Surveillance of Antimicrobial Use on Different Levels

Background: excessive and incorrect use of antibiotics is a common event that contributes to increased bacterial resistance to antibiotics. Based on the European Centre for Disease Control and Prevention (ECDC) European Surveillance of Antimicrobial Consumption (ESAC)-Net reports, outpatient antibiotics prescribing in Poland, is higher than the European average rate. However, ECDC reports do not provide data on consumption in specific patient groups. Additional studies focused on selected patient groups are needed for a more detailed analysis. The use of antibiotics during pregnancy is inevitable due to the proven risk of complications in this period, perinatal infections, and infections in newborns, in the situation of frequent infections of the genital tract, urinary tract, and asymptomatic bacteriuria in pregnant women. The aim of this study was to analyze the use of antibiotics/the implementation of antibiotic prescriptions ordered by gynecologists during pregnancy in pregnant women in Małopolska Voivodeship, with particular emphasis on demographic data and drug groups. Material and methods: the analysis used data on the reimbursement of antibiotics from the Małopolska Health Fund for 2013–2014. The database contained information of a demographic nature: age, place of residence, date of birth, as well as information on the type of drug, and the number of packages purchased by the patients. Results: the study included 67,917 women. During pregnancy, 23.6% filled their prescriptions for antibiotics. In the first trimester, the percentage of women filling their prescriptions for antibiotics was the lowest and amounted to 7.8%, in the second and third trimesters, these were 9.0% and 11.2%, respectively. The inhabitants of rural areas bought antibiotics more often (23.5%). Most frequently, antibiotics were purchased by women under 18 years of age (32.1%), but the use of antibiotics in women aged 18–34 and over 35 was similar, amounting to 23.8% and 22.7%, respectively. Most often (94.78% of cases) monotherapy was used, including beta-lactams and beta-lactams with an inhibitor (67.3%), then second-generation cephalosporins (13.5%), macrolides (14.73%), and others. Prescription of two different preparations was found in 5.06% of cases, three (0.19%), and four or more (0.03%). Conclusions: due to the fact that studies on antibiotic therapy in pregnant women in Poland are rare, it is impossible to assess the situation thoroughly. Additionally, in Poland, the prevalence of gestational infections is unknown, and their diagnostics is important, especially in relation to microbiological diagnostics and targeted treatment. However, the present results indicate the need to implement broad health promotion programs, accessible to all women, also those living outside large cities, particularly promoting the prevention of urinary tract infections and reproductive health in general. Full article

Antibiotic stewardship programs optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. In this prospective interventional study, a multidisciplinary team led by surgeons implemented a program aimed at shortening the duration of antibiotic treatment <7 days. The impact of the intervention on antibiotic consumption adjusted to bed-days and discharges, and the isolation of multiresistant bacteria (MRB) was also studied. Furthermore, the surgeons were surveyed regarding their beliefs and feelings about the program. Out of 1409 patients, 40.7% received antibiotic therapy. Treatment continued for over 7 days in 21.5% of cases, and, as can be expected, source control was achieved in only 48.8% of these cases. The recommendations were followed in 90.2% of cases, the most frequent being to withdraw the treatment (55.6%). During the first 16 months of the intervention, a sharp decrease in the percentage of extended treatments, with R² = 0.111 was observed. The program was very well accepted by surgeons, and achieved a decrease in both the consumption of carbapenems and in the number of MRB isolations. Multidisciplinary stewardship teams led by surgeons seem to be well received and able to better manage antibiotic prescription in surgery. Full article

The objective of the study was to evaluate the capacity of GERH^®-derived local resistance maps (LRMs) to predict antibiotic susceptibility profiles and recommend the appropriate empirical treatment for ICU patients with nosocomial infection. Data gathered between 2007 and 2016 were retrospectively studied to compare susceptibility information from antibiograms of microorganisms isolated in blood cultures, lower respiratory tract samples, and urine samples from all ICU patients meeting clinical criteria for infection with the susceptibility mapped by LRMs for these bacterial species. Susceptibility described by LRMs was concordant with in vitro study results in 73.9% of cases. The LRM-predicted outcome agreed with the antibiogram result in >90% of cases infected with the bacteria for which GERH^® offers data on susceptibility to daptomycin, vancomycin, teicoplanin, linezolid, and rifampicin. Full adherence to LRM recommendations would have improved the percentage adequacy of empirical prescriptions by 2.2% for lower respiratory tract infections (p = 0.018), 3.1% for bacteremia (p = 0.07), and 5.3% for urinary tract infections (p = 0.142). LRMs may moderately improve the adequacy of empirical antibiotic therapy, especially for lower respiratory tract infections. LRMs recommend appropriate prescriptions in approximately 50% of cases but are less useful in patients with bacteremia or urinary tract infection. Full article

We aimed to assess antibiotic usage and knowledge regarding antibiotics and antimicrobial resistance (AMR) among undergraduate students of the Universiti Brunei Darussalam (UBD), public university located in Brunei Darussalam. A cross-sectional study was performed using a self-administered questionnaire. The questionnaire was adapted from the World Health Organization’s (WHO) “Antibiotic resistance: Multi-country public awareness” survey distributed online. Students at the UBD were invited to participate in the online survey through internal email. The questionnaire consisted of five sections: demographic information, antibiotic usage, knowledge on antibiotics, antibiotic resistance (AMR), and use of antibiotics in agriculture. The data were analyzed descriptively and appropriate inferential statistics were used accordingly. A total of 130 students returned a completed questionnaire. The result of the study found that 51% (n = 66) of the students had good level of knowledge of antibiotic and antimicrobial resistance with a mean total knowledge score of nine out of 14. Of note, 76% (n = 99) of the respondents mistakenly believed that antibiotic resistance is the result of the body becoming resistant to antibiotics. Only 14% (n = 18) of the respondents were found to have poor knowledge on antibiotics and antimicrobial resistance in the study. Misconceptions in regards to the use of antibiotics for conditions related to viral illnesses like cold and flu (41%, n = 53) were noticed among the respondents in our study. Thus, improving knowledge on antibiotics is crucial to address these beliefs. Full article

Some of the most serious healthcare-associated infections (HAI) are highly deadly bloodstream infections (BSIs) caused by Staphylococcus aureus. The aim of the study was to analyse compliance of treatment practice with clinical guidelines in patients with S. aureus BSIs. The study was conducted at the Sosnowiec Hospital, Poland in 2019. During the study, 29,747 patients were hospitalized and 41 S. aureus BSIs (only HAIs) episodes were observed. According to local clinical practice guidelines, each case of BSI required blood cultures, echocardiography and control culture after the implementation of the targeted therapy. Incidence rate of S. aureus BSI was 0.8/1000 admissions; the greatest department admission rates were in the ICU (19.3/1000 admissions) and in the Nephrology Department (8.7/1000 admissions). Only 2 patients were treated following the protocol (4.8%); the most common errors were the use of an inappropriate drug or incorrect duration of antibiotic treatment. No patient underwent echocardiography, and control cultures were performed in 70% of cases. The case fatality rate was 7.3%. A satisfactorily low case fatality rate was found despite the poor antibiotic stewardship. Lack of discipline concerning antibiotic use can strongly impact the observed high drug resistance in HAIs and high Clostridioides difficile incidence rate in the studied hospital. Full article

Background: The most important pathomechanism of Clostridioides difficile infections (CDI) is post-antibiotic intestinal dysbiosis. CDI affects both ambulatory and hospital patients. Aim: The objective of the study was to analyze the possibility of utilizing databases from the European Centre for Disease Prevention and Control subject to surveillance for the purpose of identifying areas that require intervention with respect to public health. Methods: The analysis encompassed data concerning CDI incidence and antibiotic consumption expressed as defined daily doses (DDD) and quality indicators for antimicrobial-consumption involving both ambulatory and hospital patients in 2016. Results: In 2016, in the European Union countries, total antibiotic consumption in hospital and outpatient treatment amounted to 20.4 DDD (SD 7.89, range 11.04–39.69); in ambulatory treatment using average of ten times more antibiotics than hospitals. In total, 44.9% of antibiotics used in outpatient procedures were broad-spectrum antibiotics. We have found a significant relationship between the quality of antibiotics and their consumption: The more broad-spectrum antibiotics prescribed, the higher the sales of antibiotics both in the community sector and in total. CDI incidence did not statistically significantly correlate with the remaining factors analyzed on a country-wide level. Conclusion: Antibiotic consumption and the CDI incidence may depend on many national variables associated with local systems of healthcare organization and financing. Their interpretation in international comparisons does not give clear-cut answers and requires caution. Full article