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Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations

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A special issue of Antibiotics (ISSN 2079-6382).

Deadline for manuscript submissions: closed (31 January 2024) | Viewed by 18262

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Prof. Dr. Gyöngyvér Soós

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1. Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
2. Department of Dermato-oncology, Semmelweis University, H-1085 Budapest, Hungary
Interests: clinical pharmacy; medication use; antibiotics
Special Issues, Collections and Topics in MDPI journals

Dr. Ria Benkő

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Guest Editor

1. Clinical Pharmacy Department, Faculty of Pharmacy, University of Szeged, H-6725 Szeged, Hungary
2. Central Pharmacy, Albert Szent- Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
3. Department of Emergency Medicine, Albert Szent.- Györgyi Medical Center, University of Szeged, H-6725 Szeged, Hungary
Interests: drug utilization research regarding antibiotics both ambulatory and hospital settings
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Antimicrobial use is the one of the main drivers of antimicrobial resistance (AMR), a crisis that threatens not just modern medicine but all of us individually. As rationalizing antimicrobial use can be controlled by effective antibiotic stewardship measures, target points of interventions and determinants should be identified by drug utilization studies.

This Special Issue focuses on human antimicrobial exposure and safety issues and seeks new findings and insights related to antimicrobial use across the world. Population level national/regional drug utilization data and local field studies on antimicrobials from all healthcare settings using both quantitative and qualitative research methods are welcomed. Specific and vulnerable patient populations such as pediatrics, elderly, pregnant women, patients with different co-morbidities, ICU patients, etc. are also of interest in this Special Issue. If you have any questions or wonder whether your study is within the scope of the Special Issue, please contact the Antibiotics Editorial Office.

Prof. Dr. Gyöngyvér Soós
Dr. Ria Benkő
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

ambulatory care
hospital care
long-term healthcare facilities (nursing homes)
quality of antibiotic use
scale of use
pattern of use
prevalence of antibiotic use
specific patient populations
safety of use
antibacterial
antivirals
antifungals
anti-TBC

Published Papers (10 papers)

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Research

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16 pages, 703 KiB

Open AccessArticle

Cefto Real-Life Study: Real-World Data on the Use of Ceftobiprole in a Multicenter Spanish Cohort

by Carmen Hidalgo-Tenorio, Inés Pitto-Robles, Daniel Arnés García, F. Javier Membrillo de Novales, Laura Morata, Raul Mendez, Olga Bravo de Pablo, Vicente Abril López de Medrano, Miguel Salavert Lleti, Pilar Vizcarra, Jaime Lora-Tamayo, Ana Arnáiz García, Leonor Moreno Núñez, Mar Masiá, Maria Pilar Ruiz Seco and Svetlana Sadyrbaeva-Dolgova

Antibiotics 2023, 12(7), 1218; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12071218 - 21 Jul 2023

Cited by 2 | Viewed by 1141

Abstract

Background: Ceftobiprole is a fifth-generation cephalosporin that has been approved in Europe solely for the treatment of community-acquired and nosocomial pneumonia. The objective was to analyze the use of ceftobiprole medocaril (Cefto-M) in Spanish clinical practice in patients with infections in hospital or outpatient parenteral antimicrobial therapy (OPAT). Methods: This retrospective, observational, multicenter study included patients treated from 1 September 2021 to 31 December 2022. Results: A total of 249 individuals were enrolled, aged 66.6 ± 15.4 years, of whom 59.4% were male with a Charlson index of four (IQR 2–6), 13.7% had COVID-19, and 4.8% were in an intensive care unit (ICU). The most frequent type of infection was respiratory (55.8%), followed by skin and soft tissue infection (21.7%). Cefto-M was administered to 67.9% of the patients as an empirical treatment, in which was administered as monotherapy for 7 days (5–10) in 53.8% of cases. The infection-related mortality was 11.2%. The highest mortality rates were identified for ventilator-associated pneumonia (40%) and infections due to methicillin-resistant Staphylococus aureus (20.8%) and Pseudomonas aeruginosa (16.1%). The mortality-related factors were age (OR: 1.1, 95%CI (1.04–1.16)), ICU admission (OR: 42.02, 95%CI (4.49–393.4)), and sepsis/septic shock (OR: 2.94, 95%CI (1.01–8.54)). Conclusions: In real life, Cefto-M is a safe antibiotic, comprising only half of prescriptions for respiratory infections, that is mainly administered as rescue therapy in pluripathological patients with severe infectious diseases. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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12 pages, 1186 KiB

Open AccessArticle

Antimicrobial Stewardship in COVID-19 Patients: Those Who Sow Will Reap Even through Hard Times

by Marcella Sibani, Lorenzo Maria Canziani, Chiara Tonolli, Maddalena Armellini, Elena Carrara, Fulvia Mazzaferri, Michela Conti, SAVE Working Group, Annarita Mazzariol, Claudio Micheletto, Andrea Dalbeni, Domenico Girelli and Evelina Tacconelli

Antibiotics 2023, 12(6), 1009; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12061009 - 04 Jun 2023

Cited by 1 | Viewed by 1174

Abstract

Background: Since the SARS-CoV-2 pandemic emerged, antimicrobial stewardship (AS) activities need to be diverted into COVID-19 management. Methods: In order to assess the impact of COVID-19 on AS activities, we analyzed changes in antibiotic consumption in moderate-to-severe COVID-19 patients admitted to four units in a tertiary-care hospital across three COVID-19 waves. The AS program was introduced at the hospital in 2018. During the first wave, COVID-19 forced the complete withdrawal of hospital AS activities. In the second wave, antibiotic guidance calibration for COVID-19 patients was implemented in all units, with enhanced stewardship activities in Units 1, 2, and 3 (intervention units). In a controlled before and after study, antimicrobial usage during the three waves of the COVID-19 pandemic was compared to the 12-month prepandemic unit (Unit 4 acted as the control). Antibiotic consumption data were analyzed as the overall consumption, stratified by the World Health Organization AWaRe classification, and expressed as defined-daily-dose (DDD) and days-of-therapy (DOT) per 1000 patient-day (PD). Results: In the first wave, the overall normalized DOT in units 2–4 significantly exceeded the 2019 level (2019: 587 DOT/1000 PD ± 42.6; Unit 2: 836 ± 77.1; Unit 3: 684 ± 122.3; Unit 4: 872, ± 162.6; p < 0.05). After the introduction of AS activities, consumption decreased in the intervention units to a significantly lower level when compared to 2019 (Unit 1: 498 DOT/1000 PD ± 49; Unit 2: 232 ± 95.7; Unit 3: 382 ± 96.9; p < 0.05). Antimicrobial stewardship activities resulted in a decreased amount of total antibiotic consumption over time and positively affected the watch class and piperacillin-tazobactam use in the involved units. Conclusions: During a pandemic, the implementation of calibrated AS activities represents a sound investment in avoiding inappropriate antibiotic therapy. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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14 pages, 1280 KiB

Open AccessArticle

Antibiotic Misuse Behaviours of Older People: Confirmation of the Factor Structure of the Antibiotic Use Questionnaire

by Loni Schramm, Mitchell K. Byrne and Taylor Sweetnam

Antibiotics 2023, 12(4), 718; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12040718 - 06 Apr 2023

Cited by 1 | Viewed by 1658

Abstract

Antibacterial resistance (AR) is responsible for steadily rising numbers of untreatable bacterial infections, most prevalently found in the older adult (OA) population due to age-related physical and cognitive deterioration, more frequent and long-lasting hospital visits, and reduced immunity. There are currently no established measures of antibiotic use behaviours for older adults, and theory-informed approaches to identifying the drivers of antibiotic use in older adults are lacking in the literature. The objective of this study was to identify predictors of antibiotic use and misuse in older adults using the Antibiotic Use Questionnaire (AUQ), a measure informed by the factors of the Theory of Planned Behaviour (TPB): attitudes and beliefs, social norms, perceived behavioural control, behaviour, and a covariate—knowledge. A measure of social desirability was included, and participants scoring highly were excluded to control for social desirability bias. Confirmatory Factor Analyses and regression analyses were conducted to test the hypotheses in a cross-sectional, anonymous survey. A total of 211 participants completed the survey, 47 of which were excluded due to incompletion and high social desirability scores (≥5). Results of the factor analysis confirmed that some (but not all) factors from previous research in the general population were confirmed in the OA sample. No factors were found to be significant predictors of antibiotic use behaviour. Several suggestions for the variance in results from that of the first study are suggested, including challenges with meeting requirement for statistical power. The paper concludes that further research is required to determine the validity of the AUQ in an older adult population. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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10 pages, 1996 KiB

Open AccessArticle

A European International Multicentre Survey on the Current Practice of Perioperative Antibiotic Prophylaxis for Paediatric Liver Transplantations

by Juliane Hauschild, Nora Bruns, Elke Lainka and Christian Dohna-Schwake

Antibiotics 2023, 12(2), 292; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics12020292 - 01 Feb 2023

Viewed by 1190

Abstract

(1) Background: Postoperative infections are major contributors of morbidity and mortality after paediatric liver transplantation (pLTX). Evidence and recommendations regarding the most effective antimicrobial strategy are lacking. (2) Results: Of 39 pLTX centres, 20 responded. Aminopenicillins plus ß-lactamase inhibitors were used by six (30%) and third generation cephalosporins by three (15%), with the remaining centres reporting heterogenous regimens. Broad-spectrum regimens were the standard in 10 (50%) of centres and less frequent in the 16 (80%) centres with an infectious disease specialist. The duration ranged mainly between 24–48 h and 3–5 days in the absence and 3–5 days or 6–10 days in the presence of risk factors. Strategies regarding antifungal, antiviral, adjunctive antimicrobial, and surveillance strategies varied widely. (3) Methods: This international multicentre survey endorsed by the European Liver Transplant Registry queried all European pLTX centres from the registry on their current practice of perioperative antibiotic prophylaxis and antimicrobial strategies via an online questionnaire. (4) Conclusions: This survey found great heterogeneity regarding all aspects of postoperative antimicrobial treatment, surveillance, and prevention of infections in European pLTX centres. Evidence-based recommendations are urgently needed to optimise antimicrobial strategies and reduce the spectrum and duration of antimicrobial exposure. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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15 pages, 1472 KiB

Open AccessArticle

Developing a Tool for Auditing the Quality of Antibiotic Dispensing in Community Pharmacies: A Pilot Study

by Maarten Lambert, Ria Benkő, Athina Chalkidou, Jesper Lykkegaard, Malene Plejdrup Hansen, Carl Llor, Pia Touboul, Indrė Trečiokienė, Maria-Nefeli Karkana, Anna Kowalczyk and Katja Taxis

Antibiotics 2022, 11(11), 1529; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11111529 - 01 Nov 2022

Cited by 1 | Viewed by 2330

Abstract

Background: The European Centre for Disease Prevention and Control describes the community pharmacist as the gatekeeper to the quality of antibiotic use. The pharmacist has the responsibility to guard safe and effective antibiotic use; however, little is known about how this is implemented in practice. Aims: To assess the feasibility of a method to audit the quality of antibiotic dispensing in community pharmacy practice and to explore antibiotic dispensing practices in Greece, Lithuania, Poland, and Spain. Methods: The Audit Project Odense methodology to audit antibiotic dispensing practice was adapted for use in community pharmacy practice. Community pharmacists registered antibiotic dispensing on a specifically developed registration chart and were asked to provide feedback on the registration method. Results: Altogether, twenty pharmacists were recruited in four countries. They registered a total of 409 dispenses of oral antibiotics. Generally, pharmacists were positive about the feasibility of implementing the registration chart in practice. The frequency of checking for allergies, contraindications and interactions differed largely between the four countries. Pharmacists provided little advice to patients. The pharmacists rarely contacted prescribers. Conclusion: This tool seems to make it possible to get a useful picture of antibiotic dispensing patterns in community pharmacies. Dispensing practice does not seem to correspond with EU guidelines according to these preliminary results. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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11 pages, 405 KiB

Open AccessArticle

Effect of Fluoroquinolone Use in Primary Care on the Development and Gradual Decay of Escherichia coli Resistance to Fluoroquinolones: A Matched Case-Control Study

by Peter Konstantin Kurotschka, Chiara Fulgenzio, Roberto Da Cas, Giuseppe Traversa, Gianluigi Ferrante, Orietta Massidda, Ildikó Gágyor, Richard Aschbacher, Verena Moser, Elisabetta Pagani, Stefania Spila Alegiani and Marco Massari

Antibiotics 2022, 11(6), 822; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11060822 - 18 Jun 2022

Cited by 5 | Viewed by 1920

Abstract

The reversibility of bacterial resistance to antibiotics is poorly understood. Therefore, the aim of this study was to determine, over a period of five years, the effect of fluoroquinolone (FQ) use in primary care on the development and gradual decay of Escherichia coli resistance to FQ. In this matched case–control study, we linked three sources of secondary data of the Health Service of the Autonomous Province of Bolzano, Italy. Cases were all those with an FQ-resistant E. coli (QREC)-positive culture from any site during a 2016 hospital stay. Data were analyzed using conditional logistic regression. A total of 409 cases were matched to 993 controls (FQ-sensitive E. coli) by the date of the first isolate. Patients taking one or more courses of FQ were at higher risk of QREC colonization/infection. The risk was highest during the first year after FQ was taken (OR 2.67, 95%CI 1.92–3.70, p < 0.0001), decreased during the second year (OR 1.54, 95%CI 1.09–2.17, p = 0.015) and became undetectable afterwards (OR 1.09, 95%CI 0.80–1.48, p = 0.997). In the first year, the risk of resistance was highest after greater cumulative exposure to FQs. Moreover, older age, male sex, longer hospital stays, chronic obstructive pulmonary disease (COPD) and diabetes mellitus were independent risk factors for QREC colonization/infection. A single FQ course significantly increases the risk of QREC colonization/infection for no less than two years. This risk is higher in cases of multiple courses, longer hospital stays, COPD and diabetes; in males; and in older patients. These findings may inform public campaigns and courses directed to prescribers to promote rational antibiotic use. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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10 pages, 254 KiB

Open AccessArticle

The Impact of a Post-Prescription Review and Feedback Antimicrobial Stewardship Program in Lebanon

by Anita Shallal, Chloe Lahoud, Dunia Merhej, Sandra Youssef, Jelena Verkler, Linda Kaljee, Tyler Prentiss, Seema Joshi, Marcus Zervos and Madonna Matar

Antibiotics 2022, 11(5), 642; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11050642 - 11 May 2022

Cited by 6 | Viewed by 1603

Abstract

Antimicrobial stewardship programs (ASPs) are effective means to optimize prescribing practices. They are under-utilized in the Middle East where many challenges exist for ASP implementation. We assessed the effectiveness of infectious disease physician-driven post-prescription review and feedback as an ASP in Lebanon. This prospective cohort study was conducted over an 18-month period in the medical, surgical, and intensive care units of a tertiary care hospital. It consisted of three phases: the baseline, intervention, and follow-up. There was a washout period of two months between each phase. Patients aged ≥16 years receiving 48 h of antibiotics were included. During the intervention phase, the AMS team reviewed antimicrobial use within 72 h post-prescription and gave alternate recommendations based on the guidelines for use. The acceptance of the recommendations was measured at 72 h. The primary outcome of the study was days of therapy per 1000 study patient days. A total of 328 patients were recruited in the baseline phase (August–October 2020), 467 patients in the intervention phase (January–June 2021), and 301 patients in the post-intervention phase (September–December 2021). The total days of therapy decreased from 11.46 during the baseline phase to 8.64 during the intervention phase (p < 0.001). Intervention acceptance occurred 88.5% of the time. The infectious disease physician-driven implementation of an ASP was successful in reducing antibiotic utilization in an acute care setting in Lebanon. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

17 pages, 705 KiB

Open AccessArticle

Impact of Guideline Adherence on Outcomes in Patients Hospitalized with Community-Acquired Pneumonia (CAP) in Hungary: A Retrospective Observational Study

by Adina Fésüs, Ria Benkő, Mária Matuz, Zsófia Engi, Roxána Ruzsa, Helga Hambalek, Árpád Illés and Gábor Kardos

Antibiotics 2022, 11(4), 468; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11040468 - 30 Mar 2022

Cited by 6 | Viewed by 3802

Abstract

Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. This retrospective observational study evaluated the antibiotic prescription patterns and associations between guideline adherence and outcomes in patients hospitalized with CAP in Hungary. Main outcome measures were adherence to national and international CAP guidelines (agent choice, dose) when using empirical antibiotics, antibiotic exposure, and clinical outcomes. Demographic and clinical characteristics of patients with CAP in the 30-day mortality and 30-day survival groups were compared. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. Adherence to the national CAP guideline for initial empirical therapies was 30.61% (45/147) for agent choice and 88.89% (40/45) for dose. Average duration of antibiotic therapy for CAP was 7.13 ± 4.37 (mean ± SD) days, while average antibiotic consumption was 11.41 ± 8.59 DDD/patient (range 1–44.5). Adherence to national guideline led to a slightly lower 30-day mortality rate than guideline non-adherence (15.56% vs. 16.67%, p > 0.05). In patients aged ≥ 85 years, 30-day mortality was 3 times higher than in those aged 65–84 years (30.43% vs. 11.11%). A significant difference was found between 30-day non-survivors and 30-day survivors regarding the average CRP values on admission (177.28 ± 118.94 vs. 112.88 ± 93.47 mg/L, respectively, p = 0.006) and CCI score (5.71 ± 1.85 and 4.67 ± 1.83, p = 0.012). We found poor adherence to the national and international CAP guidelines in terms of agent choice. In addition, high CRP values on admission were markedly associated with higher mortality in CAP. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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Review

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14 pages, 731 KiB

Open AccessReview

Antibiotic Therapy for Active Crohn’s Disease Targeting Pathogens: An Overview and Update

by Gaetano Iaquinto, Giuseppe Mazzarella, Carmine Sellitto, Angela Lucariello, Raffaele Melina, Salvatore Iaquinto, Antonio De Luca and Vera Rotondi Aufiero

Antibiotics 2024, 13(2), 151; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics13020151 - 03 Feb 2024

Viewed by 1085

Abstract

Crohn’s disease (CD) is a multifactorial chronic disorder that involves a combination of factors, including genetics, immune response, and gut microbiota. Therapy includes salicylates, immunosuppressive agents, corticosteroids, and biologic drugs. International guidelines do not recommend the use of antibiotics for CD patients, except in the case of septic complications. Increasing evidence of the involvement of gut bacteria in this chronic disease supports the rationale for using antibiotics as the primary treatment for active CD. In recent decades, several pathogens have been reported to be involved in the development of CD, but only Escherichia coli (E. coli) and Mycobacterium avium paratubercolosis (MAP) have aroused interest due to their strong association with CD pathogenesis. Several meta-analyses have been published concerning antibiotic treatment for CD patients, but randomized trials testing antibiotic treatment against E. coli and MAP have not shown prolonged benefits and have generated conflicting results; several questions are still unresolved regarding trial design, antibiotic dosing, the formulation used, the treatment course, and the outcome measures. In this paper, we provide an overview and update of the trials testing antibiotic treatment for active CD patients, taking into account the role of pathogens, the mechanisms by which different antibiotics act on harmful pathogens, and antibiotic resistance. Finally, we also present new lines of study for the future regarding the use of antibiotics to treat patients with active CD. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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Other

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7 pages, 1073 KiB

Open AccessBrief Report

The Effect of the COVID-19 Pandemic on Outpatient Antibiotic Prescription Rates in Children and Adolescents—A Claims-Based Study in Germany

by Manas K. Akmatov, Claudia Kohring, Lotte Dammertz, Joachim Heuer, Maike Below, Jörg Bätzing and Jakob Holstiege

Antibiotics 2022, 11(10), 1433; https://0-doi-org.brum.beds.ac.uk/10.3390/antibiotics11101433 - 18 Oct 2022

Cited by 4 | Viewed by 1452

Abstract

The aim of the study was to examine whether the COVID-19 pandemic had any effect on antibiotic prescription rates in children in Germany. Using the nationwide outpatient prescription data from the Statutory Health Insurance from 2010 to 2021, changes in the monthly prescriptions of systemic antibiotics dispensed to children aged 0–14 years were examined (n = 9,688,483 in 2021). Interrupted time series analysis was used to assess the effect of mitigation measures against SARS-COV-2, introduced in March and November 2020, on antibiotic prescription rates. In the pre-pandemic period, the antibiotic prescription rates displayed a linear decrease from 2010 to 2019 (mean annual decrease, –6%). In 2020, an immediate effect of mitigation measures on prescription rates was observed; in particular, the rate decreased steeply in April (RR 0.24, 95% CI: 0.14–0.41) and November 2020 (0.44, 0.27–0.73). The decrease was observed in all ages and for all antibiotic subgroups. However, this effect was temporary. Regionally, prescription rates were highly correlated between 2019 and 2020/2021. Substantial reductions in antibiotic prescription rates following the mitigation measures may indicate limited access to medical care, changes in care-seeking behavior and/or a decrease of respiratory infections. Despite an all-time low of antibiotic use, regional variations remained high and strongly correlated with pre-pandemic levels. Full article

(This article belongs to the Special Issue Antimicrobial Use across Different Healthcare Settings, Countries and Specific Populations)

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