Outpatient antibiotic consumption for urinary infections in Croatia 2005 - 2014: What can be learned from utilization trends

Vojvodić, Željko; Šebeđak, Danijela Daus

doi:10.2478/sjph-2018-0023

Cited by 3 publications

(5 citation statements)

References 28 publications

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“…Likewise, an 8% increase in fluoroquinolone usage in the outpatient setting in Croatia over 2019 ( 9 ) correlates with the high burden of fluoroquinolone-resistant E coli in our study for both attributable and associated AMR burden. Resistance in uropathogenic E coli is recognized as a threat on a national level ( 19 , 20 ), while fluoroquinolone resistance in urinary E coli isolates increased by 54.5% between 2007 and 2014 ( 21 ).…”

Section: Discussionmentioning

confidence: 99%

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

Meštrović,

Ikuta,

Swetschinski

et al. 2023

Croat Med J

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Aim To deliver the most wide-ranging set of antimicrobial resistance (AMR) burden estimates for Croatia to date. Methods A complex modeling approach with five broad modeling components was used to estimate the disease burden for 12 main infectious syndromes and one residual group, 23 pathogenic bacteria, and 88 bug–drug combinations. This was represented by two relevant counterfactual scenarios: deaths/disability-adjusted life years (DALYs) that are attributable to AMR considering a situation where drug-resistant infections are substituted with sensitive ones, and deaths/DALYs associated with AMR considering a scenario where people with drug-resistant infections would instead present without any infection. The 95% uncertainty intervals (UI) were based on 1000 posterior draws in each modeling step, reported at the 2.5% and 97.5% of the draws’ distribution, while out-of-sample predictive validation was pursued for all the models. Results The total burden associated with AMR in Croatia was 2546 (95% UI 1558–3803) deaths and 46 958 (28,033–71,628) DALYs, while the attributable burden was 614 (365–943) deaths and 11 321 (6,544–17,809) DALYs. The highest number of deaths was established for bloodstream infections, followed by peritoneal and intra-abdominal infections and infections of the urinary tract. Five leading pathogenic bacterial agents were responsible for 1808 deaths associated with resistance: Escherichia coli , Staphylococcus aureus , Acinetobacter baumannii, Klebsiella pneumoniae , and Pseudomonas aeruginosa (ordered by the number of deaths). Trimethoprim/sulfamethoxazole-resistant E coli and methicillin-resistant S. aureus were dominant pathogen-drug combinations in regard to mortality associated with and attributable to AMR, respectively. Conclusion We showed that AMR represented a substantial public health concern in Croatia, which reflects global trends; hence, our detailed country-level findings may fast-track the implementation of multipronged strategies tailored in accordance with leading pathogens and pathogen-drug combinations.

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Section: Discussionmentioning

confidence: 99%

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

Meštrović,

Ikuta,

Swetschinski

et al. 2023

Croat Med J

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“…In the last few years, the use of fluoroquinolones and cefuroxime for the treatment of UTIs has increased, while the use of nitrofurantoin remained at only 0.83 DDD TID and that of fosfomycin at 0.08 DDD TID ( 9 , 21 ). Because the main objective of our intervention was only to increase the use of first-line antibiotics, guideline-based prescribing in the strict sense was not assessed.…”

Section: Discussionmentioning

confidence: 99%

“…The consumption of fluoroquinolones has continued to increase over the past decade despite restrictions in prescribing ( 8 ). Although national guidelines for antimicrobial therapy of UTIs were issued in 2007 ( 9 ), no studies in Croatia assessed the adherence to the guidelines as their primary objective. The guidelines generally emphasize the self-limiting course of uncomplicated cystitis, the empirical use of first-line antibiotics, and the need for a clear diagnostic distinction between uncomplicated disease and complicating factors and comorbidities ( 9 , 10 ).…”

mentioning

confidence: 99%

“…Although national guidelines for antimicrobial therapy of UTIs were issued in 2007 ( 9 ), no studies in Croatia assessed the adherence to the guidelines as their primary objective. The guidelines generally emphasize the self-limiting course of uncomplicated cystitis, the empirical use of first-line antibiotics, and the need for a clear diagnostic distinction between uncomplicated disease and complicating factors and comorbidities ( 9 , 10 ). Among first-line antibiotics, nitrofurantoin has played the prominent role, maintaining its efficacy over 70 years of use ( 11 , 12 ).…”

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confidence: 99%

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How effective is a brief educational intervention on prescribing first-line antibiotics in acute cystitis? A quasi-experimental study among general practitioners in Croatia

Vojvodić

Mimica

2022

Croat Med J

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AimTo assess the effectiveness of a brief educational intervention on prescribing first-line antibiotics in acute cystitis.Methods This quasi-experimental before-after study was conducted over a period of eight months. We collected prescribing data related to urinary tract infections four months before the educational intervention and four months after it. Aggregate data on office visits, diagnoses, and issued prescriptions were collected from each practice's electronic medical records based on monthly reports. ResultsOverall, 3581 prescriptions were issued: 1717 before and 1864 after the intervention. The total number of prescriptions increased by 8.5%. The use of first-line antibiotics increased by 21.2%, the use of fluoroquinolones decreased by 6.6%, while the use of beta-lactams remained unchanged. After the intervention, nitrofurantoin was the most prescribed first-line antibiotic. The proportion of women who were prescribed first-line antibiotic did not reach the acceptable range (80%-100%) according to the European Surveillance of Antimicrobial Consumption quality indicators. The proportion of fluoroquinolones (17.9%) use was well above the acceptable range (0%-5%). ConclusionA brief educational intervention proved to be a useful method in adopting better prescribing habits. Of particular importance is the considerable increase in the use of nitrofurantoin due to its reliable efficacy against multidrug-resistant urinary pathogens.

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“…Urinary Tract Infections (UTI) can be upper or lower UTI classified as pyelonephritis or cystitis, respectively (10, 11). UTI are the second most common infections after respiratory tract infections.…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Resistance pattern in Gram-Negative Uropathogens in Duhok City, Northern Iraq

Naqid

2023

Preprint

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Antimicrobial resistance (AMR) is one of the most dangerous global threats since antimicrobial discovery. The world health organization(WHO) has implemented a program called GLASS to mitigate resistance across the globe. Urinary tract infection(UTI) are the second most common infections and are the most common reason for prescription of antimicrobials, the rise in AMR has caused concerns of UTI Overuse and misuse of prescriptions and decrease of treatment options hence many researches conducted across the globe are on uropathogens resistance rate and trend. This retrospective study was conducted in duhok province of KRI to measure antimicrobial resistance percentages and identify the most common uropathogens. 309 urine samples were collected in a time span of 12 months. Urine samples were collected by clean catch midstream and inoculated on blood and MacConkey agars, Antibiotic sensitivity test (AST) was performed to identify Gram negative uropathogen and its sensitivity pattern. We found out most common Gram negative uropathogen in females were E.coli and Klebsiella pneumonia while in males it was E.coli and Pseudomonas aeruginosa and common Klebsiella pneumonia. E.coli was most resistance to amoxicillin/amp(64.2%) and it was least resistant to carbapenems(6.1%). Klebsiella pneumonia had similar resistant pattern to E.coli. pseudomonas aeruginosa was highly resistant to all antimicrobials, third gen cephalosporins were the highest 95.7%. AMR has risen to concerning levels in duhok and if not controlled would result in simple infections causing death in future we recommend guidelines for control of Overuse, misuse and ease of availability of antimicrobials as a measure to decrease AMR. Continues monitoring should be performed on AMR development in the future.

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Outpatient antibiotic consumption for urinary infections in Croatia 2005 - 2014: What can be learned from utilization trends

Cited by 3 publications

References 28 publications

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

The burden of bacterial antimicrobial resistance in Croatia in 2019: a country-level systematic analysis

How effective is a brief educational intervention on prescribing first-line antibiotics in acute cystitis? A quasi-experimental study among general practitioners in Croatia

Antimicrobial Resistance pattern in Gram-Negative Uropathogens in Duhok City, Northern Iraq

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