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Carter, Rebecca Rosaly Carter. "ANTIBIOTIC STEWARDSHIP IN AMERICAN NURSING HOMES." Case Western Reserve University School of Graduate Studies / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=case1538588980802258.
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Ramkhalawon, Shabeerah. "Antibiotic stewardship: the role of clinical pharmacist." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/10858.
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South Africa has a high prevalence of infectious diseases; the major ones being the Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome epidemic, and tuberculosis. South Africa’s burden of resistant bacteria is also increasing. Antibiotic resistance in hospitalised patients leads to an increase in morbidity and mortality, resulting in longer hospital stays, and an increase in hospital costs. In order to counteract the problem of antibiotic resistance in hospitals and other healthcare facilities and preserve the efficacy of currently available antibiotics, there is a need for serious antibiotic management. Antibiotic stewardship initiatives have thus been put in place to guide healthcare professionals on the correct use of antibiotics. Clinical pharmacists can intervene and contribute to antibiotic stewardship owing to comprehensive knowledge of antibiotics, including the properties, uses, safety and efficacy of individual agents. There is a paucity of research to support the role of the clinical pharmacist in antibiotic stewardship in public sector hospitals. The current pharmacist staffing system within public sector hospitals does not adequately support pharmacists, in particular clinical pharmacists, to participate actively in antibiotic stewardship. The primary aim of the study was to evaluate the role of the clinical pharmacist in antibiotic stewardship in a public hospital setting. A secondary aim was to contribute towards more rational inpatient use of antibiotics in the general medical ward. The hypothesis for the study was that clinical pharmacists can make a positive contribution to the correct use of antibiotics in a public hospital setting. The study showed that the introduction of a pharmacist-driven antibiotic stewardship in the ward, using a prospective audit and feedback strategy, had a positive effect on overall appropriateness of antibiotic prescribing (Chi2=7.89; df=3; p=0.04815, Cramer’s V=0.13). However, this finding did not show any reduction in the volume of antibiotic use. Positive patient outcomes were achieved and shown through a reduction in the length of hospital stay (p=0.00487; one-way ANOVA). Although patients were not followed up on discharge to assess re-admission rates, the results are relevant in order to inform the hospital staff about the implementation of antibiotic stewardship at the public hospital setting with the aims of reducing inappropriate antibiotic prescribing and improving patient outcomes. From the results of the study, it can be concluded that the hypothesis was achieved and that the clinical pharmacist did play an integral role in antibiotic prescribing at the public hospital setting. Thus, it can be concluded that the study, though limited in its scope, achieved its aims and objectives, and showed that the clinical pharmacist does play an integral role in the rational use of antibiotics in a public hospital setting.
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Shohel, Mohammad. "Antibiotic Stewardship in Residential Aged Care Facilities." Thesis, Curtin University, 2019. http://hdl.handle.net/20.500.11937/86378.
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Aged care residents are at increased risk of infections due to their frailty and comorbidities. This study aimed to identify and reduce the risk of antibiotic-related misadventure in this population. Particular medicines were associated with use of antibiotics, suggesting compromised immunity via numerous mechanisms. Potential interactions between antibiotics and residents’ other medicines were also identified, and may increase morbidity in this vulnerable group. Expanded scope of antimicrobial stewardship in aged care facilities is recommended.
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Gravander, Nikkinen Anna, and Ellen Haglund. "Sjuksköterskans potentiella roll i antimicrobial stewardship : En litteraturöversikt." Thesis, Högskolan Väst, Avdelningen för omvårdnad - grundnivå, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-16790.
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Background The antimicrobial stewardship is developed to provide a guide on the responsible use of antimicrobial drugs. Thus, slowing down the development of antimicrobial resistance. However, the nurse's role in antimicrobial stewardship is not clarified. Failure toinclude the nurse within the antimicrobial stewardship guidelines may result in poor execution of antimicrobial stewardship.Aim To explore the role of nurses in antimicrobial stewardship and how it can be practically implemented within the medical field.Method This is a literature review where seven qualitative studies, two quantitative studies and a mix-methods study examines the nurse's role in antimicrobial stewardship.Results Two main themes and five sub-themes were created. The two main themes were clinical role and collaboration. The clinical role described the nurse's role as a patient advocate and the nurse's contribution to antimicrobial stewardship through monitoring and evaluation of the patient and treatment, as well as through safe sampling, drug administration and hygiene. The collaboration showed and identified the nurse's role as a communicator and educator. Conclusion Conclusions that can be drawn from the literature review are that the potential roles the nurse may have in antimicrobial stewardship are many and those we have identified are already included in the nurse's daily work.
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Steuart, Rebecca. "Antibiotic Prescribing and Subsequent Antibiotic Resistance of Respiratory Cultures in Children with Tracheostomies." University of Cincinnati / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1623170006733706.
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Kelly, Kimberley Allison. "Antibiotic Overuse in the Geriatric Population." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5734.
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The Centers for Medicare and Medicaid are requiring long-term care facilities (LTCFs) to implement antibiotic stewardship programs (ASPs) to alleviate overuse of antibiotics in the nursing home population. Current research shows that the benefits of ASPs include improved patient outcomes, reduced adverse events related to Clostridium difficile (C-diff) infection, improvement in rates of antibiotic susceptibilities, and optimized resource utilization. This project addressed the problem of antibiotic overuse and misuse in the geriatric population and whether the implementation of an ASP reduced the overuse of antibiotics, C-diff infection, and resistance rates in the LTCF. Application of the Johns Hopkins nursing model and Centers for Disease Control framework informed this project. An ASP was implemented by the organization. This project evaluated the program preASP and postASP over a 10-month period. A descriptive analysis was used to compare the number of new antibiotic starts, C-diff cases, and resistant cases before and after ASP implementation. The total number of cases of resistance declined from 12 to 10 cases after the ASP was implemented, which was a 16.67% decline. The number of monthly new antibiotic orders for the time period evaluated declined from 120 to 110 respectively, which was an 8.3% change. There was no change in the number of C-diff infections. The results demonstrated that implementing the ASP led to a decline in antibiotic misuse, overuse, and resistance cases. This project supports social change by expanding the healthcare team's knowledge regarding the project problem and informing future interventions to be implemented to help reduce antibiotic overuse and misuse in the geriatric population.
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Hamilton, Robert M. "Knowledge, Attitudes, and Perceptions of Nurse Practitioners about Antibiotic Stewardship." BYU ScholarsArchive, 2019. https://scholarsarchive.byu.edu/etd/8550.
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Background: Antibiotic stewardship (ABS) is a set of strategies to optimize the use of antibiotics with the goal of reducing antibiotic resistance, improving patient outcomes and decreasing unnecessary costs. ABS affects all venues of patient care, including outpatient, inpatient, and long-term care. While many strategies for ABS exist and best practice continues to evolve, successful ABS programs utilize a multidisciplinary approach. Nurse practitioners (NPs) play an essential role in health care education and represent a valuable potential resource for ABS efforts. The purpose of this study is to describe the knowledge, attitudes, and perceptions of NPs towards ABS.Methods: A convenience sample of NPs attending the American Association of Nurse Practitioners annual conference was given a modified descriptive survey developed for use in a previous study conducted at a university-affiliated hospital in Florida. Descriptive statistics were used to assess normality. Chi-Square test of independence was used to test differences categorical scores by NP setting, gender, and level of education. Pearson r correlation was completed to measure the relationship between age and years in practice.Results: Two hundred NPs completed the questionnaire (88% female; 70% Master’s degree). The range of experience was 0-45 years (mean 11 years). Most NPs worked in a private office (23%) or community setting (29%). Factors affecting the decisions of antibiotic prescriptions included patient condition (79%) and patient cost (58%). NPs in this study also based their antibiotic decisions on the antibiogram (63%) in their setting, while 56% indicated they start with broad spectrum and tailor antibiotic choices when culture results are received. NPs reported understanding that inappropriate use of antibiotics causes resistance (97%), harms the patient (97%), and optimum antibiotic use will reduce resistance (94%). Participants also recognized that strong knowledge of antibiotics was important for their job (94%) and felt confident in their use of antibiotics (86%). However, while 94% of respondents somewhat or strongly agreed that antibiotics are overused nationally, only 62% thought antibiotics were overused in their health care setting. Conclusion: In this study, most NPs reported that antibiotic resistance is a problem and antibiotics are overused nationally. Fewer believe that antibiotic resistance is a problem locally and fewer still that they, personally, contribute to the problem. NPs recognize that knowledge about antibiotics is important to their career and would like more education about antibiotics and feedback about their antibiotic choices. Finding effective ways to provide this education could change practice and improve antibiotic use.
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Hamidi, Maryam. "MICROBIOME OF PRETERM INFANTFROM SKIN-TO-SKIN CARE TO ANTIBIOTIC STEWARDSHIP." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1625851422254064.
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Thompson, Mellisa. "Antibiotic Prescribing Habits of Urgent Care Providers." ScholarWorks, 2018. https://scholarworks.waldenu.edu/dissertations/5791.
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Antibiotics are commonly prescribed and requested for viral illnesses despite evidence-based research studies and societal guidelines that advise against this practice. Literature has indicated that antibiotic decision-making comes from a provider's experience or exposure to illness, uncertainty of illness, or from being pressured by the patient. Nurses and advanced practice nurses are important participants in the antibiotic stewardship initiative. The purpose of this project was to examine potential knowledge deficits responsible for inappropriate antibiotic prescribing at a rural urgent care clinic in the southeastern United States, which when addressed could promote an educational in-service to decrease the number of antibiotics prescribed during a high-volume cough, cold, and flu months. The health belief model was used as a foundational model and a knowledge, attitude, and practice survey to collect data. Antibiotic prescribing habits were evaluated in the preintervention group (n = 250) and a year later in the postintervention group (n = 265). Antibiotic prescribing decreased positively from 80% to 70% and watchful waiting also increased positively from 4% to 30%; X-² (1) = 12.302, p = .000. The increase in educational awareness from these results can support a decrease in inappropriate antibiotic prescriptions, which prevents the emergence of antibiotic-resistant bacteria, contributing to positive social change.
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Metz, Jakob Friedrich [Verfasser]. "Ein Antibiotic Stewardship Programm an der Kinderklinik München-Harlaching / Jakob Friedrich Metz." Tübingen : Universitätsbibliothek Tübingen, 2020. http://d-nb.info/1221597604/34.
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Sooter, Rachel. "Minimizing Antibiotic Exposure In Infants At Risk For Early Onset Sepsis." ScholarWorks @ UVM, 2016. http://scholarworks.uvm.edu/graddis/652.
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ABSTRACT
Current guidelines published by the Centers for Disease Control and Prevention (CDC) and American Academy of Pediatrics (AAP) recommend empiric antibiotics for all neonates born to mothers with a diagnosis of chorioamnionitis due to the risk of early onset sepsis (EOS). EOS is difficult to diagnose due to nonspecific symptoms and a lack of reliable tests, can progress quickly, and is potentially fatal or have neurodevelopmental consequences for survivors.
Antibiotics are frequently prescribed in the hospital and are lifesaving in the setting of a serious infection. Conversely, overuse of antibiotics has potential negative effects to individuals and the population as a whole. Antibiotic resistant infections are a consequence of antibiotic misuse, are costly and difficult to treat, and pose a risk to patients hospitalized.
To examine this problem at The University of Vermont Medical Center (UVMMC) a retrospective chart review was preformed. Data on the maternal risk factors associated with EOS were collected in addition to clinical characteristics of their neonates and entered into a neonatal early onset sepsis (NEOS) calculator to determine the specific risk of infection to each infant. Treatment of the infant was compared to the NEOS calculator and CDC recommendations. Using posterior probability to determine a more specific risk profile better targets antibiotic therapy to ensure all infants that need treatment receive it, while reducing the number of infants treated empirically.
UVMMC currently treats 78% of infants according to CDC guidelines. Use of the NEOS calculator would reduce antibiotic treatment to 18% of term neonates born to mothers with a diagnosis of chorioamnionitis. Using a new tool to determine risk of EOS may safely reduce the number of infants receiving antibiotic treatment.
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Lo, Chiu-sing. "Territory-wide Antibiotic Stewardship Programme and its effectiveness in public hospitals in Hong Kong." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38478626.
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Lo, Chiu-sing, and 勞超成. "Territory-wide Antibiotic Stewardship Programme and its effectiveness in public hospitals in Hong Kong." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B39724505.
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Klein, Marie-Kathrin [Verfasser]. "Nachhaltige Implementierung von Antibiotic Stewardship auf der operativen Intensivtherapiestation eines Schwerpunktversorgers / Marie-Kathrin Klein." Bonn : Universitäts- und Landesbibliothek Bonn, 2020. http://d-nb.info/1221669400/34.
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Song, Sunah. "Antibiotic Use Analysis and Modeling in the United States Nursing Homes by Utilizing Administrative Data." Case Western Reserve University School of Graduate Studies / OhioLINK, 2021. http://rave.ohiolink.edu/etdc/view?acc_num=case1619432809745251.
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Ibrahim, Mohamad. "Evaluation of antibiotic use in a Lebanese hospital." Thesis, Cranfield University, 2016. http://dspace.lib.cranfield.ac.uk/handle/1826/10012.
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Antimicrobial resistance is a significant global health problem. Misuse of antibiotics is associated with antimicrobial resistance which presents clinicians with treatment challenges and increases the complexity of the decision making process related to the selection of appropriate antibiotic therapy. Antibiotic resistant organisms can often lead to nosocomial infections (NIs) and undoubtedly causes patient harm and increases healthcare costs. According to the National Institute of Allergy and Infectious Diseases (NIAID), at least 70% of the nosocomial infections are caused by antibiotic-resistant organisms. In addition to the problem of inappropriate prescribing, the decreased production of antimicrobial agents over the past 25 years has restricted the arsenal of available antimicrobial agents. The combination of inappropriate antibiotic prescribing practices and reduced research and development of new antimicrobial agents have promoted concerns that society may soon return to a pre-antibiotic era. Addressing the attitudes and behaviours that contribute to inappropriate antibiotic prescribing is a potentially effective and immediate solution to the growing antimicrobial resistance problem. Modifying clinicians' prescribing behaviour with antibiotic decision guidelines and highlighting the problematic side of this issue can promote judicious antibiotic prescribing practices. Representing the existing data regarding the use and misuse of antimicrobials in a Lebanese hospital can support and encourage initiating and complying with antibiotic stewardship programs and prescription guidelines. Purpose: The objectives of this study were to determine current levels and trends in prescribing antibiotics to patients in a Lebanese hospital, (2) to identify the factors that physicians considered when deciding to start antibiotics, (3) to explore whether antimicrobial use (empiric, prophylactic, targeted) will change when physicians fill out a form to document why they prescribed antibiotics, (4) to explore whether an increase in bacterial resistance occurs when antimicrobial consumption increases, (5) to explore the clinicians' perception towards antimicrobial use and antimicrobial stewardship program pre- and post- implementation of an antibiotic assessment form, (6) to explore the effect of the implemented antimicrobial stewardship intervention combined with hand hygiene (HH) on healthcare associated infection rate (HAIs) in the hospital. One-year retrospective study in a Lebanese hospital was conducted to determine the percentage of patients who received antimicrobial treatment and to identify the inappropriateness of their use in different hospital departments. A 12-months intervention was then implemented during which all attending physicians were asked to fill an antimicrobial assessment form (AAF) to document their rationale for starting antimicrobial therapy. In addition, this AAF was used to identify factors physicians considered when deciding to prescribe antimicrobials. Data from the AAFs suggested that physicians in the hospital often considered elevated C-reactive protein, elevated white blood cell counts, and elevated temperatures when deciding to start antimicrobial therapy. Data showed that antibiotic consumption and the median duration of empiric and targeted therapies decreased significantly during the intervention period when compared to the pre-intervention period. Antibiotic appropriateness was also increased significantly after the intervention was conducted. In addition, a better understanding of antimicrobial stewardship strategies was also noted by physicians after the implementation of the intervention. On the basis of these results, AAF filling was a successful intervention to reduce antibiotic use and to urge physicians to refer to antibiotic guidelines when initiating an antimicrobial agent. However, additional measures such as automatic stop orders and computer decision support may be easier and useful for reducing the duration of therapy in hospitals.
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Maechler, Friederike [Verfasser]. "Umgang mit Trägern multiresistenter Gram-negativer Bakterien (MRGN) und Antibiotic Stewardship in deutschen Intensivstationen / Friederike Maechler." Berlin : Medizinische Fakultät Charité - Universitätsmedizin Berlin, 2015. http://d-nb.info/1079525165/34.
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Zhou, Helen(Helen L. ). "Large-scale prediction of patient-level antibiotic resistance : towards clinical decision support for improved antimicrobial stewardship." Thesis, Massachusetts Institute of Technology, 2018. https://hdl.handle.net/1721.1/121646.
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This electronic version was submitted by the student author. The certified thesis is available in the Institute Archives and Special Collections.Thesis: M. Eng., Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science, 2018
Cataloged from student-submitted PDF version of thesis.
Includes bibliographical references (pages 93-96).
Antibiotics are critical to modern medicine. However, levels of resistance have been rising, exacerbated by over-prescription and misuse of antibiotics. One major reason for this inappropriate usage is that doctors often must decide treatment without the results of microbiologic testing, a setting known as the empiric treatment setting. Thus, this work aims to provide clinical decision support through patient-specific predictions of resistance at the point of care. Combining information from diagnoses, procedures, medications, clinicians' notes, and other modalities present in electronic medical records, various machine learning models such as logistic regression and decision trees are used to predict patients' probabilities of resistance to various antibiotics. The full dataset consists of electronic medical records from patients presenting to the Massachusetts General Hospital and the Brigham & Women's Hospital between 2007 and 2016. On samples from the urinary tract (UTIs), which comprise approximately 48% of microbiology samples, the models achieve test AUCs ranging from 0.665 to 0.955 (depending on the antibiotic). To evaluate the practical utility of these models, we extract the uncomplicated UTI cohort. Combining model predictions with well-defined treatment guidelines, a decision algorithm is constructed to recommend antibiotic treatments. For uncomplicated UTIs, the algorithm reduces test set prescriptions of broad-spectrum antibiotics by about 6.6%, while retaining similar levels of inappropriate antibiotic therapy.
by Helen Zhou.
M. Eng.
M.Eng. Massachusetts Institute of Technology, Department of Electrical Engineering and Computer Science
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Alghamdi, Saleh. "The adoption of antimicrobial stewardship programmes in Ministry of Health hospitals in Saudi Arabia." Thesis, University of Hertfordshire, 2018. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.768496.
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Aim: This thesis aims to explore and investigate the level and process of adoption of Antimicrobial Stewardship Programmes (ASPs) and factors influencing their implementation in Saudi Ministry of Health (MOH) hospitals. The findings of this study will provide hospitals and policy makers with evidence-based recommendations on how barriers to ASPs adoption can be overcome, which will ultimately improve antimicrobial use and reduce antimicrobial resistance (AMR). Method: A mixed method approach was carried out using both qualitative and quantitative research methods. Semi-structured interviews were conducted with healthcare professionals in three Saudi hospitals to explore the enablers and barriers to their adoption of ASPs. A survey was then developed based on these findings to investigate the level of hospitals’ adoption of ASPs and factors influencing their implementation at a national level. Further, a case study using in-depth interviews was utilised to understand the process of ASP adoption in a Saudi hospital, and how adoption challenges were addressed. Finally, a self-administered questionnaire was used to examine patients’ knowledge and perceptions of antimicrobial use and resistance, and to evaluate the institutional role of patient education on antimicrobial use in two Saudi hospitals. The overall methodology of the research is summarised in Figure I. Results: Despite the introduction of a national ASP strategy, adoption of ASPs in Saudi MOH hospitals remains low. Organisational barriers such as the lack of senior management support, lack of supportive IT infrastructure and the shortage of ASP team members hinder hospitals’ efforts to adopt ASPs. Further barriers relate to the lack of formal enforcement by MOH and the physicians fears of patients' complications and clinical liability. Patients admitted to Saudi hospitals lack knowledge and perceptions of AMR, and the adoption of ASPs may improve hospitals’ role in patients' education. Conclusions: Despite the established benefits of ASPs, their adoption in Saudi MOH hospitals remains low. Urgent action is needed to address the strategies priorities associated with AMR, including access to antimicrobials, antimicrobial stewardship and education and research. Policy makers are urged to consider making ASPs adoption in hospitals a regulatory requirement supported by national guidelines and surveillance programmes. It is essential to increase the provision of ID and infection control residency and training programmes to meet the extreme shortage of ID physicians, pharmacists, microbiologists and infection control practitioners. Higher education institutions and teaching hospitals are required to introduce antimicrobial prescribing and stewardship competencies into undergraduate Medical, Pharmacy, Dental, Nursing and Veterinary curriculum, as well as introduction of AMR topics in order to increase knowledge and awareness of ASPs and AMR. Collaboration between ASPs adopting and non-adopting hospitals is essential to share implementation experience, strategies and solutions to overcome barriers. Healthcare specialised associations are needed to be part of AMR conversation and guide healthcare professionals’ training and accreditation. Multiple stakeholders should be actively part of the conversations around tacking AMR. Primary care, secondary care, community pharmacies and policy makers should strive to create a shared culture of responsibility among all healthcare partners to improve antimicrobial therapy and reduce risks of AMR
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Rost, Maximilian Johannes [Verfasser]. "Effekte wöchentlicher interdisziplinärer routinemäßig durchgeführter Antibiotic-Stewardship-(ABS)-Visiten auf den Antiinfektivaeinsatz auf einer urologischen Normalstation / Maximilian Johannes Rost." Magdeburg : Universitätsbibliothek, 2018. http://d-nb.info/1162189916/34.
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Muller, Allison. "Bon usage des antibiotiques : résultats d'actions dans différents types d'établissements de santé." Thesis, Bourgogne Franche-Comté, 2017. http://www.theses.fr/2017UBFCE021/document.
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La résistance bactérienne aux antibiotiques est un problème de santé publique mondial principalement lié à un mésusage des antibiotiques (surconsommation et prescription inadéquate).Pour lutter contre cette menace, des recommandations diffusées par les sociétés savantes et des plans d’action ont été mis en place. Même si ils sont nécessaires, ils ne sont pas suffisants pour assurer une amélioration significative de l’usage des antibiotiques. Un fort taux de non-conformité de la prescription antibiotique au regard des recommandations est observé dans les établissements de santé (ES). La mise en place de programmes volontaristes de bon usage antibiotique au sein de chaque ES s’avère essentiel pour améliorer l’usage des antibiotiques : une action sur les comportements des prescripteurs est indispensable, par le biais de différentes stratégies. Qu’elles soient persuasives ou restrictives, celles-ci ont toutes montré leur efficacité, sans entraîner d’effets cliniques néfastes pour les patients (pas d’augmentation de la mortalité ni de la durée de séjour), tout en permettant une réduction des coûts liés aux anti-infectieux.Par le biais de nos travaux, nous avons cherché à étudier le bon usage antibiotique en milieu hospitalier, à l’échelle de différents types d’ES (hôpital local, centre hospitalier régional universitaire, cohorte de 259 ES), et en évaluant l’impact de recommandations nationales ou de programmes et de guides locaux. Ces travaux nous ont permis de constater que la diffusion de recommandations nationales pouvait permettre de réduire les consommations de carbapénèmes, et qu’un programme mené dans un hôpital local pouvait être très efficace pour réduire les consommations de fluoroquinolones, mais également la résistance bactérienne à plus long terme. Des audits ciblés sur la prescription des aminosides et l’antibioprophylaxie chirurgicale ont permis de mettre en évidence des non-conformités récurrentes orientant sur des actions d’amélioration ciblées à mener.En conclusion, ce travail souligne l’importance des programmes de bon usage antibiotique au sein de chaque ES, quel que soit le type et le nombre de lits. En effet, ces programmes venant en appui aux recommandations ont démontré leur efficacité pour réduire les consommations et améliorer la qualité des prescriptions antibiotiques, grâce à leur impact positif sur les comportements des prescripteursBacterial resistance to antibiotics is a worldwide public health issue which is mainly linked to antibiotic misuse (overconsumption and inappropriate prescription).To fight this threat, recommendations from learned societies and national action plans have been set up. Even if they are necessary, they are not sufficient to provide a significant improvement in the antibiotic use. A high rate of non-compliance with the recommendations is observed among healthcare facilities (HCFs). The setting up of proactive antimicrobial stewardship programs (ASP) among every HCF is essential to improve antibiotic use: an action on prescribers’ behavior is necessary, by using various strategies. These strategies, however persuasive or restrictive, have been shown to be effective, with no clinical negative effects for the patients (no increase in mortality and in length of stay), while reducing anti-infective costs.With this work, we aimed to study the appropriateness of antibiotic use in hospitals, at different HCFs levels (local hospital, university hospital, 259 French HCFs cohort), by assessing the impact of national recommendations or local ASP and guidelines. These studies showed that national recommendations could lead to a reduction in carbapenem consumptions, and that an ASP conducted in a local hospital could be very effective to reduce fluoroquinolones consumptions, and bacterial resistance at a longer term. Targeted audits on aminoglycosides prescription and on surgical antibioprophylaxis have permitted to highlight recurrent non-compliances, guiding improvement measures to set up.In conclusion, this work supports the weight of ASPs among each HCF, whatever type and size. Indeed, these ASPs, set up in support of the national recommendations, have demonstrated their effectiveness in reducing antibiotic consumptions and improving prescription appropriateness, by their positive impact on prescribers’ behaviors
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Collineau, Lucie. "Quantify, Explain and Reduce Antimicrobial Usage in Pig Production in Europe." Thesis, Nantes, Ecole nationale vétérinaire, 2016. http://www.theses.fr/2016ONIR091F/document.
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La résistance aux antibiotiques est une menace sérieuse pour la santé publique en Europe, entrainant une augmentation des coûts de la santé, des échecs thérapeutiques, et de la mortalité (ECDC, 2011). Le développement de l'antibiorésistance est principalement lié à la consommation d'antibiotiques chez l'Homme et les animaux. Depuis le début des années 2000, les pays européens ont limité cette consommation et en 2006, l'UE a interdit l'utilisation d'antibiotiques comme promoteurs de croissance. Ceci a favorisé le développement de diverses alternatives à l'utilisation d'antibiotiques. L'objectif principal de ce projet de thèse est d'évaluer l'utilisation d'alternatives spécifiques et non spécifiques à l'utilisation d'antibiotiques dans les élevages de porcs européens. L'étude sera organisée en trois parties: i) une évaluation technique, visant à quantifier le lien entre l'utilisation d'antibiotiques et les performances techniques des élevages, ii) une évaluation économique, basée sur une analyse coût-efficacité et coûts-bénéfices des stratégies alternatives aux antibiotiques et iii) une évaluation psychosociologique, décrivant les attitudes et les comportements des éleveurs, vétérinaires et scientifiques vis-à-vis de l'utilisation d'antibiotiques en élevage porcin. Ce projet impliquera à la fois la réalisation de visites d'élevages français, l'utilisation d'outils statistiques variés et de méthodes de recherche qualitative et d'évaluation des risques. Ainsi, ce projet fournira les bases d'une compréhension globale des facteurs techniques, économiques et psychosociologiques qui orientent les décisions des éleveurs et des vétérinaires au sujet de la santé et de la production porcine et qui, par conséquent, définissent les possibles interventions sur l'utilisation d'antibiotiques. Cette étude fait partie du projet de recherche du Consortium MINAPIG financé par le programme Emida Era-Net. Un financement supplémentaire est fourni par l'Office vétérinaire fédéral suisseAntimicrobial resistance is a serious threat to public health in Europe, leading to mounting healthcare costs, treatment failure, and deaths (ECDC, 2011). The development of antimicrobial resistance is mainly due to antimicrobial consumption in humans and animals. From early 2000s, European countries have implemented restriction measures and in 2006, EU banned the use of antibiotics as growth promoters in animal feed. This has promoted the development of various alternatives to antimicrobial. The main objective of this PhD project is to assess and evaluate specific and unspecific alternatives to antimicrobials in the European pig industry. The study will be organised in three main parts: i) a technical assessment, quantifying the link between antimicrobial use and technical performances of the pig farms, ii) an economic evaluation, conducting cost-effectiveness and cost-benefit analyses of alternative strategies in comparison with antimicrobial usage, and iii) a psycho-sociological evaluation, describing farmers, veterinarians and pig experts attitudes, beliefs and behaviours regarding the use of antimicrobials in pig farming. The project will involve field work in France, statistical analysis using a range of methods, qualitative research methods, conceptual work and the use of risk assessment methods. We expect this PhD project to provide the foundation for an integrated understanding of technical, economical and psychological factors driving decisions of farmers and veterinarians about pig health and production and the consequential interventions, particularly the use of antimicrobials. This study is part of the MINAPIG Consortium Research project funded by the Era-Net programme Emida. Additional funding is available through the Federal Veterinary Office of Switzerland
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Baur, David [Verfasser], and Evelina [Akademischer Betreuer] Tacconelli. "Antibiotic Stewardship-Programme reduzieren die Inzidenz von Infektionen und Kolonisation durch Antibiotika- resistente Bakterien und Clostridium difficile : Eine systematische Review und Meta-Analyse / David Baur ; Betreuer: Evelina Tacconelli." Tübingen : Universitätsbibliothek Tübingen, 2019. http://d-nb.info/1199929565/34.
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McKay, Rachel Margaret. "In search of improved approaches to antibiotic stewardship : can we explain variations in physician practice patterns related to outpatient infection management?" Thesis, University of British Columbia, 2017. http://hdl.handle.net/2429/63396.
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The discovery of antibiotics was one of the most significant advances in modern medicine; however, our reliance on antibiotics is threatened by the spread of resistance. Antibiotic resistance is a natural phenomenon that is exacerbated by selection pressure from antibiotic use. Where prescriptions are required for antibiotics, understanding prescribing behaviour is paramount. Guidelines recommend antibiotics for respiratory tract infections (RTIs) only when pneumonia or other serious complications are suspected. Urine cultures are recommended for complicated, but not uncomplicated, urinary tract infections (UTIs). The objectives of this thesis were to identify factors related to patients, physicians, and geographic regions associated with antibiotic use for RTIs, and urine culturing for UTI; and to explore the extent of variations in these practices across physicians.
A systematic review of the literature was conducted to assess factors that have previously been empirically associated with antibiotic prescribing. Then, using linked administrative datasets, factors associated with antibiotic prescriptions for paediatric respiratory tract infection were analyzed. Urine culture data was subsequently linked in, to explore urine culturing practices.
These analyses demonstrated that observed physician characteristics had a stronger influence on practice patterns that did differences in patient characteristics. In particular, physicians who had been in practice for longer tended to be more likely to prescribe antibiotics, and to order urine cultures. Physicians trained outside of Canada were more likely to prescribe, but less likely to order a urine culture. Female physicians were less likely to prescribe antibiotics, and more likely to order urine cultures. The variation between physicians that remained after accounting for observed characteristics was substantial.
This research demonstrates some common features of physicians that are associated with antibiotic prescribing and urine culture use. However, the variation between physicians in practice styles is greater than the effects of these characteristics. These findings have implications for the design and implementation of antibiotic stewardship efforts to improve antibiotic use. For example, audit and feedback interventions and academic detailing have shown some promise, and may be particularly effective if targeted to physicians with higher prescribing or culturing practices. This thesis demonstrates the utility of administrative datasets in identifying such physicians.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Lübbert, Christoph. "Epidemiologie, Klinik, Ausbruchs- und Therapiemanagement von Krankenhausinfektionen durch Carbapenemase bildende Klebsiella pneumoniae und Toxin produzierende Stämme von Clostridium difficile." Doctoral thesis, Universitätsbibliothek Leipzig, 2015. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-163269.
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Die Mehrzahl der jährlich 400.000 bis 600.000 Krankenhausinfektionen in Deutschland wird von Erregern der sog. ESCAPE-Gruppe (Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Acinetobacter baumannii, Pseudomonas aeruginosa und verschiedene Enterobacteriaceae, u.a. Klebsiella pneumoniae) verursacht. Besondere Sorge bereitet dabei die Ausbreitung von K. pneumoniae-Stämmen mit enzymvermittelter Resistenz gegenüber Carbapenem-Antibiotika (K. pneumoniae-Carbapenemase, KPC) und die Zunahme von C. difficile-Infektionen (CDI) durch hypervirulente Epidemiestämme (z.B. Ribotyp 027).
Die spezifischen Erfahrungen eines prolongierten Ausbruchsgeschehens durch einen KPC-bildenden K. pneumoniae-Stamm (KPC-KP) am Leipziger Universitätsklinikum machen deutlich, dass bei diesem Erregertyp ein hohes Transmissionspotential bei enormer Tenazität (Umweltresistenz) zu berücksichtigen ist, ein Versagen von Standardhygienemaßnahmen in Betracht zu ziehen ist, und Infektionsketten oftmals unklar bleiben. Die Anwendung von Antibiotika ist bei KPC-KP-Infektionen auf einzelne Substanzen (Colistin, Tigecyclin, Gentamicin) beschränkt und vor allem bei immunsupprimierten Patienten (z.B. Lebertransplantierte) mit einem relevanten Risiko des Therapieversagens behaftet. Die Therapie von CDI wird gerade bei Immunsupprimierten durch eine steigende Zahl an Rezidiven erschwert, die teilweise antibiotisch (Vancomycin, Fidaxomicin) nicht beherrschbar sind, so dass alternative Therapieverfahren wie die fäkale Bakterientherapie („Stuhltransplantation“) zur Anwendung kommen. CDI-Rezidive, aber auch eine dauerhafte intestinale Besiedelung mit multiresistenten Enterobakterien wie KPC-KP, scheinen neben wirtsspezifischen Faktoren der Immunantwort durch eine Dysregulation der physiologischen intestinalen Standortflora mit Störung der Kolonisationsresistenz bedingt zu sein. Der Versuch einer Eradikationsbehandlung von Patienten mit persistierender intestinaler Besiedelung durch KPC-KP mittels oraler Applikation der nicht resorbierbaren Antibiotika Colistin und Gentamicin ist mit einem relevanten Risiko der Entstehung von Sekundärresistenzen behaftet.
Die Zulassung neuer, besser wirksamer Antibiotika ist für die nächsten Jahre nicht in Sicht, so dass der Infektionsprävention überragende Bedeutung zukommt. Die Erfahrungen der KPC-Ausbruchsbewältigung am Leipziger Universitätsklinikum zeigen, dass nahezu lückenlose Compliance bei der Händedesinfektion, rigoros praktizierte und kontrollierte Barriere- und Isolationsmaßnahmen, Optimierung des Gebrauchs von Breitspektrum-Antibiotika (sog. „Antibiotic Stewardship“) und systematisches mikrobiologisches Erregerscreening dabei unabdingbar sind.
Nachhaltige Verbesserungen hinsichtlich der globalen Ausbreitung von multiresistenten Krankenhausbakterien werden sich nur durch grundlegende Umgestaltungen in Umwelt, Landwirtschaft, Tierzucht und Gesundheitswesen mit sparsamer und möglichst gezielter Anwendung von Antibiotika erzielen lassen. Um Risikopopulationen hospitalisierter Patienten vor potentiell lebensbedrohlichen Erregertransmissionen effektiv schützen zu können, sind erweiterte Surveillance und konsequent umgesetzte krankenhaushygienische Maßnahmen erforderlich.
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Rosa, Regis Goulart. "Impacto da aderência ao programa de controle de antimicrobianos na mortalidade de pacientes com neutropenia febril." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/53148.
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Terapia empírica com antimicrobiano de amplo espectro faz parte do manejo inicial padrão de pacientes com neutropenia febril (NF). Evidências suficientes de quais esquemas antibióticos devem ser inicialmente prescritos já existem; embora, nenhum estudo randomizado tenha avaliado se a aderência a programas de controle de antimicrobianos (PCAs) resulta em diminuição das taxas de mortalidade por esta síndrome. No presente estudo de coorte prospectivo, realizado em um hospital terciário no período de outubro de 2009 a agosto de 2011, avaliou-se o impacto da aderência ao PCA, aferida através da prescrição antimicrobiana inicial, na mortalidade em 295 episódios de NF (em 145 indivíduos adultos) que necessitaram de tratamento endovenoso hospitalar. Após análise multivariada através de regressão de Cox, incluindo outros preditores de mortalidade, a aderência ao PCA mostrou-se fator de proteção independente para morte 28 dias após início do episódio de NF (razão de hazard ajustada[HR], 0.29; intervalo de confiança de 95% [IC 95%], 0.11 a 0.72). Os fatores de risco encontrados para a não-aderência ao PCA foram presença de hipotensão (risco relativo ajustado[RR], 1.90; IC 95%, 1.37 a 2.63), diarreia (RR, 2.13; IC 95%, 1.66 a 2.73), dor perianal (RR, 2.08; IC 95%, 1.54 a 2.82), suspeita de foco infeccioso em cavidade oral (RR, 2.45; IC 95%, 1.75 a 3.43) e manifestações cutâneas de infecção (RR, 2.34; IC 95%, 1.81 a 3.04). A escolha antimicrobiana inicial é particularmente importante no manejo inicial do paciente com febre em vigência de neutropenia; a aderência ao PCA, que preconiza o uso racional de antibióticos, mostrou ser efetiva na redução de mortalidade durante o curso da doença. A presença de fatores modificadores da terapia inicial representa risco para não-adesão ao programa de controle de antimicrobianos.Empirical therapy with broad-spectrum antimicrobial is part of the initial management of patients with febrile neutropenia (FN). Enough evidence on which antibiotics schemes should be initially prescribed already exists; however, no randomized study has evaluated whether adherence to antimicrobial stewardship programs (ASPs) results in lower rates of mortality from this syndrome. In the present prospective cohort study performed in a tertiary hospital, from October 2009 to August 2011, we evaluated the impact of adherence to ASP, measured by initial antimicrobial prescribing, in mortality of 295 episodes of FN (in 145 adults) that required intravenous inpatient treatment. After multivariate analysis through Cox regression, including other predictors of mortality, adherence to ASP proved to be an independent protective factor for death 28 days after the beginning of the episode of FN (adjusted hazard ratio [HR], 0.29; 95% confidence interval [95% CI], 0.11 to 0.72). The risk factors found to noncompliance to ASP were presence of hypotension (adjusted relative risk [RR], 1.90; 95% CI, 1.37 to 2.63), diarrhea (RR, 2.13; 95% CI, 1.66 to 2.73), perianal pain (RR, 2.08; 95% CI, 1.54 to 2.82), suspected source of infection in oral cavity (RR, 2.45; 95% CI 1.75 to 3.43) and cutaneous manifestations of infection (RR, 2.34; 95% CI, 1.81 to 3.04). The choice of antimicrobial is particularly important in the initial management of patients with fever in the presence of neutropenia; the adherence to ASP, which calls for rational use of antibiotics, was effective in reducing mortality during the course of the disease. The presence of signs or symptoms that demand changes in the initial therapy poses risks to nonadherence to the antimicrobial management program.
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Ibrahim, Omar Moh'd Musa. "DEVELOPMENT AND COMPARISON OF RISK-ADJUSTED MODELS TO BENCHMARK ANTIBIOTIC USE IN THE UNIVERSITY HEALTHSYSTEM CONSORTIUM HOSPITALS." VCU Scholars Compass, 2012. http://scholarscompass.vcu.edu/etd/2871.
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Background. Infectious diseases societies recommend that hospitals risk-adjust their antimicrobial use before comparing it to their peers, a process called benchmarking. The purpose of this investigation is to apply and compare 3 risk-adjustment procedures for benchmarking hospital antibacterial consumption (AbC). Two standardization of rates procedures, direct and indirect standardization, are compared with one another as well as with regression modeling. Methods. Total aggregate adult AbC for 52 systemic antibacterial agents was measured in 70 hospitals that subscribed to the University HealthSystem Consortium Clinical Resource Manager database in 2009 and expressed as days of therapy (DOTs) per either 1000 patients days (PDs) or 1000 discharges. The two AbC rates served the role of the outcome while several known risk factors for AbC served the role of potential predictor variables in the linear regression models. Selection criteria were applied to select a model that represented the first rate (Model I) and another that represented the second (Model II), respectively, and outliers were identified. Adult discharges in each hospital were then stratified into 35 clinical service lines based upon their Medicare Severity-Diagnosis Related Group (MS-DRG) assignment. Direct and indirect standardization were applied to this set and the expected-to-observed (E/O) and observed-to-expected (O/E) ratios, respectively, for AbC were determined. The agreement of the different methods in ranking hospitals according to their risk-adjusted rates and in identifying outliers was determined. Results. The mean total AbC rate was 821.2 DOTs/1000 PDs or 4487.6 DOTs/1000 discharges. Model I explained 31% of the variability in AbC measured in DOTs/1000 PDs while Model II explained 64% of the variability in AbC measured in DOTs/1000 discharges. The E/O ratios ranged from 0.76-1.44 while the O/E ratios ranged from 0.73-1.45. The comparison of the risk-adjustment methods revealed a very good agreement between the two regression models as well as between the two standardization methods whereas the agreement of Model II with either standardization method was moderate. Conclusion. Standardization provides a viable alternative to regression for benchmarking hospital AbC rates. Direct standardization appears to be especially useful for benchmarking purposes since it allows the direct comparison of risk-adjusted rates.
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Winkler, Julia Theresa [Verfasser], and André [Akademischer Betreuer] Gessner. "Strukturierte Fragebogenerhebung unter klinisch tätigen Ärzten zur Optimierung der mikrobiologischen Befundmitteilung im Rahmen des Antibiotic Stewardship-Programms am Universitätsklinikum Regensburg / Julia Theresa Winkler ; Betreuer: André Gessner." Regensburg : Universitätsbibliothek Regensburg, 2017. http://d-nb.info/1149366591/34.
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Yaeger, Eileen M. "Quantitative Study of Clostridium difficile Incidence Related to Influenza and Antimicrobial Use." ScholarWorks, 2015. https://scholarworks.waldenu.edu/dissertations/614.
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In the United States, influenza causes approximately 36,000 deaths and over 200,000 hospitalizations each year with elderly most often affected. Clostridium difficile infection (CDI) is another major health care challenge and pressing public health issue associated with 14,000 deaths and over 335,000 hospitalizations annually. The use of antibiotics has been implicated in the development of CDI. This study's purpose was to test the relationship of seasonal influenza incidence and antiviral/antibiotic use in CDI development among hospitalized patients. Grounded in the epidemiologic wheel model of man-environment interactions, this retrospective observational study described and analyzed data from a proprietary, laboratory, and pharmacy-based system from a cohort of hospitals. The association between 147 patients with a diagnosis and/or positive test for influenza, the independent variables of delivery of antivirals/antibiotics (n = 130) during the patient's hospitalization, and the dependent variable of positive test or diagnosis of CDI (n = 17) was tested using multiple logistic regressions. The study results did not prove to be significant for the 3 research questions, suggesting no impact of antiviral use (R2 = .05, p = .336), antibiotic use (R2 = .05, p = .290), or antiviral and/or antibiotic use (R2 = .04, p = .382) on development of CDI within 60 days of discharge. However, findings indicated that recommended antiviral medication was inconsistently administered to influenza positive patients and that inappropriate prescribing patterns for antimicrobial agents coincided with seasonal influenza. Implications for positive social change include confirming the importance of antibiotic stewardship as an essential aspect of quality healthcare.
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Dumartin, Catherine. "Cadre juridique du bon usage des antibiotiques : analyse comparative dans 12 Etats de l’Union européenne et étude de l’impact sur l’utilisation des antibiotiques dans des établissements de santé du Sud-Ouest de la France." Thesis, Bordeaux 2, 2010. http://www.theses.fr/2010BOR21744/document.
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Pour enrayer la progression des résistances bactériennes aux antibiotiques (AB), liée, en partie, à un mésusage de ces médicaments, l’Union européenne (UE) s’est mobilisée en adoptant, en 2001, une recommandation prônant un usage prudent des AB. En 2008, sous l’égide de la Commission européenne, nous avons évalué la mise en œuvre de cette recommandation et son impact dans les Etats membres, et nous avons réalisé une analyse du cadre juridique développé dans 12 de ces Etats. De plus, une étude a été conduite entre 2005 et 2009 sur 74 établissements de santé (ES) volontaires du Sud-Ouest de la France pour identifier l’impact du cadre juridique sur l’évolution des consommations d’AB. Les Etats de l’UE ont engagé un grand nombre d’actions pour rationaliser l’utilisation des AB, mais des progrès dans le champ de l’évaluation demeurent nécessaires. Il ressort de l’analyse sur 12 Etats qu’un cadre juridique plus important semble associé à une plus grande sensibilisation de la population générale et à une meilleure maîtrise de la consommation de fluoroquinolones. Dans les ES du Sud-Ouest, les politiques locales de bon usage des AB ont progressé. Une combinaison de mesures telles que la présence d’un référent « AB », l’organisation de formations et le recours à des prescriptions à durée limitée, était associée à une réduction significative de la consommation des fluoroquinolones. L’amélioration de l’utilisation des AB implique de préciser les conditions d’efficacité optimale des actions et de renforcer l’encadrement juridique dans les Etats de l’UE, notamment en matière de surveillance, d’évaluation, de moyens d’incitation, en l’adaptant aux caractéristiques nationalesAntimicrobial resistance (AMR) is a public health problem worldwide. As antibiotic (AB) use is one of the drivers of AMR, the Council of the European Union adopted in 2001 a recommendation on the prudent use of antimicrobial agents. To analyze the way Member States (MS) had implemented this recommendation and to approach its efficacy, we performed a survey under the auspices of the European Commission in 2008, completed by a thorough analysis of the legal framework in twelve Member States. In addition, relationships between AB stewardship programmes (ABS) and trends in AB consumption were studied from 2005 to 2009 in 74 voluntary hospitals in Southwestern France. MS had implemented a broad range of activities to improve AB use, but differences were seen namely in evaluation systems. Further analysis in 12 MS highlighted discrepancies regarding the scope of the legal framework, incentives for its enforcement, and means of evaluation. A legal framework regarding surveillance and national organisation seemed in favor of higher citizens’ knowledge and awareness and appeared to be associated with lower increase in fluoroquinolone (FQ) use. In French hospitals, ABS had sharply improved and AB consumption remained stable when adjusted on activity. The presence of an antibiotic advisor combined with provision of training and use of prescriptions with stop-orders was associated with a significant decrease in FQ use. Progress in the use of AB could be achieved by sharing experience on best practices and by enforcing legal framework, tailored to MS organisation and epidemiology, targeting activities such as surveillance and evaluation
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Bevilacqua, Sibylle. "Evaluation de l'impact d'une équipe opérationnelle en infectiologie sur la consommation et le coût des antibiotiques au CHU de Nancy : essai d'intervention contrôlé." Thesis, Nancy 1, 2011. http://www.theses.fr/2011NAN10076/document.
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L'usage excessif et inapproprié des antibiotiques a été décrit dans le monde entier depuis 25ans, tant en ville qu'à l'hôpital. En plus des effets délétères sur les patients l'utilisation abusive des antibiotiques contribue à l'émergence de résistances bactériennes et à l'augmentation des dépenses hospitalières. Dans les années 1990 plusieurs organisations du monde de la santé ont publié des plans et des recommandations visant à contrôler les consommations en antibiotiques afin de limiter la pression de sélection sur les bactéries et d'en diminuer les coûts. Au CHU de Nancy une politique de bon usage des antibiotiques a été instaurée au milieu des années 1990 puis renforcée en 2006, avec une réorganisation complète du mode prescription et de la délivrance des antibiotiques dans tout l'établissement. Une équipe opérationnelle en infectiologie (EOI) composée d'un infectiologue et d'un pharmacien est intervenue dans une partie des services afin d'améliorer la qualité des prescriptions. Pour évaluer l'impact de l'intervention de l'EOI sur les consommations antibiotique et les coûts qui en découlent, une étude contrôlée en cluster avant/après a été réalisée .Nous avons comparé les consommations globale et par classes antibiotiques ainsi que les coûts « avant » et « après » dans 2 groupes (contrôle et intervention).Les résultats ont montré qu'après l'intervention de l'EIO les consommations globales avaient diminué de 34% dans le groupe intervention et de 3% dans le groupe contrôle ( P=0,003). Pour une même activité, la réduction du coût était 14 fois plus élevée dans le groupe intervention. Nous pouvons donc avancer que l'intervention d'une EOI constitue un moyen efficace pour réduire la consommation hospitalière en antibiotiques et les coûts qui en découlentOveruse and inappropriate use of antibiotics has been described worldwide for about 25 years, in both community and hospital settings. In addition to its deleterious effect on patients, antibiotic misuse can lead to the emergence of bacterial resistance and increased the cost of hospitalization. Indeed, during the 1990s several organizations published plans to control the costs of antibiotics and limit selective pressure on microorganisms through surveillance and interventions promoting rational use. An antimicrobial policy has been implemented at the University Hospitals of Nancy since the mid-1990s. This antibiotic policy was therefore reinforced the beginning of 2006, changes included complete reorganization of the methods of prescribing and delivering antibiotics in all wards of the University hospitals of Nancy. In addition, an Operational Multidisciplinary Antibiotic Team (OMAT) including an infectious disease physician and a clinical pharmacist was established in some wards. To evaluate the effectiveness of this OMAT, in reducing the hospital antimicrobial consumption and costs a cluster controlled "before-after" study was performed. We compared consumption of antibiotics overall and by therapeutic class and cost savings between "before" and "after" in both groups (control and intervention). The results of this study have shown that overall consumption of antibiotics decreased after implementation of the OMAT by 34% in the intervention group and by 3% in the control group (p = 0.003). For the same activity, the total cost savings were 14-fold higher in the intervention group. Establishment of an operational multidisciplinary team may be an effective way to reduce hospital antibiotic use and cost
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Boyer, Alexandre. "Maîtrise de la résistance bactérienne : réflexions sur la phase empirique de l'antibiothérapie en réanimation." Thesis, Bordeaux 2, 2012. http://www.theses.fr/2012BOR21926/document.
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En réanimation, les facteurs de risque d’infection à bactéries résistantes sont nombreux et il est nécessaire d’instaurer une antibiothérapie rapide et adéquate. Cela conduit donc souvent au choix empirique d’antibiotiques à large spectre. Ce travail de thèse regroupant quatre études porte sur les éléments de ce choix. Dans la première étude, les critères de "pneumopathie associée aux soins" sont discutés. Dans la seconde, il est rapporté que le traitement antibiotique prescrit au début du séjour en réanimation est associé à l’acquisition de Pseudomonas aeruginosa. Dans le diagnostic d’une pneumopathie acquise sous ventilation, la troisième étude décrit une technique rapide d’antibiogramme permettant une désescalade antibiotique plus précoce. La néphrotoxicité des aminoglycosides dans le traitement empirique des patients en sepsis sévère est présentée dans la dernière étude. Ces travaux participent à la bonne gestion des antibiotiques à la phase empirique du traitement des infections sévères en réanimationIntensive care units (ICU) are a niche for risk factors of infection due to multidrug resistant bacteria. ICU patients are in a need for a rapid and adequate antibiotic therapy. This leads ICU physicians to use empirical broad spectrum antibiotics. This thesis comprises four studies which focus on the empirical step of the treatment. In the first study, the criteria for "health-care-associated pneumonia" are discussed. The second shows that the antibiotic selection pressure administered early during the ICU stay could lead to Pseudomonas aeruginosa acquisition. In the third study, a rapid direct specimen testing method was assessed for ventilator-associated pneumonia diagnosis in order to hasten antibiotic de-escalation. Finally, a review on aminoglycosides’ nephrotoxicity in the severe sepsis setting represents the fourth study. These studies bring a loop forward into the understanding of the antibiotic stewardship of patients with severe sepsis, with particular focus on the empirical antibiotic treatment
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Baudet, Alexandre. "Évaluation de la maîtrise de la consommation d'antibiotiques assistée par ordinateur au CHRU de Nancy." Electronic Thesis or Diss., Université de Lorraine, 2024. http://www.theses.fr/2024LORR0156.
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L'antibiorésistance est une problématique de santé publique mondiale contre laquelle il est possible de lutter par la prévention des infections et par un meilleur usage des antibiotiques. En milieu hospitalier, des outils informatiques ont été développés pour assister les professionnels de santé dans la détection et le suivi des patients porteurs de microorganismes cibles et dans le bon usage des antibiotiques. L'objectif de ce travail était d'évaluer une suite logicielle installée au CHRU de Nancy, elle comprend un logiciel de surveillance sanitaire (ZINC) dédié à l'équipe opérationnelle d'hygiène (EOH) et un logiciel de bon usage des antibiotiques (APSS) dédié à l'équipe transversale d'infectiologie (ETI).Pour cela, la première phase de travaux a permis de proposer un protocole de recherche sur 24 mois (12 mois avant et 12 mois après l'installation des logiciels) comprenant un versant quantitatif via une étude quasi-expérimentale de type avant-après par séries chronologiques interrompues et un versant qualitatif pour recueillir le point de vue des utilisateurs. La deuxième phase, comprenant une étude rétrospective auprès de patients présentant des infections associées aux soins acquises en services de réanimation, a permis d'identifier des points d'amélioration qui devraient être rendus possibles par l'utilisation de la suite logicielle APSS et ZINC. La troisième phase, comprenant deux études mixtes avec des entretiens semi-directifs menées auprès de l'ETI et de l'EOH, a permis de mettre en évidence les principaux freins, leviers et bénéfices perçus par les utilisateurs des logiciels APSS et ZINC. La quatrième phase, comprenant une étude par séries chronologiques interrompues incluant 6 ans d'audits dont 22 mois post-installation du logiciel ZINC, a permis de démontrer l'amélioration progressive de la mise en place des mesures de précautions complémentaires depuis que l'EOH utilise ZINC au CHRU de Nancy.Ces premiers résultats de recherche sont encourageants mais nécessitent d'être poursuivis afin d'évaluer plus largement les impacts de la suite logicielle APSS et ZINC, notamment sur les consommations d'antibiotiques et les résistances bactériennesAntibiotic resistance is a global public health issue that can be tackled by preventing infections and by improving the use of antibiotics. In hospitals, software tools have been developed to assist healthcare professionals in detecting and monitoring patients carrying target micro-organisms and in the proper use of antibiotics. The aim of this research was to evaluate a software suite implemented at the University Hospital of Nancy, comprising an electronic surveillance software (ZINC) for the infection prevention and control (IPC) team and a clinical decision support system (APSS) for the antimicrobial stewardship (AMS) team.To achieve this, the first phase of the project proposed a 24-month research protocol (12 months before and 12 months after the implementation of the software) including a quantitative approach via a quasi-experimental before-after study using interrupted time series, and a qualitative approach to gather users' points of view. The second phase, comprising a retrospective study among patients with healthcare-associated infections acquired in intensive care units, identified areas for improvement that should be made possible by the use of APSS and ZINC. The third phase, comprising two mixed methods studies with semi-structured interviews with the IPC and AMS teams, highlighted the main barriers, facilitators and benefits perceived by APSS and ZINC users. The fourth phase, comprising a time series study including 6 years of audits with 22 months post-installation of ZINC, demonstrated the gradual improvement in the implementation of isolation precaution measures since the IPC team began using ZINC.These first results are encouraging, but need to be completed in order to assess the wider impact of APSS and ZINC, particularly on antibiotic consumption and bacterial resistance
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Ng, Chun-kong. "Cost effectiveness study of the antibiotics stewardship program in a regional hospital." View the Table of Contents & Abstract, 2006. http://sunzi.lib.hku.hk/hkuto/record/B36886336.
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Ng, Chun-kong, and 吳振江. "Cost effectiveness study of the antibiotics stewardship program in a regional hospital." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2006. http://hub.hku.hk/bib/B39724906.
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De, Angelis Morena <1983>. "Stewardship antibiotica neonatale: valutazione dell'esposizione antimicrobica nelle sospette early onset sepsis (EOS)." Doctoral thesis, Alma Mater Studiorum - Università di Bologna, 2022. http://amsdottorato.unibo.it/9992/1/Phd%20Thesis%20M.De%20Angelis%2013.02.pdf.
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Background: Le early-onset sepsis (EOS) sono infezioni batteriche invasive definite dalla presenza di batteri nel sangue e/o nel liquor cefalorachidiano che esordiscono nelle prime 72 ore di vita e causano in epoca neonatale mortalità e morbilità importanti.
Scopo: Determinare l’eccesso di trattamento antibiotico (Overtreatment index=OI) nei neonati di EG ≥34 settimane con sospetta sepsi ad esordio precoce. Metodi: Tutti i nati dal 1.01.2014 al 31.12.2018 di EG ≥34 settimane presso IRCCS Azienda Ospedaliero-Universitaria e l’Ospedale Maggiore di Bologna che hanno ricevuto terapia antibiotica endovenosa nelle prime 168 ore di vita nel sospetto di EOS. Sono stati identificati 2 gruppi: EOS provata (N=7) ed EOS sospetta (N=465). Risultati: L’incidenza di EOS è stata 0.22 su 1000 nati vivi, rispettivamente 0.12/1000 per Streptococcus agalactiae (GBS) e 0.06/1000 per Escherichia coli (E.coli). L’1.75% dei neonati ha ricevuto terapia antimicrobica empirica a largo spettro. L’OI è risultato 68. L’esposizione al trattamento antibiotico nella popolazione è stata di 85 giorni/1000 nati vivi. Tra i fattori di rischio materni, il tampone vagino-rettale (TVR) e l’urinocoltura positiva sono risultati associati al rischio di EOS provata (p=.017, p =.000). I valori di proteina C reattiva (PCR) al T0, T1 e T2 tra i due gruppi sono risultati significativi (p=.000). All’analisi multivariata è stata confermata la significatività delle variabili descritte. (TVR non noto OR=15.1, 95%CI 1.98-115.50, p =.009, urinocoltura positiva OR=30.1, 95%CI 3.6-252.1, p = .002, PCR T0 OR=1.6, 95% CI 1.29-2.07, p = .000.)
Conclusioni: L’individuazione precoce di fattori di rischio e la valutazione degli indici di flogosi in neonati sintomatici può ridurre l’OI e la durata della terapia antibiotica in casi di sepsi non confermata. L’uso appropriato degli antibiotici in questa popolazione è particolarmente importante poichè riduce lo sviluppo di germi multiresistenti. Nelle Terapie Intensive Neonatali, i programmi di stewardship antimicrobica dovrebbero guidare la gestione delle sepsi.Background: Early-onset sepsis (EOS) are invasive bacterial infections defined with bacteremia or meningitis during the first 72 hours of life. Neonatal sepsis still represents an important cause of mortality and morbidity. Aim: To determine the excess of antibiotic treatment (Overtreatment index = OI) in newborns at gestation age ≥34 weeks with suspected EOS. Methods: All neonates born between 01.01.2014 and 31.12.2018 at a gestation age ≥34 weeks at IRCCS University Hospital and Maggiore Hospital of Bologna and treated with intravenous antibiotic within the first 168 hours following birth. 2 groups were identified: proven EOS (N = 7) and suspected EOS (N = 465). Results: The incidence of EOS was 0.22 for 1000 live births, respectively 0.12 / 1000 for Streptococcus agalactiae (GBS) and 0.06 / 1000 for Escherichia coli (E.coli). 1.75% of newborns received broad-spectrum empirical antimicrobial therapy. The OI was 68. The exposure to antimicrobial treatment was 85 days /1000 live births. Unknow maternal vaginal-rectal swab (VRS) and positive urine culture were associated with the risk of proven EOS (p = .017, p = .000). The differences in the C-reactive protein (CRP) values at T0, T1 and T2 between the two groups were statistically significant (p =.000). The significance of the factors described was confirmed in a multivariate logistic regression analysis. (TVR unknown OR=15.1, 95% CI 1.98-115.50, p = .009, positive urine culture OR=30.1, 95% CI 3.6-252.1, p = .002, PCR T0 OR=1.6, 95%CI 1.29-2.07, p = .000.) Conclusions: Early identification of risk factors and evaluation of early inflammatory markers in symptomatic infants reduce the OI and duration of antimicrobial therapy in unconfirmed sepsis. The rational use of antimicrobials is of paramount importance in this population because prevent the development of multi-drug resistant pathogens. In the Neonatal Intensive Care Unit setting structured antimicrobial stewardship interventions should be in place.
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Sartelli, Massimo, Francesco M. Labricciosa, Pamela Barbadoro, Leonardo Pagani, Luca Ansaloni, Adrian J. Brink, Jean Carlet, et al. "The Global Alliance for Infections in Surgery: defining a model for antimicrobial stewardship—results from an international cross-sectional survey." BIOMED CENTRAL LTD, 2017. http://hdl.handle.net/10150/625526.
Full textAbstract:
Background: Antimicrobial Stewardship Programs (ASPs) have been promoted to optimize antimicrobial usage and patient outcomes, and to reduce the emergence of antimicrobial-resistant organisms. However, the best strategies for an ASP are not definitively established and are likely to vary based on local culture, policy, and routine clinical practice, and probably limited resources in middle-income countries. The aim of this study is to evaluate structures and resources of antimicrobial stewardship teams (ASTs) in surgical departments from different regions of the world. Methods: A cross-sectional web-based survey was conducted in 2016 on 173 physicians who participated in the AGORA (Antimicrobials: A Global Alliance for Optimizing their Rational Use in Intra-Abdominal Infections) project and on 658 international experts in the fields of ASPs, infection control, and infections in surgery. Results: The response rate was 19.4%. One hundred fifty-six (98.7%) participants stated their hospital had a multidisciplinary AST. The median number of physicians working inside the team was five [interquartile range 4-6]. An infectious disease specialist, a microbiologist and an infection control specialist were, respectively, present in 80.1, 76.3, and 67.9% of the ASTs. A surgeon was a component in 59.0% of cases and was significantly more likely to be present in university hospitals (89.5%, p < 0.05) compared to community teaching (83.3%) and community hospitals (66.7%). Protocols for pre-operative prophylaxis and for antimicrobial treatment of surgical infections were respectively implemented in 96.2 and 82.3% of the hospitals. The majority of the surgical departments implemented both persuasive and restrictive interventions (72.8%). The most common types of interventions in surgical departments were dissemination of educational materials (62.5%), expert approval (61.0%), audit and feedback (55.1%), educational outreach (53.7%), and compulsory order forms (51.5%). Conclusion: The survey showed a heterogeneous organization of ASPs worldwide, demonstrating the necessity of a multidisciplinary and collaborative approach in the battle against antimicrobial resistance in surgical infections, and the importance of educational efforts towards this goal.
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Fabian, Evelyn C. "Nurse Practitioner Attitudes, Perceptions and Knowledge About Antimicrobial Stewardship." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/7225.
Full textAbstract:
Resistance to antibiotics has increased dramatically in the United States, with serious associated medical, social, and economic consequences. The purpose of this project was to assess nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship and knowledge in the management of anaerobic infections as well as resistant gram-negative bacteremia. Data were collected using a web-based survey in a hospital facility. The practice question explored whether nurse practitioners' attitudes, perceptions, and knowledge about antimicrobial stewardship significantly increased after an education program on antimicrobial stewardship. The project was framed by Knowles's adult learning theory. A 16-item survey was administered before and after an education program to 11 advance practice nurses to assess their knowledge, attitudes, and perceptions about antimicrobial stewardship. Seventy-seven percent of the respondents agreed that antibiotics are overused nationally, and 33% agreed that antibiotics are overused within the institution; 88.9% of respondents agreed that inappropriate use of antibiotics can harm patients and that inappropriate use of antibiotics causes antimicrobial resistance (87.5%). Overall, 55.5% of respondents agreed or strongly agreed they were concerned about antimicrobial resistance in the community when prescribing antibiotics. Awareness of antimicrobial stewardship might contribute to social change by increasing the proper identification of organisms and the appropriate use of antibiotics, with the assistance of the antimicrobial stewardship programs, to help reduce the development and spread of antimicrobial resistance.
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Coppry, Maïder. "Bon usage des antibiotiques à l’hôpital : analyse des causes profondes et indicateurs." Thesis, Bordeaux, 2020. http://www.theses.fr/2020BORD0324.
Full textAbstract:
L’utilisation excessive et inappropriée des antibiotiques a des conséquences individuelles et collectives dont l’antibiorésistance fait partie. Des programmes de bon usage des antibiotiques sont mis en place en établissement de santé (ES) sans toujours parvenir à améliorer les indicateurs d’antibiorésistance, possiblement du fait de facteurs locaux non identifiés ou non pris en compte. L’étude de ces facteurs locaux pourrait être réalisée à l’aide d’un outil spécifique d’analyse approfondie des causes (AAC) appliqué à des situations d’utilisation inappropriée des antibiotiques. Les objectifs de ce travail de thèse étaient d’identifier les facteurs humains (prescripteur et patient) et organisationnels influençant l’utilisation des antibiotiques à inclure dans un outil d’AAC ; d’identifier des situations qui sont des conséquences d’une utilisation inappropriée des antibiotiques et facilement repérables, qui seraient éligibles à une AAC ; et de définir des indicateurs pertinents pour mesurer l’effet de la réalisation des AAC sur l’utilisation appropriée des antibiotiques. Notre revue de la littérature a identifié 34 facteurs influençant l’utilisation des antibiotiques à inclure dans un outil d’AAC : six facteurs liés au prescripteur, dix liés au patient et 18 facteurs organisationnels. Notre second travail a montré que les notifications de pharmacovigilance permettraient de détecter la survenue d’effets indésirables médicamenteux (EIM) dans les suites d’une utilisation inappropriée d’un antibiotique. L’étude a montré que la moitié des EIM imputables au co-trimoxazole étaient évitables, dont 70% d’EIM graves. Deux tiers des prescriptions n’étaient pas conformes au résumé des caractéristiques du produit (RCP) et 30% des prescriptions étaient peu ou pas justifiées. Un troisième travail a montré qu’en dehors de l’exposition aux carbapénèmes, une exposition aux β-lactamines inactives sur P. aeruginosa, molécules fréquemment utilisées pour les traitements empiriques en réanimation, était un facteur de risque significatif d’acquisition de la résistance aux carbapénèmes. Ainsi les résultats de laboratoire pourraient permettre d’identifier l’acquisition d’une résistance secondaire à une utilisation inappropriée d’antibiotiques. Enfin, notre travail sur les indicateurs de suivi de l’utilisation des antibiotiques a permis de comparer trois indicateurs calculés à partir des consommations d’antibiotiques : indicateurs ANSM, AWaRe-like et ECDC. Tous types d’ES confondus, les trois indicateurs étaient corrélés, avec une corrélation plus forte entre les indicateurs ANSM et AWaRe-like. Au sein de certains types d’ES, les indicateurs n’étaient pas toujours corrélés, ce qui a entrainé des différences de classement des ES. Nos résultats ont suggéré l’utilisation de deux indicateurs complémentaires : l’indicateur ECDC reflétant davantage la pression de sélection antibiotique et l’indicateur AWaRe-like davantage perçu comme étant lié à la qualité de la prescription. Dans les suites de ce travail, il sera nécessaire de formaliser l’outil d’AAC et de le mettre en oeuvre dans différentes situations éligibles, pour orienter les choix d’interventions afin d’améliorer l’utilisation des antibiotiques à l’hôpital. L’intérêt des nouveaux indicateurs pour mesurer l’impact des actions d’amélioration et leur bonne compréhension par les acteurs locaux devront être évalués. Enfin, au-delà du niveau local des ES, nos travaux pourront être utiles au niveau national pour adapter les programmes de bon usage des antibiotiques préconisés et inclure le suivi de nouveaux indicateurs dans les surveillances nationalesExcessive and inappropriate use of antibiotics leads to individual and collective consequences, including antimicrobial resistance. Antibiotic stewardship programs are implemented in health care facilities (HCF) with contrasting results on antibiotic use, probably due to unidentified or unaccounted for local factors. These local factors could be explored using a specific tool for root cause analysis (RCA) of inappropriate use of antibiotics. The objectives of this thesis work were: 1) to identify the human (prescriber and patient) and organizational factors influencing antibiotic use to be included in an RCA tool; 2) to identify situations that are consequences of inappropriate antibiotic use and that are monitored in hospitals, which would be eligible for a RCA; and 3) to define relevant indicators to measure the effect of performing RCA on the appropriate use of antibiotics. Our literature review identified 34 factors influencing antibiotic use to be included in a RCA tool: six prescriber-related, ten patient-related and 18 organizational factors. Our second work showed that pharmacovigilance reports would detect the occurrence of adverse drug reactions (ADRs) following inappropriate antibiotic use. The study showed that half of the ADRs attributable to co-trimoxazole were preventable, of which 70% were serious, two thirds were not in compliance with the SPC, and 30% of the prescriptions were not justified. A third work showed that apart from exposure to carbapenems, exposure to β-lactam inactive on P. aeruginosa, molecules frequently used for empirical treatments in intensive care units, was a significant risk factor for the acquisition of carbapenem resistance. Thus, laboratory results could help identifying the acquisition of resistance resulting from inappropriate antibiotic use. Finally, our work on indicators consisted in comparing three indicators, based on antibiotic consumption, for HCF benchmarking: ANSM, AWaRe-like and ECDC indicators. Across all types of ES, all three indicators were correlated, with a stronger correlation between the ANSM and AWaRe-like indicators. According to HCF type, the indicators were not always correlated, resulting in differences in HCF ranking. Our results suggested the use of two complementary indicators: the ECDC indicator more reflective of antibiotic selection pressure and the AWaRe-like indicator more perceived as being related to the quality of the prescription. The next step will be to elaborate the RCA tool and implement it in different eligible situations to guide the choice of interventions to improve antibiotic use in hospitals. The usefulness of the new indicators to measure improvements resulting from interventions and their ability to be understood by local stakeholders should be assessed. Finally, beyond the use at hospital level, findings from our work will inform decision makers to guide national policies on appropriate use of antibiotics and to adapt national surveillance systems to include new relevant indicators
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Gres, Emelyne. "Usage et mésusage des antibiotiques chez les enfants de moins de 5 ans au niveau des centres de santé primaire en Afrique de l’Ouest et du Centre." Electronic Thesis or Diss., Bordeaux, 2024. http://www.theses.fr/2024BORD0223.
Full textAbstract:
Dans les pays à revenus faibles et intermédiaires (PRFI), les maladies infectieuses sont la principale cause de mortalité infantile, faisant des antibiotiques un pilier essentiel des soins médicaux. Cependant, l'utilisation croissante de ces médicaments s'accompagne souvent de prescriptions inappropriées, principalement en raison du manque de personnel formé et de moyens diagnostics. L'Organisation Mondiale de la Santé (OMS) met en garde contre l'usage irrationnel des antibiotiques. Une exposition inutile à ces médicaments augmente le risque d'effets indésirables graves, alourdit les coûts des soins de santé et contribue à l’émergence de l’antibiorésistance. Malgré ces enjeux, l'absence de systèmes de surveillance des pratiques de prescriptions entraîne un manque de données, notamment pour la population pédiatrique, limitant la mise en place d’interventions adaptées. Mon travail de doctorat a consisté à décrire et quantifier l'usage et le mésusage des antibiotiques chez les enfants malades de moins de 5 ans dans les centres de santé primaire (CSP) en Afrique de l'Ouest et du Centre. Dans le cadre du projet AIRE qui a mis en œuvre l’utilisation de l’oxymétrie de pouls (OP) dans les consultations de Prise en Charge Intégrée des Maladies de l’Enfant (PCIME), nous avons analysé les pratiques de prescriptions d’antibiotiques de 15 854 enfants malades de moins de 5 ans consultant des CSP publics du Burkina Faso, de la Guinée, du Mali et du Niger (06/2021 – 07/2022). Les résultats montrent des taux élevés de prescription d’antibiotiques chez les enfants (2 - 59 mois), s’élevant à 71 % au Burkina Faso, 66 % en Guinée, 63 % au Mali et 36 % au Niger. Chez les nouveau-nés (0 à 59 jours), les proportions étaient aussi élevées, atteignant 83 % au Burkina Faso. La grande majorité des antibiotiques prescrits appartenaient au groupe Access de la classification AWaRe, associé à un faible risque de développement de résistances bactériennes. Ces résultats sont positifs et conformes au seuil fixé par les recommandations de l'OMS qui accompagnent la classification AWaRe. L’analyse de l’adéquation des prescriptions par rapport aux recommandations PCIME des différents pays révèle des pratiques de mésusage des antibiotiques. D'une part, on observe des taux alarmants de surprescription, définie par la prescription d'antibiotiques à des enfants inéligibles d’après leur classification PCIME. Parmi les enfants inclus dans le projet AIRE, 49 % des nouveau-nés et 25 % des enfants ont reçu une surprescription d'antibiotiques. Le jeune âge, les symptômes respiratoires et un test paludisme négatif ou non réalisé sont des facteurs associés à cette surprescription, reflétant des pratiques de prescription présomptives. D'autre part, nos analyses révèlent des opportunités manquées de traitement par antibiotique chez les enfants qui en nécessiteraient selon les recommandations PCIME. Parmi les nouveau-nés ayant consulté, 7,5 % n’ont pas reçu d’antibiotiques alors qu’ils étaient éligibles. Chez les enfants âgés de 2 à 59 mois, ce taux atteint près d’un enfant sur 10. Enfin, dans un contexte différent, l'essai clinique randomisé mené en République Démocratique du Congo (07/2019 – 01/2020) sur la prise en charge simplifiée de la malnutrition aiguë (OptiMA) nous a permis d’étudier la prévalence de la consommation d'antibiotiques. Pendant le suivi, 17,8 % des 482 enfants atteints de malnutrition aiguë sévère ont reçu au moins un antibiotique, sans différence significative entre le protocole standard et le protocole OptiMA. Ces études démontrent clairement la fréquence élevée des prescriptions d'antibiotiques chez les enfants consultant les CSP dépourvus de moyens diagnostiques, dont une grande partie est injustifiée, soulignant un besoin d’interventions. Nous avons donc mené une revue systématique de la littérature pour recenser les programmes de gestion des antibiotiques disponibles en contexte pédiatrique dans les PRFI (…)In low- and middle-income countries (LMICs), infectious diseases are the leading cause of child mortality, making antibiotics a critical component of medical care. However, the increasing use of these drugs is often accompanied by inappropriate prescriptions, mainly due to a lack of trained personnel and reliable diagnostic tools. The World Health Organization (WHO) warns against the irrational use of antibiotics. Unnecessary exposure to these drugs increases the risk of severe adverse effects, raises healthcare costs, and contributes to the emergence of antibiotic resistance. Despite these challenges, the absence of surveillance systems for antibiotic prescribing practices leads to a lack of data, particularly for the paediatric population, which limits the implementation of appropriate interventions. My doctoral work aimed to describe and quantify the use and misuse of antibiotics among sick children under 5 years old in primary health care centres (PHC) in West and Central Africa. As part of the AIRE project, which implemented the use of pulse oximetry (PO) in Integrated Management of Childhood Illness (IMCI) consultations, we analysed antibiotic prescribing practices for 15,854 sick children under 5 years old attending public PHC in Burkina Faso, Guinea, Mali, and Niger (06/2021 – 07/2022). The results have shown high rates of antibiotic prescriptions among children (2-59 months), reaching 71% in Burkina Faso, 66% in Guinea, 63% in Mali, and 36% in Niger. Among neonates (0-59 days), the proportions were high, with 83% in Burkina Faso. According to the WHO's AWaRe classification, the vast majority of prescribed antibiotics belonged to the Access group, which is associated with a low risk of developing bacterial resistance. These results were consistent with the threshold set by the WHO recommendations accompanying the AWaRe classification. Analysis of prescribing practices with IMCI recommendations in different countries reveals situations of antibiotic misuse. On the one hand, there are alarming rates of overprescription, defined as the prescription of antibiotics to children who are ineligible according to their IMCI classification. Among the children included in the AIRE project, 49% of neonates and 25% of children were overprescribed antibiotics. Factors associated with this overprescription include young age, respiratory symptoms, and a negative or missed malaria test, reflecting presumptive prescribing practices. On the other hand, our analyses reveal missed opportunities for antibiotic treatment in children who would need it according to the IMCI guidelines. Among consulted neonates, 7.5% did not receive antibiotics despite being eligible. This rate rises to 9.6% for children aged 2-59 months, almost one in ten. Finally, in a different context, the randomised clinical trial on simplified management of acute malnutrition (OptiMA) in the Democratic Republic of Congo (July 2019 - January 2020) allowed us to study the prevalence of antibiotic use. During follow-up, 17.8% of the 482 children with severe acute malnutrition received at least one antibiotic, with no significant difference between the standard protocol and the OptiMA protocol. These studies document the frequency of antibiotic prescriptions among sick children in primary care centres lacking diagnostic tools, with a significant proportion being unjustified, highlighting the need for intervention. We, therefore, conducted a systematic review of the literature to identify available Antibiotic Stewardship Programs (ASP) in paediatric settings in LMICs. This research highlights different interventions depending on the level of child care and available resources. Hospitals prioritize protocols and audits, while PHCs focus on clinician training and the implementation of prescription support tools. My work provides new insights into antibiotic prescribing practices among children in West and Central Africa, revealing numerous inappropriate practices (…)
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Morgan, Jake Roberts. "A mixed methods exploration of antibiotic prescribing and stewardship." Thesis, 2017. https://hdl.handle.net/2144/20854.
Full textAbstract:
Unnecessary prescribing of antibiotics for viral respiratory tract infections is common and contributes to emerging antibiotic resistance and patient morbidity and mortality. Interventions aimed at promoting judicious use of antibiotics, such as prescribing guidelines, are often ineffective. Approaching the problem of overprescribing from new perspectives is key to making progress towards more effective antimicrobial stewardship. Exploring characteristics shared between patients and providers, attitudes of new antibiotic stewards, and the role of prescribing on subsequent use offer opportunities to better understand antibiotic stewardship and overprescribing at a time when new perspectives are needed to inform better interventions.
This dissertation contains three studies that incorporate novel perspectives to investigate the patient, provider, and practice factors that promote judicious use of antibiotics and solicit a better understanding of the current state of stewardship from future antibiotic stewards.
Study 1. A Qualitative Study of the Knowledge and Attitudes of Infectious Disease Fellows, sought to understand the attitudes and beliefs of infectious disease fellows on the front line of antibiotic stewardship. Fellows highlighted the importance of formal and informal education, explained the challenges faced when practicing stewardship, and suggested improvements to fellowship programs to encourage better antibiotic stewardship training.
Study 2. Patient-Provider Race and Sex Concordance in Prescribing, explored how race and sex concordance between patients and providers predicted overprescribing. Results showed that racial concordance was one of the most important predictors of overprescribing, suggesting that concordance can be more important to the prescribing outcome than some clinical indicators and that improving cross-cultural communication may be a way to combat overprescribing.
Study 3. Early Prescribing Behavior as a Predictor of Future Antibiotic Exposure and Resource Utilization, described how the decision whether or not to prescribe antibiotics at a child’s first acute bronchitis visit affected that child’s likelihood of returning for an additional acute bronchitis complaint and being prescribed an antibiotic. The results of this study suggested that the prescribing behavior of providers can affect future visits and subsequent prescribing.2019-03-11T00:00:00Z
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WU, HSIN-YING, and 吳昕穎. "The Impact of Cultural on Taiwan and China Physicians’ Antibiotic Prescribing Behavior Using Antibiotic Stewardship System." Thesis, 2017. http://ndltd.ncl.edu.tw/handle/69729662366236369996.
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碩士國立中正大學
資訊管理系醫療資訊管理研究所
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After the execution of the Interim Measures for the Administration of Sino-foreign Equity Joint and Cooperative Joint Medical Institutions, many Taiwan hospitals went to mainland China to open hospitals. Although, people from both sides have same language and origin, their working cultures are very different. In other words, the Taiwan hospitals may face many adaptions and management obstacles. Taiwan e-government has been ranked top worldwide for many years. Many countries came to Taiwan to learn the hospital information systems. However, can Taiwan hospitals use this advantage to run the hospitals in China is still an issue to be explored. In hospital management, antibiotic stewardship is the most important foundation for patient safety and medical care quality. Recently, misuse of antibiotics has become a world wild issue. The WHO even chose antimicrobial resistance and its global spread as the theme for the world health day in 2011.Many countries established policies and mechanism to control the spread of antimicrobial resistance. Studies showed that auditing prescription beforehand with computer-aided systems is a more effective method. Therefore, this study will explore the culture effects on physicians’ prescribing behavior while using the antibiotic steward information system. The theoretic foundation of the research model is planned behavior theory (TPB) which has been used to explore the physicians prescribing behavior in Europe. The research model will be modified by adding other variables through related literature reviews. The results of this study can be used to increase the completeness of TPB in explaining the subject area and as reference for Taiwan hospitals to understand the influence of working culture on physicians’ obedience of prescribing antibiotics using an antibiotic steward information system to further prevent antimicrobial resistance and enhance patients’ safety. The results show that, physicians in the use of antibiotic monitoring system, the greater the pressure, its use of the system will be higher. In terms of cultural regulation, the results show that the cultueal differences between the two sides will not affect the physician use antibiotic monitoring system to prescribe the behavior.
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LaClair, Bethany. "Evaluation of the Risk Factors for Antibiotic Resistance in Streptococcus Pneumoniae Cases in Georgia." 2013. http://scholarworks.gsu.edu/iph_theses/309.
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Introduction: Streptococcus pneumoniae is the main bacterial cause of pneumonia, bacteremia and meningitis. Incidence rates have decreased since the initiation of pneumococcal vaccines, but antibiotic resistant strains continue to emerge and place a heavy burden on healthcare systems to treat such serious resistant infections. This study looks at risk factors that increase a patients probability of contracting a drug resistant strain of S. pneumo.
Methods: Confirmed cases of S. pneumo were acquired through the Active Bacterial Core Surveillance program from 2009-2012 for the state of Georgia. Cumulative incidence rates, odds ratios and Pearson’s chi square were calculated to test for trends. Multi-logistic regression model was designed to control for covariates. Antibiotic Susceptibility results were analyzed by resistant profiles through WHONET.
Results: Cumulative incidence rates have decreased significantly, however antibiotic resistant and multidrug resistant strains have increased. Incidence rates for children less than five and adults over 65 have decreased, however, the burden of disease remains in young to middle adults. Antibiotic resistant strains have shifted from penicillin to erythromycin and cefotaxime.
Discussion: Interventions need to be targeted towards young to middle aged adults. Antibiotic stewardship programs should seek uniform guidelines to battle the increasing emergence of multidrug resistant strains.
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Carrara, Elena. "SAVE ‘Stewardship Antibiotica Verona’: a quality improvement project to reduce in-hospital antibiotic consumption in a setting with a high level of antimicrobial resistance." Doctoral thesis, 2021. http://hdl.handle.net/11562/1046021.
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Background: According to recent estimates from the European Centre for Disease Prevention and Control, Italy is the European country with the highest disease burden due to antimicrobial resistance (AMR). In line with the recommendations from the National Plan for Combating Antibiotic Resistance in Italy, in June 2018, the Verona University hospital started a quality improvement Antibiotic Stewardship (AS) intervention aimed at reducing antibiotic consumption and infections sustained by targeted AMR pathogens. Methods: The core elements of the SAVE (Stewardship Antibiotica VErona) intervention were: I. Qualitative assessment of determinants of antibiotic prescribing via a 21-item questionnaire; II. provision of a full-time Infectious Disease specialist to the intervention ward for 12 weeks; III. mandatory CME-accredited training for at least two physicians per intervention ward; IV. development of customized guidance on empirical antibiotic therapy, and V. nine months of periodic audits and feedbacks targeting inappropriate prescriptions. The primary outcome of the intervention was to show a reduction in the overall consumption of systemic antibiotics (ATC-J01) measured as Days of Therapy (DOTs) and Daily Defined Doses (DDDs) per 1000 patient-days (PDs). Secondary outcomes were carbapenems and fluoroquinolones consumption, all-cause in-hospital mortality, mean length of hospital stay, the incidence of Clostridium difficile infections, and carbapenem-resistant Enterobacteriaceae bloodstream infections. The AS intervention's effect on monthly antibiotic consumption, clinical and microbiological outcomes was assessed with an interrupted-time-series analysis comparing the 12-month pre-intervention phase with the 21-month following the intervention’s start. Results: from June 2018 to March 2020, four medical wards completed the follow-up, 57 medical doctors participated in the initial assessment questionnaire, eight non-Infectious Disease physicians were trained in antibiotic prescribing, and 1116 prescriptions were revised during the audit and feedback phase. The AS intervention was associated with a significant immediate reduction in the level of overall antibiotic consumption, measured both in terms of DOTs*1000 PDs (-162.2; P=0.005) and DDDs*1000 PDs (-183.6; P=<0.001). During the whole post-intervention phase, consumption kept decreasing with a monthly rate of 3.6 DDD*100PDs (P= 0.04) and 3.36 DOTs*1000PDs (P=0.03). Reduction in consumption was consistent also in the two target antibiotic classes (-35.5 DOTs*1000PDs for fluoroquinolones and - 23.1 DOTs*1000PDs for carbapenems, P=0.03 and 0.003 respectively). However, while the fluoroquinolones class maintained a long-term significant reduction (-2.1 DOTs*1000PDs, P=0.016), carbapenem consumption remained approximately stable during the whole post-intervention period (-0.04 DOTs*1000PDs, P>0.05). The AS intervention was also associated with a significant early reduction in the mean length of hospital stay (-1.72 days P<0.001) and all-cause mortality rates (-3.71 deaths*100 admissions) with a significant decrease of the trend in the post-intervention period compared to the pre-intervention period (- 0.17 days per month and -0,26 death*100 admissions per month; P= 0.012 and 0.001). Rates of Clostridium difficile and carbapenem-resistant Enterobacteriaceae bloodstream infections tended to reduce, although non-significantly, in both the early and the long-term phase after the intervention. Conclusions: The SAVE intervention was effective and safe in reducing antibiotic consumption and length of hospital-stay in four medical wards. Although results are promising, more observations and a more extended follow-up period might be needed to demonstrate the AS program's decisive effect in reducing AMR's clinical burden.
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Soares, Ana Raquel Castanheira Finote. "O contributo dos enfermeiros na Antibiotic Stewardship: perceções, atitudes e conhecimentos de um grupo de enfermeiros portugueses." Master's thesis, 2018. http://hdl.handle.net/10362/52477.
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RESUMO - Objetivos: O presente estudo tem como objetivo conhecer as perceções, atitudes e
conhecimentos de um grupo de enfermeiros portugueses em relação à Antibiotic
Stewardship (AS).
Metodologia: Este estudo assume um carácter observacional e exploratório. Recorreuse
a uma amostra de conveniência, composta por enfermeiros inscritos na ANCI e por
enfermeiros que exercem funções no CHLO. Para a recolha de dados foi elaborado um
questionário tendo-se procedido, posteriormente, à análise estatística das respostas
com recurso ao software SPSS-24.0©.
Resultados: Existe uma tendência, na amostra de enfermeiros inquiridos, para
considerar que o enfermeiro poderá contribuir para a redução das resistências aos
antibióticos. Contudo, os participantes identificam necessidades de formação, tanto a
nível pré como pós-graduado. Ao mesmo tempo, referem ser necessário o
desenvolvimento de programas que apoiem a inclusão dos enfermeiros na AS. Por outro
lado, os inquiridos apontam que a inclusão do enfermeiro na AS poderia não ser bem
aceite por toda a equipa de saúde e identificam algumas potenciais barreiras que se
relacionam com fatores relacionais, de conhecimentos e com a desmotivação dos
profissionais.
Conclusões: Os enfermeiros desempenham uma série de funções que estão
intimamente relacionadas com a promoção da AS. Contudo, o envolvimento destes nos
programas de AS nem sempre é reconhecido e não se encontra formalizado. Será
necessário que esta inclusão seja fundamentada por recomendações oficiais e
acompanhada de formação a nível pré e pós-graduado. É importante promover o
desenvolvimento de uma cultura de AS que inclua não só os enfermeiros, mas todos os
membros da equipa multidisciplinar de saúde.ABSTRACT - Objectives: This study aims to understand perceptions, attitudes and knowledge of a group of portuguese nurses on antibiotic stewardship (AS). Methods: An observational and exploratory study was conducted. A convinience sample was selected from a group of nurses enrolled on ANCI and from nurses working at CHLO. A survey was created and developed for the data collection and, subsequently, a statistical analysis was performed using SPSS-24.0©software. Results: The participants tend to consider that nurses already play a role to reduce antibiotic resistance. However, the need for education was stated both on post and pre graduate levels. At the same time, participants highlight the need to develop programs that support nursing engagement on AS. On the other hand, this group of nurses stated that the inclusion of nurses on AS would not be easily accepted by everyone on the healthcare team. Some barriers identified were related to relational factors as well as the lack of knowledge and demotivation felt by the nurses themselves. Conclusions: Although nurses are already responsible for an amount of functions that are deeply related to AS, their engage on this programs is not always recognized nor is formalized in any way. To do so, and include nurses on AS programs, the development of official recommendations will be needed and should be supported by training and educational interventions both for nurses and nursing students. Finally, it is important to develop an AS culture that includes not only nurses, but all the multidisciplinary health team.
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Al, Matar MA. "Implementation and evaluation of tailored intervention strategies to influence antibiotic prescribing for community-acquired pneumonia." Thesis, 2015. https://eprints.utas.edu.au/22746/1/Al_Matar_whole_thesis.pdf.
Full textAbstract:
Adherence to guidelines for the management of community-acquired pneumonia (CAP) has been shown to improve patients’ clinical outcomes. However, several studies have indicated that the chosen antibiotic regimen is frequently not consistent with guideline recommendations. This might lead to suboptimal treatment, either by exposing patients to a greater risk of treatment failure or by unnecessary use of broad-spectrum antibiotics, which contributes to the emergence of antibiotic-resistant pathogens or consequent development of Clostridium difficile-associated diarrhoea. It has been demonstrated that active implementation of CAP guidelines can significantly improve adherence to recommendations, which consequently, might improve patients’ clinical outcomes.
The present research developed, implemented and evaluated tailored intervention strategies to improve physicians’ concordance with CAP guidelines. A number of inter-related studies were conducted as a part of this research project.
Firstly, baseline data was collected to measure the level of physicians’ adherence to national CAP guidelines in two Tasmanian hospitals, the Royal Hobart Hospital (RHH) and North Western Regional Hospital (NWRH). It was evident in that study that adherence to CAP management guidelines was poor at both study sites (16.1% and 7.5% for RHH and NWRH, respectively).
This was followed by a study to identify and quantify potential barriers to the adherence to CAP guideline recommendations. A questionnaire was distributed to RHH doctors in non-surgical areas of practice. Of the study population, 43.1% doctors responded to the survey; of those who responded, 46.4% thought the influence of senior doctors on their juniors could be a factor affecting adherence to the guidelines. Other barriers noted were a lack of guideline awareness (39.3%), the requirement to calculate the severity of CAP (35.7%), and the existence of other guidelines that conflict with Therapeutic Guidelines: antibiotic, version 14 (TG14; 28.6%).
A qualitative study was then designed to determine factors that influence doctors working within the emergency department (ED) to prescribe ceftriaxone outside the TG14 recommendations. Eight face-to-face interviews were performed with ED doctors. Five main themes emerged as influencing decisions regarding the selection of ceftriaxone for patients with CAP: (i) clinical intuition compared to a structured evaluation of severity, (ii) clinical uncertainty, (iii) prior clinical experience, (iv) source of guidance and (v) prescribing etiquette.
A questionnaire survey was then sent to infectious disease pharmacists nationally in order to identify the strategies that have been used and perceived as successful for the management of CAP in their institutions. Of the study population, 41 pharmacists (27.3%) responded to the questionnaire. Of these, 90.2% pharmacists reported their hospitals having an antimicrobial stewardship (AMS) program. Multifaceted strategies to enhance antibiotic prescribing in ED for CAP, were mentioned as being in place in all responses. However, the largest number of the respondents (34.1%) considered use of CAP clinical pathways to be the most effective strategy.
Intervention strategies were subsequently developed and implemented based on the findings from the above studies. Two interventions were implemented over two time periods: one with general strategies across medical units and a second focused on the ED. During the general intervention period, local CAP guidelines (based on TG14) were released. The guidelines were developed and approved by the hospital’s medical and emergency departments. The release of the CAP guidelines was accompanied by a multifaceted educational package to increase awareness of the guidelines. Medical and ED teams were targeted in the educational package, which included group sessions, wall posters and laminated lanyard cards summarising the local guidelines. During the second time period, two further strategies were introduced (a CAP clinical management pathway and monthly auditing with feedback) and targeted specifically at ED staff.
We evaluated the impact of the interventions on guideline adherence rates and clinical outcomes (mortality rates and hospital length of stay, LOS). To evaluate the impact of the intervention, two hospital sites were selected, one (RHH) acted as an intervention site and the other (NWRH) as a control site where no intervention was made. The study found the intervention had an overall impact on guideline adherence rates at the intervention site, and it reduced overall mortality rates and LOS for patients with non-severe CAP. Compared to the baseline data, the adherence rate increased significantly at the RHH during the intervention period (16.1% vs 50%; p < 0.05). However, no significant improvement was indicated in the control site (7.5% vs 19.1%; p > 0.05). The in-patient mortality was significantly lower in the intervention group when compared to the non-intervention groups (all baseline data plus the data from the NWRH during the intervention period) (3.4% vs 7.3%; p < 0.05). Sub-group analysis revealed patients with non-severe CAP in the intervention group had an average LOS 0.8 days shorter than the non-intervention groups (p < 0.05).
Results from the previous study indicated a positive impact of the intervention in the overall adherence to CAP recommendations. However, two main strategies were conducted in two consecutive times during the intervention periods, a general intervention and an ED-focused intervention. Therefore, a time-series analysis was conducted to determine the impact of strategies over time at the intervention site. The rates of adherence to the CAP guidelines during the pre-intervention (5 months) and general intervention periods (5 months) were 28.1% and 31.2%, respectively. The difference was not statistically significant. During the ED-focused intervention period (7 months), the level of adherence with guidelines was significantly higher at 61.5% (p < 0.05).
Finally, we evaluated the use of ceftriaxone in all indications in two time periods, before and after the initiation of the intervention. The aim of this study was to determine if our intervention in CAP management could affect the use of ceftriaxone in other indications. Concordance to the TG14 for all indications, with the exception of respiratory tract infection (RTI), was similar between the two study periods. For the RTI, concordant use of ceftriaxone significantly increased from 50% during the first period to 64.5% during the second study period (p < 0.05). Among community-acquired lower respiratory tract infections, our findings indicated a significant decrease in the unnecessary use of ceftriaxone for patients with mild CAP and acute exacerbation of chronic obstructive pulmonary disease in the intervention group (both 19% vs 3.2%; p < 0.05). However, there were no significant changes in the appropriate prescribing of ceftriaxone for other indications.
In conclusion, this research project identified, with in-depth analysis, potential factors that lead to the prescription of discordant antibiotic regimens for empirical management of CAP. It was subsequently demonstrated that a tailored multifaceted intervention significantly improved adherence to CAP guidelines, which consequently reduced the inappropriate prescribing of ceftriaxone for this indication. This was associated with a decrease in mortality rate and length of hospital stay among patients in the intervention group.
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Laka, Mah. "The Role of Computer Computer-based Clinical Decision Support Systems (CDSS) in Improving Antibiotic Management." Thesis, 2021. https://hdl.handle.net/2440/135248.
Full textAbstract:
Background Inappropriate antibiotic prescribing is a key contributor to increasing antibiotic resistance. Despite the standard practices promoted through clinical practice guidelines (CPGs), treatment regimens are not always in accordance with these guidelines. In Australia, a significant proportion of inappropriate antibiotic prescriptions in hospitals and primary care is due to noncompliance with CPGs. This is further exacerbated by the difficulty faced by clinicians in integrating and managing multiple information streams at the point of care to inform evidence-based decision- making. There is increasing recognition that digital health interventions such as clinical decision support systems (CDSS) may assist in optimising antimicrobial management. CDSS provide treatment recommendations based on patient-specific risk factors and research evidence, allowing clinicians to provide personalised care. Many studies provide evidence of the potential of CDSS for promoting optimal antibiotic management; however, adoption of these systems in clinical practice remains low. In addition to this lack of effective system adoption, there is a high rate of clinicians’ ignoring or overriding the systems’ recommendations or only engaging with partial use of the systems’ features. These factors limit the efficacy of CDSS in improving antibiotic prescribing. Objective The objective of this thesis was to evaluate individual, organisational, and system-level factors that impact CDSS implementation for evidence-based antibiotic management. An understanding of the different aspects of CDSS implementation in Australia has been sought by bringing together the perceptions and experiences of different stakeholders. The project aimed to achieve this objective by i) synthesising the evidence on the efficacy of CDSS for antibiotic management; ii) understanding clinicians’ perceptions regarding CDSS use for optimal antibiotic prescribing; and iii) evaluating the challenges of integrating CDSS into the healthcare system. Methods To achieve the objectives outlined above, the thesis was divided into four studies: In study I, a systematic review and meta-analyses were conducted to evaluate the impact of CDSS implementation on various clinical and economic outcomes associated with antibiotic management. The study protocol was developed using the PRISMA-P checklist. Studies were selected using specific pre-defined study eligibility criteria. Studies providing sufficient data on the outcomes were included in the meta-analyses to calculate pooled effect estimates of the impact of CDSS implementation on antibiotic management. In studies II & III, a cross-sectional online survey was conducted in Australia. Clinicians directly involved in prescribing, administering, and managing antibiotics in hospital and primary care settings were invited to participate. We adopted the Unified Theory of Acceptance and Use of Technology (UTAUT) model to understand factors contributing to clinicians’ inappropriate antibiotic prescribing behaviour and their behavioural intent to adopt CDSS. Using this framework, we also examined the role of moderating factors such as gender, age, clinical experience, and care settings in shaping users’ behaviour in adopting CDSS. We used multivariate logistic regression models to investigate the association between these moderating factors and users’ perceptions regarding CDSS adoption. Finally, in study IV, we used a qualitative approach to conduct in-depth interviews with policymakers involved in the implementation and evaluation of CDSS in Australia. The focus of this study was to understand what is required to effectively scale-up CDSS implementation from pilot studies to a system-wide innovation. Participants shared their experiences and perceptions concerning the gaps and challenges in the Australian healthcare system for integration of CDSS into healthcare processes. The interview transcripts were thematically analysed to establish a contextual understanding of the system-wide challenges for CDSS implementation. Results Results from this research highlight that CDSS can help reduce the risk of inappropriate antibiotic prescribing by increasing compliance with prescribing guidelines. The findings further indicate that CDSS can improve antibiotic prescribing by reducing the volume of overall antibiotic use, duration of therapy, length of hospital stay and thereby decreasing the overall cost of therapy. However, most of the evidence included in our systematic review was from studies having moderate to low methodological quality. Non-randomised studies tended to overestimate the effect of CDSS on appropriate antibiotic management, compared to randomised studies. However, the direction of the effect was largely consistent across both study types and favoured the positive impact of CDSS for antibiotic management. There was also substantial statistical heterogeneity in the results across the included studies which can be explained by the large variability in CDSS adoption across studies. Findings from the survey with clinicians indicated that different individual and setting specific characteristics are important factors that influence clinicians’ perceptions regarding CDSS adoption and lead to variability in uptake across different clinicians. Experienced clinicians were more sceptical of using CDSS for clinical decision-making, potentially due to limited digital health literacy, mistrust in the information provided by CDSS and fear of compromising their professional autonomy. Similarly, in comparison to users, CDSS non-users were more likely to lack trust in CDSS recommendations and fear compromising their professional autonomy due to CDSS adoption. A lack of transparency and explainability in CDSS design, in which end-users are not aware of how systems have computed recommendations can reduce their trust in CDSS. Consistent with the context of primary care, primary care clinicians believed that time constraints and patient expectations were important drivers of CDSS adoption. These findings highlight that the efficacy of CDSS implementation may be limited by a lack of consideration of contextual factors such as clinical experience, setting of use, and users’ skills which impact the users’ behaviour to adopt CDSS. Targeted clinician engagement, digital health literacy and better communication of the reliability of information provided may assist with more successful implementation of CDSS at point of care. Interviews with Australian policymakers further explored system-level challenges and gaps that may impede successful CDSS implementation. The results show that the lack of shared vision between different stakeholders, and the fragmented infrastructure within the healthcare system are major barriers to the integration of CDSS within existing processes in the healthcare system. CDSS implementation needs to be supported by an effective governance structure that can establish clear roles, prioritise investment in health system capacity building and incorporate cross-discipline and inter-organisational collaboration for quality data sharing. The ability of CDSS to ensure coordinated and interoperable care by exchanging information across organisations requires mutually agreed data standards at a national level. There is a need to establish standards not only for generating data in a standardised format, but for semantic interoperability that allows data communication and interpretation across different systems. Notwithstanding the significance of standardisation to ensure interoperability in CDSS, our findings also highlight that this standardisation must be balanced with adequate flexibility in the CDSS design and implementation process, so that user and setting specific requirements can be incorporated to improve adoption. Conclusion In conclusion, our findings illustrate that CDSS reflects best practice for antibiotic management through evidence-based clinical decision making, integrating the knowledge base, and flagging medication errors. The integration of these systems in healthcare settings is, however, challenging due to the complex interaction between the system, organisational and human factors. The findings from our research suggests that individual and setting characteristics such as clinical experience, use of CDSS and the type of setting, influence the clinicians’ perception of CDSS role in antibiotic management. These characteristics provide a better understanding of why CDSS adoption varies across different clinicians and care settings. We also found that the lack of synergy evident between multiple stakeholders and organisations - who seem to have varying interests and objectives regarding CDSS implementation - is limiting the ability to develop a shared vision and collaborative action. These findings provide evidence firm foundation for policymakers for developing a holistic CDSS implementation framework that considers the interaction of the system within the context of organisational and human behavioural characteristics. Implementation processes need to be tailored to specific user and setting requirements for improved adoption and use of CDSS by clinicians. A better understanding of the clinical culture would support successful CDSS implementation, along with effective strategies to develop broader digital literacy, methods for sustaining clinicians’ engagement with the technology, and approaches to facilitating cross-discipline collaboration.Thesis (Ph.D.) -- University of Adelaide, School of Public Health, 2022
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Bashar, Muhammad Augie. "Effects of antimicrobial stewardship policy in improving antibiotic utilisation and reducing drug costs in a public hospital in Gauteng Province, South Africa." Thesis, 2018. https://hdl.handle.net/10539/25303.
Full textAbstract:
A dissertation submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science in Medicine.
Johannesburg, 2017.Antimicrobial stewardship (AMS) programmes along with infection and prevention control measures have been shown to reduce the burden of antimicrobial resistance (AMR) in hospitals. There is a global campaign by infectious diseases physicians and other stakeholders for hospitals to implement AMS programmes. In Africa, there have been a limited number of AMS studies conducted although South African private hospitals have published some outcomes on initiation of these programmes in the continent, with the aim of improving patients’ clinical outcomes and reducing the development of resistance to prescribed antibiotics. A formal AMS programme is yet to be implemented in the surgery departments of the Charlotte Maxeke Johannesburg Academic Hospital. This study was conducted in two surgical wards of the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). It was a quantitative study combining a prevalence cross-sectional observational stage, and an intervention study. It involved a retrospective review of patient records in the baseline stage followed by an intervention which took the form of a weekly antibiotic round led by an infectious diseases specialist. The appropriateness of antibiotic prescriptions was assessed using the criteria developed by Gyssens and colleagues, while the appropriateness of surgical prophylaxis was determined based on the recommendations of the South African Antibiotic Stewardship Programme (SAASP) and current Standard Treatment Guidelines and Essential Medicines Lists for South Africa. The prices of the antibiotics used were obtained from the central pharmacy of the CMJAH and Masters Price Catalogue list of the National Department of Health, while the prices of laboratory tests were obtained from the Tariff database. The volume of antibiotics consumed was determined by Defined Daily Doses (DDDs)/1000 patient days. In both stages of the study amoxicillin/clavulanic acid was the most frequently used agent. The intravenous route was the most commonly used route of drug administration in both stages of the study. There was a reduction in the proportion of patients who were treated with antibiotics for more than seven days in the intervention stage, from 6.19% in the baseline stage to 2.07% in the intervention stage. A significant reduction in the duration of antibiotic therapy for two days and more was observed from 4.74 ± 4.58 days in the baseline stage compared to 3.96 ± 2.04 days in the intervention stage (p = 0.01). A shift from empiric to culture directed therapy was also observed in the intervention stage compared to the baseline stage. There was a significant reduction in the volume of antibiotic consumption from a total of 739.30 DDDs/1000 patient days in the baseline stage to 564.93 DDDs/1000 patient days in the intervention stage (p = 0.038). Overall, there was a significant reduction of inappropriate antibiotic utilisation from 35% in the baseline stage to 26% in the intervention stage (p = 0.006). A high percentage of inappropriate surgical prophylaxis was found which was mostly due to the incorrect choice of agent with 64.75% and 61.54% in the baseline and intervention stages, respectively. The average antibiotic cost per patient was reduced from R 268.23 ± 389.32 to R 228.03 ± 326.88 in the Vascular Surgery Ward compared to the General Surgery Ward where there was an increase in average cost per patient from R 219.80 ± 400.75 in the baseline stage to R 284.06 ± 461.28 in the intervention stage. Gram-negative bacteria were the most prevalent pathogens in both stages of the study at 53% in the baseline and 54% during the intervention stage. The findings of this study show an improvement in the appropriateness of antibiotic utilisation, reduction in antibiotic consumption and cost reduction in one of the study wards, following implementation of an AMS programme. Also, there was an improvement in culture directed therapy, requests for an appropriate biological specimen for culture, with a consequent increase in the cost of laboratory investigations per patient during the intervention stage, which was due to increases in culture request. Rational antimicrobial prescribing habits, strong AMS interventions along with infection and prevention control measures, sound government policies and surveillance of resistant organisms in Africa will go a long way in preserving our antibiotics and preventing the spread of multidrug-resistant pathogens.
LG2018
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Danek, Kelly Jean. "Procalcitonin and its efficacy in reducing duration of antibiotics in critically ill patients with sepsis." Thesis, 2019. https://hdl.handle.net/2144/38647.
Full textAbstract:
The overuse of antibiotics is a large problem in healthcare today, accelerating the
development of microbial resistance to antibiotics. Antibiotic stewardship campaigns
have been implemented to help clinicians curb their use. Procalcitonin is a serum peptide
and marker of inflammation secreted in response to microbial toxins. For this reason it is
more specific to bacterial infections than other markers of general inflammation , like Creactive
protein. The population of patients with sepsis in the Intensive Care Unit is one
in which extended durations of antibiotics are used. The FDA has approved use of
procalcitonin to guide de-escalation of antibiotic therapy in critically ill patients with
sepsis to avoid both antibiotic overuse and antibiotic related side effects. Review of
current literature shows that procalcitonin is efficacious in reducing duration of antibiotic
therapy in patients with sepsis in the ICU setting. This result, however, is not being
observed in clinical practice. This discrepancy is due to the inappropriate use of
procalcitonin that does not align with use outlined in randomized control trials. We
propose a study to determine how procalcitonin is being used in clinical practice in four
Boston area hospital Intensive Care Units. Through chart review, we will identify patients
in the Intensive Care Unit with sepsis from 2013-2018 recording patient demographic
information and patient characteristics. We will determine whether they had PCT
measured during their stay, and if they did, whether or not discontinuation of antibiotics
was in accordance with FDA’s proposed algorithm. We will aim to compare whether
discontinuing antibiotic therapy in accordance with the FDA’s procalcitonin deescalation
algorithm is associated with reduced duration of antibiotic therapy or incidence
of Clostridium Difficile infection. In conducting this study, we hope to identify patterns
of procalcitonin use in clinical practice and provide further evidence that using the
algorithm to guide therapy can serve as an effective tool in reducing exposure to
unnecessary antibiotics and the complications from their use.
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Lübbert, Christoph. "Epidemiologie, Klinik, Ausbruchs- und Therapiemanagement von Krankenhausinfektionen durch Carbapenemase bildende Klebsiella pneumoniae und Toxin produzierende Stämme von Clostridium difficile." Doctoral thesis, 2014. https://ul.qucosa.de/id/qucosa%3A13218.
Full textAbstract:
Die Mehrzahl der jährlich 400.000 bis 600.000 Krankenhausinfektionen in Deutschland wird von Erregern der sog. ESCAPE-Gruppe (Enterococcus faecium, Staphylococcus aureus, Clostridium difficile, Acinetobacter baumannii, Pseudomonas aeruginosa und verschiedene Enterobacteriaceae, u.a. Klebsiella pneumoniae) verursacht. Besondere Sorge bereitet dabei die Ausbreitung von K. pneumoniae-Stämmen mit enzymvermittelter Resistenz gegenüber Carbapenem-Antibiotika (K. pneumoniae-Carbapenemase, KPC) und die Zunahme von C. difficile-Infektionen (CDI) durch hypervirulente Epidemiestämme (z.B. Ribotyp 027).
Die spezifischen Erfahrungen eines prolongierten Ausbruchsgeschehens durch einen KPC-bildenden K. pneumoniae-Stamm (KPC-KP) am Leipziger Universitätsklinikum machen deutlich, dass bei diesem Erregertyp ein hohes Transmissionspotential bei enormer Tenazität (Umweltresistenz) zu berücksichtigen ist, ein Versagen von Standardhygienemaßnahmen in Betracht zu ziehen ist, und Infektionsketten oftmals unklar bleiben. Die Anwendung von Antibiotika ist bei KPC-KP-Infektionen auf einzelne Substanzen (Colistin, Tigecyclin, Gentamicin) beschränkt und vor allem bei immunsupprimierten Patienten (z.B. Lebertransplantierte) mit einem relevanten Risiko des Therapieversagens behaftet. Die Therapie von CDI wird gerade bei Immunsupprimierten durch eine steigende Zahl an Rezidiven erschwert, die teilweise antibiotisch (Vancomycin, Fidaxomicin) nicht beherrschbar sind, so dass alternative Therapieverfahren wie die fäkale Bakterientherapie („Stuhltransplantation“) zur Anwendung kommen. CDI-Rezidive, aber auch eine dauerhafte intestinale Besiedelung mit multiresistenten Enterobakterien wie KPC-KP, scheinen neben wirtsspezifischen Faktoren der Immunantwort durch eine Dysregulation der physiologischen intestinalen Standortflora mit Störung der Kolonisationsresistenz bedingt zu sein. Der Versuch einer Eradikationsbehandlung von Patienten mit persistierender intestinaler Besiedelung durch KPC-KP mittels oraler Applikation der nicht resorbierbaren Antibiotika Colistin und Gentamicin ist mit einem relevanten Risiko der Entstehung von Sekundärresistenzen behaftet.
Die Zulassung neuer, besser wirksamer Antibiotika ist für die nächsten Jahre nicht in Sicht, so dass der Infektionsprävention überragende Bedeutung zukommt. Die Erfahrungen der KPC-Ausbruchsbewältigung am Leipziger Universitätsklinikum zeigen, dass nahezu lückenlose Compliance bei der Händedesinfektion, rigoros praktizierte und kontrollierte Barriere- und Isolationsmaßnahmen, Optimierung des Gebrauchs von Breitspektrum-Antibiotika (sog. „Antibiotic Stewardship“) und systematisches mikrobiologisches Erregerscreening dabei unabdingbar sind.
Nachhaltige Verbesserungen hinsichtlich der globalen Ausbreitung von multiresistenten Krankenhausbakterien werden sich nur durch grundlegende Umgestaltungen in Umwelt, Landwirtschaft, Tierzucht und Gesundheitswesen mit sparsamer und möglichst gezielter Anwendung von Antibiotika erzielen lassen. Um Risikopopulationen hospitalisierter Patienten vor potentiell lebensbedrohlichen Erregertransmissionen effektiv schützen zu können, sind erweiterte Surveillance und konsequent umgesetzte krankenhaushygienische Maßnahmen erforderlich.