Trends in Antibacterial Use in US Academic Health Centers

Pakyz, Amy; MacDougall, Conan; Oinonen, Michael; Polk, Ronald E.

doi:10.1001/archinte.168.20.2254

Cited by 155 publications

(124 citation statements)

References 38 publications

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“…In Europe and the United States, 35% to 63% of inpatients receive at least 1 dose of an antibiotic, and in Europe, 7.1% of patients develop health care-associated infections, including CDI (29,30). Therefore, the aim of future antibiotic stewardship programs should include organizing detailed documentation of the indications for antibiotic treatment, allowing for review, audit, and feedback.…”

Section: Discussionmentioning

confidence: 99%

Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

Wenisch

Equiluz-Bruck

Fudel

et al. 2014

Antimicrob Agents Chemother

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Clostridium difficile infections (CDI) in hospitalized patients are known to be closely related to antibiotic exposure. Although several substances can cause CDI, the risk differs between individual agents. In Vienna and other eastern parts of Austria, CDI ribotype 027 is currently highly prevalent. This ribotype has the characteristic of intrinsic moxifloxacin resistance. Therefore, we hypothesized that moxifloxacin restriction can decrease the number of CDI cases in hospitalized patients. Our antibiotic stewardship (ABS) group applied an information campaign on CDI and formal restriction of moxifloxacin in Wilhelminenspital (Vienna, Austria), a 1,000-bed tertiary care hospital. The preintervention period (period 1) was January through May 2013, and the intervention period (period 2) was June through December 2013. We recorded the defined daily doses (DDD) of moxifloxacin and the number of CDI patients/month. Moxifloxacin use was reduced from a mean (؎ standard error of the mean [SEM]) of 1,038 ؎ 109 DDD per month (period 1) to 42 ؎ 10 DDD per month (period 2) (P ‫؍‬ 0.0045). Total antibiotic use was not affected. The mean (؎SEM) numbers of CDI cases in period 1 were 59 ؎ 3 per month and in period 2 were 32 ؎ 3 per month (46% reduction; P ‫؍‬ 0.0044). Reducing moxifloxacin use in combination with providing structured information on CDI was associated with an immediate decrease in CDI rates in this large community teaching hospital.C lostridium difficile infection (CDI) is a common side effect of antimicrobial therapy, and C. difficile is endemic in hospitals due to health care-associated transmissions. CDI is associated with increased mortality rates and economic burden (1, 2). Although several substances can cause CDI, the risk differs between individual antibiotics. A recent meta-analysis of community-associated CDI comprising 30,184 patients (3) showed that the risk for CDI was greatest with clindamycin (odds ratio [OR], 20.43; 95% confidence interval [CI], 8.50 to 49.09), followed by fluoroquinolones (OR, 5.65; 95% CI, 4.38 to 7.28).

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Section: Discussionmentioning

confidence: 99%

Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

Wenisch

Equiluz-Bruck

Fudel

et al. 2014

Antimicrob Agents Chemother

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“…The number of hospitals subscribing to the CRM database that also agreed to contribute data to this investigation increased from 23 hospitals in 2002 to 35 hospitals in 2006. Additional details of the UHC network are described in a recent publication that examined trends in adult antibacterial drug use within the network (12).…”

Section: Methodsmentioning

confidence: 99%

“…Yearly carbapenem use (meropenem and imipenem) with adult patients discharged between 1 January 2002 through 31 December 2006 was obtained from billing records as previously described; antibacterial use was validated at one of these hospitals (12). We did not measure use of ertapenem.…”

Section: Methodsmentioning

confidence: 99%

Relationship of Carbapenem Restriction in 22 University Teaching Hospitals to Carbapenem Use and Carbapenem-Resistant Pseudomonas aeruginosa

Pakyz

Oinonen

Polk

2009

Antimicrob Agents Chemother

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134

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Many hospital antimicrobial stewardship programs restrict the availability of selected drugs by requiring prior approval. Carbapenems may be among the restricted drugs, but it is unclear if hospitals that restrict availability actually use fewer carbapenems than hospitals that do not restrict use. Nor is it clear if restriction is related to resistance. We evaluated the relationship between carbapenem restriction and the volume of carbapenem use and both the incidence rate and proportion of carbapenem-resistant Pseudomonas aeruginosa isolates from 2002 through 2006 in a retrospective, longitudinal, multicenter analysis among a consortium of academic health centers. Carbapenem use was measured from billing records as days of therapy per 1,000 patient days. Hospital antibiograms were used to determine both the incidence rate and proportion of carbapenem-resistant P. aeruginosa isolates. A survey inquired about restriction policies for antibiotics, including carbapenems. General linear mixed models were used to examine study outcomes. Among 22 hospitals with sufficient data for analysis, overall carbapenem use increased significantly over the 5 years of study (P < 0.0001), although overall carbapenem resistance in P. aeruginosa did not change. Hospitals that restricted carbapenems (n ‫؍‬ 8; 36%) used significantly fewer carbapenems (P ‫؍‬ 0.04) and reported lower incidence rates of carbapenem-resistant P. aeruginosa (P ‫؍‬ 0.01) for all study years. Fluoroquinolone use was a potential confounder of these relationships, but hospitals that restricted carbapenems actually used fewer fluoroquinolones than those that did not. Restriction of carbapenems is associated with both lower use and lower incidence rates of carbapenem resistance in P. aeruginosa.

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“…18,19 Similarly, at Wake Forest University Baptist Medical Center (WFUBMC), approximately 75% of inpatients receive antimicrobials at some point during their hospitalization (Ohl, unpublished data, 2007). One recent example by Hecker and colleagues conducted in a 650-bed, university-affiliated US hospital reported 30% of the total days of antibiotic therapy received by adult non-ICU inpatients was unnecessary.…”

Section: Inappropriate Antimicrobial Usementioning

confidence: 99%

Antimicrobial stewardship for inpatient facilities

Ohl

Luther

2011

Journal of Hospital Medicine

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Antibiotic stewardship aims to improve patient care and reduce unwanted consequences of antimicrobial overuse or misuse, including lowered efficacy, emergence of antimicrobial resistance, development of secondary infections, adverse drug reactions, increased length of hospital stay, and additional healthcare costs. Recent guidelines make specific recommendations for the development of institutional programs to enhance antimicrobial stewardship. Optimally, such programs should be comprehensive, multidisciplinary, supported by hospital and medical staff leadership, and should employ evidence‐based strategies that best fit local needs and resources. An infectious diseases physician and clinical pharmacist with infectious diseases training are recommended as core members of the multidisciplinary team, although a hospitalist with interest (and perhaps additional training) in antimicrobial therapy may be able to fill the void. Program directors and core members should be compensated for their time. Principal proactive strategies—with evidence supporting their consideration—include prospective audits, with intervention and feedback, formulary restriction, and preauthorization. Other strategies include persistent one‐on‐one education, guidelines adapted to local needs, and informatics to support clinical decision making. Intervention goals are to prevent unnecessary antimicrobial starts, to streamline or de‐escalate therapy early in its course, and to convert from parenteral to oral therapy, optimize dosing, and ensure the appropriate length of therapy. Most community hospitals, if sufficiently resourced, should be able to implement a successful antimicrobial stewardship program. Evidence suggests that good antimicrobial stewardship can lead to less overall and inappropriate antimicrobial use, lower drug‐related costs, reductions in Clostridium difficile–associated disease, and, in some studies, less emergence of antimicrobial resistance. Journal of Hospital Medicine 2011;6:S4‐S15 ©2011 Society of Hospital Medicine.

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Trends in Antibacterial Use in US Academic Health Centers

Cited by 155 publications

References 38 publications

Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

Decreasing Clostridium difficile Infections by an Antimicrobial Stewardship Program That Reduces Moxifloxacin Use

Relationship of Carbapenem Restriction in 22 University Teaching Hospitals to Carbapenem Use and Carbapenem-Resistant Pseudomonas aeruginosa

Antimicrobial stewardship for inpatient facilities

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