Antimicrobial stewardship impact on Pseudomonas aeruginosa susceptibility to meropenem at a tertiary pediatric institution

Stultz, Jeremy S.; Arnold, Sandra R.; Shelton, Chasity M.; Bagga, Bindiya; Lee, Kelley R.

doi:10.1016/j.ajic.2019.05.001

Cited by 14 publications

(14 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…36 The increase in antibiotic susceptibility of microorganisms is a result of implementing restriction on AM use and reduction in AMR. In our study, this benefit of ASP was evident in changing Pseudomonas aeruginosa's sensitivity towards antibiotics that is comparable with previous ASP studies, [37][38] although compared to available literature, 37 susceptibility of other microorganisms did not change significantly. Limiting use of antibiotics that have antipseudomonal activity, may be the reason for change in susceptibility of the mentioned microorganism.…”

Section: Discussionsupporting

confidence: 91%

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

Mahmoudi

Sepasian

Firouzabadi

et al. 2020

RMHP

View full text Add to dashboard Cite

Background: Inappropriate use of antimicrobials (AM) is a major concern worldwide that leads to the propagation of antimicrobial resistance (AMR). In addition to its clinical implications, AMR imposes an economic burden on communities, especially developing countries with more infectious diseases and less available resources. Antimicrobial stewardship programs (ASPs) have been found to be effective in reducing AMR. This study was designed to evaluate the effect of implementing an ASP in reducing AM consumption, its economic burden, and AMR as a consecutive result. Materials and Methods: Consumption of caspofungin, amphotericin B, voriconazole, colistin, linezolid, vancomycin, and carbapenems was compared in a prospective crosssectional study between two time periods introduced as pre-and post-ASP. Drug use density presented as anatomical therapeutic chemical (ATC)/defined daily doses (DDD) and normalized per 1000 bed days, cost savings, and AMR patterns were evaluated. Results: A total of 9400 AM prescriptions were analyzed during a 2-year period. Consumption measured in DDD/1000 bed days dropped by 24.8, 25.0, 35.3, 47.0, 39.2, 10.5, and 23.2 percent for amphotericin B, caspofungin, colistin, voriconazole, meropenem, imipenem, and vancomycin, respectively. Linezolid consumption increased by 26.8% after implementing ASP. The expenditure of target AMs in the average value of USD decreased by 41.3% after the intervention compared to the time before using ASP (P-value=0.001). Implementing ASP also increased AM susceptibility of Pseudomonas aeruginosa, while the susceptibility of methicillin-resistant Staphylococcus aureus did not change significantly. Conclusion: The results of this study suggest that establishment of ASP can lead to a reduction in improper administration of AMs and their expenditure resulting in economic benefit and lowering AMR at hospitals with minimum resources. Clinical pharmacists' role was critical to the success of this ASP and was uniquely empowered at our center.

show abstract

Section: Discussionsupporting

confidence: 91%

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

Mahmoudi

Sepasian

Firouzabadi

et al. 2020

RMHP

View full text Add to dashboard Cite

show abstract

“…This allows for the special, more conscious use of these reserve agents. Choosing these agents instead of colistin offers a possibility for antimicrobial stewardship/colistin-sparing [246]. Whilst with a small margin, the superior susceptibility levels of ceftazidime and cefepime in P. aeruginosa were also recently highlighted in the International Network for Optimal Resistance Monitoring (INFORM) Surveillance Program (ceftazidime: 85.1%, cefepime: 86.1%, meropenem: 80.2%) [247].…”

Section: Carbapenem-resistant But Cephalosporin-susceptible P Aerugimentioning

confidence: 99%

It’s Not Easy Being Green: A Narrative Review on the Microbiology, Virulence and Therapeutic Prospects of Multidrug-Resistant Pseudomonas aeruginosa

2021

View full text Add to dashboard Cite

Pseudomonas aeruginosa is the most frequent cause of infection among non-fermenting Gram-negative bacteria, predominantly affecting immunocompromised patients, but its pathogenic role should not be disregarded in immunocompetent patients. These pathogens present a concerning therapeutic challenge to clinicians, both in community and in hospital settings, due to their increasing prevalence of resistance, and this may lead to prolonged therapy, sequelae, and excess mortality in the affected patient population. The resistance mechanisms of P. aeruginosa may be classified into intrinsic and acquired resistance mechanisms. These mechanisms lead to occurrence of resistant strains against important antibiotics—relevant in the treatment of P. aeruginosa infections—such as β-lactams, quinolones, aminoglycosides, and colistin. The occurrence of a specific resistotype of P. aeruginosa, namely the emergence of carbapenem-resistant but cephalosporin-susceptible (Car-R/Ceph-S) strains, has received substantial attention from clinical microbiologists and infection control specialists; nevertheless, the available literature on this topic is still scarce. The aim of this present review paper is to provide a concise summary on the adaptability, virulence, and antibiotic resistance of P. aeruginosa to a readership of basic scientists and clinicians.

show abstract

“…31 The judicious use of broad-spectrum antibiotics can reduce the number of drug-resistant microorganisms. 32,33 Additionally, the use of broad-spectrum antibiotics is associated with a high cost of care and increased antibiotic-associated side effects, such as Clostridium di cile infection. 34 Therefore, a strategy of empirical narrow-spectrum antibiotic use in patients with recurrent COPD exacerbation may be an acceptable choice.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of empirical anti-pseudomonal antibiotics in patients with recurrent COPD exacerbation: A multicenter retrospective cohort study

Shiroshita¹,

Miyakoshi²,

Tsutsumi³

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Although frequent chronic obstructive pulmonary disease (COPD) exacerbation has been associated with the isolation of Pseudomonas aeruginosa (PA) in sputum cultures, it remains unknown whether the empirical use of anti-pseudomonal antibiotics can improve outcomes in patients with frequent COPD exacerbations. Research Question: Does empirical use of anti-pseudomonal antibiotics improve the length of the hospital stay in patients with recurrent COPD exacerbation?Study Design and Methods: This multicenter retrospective cohort study was conducted in seven hospitals in Japan. We included patients aged ≥40 years who were admitted to the hospital with COPD exacerbation more than twice during the study period (April 1, 2008 to July 31, 2020). The primary outcome was the length of the hospital stay. For statistical analysis, a log-linked Gamma model was used. Parameters were estimated using a generalized estimating equation model with an exchangeable correlation structure accounting for repeated observations from a single patient. Covariates included age, body mass index, home oxygen therapy use, respiratory rate, heart rate, oxygen use on admission, mental status, systemic steroid use, activities of daily living, and number of recurrences. Hospital-specific effects were specified as fixed effects.Results: Among 1573 patients with COPD exacerbation, 344 patients and 965 observations of recurrent COPD exacerbations were selected. Anti-pseudomonal antibiotics were used in 173 patients (18%). The estimated change in the length of the hospital stay between the anti-pseudomonal and non-anti-pseudomonal antibiotics groups was 0.044 days [95% confidence interval; -0.077, 0.166]. Interpretation: Use of empirical anti-pseudomonal antibiotics based only on recurrence may not be necessary. Further large-scale studies are needed to more precisely evaluate the effectiveness of empirical anti-pseudomonal antibiotics.

show abstract

Antimicrobial stewardship impact on Pseudomonas aeruginosa susceptibility to meropenem at a tertiary pediatric institution

Cited by 14 publications

References 9 publications

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

<p>The Impact of an Antibiotic Stewardship Program on the Consumption of Specific Antimicrobials and Their Cost Burden: A Hospital-wide Intervention</p>

It’s Not Easy Being Green: A Narrative Review on the Microbiology, Virulence and Therapeutic Prospects of Multidrug-Resistant Pseudomonas aeruginosa

Effectiveness of empirical anti-pseudomonal antibiotics in patients with recurrent COPD exacerbation: A multicenter retrospective cohort study

Contact Info

Product

Resources

About