Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs

Kim, Chung-Jong

doi:10.3947/ic.2022.0172

Cited by 6 publications

(3 citation statements)

References 175 publications

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“…Additionally, we initiated qualitative evaluations of long-term prescriptions of oral antibiotics and interventions to control the duration of injectable antibiotic administration based on each patient's condition and indications. Moreover, biomarker-integrated ASP activities are in preparation in our hospital based on recent reports that a procalcitonin level-based ASP approach decreased antibiotic use [38][39][40][41].…”

Section: Discussion and Perspectivesmentioning

confidence: 99%

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

Lee,

Cho

et al. 2024

Korean J Intern Med

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Antimicrobial stewardship programs (ASPs) can lower antibiotic use, decrease medical expenses, prevent the emergence of resistant bacteria, and enhance treatment for infectious diseases. This study summarizes the stepwise implementation and effects of ASPs in a single university-affiliated tertiary care hospital in Korea; it also presents future directions and challenges in resource-limited settings. At the study hospital, the core elements of the ASP such as leadership commitment, accountability, and operating system were established in 2000, then strengthened by the formation of the Antimicrobial Stewardship (AMS) Team in 2018. The actions of ASPs entail key components including a computerized restrictive antibiotic prescription system, prospective audit, post-prescription review through quantitative and qualitative intervention, and pharmacy-based interventions to optimize antibiotic usage. The AMS Team regularly tracked antibiotic use, the effects of interventions, and the resistance patterns of pathogens in the hospital. The reporting system was enhanced and standardized by participation in the Korea National Antimicrobial Use Analysis System, and educational efforts are ongoing. Stepwise implementation of the ASP and the efforts of the AMS Team have led to a substantial reduction in the overall consumption of antibiotics, particularly regarding injectables, and optimization of antibiotic use. Our experience highlights the importance of leadership, accountability, institution-specific interventions, and the AMS Team.

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Section: Discussion and Perspectivesmentioning

confidence: 99%

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

Lee,

Cho

et al. 2024

Korean J Intern Med

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“…, the Korea National Antimicrobial Use Analysis System (KONAS)) are needed for the appropriate use of antibiotics, and efforts are also needed to develop guidelines for appropriate use of antibiotics ( e.g. , the Korean Guidelines for Use of Antibiotics for Intra-abdominal Infections in Adults) [ 29 ] by the government and academic societies using the recent important antibiotic stewardship program [ 30 31 32 33 ].…”

Section: Discussionmentioning

confidence: 99%

Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020

et al. 2023

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Background This study aimed to identify the trends in pharmaceutical expenditure (PE), share of PE in health expenditure (HE), and trends in expenditure by pharmacological groups (ATC level 1 classification) in Korea for a 10-year period (2011 - 2020) and compare the data with those of other Organisation for Economic Co-operation and Development (OECD) countries. Using the findings, we determined the current status of pharmaceutical expenditure (PE) management in Korea and derived the implications for establishing future macroscopic policies on PE. Materials and Methods We analyzed the OECD Health Statistics and the Korean national health insurance claims database from January 2011 through December 2020. The outcome measures were HE, PE, and pharmaceutical sales data for ATC level 1 medicines from OECD Health Statistics data during 2011 - 2020. As OECD collects limited ATC level 1 data, we used the HIRA health insurance claims data for PEs of ATC level-1 classification, including D, L, P, and S. Results PE in Korea increased by 38.5% from 19.9 billion USD in 2011 to 27.6 billion USD in 2020, whereas the share of PE in HE decreased by 6.3%p from 26.4% in 2011 to 20.1% in 2020. In 2020, Korea ranked third in PE per capita (760.9 USD PPP) and had the highest share of PE (20.1%) among the 19 OECD countries studied. By ATC level 1 class, the highest PE was A (alimentary tract and metabolism) at 4.3 billion USD, and L (antineoplastic and immunomodulating agents) had the highest increase at 13.4%; in contrast, J (anti-infectives for systemic use) had the lowest increase in annual average PE at −0.2% in 2020 relative to 2011. Among the 17 OECD countries, Korea had the highest and the third-highest expenditures for ATC codes A and J, respectively. Conclusion PE in Korea has continued to increase between 2011 and 2020, indicating the need for macroscopic management of PE. Our results on PE by ATC code may help health authorities in establishing future policies on PE.

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“…Since the discovery of presepsin, most studies published to date have focused on evaluating the clinical significance of presepsin in diagnosing sepsis and predicting the mortality risk of sepsis compared to other markers such as C-reactive protein and procalcitonin [ 1 2 ]. Likewise, we recently suggested the value of presepsin in risk stratification and the potential benefit of using presepsin along with the Sepsis-3 criteria [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

No Significant Differences in Presepsin Levels According to the Causative Microorganism of Bloodstream Infection

Lee,

Park,

Yoon

et al. 2024

Infect Chemother

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Background CD14 recognizes lipopolysaccharide (LPS), and presepsin is a fragment of soluble CD14. Still, it remains uncertain whether Gram-negative bacteria induce higher presepsin levels than other microorganisms. To address this question, this study aimed to analyze presepsin levels based on microorganisms isolated in blood cultures. Materials and Methods This study was a single-center study comprising suspected sepsis patients enrolled from July 2020 to September 2020. A total of 95 patients with a single isolate confirmed in blood culture were analyzed to evaluate if there are any differences in presepsin levels according to microbial isolates. Plasma presepsin level was measured using PATHFAST assay kit and analyzer (LSI Medience Corporation, Tokyo, Japan). Results There were 26 Gram-positive bacteremia, 65 Gram-negative bacteremia, and 3 fungemia patients with median presepsin levels of 869, 1,439, and 11,951 pg/mL, respectively. Besides, one case of algaemia demonstrated a presepsin level of 1,231 pg/mL. Our results showed no statistically significant difference in presepsin levels among patients with Gram-positive bacteremia, Gram-negative bacteremia, and fungemia. Furthermore, presepsin levels did not differ significantly among bloodstream infections caused by bacteria that were isolated from at least three different patients. In particular, Gram-positive bacteria such as Staphylococcus aureus and Enterococcus faecalis were able to induce presepsin levels comparable to those induced by Gram-negative bacteria. Conclusion We demonstrated that there were no significant differences in plasma presepsin levels according to microbial isolates in blood culture. The major cause of the variability in presepsin levels during bloodstream infection might be the immunogenicity of each microorganism rather than the presence of LPS in the microorganism.

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Current Status of Antibiotic Stewardship and the Role of Biomarkers in Antibiotic Stewardship Programs

Cited by 6 publications

References 175 publications

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

Implementing antimicrobial stewardship: lessons and perspectives from a university-affiliated tertiary hospital in Korea

Trends in National Pharmaceutical Expenditure in Korea during 2011 - 2020

No Significant Differences in Presepsin Levels According to the Causative Microorganism of Bloodstream Infection

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