Antimicrobial stewardship in an Internal Medicine ward: effects on antibiotic consumption and on the use of carbapenems

Fortini, Alberto; Faraone, Antonio; Pietro, Massimo Di; Cappugi, Chiara; Magnante, Giovanna; Boccadori, Costanza; Bartolini, Sandro; Rabatti, Loredana

doi:10.1007/s11739-018-1916-9

Cited by 9 publications

(16 citation statements)

References 19 publications

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“…Respiratory infections prevailed in the medical clinic and pneumology/infectology (22.4% and 39.1%, respectively), this data reflects the characteristics of the wards described, and corroborate with studies that describe that approximately 50% of the use of antimicrobials is used in the treatment of respiratory and urinary infections [4,8,9,13]. In the ICU the main diagnostic indications were for the treatment of sepsis (34.1%).…”

Section: Discussionsupporting

confidence: 84%

“…The predominance of the use of ATMs in the ICU was also observed in a study of one-off prevalence on health-related infections in Austria, in which 67.9% of patients in this ward were exposed to some antimicrobial, other studies indicate variations from 55.1-57% [1,4,7]. Variations are also observed in the medical clinic (31.8% − 73.2%), and in the surgical clinic (37.3-84.1%) [1,7,8,13]. The weak conditions with which patients arrive at the ICUs explain the greater frequency of infections and, consequently, the greater need for antibiotic therapy in this ward.…”

Section: Discussionmentioning

confidence: 59%

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Application of Monitoring Indicators in The Management of Hospital Use of Antimicrobials

Silva¹,

Santos²,

Batista³

et al. 2020

Preprint

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Background It is described in the literature that between 25–50% of antimicrobial prescriptions, in the hospital environment, are unnecessary or inadequate. The National Health Surveillance Agency launched the “Brazil Stewardship Project”, in order to assess the national panorama of antimicrobial use management programs, therefore, it is expected that managers will be encouraged to implement the antimicrobial use management program, with publication of the results, enabling the confrontation of national data.Methods This is an observational, analytical and prospective study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology (PNE/INF) and pediatrics (PED).Results During the study period, a total of 11,628 patient-days were followed up and an average of 58.3% of patients were exposed to some antimicrobial. In 376 days, for every 1,000 days of hospitalization, patients were receiving antimicrobial therapy (LOT = 376/1000pd). The calculated global DOT / LOT ratio showed that each patient received an average of 1.5 antimicrobials during hospital stay.Conclusions The indicators addressed in this study proved to be of great relevance for obtaining data regarding the use of antimicrobials, contributing to the initiatives to be taken by the Stewardship program. This study is expected to encourage other hospitals to monitor the use of antimicrobials, allowing comparison of data.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 59%

Application of Monitoring Indicators in The Management of Hospital Use of Antimicrobials

Silva¹,

Santos²,

Batista³

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Respiratory infections prevailed in the medical clinic and pneumology/infectology (22.4% and 39.1%, respectively), this data re ects the characteristics of the wards described, and corroborate with studies that describe that approximately 50% of the use of antimicrobials is used in the treatment of respiratory and urinary infections [4,8,9,13]. In the ICU the main diagnostic indications were for the treatment of sepsis (34.1%).…”

Section: Discussionsupporting

confidence: 82%

“…The predominance of the use of ATMs in the ICU was also observed in a study of one-off prevalence on health-related infections in Austria, in which 67.9% of patients in this ward were exposed to some antimicrobial, other studies indicate variations from 55.1% to 57% [1,4,7]. Variations are also observed in the medical clinic (31.8% -73.2%), and in the surgical clinic (37.3% to 84.1%) [1,7,8,13]. The fragile conditions with which patients arrive at the ICUs explain the greater frequency of infections and, consequently, the greater need for antibiotic therapy in this ward.…”

Section: Discussionmentioning

confidence: 61%

Use of Monitoring Indicators in Hospital Management of Antimicrobials

Silva

Mendonça

Leão

et al. 2020

Preprint

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Background: It is described in the literature that between 25% to 50% of antimicrobial prescriptions, in the hospital environment, are unnecessary or inadequate, directly impacting antimicrobial resistance. The National Health Surveillance Agency launched the “Brazil Stewardship Project” to assess the national panorama of antimicrobial use management programs, therefore, it is expected that managers will be encouraged to implement the antimicrobial use management program, with the publication of the results, enabling the comparison of national data. In this context, measures and indicators of antimicrobial use will be particularly important. We demonstrate the application of the indicators DOT, LOT e DOT/LOT ratio to explore and monitor antimicrobials use. Methods: This is an observational, analytical and prospective study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology (PNE/INF) and pediatrics (PED). Results: During the study period, a total of 11,634 patient-days were followed up and an average of 50.4% of patients were exposed to some antimicrobial, showing significant reduction throughout the year. In 376 days, for every 1,000 days of hospitalization, patients were receiving antimicrobial therapy (LOT = 376/1000pd). Overall, the 1st generation cephalosporins and fluoroquinolones were highlighted both in the number of prescriptions and in the duration of therapy. The calculated global DOT / LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both Methicillin R and Carbapenem R , was 1 per 1000 patient-days. Conclusions: The indicators addressed in this study proved to be of great relevance for obtaining data regarding the use of antimicrobials, contributing to the initiatives to be taken by the Stewardship program. This study is expected to encourage other hospitals to monitor the use of antimicrobials, allowing comparison of data.

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“…In contrast, antibiotic consumption in LMICs following ASPs were associated with an average reduction of 30% (95% CI 10% to 50%; 4 effect sizes) (Figure 5). ASPs were not associated with a reduction in antibiotic prescriptions for outpatients (-4%; 95% CI, -11% to 3%; 7 effect sizes) 33,46,47,51,54,55 or inpatients and nursing home residents (-8%; 95% CI -20% to 3%; 4 effect sizes), 3,30,57,61 although reductions cannot be ruled out due to the small sample size. Similar nonsignificant results were found across different settings, including public hospitals (-18%; 95% CI, -54% to 18%; 3 effect sizes) and pediatric hospitals (-15%; 95% CI, -36% to 5%; 4 effect sizes) (Figure 5).…”

Section: Heterogeneity Of Outcomes Associated With Asps Across Health...mentioning

confidence: 92%

Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally

Win

Bielicki

et al. 2023

JAMA Netw Open

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ImportanceAntimicrobial resistance continues to spread rapidly at a global scale. Little evidence exists on the association of antimicrobial stewardship programs (ASPs) with the consumption of antibiotics across health care and income settings.ObjectiveTo synthesize current evidence regarding the association between antimicrobial stewardship programs and the consumption of antibiotics globally.Data SourcesPubMed, Web of Science, and Scopus databases were searched from August 1, 2010, to Aug 1, 2020. Additional studies from the bibliography sections of previous systematic reviews were included.Study SelectionOriginal studies of the association of ASPs with antimicrobial consumption across health care and income settings. Animal and environmental studies were excluded.Data Extraction and SynthesisFollowing the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guideline, the pooled association of targeted ASPs with antimicrobial consumption was measured using multilevel random-effects models. The Effective Public Health Practice Project quality assessment tool was used to assess study quality.Main Outcomes and MeasuresThe main outcome measures were proportion of patients receiving an antibiotic prescription and defined daily doses per 100 patient-days.ResultsOverall, 52 studies (with 1 794 889 participants) measured the association between ASPs and antimicrobial consumption and were included, with 40 studies conducted in high-income countries and 12 in low- and middle-income countries (LMICs). ASPs were associated with a 10% (95% CI, 4%-15%) reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92). ASPs were also associated with a 21% (95% CI, 5%-36%) reduction in antibiotic consumption in pediatric hospitals and a 28% reduction in World Health Organization watch groups antibiotics (rate ratio, 0.72; 95% CI, 0.56-0.92).Conclusions and RelevanceIn this systematic review and meta-analysis, ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings. Impact assessment of ASPs in resource-limited settings remains scarce; further research is needed on how to best achieve reductions in antibiotic use in LMICs.

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Antimicrobial stewardship in an Internal Medicine ward: effects on antibiotic consumption and on the use of carbapenems

Cited by 9 publications

References 19 publications

Application of Monitoring Indicators in The Management of Hospital Use of Antimicrobials

Application of Monitoring Indicators in The Management of Hospital Use of Antimicrobials

Use of Monitoring Indicators in Hospital Management of Antimicrobials

Association Between Antimicrobial Stewardship Programs and Antibiotic Use Globally

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