scholarly journals Risk Factors for Development of Multiple-Class Resistance to Streptococcus pneumoniae Strains in Belgium over a 10-Year Period: Antimicrobial Consumption, Population Density, and Geographic Location

2007 ◽  
Vol 51 (10) ◽  
pp. 3491-3497 ◽  
Author(s):  
Johan Van Eldere ◽  
Robertino M. Mera ◽  
Linda A. Miller ◽  
James A. Poupard ◽  
Heather Amrine-Madsen
Keyword(s):  
Risk Factors ◽  
Streptococcus Pneumoniae ◽  
Population Density ◽  
High Resistance ◽  
Antibiotic Use ◽  
Multiple Resistance ◽  
Defined Daily Dose ◽  
Antimicrobial Consumption ◽  
Time Space ◽  
The Impact

ABSTRACT We investigated the impact of the usage of antibiotics in ambulatory patients in Belgium in 147 defined geographical circumscriptions and at the individual isolate level. The study included 14,448 Streptococcus pneumoniae strains collected by the Belgium national reference lab from 1994 to 2004. Additional risk factors for resistance, such as population density/structure and day care attendance, were investigated for the same time-space window. A statistical model that included resistance to two or more antimicrobial classes offered the best fit for measuring the changes in nonsusceptibility to penicillin, macrolides, and tetracycline over time and place in Belgium. Analysis at the geographic level identified antimicrobial consumption with a 1-year lag (0.5% increase per additional defined daily dose) and population density as independent predictors of multiple resistance. Independent risk factors at the isolate level were age (odds ratio [OR], 1.55 for children aged <5 years), population density (7% increase in multiple resistance per 100 inhabitants/km2), conjugate 7-valent vaccine serotype (OR, 14.3), location (OR, 1.55 for regions bordering high-resistance France), and isolate source (OR, 1.54 for ear isolates). The expansion of multiple-resistant strains explains most of the overall twofold increase and subsequent decrease in single antimicrobial resistance between 1994 and 2004. We conclude that factors in addition to antibiotic use, such as high population density and proximity to high-resistance regions, favor multiple resistance. Regional resistance rates are not linearly related to actual antibiotic use but are linked to past antibiotic use plus a combination of demographic and geographic factors.

scholarly journals Neisseria meningitidis carriage and risk factors among teenagers in Suizhou city in China

2020 ◽  
Vol 148 ◽  
Author(s):  
Fei He ◽  
Hong mei Yang ◽  
Guo ming Li ◽  
Bing qing Zhu ◽  
Yating Zhang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Population Density ◽  
Neisseria Meningitidis ◽  
Old Age ◽  
Age Groups ◽  
Significant Risk ◽  
Epidemiological Data ◽  
Significant Risk Factor ◽  
Antibiotic Use ◽  
Carriage Rate

Abstract Teenagers are important carriers of Neisseria meningitidis, which is a leading cause of invasive meningococcal disease. In China, the carriage rate and risk factors among teenagers are unclear. The present study presents a retrospective analysis of epidemiological data for N. meningitidis carriage from 2013 to 2017 in Suizhou city, China. The carriage rates were 3.26%, 2.22%, 3.33%, 3.53% and 9.88% for 2013, 2014, 2015, 2016 and 2017, respectively. From 2014 to 2017, the carriage rate in the 15- to 19-year-old age group (teenagers) was the highest and significantly higher than that in remain age groups. Subsequently, a larger scale survey (December 2017) for carriage rate and relative risk factors (population density, time spent in the classroom, gender and antibiotics use) were investigated on the teenagers (15- to 19-year-old age) at the same school. The carriage rate was still high at 33.48% (223/663) and varied greatly from 6.56% to 52.94% in a different class. Population density of the classroom was found to be a significant risk factor for carriage, and 1.4 persons/m2 is recommended as the maximum classroom density. Further, higher male gender ratio and more time spent in the classroom were also significantly associated with higher carriage. Finally, antibiotic use was associated with a significantly lower carriage rate. All the results imply that attention should be paid to the teenagers and various measures can be taken to reduce the N. meningitidis carriage, to prevent and control the outbreak of IMD.

scholarly journals Risk factors for respiratory Aspergillus fumigatus in German Cystic Fibrosis patients and impact on lung function

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Uta Düesberg ◽  
Julia Wosniok ◽  
Lutz Naehrlich ◽  
Patience Eschenhagen ◽  
Carsten Schwarz
Keyword(s):  
Risk Factors ◽  
Cystic Fibrosis ◽  
Lung Function ◽  
Aspergillus Fumigatus ◽  
Age Groups ◽  
Antibiotic Use ◽  
Lower Lung ◽  
Lung Infections ◽  
The Impact

Abstract Airway inflammation and chronic lung infections in cystic fibrosis (CF) patients are mostly caused by bacteria, e.g. Pseudomonas aeruginosa (PA). The role of fungi in the CF lung is still not well elucidated, but evidence for a harmful and complex role is getting stronger. The most common filamentous fungus in CF is Aspergillus fumigatus (AF). Age and continuous antibiotic treatment have been discussed as risk factors for AF colonisation but did not differentiate between transient and persistent AF colonisation. Also, the impact of co-colonisation of PA and AF on lung function is still under investigation. Data from patients with CF registered in the German Cystic Fibrosis Registry database in 2016 and 2017 were retrospectively analysed, involving descriptive and multivariate analysis to assess risk factors for transient or persistent AF colonisation. Age represented an independent risk factor for persistent AF colonisation. Prevalence was low in children less than ten years, highest in the middle age and getting lower in higher age (≥ 50 years). Continuous antibiotic lung treatment was significantly associated with AF prevalence in all age groups. CF patients with chronic PA infection had a lower lung function (FEV1%predicted), which was not influenced by an additional AF colonisation. AF colonisation without chronic PA infection, however, was significantly associated with a lower function, too. Older age up to 49 years and continuous antibiotic use were found to be the main risk factors for AF permanent colonisation. AF might be associated with decrease of lung function if not disguised by chronic PA infection.

Multi- and Extensive-Drug Resistant Acinetobacter baumannii in ICUs: Risk Factors, Antimicrobial Resistance Profiles and co-harboring of gyrA and parC mutations

2020 ◽  
Vol EJMM29 (4) ◽  
pp. 109-116
Author(s):  
Enas A. Tantawy ◽  
Hanan M. El-Sayed ◽  
Heba M. Matar ◽  
Basma A. El-Azhary
Keyword(s):  
Risk Factors ◽  
Antimicrobial Resistance ◽  
Acinetobacter Baumannii ◽  
High Resistance ◽  
Respiratory Infections ◽  
Gene Mutations ◽  
Antibiotic Use ◽  
Quinolone Resistance ◽  
Diffusion Method ◽  
Drug Resistant

Background: Acinetobacter baumannii is a gram-negative organism that is implicated in hospital acquired infections. It confers high resistance to many classes of antibiotics. Objectives: To assess the prevalence of multi and extensive drug-resistant (MDR & XDR) Acinetobacter baumannii, their risk factors, antimicrobial resistance patterns and the presence of gyrA and parC gene mutations of quinolone resistance. Methodology: The study included 106 ICU patients (56 males & 50 females), samples were collected according to sites of infections, Acinetobacter baumannii was identified by morphology, biochemical reactions &API 20NE. Antimicrobial susceptibility testing was performed by disc diffusion method. The E-test was used to detect MIC of Ciprofloxacin & Levofloxacin, then a polymerase chain reaction- restriction fragment length polymorphism was performed to detect the occurence of gyrA and parC gene mutations of Quinolone resistance. Results: Thirty isolates were identified as Acinetobacter baumannii, most of which from respiratory infections (P=0.005) prolonged hospitalization, antibiotic use, urinary catheters & ventilator supports were found to be risk factors of infections. Acinetobacter baumannii isolates showed high resistance to most of the tested antibiotics (29 MDR & 28 XDR). All isolates were resistant to Ciprofloxacin & Levofloxacin with the co-presence of gyrA and parC mutations in all isolates (P<0.001). Conclusions: There is an increased prevalence of MDR & XDR Acinetobacter baumannii among ICU infections. The co-occurrence of gyrA and parC mutations is associated with high resistance to Quinolones.

scholarly journals IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA

2021 ◽  
pp. 20-23
Author(s):  
HIDAYAH KARUNIAWATI ◽  
TRI YULIANTI ◽  
DEWI KUROTA AINI ◽  
FINISHIA ISNA NURWIENDA
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Study Data ◽  
Defined Daily Dose ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Daily Dose ◽  
The Impact ◽  
Method Show

Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. Thestudy of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed tocontrol antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASPapplied.Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitativelyusing the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling andresults were described descriptively.Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis usingthe Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluationshows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.

scholarly journals Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252407
Author(s):  
Daniel Doyle ◽  
Gerald McDonald ◽  
Claire Pratt ◽  
Zahra Rehan ◽  
Tammy Benteau ◽  
...  
Keyword(s):  
Decision Support ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Support Tool ◽  
Survey Tool ◽  
Before And After ◽  
The Impact

Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

scholarly journals Mathematical Model To Quantify the Effects of Risk Factors on Carbapenem-Resistant Acinetobacter baumannii

2014 ◽  
Vol 58 (9) ◽  
pp. 5239-5244 ◽  
Author(s):  
Michelle W. Tan ◽  
David C. Lye ◽  
Tat-Ming Ng ◽  
Michael Nikolaou ◽  
Vincent H. Tam
Keyword(s):  
Risk Factors ◽  
Linear Regression ◽  
Acinetobacter Baumannii ◽  
Antibiotic Consumption ◽  
Model Fit ◽  
Defined Daily Dose ◽  
Content Type ◽  
Carbapenem Resistant ◽  
The Impact ◽  
Over Time

ABSTRACTCarbapenem-resistantAcinetobacter baumannii(CRAB) infections are increasing, and they are associated with an increased risk of mortality in hospitalized patients. Linear regression is commonly used to identify concurrent trends, but it cannot quantify the relationship between risk factors and resistance. We developed a model to quantify the impact of antibiotic consumption on the prevalence of CRAB over time. Data were collected from January 2007 to June 2013 from our institution. Quarterly antibiotic consumption was expressed as defined daily dose/1,000 inpatient days. Six-month prevalence of CRAB was expressed as a percentage of all nonrepeatA. baumanniiisolates tested. Individual trends were identified using linear regression. Antibiotic consumption from 2007 to 2011 was input as a step function in a relationship with CRAB. Model fit was evaluated by visual inspection and the residual sum of squares. The final model was validated using the best-fit (95% confidence interval) parameter estimates and antibiotic consumption to predict CRAB prevalence from January 2012 to June 2013. Cefepime, ertapenem, and piperacillin-tazobactam consumption and CRAB prevalence increased significantly over time. CRAB prevalence was best correlated to ertapenem (use sensitive;r2= 0.76), and accounting for additional concurrent antibiotic use did not significantly improve model fit. Prospective validation with ertapenem consumption correlated well with CRAB observations, suggesting good predicting ability of the model. Our model provided the quantitative impact of antibiotic consumption on CRAB. We plan to further refine this model to account for multiple risk factors. Interventions should focus on controlling risk factors with the highest impact on resistance.

scholarly journals 2203. Patient-Specific Risk Stratification to Identify Patients at High and Low Risk for P. aeruginosa in Community-Acquired Pneumonia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S751-S751
Author(s):  
William Justin Moore ◽  
Caroline Cruce ◽  
Karolina Harkabuz ◽  
Shereen Salama ◽  
Sarah Sutton ◽  
...  
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Risk Stratification ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Low Risk ◽  
Patient Specific ◽  
Stepwise Logistic Regression ◽  
Case Status ◽  
The Impact

Abstract Background Pseudomonas aeruginosa (PsA) is an infrequent pathogen associated with poor outcomes in community-acquired pneumonia (CAP). Identifying patients at high and low-risk for PsA in CAP is necessary to reduce inappropriate and overly broad-spectrum antibiotic use. We evaluated the distribution of risk-factors in hospitalized CAP patients with and without PsA infection. Methods Design: retrospective, single-center, case–control study. Inclusion: hospitalized CAP patients admitted to the general medicine wards between January 1, 2014 and May 29, 2018. Exclusion: cystic fibrosis, ≥ 3 admissions within 30 days, CAP requiring ICU admission, and death within 48 hours of admission. Case patients had PsA in respiratory or blood cultures during the index CAP admission. Controls were randomly selected targeting a 3:1 ratio. Comorbidities, pneumonia severity index, and m-APACHE II were assessed. Gram-negative risk factors defined by Shindo et al. 2013 (PMID: 23855620) and validated by Kobayashi et al. (2018; PMID: 30349327) were scored for each patient. Stepwise logistic regression was used to identify covariates that distinguished cases from controls at a P < 0.2; these were then used to generate propensity weights (i.e., inverse-probability conditioned on covariates). Unadjusted and adjusted odds ratios for case status were estimated using logistic regression according to: the total number of risk factors present and threshold values, respectively. All analyses were conducted using IC Stata (v.14.2). Results 54 cases and 152 controls were included. The distribution of the patient-specific sum of risk factors for PsA is shown in Figure 1. The univariate OR for case status was 4.29 (95% CI:1.55–11.9) at n = 3 risk factors, which was similar after propensity weight adjustment [aOR = 4.64 (95% CI: 1.32–16.3)]. The univariate OR of case status was 2.98 among patients with ≥ 3 risk factors (95% CI: 1.34–6.62), which was similar after propensity weight adjustment [aOR = 2.8 (95% CI: 1.02–7.72)], and correct classification was 73.8%. Conclusion At a threshold of ≥ 3 PsA risk factors, cases and controls were well classified, even after adjusting for propensity weights. The impact of patient-specific PsA risk-stratification on CAP outcomes and appropriate antibiotic use should be evaluated. Disclosures All authors: No reported disclosures.

scholarly journals Evaluation of antimicrobial consumption in Campania Region, Italy

2008 ◽  
Vol 9 (1) ◽  
pp. 57-62
Author(s):  
Simona Cammarota ◽  
Anna Citarella ◽  
Enrica Menditto ◽  
Simona De Portu
Keyword(s):  
Prescription Drugs ◽  
Age Groups ◽  
Antibiotic Use ◽  
Drug Expenditure ◽  
Elderly Subjects ◽  
Resistant Bacteria ◽  
Defined Daily Dose ◽  
Antimicrobial Consumption ◽  
Campania Region ◽  
Anatomic Therapeutic Chemical

Introduction: the antibiotic usage in Italy is above the European average. From several years the Campania was the first Italian region in terms of antimicrobial consumption. Aim: to evaluate antibiotic utilisation in primary health care in Campania, a region of approximately 5.7 million inhabitants in the south of Italy. Method: we collected, from an electronic database, all prescription drugs reimbursed in 2005. The cohort was defined as the population of subjects receiving at least one prescription of any antimicrobial agent for systemic use, classified according to their therapeutic role using Anatomic Therapeutic Chemical (ATC) classification. Drugs cost and consumption were quantified using National Health Service (NHS) prospective and Defined Daily Dose system (DDD) respectively. All costs were expressed in Euro 2005. Results: antiinfectives agents (ATC J) was the second class of drugs in terms of cost, representing 16.1% of the regional drug expenditure. Their consumption were 33 DDD/1000 inhabitants/day. Stratifying by age antibiotic use was highest in children and elderly subjects. Penicillins, macrolides and cephalosporins were the most prescribed antibiotic classes in all age groups. Discussion: despite guidelines introduced to limit the prescription of parenteral antibiotics to the patients who are most likely to benefit from it, they were mostly prescribed. This represented a serious problem for the development of drug-resistant bacteria.

Impact of Different Methods for Describing the Extent of Prior Antibiotic Exposure on the Association Between Antibiotic Use and Antibiotic-Resistant Infection

2007 ◽  
Vol 28 (6) ◽  
pp. 647-654 ◽  
Author(s):  
Emily P. Hyle ◽  
Warren B. Bilker ◽  
Leanne B. Gasink ◽  
Ebbing Lautenbach
Keyword(s):  
Risk Factors ◽  
Systematic Review ◽  
Antibiotic Use ◽  
Continuous Variable ◽  
Antibiotic Exposure ◽  
Categorical Variable ◽  
Antibiotic Resistant ◽  
E Coli ◽  
Multivariable Models ◽  
The Impact

Objective.Many studies have investigated the association between prior antibiotic use and antibiotic resistance. However, methods used in past studies to describe the extent of prior antibiotic use (eg, use of the 2 categories exposure versus no exposure and measurement of duration of exposure) have not been reviewed. The impact of the use of different methods for quantifying the use of antibiotics is unknown. The objectives of this study were to characterize past approaches to describing the extent of antibiotic use and to identify the impact of the use of different methods on associations between use of specific antibiotics and infection with an antibiotic-resistant-organism.Methods.We conducted a systematic review of studies that investigated risk factors for extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella species to identify variability in past approaches to describing the extent of antibiotic use. We then reanalyzed a data set from a prior study of risk factors for infection with ESBL-producing E. coli and Klebsiella species. We developed 2 separate multivariable models: 1 in which prior antibiotic use was described as a categorical variable (eg, exposure or no exposure) and 1 in which antibiotic use was described as a continuous variable (eg, measured in antibiotic-days). These models were compared qualitatively.Setting.Large academic medical center.Results.The 25 articles included in the systematic review revealed a variety of methods used to describe the extent of prior antibiotic exposure. Only 1 study justified its approach. Results from the 2 multivariable models that used different methodologic approaches differed substantially. Specifically, use of third-generation cephalosporins was a risk factor for infection with ESBL-producing E. coli and Klebsiella species when antibiotic use was described as a continuous variable but not when antibiotic use was described as a categorical variable.Conclusions.There has been no consistent method for assessing the extent of prior antibiotic exposure. The use of different methods may substantially alter the identified antimicrobial risk factors, which has important implications for the resultant interventions regarding antimicrobial use.

Use of antibiotics and risk factors for carriage ofStreptococcus pneumoniae: a longitudinal household study in the United Kingdom

2008 ◽  
Vol 137 (4) ◽  
pp. 555-561 ◽  
Author(s):  
R. G. PEBODY ◽  
O. MORGAN ◽  
Y. CHOI ◽  
R. GEORGE ◽  
M. HUSSAIN ◽  
...  
Keyword(s):  
Risk Factors ◽  
Random Effect ◽  
Multivariable Analysis ◽  
Antibiotic Use ◽  
Repeated Measurements ◽  
Statistical Dependence ◽  
The United Kingdom ◽  
Low Prevalence ◽  
Study Participants ◽  
The Impact

SUMMARYThis study aimed to identify risk factors and assess the impact of coincidental antibiotic therapy on carriage ofStreptococcus pneumoniae. Index children from birth to 3 years and their households were recruited from primary health-care registers in four UK general practices. Nasopharyngeal swabs were taken monthly from study participants ten times between October 2001 and July 2002. Multilevel random-effect models were used to adjust for statistical dependence between repeated measurements and family clustering of carriage. Carriage results were available for 3753 swabs from 489 individuals in 121 families. Crude prevalence of carriage was 25%. On multivariable analysis, risk of carriage was reduced by antibiotic use the previous month [odds ratio (OR) 0·34, 95% confidence interval (CI) 0·22–0·52], but increased if a child attended day care for >20 h per week (OR 2·52, 95% CI 1·41–4·52). Taking antibiotics significantly reduces the risk of carriage the following month in a setting with a low prevalence of pneumococcal antimicrobial resistance.

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