-sectional study of public knowledge, attitudes, and practices among communities.

10.21203/rs.2.19809/v2 ◽

2020 ◽

Author(s):

Tamara Jimah ◽

Ama P. Fenny ◽

Oladele Ogunseitan

Keyword(s):

Antibiotic Resistance ◽

Inappropriate Medication ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Attitudes And Practices ◽

Individual Knowledge ◽

Knowledge Attitudes And Practices

Abstract Background Antibiotic resistance is a major contributing factor to global morbidity and mortality and is associated with inappropriate medication use. However, the level of antibiotic consumption and knowledge about antibiotic resistance in Ghana is inadequately quantified. Our study identifies strategies for improved stewardship of antibiotics to prevent the proliferation of resistant pathogens by assessing the level of antibiotic knowledge, attitudes, and consumption behaviors by region, gender, age, and education in rural and urban Ghana. Methods A cross-sectional study was conducted in 12 communities in the urban Greater Accra and rural Upper West regions of Ghana. A questionnaire survey was administered to 400 individuals aged 18 years and older in selected locations during September-October 2018 to collect data on individual knowledge, attitudes, and practices concerning antibiotics and antibiotic resistance. Multivariate analysis was used to investigate the association between demographic characteristics and knowledge, attitudes, and related behaviors. Results Over 30% (125/400) had not received a doctor’s prescription during their last illness. Seventy percent (278/400) had taken at least one antibiotic in the year prior to the survey. The top five frequently used antibiotics were Amoxicillin, Amoxicillin-clavulanic acid, Ampicillin, Ciprofloxacin, and Metronidazole. Women and older adults had higher knowledge compared to their respective counterparts (p<0.01). Furthermore, prudent antibiotic use was significantly more prevalent in women than men (p<0.05). Although no regional differences were found in overall knowledge, compared to urban residents, individuals residing in rural settings exhibited higher knowledge about the ineffectiveness of antibiotics for viruses like the cold and HIV/AIDS (p<0.001). Two hundred and fifty-two (63%) respondents were unaware of antibiotic resistance. There was generally a low level of self-efficacy among participants regarding their role in preserving the effectiveness of antibiotics. Conclusion Antibiotic knowledge, attitudes, and use varied significantly across demographics, suggesting a context-specific approach to developing effective community interventions.

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Public Health Literacy, Knowledge, and Awareness Regarding Antibiotic Use and Antimicrobial Resistance during the COVID-19 Pandemic: A Cross-Sectional Study

Antibiotics ◽

10.3390/antibiotics10091107 ◽

2021 ◽

Vol 10 (9) ◽

pp. 1107

Author(s):

Suhaib M. Muflih ◽

Sayer Al-Azzam ◽

Reema A. Karasneh ◽

Barbara R. Conway ◽

Mamoon A. Aldeyab

Keyword(s):

Antibiotic Resistance ◽

Health Literacy ◽

Antimicrobial Resistance ◽

Online Survey ◽

Public Awareness ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Modern Medicine ◽

Sectional Study ◽

Cross Sectional

Multi-drug-resistant (MDR) organisms pose a global threat to modern medicine, which has grown as a result of irrational antibiotic use and misuse. This study aimed to assess general public knowledge in Jordan and awareness of antibiotics and antibiotic resistance during the COVID-19 pandemic. A cross-sectional study was carried out utilizing the WHO multicountry public awareness survey. The study population was composed mainly of social media users, and a total of 1213 participants completed the online survey. According to the findings, more than half of the participants were well versed in antibiotic use and resistance. Those with adequate health literacy were found to better understand antibiotics (OR = 1.37, p = 0.017) and antibiotic resistance (OR = 1.46, p = 0.003). The vast majority (88.5%) recognized at least one antibiotic resistance term; however, 53.2% believed that antibiotic resistance is a problem in other nations. The participants in this study reported using antibiotics incorrectly, believing that they were treating sore throats, colds, and flu. The participants were well aware of antibiotic resistance solutions and their consequences on health. Age, education, health literacy, and antibiotic knowledge were found to be substantially (p < 0.05) associated with greater awareness of antibiotic resistance. The findings highlight the need for antimicrobial resistance education campaigns, health literacy, and antibiotic stewardship initiatives.

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Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications

Antibiotics ◽

10.3390/antibiotics10070866 ◽

2021 ◽

Vol 10 (7) ◽

pp. 866

Author(s):

Iltaf Hussain ◽

Nisa Yousaf ◽

Sana Haider ◽

Pervisha Jalil ◽

Muhammad Usman Saleem ◽

...

Keyword(s):

Antimicrobial Resistance ◽

University Students ◽

Antimicrobial Stewardship ◽

Antibiotic Use ◽

Cross Sectional Study ◽

Dosing Regimen ◽

Student Knowledge ◽

Chi Square ◽

Cross Sectional ◽

Self Administered Questionnaire

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

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National Antibiotic Consumption for Human Use in Sierra Leone (2017–2019): A Cross-Sectional Study

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020077 ◽

2021 ◽

Vol 6 (2) ◽

pp. 77

Author(s):

Joseph Sam Kanu ◽

Mohammed Khogali ◽

Katrina Hann ◽

Wenjing Tao ◽

Shuwary Barlatt ◽

...

Keyword(s):

Sierra Leone ◽

Antibiotic Consumption ◽

Cross Sectional Study ◽

Defined Daily Dose ◽

Oral Antibiotics ◽

Sectional Study ◽

Beta Lactam ◽

Total Consumption ◽

Cross Sectional ◽

Procaine Penicillin

Monitoring antibiotic consumption is crucial to tackling antimicrobial resistance. However, currently there is no system in Sierra Leone for recording and reporting on antibiotic consumption. We therefore conducted a cross-sectional study to assess national antibiotic consumption expressed as defined daily dose (DDD) per 1000 inhabitants per day using all registered and imported antibiotics (categorized under the subgroup J01 under the anatomical and therapeutic classification (ATC) system) as a proxy. Between 2017–2019, total cumulative consumption of antibiotics was 19 DDD per 1000 inhabitants per day. The vast majority consisted of oral antibiotics (98.4%), while parenteral antibiotics made up 1.6%. According to therapeutic/pharmacological subgroups (ATC level 3), beta-lactam/penicillins, quinolones, and other antibacterials (mainly oral metronidazole) comprised 65% of total consumption. According to WHO Access, Watch, and Reserve (AWaRe), 65% of antibiotics consumed were Access, 31% were Watch, and no Reserve antibiotics were reported. The top ten oral antibiotics represented 97% of total oral antibiotics consumed, with metronidazole (35%) and ciprofloxacin (15%) together constituting half of the total. Of parenteral antibiotics consumed, procaine penicillin (32%) and ceftriaxone (19%) together comprised half of the total. Policy recommendations at global and national levels have been made to improve monitoring of antibiotic consumption and antibiotic stewardship.

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