Patterns Of Antibiotic Use Research Articles

Evaluation of antibiotic use pattern in Shahid Sadoughi hospital of Yazd

Antibiotics are a class of drugs that are widely used to eliminate the causes of many infectious diseases around the world. It should be borne in mind that their irrational and irregular administration will increase bacterial resistance and dangerous complications. For this reason, timely diagnosis and usage of antibiotics is one of the tasks of physicians to improve the patient's use of the lowest number of antibiotics. This was a retrospective descriptive cross-sectional study. The samples were selected by non-random sampling from all records of patients admitted to Shahid Sadoughi Hospital of Yazd from HIS hospital system with total number of 82742. The type of hospital admission, the type of prescription, the cause of antibiotic prescription, the cost of antibiotic use was entered into the questionnaire. The most commonly used antibiotics were cefazolin with a frequency of 18.41%, clindamycin with a frequency of 17.49%, ceftriaxone with a frequency of 15.48% and vancomycin with a frequency of 10.18% and metronidazole with a frequency of 7%, respectively. The most costly antibiotics were meropenem (14.28% of costs), vancomycin (13.4%), and amphotericin (10.09%). The pattern of antibiotic use in hospitals should be more carefully considered and given the cost and burden of unnecessary antibiotic use, serious consideration should be given to antibiotic use.

A Significant Question in Cancer Risk and Therapy: Are Antibiotics Positive or Negative Effectors? Current Answers and Possible Alternatives.

Cancer is predominantly considered as an environmental disease caused by genetic or epigenetic alterations induced by exposure to extrinsic (e.g., carcinogens, pollutants, radiation) or intrinsic (e.g., metabolic, immune or genetic deficiencies). Over-exposure to antibiotics, which is favored by unregulated access as well as inappropriate prescriptions by physicians, is known to have led to serious health problems such as the rise of antibiotic resistance, in particular in poorly developed countries. In this review, the attention is focused on evaluating the effects of antibiotic exposure on cancer risk and on the outcome of cancer therapeutic protocols, either directly acting as extrinsic promoters, or indirectly, through interactions with the human gut microbiota. The preponderant evidence derived from information reported over the last 10 years confirms that antibiotic exposure tends to increase cancer risk and, unfortunately, that it reduces the efficacy of various forms of cancer therapy (e.g., chemo-, radio-, and immunotherapy alone or in combination). Alternatives to the current patterns of antibiotic use, such as introducing new antibiotics, bacteriophages or enzybiotics, and implementing dysbiosis-reducing microbiota modulatory strategies in oncology, are discussed. The information is in the end considered from the perspective of the most recent findings on the tumor-specific and intracellular location of the tumor microbiota, and of the most recent theories proposed to explain cancer etiology on the notion of regression of the eukaryotic cells and systems to stages characterized for a lack of coordination among their components of prokaryotic origin, which is promoted by injuries caused by environmental insults.

Antibiotic use in patients with COVID-19: a 'snapshot' Infectious Diseases International Research Initiative (ID-IRI) survey.

BackgroundAntibiotics may be indicated in patients with COVID-19 due to suspected or confirmed bacterial superinfection.ObjectivesTo investigate antibiotic prescribing practices in patients with COVID-19.MethodsWe performed an international web-based survey and investigated the pattern of antibiotic use as reported by physicians involved in treatment of COVID-19. SPSS Statistics version 25 was used for data analysis.ResultsThe survey was completed by 166 participants from 23 countries and 82 different hospitals. Local guidelines for antibiotic use in COVID-19 patients were reported by 61.8% (n = 102) of participants and for 82.9% (n = 136) they did not differ from local community-acquired pneumonia guidelines. Clinical presentation was recognized as the most important reason for the start of antibiotics (mean score = 4.07 and SD = 1.095 on grading scale from 1 to 5). When antibiotics were started, most respondents rated as the highest the need for coverage of atypical pathogens (mean score = 2.8 and SD = 0.99), followed by Staphylococcus aureus (mean score = 2.67 and SD = 1.05 on bi-modal scale, with values 1 and 2 for disagreement and values 3 and 4 for agreement). In the patients on the ward, 29.1% of respondents chose not to prescribe any antibiotic. Combination of β-lactams and macrolides or fluoroquinolones was reported by 52.4% (n = 87) of respondents. In patients in the ICU, piperacillin/tazobactam was the most commonly prescribed antibiotic. The mean reported duration of antibiotic treatment was 7.12 (SD = 2.44) days.ConclusionsThe study revealed widespread broad-spectrum antibiotic use in patients with COVID-19. Implementation of antimicrobial stewardship principles is warranted to mitigate the negative consequences of antibiotic therapy.

International Practice Patterns of Antibiotic Therapy and Laboratory Testing in Bronchiolitis.

International patterns of antibiotic use and laboratory testing in bronchiolitis in emergency departments are unknown. Our objective is to evaluate variation in the use of antibiotics and nonindicated tests in infants with bronchiolitis in 38 emergency departments in Pediatric Emergency Research Networks in Canada, the United States, Australia and New Zealand, the United Kingdom and Ireland, and Spain and Portugal. We hypothesized there would be significant variation, adjusted for patient characteristics. We analyzed a retrospective cohort study of previously healthy infants aged 2 to 12 months with bronchiolitis. Variables examined included network, poor feeding, dehydration, nasal flaring, chest retractions, apnea, saturation, respiratory rate, fever, and suspected bacterial infection. Outcomes included systemic antibiotic administration and urine, blood, or viral testing or chest radiography (CXR). In total, 180 of 2359 (7.6%) infants received antibiotics, ranging from 3.5% in the United Kingdom and Ireland to 11.1% in the United States. CXR (adjusted odds ratio [aOR] 2.3; 95% confidence interval 1.6-3.2), apnea (aOR 2.2; 1.1-3.5), and fever (aOR 2.4; 1.7-3.4) were associated with antibiotic use, which did not vary across networks (P = .15). In total, 768 of 2359 infants (32.6%) had ≥1 nonindicated test, ranging from 12.7% in the United Kingdom and Ireland to 50% in Spain and Portugal. Compared to the United Kingdom and Ireland, the aOR (confidence interval) results for testing were Canada 5.75 (2.24-14.76), United States 4.14 (1.70-10.10), Australia and New Zealand 2.25 (0.86-5.74), and Spain and Portugal 3.96 (0.96-16.36). Testing varied across networks (P < .0001) and was associated with suspected bacterial infections (aOR 2.12; 1.30-2.39) and most respiratory distress parameters. Viral testing (591 of 768 [77%]) and CXR (507 of 768 [66%]) were obtained most frequently. The rate of antibiotic use in bronchiolitis was low across networks and was associated with CXR, fever, and apnea. Nonindicated testing was common outside of the United Kingdom and Ireland and varied across networks irrespective of patient characteristics.

Prevalence of Nosocomial Infections in Intensive Care Units in Shahid Sayyad-E-Shirazi Hospital of Gorgan During 2016-2018

Introduction: Understanding the pattern of infections in the intensive care unit and the correct pattern of antibiotic use is vital in reducing mortality. Identification of risk factors for nosocomial infection and preventive approaches can be effective in reducing the incidence. This study aimed to evaluate the intensive care unit (ICU) acquired infection.&#x0D; Material and Methods: This cross-sectional study was performed on patients admitted to the ICU of Sayyad Shirazi Hospital during 2016-18. All patients' information recorded and analyzed by SPSS version 16.&#x0D; Results: In this study, the nosocomial infection rate was 3.5%, mostly in individuals over 60 years old. Most of the positive cultures were from two sources of urine and then blood. The organisms observed in nosocomial infections were Escherichia coli (16.9%), Staphylococcus epidermis (11.5%), Enterococci, and Enterobacter. The most commonly used antibiotics were vancomycin and then meropenem. Antibiogram results indicated the highest antibiotic resistance (100%) to cefazolin, piperacillin and clindamycin, and 96.8% to ceftriaxone. Vancomycin and amikacin had the lowest resistance.&#x0D; Conclusion: According to the results of this study, the incidence of nosocomial infection is unavoidable, and its control is the most important health goals of medical centers. Proper treatment interventions are needed to reduce the impact of nosocomial infection.

The prevalence of sepsis in neonates caused by multidrug resistant bacteria

The spectrum of organisms that cause neonatal sepsis changes over time and varies from region to region. It can even vary from hospital to hospital in the same city. This is due to the changing pattern of antibiotic use and changes in lifestyle. Gram negative organisms were the most common cause of neonatal sepsis in Europe and America in the 1960s. A prospective hospital based study over a period of one year was carried out at neonatal intensive care unit of our hospital, a tertiary care centre. At least 20% deliveries require nursery admission. All neonates born at the hospital and presenting with signs and symptoms of sepsis or born to mothers with potential risk factors for sepsis were investigated for sepsis. All the neonates diagnosed to have culture positive sepsis or clinical sepsis with multidrug resistant organisms were included as study cases. The most common organism was CONS accounting for 32.79% followed by Klebsiella species (16.39%) Staph aureus (14.75%). All the CONS positive cultures were non MDR (100%). Whereas 70% of the Klebsiella species and 100% of the Staph species were MDR.

Evaluasi Penggunaan Antibiotik pada Pasien Tifoid Rawat Inap di Salah Satu Rumah Sakit Pemerintah Provinsi Bali dengan Metode Gyssens dan ATC/DDD

Typhoid is a global health problem especially in developing countries, one of which is in Indonesia. The incidence of antibiotic resistance in typhoid therapy can occur due to inappropriate use of antibiotics. This study aims to determine patterns of antibiotic use as well as the quality and quantity of antibiotic use in typhoid therapy in one of the provincial government hospitals in Bali. This study was an observational study conducted retrospectively which was analyzed using the Gyssens and ATC/DDD methods. The research data were taken from the medical records of patients in the January-December 2019 period that met the inclusion criteria. The results showed that of the 40 total antibiotics prescribing, ceftriaxone was the most widely used antibiotic for typhoid therapy. The quality of antibiotic use as much as 40% is stated rational (category 0), while the other 60% is irrational (categories I-VI) which includes the use of antibiotics with incorrect interval of administration (IIB; 5%), the use of antibiotics that is too long (IIIA; 40%), the use of antibiotics that are too short (IIIB; 5%), there are other antibiotics that are more effective (IVA; 5%), and there are other antibiotics that are less toxic/safer (IVB; 5%). The quantity of antibiotic use was stated more than WHO standards which includes the use of ceftriaxone at 83.80 DDD/100 patient days; levofloxacin at 27.47 DDD/100 patient days; and azithromycin at 3.52 DDD/100 patient days. The results of this study are expected to be a consideration for the hospital as a material for evaluation and improvement in order to improve the rationality of antibiotic use.

Efficacy and Pattern of Antibiotic Usage Among Patients with Cirrhosis and/or Chronic Liver Disease in Telangana, India

The most common Gram-negative bacteria, such as enteric bacilli, Escherichia coli and Klebsiella pneumoniae, and Gram-positive bacteria, such as Streptococcus spp., are seen in patients suffering from cirrhosis and/or chronic liver diseases. The objective of this prospective observational study was to compare the efficacy and pattern of antibiotic use in patients with bacterial translocation.

National Trends in Antibiotic Use in Australian Residential Aged Care Facilities, 2005-2016.

Understanding current patterns of antibiotic use in residential aged care facilities (RACFs) is essential to inform stewardship activities, but limited utilization data exist. This study examined changes in prevalence and consumption of antibiotics in Australian RACFs between 2005-2006 and 2015-2016. This population-based, repeated cross-sectional analysis included all long-term permanent residents of Australian RACFs between July 2005 and June 2016 who were aged ≥ 65 years. The yearly prevalence rate of antibiotic use and number of defined daily doses (DDDs) of systemic antibiotics per 1000 resident-days were determined annually from linked pharmaceutical claims data. Trends were assessed using ordinary least squares regression. This study included 502 752 residents from 3218 RACFs, with 424.9 million resident-days analyzed. Antibiotics were dispensed on 5 608 126 occasions during the study period, of which 88% were for oral use. Cefalexin, amoxicillin-clavulanic acid, and trimethoprim were the most commonly dispensed antibiotics. The annual prevalence of antibiotic use increased from 63.8% (95% confidence interval [CI], 63.3%-64.4%) to 70.3% (95% CI, 69.9%-70.7%) between 2005-2006 and 2015-2016 (0.8% average annual increase, P < .001). There was a 39% relative increase in total consumption of systemic antibiotics, with utilization increasing from 67.6 to 93.8 DDDs/1000 resident-days during the study period (average annual increase of 2.8 DDDs/1000 resident-days, P < .001). This nationwide study showed substantial increases in both prevalence of use and total consumption of antibiotics in Australian RACFs between 2005 and 2016. The increasingly widespread use of antibiotics in Australian RACFs is concerning and points to a need for enhanced efforts to optimize antibiotic use in this setting.

Assessment of antibiotics use for children upper respiratory tract infections: a retrospective, cross-sectional study from Pakistan

Background: Since drug utilization evaluation is essential to assess the appropriate use of medications, the present study was carried out to evaluate antibiotics use for children upper respiratory tract infections (URTIs).Methods: A retrospective, cross-sectional study was conducted in the six health care settings of central Punjab, Pakistan. Medical records of children ≤ 12 years who were admitted in the study settings from 1st Jan-28th Feb 2019 were reviewed. Patterns of antibiotic use were assessed in the light of the WHO prescribing indicators and appropriateness of antibiotics treatment was assessed from British National Formulary for children.Results: A total of 1843 cases of URTI were analyzed, containing 6635 total medications. All of the patients were given antibiotics (mean 1.94 ± 0.63 antibiotics). Cephalosporin was the most commonly used antibiotics class (37.8%) followed by penicillins. Injections were given to all the patients. Only 11% of the cases received appropriate therapy according to the indication. Of these (n = 204), around 93% received right dose whereas right frequency and duration were found in 96.5% and 95.5% of the cases, respectively.Conclusion: Our study revealed alarmingly high utilization of antibiotics among Pakistani children with URTIs. A great emphasis should be placed on implementing antimicrobial stewardship strategies for the rational use of antimicrobials in Pakistan and pharmacists should be in the front and centre to lead antimicrobial stewardship.

Knowledge, attitude and pattern of antibiotic utilization among Libyan University students in Zawia

Introduction: The antimicrobial agents have saved human from several infectious disease. However, bacteria have capability to develop to become resistant to antibiotics and incorrect use of antibiotics is the main determinants of development of antimicrobial resistance which is a public health issue. Attention on medical students and community people should be emphasized by both education and promotion. Thus, this study was aimed to assess the present knowledge, attitude and behavior of Libyan university students regarding antibiotic use and misuse. Methods: Sample size of 150 students attending faculty of pharmacy of university of Zawia, Libya was participated. The procedure was divided into five groups according to their grades. All the involved participants completed a health questionnaire about their utilization and mal utilization of antibiotics. Data was collected over a period of two months during July and August 1029. Results: The evaluated data was from 250 students; 132 were females and 21 were males (7.3 : 1.0). 88.0% use antibiotics to cure bacterial infection while 15.3% use it to cure viral infection. 38.0% never use antibiotics to treat respiratory tract infections such as common cold, 34.0% sometimes and 26.0% always. In addition, 61.0% stopped using antibiotic based on physician's instruction while 8.0% when symptoms decreased. Regarding their attitude toward antibiotic misuse, 82.0% agreed that it is necessary to get more education and promotion about pattern of antibiotic use and 73.0% agreed to establish courses on antibiotic rationale use. Conclusion: Students at medical university of Zawia have a considerable knowledge and a great perspective on antibiotics utilization. However, there is still a need for more additional educational programs on antibiotic utilization and mal utilization targeted university students and community people in Libya.

A prospective antibiotic point prevalence survey in two primary referral hospitals during and after pilgrims stay in Madinah, Saudi Arabia

Purpose: To assess current patterns of antibiotic use by carrying out two point-prevalence surveys (PPS) in Madinah after the return of hajj pilgrims from Makkah and when Madinah is free from pilgrims.&#x0D; Methods: In September 2016 and November 2016, a prospective PPS was conducted on two separate dates (during the hajj pilgrims stay in Madinah and after they leave). Data on antibiotics use were generated during these two periods. This involved an audit from all the departments of two referral hospitals (King Fahad Hospital (KFH) - 425 beds, and Al Ansar Hospital - 100 beds) of inpatients records. Data were collected using standard forms adapted from the European Centre for Disease Control (ECDC).&#x0D; Results: A total of 675 inpatients were included in PPS; among them, 332 (49.18 %) patients were receiving antibiotic therapy. In September 2016, 168 patients were treated with antibiotics, with a prevalence rate of 50.60 %, whereas, in November 2016, the prevalence rate was 49.40 %. Overall, 198 patients were identified in surgical wards, of which 132 patients (66.6 %) were receiving antibiotic therapy; 121 patients in ICU of which 70 patients (57.8 %) received antibiotics; 13 patients in other wards of which 6 (46.1 %) received antibiotic treatment; and 343 patients in medical wards of which 126 patients (36.7 %) were treated with antibiotics. There was no significant difference in prevalence of antibiotic prescribing between the two surveys (Pearson Chi-square test, p = 0.56) and with regards to patient age between the two surveys (Mann-Whitney U-test, p = 0.32).&#x0D; Conclusion: The results demonstrate that antibiotic use with adherence to hospital guidelines and PPS helps in identifying targets for quality improvement. Moreover, to escalate the prudent use of antibiotics in hospitals, PPS provides a useful tool. Furthermore, this survey provides a background to evaluate antibiotic use by a standardized methodology.&#x0D; Keywords: Point prevalence survey, Antibiotic use, Prescribing practices, Antibiotic resistance, Quality improvement, Antibiotic stewardship, Hajj, Pilgrims

Comprehensive insights into the occurrence, distribution, risk assessment and indicator screening of antibiotics in a large drinking reservoir system.

Drinking water reservoir is threatened globally due to anthropogenic contamination and thus in need of more attention. Here, we comprehensively investigated the occurrence, distribution and risk assessment of representative antibiotics in a large drinking water reservoir (Fengshuba Reservoir, China). The total concentrations of antibiotics in the water phase, porewater phase, sediment phase and soil phase (drawdown area) were in the ranges of 195-569ng/L, 47.1-333ng/L, 114-272μg/kg and 2.84-77.2μg/kg, respectively. The dominant antibiotic was CIP in both the water and porewater phases, while it was OTC in the sediment phase. For the water phase, seasonal factor consisting hydrologic condition and pattern of antibiotic use could influence the occurrence level and environmental fate of antibiotics. In contrast, exogenous particles derived from the soils that had used manures during the spring planting season coupled with heavy rainfall was responsible for the occurrence level and composition of antibiotics in the sediment phase. Moreover, Chl-α, NO3-, TP and EC were the most dominant factor influencing the antibiotic distributions in the water phase, porewater phase, sediment phase and soil phase, respectively. Pseudo-partitioning coefficients indicated that PENV and PENG might accumulate more easily into the sediments from the aqueous phase compared with other antibiotics. Risk assessments suggested that TC might pose high risks to the aquatic ecosystem, but the antibiotics presented no risk to the health of consumers. Generally, TC could be used as a promising indicator for evaluating the occurrence and potential risk of antibiotics in Fengshuba Reservoir.

Antibiotic use in chicken farms in northwestern China

BackgroundMisuse of antibiotics in food animals contributes to an increase of antibiotic resistant bacteria transmitting to humans. China is the largest producer and user of antibiotics in the world, of which animals share more than half of the total consumption. This study aimed to explore Chinese farmer’s practice of antibiotic use and the factors associated with their use.MethodsIn this cross-sectional survey, we interviewed farmers from 88 chicken farms in northwestern China. We defined two kinds of misuse: 1) using antibiotics in the Chinese prohibited list, and 2) using antibiotics within the recommended withdrawal period. Factor analysis was used to select farmers’ knowledge variables and multinomial logistic regression was used to determine factors associated with antibiotic misuse.ResultsAll the participating farmers used antibiotics on their farms. Amoxicillin was the most common antibiotic used (76.5%), followed by norfloxacin, ofloxacin, ceftriaxone and oxytetracycline. 75% of farmers used antibiotics in the prohibited list while 14.8% continued to use antibiotics during the withdrawal period. Hierarchical cluster analysis revealed three patterns of antibiotic use: 1) excessive use of non-prohibited and prohibited antibiotics or an excessive user, 2) low use of a few types of non-prohibited and moderate use of prohibited antibiotics or a low user, 3) multiple use of a variety (≥ 7 types) of non-prohibited and prohibited antibiotics or a moderate user. Farmers from medium size, family-based farms, those with a low education level and low income were more likely to misuse antibiotics. Prior formal agricultural training was associated with reducing multiple types of antibiotic use. There was a huge gap between policy and reinforcement causing antibiotic misuse in the study community.ConclusionAntibiotics are commonly used on chicken farms; misuse of antibiotics is high; improvement in farm sanitation, education on antibiotic use for farmers and veterinarians/pharmacists and enforcement of the regulations may reduce antibiotic use on chicken farms in China.

Prescribing patterns of antibiotics outpatients received by pharmacies in Medan city, Indonesia in 2017

IntroductionThis study aimed to determine the patterns of antibiotic use from prescriptions of physicians received by pharmacies in Medan from January to March 2017.MethodsThis study was conducted in a cross-sectional method using direct observation of prescriptions received by 100 pharmacies in Medan city. The data obtained were analyzed descriptively and grouped based on the antibiotic names, antibiotic classes, type of drugs, dosage forms and prescriptions.ResultsA total of 12,388 prescription sheets were obtained from 100 pharmacies in Medan during the study period in which 3,823 of the prescription sheets (30.96%) contained antibiotics. According to the data, 4,029 antibiotics were prescribed by physicians in which amoxicillin (20.63%) and cephalosporin groups (25.94%) as the most widely prescribed antibiotic and antibiotic class, respectively. A total of 1,923 antibiotics (47.73%) were prescribed with generic names and more than half of the antibiotics were prescribed in the dosage form of tablets (65.65%). This study also found that Ear Nose Throat (ENT) specialists are medical doctors who prescribe antibiotics the most.ConclusionBased on the study results, it can be concluded that the frequency of antibiotic prescriptions is still quite high in which amoxicillin as the most commonly prescribed antibiotic. In addition, ENT specialists as the most frequent prescribers of antibiotics.

Antibiotics use and gentamicin residues in commercial poultry and chicken eggs from Oyo and Lagos States, Nigeria

Nigeria poultry industry is fast growing to meet the demand of the increasing population with overdependence on antibiotics for production leading to consumer safety and public health concerns. The antibiotic use in poultry farms and presence of gentamicin residues in chicken eggs from city markets of Southwest Nigeria were investigated. A semi-structured questionnaire was administered to 45 poultry farmers to determine the patterns of antibiotic use, knowledge of withdrawal periods and food safety implications. Furthermore, 270 egg samples from six retail markets in Oyo and Lagos states were analyzed with ELISA for gentamicin residues. Residue concentrations were compared with Student’s t test and ANOVA (p &lt; 0.05). About 90% of the respondents reported they frequently administered antibiotics, 85% engaged in non-prescribed medication, and about 80% did not observe a withdrawal period before selling the eggs from treated chickens. In addition, 60% and 80% of pooled eggs from Oyo and Lagos states, respectively, contained gentamicin residues with means of 1461 ± 74 and 1350 ± 92 µg/kg, respectively. The mean residues obtained from the two states were higher than the maximum recommended residue limits. High levels of gentamicin residues, from unbridled use of antibiotics in poultry production, detected in retail eggs from markets rendered the eggs unsafe for human consumption. Therefore, regulatory control and veterinary supervision of antibiotic use are advocated to ensure Nigerian consumer protection.

Assessment of knowledge and attitude toward the new antibiotic dispensing law and its effect on antibiotic use in Saudi Arabia

BackgroundAntibiotics resistance is a serious problem around the world, which has been increasing in the last century due to misuse of antibiotics. Recently, Saudi Arabia enforced the Executive Regulations of Health Practice Law that prohibits dispensing antibiotics without prescription. Aim(1) To assess the association between the knowledge and attitude toward the recent enforcement of the antibiotic restriction Law and the antibiotic use among Saudi population.(2) To assess the pattern of antibiotic use before and after the enforcement of the Law. MethodAn online cross-sectional study was conducted among residents of Saudi Arabia. ResultsThe study was carried out among 570 Saudi participants; the result shows no considerable difference before and after law enforcement in purchasing and use of antibiotics. During the six months before the law implementation, antibiotics were obtained by 42 (7%) through purchase from the pharmacy without a prescription, 23 (4%) through remains of previously used containers, and 7 (1%) through a relative or a friend; while during the six months after the law implementation it was 31 (5%), 22 (4%) and 7 (1%), respectively. Only 48% agreed that they always received advice from a doctor, nurse or pharmacist on how to use your antibiotics. 32% have no knowledge about antibiotic resistance or drug resistance or antibiotic-resistant bacteria. More than two third (75%) were aware of the recent enforcement of the law that prohibits dispensing antibiotics without prescription. Among the participants, 91 (16%), 285 (50%) and 194 (34%) were expressed negative, neutral and positive attitude towards the law, respectively. ConclusionIn spite of the recent enforcement of the Law, there is still misuse of antibiotics, which indicate need for educational programs and campaigns to improve the knowledge of the population.

Patterns of antimicrobial consumption in neonatal and pediatric intensive care units in Germany and Brazil.

Antibiotic consumption (AC) is a key component of antimicrobial stewardship programs to recognize local patterns of antibiotic use. Our aim was to measure AC in neonatal units, including neonatal (NICU)/paediatric (PICU) intensive care units in different countries. We conducted a multicenter, retrospective, cohort study in three NICUs, one neonatal ward, and three PICUs with a total of 84 beds. Global and individual AC in days of therapy (DOT) and DOT per 1000 patient-days were assessed. During the study period, 2567 patients were admitted, corresponding to 4961 patient-days in neonatal units and 9243 patient-days in PICUs. Multidrug-resistant Gram-negative bacteria and methicillin-resistant Staphylococcus aureus were more frequent in Brazil than in Germany. Average AC was 386.5 and 1335.5 DOT/1000PD in German and Brazilian neonatal units, respectively. Aminopenicillins plus 3rd generation cephalosporins were the most commonly prescribed antibiotics in German neonatal units, while aminopenicillins plus aminoglycosides were the class most commonly used in Brazilian NICU. Average AC was 888.1 and 1440.7 DOT/1000PD in German and Brazilian PICUs, respectively. Antipseudomonal penicillins were most commonly used in the German PICU, and glycopeptides were the most frequently prescribed in Brazilian PICUs. Carbapenems represented 2.3-14% of total DOTs in German neonatal units and 4% in the Brazilian NICU and 13.0% in the German PICU and 6-12.2% in Brazilian PICUs. We concluded that different patterns of most commonly prescribed antibiotics were observed in neonatal units and PICUs in these two countries, probably related to different local patterns of antibiotic resistance, with a higher antibiotic consumption in Brazilian study units.

1137. Variability of Antibiotic Use in Neonatal Intensive Care Units in the United States

BackgroundAlthough antibiotics are often indicated to treat early-life infections, such exposure may lead to serious adverse outcomes. Few studies have characterized patterns of antibiotic use among neonatal intensive care units (NICUs).MethodsWe performed a cross-sectional study of antibiotic use in 51 NICUs participating in the Pediatric Health Information System (PHIS), a database that includes clinical and resource utilization data for standalone children’s hospitals in the United States. Assessments were conducted on a single mid-week day of 2017. We examined the use of any antibiotic and broad-spectrum antibiotics using charge data in children admitted in each NICU on the study day. We compared antibiotic use among NICUs and geographical regions, and assessed its association with the NICU median case mix index (CMI) (as a surrogate for clinical complexity).Results2813 infants were hospitalized in NICUs on the study day; the median number of patients at each study site was 47 (IQR = 34 – 62). 90% were <1 month old, 56% were male, 46% were white, and 62% were extremely/very preterm. Overall, 23% received at least one antibiotic and 6% received broad-spectrum antibiotics. Broad-spectrum antibiotic use was twice as prevalent in surgical compared with medical patients. Antibiotic use prevalence varied by region, ranging from 19% in the Midwest to 26% in the West (table). Ampicillin, gentamicin and vancomycin were the most common antibiotics used (25.2%, 18.8% and 9.9%, respectively). Antibiotic use prevalence varied substantially across NICUs (Figure 1). There was a moderate but significant positive correlation between overall or broad-spectrum antibiotic use and median NICU CMI (Figure 2).ConclusionThere is substantial variability in antibiotic use among US NICUs, which seems partially explained by patient case-mix. Additional studies are needed to identify drivers of unwarranted variability in antibiotic use among NICUs. DisclosuresRitu Banerjee, MD, PhD, Accelerate Diagnostics: Grant/Research Support; BioFire: Research Grant; Biomerieux: Research Grant; Roche: Research Grant.

2029. Prevalence of Antibiotic Use and Administration among Hospitalized Adult Patients at a Tertiary Care Hospital in Kilimanjaro, Tanzania

BackgroundAntimicrobial stewardship programs (ASPs) have been shown to improve the appropriate use of antimicrobials, especially in high-income countries. However, ASPs are relatively less well implemented in low-or-middle income countries. To improve the effectiveness of ASPs in these settings, it is important to determine the core actions and targets for improving antimicrobial use. We sought to describe the prevalence and patterns of antibiotic use at a tertiary care hospital in Tanzania.MethodsConsecutive patients admitted to an adult medical ward at a tertiary care hospital, Kilimanjaro Christian Medical Centre, in Moshi, Tanzania were enrolled from June 2018 to March 2019. The medical record was reviewed for data regarding the type of antibiotics prescribed, indications for use, and microbiologic testing ordered.ResultsA total of 1103 patients were enrolled during the study period. The majority of patients were males (663, 60.1%), with the median age being 54 years (IQR 39–70). About one-third (390, 35.4%) of the admitted patients received antimicrobials during hospitalization, with pneumonia being the leading indication for antimicrobial use (158, 40.5%). The most commonly used antibiotics included ceftriaxone in 285 (73.1%), metronidazole in 155 (39.7%), and amoxicillin/ ampicillin in 46 (11.8%) patients. The median duration of antimicrobial use was 5 days (IQR 3–7). Few patients on antimicrobials (27, 6.9%) had culture results, of which half (15, 55.6%) were positive for an organism and a minority (8, 29.6%) were susceptible to the antibiotics being used. Overall, mortality in the cohort was 22.7% and the median duration of hospitalization was 5 days (IQR 3–8).ConclusionAntibiotics were used in a substantial proportion of admitted patients. However, in most cases, treatment was empirical with limited use of culture results. Future ASP efforts can target the improved use of microbiologic cultures to target antimicrobial use.Disclosures All authors: No reported disclosures.