Prescription Surveillance Research Articles

Selected Acute Safety Events Following the Use of Nirmatrelvir/Ritonavir or Molnupiravir for COVID-19: A Nationwide Cohort Study in South Korea.

There had been concerns about the acute complications during or shortly after coronavirus disease 2019 (COVID-19) treatment with nirmatrelvir/ritonavir (NMVr) and molnupiravir (MOL). This study aimed to compare the risks of selected acute safety events in patients treated with or without NMVr or MOL using the COVID-19 oral treatment safety assessment data, constructed through the linkage of nationwide databases: National COVID-19 registry, Real-time Prescription Surveillance, and National Health Insurance data. We identified all adults diagnosed with COVID-19 between January and November 2022, and then constructed two cohorts by matching up to four patients without antiviral treatment records to NMVr or MOL users using propensity score matching. Outcomes of interest were incident-selected cardiac (i.e., atrial fibrillation, other arrhythmia, bradycardia), neurological (i.e., seizure, neuropathy, encephalomyelitis), and miscellaneous (i.e., acute pancreatitis, acute liver injury, dysgeusia) events. A total of 739,935 NMVr users were matched with 2,951,690 comparators and 150,431 MOL users with 759,521 comparators. NMVr users were at lower risk for developing selected cardiac events (hazard ratio 0.74 [95% CI 0.65-0.87] for atrial fibrillation, 0.81 [0.65-0.99] for other arrhythmia, and 0.82 [0.70-0.96] for bradycardia) and dysgeusia (0.58 [0.45-0.74]). For MOL users, the risk was lower for atrial fibrillation (0.72 [0.53-0.96]) and dysgeusia (0.34 [0.18-0.65]). Overall, there were no increased risks of acute complications during and shortly after treatment with oral COVID-19 antivirals. Rather, the findings underscore their effectiveness in attenuating the risk of potential acute sequelae of COVID-19.

Anomaly detection in the veterinary antibiotic prescription surveillance system (IS ABV)

Antibiotic resistance is one of the major concerns in veterinary and human medicine and poses a considerable threat to both human and animal health. It has been shown that over- or misuse of antibiotics is one of the primary drivers of antibiotic resistance. To develop the surveillance of antibiotic use, Switzerland introduced the "Informationssystem Antibiotika in der Veterinärmedizin" (IS ABV) in 2019, mandating electronic registration of antibiotic prescriptions by all veterinarians in Switzerland. However, initial data analysis revealed a considerable amount of implausible data entries, potentially compromising data quality and reliability. These anomalies may be caused by input errors, inaccuracies, incorrect or aberrant master data or data transmission and make analysis impossible. To address this issue efficiently, we propose a two-stage anomaly detection framework utilizing machine learning algorithms. In this study, our primary focus was on cattle treatments with either single or group therapy, as they were the species with the highest prescription volume. However, not all outliers are necessarily incorrect; some may be legitimate but unusual antibiotic treatments. Thus, expert review plays a crucial role in distinguishing outliers, that are correct from actual errors. Initially, relevant prescription variables were extracted and pre-processed with a custom-built scaler. A set of unsupervised algorithms calculated the probability of each data point and identified the most likely outliers. In collaboration with experts, we annotated anomalies and established anomaly thresholds for each production type and active substance. These expert-annotated labels were then used to fine-tune the final supervised classification algorithms. With this methodology, we identified 22,816 anomalies from a total of 1,994,170 prescriptions in cattle (1.1 %). Cattle with no further specified production type had the most (2 %) anomalies with 7758 out of 379,995. The anomalies were consistently identified and comprised prescriptions with too high and too low dosages. Random Forest achieved a ROC-AUC score of 0.994, (95 % CI: 0.992, 0.995) and a F1-Score of 0.962 (95 % CI: 0.958, 0.966) for single treatments. The versatility of this framework allows its adaptation to other species within IS ABV and potentially to other prescription-based surveillance systems. If applied regularly to uploaded prescriptions, it should reduce input errors over time, improving the validity of the data in the long term.

Evaluating the relationship between ciprofloxacin prescription and non-susceptibility in Salmonella Typhi in Blantyre, Malawi: an observational study

Ciprofloxacin is the first-line drug for treating typhoid fever in many countries in Africa with a high disease burden, but the emergence of non-susceptibility poses a challenge to public health programmes. Through enhanced surveillance as part of vaccine evaluation, we investigated the occurrence and potential determinants of ciprofloxacin non-susceptibility in Blantyre, Malawi. We conducted systematic surveillance of typhoid fever cases and antibiotic prescription in two health centres in Blantyre, Malawi, between Oct 1, 2016, and Oct 31, 2019, as part of the STRATAA and TyVAC studies. In addition, blood cultures were taken from eligible patients presenting at Queen Elizabeth Central Hospital, Blantyre, as part of routine diagnosis. Inclusion criteria were measured or reported fever, or clinical suspicion of sepsis. Microbiologically, we identified Salmonella enterica serotype Typhi (S Typhi) isolates with a ciprofloxacin non-susceptible phenotype from blood cultures, and used whole-genome sequencing to identify drug-resistance mutations and phylogenetic relationships. We constructed generalised linear regression models to investigate associations between the number of ciprofloxacin prescriptions given per month to study participants and the proportion of S Typhi isolates with quinolone resistance-determining region (QRDR) mutations in the following month. From 46 989 blood cultures from Queen Elizabeth Central Hospital, 502 S Typhi isolates were obtained, 30(6%) of which had either decreased ciprofloxacin susceptibility, or ciprofloxacin resistance. From 11 295 blood cultures from STRATAA and TyVAC studies, 241 microbiologically confirmed cases of typhoid fever were identified, and 198isolates from 195 participants sequenced (mean age 12·8 years [SD 10·2], 53% female, 47% male). Between Oct1,2016, and Aug31, 2019, of 177 typhoid fever cases confirmed by whole-genome sequencing, four (2%) were caused by S Typhi with QRDR mutations, compared with six (33%) of 18 cases between Sept 1 and Oct 31, 2019. This increase wasassociated with a preceding spike in ciprofloxacin prescriptions. Every additional prescription of ciprofloxacin given to study participants in the preceding month was associated with a 4·2% increase (95% CI 1·8-7·0) in the relative risk of isolating S Typhi with a QRDR mutation (p=0·0008). Phylogenetic analysis showed that S Typhi isolates with QRDR mutations from September and October, 2019, belonged to two distinct subclades encoding two different QRDR mutations, and were closely related (4-10 single-nucleotide polymorphisms) to susceptible S Typhi endemic to Blantyre. We postulate a causal relationship between increased ciprofloxacin prescriptions and an increase in fluoroquinolone non-susceptibility in S Typhi. Decreasing ciprofloxacin use by improving typhoid diagnostics, and reducing typhoid fever cases through the use of an efficacious vaccine, could help to limit the emergence of resistance. Wellcome Trust, Bill & Melinda Gates Foundation, and National Institute for Health and Care Research (UK).

Prevalence of Hospital Bacterial Resistance from 2016 to 2018 in Northwest Mexico

In Mexico, antimicrobial resistance, a public health problem, is difficult to address because of the absence of a regulatory body to effectively control the use and sale of antimicrobials; the low surveillance of prescription and self-medication; and the lack of information. This study aimed to determine the prevalence of resistance to antibiotics in bacteria isolated from hospital clinical samples in northwest Mexico. This study consisted of collecting the information from the logs of the cultures that were carried out in the Microbiology area of ​​the Clinical Analysis Laboratory and its resistance to antibiotics, from December 2016 to January 2018, in Hospital in Northwest Mexico. Escherichia coli, Klebsiella pneumoniae, and Staphylococcus aureus infections were the most common among patients from all care services. Klebsiella pneumonia Pseudomonas aeruginosa, Enterobacter cloacae, S. aureus, Staphylococcus epidermidis, and E. coli showed antibiotic resistance up to 90 and 100%. Benzylpenicillin was the antibiotic to which a high resistance was observed in the intensive care unit service (100%). High bacterial resistance to antibiotics was found from December 2016 to January 2018 in the present study and, in comparison with few Mexican studies, it has remained unchanged.

Surveillance of Antimicrobial Prescriptions in Community Pharmacies Located in Tokyo, Japan.

An antimicrobial resistance (AMR) Action Plan was launched in 2016 to prevent the spread of antimicrobial-resistant bacteria in Japan. Additional support for the appropriate use of pediatric antimicrobial agents was initiated in 2018 to promote the appropriate use of antimicrobial agents in the community. To evaluate the effectiveness of the AMR Action Plan in the community, we investigated antimicrobial prescriptions in community pharmacies. Data on prescriptions for antimicrobial agents dispensed in 42 community pharmacies located in the Tama district, Tokyo, Japan, were collected between April 2013 and December 2019. In this study, we employed the DPY, which was calculated as defined daily doses (DDDs)/1000 prescriptions/year. The DPY is the number of antimicrobial agents used (potency) per 1000 antimicrobial prescriptions dispensed in pharmacies per year. The number of prescriptions for third-generation cephalosporins, fluoroquinolones, and macrolides decreased after the initiation of the AMR Action Plan; the DPYs of these antimicrobial agents decreased significantly by 31.4%, increased by 15.8%, and decreased by 23.6%, respectively (p < 0.05). The number of antimicrobial prescriptions for pediatric patients has been decreasing since 2018. Declines in the DPYs of third-generation cephalosporins, fluoroquinolones, and macrolides were higher in pediatric pharmacies than in other pharmacies. Our data suggest that the AMR Action Plan and additional support for the appropriate use of antimicrobial agents in children influenced the number of antimicrobial prescriptions in community pharmacies in Japan.

Multiple antibiotic resistance index (MARI) of human-isolated Salmonella species: a practical bacterial antibiotic surveillance tool.

Drug-resistant Salmonella plays a significant role in disease morbidity and mortality worldwide. The present study aimed to determine the multiple antibiotic resistance index (MARI) of Salmonella isolated from children hospitalized for gastroenteritis in Hong Kong. Salmonella isolates from stool samples of children aged from 30 days to <5 years were confirmed by using MALDI-TOF MS and subjected to serotyping methods according to the White-Kauffmann-Le Minor scheme. Antimicrobial susceptibility was determined by agar disc diffusion. A total of 101 Salmonella isolates were serogrouped into Group B (n = 46, 45.5%), Group C (n = 9, 9.0%) or Group D (n = 46, 45.5%), and successfully classified into S. Enteritidis (n = 15) and S. Typhimurium (n = 7). Overall Salmonella susceptibilities demonstrated the highest level of resistance to ampicillin (76.2%), ciprofloxacin (54.0%) and tetracycline (61.2%) whereas MDR strains had high resistance toward ampicillin (100%), tetracycline (100%), cotrimoxazole (84.6%), chloramphenicol (83.3%) and ciprofloxacin (83.3%). MARI revealed that 80.2% of Salmonella including all MDR strains (n = 13) had indexes greater than 0.2. The MARI captures a snapshot of a high rate of antibiotic use and resistance in the isolated Salmonella, indicating the urgent need for continuous antimicrobial susceptibility surveillance and control of antibiotic prescription in selecting effective treatments for human diseases.

Evaluation of the Risk Factors of Nosocomial Pneumonia and the Prevalence of Antibiotic Resistance in Trauma Patients in Need of Immediate Intervention

Background: Pneumonia is the most common nosocomial infection reported worldwide in intensive care units. This study aimed to evaluate the risk factors of nosocomial pneumonia and the frequency of antibiotic resistance in trauma patients who need immediate intervention. Patients and Methods: This prospective cohort study was conducted in Shahid Rajaei Trauma Hospital in Shiraz between 2020 and 2021. All the trauma patients who needed immediate intervention (levels 1 and 2 based on the Canadian Emergency Department Triage and Acuity Scale) and had no symptoms of infection were included. Patients who were discharged or died before 48 hours were excluded. Results: The results demonstrated that major trauma (Injury Severity Score [ISS] ≥16), intubation, and use of invasive mechanical ventilation increase nosocomial pneumonia and death rate. The most common causes of nosocomial infections were Acinetobacter baumannii (23%) and coagulase-negative staphylococcus (18.5%). The highest levels of antibiotic resistance were related to cefoxitin, erythromycin, ciprofloxacin, and trimethoprim-sulfamethoxazole. Conclusions: Major trauma, intubation, and invasive mechanical ventilation were the effective factors in the development of nosocomial pneumonia. Continuous monitoring for mentioned risk factors and strict surveillance of antibiotic prescription can decrease the prevalence of nosocomial infections and subsequent deaths.

Prescription of antibiotics in acute respiratory infections non-pneumonia in a private outpatient practice

The over prescription of antibiotics for acute respiratory infections is a major public health problem worldwide. To evaluate the frequency of prescription of antibiotics for non-pneumonia acute respiratory infections in private outpatient clinics in individuals without chronic diseases or immunosuppression. All medical records of adult consultants in a national network of private ambulatory medical centers during May 2018 whose primary diagnosis corresponded to acute respiratory infections not pneumonia (ICD10) were identified and retrospectively analyzed, excluding those with chronic respiratory conditions or states of immunosuppression. Of the 38,072 consultants (aged 36 years, 63% women) who met this criterion, 54% (n = 20,499) received a prescription for at least one antibiotic. The diagnoses that most frequently received this prescription were acute bronchitis (28.7%), acute sinusitis (16.5%) and acute tonsillitis (16.2%). The most frequently prescribed antibiotic globally was azithromycin (37.4%), followed by amoxicillin (20.1%) and amoxicillin plus clavulanic acid (17.7%). Levofloxacin prescription reached 12.5% of total prescriptions. An antibiotic was prescribed in more than half of the non-pneumonia outpatient acute respiratory infections. Azithromycin was the most prescribed antibiotic, while levofloxacin exceeded 10% of prescriptions. These results reinforce the need to implement an antibiotic prescription surveillance system at the outpatient level.

Wastewater surveillance for rapid identification of infectious diseases in prisons

Wastewater surveillance for rapid identification of infectious diseases in prisons

Electronic Prescribing System and electronic health record priorities for antimicrobial stewardship

Rationale, aims, and objectives: This study provided a platform for electronic prescribing design features that may facilitate antimicrobial stewardship. This study aimed to identify software features within electronic prescribing systems and to assign priorities to these software features according to the opinions of the infection specialist health care professionals. Also, to identify any differences in priorities according to a professional group and experience in using electronic prescribing and communicate research findings to policy-makers and electronic prescribing manufacturers.&#x0D; Methods: The study was conducted in a large (600-bed) governmental tertiary and teaching hospital in Amman, Jordan. The survey was delivered by hand to antimicrobial prescribers (internists, surgeons, paediatricians, infectious diseases specialists, and critical care specialists) and non-prescribers (medical interns, clinical pharmacists, nurses, and other allied health care professionals) who filled out the survey face to face. The delivery of the survey started on March 15, 2020, and was closed on April 7, 2020.&#x0D; Results: Responses were received from 210 individuals. Interns represented more than one-third of respondents (n= 79, 37.6%), with 15.7% were internal medicine physicians. Among the healthcare professionals, around 44.7% (n= 94) are considered prescribers to antimicrobials, while others are considered non-prescribers (n= 116, 55.2%). The majority of respondents (n= 205, 97.6%) reported using an electronic prescribing and electronic health record system for part or all in their hospital, with 35.7% (n= 75) of them reported using these systems for more than one year. The prompt prescribing feature having the highest assigned priority was the allergy checker (n= 193, 91.9%) followed by the dose checker (n= 192, 91.4%).&#x0D; Conclusion: This study demonstrates the first attempt to describe views of healthcare professionals in Jordan about the potential significance of prescribing prompt and active prescription surveillance software features on clinical, microbiological and process outcomes to support antimicrobial stewardship. Findings from this study reveal considerable demand for additional software features expressed by the healthcare professionals charged with promoting rational use of antimicrobials and a consensus of anticipated positive impact on patient safety and efficiency outcomes.

Impact of a hospital-wide computerised approach to optimise the quality of antimicrobial prescriptions in patients with severe obesity: a quasi-experimental study

BackgroundRates of adherence to available recommendations for dose adjustments in patients with severe obesity are generally low. Hence, antimicrobials are often underdosed in these patients. Antimicrobial stewardship programmes can improve the use of antimicrobials in hospitalised patients. The aim of the study was to analyse the impact of an antimicrobial stewardship programme based on a computerised clinical decision support system for optimal dosing and antimicrobial use in inpatients with severe obesity.MethodsThis quasi-experimental retrospective study using interrupted time series was conducted in an academic centre in Canada from August 2008 to June 2018. The Antimicrobial Prescription Surveillance System was implemented in August 2010 (intervention 1) and specific rules targeting patients with class III obesity (body mass index ≥ 40 kg/m2) were added in June 2014 (intervention 2). Data were collected from all hospitalised adults receiving antimicrobials which required dose adjustment for severe obesity and were stratified by body mass index. Segmented regression analysis of interrupted time series was used to evaluate the impact of the Antimicrobial Prescription Surveillance System on the proportion of inappropriate days of therapy according to posology and on antimicrobial consumption.ResultsOverall, 65 205 antimicrobial prescriptions (68% non-obese, 25% class I-II obesity, and 7% class III obesity) were analysed. In patients with class III obesity, the intervention was associated with a decrease in the proportion of inappropriate days of therapy (trend after the first intervention, −0.8% per 2-month period [95% CI −1.1 to −0.5], p < 0.001; intercept, 11.3% [95% CI 8.2 to 14.5], p < 0.001), which led to a reduction of 35% over an eight-year period (from pre-intervention level of 19.1%). Intervention 1 resulted in a downward trend in antimicrobial consumption, followed by an increasing trend after intervention 2. In these patients, the most frequent interventions made by pharmacists targeted posology (46%).ConclusionsAntimicrobial Prescription Surveillance System had a positive impact on dosing optimisation and antimicrobial consumption in patients with class III obesity. Improving antimicrobial prescriptions in these patients is important because suboptimal dosing could be associated with unfavourable outcomes.

IDENTIFICATION AND CHARACTERIZATION OF METALLO--LACTAMASES PRODUCING PSEUDOMONAS AERUGINOSA CLINICAL ISOLATES IN AL-AZHER UNIVERSITY HOSPITAL, ASSIUT

Purpose: Study aimed to determine the frequency of nosocomial infections caused by P. aeruginosa and its distribution among different intensive care units (ICUs), to determine the antibiotic resistance pattern, and to determine the prevalence of Metallo-b-lactamase (MbL) among isolates by phenotypic methods. Methods: A total of 74 P. aeruginosa isolates were identified from different clinical specimens in AL-Azher University Hospital. The antimicrobial susceptibility was tested by disk diffusion (Kirby-Bauer) method and phenotypic screening for MbLs was performed using Combined Disk Test (CDT) and double-disk synergy test (DDST). Results: The frequency of P. aeruginosa isolates from clinical specimens was 18% (74/412). The highest sensitivity was to imipenem 38 isolates (51.3%). The antibiotic sensitivity was in descending manner to meropenem (48.6%) > levofloxacin (28.4%) > ciprofloxacin and ceftazidime (21.6%), while the highest resistance rates were to carbenicillin 70 isolates (94.6%) then gentamicin (70.3%). Out of 74 P. aeruginosa isolates, 51/74 (69%) strains were multidrug resistant (MDR), based on the CDT results 26/74 (35.1%) isolates and by DDST 23/74 (31.1%) isolates were confirmed to be MbLs producers. Conclusion: There is a growing risk for isolation of MDR P. aeruginosa among the MBL-producer isolates suggests the need for continuous assessment of antimicrobial susceptibility and surveillance of antibiotic prescription. In addition, infection control measures are needed to prevent further dissemination of these organisms.

Analysis of Monacolins and Berberine in Food Supplements for Lipid Control: An Overview of Products Sold on the Italian Market.

The use of dietary supplements for the prevention and management of diseases associated with excess of lipids is spreading in Western countries. Supplements containing red yeast rice (RYR) and extracts from Berberis species, characterized, respectively, by the active compounds monacolin K (MK) and berberine (BBR), are sold in pharmacies as over the counter medicines (OTC) and in regular markets without the need of medical prescription and medical surveillance. However, MK is chemically identical to lovastatin, a drug commonly used to treat hypercholesterolemia, and is characterized by the same mechanism of action, pharmacokinetic profile and toxicity. On the other hand, although BBR-containing supplements are considered to be well-tolerated and safe, they frequently show poor standardization of active ingredients, and this could lead to lack of effects. In this work, with the aim to give an overview on the potency of RYR- and BBR-containing supplements available on the Italian market, we analyzed a pool of supplements bought from both local pharmacies and markets. Results confirm the data already published by other authors, showing scarce standardization of bioactives and discrepancy between the doses of bioactives reported by the manufacturers and the amounts resulting from analysis of the same products. Overall, our data represent a further proof that a strict legislation regulating the production and marketing of dietary supplements and a close monitoring of these products by food and drug regulatory organs is mandatory.

#86: A Quality Improvement Study Using Blended Learning as Part of Antimicrobial Stewardship Program (ASP) to Improve Ampicillin Sulbactam Prescription in Pediatric Hospital in Bogotá, Colombia

Abstract Background Antimicrobial agents are the second most common prescribed drugs in hospital settings. Antibiotic resistance is a major public health problem. Some studies have found that 20–50% of antibiotics prescriptions are inadequate or not necessary. Ampicillin-sulbactam is the second most common prescribed antibiotic in inpatients children in our hospital. We designed a quality improvement study to improve ampicillin–sulbactam prescription in a third-level children hospital in Bogotá, Colombia. Methods A before and after study was designed. We obtained days of treatment (DOT) for ampicillin–sulbactam in last 3 years (2017, 2018, and 2019). In October of 2019, we included ampicillin–sulbactam as a targeted antibiotic in our ASP. We focus the efforts in 2 principals’ strategies: Educative strategy and audit and feedback strategy. Educative strategy included a blended learning intervention and audit and feedback strategy included surveillance of prescriptions in real time to evaluate local guidelines adherence with feedback to prescribers. We designed a form to collect and analyze data with Epi Info®. Results In 2 months of surveillance, we reviewed and analyzed 67 prescriptions. Median age of patients was 2 years (0.75–7.5 years). The main diagnosis was pulmonary infection in 70.1% (multilobar pneumonia 13 patients, lobar pneumonia 8 patients and bacterial co-infected bronchiolitis in 5 patients). Three prescriptions were based in etiologic isolation while 64 was an empiric formulation. Only 24 prescriptions (35%) were considered adequate according to local guidelines. The principal’s reasons of inadequate prescription were the possibility to use a narrow-spectrum antibiotic (58.1%) and error about inadequate infectious disease diagnosis (39.5%). In 43 of inadequate prescriptions, ASP changed the antibiotic in 24 patients, stopped all antimicrobial therapy in 14, and changed to oral rout in other 4. In the patient’s follow-up, all have an adequate clinical course, and only 3 required to restart antimicrobial therapy. There were no deaths related to infectious diseases. In the educational strategy we trained 34 staff members (32.9%) with lectures and 72 staff members (69.2%) using virtual strategy. We use a pre- and post-test evaluations, with a score improvement in 33% after the educational strategy. Finally, we compared DOT of ampicillin-sulbactam for the last 3 years and we found a reduction of 65% in prescription between October 2017 and October 2019 (Figure 1). Conclusion This is the first quality improvement study with an ASP targeting a narrow-spectrum antibiotic in children. Many ASP focused their efforts only in broad-spectrum antibiotics, but few studies have been published in narrow-spectrum antibiotics. The implementation of an ASP to improve prescription of ampicillin–sulbactam had a dramatic impact in reduction of prescriptions in our settings. The educational strategy using blended learning strategy is especially valuable in hospital education because virtual learning has a great flexibility and if facilitated by the high availability of mobile devices.

Antibiotic prescription analysis of inpatients in a tertiary care teaching hospital

Background: Antibiotics are one among the commonly prescribed drugs. Patterns of antibiotic resistance widely follows local patterns of antibiotic prescribing and usage. Periodic surveillance of antibiotic prescriptions at regional level are essential to understand and combat antimicrobial resistance. To study the prescribing pattern of antibiotics among inpatients of various specialties in a tertiary care teaching hospital. Method: A prospective observational study of prescribing pattern of antibiotics was conducted among inpatients of various specialties in a tertiary care teaching hospital. Antibiotic prescribing data was collected using a semi structured proforma. The data obtained was analyzed and the conclusions were drawn using descriptive analysis.Results: A total of 1161 prescriptions were collected. 3211 antibiotics were prescribed. Mean average duration of treatment with antibiotics per patient was 11.8 days. Use of 3rd generation cephalosporins, imipenem, piperacillin and vancomycin observed. 75% of antibiotics were prescribed for prophylactic use. Antibiotics prescribed for therapeutic indication were supported by clinical, radiological and other investigations like culture and sensitivity reports.Conclusions: The present study highlights the use of antibiotics for long duration among admitted patients. Implementation of antimicrobial stewardship program with adherence to standard treatment guidelines is essential to combat antimicrobial resistance.

Long-Term Surveillance of Antibiotic Prescriptions and the Prevalence of Antimicrobial Resistance in Non-Fermenting Gram-Negative Bacilli.

The increasing emergence of multidrug-resistant (MDR) bacteria has been recognized as a public health threat worldwide. Hospitalized patients and outpatients are commonly infected by non-fermenting Gram-negative bacilli (NFGNB), particularly the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB) and Pseudomonas aeruginosa. Antimicrobial agents are critical for treating the nosocomial infections caused by NFGNB. The aim of this study was to assess antimicrobial resistance and the use of antimicrobial agents. The bacterial isolates of 638,152 specimens from both inpatients and outpatients, retrieved from 2001 to 2008 at a medical center in central Taiwan, were examined for their susceptibility to various antimicrobial agents, including cefepime, imipenem, ciprofloxacin, gentamicin, amikacin, meropenem, and levofloxacin. Administrated prescriptions of the monitored antibiotics were analyzed using the Taiwan National Health Insurance Research Database (NHIRD). Our results show that the defined daily doses (DDDs) for cefepime, imipenem, and ciprofloxacin increased with time, and a trend toward reduced antimicrobial sensitivities of both ACB and P. aeruginosa was noticeable. In conclusion, the antimicrobial sensitivities of ACB and P. aeruginosa were reduced with the increased use of antibiotics. Continuous surveillance of antibiotic prescriptions and the prevalence of emerging resistance in nosocomial infections is warranted.

A PROSPECTIVE RANDOMISED STUDY ON PREVALENCE AND AWARENESS OF SELF MEDICATION OF ANALGESICS AMONG TERITIARY CARE HOSPITAL

self- medication is described as obtaining and consuming one (or) more drugs or medications without the advice of physician either for diagnosis, prescription (or) surveillance of the treatment. The main aim of research is to estimate the prevalence of self- medication of analgesics among hospitalized patients along with causes of illness and symptoms that lead to self-medication. The study was conducted in a tertiary care hospital .a total sample of 226 subjects was investigated by using a self- questionnaire form .based on findings the prevalence of irrational use of analgesics are about 65% of females (n=144) and 37% of males (n=82).self -medication was more prevalent among age group above 45years in which female are in greater use. self -medication is most commonly used in participants who are having joint pains (51%), muscle pains (29%), head ache (28%), back pain (21%),.among them 21.26% are having confidence on knowledge about medication. During self -medication with analgesics patients stop taking medicine after symptoms disappeared(62.30%),a few days after recovery (13.11%),after completion of course (18.85%),after consulting doctor /pharmacist (4.92%).over use of analgesics causes kidney and heart problems .72.72%does not know causes and uses analgesics frequently of the total participants only 43.52%are in aware that pharmacist will explain about medication usage. This research is carried out mainly in the context to raise awareness of the dangers of self -medication of analgesics. There is need to aware public that pharmacist can explain about drugs, their side effects.

Analyzing data from the digital healthcare exchange platform for surveillance of antibiotic prescriptions in primary care in urban Kenya: A mixed-methods study.

BackgroundKnowledge of antibiotic prescription practices in low- and middle-income countries is limited due to a lack of adequate surveillance systems.ObjectiveTo assess the prescription of antibiotics for the treatment of acute respiratory tract infections (ARIs) in primary care.MethodAn explanatory sequential mixed-methods study was conducted in 4 private not-for-profit outreach clinics located in slum areas in Nairobi, Kenya. Claims data of patients who received healthcare between April 1 and December 27, 2016 were collected in real-time through a mobile telephone-based healthcare data and payment exchange platform (branded as M-TIBA). These data were used to calculate the percentage of ARIs for which antibiotics were prescribed. In-depth interviews were conducted among 12 clinicians and 17 patients to explain the quantitative results.ResultsA total of 49,098 individuals were registered onto the platform, which allowed them to access healthcare at the study clinics through M-TIBA. For 36,210 clinic visits by 21,913 patients, 45,706 diagnoses and 85,484 medication prescriptions were recorded. ARIs were the most common diagnoses (17,739; 38.8%), and antibiotics were the most frequently prescribed medications (21,870; 25.6%). For 78.5% (95% CI: 77.9%, 79.1%) of ARI diagnoses, antibiotics were prescribed, most commonly amoxicillin (45%; 95% CI: 44.1%, 45.8%). These relatively high levels of prescription were explained by high patient load, clinician and patient perceptions that clinicians should prescribe, lack of access to laboratory tests, offloading near-expiry drugs, absence of policy and surveillance, and the use of treatment guidelines that are not up-to-date. Clinicians in contrast reported to strictly follow the Kenyan treatment guidelines.ConclusionThis study showed successful quantification of antibiotic prescription and the prescribing pattern using real-world data collected through M-TIBA in private not-for-profit clinics in Nairobi.

Retrospective Evaluation for ORCA Surveillance Comparison with Prescription Surveillance

Background: “Online Receipt Computer Advantage” (ORCA) surveillance, an online medical claim service produced and provided freely to medical facilities by the Japan Medical Association, has been available for public use since 2010. However, its preciseness has not been evaluated. The object of the present study is comparison with ORCA surveillance and prescription surveillance (PS), which is the most reliable daily surveillance for influenza nationwide in Japan, and evaluating preciseness of ORCA surveillance. Method: We specifically examined influenza as a targeted disease. We regarded PS as the gold standard daily real-time monitoring system for influenza nationwide and for each prefecture. This study assesses correlation and discrepancies between ORCA and PS results for influenza nationwide and by prefecture. Results: Nationwide, the correlation coefficient of PS and ORCA was 0.9653; the discrepancy rate was 27%. Among prefectures, results show that Mie and Fukui prefectures had two quite similar epidemic curves. Conclusion: Results demonstrate that ORCA surveillance is comparable to PS nationwide. However, some prefectures exhibited comparable results whereas others did not. ORCA surveillance cannot break down to the municipal level.

Providing Infectious Disease Information to Child-Rearing Families and Its Evaluation

Background: Earlier study without actual trial indicated that caregivers needed delivery of information about outbreak situations independently of their job status. This report describes, for about two months in winter, actual delivery outbreak information to families with preschool children. The study objective was to confirm the usefulness of this information delivery. Method: Participants receiving outbreak information were recruited from the Child Care Support Service in a ward in Tokyo, Japan. Outbreak information was obtained from the Nursery School Absenteeism Surveillance System (NSASSy) covering approximately 40% of all nursery schools in Japan, prescription surveillance and other resources. Delivery of outbreak information started in December 2017 and ceased at the end of February in 2018. After the delivery period, a questionnaire survey was administered to participants. Results: For this area, NSASSy showed the most dominant disease was influenza, with 707 patients, followed by group A streptococcal pharyngitis with 98 patients. The outbreak peak was inferred to be as Monday, 22 January, and it was announced by e-mail on 23 January. Of the 202 persons joined this trial, 60 participants responded to the questionnaire survey after the delivery period. Of those respondents, 98% wanted delivery of that information to continue. Conclusion: We found that almost all respondents confirmed usefulness of the information about infectious diseases which was delivered.