Experience with developing antibiotic stewardship programs in Serbia: potential model for other Balkan countries?

Kalaba, Marija; Košutić, Jovan; Godman, Brian; Radonjić, Vesela; Vujic, Ana; Janković, Slobodan M.; Srebro, Dragana; Kalaba, Zlatko; Stojanović, Rastko; Prostran, Milica

doi:10.2217/cer-2017-0055

Cited by 10 publications

(17 citation statements)

References 46 publications

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“…In our current study, most common microorganism isolated from the patient's sample was gram-positive MSSA, with similar results seen in other studies [20,21,51]. However, in other studies, gram negative bacteria appear more common that gram-positive bacteria [32].…”

Section: Discussionsupporting

confidence: 90%

“…Consequently, we aimed to address this by ascertaining the resistance patterns of bacterial isolates and the subsequent impact of culture sensitivity tests on the subsequent use of antibiotics as well as the cost of therapy in a leading tertiary-care hospital in Pakistan. This builds on similar activities in other LMICs [44]. We believe the ndings can guide subsequent utilization of antibiotics in this leading tertiary hospital in Pakistan and wider.…”

Section: Introductionsupporting

confidence: 54%

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Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Altaf

Akhtar

Ahmad

et al. 2020

Preprint

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Background: There are concerns with inappropriate prescribing of antibiotics in hospitals especially broad spectrum in Pakistan and the subsequent impact on antimicrobial resistance rates. One recognized way to reduce inappropriate prescribing is for empirical therapy to be adjusted according to the result of culture sensitivity reports.Objective: To find the impact of culture sensitivity reports on the use of antibiotics and cost in a leading tertiary care hospital in Lahore.Methods: This prospective observational study was carried out in Ghurki trust teaching hospital. A total of 465 positive culture patients were taken over an 8 month study period using convenient sampling techniques and immediately sent to the microbiology laboratory for pathogen identification and susceptibility testing using the Kirby-Bauer disc diffusion method. Additional data was collected from the patient medical file which included demographic data, sample type, causative microbe, anti-microbial treatment given in empirical and definitive treatment as well as medicine costs. Results: Total of 497 isolates were detected from the 465 patient samples, which included 309 gram-negative rods and 188 gram-positive cocci. Out of 497 isolates, the most common Gram-positive pathogen isolated was MSSA (28.4%) and Gram-negative was E. coli (23.8%). Most of the gram-negative isolates were found to be resistant to ampicillin and co-amoxiclav. Most of the A. baumannii isolates were resistant to carbapenems. Gram-positive microorganism showed the maximum sensitivity to linezolid and vancomycin. The most widely used antibiotics in empirical therapy were cefoperazone+sulbactam, ceftriaxone, amikacin, vancomycin and metronidazole whereas high use of linezolid, clindamycin, meropenem and piperacillin + tazobactam was evidenced in definitive treatment. Empiric therapy was adjusted in 222 (71.8%) cases of Gram-negative infections and 131 (69.6%) cases of gram-positive infections (p-value <0.0001). Compared with empirical therapy, there was a 13.8% reduction in the number of antibiotics in definitive treatment. The average costs of antibiotics in definitive treatment was less than the empirical treatment (8.2%) and the length of hospitalization also decreased.Conclusion: Culture sensitivity reports helped reduce antibiotic utilization, hospital stay and costs as well as helping select the most appropriate treatment. We also found an urgent need for implementing antimicrobial stewardship programs and the development of hospital antibiotic guidelines within the hospital to reduce future unnecessary prescribing of broad-spectrum antibiotics.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionsupporting

confidence: 54%

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Altaf

Akhtar

Ahmad

et al. 2020

Preprint

Self Cite

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“…The reasons for this require local level investigation. However, limited resources have compromised the implementation of physician education programs, promotion of rational use of antibiotics and hospital-based antimicrobial stewardship programs (Kalaba et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Medicines Consumption in Eastern Europeand Central Asia – An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action

et al. 2019

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Introduction: Surveillance of antimicrobial medicines consumption is central to improving their use and reducing resistance rates. There are few published data on antibiotic consumption in Eastern Europe and Central Asia. To address this, 18 non-European Union (EU) countries and territories contribute to the WHO Regional Office for Europe (WHO Europe) Antimicrobial Medicines Consumption (AMC) Network.Objectives: (i) Analyze 2015 consumption of J01 class antibacterials for systemic use from 16 AMC Network members; (ii) compare results with 2011 data and 2015 ESAC-Net estimates; (iii) assess consumption against suggested indicators; (iv) evaluate the impact of planned changes to defined daily doses (DDDs) in 2019 for some commonly used antibiotics; and (v) consider the utility of quantitative metrics of consumption for policy action.Methods: Analysis methods are similar to ESAC-Net for EU countries. The Anatomical Therapeutic Chemical (ATC) classification and DDD methodology were used to calculate total consumption (DDD/1000 inhabitants/day [DID]), relative use measures (percentages), extent of use of WHO Watch and Reserve group antibiotics and impact of DDD changes.Findings: Total J01 consumption in 2015 ranged 8.0–41.5 DID (mean 21.2 DID), generally lower than in 2011 (6.4–42.3 DID, mean 23.6 DID). Beta-lactam penicillins, cephalosporins, and quinolones represented 16.2–56.6, 9.4–28.8, and 7.5–24.6% of total J01 consumption, respectively. Third-generation cephalosporins comprised up to 90% of total cephalosporin consumption in some countries. Consumption of WHO Reserve antibiotics was very low; Watch antibiotics comprised 17.3–49.5% of total consumption (mean 30.9%). Variability was similar to 2015 ESAC-Net data (11.7–38.3 DID; mean 22.6 DID). DDD changes in 2019 impact both total and relative consumption estimates: total DIDs reduced on average by 12.0% (7.3–35.5 DID), mostly due to reduced total DDDs for commonly used penicillins; impact on rankings and relative use estimates were modest.Discussion: Quantitative metrics of antibiotic consumption have value. Improvements over time reflect national activities, however, changes in total volumes may conceal shifts to less desirable choices. Relative use measures targeting antibiotics of concern may be more informative. Some, including WHO Watch and Reserve classifications, lend themselves to prescribing targets supported by guidelines and treatment protocols.

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“…The necessity to guide AMU via stewardship was first recognized in human medicine [ 11 ]. In Serbia and Croatia, various efforts in rational AMU implementation and in hospital-based AMS programs development in human medicine have been exerted [ 12 , 13 ].…”

Section: Introductionmentioning

confidence: 99%

Mapping knowledge and comprehension of antimicrobial stewardship and biosecurity among veterinary students

et al. 2020

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Objectives As an important public health concern, antimicrobial resistance (AMR) is related to lack of knowledge among healthcare professionals. Since the Global Action Plan on AMR highlights the importance of training all healthcare professionals, it is essential to focus our attention on the education related to judicious antimicrobial use. The current study was the first attempt in southeastern Europe to quantify the knowledge about antimicrobial usage and biosecurity measure among veterinary students.

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Experience with developing antibiotic stewardship programs in Serbia: potential model for other Balkan countries?

Cited by 10 publications

References 46 publications

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Impact of Culture Sensitivity Reports on the Pattern of Antibiotics use and Cost of Therapy: A Prospective Observational study

Antimicrobial Medicines Consumption in Eastern Europeand Central Asia – An Updated Cross-National Study and Assessment of QuantitativeMetrics for Policy Action

Mapping knowledge and comprehension of antimicrobial stewardship and biosecurity among veterinary students

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