scholarly journals Impact of a Critical National Shortage of Cefazolin on Antimicrobial Practice at a Tertiary-Care Center in Japan

2020 ◽  
Vol 41 (S1) ◽  
pp. s256-s256
Author(s):  
Shutaro Murakami ◽  
Junko Hiroi ◽  
Yasuaki Tagashira ◽  
Akane Takamatsu ◽  
Shinya Hasegawa ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Antimicrobial Prophylaxis ◽  
Care Center ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Essential Medicines ◽  
Antimicrobial Use ◽  
Third Generation ◽  
Tertiary Care Center ◽  
Surgical Antimicrobial Prophylaxis

Background: Shortages of essential medicines, a long-standing issue in healthcare, apply equally to antimicrobial agents, a group of essential drugs necessary for sustainable healthcare. The WHO categorized essential medicines into the access, watch, and reserve groups. Older antimicrobials, in particular, were categorized into the access group, meaning that these drugs are in theory widely available at an affordable cost. The shortage of essential antimicrobial agents like cefazolin leads to increased consumption of alternative antimicrobial agents with broad-spectrum activity, which often has the undesirable consequence of defeating antimicrobial stewardship efforts in inpatient settings and potentially promoting antimicrobial resistance. In Japan, cefazolin has been in critically short supply since March 2019. Cefazolin is a first-line agent against common infectious diseases and in surgical antimicrobial prophylaxis, and its shortage has substantially impacted inpatient care. The aim of the present study was to investigate changes in antimicrobial practice at a tertiary-care center in Japan following the emergence of the national cefazolin shortage in March 2019. Methods: Data on each antimicrobial use are logged as days of therapy (DOT) per 1,000 patient days (PD) for antimicrobial stewardship purposes at the study institution. We extracted weekly data from September 2018 to September 2019 to evaluate the impact of the national cefazolin shortage on antimicrobial use at our tertiary-care center. Changes in weekly antimicrobial use and the weekly incidence of Clostridium difficile infections were analyzed by interrupted time series analysis. We also investigated changes in antimicrobial practice at selected situations. Results: As weekly cefazolin use significantly declined after the emergence of the national shortage, use of third-generation cephalosporin (+18.9 DOT per 1,000 PD for intercept [P < .001] and +0.65 DOT per 1,000 PD per week for trend [P = .037]) and clindamycin (18 DOT per 1,000 PD for intercept [P = .008] and 0.12 DOT per 1,000 PD per week for trend [P = .003]) significantly increased. Significant changes in antimicrobial practice were also observed in surgical antimicrobial prophylaxis: third-generation cephalosporin use increased from 1.0% (31 of 3,032) to 62.9% (2,237 of 3,554) (P < .001). However, no significant change in the incidence of Clostridium difficile infection was observed during the study period: +1.72 per 10,000 PD for intercept (P = .12) and 0.12 per 10,000 PD per week for the trend (P = .09). Conclusions: The national cefazolin shortage had a significantly negative impact on patient care and led to increased use of alternative, broader-spectrum antimicrobials, which are not ideal choices either for prophylaxis or treatment.Funding: NoneDisclosures: None

scholarly journals Antimicrobial resistance of selected invasive bacteria in a tertiary care center: results of a prospective surveillance study

2016 ◽  
Vol 10 (12) ◽  
pp. 1325-1331 ◽  
Author(s):  
Olivera Djuric ◽  
Snezana Jovanovic ◽  
Branka Stosovic ◽  
Tanja Tosic ◽  
Milica Jovanovic ◽  
...  
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Aminoglycoside Resistance ◽  
Methicillin Resistant ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Acinetobacter Spp ◽  
Clinically Relevant Bacteria

Introduction: We aimed to report the distribution and resistance patterns of eight invasive clinically relevant bacteria surveyed in the Clinical Center of Serbia (CCS) in Belgrade. Methodology: A total of 477 clinical blood stream isolates of Staphylococcus aureus, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter spp. were collected in the period from January to December 2013. Antimicrobial susceptibility testing was performed using standard methods and interpreted using the Clinical and Laboratory Standards Institute (CLSI) breakpoint criteria. Results: Acinetobacter spp. was the most prevalent bacteria encountered (37%), followed by K. pneumoniae (25.7%). Multidrug resistance was observed in 92.5% of all isolates. Out of 177 strains of Acinetobacter spp., 97.7% were resistant to fluoroquinolones and carbapenems. Resistance to aminoglycosides, fluoroquinolones, and third-generation cephalosporins was 97.1%, 95.4%, and 95.8% among K. pneumoniae and 21.4%, 21.7%, and 31% among E. coli isolates, respectively. In total, 65.1% of K. pneumoniae and 12.1% of E. coli isolates were determined to be extended-spectrum beta-lactamase (ESBL) positive. High-level aminoglycoside resistance of E. faecalis was 71.4%, and glycopeptide resistance of E. faecium was 95%. Out of 66 strains of S. aureus, 63.4% were methicillin resistant. Conclusions: The majority of bloodstream isolates of clinically relevant bacteria in CCS were multidrug resistant. The biggest concerns are carbapenem-resistant Acinetobacter spp., K. pneumoniae, and P. aeruginosa; third-generation cephalosporin-resistant E. coli; vancomycin-resistant E. faecium; and methicillin-resistant S. aureus. Stricter measures of infection control and antibiotic use are needed.

scholarly journals 2024. A Multifaceted Intervention to Improve Oral Antimicrobial Prescription at the Emergency Department at a Japanese Tertiary Care Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S679-S679
Author(s):  
Yasuaki Tagashira ◽  
Hitoshi Honda
Keyword(s):  
Emergency Department ◽  
Care Center ◽  
Tertiary Care ◽  
Developed Countries ◽  
Multifaceted Intervention ◽  
Evidence Based ◽  
Antimicrobial Use ◽  
Tertiary Care Center ◽  
Appropriate Prescription ◽  
Antimicrobial Prescription

Abstract Background The emergency department (ED) is one of the most important settings where antimicrobials are frequently prescribed in developed countries, and at least 30% of antimicrobials prescribed at the ED are inappropriate. Some studies revealed that various factors, especially the physician-related factors were associated with inappropriate antimicrobial use. Implementing effective strategies to modify prescribing practice is needed to optimize antimicrobial therapy at the ED. Methods We implemented a multifaceted intervention to patients discharged with oral antimicrobial agents in the ED at a Japanese tertiary care center from October 2018 to March 2019. The intervention included (1) an educational didactic session to physicians, (2) an evidence-based tool book regarding antimicrobial use for common diagnoses, (3) antimicrobial order sets for common diagnoses, (4) monthly reports of the appropriateness of antimicrobial use, and (5) post-prescription review and feedback by an infectious diseases physician. The proportion of appropriate discharge antimicrobial prescription at ED, and changes in the prescription density, measured as the number of prescription per 1,000 patient visits between pre- and post-intervention were evaluated. Results The total number of patient visits at the ED during the study period was 52,274. With the intervention, the mean monthly discharge antimicrobial prescription decreased from 42.7 to 34.2 per 1,000 visits (proportional reduction 0.20; P < 0.01). Overall, appropriate prescription rate significantly increased from 47.7% (742/1,555) to 77.4% (421/544) (P < 0.01). The rate of unnecessary and inappropriate discharge antimicrobial prescription accounted from 27.5% (428/1,555) and 21.7% (337/1,555) to 8.5% (46/544) and 10.7% (58/544), respectively. A substantial improvement in discharge antimicrobial prescription against intra-abdominal infections and odontogenic infections during the intervention period was observed (changes in the proportion of appropriate prescription was 0.37 [P < 0.01] and 0.51 [P < 0.01], respectively. Conclusion An evidence-based, multifaceted intervention led to decreasing unnecessary prescription and optimizing physicians’ antimicrobial prescriptions at the ED. Disclosures All authors: No reported disclosures.

scholarly journals Antimicrobial Agents Administration among Patients with Extensively Drug-resistant Pseudomonas aeruginosa Infection in Intensive Care Unit in Tertiary Care: A Hospital-based Study

2020 ◽  
Author(s):  
Somkiattiyos Woradet ◽  
Bhunyabhadh Chaimay ◽  
Nuntiput Putthanachot ◽  
Narongchai Sangsa ◽  
Phatsaraporn Sirisa
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Antimicrobial Agent ◽  
Antimicrobial Agents ◽  
Tertiary Care ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Drug Resistant ◽  
Extensively Drug Resistant

Introduction: Infections caused by Extensively Drug-resistant Pseudomonas aeruginosa (XDR-PA) is a medical problem worldwide. In Thailand, the incidence of XDR-PA bacteremia remains and is continuously increasing.Aim: To investigate an association between antimicrobial agent administration and the treatment of XDR-PA infection among patients admitted in Intensive Care Unit (ICU). Materials and Methods: A hospital-based analytic cross-sectional study was performed from January 2014 to December 2015. Of these, 47 cases diagnosed with XDR-PA bacteremia infection and 94 controls without XDR-PA infection were enrolled. Data were retrieved and retrospectively reviewed from medical records of the patients hospitalised in the ICU at Roi-Et Hospital, Thailand. Multiple logistic regressions were used and perform to investigate an association between antimicrobial agent administrations for treatment of XDR-PA infection. Results: Third generation Cephalosporin (OR=1.99; 95%CI: 1.22 to 4.13), Ciprofloxacin (OR=3.40; 95%CI: 1.24 to 9.49) and Carbapenem (OR=4.66; 95%CI: 2.04 to 10.64) were more likely to be administrated for treatment of XDR-PA infection among patients. Conclusion: Antimicrobial agents associated with the treatment of XDR-PA bacteremia infection among patients were third generation Cephalosporin, Ciprofloxacin and Carbapenem.

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