Inpatient Antibiotic Use Research Articles

Clostridium difficile Is Associated With Poor Outcomes in Patients With Cirrhosis: A National and Tertiary Center Perspective

Clostridium difficile-associated disease (CDAD) is associated with antibiotic use, acid suppression, and hospitalization, all of which occur frequently in cirrhosis. The aim was to define the effect of CDAD on outcomes and identify risk factors for its development in cirrhosis. Case-control studies using the de-identified national (Nationwide Inpatient Sample, NIS) and an identified liver transplant center database of hospitalized cirrhotics with and without CDAD were performed. The NIS 2005 was queried for mortality, charges, and length of stay (LOS) in cirrhotics with/without CDAD. Outcomes of cirrhosis and infections were also analyzed. In the transplant center database, risk factors for CDAD were defined in hospitalized cirrhotics with/without CDAD who were age matched in a 1:2 ratio. The NIS 2005 included 1,165 cirrhotics with and 82,065 without CDAD. Cirrhotics with CDAD had a significantly higher mortality (13.8% vs. 8.2%, P<0.001), LOS (14.4 days vs. 6.7 days, P<0.001), and charges ($79,351 vs. $35,686, P<0.001) compared with those without CDAD. On multivariate analysis, CDAD was associated with higher mortality (odds ratio (OR) 1.55, 95% confidence interval (CI) 1.29-1.85), charges, and LOS despite controlling for cirrhosis complications and infections. In the transplant center database, 54 cirrhotics with and 108 cirrhotics without CDAD were included. Outpatient spontaneous bacterial peritonitis prophylaxis (35% vs. 13%, P=0.01), inpatient antibiotic (63% vs. 35%, P=0.0001), and proton pump inhibitor (PPI) use (74% vs. 31%, P=0.0001) were significantly higher in those with CDAD. Cirrhotics with CDAD have a higher mortality, LOS, and charges on the NIS 2005 compared with those without CDAD. Antibiotic and PPI use are risk factors for CDAD development in hospitalized cirrhotics.

Drug utilisation 90% (DU90%) profiles of antibiotics in five Chinese children's hospitals (2002–2006)

This study surveyed the pattern of inpatient antibiotic use in five Chinese children's hospitals between 2002 and 2006, focusing on the antibiotics accounting for 90% of the volume utilised as well as the level of adherence to guidelines. The Anatomical Therapeutical Chemical Classification/Defined Daily Doses (ATC/DDD) and the drug utilisation 90% (DU90%) methodologies were used. In October 2004, national antibiotic guidelines were issued that divided antibiotics into non-restricted, restricted and special use grades. In five children's hospitals, a total of 56 different systemic antibiotics were used during the study period. Antibiotics that could be injected accounted for 59.0–99.8%. β-Lactam antibacterials (ATC codes J01C and J01D) were the most used subgroups. The numbers of antimicrobial agents and non-restricted antibiotics within the DU90% segment were 11–20 and 5–9, respectively. The proportion of non-restricted antibiotic consumption was ca. 40% in 2006 in four hospitals, which varied among hospitals during the period 2002–2005. There was considerable variation both in the pattern and amount of antibiotics used in the five hospitals, with amoxicillin/clavulanic acid, cefuroxime and cefazolin being the most commonly used substances. We also observed a decrease in the ranks of some restricted and special use antibiotics after the guidelines were issued in one hospital. The DU90% profiles were proven to be useful in studying the pattern of antibiotic use in hospitals. Finally, the study observed the effectiveness of guidelines for antibiotic use in some hospitals, although injectable antibiotics were widely used in children's hospitals in China.

Bon usage des antibiotiques : optimisation du relais per os des fluoroquinolones

Intravenous-to-oral switch therapy is strongly recommended in the medical literature. The aim of this study was to assess how we can improve fluoroquinolone switch therapy. In this comparative prospective study, we analyzed 243 intravenous ciprofloxacin treatments and assessed the impact of promoting a switch to oral step-down therapy. This study found that switches from intravenous to oral therapy increased, mainly in medical wards, and led to significant savings in direct costs. Promoting switch therapy has improved clinical practices in antibiotic use and led to lower direct and probably indirect drug-related costs. Our findings will help define the role of switch therapy in improving clinical practices in inpatient antibiotic use.

Pharmoeconomics of Penicillin Skin Testing (PST) on Inpatient Antibiotic Use in Patients with Penicillin Allergy (PA)

RATIONALE: Penicillin is frequently cited on inpatients self-reported drug allergies. PST is a reliable and useful diagnostic tool to determine the risk of an immediate systemic allergic reaction. Pharmoeconomic analysis of PST on inpatients with PA requiring antimicrobial therapy is limited. METHODS: A retrospective chart review of 30/120 inpatients (ages 19-92) consulted for PST between January 2001 to June 2005 was done. Prick and intradermal testing to minor and major (Pre-Pen) determinants was performed. Therapeutic changes implemented as a result of PST, reduction in cost of antibiotics, and adverse reactions were assessed. Cost analysis was based on the hospital cost of antibiotics. RESULTS: 87% (26/30) of subjects had PST (-) 10% (3/30) refused PST, and 3% (1/30) had a PST (-). 85% (22/26) subjects with PST (-), had antimicrobials switched to beta-lactam, 4 (15%) didn't receive beta-lactams. The average cost of antibiotics prior to PST was $4,767 that decreased to $3,864 (19%). Pre-PST prescribed regimens included vancomycin/gentamycin ($10/day,n=4), and quinolones ($18/day,n=5). With piperacillin/tazobactam ($52/day,n=3), there was an increase in cost, but when naficillin ($11/dayn=4), or cephalosporins ($10-15,n=3) were used, switching to beta-lactams proved to be cost effective and decreased broad spectrum antibiotics use. There were no adverse reactions in the PST (-) group of patients who received beta-lactams. 92% of PST (-) patients were still listed as PA on their discharge sheets. CONCLUSIONS: Inpatient PST contributed to changes in antimicrobial therapy from broad spectrum agents to beta-lactams, with a decrease in therapy cost.

A Large Outbreak ofClostridium difficile–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use

Fluoroquinolones have not been frequently implicated as a cause of Clostridium difficile outbreaks. Nosocomial C. difficile infections increased from 2.7 to 6.8 cases per 1000 discharges (P < .001). During the first 2 years of the outbreak, there were 253 nosocomial C. difficile infections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a large C. difficile outbreak in our hospital to identify risk factors and characterize the outbreak. A retrospective case-control study of case-patients with C. difficile infection from January 2000 through April 2001 and control-patients matched by date of hospital admission, type of medical service, and length of stay; an analysis of inpatient antibiotic use; and antibiotic susceptibility testing and molecular subtyping of isolates were performed. On logistic regression analysis, clindamycin (odds ratio [OR], 4.8; 95% confidence interval [CI95], 1.9-12.0), ceftriaxone (OR, 5.4; CI95, 1.8-15.8), and levofloxacin (OR, 2.0; CI95, 1.2-3.3) were independently associated with infection. The etiologic fractions for these three agents were 10.0%, 6.7%, and 30.8%, respectively. Fluoroquinolone use increased before the onset of the outbreak (P < .001); 59% of case-patients and 41% of control-patients had received this antibiotic class. The outbreak was polyclonal, although 52% of isolates belonged to two highly related molecular subtypes. Exposure to levofloxacin was an independent risk factor for C. difficile-associated diarrhea and appeared to contribute substantially to the outbreak. Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak

Utilization of fluoroquinolones andEscherichia coli resistance in urinary tract infection: inpatients and outpatients

The aim of this study was to evaluate the dependence of Escherichia coli resistance to fluoroquinolones on their use in the outpatients and inpatients in the Olomouc region of the Czech Republic. Data on inpatient antibiotic use were obtained from the database of the Department of Pharmacology and expressed as defined daily dose per 100 bed-days (DBD). Data on outpatient prescriptions were obtained from the database of General Health Insurance Company and expressed in defined daily doses per 1000 clients per day (DID). Escherichia coli strains were isolated from samples of urine of both community and hospitalized patients suffering from acute bacterial urinary tract infection, examined using aerobic cultivation, and determined by standard biochemical procedures. The utilization of fluoroquinolones in inpatients has significantly (p < 0.01) increased from 2.52 DBD in 1997 to 4.29 DBD in 2002. In outpatients, fluoroquinolone utilization has also increased significantly from 0.14 to 0.95 DID (p < 0.01). In the same period, 9192 E. coli strains were isolated from inpatients and outpatients suffering by urinary tract infections and tested for the susceptibility to fluoroquinolones. Resistance increased significantly (p < 0.01) both in the hospital (from 2 to 9%) and in the community (from 1 to 10%). The development of E. coli resistance to fluoroquinolones correlates significantly with their utilization both in the hospital (r = 0.944, p = 0.005) and in the community (r = 0.859, p = 0.029). Results of this study shows the impact of fluoroquinolone utilization on E. coli resistance and support the need of controlled use of these effective antibiotics.