Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department

Dinh, Aurélien; Duran, Clara; Davido, Benjamin; Bouchand, Frédérique; Deconinck, Laurène; Matt, Morgan; Sénard, Olivia; Guyot, Caroline; Levasseur, Anne-Sophie; Attal, Julie; Razazi, D.; Tritz, T.; Beauchet, Alain; Salomon, Jérôme; Beaune, Sébastien; Grenet, J.

doi:10.1016/j.jhin.2017.07.005

Cited by 29 publications

(15 citation statements)

References 27 publications

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“…There were likely a substantial number of cases that were prescribed antimicrobials unnecessarily, however and closer adherence to published guidelines would be desirable. Education and antimicrobial stewardship programs have been effective in human emergency room in decreasing the number of inappropriate prescriptions (61), and implementation of a targeted antimicrobial stewardship training program and in house guidance might be of value in veterinary ECC settings.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

et al. 2020

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Background: Antimicrobial use contributes to emergence of antimicrobial resistance. It was hypothesized that antimicrobial prescribing behavior varies between the emergency (ER) and critical care (CC) services in a veterinary teaching hospital. This study aimed to: (i) describe antimicrobial prescribing patterns in the ER and CC services; (ii) assess adherence to stewardship principles; (iii) evaluate the prevalence of multidrug resistant (MDR) bacterial isolates. Methods: Institution electronic medical records were queried for all antimicrobial prescriptions from the ER and CC services between 1/1/2017 and 12/31/2017. Prescriptions were manually reviewed, and the following data recorded: drug, dosage, duration, diagnosis, outcome, hospitalization duration, culture submission, and susceptibility results. Results: There were 5,091 ER visits, of which 3,125 were not transferred to another service. Of these emergency visits, 516 (16.5%) resulted in 613 antimicrobial drug prescriptions. The most commonly prescribed drugs for the ER were amoxicillin/clavulanate (n = 243, 39.6%), metronidazole (n = 146, 23.8%), and ampicillin/sulbactam (n = 55, 9.0%). The most common reasons for antimicrobial prescriptions were skin disease (n = 227, 37.0%), gastrointestinal disease (n = 173, 28.2%), and respiratory disease (n = 50, 8.2%). For ER patients 18 cultures were submitted, equivalent to a 3.5% submission rate. The CC service managed 311 case visits for 822 patient days. Of these, 133 case visits (42.7%) resulted in 340 prescriptions. The most commonly prescribed drugs for the CC service were ampicillin/sulbactam (n = 103, 30.3%), enrofloxacin (n = 75, 22.1%), and metronidazole (n = 59, 17.4%). The most common reasons for antimicrobial prescriptions were gastrointestinal disease (n = 106, 31.2%), respiratory disease (n = 71, 20.9%), and sepsis (n = 61, 17.9%). On the CC service, 46 patients had ≥1 culture submitted, equivalent to a 34.6% submission rate. Of patients prescribed antimicrobials, 13/38 (34%) with urinary tract disease, 2/28 (7%) with pneumonia, 1/11 (9%) with canine infectious respiratory disease complex and 2/8 (25%) with feline upper respiratory infection were compliant with published guidelines. Robbins et al. Antimicrobial Prescribing Emergency Critical Care Conclusions: Antimicrobial prescription was common in both ER and CC services and followed similar patterns. Adherence to published guidelines for urinary and respiratory infections was poor.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

et al. 2020

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“…The clinical pathway specific for the patients with febrile neutropenia was shown to decrease inappropriate antimicrobial use (Madran et al, 2018). In a recent study conducted in a tertiary university hospital in France, several ASPs including local treatment guidelines were implemented in ED and unnecessary antimicrobial prescriptions were decreased after implementation of these ASPs (Dinh et al, 2017).…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

Madran

Keske

Uzun

et al. 2019

International Journal of Infectious Diseases

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Objective: We aimed to demonstrate the benefits of implementing a clinical pathway to decrease the inappropriate use of antibiotics in upper respiratory tract infections (URTI) in an emergency department (ED). Methods: The study was performed in a hospital with 300 beds. All patients who applied with URTI from 1st to 30th of April 2017 were included and the appropriateness of the antibiotics were compared with the patients in the same period in 2016. A checklist for the clinical pathway of URTI was completed by the ED physicians. Results: 351 patients were included, 176 these patients were in pre-ASP period and 175 patients were in post-ASP period. The rate of prescriptions including antibiotics was 49% in pre-ASP period and has decreased to 29% in post-ASP period (p < 0.001). Adherence to clinical pathway has increased from 50% to 80% (p < 0.001). In the post-ASP period, clinical pathway was used in 133 out of 175 patients (76%) and the consequently rate of appropriate antibiotic use was 82%. Conclusion: The implementation of clinical pathway for URTI has decreased inappropriate antibiotic use in ED. As the secondary effect, using clinical pathway in ED also has increased the awareness of ED physicians who did not adhere to clinical pathway.

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“…In other cases, antibiotics are prophylactically prescribed to patients with viral infections, in order to limit the occurrence of a secondary bacterial infection [ 13 ]. A push for antimicrobial stewardship has reduced the number of inappropriate antibiotic prescriptions, but vigilance remains important [ 14 ].…”

Section: History Of Antibiotics and Resistancementioning

confidence: 99%

A New Era of Antibiotics: The Clinical Potential of Antimicrobial Peptides

Browne

Chakraborty

Chen

et al. 2020

IJMS

303

241

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Antimicrobial resistance is a multifaceted crisis, imposing a serious threat to global health. The traditional antibiotic pipeline has been exhausted, prompting research into alternate antimicrobial strategies. Inspired by nature, antimicrobial peptides are rapidly gaining attention for their clinical potential as they present distinct advantages over traditional antibiotics. Antimicrobial peptides are found in all forms of life and demonstrate a pivotal role in the innate immune system. Many antimicrobial peptides are evolutionarily conserved, with limited propensity for resistance. Additionally, chemical modifications to the peptide backbone can be used to improve biological activity and stability and reduce toxicity. This review details the therapeutic potential of peptide-based antimicrobials, as well as the challenges needed to overcome in order for clinical translation. We explore the proposed mechanisms of activity, design of synthetic biomimics, and how this novel class of antimicrobial compound may address the need for effective antibiotics. Finally, we discuss commercially available peptide-based antimicrobials and antimicrobial peptides in clinical trials.

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Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department

Cited by 29 publications

References 27 publications

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Antimicrobial Prescribing Practices in Small Animal Emergency and Critical Care

Effectiveness of clinical pathway for upper respiratory tract infections in emergency department

A New Era of Antibiotics: The Clinical Potential of Antimicrobial Peptides

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