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Abstract

Background

Robust data on the quality of antimicrobial prescriptions in German acute care hospitals are scarce. To establish and implement antimicrobial stewardship (AMS) measures and to increase prudent antimicrobial use (AMU), the identification of appropriate process and quality indicators is pertinent.

Aim

Our main objective was to identify parameters associated with adequate AMU and inadequate AMU by analysing point prevalence data. Our secondary goal was to describe the current state of AMS implementation in Germany.

Methods

A national point prevalence survey for healthcare-associated infections and AMU was conducted in German hospitals in 2016. Data on structure and process parameters were also collected. Recorded antimicrobial prescriptions were divided into adequate, inadequate and undefinable AMU. A multivariable linear regression analysis was performed to examine the correlation of selected structure and process parameters with the adequacy of recorded antimicrobials.

Results

Data from 218 acute care hospitals, 64,412 patients and 22,086 administered antimicrobials were included. Multivariable linear regression analysis revealed that documentation of a reason for AMU in the patient notes increased the likelihood of adequate AMU and decreased the likelihood of inadequate AMU significantly (p < 0.001), while tertiary care hospital type had the opposite effect (p < 0.001).

Conclusion

Through associating structural and process parameters with adequacy of AMU, we identified parameters that increased the odds of prudent AMU. Documentation was a key element for improving AMU. Revealed deficits regarding the implementation of AMS in German hospitals concerning dedicated staff for AMS activities and establishment of regular AMU training and AMU audits should be tackled.

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/content/10.2807/1560-7917.ES.2019.24.46.1900281
2019-11-14
2024-12-10
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.46.1900281
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References

  1. Charani E, Holmes A. Antibiotic Stewardship-Twenty Years in the Making. Antibiotics (Basel). 2019;8(1):E7.  https://doi.org/10.3390/antibiotics8010007  PMID: 30678365 
  2. Dyar OJ, Huttner B, Schouten J, Pulcini C, ESGAP (ESCMID Study Group for Antimicrobial stewardshiP). What is antimicrobial stewardship? Clin Microbiol Infect. 2017;23(11):793-8.  https://doi.org/10.1016/j.cmi.2017.08.026  PMID: 28882725 
  3. Aghdassi SJS, Gastmeier P, Piening BC, Behnke M, Peña Diaz LA, Gropmann A, et al. Antimicrobial usage in German acute care hospitals: results of the third national point prevalence survey and comparison with previous national point prevalence surveys. J Antimicrob Chemother. 2018;73(4):1077-83.  https://doi.org/10.1093/jac/dkx494  PMID: 29309607 
  4. Lübbert C, Schumacher U, Stareprawo S, Claus J, Heeß-Erler G, Fiebig C, et al. [Can the antibiotic prescription practice in a hospital be influenced by in-house guidelines? An interventional study at the University Hospital Halle (Saale), Germany]. Dtsch Med Wochenschr. 2014;139(50):2578-84. PMID: 25271804 
  5. Schweickert B, Kern WV, de With K, Meyer E, Berner R, Kresken M, et al. [Surveillance of antibiotic consumption : clarification of the "definition of data on the nature and extent of antibiotic consumption in hospitals according to § 23 paragraph 4 sentence 2 of the IfSG"]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2013;56(7):903-12.  https://doi.org/10.1007/s00103-013-1764-8  PMID: 23807401 
  6. Thern J, de With K, Strauss R, Steib-Bauert M, Weber N, Kern WV. Selection of hospital antimicrobial prescribing quality indicators: a consensus among German antibiotic stewardship (ABS) networkers. Infection. 2014;42(2):351-62.  https://doi.org/10.1007/s15010-013-0559-z  PMID: 24326986 
  7. de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, et al. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection. 2016;44(3):395-439.  https://doi.org/10.1007/s15010-016-0885-z  PMID: 27066980 
  8. Maechler F, Schwab F, Geffers C, Meyer E, Leistner R, Gastmeier P. Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units. Infection. 2014;42(1):119-25.  https://doi.org/10.1007/s15010-013-0531-y  PMID: 24135909 
  9. Kumar J, Raina R. ‘Never Events in Surgery’: Mere Error or an Avoidable Disaster. Indian J Surg. 2017;79(3):238-44.  https://doi.org/10.1007/s12262-017-1620-4  PMID: 28659678 
  10. Glowacki RC, Schwartz DN, Itokazu GS, Wisniewski MF, Kieszkowski P, Weinstein RA. Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance. Clin Infect Dis. 2003;37(1):59-64.  https://doi.org/10.1086/376623  PMID: 12830409 
  11. Liu J, Kaye KS, Mercuro NJ, Davis SL, Patel TS, Petty LA, et al. It is time to define antimicrobial never events. Infect Control Hosp Epidemiol. 2019;40(2):206-7.  https://doi.org/10.1017/ice.2018.313  PMID: 30516126 
  12. European Centre for Disease Prevention and Control (ECDC). Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals. Protocol version 5.3. Stockholm: ECDC; 2016. Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/PPS-HAI-antimicrobial-use-EU-acute-care-hospitals-V5-3.pdf
  13. Behnke M, Aghdassi SJ, Hansen S, Diaz LAP, Gastmeier P, Piening B. The Prevalence of Nosocomial Infection and Antibiotic Use in German Hospitals. Dtsch Arztebl Int. 2017;114(50):851-7.  https://doi.org/10.3238/arztebl.2017.0851  PMID: 29271343 
  14. WHO Collaborating Centre for Drug Statistics Methodology (WHOCC). Guidelines for ATC classification and DDD assignment 2013. Oslo: WHOCC; 2012. Available from: https://www.whocc.no/filearchive/publications/1_2013guidelines.pdf
  15. Charani E, Castro-Sanchéz E, Bradley S, Nathwani D, Holmes AH, Davey P. Implementation of antibiotic stewardship in different settings - results of an international survey. Antimicrob Resist Infect Control. 2019;8(1):34.  https://doi.org/10.1186/s13756-019-0493-7  PMID: 30805181 
  16. Nathwani D, Varghese D, Stephens J, Ansari W, Martin S, Charbonneau C. Value of hospital antimicrobial stewardship programs [ASPs]: a systematic review. Antimicrob Resist Infect Control. 2019;8(1):35.  https://doi.org/10.1186/s13756-019-0471-0  PMID: 30805182 
  17. Woodford EM, Wilson KA, Marriott JF. Documentation of antibiotic prescribing controls in UK NHS hospitals. J Antimicrob Chemother. 2004;53(4):650-2.  https://doi.org/10.1093/jac/dkh152  PMID: 15014063 
  18. Katsios CM, Burry L, Nelson S, Jivraj T, Lapinsky SE, Wax RS, et al. An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients. Crit Care. 2012;16(6):R216.  https://doi.org/10.1186/cc11854  PMID: 23127353 
  19. Pulcini C, Dellamonica J, Bernardin G, Molinari N, Sotto A. Impact of an intervention designed to improve the documentation of the reassessment of antibiotic therapies in an intensive care unit. Med Mal Infect. 2011;41(10):546-52.  https://doi.org/10.1016/j.medmal.2011.07.003  PMID: 21855239 
  20. Moody J, Cosgrove SE, Olmsted R, Septimus E, Aureden K, Oriola S, et al. Antimicrobial stewardship: a collaborative partnership between infection preventionists and healthcare epidemiologists. Infect Control Hosp Epidemiol. 2012;33(4):328-30.  https://doi.org/10.1086/665037  PMID: 22418626 
  21. Schuts EC, Hulscher MEJL, Mouton JW, Verduin CM, Stuart JWTC, Overdiek HWPM, et al. Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 2016;16(7):847-56.  https://doi.org/10.1016/S1473-3099(16)00065-7  PMID: 26947617 
  22. van Daalen FV, Prins JM, Opmeer BC, Boermeester MA, Visser CE, van Hest RM, et al. Effect of an antibiotic checklist on length of hospital stay and appropriate antibiotic use in adult patients treated with intravenous antibiotics: a stepped wedge cluster randomized trial. Clin Microbiol Infect. 2017;23(7):485.e1-8.  https://doi.org/10.1016/j.cmi.2017.01.019  PMID: 28159671 
  23. van Daalen FV, Prins JM, Opmeer BC, Boermeester MA, Visser CE, van Hest RM, et al. A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist. BMC Infect Dis. 2015;15(1):134.  https://doi.org/10.1186/s12879-015-0867-2  PMID: 25888180 
  24. Kuster SP, Ruef C, Bollinger AK, Ledergerber B, Hintermann A, Deplazes C, et al. Correlation between case mix index and antibiotic use in hospitals. J Antimicrob Chemother. 2008;62(4):837-42.  https://doi.org/10.1093/jac/dkn275  PMID: 18617509 
  25. Kaier K, Mutters NT, Frank U. Bed occupancy rates and hospital-acquired infections--should beds be kept empty? Clin Microbiol Infect. 2012;18(10):941-5.  https://doi.org/10.1111/j.1469-0691.2012.03956.x  PMID: 22757765 
  26. May M, Vetterlein MW, Wagenlehner FM, Brookman-May SD, Gilfrich C, Fritsche HM, et al. [What is the perception of the 10-point plan of the German Federal Ministry of Health against multidrug-resistant pathogens and measures of antibiotic stewardship?] Urologe A. 2017;56(10):1302-10.  https://doi.org/10.1007/s00120-017-0425-1  PMID: 28593351 
  27. Kallen MC, Binda F, Ten Oever J, Tebano G, Pulcini C, Murri R, et al. Comparison of antimicrobial stewardship programmes in acute-care hospitals in four European countries: A cross-sectional survey. Int J Antimicrob Agents. 2019;54(3):338-45.  https://doi.org/10.1016/j.ijantimicag.2019.06.005  PMID: 31200022 
  28. Perozziello A, Lescure FX, Truel A, Routelous C, Vaillant L, Yazdanpanah Y, et al. Prescribers’ experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey. J Antimicrob Chemother. 2019;74(8):2451-8.  https://doi.org/10.1093/jac/dkz179  PMID: 31167027 
  29. Christoph A, Ehm C, de With K. [Impact of an |A|B|S|-training initiative on |A|B|S|-structural quality of participating hospitals]. Z Evid Fortbild Qual Gesundhwes. 2015;109(7):521-7.  https://doi.org/10.1016/j.zefq.2015.09.021  PMID: 26593768 
  30. Chaberny IF, Wriggers A, Behnke M, Gastmeier P. Antibiotics: MRSA prevention measures in German hospitals: results of a survey among hospitals, performed as part of the MRSA-KISS module. Dtsch Arztebl Int. 2010;107(37):631-7. PMID: 20959890 
  31. Schweickert B, Feig M, Schneider M, Willrich N, Behnke M, Peña Diaz LA, et al. Antibiotic consumption in Germany: first data of a newly implemented web-based tool for local and national surveillance. J Antimicrob Chemother. 2018;73(12):3505-15.  https://doi.org/10.1093/jac/dky345  PMID: 30239728 
  32. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev. 2017;2:CD003543.  https://doi.org/10.1002/14651858.CD003543.pub4  PMID: 28178770 
  33. Allegranzi B, Bischoff P, de Jonge S, Kubilay NZ, Zayed B, Gomes SM, et al. New WHO recommendations on preoperative measures for surgical site infection prevention: an evidence-based global perspective. Lancet Infect Dis. 2016;16(12):e276-87.  https://doi.org/10.1016/S1473-3099(16)30398-X  PMID: 27816413 
  34. Ewig S, Höffken G, Kern WV, Rohde G, Flick H, Krause R, et al. [Management of Adult Community-acquired Pneumonia and Prevention - Update 2016]. Pneumologie. 2016;70(3):151-200. PMID: 26926396 
  35. van den Bosch CM, Geerlings SE, Natsch S, Prins JM, Hulscher ME. Quality indicators to measure appropriate antibiotic use in hospitalized adults. Clin Infect Dis. 2015;60(2):281-91.  https://doi.org/10.1093/cid/ciu747  PMID: 25266285 
  36. Kranz J, Schmidt S, Lebert C, Schneidewind L, Mandraka F, Kunze M, et al. The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients. Part II: Therapy and Prevention. Urol Int. 2018;100(3):271-8.  https://doi.org/10.1159/000487645  PMID: 29539622 
  37. Onakpoya IJ, Walker AS, Tan PS, Spencer EA, Gbinigie OA, Cook J, et al. Overview of systematic reviews assessing the evidence for shorter versus longer duration antibiotic treatment for bacterial infections in secondary care. PLoS One. 2018;13(3):e0194858.  https://doi.org/10.1371/journal.pone.0194858  PMID: 29590188 
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