Special Issue "Antimicrobial Prescribing and Stewardship, 2nd Volume"

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 December 2021) | Viewed by 21577

Special Issue Editor

Dr. Diane Ashiru-Oredope
E-Mail Website
Guest Editor
1. HCAI and AMR division, Public Health England, London, UK
2. Commonwealth Pharmacists Association, London E1W 1AW, UK
Interests: antimicrobial resistance; antibiotics; antibiotic awareness; healthcare associated infection; antimicrobial stewardship; antimicrobial prescribing
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

The current COVID-19 pandemic is occurring amid the already ongoing global health crisis of antimicrobial resistance (AMR). Drug resistant infections/antimicrobial resistance are estimated to cause 700,000 deaths each year globally, and may complicate the care of COVID-19 patients, potentially leading to increased mortality and resulting in a significant economic burden.

Antimicrobial stewardship, as “a coherent set of actions which promote using antimicrobials in ways that ensure sustainable access to effective therapy for all who need them” (Dyar, O.J., 2017), is critical (alongside, e.g., infection prevention and control strategies) for tackling antimicrobial resistance/drug resistant infections.

“Volume 2 of the Special Edition of Antimicrobial Prescribing and Stewardship” Special Issue will consist of manuscripts, which may include original research, review articles, case series, and opinion papers. Relevant antimicrobial (antibiotic and antifungal) stewardship related topics will be considered for review; specific areas of interest include the following:

  1. Antimicrobial use and stewardship in the context of the COVID-19 pandemic
  2. Novel methods to promote appropriate antibiotic utilization
  3. Disease-based/organism-based antimicrobial stewardship
  4. Diagnostic stewardship
  5. Antifungal stewardship
  6. Influence of antimicrobial utilization changes on antimicrobial resistance
  7. Impact of antimicrobial stewardship on quality performance measures and patient outcomes
  8. Novel antimicrobial stewardship education and training approaches or interventions aimed at public and/or healthcare workers
  9. Behavioral change approaches to antimicrobial stewardship
  10. Review of specific controversial stewardship issues that have a major impact on utilization, cost, or resistance
  11. Collaborative practice agreements in antimicrobial stewardship
  12. Antimicrobial stewardship in special populations (e.g., pediatrics, geriatrics, emergency medicine, and hematology/oncology)
  13. Tackling AMR through antimicrobial stewardship in low- and middle-income countries
  14. Antimicrobial stewardship in alternative settings (e.g., community practice, long-term care, resource limited, and small and rural hospitals)
  15. Risk-stratified approach to treating common infections in hospitalized patients
  16. Role of antimicrobial stewardship in managing medication shortages
  17. Building a business case/model for antimicrobial stewardship
  18. Global collaborations to tackle AMR through antimicrobial stewardship 

Dr. Diane Ashiru-Oredope
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 2000 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

  • Antibiotics
  • Antifungals
  • Antibiotic utilization
  • Antimicrobial prescribing
  • Diagnostic stewardship
  • Antimicrobial stewardship education and training
  • Antimicrobial stewardship
  • Antifungal stewardship
  • Antimicrobial resistance
  • AMR awareness raising
  • Behaviour change
  • COVID-19
  • Healthcare associated infection

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Published Papers (23 papers)

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Article
Exploring the Antimicrobial Stewardship Educational Needs of Healthcare Students and the Potential of an Antimicrobial Prescribing App as an Educational Tool in Selected African Countries
Antibiotics 2022, 11(5), 691; https://doi.org/10.3390/antibiotics11050691 - 19 May 2022
Viewed by 547
Abstract
Antimicrobial resistance (AMR) is a global health threat and one of the top 10 global public health threats facing humanity. AMR contributes to 700,000 deaths annually and more deaths, as many as 10 million are projected to happen by 2050. Antimicrobial stewardship (AMS) [...] Read more.
Antimicrobial resistance (AMR) is a global health threat and one of the top 10 global public health threats facing humanity. AMR contributes to 700,000 deaths annually and more deaths, as many as 10 million are projected to happen by 2050. Antimicrobial stewardship (AMS) activities have been important in combating the ripple effects of AMR and several concerted efforts have been taken to address the issues of antimicrobial resistance. The Commonwealth Pharmacists Association through the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) programme has been enhancing the capacity of health institutions in Low-Middle-Income Countries (LMIC) to combat AMR. Through such efforts, an antimicrobial prescribing app (CwPAMS app) was launched and delivered to support antimicrobial prescribing and improve AMS practice in four African countries; Ghana, Uganda, Zambia, and Tanzania. The app provides easy access to infection management resources to improve appropriate use of antimicrobials in line with national and international guidelines. This study aimed to identify and explore the potential for the usability of the CwPAMS app among healthcare students across selected African countries that are part of the Commonwealth. The study equally evaluated the healthcare students’ understanding and attitudes towards antimicrobial resistance and stewardship. Despite 70% of the respondents indicating that they had been taught about prudent use of antibiotics, diagnosis of infections and their management using antibiotics in their universities, notable knowledge gaps were discovered: 52.2% of the respondents had no prior information on the term AMS, 50.6% of them reported a lack of resources for accessing up-to-date information on drugs, for instance only 36% had had an opportunity to access an app as a learning resource even when 70% of the respondents thought that a mobile app would support in increasing their knowledge. Those challenges reveal an opportunity for the CwPAMS App as a potential option to address AMR and AMS gaps among healthcare students. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Development of and User Feedback on a Board and Online Game to Educate on Antimicrobial Resistance and Stewardship
Antibiotics 2022, 11(5), 611; https://doi.org/10.3390/antibiotics11050611 - 01 May 2022
Viewed by 919
Abstract
Antimicrobial resistance (AMR), particularly antibiotic resistance, is one of the most challenging global health threats of our time. Tackling AMR requires a multidisciplinary approach. Whether a clinical team member is a cleaner, nurse, doctor, pharmacist, or other type of health worker, their contribution [...] Read more.
Antimicrobial resistance (AMR), particularly antibiotic resistance, is one of the most challenging global health threats of our time. Tackling AMR requires a multidisciplinary approach. Whether a clinical team member is a cleaner, nurse, doctor, pharmacist, or other type of health worker, their contribution towards keeping patients safe from infection is crucial to saving lives. Existing literature portrays that games can be a good way to engage communities in joint learning. This manuscript describes an educational antimicrobial stewardship (AMS) game that was co-created by a multidisciplinary team of health professionals spanning across high- and low- to middle-income countries. The online AMS game was promoted and over 100 players across 23 countries registered to participate on 2 occasions. The players were asked to share feedback on the game through a short online form. Their experiences revealed that the game is relevant for creation of awareness and understanding on antimicrobial stewardship in both high- and low-to-middle income settings worldwide. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Understanding Internal and External Drivers Influencing the Prescribing Behaviour of Informal Healthcare Providers with Emphasis on Antibiotics in Rural India: A Qualitative Study
Antibiotics 2022, 11(4), 459; https://doi.org/10.3390/antibiotics11040459 - 29 Mar 2022
Viewed by 876
Abstract
Globally, Antibiotic resistance is a major public health concern, with antibiotic use contributing significantly. Targeting informal healthcare providers (IHCPs) is important to achieve universal health coverage and effective antibiotic stewardship in resource-constrained settings. We, therefore, aimed to analyse the internal and external drivers [...] Read more.
Globally, Antibiotic resistance is a major public health concern, with antibiotic use contributing significantly. Targeting informal healthcare providers (IHCPs) is important to achieve universal health coverage and effective antibiotic stewardship in resource-constrained settings. We, therefore, aimed to analyse the internal and external drivers that influence IHCPs’ prescribing behaviour for common illnesses in children under five, with an emphasis on antibiotic use in rural areas of India. A total of 48 IHCPs participated in focus group discussions. Thematic framework analysis with an inductive approach was used, and findings were collated in the theoretical framework based on knowledge, attitude, and practice model which depicted that the decisions made by IHCPs while prescribing antibiotics are complex and influenced by a variety of external and internal drivers. IHCPs’ internal drivers included the misconception that it is impossible to treat a patient without antibiotics and that antibiotics increase the effectiveness of other drugs and cure patients faster in order to retain them. Formal healthcare providers were the IHCPs’ sources of information, which influences their antibiotic prescribing. We found when it comes to seeking healthcare in rural areas, the factors that influence their choice include ‘rapid cure’, ‘cost of treatment’, ‘distance’ and ‘24 h availability’, instead of qualification, which may create pressure for IHCPs to provide a quick fix. Targeted and coordinated efforts at all levels will be needed to change the antibiotic prescribing practices of IHCPs with a focus on behaviour change and to help resolve misconceptions about antibiotics. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Categorisation of Antimicrobial Use in Fijian Livestock Production Systems
Antibiotics 2022, 11(3), 294; https://doi.org/10.3390/antibiotics11030294 - 23 Feb 2022
Cited by 2 | Viewed by 461
Abstract
Antimicrobial resistance (AMR) is a major global threat to human and animal health. The use of antimicrobials in the livestock sector is considered to contribute to AMR. Therefore, a reduction in and prudent use of antimicrobials in livestock production systems have been advocated. [...] Read more.
Antimicrobial resistance (AMR) is a major global threat to human and animal health. The use of antimicrobials in the livestock sector is considered to contribute to AMR. Therefore, a reduction in and prudent use of antimicrobials in livestock production systems have been advocated. This cross-sectional survey aimed to investigate the extent of imprudent antimicrobial use (AMU) and to determine whether the AMU practice was affected by either the farming system or species of farmed livestock in the largest island (Viti Levu) of Fiji. A total of 276 livestock enterprises were surveyed and antimicrobials were used on 309 occasions over 90 days. Overall, in 298 of 309 (96%) incidents, antimicrobials were used imprudently, comprising antibiotics, 160 of 170 (94%) and anthelmintics, 138 of 139 (99%). Prudent use of antibiotics was associated with commercial farming systems (X2 = 13, p = 0.001), but no association was observed with anthelmintic use (p > 0.05). Imprudent antibiotic use was associated with dairy (OR = 7.6, CI = 1.41, 41.57, p = 0.018) followed by layer and beef (p > 0.05) compared to broiler enterprises. Imprudent AMU was more common in the backyard and semi-commercial enterprises compared to commercial broiler enterprises. Policies promoting the prudent use of antimicrobials in Fiji should focus on smaller livestock production systems and enterprises. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Antibiotic Use in Alpine Dairy Farms and Its Relation to Biosecurity and Animal Welfare
Antibiotics 2022, 11(2), 231; https://doi.org/10.3390/antibiotics11020231 - 10 Feb 2022
Viewed by 505
Abstract
The quantification of antimicrobial usage (AMU) in food-producing animals can help identify AMU risk factors, thereby enhancing appropriate stewardship policies and strategies for a more rational use. AMU in a sample of 34 farms in the Province of Trento (north-eastern Italy) from 2018 [...] Read more.
The quantification of antimicrobial usage (AMU) in food-producing animals can help identify AMU risk factors, thereby enhancing appropriate stewardship policies and strategies for a more rational use. AMU in a sample of 34 farms in the Province of Trento (north-eastern Italy) from 2018 to 2020 was expressed as defined daily doses for animals per population correction unit according to European Surveillance of Veterinary Antimicrobial Consumption guidelines (DDDvet) and according to Italian guidelines (DDDAit). A retrospective analysis was carried out to test the effects of several husbandry practices on AMU. Overall, the average AMU ranged between 6.5 DDDAit in 2018 and 5.2 DDDAit in 2020 (corresponding to 9 and 7 DDDvet, respectively), showing a significant trend of decrement (−21.3%). Usage of the highest priority critically important antimicrobials (HPCIA) was reduced by 83% from 2018 to 2020. Quarantine management, available space, water supply, animals’ cleanliness and somatic cell count had no significant association with AMU. Rather, farms with straw-bedded cubicles had lower AMU levels than those with mattresses and concrete floors (p < 0.05). In conclusion, this study evidenced a decrement in AMU, particularly regarding HPCIA, but only a few risk factors due to farm management. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
Article
Point Prevalence Survey of Antibiotic Use across 13 Hospitals in Uganda
Antibiotics 2022, 11(2), 199; https://doi.org/10.3390/antibiotics11020199 - 04 Feb 2022
Viewed by 1203
Abstract
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s [...] Read more.
Standardized monitoring of antibiotic use underpins the effective implementation of antimicrobial stewardship interventions in combatting antimicrobial resistance (AMR). To date, few studies have assessed antibiotic use in hospitals in Uganda to identify gaps that require intervention. This study applied the World Health Organization’s standardized point prevalence survey methodology to assess antibiotic use in 13 public and private not-for-profit hospitals across the country. Data for 1077 patients and 1387 prescriptions were collected between December 2020 and April 2021 and analyzed to understand the characteristics of antibiotic use and the prevalence of the types of antibiotics to assess compliance with Uganda Clinical Guidelines; and classify antibiotics according to the WHO Access, Watch, and Reserve classification. This study found that 74% of patients were on one or more antibiotics. Compliance with Uganda Clinical Guidelines was low (30%); Watch-classified antibiotics were used to a high degree (44% of prescriptions), mainly driven by the wide use of ceftriaxone, which was the most frequently used antibiotic (37% of prescriptions). The results of this study identify key areas for the improvement of antimicrobial stewardship in Uganda and are important benchmarks for future evaluations. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Fluoroquinolones and Other Antibiotics Redeemed for Cystitis—A Swedish Nationwide Cohort Follow-Up Study (2006–2018)
Antibiotics 2022, 11(2), 172; https://doi.org/10.3390/antibiotics11020172 - 28 Jan 2022
Viewed by 720
Abstract
Background: Antibiotics are commonly prescribed for outpatient management of cystitis. Previous evidence suggests that certain factors likely beyond the infection seem to influence the choice of antimicrobial treatment. However, studies on the specific antibiotic treatments for cystitis are lacking. This study aimed to [...] Read more.
Background: Antibiotics are commonly prescribed for outpatient management of cystitis. Previous evidence suggests that certain factors likely beyond the infection seem to influence the choice of antimicrobial treatment. However, studies on the specific antibiotic treatments for cystitis are lacking. This study aimed to explore the antibiotic treatments for cystitis using nationwide primary healthcare data and investigate if factors beyond the infection could be associated with fluoroquinolone treatment. Methods: This nationwide follow-up cohort study consisted of 352,507 women with cystitis. The primary aim was to investigate what specific classes of antibiotics were redeemed by patients within five days from the cystitis diagnosis. Each patient could only be included once. Logistic regression models were also used to examine the relationship between fluoroquinolone (FQ) treatment, parity, and sociodemographic factors. Results: In total, 192,065 antibiotic prescriptions were redeemed. Pivmecillinam (58.4%) followed by nitrofurantoin (22.2%), trimethoprim (12.0%), fluoroquinolone (5.6%), and cephalosporins (1.5%) were the most redeemed antibiotics. Sociodemographic factors were weakly associated with fluoroquinolone treatment; young age was inversely associated with fluoroquinolone treatment. Parity and cervical cancer history were not associated with fluoroquinolone treatment. The proportion of fluoroquinolone and trimethoprim treatments decreased over time, while pivmecillinam and nitrofurantoin increased. Conclusions: The treatment trends of antibiotics redeemed within five days from a cystitis diagnosis were similar to the national surveillance program of these antibiotics (not diagnosis linked). Fluoroquinolones were weakly associated with sociodemographic factors, which likely is only of historical relevance. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
Article
Factors Associated with Antimicrobial Stewardship Practices on California Dairies: One Year Post Senate Bill 27
Antibiotics 2022, 11(2), 165; https://doi.org/10.3390/antibiotics11020165 - 27 Jan 2022
Viewed by 760
Abstract
Background: The current study is aimed at identifying the factors associated with antimicrobial drug (AMD) use and stewardship practices on conventional California (CA) dairies a year after CA Senate Bill 27. Methods: Responses from 113 out of 1282 dairies mailed a questionnaire in [...] Read more.
Background: The current study is aimed at identifying the factors associated with antimicrobial drug (AMD) use and stewardship practices on conventional California (CA) dairies a year after CA Senate Bill 27. Methods: Responses from 113 out of 1282 dairies mailed a questionnaire in 2019 were analyzed to estimate the associations between management practices and six outcomes including producer familiarity with medically important antimicrobial drugs (MIADs), restricted use of MIADs previously available over the counter (OTC), use of alternatives to AMD, changes in on-farm management practices, changes in AMD costs, and animal health status in dairies. Results: Producers who reported having a veterinarian–client–patient relationship (VCPR) and tracking AMD withdrawal intervals had greater odds of being familiar with the MIADs. Producers who began or increased the use of preventive alternatives to AMD in 2019 had higher odds (OR = 3.23, p = 0.04) of decreased use of MIADs previously available OTC compared to those who did not. Changes in management practices to prevent disease outbreak and the use of diagnostics to guide treatment were associated with producer-reported improved animal health. In addition, our study identified record keeping (associated with familiarity with MIADs), use of alternatives to AMD (associated with management changes to prevent diseases and decreased AMD costs), and use of diagnostics in treatment decisions (associated with reported better animal health) as factors associated with AMD stewardship. Conclusions: Our survey findings can be incorporated in outreach education materials to promote antimicrobial stewardship practices in dairies. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Retrospective Cohort Analysis of the Effect of Antimicrobial Stewardship on Postoperative Antibiotic Therapy in Complicated Intra-Abdominal Infections: Short-Course Therapy Does Not Compromise Patients’ Safety
Antibiotics 2022, 11(1), 120; https://doi.org/10.3390/antibiotics11010120 - 17 Jan 2022
Cited by 3 | Viewed by 1433
Abstract
Background: Recent evidence suggests that short-course postoperative antibiotic therapy (PAT) of intra-abdominal infections is non-inferior considering clinical outcomes. The aim of this study was to compare the outcome of short vs. long PAT in complicated intra-abdominal infections (cIAIs) without sepsis. Methods: We performed [...] Read more.
Background: Recent evidence suggests that short-course postoperative antibiotic therapy (PAT) of intra-abdominal infections is non-inferior considering clinical outcomes. The aim of this study was to compare the outcome of short vs. long PAT in complicated intra-abdominal infections (cIAIs) without sepsis. Methods: We performed a single center-quality improvement study at a 1500 bed sized university hospital in Bavaria, Germany, with evaluation of the length of antibiotic therapy after emergency surgery on cIAIs with adequate source control during 2016 to 2018. We reviewed a total of 260 cases (160 short duration vs. 100 long duration). The antibiotic prescribing quality was assessed by our in-house antimicrobial stewardship team (AMS). Results: No significant differences of patient characteristics were observed between short and long PAT. The frequency of long PAT declined during the observation period from 48.1% to 26.3%. Prolongation of PAT was not linked with any clinical benefits, on the contrary clinical outcome of patients receiving longer regimes were associated with higher postoperative morbidity. AMS identified additional educational targets to improve antibiotic prescribing quality on general wards like unnecessary postoperative switches of antibiotic regimes, e.g., unrequired switches to oral antibiotics as well as prolongation of PAT due to elevated CRP. Conclusion: Short-course antibiotic therapy after successful surgical source control in cIAIs is safe, and long-duration PAT has no beneficial effects. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
Article
Factors Affecting Antibiotic Prescription among Hospital Physicians in a Low-Antimicrobial-Resistance Country: A Qualitative Study
Antibiotics 2022, 11(1), 98; https://doi.org/10.3390/antibiotics11010098 - 13 Jan 2022
Cited by 1 | Viewed by 793
Abstract
Antimicrobial resistance (AMR) is a threat to hospital patients. Antimicrobial stewardship programs (ASPs) can counteract AMR. To optimize ASPs, we need to understand what affects physicians’ antibiotic prescription from several contexts. In this study, we aimed to explore the factors affecting hospital physicians’ [...] Read more.
Antimicrobial resistance (AMR) is a threat to hospital patients. Antimicrobial stewardship programs (ASPs) can counteract AMR. To optimize ASPs, we need to understand what affects physicians’ antibiotic prescription from several contexts. In this study, we aimed to explore the factors affecting hospital physicians’ antibiotic choices in a low-resistance country to identify potential targets for future ASPs. We interviewed 14 physicians involved in antibiotic prescription in a Norwegian hospital. The interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. The main factors affecting antibiotic prescription were a high work pressure, insufficient staff resources, and uncertainties regarding clinical decisions. Treatment expectations from patients and next of kin, benevolence towards the patients, suboptimal microbiological testing, and limited time for infectious disease specialists to offer advisory services also affected the antibiotic choices. Future ASP efforts should evaluate the system organization and prioritizations to address and manage potential time-pressure issues. To limit the use of broad-spectrum antibiotics, improving microbiology testing and the routines for consultations with infectious disease specialists seems beneficial. We also identified a need among the prescribing physicians for a debate on ethical antibiotic questions. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Antibiotic Prevalence Study and Factors Influencing Prescription of WHO Watch Category Antibiotic Ceftriaxone in a Tertiary Care Private Not for Profit Hospital in Uganda
Antibiotics 2021, 10(10), 1167; https://doi.org/10.3390/antibiotics10101167 - 26 Sep 2021
Cited by 1 | Viewed by 754
Abstract
Background: Excessive use of ceftriaxone contributes to the emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries, antibiotics are overused but data on consumption are scarcely available. We aimed to determine the prevalence and factors influencing ceftriaxone prescription in a [...] Read more.
Background: Excessive use of ceftriaxone contributes to the emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries, antibiotics are overused but data on consumption are scarcely available. We aimed to determine the prevalence and factors influencing ceftriaxone prescription in a tertiary care private not-for-profit hospital in Uganda. Methods: A cross-sectional study was carried out from October 2019 through May 2020 at Mengo Hospital in Uganda. Patients admitted to the medical ward and who had been prescribed antibiotics were enrolled. Sociodemographic and clinical data were recorded in a structured questionnaire. Bivariate and adjusted logistic regression analyses were performed to determine factors associated with ceftriaxone prescription. Results: Study participants were mostly female (54.7%). The mean age was 56.2 years (SD: 21.42). The majority (187, 73.3%) presented with fever. Out of the 255 participants included in this study, 129 (50.6%) participants were prescribed ceftriaxone. Sixty-five (25.5%) and forty-one (16.0%) participants had a prescription of levofloxacin and metronidazole, respectively. Seven participants (2.7%) had a prescription of meropenem. Out of 129 ceftriaxone prescriptions, 31 (24.0%) were in combination with other antibiotics. Overall, broad-spectrum antibiotic prescriptions accounted for 216 (84.7%) of all prescriptions. Ceftriaxone was commonly prescribed for pneumonia (40/129, 31%) and sepsis (38/129, 29.5%). Dysuria [OR = 0.233, 95% CI (0.07–0.77), p = 0.017] and prophylactic indication [OR = 7.171, 95% CI (1.36–37.83), p = 0.020] were significantly associated with ceftriaxone prescription. Conclusions: Overall, we observed a high prevalence of prescriptions of ceftriaxone at the medical ward of Mengo Hospital. We recommend an antibiotic stewardship program (ASP) to monitor antibiotic prescription and sensitivity patterns in a bid to curb AMR. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Antibiotic Prescribing Patterns in Ghana, Uganda, Zambia and Tanzania Hospitals: Results from the Global Point Prevalence Survey (G-PPS) on Antimicrobial Use and Stewardship Interventions Implemented
Antibiotics 2021, 10(9), 1122; https://doi.org/10.3390/antibiotics10091122 - 17 Sep 2021
Cited by 4 | Viewed by 1937
Abstract
Antimicrobial resistance (AMR) remains an important global public health issue with antimicrobial misuse and overuse being one of the main drivers. The Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance assesses the prevalence and the quality of antimicrobial prescriptions across hospitals [...] Read more.
Antimicrobial resistance (AMR) remains an important global public health issue with antimicrobial misuse and overuse being one of the main drivers. The Global Point Prevalence Survey (G-PPS) of Antimicrobial Consumption and Resistance assesses the prevalence and the quality of antimicrobial prescriptions across hospitals globally. G-PPS was carried out at 17 hospitals across Ghana, Uganda, Zambia and Tanzania. The overall prevalence of antimicrobial use was 50% (30–57%), with most antibiotics prescribed belonging to the WHO ‘Access’ and ‘Watch’ categories. No ‘Reserve’ category of antibiotics was prescribed across the study sites while antimicrobials belonging to the ‘Not Recommended’ group were prescribed infrequently. Antimicrobials were most often prescribed for prophylaxis for obstetric or gynaecological surgery, making up between 12 and 18% of total prescriptions across all countries. The most prescribed therapeutic subgroup of antimicrobials was ‘Antibacterials for systemic use’. As a result of the programme, PPS data are now readily available for the first time in the hospitals, strengthening the global commitment to improved antimicrobial surveillance. Antimicrobial stewardship interventions developed included the formation of AMS committees, the provision of training and the preparation of new AMS guidelines. Other common interventions included the presentation of findings to clinicians for increased awareness, and the promotion of a multi-disciplinary approach to successful AMS programmes. Repeat PPS would be necessary to continually monitor the impact of interventions implemented. Broader participation is also encouraged to strengthen the evidence base. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Empowering Patients to Self-Manage Common Infections: Qualitative Study Informing the Development of an Evidence-Based Patient Information Leaflet
Antibiotics 2021, 10(9), 1113; https://doi.org/10.3390/antibiotics10091113 - 15 Sep 2021
Cited by 1 | Viewed by 824
Abstract
Common self-limiting infections can be self-managed by patients, potentially reducing consultations and unnecessary antibiotic use. This qualitative study informed by the Theoretical Domains Framework (TDF) aimed to explore healthcare professionals’ (HCPs) and patients’ needs on provision of self-care and safety-netting advice for common [...] Read more.
Common self-limiting infections can be self-managed by patients, potentially reducing consultations and unnecessary antibiotic use. This qualitative study informed by the Theoretical Domains Framework (TDF) aimed to explore healthcare professionals’ (HCPs) and patients’ needs on provision of self-care and safety-netting advice for common infections. Twenty-seven patients and seven HCPs participated in semi-structured focus groups (FGs) and interviews. An information leaflet was iteratively developed and reviewed by participants in interviews and FGs, and an additional 5 HCPs, and 25 patients (identifying from minority ethnic groups) via online questionnaires. Qualitative data were analysed thematically, double-coded, and mapped to the TDF. Participants required information on symptom duration, safety netting, self-care, and antibiotics. Patients felt confident to self-care and were averse to consulting with HCPs unnecessarily but struggled to assess symptom severity. Patients reported seeking help for children or elderly dependents earlier. HCPs’ concerns included patients’ attitudes and a lack of available monitoring of advice given to patients. Participants believed community pharmacy should be the first place that patients seek advice on common infections. The patient information leaflet on common infections should be used in primary care and community pharmacy to support patients to self-manage symptoms and determine when further help is required. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Effectiveness of an Electronic Automated Antibiotic Time Out Alert in the Setting of Gram-Negative Bacteremia
Antibiotics 2021, 10(9), 1078; https://doi.org/10.3390/antibiotics10091078 - 06 Sep 2021
Viewed by 645
Abstract
To minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO); however, limited data are available to support its effectiveness. This was a single-center retrospective cohort study assessing the impact of the automated electronic ATO [...] Read more.
To minimize complications associated with over-utilization of antibiotics, many antimicrobial stewardship programs have incorporated an antibiotic time out (ATO); however, limited data are available to support its effectiveness. This was a single-center retrospective cohort study assessing the impact of the automated electronic ATO in the setting of Gram-negative bacteremia. The primary outcome was the proportion of patients who received a modification of therapy within 24 h of final culture results. Secondary outcomes included modification at any point in therapy, time to modification of therapy, time to de-escalation, and days of therapy of broad-spectrum antibiotics. There was a total of 222 patients who met inclusion criteria, 97 patients pre-ATO and 125 patients post-ATO. The primary outcome of modification of therapy within 24 h of final culture results was not significantly different (24% vs. 30%, p = 0.33). The secondary outcome of modification of therapy at any point in therapy was not significantly different between the two groups (65% vs. 67%, p = 0.73). All other secondary outcomes were not significantly different. The ATO alert was not associated with a higher rate of antibiotic modification within 24 h of culture results in patients with GNB. Further efforts are needed to optimize the ATO strategy and antibiotic prescribing practices. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Antimicrobial Prescribing in the Emergency Department; Who Is Calling the Shots?
Antibiotics 2021, 10(7), 843; https://doi.org/10.3390/antibiotics10070843 - 10 Jul 2021
Viewed by 984
Abstract
Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, [...] Read more.
Objective: Inappropriate antimicrobial prescribing in the emergency department (ED) can lead to poor outcomes. It is unknown how often the prescribing clinician is guided by others, and whether prescriber factors affect appropriateness of prescribing. This study aims to describe decision making, confidence in, and appropriateness of antimicrobial prescribing in the ED. Methods: Descriptive study in two Australian EDs using both questionnaire and medical record review. Participants were clinicians who prescribed antimicrobials to patients in the ED. Outcomes of interest were level of decision-making (self or directed), confidence in indication for prescribing and appropriateness (5-point Likert scale, 5 most confident). Appropriateness assessment of the prescribing event was by blinded review using the National Antibiotic Prescribing Survey appropriateness assessment tool. All analyses were descriptive. Results: Data on 88 prescribers were included, with 61% making prescribing decisions themselves. The 39% directed by other clinicians were primarily guided by more senior ED and surgical subspecialty clinicians. Confidence that antibiotics were indicated (Likert score: 4.20, 4.35 and 4.35) and appropriate (Likert score: 4.07, 4.23 and 4.29) was similar for juniors, mid-level and senior prescribers, respectively. Eighty-five percent of prescriptions were assessed as appropriate, with no differences in appropriateness by seniority, decision-making or confidence. Conclusions: Over one-third of prescribing was guided by senior ED clinicians or based on specialty advice, primarily surgical specialties. Prescriber confidence was high regardless of seniority or decision-maker. Overall appropriateness of prescribing was good, but with room for improvement. Future qualitative research may provide further insight into the intricacies of prescribing decision-making. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Parental Knowledge, Attitude, and Practices on Antibiotic Use for Childhood Upper Respiratory Tract Infections during COVID-19 Pandemic in Greece
Antibiotics 2021, 10(7), 802; https://doi.org/10.3390/antibiotics10070802 - 01 Jul 2021
Cited by 1 | Viewed by 1036
Abstract
This cross-sectional study aims to assess parents’ knowledge, attitude, and practices on antibiotic use for children with URTIs symptoms in Greece in the era of the COVID-19 pandemic. We distributed a questionnaire to a random sample of parents who visited primary health care [...] Read more.
This cross-sectional study aims to assess parents’ knowledge, attitude, and practices on antibiotic use for children with URTIs symptoms in Greece in the era of the COVID-19 pandemic. We distributed a questionnaire to a random sample of parents who visited primary health care centers in Patras, Greece. Out of 412 participants, 86% believed that most infections with common cold or flu symptoms were caused by viruses, although 26.9% believed that antibiotics may prevent complications. Earache was the most common symptom for which antibiotics were needed. Most of them (69%) declare being considerably anxious about their children’s health during the COVID-19 pandemic. The majority (85%) knew that COVID-19 was of viral origin, yet half of them declared uncertain whether antibiotics were needed. All demographic characteristics, except for gender, were found to have a significant effect on parents’ knowledge, attitude, and practices on antibiotic use for URTIs and COVID-19. Factor analysis revealed six groups of parents with common characteristics associated with misuse of antibiotics. Our findings highlight the need to decrease misconceptions regarding antibiotic use by providing relevant education for parents targeting particular characteristics, especially during the COVID-19 pandemic. Continuous education of healthcare providers in the field is also of paramount importance. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
Article
Comparing Hospital and Primary Care Physicians’ Attitudes and Knowledge Regarding Antibiotic Prescribing: A Survey within the Centre Region of Portugal
Antibiotics 2021, 10(6), 629; https://doi.org/10.3390/antibiotics10060629 - 25 May 2021
Cited by 2 | Viewed by 961
Abstract
Background: Antibiotic resistance is a worldwide public health problem, leading to longer hospital stays, raising medical costs and mortality levels. As physicians’ attitudes are key factors to antibiotic prescribing, this study sought to explore their differences between primary care and hospital settings. Methods: [...] Read more.
Background: Antibiotic resistance is a worldwide public health problem, leading to longer hospital stays, raising medical costs and mortality levels. As physicians’ attitudes are key factors to antibiotic prescribing, this study sought to explore their differences between primary care and hospital settings. Methods: A survey was conducted between September 2011 and February 2012 in the center region of Portugal in the form of a questionnaire to compare hospital (n = 154) and primary care (n = 421) physicians’ attitudes and knowledge regarding antibiotic prescribing. Results: More than 70% of the attitudes were statistically different (p < 0.05) between hospital physicians (HPs) and primary care physicians (PCPs). When compared to PCPs, HPs showed higher agreement with antibiotic resistances being a public health problem and ascribed more importance to microbiological tests and to the influence of prescription on the development of resistances. On the other hand, PCPs tended to agree more regarding the negative impact of self-medication with antibiotics dispensed without medical prescription and the need for rapid diagnostic tests. Seven out of nine sources of knowledge’s usefulness were statistically different between both settings, with HPs considering most of the knowledge sources to be more useful than PCPs. Conclusions: Besides the efforts made to improve both antibiotic prescribing and use, there are differences in the opinions between physicians working in different settings that might impact the quality of antibiotic prescribing. In the future, these differences must be considered to develop more appropriate interventions. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Article
Pharmacist-Driven Antibiotic Stewardship Program in Febrile Neutropenic Patients: A Single Site Prospective Study in Thailand
Antibiotics 2021, 10(4), 456; https://doi.org/10.3390/antibiotics10040456 - 17 Apr 2021
Cited by 3 | Viewed by 954
Abstract
The antibiotic stewardship program (ASP) is a necessary part of febrile neutropenia (FN) treatment. Pharmacist-driven ASP is one of the meaningful approaches to improve the appropriateness of antibiotic usage. Our study aimed to determine role of the pharmacist in ASPs for FN patients. [...] Read more.
The antibiotic stewardship program (ASP) is a necessary part of febrile neutropenia (FN) treatment. Pharmacist-driven ASP is one of the meaningful approaches to improve the appropriateness of antibiotic usage. Our study aimed to determine role of the pharmacist in ASPs for FN patients. We prospectively studied at Thammasat University Hospital between August 2019 and April 2020. Our primary outcome was to compare the appropriate use of target antibiotics between the pharmacist-driven ASP group and the control group. The results showed 90 FN events in 66 patients. The choice of an appropriate antibiotic was significantly higher in the pharmacist-driven ASP group than the control group (88.9% vs. 51.1%, p < 0.001). Furthermore, there was greater appropriateness of the dosage regimen chosen as empirical therapy in the pharmacist-driven ASP group than in the control group (97.8% vs. 88.7%, p = 0.049) and proper duration of target antibiotics in documentation therapy (91.1% vs. 75.6%, p = 0.039). The multivariate analysis showed a pharmacist-driven ASP and infectious diseases consultation had a favorable impact on 30-day infectious diseases-related mortality in chemotherapy-induced FN patients (OR 0.058, 95%CI:0.005–0.655, p = 0.021). Our study demonstrated that pharmacist-driven ASPs could be a great opportunity to improve antibiotic appropriateness in FN patients. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
Article
Impact of an Education-Based Antimicrobial Stewardship Program on the Appropriateness of Antibiotic Prescribing: Results of a Multicenter Observational Study
Antibiotics 2021, 10(3), 314; https://doi.org/10.3390/antibiotics10030314 - 17 Mar 2021
Cited by 4 | Viewed by 845
Abstract
To evaluate the effect that an education-based Antimicrobial stewardship program (ASP) implemented in two hospitals in southern Italy had on the quality and appropriateness of antibiotic prescription. We conducted a multicenter observational study in two hospitals in the Campania region. Only some departments [...] Read more.
To evaluate the effect that an education-based Antimicrobial stewardship program (ASP) implemented in two hospitals in southern Italy had on the quality and appropriateness of antibiotic prescription. We conducted a multicenter observational study in two hospitals in the Campania region. Only some departments of both hospitals were already participating in the ASP. We collected data on all patients admitted on the day of evaluation in antibiotic therapy or prophylaxis through a case report form. The primary outcome was to investigate the difference in the appropriateness of the antibiotic prescriptive practice in the departments that had joined the ASP and in those that had not participated in the project (non-ASP). The total number of patients assessed was 486. Of these, 78 (16.05%) were in antibiotic prophylaxis and 130 (26.7%) in antibiotic therapy. The prescriptive appropriateness was better in the units that had joined ASP than in those that had not, with respectively 65.8% versus 22.7% (p < 0.01). Patients in the non-ASP units more frequently received unnecessary antibiotics (44.9% versus 0%, p = 0.03) and, as surgical prophylaxis, the use of antibiotics not recommended by the guidelines (44.2% versus 0%, p = 0.036). Multivariable analysis of the factors associated with prescriptive appropriateness identified ASP units (p = 0.02) and bloodstream or cardiovascular infections (p = 0.03) as independent predictors of better prescriptive appropriateness. The findings of the present study reinforce the importance of adopting an educational ASP to improve the quality of antimicrobial prescription in clinical practice. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
Article
Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study
Antibiotics 2021, 10(3), 280; https://doi.org/10.3390/antibiotics10030280 - 09 Mar 2021
Cited by 2 | Viewed by 874
Abstract
Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials’ use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation [...] Read more.
Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials’ use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation is the lack of knowledge of how to implement them. This study aims to explore how an antimicrobial stewardship programme was implemented in a Saudi hospital, the challenges faced and how they were overcome, and the program outcomes. A key stakeholder case study design was used, involving in-depth semi-structured interviews with the core members of the ASP team and analysis of 35 ASP hospital documents. ASP implementation followed a top-down approach and involved an initial preparatory phase and an implementation phase, requiring substantial infectious diseases and clinical pharmacy input throughout. Top management support was key to the successful implementation. ASP implementation reduced rates of multi-drug resistance and prescription of broad-spectrum antimicrobials. The implementation of ASPs in hospital is administrator rather than clinician driven. Outsourcing expertise and resources may help hospitals address the initial implementation challenges. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Review

Jump to: Research, Other

Review
Is Antibiotic Prophylaxis Necessary before Dental Implant Procedures in Patients with Orthopaedic Prostheses? A Systematic Review
Antibiotics 2022, 11(1), 93; https://doi.org/10.3390/antibiotics11010093 - 12 Jan 2022
Viewed by 670
Abstract
As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to [...] Read more.
As the population ages, more and more patients with orthopaedic prostheses (OPs) require dental implant treatment. Surveys of dentists and orthopaedic surgeons show that prophylactic antibiotics (PAs) are routinely prescribed with a very high frequency in patients with OPs who are about to undergo dental procedures. The present study aims to determine the need to prescribe prophylactic antibiotic therapy in patients with OPs treated with dental implants to promote their responsible use and reduce the risk of antimicrobial resistance. An electronic search of the MEDLINE database (via PubMed), Web of Science, LILACS, Google Scholar, and OpenGrey was carried out. The criteria used were those described by the PRISMA® Statement. No study investigated the need to prescribe PAs in patients with OPs, so four studies were included on the risk of infections of OPs after dental treatments with varying degrees of invasiveness. There is no evidence to suggest a relationship between dental implant surgeries and an increased risk of OP infection; therefore, PAs in these patients are not justified. However, the recommended doses of PAs in dental implant procedures in healthy patients are the same as those recommended to avoid infections of OPs. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Other

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Protocol
Canadian Collaboration to Identify a Minimum Dataset for Antimicrobial Use Surveillance for Policy and Intervention Development across Food Animal Sectors
Antibiotics 2022, 11(2), 226; https://doi.org/10.3390/antibiotics11020226 - 10 Feb 2022
Viewed by 519
Abstract
Surveillance of antimicrobial use (AMU) and antimicrobial resistance (AMR) is a core component of the 2017 Pan-Canadian Framework for Action. There are existing AMU and AMR surveillance systems in Canada, but some stakeholders are interested in developing their own AMU monitoring/surveillance systems. It [...] Read more.
Surveillance of antimicrobial use (AMU) and antimicrobial resistance (AMR) is a core component of the 2017 Pan-Canadian Framework for Action. There are existing AMU and AMR surveillance systems in Canada, but some stakeholders are interested in developing their own AMU monitoring/surveillance systems. It was recognized that the establishment of core (minimum) AMU data elements, as is necessary for policy or intervention development, would inform the development of practical and sustainable AMU surveillance capacity across food animal sectors in Canada. The Canadian Animal Health Surveillance System (CAHSS) AMU Network was established as a multisectoral working group to explore the possibility of harmonizing data inputs and outputs. There was a consensus that a minimum AMU dataset for AMU surveillance (MDS-AMU-surv) should be developed to guide interested parties in initiating AMU data collection. This multisectoral collaboration is an example of how consultative consensus building across relevant sectors can contribute to the development of harmonized approaches to AMU data collection and reporting and ultimately improve AMU stewardship. The MDS-AMU-surv could be used as a starting point for the progressive development or strengthening of AMU surveillance programs, and the collaborative work could serve as a model for addressing AMR and other shared threats at the human–animal–environment interface. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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Brief Report
Long-Term Outcomes in Patients on Life-Long Antibiotics: A Five-Year Cohort Study
Antibiotics 2022, 11(1), 62; https://doi.org/10.3390/antibiotics11010062 - 05 Jan 2022
Cited by 1 | Viewed by 442
Abstract
Background: Little is known about the impacts at an individual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients [...] Read more.
Background: Little is known about the impacts at an individual level of long-term antibiotic consumption. We explored health outcomes of long-term antibiotic therapy prescribed to a cohort of patients to suppress infections deemed incurable. Methods: We conducted a 5-year longitudinal study of patients on long-term antibiotics at Monash Health, a metropolitan tertiary-level hospital network in Australia. Adults prescribed antibiotics for >12 months to suppress chronic infection or prevent recurrent infection were included. A retrospective review of medical records and a descriptive analysis was conducted. Results: Twenty-seven patients were followed up during the study period, from 29 patients originally identified in Monash Health in 2014. Seven of the 27 patients (26%) died from causes unrelated to the suppressed infection, six (22%) ceased long-term antibiotic therapy and two (7%) required treatment modification. Fifteen (56%) were colonised with multiresistant microorganisms, including vancomycin resistant Enterococci, methicillin resistant Staphylococcus aureus, and carbapenem resistant Enterobacteriaciae. Conclusions: This work highlights the potential pitfalls of long-term antibiotic therapy, and the frailty of this cohort, who are often ineligible for definitive curative therapy. Full article
(This article belongs to the Special Issue Antimicrobial Prescribing and Stewardship, 2nd Volume)
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