Trends in Aminoglycoside Use and Gentamicin-Resistant Gram-Negative Clinical Isolates in US Academic Medical Centers: Implications for Antimicrobial Stewardship

Ababneh, Mera A.; Harpe, Spencer E.; Oinonen, Michael; Polk, Ron E.

doi:10.1086/665724

Cited by 30 publications

(27 citation statements)

References 43 publications

(30 reference statements)

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“…Consequently, the KDIGO AKI guidelines recommended avoiding AG in patients at risk or with AKI, if possible [9]. We found that AG utilization decreased over the last decade, a finding consistent with results from other multicenter studies [11,35]. …”

Section: Discussionsupporting

confidence: 88%

“…In addition, the side effects associated with the prescription of alternative antibiotic agents need to be balanced against those associated with AG. A recent multicenter study reported a sharp decline in AG use over the last decade and a parallel increase in quinolone prescription, which was associated with greater gram-negative bacilli resistance to quinolone [11]. The use of quinolone has also clearly been associated with Clostridium difficile -associated diarrhea [12].…”

Section: Introductionmentioning

confidence: 99%

“…Gentamicin and tobramycin are the most commonly used AG, with amikacin typically reserved for complex and multiresistant infections [6,11,16]. Typically, non-oliguric AKI occurs after 5 days of treatment [6,8,13], and the incidence of AG-induced AKI varies between 5 and 25% depending on the definition employed [7,9,17,18,19,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury and Renal Recovery with the Use of Aminoglycosides: A Large Retrospective Study

Paquette

Bernier-Jean

Brunette³

et al. 2015

Nephron

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Background: Recent acute kidney injury (AKI) guidelines, based on studies performed a decade ago, recommend avoiding aminoglycosides (AGs) in patients at risk of AKI. Whether present patient characteristics and management have changed this risk is uncertain. We determined the current incidence, risk factors and outcomes of AG-AKI. Methods: We retrospectively identified adult patients who received gentamicin or tobramycin for ≥5 days in 2 large university-affiliated centers, excluding critically ill and dialysis patients. We assessed the incidence of Risk, Injury, Failure, Loss and End-stage kidney disease criteria of AKI risk and then matched each AKI to 2 controls of same age and gender to determine factors associated with AG-AKI and its recovery, defined by a creatinine within 150% of baseline by 21 days. Results: Since 2001, the frequency of AG administration and dosing declined, but the incidence of AG-AKI remained constant. Of the 562 patients who received AG for ≥5 days, 65 (12%) developed AG-AKI after 11 (IQR 8-15) days, with 56, 29 and 15% having stages 1, 2 and 3 AKI, respectively. We matched these to 130 controls. In this nested case-control study, independent AKI risk factors were vancomycin coadministration, high AG trough levels and heart failure. AG-AKI compared to AG exposure without AKI was associated with greater mortality. Renal recovery occurred in 51% of the AKI patients and was less likely with heart failure and higher AKI severity. Conclusion: AG administration has recently decreased but the risk of AKI remained unchanged and half of the patients did not recover. Vancomycin coadministration, high AG trough levels and heart failure independently predicted AKI.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

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Acute Kidney Injury and Renal Recovery with the Use of Aminoglycosides: A Large Retrospective Study

Paquette

Bernier-Jean

Brunette³

et al. 2015

Nephron

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“…This downward trend is consistent with national reports of use from 2002 to 2009 showing aminoglycoside use has decrease by 41%. 25 It has Volume 51, October 2016 been suggested that the decreased use in aminoglycosides relates to the availability of other agents with gram-negative activity and superior safety profiles. 26 Corresponding to our decreased aminoglycoside use, we observed increased susceptibility to aminoglycosides with P. aeruginosa, E. coli, and A. baumannii.…”

Section: Discussionmentioning

confidence: 99%

Impact of an Antimicrobial Stewardship Program on Antimicrobial Utilization, Bacterial Susceptibilities, and Financial Expenditures at an Academic Medical Center

2016

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Background: Antimicrobial stewardship programs (ASPs) have the potential to improve patient outcomes, decrease microbial resistance, increase patient safety, and decrease costs. However, to justify the costs involved with providing an ASP, it is necessary to assess its impact in achieving these outcomes on an ongoing basis. Objective: The purpose of this study was to characterize the overall impact of the ASP at an academic medical center. Methods: Quasi-experimental, before and after stewardship program implementation, retrospective analyses of quarterly antimicrobial utilization, bacterial susceptibilities, and antibiotic acquisition costs were utilized. Results: Mean stewardship-focused antibiotic utilization was 510.3 defined daily doses (DDD) per 1,000 patient days for the pre-ASP period and 426.4 DDD per 1,000 patient days for the ASP period (16.4% decrease; p < .001). Significant changes in Pseudomonas aeruginosa susceptibility to tobramycin (8% increase; p = .006) and piperacillin-tazobactam (8% decrease; p = .024) were noted. Changes in susceptibility of Staphylococcus aureus to methicillin (7% increase, p = .012) were also observed. ASP-focused antibiotic expenditures decreased from $4,028,068 in fiscal year (FY) 2010 to $2,135,173 in FY2013 (p = .01). Conclusions: ASP initiatives were associated with an observed reduction in stewardship-focused antibiotic utilization. Significant changes in susceptibilities of some bacteria were noted but did not seem to consistently reflect antibiotic utilization changes. Significant decreases in antimicrobial expenditures were observed. Observed outcomes are temporally related to shifts in antimicrobial selection through the initiation of stewardship program-driven antibiotic policy changes. These outcomes have been used to justify and expand our stewardship program moving forward.

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“…These reports have relied on data from proprietary systems, including single-center studies or multicenter studies that are not nationally representative nor sufficiently large enough to allow projection to the national level [5, 6, 18, 19]. These reports, such as those from the European Union, highlight the importance of considering the source of data [16, 17].…”

Section: Influential Experiencementioning

confidence: 99%

Implementing a Strategy for Monitoring Inpatient Antimicrobial Use Among Hospitals in the United States

Fridkin

Srinivasan

2013

Clinical Infectious Diseases

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Measuring antimicrobial use is an important way to provide metrics that support more vigorous, facility-specific stewardship efforts, which in turn will be a major step toward reducing unnecessary use of broad-spectrum antimicrobials. Yet no single system is available in the United States that can meet stewardship needs at the level of individual hospitals and provide benchmarks, monitor trends, and measure the magnitude of antimicrobial use at the regional, state, and national levels. Therefore, the Centers for Disease Control and Prevention is pursuing 3 distinct and complimentary efforts that remain focused on providing “data for action,” including facility-level use metrics for benchmarking across comparable patient care settings, national estimates of usage patterns using sentinel surveillance sites, and limited assessments using proprietary data.

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Trends in Aminoglycoside Use and Gentamicin-Resistant Gram-Negative Clinical Isolates in US Academic Medical Centers: Implications for Antimicrobial Stewardship

Cited by 30 publications

References 43 publications

Acute Kidney Injury and Renal Recovery with the Use of Aminoglycosides: A Large Retrospective Study

Acute Kidney Injury and Renal Recovery with the Use of Aminoglycosides: A Large Retrospective Study

Impact of an Antimicrobial Stewardship Program on Antimicrobial Utilization, Bacterial Susceptibilities, and Financial Expenditures at an Academic Medical Center

Implementing a Strategy for Monitoring Inpatient Antimicrobial Use Among Hospitals in the United States

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