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Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting.

ABSTRACT: Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center involved post-prescriptive audits tracking polymyxin consumption and evaluating prescription appropriateness in terms of the right indication, right frequency, right drug, right duration of therapy and administration of the right loading dose (LD) and maintenance dose (MD). Among the 2442 polymyxin prescriptions tracked over the entire study period ranging from February 2016 to January 2020, the number of prescriptions dropped from 772 prescriptions in the pre-implementation period to an average of 417 per year during the post-implementation period, recording a 45% reduction. The quarterly patient survival rates had a significant positive correlation with the quarterly prescription appropriateness rates (r = 0.4774, p = 0.02), right loading dose (r = 0.5228, p = 0.015) and right duration (r = 0.4361, p = 0.04). Our study on the epidemiology of polymyxin use demonstrated favorable effects on the appropriateness of prescriptions and mortality benefits after successful implementation of antimicrobial stewardship in a real-world setting.

SUBMITTER: Sathyapalan DT

PROVIDER: S-EPMC8142974 | biostudies-literature | 2021 Apr

REPOSITORIES: biostudies-literature

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Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting.

Sathyapalan Dipu T DT James Jini J Sudhir Sangita S Nampoothiri Vrinda V Bhaskaran Praveena N PN Shashindran Nandita N Thomas Jisha J Prasanna Preetha P Mohamed Zubair Umer ZU Edathadathil Fabia F Singh Sanjeev S Moni Merlin M

Antibiotics (Basel, Switzerland) 20210421 5

Polymyxins being last resort drugs to treat infections triggered by multidrug-resistant pathogens necessitates the implementation of antimicrobial stewardship program (ASP) initiatives to support its rational prescription across healthcare settings. Our study aims to describe the change in the epidemiology of polymyxins and patient outcomes following the implementation of ASP at our institution. The antimicrobial stewardship program initiated in February 2016 at our 1300 bed tertiary care center ...[more]

PMID: 33918994

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Project description:ImportanceThere is a lack of studies comparing the intended and unintended consequences of prospective review and feedback (PRF) with computerized decision support systems (CDSS), especially in the longer term in antimicrobial stewardship.ObjectiveTo examine the outcomes associated with the sequential implementation of PRF and CDSS and changes to these interventions with long-term use of antibiotics for and incidence of multidrug resistant organisms (MDROs) and other unintended outcomes.Design, setting, and participantsThis cohort study used an interrupted time series with segmented regression analysis of data from January 2007 to December 2018. Data were extracted from the electronic medical records of patients admitted at a large university teaching hospital with high rates of antibiotic resistance in Singapore. Data were analyzed from June 2019 to June 2020.ExposuresPRF of piperacillin-tazobactam and carbapenems (intervention 1, April 2009), with the addition of hospital-wide CDSS (intervention 2, April 2011), and lifting of CDSS for half of the hospital wards for 6 months (intervention 3, March 2017).Main outcomes and measuresMonthly antimicrobial use was measured in defined daily doses (DDDs) per 1000 patient-days. The monthly incidence of MDROs was calculated as number of clinical isolates detected per 1000 inpatient-days over a 6-month period. Unintended outcomes examined included in-hospital mortality and age-adjusted length of stay (LOS).ResultsThe number of inpatients increased from 56 263 in 2007 to 63 572 in 2018. During the same period, the mean monthly patient days increased from 33 929 in 2007 to 45 603 in 2018, and the proportion of patients older than 65 years increased from 45.5% in 2007 to 56.6% in 2018. After intervention 1, there were 0.33 (95% CI, 0.18 to 0.48) more DDDs per 1000 patient-days per month of piperacillin-tazobactam and carbapenems and -11.05 (95% CI, -15.55 to -6.55) fewer DDDs per 1000 patient-days per month for other broad-spectrum antibiotics. After intervention 2, there were -0.22 (95% CI, -0.33 to -0.10) fewer DDDs per 1000 patient-days per month of piperacillin-tazobactam and carbapenems and -2.10 (95% CI, -3.13 to -1.07) fewer DDDs per 1000 patient-days per month for other broad-spectrum antibiotics. After intervention 3, use of piperacillin-tazobactam and carbapenem increased by 0.28 (95% CI, 0.02 to 0.55) DDDs per 1000 patient-days per month. After intervention 2, incidence of Clostridioides difficile decreased (estimate, -0.02 [95% CI, -0.03 to -0.01] cases per 1000 patient-days per month).Conclusions and relevanceIn this cohort study, concurrent PRF and CDSS were associated with limiting the use of piperacillin-tazobactam and carbapenems while reducing use of other antibiotics.

Project description:BackgroundExisting evidence underscores inappropriate antimicrobial prescribing and use in the community setting. Increased and inappropriate antimicrobial use are major factors contributing to the emergence and transmission of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programmes are critical for mitigating AMR, enhancing patient outcomes, and reducing healthcare costs. Despite the existing Australian National Action Plan on AMR, optimisation of antimicrobial use in the community setting remains inadequately investigated. This study explored health professionals' perspectives on community AMS practices and systems, identifying challenges and areas for improvement.MethodsThis qualitative study utilised semi-structured interviews to explore the perspectives of 17 different health professionals from diverse community practice settings in South-East Queensland, Australia. Interviews were audio-recorded, anonymised, and transcribed verbatim. Data were thematically analysed, with NVivo 12 utilised for organisation and analysis. Data were then mapped and examined using the Elements of Medicines Stewardship (EMS), which aligns with United States Centers for Disease Control and Prevention- Core Elements of Antibiotic Stewardship. This was reported following the consolidated criteria for reporting qualitative research checklist.ResultsFour main themes described the health professionals' insights on community AMS practices and systems. Thematic analysis from these findings reveals a state of ambiguity and fragmentation in the community AMS practices and systems. In comparison to the hospital-based AMS system, the Australian community AMS system appears to be in its nascent stages of development. Applying the EMS is essential for developing and implementing community AMS strategies to enhance practices and systems.ConclusionThe study identified key health system factors that impact the implementation of community AMS programmes and highlighted the need for developing community-specific governance and frameworks that integrate multidisciplinary strategies to support effective implementation and enhance patient outcomes. This research will inform community AMS intervention strategies, influencing policy and practice to advance sustainable healthcare and address antimicrobial resistance.

Dataset Information

Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting.

Publications

Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting.

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