ABSTRACT
OBJECTIVE: To investigate the usage of antimicrobial in outpatients with laboratory-confirmed influenza in a children′s hospital during the flu season, and to provide evidence for scientific antimicrobial stewardship. METHODS: During the 2017-2018 flu season, medical records of laboratory-confirmed influenza positive cases in our hospital were reviewed to collect information including prescription of antimicrobial, laboratory data; and the rationality of the use of antimicrobial was evaluated based on clinical diagnosis. Logistic regression was used to establish the prediction model of antimicrobial usage, which was used to test the factors affecting usage of antimicrobial in outpatients with influenza infections. RESULTS: Among 201 confirmed-influenza cases, 107 (53.2%) were prescribed antimicrobial (at least one drug), and 92 (86.0%) were treated irrationally. In most patients, macrolides and the third generation of cephalosporins were used; and the most frequently used antimicrobials were azithromycin, cefixime and clarithromycin. According to the prediction model, the use of antimicrobial was significantly associated with abnormal C-reactive protein (CRP) level in children (adjusted OR=4.697; 95%CI: 2.187-10.090) and negative results of rapid influenza diagnostic test (RIDT) (adjusted OR=2.228; 95%CI:1.058-4.692); age, onset season, use of anti-influenza virus drugs, white blood cell counting, proportion of neutrophils, RIDT positive results, a clinical diagnosis of influenza and influenza typing were not risk factors. CONCLUSION: The rate of antimicrobial usage in out patients with in fluenza is high, and the management department should take targeted measures to reduce the unreasonable use of antimicrobial.
ABSTRACT
Introduction: Surgical site infections (SSI) are common healthcare associated infections (HAI) that is associated with increased morbidity and cost. Antimicrobial prophylaxis is effective when used appropriately. This study assesses the prophylactic antimicrobial prescribing and practice in the orthopaedic wards based on the Scottish Intercollegiate Guidelines Network (SIGN) guideline on antibiotic prophylaxis in surgery. Materials and Methods: Patients admitted to the Orthopaedics wards over a four-week period were studied (n = 68). Criterions 1 to 4; appropriateness, choice of antimicrobial and route of administration (1- given when indicated, 2- not given when not indicated, 3- appropriate choice and 4- given intravenously), criterions 5 to 7; allergy status and documentation (5: documentation, 6- details and 7- definite or possible history reaction immediately after penicillin therapy should not receive prophylaxis with a beta-lactam antimicrobial), criterions 8 to 10; documentation of antimicrobial given (8- name, dose and route of administration, 9- documentation in the appropriate 'one-off' section of the drug chart and 10- documentation of time of administration and surgical incision) and criterion 11 to 14; time and doses required (11- prophylaxis should be given 30 minutes before surgery, 12- additional intra-operative dose not required, 13- post-operative doses of prophylaxis not given and 14- a 24 hours regimen of prophylactic antimicrobial is given for primary arthroplasty procedures). A simple scoring system was used to allocate level of appropriateness. The rate was considered 'very good' for above 85%, 'good' for 70%-85%, 'moderate' for 50%-69%, 'poor' for 30%-49% and 'very poor' for below 30%. Results: The overall conformation to criteria and standards was 66.4% (95% CI 61.7-70.7). The rates were rated as 'very good' for criterion 1, 3, 4, 5b, 6, 8 and 9, 'good' for criterion 5a and 'poor' for criterions 2 and 5c. The adherence rates were 'very poor' to criterion 10a, 10b, 13 and 14. Intravenous cefuroxime was used as the first choice for antimicrobial prophylaxis. Conclusions: The overall practice was moderate and the choice of drug was considered appropriate. However, certain areas such as documentation need improvement. A local guideline may be useful.