Quality Of Antibiotic Use Research Articles

The Accuracy of using Antibiotics with the Gyssens Method on MDRO Events and its Impact on Cost Effectiveness Analysis (CEA) and Length of stay at RSUD dr. Iskak Tulungagung

Evaluation of antibiotics in terms of the quality of antibiotic use was carried out using the Gyssens method to evaluate the accuracy of the use of MDRO incidence antibiotics. The purpose of the study was to analyze the effect of the accuracy of antibiotic use on the incidence of MDRO and its impact on cost effectiveness analysis (CEA) and length of stay at Dr. Iskak Hospital Tulungagung. Research design in the form of quantitative research with case control analytical observational research methods with a retrospective approach. The research samples were some employees at RSUD dr. Iskak Tulunggung Regency as many as 50 case groups and 50 control groups with sampling techniques using the simple random sampling method. Data analysis using Path Analysis. The results showed that the punctuality variable of antibiotic administration had an indirect influence on the variable length of hospitalization days of -0.065, indicating that the timeliness of antibiotic administration would affect the length of hospitalization days must pass the MDRO incidence of -0.194. The variable accuracy of antibiotic administration has a direct effect on the length of days of treatment by -0.522. The variables of timeliness of antibiotic administration and the accuracy of the duration of antibiotic administration have a direct influence on the cost effective analysis of -0.191 and -0.426 without passing the MDRO event. Revise antibiogram guidelines, Increase monitoring activities for the use of antibiotics regularly, Increase teamwork of health professionals in an effort to improve the quality of antibiotic use and prevention of MDRO.

Impact of COVID-19 pandemic on the utilization and quality of antibiotic use in the primary care setting in England, March 2019–March 2023: a segmented interrupted time series analysis of over 53 million individuals

ABSTRACT Background Amid the COVID-19 pandemic, we evaluated the short-term impact of COVID-19 on antibiotic use in primary care in England, focusing on both antibiotic quantity (overuse) and quality (misuse) of use. Research design and methods A population-based segmented interrupted analysis was applied on monthly dispensed antibiotics prescriptions using the Prescription Cost Analysis dataset (March/2019–March/2023). The quantity was assessed using number of items dispensed per 1000 inhabitants (NTI) and defined daily doses per 1000 inhabitants per day (DID), while quality was evaluated using WHO’s Access Watch Reserve (AWaRe) classification, the proportion of ‘4C’ antibiotics and the percentage of broad- to narrow-spectrum antibiotics. Results Findings indicate 8.6 (17.2%) and 0.4 (2.6%) increase in the NTI and DID, respectively, with a statistically significant uptick in trend noted after the second lockdown (β5) for ‘total antibiotics’ for NTI only (β5 = 1.6; 95% CI:0.17, 3.1). Quality assessment showed an increase in ‘Access’ antibiotics from 77% in March/2019 to 86% in March/2023; however, COVID-19 had no significant impact on WHO AWaRe classes. Conclusion COVID-19’s impact on antibiotic use quality and quantity appeared to be minimal, though an increase in utilization post-second lockdown coincided with healthcare system recovery. This suggests a nuanced impact of the pandemic, highlighting the importance of continued antimicrobial stewardship.

Impact of the COVID-19 pandemic on the utilisation and quality of antibiotic use in the Scottish primary care setting: a population-based segmented interrupted time-series analysis

ABSTRACT Background Inappropriate use of antibiotics is expected to increase during the COVID-19 pandemic, but there are limited data on COVID-19’s long-term impact. We assessed the impact of COVID-19 on the quantity and quality of antibiotic use in Scotland. Research design and methods A segmented interrupted time series was applied to monthly dispensed antibiotics using prescription cost analysis data from March/2019 to March/2023. Antibiotic use was quantified using the number of items dispensed/1000 inhabitants (TIDs) and defined daily dose/1000 inhabitants/day (DIDs). The quality of antibiotic use was assessed using key quality indicators including the WHO AWaRe classification, proportion of broad-spectrum and ”4C”-antibiotics. Results Overall, for all antibiotics, there was a non-significant increase in TIDs and DIDs before the first lockdown (March/2020) (β1), but a decline in the level immediately after the first (β2) and second lockdowns (β4) (November/2020), albeit non-significant. However, a significant increase in the time trend after the second lockdown (β5) for all antibiotic classes was observed. COVID-19 had no negative impact on AWaRe utilisation, with the proportion of all antibiotics from the Access group increasing from 76% in March/2019 to 90% in March/2023. The proportion of ”4C” antibiotic reduced significantly after the second lockdown. Conclusions Neither the utilisation nor the quality of total antibiotic use appeared to have been significantly affected by COVID-19.

Evaluation of the Quantity and Quality of Antibiotic Use in Inpatient Pediatric Urinary Tract Infection (UTI) Patients at RSUD KRMT Wongsonegoro Semarang

Evaluation of the Quantity and Quality of Antibiotic Use in Inpatient Pediatric Urinary Tract Infection (UTI) Patients at RSUD KRMT Wongsonegoro Semarang

QUALITATIVE ANALYSIS OF ANTIBIOTIC USE IN POSTOPERATIVE PATIENTS IN THE ICU (INTENSIVE CARE UNIT) ROOM OF HOSPITAL X IN ACEH IN 2022

The irrational use of antibiotics can lead to increased bacterial resistance to antibiotics in hospitals, which can complicate the treatment process. Potential problems with antibiotic use in the ICU arise from inappropriate use. A study mentioned that 30%-60% of antibiotic use in ICU is unnecessary, inappropriate, or suboptimal. Antimicrobial Resistance in Indonesia (AMRIN) research showed that 42% of antibiotic use indicated inappropriate in surgical patients. This study is an analytic descriptive study with a cross-sectional design using retrospective data with a qualitative approach to the Gyssens method. This study used retrospective secondary data in the form of medical records of postoperative patients in the ICU in 2022. 116 patient medical records met the inclusion criteria. The results of the Gyssens analysis showed a category 0 (rational) of 71.58% and an inappropriate category of 28.42% spread in several categories. The results of the chi-square test showed a difference in the quality of antibiotic use with the type of single or combined antibiotic use, and there was a difference in the quality of antibiotic use with the condition of the patient leaving the ICU.

Analysis of the use of antibiotics by AWaRe categories during the COVID-19 pandemic in hospitals across Scotland: a national population-based study

ObjectiveThe Access, Watch and Reserve (AWaRe) list of antibiotics was developed by the WHO to support antibiotic stewardship programmes (ASP). The Access group incorporates first-line options, while Watch antibiotics have...

Development of quality indicators for antimicrobial stewardship in Belgian hospitals: a RAND – modified Delphi procedure

ABSTRACT Introduction Inappropriate antibiotic use is a major cause of antibiotic resistance. Therefore, optimizing antibiotic usage is essential. In Belgium, optimization of antimicrobials for the fight against multidrug resistant organisms (MDROs) is followed up by national surveillance by public health authorities. To improve appropriate antimicrobial use in hospitals, an effective national Antimicrobial Stewardship (AMS) program should include indicators for measuring both the quantity and quality of antibiotic use. Objectives The aim of this study was to develop a set of process quality indicators (QIs) to evaluate and improve AMS in hospitals. Methods A RAND-modified Delphi procedure was used. The procedure consisted of a structured narrative literature review to select the QIs, followed by two online questionnaires and an intermediate multidisciplinary panel discussion with experts in infectious diseases from general and teaching hospitals in Belgium. Results A total of 38 QIs were selected after the RAND-modified Delphi procedure, from which 11 QIs were selected unanimously. These QIs address compliancy of antibiotic therapy and prophylaxis with local guidelines, documentation of the rationale for antibiotic treatment in the medical record, the availability of AMS Programs and Outpatient Parenteral Antibiotic Therapy, resistance patterns and antimicrobial prescribing during focused ward rounds. Conclusion Our study selected 38 relevant process QIs, from which 11 were unanimously selected. The QIs can contribute to the improvement of quality of antibiotic use by stimulating hospitals to present better outcomes and by providing a focus on how to intervene and to improve prescribing of antimicrobials.

Analysis of the Use of Antibiotic Therapy in Surgical Patients at Royal Prima Marelan Hospital

The use of antibiotics in surgical patients aims to reduce Surgical Site Infection (SSI) so that it can reduce the number of patient admissions to hospital. Fully used antibiotics in patient’s cancontributes to the spread of antibiotic resistance, so it is necessary to evaluate the use of antibiotics in hospitals.Quantitative and qualitative assessment of antibiotic use is an important metric in evaluating rational antibiotic prescribing and controlling drug resistance. This study aims to evaluate the use of antibiotics in surgical patients at Royal Prima Marelan Hospital based on assessing the quantity and quality of use. This research is a retrospective study using an observational-analytic design using a quantitative and qualitative approach with secondary data referring to the medical records of 200 surgical patients who received antibiotic therapy and were treated at the Royal Prima Marelan Hospital in the period June - November 2022. Quantitative analysis was carried out using the method ATC/DDD and qualitative analysis using Gyssens criteria. Correlation analysis uses the contingency coefficient statistical test. The results of the quantity of antibiotic use show that the total DDD/100 patient-days value is 77.6 and the quality of antibiotic use using the Gyssens criteria is appropriate/rational, with the most widely used antibiotic being ceftriaxone and the majority of patients' length of stay being ≤ 7 days. This research shows that age (p=0.761), gender (p=0.920), and quality of antibiotic use (p=0.610) do not correlate with length of stay in surgical patients at Royal Prima Marelan Hospital for the period June - November 2022.

Evaluasi penggunaan antibiotik pada neonatus di NICU rumah sakit umum milik pemerintah daerah Banyumas

Infection is one of the leading causes of death in neonatal patients. One of the causes of these infectious diseases is bacteria, so antibiotics are the primary therapy in treating infections. The harmful effects of improper administration of antibiotics are pathogenic bacterial resistance, unwanted drug reactions, and inefficient treatment costs. The purpose of this study was to evaluate the quality of antibiotic use in neonatal patients treated in the Banyumas District Government Hospital NICU from December 2019 to March 2020 by using the Gyssens flow criteria and knowing the outcome of antibiotic use. This research is descriptive and observational. Data obtained from medical records and patient monitoring data with prospective data collection techniques. The inclusion criteria of this study were neonatal patients who were admitted to the NICU and received antibiotics for prophylactic and curative treatment. Total respondent for this study is 56 patients. The Gyssens flow criteria evaluation results were obtained from 53 medical records (94%)tegorized in category 0. There is one medical record each categorized in categories IV D (2%), IV B (2%), and III A (2%). Most of the use of antibiotics is rational. Antibiotics are not a determining factor for the outcome of patients with the same diagnosis and laboratory test results.

Quantitative and Qualitative Analysis of Antibiotics in the Intensive Care Unit (ICU)

The high incidence of infection in the ICU requires frequent use of antibiotics, thereby increasing the risk of developing antibiotic resistance when used irrationally. To assess the quantity and quality of antibiotic use, the World Health Organization (WHO) recommends using the Anatomical Therapeutic Chemical (ATC) classification system or the Defined Daily Dose (DDD) method. In that study, 25 articles were analyzed, including 21 quantitative research articles and four qualitative research articles. These articles were obtained from three databases: PubMed Central (PMC), Research Gate, and Google Scholar. The most commonly used antibiotics in the ICU are ceftriaxone (1×2g, IV) with a DDD value of 358,139/100 bed-days, meropenem (3×2g, IV) with a DDD value of 289,747/100 bed-days, and piperacillin-tazobactam (4×4.5g, IV) with a DDD value of 164,816/100 bed-days. These values indicate the number of antibiotics used in relation to 100 days of sleep. In addition, evaluation of the quality of antibiotic use in the ICU revealed that it is generally characterized by irrational use. By conducting such research, healthcare professionals can optimize the use of antibiotics in the ICU, leading to more effective treatment outcomes while minimizing the development of antibiotic resistance. Keywords: Antibiotics, ATC/DDD, Gyssens, intensive care unit

COVID-19 pandemic and the quality of antibiotic use in primary care: an interrupted time-series study.

The coronavirus disease-19 pandemic and the related public health mitigation measures have impacted the transmission of infectious diseases; however, their impact on the use of antibacterials has not yet been extensively evaluated. This study evaluated the impact of the pandemic on the consumption patterns of antibacterials for systemic use in primary care in Portugal. An interrupted time-series analysis was performed using the autoregressive integrated moving average model of the antibacterials dispensed in the community pharmacies in Portugal from 1 January 2016 to 30 June 2022. Monthly rates of absolute consumption (all antibacterials for systemic use, and specifically penicillins; cephalosporins; macrolides, lincosamides, and streptogramins; and quinolones) and the relative consumption of antibacterials (penicillins sensitive to β-lactamase, penicillin combinations including β-lactamase inhibitors, third- and fourth-generation cephalosporins, fluoroquinolones, and the ratio of broad- to narrow-spectrum antibacterials) were estimated. Antibiotic consumption was expressed in defined daily doses per 1000 inhabitants per day (DID). In Portugal, the consumption of antibacterials (J01) declined sharply immediately after the beginning of the pandemic, having a significant reduction of >5 DID (P < .0001). A similar, short-term impact was found for penicillins (-2.920 DID; P < .0001); cephalosporins (-0.428 DID; P < .0001); macrolides, lincosamides, and streptogramins (-0.681 DID; P = .0021); and quinolones (-0.320 DID; P < .0001). A long-term increase was found for cephalosporins (+0.019 DID per month; P < .0001). Relative consumption changes were only found for third- and fourth-generation cephalosporins (0.0734%). Our study suggests that the coronavirus disease-19 pandemic may have resulted in a decrease in antibiotic use, with no significant changes in the relative dispense. Uncertainties regarding the long-term effects of the pandemic and its impact on the rates of resistance remain.

The Impact of Clinical Pathway Application on The Quality and Quantity of Antibiotic Use in Inpatient Patients With Tyfoid Fever at Fmc Bogor Hospital

&lt;p&gt;Typhoid fever is a global health problem, especially in developing countries, one of which is Indonesia. The incidence of resistance to the use of antibiotics in the treatment of typhoid fever can occur due to inappropriate use of antibiotics. This study aims to determine the impact of the application of clinical pathways on the quality and quantity of antibiotic use in typhoid therapy at FMC Bogor Hospital. This research is a descriptive analytic study conducted retrospectively which was analyzed using the Gyssens and ATC/DDD methods. The research data was taken from patient medical records for the period January-December 2018 and January-December 2020 which met the inclusion criteria. The results showed that from 115 medical records of typhoid fever patients, ceftriaxone was used as the most widely used antibiotic for typhoid therapy. The quality of antibiotic use as much as 40% was declared rational before the use of clinical pathways and as much as 57.3% after the use of clinical pathways (category 0), while the other 60% were irrational (categories I-VI) and after CP as much as 42.7% were included in category 0, the rest fall into the irrational category (Categories I-VI) which includes the use of antibiotics that are not appropriate for the administration interval, the use of antibiotics that are too long, the use of antibiotics that are too short, there are other antibiotics that are more effective, and there are other antibiotics that are less toxic /safer. The quantity of antibiotic use was stated to exceed WHO standards, namely the use of ceftriaxone by 81 DDD/100 patient days before the clinical pathway and 92.4 DDD/100 patient days after the clinical pathway. Based on the results of statistical tests, it was obtained 1) There were differences in the quality of antibiotic use between before and after the implementation of the clinical pathway in inpatients with typhoid fever at FMC Bogor Hospital; 2) There are differences in the quantity of antibiotic use between before and after the implementation of the clinical pathway in inpatients with typhoid fever at FMC Bogor Hospital. The results of this study are expected to be a consideration for the hospital as material for evaluation and improvement in order to increase the rationality of using antibiotics.&lt;/p&gt;

Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study

The European Centre for Disease Prevention and Control describes the community pharmacist as the gatekeeper to the quality of antibiotic use. The pharmacist has the responsibility to guard safe and effective antibiotic use; however, little is known about how this is implemented in practice. To assess the feasibility of a method to audit the quality of antibiotic dispensing in community pharmacy practice and to explore antibiotic dispensing practices in Greece, Lithuania, Poland, and Spain. The Audit Project Odense methodology to audit antibiotic dispensing practice was adapted for use in community pharmacy practice. Community pharmacists registered antibiotic dispensing on a specifically developed registration chart and were asked to provide feedback on the registration method. Altogether, twenty pharmacists were recruited in four countries. They registered a total of 409 dispenses of oral antibiotics. Generally, pharmacists were positive about the feasibility of implementing the registration chart in practice. The frequency of checking for allergies, contraindications and interactions differed largely between the four countries. Pharmacists provided little advice to patients. The pharmacists rarely contacted prescribers. This tool seems to make it possible to get a useful picture of antibiotic dispensing patterns in community pharmacies. Dispensing practice does not seem to correspond with EU guidelines according to these preliminary results.

Qualitative Evaluation of Antibiotics Use with Gyssens Method in Sepsis Patients at Fatmawati Central General Hospital Jakarta

Sepsis still becomes a major health problem worldwide, with a fairly high mortality rate ranging from 20 to 50%. Antibiotic therapy with rational use can reduce the mortality rate. In contrast, the irrational use of antibiotic therapy will increase the occurrence of resistance, which impacts the increase of morbidity, mortality, and health costs. The objective of this study was to evaluate the quality in the use of antibiotics using the Gyssens method in patients with sepsis. This study was an observational study with a cross-sectional method conducted at Fatmawati Central General Hospital Jakarta from January to December 2020. The research subjects were 110 patients with sepsis who met the inclusion criteria. In this study, 49.09% of patients used rational antibiotics and 50.91% of patients used irrational antibiotics that were found in category VI (0.91%), V (17.28%), IVa (3.63%), IVb (0.91%), IVc (0.91%), IIIa (3.63%), IIIb (20%), IIa (0.91%), and IIb (2.73%). The duration of antibiotic therapy was the only factor that affected the quality of antibiotic use (p = 0.012). There was no difference in mortality between patients with rational and irrational use of antibiotics (p = 0.333, OR = 1.654, 95% CI 0.714-3.829). However, after adjusting for the duration of therapy, irrational use of antibiotics significantly affected mortality (p = 0.017, OR = 3.5, 95% CI 1.255-9.761). In conclusion, the antibiotic use in half of the sepsis patients were irrational. Since irrational use was associated with mortality, efforts need to be taken to improve the quality of antibiotic use.

Impact of interactive computerised decision support for hospital antibiotic use (COMPASS): an open-label, cluster-randomised trial in three Swiss hospitals

BackgroundComputerised decision-support systems (CDSSs) for antibiotic stewardship could help to assist physicians in the appropriate prescribing of antibiotics. However, high-quality evidence for their effect on the quantity and quality of antibiotic use remains scarce. The aim of our study was to assess whether a computerised decision support for antimicrobial stewardship combined with feedback on prescribing indicators can reduce antimicrobial prescriptions for adults admitted to hospital.MethodsThe Computerised Antibiotic Stewardship Study (COMPASS) was a multicentre, cluster-randomised, parallel-group, open-label superiority trial that aimed to assess whether a multimodal computerised antibiotic-stewardship intervention is effective in reducing antibiotic use for adults admitted to hospital. After pairwise matching, 24 wards in three Swiss tertiary-care and secondary-care hospitals were randomised (1:1) to the CDSS intervention or to standard antibiotic stewardship measures using an online random sequence generator. The multimodal intervention consisted of a CDSS providing support for choice, duration, and re-evaluation of antimicrobial therapy, and feedback on antimicrobial prescribing quality. The primary outcome was overall systemic antibiotic use measured in days of therapy per admission, using adjusted-hurdle negative-binomial mixed-effects models. The analysis was done by intention to treat and per protocol. The study was registered with ClinicalTrials.gov (identifier NCT03120975).Findings24 clusters (16 at Geneva University Hospitals and eight at Ticino Regional Hospitals) were eligible and randomly assigned to control or intervention between Oct 1, 2018, and Dec 31, 2019. Overall, 4578 (40·2%) of 11 384 admissions received antibiotic therapy in the intervention group and 4142 (42·8%) of 9673 in the control group. The unadjusted overall mean days of therapy per admission was slightly lower in the intervention group than in the control group (3·2 days of therapy per admission, SD 6·2, vs 3·5 days of therapy per admission, SD 6·8; p<0·0001), and was similar among patients receiving antibiotics (7·9 days of therapy per admission, SD 7·6, vs 8·1 days of therapy per admission, SD 8·4; p=0·50). After adjusting for confounders, there was no statistically significant difference between groups for the odds of an admission receiving antibiotics (odds ratio [OR] for intervention vs control 1·12, 95% CI 0·94–1·33). For admissions with antibiotic exposure, days of therapy per admission were also similar (incidence rate ratio 0·98, 95% CI 0·90–1·07). Overall, the CDSS was used at least once in 3466 (75·7%) of 4578 admissions with any antibiotic prescription, but from the first day of antibiotic treatment for only 1602 (58·9%) of 2721 admissions in Geneva. For those for whom the CDSS was not used from the first day, mean time to use of CDSS was 8·9 days. Based on the manual review of 1195 randomly selected charts, transition from intravenous to oral therapy was significantly more frequent in the intervention group after adjusting for confounders (154 [76·6%] of 201 vs 187 [87%] of 215, +10·4%; OR 1·9, 95% CI 1·1–3·3). Consultations by infectious disease specialists were less frequent in the intervention group (388 [13·4%] of 2889) versus the control group (405 [16·9%] of 2390; OR 0·84, 95% CI 0·59–1·25).InterpretationAn integrated multimodal computerised antibiotic stewardship intervention did not significantly reduce overall antibiotic use, the primary outcome of the study. Contributing factors were probably insufficient uptake, a setting with relatively low antibiotic use at baseline, and delays between ward admission and first CDSS use.FundingSwiss National Science Foundation.TranslationsFor the French and Italian translations of the abstract see Supplementary Materials section.

Evaluasi Penggunaan Antibiotik Secara Kuantitatif dan Kualitatif Pada Pasien Bedah Digestif di RSUD Abdul Wahab Sjahranie Samarinda

Antibiotics are drugs that are the most widely prescribed to treat bacterial infections. Prescription of high and not wise antibiotics has a detrimental impact: increasing antibiotic resistance. This study aimed to determine patient characteristics, quantity, and quality of antibiotic use in digestive surgery patients at Abdul Wahab Sjahranie Hospital Samarinda from January-December 2020. This study is a retrospective observational study with data collection techniques using the purposive sampling method. The results obtained 75 medical records, with the majority of the adults (26-45 years old) were 35 patients (48%), men were 45 patients (60%), length of stay 4-5 days were 30 patients (40%), private workers were 23 patients (30.7%), and type of disease appendicitis were 27 patients (36%). The most used antibiotic is ceftriaxone, which is 64.41 DDD/100 patient days, and antibiotics included in segment 90% were ceftriaxone and metronidazole. The quality of antibiotic use was 54.91% included in category 0 including ceftriaxone, metronidazole, cefpirom, and levofloxacin, category IIIB as 35.26% including ceftriaxone, metronidazole, cefpirom, and cefixime, category IIIA as 4.05% including ceftriaxone and metronidazole, the IVC category as 4.62% including ceftriaxone and cefixime, and IVA as 1.16% including metronidazole.

EVALUASI KUALITATIF PENGGUNAAN ANTIBIOTIK PADA PASIEN PNEUMONIA RS “X’’ DI MALANG

Abstract—Pneumonia was an inflammation that occurs in the lungs accompanied by exudation and consolidation of microorganisms. In Indonesia, the prevalence of pneumonia continues to increase. Treatment of pneumonia uses antibiotic therapy. The use of antibiotics needs to be controlled by evaluating the quality of antibiotic use to prevent negative effects that can occur on patients, such as antibiotic resistance. The purpose of this study was to determine the quality of antibiotic use in pneumonia patients. This study did with observational method with cross-sectional design. The study was conducted in August-September 2019. Qualitative evaluations did with Gyssen method. The results of 35 medical record samples that fulfill the criteria showed that 21.43% of cases category 0; 16.67% of cases category I; 0% of cases category II C; 33.34% of cases in category II B; 4.76% of cases category II A; 0% of cases category III B; 0% of cases category III A; 0% of cases category IV D; 19.05% of cases category IV C; 4.76% of cases category IV B; 61.90% of cases category IV A; 0% of cases category V; 0% of cases category VI. Thus, rational cases (category I) were 21,43% and irrational cases (categories I-IV) were 78,57%.

102. Evaluation of the Association between the Antibiotic Spectrum Index and Antibiotic Days of Therapy: A Retrospective Study across 124 Acute-care Hospitals

BackgroundAntibiotic stewardship programs often measure antibiotic days of therapy (DOT), but this metric does not reflect the antibiotic spectrum. In this study, we used the previously published Antibiotic Spectrum Index (ASI), which attaches a score (1-13) to the spectrum of each antibiotic, to evaluate the content of antibiotic use across all Veterans Health Administration (VHA) hospitals. We also assessed how benchmarking hospital performance changed when ASI was used instead of DOT. MethodsWe conducted a retrospective cohort study of patients admitted to 124 acute-care VHA hospitals during 2018. We obtained data on administered antibiotics, the days of antibiotic use (DOT), and days-present (DP) from the VHA Corporate Data Warehouse and then aggregated data to the hospital-level using the National Healthcare Safety Network’s methodology. We modified the original ASI by changing 3.8% of the bug-drug scores to ensure consistency across all scores and adding 27 new antibiotics agents. For each hospital, we calculated ASI/DOT, ASI/1,000 DP, and DOT/1,000 DP and ranked hospitals on their performance. We performed a Spearman’s rank-order correlation to compare hospitals on these metrics and their associated rankings.ResultsAt the hospital-level, the median ASI/DOT, ASI/1,000 DP and DOT/1,000 DP were 5.4 (interquartile range: 5.2-5.8), 2,332.7 (1,941.8-2,796.2) and 443.5 (362.5-512.2), respectively. There was a strong correlation between the ASI/1,000 DP and DOT/1,000 DP metrics [Spearman’s correlation test: r=0.97 (p< 0.01)] but only a weak and insignificant correlation between ASI/DOT and DOT/1,000 DP [r=0.17 (p=0.06), Figure 1]. Twenty (16.1%) hospitals showed a difference of 10% or more in their ranking for ASI/1,000 DP compared to their ranking for DOT/1,000 DP. The range of ranking difference was from -17.7% to 21.0% (Figure 2a and b).Figure 1. Distribution of the Antibiotic Spectrum Index / Day of Therapy by Days of Therapy / 1000 Days Present for 124 Acute-Care VHA Hospitals during 2018. Black line: Median values of DOT/1,000 DP and ASI/DOT, respectively. Figure 2. (a) Distribution of the rankings in DOT/1,000 DP and ASI/1,000 DP. Blue line: the position of same ranking between ASI/1,000 DP and DOT/1,000 DP. (b) Distribution of the differences in each hospital’s ranking for DOT/1,000 DP and ASI/1,000 DP ConclusionOur findings suggest that hospitals using fewer days of antibiotic therapy did not necessarily use narrower-spectrum antibiotics. ASI/1,000 DP, as a combined measure of antibiotic consumption quantity and average spectrum, provided a different view of hospital performance than DOT/1,000 DP alone. Future work is needed to define how this new metric relates to the quality of antibiotic use. Disclosures All Authors: No reported disclosures

Quantifying the Gap between Expected and Actual Rates of Antibiotic Prescribing in British Columbia, Canada.

Despite decades of stewardship efforts to combat antimicrobial resistance and quantify changes in use, the quality of antibiotic use in British Columbia (BC) remains unknown. As the overuse and misuse of antibiotics drives antibiotic resistance, it is imperative to expand surveillance efforts to examine the quality of antibiotic prescriptions. In late 2019, Canadian expected rates of antibiotic prescribing were developed for common infections. These rates were utilized to quantify the gap between the observed rates of prescribing and Canadian expected rates for antibiotic use for the province of BC. The prescribing data were extracted and matched to physician billing systems using anonymized patient identifiers from 1 January 2000 to 31 December 2018. Outpatient prescribing was further subdivided into community and emergency department settings and stratified by the following age groups: <2 years, 2–18 years, and ≥19 years. The proportions of physician visits that received antibiotic prescription were compared against the Canadian expected rates to quantify the unnecessary use for 18 common indications. Respiratory tract infections (RTI), including acute bronchitis, acute sinusitis, and acute pharyngitis, reported significant levels of overprescribing. Across all ages and health care settings, prescribing for RTI indications occurred at rates 2–8 times higher than the expected rates recommended by a group of expert Canadian physicians. Understanding the magnitude of unnecessary prescribing is a first step in delineating the provincial prescribing quality. The quantification of antibiotic overuse offers concrete targets for provincial stewardship efforts to reduce unnecessary prescribing by an average of 30% across both outpatient and emergency care settings.

Discordance to ASHP Therapeutic Guidelines Increases the Risk of Surgical Site Infection.

Clean surgery without contamination does not require prophylactic antibiotics, but there are high-risk surgical procedures that may cause infection and/or involve vital organs such as the heart, brain, and lungs, and these indeed require the use of antibiotics. This study aimed to determine the quantity of antibiotic use based on the defined daily dose (DDD) per 100 bed days and the quality of antibiotic use based on the percentage of concordance with The American Society of Health-System Pharmacists (ASHP) therapeutic guidelines (i.e., route of administration, time of administration, selection, dose, and duration). This includes the profiles of surgical site infection (SSI) in surgical patients from January through June 2019. The study subjects were 487 surgical patients from two hospitals who met the inclusion criteria. There were 322 patients out of 487 patients who had a clean surgical procedure. Ceftriaxone (J01DD04) was the most used antibiotic, with a total DDD/100 bed days value in hospitals A and B, respectively: pre-surgery: 14.71, 77.65, during surgery: 22.57, 87.31, and postsurgery: 38.34, 93.65. In addition, 35% of antibiotics were given more than 120 min before incision. The lowest concordance to ASHP therapeutic guideline in hospital A (17.6%) and B (1.9%) was antibiotic selection. Two patients experienced SSI with bacterial growths of Proteus spp., Staphylococcus aureus, Staphylococcus epidermidis, and Escherichia coli. The usage of prophylactic antibiotics for surgical procedures was high and varied between hospitals. Hospital B had significantly lower concordance to antibiotic therapeutic guidelines, resulting to a higher infection rate, compared with hospital A. ASHP adherence components were then further investigated, after which antibiotic dosing interval and injection time was found to be a significant predictor for positive bacterial growth based on logit–logistic regression. Further interventions and strategies to implement antibiotic stewardship is needed to improve antibiotic prescriptions and their use.