Antibiotics

2024

Jump to: 2023, 2022

11 pages, 368 KiB

Open AccessArticle

Diagnostic Accuracy of Urine Dipsticks for Urinary Tract Infection Diagnosis during Pregnancy: A Retrospective Cohort Study

by Dominique E. Werter, Caroline Schneeberger, Suzanne E. Geerlings, Christianne J. M. de Groot, Eva Pajkrt and Brenda M. Kazemier

Antibiotics 2024, 13(6), 567; https://doi.org/10.3390/antibiotics13060567 - 19 Jun 2024

Viewed by 1873

Abstract

Objective: Urinary tract infections (UTIs) represent the most prevalent infections among pregnant women. Many pregnant women experience frequent voiding or lower abdominal pain during pregnancy due to physiologic changes. Due to the possible consequences of a UTI in pregnancy, pregnant women are more [...] Read more.

Objective: Urinary tract infections (UTIs) represent the most prevalent infections among pregnant women. Many pregnant women experience frequent voiding or lower abdominal pain during pregnancy due to physiologic changes. Due to the possible consequences of a UTI in pregnancy, pregnant women are more often tested for UTIs. This study aimed to assess the diagnostic accuracy of dipsticks in diagnosing UTIs in pregnant women while using the urine culture as the reference standard. Study design: This was a retrospective cohort study, conducted at two academic hospitals in the Netherlands among pregnant women. Pseudonymized data were collected from patient files. The results of the urine dipstick and the urine culture in pregnant women were linked. Additionally, nitrofurantoin prescriptions were linked to culture results. A positive urine culture was considered the reference test for a UTI. Results: Between 1 January 2017 and 28 February 2021, a total of 718 urine samples with leukocyte esterase dipstick results within 24 h of the urine culture were analyzed. Of these samples, a nitrite dipstick result was also available in 337 cases. Only 6.8% of the 718 urine samples yielded positive cultures. The sensitivity and specificity of leukocyte esterase were 75.5% and 40.4%, respectively; for nitrite, 72.0% sensitivity and 73.4% specificity were found. When at least one of the two tests was positive, the sensitivity and specificity were 92.0% and 27.9%, respectively. When both tests were positive, the sensitivity and specificity were 52.0% and 82.7%, respectively. In only 16.8% of the women to whom nitrofurantoin was prescribed, the urine cultures returned positive using a cut-off of 10⁵ colony forming units/mL. Conclusion: The diagnostic performance of leukocyte esterase, nitrite, or their combination in clinical practice is lower than previously reported in study settings among pregnant women. A significant proportion of women treated with nitrofurantoin were found to have no UTI, suggesting potential over-prescription based on dipstick test results. Healthcare providers should be aware of this reduced performance in clinical practice and carefully weigh the risks of antibiotic treatment by suspicion of a UTI against the possibility of delayed treatment awaiting culture results in individual patients. Full article

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13 pages, 363 KiB

Open AccessArticle

Accordance of Registered Drug Packages with Guideline-Recommended Treatment Durations for Community-Acquired Pneumonia—A New Antibiotic Stewardship Target?

by Martina Prusac, Maja Ortner Hadziabdic, Doris Rusic and Darko Modun

Antibiotics 2024, 13(6), 546; https://doi.org/10.3390/antibiotics13060546 - 12 Jun 2024

Viewed by 1168

Abstract

In most countries, antibiotics for oral administration are put on the market in fixed packages. When there is no exact unit dispensing of antimicrobials, drug pack size may influence prescribers’ choice of treatment duration. The aim of this study was to investigate the [...] Read more.

In most countries, antibiotics for oral administration are put on the market in fixed packages. When there is no exact unit dispensing of antimicrobials, drug pack size may influence prescribers’ choice of treatment duration. The aim of this study was to investigate the accordance of approved antibiotic packages with national guidelines for the treatment of community-acquired pneumonia (CAP). For the purpose of this study, criteria were developed to determine the accordance of approved antibiotic packages for treating CAP (criteria), which are based on recommendations from national guidelines for treating CAP. Subsequently, the accordance of approved antibiotic packages with the number of antibiotic doses resulting from the specified criteria was determined. Of 39 identified therapeutic option-package size combinations, 11 were found to be matched (28.2%), meaning there were no leftover medication units after completing therapy, and 28 were mismatched combinations (71.8%), indicating that there were excess doses of antibiotics remaining at the end of therapy. The results of this research showed a significant non-accordance of the approved antibiotic packages with the national guidelines for the treatment of CAP and, consequently, the creation of a large amount of residues of unit doses of antibiotics in the community. Full article

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16 pages, 3926 KiB

Open AccessSystematic Review

Systematic Review and Meta-Analysis Provide no Guidance on Management of Asymptomatic Bacteriuria within the First Year after Kidney Transplantation

by José Medina-Polo, Eva Falkensammer, Béla Köves, Jennifer Kranz, Zafer Tandogdu, Ana María Tapia, Tommaso Cai, Florian M. E. Wagenlehner, Laila Schneidewind and Truls Erik Bjerklund Johansen

Antibiotics 2024, 13(5), 442; https://doi.org/10.3390/antibiotics13050442 - 14 May 2024

Viewed by 1489

Abstract

(1) Background: Urinary tract infections (UTIs) are among the most frequent complications in kidney transplant (KT) recipients. Asymptomatic bacteriuria (ASB) may be a risk factor for UTIs and graft rejection. We aimed to evaluate available evidence regarding the benefit of screening and treatment [...] Read more.

(1) Background: Urinary tract infections (UTIs) are among the most frequent complications in kidney transplant (KT) recipients. Asymptomatic bacteriuria (ASB) may be a risk factor for UTIs and graft rejection. We aimed to evaluate available evidence regarding the benefit of screening and treatment of ASB within the first year after KT. (2) Evidence acquisition: A systematic literature search was conducted in MEDLINE, the Cochrane Library CENTRAL and Embase. Inclusion criteria were manuscripts in English addressing the management of ASB after KT. The PICO questions concerned Patients (adults receiving a KT), Intervention (screening, diagnosis and treatment of ASB), Control (screening and no antibiotic treatment) and Outcome (UTIs, sepsis, kidney failure and death). (3) Evidence synthesis: The systematic review identified 151 studies, and 16 full-text articles were evaluated. Seven were excluded because they did not evaluate the effect of treatment of ASB. There was no evidence for a higher incidence of lower UTIs, acute pyelonephritis, graft loss, or mortality in patients not treated with antibiotics for ASB. Analysis of comparative non-randomized and observational studies did not provide supplementary evidence to guide clinical recommendations. We believe this lack of evidence is due to confounding risk factors that are not being considered in the stratification of study patients. Full article

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10 pages, 525 KiB

Open AccessArticle

Efficacy of a Novel Prophylactic Scheme of Fosfomycin Trometamol in Patients Undergoing Endoscopic Surgery for Benign Prostatic Hyperplasia: Findings from a Prospective Monocentric Single-Arm Study

by Pasquale Maria Berrino, Milo Gatti, Valeria Rotaru, Lorenzo Bianchi, Fabio Tumietto, Elena Sora, Riccardo Schiavina, Eugenio Brunocilla, Pierluigi Viale and Federico Pea

Antibiotics 2024, 13(5), 424; https://doi.org/10.3390/antibiotics13050424 - 6 May 2024

Viewed by 1712

Abstract

This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign [...] Read more.

This study aimed to assess the efficacy of a novel prophylactic scheme of fosfomycin trometamol in patients undergoing elective HoLEP (holmium laser enucleation of the prostate) or TURP (transurethral resection of the prostate) procedures for treating benign prostatic hyperplasia. Patients affected by benign prostatic hyperplasia and undergoing elective HoLEP or TURP procedures during the period February 2022–June 2023 were prospectively enrolled. Two 3 g oral fosfomycin trometamol doses 12 h apart were administered at 8.00 p.m. on day −1 (i.e., the day before HoLEP or TURP procedure) and at 8.00 a.m. on day 0 (i.e., the day of the surgical procedure). The following outcomes were assessed: prevalence of fever occurring in the first 48 h after surgical procedure; prevalence of urological complications occurring after the surgical procedure; prevalence of proven urinary tract infections (UTIs) and/or bloodstream infections (BSIs) at 14 days post-procedure; and prevalence of emergency department admission for UTI-related sepsis at 14 days post-procedure. Univariate analysis comparing patients with and without proven UTI, BSI, or emergency department admission at 14 days post-procedure was carried out. Overall, 96 patients (median age 70 years) undergoing HoLEP (82.3%) or TURP (17.7%) were prospectively included. Median (IQR) time of surgical procedure after the morning fosfomycin dose was 226.5 min (range 88.5–393.75 min). Fever in the post-surgical 48 h occurred in 3/96 patients (3.1%). Prevalence of proven UTI at 14 days was as low as 1.0% (1/96), whereas no patient had proven BSI or UTI-related sepsis requiring emergency department admission at 14 days. Our findings support the contention that a prophylactic scheme based on two doses of fosfomycin trometamol 12 h apart before surgical intervention may represent a valuable strategy for preventing infectious complications in urologic patients undergoing HoLEP or TURP. Larger definitive confirmatory studies are warranted. Full article

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19 pages, 540 KiB

Open AccessArticle

Antibiotics Prescribing Pattern and Quality of Prescribing in Croatian Dental Practices—5-Year National Study

by Lucija Petrac, Katarina Gvozdanovic, Vjera Perkovic, Nikolina Petek Zugaj and Neven Ljubicic

Antibiotics 2024, 13(4), 345; https://doi.org/10.3390/antibiotics13040345 - 9 Apr 2024

Cited by 3 | Viewed by 1670

Abstract

Purpose: Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period. Methods: This is a retrospective observational study [...] Read more.

Purpose: Antibiotic resistance is one of the biggest threats to global health today. The aim of this study was to analyze antibiotic prescribing patterns and quality of prescribing in Croatian dental practices over a 5-year period. Methods: This is a retrospective observational study based on the analysis of the electronic prescriptions (medicines in ATC groups J01 and P01) from dental practices in Croatia prescribed from 1 January 2015 to 31 December 2019. Prescriptions were retrieved from the Croatian Health Insurance Fund (HZZO). The analyses included the number of prescriptions, type and quantity of prescribed drugs, indication, and the patient’s and prescriber’s characteristics. Results: The consumption increased from 1.98 DID in 2015, to 2.10 DID in 2019. The most prescribed antibiotic was Amoxicillin with clavulanic acid followed by Amoxicillin, Clindamycin, Metronidazole and Cefalexin. The analyses showed that 29.79% of antibiotics were not prescribed in accordance with the contemporary guidelines for the proper use of antibiotics. Additionally, 22% of antibiotics were prescribed in inconclusive indications. Conclusion: The research showed an increase in antibiotic consumption over five years along with unnecessary prescribing of antibiotics in cases with no indications for its use. The development of national guidelines for antibiotic use is necessary. Full article

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11 pages, 271 KiB

Open AccessArticle

Hospital Antibiotic Consumption before and during the COVID-19 Pandemic in Hungary

by Roxána Ruzsa, Ria Benkő, Helga Hambalek, Erika Papfalvi, Dezső Csupor, Róbert Nacsa, Márta Csatordai, Gyöngyvér Soós, Edit Hajdú and Mária Matuz

Antibiotics 2024, 13(1), 102; https://doi.org/10.3390/antibiotics13010102 - 20 Jan 2024

Cited by 4 | Viewed by 2265

Abstract

The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010–2021 period. Classifications and calculations were performed according to the WHO [...] Read more.

The aim of this study was to assess antibiotic use in the Hungarian hospital care sector during and before the pandemic. Aggregated systemic antibiotic (ATC: J01) utilisation data were obtained for the 2010–2021 period. Classifications and calculations were performed according to the WHO ATC/DDD index and expressed as DDD per 1000 inhabitants and per day (DID), DDD per 100 patient-days (DHPD) and DDD/discharge. A linear regression (trend analysis) was performed for the pre-COVID years (2010–2019) and a prediction interval was set up to assess whether the pandemic years’ observed utilisation fit in. Antibiotic utilisation was constant in DID before and during the pandemic (2019: 1.16; 2020: 1.21), while we observed a substantial increase in antibiotic use when expressed in DDD per 100 patient-days (2019: 23.3, 2020: 32.2) or DDD/discharge (2019: 1.83, 2020: 2.45). The observed utilisation level of penicillin combinations; first-, third- and fourth-generation cephalosporins; carbapenems; glycopeptides; nitroimidazoles and macrolides exceeded the predicted utilisation values in both pandemic years. Before the pandemic, co-amoxiclav headed the top list of antibiotic use, while during the pandemic, ceftriaxone became the most widely used antibiotic. Azithromycin moved up substantially on the top list of antibiotic use, with a 397% increase (2019: 0.45; 2020: 2.24 DHPD) in use. In summary, the pandemic had a major impact on the scale and pattern of hospital antibiotic use in Hungary. Full article

2023

Jump to: 2024, 2022

23 pages, 951 KiB

Open AccessSystematic Review

Physicochemical Characteristics of Antimicrobials and Practical Recommendations for Intravenous Administration: A Systematic Review

by Fabio Borgonovo, Massimiliano Quici, Antonio Gidaro, Davide Giustivi, Dario Cattaneo, Cristina Gervasoni, Maria Calloni, Elena Martini, Leyla La Cava, Spinello Antinori, Chiara Cogliati, Andrea Gori and Antonella Foschi

Antibiotics 2023, 12(8), 1338; https://doi.org/10.3390/antibiotics12081338 - 19 Aug 2023

Cited by 6 | Viewed by 3405

Abstract

Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant [...] Read more.

Most antimicrobial drugs need an intravenous (IV) administration to achieve maximum efficacy against target pathogens. IV administration is related to complications, such as tissue infiltration and thrombo-phlebitis. This systematic review aims to provide practical recommendations about diluent, pH, osmolarity, dosage, infusion rate, vesicant properties, and phlebitis rate of the most commonly used antimicrobial drugs evaluated in randomized controlled studies (RCT) till 31 March 2023. The authors searched for available IV antimicrobial drugs in RCT in PUBMED EMBASE^®, EBSCO^® CINAHL^®, and the Cochrane Controlled Clinical trials. Drugs’ chemical features were searched online, in drug data sheets, and in scientific papers, establishing that the drugs with a pH of <5 or >9, osmolarity >600 mOsm/L, high incidence of phlebitis reported in the literature, and vesicant drugs need the adoption of utmost caution during administration. We evaluated 931 papers; 232 studies were included. A total of 82 antimicrobials were identified. Regarding antibiotics, 37 reach the “caution” criterion, as well as seven antivirals, 10 antifungals, and three antiprotozoals. In this subgroup of antimicrobials, the correct vascular access device (VAD) selection is essential to avoid complications due to the administration through a peripheral vein. Knowing the physicochemical characteristics of antimicrobials is crucial to improve the patient’s safety significantly, thus avoiding administration errors and local side effects. Full article

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11 pages, 793 KiB

Open AccessArticle

Do Patients’ Psychosocial Characteristics Impact Antibiotic Prescription Rates?

by Säde Stenlund, Louise C. Mâsse, David Stenlund, Lauri Sillanmäki, Kirstin C. Appelt, Heli Koivumaa-Honkanen, Päivi Rautava, Sakari Suominen and David M. Patrick

Antibiotics 2023, 12(6), 1022; https://doi.org/10.3390/antibiotics12061022 - 7 Jun 2023

Viewed by 1705

Abstract

Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients’ psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between [...] Read more.

Previous research suggests that the characteristics of both patients and physicians can contribute to the overuse of antibiotics. Until now, patients’ psychosocial characteristics have not been widely explored as a potential contributor to the overuse of antibiotics. In this study, the relationship between a patient’s psychosocial characteristics (self-reported in postal surveys in 2003) and the number of antibiotics they were prescribed (recorded in Finnish national registry data between 2004–2006) were analyzed for 19,300 working-aged Finns. Psychosocial characteristics included life satisfaction, a sense of coherence, perceived stress, hostility, and optimism. In a structural equation model, patients’ adverse psychosocial characteristics were not related to increased antibiotic prescriptions in the subsequent three years. However, these characteristics were strongly associated with poor general health status, which in turn was associated with an increased number of subsequent antibiotic prescriptions. Furthermore, mediation analysis showed that individuals who used healthcare services more frequently also received more antibiotic prescriptions. The current study does not support the view that patients’ adverse psychosocial characteristics are related to an increased number of antibiotic prescriptions. This could encourage physicians to actively discuss treatment options with their patients. Full article

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14 pages, 1288 KiB

Open AccessArticle

Non-Adherence in Adult Male Patients with Community-Acquired Pneumonia: Relative Forgiveness of Amoxicillin versus Respiratory Fluoroquinolones

by Nerea Carral, John C. Lukas, Oskar Estradé, Nerea Jauregizar, Héctor Morillas and Elena Suárez

Antibiotics 2023, 12(5), 838; https://doi.org/10.3390/antibiotics12050838 - 1 May 2023

Cited by 1 | Viewed by 2024

Abstract

The consequences of non-adherence to treatment (NAT) on antimicrobial efficacy may depend on drug forgiveness—a property that should account for pharmacokinetics (PK) and pharmacodynamics (PD) as well as interindividual variability. In this simulation study, relative forgiveness (RF) in NAT, defined as the probability [...] Read more.

The consequences of non-adherence to treatment (NAT) on antimicrobial efficacy may depend on drug forgiveness—a property that should account for pharmacokinetics (PK) and pharmacodynamics (PD) as well as interindividual variability. In this simulation study, relative forgiveness (RF) in NAT, defined as the probability of a successful PK/PD target (PTA) attained under perfect adherence compared to imperfect adherence, was evaluated for amoxicillin (AMOX) (oral 1000 mg/8 h) and two respiratory fluoroquinolones—levofloxacin (LFX) (oral 750 mg/24 h) and moxifloxacin (MOX) (oral 400 mg/24 h)—in virtual outpatients with community-acquired pneumonia for S. pneumoniae. Several NAT scenarios (delay in dose intake and a missed dose) were considered. PK characteristics of virtual patients, including variability in creatinine clearance (70–131 mL/min) and S. pneumoniae susceptibility variability associated with geographical location, were simulated in NAT. In this regard, in regions of low MIC delays from 1 h to 7 h or omission of dose ingestion would not have negative consequences on the efficacy of AMOX because of its good RF associated with the AMOX PK and PD properties; RF of LFX 750 mg or MOX 400 mg/24 h regimen vs. AMOX 1000 mg/8 h is one. However, in regions of elevated MIC for S. pneumoniae AMOX loses its RF, LFX and MOX vs. AMOX, showing higher RF (>1) depending on the CL_CR of patients. These results illustrate the importance of considering the RF of antimicrobial drugs in NAT and provide a framework for further studying its implications for clinical success rates. Full article

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10 pages, 269 KiB

Open AccessArticle

Pharmacological Treatment of Herpes Zoster and Factors Associated with Its Recurrence

by Luis Fernando Valladales-Restrepo, Santiago Velasquez-Quimara and Jorge Enrique Machado-Alba

Antibiotics 2023, 12(4), 757; https://doi.org/10.3390/antibiotics12040757 - 14 Apr 2023

Cited by 2 | Viewed by 3818

Abstract

The burden of herpes zoster disease is significant worldwide, with millions affected and an increasing incidence. Increased age and immunosuppression due to disease or drugs have been related to its recurrence. The aim of this work was to determine the pharmacological management of [...] Read more.

The burden of herpes zoster disease is significant worldwide, with millions affected and an increasing incidence. Increased age and immunosuppression due to disease or drugs have been related to its recurrence. The aim of this work was to determine the pharmacological management of herpes zoster and identify factors associated with recurrence, representing a longitudinal retrospective study identifying the pharmacological management of patients with herpes zoster and the factors related to the first recurrence using a population database. Follow-up was carried out for up to 2 years, and descriptive analysis and Cox proportional hazards regression were performed. A total of 2978 patients with herpes zoster were identified, with a median age of 58.9 years and 65.2% being women. The treatment mainly involved acyclovir (98.3%), acetaminophen (36.0%), and non-steroidal anti-inflammatory drugs (33.9%). A total of 2.3% of patients had a first recurrence. Corticosteroids were used in a greater proportion for recurrence than for the initial herpes episode (18.8% vs. 9.8%, respectively). Being female (HR:2.68;95%CI:1.39–5.17), age ≥60 years (HR:1.74;95%CI:1.02–2.96), having liver cirrhosis (HR:7.10;95%CI:1.69–29.80), and having hypothyroidism (HR:1.99;95%CI:1.16–3.40) were associated with greater probability of a first recurrence. The vast majority of patients were managed with acyclovir, and the use of acetaminophen or non-steroidal anti-inflammatory drugs for pain management was frequent. Several conditions were found that increased the probability of presenting a first recurrence of herpes zoster, such as age over 60 years, being a woman, suffering from hypothyroidism, and liver cirrhosis. Full article

10 pages, 286 KiB

Open AccessArticle

Knowledge, Attitudes and Practice Regarding Antibiotic Prescription by Medical Interns: A Qualitative Study in Spain

by Germán Molina-Romera, Olalla Vazquez-Cancela, Juan Manuel Vazquez-Lago, Rodrigo Alonso Montes-Villalba, Fátima Roque, Maria Teresa Herdeiro and Adolfo Figueiras

Antibiotics 2023, 12(3), 457; https://doi.org/10.3390/antibiotics12030457 - 24 Feb 2023

Cited by 2 | Viewed by 2002

Abstract

Antibiotic resistance is an issue of growing importance in the public health sphere. Medical interns are of great relevance when it comes to the source of this problem. This study therefore sought to ascertain which factors influence the management of antibiotic therapy by [...] Read more.

Antibiotic resistance is an issue of growing importance in the public health sphere. Medical interns are of great relevance when it comes to the source of this problem. This study therefore sought to ascertain which factors influence the management of antibiotic therapy by this population, in order to pinpoint the possible causes of misprescribing habits. We conducted a qualitative study based on focus group techniques, with groups consisting of medical interns from the Santiago de Compostela Clinical University Teaching Hospital. Our study identified factors which the participants considered to be determinants of antibiotic use and their relationship with the appearance of resistance. The single most repeated factor was the influence of the attending physician’s judgement; other factors included a high healthcare burden or prescribing inertia. This stage is an opportunity to correct misprescribing habits, by implementing educational interventions aimed at modifying the identified factors. Full article

13 pages, 821 KiB

Open AccessArticle

Antimicrobial Stewardship Program for Patients in the Hematological Department Receiving Carbapenem Therapy: A Single-Center and Interrupted Time Series Analysis

by Ayako Suzuki, Fumihiro Yamaguchi, Masayuki Maeda, Miyuki Hashiguchi, Nobuyuki Kabasawa, Jun Sasaki, Tokutada Sato, Masaki Fuyama, Yohei Yamazaki, Kei Endo, Kae Iwata, Sei Kobayashi and Hisato Fujihara

Antibiotics 2023, 12(2), 302; https://doi.org/10.3390/antibiotics12020302 - 2 Feb 2023

Cited by 1 | Viewed by 2107

Abstract

As antibiotic resistance has become a global problem, the intervention of an antimicrobial stewardship team (AST) is warranted. In hematological disorders, infectious complications are crucial owing to abnormal neutrophil function and decreased cell-mediated immunity. Despite the widespread implementation of AST intervention, the effectiveness [...] Read more.

As antibiotic resistance has become a global problem, the intervention of an antimicrobial stewardship team (AST) is warranted. In hematological disorders, infectious complications are crucial owing to abnormal neutrophil function and decreased cell-mediated immunity. Despite the widespread implementation of AST intervention, the effectiveness of stewardship practices for immunocompromised patients remains uncertain. We determined the effect of AST interventions on carbapenem therapy in the department of hematology. Patients admitted to the department and undergoing carbapenem therapy were enrolled. We compared carbapenem use between the pre-AST (April 2016–March 2018) and post-AST (April 2018–March 2021) periods. Factors associated with long-term carbapenem therapy were investigated. Overall, 515 episodes of carbapenem therapy in 264 patients in the department were evaluated. According to the interrupted time series analysis, the number of days of therapy decreased with AST intervention (β = −0.263, p = 0.011). In multivariate analysis, predictive factors associated with long-term carbapenem therapy (>8 days) were outpatient onset, chronic obstructive pulmonary disease, acute myeloid leukemia, multiple myeloma, and infection with resistant bacteria (such as extended spectrum β-lactamases and AmpC) (95% confidence interval, 1.030–2.818, 1.067–66.667, 1.057–2.782, 0.168–0.742, and 1.382–5.750, respectively). The AST intervention reduced carbapenem use in patients with hematological disorders. Full article

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2022

Jump to: 2024, 2023

9 pages, 765 KiB

Open AccessArticle

Association between Carbapenem Consumption and Clinical Outcomes in an In-Hospital Setting: Analysis of a Japanese Nationwide Administrative Database in 2020

by Kozue Yamaguchi, Masayuki Maeda, Norio Ohmagari and Yuichi Muraki

Antibiotics 2022, 11(12), 1807; https://doi.org/10.3390/antibiotics11121807 - 13 Dec 2022

Cited by 2 | Viewed by 1863

Abstract

This study aimed to clarify the relationship between carbapenem consumption and clinical outcome using the diagnosis procedure combination (DPC) payment system database (2020) published by the Ministry of Health, Labour, and Welfare of Japan. This study divided 5316 medical facilities subject to aggregation [...] Read more.

This study aimed to clarify the relationship between carbapenem consumption and clinical outcome using the diagnosis procedure combination (DPC) payment system database (2020) published by the Ministry of Health, Labour, and Welfare of Japan. This study divided 5316 medical facilities subject to aggregation into five facilities and calculated the median values, including facility characteristics, clinical outcomes, and carbapenem consumption. Next, a correlation analysis was performed between carbapenem consumption and clinical outcome, as well as a multiple regression analysis between carbapenem consumption as the dependent variable and clinical outcome, bed size, and proportion of patients by disease as independent variables. Additionally, three clinical outcomes available from the DPC payment system database were selected, including cure, readmission within 4 weeks, and the average length of stay. This study revealed no relationship between carbapenem consumption and clinical outcome in university hospitals and university hospital-equivalent community hospitals; however, a relationship was suggested in the community, DPC-prepared, and non-DPC hospitals. University hospitals and university hospital-equivalent community hospitals with a high consumption of carbapenems may need to reconsider the classification because of the limited number of facilities in this classification. Full article

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9 pages, 3340 KiB

Open AccessArticle

Days of Antibiotic Spectrum Coverage Trends and Assessment in Patients with Bloodstream Infections: A Japanese University Hospital Pilot Study

by Masayuki Maeda, Mari Nakata, Yuika Naito, Kozue Yamaguchi, Kaho Yamada, Ryoko Kinase, Takahiro Takuma, Rintaro On and Issei Tokimatsu

Antibiotics 2022, 11(12), 1745; https://doi.org/10.3390/antibiotics11121745 - 2 Dec 2022

Cited by 3 | Viewed by 2819

Abstract

The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this [...] Read more.

The antibiotic spectrum is not reflected in conventional antimicrobial metrics. Days of antibiotic spectrum coverage (DASC) is a novel quantitative metric for antimicrobial consumption developed with consideration of the antibiotic spectrum. However, there were no data regarding disease and pathogen-specific DASC. Thus, this study aimed to evaluate the DASC trend in patients with bloodstream infections (BSIs). DASC and days of therapy (DOT) of in-patients with positive blood culture results during a 2-year interval were evaluated. Data were aggregated to calculate the DASC, DOT, and DASC/DOT per patient stratified by pathogens. During the 2-year study period, 1443 positive blood culture cases were identified, including 265 suspected cases of contamination. The overall DASC, DASC/patient, DOT, DOT/patient, and DASC/DOT metrics were 226,626; 157.1; 28,778; 19.9; and 7.9, respectively. A strong correlation was observed between DASC and DOT, as well as DASC/patient and DOT/patient. Conversely, DASC/DOT had no correlation with other metrics. The combination of DASC and DOT would be a useful benchmark for the overuse and misuse evaluation of antimicrobial therapy in BSIs. Notably, DASC/DOT would be a robust metric to evaluate the antibiotic spectrum that was selected for patients with BSIs. Full article

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17 pages, 260 KiB

Open AccessArticle

Implementation of Clinical Practice Guidelines for Empirical Antibiotic Therapy of Bacteremia, Urinary Tract Infection, and Pneumonia: A Multi-Center Quasi-Experimental Study

by Pornpan Koomanachai, Jintana Srisompong, Sunee Chayangsu, Darat Ruangkriengsin, Visanu Thamlikitkul, Walaiporn Wangchinda, Rujipas Sirijatuphat and Pinyo Rattanaumpawan

Antibiotics 2022, 11(7), 903; https://doi.org/10.3390/antibiotics11070903 - 6 Jul 2022

Cited by 5 | Viewed by 2378

Abstract

A quasi-experimental study was conducted on the implementation of locally developed clinical practice guidelines (CPGs) for empirical antibiotic (ATB) therapy of common infections (bacteremia, urinary tract infection (UTI), pneumonia) in the hospitals from January 2019 to December 2020. The CPGs were developed using [...] Read more.

A quasi-experimental study was conducted on the implementation of locally developed clinical practice guidelines (CPGs) for empirical antibiotic (ATB) therapy of common infections (bacteremia, urinary tract infection (UTI), pneumonia) in the hospitals from January 2019 to December 2020. The CPGs were developed using data from patients with these infections at individual hospitals. Relevant CPG data pre- and post-implementation were collected and compared. Of the 1644 patients enrolled in the study, 808 and 836 were in the pre- and post-implementation periods, respectively, and patient outcomes were compared. Significant reductions in the mean durations of intensive care unit stay (3.44 ± 9.08 vs. 2.55 ± 7.89 days; p = 0.035), ventilator use (5.73 ± 12.14 vs. 4.22 ± 10.23 days; p = 0.007), piperacillin/tazobactam administration (0.954 ± 3.159 vs. 0.660 ± 2.217 days, p = 0.029), and cefoperazone/sulbactam administration (0.058 ± 0.737 vs. 0.331 ± 1.803 days, p = 0.0001) occurred. Multivariate analysis demonstrated that CPG-implementation was associated with favorable clinical outcomes (adjusted odds ratio 1.286, 95% confidence interval: 1.004–1.647, p = 0.046). Among patients who provided follow-up cultures (n = 284), favorable microbiological responses were significantly less frequent during the pre-implementation period than the post-implementation period (80.35% vs. 91.89%; p = 0.01). In conclusion, the locally developed CPG implementation is feasible and effective in improving patient outcomes and reducing ATB consumption. Hospital antimicrobial stewardship teams should be able to facilitate CPG development and implementation for antimicrobial therapy for common infections. Full article

14 pages, 1289 KiB

Open AccessArticle

Pattern of Antibiotic Use among Hospitalized Patients according to WHO Access, Watch, Reserve (AWaRe) Classification: Findings from a Point Prevalence Survey in Bangladesh

by Md. Mahbubur Rashid, Zubair Akhtar, Sukanta Chowdhury, Md. Ariful Islam, Shahana Parveen, Probir Kumar Ghosh, Aninda Rahman, Zobaidul Haque Khan, Khaleda Islam, Nitish Debnath, Mahmudur Rahman and Fahmida Chowdhury

Antibiotics 2022, 11(6), 810; https://doi.org/10.3390/antibiotics11060810 - 16 Jun 2022

Cited by 21 | Viewed by 6168

Abstract

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed [...] Read more.

For supporting antibiotic stewardship interventions, the World Health Organization (WHO) classified antibiotics through the AWaRe (Access, Watch, and Reserve) classification. Inappropriate use of antimicrobials among hospital-admitted patients exposes them to the vulnerability of developing resistant organisms which are difficult to treat. We aimed to describe the proportion of antibiotic use based on the WHO AWaRe classification in tertiary and secondary level hospitals in Bangladesh. A point prevalence survey (PPS) was conducted adapting the WHO PPS design in inpatients departments in 2021. Among the 1417 enrolled patients, 52% were female and 63% were from the 15–64 years age group. Nearly 78% of patients received at least one antibiotic during the survey period. Third-generation cephalosporins (44.6%), penicillins (12.3%), imidazoles (11.8%), aminoglycosides (7.2%), and macrolides (5.8%) were documented as highly used antibiotics. Overall, 64.0% of Watch, 35.6% of Access, and 0.1% of Reserve group antibiotics were used for treatment. The use of Watch group antibiotics was high in medicine wards (78.7%) and overall high use of Watch antibiotics was observed at secondary hospitals (71.5%) compared to tertiary hospitals (60.2%) (p-value of 0.000). Our PPS findings underscore the need for an urgent nationwide antibiotic stewardship program for physicians including the development and implementation of local guidelines and in-service training on antibiotic use. Full article

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9 pages, 436 KiB

Open AccessArticle

Search for Indexes to Evaluate Trends in Antibiotic Use in the Sub-Prefectural Regions Using the National Database of Health Insurance Claims and Specific Health Checkups of Japan

by Kanako Mizuno, Ryo Inose, Yuna Matsui, Mai Takata, Daisuke Yamasaki, Yoshiki Kusama, Ryuji Koizumi, Masahiro Ishikane, Masaki Tanabe, Hiroki Ohge, Norio Ohmagari and Yuichi Muraki

Antibiotics 2022, 11(6), 763; https://doi.org/10.3390/antibiotics11060763 - 2 Jun 2022

Cited by 4 | Viewed by 2492

Abstract

The evaluation indexes of antimicrobial use (AMU) in sub-prefectural regions have not been established because these regional units are susceptible to the effects of population inflows and outflows. We defined the difference in AMU calculated each year as a new evaluation index and [...] Read more.

The evaluation indexes of antimicrobial use (AMU) in sub-prefectural regions have not been established because these regional units are susceptible to the effects of population inflows and outflows. We defined the difference in AMU calculated each year as a new evaluation index and compared the AMU of secondary medical areas with those already reported for Japan and each prefecture. Patients/1000 inhabitants/day (PID) for oral antibiotics in 2013 and 2016 were calculated using the National Database of Health Insurance Claims and Specific Health Checkups. ΔPID was defined as the difference between the PIDs in 2013 and 2016. Differences in AMUs for Japan and prefectures that have already been published were also calculated, and the concordance rate with ΔPID in each secondary medical area was evaluated. Antibiotics and age groups with less than 50% concordance between secondary medical area and previously reported AMU changes were observed. This revealed that even at the secondary medical area level, which is more detailed than the prefectural level, the AMU changes were not consistent. Therefore, in order to appropriately promote measures against antimicrobial resistance, we suggest the necessity of not only surveying AMU at the national or prefectural levels but also examining sub-prefectural trends in AMU. Full article

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14 pages, 1116 KiB

Open AccessArticle

Exploration of Trends in Antimicrobial Use and Their Determinants Based on Dispensing Information Collected from Pharmacies throughout Japan: A First Report

by Yuichi Muraki, Masayuki Maeda, Ryo Inose, Koki Yoshimura, Naoki Onizuka, Masao Takahashi, Eiji Kawakami, Yoshiaki Shikamura, Naotaka Son, Makoto Iwashita, Manabu Suzuki, Masayuki Yokoi, Hirokazu Horikoshi, Yasuaki Aoki, Michiyo Kawana, Miwako Kamei, Hajime Hashiba and Choichiro Miyazaki

Antibiotics 2022, 11(5), 682; https://doi.org/10.3390/antibiotics11050682 - 18 May 2022

Cited by 5 | Viewed by 3504

Abstract

The purpose of this study was to evaluate the defined daily doses (DDD)/1000 prescriptions/month (DPM) as a new indicator that can be used in pharmacies, and to describe antimicrobial use patterns in pharmacies nationwide in Japan. Dispensing volumes, number of prescriptions received, and [...] Read more.

The purpose of this study was to evaluate the defined daily doses (DDD)/1000 prescriptions/month (DPM) as a new indicator that can be used in pharmacies, and to describe antimicrobial use patterns in pharmacies nationwide in Japan. Dispensing volumes, number of prescriptions received, and facility information were obtained from 2638 pharmacies that participated in a survey. DPM was calculated based on the dispensing volume and number of prescriptions, which are routinely collected data that are simple to use. Use of third-generation cephalosporins, quinolones, and macrolides in pharmacies that received prescriptions primarily from hospitals or clinics decreased from January 2019 to January 2021. In particular, the antimicrobial use was higher in otorhinolaryngology departments than in other departments, despite a decrease in the antimicrobial use. In the linear multiple regression analysis, otorhinolaryngology department was independently associated with the third-generation cephalosporin, quinolone, and macrolide prescription in all periods. This study reveals for the first-time trends in antimicrobial use through a new indicator using the volume of drugs dispensed in pharmacies throughout Japan. Antimicrobial use differed by the medical department, suggesting the need to target interventions according to the department type. Full article

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