Measuring antimicrobial use in hospitalized patients: a systematic review of available measures applicable to paediatrics

Fortin, Élise; Fontela, Patricia; Manges, Amee R.; Platt, Robert W.; Buckeridge, David L.; Quach, Caroline

doi:10.1093/jac/dku003

Cited by 41 publications

(28 citation statements)

References 29 publications

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“…We chose DOT divided by time-at-risk (i.e., accumulated person days) to compare the rate of antimicrobial use between the case and the control group. As the measure of antimicrobial use that best predicts the prevalence of antimicrobial resistance has not yet been defined [33], one advantage of DOT is that it is not affected by changes in dosing regimen [21]. Moreover, DOT could be more helpful in comparing the use of different classes of antimicrobials within a given institution and indicate timely antimicrobial usage in a particular patient [21].…”

Section: Discussionmentioning

confidence: 99%

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Huang

Shie

et al. 2017

BMC Infect Dis

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BackgroundInformation is limited about the effect of restricted carbapenem use on clearance of multi-drug resistant Acinetobacter baumannii (MDRAB). We sought to determine the time effect of antibiotic exposure on multi-drug resistant Acinetobacter baumannii (MDRAB) acquisition and clearance.MethodsWe conducted a retrospective observational study at the intensive care units of a tertiary medical center. Forty-two of a cohort of previously healthy young adults who were concurrently burned by a dust explosion was included. Cases consisted of those from whom MDRAB was isolated during hospitalization. Controls consisted of patients from whom MDRAB was not isolated in the same period. Use of antimicrobial agents was compared based on days of therapy per 1,000 patient-days (DOT/1,000PD). A 2-state Markov multi-state model was used to estimate the risk of acquisition and clearance of MDRAB.ResultsMDRAB was discovered in 9/42 (21.4%) individuals. The cases had significantly higher use of carbapenem (652 DOT/1,000PD vs. 385 DOT/1,000PD, P < 0.001) before MDRAB isolation. For the cases, clearance of MDRAB was associated with lower use of carbapenem (469 DOT/1,000PD vs. 708 DOT/1,000PD, P = 0.003) and higher use of non-carbapenem beta-lactam (612 DOT/1,000PD vs. 246 DOT/1,000PD, P <0.001). In multi-state model, each additional DOT of carbapenem increased the hazard of acquiring MDRAB (hazard ratio (HR), 1.08; 95% confidence interval (CI) 1.01–1.16) and each additional DOT of non-carbapenem beta-lactam increased the protection of clearing MDRAB (HR, 1.25; 95% CI 1.07–1.46).ConclusionsBoth acquisition and clearance of MDRAB were related to antibiotic exposure in a homogeneous population. Our findings suggest that early discontinuation of carbapenem could be an effective measure in antibiotic stewardship for the control of MDRAB spreading.

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Section: Discussionmentioning

confidence: 99%

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Huang

Shie

et al. 2017

BMC Infect Dis

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“…A review regarding ways of measuring antimicrobial consumption concluded that up to date there are no ideal ways of measuring the consumption of antimicrobials in children 29. Fortin et al concluded that the most frequently used method of measuring antimicrobial consumption in paediatrics was the use of DDDs, which was applied by 42% of studies.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial consumption in a tertiary children’s hospital in Finland (2003–2013)

et al. 2016

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Background Numbers of resistant pathogens are constantly increasing, and prudent use of antimicrobials is of paramount importance. In order to see whether any changes in the use of antimicrobials in recent years have occurred, we decided to monitor the consumption of these drugs at a single tertiary paediatric hospital. Materials and methods This single-centre retrospective study investigated the consumption of antimicrobials in defined daily doses (DDDs according to the Anatomical Therapeutical Chemical /DDD index) in a 130-bed paediatric tertiary hospital. The data on the consumption of antimicrobials were collected from years 2003-2013 by using electronic surveillance records provided by the local pharmacy. The consumption was related to days of hospital care. Results During 2003-2013, the use of penicillins, cephalosporins and carbapenems increased by 28%, 46% and 110%, respectively. The consumption of both aminoglycosides and vancomycin decreased by 61% and 41%, respectively. Amphotericin B use clearly decreased by 39% while the use of novel azoles and echinocandins increased. Conclusions Increased use of carbapenems was the most significant finding of our study. The year-to-year consumption of antibacterials was in general relatively stable and new antibacterials were taken into use conservatively. In contrast to antibacterials, novel antifungals were rapidly adopted into use despite scarce evidence on their safety in children. INTRODUCTIONInvestigating and monitoring the consumption of antimicrobials in hospitals is necessary in order to encourage prudent use of these drugs. The use of broad spectrum antibacterials is a potential problem. It causes selection pressure and may lead to increasing numbers of resistant pathogens. In addition, such use of antibacterials most probably also causes difficult secondary infections. Similarly, local knowledge on the use of antimicrobials is crucial and allows us to implement necessary measures to support appropriate use of antimicrobials.When investigating the consumption of antimicrobials, defined daily doses (DDDs) can be used. DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults.3 4 Numerous studies have investigated the consumption of antimicrobials in hospitalised adult patients by using DDDs, 5-8 but such studies in paediatric patients are in large scale missing.There are obvious obstacles when using DDDs in children. The most important being that the paediatric population is a very heterogeneous group with great variation in weight and age. Thus, comparing neonatal use with that of the adolescents is very challenging. The DDDs may, however, be used to describe paediatric consumption of individual antimicrobials over a certain period of time in a setting where no major changes in the hospital clientele took place.We have studied the consumption of these drugs in the Children's Hospital, University of Helsinki, by using DDDs as parameters of antibiotic use. The overall age bands of our patients have stayed...

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“…With respect to pediatric populations, these outcomes are far from optimal, because they are based on adult dosages. This should be taken into account, although up to now it is unclear what measure should preferably be used instead of DDDs [51]. It should thus be noted that a change in DDDs is not entirely suitable for drawing conclusions on the success of an ASP.…”

Section: Antimicrobial Consumption Outcome Measuresmentioning

confidence: 99%

Measuring the impact of antimicrobial stewardship programs

Dik

Hendrix

Poelman

et al. 2016

Expert Review of Anti-infective Therapy

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Antimicrobial Stewardship Programs (ASPs) are being implemented worldwide to optimize antimicrobial therapy, and thereby improve patient safety and quality of care. Additionally, this should counteract resistance development. It is, however, vital that correct and timely diagnostics are performed in parallel, and that an institution runs a well-organized infection prevention program. Currently, there is no clear consensus on which interventions an ASP should comprise. Indeed this depends on the institution, the region, and the patient population that is served. Different interventions will lead to different effects. Therefore, adequate evaluations, both clinically and financially, are crucial. Here, we provide a general overview of, and perspective on different intervention strategies and methods to evaluate these ASP programs, covering before mentioned topics. This should lead to a more consistent approach in evaluating these programs, making it easier to compare different interventions and studies with each other and ultimately improve infection and patient management. ARTICLE HISTORY

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Measuring antimicrobial use in hospitalized patients: a systematic review of available measures applicable to paediatrics

Abstract: The measure of antimicrobial use that best predicts antimicrobial resistance prevalence and rates, for surveillance purposes, has still not been identified; additional evidence on this topic is a necessity.

Cited by 41 publications

References 29 publications

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Acquisition and clearance of multidrug resistant Acinetobacter baumannii on healthy young adults concurrently burned in a dust explosion in Taiwan: the implication for antimicrobial stewardship

Antimicrobial consumption in a tertiary children’s hospital in Finland (2003–2013)

Measuring the impact of antimicrobial stewardship programs

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