Restriction Of Antibiotic Use Research Articles

Endocarditis: An Ever Increasing Problem in Cardiac Surgery.

Endocarditis remains one of the most threatening diagnoses in cardiac surgery and is still increasing. Particularly, device-related as well as prosthetic endocarditis appears to be on the rise. Early mortality and periprocedural complications are high jeopardizing the success of surgical efforts. We looked at the development of the numbers and the distribution of endocarditis in an all-comer analysis. From 2003 to 2017, 752 patients with endocarditis were transferred to our cardiosurgical institution (mean age 65 ± 13 years; mean logistic EuroSCORE 28.01%; males 74.33%). A total of 89.49% of them were surgically treated; 30.01% redo cases thereof; and 9.17% had been operated previously for acute endocarditis. While the total number of cardiosurgical procedures remained relatively stable throughout the years, 20 patients were admitted in 2003 and 79 in 2017 yielding more than fourfold increase (p < 0.001). Early mortality of all patients was 25.1%. Septic emboli occurred in 23.7% and 43.8% cerebral emboli thereof. A significant increase of aortic, mitral, and tricuspid valves involvement was observed (p < 0.001). An increase of device-related endocarditis was also noted (p < 0.001). Endocarditis remains a serious problem with high early mortality and morbidity. The vast increase of electrophysiological device implantations has resulted in an increase of tricuspid valve involvement. Liberalization of endocarditis prophylaxis, that is, more restrictive use of antibiotics in 2007 may have at least partially contributed to an increase of the individual risk to suffer from acute endocarditis. A renaissance of a stricter endocarditis-prophylaxis may thus be considered.

Treatment of acne.

Acne should not be perceived as a self-limiting affliction of adolescence. Due to the growing problem of antimicrobial-resistant bacteria, restrictive use of peroral and topical antibiotics is recommended. There are a number of effective agents for topical treatment of mild to moderate acne. In cases of severe, therapy-resistant acne, treatment with peroral isotretinoin is recommended.

Restricting high-end antibiotics usage - challenge accepted!

Objectives:Antimicrobial resistance (AMR) leads to increased morbidity, mortality, and healthcare expenditure. The rate of development of AMR is accelerated by the use and misuse of antimicrobials. Preauthorization and restricted use of high-end antibiotics are the key modalities of antimicrobial stewardship. Hence, choosing the right antibiotics is the key to better clinical outcomes and preventing resistance in hospitals as well as communities. The present study was done to assess the judicious usage of high-end antibiotics among inpatients treated at our hospital.Materials and Methods:A prospective observational study was conducted on high-end antibiotic usage using a structured proforma among inpatients treated at our hospital for a 3 month period. Department wise educational intervention was done and feedbacks were provided, after which reassessment was done.Results and Analysis:Meropenem was the most commonly used high-end antibiotics. After the feedback and intervention, there was 51.2% reduction in the unjustified antibiotic usage. The appropriateness of the usage increased from 77% observed during preintervention to 88% postintervention.Conclusion:The increasing compliance of judicious usage of high-end antibiotics needs to be sustained. Therefore, continuous strengthening of antimicrobial stewardship practices are crucial.

242. Evaluating the Effectiveness of Antimicrobial Restriction at an Academic Medical Center

BackgroundAntimicrobial Stewardship Programs (ASPs) promote the optimal use of antimicrobial agents with the goal of preserving the effectiveness of existing drugs. One core ASP strategy is formulary restriction and preauthorization (PA). We evaluated restricted antimicrobial use at an academic medical center in Virginia; our program has a comprehensive restriction program that applies to adults only.MethodsData from August 2012 to June 2017 were evaluated at the hospital unit level by month in days of therapy (DOT) per 1,000 patient-days. Ordinary least squares regression was used to compare the time trend of restricted use with that of nonrestricted agents within the same unit.ResultsAcross the study period significant decreases in restricted antibiotic use were detected for medical and pediatric units with no significant increases in use. However, significant increases were identified for surgical units. Table 1: Results of Time Trend Analysis by Unit for Restricted Drugs.RestrictedTypeUnitTime Trend P MedicalOncology0.640.0924Acute Care Medicine0.390.4058Cardiac ICU−0.370.1057Medical ICU−2.060.0002Bone Marrow Transplant0.520.5002Digestive Health−0.140.3004Progressive Care−0.930.0002PediatricGeneral Pediatrics−0.360.1363Neonatal ICU−0.290.0007Pediatric ICU−0.120.7849Progressive Care−0.290.0993SurgicalAcute Care Surgery−0.300.1574Burn ICU0.840.0021Cardiac Surgery ICU−0.500.2766Surgical Trauma ICU−0.520.1019 Table 2: Significant Increases/ Decreases in Restricted Antimicrobials by Unit TypeRestrictedUnit TypeIncreaseDecreaseMedical0/7 (0%)2/7 (29%)Pediatric0/4 (0%)1/4 (25%)Surgical1/4 (25%)0/4 (0%)ConclusionThese data suggest that the PA strategy for medical wards was effective across the time period whereas the PA strategy for surgical wards was suboptimal. However, it is unclear why pediatric wards (that were not subject to PA activities) also saw reductions in use; more research into this is needed. These data will help us to refine our PA strategy by targeting use on surgical wards. We believe that this type of analysis may be useful for other ASPs utilizing the PA strategy.Disclosures All authors: No reported disclosures.

Multidrug-Resistant Enterobacteriaceae Colonising the Gut of Adult Rural Population in South India

Background: Multidrug-resistant (MDR) colonisers act as a reservoir for transmission of antibiotic resistance and are a source of infection. Exposure to antibiotics by the commensal flora renders them resistant. Antibiotic consumption and hospitalisation are two major factors influencing this. We studied, antibiotic-resistant bacteria colonising rural adult population who had restricted access to health care and presumably had low consumption of antibiotics. Aim: Detection of multidrug resistance genes of extended spectrum β-lactamase (ESBL-CTX-M), AmpC β-Lactamase (CIT), Klebsiella pneumoniae carbapenemase (KPC) and New Delhi Metallo β-lactamase (NDM) in Enterobacteriaceae colonising the gut of adult population in a South Indian rural community. Methodology: Faecal samples of 154 healthy volunteers were screened for Enterobacteriaceae resistant to commonly used antibiotics by standard methods, followed by phenotypic detection of ESBL by double disk synergy method, AmpC by spot inoculation and carbapenemases by imipenem and ethylenediaminetetraacetic acid + imipenem combined E-test strips and modified Hodge test. Polymerase chain reaction was done to detect blaCTX-M, blaCIT, blaKPC-1 and blaNDM-1 genes coding for ESBL, AmpC, KPC and NDM, respectively. Results: Colonisation rate of enteric bacteria with MDR genes in the community was 30.1%. However, phenotypically, only ESBL (3.2%) and NDM (0.65%) were detected. While the genes coding for ESBL, AmpC and NDM were detected in 35.6%, 17.8% and 4.4% of the MDR isolates, respectively. Conclusions: Carriage of MDR strains with a potential to express multidrug resistance poses a threat of dissemination in the community. Awareness for restricted use of antibiotics and proper sanitation can contain the spread of resistant bacteria.

A survey on antimicrobial stewardship in 116 tertiary hospitals in China

ObjectivesWe aimed to assess the status and possible problems of antimicrobial stewardship (AMS) in Grade-A tertiary hospitals in China. MethodsA questionnaire was designed according to the United States Centers for Disease Control and Prevention ‘Core Elements of Hospital Antibiotic Stewardship Programs’. We extracted 10–15% from Grade A tertiary hospitals in every province of mainland China; 165 hospitals in total were selected. Electronic questionnaires were forwarded to these hospitals. ResultsOf the hospitals surveyed, 116 (70.3%) responded. Participating hospitals accounted for 8.9% (116/1308) of all the Grade A tertiary hospitals in mainland China, covering all provinces and municipalities. Our study revealed that an AMS team was set up for an antimicrobial stewardship programme (ASP) in 110 hospitals (94.8%). Thirty hospitals lacked a formal department of infectious diseases (DID). A formal DID can positively promote an ASP. More hospitals with a formal DID developed their internal guidelines (54.7% versus 33.3%, p 0.044) and technical documents (83.7% versus 63.3%, p 0.019) on antimicrobial use than hospitals without a formal DID. All the 116 hospitals strengthened appropriate use of antimicrobials by some administration-dominated measures, among which the most frequent measures were classification management of antimicrobial agents (114 hospitals, 98.3%) and post-prescription review with feedback (106 hospitals, 91.4%). Prescription preauthorization and pre-prescription review with feedback were implemented in nearly 50% of the hospitals. More hospitals with a DID conducted pre-prescription review with feedback (53.5% versus 26.7%, p 0.027). The most frequent indicator to assess the impact of AMS was the defined daily dose (DDD) (103 hospitals, 96.3%). ConclusionsThe survey showed significant achievements in China in AMS, mainly including the antibiotic consumption index; there is still a lot of work to be done, such as how to evaluate patient safety and infection outcome after strict restriction of antibiotic use.

Antibiotic resistance in travellers' diarrhoeal disease, an external perspective.

There are many recommendations on the use of antibiotics for prophylaxis and treatment of travellers' diarrhoea (TD). As pharmacists with a special interest in antimicrobial stewardship, we examine and offer our perspective on advice that is recommended to travellers in terms of prevention, treatment and management of TD with a focus on antibiotic use and resistance. Publications on TD were identified through PubMed, Google Scholar and Cochrane Library databases searches using search terms 'travellers diarrhoea', 'travellers diarrhoea', 'travellers' diarrhoea' 'guidelines', 'expert opinion', 'expert reviews', 'South Asia' and 'South East Asia' (S and SE Asia), 'antibiotics', 'resistance genes', 'travel advice', 'pharmacists', 'guidelines', 'prevention' and 'treatment'. References of articles were also screened for additional relevant studies. Whilst most guidelines and expert reviews were in agreement with the restricted use of antibiotics unless there was a clinical need, the literature review identified gaps in research into behaviours of travellers regarding non-compliance with the pre-travel advice provided and the need for in depth training and education for all healthcare professionals in providing 'tailored' advice for travellers going to high-risk destinations. Travellers should be made aware of the problems of antimicrobial resistance in their destination and home countries and offered alternative forms of prophylaxis for TD. Strategies for prevention of TD, other than the use of antibiotics, also need to be emphasized. All healthcare professionals involved in giving advice about TD should be familiar with the epidemiology of the condition as this will inform responsible behaviours, risk assessment and management strategies in different geographical areas.

Analysis of Acinetobacter baumannii hospital infections in patients treated at the intensive care unit of the University Hospital, Wroclaw, Poland: a 6-year, single-center, retrospective study.

BackgroundAcinetobacter baumannii (AB) is one of the most frequently isolated strains of bacteria in intensive care unit (ICU) patients, which provides huge therapeutic problems due to its multidrug resistance (MDR).Patients and methodsThe overall purpose of the study was analysis of health care- associated infections in terms of the incidence of AB strain infections and the changing susceptibility of this strain within a 6-year observation (2011–2016). The study was carried out in an ICU of the University Hospital in Wroclaw (Poland).ResultsAmong 589 isolated strains responsible for 540 health care-associated infections (21.2%) in 2549 ICU patients, AB was the pathogen in 183 (31%) cases. The incidence of AB infection amounted to 6.4/1000 patient-days. An increase was noted in the total number of hospital infections caused by AB strain from 16.5% and 3.39/1000 patient-days in 2011 to 41% and 9.64/1000 in 2016 (p=0.0003 and p=0.000, respectively). AB infections most frequently concerned ventilator-associated pneumonia (73.8%). AB was susceptible to colistin, amikacin, imipenem, meropenem, and ciprofloxacin in 100%, 10.7%, 12.3%, 11.5%, and 2.4% respectively, and it was characterized by MDR in 98.36% of the strains.ConclusionThe study revealed a 3-fold increase in the incidence of AB strain infections, significant increase in the resistance to carbapenems in the observed period, and a very high MDR. The solution to this problem would be the implementation of a repair program aiming at inhibition of AB strain transmission, measures to prevent infections, and restricted use of antibiotics.

Challenges of a one-health approach to the development of alternatives to antibiotics.

By 2050, global infectious disease caused by antibiotic-resistant bacteria is projected to be responsible for 10 million human deaths per year—1.8 million more than cancer. Antibiotic resistance is a natural phenomenon, but the anthropomorphic use of antimicrobials has created heightened selective pressure that has led to an increased presence of antibiotic-resistant bacteria in agriculture, aquaculture, and hospital environments. Concerns over the emergence of antibiotic-resistant bacteria that threaten human health has prompted the retail and fast food sector to promote meat and milk produced from livestock that are raised “without the use of antibiotics.” Antibiotics have become an integral component of intensive livestock production and are used to treat (therapeutic use) and prevent (prophylactic, metaphylactic) infectious disease and promote growth (subtherapeutic). The growing restriction of antibiotic use in livestock production has promoted research into a plethora of potential alternatives.

Results from the Survey of Antibiotic Resistance (SOAR) 2014-16 in the Czech Republic.

To determine the antibiotic susceptibility of isolates of Streptococcus pneumoniae and Haemophilus influenzae collected in 2014-16 from patients with community-acquired respiratory infections in the Czech Republic. MICs were determined by CLSI broth microdilution and susceptibility was assessed using CLSI, EUCAST and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. S. pneumoniae isolates (n = 200) showed high rates of susceptibility (>95%) to amoxicillin, amoxicillin/clavulanic acid, penicillin [intravenous (iv) non-meningitis], ceftriaxone, cefuroxime and the fluoroquinolones using CLSI breakpoints. Susceptibility to cefaclor and trimethoprim/sulfamethoxazole was 94%-94.5%, to penicillin (oral) 91.5% and to the macrolides 89.5%. Susceptibility of H. influenzae (n = 197) to amoxicillin/clavulanic acid, ceftriaxone, cefuroxime, azithromycin and the fluoroquinolones was ≥98% by CLSI criteria. Rates of susceptibility to the remaining agents were ≥75% except for clarithromycin at 37.1%. Great variability was seen across breakpoints, especially for the macrolides, cefaclor and cefuroxime (oral), 98.0% of H. influenzae showing susceptibility to the latter by CLSI criteria, 69.5% by PK/PD and 1.5% by EUCAST standards. The β-lactamase rate was 13.7% with no β-lactamase-negative-ampicillin-resistant (BLNAR) isolates by CLSI criteria. Antibiotic resistance among the two major respiratory pathogens remained low in the Czech Republic. These findings support local clinicians in continuing the historically restrictive use of antibiotics in the Czech Republic, with selection of narrower-spectrum agents for the empirical therapy of community-acquired respiratory tract infections. This highlights one of the great benefits of continuous surveillance of antimicrobial resistance: knowledge of current local resistance patterns reduces the need to choose broad-spectrum agents that contribute to increasing resistance worldwide.

Arrival of carbapenem-hydrolyzing-oxacillinases in Acinetobacter baumannii in Bosnia and Herzegovina

Multidrug-resistant Acinetobacter baumannii (MDR-AB) is an important threat for critically ill patients. It can infect the respiratory tract, blood, soft tissues, urinary tract and central nervous system. Recently, carbapenem-resistance was observed in A. baumannii clinical isolates from Bosnia and Herzegovina. This prompted us to analyze these isolates with regards to genotypic diversity, antibiotic susceptibility and occurrence of acquired carbapenem resistance genes. Twelve carbapenem-resistant isolates were collected at a University hospital during two different periods of 2011 and 2015–2016: four isolates in 2011 and eight isolates 2015–2016 and compared to determine the dynamic changes in carbapenemase resistance mechanisms and population structure. All twelve isolates were positive for intrinsic blaOXA-51-like, nine for blaOXA-40-like and one for the blaOXA-23-like gene. ISAba1 was found upstream of blaOXA-51 in all and upstream of blaOXA-23-like gene in one isolate. Sequencing of the selected PCR products revealed the presence of OXA-72 β-lactamase (strain 1) and OXA-23 β-lactamase (strain 41). WGS of the selected isolate (AB 5) revealed the presence of blaOXA-72, chromosomal genes blaOXA-69 and blaADC. Moreover, the aac (3)-1a and aadA1 genes encoding aminoglycoside resistance, and sul1encoding sulphonamide resistance were identified. PFGE and rep-PCR revealed two clones containing highly similar isolates positive for OXA-40-like; one from 2011 and the other from 2015 to 2016.Implementation of hospital hygiene measures, screening of the patients on admission for carriage of MDR-AB, and the early and accurate detection, with restriction of antibiotic use should be recommended to control the spread of these important hospital pathogenes. To our knowledge, this is the first report of A. baumannii isolates producing carbapenem-hydrolyzing oxacillinases (CHDL) from Bosnia and Herzegovina.

Tonsillectomy for persistent MRSA carriage in the throat—Description of three cases

In several countries, including the Netherlands, a search and destroy policy is part of the standard of care. Due to this policy and the restrictive use of antibiotics, the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the Netherlands – carrier state and infections – is among the lowest in the world. In the Netherlands, healthcare workers who are MRSA carriers are not allowed to perform work involving direct patient care. This means that treatment failure can have major implications for their working career. Despite repeated treatments according to guidelines, the eradication of MRSA fails in a minority of cases. It appears that performing a tonsillectomy can be part of the solution to this problem. As yet, tonsillectomy is not recommended as supplementary treatment for persistent MRSA carriage in the throat. There are a few expert opinions suggesting that tonsillectomy could possibly be helpful in decolonization. This article reports three recent cases in which MRSA eradication was successful only after tonsillectomy. It is believed that if eradication is necessary, tonsillectomy, if applicable, should be considered.

Assessment of antibiotic use and impact of an intervention intended to modify the prescribing behaviour in surgical prophylaxis in 6 hospitals in the metropolitan area of Monterrey, Mexico

BACKGROUND Improper use of antibiotics increases antimicrobial resistance. OBJECTIVE Evaluate the use of antibiotics and the impact of an intervention designed to improve antibiotic prescription for surgical prophylaxis in 6 hospitals of Monterrey, Mexico. MATERIAL AND METHODS Design: A prospective multicenter survey and a pretest-postest experimental study. Phase 1: Survey to evaluate the use of antibiotics through an especially designed guide. Phase 2: Intervention designed to improve antibiotic prescription for surgical prophylaxis by the medical staff by using printed, audiovisual and electronic messages. Phase 3: Survey to evaluate the impact of the intervention. ANALYSIS Frequencies, percentages, medians, ranges and X2 test. RESULTS Phase 1: We evaluated 358 surgical patients, 274 prophylactic antibiotic regimens. A total of 96% of antibiotics regimens began with inappropriate timing (290/302), 82.8% were inappropriate regimens (274/331), 77.7% were in inappropriate dosage (230/296), 86% of inadequate length (241/280), and in 17.4% restricted antibiotics were used (52/299). Phase 2: 9 sessions including 189 physicians (14 department chairs, 58 general practitioners and 117 residents). Phase 3: We evaluated 303 surgical patients, 218 prophylactic antibiotics regimens. Inappropriate treatment commencement was reduced to 84.1% (180/214) (P<0.001), inappropriate regimens to 75.3% (162/215) (P=0.03), inappropriate dosages to 51.2% (110/215) (P<0.001), and use of restricted antibiotics to 8.3% (18/215) (P=0.003). CONCLUSIONS Inappropriate use of prophylactic antibiotics in surgery is a frequent problem in Monterrey. The intervention improved the antibiotic prescription for surgical prophylaxis by reducing inappropriate treatment commencement, regimens, dosages, and overuse of restricted antibiotics. It is necessary to strengthen strategies to improve the prescription of antibiotics in surgical prophylaxis.

Description of a restriction program for gram-positive antimicrobial agents at an academic medical center

This report examines the effectiveness of antimicrobial restriction at 1 tertiary care health care system by analyzing the consumption of restricted versus nonrestricted gram-positive agents over time for medical versus surgical units. Significant reductions in restricted antibiotic use were detected in 57% of medical units versus none of the surgical units. There were no significant reductions in nonrestricted antibiotic use. We think looking at antibiotic consumption by service line provides opportunities for targeted antibiotic restriction program refinement.

Monitoring, documenting and reporting the quality of antibiotic use in the Netherlands: a pilot study to establish a national antimicrobial stewardship registry

BackgroundThe Dutch Working Party on Antibiotic Policy is developing a national antimicrobial stewardship registry. This registry will report both the quality of antibiotic use in hospitals in the Netherlands and the stewardship activities employed. It is currently unclear which aspects of the quality of antibiotic use are monitored by antimicrobial stewardship teams (A-teams) and can be used as indicators for the stewardship registry. In this pilot study we aimed to determine which stewardship objectives are eligible for the envisioned registry.MethodsWe performed an observational pilot study among five Dutch hospitals. We assessed which of the 14 validated stewardship objectives (11 process of care recommendations and 3 structure of care recommendations) the A-teams monitored and documented in individual patients. They provided, where possible, data to compute quality indicator (QI) performance scores in line with recently developed QIs to measure appropriate antibiotic use in hospitalized adults for the period of January 2015 through December 2015ResultsAll hospitals had a local antibiotic guideline describing recommended antimicrobial use. All A-teams monitored the performance of bedside consultations in Staphylococcus aureus bacteremia and the prescription of restricted antimicrobials. Documentation and reporting were the best for the use of restricted antimicrobials: 80% of the A-teams could report data. Lack of time and the absence of an electronic medical record system enabling documentation during the daily work flow were the main barriers hindering documentation and reporting.ConclusionsFive out of 11 stewardship objectives were actively monitored by A-teams. Without extra effort, 4 A-teams could report on the quality of use of restricted antibiotics. Therefore, this aspect of antibiotic use should be the starting point of the national antimicrobial stewardship registry. Our registry is expected to become a powerful tool to evaluate progress and impact of antimicrobial stewardship programs in hospitals.

Influence of Manure Application on the Environmental Resistome under Finnish Agricultural Practice with Restricted Antibiotic Use.

The co-occurrence of antibiotic-resistance genes (ARGs) and mobile genetic elements (MGEs) in farm environments can potentially foster the development of antibiotic-resistant pathogens. We studied the resistome of Finnish dairy and swine farms where use of antibiotics is limited to treating bacterial infections and manure is only applied from April to September. The resistome of manure, soil, and tile drainage water from the ditch was investigated from the beginning of the growing season until forage harvest. The relative ARG and MGE abundance was measured using a qPCR array with 363 primer pairs. Manure samples had the highest abundance of ARGs and MGEs, which increased during storage. Immediately following land application, the ARGs abundant in manure were detected in soil, but their abundance decreased over time with many becoming undetectable. This suggests that increases in ARG abundances after fertilizing are temporary and occur annually under agricultural practices that restrict antibiotic use. A few of the ARGs were detected in the ditch water, but most of them were undetected in the manure. Our results document the dissipation and dissemination off farm of ARGs under Finnish limited antibiotic use and suggest that such practices could help reduce the load of antibiotic-resistance genes in the environment.

Evaluation of a Second-Sign Process for Antimicrobial Prior Authorization.

A second-sign prospective restriction of select broad-spectrum antimicrobials was fully implemented in January 2015 as a pediatric antimicrobial stewardship program (ASP) initiative to help ensure the most appropriate empiric use of ceftaroline, cefepime, fidaxomicin, linezolid, and vancomycin (intravenous). The objective of this evaluation is to assess the effectiveness of a forced second-sign process in the electronic medical record as a pediatric ASP strategy. We anticipated that the second-sign process for antibiotics would increase the appropriateness of empiric antibiotic use, as defined by preapproved criteria, clinical pathways, national guidelines, and pediatric-specific infectious diseases reference texts, while not causing significant delay in the initial administration of antibiotic therapy. This was a retrospective before and after intervention chart review conducted from July 2014 to June 2015. The study was conducted at a 187-bed, freestanding teaching children's hospital that included the following: level-1 pediatric trauma center, 18-bed pediatric intensive care unit, and 32-bed neonatal intensive care unit. A total of 1178 orders were identified, and 389 met inclusion criteria. The vast majority of second-sign orders were for vancomycin (92%), 61% were written for males, and the median age was 6 years old. Appropriateness of second-sign restricted antibiotic use significantly increased after second-sign implementation (84.5% to 92.9%, P = .01). The secondary outcome of time from initial order entry to medication administration was not different between the before and after groups (median time, 184.5 [interquartile range, 110.25-280.75] vs 174 [interquartile range, 104-228] minutes; P = .342). The use of a second-sign approval process for antimicrobial restriction can lead to increased appropriateness of antibiotic use at a pediatric hospital, without causing a delay in administration.

MP46-12 EFFECTS OF PERIOPERATIVE COMPLICATIONS ON FAVORABLE OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR MALE NON-NEUROGENIC STRESS URINARY INCONTINENCE

MP46-12 EFFECTS OF PERIOPERATIVE COMPLICATIONS ON FAVORABLE OUTCOMES AFTER PRIMARY ARTIFICIAL URINARY SPHINCTER IMPLANTATION FOR MALE NON-NEUROGENIC STRESS URINARY INCONTINENCE

KNOWLEDGE AND ATTITUDES OF GENERAL PRACTITIONERS AND PHARMACISTS ABOUT APPROPRIATE USE OF ANTIBIOTICS

INTRODUCTION: The unprecedented multiplication of infection rates with antibiotic-resistant germs currently represents a complex problem that doctors face, driven by closely linked factors. The antibiotic resistance rate of microbial agents is unknown, however, it is provided by various factors such as the knowledge of microbiology of general practitioners and pharmacists, as well as patient self-medication. The purpose of this study was to investigate the way antibiotics are prescribed by general practitioners and the way they are released by pharmacists. Another aim was to update the knowledge about the appearance of multiresistant microorganisms to antibiotics. MATERIALS AND METHODS: We used a questionnaire consisting of 33 questions on the knowledge of general practitioners and pharmacists about antibiotic therapy and antibiotic resistance. RESULTS: Most general practitioners considered that antibiotic resistance was a matter of practice, while pharmacists regarded it a national problem. In the view of the respondents, the important causes of antibiotic resistance are excessive prescriptions/ release of antibiotics (68.5%), unnecessary prescription/ release of antibiotics (63.8%), inappropriate duration of the antibiotic treatment (49.1%). The most important factor for prescribing/ release of proper antibiotics is the correct diagnosis of the infection with resistant germs. Important criteria also include the restrictive use of antibiotics in targeted therapy against resistant bacteria and the correct duration of drug administration. CONCLUSIONS: The main causes affecting antibiotic resistance are determined by professionalism and the lack of an effective national program to combat antibiotic resistance, or the lack of educational programs for the population, but also due to insufficient medical knowledge in the general population, which inevitably leads to self-medication with antibiotics without a medical examination and a microbiological diagnosis. Keywords: Antibiotics, general practitioners, pharmacists, antibiotic resistance, knowledge and attitudes Normal 0 21 false false false RO X-NONE X-NONE /* Style Definitions */ table.MsoNormalTable {mso-style-name:Table Normal; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-priority:99; mso-style-parent:; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin-top:0cm; mso-para-margin-right:0cm; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0cm; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:Calibri,sans-serif; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:Times New Roman; mso-bidi-theme-font:minor-bidi; mso-fareast-language:EN-US;}

Antibiotic management of children with infectious diseases in Dutch Primary Care.

Childhood infections are common in general practice. Although clinical guidelines recommend restrictive antibiotic use for children, antibiotics are too often prescribed. The aim of this study was to obtain insight in antibiotic prescribing for children related to clinical diagnoses. This is pivotal to define improvement strategies in the antibiotic management. In this observational study, we used consultation data collected from 45 general practices in the Netherlands in 2012. Infectious disease episode incidences, the number of antibiotic prescriptions per 1000 person-years, the proportion of episodes with an antibiotic prescription and the choice of antibiotic subclass were analysed for the most relevant diagnoses over different ages. A total of 262 antibiotic courses were prescribed per 1000 person-years on average, with the highest number among children of 1 year (714/1000 person-years). Antibiotics were prescribed in 24% of infectious disease episodes. Acute upper respiratory tract infection (RTI) was the most common reason to visit the GP (173/1000 person-years), and the second most frequent indication to prescribe antibiotics. Antibiotics were most often prescribed for acute otitis media (58/1000 person-years). Amoxicillin dominated prescribing (55%), followed by macrolides (14%) and amoxicillin/clavulanate (10%), prescribing of narrow-spectrum antibiotics was low (10%). This detailed insight in antibiotic management of childhood infections shows targets for Dutch improvement strategies: (i) prevent antibiotic prescribing for acute upper RTI and bronchitis; (ii) stimulate the use of narrow-spectrum antibiotics; and (iii) reduce the use of macrolides and amoxicillin/clavulanate. Furthermore, this information is helpful to compare antibiotic policy between countries.