Prescribing of antibiotics on almost every second day of hospitalization was extensive and highly variable, and the frequent use of cephalosporins is noteworthy. It is possible that the development of resistance and the rate of Clostridium difficile infection is associated with the diverse antibiotic use intensity and preferences for prescribing of cephalosporins and fluoroquinolones. Continuous antibiotic use surveillance and evaluation of prescribing patterns in acute care with feedback and benchmarking will help optimizing antibiotic use and better assessing strategies to minimize resistance and Clostridium difficile infection, and eventually improve patient safety.
Background
The WHO/ATC (Anatomical Therapeutic Chemical) index DDD (WHO-DDD) is commonly used for drug consumption measurement. Discrepancies between WHO-DDD and actual prescribed daily doses (PDD) in hospitals have prompted alternative dose definitions adapted to doses recommended in hospital practice guidelines [recommended daily doses (RDD)].
Methods
In order to validate RDD we performed modified point prevalence surveys in 24 acute care hospitals and recorded 20620 PDD of antibiotics given to 4226 adult patients on the day of the survey and the 6 preceding days. We calculated RDD and WHO-DDD and compared them with PDD.
Results
The rate of RDD corresponding to PDD was higher than the corresponding rate for WHO-DDD (pooled data, 55% versus 30%) and the differences were similar across the hospital sample, but varied according to drug/drug class, route of administration, indication and renal function. RDD underestimated actual consumption by 14% overall, while WHO-DDD overestimated total antibacterial consumption by 28% (pooled data; median values RDD −10% versus WHO-DDD +32%). The deviations of estimated from actual drug use volumes were largest for β-lactams (RDD −11% versus WHO-DDD +49%), in particular for penicillins (−11% versus +64%), if WHO-DDD were used.
Conclusions
Hospital antibiotic consumption surveillance systems using current WHO-DDD should address the uneven discrepancies between actual prescribing and consumption estimates according to drug class that may lead to misclassification in benchmark analyses. We recommend using validated RDD as a supplementary measure to the WHO-DDD for detailed analyses.
The interaction of liposomal membranes composed of soybean phosphatidylcholine with the bile salts (BSs) cholate (Ch), glycocholate (GC), chenodeoxycholate (CDC), and glycochenodeoxycholate (GCDC) was studied. The BSs differed with regard to their lipophilicity, pKa values, and the size of their hydrophilic moiety. Their membrane interactions were investigated using Laurdan as a membrane-anchored fluorescent dye. The apparent membrane/water partition coefficient, D, at pH 7.4 was calculated from binding plots and compared with direct binding measurements using ultracentrifugation as a reference. The Laurdan-derived LogD values at pH 7.4 were found to be 2.10 and 2.25 for the trihydroxy BSs, i.e., Ch and GC, and 2.85 and 2.75 for the dihydroxy BSs, i.e., CDC and GCDC, respectively. For the membrane-associated glycine-conjugated GC and GCDC (pK a values of~3.9), no differences in the Laurdan spectra of the respective BS were found at pH 6.8, 7.4, and 8.2. Unconjugated Ch and CDC (pK a values of~5.0) showed pronounced differences at the three pH values. Furthermore, the kinetics of membrane adsorption and transbilayer movement differed between conjugated and unconjugated BSs as determined with Laurdan-labeled liposomes.
Was ist neu?
Pyelonephritis Eine Therapiedauer von 7 Tagen ist bei Patienten mit Pyelonephritis nach neueren Studien sicher und in der Regel ausreichend – auch, wenn anstelle eines Fluorchinolons in der gezielten Behandlung Cotrimoxazol (bei nachgewiesener In-vitro-Aktivität) verwendet wird.
Bauchrauminfektionen Die Therapiedauer bei vielen intraabdominellen Infektionen kann bei entsprechenden Patienten postoperativ bzw. nach adäquater Drainage kurz sein. Vor allem bei Cholezystektomie braucht es in der Regel keine postoperative Antibiotikatherapie.
Gram-negative Bakteriämie/Sepsis Die Therapiedauer bei Gram-negativer Bakteriämie/Sepsis kann bei gutem Ansprechen individuell bis auf 7 Tage (ggf. bei z. B. erfolgter Herdsanierung/Drainage auch kürzer) verkürzt werden. Klinische Kriterien zur Therapiedauersteuerung reichen meist aus.
Ambulant erworbene Pneumonie Die Therapiedauer kann bei Patienten mit ambulant erworbener Pneumonie und gutem Ansprechen nach 3 – 5 Tagen entsprechend kurz sein.
Fieber (unklarer Ursache) und Neutropenie Daten aus einer randomisierten klinischen Studie und weitere Beobachtungen weisen darauf hin, dass bei Fieber unklarer Ursache im Falle von Ansprechen nach empirischer Antibiotikagabe Kurzzeittherapien auch bei Hochrisikopatienten mit Neutropenie adäquat sein können.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.