Pattern of inappropriate antibiotic use among patients in the medical wards of a tertiary hospital in southwest Nigeria

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.

Description of changes in clinical outcomes following the implementation of an antibiotic stewardship program in a level IV hospital / Descripción del cambio en desenlaces clínicos posteriores a la implementación de un programa de gestión de antibióticos en un hospital de cuarto nivel de atención en salud

Introduction. Inadequate prescription of antibiotics has been recognized as a public health problem by the World Health Organization. In this context, antibiotic stewardship programs have been implemented as a tool to mitigate its impact. Objective. To describe the changes in clinical outcomes after the implementation of an antibiotic stewardship program in a level IV hospital. Materials and methods. We conducted a unique cohort study of patients hospitalized for infectious pathologies that were treated with antibiotics in an advanced medical facility. We collected the clinical history before the implementation of the antibiotic stewardship program (2013 to 2015) and then we compared it to the records from 2018 to 2019 collected after the implementation of the program. We evaluated changes in clinical outcomes such as overall mortality, and hospital stay, among others. Results. We analyzed 1,066 patients: 266 from the preimplementation group and 800 from the post-implementation group. The average age was 59.2 years and 62% of the population was male. Statistically significant differences were found in overall mortality (29% vs 15%; p<0.001), mortality due to infectious causes (25% vs 9%; p<0.001), and average hospital stay (45 days vs 21 days; p<0.001); we also observed a tendency to decrease hospital re- admission at 30 days for infectious causes (14% vs 10%; p=0.085). Conclusions. The antibiotic stewardship program implemented was associated with a decrease in overall mortality and mortality due to infectious causes, as well as in average hospital stay. Our results evidenced the importance of interventions aimed at mitigating the impact of inadequate prescription of antibiotics.

Introducción. La inadecuada prescripción de antibióticos es un problema de salud pública, reconocido por la Organización Mundial de la Salud. Los programas de gestión de antibióticos son implementados como una herramienta para mitigar su impacto. Objetivo. Describir los cambios observados en los desenlaces clínicos después de la implementación de un programa de gestión de antibióticos en un hospital de IV nivel de atención. Materiales y métodos. Se llevó a cabo un estudio de cohorte única de pacientes hospitalizados por patologías infecciosas y tratados con antibióticos en una institución médica de alta complejidad. Inicialmente, se recolectaron las historias clínicas anteriores a la implementación del programa de gestión de antibióticos (2013 a 2015) y luego se compararon con los datos obtenidos después de la implementación del programa de gestión de antibióticos de 2018 a 2019. Se evaluaron los cambios en los desenlaces clínicos como mortalidad y estancia hospitalaria, entre otros. Resultados. Se analizaron las historias clínicas de 1.066 pacientes: 266 con historia previa a la implementación del programa y 800 con historia posterior a la implementación. El promedio de edad fue 59,2 años y 62 % de la población era masculina. Se encontraron diferencias estadísticamente significativas en mortalidad global (29 Vs. 15 %; p<0,001), mortalidad por causa infecciosa (25 % Vs. 9 %; p<0,001) y promedio de estancia hospitalaria (45 Vs.21 días; p<0,001), con tendencia a disminuir nuevas hospitalizaciones en 30 días por patología infecciosa (14 Vs.10 %; p=0,085). Conclusiones. El desarrollo del programa de gestión de antibióticos se asoció con a una disminución en la mortalidad global, la mortalidad por causa infecciosa y la estancia hospitalaria. Esto demuestra la importancia de desarrollar intervenciones dirigidas a mitigar el impacto de la prescripción inadecuada de antibióticos.

Cálculo de los Días de Terapia Antimicrobiana (DOT) en Cuidados Intensivos Pediátricos: una propuesta de metodología basada en el sistema informático de dispensación de medicamentos

Introducción: El método recomendado para la medición de consumo de antimicrobianos (AMB) en pediatría es el cálculo del indicador Días de Terapia estandarizado por ocupación (DOT-std). Sin embargo, en hospitales que no cuentan con fichas electrónicas, obtener el numerador de los días de terapia (DOT) requiere revisión directa de las indicaciones del paciente, dificultando su aplicabilidad. Objetivos: Validar el sistema de registros electrónicos de dispensación de medicamentos desde farmacia como fuente para el cálculo de DOT y DOT-std en la Unidad de Cuidados Intensivos Pediátrica (UCIP). Materiales y Métodos: Se revisaron las prescripciones de AMB desde la ficha clínica (método manual) y se compararon con los registros de dispensación de AMB a la UCIP (método informático) obtenidos del sistema de medicamentos de farmacia. Se evaluó la concordancia entre los DOT obtenidos mediante el Coeficiente de Correlación Intraclase. Resultados: Los AMB más utilizados fueron vancomicina, meropenem y piperacilina/tazobactam. En 9 de 12 AMB se encontró concordancia significativa entre ambos métodos. Conclusiones: Tras un proceso de validación local, los registros del sistema informático de dispensación de medicamentos desde farmacia podrían utilizarse para el cálculo de DOT en pediatría en hospitales que no cuenten con una ficha electrónica que permita su cálculo directo.

Background: The recommended indicator for measuring antimicrobial (AMB) consumption in pediatric patients is the Days of Therapy indicator (DOT), which is then standardized by hospital occupancy rates (DOT-std). However, in hospitals that do not have electronic health records, obtaining the DOT requires a direct review of each pharmacological indication, which is not feasible in the long term. Aims: To validate electronic records from the pharmacy dispensation system as a source for calculating DOT and estimating DOT-std in a Pediatric Intensive Care Unit (PICU). Methods: AMB prescriptions at the PICU of a university hospital were directly reviewed (manual method) and compared with AMB dispensation records (computer method) obtained from the hospital pharmacy system. The Intraclass Correlation Coefficient was used to evaluate the agreement between the DOT obtained by both methods. Results: The most used AMB were vancomycin, meropenem, and piperacillin/tazobactam. A significant agreement between the DOT obtained by using manual and computer methods was found in 9 of 12 evaluated AMB. Conclusions: After a local validation process, the electronic records of the pharmacy drug dispensation system could be considered a valid source for calculating DOT in PICUs in hospitals where electronic health records with prescription data are not yet available.

Effect evaluation of the clinical pharmacists participating in the treatment of patients with diabetic foot / 药学实践杂志

Objective To evaluate the effect of clinical pharmacists participating in the treatment of hospitalized patients with diabetic foot by antibiotics management index and health economics index. Methods 40 hospitalized patients with diabetic foot of Wagner Grade 4 in the Endocrine Department of Air Force Medical Center from April to September 2017 were selected as control group, and 40 hospitalized patients with diabetic foot of Wagner Grade 4 in the Endocrine Department from April to September 2019 were selected as interventional group. No clinical pharmacists were involved in drug treatment of patients in the control group, while the clinical pharmacists in the interventional group participated in drug treatment, and implemented antimicrobial stewardship, medication reconciliation, pharmaceutical care and medication education. Antibiotics management indexes (use intensity of antibiotics, use rate of special class antibiotics) and health economics indexes (medicine expenses, hospitalization expenses) of the two groups were compared. Results The efficacy of the two groups was similar. The use intensity of antibiotics and use rate of special class antibiotics of the interventional group in which clinical pharmacists participated were significantly lower than the control group (P<0.01), so were the medicine expenses and hospitalization expenses (P<0.01). Conclusion Clinical pharmacists participating in the treatment of hospitalized patients with diabetic foot could reduce antibiotics administration index and health economics index, promote rational medicine use and save medical expenses.

A Survey on Current Activities and Issues of Pharmacists at Facilities Calculating Fees for the Implementation of Antimicrobial Stewardship in Ehime / 社会薬学

Although the fees for the implementation of antimicrobial stewardship (AS addition) were newly established in the 2018 revision of medical fees, more detailed activities and issues of pharmacists at facilities calculating AS addition have not been clarified so far. Therefore, to understand the current status of AS activities and problems, we conducted a questionnaire survey of facilities that calculate the additional fee for infection prevention measures 1 and investigated whether there are differences in AS activities between facilities where pharmacists are full-time employees and facilities where non-pharmacists are full-time employees. The results showed that the number of antimicrobial agents used by full-time pharmacists was larger than that by non-pharmacists. In addition, the frequency of AS was lower for non-full-time workers than for full-time workers, with most full-time workers performing AS every day, while non-full-time workers performing AS two to three days a week. In addition, non-full-time workers lacked human resources and work time, and did not have sufficient work materials. The survey revealed that AS activities’ current status and problems differ between full-time and non-full-time employees.

READ-ing antimicrobial stewardship in the Caribbean: a tri-nation document review / El método READ y la administración de antimicrobianos en el Caribe: una revisión trinacional de documentos / Uso racional de antibióticos no Caribe com base na abordagem READ: revisão de documentos de três países

ABSTRACT Objective. To explore the antimicrobial stewardship policy landscape in three English-speaking Caribbean countries (Barbados, Guyana, and Saint Lucia) and examine the key enablers and challenges to the design and implementation of formal antimicrobial stewardship programs. Methods. A document analysis that searched for existing policy, communications, and contributions on antimicrobial stewardship from these three countries, adapting the READ (Ready materials; Extract data; Analyze data; Distill findings) approach, a systematic procedure for health policy document review. Results. The search strategy identified 726 initial records. Of those, 15 (2%) met the inclusion criteria. The analysis included official policy documents (n = 3), scholarly works/reviews (n = 3), advocacy documents (n = 2), news articles (n = 4), and confidential reports (n = 3) from the three countries. Conclusions. Critical matters such as cross-programmatic coordination, the significance of individual action, and the need for bidirectional knowledge discourse are prominent in optimizing antimicrobial stewardship adaptation in these countries. CARICOM regional coordination has positively impacted the integration of infection prevention and control with antimicrobial stewardship across this knowledge network.

RESUMEN Objetivo. Explorar el panorama de las políticas de optimización del uso de antimicrobianos en tres países caribeños de habla inglesa (Barbados, Guyana y Santa Lucía) y examinar los principales facilitadores y desafíos para elaborar y aplicar programas formales de optimización del uso de antimicrobianos. Métodos. Se adaptó el método READ (acrónimo en inglés de "materiales listos; extraer los datos; analizar los datos; destilar los resultados"), un procedimiento sistemático para la revisión de documentos sobre políticas de salud, a fin de realizar un análisis de documentos que buscó las políticas, comunicaciones y contribuciones existentes sobre la optimización del uso de antimicrobianos en esos tres países. Resultados. La estrategia de búsqueda permitió localizar 726 documentos iniciales. De ellos, 15 (el 2%) cumplían los criterios de inclusión. El análisis abarcó documentos oficiales de políticas (n = 3), trabajos académicos o revisiones (n = 3), documentos de promoción de la causa (n = 2), artículos de noticias (n = 4) e informes confidenciales (n = 3) de los tres países. Conclusiones. Varios aspectos críticos, como la coordinación interprogramática, la importancia de la acción individual y la necesidad de una comunicación bidireccional del conocimiento, son preponderantes para adaptar de la mejor manera la optimización del uso de antimicrobianos en estos países. La coordinación regional de la CARICOM ha influido positivamente para integrar la prevención y el control de infecciones con la optimización del uso de antimicrobianos en toda esta red de conocimientos.

RESUMO Objetivo. Explorar o cenário da política para uso racional de antibióticos em três países anglófonos do Caribe (Barbados, Guiana e Santa Lúcia) e examinar os principais fatores facilitadores e desafios para a elaboração e implementação de programas formais de uso racional de antibióticos. Métodos. Análise de documentos em busca de políticas, comunicações e contribuições existentes sobre o uso racional de antibióticos nesses três países, adaptando a abordagem READ (sigla em inglês para preparar materiais, extrair e analisar dados e destacar os principais achados), um procedimento sistemático para a revisão de documentos de políticas de saúde. Resultados. A estratégia de busca identificou 726 registros iniciais. Desses, 15 (2%) atenderam aos critérios de inclusão. A análise incluiu documentos oficiais de políticas (n = 3), trabalhos acadêmicos/revisões (n = 3), documentos em defesa da causa (n = 2), reportagens (n = 4) e relatórios confidenciais (n = 3) dos três países. Conclusões. Questões críticas, como a coordenação interprogramática, a importância da ação individual e a necessidade de um discurso bidirecional de conhecimento, se destacam na adaptação otimizada das diretrizes de uso racional de antibióticos nesses países. A coordenação regional da Comunidade do Caribe (CARICOM) contribuiu para integrar a prevenção e o controle de infecções ao uso racional de antibióticos em toda essa rede de conhecimento.

Antibiotic indication in endodontics by Colombian dentists with different levels of training: a survey / Indicação dos antibióticos em Endodontia por dentistas colombianos com diferentes níveis de formação: uma pesquisa por questionário

ABSTRACT Aim: This study investigated how Colombian dentists with different academic levels indicate antibiotics with therapeutic purposes in endodontics. Materials and method: A cross-sectional survey was conducted among 559 dentists in the form of an online questionnaire. Results: Three hundred and twenty questionnaires were answered (57.2%). There were significant differences among respondents. For irreversible pulpitis, 140 dentists (43.7%) said they prescribe antibiotics (57.5% of general practitioners, 20.1% of specialists and 38.9% of those with Master's and/or PhD degrees), while for symptomatic apical periodontitis, 183 (57.2%) did so (74.1% of general practitioners, 28.4% of specialists and 50.0% of those with Master's and/or PhD degrees) (p < 0.05). Amoxicillin was the most frequently prescribed antibiotic, and its association with clavulanic acid was the most often cited for acute periradicular abscess with systemic involvement. Conclusions: The greatest misunderstandings in prescribing antibiotics occurred among general practitioners. Considering all clinical conditions that do not require antibiotics, 60% of general practitioners and 34% of specialists, on average, indicated antibiotics.

RESUMO Objetivo: Este estudo investigou como dentistas colombianos com diferentes níveis acadêmicos indicaram antibióticos com fins terapêuticos em Endodontia. Materiais e método: Realizou-se um levantamento transversal com 559 dentistas. Foi enviado um questionário online. Resultados: Foram respondidos 320 questionários (57,2%). Houve diferenças significativas entre os profissionais com diferentes níveis de formação. Para pulpite irreversível, 140 (43,7%) dentistas afirmaram indicar antibióticos (57,5% clínicos gerais, 20,1% especialistas e 38,9% com mestrado e/ou doutorado), enquanto para periodontite apical sintomática, 183 (57,2%) prescrevem estes medicamentos (74,1% clínicos, 28,4% especialistas e 50,0% com mestrado e doutorado) (p < 0,05). A amoxicilina foi a mais indicada entre os profissionais, e sua associação com ácido clavulânico foi a mais referida para abscesso perirradicular agudo com acometimento sistêmico. Conclusões: Os maiores equívocos na prescrição de antibióticos ocorreram com os clínicos gerais. Considerando todas as condições clínicas que não requerem antibióticos, 60% dos clínicos gerais e 34% dos especialistas, em média, indicaram estes medicamentos.

Evaluation of knowledge, awareness, and practice of antimicrobial stewardship among prescribers of a teaching hospital in South India

Background: The injudicious and indiscriminate use of antimicrobials has led to the development of antimicrobial resistance (AMR), particularly in the low- and middle-income countries. Antimicrobial Stewardship (AMS) is the coordinated intervention to enhance the appropriate use of antimicrobials. Antimicrobial stewardship program (ASP) is a multidisciplinary program with interventions and strategies to encourage AMS to prevent emergence of AMR. Aims and Objectives: This study aimed at evaluating the knowledge, awareness, and practice (KAP) of AMS among prescribers of a teaching hospital in South India. Materials and Methods: A cross-sectional questionnaire based study conducted after obtaining Institutional Ethics Committee approval was conducted among prescribers of a teaching hospital from September 2022 to October 2022. Responses to the questionnaires issued to the prescribers through Google Forms were analyzed by descriptive statistics using Microsoft excel. Results: A total of 230 prescribers submitted the filled in questionnaires. The definition of AMS was known to 62%. The constitution and functioning of ASP was known to 59%. However, only a few (38%) prescribers agreed that antimicrobials are avoided in viral infections. More than 60% had good awareness of AMS. However, only 25% were aware of an ASP program is their hospital. Fifty percent agreed to the practice of reviewing antimicrobial use after 48–72 h and only 38% to the practice of obtaining cultures before prescribing antimicrobials. Conclusions: The prescribers had moderate knowledge and awareness and poor practice of AMS. To address these gaps, educational interventions and capacity building approaches are required.

Programa de Segurança do Paciente Focado nas Estratégias do Stewardship de Antimicrobianos para Staphylococcus Spp / Patient safety program focused on antimicrobial stewardship strategies for Staphylococcus spp

Introdução: A sedimentação do Programa de Stewardship de Antimicrobianos (ATMs), além de reduzir a indução da resistência bacteriana, assegura maior segurança aos pacientes. Este estudo teve por objetivo descrever o perfil de sensibilidade do Staphylococcus aureus e Staphylococcus coagulase negativo (S. CON) nas unidades de internação adulta do hospital para instrumentalizar as equipes e realizar o gerenciamento de ATMs. Métodos: Este estudo retrospectivo foi realizado através de busca em prontuário eletrônico de culturas laboratoriais com S. aureus e S. CON, independentemente do foco, dos anos de 2017, 2018 e 2019, das unidades de internação adultas não críticas e UTI adulto. Para análise, foi realizado o cálculo de coeficiente de sensibilidade absoluto e de médias. As variáveis qualitativas foram apresentadas em relação ao agente etiológico, antibiótico e local de isolamento, com posterior identificação de variabilidade e possibilidades terapêuticas disponíveis. Resultados: Apesar de ocorrer similaridade na distribuição das cepas de Staphylococcus spp. nos locais analisados do hospital, observou-se divergência entre os perfis de sensibilidade do S. aureus e S. CON. Existe superioridade no perfil de sensibilidade do S. aureus em comparação com o S. CON em relação a todos ATMs. A sensibilidade do S. aureus à oxacilina, ainda, possibilita tratamento com ß-lactâmicos; entretanto, a escolha de outras classes de ATMs torna-se necessária em casos de infecções complexas e graves. Conclusão: A análise periódica do perfil de sensibilidade aos ATMs é uma estratégia a ser alcançada para um eficaz programa de gerenciamento de ATMs, com fundamentação de protocolos e melhor assistência dos pacientes.

Introduction: The sedimentation of the antimicrobial stewardship program (ASP) reduces the induction of bacterial resistance and ensures greater patient safety. This study aimed to describe the sensitivity profile of Staphylococcus aureus and negative-coagulase Staphylococcus (CoNS) in adult inpatient units of the hospital to instrumentalize the teams and perform ASP management. Methods: This retrospective study was conducted by searching electronic medical records for laboratory cultures with S. aureus and CoNS, regardless of the focus, from 2017, 2018, and 2019, from the adult non-critical inpatient units and adult ICU. For the analysis, the study calculated the absolute sensitivity coefficient and means. Qualitative variables were related to the etiologic agent, antibiotic, and isolation site, with subsequent identification of variability and available therapeutic possibilities. Results: Although similarity occurred in the distribution of Staphylococcus spp. strains in the analyzed hospital sites, divergence was observed between the sensitivity profiles of S. aureus and CoNS. There is superiority in the sensitivity profile of S. aureus over CoNS concerning all ASP. The sensitivity of S. aureus to oxacillin still allows treatment with ß-lactams. However, the choice of other classes of ASP becomes necessary in cases of complex and severe infections. Conclusion: Periodic analysis of the ASP sensitivity profile is a strategy to achieve an effective ASP management program to support protocols and better patient care.

Programa de optimización del uso de antimicrobianos durante la pandemia de COVID-19 / Antimicrobial stewardship program during the COVID-19 pandemic

Resumen A pesar de la baja frecuencia de coinfecciones bacterianas asociadas al COVID-19, la tasa de uso de antibióticos (ATB) empíricos varía entre 70 y 90%. El objetivo primario del estudio fue evaluar el impacto de la implementación de un programa de optimización de antimicrobianos en pacientes con COVID-19 (PROA-COVID). Se realizó un estudio prospectivo de serie de tiempo interrumpida. Se evaluó la prevalencia, adecuación y consumo de ATB en adultos internados con COVID previo a la implementación del PROA-COVID (P1, junio 2020) y en tres períodos posteriores (P2 en agosto 2020, P3 en octubre 2020 y P4 en junio 2021). Se incluyeron 301 pacientes. Las formas clínicas moderadas-graves fueron más frecuentes en los P2, 3 y 4 (p < 0.001). La implementación del programa mostró una disminución significativa del uso de ATB (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), de la indicación de tratamiento combinado con macrólidos (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03) y aumento del uso adecuado (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). El consumo de ATB en DDT (días de tratamiento) totales/1000 días paciente fue: 347.9 vs. 272.8 vs. 134.3 vs. 43.6 (p < 0.001). No hubo diferencias significativas en el pase a unidades de cuidados críticos ni en la mortalidad. La implementación del PROA-COVID fue una estrategia efectiva para reducir el uso de antibióticos y optimizar sus indicaciones sin impacto en la morbimortalidad.

Abstract In spite of the low frequency of COVID-19 associated bacterial coinfections, the rate of empiric an tibiotic use varies between 70% and 90%. The primary objective of this study was to evaluate the impact of an antimicrobial stewardship program (ASP) on COVID-19 patients. The study design was an interrupted time series, assessing prevalence of antibiotic use, adequacy of treatment and antimicrobial consumption in adult patients hospitalized with COVID before the COVID-ASP implementation in June 2020, and on three subsequent periods (P2 in August 2020, P3 in October 2020 and P4 in June 2021). One hundred and one patients were included. Moderate and severe disease was more frequent in P2, P3, and P4 periods (p < 0.001). After the implementation we observed a significant reduction on ATM use (61% vs. 41% vs. 31.1% vs. 8.1%, p < 0.001), and macrolid combination therapy (17.3% vs. 19.2% vs. 10.8% vs. 1.4%, p = 0.03), and an increase of adequate use (37.5% vs. 46.9% vs. 69.9% vs. 66.6%, p = 0.039). Antimicrobial consumption by period in days of therapy (DOT)/1000 patient-day was 347.9 vs. 272.8 vs. 134.29 vs. 43.6 (p<0.001). We did not find any difference in intensive care unit transfer or mortality. COVID-ASP implementation was an effective strategy to reduce antimicrobial consump tion and optimize antibiotic indications without affecting morbidity or mortality.

Transição de via de linezolida endovenosa para via oral: uma análise de custo-minimização / Switching from intravenous to oral linezolid therapy: a cost-minimization analysis

Objetivo: Comparar custos da terapia endovenosa exclusiva com linezolida com os custos da terapia iniciada por via endovenosa com transição para via oral após 72 horas, como estratégia de intervenção em programas de gestão de antimicrobianos. Métodos: Avaliação econômica de custo-minimização comparando custos diretos da terapia endovenosa exclusiva com linezolida com a terapia endovenosa seguida de transição para via oral em cenário simulado, sob a perspectiva do Sistema Único de Saúde (SUS), com árvore de decisão como modelo para tomada de decisão. Resultados: A alternativa englobando a transição de via mostrou-se a mais econômica em todos os cenários analisados. Para 28 dias de tratamento com linezolida, houve redução de 22% nos custos, considerando o paciente internado. Ao considerar alta após o sexto dia de tratamento, a redução de custos variou de 26%, com financiamento pelo SUS do restante do tratamento, a 84%, com financiamento do tratamento pós-alta pelo paciente. Conclusão: Conclui-se que a transição de via de linezolida é uma importante estratégia nos programas de gerenciamento de antimicrobianos, capaz de gerar economia significativa para a instituição. As avaliações econômicas de custo-minimização, nesse contexto, são uma importante ferramenta para demonstrar o aspecto econômico com potencial para sensibilizar gestores e tomadores de decisão.

Objective: To compare the direct costs of linezolid intravenous therapy with the costs of intravenous therapy switching to oral therapy after 72 hours as an intervention strategy in antimicrobial stewardship programs. Methods: Economic evaluation cost-minimization comparing direct costs of exclusive linezolid intravenous therapy with intravenous therapy for 72 hours and after switching to oral therapy in a simulated scenario, from the perspective of the National Health Service, with a decision tree as a decision modeling. Results: The alternative encompassing the therapy transition proved to be the most economical in all analyzed scenarios. For 28 days of treatment with linezolid, there was a 22% reduction in costs, considering the hospitalized patient. When considering discharge after the sixth day of treatment, the cost reduction ranged from 26%, with funding from the National Health Service for the rest of the treatment, to 84%, with funding for the post-discharge treatment by the patient. Conclusion: It was concluded that the linezolid therapy transition is an important strategy in antimicrobial management programs, capable of generating significant savings for the institution. In this context, economic cost-minimization assessments are an important tool to demonstrate the economic aspect with the potential to raise awareness among managers and decision-makers.

Utility of a real?time fluorescence imaging device in guiding antibiotic treatment in superficial skin infections

The prescription of antibiotics empirically without confirmation of an infective etiology is on the rise. Administration of appropriate antibiotics can be guided by real-time fluorescence imaging using a point-of-care device. These composite images show the presence, type and the burden of infection. The time saved by this method over microbiological testing, especially in resource-poor settings, can lead to a paradigm shift in treatment by facilitating prompt and adequate antimicrobial therapy, surgical debridement as well as follow-up. Thumbnail sketches of a series of four cases highlighting different scenarios in which a fluorescent imaging device utilizing artificial intelligence and machine learning was found useful is presented in this report.

Estado de los programas de optimización del uso de antimicrobianos en hospitales: resultados de una Encuesta Nacional 2022 en Perú

Introducción: Los programas de Optimización de Antimicrobianos (PROA) en Instituciones Sanitarias son una estrategia implementada en diversos países. El estudio: Nuestro objetivo fue realizar una encuesta electrónica en los establecimientos de salud que cuentan con servicios de hospitalización en el Perú. Hallazgos: Ciento setenta establecimientos (38.4%) respondieron la encuesta entre MINSA (90%), ESSALUD (4.2%), FFAA PNP (2.9%) y Privados (2.9%). Solo 49 (28.8%) contaba con PROA funcionando dentro de su institución. El 83.7% contaban con una Resolución directoral que respalda sus funciones y el 38.8% referían contar con un plan de actividades PROA. Los problemas más frecuentemente identificados son la falta de recursos humanos capacitados (24.6%), la falta de capacitación y asistencia técnica (13.1%) y la falla en la prescripción de antibióticos (11.5%). Conclusión: Es prioritario seguir fortaleciendo los PROA en hospitales en el corto plazo con actividades que estimulen el uso racional de antimicrobianos.

Background: The Antimicrobial Optimization Programs (PROA in Spanish) in Health Institutions are a strategy implemented in different countries. The study: Our objective was to carry out an electronic survey in health establishments that have hospitalization services in Peru. Findings: One hundred seventy establishments (38.4%) responded to the survey between MINSA (90%), ESSALUD (4.2%), Armed Forces PNP (2.9%) and Private (2.9%). Only 49 (28.8%) had PROA working within their institution. 83.7% had a Director Resolution that supported their functions and 38.8% reported having a PROA activity plan. The most frequent problems identified are the lack of trained human resources (24.6%), the lack of training and technical assistance (13.1%) and the failure to prescribe antibiotics (11.5%). Conclusion: It is a priority to continue strengthening the PROA in hospitals in the short term with activities that stimulate the rational use of antimicrobials.

Prevenção e controle de resistência aos antimicrobianos na Atenção Primária à Saúde: evidências para políticas / Prevention and control of antimicrobial resistance in Primary Health Care: evidence for policies

Resumo A resistência aos antimicrobianos é um problema mundial que põe em risco a segurança da saúde da população. O objetivo deste artigo é identificar e avaliar estratégias para prevenção e controle de resistência microbiana, bem como barreiras para sua implementação em serviços de Atenção Primária à Saúde (APS). Realizou-se uma síntese de evidências para políticas. As buscas de evidências foram realizadas entre novembro/dezembro de 2018, em 13 bases de dados. Um diálogo deliberativo foi realizado para validação dos resultados e levantamento de barreiras e facilitadores para implementação das estratégias. As 13 revisões sistemáticas incluídas mostraram que intervenções com foco em educação, uso de sistemas eletrônicos e biomarcadores reduziram o consumo e prescrição de antimicrobianos. É um obstáculo à implementação a expectativa de usuários/cuidadores em receber prescrição de antibióticos, e são facilitadores as ações educativas que envolvem profissionais de saúde. O uso racional de medicamentos se impõe na APS com vistas à prevenção da resistência dos microrganismos aos antibióticos. As intervenções identificadas neste estudo podem ser implementadas isoladamente ou em conjunto, conforme o contexto local.

Abstract Antimicrobial resistance is a global problem that puts the population's health at risk. This paper aims to identify and evaluate strategies for the prevention and control of antimicrobial resistance, and barriers to their implementation in Primary Health Care (PHC) services. We developed an evidence brief for policies. The search for evidence occurred in 13 databases from November to December 2018. A deliberative dialogue was performed to validate the results and we identified barriers and facilitators to implementing the strategies. The 13 systematic reviews included evidenced that the interventions focused on education, use of electronic systems and biomarkers reduced antimicrobial consumption and prescription. User/caregiver's expectation to receive antibiotic prescriptions was the main obstacle to implementing strategies, while education actions involving health professionals were facilitators. The rational use of medications in the PHC services is crucial to prevent antimicrobial resistance to antibiotics. The interventions identified in this study can be implemented alone or combined, according to local context.

A Trial to Establish an Antimicrobial Prescription Monitoring System for Antimicrobial Stewardship in Clinics / 日本プライマリ・ケア連合学会誌

Introduction: We investigated the feasibility and validity of developing a system to monitor prescriptions prescribed by physicians for the promotion of appropriate antimicrobial use in clinics.Methods: The names of injuries and diseases and prescribed drugs stored in the receipt computers of six clinics were output and anonymized. Antimicrobial prescriptions for acute respiratory tract infections and acute diarrhea were compiled and evaluated.Results: Anonymized data were available for all six clinics. We were able to extract data and aggregate prescriptions by linking the name of the injuries and diseases to the prescribed drug.Conclusions: We consider it possible to establish antimicrobial stewardship in clinics through antimicrobial prescription monitoring and to develop such a system. On the other hand, there are multiple ways of naming injuries and diseases, and further investigation is needed to define the names of injuries and diseases to be extracted.

Establishing the diagnostic stewardship for infectious diseases with multidisciplinary cooperation / 中华检验医学杂志

Many new rapid microbiological diagnostic technologies have been used in clinical setting at present. It is necessary to follow the 5R principles (right patient, right time, right test, right reporting and right interpretation) to establish the diagnostic stewardship system with multidisciplinary cooperation. Diagnostic stewardship will give full play to the advantages of conventional and new technologies, improve clinical practice, save medical cost and curb the development of antimicrobial resistance.

Discussion on the rationality of clinical application of prolonging antibiotic infusion time / 中国小儿急救医学

The rapidly growing emergence of drug resistant bacteria has become one of the most important public health concerns.However, the development of new drugs is of more difficulties.Extended infusion or prolonged infusion of antibiotics is a significant way of antimicrobial stewardship programs, which has been proven beneficial to better pharmacokinetic/pharmacodynamic targets attainment and improved clinical outcomes.This review discussed the rationality of prolonging the infusion time of commonly used antibiotics in PICU.

Evaluation and management of application of antibiotics in PICU / 中国小儿急救医学

Antibiotics are the most commonly used medicines in PICU.For children with severe infection, it is very important to ensure the curative effect of patients and reduce the adverse effects of antibiotic abuse through reasonable empirical initial use of antibiotics, timely evaluation and regulation, and appropriate course of antibiotic treatment.This review discussed several main problems of clinical application of antibiotics in PICU, in order to help clinicians in PICU improve the evaluation and management of antibiotics use.

Analysis on effect of antimicrobial stewardship based on information technology for 6 years / 中华急诊医学杂志

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.

Point-of-Care Procalcitonin to Guide the Discontinuation of Antibiotic Treatment in the Intensive Care Unit: A Malaysian Randomised Controlled Trial

@#Introduction: This work aims to establish the practicality of simple point-of-care (POC) measurements of procalcitonin (PCT) coupled with the standard PCT-guided antibiotic treatment discontinuation algorithm to guide the cessation of antibiotic treatment in intensive care unit (ICU). Methods: In this randomised-controlled trial, 80 adult patients with suspected bacterial infections were randomised to either the POC PCT-guided arm (n = 40) or the standard-of-care arm (n = 40). The decision to discontinue antibiotic treatment in the POC PCT-guided arm was based on the POC PCT-guided antibiotic-treatment discontinuation strategy, which states that discontinuation is urged once the PCT concentration has reduced by ≥ 80% or to < 0.5 ng/mL. In the standard-of-care arm, the antibiotic-treatment duration followed the local guidelines. Results: The median duration of antibiotic treatment was 6.5 [IQR = 5.0-7.0] days in the POC PCT-guided antibiotic-treatment arm versus 7.5 [IQR = 5.0-14.0] days in the standard-of-care arm (p = 0.010). The mean antibiotic-free days in the first 30 days after study inclusion was 20.7 (SD = 5.3) days in the POC PCT-guided antibiotic-treatment arm versus 16.4 (SD = 7.4) days in the standard-of-care arm (p = 0.004). The number of patients who took an antibiotic for more than 10 days was 2 (5%) in the POC PCT-guided antibiotic-treatment arm versus 13 (32.5%) in the standard-of-care arm (p = 0.002). Conclusion: Antibiotic use in patients with symptoms of bacterial infections in the ICU was substantially minimised with the installation of a POC PCT-guided antibiotic-treatment cessation.