An Interventional Program to Improve Antibiotic Use

2003 ◽  
Vol 37 (5) ◽  
pp. 646-651 ◽  
Author(s):  
Cynthia L Feucht ◽  
Louis B Rice
Keyword(s):  
Clinical Pharmacist ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Antibiotic Use ◽  
Resistant Bacteria ◽  
Prescribing Practices ◽  
Gram Negative ◽  
Inappropriate Use ◽  
Multidisciplinary Program ◽  
Empiric Antibiotic

BACKGROUND: Large volume and often inappropriate use of specific antimicrobial agents increase selective pressure for emergence of resistant bacteria and place strain on the pharmacy budget. OBJECTIVE: To initiate a multidisciplinary program designed to align intravenous vancomycin and fluoroquinolone prescribing practices with guidelines for appropriate use of these agents. METHODS: A multidisciplinary, prospective interventional program was implemented to encourage early discontinuation of inappropriate vancomycin and fluoroquinolone therapy and decrease inappropriate duplicative gram-negative coverage using fluoroquinolones. A computerized review was performed for patients receiving intravenous vancomycin and fluoroquinolones for 1998 in a Veterans Affairs Medical Center. In June 1999, guidelines were disseminated and an interventional program was initiated, with a monthly conference for medical residents regarding antimicrobial resistance and local hospital practices. Concurrently, a prospective review of new orders was assessed by the clinical pharmacist and interventions performed when inappropriate use occurred. RESULTS: The interventional program was successful in reducing unnecessary duplicative gram-negative coverage with intravenous fluoroquinolones by 26% (p < 0.001) from 1998 to 2001. Overall, a 43% reduction in the number of courses of intravenous fluoroquinolones was seen during these 4 years. Courses lasting >5 days were reduced by 22% (p < 0.001). Vancomycin prescriptions deemed inappropriate that were administered >5 days were reduced by 16% (p < 0.001) during the same time period. The interventions performed by the clinical pharmacist were deemed successful, with a 76% acceptance rate by providers. CONCLUSIONS: Education of physicians through monthly conferences and personal interventions resulted in an increase in appropriate empiric antibiotic use, a decrease in the duration of inappropriate use, and a decrease in duplicate gram-negative coverage.

scholarly journals 1305. Application of Standard Antibiotic Use Criteria to Evaluate Inpatient Antibiotic Use

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S399-S399
Author(s):  
Maureen Campion ◽  
Emily Dionne ◽  
Elizabeth Radigan ◽  
Gail Scully ◽  
Moamen Al Zoubi ◽  
...  
Keyword(s):  
Antimicrobial Agents ◽  
Average Length ◽  
Medical Center ◽  
Pharmacy Practice ◽  
Antibiotic Use ◽  
Antifungal Prophylaxis ◽  
Prescribing Practices ◽  
Icu Patients ◽  
Inappropriate Use ◽  
Days Of Therapy

Abstract Background It is estimated that 30–50% of antimicrobial agents prescribed inpatient are not optimal. Historically, antimicrobial evaluation has been based primarily upon expert opinion of ID trained individuals. Spivak and colleagues proposed standard terminology and definitions to assess antimicrobial prescribing practices. At UMass Memorial Medical Center we utilized Spivak’s criteria to measure antimicrobial use within point prevalence studies (PPS) and assessed the ability of Spivak’s criteria to provide consistent results between different evaluators. Methods A PPS was conducted in September 2017 (SEPT) by infectious disease (ID) attendings and ID trained pharmacists. A follow-up PPS was completed in November 2017 (NOV) by a pharmacy practice resident (PGY-1) and first year ID fellow. Patients were included if they were prescribed antibiotics at the time of review, greater than 18 years of age, and admitted to an inpatient unit. Patients only receiving antiretroviral therapy or antifungal prophylaxis were excluded from the study. Antibiotics, indications, days of therapy, and appropriateness or reason for inappropriateness, as defined by Spivak’s criteria, were collected. Results Four hundred five patients in SEPT and 475 patients in NOV were reviewed. Baseline characteristics between SEPT and NOV, including sex, age, average length of hospital stay (LOS) at time of review were similar between groups, (SEPT vs. NOV: male sex: 53.2% vs. 51.1%; age: 60.4 vs. 61.7; LOS:8.55 vs. 8.36 days). Number of antibiotics per patient was different between PPS (SEPT 1.69 vs. NOV 1.28). For non-intensive care unit (ICU) patients, 64.9% of use was considered appropriate in SEPT vs. 69.3% in NOV. The top reasons for inappropriate use in non-ICU patients in both PPS were no indication and excess length of therapy. Within the ICU, 89.4% of use was considered appropriate in SEPT, with 75% of use considered appropriate in NOV. The top reason for inappropriate use in ICU patients in both PPS was overly broad therapy. Conclusion Application of standard antibiotic evaluation criteria can assist healthcare professionals with different levels of ID training to assess antibiotic use in non-ICU patients. Further evaluation should be considered for critically ill patients. Disclosures All authors: No reported disclosures.

scholarly journals 1050. Oral Antibiotics for the Treatment of Gram-Negative Bloodstream Infections: Prescribing Practices and Outcomes at a Large Academic Medical Center

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S313-S314
Author(s):  
Kimberly Claeys ◽  
Nora Loughry ◽  
Sanjay Chainani ◽  
Surbhi Leekha ◽  
Emily Heil
Keyword(s):  
Antibiotic Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Antibiotic Use ◽  
Optimal Time ◽  
Oral Antibiotics ◽  
Prescribing Practices ◽  
Gram Negative ◽  
Academic Medical

Abstract Background There is limited data to guide the use of oral (PO) antibiotics for the treatment of Gram-negative (GN) bloodstream infection (BSI). The objective of this study was to describe the characteristics and outcomes at a large academic medical center. Methods Retrospective observational cohort of adult patients (age ≥18 years) with at least one blood culture positive for aerobic Gram-negative organism(s) treated with antibiotic therapy (IV or oral [PO]) at University of Medical Center from November 2015 to May 2017. Oral antibiotics were described based on bioavailability. The primary outcome of interest was 30-day infection-related readmission. Secondary objectives included evaluation of patient characteristics associated with PO antibiotic use. Results During the defined study period 310 patients met inclusion; 113 (36.5%) were switched to PO antibiotic therapy for the treatment of GN BSI within a median of 5 (IQR 3–11) days. Oral antibiotics were initiated at discharge for 50 (44%) of patients switched. Patients switched to PO were less likely to have has a stay in the ICU (24.8% vs. 47.7%, P &lt; 0.0001) and were less likely to have an ID consult (57.5% vs. 71.1%, P = 0.034). There was no difference in median Charlson Comorbidity Score (2, IQR 0–4). The most common sources of infection among those switched to PO agents were urinary (50, 44.2%) and intra-abdominal (25, 22.1%). The majority of patients were placed on a PO agent with high bioavailability (61, 54%), which included levofloxacin and moxifloxacin. There was a slightly higher proportion of use of high (vs. low) bioavailable antibiotics in patients with ID consult compared with those without (59% vs. 41%, P = 0.053). PO antibiotics were more frequently prescribed for patients discharged home (78, 69%) compared with patients discharged to Rehab/Short-term facility (28, 24.8%). Thirty-day hospital readmission was more common among the patients treated with PO antibiotics (18.6 vs. 8.1%, P = 0.006); however, ID-related readmission was rare (0.9% vs. 1%, P = 0.91). Conclusion Urinary and intra-abdominal sources and home discharge were common among those with PO antibiotic use. ID-related outcomes were similar among those treated with IV vs. PO agents. More research is necessary to determine optimal time to PO antibiotic switch. Disclosures K. Claeys, Nabriva: Scientific Advisor, Consulting fee. Melinta: Scientific Advisor, Consulting fee. E. Heil, ALK-Abelló: Grant Investigator, Research grant.

scholarly journals Impact of Infection caused by Extended Spectrum ?-Lactamase Producing Bacteria: A Review Update

2014 ◽  
Vol 1 (1) ◽  
pp. 13-20
Author(s):  
M Saiful Islam ◽  
Naima Moazzem ◽  
M Abdullah Yusuf ◽  
Shahin Ara Begum
Keyword(s):  
Bacterial Resistance ◽  
Antimicrobial Agents ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Resistant Bacteria ◽  
Klebsiella Species ◽  
Gram Negative ◽  
Extended Spectrum Beta Lactamase ◽  
Extended Spectrum ◽  
Gram Negative Organisms

Emergence of bacterial resistance causes limitation of the action of antimicrobial agents. Frequency of extended spectrum ?-Lactamase (ESBL) production is high among Escherichia coli (E. coli) and Klebsiella species. This has created a worldwide problem resulting in treatment failure. ESBLs have become widespread throughout the world. Microbes undergo mutation of genes, which can spread from cell to cell by mobile genetic elements such as plasmids, transposons and bacteriophages. Resistant bacteria flourish in areas of heavy antibiotic use such as hospitals and ICU. With widespread use of antibiotic, the frequency of penicillinase producing staphylococci increased. The availability of the second-generation cephalosporin, such as cefamondole, cefoxitin, and cefuroxime, or 3rd generation cephalosporin, such as cefotaxime, ceftazidime, ceftriaxone has been the leading cause of potential resistances in nosocomial Gram-negative bacilli. Hospital outbreaks of multi-drug resistant Enterobacteriaceae are now being frequently caused by extended spectrum beta-lactamase (ESBL) producers. Incidence of ESBL producing strains among clinical isolates has been steadily increasing over past years resulting in limitation of therapeutic options. Bacterial antibiotic resistance has become a major clinical concern worldwide including Bangladesh. Recently, the use of second and third generation cephalosporin has led to the selection of Gram-negative organisms resistant to ?-lactamase stable cephalosporin. This resistance is attributed to the production of extended spectrum ?-lactamases.DOI: http://dx.doi.org/10.3329/jcamr.v1i1.19560J Curr Adv Med Res 2014;1(1):13-19

scholarly journals PROBLEM OF ANTIBIOTIC USE AND ANTIMICROBIAL RESISTANCE IN INDONESIA: ARE WE REALLY MAKING PROGRESS?

2013 ◽  
Vol 4 (4) ◽  
pp. 5 ◽  
Author(s):  
Usman Hadi ◽  
Kuntaman Kuntaman ◽  
Mariyatul Qiptiyah ◽  
Hari Paraton
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Use ◽  
Teaching Hospitals ◽  
Resistant Bacteria ◽  
Prevention Study ◽  
Antibiotic Resistant ◽  
Inappropriate Use ◽  
Government Hospitals ◽  
Inappropriate Antibiotics ◽  
Very High

Background: Based on the results Antimicrobial Resistance in Indonesia: prevalence and prevention-study (AMRIN-study), the Ministry of Health of Indonesia in 2005 began a program antibiotic resistance control (PPRA) in some government hospitals, and is currently developing to all government teaching hospitals in Indonesia. Aim: The core activities of the PPRA are to implement standardized surveillance emergence of antibiotic resistant bacteria, and the surveillance of antibiotic use in terms of quantity and quality. Method: Our research in the years 2003 showed the proportion of antibiotic use 84% of patients in a hospital. The use of inappropriate antibiotics was very high, 42% no indication. Result: In 2012 the results of surveillance showed decline of inappropriate use of antibiotic, but prevalence extended-spectrum b-lactamase (ESBL)-producing K.pneumoniae (58%), and E.coli (52%) andmethicillin-resistant S.aures (MRSA) (24%) were increasing. Conclusion: It was needed to implement the most appropriate programs to prevent the growth and development of bacteria resistant to antibiotics.

scholarly journals A PROSPECTIVE STUDY ON ANTIMICROBIAL UTILIZATION PATTERN IN OUTPATIENT DEPARTMENT AT TERTIARY CARE HOSPITAL, PUNE, INDIA.

2018 ◽  
Vol 11 (5) ◽  
pp. 131
Author(s):  
Sarang A Deshmukh ◽  
Yashasvi Agarwal ◽  
Harshita Hiran ◽  
Uma Bhosale
Keyword(s):  
Antimicrobial Agents ◽  
Demographic Data ◽  
Tertiary Care ◽  
Essential Medicine ◽  
Antibiotic Use ◽  
Oral Dosage ◽  
Fixed Dose ◽  
Care Hospital ◽  
Prescribing Practices ◽  
Cross Sectional

 Objective: The objective of the study was to evaluate antimicrobial prescription pattern in outpatient departments.Method: This was a prospective, cross-sectional and observational study over 12 weeks total 400 prescriptions of either gender and age; containing antimicrobial agents (AMAs) were analyzed for demographic data and the WHO prescribing indicators.Results: Most of prescription were given to men (n=262). The most common group of AMA used was Cephalosporins (n=141, 35.25%); of which Ceftriaxone was most commonly prescribed (n=73, 18.25%). 10 AMAs were from the WHO essential medicine list AMAs. Men outnumbered women in prescribing antibiotics (n=262 vs. 138). Most of AMAs receivers were between 26 and 35 years (n=128, 32%). Amoxicillin+Clavulanic acid fixed-dose combination was most common (n=84, 21%). Most of the prescriptions were containing four drugs per prescriptions (n=130, 32.5%). Only 10% of the prescription was given by generic name and rest 90% were given by brand name. Oral dosage form of AMAs was predominant (n=340, 85%). Vitamins and supplement were most common comedication received by patients.Conclusion: Antibiotic use was found to be reasonable and rational in most of the cases. However, still, prescribers should improve prescribing practices and make it more rational.

Clinical Pharmacist–Led Impact on Inappropriate Albumin Use and Costs in the Critically Ill

2019 ◽  
Vol 54 (2) ◽  
pp. 105-112
Author(s):  
Mitchell S. Buckley ◽  
Kristen D. Knutson ◽  
Sumit K. Agarwal ◽  
Jake M. Lansburg ◽  
Laura M. Wicks ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Critically Ill ◽  
Clinical Pharmacist ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Strategy ◽  
Cost Savings ◽  
Pharmacist Intervention ◽  
Total Annual Cost ◽  
Inappropriate Use

Background:Optimal albumin use in the intensive care unit (ICU) remains challenging with inappropriate use approaching 50%. No published reports have described clinical pharmacist impact aimed at mitigating inappropriate albumin use in the ICU. Objective: To evaluate the clinical and economic impact of a clinical pharmacist–led intervention strategy targeting inappropriate albumin in the ICU. Methods: A retrospective cohort study evaluated all adult (≥18 years) ICU patients administered albumin at an academic medical center over a 2-year period. Institutional guidelines were developed with clinical pharmacists targeting inappropriate albumin use. The primary end point was to compare inappropriate use of albumin administered before and after pharmacist intervention implementation. Secondary analyses compared the overall albumin use between study periods. In-hospital mortality, length of stay, and albumin-related costs between study periods were also compared. Results: A total of 4419 patients were identified, with 2448 (55.4%) critically ill patients included. The pharmacist-led strategy resulted in a 50.9% reduction of inappropriate albumin use ( P < 0.001). The rate of inappropriate albumin use was 44.3 ± 10.5 and 5.5 ± 2.9 g per patient-day in the preimplementation and postimplementation periods, respectively ( P < 0.001). Costs associated with overall and inappropriate albumin use in the ICU decreased by 34.8% and 87.1%, respectively. Total annual cost-savings was $355 393 in the ICUs. No differences in clinical outcomes were found. Conclusion and Relevance: Clinical pharmacist–led interventions reduced overall and inappropriate albumin use and costs without negatively affecting clinical outcomes.

scholarly journals Risk factors and outcomes for multidrug-resistant Gram-negative bacilli bacteremia

2017 ◽  
Vol 5 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Swati Patolia ◽  
Getahun Abate ◽  
Nirav Patel ◽  
Setu Patolia ◽  
Sharon Frey
Keyword(s):  
Risk Factors ◽  
Urinary Catheter ◽  
Medical Center ◽  
Demographic Data ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Solid Organ ◽  
Gram Negative ◽  
Source Of Infection

Background: The incidence of multidrug-resistant (MDR) organisms is increasing along with mortality. Identifying risk factors for the development of MDR Gram-negative bacilli (GNB) bacteremia could greatly impact patient care and management. Methods: Data from the electronic health record of patients with GNB over 13-month period were collected at a single university medical center. Baseline demographic data, risk factor, microbiological data, recurrence of bacteremia, and mortality were recorded. Results: A total of 177 patients were included in the analysis. MDR GNB occurred in 46 patients (26%). The mortality rate in the MDR group was 34.8% compared to 13.7% in non-MDR group ( p = 0.002). In multivariate analysis, diabetes mellitus [DM; odds ratio (OR): 2.8, 95% confidence interval (CI): 1–4.88], previous antibiotic use (OR: 2.93, 95% CI: 1.25–6.87), and urinary catheter as a source of infection (OR 5.96, 95% CI: 1.78–19.94) were significant risk factors for the development of MDR GNB. In addition, end-stage liver disease (OR: 3.64, 95% CI: 1.07–12.3), solid organ malignancy (OR: 3.64, 95% CI: 1.25–10.56), intra-abdominal source of infection (OR: 3.66, 95% CI: 1.14–11.73), inappropriate empiric antibiotics (OR 7.59, 95% CI: 1.68–34.34) and urinary catheter as a source of infection (OR 5.68, 95% CI: 1.37–23.5) were significant factors for mortality in patients with MDR GNB. Conclusion: Our study provides important information about the risk factors for the development of MDR GNB bacteremia and helps prognosticate patient with MDR GNB.

Oral, nasopharyngeal, and gut decontamination in the ICU

2016 ◽  
Author(s):  
Evelien Oostdijk ◽  
Marc Bonten
Keyword(s):  
Digestive Tract ◽  
Antibiotic Use ◽  
Multidrug Resistant ◽  
Selective Decontamination ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Detailed Data ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative ◽  
Selective Oropharyngeal Decontamination

Many infections are caused by enteric bacilli, presumably from endogenous origin. Selective decontamination of the digestive tract (SDD) was developed to selectively eliminate the aerobic Gram-negative bacilli from the digestive tract, leaving the anaerobic flora unaffected. As an alternative to SDD, investigators have evaluated the effects of selective oropharyngeal decontamination (SOpD) alone. Most detailed data on the effects of SDD and SOpD in ICU-patients come from two studies performed in Dutch ICUs. The Dutch studies provide strong evidence that SDD and SOpD reduce ICUmortality, ICU-acquired bacteraemia with Gram-negative bacteria, and systemic antibiotic use. Although successful application has been reported from several solitary ICUs across Europe, it is currently unknown to what extent these effects can be achieved in settings with different bacterial ecology. More studies are needed on the use of SDD or SOpD as a measure to control outbreaks with multidrug resistant bacteria.

scholarly journals Bacteriocins, Antimicrobial Peptides from Bacterial Origin: Overview of Their Biology and Their Impact against Multidrug-Resistant Bacteria

2020 ◽  
Vol 8 (5) ◽  
pp. 639 ◽  
Author(s):  
Alexis Simons ◽  
Kamel Alhanout ◽  
Raphaël E. Duval
Keyword(s):  
Antimicrobial Resistance ◽  
Bacterial Infections ◽  
Antimicrobial Agents ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Gram Negative Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Gram Negative ◽  
Gram Positive Bacteria ◽  
Further Development

Currently, the emergence and ongoing dissemination of antimicrobial resistance among bacteria are critical health and economic issue, leading to increased rates of morbidity and mortality related to bacterial infections. Research and development for new antimicrobial agents is currently needed to overcome this problem. Among the different approaches studied, bacteriocins seem to be a promising possibility. These molecules are peptides naturally synthesized by ribosomes, produced by both Gram-positive bacteria (GPB) and Gram-negative bacteria (GNB), which will allow these bacteriocin producers to survive in highly competitive polymicrobial environment. Bacteriocins exhibit antimicrobial activity with variable spectrum depending on the peptide, which may target several bacteria. Already used in some areas such as agro-food, bacteriocins may be considered as interesting candidates for further development as antimicrobial agents used in health contexts, particularly considering the issue of antimicrobial resistance. The aim of this review is to present an updated global report on the biology of bacteriocins produced by GPB and GNB, as well as their antibacterial activity against relevant bacterial pathogens, and especially against multidrug-resistant bacteria.

scholarly journals Emergence of Antibiotic Resistance during Therapy for Infections Caused by Enterobacteriaceae Producing AmpC β-Lactamase: Implications for Antibiotic Use

2007 ◽  
Vol 52 (3) ◽  
pp. 995-1000 ◽  
Author(s):  
Sang-Ho Choi ◽  
Jung Eun Lee ◽  
Su Jin Park ◽  
Seong-Ho Choi ◽  
Sang-Oh Lee ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Antibiotic Use ◽  
Significance Level ◽  
Risk Of Mortality ◽  
Asan Medical ◽  
Bile Duct Invasion ◽  
Emergence Of Resistance

ABSTRACT Enterobacter spp., Serratia marcescens, Citrobacter freundii, and Morganella morganii are characterized by chromosomally encoded AmpC β-lactamases and possess the ability to develop resistance upon exposure to broad-spectrum cephalosporins. To determine the incidences of the emergence of resistance during antimicrobial therapy for infections caused by these organisms and the effect of the emergence of resistance on patient outcomes, all patients who were admitted to the Asan Medical Center (Seoul, Republic of Korea) from January 2005 to June 2006 and whose clinical specimens yielded Enterobacter spp., S. marcescens, C. freundii, or M. morganii were monitored prospectively. The main end point was the emergence of resistance during antimicrobial therapy. A total of 732 patients with infections were included for analysis. The overall incidence of the emergence of antimicrobial resistance during antimicrobial therapy was 1.9% (14/732). Resistance to broad-spectrum cephalosporins, cefepime, extended-spectrum penicillin, carbapenem, fluoroquinolones, and aminoglycosides emerged during treatment in 5.0% (11/218), 0% (0/20), 2.0% (2/100), 0% (0/226), 0% (0/153), and 1.1% (1/89) of patients, respectively. The emergence of resistance to broad-spectrum cephalosporins occurred more often in Enterobacter spp. (8.3%, 10/121) than in C. freundii (2.6%, 1/39), S. marcescens (0%, 0/37), or M. morganii (0%, 0/21). Biliary tract infection associated with malignant bile duct invasion was significantly associated with the emergence of resistance to broad-spectrum cephalosporins (P = 0.024 at a significance level of 0.042, by use of the Bonferroni correction). Only 1 of the 14 patients whose isolates developed resistance during antimicrobial therapy died. The emergence of resistance was more frequently associated with broad-spectrum cephalosporins than with the other antimicrobial agents tested, especially in Enterobacter spp. However, the emergence of resistance was associated with a low risk of mortality.

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