How to measure and monitor antimicrobial consumption and resistance

Grau, Santiago; Bou, Germán; Fondevilla, Esther; Nicolás, Jordi; Rodríguez-Maresca, Manuel Ángel; Martínez-Martínez, Luis

doi:10.1016/s0213-005x(13)70128-9

Cited by 37 publications

(14 citation statements)

References 43 publications

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“…Antimicrobial surveillance monitors the epidemiology of and changes in antimicrobial resistance as well as helping to reduce the spread of resistant organisms. Longitudinal surveillance studies such as the Study for Monitoring Antimicrobial Resistance Trends (SMART), SENTRY, and TEST are thus important tools in the development of guidelines for rational empiric antimicrobial therapy and, more immediately, directing local empiric therapy [ 5 , 20 , 22 , 23 ]. The development and rapid distribution of carbapenemases such as New Delhi metallo-β-lactamase in recent years highlights the importance of multinational and global antimicrobial surveillance [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Numerous important resistance mechanisms have shown alarming increases in distribution in recent years, such as extended-spectrum β-lactamases (ESBLs) and carbapenemases [ 3 , 4 ]. This situation is further complicated by the current shortage of new antimicrobial development, increasing the probability that today’s resistant organisms may become tomorrow’s pan-resistant pathogens [ 5 ].…”

Section: Introductionmentioning

confidence: 99%

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Global in vitro activity of tigecycline and comparator agents: Tigecycline Evaluation and Surveillance Trial 2004–2013

Hoban

Reinert

Bouchillon³

et al. 2015

Ann Clin Microbiol Antimicrob

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BackgroundThe Tigecycline Evaluation and Surveillance Trial (TEST) is a global antimicrobial susceptibility surveillance study which has been ongoing since 2004. This report examines the in vitro activity of tigecycline and comparators against clinically important pathogens collected globally between 2004 and 2013.MethodsAntimicrobial susceptibility was determined using guidelines published by the Clinical and Laboratory Standards Institute. The Cochran Armitage Trend Test was used to identify statistically significant changes in susceptibility between 2004 and 2013.ResultsAmong the Enterobacteriaceae susceptibility was highest to the carbapenems [imipenem 97.1% (24,655/25,381), meropenem 97.0% (90,714/93,518)], tigecycline (97.0%, 115,361/118,899) and amikacin (96.9%, 115,200/118,899). Against Acinetobacter baumannii the highest rates of susceptibility were for minocycline (84.5%, 14,178/16,778) and imipenem (80.0%, 3,037/3,795). The MIC90 for tigecycline was 2 mg/L. 40% (6,743/16,778) of A. baumannii isolates were multidrug-resistant. Enterococci were highly susceptible to tigecycline and linezolid (>99%); vancomycin resistance was observed among 2% of Enterococcus faecalis (325/14,615) and 35% of Enterococcus faecium (2,136/6,167) globally. 40% (14,647/36,448) of Staphylococcus aureus were methicillin-resistant while 15% (2,152/14,562) of Streptococcus pneumoniae were penicillin-resistant. Against S. aureus and S. pneumoniae susceptibility to linezolid, vancomycin, and tigecycline was ≥99.9%. Globally, 81% (331/410) of statistically significant susceptibility changes during the study period were decreases in susceptibility.ConclusionsAmikacin, the carbapenems, and tigecycline were active against most gram-negative pathogens while linezolid, tigecycline, and vancomycin retained activity against most gram-positive pathogens collected in TEST during 2004–2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12941-015-0085-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Global in vitro activity of tigecycline and comparator agents: Tigecycline Evaluation and Surveillance Trial 2004–2013

Hoban

Reinert

Bouchillon³

et al. 2015

Ann Clin Microbiol Antimicrob

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“…AU measured in DOT/100PD slightly increased and AU measured in LOT and LOS showed a decreasing trend, albeit none of these changes were statistically significant. We could not demonstrate that our ASP reduced these parameters; nevertheless, the reduction in LOT and LOS over time may still be relevant for patients' quality of life and hospital management issues [13,31]. These findings are at least partially attributable to an increase in gangrenous appendicitis admission rates (that require a 3-day to 5-day course of antibiotics) together with a decrease in phlegmonous appendicitis admission rates (maximum 1-day course of antibiotics), but also to a change in the peritonitis treatment protocol from 2017 onwards.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

et al. 2020

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The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

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“…The WHO definition of DDD (assumed average maintenance dose per day for a drug used for its main indication in adults), and the WHO classification of DDD of each antimicrobial were used [53]. The DDD per 100 bed-days and DDD per 100 discharges were calculated from the following formula: antimicrobial consumption (grams) during the selected period of time x 100 / DDD x the number of stays (or discharges) during the selected period of time [54]. Consumptions in grams were obtained by multiplying the grams of the pharmaceutical form by the consumption in units.…”

Section: Consumption Of Antibioticsmentioning

confidence: 99%

Surgeon-led 7-VINCut Antibiotic Stewardship Intervention Decreases Duration of Treatment and Carbapenem Use in a General Surgery Service

et al. 2020

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Antibiotic stewardship programs optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. In this prospective interventional study, a multidisciplinary team led by surgeons implemented a program aimed at shortening the duration of antibiotic treatment <7 days. The impact of the intervention on antibiotic consumption adjusted to bed-days and discharges, and the isolation of multiresistant bacteria (MRB) was also studied. Furthermore, the surgeons were surveyed regarding their beliefs and feelings about the program. Out of 1409 patients, 40.7% received antibiotic therapy. Treatment continued for over 7 days in 21.5% of cases, and, as can be expected, source control was achieved in only 48.8% of these cases. The recommendations were followed in 90.2% of cases, the most frequent being to withdraw the treatment (55.6%). During the first 16 months of the intervention, a sharp decrease in the percentage of extended treatments, with R2 = 0.111 was observed. The program was very well accepted by surgeons, and achieved a decrease in both the consumption of carbapenems and in the number of MRB isolations. Multidisciplinary stewardship teams led by surgeons seem to be well received and able to better manage antibiotic prescription in surgery.

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How to measure and monitor antimicrobial consumption and resistance

Cited by 37 publications

References 43 publications

Global in vitro activity of tigecycline and comparator agents: Tigecycline Evaluation and Surveillance Trial 2004–2013

Global in vitro activity of tigecycline and comparator agents: Tigecycline Evaluation and Surveillance Trial 2004–2013

Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Surgeon-led 7-VINCut Antibiotic Stewardship Intervention Decreases Duration of Treatment and Carbapenem Use in a General Surgery Service

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