Estimating daily antibiotic harms: an umbrella review with individual study meta-analysis

Curran, Jennifer; Lo, Jennifer; Leung, Valerie; Brown, Kevin A.; Schwartz, Kevin L; Daneman, Nick; Garber, Gary; Wu, JH; Langford, Bradley J

doi:10.1016/j.cmi.2021.10.022

Cited by 62 publications

(52 citation statements)

References 103 publications

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“…9 Furthermore, each day of antibiotic therapy is associated with 4% increased odds of experiencing an adverse event. 10 Even if treatment of ASB cannot be completely avoided, shortening duration of therapy may be a compromise to reduce unnecessary antibiotic exposure and potential harm. The presence of a Foley catheter was counted if it was present either on the day of or day before the urine culture was obtained.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and treatment of asymptomatic bacteriuria at academic and critical-access hospitals—Opportunities for stewardship efforts

Liu

Macdonald²,

Jain

et al. 2022

Infect. Control Hosp. Epidemiol.

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Section: Discussionmentioning

confidence: 99%

Prevalence and treatment of asymptomatic bacteriuria at academic and critical-access hospitals—Opportunities for stewardship efforts

Liu

Macdonald²,

Jain

et al. 2022

Infect. Control Hosp. Epidemiol.

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“…The treatment duration for mild-to-moderate severe CAP, for example, was shown to be too long in 40% of patients, considering the guideline recommendation of ve days. Each day of antibiotic therapy is associated with 4% increased odds of experiencing an adverse event [4]. For example, three days of ß-lactam therapy for CAP patients was shown to be non-inferior to eight days of therapy [15], while seven days of therapy instead of three is associated with a 1.19-fold increase in experiencing an adverse drug event [4].…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotic courses that are longer than necessary increase the selective pressure on bacterial ora [3]. and each additional day of antibiotic use may increase the risk of patient harm [4]. It is therefore important to monitor the appropriateness of antibiotic course durations, in order to identify target-areas for improvement.…”

Section: Introductionmentioning

confidence: 99%

Detecting inappropriate total duration of antimicrobial therapy using semi-automated surveillance

Broek

Court

Groot

et al. 2022

Preprint

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Objectives Evaluation of the appropriateness of the duration of antimicrobial treatment is a cornerstone of antibiotic stewardship programs, but it is time-consuming. Furthermore, it is often restricted to antibiotics prescribed during hospital admission. This study aimed to determine whether mandatory prescription-indication registration enables reliable semi-automated assessment of the duration of antibiotic therapy, including post-discharge duration. Methods Antibiotic prescription and admission data, from 1-6-2020 to 31-12-2021, were electronically extracted from the Electronic Medical Record of two hospitals using mandatory indication registration. All consecutively prescribed antibiotics of adult patients who received empiric therapy in the first 24 hours of admission were merged to calculate the total length of therapy (LOT) per patient, broken down per registered indication. Endpoints were the accuracy of the data, evaluated by comparing the extracted LOT and registered indication with the clinical notes in 400 randomly selected records, and guideline adherence of treatment duration. Data were analysed using a reproducible syntax, allowing semi-automated surveillance . Results A total of 3,466 antibiotic courses were analysed. LOT was accurately retrieved in 96% of the 400 evaluated antibiotic courses. The registered indication did not match chart review in 17% of antibiotic courses, of which only half affected the assessment of guideline adherence. On average, in 44% of patients treatment was continued post-discharge, accounting for 60% (± 19%) of their total LOT. Guideline adherence ranged from 26 to 75% across indications. Conclusions Mandatory prescription-indication registration data can be used to reliably assess total treatment course duration, including post-discharge antibiotic duration, allowing semi-automated surveillance.

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“…There is a strong relationship between the duration of bacteraemia and subsequent risk of death [67]. Staphylococcus aureus requires extended treatment durations as discussed below.…”

Section: Staphylococcus Aureus and Mrsamentioning

confidence: 99%

“…Minimising the duration of exposure to antimicrobials is important to optimise patient outcomes. A recent umbrella review established how each additional day of therapy is associated with measurable harm [67]. This includes a 4% daily increase in the odds of an adverse drug reaction (OR 1.04, 95% CI 1.02-1.07) and a 3% increase in the odds of antimicrobial resistance (OR 1.03, 95% CI 0.98-1.07).…”

Section: When and How To Stop Therapymentioning

confidence: 99%

Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review

et al. 2022

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Bloodstream infections (BSIs) in critically ill patients are associated with significant mortality. For patients with septic shock, antibiotics should be administered within the hour. Probabilistic treatment should be targeted to the most likely pathogens, considering the source and risk factors for bacterial resistance including local epidemiology. Source control is a critical component of the management. Sending blood cultures (BCs) and other specimens before antibiotic administration, without delaying them, is key to microbiological diagnosis and subsequent opportunities for antimicrobial stewardship. Molecular rapid diagnostic testing may provide faster identification of pathogens and specific resistance patterns from the initial positive BC. Results allow for antibiotic optimisation, targeting the causative pathogen with escalation or de-escalation as required. Through this clinically oriented narrative review, we provide expert commentary for empirical and targeted antibiotic choice, including a review of the evidence and recommendations for the treatments of extended-spectrum β-lactamase-producing, AmpC-hyperproducing and carbapenem-resistant Enterobacterales; carbapenem-resistant Acinetobacter baumannii; and Staphylococcus aureus. In order to improve clinical outcomes, dosing recommendations and pharmacokinetics/pharmacodynamics specific to ICU patients must be followed, alongside therapeutic drug monitoring.

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Estimating daily antibiotic harms: an umbrella review with individual study meta-analysis

Cited by 62 publications

References 103 publications

Prevalence and treatment of asymptomatic bacteriuria at academic and critical-access hospitals—Opportunities for stewardship efforts

Prevalence and treatment of asymptomatic bacteriuria at academic and critical-access hospitals—Opportunities for stewardship efforts

Detecting inappropriate total duration of antimicrobial therapy using semi-automated surveillance

Use of Antimicrobials for Bloodstream Infections in the Intensive Care Unit, a Clinically Oriented Review

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