Trends in Antibiotic Use in a Single University Hospital

Hwang

et al. 2020

Korean J Intern Med

Background/Aims: This study was performed to evaluate trends in antibiotic usage at a tertiary care hospital in Korea. Methods: This study collated antibiotic prescription data and total patient days for inpatients at a tertiary care hospital in Korea between 2004 and 2013. The consumption of each class of antibiotic was converted to def ined daily dose (DDD)/1,000 patient-days. We defined 3rd generation cephalosporins, 4th generation cephalosporins, β-lactam/β-lactamase inhibitors, and fluoroquinolones as broad-spectrum antibiotics; carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin were defined as antibiotics against multidrug-resistant (MDR) pathogens. Other antibiotic classes were defined as nonbroad-spectrum antibiotics. Results: Mean antibiotic consumption was 920.69 DDD/1,000 patient-days. The proportions of broad-spectrum antibiotics, antibiotics against MDR pathogens, and nonbroad-spectrum antibiotics were 41.8% (384.48/920.69), 3.5% (32.24/920.69), and 54.7% (503.97/920.69), respectively. Consumption of broad-spectrum antibiotics (coefficient for time 0.141; p = 0.049) and antibiotics against MDR pathogens (coefficient for time 0.185; p < 0.001) showed a significant increasing trend over the study period. Nonbroad-spectrum antibiotic consumption showed a significant decreasing trend over the study period (coefficient for time-2.601; p < 0.001). Conclusions: Over the 10-year period, a stepwise increase in the consumption of broad-spectrum antibiotics and antibiotics against MDR pathogens was observed at a tertiary care hospital in Korea. Conversely, during the same period, nonbroad-spectrum antibiotic consumption showed a significant decreasing trend.

Section: Discussionmentioning

confidence: 99%

Ten-year trends in antibiotic usage at a tertiary care hospital in Korea, 2004 to 2013

Hwang

et al. 2020

Korean J Intern Med

“…The national use of quinolones steadily increased from 1994 to 2000 in US intensive care units (ICUs), and this use was significantly associated with decreased overall susceptibility to ciprofloxacin in the same period [ 6 ]. The consumption of quinolones doubled during 2001-2012 in a Korean hospital with the increased ciprofloxacin resistance in clinical isolates of Escherichia coli in ICUs [ 7 ]. While newer class quinolones that expand the spectrum of activity to include gram-positive bacteria and even anaerobes have been developed, quinolone resistance has nonetheless increased in many bacterial species, and no new quinolones with activity against gram-negative bacteria greater than that of ciprofloxacin have yet become available.…”

Section: Introductionmentioning

confidence: 99%

Clinical Importance and Epidemiology of Quinolone Resistance

Hooper

2014

Infect Chemother

The quinolone class of antimicrobial agents is one of most widely used classes of antimicrobial agents in outpatient and inpatient treatment. However, quinolone resistance in gram-positive and gram-negative bacteria has emerged and increased globally. This resistance limits the usefulness of quinolones in clinical practice. The review summarizes mechanisms of quinolone resistance and its epidemiology and implications in the most common clinical settings, urinary tract infections, respiratory tract infections, intraabdominal infections, skin and skin structure infections, and sexually transmitted diseases.

“…In our institution, over the last 12 years, about 60% of S. aureus infections were methicillin-resistant (MRSA), and this proportion has not changed significantly [ 12 ], whereas vancomycin consumption has increased more than twofold, from 18 defined daily doses (DDDs) per 1000 patient-days to 40.0 DDDs per 1000 patient-days [ 13 ]. Our previous analysis showed that a quarter of total vancomycin use represented inappropriately continued empirical use [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of an intervention targeting inappropriate continued empirical parenteral vancomycin use: a quasi-experimental study in a region of high MRSA prevalence

et al. 2018

Self Cite

BackgroundDespite vancomycin use is a major risk factor for the emergence of vancomycin resistance, it is frequently inappropriately prescribed, especially as empirical treatment. We evaluated the effect of an antimicrobial stewardship intervention targeting for inappropriate continued empirical vancomycin use.MethodsThis was a quasi-experimental study comparing vancomycin use in a 6-month pre-intervention and 6-month intervention period. If empirical vancomycin was continued for more than 96 h without documentation of beta-lactam-resistant gram-positive microorganisms, it was considered inappropriate continued empirical vancomycin use. The intervention consisted of the monitoring of appropriateness by a pharmacist and direct discussion with the prescribing physicians by infectious disease specialists when empirical vancomycin was continued inappropriately. An interrupted time series analysis was used to compare vancomycin use before and during the intervention.ResultsFollowing implementation of the intervention, overall vancomycin consumption decreased by 14.6%, from 37.6 defined daily doses (DDDs)/1000 patient-days in the pre-intervention period to 32.1 DDDs/1000 patient-days in the intervention period (P < 0.001). The inappropriate consumption of vancomycin also declined from 8.0 DDDs/1000 patient-days to 5.8 DDDs/1000 patient-days (P = 0.009).ConclusionInterventions such as direct communication with prescribing physicians and infectious disease clinicians can help reduce the inappropriate continued use of vancomycin.