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Background: The inappropriate use of antibiotics results in the emergence of antimicrobial resistance and adverse clinical and economic outcomes in hospital in-patients. A lack of institutional and national antibiotic guidelines promotes inappropriate antibiotic use. The objectives of this study are to evaluate the appropriateness of antibiotic prescribing, and the quality of antibiotic use in medical wards of the Lagos University Teaching Hospital, Lagos, Nigeria. Methodology: This was a descriptive cross-sectional study of patients admitted and placed on antibiotics in the medical wards of Lagos University Teaching Hospital between July 2013 and August 2014. The appropriateness of antibiotic therapy was determined by compliance with the guidelines of the Infectious Diseases Society of America (IDSA). Results: A total of 350 hospitalized patients on antibiotic therapy during the period of the study were reviewed, including 197 (56.3%) males and 153 females (43.7%). The mean age of the patients was 48.7±17.6 years and a total of 539 initial antibiotics were empirically prescribed. Antibiotic therapy was considered inappropriate in 290 (82.9%) patients, of which 131 (37.4%) patients had no evidence of infection. Pneumonia (23.1%) was the most common indication for antibiotic use, out of which 59.3% had inappropriate antibiotic therapy. Overall, the most frequently prescribed initial empirical antibiotic classes were imidazole derivatives (32.4%) and cephalosporins (22.0%), while the most frequently prescribed inappropriate antibiotic classes were carbapenems (100.0%) and quinolones (89.3%). Conclusion: The study revealed a high rate of inappropriate antibiotic therapy. There is an imperative need to establish antimicrobial stewardship programmes to curb the inappropriate use of antibiotics in the hospital.
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Male , Female , Drug Prescriptions , Drug Resistance, Microbial , Drug Overdose , Anti-Bacterial AgentsABSTRACT
Background: The misuse and overuse of antibiotics can lead to antibiotic resistance. Thus, it is important to have adequate knowledge and attitude toward antibiotic use and resistance for all specially the medical students who are the future healthcare practitioners. The aim of this study was to assess the knowledge and attitude toward antibiotic use and resistance among 4th year students of Shaheed Monsur Ali medical college. Material & Methods: This cross-sectional study was conducted in Shaheed Monsur Ali medical college, Dhaka, Bangladesh from October 2022 to December 2022. A structured questionnaire was administered to 126 randomly selected undergraduate medical students. Results: In our study, the percentage of male and female was same. Majority of the participants (55.56%) always get a prescription before starting antibiotics. Most of the participants (60.32%) never stop taking the prescribed antibiotics after their symptoms improved. Majority of the participants (54.76%) sometimes completed the course of the prescribed antibiotic treatment. In our study, majority of the participants (54.76%) sometimes take the correct dose of their antibiotics at the right time for the full duration. In this study, majority of the participants (47.62%) never save the remaining antibiotics for next time they get sick. Majority of the participants (73.02%) sometimes give leftover medication to friends or family if they get sick. For cough or sore throat, majority of the participants (48.41%) sometimes prefer taking an antibiotic. Most of the participants (69.05%) never buy the same antibiotics if they are sick that helped them get better when they had the same symptoms before. Most of the participants (96.03%) always check the expiry date of the antibiotic before using it. Knowledge level of antibiotic in majority of the participants (47.62%) was very good. Knowledge level of antibiotic resistance in majority of the participants (54.76%) was very good. Attitude level of antibiotic usage in majority of the participants (34.13%) was average, followed by 32.54% had bad, 32.54% good attitude level. Conclusion: From the findings of the study, it can be concluded though the knowledge level of the medical students is adequate, they are not careful about the usage of antibiotics and often misuse it. The students tend to not follow the rules of the usage guideline of antibiotics which ultimately results in antibiotic resistance. They should be more conscious to follow the guidelines of antibiotic usage.
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The composition and diversity of the gut microbiota are essential for the health and development of the immune system of infants. However, there is limited information on factors that influence the gut microbiota of very preterm infants. In this study, we analyzed factors that affect the gut microbiota of very preterm infants. The stool samples from 64 very preterm infants with a gestational age less than 32 weeks were collected for 16S rRNA gene sequencing. The infants were divided according to the delivery mode, antibiotic use during pregnancy, and feeding methods. The abundance of Proteobacteria was high in both cesarean (92.7%) and spontaneous (55.5%) delivery groups and then shifted to Firmicutes after the first week of birth. In addition, Proteobacteria was also the dominant phylum of infant gut microbiome for mothers with antibiotic use, with more than 50% after the first week of birth. In comparison, the dominant phylum for mothers without antibiotic use was Firmicutes. Proteobacteria level was also high in breastfeeding and mixed-feeding groups, consisting of more than 90% of the community. By contrast, Proteobacteria was the dominant phylum at the first week of birth but then shifted to Firmicutes for the formula-fed group. The alterations of gut microbiota in infants can affect their health condition during growth. This study confirmed that the different feeding types, delivery modes, and use of antibiotics during pregnancy can significantly affect the composition of the gut microbiota of very preterm infants.
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Objectives To explore the associations between higher antibiotic use rates (AURs) and adverse outcomes in very-low-birthweight (VLBW) infants without culture-proven sepsis or necrotizing enterocolitis (NEC) in a multicenter of China. Methods A prospective cohort study was performed on VLBW infants admitted to 24 neonatal intensive care units from January 1, 2018, to December 31, 2018. AUR was calculated as calendar days of antibiotic therapy divided by total hospital days. The composite primary outcome was defned as mortality or severe morbidity, including any of the following: severe neurologic injury, bronchopulmonary dysplasia (BPD), and stage 3 or higher retinopathy of prematurity. Results A total of 1,034 VLBW infants who received antibiotics without culture-proven sepsis or NEC were included in this study. The overall AUR of eligible VLBW infants was 55%, and the AUR of each eligible VLBW infant ranged from 3 to 100%, with a median of 56% (IQR 33%, 86%). After generalized propensity score and logistic regression analysis of 4 groups of VLBW infants with diferent AUR range, infants in the higher quartile AUR, (Q3, 0.57~0.86) and (Q4, 0.87~1.00), had higher odds of composite primary outcome (adjusted OR: 1.81; 95% CI: 1.23–2.67; adjusted OR 2.37; 95% CI: 1.59–3.54, respectively) and BPD (adjusted OR: 3.09; 95% CI: 1.52–6.57; adjusted OR 3.17; 95% CI: 1.56–6.57, respectively) than those in the lowest AUR (Q1). Conclusions Antibiotic overexposure in VLBW infants without culture-proven sepsis or NEC was associated with increased risk of composite primary outcome and BPD. Rational empirical antibiotic use in VLBW infants is urgently needed in China.
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@#Introduction: Adequate knowledge of antibiotics usage among users is one of the key factors preventing the spread of antibiotic-resistant strains’ infections. This study is conducted to determine the level of awareness on antibiotic usage and antibiotic resistance among the residents in Selangor, Malaysia. Methods: This study is a cross-sectional, questionnaire-based study that consisted of three parts: socio-demographic profile, antibiotic use awareness, and antibiotic resistance awareness. The questionnaire was distributed online using the snowball sampling method from January to March 2021. Results: A total of 239 respondents have participated in this study. The majority of the respondents involved were among the Malay youth residents in Selangor. Results showed that most residents in Selangor (65%) misunderstand that antibiotics can treat cold and flu. More than 44% of respondents also thought that antibiotic resistance could only occur to individuals who frequently take antibiotics and could not be spread to other people. Findings also showed associations (p<0.05) between the level of awareness on antibiotic resistance and the respondents’ socio-demographic profile (education level, household income and settlement category). A significant positive correlation was also observed between the level of awareness of antibiotic use and antibiotic resistance (r=0.42, p<0.05). Conclusion: In conclusion, the Selangor respondents’ antibiotic usage and antibiotic resistance level of awareness are moderate to high. However, there is still a need to increase awareness of antibiotic resistance and correct the misunderstandings among the public to help curb the antibiotic resistance issue from rapidly increasing in the future.
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Objective:To evaluate the effectiveness of antimicrobial stewardship based on self-developed antibiotic clinical decision support system (aCDSS) in the inpatients at a tertiary hospital for consecutive 6 years, and to provide reference for rational use and antimicrobial stewardship.Methods:aCDSS was self-designed based on information technology and applied in clinical use in our hospital from 2015. Data of inpatient information and antibacterial use from January 2015 to December 2020 were collected from HIS and aCDSS. A retrospective study was conducted in all inpatients on the utilization rate and antibiotic use density.Results:Since 2015, with the comprehensive implementation of antimicrobial stewardship based on the aCDSS,there was a significant decline on the annual rate of antibiotic usage from 44.18% in 2015 to 38.70% in 2020, as well as on the usage rate of extended-spectrum antimicrobial agents including carbapenems, broad-spectrum β-lactam/β-lactamase inhibitors, tigecycline, broad-spectrum cephalosporins, fluoroquinolones, as well as glycopeptide and antifungal drugs. Compared with 2015, the usage of carbapenems, tigecycline and broad-spectrum β-lactam/β-lactamase inhibitors was declined nearly 50% in 2020, and the density of carbapenems and tigecycline were decreased by 29.6% and 7.1%, respectively in 2020. On the other side, the utilization rate and use density of narrow-spectrum cephalosporins continued to increase by year, the use density of narrow-spectrum cephalosporins accounting for 28.2% of all antibiotics in 2020.Conclusions:With the comprehensive implementation of aCDSS, the utilization rate and density of broad-spectrum and high-priced antibacterial drugs in our hospital have decreased continuously to decline in the past 6 years, while the proportion of narrow-spectrum antimicrobials has increased year by year, indicating that the structure of antimicrobial use has been continuously optimized and that antimicrobial stewardship based on the information technology have achieved remarkable results.
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Introduction: Introduction: Antibiotics are a class of natural and synthetic compounds that inhibit the growth of or kill other microorganisms. Overuse of antibiotic is one of the most important factors for the development and spread of resistance in the hospital, as well as in the community. Present study was designed to describe antibiotic use in children and to assess the impact of an educational intervention on antibiotic prescription. Methodology:The present study was conducted in pediatric ward of a tertiary care institute. The study population included two groups of children – each having 250 children. The first group consisted of 250 consecutive children admitted in one unit of the pediatric ward and they were analyzed for antibiotic use without any prior priming of the members of the unit regarding rationality of antibiotic use. This was followed by an intervention in the form of a 3hour workshop for all members of the unit. The second group included another 250 children consecutively admitted in the wards after this intervention. Results:In Pre intervention group 55 (44%) children received antibiotics in rational way, while in Post intervention group 90(60.40%) children received antibiotic in rational way. One hundred and thirty-six children (49.4%) received antibiotics for respiratory tract infections, this being the commonest disease for which antibiotics were received. As seen in the table, unindicated use of antibiotic was significantly reduced in Post intervention group (p = 0.03).Conclusion: The present study included 500 children. There were 285 (57%) males and 215 (43%) females. Amongst these 500 patients, 178 (35.6%) were below 1 year of age. This group had the highest number of patients. In the Pre intervention group, 55 (44%) children received antibiotics rationally, while in Post intervention group 90(60.40%) children received antibiotic rationally
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Objectives: Education and awareness-raising are global health policy tools to modify public behavior towards antibiotic resistance. Considering the high frequency of antibiotic use and self-medication in Egypt, together with the lack of an awareness agenda, our objectives were to assess the knowledge and practices related to antibiotic use and resistance among patients attending dental clinics, and to evaluate the changes in knowledge following a specially designed one-on-one educational session. Material and Methods: A convenience sample of 310 dental patients participated in this study. A modified questionnaire was used to assess knowledge and practices related to antibiotic use and resistance. Second-year dental students were trained to administer the questionnaire and to use the educational materials they designed to raise awareness. Following the education session, patients completed another similar questionnaire to assess the changes in their knowledge. Results: Increasing awareness of antibiotic resistance can be an effective way to address the antibiotic resistance crisis. More than half of the participants (55.6%) did not know whether antibiotics treat diseases caused by bacterial or viral infections. The majority of participants (85.5%) had taken antibiotics during the last year, and (50.5%) of them had taken the same antibiotic more than once. Higher educational levels of the participants were significantly associated with a higher level of knowledge. Statistically significant increase in the percentages of correct answers to all questions were observed after the educational sessions. Conclusion: The one-on-one educational session is an effective approach to address the antibiotic resistance crisis (AU)
Objetivos: Educação e conscientização são ferramentas de política de saúde global para modificar o comportamento do público em relação à resistência aos antibióticos. Considerando a alta frequência de uso de antibióticos e automedicação no Egito, juntamente com a falta de uma agenda de conscientização, nossos objetivos foram avaliar o conhecimento e as práticas relacionadas ao uso de antibióticos e resistência entre pacientes atendidos em clínicas odontológicas, e avaliar as mudanças em conhecimento após uma sessão educacional especialmente projetada para este assunto. Material e Métodos: Uma amostra de 310 pacientes odontológicos participou deste estudo. Um questionário modificado foi usado para avaliar o conhecimento e as práticas relacionadas ao uso e resistência a antibióticos. Os alunos do segundo ano do curso de odontologia foram treinados para aplicar o questionário e usar os materiais educacionais que elaboraram para aumentar a conscientização. Após a sessão educacional, os pacientes responderam a outro questionário semelhante para avaliar as mudanças em seus conhecimentos. Resultados: Aumentar a conscientização sobre a resistência aos antibióticos pode ser uma forma eficaz de lidar com a crise de resistência aos antibióticos. Mais da metade dos participantes (55,6%) não sabia se os antibióticos tratam doenças causadas por infecções bacterianas ou virais. A maioria dos participantes (85,5%) havia tomado antibiótico no último ano e (50,5%) deles havia tomado o mesmo antibiótico mais de uma vez. O maior nível de escolaridade dos participantes foi significativamente associado a um maior nível de conhecimento. Aumentos estatisticamente significativos nas porcentagens de respostas corretas para todas as questões foram observados após a sessão educacional. Conclusão: A sessão educacional individual é uma abordagem eficaz para lidar com a crise de resistência aos antibióticos. (AU)
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Humans , Male , Female , Drug Resistance, Microbial , Knowledge , Anti-Bacterial AgentsABSTRACT
Antimicrobial resistance poses a growing threat to public health, as infections from resistant strains of microbial become increasingly difficult and expensive to treat, resulting in prolonged illness and greater risk of death. A cross-sectional descriptive study was done among 471 higher secondary level students of private schools in Kathmandu Valley. Data were collected from Grade 11 and 12 non-science faculty students through self-administered questionnaires. Half (50.5%) of the students gave correct response by saying that antibiotic kills bacteria and 49.1% said that it is for fever. Majority (93.0%) of them said that it should be taken with water. Regarding the response on when to stop taking antibiotic, 46.9% said correctly by saying when all prescribed medicines are taken whereas and 40.8% said that after feeling better. More than half (58.8%) of the students had not heard about antibiotic resistance, whereas those who have heard among them 24% of students said that they had heard from doctor and nurses and 21.8% from family member and friends. Nearly one-third (32.7%) of students knew that antibiotic resistance occurs using antibiotic when they are not necessary. Regarding the response on consequences of antibiotic resistance, more than one-third (38.2%) of students gave correct answer. Nearly half of the students have lack of knowledge about antibiotic. Thus, it is imperative to create awareness among students by introducing a specific course on antibiotic in the 9th and 10th grade core curriculum to prevent antibiotic resistance and its consequences.
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A lot of experiments have been carried out in Saudi Arabia concerning the misuse of antibiotics and buying themwithout being prescribed by a doctor. However, despite all these studies, a few or none of them have appraisedthe parental awareness, practices and attitude toward the use of antibiotics in the treatment of URTIs in theirchildren. As such, the objective of this experiment was to document and analyze the parental levels of knowledge,attitudes, and practices (KAP) regarding the use for upper respiratory tract infections in children. This is a crosssectional study that was conducted across 8 cities: Riyadh, Jeddah, Taif, Makkah, Dammam, Al Ahsa, Albahaand Asir Saudi Arabia from 01/09/2019 to 26/09/2019, according to which a total of 714 parents took part in thestudy. Convenience sampling was the method that was used to select the participants of the experiment. Thefindings of the current research were found to be the same as those of the studies that were conducted before inPalestine. The researcher found out that the parents in Saudi Arabia lack adequate knowledge regarding the useof antibiotics in the treatment of URTIs and this led to their wrong practices and attitudes toward the same.Despite all these, the study established a relationship of trust between the subjects and the doctors, meaning thatthere is a trust in the information and recommendations that the doctors give them concerning the medications.
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@#Antibiotic resistance is a global threat to public health, leads to health and economic burden. Studies show that knowledge and attitude towards antibiotic use is poor, especially among rural residents. However, there is no study conducted on knowledge and attitude towards antibiotic use among the public in rural area Malaysia. The aim of this study is to assess knowledge and attitude on antibiotic use among public in rural area Batu Pahat, Johor. This was a cross-sectional study in which closed-ended questionnaires were distributed to 350 rural residents in Batu Pahat by convenience sampling method. The questionnaire was constructed into socio-demographic, antibiotic use and indication, knowledge and attitude towards antibiotic use. The most inappropriate knowledge responses were found for assumption about the effectiveness of antibiotics towards viral infection (69.1%), colds and coughs (57.7%). Only few were aware about the decrease in antibiotic effectiveness following antibiotic overuse (29.1%). Misuse antibiotics for cold (64.0%), expect antibiotics to be prescribed for common cold symptoms (52.6%) and discontinue antibiotics when start feeling better (63.4%) were the several highest inappropriate responses in attitude domain. Significant association was shown between both knowledge level and attitude level with age, gender, educational level, monthly income, occupation related to healthcare, family member’s occupation related to healthcare and most common location seek for healthcare. In conclusion, the rural residents demonstrated moderate knowledge (50%) but negative attitude (56.9%) towards antibiotic use. To cope with antibiotic resistance issue, proper planning on effective methods to promote appropriate use of antibiotics are necessary.
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Background: Antibiotic resistance has emerged as a serious global problem. Irrational prescribing of antibiotics is one of the key factors responsible for the development of antibiotic resistance. As today’s medical students will be the future prescribers their awareness regarding antibiotic resistance and rational prescribing of antibiotics is very much important. The main objective of the study was to evaluate the knowledge, attitude and practices of the medical students towards antibiotic use.Methods: A cross-sectional questionnaire-based study was conducted involving the medical students from all the semesters. A predesigned questionnaire was used to evaluate the knowledge, attitude and practices of the respondents. The response options were ‘yes’ or ‘no’ for some questions, and a 5 point Likert scale used to assess some questions. The data was analyzed using MS office Excel.Results: A total of 457 fully completed questionnaires from the respondents were evaluated. Majority of the respondents (70%) were females, and 91% of the respondents were aware of antibiotic resistance as a global problem. On analysis of score of questions assessing knowledge, 91% of respondents had attained a score in the range of 5-7. Majority (83%) of the respondents used antibiotics only on doctor’s prescription and 74% of the respondents had completed the prescribed course.Conclusions: The present study gives an insight on the knowledge, attitude and practices of medical students on antibiotic use, and can be used as a tool to plan educational strategies to improve the knowledge of the students regarding rational use of antibiotics.
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Background & objectives: Antimicrobial resistance is a major challenge in the treatment of typhoid fever with limited choices left to empirically treat these patients. The present study was undertaken to determine the current practices of antibiotic use in children attending a tertiary care hospital in north India. Methods: This was a descriptive observational study in children suffering from enteric fever as per the case definition including clinical and laboratory parameters. The antibiotic audit in hospitalized children was measured as days of therapy per 1000 patient days and in outpatient department (OPD) as antibiotic prescription on the treatment card. Results: A total of 128 children with enteric fever were included in the study, of whom, 30 were hospitalized and 98 were treated from OPD. The mean duration of fever was 9.5 days at the time of presentation. Of these, 45 per cent were culture positive with Salmonella Typhi being aetiological agent in 68 per cent followed by S. Paratyphi A in 32 per cent. During hospitalization, the average length of stay was 10 days with mean duration of defervescence 6.4 days. Based on antimicrobial susceptibility ceftriaxone was given to 28 patients with mean duration of treatment being six days. An additional antibiotic was needed in six patients due to clinical non-response. In OPD, 79 patients were prescribed cefixime and additional antibiotic was needed in five during follow up visit. Interpretation & conclusions: Based on our findings, ceftriaxone and cefixime seemed to be the first line of antibiotic treatment for typhoid fever. Despite susceptibility, clinical non-response was seen in around 10 per cent of the patients who needed combinations of antibiotics.
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Background: Urinary tract infection (UTI) being the most common bacterial infection with considerable morbidity and mortality. In hospitalized geriatric patients, the risk is more attributable to differing characteristics such as anatomical and hormonal changes, presence of comorbidities such as neurological and urological abnormalities, diabetes mellitus and prolonged indwelling catheter use in hospitals and long-term care facilities.Methods: A retrospective study of patients admitted to medicine wards of age above 60 years with symptoms of urinary tract infection and positive urine culture spanning over a year were included. Demographic profile, clinical features, predisposing factors, laboratory features, urine culture reports, antimicrobial susceptibility patterns and outcome were noted and analysed.Results: Of the 120 patients included in our study, 58.2% were males and 41.8% were females. Dysuria was the most common major symptom (77.5%). Diabetes mellitus was the most common Predisposing factor observed in (63.3%) of the patients. Gram negative organism were responsible for (68.27%) of the uropathogen profile; Escherichia coli was the commonest isolate (31.66%) seen. Mortality rate was 29.16%. Significantly higher mortality was seen in patients with diabetes mellitus (p<0.001), complicated UTI (p<0.001), serum creatinine >1.4mg/dl (p<0.001) and increasing number of predisposing factors. Mortality was also associated with higher leucocyte count in the study population.Conclusions: Urinary tract infection in elderly increases the population mortality and morbidity; and the co morbid factors associated play a key role in the severity of the infection. Early management and appropriate antibiotic therapy will help in preventing antibiotic resistance and also in decreasing the overall geriatric population fatality.
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Objective To explore the main pathogenic bacteria and sensitive antibiotics and related factors in bile in patients with acute biliary pancreatitis (ABP).Methods 176 patients with ABP from September2015 to September 2017 were selected as the study subjects.Bile was collected for bacterial culture and antibiotic susceptibility testing.The relationship between different obstruction sites and total bilirubin levels and bacterial detection rates was compared.Results The positive rate of bacterial culture was 68.18％.There were 155 aerobic bacteria and 25 anaerobic bacteria.Among the G-bacteria, E.coli (62.85％) accounted for the largest proportion, Enterococcus (12.26％) accounted for the highest proportion of G+ bacteria, and Bacteroides fragilis (52.00％) accounted for the majority of anaerobes..The sensitivity of G-bacteria to meropenem, cefepime and ciprofloxacin was greater than 80％, which was 96.77％, 91.13％ and 84.68％, respectively.The sensitivity rate of G+ to vancomycin was 100％, and the sensitivity rate to meropenem, tetracycline, and azithromycin was higher than 80％.The positive rate of bacterial culture in high obstruction was significantly higher than that in middle-low obstruction (P＜0.05).The low-level group was significantly higher than the middle-level group and the high-level group (P＜0.05), and the middle-level group was significantly higher than the high-level group (P＜0.05).Conclusion For the early anti-infection treatment of ABP patients, aminoglycosides+third-generation cefquinolones+ metronidazole can be used for treatment.Patients with high obstruction and low TB levels need to strengthen anti-infection treatment.
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Background: Antibiotic resistance is rising to alarming levels that necessitates the evaluation of prescription patterns for the rational use of antibiotics. Hence this study was conducted to evaluate antibiotic use in a government run general hospital.Methods: A prospective observational study was conducted to evaluate the rationality of antimicrobial prescription in a paediatric intensive care unit (PICU) of a government run tertiary care teaching hospital using the USAID indicators for rational use of antibiotics. Case records of 104 patients were documented and analysed.Results: The most common antimicrobials prescribed were 3rd generation Cephalosporins namely Ceftriaxone, followed by Aminoglycosides (Amikacin), Imipenams (Meropenam), Anti-Influenza Antiviral (Oseltamivir) and Oxazolidinones (Linezolid). A common trend of antibiotic overuse emerged due to paucity of resources to support decision making and choice of antibiotic. This led to patients being exposed to a high number of antibiotics with an associated increase in morbidity.Conclusions: Antibiotic resistance would remain a challenge until systems for rapid, precise and low cost detection of the causative micro-organisms and antibiotic sensitivity are developed, surveillance systems are increased and antibiotic stewardship programs are enforced.
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The intestinal microflora in early life mainly comes from the exchange of bacteria between the mother and the newborn.From birth to childhood,intestinal microflora undergoes a dynamic change.An increasing number of studies have shown that mode of delivery and feeding as well as the use of antibiotics during pregnancy are the main influencing factors of intestinal microflora in early life.However,the specific mechanisms have yet to be fully understood.This article reviews the dynamics of intestinal microflora in early life and the related influencing factors.
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Objective To investigate the utilization of antibiotics in emergency departments (EDs) of class Ⅲ general hospitals in China.Methods Data from a national monitoring network for rational use of drugs was used.The data included prescriptions of EDs from 114 class Ⅲ general hospitals in 30 provinces (autonomous regions,municipalities) of China.A total of 10 260 595 prescriptions from October 1,2014 to December 31,2016 were extracted.The Anatomical Therapeutic Chemical Classification/Defined Daily Dose (DDD) system was used for the classification of antibiotics and calculation of antibiotic use intensity.An auto-regression model was used to analyze the trend over time and seasonal variation of antibiotic use in EDs.Results The rate of antibiotic prescriptions was 27.82％ in EDs,among the antibiotics prescribed,25.58％ were for the combination therapy with 2 or more antibiotic agents,and injectable antibiotic prescriptions accounted for 60.59％.Besides,the number of DDDs per 100 patient visits was 81.84.Broad-spectrum agents were the most commonly used antibiotics,among which the second and third generation cephalosporins,quinolones and macrolides accounted for 23.83％,21.68％,19.17％ and 7.89％ of all prescribed antibiotics,respectively.The use of antibiotics,including prescription frequency and use intensity,in EDs had a slight but significant increase tendency (P＜0.05),and the seasonal variation of antibiotic use in EDs was obvious,characterized by the highest frequency and intensity of antibiotic use in winter,the differences were significant (P＜0.05).Conclusion The antibiotic prescription rate in EDs of class Ⅲ general hospitals in China was controlled at a low level,but the proportions of broad-spectrum antibiotics and injectable antibiotics were high,and a significant increase trend in antibiotic use in EDs was found.
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Objective To investigate the utilization of antibiotics in emergency departments (EDs) of class Ⅲ general hospitals in China.Methods Data from a national monitoring network for rational use of drugs was used.The data included prescriptions of EDs from 114 class Ⅲ general hospitals in 30 provinces (autonomous regions,municipalities) of China.A total of 10 260 595 prescriptions from October 1,2014 to December 31,2016 were extracted.The Anatomical Therapeutic Chemical Classification/Defined Daily Dose (DDD) system was used for the classification of antibiotics and calculation of antibiotic use intensity.An auto-regression model was used to analyze the trend over time and seasonal variation of antibiotic use in EDs.Results The rate of antibiotic prescriptions was 27.82％ in EDs,among the antibiotics prescribed,25.58％ were for the combination therapy with 2 or more antibiotic agents,and injectable antibiotic prescriptions accounted for 60.59％.Besides,the number of DDDs per 100 patient visits was 81.84.Broad-spectrum agents were the most commonly used antibiotics,among which the second and third generation cephalosporins,quinolones and macrolides accounted for 23.83％,21.68％,19.17％ and 7.89％ of all prescribed antibiotics,respectively.The use of antibiotics,including prescription frequency and use intensity,in EDs had a slight but significant increase tendency (P＜0.05),and the seasonal variation of antibiotic use in EDs was obvious,characterized by the highest frequency and intensity of antibiotic use in winter,the differences were significant (P＜0.05).Conclusion The antibiotic prescription rate in EDs of class Ⅲ general hospitals in China was controlled at a low level,but the proportions of broad-spectrum antibiotics and injectable antibiotics were high,and a significant increase trend in antibiotic use in EDs was found.
ABSTRACT
Resumen Antecedentes: Los antimicrobianos (ATM) son uno de los medicamentos más utilizados en recién nacidos (RN) hospitalizados. El uso indiscriminado de ATM trae consecuencias negativas como son el predominio de bacterias resistentes a los ATM usualmente utilizados y asociaciones individuales a morbilidad relevante como son la displasia broncopulmonar, enterocolitis necrosante, sepsis tardía y/o muerte. Objetivo: Registrar y evaluar las tendencias del uso de ATM a lo largo del tiempo en RN hospitalizados en el Servicio de Neonatología (SRN) del Complejo Asistencial Dr. Sótero del Río, con el fin de objetivar los cambios en la práctica habitual de la indicación de ATM. Un objetivo secundario fue evaluar el impacto de estas conductas sobre la resistencia antimicrobiana. Métodos: Estudio de cohorte, prospectivo, observacional, unicéntrico, en todos los pacientes hospitalizados entre enero de 2011 y diciembre de 2014. Se registró el peso al nacer, días de hospitalización, indicación y días de uso de ATM para cada paciente. El uso de ATM fue cuantificado por medio de distintas tasas: días de indicación de un o más ATM para el consumo global (TUA), sumatoria total de días de uso (STUA) como para los ATM más frecuentemente utilizados. Cada tasa calculada por 100 días hospitalizados. Además, se registró la susceptibilidad antimicrobiana de las bacterias más frecuentemente aisladas en nuestro servicio: Staphylococcus coagulasa negativa (SCN) y bacilos gramnegativos (BGNs). Resultados: El 34,7% de los pacientes hospitalizados recibió algún tipo de antimicrobiano, correspondiendo 32,3% a antibacterianos. El ATM más utilizado fue ampicilina (20,2% del total) y luego cefadroxilo (11,6%). El TUA no cambió entre 2011 y 2014. La STUA disminuyó en 10,7% entre 2011 y 2014 (p < 0,05). En el análisis por rangos de peso, en el grupo < 750 g disminuyó la tendencia de uso de vancomicina (descenso de uso en 9,9%) y un aumento de 18,8% para metronidazol. Por otra parte, hubo un aumento en el uso del régimen de piperacilina/tazobactam en el grupo > 1.500 g. Al evaluar la susceptibilidad antimicrobiana, hubo una disminución de la susceptibilidad a cloxacilina en SCN entre 2011 y 2014 desde 27 a 10,3%, respectivamente. Para BGN hubo una disminución desde 76,9 a 40,5% en la susceptibilidad a cefalosporinas de tercera generación, principalmente debido a Klebsiella pneumoniae que pasó a ser el BGN predominante, con un aumento de 6,7 a 50% en los años 2011 y 2014, respectivamente. Para Klebsiella pneumoniae la susceptibilidad a cefalosporinas de tercera generación descendió desde 77 a 22%. Por último, amikacina mostró una actividad sobre 85% en todos los BGNs entre 2011 y 2014. Conclusiones: Es recomendable planificar y mantener un registro continuo del consumo de ATM tanto como terapia y profilaxis, idealmente llevar el TUA, el STUA y siendo categorizado por tipo de ATM y rango de peso de los RN. En forma concomitante, es de considerable importancia analizar y evaluar la susceptibilidad de microorganismos. Es esencial que un equipo interdisciplinario prepare este registro, y que continuamente proporcione retroalimentación a los profesionales que mantienen el funcionamiento de las unidades de cuidados neonatales.
Background: Antibiotics (ATB) are drugs widely used in hospitalized newborns. The indiscriminate use of ATBs promote the rise of resistant bacteria to the most commonly indicated antimicrobials. In addition, ATB prescription presents associations to morbidity, such as bronchopulmonary dysplasia, necrotizing enterocolitis, late sepsis and even death. All of the above leads to an increase in health care costs. Aim: To record and to evaluate trends of antibiotic use over time in hospitalized NB in the Neonatology Unit at Dr. Sótero del Río Hospital, in order to objectify the changes in the usual practice of the ATM indication. A secondary objective was to assess its impact on antimicrobial resistance. Methods: Cohort, observational, prospective unicenter study which included all hospitalized patients between January 2011 and December 2014. Birth weight, hospitalization days, ATB indication and days of ATB use were recorded for each patient. The use of ATB was quantified by means of different rates; days of indication of one or more ATBs for global consumption (RUA), total sum of days of use (TSUA) and for the most frequently used ATBs. Each calculated rate for 100 days hospitalized. In addition, the antimicrobial susceptibility of the most frequently isolated bacteria in our service: coagulase-negative Staphylococcus (SCN) and Gram-negative bacilli (BGN) were recorded continuously. Results: The 34.7% of the hospitalized patients received some type of antimicrobial agent. ATBs were 32.3% of medicines used. The most widely used was ampicillin (with 20.2% of the total) and cefadroxyl (with 11.6%). The RUA did not change during the study time, but STUA decreased by 10.7% between 2011 and 2014 with p < 0.05. When subgroup analyzes were divided by weight ranges, in the < 750 g group, the use of vancomycin decreased in use by 9.9% and an increase of 18.8% for metronidazole was observed. On the other hand, there was an increase in the use of the piperacillin-tazobactam regimen in the range > 1,500 g. When evaluating antimicrobial susceptibility, there was a decrease in susceptibility for oxacillin in SCN between 2011 and 2014 from 27% to 10.3% respectively. In addition, for Gram negative there was a decrease from 76.9% to 40.5% in susceptibility to third generation cephalosporins, mainly due to Klebsiella pneumoniae, which became the predominantly isolated BGN with an increase of 6.7% to 50% between 2011 and 2014, respectively. For K. pneumoniae the loss of susceptibility to third generation cephalosporins decreased from 77% to 22%. Finally, amikacin showed an activity over 85% in all BGNs between 2011 and 2014. Conclusions: It is advisable to plan and to maintain a continuous record of ATB consumption, as well as therapy and prophylaxis, being categorized by ATB type and range of newborn weight. It is of considerable importance to analyze and to evaluate the susceptibility of microorganisms. It is essential that an interdisciplinary team prepare this recording, and to continuously provide feedback to professionals who maintain the functioning of neonatal care units.