Prevalence Of Antibiotic Prescriptions Research Articles

P-1638. Prevalence and Correlates of Inappropriate Antibiotic Prescribing in Japanese Primary Care Settings

Abstract Background Since the release of its 2016 National Action Plan on Antimicrobial Resistance (AMR), Japan has promoted antimicrobial stewardship in various ways (e.g. AMR awareness campaigns) but remains short of meeting benchmarks, e.g. reduction of antibiotic use per capita by one-third by 2020 versus 2013 (decreased only by 4.4% as of 2019). Effective stewardship interventions require comprehensive assessment of antibiotic prescribing appropriateness, with the most recent national-level data from 2012–2015. To fill this knowledge gap, we evaluated antibiotic prescribing appropriateness in Japanese outpatient primary care visits using nationally representative data. Characteristics of patients who received ≥1 antibiotic prescription and visits in which physicians wrote antibiotic prescriptions from October 2022 to September 2023, JAMDAS Methods In a cross-sectional analysis of 2,809 primary care clinics, we analyzed all antibiotic prescriptions from October 1, 2022, to September 30, 2023. We adapted an established ICD-10-based classification scheme (Chua et al, BMJ, 2019) to the Japanese context, classifying prescriptions as “appropriate” (associated with ≥1 “always” code), “potentially appropriate” (associated with ≥1 “sometimes” code but no “always” codes), “inappropriate” (associated only with “never” codes), or “not associated with recent diagnoses.” We used regression to examine the association between prevalence of inappropriate antibiotic prescriptions and patient, clinic, and visit characteristics, adjusting for month indicators. Prevalence of antibiotic prescriptions in each appropriateness category, JAMDAS Results Table 1 shows characteristics for patients who received ≥1 antibiotic prescription and visits in the sample. Among 2,058,021 prescriptions to 1,267,708 patients, 17.9% were inappropriate (Table 2). The adjusted prevalence of inappropriate antibiotic prescriptions was higher for children (< 18 years), patients with comorbidities (sourced from the Charlson Comorbidity Index), older physicians, physicians with higher antibiotic prescription volumes, and telehealth visits versus office visits (Figure 1). There were no differences by patient or physician sex, total patient volume, region, or regular versus after hours. Association of patient, clinic, and visit characteristics with prevalence of inappropriate antibiotic prescriptions Conclusion Antibiotic stewardship initiatives in Japanese primary care targeting children, patients with more comorbidities, older physicians, physicians with high antibiotic prescription volumes, and telehealth settings may be warranted. Disclosures Atsushi Miyawaki, MD, PhD, M3, Inc.: Advisor/Consultant

Beyond CDC-Defined Surgical Site Infection: Factors Associated with Antibiotic Prescription After Breast Operation.

Background: Most studies on surgical site infections (SSIs) use the US Centers for Disease Control and Prevention (CDC) guidelines, which excludes inflammation or cellulitis without fever. The aim of this study was to evaluate antibiotic prescription trends in the post-operative period among patients undergoing breast operation. We explore the outcomes of patients receiving antibiotic agents outside of the CDC-defined SSI. Patients and Methods: A retrospective review of patients undergoing breast operation from January 2021 to May 2021 was conducted. Solely reconstructive and cosmetic cases were excluded. The primary outcome was the prevalence of antibiotic prescription in the absence of CDC-defined SSI, excluding routine prophylactic antibiotic agents, with analysis of associated factors. Results: A total of 754 breast surgical procedures were included. Seventy-seven patients (10.2%) were prescribed outpatient antibiotic agents. CDC-defined SSI occurred in 5.3% (n = 40), mostly involving tissue expander/implant-based reconstruction (47.5%, n = 19). However, 37 (4.9%) did not progress to meet the CDC criteria for SSI. Patients prescribed outpatient antibiotic agents without CDC-defined SSI did not have increased rates of diabetes mellitus, obesity, or current smoking. These patients were more likely to have a surgical drain (48.6% vs. 28.4%, p = 0.02), plastic surgery involvement (32.4% vs. 18.0%, p = 0.048), and a post-operative seroma (32.4% vs. 8.1%, p < 0.001) and or or cellulitis (18.9% vs. 0%, p < 0.001). Conclusion: Patients are prescribed antibiotic agents after breast operation based on clinical judgment for indications other than CDC-defined SSI. Post-operative wound morbidity including seroma and cellulitis could be contributing to these antibiotic prescriptions. Further study is needed to determine whether providers are preemptively treating SSIs appropriately or over-treating non-infectious wound complications.

Exploring antibiotic prescribing practices in multidisciplinary hospitals in the Republic of Moldova

Antimicrobial resistance (AMR) represents a major global challenge, amplified by the excessive and incorrect use of antibiotics. Th is study conducted in the Republic of Moldova investigated antibiotic prescribing practices in multidisciplinary hospitals to identify correlations between these practices and the increase in AMR. Th e study included a sample of 222 patients from four hospitals, selected based on the availability of a bacteriological laboratory and bed capacity. Data were collected using standardized questionnaires, which evaluated the type, duration, and changes in antibiotic therapy, as well as the results of bacteriological tests. Th e analysis revealed a high prevalence of antibiotic prescriptions, at 86.5%, with higher rates in urology (96%) and intensive care (92%) departments. Approximately 70% of patients hospitalized for 3-5 days received an antibiotic, while those hospitalized for more than 10 days were three times more likely to receive two or more antibiotics. The justification for these prescriptions was missing in most cases, signaling an urgent need for improvement in prescribing practices. Third-generation cephalosporins were the most frequently prescribed antibiotics (44.9%), followed by fluoroquinolones and aminoglycosides. Th e majority of the prescribed antibiotics were classified as „Watch” according to the WHO AWARe classification, indicating a need for intensive monitoring due to the risk of AMR. Th e results underscore the importance of implementing effective antimicrobial management programs and enhancing the monitoring of antibiotic use to combat the rise in AMR.

Evaluation of Antibiotic Prescribing Practices in Surgical Departments at the University Hospital Center-Yalgado Ouedraogo, Burkina Faso

Introduction: Inappropriate use of antibiotics is one of the main causes of the emergence of antibiotic resistance in sub-Saharan Africa. To contribute to better antibiotic prescribing, the aim of this work was to evaluate prescribing in the surgery and surgical specialties department at the University Hospital Center Yalgado Ouedraogo (CHU-YO). Methods: This was a prospective cross-sectional study from December 15 to 21, 2021. Patients hospitalized in the surgical department were included. Compliance guidelines were the recommendations of the SFAR and the guide to good antibiotic prescribing in Burkina Faso. Results: A total of 162 patients were hospitalized during the study period, of whom 97 were included. The prevalence of antibiotic prescriptions was 59.9%. Curative antibiotic therapy accounted for 66% of prescriptions, while all surgical patients received antibiotic prophylaxis. The β-lactam family was prescribed in 88.5% of cases for prophylaxis and 91.3% for curative treatment. Ceftriaxone was prescribed in 71.3% of cases for prophylaxis and 44.9% for curative antibiotic therapy. Overall compliance was 22.3% for antibiotic prophylaxis and 49.3% for antibiotic therapy. Non-compliance with antibiotic prophylaxis was linked to an inappropriate choice of antibiotic for prophylaxis, and to unjustified prescribing for antibiotic therapy. Conclusion: Capacity-building for prescribers and the development of guidelines could help improve the appropriateness of antibiotic use at CHU-YO.

Implementation of a Multifaceted Program to Improve the Rational Use of Antibiotics in Children under 3 Years of Age in Primary Care.

A multifaceted, participatory, open program based on a qualitative and quantitative approach was developed in the Region of Murcia (Spain) aimed to reduce antibiotic use in children under 3 years of age diagnosed with upper respiratory tract infections (acute otitis media, pharyngitis, and common cold). Antibiotic consumption was measured using the defined daily dose per 1000 inhabitants per day (DHD). Pre-intervention data showed a prevalence of antibiotic prescriptions in the primary care setting of 45.7% and a DHD of 19.05. In 2019, after the first year of implementation of the program, antibiotic consumption was 10.25 DHD with an overall decrease of 48% as compared with 2015. Although antibiotic consumption decreased in all health areas, there was a large variability in the magnitude of decreases across health areas (e.g., 12.97 vs. 4.77 DHD). The intervention program was effective in reducing the use of antibiotics in children under 3 years of age with common upper respiratory diseases, but reductions in antibiotic consumption were not consistent among all health areas involved.

Prescrizione di antibiotici in Pronto Soccorso pediatrico

Background - The emergency department (ED) is an important site of care in which inappropriate antibiotic prescribing and the consequent impact of antibiotic-resistant bacteria can be reduced. Objective - The aim of this retrospective study was to investigate the pattern of antibiotic prescriptions for upper respiratory tract infections in children examined in 3 different ED located in Azienda Ospedaliera Bergamo-Est and to highlight the possibilities for a reduction and a more appropriate use of this class of drugs, overprescribed in paediatric age. Methods - A retrospective observational study was performed on children younger than 18 years of age, who were examined in a general hospital near Bergamo from January 2020 to September 2022. The proportion and type of antibiotic prescription according to demographic, clinical, laboratory and imaging data were determined. Results - 4,731 children were included in the study and 894 (18.9%) received an antibiotic prescription. The prevalence of antibiotic prescription varies with age, with a peak at 1-5 years (21.7%), and depending on the diagnosis, from 2.5 % in children with influenza to 78.4% in children with otitis. Amoxicillin/clavulanate was the most prescribed antibiotic (47% of antibiotic prescriptions), while the percentage of amoxicillin prescription was low (36%). In patients examined for pharyngotonsillitis, amoxicillin was prescribed to 43% of those treated with antibiotics. Conclusions - This study supports the need for a new comprehensive approach to ensure successful antibiotic stewardship. A guide to the use of new diagnostic tests (molecular biology, genome sequencing and immunoenzymatic assays) in a “diagnostic stewardship” perspective may be helpful; however, clinical evaluation remains of fundamental and central importance.

Prevalence of Antibiotic Prescription in Primary Healthcare Settings in the Municipality of Prishtina, Kosovo

Background: Antibiotics remain among the most prescribed drugs in primary healthcare, contributing to increased antibiotic resistance in the community and prevailing as an emerging global health concern. We aimed to quantify the prevalence and quality of antibiotic prescription in primary healthcare settings in the Municipality of Prishtina to identify targets for quality improvement.Methods and Results: This study represents a population-based, retrospective cohort, including data from eight randomly selected family medical centers in the Municipality of Prishtina. Each 150th patient on medical records was assessed for demographic data, diagnosis (ICD-10), antibiotic prescription, antibiotic class, and antibiotic form. In total, the study included 1614 cases reviewed. The antibiotic prescription rate was 16%. The health condition for which most of the cases received antibiotics was J18 - Pneumonia, unspecified organism (67%), followed by J03 - Acute tonsillitis (54%), J42 - Unspecified chronic bronchitis (46%), and N39 - Other disorders of the urinary system (43%) Broad-spectrum antibiotics, such as co-amoxiclav (17.7%), amoxicillin (16.5%), and ceftriaxone (12.6%), featured among the most routinely prescribed antibiotics. The antibiotic prescription rate was the highest for cases in the 3-5 age group, of whom 27% received an antibiotic prescription. In 73% of cases, oral antibiotics were prescribed, 69% of which belong to the WHO AWaRe (Access, Watch, Reserve) essential medicines list. Only 18% of antibiotics were prescribed with their generic names. Conclusion: The prevalence of antibiotic prescription in primary healthcare settings in Prishtina is moderately low. These data cannot be extrapolated to other municipalities in Kosovo or other countries due to different organizational levels. High antibiotic prescription rates for young age groups, prescription of broad-spectrum antibiotics, and high rates of parenteral antibiotics were identified as targets for quality improvement.

In Utero Exposure to Antibiotics and Risk of Serious Infections in the First Year of Life.

Given the high prevalence of antibiotic prescription during pregnancy in France and previous studies suggesting an increased risk of infection in offspring with such exposures, our study aimed to investigate the association between prenatal exposure to systemic antibiotics and serious infections in full-term infants during their first year of life. We conducted a retrospective population-based cohort study on singleton, full-term liveborn non-immunocompromised infants, using the French National Health Data System (SNDS) between 2012 and 2021. Systemic antibiotic dispensing in ambulatory care settings during pregnancy defined the exposure. Outcomes concerned serious infections (i.e., infections requiring hospitalization) in offspring identified between 3 and 12 months of life, hence excluding infections of maternal origin. Adjusted odds ratios (aORs) were estimated using logistic regression with multivariate models to control for potential confounders. Of 2,836,630 infants included, 39.6% were prenatally exposed to systemic antibiotics. Infants prenatally exposed to antibiotics had a higher incidence of serious infections compared with unexposed infants {aOR 1.12 [95% confidence interval (95% CI) 1.11-1.13]}. Similar associations were observed according to the timing of exposure during pregnancy, antibiotic class, and site of infections. The strongest association was observed when infants were prenatally exposed to three or more antibiotic courses during pregnancy [aOR 1.21 (95% CI 1.19-1.24)]. Limitations include residual confounders, such as genetic susceptibility to infections and the role of the underlying pathogen agent. Prenatal exposure to systemic antibiotics is very common and is associated with a weak yet significant associations with subsequent serious infectious events during the first year of life. While our study revealed associations, it is important to note that causation cannot be established, given the acknowledged limitations, including potential confounding by indication.

The Behavior of Primary Healthcare Doctors Toward Antibiotic Prescriptions for Upper Respiratory Tract Infections.

Unnecessary prescription of antibiotics for patients with upper respiratory tract infections (URTIs) carries the potential risk to the development of bacterial resistance. This study aimed to investigate the behavior of primary healthcare (PHC) physicians toward an antibiotic prescription for URTI, Al-Madinah City, Saudi Arabia in 2021. A cross-sectional study was conducted at PHC centers in Al-Madinah City, Saudi Arabia. The study invited all physicians in the randomly selected 28 PHC centers to participate in the study. A master sheet adopted from a researcher done in the Asir region of Saudi Arabia about the pattern of prescription for URTIwas used and included data about socio-demographic characteristics and data about presenting symptoms and signs of URTIs, the clinical diagnosis, type of medication prescribed, and duration of treatment also, included data about the factors that press physicians to prescribe antibiotics and their response. The questionnairewas filled out and returned back by 140 physicians. The collected data were analyzed and tabulated using appropriate statistical tests. The mean age of the studied physicians was 34.4 ± 7.6 years (25-59 years). General practitioners and specialists were 66.4% and 33.6%, respectively. The prevalence of antibiotic prescriptions was 44.3%. The most prescribed antibiotics were amoxicillin (58.6%)and Augmentin(28.6%). Congested tonsils (87.1%), ear discharge (84.2%), and cervical lymphadenopathy (89.3%) were the most clinical factors that affected physicians' decisions to prescribe antibiotics for URTI. The non-clinical factors affecting physicians' decisions include patient request (52.8%) and press (28.5%), with no statistically significant difference detected between general practitioners and specialists. The study findings indicate the need to develop intervention programs targeting physicians as well as the general population to decrease inappropriate antibiotic prescriptions in primary care centers.

Changes in the Prescription of Antibiotics and Phytopharmaceuticals in Children Treated for Acute Upper and Lower Respiratory Tract Infections in Pediatric Practices in Germany in 2013, 2018, and 2022.

Background: Little is known about the recent trends in antibiotic and phytopharmaceutical prescribing for acute upper (URIs) and lower respiratory tract infections (LRIs) in children and adolescents. Therefore, this study investigated changes in the prescription of antibiotics and phytopharmaceuticals in children diagnosed with acute URIs and LRIs in pediatric practices in Germany in 2013, 2018, and 2022. Methods: The present retrospective study included children aged 2-12 years diagnosed with acute URIs or LRIs in one of 180 pediatric practices in 2013, 2018, and 2022. The URIs included nasopharyngitis, sinusitis, pharyngitis, tonsillitis, laryngitis and tracheitis, and upper respiratory infections of multiple and unspecified sites, while the LRIs corresponded to bronchitis. The primary outcomes were the proportion of children being prescribed antibiotics and the proportion of those being prescribed phytopharmaceuticals. Results: A total of 120,894 children were diagnosed with acute URIs or LRIs in 2013 compared to 116,844 in 2018 and 127,821 in 2022. The prevalence of antibiotic prescription decreased for all diagnoses between 2013 and 2022. This decrease was statistically significant for both 2013-2018 and 2018-2022 for nasopharyngitis, pharyngitis, and bronchitis. Meanwhile, there was a significant increase in the use of phytopharmaceuticals for all diagnoses between 2013 and 2018. The prevalence of phytopharmaceutical prescription decreased slightly between 2018 and 2022, but this decrease was generally not statistically significant. Conclusions: The prescription of antibiotics has decreased and that of phytopharmaceuticals has increased in children diagnosed with acute URIs and LRIs in Germany over the last decade. More data are needed to corroborate these findings in other settings.

Antibiotic prescription among children with common cold at a district hospital in Uganda.

Most childhood infections are of viral origin making antibiotics unnecessary. They are, however, the most frequently prescribed drugs dispensed to children, resulting in inappropriate antibiotic prescriptions, which are one of the main drivers of antibiotic resistance. The study aimed to determine the prevalence of antibiotic prescriptions and identify its associated factors among children below 5 years with common cold who attend the outpatient department in Tororo General Hospital. The study was carried out in Tororo General Hospital, Eastern Uganda. A cross-sectional survey using consecutive sampling was performed among children below 5 years with common cold attending the outpatient department. Data were collected using an interviewer-administered, structured questionnaire and analysed using STATA version 14.0. Prevalence of antibiotic prescriptions was calculated. Bivariate analysis using chi-square test and multivariate analysis using logistic regression was performed to establish factors associated with antibiotic prescription. The prevalence of antibiotic prescriptions for common cold among children below 5 years was 23.3%. Factors associated with antibiotic prescription for common cold were duration of symptoms of more than 5 days (OR, 95% CI: 4.49; 1.16-17.23, p = 0.029) and being attended to by a clinical officer (OR, 95% CI: 0.19; 0.04-0.91, p = 0.038). There is inappropriate antibiotic prescription among children with common cold in Tororo General Hospital. There is need for antibiotic stewardship programmes to promote optimal antibiotic use in primary care facilities.Contribution: The study's findings can be used to develop context-specific antibiotic stewardship programmes tailored to promote judicious use of antibiotics in primary care.

Pattern of Antibiotic Use among Hospitalized Patients at a Level One Multidisciplinary Care Hospital.

Antimicrobial resistance is one of the world's most serious health issues. Antibiotic resistance, excessive drug expense, and an increased risk of adverse reactions are all common outcomes of incorrect antibiotic prescribing. The goal of this study was to evaluate the prevalence of antibiotic prescriptions for inpatients to find areas for improvement. A retrospective study at Emergency Clinical County Hospital of Oradea, Romania was performed for five years between 2017 and 2021. Data was collected using medical records of the patients and reports from the pharmacy. Antibiotic consumption was expressed as DDD/100 BD according to the World Health Organization (WHO) by antibiotics, classes, and AWaRe classification. The prevalence of antibiotic prescription was 53.8% during five years evaluated with a significant increase in 2021. A total of 13,677.42 DDD/100 BD antibiotics were prescribed, especially for surgical and medical prophylaxes. The most prescribed antibiotics were ceftriaxone, followed by metronidazole, and cefuroxime but there were some differences between years and wards. The most frequent antibiotic classes prescribed were cephalosporins (43.73%). The use of Watch Group antibiotics was high in all wards (59.69%). The prevalence of antibiotic use was high with cephalosporins being the most prescribed antibiotics. As a result, interventions are required.

ANTIBIOTICS PRESCRIBING IN PEDIATRIC PRACTICE AND OPTIMIZATION WAY THE STUDY OF THE USE OF ANTIBIOTICS IN PEDIATRIC PRACTICE AND WAYS OF OPTIMIZATION

Antimicrobials are the most commonly prescribed drugs in the community and hospital setting. The rational use of antibiotics in Georgia, as in the world is an important issues for health care structures. Global spread is strictly associated &nbsp;with an inappropriate use of antimicrobials. There are just a few studies describing the real antibiotic consumption in Georgia Aim of our study was To describe the prevalence of antibiotic prescription for prophylaxis and treatment of infections. To evaluate antibiotic prescriptions, indications, number and type of antibiotic agents.3 pediatric or mixed adult-pediatric hospitals were studied in 2015 and 9 hospitals in 2017. In 2015 total number of patients was 95 and 66 (30.52%) of these had an on-going prescription for one or more antibiotics. In 2017 total number was 157 and 107 &nbsp;(31.84%) of these had an on-going prescription.&nbsp; Our study presented a picture of the situation in Georgia in terms of antibiotic prescriptions in hospitalized neonates and children. Last year there was seen increased use of the third generation cephalosporins. In neonatal and surgical wards the use of broad spectrum antibiotics decreased. Also it is important that there was seen a trend of increased use of oral forms of antibiotics and targeted treatment became a priority. Implementation of disease-specific clinical pathways associated with annual PPSs could be a good way to monitor and ameliorate antibiotic prescription patterns in neonatal and pediatric inpatients over time, in order to reduce as much as possible the worrisome emergence of MDR bacteria in this vulnerable population. &nbsp

Prevalence of Antibiotic Prescription in Patients with Acute Rhinosinusitis Treated by General Practitioners and Otolaryngologists in Germany-A Retrospective Cohort Study.

(1) Background: The goal of this retrospective cohort study, based on real-world data and conducted in Germany, was to investigate the prevalence of antibiotic (AB) prescription in patients with acute rhinosinusitis (ARS). (2) Methods: Data from the Disease Analyzer database were used for this cross-sectional study. Patients aged ≥18 years diagnosed with acute sinusitis by general practitioners (GPs) and ear, nose, throat (ENT) specialists between January 2012 and December 2020 were included. The main outcome of the study was the proportion of patients with ARS who received an AB prescription on the day of diagnosis or within three days afterwards. The proportion was estimated separately for patients treated by GPs and ENTs, and also for five age groups, as well as women and men. (3) Results: In total, 308,095 patients were diagnosed with ARS (187,838 by GPs and 120,257 by ENTs). 50.9% of patients treated by GPs and 50.0% treated by ENTs received an AB prescription. AB prevalence increased with age from 46.9% in the age group 18-30 years to 55.5% in the age group &gt; 60 years. (4) Conclusions: We have shown a high prevalence of potentially inappropriate AB prescription for adult patients with ARS in both GP and ENT practices and also among both women and men and in several age groups. There is an urgent need for interventions to reduce inappropriate AB use.

Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study

ObjectivesThere are limited data on factors influencing antibiotic prescription among insured patients. We assessed for correlates of an antibiotic prescription among insured patients.DesignA cross-sectional study.SettingThe study was conducted at the...

Incidence of postpartum infections and outcomes associated with antibiotic prophylaxis after normal vaginal birth.

Antibiotic consumption accounted for approximately 15–20% of total drug costs in Thailand. From 2017 to 2018, 24.86% of Thai women who experienced vaginal delivery during normal term labour received antibiotics for postpartum infection. The Thai national practice guidelines set the target use of antibiotic prophylaxis in women following vaginal delivery of normal term labour to be no more than 10%. This study aimed to determine the incidence of postpartum infections and the outcomes and factors associated with antibiotic prophylaxis in women following vaginal delivery. The prospective cohort study was collected from 909 eligible patients who delivered infants in 7 secondary hospitals in Chiang Mai from July 2020 to February 2021. Antibiotic prescribing data and infections in women experiencing vaginal delivery during normal term labour were collected. The incidence of postpartum infections was calculated at 2 periods, 48 h and 6 weeks, after labour. Factors associated with the prescription of antibiotic prophylaxis in vaginal delivery were analysed using multivariate logistic regression. The results showed that the prevalence of antibiotic prescribing was 12.87% in a cohort of 117 patients. Postpartum infection was reported in 3 of 117 patients with antibiotics prophylaxis and 11 of 792 without antibiotics, with no statistically significant difference (RR: 1.04, 95% CI: 0.26–4.14; p = 0.956). Postpartum hygiene self-care practices were collected in the 6th week. The results found that there were no statistical differences in mean scores for all questions on postpartum hygiene self-care practices between the infected and non-infected groups (p-value > 0.05). One of the factors associated with antibiotic prophylaxis was third to fourth degree of tear and episiotomy (OR: 7.72, 95% CI: 1.13–52.75; p = 0.037 and OR: 2.41, 95% CI: 1.24–4.70; p = 0.010, respectively). There was no significance difference in postpartum infection among patients receiving antibiotic and those who did not receive antibiotics. Third to fourth degree of tear and episiotomy were significantly factors related to antibiotic prophylaxis in women with vaginal delivery after labour. This study supports practice guidelines and helps healthcare team to be assured on the use of antibiotics in no more than 10% of women experiencing normal vaginal delivery.

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: A systematic review and meta-analysis.

Evidence around prevalence of bacterial coinfection and pattern of antibiotic use in COVID-19 is controversial although high prevalence rates of bacterial coinfection have been reported in previous similar global viral respiratory pandemics. Early data on the prevalence of antibiotic prescribing in COVID-19 indicates conflicting low and high prevalence of antibiotic prescribing which challenges antimicrobial stewardship programmes and increases risk of antimicrobial resistance (AMR). To determine current prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patients. OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Adults (aged ≥ 18 years) with RT-PCR confirmed diagnosis of COVID-19, regardless of study setting. Systematic review and meta-analysis. Proportion (prevalence) data was pooled using random effects meta-analysis approach; and stratified based on region and study design. A total of 1058 studies were screened, of which 22, hospital-based studies were eligible, compromising 76,176 of COVID-19 patients. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26-10.31) and 61.77% (CI 50.95-70.90), respectively. Sub-group analysis by region demonstrated that bacterial co-infection was more prevalent in North American studies (7.89%, 95% CI 3.30-14.18). Prevalence of bacterial coinfection in COVID-19 is low, yet prevalence of antibiotic prescribing is high, indicating the need for targeted COVID-19 antimicrobial stewardship initiatives to reduce the global threat of AMR.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient’s demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Appropriateness of antibiotic prescriptions during hospitalization and ambulatory care: a multicentre prevalence survey in Korea

Antimicrobial resistance is one of the most urgent global health threats. The need for the qualitative evaluation of antibiotic use at the national level is increasing. To identify areas for improvement, we aimed to assess the prevalence and appropriateness of antibiotic prescriptions during hospitalization and ambulatory care in Korea. The prevalence and appropriateness of antibiotic prescriptions on 29 August 2018 were assessed for 20 hospitals in Korea. Infectious disease specialists determined appropriateness. Except for antiviral and anti-tuberculosis agents, all antibacterial or antifungal agent prescriptions during hospitalization or ambulatory care were evaluated. The prevalence of antibiotic prescription was 14.1% (8,400/59 216 patients) on the study date. Antibiotics were prescribed for 50.8% of inpatients (6557/12 902), with two or more antibiotics prescribed for 27.4% (1798/6557) of patients. A total of 10 948 prescriptions (7999 therapeutic, 2105 surgical prophylaxes, and 844 medical prophylaxes) were included in the final analysis, and 27.7% of these were inappropriate. Surgical prophylaxis was inadequately prescribed most frequently (54.4%), followed by medical prophylaxis (29.5%) and therapeutic antibiotics (20.5%). The most common indications for therapeutic antibiotics were respiratory (29.1%, n=2332), gastrointestinal (22.4%, n=1791), and urinary tract infections (13.1%, n=1050). The most frequently prescribed antibiotics were cephalosporins (52.0%, n=5490), followed by beta lactam/beta lactamase inhibitors (13.7%, n=1373), fluoroquinolones (9.1%, n=957), and metronidazole (6.6%, n=699). This was the first nationwide qualitative antibiotic prescription adequacy evaluation in Korea. A significant proportion of antibiotic prescriptions were inappropriate. Therefore, interventions for high-frequency infections and prescription antibiotics are needed.

Prevalence of bacterial coinfection and patterns of antibiotics prescribing in patients with COVID-19: a systematic review and meta-analysis

IntroductionEvidence on prevalence of bacterial coinfection in Coronavirus Disease 2019 (COVID-19) is controversial; previous global viral respiratory pandemics reported high prevalence of bacterial coinfection, which was associated with increased risk of morbidity and mortality (1). Data on Prevalence of antibiotic prescribing in COVID-19 indicates high antibiotic prescribing, causing a potential setback in antimicrobial stewardship and potential increase in antimicrobial resistance (2). The study protocol was registered in the international register of systematic reviews, PROSPERO, under the following ID: CRD42021261734AimTo determine the prevalence of bacterial coinfection and antibiotic prescribing in COVID-19 patientsMethodsSystematic review and meta-analysis was conducted using Covidence. Data were extracted by one reviewer. Proportion data was pooled using random effects meta-analysis approach using STATA 17; and stratified based on region and study design. Data Source: OVID MEDLINE, OVID EMBASE, Cochrane and MedRxiv between January 2020 and June 2021. Study Eligibility: English language studies of laboratory-confirmed COVID-19 patients which reported (a) prevalence of bacterial coinfection and/or (b) prevalence of antibiotic prescribing with no restrictions to study designs or healthcare setting. Participants: Adults with RT-PCR confirmed diagnosis of COVID-19ResultsA total of 1058 studies were screened, of which 22 studies were eligible. Retrospective cohort studies accounted for the majority of the studies involved (n = 18, 81%), whilst prospective cohort studies accounted for the remaining (n=4, 18%). Of the 22 studies included, 3 (13%) studies were pre-prints, whilst the remaining (n=19, 86%) were peer-reviewed. A total of 13 (59%) studies were conducted in multicentre settings, whilst the remaining (n=9, 40%) were conducted in single centre settings. All of the studies included were conducted in hospital setting, whether it be in a normal, isolation or an intensive care ward. Twenty-one out of 22 studies have been rated “Good” rating during the quality assessment process. Pooled estimates for the prevalence of bacterial co-infection and antibiotic use were 5.62% (95% CI 2.26 – 10.31) and 61.77% (CI 50.95 – 70.90), respectively.ConclusionThe prevalence of bacterial coinfection amongst COVID-19 patients is low (5.62%) when compared with previous pandemics, yet antibiotic prescribing in COVID-19 patients was high (61.77%) indicating the need for stronger antimicrobial stewardship to reduce the global threat of AMR. Prescribing of antibiotics in COVID-19 should be based on clinical and/or laboratory evidence of bacterial coinfection. Key strengths of this review, is that it included a comprehensive search strategy spanning over several databases, including both pre-prints and peer-reviewed studies. Limitations in this review was that during the screening process, a significant number of studies have been excluded due to not meeting the inclusion criteria, therefore, bacterial coinfection and antibiotic use may be under- or over-reported. In addition, disproportionate representation from North America and failure to include studies from regions other than Europe and Asia, can limit the generalizability of the results to other regions impacted by COVID-19References(1) Morris DE, Cleary DW, Clarke SC. Secondary bacterial infections associated with influenza pandemics. Front Microbiol. 2017;8:1041.(2) International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC). COVID-19 Clinical data report. 19May 2020.