A point prevalence survey of antibiotic use in four acute-care teaching hospitals utilizing the European Surveillance of Antimicrobial Consumption (ESAC) audit tool

Aldeyab, Mamoon A.; Kearney, Mary P.; McElnay, James; Magee, Fidelma A.; Conlon, Geraldine; MacIntyre, James C.; McCullagh, Bernie; Ferguson, Caleb; Friel, Anne; Gormley, Cairine; McElroy, Sinead; Boyce, Thomas G.; McCORRY, A.; Müller, A.; Goossens, Herman; Scott, Michael

doi:10.1017/s095026881100241x

Cited by 25 publications

(21 citation statements)

References 14 publications

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“…Overall wasting of Ab's appeared to be much less than expected based on our prior studies of surgical drugs and controlled substances, perhaps due to adherence to the principles of antibiotic stewardship. We conclude, in agreement with others [1], that extension of these guidelines [40][41][42], from Ab to all other drugs used in healthcare would result in significant reductions in drug wasting. We also conclude, in agreement with proposed USEPA guidelines [74], that waste drug disposal should not involve flushing but rather controlled and regulated incineration in commercial facilities as commonly recommended by the manufacturer's MSDS.…”

Section: Discussionsupporting

confidence: 92%

“…This disparity between Ab wasting and other pharmaceuticals may be attributable to the longstanding process of antibiotic stewardship [40]. Although originally promulgated to combat the rising phenomena of bacterial resistance and decreasing efficacy of drug treatments for microbial diseases [41][42][43][44], these guidelines for antimicrobial stewardship could be applied to other classes of pharmaceuticals and lead to reductions in drug dispensing, drug wasting and environmental contamination [45]. This would supplement the process for lower dose prescribing advocated by Daughton and Ruhoy [1].…”

Section: Discussionmentioning

confidence: 99%

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Hospital Antibiotic Wasting and Evaluation of Potential Ecologic Effects

F¹,

D²

2016

Ann Environ Sci Toxicol

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Drugs in wastewater arise from direct disposal by healthcare facilities among many other sources. We report the wasting of antibiotics (Ab) dispensed at 2 hospitals in Albany, NY during a 2 year period. We consider drug metabolism, excretion, disposal and toxicity to aquatic organisms in strategies for reducing antibiotic waste and impacts on bacterial resistance. Drug records (12,345) from August, 2008 through April, 2009 included: numbers of drugs dispensed, returned and wasted. Overall, 77 kg of Ab were dispensed but only 1.3 kg were wasted. Six Ab (bacitracin, cefazolin, ceftriaxone, clindamycin, levofloxacin and vancomycin) accounted for 85% (66 kg) of drug dispensed; vancomycin (22 kg) was the most dispensed. Drug wasting as a percent of drug dispensed averaged 1.7% but varied widely. Almost one-half (45%) of the polymyxin B dispensed as a topical ointment was wasted or discarded. Only about 1.6% of vancomycin dispensed was wasted or discarded. None of the top 4 wasted and only 3 of the top 6 dispensed Ab had Persistence, Bioaccumulation and Toxicity (PBT) Index values or environmental risk ratio (PEC/PNEC) data available. Vancomycin was minimally toxic to invertebrates, fish or green algae. Bacitracin was the most toxic to invertebrates or fish. Cefazolin was essentially non-toxic to green algae. All of the wasted, discarded or dispensed Ab were excreted as parent compound in the urine and or feces of human patients at levels of 10-100% of the administered dose. In healthcare facilities, Ab are disposed by wasting into water or other receptacles. We recommend returning excess drugs to the hospital pharmacy for incineration as the recommended method of disposal. Ab use and dispensing should be monitored according to recognized guidelines of antimicrobial stewardship. Knowledge of the adverse impacts from the release of highly toxic drugs into the environment must influence Ab selection and disposal.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Hospital Antibiotic Wasting and Evaluation of Potential Ecologic Effects

F¹,

D²

2016

Ann Environ Sci Toxicol

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“…In the present study the prevalence of antimicrobial agents prescribed was 46.2% for the Antrim Area Hospital in Northern Ireland and 78.2% for the Specialty Hospital in Jordan. A number of studies have addressed PPS from the Northern Ireland hospital setting (four acute care hospitals), finding that the prevalence of prescribing antibiotics had ranged from 31 to 36% in May 2008 and May–June 2009, respectively [ 25 , 26 ], which is consistent with the prevalence of antimicrobial use within European countries (34.6%) [ 19 , 27 ] within approximately the same period. It is unclear why we observed a higher prevalence of antibiotic prescribing in the Antrim Area Hospital in 2015.…”

Section: Discussionmentioning

confidence: 73%

Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan

El‐Hajji

Al-Taani

Anani

et al. 2018

BMC Health Serv Res

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BackgroundTo assess antimicrobial prescribing in a Northern Ireland hospital (Antrim Area Hospital (AAH)) and compare them with those of a hospital in Jordan (Specialty Hospital).MethodsUsing the Global-PPS approach, the present study surveyed patients admitted to the hospital in 2015, the prescribed antibiotics, and a set of quality control indicators related to antibiotics.ResultsUltimately, 444 and 112 inpatients in the AAH and the Specialty Hospital, respectively, were surveyed. For the medical group, 165 inpatients were prescribed 239 antibiotics in the AAH, while 44 patients in the Specialty Hospital were prescribed 65 antibiotics. In relation to the surgical group, 34 inpatients treated for infection were prescribed 66 antibiotics in the AAH, while 41 patients in the Specialty Hospital treated for infection were prescribed 56 antibiotics. For the medical patients, the most frequently prescribed antibiotics in the AAH were a combination of penicillins (18.8%) and penicillins with extended spectrum (18.8%). For the surgical patients, the most frequently prescribed antibiotics in the AAH were imidazole derivatives (24.2%). For the medical and surgical patients in the Specialty Hospital, the most frequently prescribed antibiotics were third-generation cephalosporins (26.2 and 37.5%, respectively). In medical patients, compliance to guidelines was 92.2% in the Specialty Hospital compared to 72.0% in the AAH (p < 0.001). In surgical patients, compliance to guidelines was 92.7% in the Specialty Hospital compared to 81.8% in the AAH (p = 0.012).ConclusionsThe present study highlighted differences in the utilisation of antimicrobials between two hospitals in two distinct regions and benchmarked antibiotic prescriptions across two hospitals.

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“…It is clear that improving antibiotic prescribing practices contribute to reducing antibiotic use, and should lead to a reduction in healthcare-acquired infections [22]. Of note, PPS allows hospitals to benchmark their antibiotic use, internally and externally, leading to better utilisation of antibiotics and best clinical practices [23].…”

Section: Discussionmentioning

confidence: 99%

Longitudinal point prevalence survey of antibacterial use in Northern Ireland using the European Surveillance of Antimicrobial Consumption (ESAC) PPS and Global-PPS tool

et al. 2018

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Antimicrobial resistance is a limiting factor for the success of the treatment of infectious diseases and is associated with increased morbidity and cost. The present study aims to evaluate prescribing patterns of antimicrobials and quantify progress in relation to targets for quality improvement in the prescription of antimicrobials in Northern Ireland's secondary care sector using three repetitive point prevalence surveys (PPS) over a 6-year period: the European Surveillance of Antimicrobial Consumption (ESAC-PPS) in 2009 and 2011 and the Global-PPS on Antimicrobial Consumption and Resistance in 2015. Out of 3605 patients surveyed over the three time points, 1239 (34.4%) were treated with an antibiotic, the most frequently prescribed antibiotic groups were a combination of penicillins, including β-lactamase inhibitors. Compliance with hospital antibiotic policies in 2009, 2011 and 2015 were 54.5%, 71.5% and 79.9%, respectively. Likewise, an indication for treatment was recorded in patient notes 88.5%, 87.7% and 90.6% in 2009, 2011 and 2015, respectively, and surgical prophylactic antibiotic prescriptions for >24 h was 3.9%, 3.2% and 0.7% in 2009, 2011 and 2015, respectively. Treatment based on biomarker data was used in 61.5% of cases. In conclusion, a general trend in the improvement of key antimicrobial-related quality indicators was noted. The PPS tool provided a convenient, inexpensive surveillance system of antimicrobial consumption and should be considered an essential component to establish and maintain informed antibiotic stewardship in hospitals.

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A point prevalence survey of antibiotic use in four acute-care teaching hospitals utilizing the European Surveillance of Antimicrobial Consumption (ESAC) audit tool

Cited by 25 publications

References 14 publications

Hospital Antibiotic Wasting and Evaluation of Potential Ecologic Effects

Hospital Antibiotic Wasting and Evaluation of Potential Ecologic Effects

Comparative point prevalence survey of antimicrobial consumption between a hospital in Northern Ireland and a hospital in Jordan

Longitudinal point prevalence survey of antibacterial use in Northern Ireland using the European Surveillance of Antimicrobial Consumption (ESAC) PPS and Global-PPS tool

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