Rational Use Of Antimicrobial Agents Research Articles

Transmission Routes and Prevention Strategies of Multidrug-Resistant Organism Infections in Hospitals

With the spread of multidrug-resistant organisms (MDROs) in hospitals, infection control faces significant challenges. MDROs refer to microorganisms resistant to three or more antimicrobial agents, commonly including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum β-lactamase-producing bacteria (ESBL). These resistant organisms primarily transmit through direct contact, indirect contact, and airborne routes within hospitals. Effective prevention and control of these infections require a comprehensive approach, including strict hand hygiene and personal protection, implementation of infection control standards, environmental cleaning and disinfection, management of medical device sterilization, and rational use of antimicrobial agents along with resistance monitoring. This paper summarizes the transmission routes and prevention strategies for MDRO infections, providing references for hospital management and clinical practice. Future research should focus on optimizing prevention measures and resistance monitoring to address the changing patterns of resistant organisms and enhance infection control effectiveness.

Trend of distribution and antimicrobial resistance in uropathogens in China from the CHINET antimicrobial resistance surveillance program, a 7-year retrospective study

AbstractUrinary tract infections (UTIs) are common urological diseases that easily relapse and have led to an increasing economic and health burdens. The China Antimicrobial Surveillance Network (CHINET) system is one of the most influential antimicrobial resistance surveillance networks in China. This study analyzed antimicrobial resistance and distribution trends of uropathogens from 2015 to 2021 using the CHINET system. A total of 261,893 non-duplicate strains were collected; Gram-positive bacteria accounted for 23.8% while Gram-negative bacteria accounted for 76.2%. Escherichia coli, Enterococcus faecium, Klebsiella pneumoniae, and Enterococcus faecalis were the most common species. The resistance to vancomycin, linezolid, and teicoplanin in E. faecalis and E. faecium was less than 3%. The prevalence of carbapenem-resistant strains of E. coli, K. pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii was 1.7%, 18.5%, 16.4%, and 40.3%, respectively. The prevalence of carbapenem-resistant A. baumannii increased from 27.6% in 2015 to 43.4% in 2021. The prevalence of methicillin-resistant Staphylococcus aureus decreased from 40.6% in 2015 to 22.9% in 2021. The resistance rates to most β-lactam antimicrobials, aminoglycosides and fluoroquinolones in E. coli, K. pneumoniae, P. aeruginosa and A. baumannii isolated from ICU inpatients were significantly higher than in those isolated from outpatients and non-ICU inpatients. This study indicates that E. coli, Enterococcus, and K. pneumoniae were the most commonly isolated uropathogens in China. The bacterial species isolated and their antimicrobial resistance patterns differed in different patient populations. More attention must be paid uropathogen resistance surveillance to provide data for the rational use of antimicrobial agents.

Community awareness initiative about antimicrobial resistance: An educational intervention by medical undergraduates.

Antimicrobial resistance (AMR) is a global problem and an important consequence of inappropriate use of antimicrobial agents (AMAs). Studies have observed that a lack of awareness of AMR among healthcare professionals as well as consumers results in the irrational use of AMAs, a significant driver of AMR. This educational intervention study was undertaken to assess community awareness regarding AMAs and AMR and to educate them. Ten volunteer students from II MBBS were made aware of AMR, its impact and measures to reduce resistance through a lecture by Pharmacology faculty. Students interacted with 220 family representatives in the community to assess their knowledge about AMAs and AMR using a 15-item pre-validated questionnaire. Charts, videos, and role-play were used to impart knowledge about the rational use of AMAs, AMR, and its consequences. Participants' understanding was ensured with feedback taken on Lickert scale. Students interacted with the study participants and found that most were aware of the term 'antibiotic' (90.8%), but 67% were clueless regarding antibiotic resistance. The purpose of AMA use was not adequately known to 43% as they mentioned using these for diarrhea, viral fever, cough, cold, and sore throat. AMAs were purchased by 40% of participants as OTC medicine, whereas Azithromycin and Amoxicillin were the AMAs they could remember by name. The reasons for buying OTC antibiotics were the inconvenience of doctors' clinic timings, unaffordable consultation charges, and easy antibiotic availability. Students also learned about communication etiquette during this community interaction. This educational intervention proved helpful as the participants agreed that the unnecessary use of AMAs makes them ineffective and AMR is preventable by simple measures. A multifactorial approach involving prescribers, regulatory Government authorities and general public is needed to control irrational use of antimicrobials. Timely interventions are necessary to increase the awareness of AMR in the community.

Drug Utilization Pattern of Antimicrobial Agents in Medicine IPD of a Tertiary Care Teaching Hospital of Western Odisha

Background: Around the world, doctors frequently prescribe antimicrobial agents (AMAs). However, irrational and inappropriate use of AMAs results in several negative outcomes, including antimicrobial resistance, connected health issues, lengthened hospital stays, and increased treatment costs. Antimicrobial resistance (AMR) is becoming a more serious global challenge in hospitals and communities. Hence, Drug Utilization Evaluation (DUE) studies are created primarily to evaluate and improve prescribing procedures and enhance the rational use of pharmaceuticals to address this significant condition. Materials and methods: A prospective observational study was conducted in a tertiary care hospital’s in-patient department of medicine. Analyses were done on the antibacterial agent drug usage patterns. Using Defined Daily Doses (DDDs) and Anatomical Therapeutic Chemical (ATC) Classification. The cost of the AMA therapy was estimated using the government’s approval rate for generic drugs. Results: Sixty-seven of the 100 patients were women, and 33 were men. Throughout the research period, 432 medications were prescribed, of which 39.8% were antibiotics and 77 % of patients had their AMA prescriptions based on data from bacteriological culture and sensitivity tests. The National List of Essential Medicines (NLEM) of India and the state essential drug lists were followed for prescribing the antimicrobial drugs by their generic names, respectively. In 27% of prescriptions, there was evidence of polypharmacy, and 70% of the combinations were logical. The patient spent 3.47 days in the hospital on average throughout their stay. It was discovered that antibiotics cost an average of Rs 200.17 per patient every day. Conclusion: Hospital antibiotic policy according to the ASP (Antibacterial Stewardship Programme) is essential for the optimization of antimicrobial therapy in this institution to ensure rational use of AMAs and to fight antimicrobial resistance.

Antibiotic Resistance: Retrospective, Concurrent, and Prospective Data

Background: Over decades, antimicrobial medicines have been extensively used in industries such as agriculture and cattle husbandry, not only for the treatment of illnesses but also as preventative measures. Because of this extensive usage, bacteria have unintentionally developed antibiotic resistance (ABR), sometimes without the host's knowledge. It has made treating infectious infections more unclear and difficult. Purpose: This review examines the patterns of antibiotic use and the types of bacteria that have developed resistance. It also explores their therapeutic mechanisms of action and the mechanisms behind resistance development. Additionally, the review discusses retrospective and concurrent data on ABR and proposes a prospective approach for the surveillance and monitoring of ABR globally. Method: The review analyses both historical and current data on the global use of antimicrobial agents and their impact on antibiotic resistance. It assesses various strategies for the rational use of antibiotics, considering past patterns and current trends in ABR. The study also evaluates ongoing efforts to monitor and prevent the spread of ABR. Result: Here, findings highlight the widespread and growing issue of antibiotic resistance, driven by both human and agricultural use of antibiotics. The review underscores the significance of continuous surveillance, monitoring, and the rational use of antimicrobial agents to combat the global threat of ABR, ensuring more effective management of infectious diseases. Conclusion: Urgent global action is needed against antibiotic resistance because of both human and agricultural use. Improved surveillance and rational use of antibiotics are a prerequisite for preserving the efficacy of treatments available today and for maintaining public health. Strategic planning ahead will be the best management of infectious diseases.

GEFAAR: a generic framework for the analysis of antimicrobial resistance providing statistics and cluster analyses

Easy access to antimicrobial resistance data and meaningful visualization is essential to guide the empirical antimicrobial treatment and to promote the rational use of antimicrobial agents. Currently available solutions are commonly externally hosted, centralized systems. However, there is a need for close monitoring by local analysis tools. To fill this gap, we developed GEFAAR—a generic framework for the analysis of antimicrobial resistance data. Following the example of the German Robert Koch Institute (RKI), an interactive web-application is provided to determine basic pathogen and resistance statistics. In addition to the RKI’s externally maintained database, our application provides a generic framework to import tabular data and to analyze them safely in a local environment. Moreover, our application offers an intuitive web-based user interface to visualize resistance trend analysis as well as advanced cluster analyses on species- or clinic/unit level to generate alerts of potential transmission events.

Distribution of MecA and Erm Genes among Methicillin-resistant Staphylococcus Aureus with Inducible Resistance to Clindamycin.

The emergence of Methicillin-resistant Staphylococcus aureus and its ability to confer cross-resistance to macrolide-lincosamide-streptogramin B has complicated the treatment against it. Gene-based studies among phenotypic methicillin-resistant isolates with inducible resistance to clindamycin are less available in Nepal. This work was undertaken to detect the mecA and erm genes among such phenotypes isolated from clinical samples. S. aureus isolated from different clinical samples was identified by standard microbiological procedures (Gram-staining, colony morphology, and different biochemical tests). Methicillin-resistant and inducible resistant to clindamycin phenotypes were detected by using cefoxitin disc (30 µg) and a double disk diffusion test according to the Clinical and Laboratory Standards Institute guidelines and mecA and erm genes were detected by polymerase chain reaction. Among 120 S. aureus isolates, 51.67% (n=62) were MRSA, and the prevalence of inducibly-resistant, constitutively-resistant and Macrolide-Streptogramin phenotypes were 15.83% (n=19), 28.33% (n=34) and 15.83% (n=19) respectively. While 35.84% (n=43) of isolates showed sensitivity to both antibiotics, erythromycin and clindamycin. Out of 14 inducibly-resistant phenotypes, 57.14% (n=8) were found carrying ermC and 28.57% (n=4) phenotypes contained both ermA and ermC. All phenotypes were positive for the mecA gene. Macrolides-Lincosamide-Streptogramin B resistance was predominant among methicillin-resistant S. aureus. While all isolates with inducible clindamycin resistance harbored mecA gene, most of them also harbored ermC gene. The higher prevalence of inducible-resistant to clindamycin indicated the need for rational use of antimicrobial agents.

Development and Application of a Reference Manual for Diagnosis and Rational Use of Antimicrobial Agents for Outpatient Primary Care (Digestive System Part): A Delphi Study.

To establish a concise and easy-to-understand reference manual for outpatient primary care providers, promoting correct diagnosis of digestive system diseases and rational antimicrobial use. The establishment of the manual encompassed two processes: the development of a draft manual and the validation of the manual. The development process was based on a literature review and expert discussion. The manual comprises portions for disease diagnosis and rationality of antimicrobial use. The validation process employed a two-round Delphi technique, collecting consensus through paper-based or mail-based communications. The response of the Delphi group was assessed by the level of authority and commitment of the panelists and the degree of agreement among them. Furthermore, the manual was preliminarily applied among primary care physicians. A total of 29 panelists completed the Delphi working process. They were authoritative in their professional fields with authority coefficients of 0.813 and 0.818 for the two portions of the manual, respectively. The level of commitment of the panelists was measured by response rates, which were 100.00% and 96.67% for Round 1 and 2. After two rounds, a consensus was achieved with the consensus rates for the two portions of the manual being greater than 65% and 70%, respectively. Kendall W-tests had P-values < 0.001 in both rounds. This reference manual provides 200 diagnostic indicators for 29 common digestive diseases and recommendations for the rational use of antimicrobial agents for 13 categories of digestive diseases. The primary care physicians who used the reference manual reported high satisfaction and frequent usage. Based on a collective consensus of professionals, a reference manual has been established, to provide a concise and easy-to-understand guide specifically for physicians and pharmacists in outpatient primary care. It could facilitate rapid learning to improve the accuracy of diagnosis and treatment for digestive disorders.

PRESCRIBING PATTERN OF DRUGS IN OUTPATIENT DEPARTMENT IN TERTIARY CARE HOSPITAL

Aim: The study was conducted to assess the prescribing behaviour for antimicrobials and various groups of drugs in tertiary care hospital in Puducherry. Prescription audit was done. Total 500 presc Method: riptions were analysed for sex wise distribution, no of patients for specic age group, antimicrobials prescribed in generic name, percentage of antibiotics, antacids, NSAIDs and multivitamins, among the prescribed drugs, groups of antibiotics, drugs prescribed from National List of Essential Medicines (2022), use ofxed drug combinations, injectable preparations if any. Results: Demographic analysis showed that out of 500 patients in OPD, most were female (53%) and in the age group between 41 to 60 years. In 500 number of prescriptions,9.96% of antibiotics were prescribed; uoroquinolones (5.42%) were prescribed more from antibiotics followed by extended spectrum penicillin (1.64%). 14.78%of antacids were prescribed; PPIs (11.28%) were prescribed more from antacids. 21.63% of NSAIDs were prescribed.11.66% were prescribed in generic names, 65.44% drugs were prescribed from National List of Essential Medicines (2022), 15.88% of FDCs were prescribed,6.13% of injectable preparations were prescribed. The rational use of antimicrobial agents is one of the main contribut Conclusion: ors to control worldwide emergence of bacterial resistance, side effects and reduced cost of the treatment

Microbiological profile of bloodstream infections and antimicrobial resistance patterns at a tertiary referral hospital in Amazon, Brazil.

Bloodstream infections (BSI) are a global health issue, leading to high mortality and morbidity among hospitalized patients. A retrospective, observational and descriptive study was conducted by reviewing blood culture records collected from patients with suspected BSI, between January 2017 and December 2019. The most frequent antimicrobial resistant (AMR) pathogens were methicillin-resistantStaphylococcus aureus(MRSA) (40%), methicillin-resistantS. epidermidis (MRSE) (9.5%), and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae (35.3%). Our findings underscore the importance of continued vigilance and advocate for the rational use of antimicrobial agents.

The potential for the double risk of rabies and antimicrobial resistance in a high rabies endemic setting: detection of antibiotic resistance in bacterial isolates from infected dog bite wounds in Uganda

BackgroundPost-exposure treatment for dog bites in humans aims at alleviating the risk of rabies and promoting wound healing. Wound healing may be complicated by bacteria. This study identified the different bacteria and their antibiotic susceptibilities in infected dog bite wounds (DBWs) in Uganda.MethodsA cross-sectional study was conducted among 376 dog bite patients. Wound swabs from patients with infected DBWs were collected and inoculated into recommended media. They were cultured for both aerobic and anaerobic bacteria. All isolated bacteria were identified based on colony characteristics, gram stain, and standard biochemical tests. Molecular identification was performed for strains that were resistant to three or more antibiotics. Antibiotic susceptibility testing was conducted using the disc diffusion method following the modified Kirby-Bauer method. The data were analysed using Stata version 15 software.ResultsApproximately half of the patients (52.9%, 199/376) presented with infected wounds. Majority of the swabs (84.4%, 168/199) were culture positive, and yielded a total of 768 isolates where about half (52.9%, 406/768) were gram positive bacteria, and about two-thirds (64.6%, 496/768) were recovered from category II wounds. Among the gram positive bacteria, 339 (83.5%) were aerobes where Staphylococcus aureus (103, 30.4%), Coagulase-negative staphylococci (68, 20.1%), and Corynebacterium spp (33, 9.7%) had the highest prevalence. For the 362 Gram negative isolates, 217 (59.9%) were aerobes and the commonest isolates were P. maltocida (64, 29.5%), Capnocytophaga canimorsus (36, 16.6%) and P. canis (26, 12.0%). Gram-positive isolates were resistant to metronidazole (93.6%), oxacillin (68.5%), ceftriaxone (14.6%) and amoxicillin/clavulanic acid (14.0%). Gram negative isolates were resistant to metronidazole (100%), ampicillin (30.7%), oxacillin (29.3%), and doxycycline (22.9%). Multidrug resistance was in 105 (29.0%) and 121/406 (29.8%) of the gram-negative and gram-positive isolates, respectively. All gram-positive isolates were susceptible to vancomycin and ciprofloxacin.ConclusionsInfection rates of DBWs in Uganda are high and the dominant bacterial isolates are Staphylococcus aureus, Pasteurella spps, and Capnocytophaga canimorsus. Multidrug resistance to commonly used antibiotics is high. The recommendation in the Uganda Clinical Guidelines to use metronidazole in the management of DBWs should be reviewed. DBWs should be enlisted for routine antimicrobial resistance surveillance and rational use of antimicrobial agents should be promoted.

Sub-inhibitory concentrations of cefotaxime treatment enhances biofilm formation of monophasic Salmonella Typhimurium variant strain SH16SP46.

Salmonella is one of the most important foodborne and zoonotic pathogens, and monophasic S. Typhimurium is ranked among the top-five Salmonella serovars causing animal and human infections worldwide. Resistance to the third- and higher-generation cephalosporins in Salmonella has attracted great attention. Bacteria are frequently exposed to sub-minimal inhibitory concentrations (sub-MICs) of antimicrobials that can trigger diverse adaptive responses such as biofilm formation. Biofilms can promote bacterial defense to external and internal harsh conditions. This study aimed to investigate the effect of sub-MICs of cefotaxime, one of the third-generation cephalosporins, on biofilm formation by non-clinical S. enterica strains. Crystal violet staining demonstrated that cefotaxime at 1/8 MIC enhanced biofilm formation by two monophasic S. Typhimurium strains. Confocal laser scanning microscopy and enzymatic treatment assay revealed that cellulose was the most dominant extracellular matrix component contributing to Salmonella biofilm formation. Scanning electron microscopy demonstrated that cefotaxime treatment led to bacterial incomplete cell division and filamentous morphology during the whole process of biofilm formation. Our study is the first to report the enhancement effect of cefotaxime on non-clinical, monophasic S. Typhimurium by affecting bacterial morphology. The results will contribute to conducting risk assessments of Salmonella in the pork production chain and guiding the rational use of antimicrobial agents to reduce the risk of biofilm formation.

Protocolo diagnóstico y tratamiento empírico de la infección sin focalidad en el paciente neutropénico

Neutropenic patients are at particularly high risk of infection, with fever being the only sign they present with in the majority of cases. An etiological diagnosis is made in just 20% to 30% of febrile episodes. Early diagnosis and effective treatment are crucial for decreasing morbidity and mortality in this population. The treatment of fever in neutropenic patients includes intravenous beta-lactam antibiotics such as cefepime. Multidrug-resistant pathogens are emerging and there are few new anti-infectious agents being developed. Therefore, a rational use of antimicrobial agents is fundamental.

Multidrug-resistant organisms in intensive care units and logistic analysis of risk factors.

BACKGROUNDIntensive care unit (ICU) patients are critically ill and have low immunity. They will undergo various trauma medical procedures during diagnosis and treatment. The use of high-dose hormones and broad-spectrum antibiotics will increase the incidence of nosocomial infection in ICU patients. Therefore, it is necessary to explore the causes of nosocomial infection in ICU and provide basis for the prevention and control of nosocomial infection in ICU.AIMTo explore major pathogens of nosocomial infection in ICUs, methods of detection and drug resistance trends. METHODSRisk factors of multidrug-resistant infection were analyzed to provide a basis for clinical rational use of antimicrobial drugs in the ICU. These findings were used to standardize rational use of antimicrobial agents. BD PhoenixTM100 automatic bacterial identification analyzer was used to for cell identification in specimens collected from the ICU between January 2016 and December 2019. Drug sensitivity tests were carried out and drug resistance trends were analyzed using the optical disc diffusion method. Odds ratios and corresponding 95%CI of independent variables were calculated using a logistic regression model. Backward elimination (trend = 0.1) was used as an inclusion criterion for multivariate analysis. All data were analyzed using SPSS version 22.0, and P < 0.05 was considered statistically significant. RESULTSWe collected 2070 samples from ICU patients between January 2016 and December 2019. Sample types comprised sputum (1139 strains, 55.02%), blood (521 strains, 25.17%), and drainage fluid (117 strains, 5.65%). A total of 1051 strains of major pathogens, including Acinetobacter baumannii, Escherichia coli (E. coli), Pseudomonas aeruginosa (P. aeruginosa), Klebsiella pneumoniae (K. pneumoniae) and Staphylococcus aureus, were detected, with a detection rate of 35.97% (378/1051). Most of these strains were resistant to antibiotics. Detection rate of E. coli was 21.79% (229/1051), and it was generally sensitive to many antimicrobial drugs. Detection rate of P. aeruginosa was 24.74% (260/1051), and showed low sensitivity to most antibiotics. Detection rate of K. pneumoniae was 9.42% (99/1051), which was generally resistant to multiple antimicrobial drugs and resistant forms. K. pneumoniae was resistant to imipenem for approximate 4 years, and showed a 19.9% (19/99) and 20.20% (20/99) rate of meropenem resistance. Logistic analysis showed that mechanical ventilation and ureteral intubation were risk factors for multidrug-resistant bacterial infections. CONCLUSIONThis study showed a high incidence of ICU infections. Mechanical ventilation and urine tube intubation were risk factors for infection with multidrug-resistant bacteria.

The Five Ds for Rational use of Antimicrobial Agents

The Five Ds for Rational use of Antimicrobial Agents

Pathogenic Characteristics and Risk Factors for ESKAPE Pathogens Infection in Burn Patients

ObjectiveThis study aimed to determine the clinical manifestations, antimicrobial resistance, molecular characteristics, and risk factors for ESKAPE pathogens infection in burn patients.MethodsA retrospective study of 187 burn patients infected with ESKAPE pathogens was conducted at the Department of Plastic and Burn Surgery of the Affiliated Hospital of Southwest Medical University (Luzhou, China) from October 2018 to June 2021. All strains were identified using a MicroScan WalkAway 96 Plus System, and antimicrobial susceptibilities were determined using the VITEK system or the disk diffusion method. The antimicrobial resistance genes of multi-drug resistant ESKAPE (MDR-ESKAPE) were detected by polymerase chain reaction (PCR). The multivariable logistic regression analysis was used to estimate the risk factors for ESKAPE infection and MDR-ESKAPE infection.ResultsA total of 255 strains were isolated in various types of clinical specimens from 187 burn patients, of which 47.5% were ESKAPE pathogens (121/255). Among these, MDR-ESKAPE pathogens accounted for 55% (67/121). Additionally, aph3ʹIII, mecA, blaSHV, blaTEM, blaPDC, and blaSHV were the most prevalent genes detected in Enterococcus faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp., respectively. The independent risk factors for ESKAPE infection were total body surface area (TBSA) >30–50% (odds ratio [OR] = 10.428; 95% confidence interval [CI], 2.047 to 53.108), TBSA >50% (OR = 15.534; 95% CI, 1.489 to 162.021), and parenteral nutrition (OR = 3.597; 95% CI, 1.098 to 11.787). No independent risk factors were found for MDR-ESKAPE infection.ConclusionClinical staff should be alert to the risk of nosocomial infection with ESKAPE pathogens in burn patients receiving parenteral nutrition and under TBSA >30%. Full attention should also be paid to the ESKAPE resistance, strict adherence to infection control protocols for the rational use of antimicrobial agents, and enhanced clinical standardization of antimicrobial agents management.

Patterns of Antimicrobials Prescribed to Patients Admitted to a Tertiary Care Hospital: A Prescription Quality Audit.

IntroductionRational use of antimicrobial agents is necessary to prevent the emergence of drug resistance. This study aims to assess the prescription pattern of antibiotics using the Anatomic Therapeutic Chemical Classification (ATCC)/Defined Daily Dose (DDD) metrics in real-world practice.MethodsA retrospective audit of antibiotics prescribed to patients admitted to a tertiary hospital over 20 months. The demographics and clinical information of patients were collected. The ATCC/DDD system was used to classify antibiotics. The DDD per 100 bed-days was calculated and the quality of prescription, including generic and parenteral formulation use, was evaluated.ResultsNine-hundred ninety-four prescriptions were analyzed. The average number of antibiotics prescribed was 2±1. Only 23% of the patients had confirmed cases of bacterial infection. Imidazole derivatives (J01X) were the most prescribed antibiotics (68.8 DDDs per 100 bed-days) followed by cephalosporins (45.0 DDDs), beta-lactams (35.3 DDDs), fluoroquinolones (30.9 DDDs), and macrolides/lincosamides (14.4 DDDs). Sulphonamides/trimethoprim (4.7 DDD), aminoglycosides (0.8 DDD), penicillin (0.3 DDD), and carbapenems (0.1 DDD) were the least prescribed. Metronidazole was the most prescribed drug (34.2%). Generic names and parenteral formulations were used in 55% and 72% of antibiotics prescribed.ConclusionThe continued low generics prescribing calls for interventions to be put in place to improve prescribing quality. Parenteral formulation prescribing encountered was very high, though this may not be unexpected in in-patients, it is vital to curtail the use of parenteral formulations so as to minimize the risk of infection.Irrational antibiotics prescription remains a serious concern in Nigeria. Drug utilization research using the ATCC/DDD metric is helpful in monitoring trends of drug use over time. This will help improve antibiotics stewardship and promote the rational use of antibiotics.

Pharmacoeconomic analysis of the choice of antimicrobial drugs for the treatment of community-acquired pneumonia by physicians and final year medical students

The authors of the article conduct a pharmacoeconomic analysis of antimicrobial agents (AMA) prescriptions based on a survey of graduates of the medical faculty of a medical university and outpatient healthcare practitioners in Moscow. In addition to the pharmacoepidemiological part, the article also contains a pharmacoeconomic aspect to obtain a more complete picture, reflecting the choice of drugs not only in primary healthcare, but also among graduates of the medical faculty, who can potentially become its members without preliminary training in medical residency.The purpose of this study is to conduct a comparative pharmacoeconomic analysis of the AMA choice in the treatment of community-acquired pneumonia based on the data of a survey of general practitioners, district physicians and graduates of the medical faculty.Methodology. The 206 physicians took part in the anonymous voluntary survey.Results. 177 (85.9 %) of surveyed doctors were women and 62 (14.1 %) were men who made up Group 1. The average age of the surveyed doctors was 47.8±13.3 years, the average medical experience was 21.4±13.4 years. Group 2 consisted of 240 students, of which 178 were women (74.17 %) and 62 were men (25.83 %). The average age of the respondents in the group 2 was 24.8±3.3 years. When calculating the average cost of a treatment course of community-acquired pneumonia, depending on the structure of prescriptions, the value in Group 1 amounted to 420.82 rubles and 367.44 rubles in Group 2, while the share of costs for aminopenicillin drugs directly recommended for prescription to treat community-acquired pneumonia amounted to 8.35 and 4.97 %, respectively. Despite the current recommendations, respondents prefer to choose second-line AMAs, which are more expensive drugs. Respondents in both groups underestimate the first-line drugs that meet the current recommendations, namely aminopenicillins. Despite their low cost and ease of use in an outpatient setting, the frequency of their prescription remains low. The authors believe that more attention should be paid to the problem of rational use of antimicrobial agents. This problem can be solved through educational interventions at all levels of education, which can change the picture of drugs prescriptions in future, will allow practitioners and graduates of medical faculties to refer more often to clinical guidelines and patient treatment protocols. Comprehensive measures in this direction can not only positively affect the quality of medical care, but also reduce antibiotic resistance in the outpatient setting.

Impact of Drug Information Services on Promotion of Rational Use of Antimicrobial Agents: A Descriptive Retrospective Study

Introduction: Drug Information Services (DIS) is dedicated to provide information about drugs and pharmacotherapy, on request from health care professionals, organisations or patients. World Health Organisation (WHO) recommends DIS to promote rational use of medicines. Aim: The study was done to understand the impact of DIS on promotion of rational use of antimicrobial agents, at a tertiary care hospital. Materials and Methods: In this retrospective descriptive study, 126 cases with infection related medication issues requiring opinion related to appropriate antimicrobial therapy from January 2014-June 2018 were included and studied in September 2018. Data related to culture/susceptibility results, treatment offered, reason for referral and suggestions given by the DIS captured in the case details form were analysed. The number of antimicrobials prescribed per case before and after DIS opinion was compared using paired t-test. Results: Of the 126 cases (mean age: 35±18.2 years), 82 were culture positive, of which 43 samples reported Multi-Drug Resistant (MDR) organisms. Of 126 case referrals, 53 (42.1%) were regarding opinion on appropriate antimicrobial therapy, 18 (14.3%) for suspected ADRs and rechallenge opinion, 27 (21.5%) for dosage adjustment of antimicrobials and 12(9.5%) for suspected drug-drug interactions. Based on DIS recommendations, mean number of antimicrobials prescribed per patient reduced from 3.4±1.85 to 1.62±1.38 (p&lt;0.0001) when tested by paired t-test. Sixteen culture-negative cases were referred for opinion on appropriate antimicrobial therapy. Conclusion: DIS is a very useful resource, which provides unbiased, factual drug information to clinicians and patients and must be established in all healthcare facilities. DIS strengthen rational use of antimicrobials.

Evaluation of a Large Urban–Rural Outpatient Antibiotic Stewardship Program

Background: Judicious prescribing of antibiotics is necessary in addressing the crisis of emerging antibiotic resistance and reducing adverse events. Nearly half of antibiotic prescriptions in the outpatient setting are inappropriate, most for viral upper respiratory infections (URIs). Data outlining the misuse of antibiotics in the outpatient setting provide compelling evidence of the need for more rational use of antimicrobial agents beyond hospital settings. Objectives: We evaluated the effect of a behaviorally enhanced quality improvement (QI) intervention to reduce inappropriate antibiotic prescribing for viral URI in the ambulatory care clinics of a large quaternary care healthcare system serving an urban-rural population. Methods: The outpatient antibiotic stewardship program was implemented in January 2018 at 5 pilot sites. Interventions included identification of a site champion, educational sessions, sharing of clinic and individual provider data, and patient and provider educational materials. In addition, preclinic huddles and resident education sessions for internal medicine resident physicians were conducted with a display of public commitment to prescribe antibiotics appropriately. Site champions collaborated with onsite staff to ensure interventions were consistent with local workflows, policies, and standards. The primary outcome was defined as the provider-level antibiotic prescribing rate for acute URI, defined as patient visits with antibiotic-nonresponsive diagnoses without concomitant diagnostic codes to support antibiotic prescribing (see the public MITIGATE tool kit for a complete list). Results: In total, 116,122 antibiotic prescriptions were dispensed from April 2017 through December 2018 compared to the period from April 2017 to December 2017 during which 9,129 fewer prescriptions were ordered. Inappropriate antibiotic prescribing for viral URI for ambulatory clinic encounters (n ≥ 45,000 visits per month) declined from 14.3% to 7.6%. Academic hospital-based sites showed little seasonality trends and no statistically significant decrease in prescription rates (P = .5176). On the other hand, community-based sites showed strong seasonal fluctuations and a statistically significant decrease in prescription rates after intervention (P = .000189). Conclusions: A multifaceted behaviorally enhanced QI intervention to reduce inappropriate prescribing for URI in ambulatory care encounters at a large integrated health system was successful in reducing both inappropriate prescriptions for presumed viral URI as well as total antibiotic use. Findings suggest that implementing leadership roles, education sessions, and low resource behavioral nudging (peer comparison and public commitment) together can decrease excessive use of antibiotics by physicians. A Hawthorne effect may be an important component of these interventions. Future studies are needed in order to determine the optimal combination of behavioral interventions that are cost-effective in outpatient settings.Funding: NoneDisclosures: Larissa May reports receiving speaking honoraria from Cepheid, research grants from Roche, and consultancy fees from BioRad and Nabriva. She serves on the advisory board for Qvella.