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Antibiotics
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Antibiotic Use and Stewardship in Hospital
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Antibiotic Use and Stewardship in Hospital

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 (31 August 2023) | Viewed by 35216

Special Issue Editors

Dr. Daniel Echeverría-Esnal

E-Mail Website
Guest Editor
1. Pharmacy Department, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
2. Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain
Interests: antimicrobial stewardship; antibiotics; antifungals; bacteraemia; Enterococcus faecium; respiratory infectious diseases; antimicrobial prescribing; pharmacology
Dr. Santíago Grau

E-Mail Website
Guest Editor
1. Pharmacy Department, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
2. Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain
Interests: antimicrobial stewardship; antibiotics; antifungals; defined daily doses; days of therapy; pharmacokinetics; pharmacodynamics
Dr. Silvia Gómez-Zorrilla

E-Mail Website
Guest Editor
1. Infectious Diseases Department, Hospital del Mar, Passeig Maritim 25-29, 08003 Barcelona, Spain
2. Infectious Pathology and Antimicrobials Research Group (IPAR), Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), Dr. Aiguader 88, 08003 Barcelona, Spain
Interests: antimicrobial stewardship; antibiotics; Pseudomonas aeruginosa; multidrug-resistant bacteria; host-pathogen interaction; rational use of antibiotics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The increase in antimicrobial resistance, mainly due to antimicrobial use, makes the treatment of infections increasingly complex. In this setting, antimicrobial stewardship programs are essential to optimize antimicrobial use within hospitals. These programs focus on improving the efficacy of antimicrobial treatments, reducing the number of side effects (including the selection of multidrug-resistant microorganisms), and optimizing their cost. 

In this Special Issue, we seek manuscripts related to antibiotic use and antimicrobial stewardship in the hospital setting. Original research, reviews, short communications, case series’, and perspectives will be invited. More specifically, related topics include:

  1. Impact of COVID-19 pandemic on antimicrobial use;
  2. Implementation of antimicrobial stewardship related activities;
  3. Initiatives to optimize antimicrobial use in the hospital;
  4. Antibiotic allergy management;
  5. New antibiotics placement within hospital formulary;
  6. Assessment of stewardship metrics: process, outcome, and antibiotic use measures;
  7. Pharmacology of antimicrobials;
  8. Antimicrobial related side effects;
  9. Antimicrobial dosing optimization, including paediatrics, critically ill, elderly, pregnant women, obese, cachectic, and immunosuppressed;
  10. Antimicrobial related drug-drug interactions.

Dr. Daniel Echeverría-Esnal
Dr. Santíago Grau
Dr. Silvia Gómez-Zorrilla
Guest Editors

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

  • antimicrobials
  • antibiotics
  • antifungals
  • antibiotic use
  • antimicrobial stewardship
  • defined daily doses
  • days of therapy
  • antimicrobial resistance
  • pharmacology
  • side effects
  • drug-drug interactions

Published Papers (16 papers)

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13 pages, 457 KiB  
Article
Clinical Impact of Rapid Bacterial Microbiological Identification with the MALDI-TOF MS
by Miriam Uzuriaga, José Leiva, Francisco Guillén-Grima, Marta Rua and José R. Yuste
Antibiotics 2023, 12(12), 1660; https://doi.org/10.3390/antibiotics12121660 - 25 Nov 2023
Viewed by 872
Abstract
Rapid microbiological reports to clinicians are related to improved clinical outcomes. We conducted a 3-year quasi-experimental design, specifically a pretest–posttest single group design in a university medical center, to evaluate the clinical impact of rapid microbiological identification information using MALDI-TOF MS on optimizing [...] Read more.
Rapid microbiological reports to clinicians are related to improved clinical outcomes. We conducted a 3-year quasi-experimental design, specifically a pretest–posttest single group design in a university medical center, to evaluate the clinical impact of rapid microbiological identification information using MALDI-TOF MS on optimizing antibiotic prescription. A total of 363 consecutive hospitalized patients with bacterial infections were evaluated comparing a historical control group (CG) (n = 183), in which the microbiological information (bacterial identification and antibiotic susceptibility) was reported jointly to the clinician between 18:00 h and 22:00 h of the same day and a prospective intervention group (IG) (n = 180); the bacterial identification information was informed to the clinician as soon as it was available between 12:00 h and 14:00 h and the antibiotic susceptibility between 18:00 h and 22:00 h). We observed, in favor of IG, a statistically significant decrease in the information time (11.44 h CG vs. 4.48 h IG (p < 0.01)) from the detection of bacterial growth in the culture medium to the communication of identification. Consequently, the therapeutic optimization was improved by introducing new antibiotics in the 10–24 h time window (p = 0.05) and conversion to oral route (p = 0.01). Additionally, we observed a non-statistically significant decrease in inpatient mortality (global, p = 0.15; infection-related, p = 0.21) without impact on hospital length of stay. In conclusion, the rapid communication of microbiological identification to clinicians reduced reporting time and was associated with early optimization of antibiotic prescribing without worsening clinical outcomes. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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11 pages, 579 KiB  
Article
Randomized Clinical Trial of the Need for Antibiotic Treatment for Low-Risk Catheter-Related Bloodstream Infection Caused by Coagulase-Negative Staphylococci
by Laia Badia-Cebada, João Carmezim, María-Teresa Pérez-Rodríguez, Elena Bereciartua, Luis-Eduardo López, Marta Represa Montenegro, Virginia Pomar, Marta Andrés, Elizabet Petkova, Nieves Sopena, Jaime Lora-Tamayo, Víctor Monsálvez, Maria Fernanda Ramirez-Hidalgo, Silvia Gómez-Zorrilla, Lucía Boix, Yolanda Meije, Emili Jiménez and Oriol Gasch
Antibiotics 2023, 12(5), 839; https://doi.org/10.3390/antibiotics12050839 - 01 May 2023
Cited by 1 | Viewed by 1772
Abstract
According to clinical guidelines, the management of catheter-related bloodstream infections (CRBSI) due to coagulase-negative staphylococci (CoNS) includes catheter removal and antibiotic treatment for 5 to 7 days. However, in low-risk episodes, it remains uncertain whether antibiotic therapy is necessary. This randomized clinical trial [...] Read more.
According to clinical guidelines, the management of catheter-related bloodstream infections (CRBSI) due to coagulase-negative staphylococci (CoNS) includes catheter removal and antibiotic treatment for 5 to 7 days. However, in low-risk episodes, it remains uncertain whether antibiotic therapy is necessary. This randomized clinical trial aims to determine whether the non-administration of antibiotic therapy is as safe and effective as the recommended strategy in low-risk episodes of CRBSI caused by CoNS. With this purpose, a randomized, open-label, multicenter, non-inferiority clinical trial was conducted in 14 Spanish hospitals from 1 July 2019 to 31 January 2022. Patients with low-risk CRBSI caused by CoNS were randomized 1:1 after catheter withdrawal to receive/not receive parenteral antibiotics with activity against the isolated strain. The primary endpoint was the presence of any complication related to bacteremia or to antibiotic therapy within 90 days of follow-up. The secondary endpoints were persistent bacteremia, septic embolism, time until microbiological cure, and time until the disappearance of a fever. EudraCT: 2017-003612-39 INF-BACT-2017. A total of 741 patients were assessed for eligibility. Of these, 27 were included in the study; 15 (55.6%) were randomized to the intervention arm (non-antibiotic administration) and 12 (44.4%) to the control arm (antibiotic therapy as per standard practice). The primary endpoint occurred in one of the 15 patients in the intervention group (septic thrombophlebitis) and in no patients in the control group. The median time until microbiological cure was 3 days (IQR 1–3) in the intervention arm and 1.25 days (IQR 0.5–2.62) in the control arm, while the median time until fever resolution was zero days in both arms. The study was stopped due to the insufficient number of recruited patients. These results seem to indicate that low-risk CRBSI caused by CoNS can be managed without antibiotic therapy after catheter removal; efficacy and safety are not affected. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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12 pages, 1291 KiB  
Article
Impact of an Antimicrobial Stewardship Strategy on Surgical Hospital Discharge: Improving Antibiotic Prescription in the Transition of Care
by Alfredo Jover-Sáenz, Carlos Santos Rodríguez, Miguel Ángel Ramos Gil, Meritxell Palomera Fernández, Liliana Filippa Invencio da Costa, Joan Torres-Puig-gros, Dolors Castellana Perelló, Elisa Montiu González, Joan Antoni Schoenenberger-Arnaiz, Juan Ramón Bordalba Gómez, Xavier Galindo Ortego and María Ramirez-Hidalgo
Antibiotics 2023, 12(5), 834; https://doi.org/10.3390/antibiotics12050834 - 30 Apr 2023
Viewed by 1666
Abstract
Antimicrobial stewardship programs (AMSPs) are essential elements in reducing the unnecessary overprescription of antibiotics. Most of the actions of these programs have focused on actions during acute hospitalization. However, most prescriptions occur after hospital discharge, which represents a necessary and real opportunity for [...] Read more.
Antimicrobial stewardship programs (AMSPs) are essential elements in reducing the unnecessary overprescription of antibiotics. Most of the actions of these programs have focused on actions during acute hospitalization. However, most prescriptions occur after hospital discharge, which represents a necessary and real opportunity for improvement in these programs. We present an AMSP multifaceted strategy implemented in a surgical department which was carried out by a multidisciplinary team to verify its reliability and effectiveness. Over a 1-year post-implementation period, compared to the pre-intervention period, a significant reduction of around 60% in antibiotic exposure occurred, with lower economic cost and greater safety. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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33 pages, 713 KiB  
Article
Ongoing Strategies to Improve Antimicrobial Utilization in Hospitals across the Middle East and North Africa (MENA): Findings and Implications
by Abdul Haseeb, Zikria Saleem, Aseel Fayk Maqadmi, Roaa Abdulrahman Allehyani, Ahmad J. Mahrous, Mahmoud E. Elrggal, Sairah Hafeez Kamran, Manal AlGethamy, Asem Saleh Naji, Abdullmoin AlQarni, Khalid W. Alhariqi, Muhammad Arslan Khan, Kiran Ibrahim, Fahad Raees, Aisha Azmat, Aislinn Cook, Stephen M. Campbell, Giulia Lorenzetti, Johanna C. Meyer, Brian Godman and Catrin E. Mooreadd Show full author list remove Hide full author list
Antibiotics 2023, 12(5), 827; https://doi.org/10.3390/antibiotics12050827 - 28 Apr 2023
Cited by 8 | Viewed by 2876
Abstract
Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial [...] Read more.
Antimicrobial resistance (AMR) is an increasing global concern, increasing costs, morbidity, and mortality. National action plans (NAPs) to minimize AMR are one of several global and national initiatives to slow down rising AMR rates. NAPs are also helping key stakeholders understand current antimicrobial utilization patterns and resistance rates. The Middle East is no exception, with high AMR rates. Antibiotic point prevalence surveys (PPS) provide a better understanding of existing antimicrobial consumption trends in hospitals and assist with the subsequent implementation of antimicrobial stewardship programs (ASPs). These are important NAP activities. We examined current hospital consumption trends across the Middle East along with documented ASPs. A narrative assessment of 24 PPS studies in the region found that, on average, more than 50% of in-patients received antibiotics, with Jordan having the highest rate of 98.1%. Published studies ranged in size from a single to 18 hospitals. The most prescribed antibiotics were ceftriaxone, metronidazole, and penicillin. In addition, significant postoperative antibiotic prescribing lasting up to five days or longer was common to avoid surgical site infections. These findings have resulted in a variety of suggested short-, medium-, and long-term actions among key stakeholders, including governments and healthcare workers, to improve and sustain future antibiotic prescribing in order to decrease AMR throughout the Middle East. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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12 pages, 2021 KiB  
Article
Changing Trends in the Global Consumption of Treatments Used in Hospitalized Patients for COVID-19: A Time Series Multicentre Study
by Judit Aranda, Jose Loureiro-Amigo, Anna Murgadella, Núria Vàzquez, Lucía Feria, Miriam Muñoz, Ariadna Padulles, Gabriela Abelenda, Carol Garcia-Vidal, Montse Tuset, Marta Albanell, Lucía Boix-Palop, Núria Sanmartí-Martínez, Sílvia Gómez-Zorrilla, Daniel Echeverria-Esnal, Alicia Rodriguez-Alarcón, Beatriz Borjabad, Ana Coloma, Jordi Carratalà and Isabel Oriol
Antibiotics 2023, 12(5), 809; https://doi.org/10.3390/antibiotics12050809 - 25 Apr 2023
Cited by 1 | Viewed by 1310
Abstract
Aim: To analyze trends in the prescription of COVID-19 treatments for hospitalized patients during the pandemic. Methods: Multicenter, ecological, time-series study of aggregate data for all adult patients with COVID-19 treated in five acute-care hospitals in Barcelona, Spain, between March 2020 and May [...] Read more.
Aim: To analyze trends in the prescription of COVID-19 treatments for hospitalized patients during the pandemic. Methods: Multicenter, ecological, time-series study of aggregate data for all adult patients with COVID-19 treated in five acute-care hospitals in Barcelona, Spain, between March 2020 and May 2021. Trends in the monthly prevalence of drugs used against COVID-19 were analyzed by the Mantel–Haenszel test. Results: The participating hospitals admitted 22,277 patients with COVID-19 during the study period, reporting an overall mortality of 10.8%. In the first months of the pandemic, lopinavir/ritonavir and hydroxychloroquine were the most frequently used antivirals, but these fell into disuse and were replaced by remdesivir in July 2020. By contrast, the trend in tocilizumab use varied, first peaking in April and May 2020, declining until January 2021, and showing a discrete upward trend thereafter. Regarding corticosteroid use, we observed a notable upward trend in the use of dexamethasone 6 mg per day from July 2020. Finally, there was a high prevalence of antibiotics use, especially azithromycin, in the first three months, but this decreased thereafter. Conclusions: Treatment for patients hospitalized with COVID-19 evolved with the changing scientific evidence during the pandemic. Initially, multiple drugs were empirically used that subsequently could not demonstrate clinical benefit. In future pandemics, stakeholders should strive to promote the early implementation of adaptive randomized clinical trials. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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14 pages, 1184 KiB  
Article
Cross-Sectional Survey on the Current Role of Clinical Pharmacists among Antimicrobial Stewardship Programmes in Catalonia: Much Ado about Nothing
by Daniel Echeverria-Esnal, Sergi Hernández, Anna Murgadella-Sancho, Ramón García-Paricio, Sara Ortonobes, Melisa Barrantes-González, Ariadna Padullés, Alexander Almendral, Montse Tuset, Enric Limón, Santiago Grau and on behalf of the Catalan Infection Control Antimicrobial Stewardship Programme (VINCat-ASP)
Antibiotics 2023, 12(4), 717; https://doi.org/10.3390/antibiotics12040717 - 06 Apr 2023
Viewed by 1847
Abstract
Background. Antimicrobial resistance killed 1.27 million people in 2019, so urgent actions are desperately needed. Antimicrobial stewardship programmes (ASPs) are essential to optimize antimicrobial use. The objective was to acknowledge the current role of clinical pharmacists engaged in ASP activities in Catalonia. Methods. [...] Read more.
Background. Antimicrobial resistance killed 1.27 million people in 2019, so urgent actions are desperately needed. Antimicrobial stewardship programmes (ASPs) are essential to optimize antimicrobial use. The objective was to acknowledge the current role of clinical pharmacists engaged in ASP activities in Catalonia. Methods. This was a cross-sectional survey shared through the Catalan Infection Control Programme (VINCat). The survey consisted of four sections and was sent by e-mail. Results. A total of 69.0% of the centres answered. Pharmacists dedicated a median of 5.0 h per week (2.1 h/week/100 acute care beds), representing 0.15 full time equivalents. The ASP lacked information technology (IT) support, as only 16.3% of centres automatically calculated defined daily doses and days of therapy. Those with less than 15% of their time available for ASPs conducted fewer clinical activities, especially prospective audits and feedback. Those without official infectious diseases training also performed fewer clinical activities, but training was less determinant than IT support or time. Pharmacists performed interventions mostly through annotation in the medical records. Conclusions. Clinical pharmacists from Catalonia dedicated to ASPs present an important lack of time and IT support to perform clinical activities. Pharmacists should also improve their clinical skills and try to conduct clinical advice to prescribers, either by phone or face-to-face. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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15 pages, 933 KiB  
Article
Impact of Adding a Rapid PCR-Based Blood Culture Identification Panel to the Antimicrobial Stewardship Program of Patients with Febrile Neutropenia in a Peruvian Referral Hospital
by Giancarlo Pérez-Lazo, Juana del Valle-Mendoza, Roxana Sandoval-Ahumada, Fernando Soto-Febres, Raúl Castillo-Córdova, Melissa Zárate-Tantaleán, Liliana Morales-Castillo, Celia Joanna Páucar-Miranda, Milagros Altamirano-Molina, Iván Pacheco-Modesto, Claudia Ruiz de Somocurcio-Cruzado, Denis Arana-Jurado, Carmen del Villar-Alarcón, Olga Vargas-Castro, Carol Díaz-Bardales, Bruno Guerrero-Arismendiz, Renee Eyzaguirre-Zapata, Miguel Angel Aguilar-Luis, Johanna Martins-Luna and Wilmer Silva-Caso
Antibiotics 2023, 12(4), 648; https://doi.org/10.3390/antibiotics12040648 - 24 Mar 2023
Cited by 2 | Viewed by 2036
Abstract
The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference [...] Read more.
The addition of Biofire® FilmArray® Blood Culture Identification panel 2 (BCID2) to the antimicrobial stewardship program (ASP) could improve outcomes in bloodstream infections (BSI) of patients with febrile neutropenia (FN). A pre- and post-quasi-experimental single-center study was conducted at a reference hospital in Peru. Three groups were considered: patients with BSI before ASP intervention (control group), patients with BSI after ASP intervention (group 1), and patients with BSI after ASP intervention plus BCID2 PCR Panel implementation (group 2). Overall, 93 patients were identified (32 control, 30 group 1, 31 group 2). The median time to effective therapy was significantly shorter in group 2 compared to group 1 and control group, respectively (3.75 vs. 10 h, p = 0.004; 3.75 vs. 19 h, p < 0.001). No significant differences in terms of relapse of bacteremia, in-hospital mortality (all cause), and 30-day-all-cause hospital readmission between the three study periods were found. The appropriateness of empirical antimicrobial use, adding or change, and the following de-escalation or discontinuation was significant when the two intervention periods were compared with the control group (p < 0.001). In addition to the lack of local studies documenting the microbiological profile of FN episodes, adding syndromic panels-based testing could allow for the consolidation of ASP strategies. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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10 pages, 965 KiB  
Article
The Role of Procalcitonin as an Antimicrobial Stewardship Tool in Patients Hospitalized with Seasonal Influenza
by Ingrid Christensen, Dag Berild, Jørgen Vildershøj Bjørnholt, Lars-Petter Jelsness-Jørgensen, Sara Molvig Debes and Jon Birger Haug
Antibiotics 2023, 12(3), 573; https://doi.org/10.3390/antibiotics12030573 - 14 Mar 2023
Viewed by 2065
Abstract
Background: Up to 60% of the antibiotics prescribed to patients hospitalized with seasonal influenza are unnecessary. Procalcitonin (PCT) has the potential as an antimicrobial stewardship program (ASP) tool because it can differentiate between viral and bacterial etiology. We aimed to explore the role [...] Read more.
Background: Up to 60% of the antibiotics prescribed to patients hospitalized with seasonal influenza are unnecessary. Procalcitonin (PCT) has the potential as an antimicrobial stewardship program (ASP) tool because it can differentiate between viral and bacterial etiology. We aimed to explore the role of PCT as an ASP tool in hospitalized seasonal influenza patients. Methods: We prospectively included 116 adults with seasonal influenza from two influenza seasons, 2018–2020. All data was obtained from a single clinical setting and analyzed by descriptive statistics and regression models. Results: In regression analyses, we found a positive association of PCT with 30 days mortality and the amount of antibiotics used. Influenza diagnosis was associated with less antibiotic use if the PCT value was low. Patients with a low initial PCT (<0.25 µg/L) had fewer hospital and intensive care unit (ICU) days and fewer positive chest X-rays. PCT had a negative predictive value of 94% for ICU care stay, 98% for 30 days mortality, and 88% for bacterial coinfection. Conclusion: PCT can be a safe rule-out test for bacterial coinfection. Routine PCT use in seasonal influenza patients with an uncertain clinical picture, and rapid influenza PCR testing, may be efficient as ASP tools. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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10 pages, 739 KiB  
Article
Ciprofloxacin Alone vs. Ciprofloxacin plus an Aminoglycoside for the Prevention of Infectious Complications following a Transrectal Ultrasound-Guided Prostate Biopsy: A Retrospective Cohort Study
by Daniel J. G. Thirion, Jean-Alexandre Caissy, Florence Poulin, Camille S. H. Lanfranchi, Albin Deda, Armen Aprikian, Charles Frenette and Sero Andonian
Antibiotics 2023, 12(1), 56; https://doi.org/10.3390/antibiotics12010056 - 29 Dec 2022
Cited by 1 | Viewed by 1762
Abstract
The purpose of this study was to evaluate the impact of augmented prophylaxis (ciprofloxacin augmented with an aminoglycoside) compared with that of empirical prophylaxis (ciprofloxacin alone) on transrectal post-prostate biopsy infectious complication (PBIC) rates. A retrospective cohort study evaluated 2835 patients receiving either [...] Read more.
The purpose of this study was to evaluate the impact of augmented prophylaxis (ciprofloxacin augmented with an aminoglycoside) compared with that of empirical prophylaxis (ciprofloxacin alone) on transrectal post-prostate biopsy infectious complication (PBIC) rates. A retrospective cohort study evaluated 2835 patients receiving either augmented or empirical prophylactic regimen before undergoing a transrectal ultrasound-guided prostate biopsy between January 2010 and October 2018. The patients were compared according to prophylactic regimen received. The incidence of PBICs and the impact of risk factors were evaluated. A total of 1849 patients received the empirical regimen, and 986 patients received the augmented regimen. The composite PBIC rate was 2.1% (n = 39) and 0.9% (n = 9) (p = 0.019), respectively, and the SIRS rate was 1.9% and 0.8% (p = 0.020), respectively. Of the 50 patients presenting with a PBIC, 29 (58%) had positive cultures (blood and/or urine) for Escherichia coli, of which 28 (97%) were ciprofloxacin-resistant. Taking a fluoroquinolone in the previous 6 months and having a previous urinary tract infection within 1 year prior to the biopsy had significant impact on PBIC rates (p = 0.009 and p = 0.011, respectively). Compared with ciprofloxacin alone, augmented prophylaxis was associated with significantly lower PBICs. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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37 pages, 956 KiB  
Article
Ongoing Efforts to Improve Antimicrobial Utilization in Hospitals among African Countries and Implications for the Future
by Zikria Saleem, Brian Godman, Aislinn Cook, Muhammad Arslan Khan, Stephen M. Campbell, Ronald Andrew Seaton, Linda Siachalinga, Abdul Haseeb, Afreenish Amir, Amanj Kurdi, Julius C. Mwita, Israel Abebrese Sefah, Sylvia A. Opanga, Joseph O. Fadare, Olayinka O. Ogunleye, Johanna C. Meyer, Amos Massele, Dan Kibuule, Aubrey C. Kalungia, Moyad Shahwan, Hellen Nabayiga, Giuseppe Pichierri and Catrin E. Mooreadd Show full author list remove Hide full author list
Antibiotics 2022, 11(12), 1824; https://doi.org/10.3390/antibiotics11121824 - 15 Dec 2022
Cited by 32 | Viewed by 4476
Abstract
There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the [...] Read more.
There are serious concerns with rising antimicrobial resistance (AMR) across countries increasing morbidity, mortality and costs. These concerns have resulted in a plethora of initiatives globally and nationally including national action plans (NAPs) to reduce AMR. Africa is no exception, especially with the highest rates of AMR globally. Key activities in NAPs include gaining a greater understanding of current antimicrobial utilization patterns through point prevalence surveys (PPS) and subsequently instigating antimicrobial stewardship programs (ASPs). Consequently, there is a need to comprehensively document current utilization patterns among hospitals across Africa coupled with ASP studies. In total, 33 PPS studies ranging from single up to 18 hospitals were documented from a narrative review with typically over 50% of in-patients prescribed antimicrobials, up to 97.6% in Nigeria. The penicillins, ceftriaxone and metronidazole, were the most prescribed antibiotics. Appreciable extended prescribing of antibiotics up to 6 days or more post-operatively was seen across Africa to prevent surgical site infections. At least 19 ASPs have been instigated across Africa in recent years to improve future prescribing utilizing a range of prescribing indicators. The various findings resulted in a range of suggested activities that key stakeholders, including governments and healthcare professionals, should undertake in the short, medium and long term to improve future antimicrobial prescribing and reduce AMR across Africa. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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11 pages, 444 KiB  
Article
Multidisciplinary Collaboration for the Optimization of Antibiotic Prescription: Analysis of Clinical Cases of Pneumonia between Emergency, Internal Medicine, and Pharmacy Services
by Lorea Arteche-Eguizabal, Iñigo Corcuera-Martínez de Tobillas, Federico Melgosa-Latorre, Saioa Domingo-Echaburu, Ainhoa Urrutia-Losada, Amaia Eguiluz-Pinedo, Natalia Vanina Rodriguez-Piacenza and Oliver Ibarrondo-Olaguenaga
Antibiotics 2022, 11(10), 1336; https://doi.org/10.3390/antibiotics11101336 - 30 Sep 2022
Cited by 1 | Viewed by 1408
Abstract
Background: Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. Objective: Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at [...] Read more.
Background: Pneumonia is a lung parenchyma acute infection usually treated with antibiotics. Increasing bacterial resistances force the review and control of antibiotic use criteria in different health departments. Objective: Evaluate the adequacy of antibiotic treatment in community-acquired pneumonia in patients initially attended at the emergency department and then admitted to the internal medicine service of the Alto Deba Hospital—Osakidetza Basque Country Health Service (Spain). Methods: Observational, retrospective study, based on the review of medical records of patients with community-acquired pneumonia attended at the hospital between January and May 2021. The review was made considering the following items: antimicrobial treatment indication, choice of antibiotic, time of administration of the first dose, adequacy of the de-escalation-sequential therapy, duration of treatment, monitoring of efficacy and adverse effects, and registry in the medical records. The review was made by the research team (professionals from the emergency department, internal medicine, and pharmacy services). Results: Fifty-five medical records were reviewed. The adequacy of the treatments showed that antibiotic indication, time of administration of the first dose, and monitoring of efficacy and adverse effects were the items with the greatest agreement between the three departments. This was not the case with the choice of antibiotic, de-escalation/sequential therapy, duration of treatment, and registration in the medical record, which have been widely discussed. The choice of antibiotic was optimal in 63.64% and might have been better in 25.45%. De-escalation/oral sequencing might have been better in 50.91%. The treatment duration was optimal in 45.45% of the patients and excessive in 45.45%. Discussion: The team agreed to disseminate these data among the hospital professionals and to propose audits and feedback through an antibiotic stewardship program. Besides this, implementing the local guideline and defining stability criteria to apply sequential therapy/de-escalation was considered essential. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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14 pages, 824 KiB  
Article
Antimicrobial Utilization among Neonates and Children: A Multicenter Point Prevalence Study from Leading Children’s Hospitals in Punjab, Pakistan
by Zia Ul Mustafa, Amer Hayat Khan, Muhammad Salman, Syed Azhar Syed Sulaiman and Brian Godman
Antibiotics 2022, 11(8), 1056; https://doi.org/10.3390/antibiotics11081056 - 04 Aug 2022
Cited by 9 | Viewed by 1945
Abstract
Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups [...] Read more.
Antimicrobial resistance (AMR) compromises global health due to the associated morbidity, mortality, and costs. The inappropriate use of antimicrobial agents is a prime driver of AMR. Consequently, it is imperative to gain a greater understanding of current utilization patterns especially in high-risk groups including neonates and children. A point prevalence survey (PPS) was conducted among three tertiary care children’s hospitals in the Punjab province using the World Health Organization (WHO) methodology. Antibiotic use was documented according to the WHO AWaRe classification. Out of a total of 1576 neonates and children, 1506 were prescribed antibiotics on the day of the survey (prevalence = 95.5%), with an average of 1.9 antibiotics per patient. The majority of antibiotics were prescribed in the medical ward (75%), followed by surgical ward (12.8%). Furthermore, 56% of antibiotics were prescribed prophylactically, with most of the antibiotics (92.3%) administered via the parenteral route. The top three indications for antibiotics were respiratory tract infections (34.8%), gastrointestinal infections (15.8%), and prophylaxis for medical problems (14.3%). The three most common antibiotics prescribed were ceftriaxone (25.8%), amikacin (9.2%), and vancomycin (7.9%). Overall, 76.6% of the prescribed antibiotics were from Watch category followed by 21.6% from the Access group. There was a very high prevalence of antibiotic use among hospitalized neonates and children in this study. Urgent measures are needed to engage all the stakeholders to formulate effective ASPs in Pakistan, especially surrounding Watch antibiotics. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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Review

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24 pages, 1452 KiB  
Review
Successful Integration of Clinical Pharmacists in an OPAT Program: A Real-Life Multidisciplinary Circuit
by Sara Ortonobes, Abel Mujal-Martínez, María de Castro Julve, Alba González-Sánchez, Rafael Jiménez-Pérez, Manuel Hernández-Ávila, Natalia De Alfonso, Ingrid Maye-Pérez, Teresa Valle-Delmás, Alba Rodríguez-Sánchez, Jessica Pino-García and Mònica Gómez-Valent
Antibiotics 2022, 11(8), 1124; https://doi.org/10.3390/antibiotics11081124 - 19 Aug 2022
Cited by 4 | Viewed by 3839
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness [...] Read more.
Outpatient parenteral antimicrobial therapy (OPAT) programs encompass a range of healthcare processes aiming to treat infections at home, with the preferential use of the intravenous route. Although several barriers arise during the implementation of OPAT circuits, recent cumulative data have supported the effectiveness of these programs, demonstrating their application in a safe and cost-effective manner. Given that OPAT is evolving towards treating patients with higher complexity, a multidisciplinary team including physicians, pharmacists, and nursing staff should lead the program. The professionals involved require previous experience in infectious diseases treatment as well as in outpatient healthcare and self-administration. As we describe here, clinical pharmacists exert a key role in OPAT multidisciplinary teams. Their intervention is essential to optimize antimicrobial prescriptions through their participation in stewardship programs as well as to closely follow patients from a pharmacotherapeutic perspective. Moreover, pharmacists provide specialized counseling on antimicrobial treatment technical compounding. In fact, OPAT elaboration in sterile environments and pharmacy department clean rooms increases OPAT stability and safety, enhancing the quality of the program. In summary, building multidisciplinary teams with the involvement of clinical pharmacists improves the management of home-treated infections, promoting a safe self-administration and increasing OPAT patients’ quality of life. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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Other

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8 pages, 558 KiB  
Systematic Review
Feasibility, Effectiveness and Safety of Elastomeric Pumps for Delivery of Antibiotics to Adult Hospital Inpatients—A Systematic Review
by Joseph Spencer-Jones, Timothy Luxton, Stuart E. Bond and Jonathan Sandoe
Antibiotics 2023, 12(9), 1351; https://doi.org/10.3390/antibiotics12091351 - 22 Aug 2023
Viewed by 1243
Abstract
Elastomeric infusion pumps (EMPs) have been implemented in many fields, including analgesia, chemotherapy and cardiology. Their application in antimicrobials is mainly limited to the outpatient setting, but with a need to optimise inpatient antimicrobial treatment, the use of EMPs presents a potential option. [...] Read more.
Elastomeric infusion pumps (EMPs) have been implemented in many fields, including analgesia, chemotherapy and cardiology. Their application in antimicrobials is mainly limited to the outpatient setting, but with a need to optimise inpatient antimicrobial treatment, the use of EMPs presents a potential option. This review aimed to identify if the use of EMPs within an inpatient setting is feasible, effective and safe for antimicrobial use. Criteria for inclusion were human studies that involved the treatment of an infection with intravenous antimicrobial agents via an EMP. A search strategy was developed covering both the indexed and grey literature, with all study designs included. The review found 1 eligible study enrolling 6 patients. There was strong patient preference for EMPs (6/6), and daily tasks were easily completed whilst attached to the EMP. Nurses (5/5) also preffered the pumps, and the majority reported them as easy to use. The review has identified the need for further research in the area. Evidence for the use of EMPs to administer antibiotics in the inpatient setting is scarce, and more work is needed to understand the advantages to patients, to healthcare workers and from an antimicrobial stewardship perspective. Potential disadvantages that may put patients at risk also need investigating. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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6 pages, 5269 KiB  
Brief Report
Ventilator-Associated Pneumonia Due to MRSA vs. MSSA: What Should Guide Empiric Therapy?
by Marta Colaneri, Domenico Di Carlo, Alessandro Amatu, Lea Nadia Marvulli, Marta Corbella, Greta Petazzoni, Patrizia Cambieri, Alba Muzzi, Claudio Bandi, Angela Di Matteo, Paolo Sacchi, Francesco Mojoli and Raffaele Bruno
Antibiotics 2022, 11(7), 851; https://doi.org/10.3390/antibiotics11070851 - 24 Jun 2022
Cited by 1 | Viewed by 1845
Abstract
The guidelines on ventilator-associated pneumonia (VAP) recommend an empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) according to its prevalence rate. Considering the MRSA and MSSA VAP prevalence over the last 9 years in our tertiary care hospital, we assessed the clinical value of [...] Read more.
The guidelines on ventilator-associated pneumonia (VAP) recommend an empiric therapy against methicillin-resistant Staphylococcus aureus (MRSA) according to its prevalence rate. Considering the MRSA and MSSA VAP prevalence over the last 9 years in our tertiary care hospital, we assessed the clinical value of the MRSA nasal-swab screening in either predicting or ruling out MRSA VAP. We extracted the data of 1461 patients with positive bronchoalveolar lavage (BAL). Regarding the MRSA nasal-swab screening, 170 patients were positive for MRSA or MSSA. Overall, MRSA had a high prevalence in our ICU. Despite the COVID-19 pandemic, there was a significant downward trend in MRSA prevalence, while MSSA remained steady over time. Having VAP due to MRSA did not have any impact on LOS and mortality. Finally, the MRSA nasal-swab testing demonstrated a very high negative predictive value for MRSA VAP. Our results suggested the potential value of a patient-centered approach to improve antibiotic stewardship. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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15 pages, 3938 KiB  
Systematic Review
Routine Postoperative Antibiotic Prophylaxis Offers No Benefit after Hepatectomy—A Systematic Review and Meta-Analysis
by Anastasia Murtha-Lemekhova, Juri Fuchs, Miriam Teroerde, Ute Chiriac, Rosa Klotz, Daniel Hornuss, Jan Larmann, Markus A. Weigand and Katrin Hoffmann
Antibiotics 2022, 11(5), 649; https://doi.org/10.3390/antibiotics11050649 - 12 May 2022
Cited by 2 | Viewed by 2876
Abstract
Background: Prophylactic antibiotics are frequently administered after major abdominal surgery including hepatectomies aiming to prevent infective complications. Yet, excessive use of antibiotics increases resistance in bacteria. The aim of this systematic review and meta-analysis is to assess the efficacy of prophylactic antibiotics after [...] Read more.
Background: Prophylactic antibiotics are frequently administered after major abdominal surgery including hepatectomies aiming to prevent infective complications. Yet, excessive use of antibiotics increases resistance in bacteria. The aim of this systematic review and meta-analysis is to assess the efficacy of prophylactic antibiotics after hepatectomy (postoperative antibiotic prophylaxis, POA). Method: This systematic review and meta-analysis were completed according to the current PRISMA guidelines. The protocol has been registered prior to data extraction (PROSPERO registration Nr: CRD42021288510). MEDLINE, Web of Science and CENTRAL were searched for clinical reports on POA in hepatectomy restrictions. A random-effects model was used for synthesis. Methodological quality was assessed with RoB2 and ROBINS-I. GRADE was used for the quality of evidence assessment. Results: Nine comparative studies comprising 2987 patients were identified: six randomized controlled trials (RCTs) and three retrospectives. POA did not lead to a reduction in postoperative infective complications or have an effect on liver-specific complications—post-hepatectomy liver failure and biliary leaks. POA over four or more days was associated with increased rates of deep surgical site infections compared to short-term administration for up to two days (OR 1.54; 95% CI [1.17;2.03]; p = 0.03). Routine POA led to significantly higher MRSA incidence as a pathogen (p = 0.0073). Overall, the risk of bias in the studies was low and the quality of evidence moderate. Conclusion: Routine POA cannot be recommended after hepatectomy since it does not reduce postoperative infection or liver-specific complications but contributes to resistance in bacteria. Studies into individualized risk-adapted antibiotic prophylaxis strategies are needed to further optimize perioperative treatment in liver surgery. Full article
(This article belongs to the Special Issue Antibiotic Use and Stewardship in Hospital)
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