The rapid LRSE dissemination in Greek hospitals threatens linezolid activity. The observation that most LRSE belonged to ST22 and expressed dependence on linezolid clearly implies that the spread of linezolid resistance should have been driven by this trait, which provided the LRSE with a selective advantage under linezolid pressure.
The aim of this study was to investigate the effect of the implementation of an antibiotic stewardship program (ASP) on antibiotic consumption in our 428-bed hospital. The Infection Control Committee implemented an ASP beginning in January 2016, aiming to reduce inappropriate antibiotic use through improved prescribing practices. The ASP included both pre-authorization and prospective audit and feedback strategies. We collected pharmacy and hospital data for the years 2015 (pre-intervention) and 2016 (post-intervention). Consumption data were expressed as daily defined doses (DDDs) per 100 patient-days (PD) and the significance of the differences between 2015 and 2016 was assessed by paired t-test. Antibiotic resistance rates for the most important hospital pathogens were monitored for 2015-2016. The ASP effectively reduced consumption of most antimicrobials; total antibiotic use decreased by 16.7% (from 104.3 in 2015 to 86.9 DDDs/100 patient-days in 2016, p < 0.001) owing to reduction of 19.1% for non-restricted and 13.8% for restricted antibiotics. Important restricted antimicrobials, such as colistin, carbapenems, quinolones and tigecycline showed significantly decreased usage post-intervention. Significant changes in the resistance rates were not observed, except a decreasing trend for colistin and tigecycline (Acinetobacter baumannii and Klebsiella pneumoniae) and also vancomycin (enterococci). The ASP was successful in terms of reducing the antibiotic consumption for the first year of its implementation. Interestingly, antimicrobials requiring pre-authorization exhibited a lower reduction than other antibiotics. Potential effects of the ASP in reducing resistance rates remain to be shown.
A351 general hospital (PB 6M€). We chose 24 active ingredients (95 different antibiotics) that represent about 1/3 of total hospital antibiotics and 80% of the total antibiotics' budget. We studied their consumption for the years 2011 and 2012 and calculated the costs based on the official drug pricelist and their price after the negotiation. Results: From 2011 to 2012 the discounts gained from each hospital were increased. Price negotiation does not apply in prototype drugs that their companies are only obliged to offer a 5% rebate. Unfortunately, these medications are more expensive, represent 36% of the studied antibiotics' cost and their consumption was increased by 20%. But, the discounts for all the studied off-patent drugs and their generics were from 12.8% till 89.9%. Thus, the total cost saving for them was 33.2% at PAGNI, 26.0% at Evaggelismos and 43.1% at Tzaneio. The total benefit for the pharmaceutical expenditure was 3% for both PAGNI and Evaggelismos, and 6% for Tzaneio. ConClusions: Price negotiation is an effective mean of decreasing the cost of off-patent and generic drugs but newer and expensive drugs get doctors' preference, undermining the Pharmacy's cost-saving effort.
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