Predictors of inappropriate antimicrobial prescription: Eight-year point prevalence surveys experience in a third level hospital in Spain

Núñez-Núñez, María; Pérez-Galera, Salvador; Girón-Ortega, José Antonio; Fernández-Del-Castillo, Santiago Sandoval; Beltrán-García, Margarita; Cueto, Marina de; Suárez-Barrenechea, Ana Isabel; Palacios‐Baena, Zaira R.; Terol-Barrero, Pedro; Oltra-Hostalet, Fernando; Arenzana-Seisdedos, Ángel; Rodríguez‐Baño, Jesús; Retamar-Gentil, Pilar

doi:10.3389/fphar.2022.1018158

Cited by 3 publications

(3 citation statements)

References 33 publications

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“…When prescriptions were incorrect according to local guidelines, after the evaluation of many different aspects (dosing, route of administration, duration, etc. ), they were considered as inadequate ( Nunez-Nunez et al, 2022 ). Result from PPS showed a 49.2% of inadequate prescriptions’ rate, similar to the findings in our cohort.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study

et al. 2023

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Introduction: Bloodstream infections (BSI) are a major cause of mortality all over the world. Inappropriate empirical antimicrobial treatment (i-EAT) impact on mortality has been largely reported. However, information on related factors for the election of i-EAT in the treatment of BSI in adults is lacking. The aim of the study was the identification of risk-factors associated with the use of i-EAT in BSI.Methods: A retrospective, observational cohort study, from a prospective database was conducted in a 400-bed acute-care teaching hospital including all BSI episodes in adult patients between January and December 2018. The main outcome variable was EAT appropriation. Multivariate analysis using logistic regression was performed.Results: 599 BSI episodes were included, 162 (24%) received i-EAT. Male gender, nosocomial and healthcare-associated acquisition of infection, a high Charlson Comorbidity Index (CCI) score and the isolation of multidrug resistant (MDR) microorganisms were more frequent in the i-EAT group. Adequation to local guidelines’ recommendations on EAT resulted in 91% of appropriate empirical antimicrobial treatment (a-EAT). Patients receiving i-EAT presented higher mortality rates at day 14 and 30 when compared to patients with a-EAT (14% vs. 6%, p = 0.002 and 22% vs. 9%, p < 0.001 respectively). In the multivariate analysis, a CCI score ≥3 (OR 1.90 (95% CI 1.16–3.12) p = 0.01) and the isolation of a multidrug resistant (MDR) microorganism (OR 3.79 (95% CI 2.28–6.30), p < 0.001) were found as independent risk factors for i-EAT. In contrast, female gender (OR 0.59 (95% CI 0.35–0.98), p = 0.04), a correct identification of clinical syndrome prior to antibiotics administration (OR 0.26 (95% CI 0.16–0.44), p < 0.001) and adherence to local guidelines (OR 0.22 (95% CI 0.13–0.38), p < 0.001) were identified as protective factors against i-EAT.Conclusion: One quarter of BSI episodes received i-EAT. Some of the i-EAT related factors were unmodifiable (male gender, CCI score ≥3 and isolation of a MDR microorganism) but others (incorrect identification of clinical syndrome before starting EAT or the use of local guidelines for EAT) could be addressed to optimize the use of antimicrobials.

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Section: Discussionmentioning

confidence: 99%

Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study

et al. 2023

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“…This is partly related to the different definitions of inappropriate antimicrobial treatment found in the literature and to the paucity of studies specifically conducted in elderly patients (Table 5 ) [ 216 – 226 ]. Some studies have defined inappropriateness based on clinical variables (presence of signs and/or symptoms of infection despite antimicrobial treatment [ 217 , 219 ], while others have considered the appropriateness of diagnosis, dosage, route of administration, or duration of antimicrobial treatment [ 222 , 224 – 227 ]. More objective methods to evaluate appropriateness are based on positivity of microbiological testing results but they are time-consuming and are not always available [ 218 ].…”

Section: Interventions To Improve Safety and Tolerabilitymentioning

confidence: 99%

Safety and Tolerability of Antimicrobial Agents in the Older Patient

et al. 2023

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Older patients are at high risk of infections, which often present atypically and are associated with high morbidity and mortality. Antimicrobial treatment in older individuals with infectious diseases represents a clinical challenge, causing an increasing burden on worldwide healthcare systems; immunosenescence and the coexistence of multiple comorbidities determine complex polypharmacy regimens with an increase in drug–drug interactions and spread of multidrug-resistance infections. Aging-induced pharmacokinetic and pharmacodynamic changes can additionally increase the risk of inappropriate drug dosing, with underexposure that is associated with antimicrobial resistance and overexposure that may lead to adverse effects and poor adherence because of low tolerability. These issues need to be considered when starting antimicrobial prescriptions. National and international efforts have been made towards the implementation of antimicrobial stewardship (AMS) interventions to help clinicians improve the appropriateness and safety of antimicrobial prescriptions in both acute and long-term care settings. AMS programs were shown to decrease consumption of antimicrobials and to improve safety in hospitalized patients and older nursing home residents. With the abundance of antimicrobial prescriptions and the recent emergence of multidrug resistant pathogens, an in-depth review of antimicrobial prescriptions in geriatric clinical practice is needed. This review will discuss the special considerations for older individuals needing antimicrobials, including risk factors that shape risk profiles in geriatric populations as well as an evidence-based description of antimicrobial-induced adverse events in this patient population. It will highlight agents of concern for this age group and discuss interventions to mitigate the effects of inappropriate antimicrobial prescribing.

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“…Limiting the excessive use of antibiotics can reduce the incidence of CDI [98,99]. It is very common nowadays for hospitalized patients to receive one or more combinations of antibiotics or consecutive courses of antibiotics [100][101][102]. Other authors underline the need for a serious vaccination policy aimed at reducing all those bacterial or viral pathologies whose infectious complications can be prevented by effective immunization without the expense of antimicrobial therapy [103][104][105].…”

Section: Epidemiological Consideration Approaching CDI With Clusterin...mentioning

confidence: 99%

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

Crispino

2023

Microbiology Research

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Clostridioides difficile is a bacterium responsible for a healthcare-associated gastrointestinal infection, primarily affecting people who have undergone prolonged antibiotic treatment or who have compromised immune systems. The CD is of particular concern due to its high recurrence rates and the potential for serious outcomes, including life-threatening conditions such as pseudomembranous colitis, septic shock, and all associated conditions. Since this infection is a disease associated with other health conditions, a general vision of the problems is necessary which aims to obtain a general overview of the manifestations that generally correlate with care. Clinical reasoning following the disease-clustering method is able to produce a categorization process by grouping the possible correlations of the various conditions or factors underlying diseases on the basis of certain similarities or common models. The clustering process is performed using data analysis techniques which, by statically correlating each other, give an exact dimension of all the information related to a particular disease. In the case of CD, reasoning based on disease clustering has better clarified the practices, appropriateness in infection control, judicious use of antibiotics, and research into therapeutic and preventive strategies. This review, taking advantage of the clustering strategy, aimed to analyze the contingent conditions of the infection under examination, to reduce the incidence and impact of CD, having as its mission the improvement of the results deriving from the contrast of all those correlated pathological conditions to healthcare for the improvement of public health.

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Predictors of inappropriate antimicrobial prescription: Eight-year point prevalence surveys experience in a third level hospital in Spain

Cited by 3 publications

References 33 publications

Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study

Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study

Safety and Tolerability of Antimicrobial Agents in the Older Patient

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

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