In April , a system for monitoring unnecessary double anaerobic coverage prescription was established. The IDS confirmed the appropriateness as mentioned in a previous report by Song et al. The trends in antibiotic use, antimicrobial resistance rate for major pathogens, and in-hospital mortality before, and after interventions were analysed.
The primary outcome of the study was antibiotic use. The secondary outcomes consisted of the antimicrobial resistance rate for major pathogens, and in-hospital mortality.
Patients in the general wards GWs and ICU were analysed separately, and the trauma unit, neonatal ICU, and paediatric ward were excluded from analysis. In-hospital mortality was analysed only for ICU patients. Data on the number of monthly antibiotic prescriptions, monthly patient-days, and monthly antimicrobial sensitivity tests of major bacterial pathogens among inpatients between September and August were acquired from the electronic database.
The study protocol was approved by the Institutional Review Boards of the Eulji University Hospital , and the requirement for written informed consent from patients was waived due to the retrospective nature of the study, and its impracticability. In this paper, Anatomical Therapeutic Chemical ATC classification system class J01 antibiotics, which does not include antifungal agents or anti-tuberculosis agents, were included for analysis Systemic agents with per oral or parenteral administration routes were included, while topical agents were excluded.
Each class of antibiotic was quantified via days of therapy DOT , which was then standardized per 1, patient-days PD Other antibiotics, such as amphenicol, fosfomycin, and streptogramin were excluded because they are rarely used.
Carbapenems, tigecycline, glycopeptides, oxazolidinone, and polymyxin were defined as antibiotics against multidrug-resistant MDR pathogens. The remaining antibiotic classes were defined as non-broad-spectrum antibiotics.
The first isolate of these pathogens for each admission per patient was included in the analysis. In addition, we performed subgroup analysis according to the type of specimens blood, urine, and sputum.
In this paper, the major bacterial pathogens were: Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, Staphylococcus aureus , and Enterococcus faecium.
We defined the antimicrobial resistance rate as the proportion of resistant isolates among total isolates. The breakpoints of each compound were defined in reference to the Clinical and Laboratory Standards Institute CLSI 12 , and outcomes of R resistance or I intermediate were defined as resistance. The impact of intervention on antibiotic use, antimicrobial resistance rate, and in-hospital mortality were evaluated through segmented regression analysis of an interrupted time series with adjustment for autocorrelation We confirmed that Durbin-Watson test statistics for the overall antibiotic usage and resistance rate indicated no serious autocorrelation after the adjustment.
The study period September —August was divided by interventions and analysed as follows:. In the analysis of the impact by major intervention, the study period was divided into pre-intervention September —August and major intervention September —August In the analysis of the impact by minor intervention, the study period was divided into pre-intervention September —August , major intervention September —March , and minor intervention April —August The impact of minor intervention was tested against the whole previous period September —March because main target antibiotics of the minor intervention lincosamides and metronidazole were not included in designated antibiotics of the restrictive measures.
The total antibiotic use in GWs during the pre-intervention, and intervention periods were Although an immediate increase in use by The total antibiotic use in ICUs were As for broad-spectrum antibiotics in GWs, there was a significant increase in level of antibiotic usage after the intervention The intervention did not affect the trend of non-broad-spectrum antibiotics for patients in both the GWs and ICUs Fig.
Changing trends in antibiotic use among inpatients over time. A Antibiotics against multidrug-resistant pathogens in general wards; B Broad-spectrum antibiotics in general wards; C Non-broad-spectrum antibiotics in general wards; D Antibiotics against multidrug-resistant pathogens in intensive care units; E Broad-spectrum antibiotics in intensive care units; F Non-broad-spectrum antibiotics in intensive care units.
Among antibiotics against MDR pathogens, the impact of the major intervention on carbapenems and glycopeptides were particularly prominent. Furthermore, the major intervention resulted in a significant decrease in both level and trend for the use of polymyxin among patients of ICUs. As for broad-spectrum antibiotics, the impact of the intervention was more significant in GWs compared to ICUs. The usage of FQs in ICUs was significantly reduced immediately after the intervention, but no significant change in trend was observed.
The impact of restrictive measures for designated antibiotics on non-broad-spectrum antibiotics was not as significant as that on antibiotics against MDR pathogens, or broad-spectrum antibiotics. The intervention effect was prominent for the resistance rate of S. In addition, a significant decrease in trend was observed for the resistance rate of P.
Changing trends in antimicrobial resistance over time. A Resistant rate of Staphylococcus aureus to gentamicin in general wards; B Resistant rate of Staphylococcus aureus to ciprofloxacin in intensive care units; C Resistant rate of Staphylococcus aureus to oxacillin in intensive care units; D Resistance rate of Pseudomonas aeruginosa to imipenem in intensive care units. According to the subgroup analysis, there was a significant negative change in slope for ciprofloxacin resistance rate of E.
Furthermore, as for K. The average in-hospital mortality rates per 1, patient-days were In-hospital mortality among ICU patients remained stable between the two periods: there was no significant change in level coefficient 0.
These results show that a significant reduction in antibiotic use, and a decrease in antimicrobial resistance rates were achieved by an IDS-driven ASP in a large hospital in Korea. The effect of IDS-driven ASPs is well established by several studies: a significant improvement in the appropriateness of antibiotic prescription, and a decreased antibiotic consumption were commonly found 15 , As with most large hospitals in Korea, the major intervention at this study site was restrictive measures for designated antibiotics 7 ; which is similar to the preauthorization-of-antibiotic use programme in that the prescription of certain antibiotics is restricted unless approval is granted.
The efficacy of restrictive antibiotic measures on both the reduction of antibiotic usage, and a decrease in the incidence of MDR pathogens is well established 18 , However, there are several potential drawbacks to restrictive measures. We found that designated antibiotics comprise 9. The designated antibiotics in the study hospital are commonly controlled in large hospitals in Korea; carbapenems, tigecycline, glycopeptides, oxazolidione, and polymyxin 7. Thirdly, the effect on the reduction of antibiotic use declines gradually with the passage of time This may be attributable to the effect of the written suggestion for appropriate antibiotic usage, which was given with the outcome of the decision on the prescription of designated antibiotics.
Similar to these findings, the result of a recent single-centre-based study in Italy showed a mixed educational and restrictive measure for designated antibiotics resulted in reduction of both designated and undesignated antibiotic use Furthermore, a previous single-centre-based study in Korea showed that even though the compliance rate of attending physicians was low after antibiotic advisory consultation, a significant reduction in antibiotic use was observed In fact, non-restrictive feedback measures such as prospective audit and feedback are considered to be another key strategy for intervention measures of ASPs 6.
A recent study in the US revealed that a non-restrictive feedback measure post-prescription review with feedback was superior to a restrictive measure such as preauthorization-of-antibiotic use Therefore, reinforcement of feedback measures should be considered for better ASPs in Korean hospitals. Unfortunately, ASPs in Korean hospitals heavily depended on restrictive measures for designated antibiotics due to limited manpower 7.
According to Infectious Disease Society of America IDSA guidelines, multidisciplinary antimicrobial stewardship teams, which include an IDS and a clinical pharmacist with infectious diseases training are essential for realizing ASPs, and individuals of the team should be compensated appropriately for their time 6.
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Gilbert and R. Moellering and G. Eliopoulos and H. Chambers and M. Gilbert , R. Antibiotics have played an essential role in decreasing morbidity and mortality from infectious diseases. However, indiscriminate use and unrestricted access is contributing to the emergence of bacterial resistance. This paper reports on a situational analysis of antimicrobial use and resistance in Ghana, with focus on policy and regulation.
Relevant policy documents, reports, regulations and enactments were reviewed. PubMed and Google search engines were used to extract relevant published papers. An interview guide was used to elicit responses from selected officials from these sectors. Laws and guidelines to control the use of antimicrobials in humans were available but not for animals. Slideshare uses cookies to improve functionality and performance, and to provide you with relevant advertising.
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Been Medical Video Lectures Dr. Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs ASPs in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India.
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Features of The Sanford Guide to Antimicrobial Therapy 50th Edition PDF: Following are the features of this book given below; Available in print in pocket size, spiral bound and large library editions. Leave a Reply Cancel reply Your email address will not be published.
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