Antibiotic Consumption Pattern in the Neonatal Special Care Unit Before and After Implementation of the Hospital’s Antibiotic Policy

Nitsch–Osuch, Aneta; Kurpas, Donata; Kuchar, Ernest; Życińska, Katarzyna; Zielonka, Tadeusz M.; Wardyn, Kazimierz

doi:10.1007/5584_2014_32

Cited by 15 publications

(14 citation statements)

References 19 publications

(26 reference statements)

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“…Studies conducted in the United States (30,(34)(35)(36) and in Europe (29,33,(37)(38)(39)(40)(41)(42)(43)(44)(45)(46) reported the highest pooled decrease in antimicrobial consumption after the implementation of ASP (Ϫ19.9% [95% CI ϭ Ϫ27.7 to Ϫ12.1, 2 ϭ 0.00] and Ϫ20.9% [95% CI ϭ Ϫ30.5 to Ϫ15, 2 ϭ 0.05], respectively), whereas studies in Asia reported a reduction of Ϫ16% (95% CI ϭ Ϫ36.5 to Ϫ5.3], 2 ϭ 0.11) (28, 31, 32, 47-52) (Fig. 2).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

304

192

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bThe implementation of antimicrobial stewardship programs (ASPs) is a promising strategy to help address the problem of antimicrobial resistance. We sought to determine the efficacy of ASPs and their effect on clinical and economic parameters. We searched PubMed, EMBASE, and Google Scholar looking for studies on the efficacy of ASPs in hospitals. Based on 26 studies (extracted from 24,917 citations) with pre-and postimplementation periods from 6 months to 3 years, the pooled percentage change of total antimicrobial consumption after the implementation of ASPs was ؊19.1% (95% confidence interval [CI] ‫؍‬ ؊30.1 to ؊7.5), and the use of restricted antimicrobial agents decreased by ؊26.6% (95% CI ‫؍‬ ؊52.3 to ؊0.8). Interestingly, in intensive care units, the decrease in antimicrobial consumption was ؊39.5% (95% CI ‫؍‬ ؊72.5 to ؊6.4). ). Hospital ASPs result in significant decreases in antimicrobial consumption and cost, and the benefit is higher in the critical care setting. Infections due to specific antimicrobial-resistant pathogens and the overall hospital length of stay are improved as well. Future studies should focus on the sustainability of these outcomes and evaluate potential beneficial long-term effects of ASPs in mortality and infection rates.A bout one-third of the hospitalized patients and more than two-thirds of critically ill patients are on antimicrobial therapy at any time (1, 2), and up to half of antibiotic prescriptions are inappropriate or not necessary (3). In 2013, the Centers for Disease Control and Prevention (CDC) reported that about 2 million patients are infected yearly with antimicrobialresistant organisms in the United States, and about 23,000 deaths are directly attributed to these infections (3). This resulted in a call to action for acute care hospitals to implement antimicrobial stewardship programs (ASPs) (4, 5), a term that is used to describe the integrated strategy of improving antimicrobial use in order to enhance patient outcomes, reduce antimicrobial cost, and minimize the side effects associated with antimicrobial use, including drug resistance and nosocomial infections (4, 6, 7). Although there are studies that have already presented data on the efficacy of ASPs in the inpatient setting (8-10), limitations compromise their generalization (i.e., the studies were only conducted in the United States [8], age and study design limitations [9], a lack of clinical outcomes [10], etc.). The purpose of our systematic review and meta-analysis was to measure the efficacy of the implementation of an ASP expressed in daily defined doses (DDD) per 1,000 patient days in the hospital setting independently of the age and study design and to assess the subsequent clinical and economic outcomes. MATERIALS AND METHODSThis systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol (11).Search strategy. A systematic electronic search of PubMed, EMBASE, and Google Scholar databases was performed for pertinent studies up t...

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Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

304

192

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“…Table 4 shows that the ATC/DDD system was only used in three studies evaluating antibiotics (Liem et al, 2010b ; Porta et al, 2012 ; Nitsch-Osuch et al, 2013 ). Two studies used the DDD system without ATC classification, whereas one study reported antibiotics consumption using Days of Therapy (Zingg et al, 2011 ; Salehifar et al, 2014 ; Nitsch-Osuch et al, 2015 ). Only one study reported antibiotics consumption using the PDD system (Porta et al, 2012 ).…”

Section: Resultsmentioning

confidence: 99%

“…Only one study reported antibiotics consumption using the PDD system (Porta et al, 2012 ). In addition, DU90 or DU100% was used as one of the reporting methods in four studies evaluating antibiotic utilization (Liem et al, 2010b ; Porta et al, 2012 ; Nitsch-Osuch et al, 2013 , 2015 ).…”

Section: Resultsmentioning

confidence: 99%

Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies

et al. 2017

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Despite limited evidence on safety and efficacy of drug use in neonates, drugs are extensively used in this age group. However, the availability of information on drug consumption in neonates, especially inpatient neonates, is limited. This paper systematically reviews published studies on drug utilization in hospitalized neonates. A systematic literature review was carried out to identify observational studies published from inception of databases used till August 2016. Four search engines, namely Medline, CINAHL, Embase, and PubMed, were used. Publications written in English that described drug utilization in neonatal wards were selected. Assessment of the data was based on the category of the study design, the objective of study and the method used in reporting drug consumption. A total of 20 drug utilization studies were identified, 12 of which focused on all drug classes, while the other eight evaluated antimicrobials. Studies were reported in Europe (n = 7), the United States (n = 6), India (n = 5), Brazil (n = 1), and Iran (n = 1). Substantial variance with regard to study types (study design and methods), data source, and sample size were found among the selected studies. Of the studies included, 45% were cross-sectional or retrospective, 40% were prospective studies, and the remaining 15% were point prevalence surveys. More than 70% of the studies were descriptive studies, describing drug consumption patterns. Fifteen per cent of the descriptive studies evaluated changes in drug utilization patterns in neonates. Volume of units was the most prevalent method used for reporting all drug categories. The ATC/DDD system for reporting drug use was only seen in studies evaluating antimicrobials. The most commonly reported drugs across all studies are anti-infectives for systemic use, followed by drugs for the cardiovascular system, the nervous system and the respiratory system. Ampicillin and gentamicin were the most prescribed antimicrobials in hospitalized neonates. The present review reveals that neonates are exposed to a high number of drugs and various methods are used to report drug consumption in this age group. The best measure of drug consumption to quantify prevalence of drug use in neonates remains to be identified and additional research in this area is warranted.

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“…These results are thus more advantageous than those described previously for the Special Care Neonatal Unit (SCNU) (Nitsch-Osuch et al 2015), where just the consumption pattern of antibiotics was improved. The difference may be explained by several factors.…”

Section: Discussionmentioning

confidence: 72%

Pulmonary Infection

2015

Advances in Experimental Medicine and Biology

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Antibiotic Consumption Pattern in the Neonatal Special Care Unit Before and After Implementation of the Hospital’s Antibiotic Policy

Cited by 15 publications

References 19 publications

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Drug Utilization on Neonatal Wards: A Systematic Review of Observational Studies

Pulmonary Infection

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