Impact of carbapenem restriction on the antimicrobial susceptibility pattern of Pseudomonas aeruginosa isolates in the ICU

Abdallah, Mohammad; Badawi, Mohammad; Amirah, Mohammad F; Rasheed, Akram Mohammad; Mady, Ahmed; Alodat, Mohammed; Alharthy, Abdurahman

doi:10.1093/jac/dkx273

Cited by 41 publications

(45 citation statements)

References 17 publications

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“…As a result, the comprehensive evaluation enables us to know that our intervention might promote optimal use of antimicrobials-that is, reduce unnecessary empirical carbapenem use and using narrow-spectrum antimicrobials such as rst-and third-generation cephalosporins-without a change in in-hospital mortality. Thus, we emphasize that not only a reduction in carbapenem consumption but also the positive impact of ASPs on optimizing the use of antimicrobials; the concepts supported by several previous reports [19,20].…”

Section: Discussionsupporting

confidence: 79%

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

Matono¹,

Umeda²,

Uchida³

et al. 2020

Preprint

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Background: There are a few infectious disease (ID) specialists in Japan. A solution to promote the implementation of antimicrobial stewardship activities under these resource-limited settings is required.Methods: We compared carbapenem consumption between a 24-month baseline and 12-month intervention periods. During the intervention period, an ID specialist provided daily advises through a chart review and ID consultation service to prescribers against all prolonged carbapenem use (≥ 14 days). Additionally, we send an aggregated table containing the weekly point prevalence amount of each departmental carbapenem use for 7–13 and ≥ 14 days through e-mail to all doctors.Results: Among the 1,241 carbapenem courses during the intervention period, the ID specialist provided a total of 96 instances of feedback regarding carbapenem use for ≥ 14 days, and the feedback acceptance rate was 76%. After the initiation of the intervention, the trend in monthly carbapenem consumption changed (coefficient: -0.62; 95% CI: -1.15 to -0.087, p = 0.024), and its consumption decreased (coefficient: -0.098; 95% CI: -0.16 to -0.039, p = 0.002) without an increase in the consumption of broad-spectrum antimicrobials or in-hospital mortality. Interestingly, the monthly number of carbapenem courses, but not the duration of carbapenem use, significantly decreased (coefficient: -3.02; 95% CI: -4.63 to -1.42, p = 0.001). The carbapenem-related annual estimated savings after the intervention was $83,745, with a 22% cost reduction.Conclusions: Our ID specialist-led daily intervention with weekly feedback regarding long-term carbapenem use was effective in reducing antimicrobial consumption. Such feedback may be useful in changing the prescribing behavior and promoting appropriate antimicrobial usage even in resource-limited settings.

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Section: Discussionsupporting

confidence: 79%

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

Matono¹,

Umeda²,

Uchida³

et al. 2020

Preprint

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“…Restricting carbapenems even for a short duration has been suggested to effectively manage the problem of CRPA [ 20 ]. Our study indicated that carbapenem consumption is correlated with the rate of CRPA, similar to the conclusion of a previous study in China [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Association between antibiotic consumption and the rate of carbapenem-resistant Gram-negative bacteria from China based on 153 tertiary hospitals data in 2014

Yang

Chen

Jiang

et al. 2018

Antimicrob Resist Infect Control

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BackgroundThis study aimed to investigate the relationship between the rate of carbapenem-resistant Gram-negative bacteria and antibiotic consumption intensity in 153 tertiary hospitals from China in 2014.MethodsA retrospective study using national surveillance data from 2014 was conducted. Data on the annual consumption of each antibiotic, as well as the rate of carbapenem-resistant Gram-negative bacteria, were collected from each participating hospital, and the correlation between antibiotic consumption and carbapenem- resistant rate was analyzed.ResultsThe overall antibiotic consumption intensity among the hospitals varied between 23.93 and 86.80 defined daily dosages (DDDs) per 100 patient-days (median, 46.30 DDDs per 100 patient-days). Cephalosporins were the most commonly used antibiotic, followed by quinolones, penicillins, and carbapenems, and the rate of carbapenem-resistant Gram-negative bacteria from each hospital varied. The correlations between carbapenem consumption intensity and rate of carbapenem resistance revealed correlation factors of 0.271 for Escherichia coli (p < 0.01), 0.427 for Klebsiella pneumoniae (p < 0.01), 0.463 for Pseudomonas aeruginosa (p < 0.01), and 0.331 for Acinetobacter baumannii (p < 0.01).ConclusionsA significant relationship existed between the carbapenem consumption and the rates of carbapenem-resistant gram negative bacilli. Rational use of carbapenems should be implemented to address the issue of carbapenem resistance in hospitals.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0430-1) contains supplementary material, which is available to authorized users.

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“…Therefore, hypothesis 2 was supported ( Table 5). ln STAFF refers to ln PHY in model(5) and model (6), ln NUR in model (7) and model (8), ln PHA in model(9) and model (10) , ln MCB in model (11) and model (12).…”

Section: The Moderation Effect Test Of Medical Professionals Workloadmentioning

confidence: 99%

Impact of Medical Professionals on Carbapenem-Resistant Pseudomonas Aeruginosa: Moderating Effect of Workload Based on the Panel Data in China

Han

Zhang

2020

Preprint

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Abstract Background: Antimicrobial resistance (AMR), especially carbapenem-resistant Pseudomonas aeruginosa (CRPA), causes a serious increase in morbidity, mortality and costs. Medical professionals play an important role in curbing AMR. Previous studies overlooked the impact of workload on the relationship between medical professionals and AMR. This study aimed to explore the relationship between medical professionals and the CRPA rate as well as the moderating effect of medical professionals’ workload on this relationship. Methods: A provincial-level panel dataset from 2014 to 2017 was constructed. Medical professionals were measured by the numbers of physicians, registered nurses, pharmacists, and clinical microbiologists per 1000 population. Workload was measured by the number of daily physician visits. Fixed effect model and hierarchical regression analysis were performed to explore the moderating effect of workload on medical professionals and the CRPA rate. Results: The numbers of physicians, registered nurses, pharmacists and clinical technicians were signiﬁcantly negative associated with the CRPA rate (coef. = -0.889, -0.775, -1.176, and -0.822; P= 0.003, 0.003, 0.011, and 0.007, respectively). Workload had a significant and positive moderating effect on physicians, registered nurses, pharmacists, clinical technicians and the CRPA rate (coef.= 1.270, 1.400, 2.210, and 1.634; P=0.004, 0.001, 0.035, and 0.003, respectively). Conclusions: Increasing the number of medical professionals may help curb the CRPA rate. Measures aimed at reducing medical professionals’ workload should be implemented to further improve CRPA performance.

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Impact of carbapenem restriction on the antimicrobial susceptibility pattern of Pseudomonas aeruginosa isolates in the ICU

Abstract: These data suggest that restricting carbapenems, even for a short duration, may be an effective strategy for managing the problem of carbapenem resistance in P. aeruginosa.

Cited by 41 publications

References 17 publications

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

Impact of an Infectious Disease Specialist-Led Postprescription Carbapenem Intervention on Prescribing Behavior in a Japanese Tertiary Hospital: a Before-After Study

Association between antibiotic consumption and the rate of carbapenem-resistant Gram-negative bacteria from China based on 153 tertiary hospitals data in 2014

Impact of Medical Professionals on Carbapenem-Resistant Pseudomonas Aeruginosa: Moderating Effect of Workload Based on the Panel Data in China

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