Prevalence of antimicrobial use in a tertiary academic hospital: a venue for antimicrobial stewardship programs

Antimicrobial stewardship implementation before and during the COVID-19 pandemic in the acute care settings: a systematic review

“…The geographical origin of the 13 studies was as follows: United States ( n = 4) [ 19 , 21 , 23 , 24 ], United Kingdom ( n = 2) [ 30 , 31 ], India ( n = 2) [ 26 , 27 ], Germany ( n = 1) [ 22 ], Netherlands ( n = 1) [ 20 ], Jordan ( n = 1) [ 28 ], Japan ( n = 1) [ 25 ], Greece ( n = 1) [ 29 ]. 10 of 13 (77%) studies were conducted before the pandemic.…”

“…However, only 3 of 10 (23%) studies were conducted during the COVID-19 pandemic [ 29 – 31 ]. The following study designs were identified: retrospective cohort ( n = 2) [ 22 , 31 ], cross-sectional ( n = 6) [ 19 , 23 , 25 , 28 – 30 ], prospective cohort ( n = 2) [ 21 , 26 ], Quasi-experimental study ( n = 2) [ 24 , 27 ], and 1 Randomized clinical trial [ 20 ]. In this review, the PHE toolkit of AMS was used as a gold standard for analysing AMS implementation.…”

“…Intervention procedures to use broad-spectrum antimicrobials within 7 d were statistically more frequent in small/middle-sized hospitals than in large hospitals with findings as follows: overall, OR = 5.7, 95% CI = 1.4–23.5, p = 0.023; carbapenem, OR = 4.7, 95% CI = 1.1–19.1, p = 0.049; piperacillin/tazobactam, OR = 7.3, 95% CI = 1.3–39.9, p = 0.018; and intravenous quinolone, OR = 8.8, 95% CI = 1.6–48.2, p = 0.008 Thakkar (2021) [ 26 ] India Prospective study - The pre-existing components of the hospital antimicrobial stewardship program included generation of antibiogram, formulation/ education and dissemination of antibiotic policies for surgical prophylaxis, community and hospital acquired infections and auditing antibiotics for surgical prophylaxis - Prospective audit and feedback for the restricted antimicrobials - Antibiotic restriction using the justification form - Around 1.4% of admitted patients were put on restricted antimicrobials. The total days of therapy (DOT) were 41.5/1000 inpatient days - Unjustified use of antimicrobials was reported in 13% and recommendation of the AMS for de-escalation were accepted in 89% by the treatment team - There was no significant difference between antimicrobial DOT of the restricted antimicrobials between 2018 and 2019 - The colistin susceptibility rates remained stable compared to the previous years Panditrao (2021) [ 27 ] India Quasi-experimental study - Baseline Phase: from April–June 2017 Routine prospective audit and feedback was undertaken - Intervention Phase: from July–December 2017 The following interventions were added: Timeout, Correction of doses, continued education for rational use of antimicrobials, Care bundle approach for prevention of hospital-acquired infections (HAIs) - There was a reduction in the cumulative DDD/1000 PD for all antimicrobials in the intervention phase compared with baseline (baseline phase 1326.3 DDD/1000PD vs. intervention phase 1313.5 DDD/1000PD) - There was no change in the average number of antimicrobials per individual patient stay in the hospital between the baseline and intervention phases; P = 0.59) - DOT/1000PD declined from 1112.3 in the baseline phase to 1048.6 days in the intervention phase, while LOT/1000 PD changed from 956.0 in the baseline phase to 936.3 during the intervention phase - There was a decrease in DDD/1000 PD for antimicrobials such as piperacillin/tazobactam, imipenem, meropenem, clindamycin, levofloxacin, and amikacin, while there was an increase in DDD/1000 PD of vancomycin, colistin, cefoperazone/sulbactam, metronidazole and teicoplanin - There was a decrease in percentage of carbapenem use in the intervention phase compared with the baseline phase (26.3% vs. 20.9%), whereas there was an increase in the use of polymyxins, particularly colistin (11.1% vs. 6.2%) and glycopeptides (vancomycin and teicoplanin) (12.3% vs 11.0%) Ababneh (2020) [ 28 ] ...…”

Antimicrobial Stewardship Intervention Before and During The COVID-19 Pandemic in the Acute Care Settings: A Systematic Review

“…In both PP and DP, most of the sixteen studies included in this research report AMS measures in terms of Daily De ned Dose (DDD) and/or Day of Therapy (DOT) [23,32,33] (Table 5).…”

“…The clinical practice guidelines and streamlining/escalation were the third most used AMS strategies DP. Antibiotic review strategy was reported in three studies PP [23,32,21]. Descriptive statistics were used to describe the variability and proportion of the AMS implementation strategies reported in all the included studies.…”