A Survey on Antimicrobial Prescriptions and Stewardship Programs in Korea / 감염과화학요법

BACKGROUND: Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery. MATERIALS AND METHODS: We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital. RESULTS: Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem. CONCLUSION: This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.

A Survey on Antimicrobial Prescriptions and Stewardship Programs in Korea / 감염과화학요법

BACKGROUND: Previous studies in Korea showed that unnecessary antibiotic use could not be neglected, especially in prophylactic use. Currently many hospitals employ diverse antibiotic stewardship programs, but there are few studies on surveillance of such programs. So, we planned this study to evaluate current status of antimicrobial stewardship and adequacy of antimicrobial prophylaxis in surgery. MATERIALS AND METHODS: We sent questionnaires about policy on antibiotic usage, control program for adequate antibiotic prescription, and actual status of prophylactic antibiotic usage to 55 infectious disease physicians in each hospital. RESULTS: Of 55 contacted infectious diseases clinicians, 44 answered the questionnaire. Majority of hospitals employed restricted antimicrobial system (95.5%), education (79.5%), control by order communicating system (59.1%), consult to infectious disease physicians (59.1%), and review of cumulative antimicrobial usage (52.3%) to prevent inadequate antibiotic use. Glycopeptides were designated as a restricted antimicrobial agent in 100.0% of hospitals; carbapenems, 93.0%; quinupristin/ dalfopristin or linezolid, 93.0%; the 4th generation cephalosporins, 74.4%; caspofungin or voriconazole, 62.8%; liposomal amphotericin B, 60.5%, and so on. Unnecessary perioperative prophylactic antimicrobial agents were prescribed in gastrectomy and mastectomy in all the hospitals. The second generation cephalosporins and the third generation cephalosporins were the most commonly prescribed prophylactic antimicrobial agents in total knee replacement arthroplasty (TKRA) and coronary artery bypass graft surgery (CABG) respectively. In 70.5% of institutes they use prophylactic antimicrobial agents more than four days in gastrectomy; 63.6% in mastectomy; 81.8% in TKRA; 81.1% in CABG. Unnecessary combination of aminoglycosides with other antimicrobial agents for prophylactic use was another common problem. CONCLUSION: This study shows that more effort is required to diminish antimicrobial misuse or overuse, especially in prophylactic use for surgical patients.

Infections in Patients with Acute Leukemia (1993~1996) / 대한혈액학회지

BACKGROUND: Infection is one of the major complications in patients with hematologic malignancies. Clinical spectrums of infectious diseases are changing due to the recent progress in the conservative management. The objective of this study was to determine the patterns and trends of infections in patients with acute leukemia. METHODS: The medical records for 253 adult patients with acute leukemia admitted at the Seoul National University Hospital from January 1993 to December 1996 were reviewed retrospectively. RESULTS: Clinical data of 186 subjects were available. Four hundred and four febrile episodes developed in 161 (86.6%) patients. Median duration of neutropenia, defined as absolute neutrophil count (ANC)<500/, was 18 days and ANC on the 1st day of infection was 0 (0~73,360)/microliter. Fever resolved in a median duration of 4 (1~73) days. Clinically-defined infection, microbiologically-defined infection and unknown fever accounted for 44.3, 36.6 and 19.1%, respectively. Pneumonia occured in 19.0% (62/327), infection of oral cavity in 15.6%, and perianal infection in 13.8%. Of 164 bacterial isolates, 100 were gram-negative, 62 gram-positive, and 2 Mycobacterium tuberculosis. Escherichia coli (32 isolates) was the most common organism, followed by Klebsiella pneumonia (24), Staphylococcus aureus (21) and Pseudomonas aeruginosa (18). Ten fungi including 1 Pneumocystis carinii and 6 Candida species were isolated. Out of 404 cases, 33 patients (8.2%) expired despite aggressive treatment. Twenty-eight patients died of infectious complications, including 17 pneumonia and 4 primary bacteremia. CONCLUSIONS: There was a tendency to a increased proportion of microbiologically-defined infection, a fall in the frequency of P. aeruginosa and treatment outcomes significantly improved.

Infections in Bone Marrow Recipients (1985~1996) / 감염

BACKGROUND: Infection and graft-versus-host disease (GVHD) are major causes of morbidity and mortality following bone marrow transplantation (BMT). The objective of this study was to define the incidence, type, and timing of infectious complications in bone marrow recipients. METHODS: Ninety-four patients, including 71 allogeneic and 23 autologous cases, underwent BMT at the Seoul National University Hospital. Their medical records were reviewed retrospectively. RESULTS: Medical records of 74 subjects (53 allogeneic, 21 autologous) were available. In allogeneic recipeints the majority of patients had a diagnosis of leukemia (47.9%) and in autologous ones lymphoma (66.7%). Median duration of follow-up was 11 (0~82) months and 3 (1~45) months in each group. Out of 40 allogeneic and 17 autologous recipients, 95 and 27 febrile episodes occurred, respectively. During pre-engraftment, post-engraftment (to day 100), and post-transplantation period (100 days or later), 57, 45, and 19 episodes developed, respectively. Clinically-defined infection, microbiologically-defined infection, and un-known fever accounted for 52.5% (64/112), 33.6% (41/112) and 13.9% (17/112), respectively. Infection of the oral cavity occurred in 27.6% (28/105), skin infection in 21.9% (23/105), and pneumonia in 14.3% (15/105). Fourteen (58.3%) of 24 bacterial infections were caused by gram-negative bacilli and 10 (41.7%) by gram-positive cocci, most often coagulase-negative staphylococci. Fungi, including Pneumocystis carinii, and viruses were involved in 16.0% (7/44) and 29.5% (13/44), respectively. Ten of 122 cases (8.2%) expired despite treatment; eight patients died due to infectious complications, including 7 with pneumonia and 1 with primary bacteremia, and 2 dies due to non-infectious complications. CONCLUSION: Infections are the most frequent serious complications of bone marrow transplantation. The majority occurred by day 100 after BMT and oral mucositis was the most common type of infection.