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Zachariassen Choate posted an update 6 months ago
fect.Graphical Abstract.
Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimize antimicrobial use. Most hospitals depend on time-consuming manual audits to monitor clinicians’ prescribing. But much of the information needed could be sourced from electronic health records (EHRs).
To develop an informatics methodology to analyse characteristics of hospital AMS practice using routine electronic prescribing and laboratory records.
Feasibility study using electronic prescribing, laboratory and clinical coding records from adult patients admitted to six specialities at Queen Elizabeth Hospital, Birmingham, UK (September 2017-August 2018). The study involved (i) a review of AMS standards of care; (ii) their translation into concepts measurable from commonly available EHRs; and (iii) a pilot application in an EHR cohort study (
=
61679 admissions).
We developed data modelling methods to characterize antimicrobial use (antimicrobial therapy episode linkage methods, therapy table, therapy chnd AMS impact evaluation studies.
It is feasible to use hospital EHRs to construct rapid, meaningful measures of prescribing quality with potential to support quality improvement interventions (audit/feedback to prescribers), engagement with front-line clinicians on optimizing prescribing, and AMS impact evaluation studies.
In 2020 the Australian Priority Antibacterial List (PAL) was developed to support national surveillance of antibacterial usage.
To compare the WHO AwaRe classification system with the Australian PAL to analyse antibacterial utilization in Australian acute care hospitals.
Monthly antibacterial usage rates (defined daily dose per 1000 occupied bed days) were calculated using pharmacy dispensing records together with patient occupancy data for all acute care hospitals contributing to the National Antimicrobial Utilisation Surveillance Program for 2015-19. Annual usage rates as a proportion were determined using the WHO AWaRe and Australian PAL categorization systems.
In 2019, 70.0% of total-hospital aggregate antibacterial use in Australian acute-care hospitals fell into the WHO
category, with 29.4% of usage in
and 0.6% in the
category. Analysis using the PAL classification system showed 40.1% of hospital usage fell into the
category, 55.6% in
and 3.8% in the
categories. On average, cefL categorization system. The use of a targeted, nationally approved prioritized classification system can provide a focus for antimicrobial stewardship at a national level, however a clear understanding of the consumption metric used, as well as its limitations, are required for interpretation.Infectious disease (ID) physicians and ID pharmacists commonly confront therapeutic questions relating to antibiotic resistance. Randomized controlled trial data are few and meta-analytic-based approaches to develop the evidence-base from several small studies that might relate to an antibiotic resistance question are not simple. The overriding challenge is the sparsity of data which is problematic for traditional frequentist methods, being the paradigm underlying the derivation of ‘P value’ inferential statistics. In other sparse data contexts, simulation methods enable answers to key questions that are meaningful, quantitative and potentially relevant. How these simulation methods ‘work’ and how Bayesian-based methods, being not ‘P value based’, can facilitate simulation are reviewed. These methods are becoming increasingly accessible. This review highlights why sparse data is less of an issue within Bayesian versus frequentist paradigms. A fictional pharmacokinetic study with sparse data illustrates a simplistic application of Bayesian and simulation methods to antibiotic dosing. Whether within epidemiological projections or clinical studies, simulation methods are likely to play an increasing role in antimicrobial resistance research within both hospital and community studies of either rare infectious disease or infections within specific population groups.
Carbapenem resistance in Gram-negative bacteria is an ongoing public health problem of global dimensions leaving very few treatment options for infected patients.
To study the dissemination of plasmid-borne carbapenemase genes in Gram-negative bacteria from a diagnostic centre in Tamil Nadu, India.
A total of 151 non-repetitive isolates belonging to 10 genera were collected between January 2015 and December 2016 from a diagnostic centre in Tamil Nadu. The isolates included
(
57),
(
45),
(
10),
Typhi (
8),
(
8),
(
7),
(
5),
(
5),
(
5),
(
5) and
(
1).
Of the 151 isolates, 71% (
107) and 68% (
103) were found to be resistant to meropenem and imipenem, respectively. The most prevalent β-lactamase gene was
(
22), followed by
(
21),
(
11),
(
9),
(
8),
(
7) and
(
3). We also observed
in
(
4), and three
were positive for both,
and
. Plasmid incompatibility (inc/rep) typing results showed that the resistance genes (
11) were present in the isolates carrying plasmid-types IncX, IncA/C, IncFIA-FIB and IncFIIA. The plasmid-borne resistance genes in
and
were transferred to susceptible
AB1157.
This study highlights the prevalence of carbapenem resistance and the acquisition of plasmid-borne carbapenemase genes in Gram-negative bacteria isolated at this centre.
This study highlights the prevalence of carbapenem resistance and the acquisition of plasmid-borne carbapenemase genes in Gram-negative bacteria isolated at this centre.Graphical Abstract.Ceftriaxone resistance in the Enterobacterales is typically the result of production of ESBLs or AmpC β-lactamases. The genes encoding these enzymes are often co-located with other antibiotic resistance genes leading to resistance to aminoglycosides, quinolones and trimethoprim/sulfamethoxazole. Carbapenems are stable to ESBLs and AmpC giving them reliable in vitro activity against producers of these β-lactamases. In contrast, piperacillin/tazobactam and amoxicillin/clavulanate are compromised by co-production of OXA-1, which is not inhibited by tazobactam or clavulanate. These in vitro findings provide an explanation for the MERINO trial outcomes, where 3.7% (7/191) randomized to meropenem died compared with 12.3% (23/187) randomized to piperacillin/tazobactam as definitive treatment of bloodstream infection due to ceftriaxone-resistant organisms. Ro-3306 in vivo No randomized trials have yet put cefepime and carbapenems head to head, but some observational studies have shown worse outcomes with cefepime. We argue that carbapenems are the antibiotics of choice for ceftriaxone-resistant Enterobacterales.
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