Antimicrobial stewardship for acute-care hospitals: An Asian perspective

2018 ◽  
Vol 39 (10) ◽  
pp. 1237-1245 ◽  
Author(s):  
Anucha Apisarnthanarak ◽  
Andrea Lay-Hoon Kwa ◽  
Cheng-Hsun Chiu ◽  
Suresh Kumar ◽  
Le Thi Anh Thu ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Resource Constraints ◽  
Multidrug Resistant ◽  
Team Members ◽  
Inappropriate Use ◽  
Carbapenem Resistant ◽  
Simple Program ◽  
Improve Patient ◽  
Formulary Restriction

AbstractInappropriate use of antibiotics is contributing to a serious antimicrobial resistance problem in Asian hospitals. Despite resource constraints in the region, all Asian hospitals should implement antimicrobial stewardship (AMS) programs to optimize antibiotic treatment, improve patient outcomes, and minimize antimicrobial resistance. This document describes a consensus statement from a panel of regional experts to help multidisciplinary AMS teams design programs that suit the needs and resources of their hospitals. In general, AMS teams must decide on appropriate interventions (eg, prospective audit and/or formulary restriction) for their hospital, focusing on the most misused antibiotics and problematic multidrug-resistant organisms. This focus is likely to include carbapenem use with the goal to reduce carbapenem-resistant gram-negative bacteria. Rather than initially trying to introduce a comprehensive, hospital-wide AMS program, it would be practical to begin by pilot testing a simple program based on 1 achievable core intervention for the hospital. AMS team members must work together to determine the most suitable AMS interventions to implement in their hospitals and how best to put them into practice. Continuous monitoring and feedback of outcomes to the AMS teams, hospital administration, and prescribers will enhance sustainability of the AMS programs.

scholarly journals Mechanisms of Antimicrobial Resistance in ESKAPE Pathogens

2016 ◽  
Vol 2016 ◽  
pp. 1-8 ◽  
Author(s):  
Sirijan Santajit ◽  
Nitaya Indrawattana
Keyword(s):  
Public Health ◽  
Antimicrobial Resistance ◽  
Antimicrobial Agents ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Global Public Health ◽  
Drug Usage ◽  
Inappropriate Use ◽  
Public Health Challenges ◽  
Eskape Pathogens

The ESKAPE pathogens (Enterococcus faecium,Staphylococcus aureus,Klebsiella pneumoniae,Acinetobacter baumannii,Pseudomonas aeruginosa, andEnterobacterspecies) are the leading cause of nosocomial infections throughout the world. Most of them are multidrug resistant isolates, which is one of the greatest challenges in clinical practice. Multidrug resistance is amongst the top three threats to global public health and is usually caused by excessive drug usage or prescription, inappropriate use of antimicrobials, and substandard pharmaceuticals. Understanding the resistance mechanisms of these bacteria is crucial for the development of novel antimicrobial agents or other alternative tools to combat these public health challenges. Greater mechanistic understanding would also aid in the prediction of underlying or even unknown mechanisms of resistance, which could be applied to other emerging multidrug resistant pathogens. In this review, we summarize the known antimicrobial resistance mechanisms of ESKAPE pathogens.

scholarly journals Retail Chicken Carcasses as a Reservoir of Antimicrobial- Resistant Escherichia coli

2020 ◽  
Author(s):  
Nahla Omer Eltai ◽  
Hadi M. Yassine ◽  
Sara H. Al-Hadidi ◽  
Tahra ElObied ◽  
Asmaa A. Al Thani ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Antimicrobial Resistance ◽  
Growth Promotion ◽  
Multidrug Resistant ◽  
Chicken Meat ◽  
Resistant Bacteria ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Inappropriate Use ◽  
Esbl Producers

The dissemination of antimicrobial resistance (AMR) bacteria has been associated with the inappropriate use of antibiotics in both humans and animals and with the consumption of food contaminated with resistant bacteria. In particular, the use of antibiotics as prophylactic and growth promotion purposes in food-producing animals has rendered many of the antibiotics ineffective. The increased global prevalence of AMR poses a significant threat to the safety of the world’s food supply. Objectives: This study aims at determining the prevalence of antibiotic-resistant Escherichia coli (E. coli) isolated from local and imported retail chicken meat in Qatar. Methodology: A total of 270 whole chicken carcasses were obtained from three different hypermarket stores in Qatar. A total of 216 E. coli were isolated and subjected to antibiotic susceptibility testing against 18 relevant antibiotics using disc diffusion and micro- dilution methods. Furthermore, extended-spectrum β-lactamase (ESBL) production was determined via a double-disc synergetic test. Isolates harboring colistin resistance were confirmed using multiplex-PCR and DNA sequencing. Results: Nearly 89% (192/216) of the isolates were resistant to at least one antibiotics. In general, isolates showed relatively higher resistance to sulfamethoxazole (62%), tetracycline (59.7%), ampicillin and trimethoprim (52.3%), ciprofloxacin (47.7%), cephalothin, and colistin (31.9%). On the other hand, less resistance was recorded against amoxicillin/clavulanic acid (6%), ceftriaxone (5.1%), nitrofurantoin (4.2%) and piperacillin/tazobactam (4.2%), cefepime (2.3%), meropenem (1.4%), ertapenem (0.9%), and amikacin (0.9%). Nine isolates (4.2%) were ESBL producers. Furthermore, 63.4% were multidrug-resistant (MDR). The percentage of MDR, ESBL producers, and colistin-resistant isolates was significantly higher among local isolates compared to imported chicken samples. Conclusion: We reported a remarkably high percentage of the antibiotic-resistant E. coli in chicken meat sold at retail in Qatar. The high percentage of MDR and colistin isolates is troublesome to the food safety of raw chicken meat and the potential of antibiotic resistance spread to public health. Our findings support the need for the implementation of one health approach to address the spread of antimicrobial resistance and the need for a collaborative solution.

Impact of a Comprehensive Antimicrobial Stewardship Program on Institutional Burden of Antimicrobial Resistance: A 14-Year Controlled Interrupted Time-series Study

2019 ◽  
Vol 71 (11) ◽  
pp. 2897-2904 ◽  
Author(s):  
Christine Peragine ◽  
Sandra A N Walker ◽  
Andrew Simor ◽  
Scott E Walker ◽  
Alexander Kiss ◽  
...  
Keyword(s):  
Time Series ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Audit And Feedback ◽  
Time Series Study ◽  
Stewardship Program ◽  
Hospital Acquired ◽  
Series Study

Abstract Background Antimicrobial resistance (AMR) constitutes an international public health threat widely believed to result from excessive antimicrobial use (AMU). Numerous authorities have recommended antimicrobial stewardship programs (ASPs) to curb the selection of AMR, but there is a lack of data confirming this benefit. Methods A controlled interrupted time-series study spanning 14 years was performed to assess impact of a comprehensive hospital-based ASP that included pharmacist-led audit and feedback on institutional AMR. Patient-level microbiologic and AMU data were obtained from October 2002 to September 2016. Poisson regression models were used to identify changes in the incidence and trend of hospital-acquired (HA) antibiotic-resistant organisms (AROs) and multidrug-resistant organisms (MDROs). Changes in community-acquired (CA)–ARO, CA-MDRO, and inpatient AMU were assessed as controls and process outcomes. Results Statistically significant shifts in AMU, HA-ARO, and HA-MDRO trends coinciding with ASP implementation were observed, corresponding with a 9% reduction in HA-ARO burden (incidence rate ratio [IRR], 0.91 [95% confidence interval {CI}, .83–.99]; P = .03) and a 13% reduction in HA-MDRO burden (IRR, 0.87 [95% CI, .73–1.04]; P = .13) in the intervention period. In contrast, CA-ARO and CA-MDRO incidence continued to rise, with 40% (IRR, 1.40 [95% CI, 1.28–1.54]; P < .0001) and 68% (IRR, 1.68 [95% CI, 1.57–1.82]; P < .0001) increases in burden found, respectively. Conclusions Implementation of a comprehensive ASP resulting in reduced AMU was associated with a significant reduction in institutional AMR, even though community AMR increased during the same period. These results confirm that ASPs play an important role in the fight against AMR.

scholarly journals 699. Relationship Between Klebsiella pneumoniae Antimicrobial Resistance and Biofilm Formation

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S252-S252
Author(s):  
Jaclyn Cusumano ◽  
Kathryn Daffinee ◽  
Megan Luther ◽  
Vrishali Lopes ◽  
Aisling Caffrey ◽  
...  
Keyword(s):  
Protein Synthesis ◽  
Antimicrobial Resistance ◽  
Klebsiella Pneumoniae ◽  
Rhode Island ◽  
Biofilm Formation ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Protein Synthesis Inhibitors ◽  
Carbapenem Resistant ◽  
Research Grant

Abstract Background Klebsiella pneumoniae is a frequently multidrug-resistant organism with a high propensity to form biofilm. K. pneumoniae is the most common carbapenem-resistant Enterobacteriaceae (CRE), and labeled an urgent threat by the CDC. The relationship between K. pneumoniae biofilm formation and specific antimicrobial resistance patterns has not been well defined. Methods K. pneumoniae isolates (n = 139) were evaluated for antimicrobial resistance and biofilm formation (CDC, Providence VA Med. Ctr., Rhode Island Hosp., BEI, and ATCC). Susceptibility was based predominantly on 2017 CLSI (Clinical and Laboratory Standards Institute) breakpoints. Isolates were categorized as multidrug-resistant (MDR: resistant to ≥ 1 antimicrobial in ≥ 3 out of 16 antimicrobial categories) or extensively drug-resistant (XDR: resistant to ≥ 1 antimicrobial in all but ≤ 2 out of 16 antimicrobial categories) based on expert consensus criteria for Enterobacteriaceae (European CDC (ECDC)/CDC, 2012). We collapsed antimicrobial categories described by the ECDC/CDC consensus group into nine categories: penicillins, cephalosporins, monobactam, carbapenems, protein synthesis inhibitors, fluoroquinolones, folate pathway inhibitors, fosfomycin, and colistin. Biofilm formation was assessed using a modified crystal violet method (OD570) and defined by tertile cut-points. Antimicrobial resistance was compared for weak (n = 47) vs. strong (n = 46) biofilm formation by chi-square or Fisher’s exact test. Predictors of strong biofilm formation were identified using logistic regression. Results MDR isolates were more common among weak (n = 46/47, 97.9%) vs. strong biofilm formers (n = 35/46, 76.1%; P = 0.002), whereas XDR was similar between groups (n = 12/47, 25.5% vs. n = 13/46, 28.3% P = 0.77). Resistance to penicillins, cephalosporins, monobactams, carbapenems, protein synthesis, or fluoroquinolones was more common among weak biofilm formers (P < 0.05). Carbapenem resistance was inversely associated with strong biofilm formation (odds ratio 0.09; 95% confidence interval 0.02–0.33). Conclusion Carbapenem-resistant K. pneumoniae was 91% less likely to form strong biofilm. Potential trade-off mechanisms between antimicrobial resistance and biofilm formation require further exploration. Disclosures A. Caffrey, Merck: Grant Investigator, Research grant. The Medicine’s Company: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. K. LaPlante, Merck: Grant Investigator, Research grant. Pfizer Pharmaceuticals: Grant Investigator, Research grant. Allergan: Scientific Advisor, Honorarium. Ocean Spray Cranberries, Inc.: Grant Investigator and Scientific Advisor, Honorarium and Research grant. Achaogen, Inc.: Scientific Advisor, Honorarium. Zavante Therapeutics, Inc.: Scientific Advisor, Honorarium.

scholarly journals Decreased Outpatient Fluoroquinolone Prescribing Using a Multimodal Antimicrobial Stewardship Initiative

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kevin Lin ◽  
Yorgo Zahlanie ◽  
Jessica K Ortwine ◽  
Norman S Mang ◽  
Wenjing Wei ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Hospital System ◽  
Inappropriate Use ◽  
History Of ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Fluoroquinolones are antibiotics prescribed in the outpatient setting, though they have serious side effects. This study evaluates the impact of stewardship interventions on total and inappropriate prescribing of fluoroquinolones in outpatient settings in a large county hospital and health system. Methods In an effort to decrease inappropriate outpatient fluoroquinolone usage, a multimodal antimicrobial stewardship initiative was implemented in November 2016. Education regarding the risks, benefits, and appropriate uses of fluoroquinolones was provided to providers in different outpatient settings, Food and Drug Administration warnings were added to all oral fluoroquinolone orders, an outpatient order set for cystitis treatment was created, and fluoroquinolone susceptibilities were suppressed when appropriate. Charts from October 2016, 2017, and 2018 were retrospectively reviewed if the patient encounter occurred in primary care clinics, emergency departments, or urgent care centers within Parkland Health & Hospital System and a fluoroquinolone was prescribed. Inappropriate use was defined as a fluoroquinolone prescription for cystitis, bronchitis, or sinusitis in a patient without a history of Pseudomonas aeruginosa or multidrug-resistant organisms and without drug allergies that precluded use of other oral antibiotics. Results Total fluoroquinolone prescriptions per 1000 patient visits decreased significantly by 39% (P < .01), and inappropriate fluoroquinolone use decreased from 53% to 34% (P < .01). More than 90% of inappropriate fluoroquinolone prescriptions were given for cystitis, while bronchitis and sinusitis accounted for only 4.4% and 1.6% of inappropriate indications, respectively. Conclusion A multimodal stewardship initiative appears to effectively reduce both total and inappropriate outpatient fluoroquinolone prescriptions.

scholarly journals The Hospital Antimicrobial Use Process: From Beginning to End

2018 ◽  
Vol 5 (6) ◽  
Author(s):  
William R Truong ◽  
Jason Yamaki
Keyword(s):  
Antimicrobial Resistance ◽  
Patient Outcomes ◽  
Adverse Drug Reactions ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Drug Reactions ◽  
Improve Patient ◽  
Appropriate Antimicrobial Use

Abstract Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient’s treatment course. Hence, approaching AMS through the framework of a hospital’s AUP is essential to improving appropriate antimicrobial use.

scholarly journals Antimicrobial stewardship: Assessment of knowledge, awareness of antimicrobial resistance and appropriate antibiotic use among healthcare students in a Nigerian University

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Wuraola Akande-Sholabi ◽  
Amen T. Ajamu
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Healthcare Professionals ◽  
Antibiotic Use ◽  
The Body ◽  
Healthcare Students ◽  
Inappropriate Use ◽  
The Past ◽  
Inadequate Knowledge ◽  
Nigerian University

Abstract Background Inappropriate use of antibiotics is a major cause of antimicrobial resistance (AMR). Inadequate knowledge about AMR among healthcare students could affect their practice of antimicrobial stewardship as future healthcare professionals. This study aims to assess the use of antibiotics and knowledge of AMR among future healthcare professionals of a Nigerian University. Methods Respondents’ knowledge of antimicrobial resistance, use of antibiotics, and source of antibiotics in the past 12 months was explored using a self-administered questionnaire. Multivariate analyses were used to evaluate the relationship between specific variables and respondents’ knowledge. Results Of the 939 questionnaires administered to the students, 866 were filled given a response rate of 92.2 %. A total of (765; 88.3 %) of the respondents were aware that antimicrobial resistance makes it harder to eliminate the infection from the body as existing drugs become less effective. In all 824, (95.2 %) of the respondents had use antibiotics in the past 12 months. The use of antibiotics to treat malaria was self-reported by (175; 21.2 %). About half (432; 52.4 %) purchased the antibiotics from community pharmacies, while others obtained their antibiotics from the hospitals (192; 23.3 %), patent medicine stores (150; 18.2 %), and friends and family (50; 6.1 %) in the last 12 months. In all 506, (58.4 %) had good knowledge of antimicrobial resistance. Logistic regression shows that students in 3rd to 6th year 9.29 [AOR = 9.29, 95 % CI: (3.7–22.96)], had greater knowledge of antimicrobial resistance. Conclusions The healthcare students demonstrated a moderate knowledge of AMR. This underscores the need to adopt several educational tactics to introduce the concepts of AMR to the students and ensure there are strict policies to regulate the flow of antibiotics.

Antimicrobial Terpenoids as a Potential Substitute in Overcoming Antimicrobial Resistance

2020 ◽  
Vol 21 (14) ◽  
pp. 1476-1494
Author(s):  
Aditi Sharma ◽  
Avadh Biharee ◽  
Amit Kumar ◽  
Vikas Jaitak
Keyword(s):  
Antimicrobial Resistance ◽  
Cause Of Death ◽  
Efflux Pump ◽  
Acquired Resistance ◽  
Multidrug Resistant ◽  
Time Span ◽  
Membrane Disruption ◽  
Inappropriate Use ◽  
Site Of Action ◽  
Microbial Attack

There was a golden era where everyone thought that microbes can no longer establish threat to humans but the time has come where microbes are proposing strong resistance against the majority of antimicrobials. Over the years, the inappropriate use and easy availability of antimicrobials have made antimicrobial resistance (AMR) to emerge as the world’s third leading cause of death. Microorganisms over the time span have acquired resistance through various mechanisms such as efflux pump, transfer through plasmids causing mutation, changing antimicrobial site of action, or modifying the antimicrobial which will lead to become AMR as the main cause of death worldwide by 2030. In order to overcome the emerging resistance against majority of antimicrobials, there is a need to uncover drugs from plants because they have proved to be effective antimicrobials due to the presence of secondary metabolites such as terpenoids. Terpenoids abundant in nature are produced in response to microbial attack have huge potential against various microorganisms through diverse mechanisms such as membrane disruption, anti-quorum sensing, inhibition of protein synthesis and ATP. New approaches like combination therapy of terpenoids and antimicrobials have increased the potency of treatment against various multidrug resistant microorganisms by showing synergism to each other.

scholarly journals 1051. The Use of Survey-Driven Feedback to Improve Antimicrobial Stewardship Efforts at a Single Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S370-S371
Author(s):  
Fritzie S Albarillo ◽  
Cara J Joyce ◽  
Maressa Santarossa
Keyword(s):  
Patient Outcomes ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Medical Center ◽  
Order Entry ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Baseline Knowledge ◽  
Formulary Restriction

Abstract Background Antimicrobial stewardship (AS) efforts have led to improved patient outcomes, reduction in unnecessary costs, and decrease in antimicrobial resistance (AR). Loyola University Medical Center (LUMC) is a quaternary care system that has primarily employed a formulary restriction and preauthorization process as the foundation of its Antimicrobial Stewardship Program (ASP). Methods In January 2018, a voluntary online survey was created and disseminated to all providers at LUMC to evaluate their baseline knowledge and perception of AS and AR, as well as to solicit feedback on current AS practices at LUMC. Based on the results of the survey, our AS team implemented the following changes to the AS program: removed prior-authorization of cefepime, piperacillin–tazobactam and vancomycin; required documentation of antimicrobial indications and duration upon order entry in the electronic medical record; and provided education to all providers via newsletters and lectures. In January 2019, a second survey was distributed to all providers with the primary goal of evaluating changes in the providers’ knowledge and perception of AS and AR post-program modifications. The secondary goal was to gather feedback on the major changes we have implemented in our program. Results A total of 167 providers completed the first survey and 173 completed the second survey. Over 95% of providers were aware that inappropriate use of antimicrobials can be harmful to patients, and that AS can decrease AR. Unfamiliarity with AS practices remains an issue. More than half agreed that unrestricting antibiotics improved their workflow, though almost half agreed that it led to inappropriate use by providers in general but not their own. Finally, most providers agreed that documenting indications and duration of antibiotics facilitated antibiotic optimization with no interference in their workflow. Conclusion Hospital-specific surveys on providers’ perception and knowledge on AS and AR can be used to guide future ASP interventions, as well as to evaluate the effectiveness of these interventions. Our ASP at LUMC implemented strategies to improve antimicrobial utilization based on our providers’ feedback. Our team will continue to use surveys to further guide our AS efforts. Disclosures All authors: No reported disclosures.

scholarly journals First Case of Bacteraemia Due to Carbapenem-Resistant Bacteroides faecis

Antibiotics ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 319
Author(s):  
Charlotte Kaeuffer ◽  
Tiffany Ruge ◽  
Laure Diancourt ◽  
Benoît Romain ◽  
Yvon Ruch ◽  
...  
Keyword(s):  
Case Report ◽  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Scientific Literature ◽  
Anaerobic Bacteria ◽  
Multidrug Resistant ◽  
Clinical State ◽  
Digestive Surgery ◽  
Carbapenem Resistant ◽  
First Case

Multidrug resistant (MDR) bacteria are increasingly observed in nosocomial and community-acquired settings. Anaerobes are no exception to this rule, but there are fewer reports of MDR in the scientific literature on anaerobes than there are for other bacteria. In this short case report, we describe the first case of bacteraemia caused by a multidrug-resistant Bacteroides faecis, which produces a carbapenemase encoded by the blaCfiA gene. This bacteraemia followed a digestive surgery operation. Surprisingly, these findings did not lead to a change in antibiotic therapy, probably because the patient’s clinical state had improved. Nevertheless this report calls for better knowledge of anaerobic bacteria and for a systematic antimicrobial stewardship procedure following bacteraemia.

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