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Interventions to Improve Antibiotic Use

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A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: closed (30 December 2020) | Viewed by 45548

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Special Issue Editors

Dr. Maria Teresa Herdeiro

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Guest Editor

Medical Sciences Department, Institute of Biomedicine (iBiMED), Aveiro University, Aveiro, Portugal
Interests: pharmacoepidemiology; pharmacovigilance; drug utilization studies
Special Issues, Collections and Topics in MDPI journals

Prof. Dr. Fátima Roque

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Guest Editor

School of Health Sciences, Polytechnic Institute of Guarda, Avenida Rainha D. Amélia, S/N, 6300-749 Guarda, Portugal
Interests: pharmacotherapy; pharmacovigilance; pharmacology; drug interactions; epidemiology; public health; geriatric pharmacotherapy; clinical pharmacy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antibiotic resistance is one of the major public health problems world-wide. World Health Organization reports that the prevalence of resistance to antibiotics can reach values up to 70% for Streptococcus pneumoniae, which is the most common extra hospital pathogen, the cause of otitis media in children and invasive infections in adults. Furthermore, many of the most common pathogens become resistant to conventional antimicrobial treatment which involves the loss of efficiency and thus an increased use of combinations of broad spectrum. Association between consumption of antibiotics and spread of bacterial resistance is well established, so, improving the use of antibiotics is essential. Inappropriate use of antibiotics is currently regarded as the main determinant of such resistance. We welcome contributions based on interventions to improve the antibiotics use and we hope to receive manuscripts from a broad spectrum of geographical, cultural, and economic settings, which may include original research, review articles, case series, and opinion papers.

I would like to invite you to submit manuscripts covering in both qualitative and quantitative research across the following areas:

Multifaceted educational interventions related to antibiotic prescribing, dispensing practices and use (e.g., patients and health care professionals)
Implementation of campaigns, social media, policies, regulations, guidelines related to antibiotic prescribing, dispensing practices and use (e.g., analyses of factors determining the consume of antibiotics in different contexts)
Intervention with inter-professional collaboration with support of eHealth tools (e.g. analyses and interventions promoting collaborative work between general practitioners, dentists, pharmacists, and nurses)

Prof. Maria Teresa Herdeiro
Dr. Fátima Roque
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Antibiotic resistance
Intervention to improve antibiotic use
Pharmaceutical care
Prescription, dispensing and consume of antibiotic
Quality indicators
Support Decision Systems
eHealth tools

Published Papers (9 papers)

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Research

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10 pages, 900 KiB

Open AccessArticle

Incidence of Cholangitis and Sepsis Associated with Percutaneous Transhepatic Cholangiography in Pediatric Liver Transplant Recipients

by Naire Sansotta, Ester De Luca, Emanuele Nicastro, Alessandra Tebaldi, Alberto Ferrari and Lorenzo D’Antiga

Antibiotics 2021, 10(3), 282; https://doi.org/10.3390/antibiotics10030282 - 10 Mar 2021

Cited by 3 | Viewed by 2666

Abstract

Background. Percutaneous transhepatic cholangiography (PTC) is an established treatment in the management of biliary strictures. The aim of our study was to determine the incidence of PTC-related infectious complications in transplanted children, and identify their precise aetiol-ogy. Methods. We retrospectively reviewed all PTC performed from January 2017 to October 2020 in our center. Before the procedure, all patients received antibiotic prophylaxis defined as first line, while second line was used in case of previously microbiological isolation. Cholangitis was defined as fever (>38.5°) and elevated inflammatory markers after PTC, while sepsis included hemodynamic instability in addition to cholangitis. Results. One hundred and fifty-seven PTCs from 50 pediatric recipients were included. The overall incidence of cholangitis and sepsis after PTC was 44.6% (70/157) and 3.2% (5/157), respectively, with no fatal events. Blood cultures yielded positive results in 15/70 cases (21.4%). Enterococcus faecium and Pseudomonas aeruginosa were the most common isolated pathogens. Multidrug-resistant (MDR) pathogens were found in 11/50 patients (22%). Conclusion. PTC is associated with a relatively high rate of post-procedural cholangitis, although with low rate of sepsis and no fatal events. Blood cultures allowed to find a precise aetiology in roughly a quarter of the cases, showing prevalence of Enterococcus faecium and Pseudomonas aeruginosa. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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13 pages, 1423 KiB

Open AccessArticle

Antibiotic Use and Antibiotic Resistance: Public Awareness Survey in the Republic of Cyprus

by Mikaela Michaelidou, Spyridon A. Karageorgos and Constantinos Tsioutis

Antibiotics 2020, 9(11), 759; https://doi.org/10.3390/antibiotics9110759 - 30 Oct 2020

Cited by 22 | Viewed by 4551

Abstract

We aimed to assess the knowledge and understanding of antibiotic use and resistance in the general population of Cyprus, in order to inform future antibiotic awareness campaigns with local evidence. Cross-sectional survey following the methodology of the “Antibiotic resistance: Multi-country public awareness survey” of the World Health Organization, during December 2019–January 2020. A total of 614 respondents participated: 64.3% were female and most were aged 35–44 years (33.2%) or 25–34 years (31.8%). One-third had used antibiotics >1 year ago and 91.6% reported receiving advice on appropriate use from a medical professional. Despite high awareness on correct use of antibiotics, lack of knowledge was noted for specific indications, where approximately one-third believed that viral infections respond to antibiotics and 70.7% lack understanding of how antibiotic resistance develops. Higher education graduates exhibited significantly higher knowledge rates. As high as 72.3% were informed about “antibiotic resistant bacteria” from healthcare professionals or social media. Most agreed on the usefulness of most suggested actions to address antibiotic resistance, with higher proportions acknowledging the role of prescribers. Up to 47% could not identify their role in decreasing antibiotic resistance. Our study provides local evidence to inform future efforts in a country characterized by high antibiotic consumption rates. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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8 pages, 492 KiB

Open AccessArticle

Impact of a Multiplex Polymerase Chain Reaction Assay on the Clinical Management of Adults Undergoing a Lumbar Puncture for Suspected Community-Onset Central Nervous System Infections

by Matthew A. Moffa, Derek N. Bremmer, Dustin Carr, Carley Buchanan, Nathan R. Shively, Rawiya Elrufay and Thomas L. Walsh

Antibiotics 2020, 9(6), 282; https://doi.org/10.3390/antibiotics9060282 - 26 May 2020

Cited by 20 | Viewed by 3697

Abstract

Patients admitted from the community with a suspected central nervous system (CNS) infection require prompt diagnostic evaluation and correct antimicrobial treatment. A retrospective, multicenter, pre/post intervention study was performed to evaluate the impact that the BioFire^® FilmArray^® meningitis/encephalitis (ME) panel run in-house had on the clinical management of adult patients admitted from the community with a lumbar puncture (LP) performed for a suspected CNS infection. The primary outcome was the effect that this intervention had on herpes simplex virus (HSV) polymerase chain reaction (PCR) turnaround time (TAT). Secondary outcomes included the effect that this intervention had on antiviral days of therapy (DOT), total antimicrobial DOT, and hospital length of stay (LOS). A total of 81 and 79 patients were included in the pre-intervention and post-intervention cohorts, respectively. The median HSV PCR TAT was significantly longer in the pre-intervention group (85 vs. 4.1 h, p < 0.001). Total antiviral DOT was significantly greater in the pre-intervention group (3 vs. 1, p < 0.001), as was total antimicrobial DOT (7 vs. 5, p < 0.001). Pre-intervention hospital LOS was also significantly longer (6.6 vs. 4.4 days, p = 0.02). Implementing the ME panel in-house for adults undergoing an LP for a suspected community-onset CNS infection significantly reduced the HSV PCR TAT, antiviral DOT, total antimicrobial DOT, and hospital LOS. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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8 pages, 515 KiB

Open AccessArticle

Impact of Antimicrobial Stewardship Interventions on Appropriateness of Surgical Antibiotic Prophylaxis: How to Improve

by Beatrice Tiri, Paolo Bruzzone, Giulia Priante, Emanuela Sensi, Monya Costantini, Carlo Vernelli, Lucia Assunta Martella, Marsilio Francucci, Paolo Andreani, Alessandro Mariottini, Andrea Capotorti, Vito D’Andrea, Daniela Francisci, Roberto Cirocchi and Stefano Cappanera

Antibiotics 2020, 9(4), 168; https://doi.org/10.3390/antibiotics9040168 - 9 Apr 2020

Cited by 12 | Viewed by 3694

Abstract

Surgical site infections (SSIs) are the most common healthcare-associated infections. The appropriate use of Surgical Antibiotic Prophylaxis (SAP) is a key component to reduce SSIs, while its inappropriate application is a major cause of some emerging infections and selects for antibiotic resistance. We describe an Antimicrobial Stewardship (AMS) intervention on SAP appropriateness. The prospective study was conducted in an Italian hospital, in 12 main surgical units, and was organized in three subsequent phases, as follows. Phase 0: Definition of hospital evidence-based guidelines and a new workflow to optimize the process of ordering, dispensing, administering and documenting the SAP. Phase 1: We analysed 2059 elective surgical cases from January to June 2018 for three SAP parameters of appropriateness: indication, choice and dose. Phase 2: In July 2018, an audit was performed to analyse the results; we reviewed 1781 elective surgical procedures from July to December 2018 looking for the same three SAP appropriateness parameters. The comparative analysis between phases 1 and 2 demonstrated that the correct indication, the correct dose and the overall compliance significantly improved (p-value 0.00128, p-value < 2.2·10¹⁶ and p-value < 5.6·10¹² respectively). Our prospective study demonstrates a model of successful antimicrobial stewardship intervention that improves appropriateness on SAP. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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Review

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49 pages, 865 KiB

Open AccessReview

Antibiotic Dispensation without a Prescription Worldwide: A Systematic Review

by Ana Daniela Batista, Daniela A. Rodrigues, Adolfo Figueiras, Maruxa Zapata-Cachafeiro, Fátima Roque and Maria Teresa Herdeiro

Antibiotics 2020, 9(11), 786; https://doi.org/10.3390/antibiotics9110786 - 7 Nov 2020

Cited by 54 | Viewed by 13794

Abstract

Antibiotic resistance still remains a major global public health problem and the dispensing of antibiotics without a prescription at community pharmacies is an important driver of this. MEDLINE, Pubmed and EMBASE databases were used to search and identify studies reporting the dispensing of non-prescribed antibiotics in community pharmacies or drugstores that sell drugs for human use, by applying pharmacy interviews/questionnaires methods and/or simulated patient methods. Of the 4683 studies retrieved, 85 were included, of which 59 (69.4%) were published in low-and middle-income countries. Most of the papers (83.3%) presented a percentage of antibiotic dispensing without a prescription above 60.0%. Sixty-one studies evaluated the active substance and the most sold antibiotics without a prescription were amoxicillin (86.9%), azithromycin (39.3%), ciprofloxacin (39.3%), and amoxicillin-clavulanic acid (39.3%). Among the 65 articles referencing the diseases/symptoms, this practice was shown to be mostly associated with respiratory system problems (100.0%), diarrhea (40.0%), and Urinary Tract Infections (30.8%). In sum, antibiotics are frequently dispensed without a prescription in many countries and can thus have an important impact on the development of resistance at a global level. Our results indicate the high need to implement educational and/or regulatory/administrative strategies in most countries, aiming to reduce this practice. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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12 pages, 248 KiB

Open AccessReview

Role of Artificial Intelligence in Fighting Antimicrobial Resistance in Pediatrics

by Umberto Fanelli, Marco Pappalardo, Vincenzo Chinè, Pierpacifico Gismondi, Cosimo Neglia, Alberto Argentiero, Adriana Calderaro, Andrea Prati and Susanna Esposito

Antibiotics 2020, 9(11), 767; https://doi.org/10.3390/antibiotics9110767 - 1 Nov 2020

Cited by 22 | Viewed by 5206

Abstract

Artificial intelligence (AI) is a field of science and engineering concerned with the computational understanding of what is commonly called intelligent behavior. AI is extremely useful in many human activities including medicine. The aim of our narrative review is to show the potential role of AI in fighting antimicrobial resistance in pediatric patients. We searched for PubMed articles published from April 2010 to April 2020 containing the keywords “artificial intelligence”, “machine learning”, “antimicrobial resistance”, “antimicrobial stewardship”, “pediatric”, and “children”, and we described the different strategies for the application of AI in these fields. Literature analysis showed that the applications of AI in health care are potentially endless, contributing to a reduction in the development time of new antimicrobial agents, greater diagnostic and therapeutic appropriateness, and, simultaneously, a reduction in costs. Most of the proposed AI solutions for medicine are not intended to replace the doctor’s opinion or expertise, but to provide a useful tool for easing their work. Considering pediatric infectious diseases, AI could play a primary role in fighting antibiotic resistance. In the pediatric field, a greater willingness to invest in this field could help antimicrobial stewardship reach levels of effectiveness that were unthinkable a few years ago. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

19 pages, 521 KiB

Open AccessReview

Systematic Review on the Impact of Guidelines Adherence on Antibiotic Prescription in Respiratory Infections

by Inês Oliveira, Catarina Rego, Guilherme Semedo, Daniel Gomes, Adolfo Figueiras, Fátima Roque and Maria Teresa Herdeiro

Antibiotics 2020, 9(9), 546; https://doi.org/10.3390/antibiotics9090546 - 27 Aug 2020

Cited by 11 | Viewed by 4431

Abstract

Overuse and inappropriate antibiotic prescription for respiratory tract infections (RTI) are one of the major contributors to the current antibiotic resistance problem. Guidelines provide support to prescribers for proper decision-making. Our purpose is to review the impact of prescribers’ exposure to guidelines in antibiotic prescription for RTIs. A systematic review was performed searching in the scientific databases MEDLINE PubMed and EMBASE for studies which exposed prescribers to guidelines for RTI and compared antibiotic prescription rates/quality before and after the implementation, with thirty-four articles included in the review. The selected studies consisted on a simple intervention in the form of guideline implementation while others involved multifaceted interventions, and varied in population, designs, and settings. Prescription rate was shown to be reduced in the majority of the studies, along with an improvement in appropriateness, defined mainly by the prescription of narrow-spectrum rather than broad-spectrum antibiotics. Intending to ascertain if this implementation could decrease prescription costs, 7 articles accessed it, of which 6 showed the intended reduction. Overall interventions to improve guidelines adherence can be effective in reducing antibiotic prescriptions and inappropriate antibiotic selection for RTIs, supporting the importance of implementing guidelines in order to decrease the high levels of antibiotic prescriptions, and consequently reduce antimicrobial resistance. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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15 pages, 503 KiB

Open AccessReview

E-Health Tools to Improve Antibiotic Use and Resistances: A Systematic Review

by Érico Carvalho, Marta Estrela, Maruxa Zapata-Cachafeiro, Adolfo Figueiras, Fátima Roque and Maria Teresa Herdeiro

Antibiotics 2020, 9(8), 505; https://doi.org/10.3390/antibiotics9080505 - 12 Aug 2020

Cited by 11 | Viewed by 4519

Abstract

(1) Background: e-Health tools, especially in the form of clinical decision support systems (CDSSs), have been emerging more quickly than ever before. The main objective of this systematic review is to assess the influence of these tools on antibiotic use for respiratory tract infections. (2) Methods: The scientific databases, MEDLINE-PubMed and EMBASE, were searched. The search was conducted by two independent researchers. The search strategy was mainly designed to identify relevant studies on the effectiveness of CDSSs in improving antibiotic use, as a primary outcome, and on the acceptability and usability of CDSSs, as a secondary outcome. (3) Results: After the selection, 22 articles were included. The outcomes were grouped either into antibiotics prescription practices or adherence to guidelines concerning antibiotics prescription. Overall, 15 out of the 22 studies had statistically significant outcomes related to the interventions. (4) Conclusions: Overall, the results show a positive impact on the prescription and conscientious use of antibiotics for respiratory tract infections, both with respect to patients and prescribing healthcare professionals. CDSSs have been shown to have great potential as powerful tools for improving both clinical care and patient outcomes. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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Other

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8 pages, 218 KiB

Open AccessBrief Report

The Case for Intermittent Carbapenem Dosing in Stable Haemodialysis Patients

by Vanda Ho, Felecia Tay, Jia En Wu, Lionel Lum and Paul Tambyah

Antibiotics 2020, 9(11), 815; https://doi.org/10.3390/antibiotics9110815 - 16 Nov 2020

Cited by 1 | Viewed by 2242

Abstract

Purpose: Antimicrobial resistant infections are common in patients on haemodialysis, often needing long courses of carbapenems. This results in a longer hospital stay and risk of iatrogenic complications. However, carbapenems can be given intermittently to allow for earlier discharge. We aim to describe the clinical outcomes of intermittent versus daily meropenem in stable, intermittently haemodialysed patients. Methods: In total, 103 records were examined retrospectively. Data collected include demographics, clinical interventions and outcomes such as hospital length of stay (LOS), 30-day readmission rates and adverse events. Findings: Mean age 61.6 ± 14.2 years, 57.3% male. Most common bacteria cultured were Klebsiella pneumoniae (16.5%). The most common indication was pneumonia (27.2%). Mean duration of therapy on meropenem was 12.4 ± 14.4 days; eight patients needed more than 30 days of meropenem. In total, 55.3% did not have intervention for source control; 86.4% received daily dosing of meropenem; 7.8% patients received intermittent dosing of meropenem only, and 5.8 patients received both types of dosing regimens. LOS of the index admission was shorter for the intermittent arm (15.5 ± 7.6 days versus daily: 30.2 ± 24.5 days), though 30-day readmission was higher (50% versus daily: 38.2%). Implications: We recommend further rigorous randomised controlled trials to investigate the clinical utility of intermittent meropenem dosing in patients on stable haemodialysis. Full article

(This article belongs to the Special Issue Interventions to Improve Antibiotic Use)

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