Empiric Antibiotic Prescribing Research Articles

Measuring empiric antibiotic spectrum-A journey through space and time.

The typical 5-day work week affects healthcare outcomes. Structured work hours have also been implicated in antimicrobial prescribing choice. We developed a visualization tool to aid in evaluating breadth of antibiotic use in various time (day of week and hour of day) and space (patient location) combinations. We evaluated antibiotic administration data from a tertiary-care academic medical center between July 1, 2018, and July 1, 2020. We calculated a cumulative empiric antibiotic spectrum score by adapting a previously validated antibiotic spectrum index (ASI) and applying that score to empiric antibiotic use. We visualized these data as a heat map based on various day-of-week-time combinations and then compared the distribution of scores between weekday nights, weekend days, and weekend nights to the typical workweek hours (weekday days, weekday days) using the Mann-Whitney U nonparametric test with a Bonferroni correction. The analysis included 76,535 antibiotic starts across 53,900 unique patient admissions over 2 years. The mean cumulative ASI was higher in all 3 night and weekend combinations (weekday nights, 7.3; weekend days, 7.6; weekend nights, 7.5) compared to the weekday daytime hours (weekday days, 7.1) and the distribution of scores was different in all groups compared to the weekday daytime reference. The cumulative ASI was also higher in intensive care units. Empiric antibiotic prescribing patterns differed across space and time; broader antibiotic choices occurred in the intensive care units and on nights and weekends. Visualization of these patterns aids in antimicrobial prescribing pattern recognition and may assist in finding opportunities for additional antimicrobial stewardship interventions.

Decreased survival in children inpatients with COVID-19 and antibiotic prescription

BackgroundThe empirical prescription of antibiotics to inpatients with Coronavirus Disease 2019 (COVID-19) is frequent despite uncommon bacterial coinfections. Current knowledge of the effect of antibiotics on the survival of hospitalized children with COVID-19 is limited.ObjectiveTo characterize the survival experience of children with laboratory-positive COVID-19 in whom antibiotics were prescribed at hospital admission.MethodsA retrospective cohort study was conducted in Mexico, with children hospitalized due to COVID-19 from March 2020 to December 2021. Data from 1601 patients were analyzed using the Kaplan–Meier method and the log-rank test. We computed hazard ratios (HR) and 95% confidence intervals (CI) to evaluate the effect of the analyzed exposures on disease outcomes.ResultsAntibiotics were prescribed to 13.2% (n = 211) of enrolled children and a higher mortality rate [14.9 (95% CI 10.1–19.8) vs. 8.3 (95% CI 6.8–9.8)] per 1000 person-days, p < 0.001) was found among them. At any given cut-off, survival functions were lower in antibiotic-positive inpatients (p < 0.001). In the multiple model, antibiotic prescription was associated with a 50% increase in the risk of fatal outcome (HR = 1.50, 95% CI 1.01–2.22). A longer interval between illness onset and healthcare-seeking and pneumonia at hospital admission was associated with a poorer prognosis.ConclusionsOur results suggest that antibiotic prescription in children hospitalized due to COVID-19 is associated with decreased survival. If later replicated, these findings highlight the need for rational antibiotics in these patients.

Empirical Antibiotic Prescribing in Adult COVID-19 Inpatients over Two Years in Mexico.

Background and Objectives: Empirical antibiotic prescribing in patients with coronavirus disease 2019 (COVID-19) has been common even though bacterial coinfections are infrequent. The overuse of antibacterial agents may accelerate the antibiotic resistance crisis. We aimed to evaluate factors predicting empirical antibiotic prescribing to adult COVID-19 inpatients over 2 years (March 2020–February 2021) in Mexico. Materials and Methods: A cross-sectional analysis of a nationwide cohort study was conducted. Hospitalized adults due to laboratory-confirmed COVID-19 were included (n = 214,171). Odds ratios (OR) and 95% confidence intervals (CI), computed by using logistic regression models, were used to evaluate factors predicting empirical antibiotic prescribing. Results: The overall frequency of antibiotic usage was 25.3%. In multiple analysis, the highest risk of antibiotic prescription was documented among patients with pneumonia at hospital admission (OR = 2.20, 95% CI 2.16–2.25). Male patients, those with chronic comorbidities (namely obesity and chronic kidney disease) and longer interval days from symptoms onset to healthcare seeking, were also more likely to receive these drugs. We also documented that, per each elapsed week during the study period, the odds of receiving antibiotic therapy decreased by about 2% (OR = 0.98, 95% CI 0.97–0.99). Conclusion: Our study identified COVID-19 populations at increased risk of receiving empirical antibiotic therapy during the first two years of the pandemic.

P17 Quality assurance in bacterial identification and antimicrobial susceptibility testing results: an essential component of antimicrobial resistance surveillance

BackgroundAntimicrobial resistance (AMR) is a major threat to human health. Bacterial identification and antibiotic susceptibility testing play an essential role in patient care and control of antibiotic resistance mechanisms by indicating which antibiotics are most likely to treat an infection, reducing the empirical prescription of broad-spectrum antibiotics and avoiding the unnecessary prescription of antibiotics to reduce healthcare costs. AMR surveillance in Kenya has historically been focused on pathogens that cause significant mortality and morbidity such as diarrhoea illnesses and bacteraemia. Many private hospitals and a few public hospitals in Kenya have the capacity to conduct antimicrobial susceptibility testing; however, the available data are rarely verified for quality.MethodsThis study was conducted in five sentinel sites in Kenya. Clinical samples were processed in the sites as part of routine microbiology. Each sentinel site selected isolates as per the National AMR sample referral guide and sent them to the National Microbiology Reference Laboratory (NMRL) for quality assessment. Upon reception of isolates at NMRL, they were subcultured and subjected to organism identification testing using MALDI-TOF equipment. Antimicrobial susceptibility testing was performed using Vitek 2 compact. In case of any discrepancy on organism identification, correct antibiotic selection and resistance interpretation, the sites were informed.ResultsAntimicrobial susceptibility testing was conducted on Escherichia coli and Staphylococcus aureus, which were the most frequently isolated pathogens. High resistance to cephalosporins was observed with the E. coli isolates. Over 80% susceptibility of E. coli to amikacin, ampicillin, gentamicin, meropenem, nitrofurantoin and piperacillin/tazobactam was observed. This shows that the antibiotics can be used for empirical therapy in areas where there is no laboratory capacity for antibiotic susceptibility testing. Resistance to gentamicin of S. aureus isolates was found to be 10%, which shows that gentamicin still finds a role in controlling S. aureus infections. Penicillin resistance in S. aureus was 100%. High levels of resistance were observed with erythromycin (61%) and ampicillin (84%)ConclusionsThere is no site that scored 100% in pathogen identification and drug–bug combination. Continuous capacity building of AMR surveillance sites through mentorships to improve quality of data generated is of paramount importance. E. coli and S. aureus were the most frequently isolated pathogens. High levels of resistance were observed with erythromycin (61%) and ampicillin (84%), which calls for antibiotic stewardship programmes to educate on optimal antibiotic use.

Dismantling antibiotic infrastructures in residential aged care: The invisible work of antimicrobial stewardship (AMS)

Recent social science scholarship has sought to understand the visible and invisible impacts of how antibiotics are entrenched as infrastructures and put to work as a proxy for higher levels of care (clinical or otherwise) within modern healthcare. Using a qualitative research design, in this paper our aim is to draw attention to less visible aspects of antimicrobial stewardship (AMS) in residential aged care and their implications for nurse-led optimization of antibiotic use in these settings. By developing an account of the perceptions, experiences and practices of staff regarding the ‘on the ground’ work associated with implementing and upholding AMS objectives our study extends research on attempts to dismantle antibiotic infrastructures in Australian residential aged care facilities (RACF). Drawing on a review of relevant policies, empirical data is presented from fifty-six in-depth interviews conducted in 2021 with staff at 8 different RACFs. Interview participants included managers, nurses, and senior and junior personal care assistants. Our results suggest that registered nurses in residential aged care have been tasked with promoting antibiotic optimization and assigned with AMS responsibilities without sufficient authority and resourcing. A host of hidden care work associated with AMS strategies was evident, reinforcing some staff support for empirical antibiotic prescribing as a ‘safety net’ in uncertain clinical cases. We argue that this hidden work occurs where AMS strategies displace the infrastructural role previously performed by antibiotics, exposing structural gaps and pressures. The inability of organisational accounting systems and the broader AMS policy agenda to capture hidden AMS workflows in RACFs has consequences for future resourcing and organisational learning in ways that mean AMS gaps may remain unaddressed. These results support findings that AMS interventions might not be easily accepted by aged care staff in view of associated burdens which are under recognised and under supported in this domain.

The development and implementation of a guideline-based clinical decision support system to improve empirical antibiotic prescribing

BackgroundTo describe and evaluate a clinical decision support system (CDSS) for empirical antibiotic therapy using a systematic framework.MethodsA reporting framework for behavior change intervention implementation was used, which includes several domains: development, evaluation and implementation. Within the development domain a description is given of the engagement of stakeholders, a rationale for how the CDSS may influence antibiotic prescribing and a detailed outline of how the system was developed. Within the evaluation domain a technical validation is performed and the interaction between potential users and the CDSS is analyzed. Within the domain of implementation a description is given on how the CDSS was tested in the real world and the strategies that were used for implementation and adoption of the CDSS.ResultsDevelopment: a CDSS was developed, with the involvement of stakeholders, to assist empirical antibiotic prescribing by physicians. Evaluation: Technical problems were determined during the validation process and corrected in a new CDSS version. A usability study was performed to assess problems in the system-user interaction. Implementation: In 114 patients the antibiotic advice that was generated by the CDSS was followed. For 54 patients the recommendations were not adhered to.ConclusionsThis study describes the development and validation of a CDSS for empirical antibiotic therapy and shows the usefulness of the systematic framework for reporting CDSS interventions. In addition it shows that CDSS recommendations are not always adhered to which is associated with incorrect use of the system.

Risk Factors for Trimethoprim and Sulfamethoxazole-Resistant Escherichia Coli in ED Patients with Urinary Tract Infections

BackgroundWhile trimethoprim-sulfamethoxazole (TMP-SMX) is recommended as one of the first-line empiric therapies for treatment of acute uncomplicated cystitis, institutions that observe resistance rates exceeding 20% for Escherichia coli (E. coli) should utilize alternative empiric antibiotic therapy per the Infectious Diseases Society of America (IDSA). Identifying risk factors associated with TMP-SMX resistance in E. coli may help guide empiric antibiotic prescribing for urinary tract infections (UTIs). MethodsThis multicenter, retrospective study included adult patients who were discharged from 12 emergency departments (EDs) with a urine culture positive for E. coli between January 1, 2019 and December 31, 2019. Logistic regression was used to assess the relationship between potential risk factors and TMP-SMX resistance. The overall institutional antimicrobial resistance rates for E. coli were compared to the rates seen in the study population of ED urinary isolates. ResultsAmong 427 patients included from a randomized sample of 500 with a urine culture positive for E. coli, 107 (25.1%) were resistant to TMP-SMX. Three predictors of TMP-SMX resistance were identified: recurrent UTI (OR 2.27 [95% CI 1.27–3.99]), genitourinary abnormalities (OR 2.31 [95% CI 1.17–4.49]), and TMP-SMX use within 90 days (OR 8.77 [95% CI 3.19–28.12]). When the antibiotic susceptibilities for this ED cohort were compared to the institutional antibiogram, the TMP-SMX resistance rate was found to be higher in the ED population (25.1% vs 20%). ConclusionsTMP-SMX should likely be avoided as first-line therapy for UTI in patients who have recurrent UTIs, genitourinary abnormalities, or have previously received TMP-SMX within the past 90 days. The use of an ED-specific antibiogram should be considered for assessing local resistance rates in this population.

Study protocol for a population-based observational surveillance study of culture-confirmed neonatal bloodstream infections and meningitis in South Africa: Baby GERMS-SA

IntroductionWorldwide, neonatal mortality remains high accounting for 47% of childhood deaths in 2019 and including an estimated 500 000 deaths from neonatal infections. While 42% of global neonatal deaths occur...

Prevalence of Empiric Antibacterial Therapy, Community-Acquired Bacterial Superinfection, and Antibiotic-Associated Adverse Reactions among Patients with COVID-19 Pneumonia Admitted in Makati Medical Center from March 2020 to March 2021.

BackgroundCoronavirus disease 2019 (COVID-19) is caused by the novel coronavirus which was first discovered in Wuhan, China. Being a viral illness, antibacterial agents theoretically have no role in patients with pure COVID-19 infection. However, like any viral illness, concomitant bacterial infection may occur. The dilemma of starting an antibacterial agent in a COVID-19 patient remains a debate since the use of antibacterial agents may pose a risk of developing antibiotic-associated adverse events such as the emergence of drug-resistant pathogens and other antibiotic-associated drug toxicity. The primary objective of the study is to determine the amount of empiric antibacterial prescription done by physicians among admitted patients with COVID-19 infection as well as the trend of antibiotic prescription by physicians during the past 12 months of the COVID-19 pandemic. The secondary objective was to determine and quantify antibiotic-associated adverse effects.Materials and MethodsThis is a retrospective cohort study wherein charts of patients admitted for COVID-19 last March 2020 to March 2021 were reviewed and analyzed. Empiric antibiotic prescription during the first 48 hours of admission was noted as well as the proportion of concomitant bacterial infections. Development of antibiotic-associated adverse events such as the development of the multidrug-resistant organism and fungal infections, Clostridiodes difficile and/or gastrointestinal side effects, and hypersensitivity reactions were also noted.ResultsResults showed that among the 895 patients with COVID-19 admitted, 533 (59.6%) patients were started antibiotics during the first 48 hours of admission. Among those patients who are started with antibacterial therapy during the first 48 hours of admission, 60 (15.3%) patients had bacterial coinfection. The prevalence of antibiotic-associated adverse events was 46.9%, the most common of which was gastrointestinal reactions. The overall mortality rate of the patients given antibiotics was 18.8%. The median length of hospital stay was 11 days.ConclusionCommunity-acquired bacterial infections in COVID-19 patients admitted during the study period were low while empiric antibiotic prescription was high especially during the first few months of the pandemic, especially during the surge. Antibiotic-related adverse effects were high. There was a noted decreasing trend of antibiotic prescription during the latter part of the pandemic when new developments in COVID-19 treatment were discovered. All in all, routine antibacterial prescription in patients with COVID-19 is not recommended given the real-world data in this study.

Pattern of Antibiotic Prescription for Orofacial Infections among Dentists: A Narrative Review of Literature

Bacterial infections are common in dental and oral clinical practice. It is been estimated that about 10% of total antibiotic prescriptions are related to dental infections. Combination of amoxicillin-clavulanate and plain amoxycillin is the most commonly used drug by dentists across the world. Three general considerations were recognized in this literature review—Empirical antibiotic prescription by dentists without a culture test; concomitant prescription of antibiotics with non-steroidal anti-inflammatory drugs which may ultimately affect the bioavailability of the former drug; and the increased antimicrobial resistance amongst oral pathogens. Since decades, antibiotics have been prescribed for the treatment of odontogenic infections and non-odontogenic oral infections, and for focal infections and sepsis prophylaxis. Renal failure, liver failure, and pregnancy are situations that require special attention when considering an antibiotic prescription. This review attempted to contribute to the rational use and abuse of antibiotics while focusing on the general characteristics of these drugs.

Predictors of respiratory bacterial co-infection in hospitalized COVID-19 patients

The primary objectives were to determine the prevalence of and identify variables associated with respiratory bacterial co-infection in COVID-19 inpatients. Secondary outcomes included length of stay and in-hospital mortality. Eighty-two (11.2%) of 735 COVID-19 inpatients had respiratory bacterial co-infection. Fifty-seven patients met inclusion criteria and were matched to three patients lacking co-infection (N = 228 patients). Patients with co-infection were more likely to receive antibiotics [57 (100%) vs 130 (76%), P < 0.0001] and for a longer duration [19 (13-33) vs 8 (4-13) days, P < 0.0001]. The multi-variable logistic regression model revealed risk factors of respiratory bacterial co-infection to be admission from SNF/LTAC/NH (AOR 6.8, 95% CI 2.6-18.2), severe COVID-19 (AOR 3.03, 95% CI 0.78-11.9), and leukocytosis (AOR 3.03, 95% CI 0.99-1.16). Although respiratory bacterial co-infection is rare in COVID-19 inpatients, antibiotic use is common. Early recognition of respiratory bacterial coinfection predictors in COVID-19 inpatients may improve empiric antibiotic prescribing.

Appropriateness of the Empirical Antibiotics Prescribed and Their Concordance with National Guidelines for Three Selected Infections among Cancer Patients in a Tertiary Care Centre in Sri Lanka.

Background Prophylactic and empirical antibiotic use is essential in cancer patients due to the underlying immune deficiencies. We examined the spectrum of causative bacteria and the appropriateness of empirical antibiotic prescription for three selected infections in cancer patients. Methodology. A descriptive cross-sectional study was conducted at the National Institute of Cancer (NIC), Sri Lanka, from June 2018 to February 2019. Bacterial isolates obtained from adult cancer patients with a diagnosis of lower respiratory tract infections (LRTI), skin and soft tissue infections (SSTI), or urinary tract infections (UTI) were included. Causative bacteria were identified and the antibiotic susceptibility was determined by standard microbiological methods. Empirical therapy was defined as appropriate if the isolated pathogen was susceptible in vitro to the given antibiotic. Results A total of 155 bacterial isolates were included in the analysis. LRTI were the most prevalent infections (37.2%, 55/148) encountered during the study period. Majority (90.9%) of the isolated bacteria were ESKAPE pathogens. Klebsiella pneumoniae was the most frequent pathogen causing LRTI (42.4%, 25/59), whereas Escherichia coli (32%, 16/50) and Staphylococcus aureus (26.1%, 12/46) predominated in UTI and SSTI, respectively. Meropenem was the most prescribed empirical antibiotic for LRTI (29.1%, 16/55) and SSTI (26.6%, 11/43) while it was ceftazidime for UTI (36%, 18/50). Only 20.6% (32/155) of the isolated bacteria were susceptible to the empirical antibiotic prescribed while 48.4% (75/155) were resistant to them. The prescribed empirical antibiotic did not have the spectrum of activity for the isolated bacteria in 29% (45/155) of cases. Conclusion High resistance rates were observed against the prescribed empirical antibiotics. National empirical antibiotic guidelines should be revised with updated data on causative organisms and their susceptibility patterns to ensure appropriate empirical antibiotic prescription.

Antibiotic prescription consistent with guidelines in emergency department is associated with 30-day survival in severe community-acquired pneumonia

BackgroundThe selection of initial empirical antibiotics is an important issue in the treatment of severe community-acquired pneumonia (CAP). This study aimed to investigate whether empirical antibiotic prescription concordant with guidelines in the emergency department (ED) affects 30-day mortality in patients with severe CAP.MethodsWe conducted a retrospective analysis of adult patients with severe CAP who were hospitalized in the ED. Severe CAP was defined according to the criteria of the 2007 Infectious Diseases Society of America/American Thoracic Society guidelines. Patients were divided into two groups according to whether they were prescribed empirical antibiotics concordant with guidelines. Multivariable Cox proportional hazard regression analysis was performed to identify the independent association between the prescription of initial empirical antibiotics concordant with the guidelines and 30-day mortality. Propensity score matching was performed to reduce selection bias between groups and Kaplan–Meier survival analysis was performed to analyze the time-to-event of 30-day survival.ResultsIn total, 630 patients were hospitalized in the ED for severe CAP, and 179 (28.4%) died within 30 days. Antibiotics consistent with guidelines were prescribed to 359 (57.0%) patients. The 30-day mortality was significantly higher in the guideline-discordant group (p = 0.003) and multivariable Cox proportional hazard regression analysis revealed that the prescription of antibiotics discordant with the guidelines was independently associated with 30-day mortality (hazard ratio 1.43, 95% CI 1.05–1.93). After propensity score matching, there were 255 patients in each group. The 30-day mortality was lower in the group prescribed guideline-concordant antibiotics than in the group prescribed guideline-discordant antibiotics (23.9% vs. 33.3%, p = 0.024). Kaplan–Meier survival analysis showed that antibiotic prescription concordant with the guidelines resulted in higher survival rates at 30 days (p = 0.002).ConclusionsThe prevalence of antibiotic prescription consistent with guidelines for severe CAP seemed to be low in the ED, and this variable was independently associated with 30-day survival.

Appropriateness of empirical antibiotic prescription for bloodstream infections in an emergency department from 2006 to 2018: impact of the spread of ESBL-producing Enterobacterales.

The spread of ESBL producers in the community may impact the management of patients with bloodstream infections (BSI) involving Enterobacterales in emergency departments. Thus, from 2006 to 2018, data for all BSI episodes involving Enterobacterales from the emergency department of a French teaching hospital were retrospectively included. Antimicrobial susceptibility test results and empirical antibiotic regimens were recorded. Treatment was considered as appropriate if all isolates were susceptible in vitro to at least one prescribed antibiotic. A total of 1369 BSI episodes in 1321 patients was included. Urinary tract infection was the main source of BSI (61%). The prevalence of ESBL producers increased from zero to 9.2/100 Enterobacterales BSI cases (p < 0.001), mainly Escherichia coli (6.9 cases/100 BSI in 2018); and no Klebsiella. Third-generation cephalosporins (3GC) were used most frequently (71.8%) and their use as monotherapy increased during the study period (p < 0.001). The rate of appropriate treatment decreased from 95.8 to 89.2% (p = 0.023). Appropriateness of treatment was greater using two drugs vs one (97.3% vs 89.3%, p < 0.001). Treatments with 3GC were appropriate in 92% and 98.3%, when used alone or with another antibiotic, respectively (p < 0.001). Among inappropriate treatments, 45% concerned 3GC, with 74.6% of them attributable to ESBL production. The spread of ESBL producers in the community had a direct impact on the rate of inappropriate empirical treatment. Local antimicrobial resistance monitoring is required to optimize the management of BSI in emergency departments.

Improving empiric antibiotic prescribing in pediatric bloodstream infections: a potential application of weighted-incidence syndromic combination antibiograms (WISCA)

ABSTRACT Background: Increasing antibiotic resistance to WHO-recommended first- and second-line treatments of pediatric sepsis requires adaptation of prescribing guidelines. We discuss the potential and limitations of a weighted-incidence syndromic combination antibiogram (WISCA) as a practical tool for incorporating local microbiology data when assessing empiric coverage of commonly used antibiotics. Research design and methods: A brief questionnaire of 18 clinically significant isolates from pediatric blood cultures (Jan-Dec 2018) was sent to a global network of pediatric hospitals in July 2019. Weighted coverage estimates of non-antipseudomonal third-generation cephalosporins (3GC) and meropenem were estimated using Monte–Carlo simulation for each site reporting >100 isolates. Results: 52 hospitals in 23 countries in 5 WHO regions responded to the questionnaire; 13 sites met the sample size requirement. The most common isolates were S. aureus, Klebsiella spp., E. coli and Enterococcus spp. Coverage of 3GC ranged from 39% [95%CrI: 34–43%] to 73% (two sites: [95%CrI: 65–80%]; [95%CrI: 68–86%]) and meropenem coverage ranged from 54% [95%CrI: 47–60%] to 88% [95%CrI:84–91%]. Conclusions: A WISCA is a data-driven, clinically intuitive tool that can be used to compare empiric antibiotic regimens for pediatric sepsis using existing large datasets. The estimates can be further refined using more complex meta-analytical methods and patient characteristics.

Evaluation of prescription practices of antibiotics in respiratory tract infections at Al-Ahrar Teaching Hospital in 2019

Background Antibiotics are prescribed at more than 100 million adult ambulatory care visits annually, and 41% of these prescriptions are for respiratory conditions. Unsuitable antibiotic use for respiratory tract infection (RTI) is an important factor in antibiotic resistance, and this is a vital public health threat. Objective To evaluate the practices of antibiotics prescribed in RTIs at Al-Ahrar Teaching Hospital in the period between March 2019 and October 2019. Patients and methods A total of 125 patients with RTI admitted at Al-Ahrar Teaching Hospital and 25 physicians working at the same hospital were included in the study. Patients were subjected to medical history and clinical and laboratory assessment. Plain chest radiograph and computed tomography of chest, if needed, were done. Results The most frequent antibiotic prescribed empirically was broad-spectrum penicillin (76%). Overall, 56% of physicians prescribed empirical antibiotic for 4–6 days. Overall, 60% of them depended on international guidelines in prescription, and the same percentage reported that prescription was based on combination of clinical, laboratory, and radiological findings. Conclusion Overall, 92% of the studied physicians reported empirical prescription of antibiotics. The most frequent antibiotic prescribed empirically was broad-spectrum penicillin. Moreover, 60% of the studied physicians depended on international guidelines in prescription of antibiotics.

Restricted antimicrobial prescribing in an area of highly prevalent antimicrobial resistance

ObjectiveTo assess the predictive value for infection with multidrug-resistant organisms (MDROs) of reasons for empirical prescription of restricted antibiotics (rABX), in a setting with high resistance rates. MethodsWe prospectively studied all rABX prescriptions in a 550-bed tertiary teaching hospital from April 15 to June 14, 2018 and from September 1 to October 30, 2018. Prescribing physicians had to justify their decision by choosing one or more prespecified reasons. ResultsWe reviewed 172 empirical prescriptions of rABX, which accounted for 67.2% of all rABX prescriptions. Stated reasons for empirical prescription of rABX were recent hospitalization (72.7%), escalation due to non-response to previous antimicrobials (47.7%), treatment for severe sepsis/septic shock (45.9%), escalation due to recurrence or deterioration (22.1%), prior MDRO infection (12.8%), and prior MDRO colonization (7.6%). Empirical treatment for septic shock or severe sepsis was the only significant predictor of MDRO isolation (OR=5.26, 95% CI: 1.5–18.4, P=0.009), while recent hospitalization had a high negative predictive value for MDRO (97.4%). Fourteen per cent of microbiologically documented infections were associated with MDROs resistant to the prescribed rABX. ConclusionsEmpirical treatment for severe sepsis or septic shock was the only independent predictor of MDRO isolation. Recent hospitalization had a high negative predictive value for MDRO infection. The isolation of pathogens resistant to the prescribed rABX suggests that in a setting with widespread antimicrobial resistance, it could be difficult to reduce the empirical use of rABX without risking inadequate treatment.

Correlation Between Appropriateness Prescribing Antibiotics and Clinical Improvement on Hospitalized Patients with Community Acquired Pneumonia Based on The Gyssens Method

Community-acquired pneumonia is an acute inflammation of the pulmonary parenchyma caused by bacterial infection. . The main therapy for community-acquired pneumonia is the use of antibiotics. Inappropriate antibiotics can lead to bacterial resistance. The study aims to determine Appropriateness of antibiotics prescribing using the method Gyssens with clinical improvement. This study is a retrospective analytic cohort descriptive. Data was collected retrospectively based on medical records of inpatients at one of the hospital in Yogyakarta for the January-December 2019 period based. The accuracy of empiric antibiotic prescription using the Gyssens method. The clinical improvements observed were leukocyte count, temperature, respiratory rate. This study was analyzed using the chi square method. The results showed 41 patients met the inclusion and exclusion criteria, male gender (51.2%), age&gt; 60 years 68.3%, the average length of stay was five days. Ceftriaksone is a commonly used antibiotic. Evaluation prescribing appropriateness based on the Gyssens method of 52 antibiotic regimens. appropriate antibiotic prescribing (13.5%) and inappropriate (86.5%). The correlation between appropriateness of antibiotics prescribing with clinical improvement leukocytes count, respiratory rate and temperature did not significant (p&gt; 0.05). There was no correlation between the accurasy of antibiotics prescribing based on the Gyssens method with clinical improvement.

Improved empiric antibiotic prescribing for common infectious disease diagnoses using order sets with built-in clinical decision support in the emergency department.

Improved empiric antibiotic prescribing for common infectious disease diagnoses using order sets with built-in clinical decision support in the emergency department.

Creation of State Antibiogram and Subsequent Launch of Public Health-Coordinated Antibiotic Stewardship in New Hampshire: Small State, Big Collaboration.

An antibiogram is a summary of antibiotic susceptibility patterns for selected bacterial pathogens and antibiotics. The New Hampshire Department of Health and Human Services' Division of Public Health Services (DPHS) sought to create an annual state antibiogram to monitor statewide antibiotic resistance trends, guide appropriate empiric antibiotic prescribing, and inform future statewide antibiotic stewardship. Through legislative authority, DPHS required hospital laboratories to report antibiogram data annually. DPHS convened an advisory group of infectious disease and pharmacy stakeholders and experts to develop a standardized reporting form for bacteria and antibiotic susceptibility, which was disseminated to all 26 hospitals in New Hampshire. We combined the reported data into a statewide antibiogram, and we created clinical messaging to highlight findings and promote rational antibiotic prescribing among health care providers. All hospital laboratories in New Hampshire submitted annual antibiogram data for 2016 and 2017, including more than 30 000 and 20 000 bacterial isolates recovered from urine and nonurine cultures, respectively, each year. The advisory group created clinical messages for appropriate treatment of common infectious syndromes, including uncomplicated urinary tract infections, community-acquired pneumonia, skin and soft-tissue infections, intra-abdominal infections, and health care-associated gram-negative aerobic infections. The statewide antibiograms and clinical messaging were widely disseminated. The small size of New Hampshire, a centralized public health structure, and close working relationships with hospitals and clinical partners allowed for efficient creation and dissemination of an annual statewide antibiogram, which has fostered public health-clinical partnerships and built a foundation for future state-coordinated antibiotic stewardship. This process serves as a model for other jurisdictions that are considering antibiogram development.