Application of ATC/DDD methodology to evaluate perioperative antimicrobial prophylaxis

Objective To evaluate quality of perioperative antibiotic prophylaxis (PAP) and to calculate the cost per procedure in a Turkish university hospital. Setting A 352-bed teaching hospital in Denizli, Turkey. Method An prospective audit was performed between July and October 2010. All clean, clean-contaminated and contaminated elective surgical procedures in ten surgical wards were recorded. Antimicrobial use was calculated per procedure using the ATC-DDD system. The appropriateness of antibiotic use for each procedure was evaluated according to international guidelines on PAP. In addition, the cost per procedure was calculated. Results Overall, in 577 of the 625 (92.3%) of the studied procedures, PAP was used. PAP was indicated in 12.5% of the group where it was not used, and not indicated in 7.1% of the group where it was used. Unnecessarily prolonged antimicrobial prophylaxis was observed in 56.9% of the procedures, mean duration was 2.6?±?2.7?days. The most frequently used antimicrobials were cefazolin (117.9 DDD/100-operation) and sulbactam/ampicillin (102.2 DDD/100-operation). The timing of the starting dose was appropriate in 545 procedures (94.5%). In the group that received PAP, only 80 (13.7%) of the procedures were found to be fully appropriate and correct. The density of antimicrobial use per operation was 2.8 DDD. The mean cost of the use of prophylactic antimicrobials ?18.6 per procedure. Conclusion The density of antimicrobial use in PAP was found to be very high in our hospital. Antibiotic overuse extended into the postoperative period.     

Utilization of surgical antibiotic prophylaxis for obstetrics and gynaecology surgeries in Northern Nigeria

Background Audit of antibiotic prophylaxis is an important strategy used to identify areas where stewardship interventions are required. Objectives To evaluate compliance with surgical antibiotic prophylaxis in obstetrics and gynaecology surgeries and determine the Defined Daily Dose (DDD) of antibiotic. Settings Three public tertiary hospitals located in Northern Nigeria. Methods This prospective study included women who had obstetrics and gynaecology surgeries with no infection at the time of incision. Appropriateness of antibiotic prophylaxis was determined by a clinical pharmacist. DDD of antibiotics was determined using ATC/DDD index 2017 from the World Health Organization Collaborating Centre for Drugs Statistics Methodology. Main outcome measure Compliance with antibiotic prophylaxis and DDD of antibiotic per procedure. Results A total of 248 procedures were included (mean age: 31.7?±?7.9 years). Nitroimidazole in combination with either beta-lactam/beta-lactamase inhibitor or third generation cephalosporin were the most prescribed antibiotics. Redundant anaerobic antibiotic combination was detected in 71.4% of the procedures. Timing of antibiotic prophylaxis was optimal in 16.5% while duration of prophylaxis was prolonged in all the procedures (mean duration was 8.7?±?1.0 days). The DDD of antibiotics prophylaxis was 16.75 DDD/procedure. Antibiotic utilisation was higher in caesarean section and myomectomy (17.9 DDD/procedure) than hysterectomy (14.5 DDD/procedure); P?<?0.001. Redundant metronidazole represents one-third of total DDD and 87% of the DDD for metronidazole. Conclusion Excessive and inappropriate use of antibiotic prophylaxis was observed in women who had obstetrics and gynaecology surgeries. These observations underline the need for antimicrobial stewardship interventions to improve antibiotic use.     

Utilization of neurosurgical perioperative antimicrobial prophylaxis in a Chinese teaching hospital

Background Audits of antimicrobial prophylaxis is an essential strategy to identify practice gaps in antimicrobial prescribing in healthcare facilities. There is a lack of studies on the costs, quality, and antimicrobial use density of neurosurgical perioperative antimicrobial prophylaxis in China. Objectives Evaluate the appropriateness of perioperative antimicrobial prophylaxis in neurosurgeries and analyze the costs, quality, and antimicrobial use density of neurosurgical perioperative antimicrobial prophylaxis. Setting Beijing Tsinghua Changgung Hospital, a teaching hospital in Beijing. Methods This retrospective study was conducted among 262 neurosurgical patients without infections during 2017. The appropriateness of perioperative antimicrobial prophylaxis was determined based on relevant international and Chinese perioperative antimicrobial prophylaxis guidelines. Main outcome measures Discrepancy rates in perioperative antimicrobial prophylaxis, including indication, choice of antimicrobials, dose, route of administration, time of administration of the first dose, re-dosing, and duration, were analyzed. Results Discrepancies were observed between current practice and relevant guidelines. A total of 51 (32.1%) procedures failed to administer intraoperative re-dosing as needed, and the perioperative antimicrobial prophylaxis duration of 217 (82.8%) procedures was inappropriately prolonged. The choice of antimicrobial agents was optimal in 249 (95%) procedures, and the timing of perioperative antimicrobial prophylaxis was appropriate in all procedures. If perioperative antimicrobial prophylaxis was implemented according to guidelines, the defined daily dose per 100 procedures would decrease from 31.97 to 16.99, and the total cost would reduce from $2000 to $490. Conclusions Effective antimicrobial stewardship is urgently needed to promote the appropriateness of neurosurgical perioperative antimicrobial prophylaxis in China.

     

How does the general public view antibiotic use in China? Result from a cross-sectional survey

Background Resistance to antibiotics is a major threat to global health and general public play a significant role in the fight against antimicrobial resistance. Objective The present study aimed to identify the knowledge, attitudes, and practice of the general public towards antibiotic use in China. Setting Randomly selected parks in three cities of western, central and eastern China: Xi’an, Changsha, and Nanjing. Method A cross-sectional survey was conducted on a sample of 1400 residents, from January to June 2015. Main outcome measures Knowledge, attitudes and practices scores toward self-medication with antibiotics and compliance with antibiotic regimens. Results The response rate was 86.0% (n = 1204). Only 192 (19.5%) respondents gained a score of 3 or above, and the maximum score of 4, reflecting poor knowledge towards antibiotics. Just over half (54.8%) of respondents incorrectly believed antibiotics were effective against viral infections and only one-third (34.3%) knew that antibiotics were not anti-inflammatories. Nearly half of the respondents (49.0%) had changed the dosage when taking antibiotics, 35.6% switched to another class, 33.4% had not finished the full treatment course and over 60.0% kept leftover antibiotics for future use. Almost half of the respondents (45.7%) stated they had used antimicrobials during the last 6 months and 64.4% of them had self-medicated. Conclusion This study identified serious misconceptions regarding antibiotics use in the Chinese general public. Effective interventions should be developed to provide practical and appropriate advice to effect behaviour change within this population.

     

Outpatient Use of Systemic Antibiotics in Croatia

Objective: The aim was to estimate the outpatient utilization of antibacterials for systemic use in Zagreb, Croatia, and to define the antibiotic utilization characteristics and consequences.Method: Using the WHO ATC/DDD methodology, the number of defined daily doses per 1000 inhabitants per day (DDDs/TID) was calculated for each individual antibiotic and ATC system levels were calculated from data collected on the number and size of packages prescribed and dispensed from pharmacies. The Drug Utilization 90% (DU90%) method was used to evaluate the quality of drug prescribing.Results: The total utilization of antibiotics was found to be extremely high, 55.0 DDDs/TID. The leading antibiotic was amoxicillin + clavulanic acid with 14.7 DDDs/TID. Penicillins accounted for the highest utilization (46.3%) expressed in DDDs/TID (25.4), followed by cephalosporins and macrolides 25 and 12.5% of utilization, respectively expressed in DDDs/TID), tetracyclines, quinolones, aminoglycosides and other agents. Nine of 27 antibiotics fell within the DU90% segment. The cost/DDD foldrugs within DU90% segment was 1.2 EUR, for drugs beyond DU90% segment was 1.4 EUR, and the average was 1.2 EUR.Conclusion: Irrational prescribing and preference to more expensive drugs have been reported in Zagreb. Therefore, the risk of resistance of microorganisms to beta-lactamase antibiotics, macrolides and quinolones could be expected. Prescribing patterns should be changed by introducing national guidelines on rational antibiotic prescribing, monitoring and evaluation of their implementation. Additional continuing education of physicians and pharmacists from independent sources should be organized and proper education should be provided to patients.     

全程管理模式对临床药师抗感染会诊效果影响的前后对照单臂观察性研究

目的 探讨全程管理模式对医院临床药师抗感染会诊的影响效果。方法 对长沙市第四医院临床药师抗感染会诊实施全程管理模式前(2021年2—7月)的592例会诊病例和实施全程管理模式后(2022年2—7月)的688例会诊病例的抗菌药物使用疗程、抗菌药物使用品种数、抗菌药物使用费用、抗菌药物使用累计DDD(限定日剂量)数、抗菌药物使用强度、病人住院天数、病人住院费用和病人住院药品费用等指标进行对比和分析。结果 实施全程管理模式后,临床药师参与管理的抗感染会诊病例的抗菌药物使用累计DDD数减少3.31(实施前21.16±19.65,实施后17.85±16.09)、抗菌药物使用强度减少6.79(实施前103.22±58.37,实施后96.43±48.80)、病人住院天数减少2.26 d[实施前(20.59±13.13)d,实施后(18.33±11.71)d],抗菌药物使用天数、抗菌药物使用品种数、抗菌药物使用费用、病人住院费用以及病人住院药品费用等指标差异无统计学意义。结论 全程管理模式对临床药师抗感染会诊效果影响显著,对降低临床药师参与抗感染会诊病例的抗菌药物使用强度及减轻病人疾病负担具有重要意义...     

Low levels of methylmercury induce DNA damage in rats: protective effects of selenium

In this study we examined the possible antigenotoxic effect of selenium (Se) in rats chronically exposed to low levels of methylmercury (MeHg) and the association between glutathione peroxidase (GSH-Px) activity and DNA lesions (via comet assay) in the same exposed animals. Rats were divided into six groups as follows: (Group I) received water; (Group II) received MeHg (100 μg/day); (Group III) received Se (2 mg/L drinking water); (Group IV) received Se (6 mg/L drinking water); (Group V) received MeHg (100 μg/day) and Se (2 mg/L drinking water); (Group VI) received MeHg (100 μg/day) and Se (6 mg/L drinking water). Total treatment time was 100 days. GSH-Px activity was determined spectrophotometrically and DNA damage was determined by comet assay. Mean GSH-Px activity in groups I, II, III, IV, V and VI were, respectively: 40.19 ± 17.21; 23.63 ± 6.04; 42.64 ± 5.70; 38.50 ± 7.15; 34.54 ± 6.18 and 41.39 ± 11.67 nmolNADPH/min/gHb. DNA damage was represented by a mean score from 0 to 300; the results for groups I, II, III, IV, V and VI were, respectively: 6.87 ± 3.27; 124.12 ± 13.74; 10.62 ± 3.81; 13.25 ± 1.76; 86.87 ± 11.95 and 76.25 ± 7.48. There was a significant inhibition of GSH-Px activity in group II compared with group I (P < 0.05). Groups V and VI did not show a difference in enzyme activity compared with groups III and IV, showing the possible protective action of Se. Comet assay presented a significant difference in DNA migration between group II and group I (P < 0.0001). Groups V and VI showed a significant reduction in MeHg-induced genotoxicity (P < 0.001) when compared with group II. A negative correlation (r = −0.559, P < 0.05) was found between GSH-Px activity and DNA lesion, showing that the greater the DNA damage, the lower the GSH-Px activity. Our findings demonstrated the oxidative and genotoxic properties of MeHg, even at low doses. Moreover, Se co-administration reestablished GSH-Px activity and reduced DNA damage.     

Are local clinical guidelines useful in promoting rational use of antibiotic prophylaxis in Caesarean delivery?

Objectives To identify changes in prescribing patterns of antibiotic prophylaxis in Caesarean delivery after introduction of local clinical guidelines. To identify changes in outcomes of prescribing antibiotics following the implementation of local clinical guidelines on antibiotic prophylaxis. Setting University of Belgrade, Medical School, Clinic of Gynaecology and Obstetrics “Narodni front” Belgrade, Serbia. Method A quantitative retrospective analysis of antibiotic use before (January–June 2005), and following (January–June 2006) implementation of guidelines on antibiotic prophylaxis in two wards. Patients who underwent Caesarean section prior to (261) and following (281) introduction of local guidelines, participated in this study. Main outcome measures Drug utilization cost presented as the number of DDD/100 bed days/eur, the average duration of hospital stay, number of wound infections. Results There was a significant change in prescribing patterns of antibiotic prophylaxis in Caesarean section following introduction of local guidelines. The use of ceftriaxone, amikacin and metronidazole decreased (57.47% vs. 11.74%; 9.19% vs. 4.27%; 61.69% vs. 46.26%, respectively). On the other hand, the use of “older” antibiotics such as gentamicin, cefuroxime, cefazolin and ampicillin increased (14.56% vs. 29.18%; 9.2% vs. 17.44%; 9.58% vs. 45.2% and 0% vs. 3.9%, respectively). DDD/100 bed days/eur analysis revealed a 47% decrease of total cost for prophylactic antibiotic treatment in Caesarean section following local guideline implementation. In contrast, rate of wound infections and duration of hospital stay were not significantly different in both groups. Conclusion In an attempt to ensure cost-effective prophylactic use of antibiotics in Caesarean delivery, local clinical guidelines were introduced. They resulted in changes in prescribing patterns of antibiotics. There was a significant decrease in use of ‘third’ generation of cephalosporin’s whereas the use of “older” antibiotics with proven efficacy and safety increased. In contrast, there was no significant change in treatment outcomes such as wound infection and average hospital stay.     

The short‐term effects of angiotensin II receptor blockers on albuminuria and renal function in Korean patients

Each angiotensin II receptor blocker (ARB) asserts independent molecular effects. No study has compared the renoprotective potency of different types of ARBs in Korea. This study evaluated the differences among medications for treating albuminuria. Data were obtained from electronic medical records of adult patients who underwent albuminuria test and received treatment with either angiotensin‐converting enzyme inhibitors (ACEIs) or ARBs between January 2009 and June 2016. Patients' albuminuria and renal function data were observed for three months after treatment initiation. In total, 1475 patients were included. Patients treated with ACEIs had no significant changes in albuminuria (from 127.7 ± 55.1 mg/g to 46.7 ± 18.7 mg/g, P = .127), but those treated with ARBs showed significant improvement (from 491.2 ± 33.2 mg/g to 372.0 ± 28.0 mg/g, P < .001). The ARB group had significantly more patients with normal albuminuria after treatment (from 55.8% to 59.3% for normal albuminuria, from 16.7% to 18.5% for moderately increased albuminuria and from 27.5% to 22.2% for severely increased albuminuria, P = .005), but renal function did not change significantly. Subgroup analysis of ARB types showed that candesartan (from 712.5 ± 71.1 to 489.8 ± 57.8 mg/g, P < .001) and irbesartan (from 522.6 ± 65.7 to 352.6 ± 54.3 mg/g, P < .001) had significant effects. Candesartan improved albuminuria in patients older than 60 years (from 506.9 ± 84.2 to 371.9 ± 70.6 mg/g, P = .004) and irbesartan improved albuminuria in patients with glomerular filtration rate <60 (from 551.6 ± 100.0 to 392.4 ± 76.2, P = .007). Only irbesartan and candesartan could reduce albuminuria, suggesting that all ARBs do not have the same outcome. This indicates the importance of optimizing ARB selection, considering both patient condition and organ‐specific characteristics of medications.     

Utilisation of antibiotics in young children: opposite relationships to adult educational levels in Danish and Swedish counties

Background Antibiotic utilisation varies profoundly among and within countries, and the extent of antibiotic utilisation correlates with the frequency of bacterial resistance, particularly among children. Hence, it is important to assess which factors may influence prescribing. In addition to variations in morbidity, health-care organisation, drug regulatory and supply systems, prescriber's attitudes, parents' behaviour, attitudes and socio-economic positions seem important. We compared socio-economic position (educational level of adults) and antibiotic utilisation in children in the municipalities within a Danish and a Swedish county which are geographically close, have similar social and economic development, and similar drug regulatory and supply systems.Methods Data on antibiotic utilisation (1998), expressed in defined daily doses per 1000 inhabitants per day (DDD/TID), were obtained from the Copenhagen County Health Insurance register and from the National Corporation of Swedish Pharmacies. Data on municipal educational levels were obtained from Statistics Denmark and Statistics Sweden.Results The utilisation of antibiotics in 0- to 6-year-old children was higher in the Swedish than in the Danish county but varied between the municipalities within both the Swedish (9.6–17.7 DDD/TID) and the Danish (8.0–12.9 DDD/TID) counties. Most notably, utilisation rates correlated negatively with the education levels in the Danish (r=–0.539, P=0.021) but positively in the Swedish (r=+0.390, P=0.025) municipalities.Conclusion The observed variations in antibiotic prescribing may reflect different parental and/or prescriber attitudes towards use of antibiotics and they emphasise that antibiotic prescribing is influenced by factors other than the prevalence of bacterial infections. Relationships between socio-economic position (educational level) and drug utilisation should not be generalised from one area to another.     

Remote per‐conditioning reduces oxidative stress,downregulates cyclo‐oxygenase‐2 expression and attenuates ischaemia–reperfusion‐induced acute kidney injury

相似文献   

The inductive effects of <Emphasis Type="Italic">Centella asiatica</Emphasis> on rat spermatogenic cell apoptosis in vivo

Centella asiatica (L.) Urban has been traditionally used for the treatment of various disease and as a food for thousands of years in various parts of the world including eastern Asia, China and India. The goal of this study was to investigate the effects of Centella asiatica aqueous leaf extract on the induction of spermatogenic cell apoptosis in male rats. After lethal dose (LD₅₀) assessment of plant extract, rats were divided in five groups. The experimental groups received orally 10, 50, 80 and 100 mg/kg aqueous leaf extract daily for 60 days and the control group received just water. After 60 days, body and testis weight were measured and blood samples were taken from the heart. To evaluate apoptosis and histological changes, tissue samples obtained from rat testes were stained by TUNEL assay and hematoxylin and eosin stain. Results showed that the sperm count, motility, and viability and the number of spermatogenic cells in the seminiferous tubules were significantly decreased compared with the control group. The number of apoptotic germ cells per seminiferous tubule cross-section was significantly increased in the experimental group (18.11 ± 3.5) compared with the control group (8.7 ± 0.81) (P < 0.05). Serum testosterone, follicle-stimulating hormone, and luteinizing hormone levels also showed significant decreases in the experimental groups (P < 0.05). There was also a significant decrease in testis weight in experimental groups compared with the control group (P < 0.05). It is concluded that Centella asiatica has toxicological effects on the reproductive system in male rats and, therefore, it is suggested that leaf extracts of Centella asiatica possess antifertility effects in the male rat.     

Discrepancies between prescribed daily doses and WHO defined daily doses of antibacterials at a university hospital

AIMS: The defined daily doses (DDD) defined by the WHO are widely used as an indicator to measure antibiotic use in the hospital setting. However, discrepancies exist between countries in terms of antibiotic dosage. The aim of the present study was to compare, for each antibacterial agent available at our university hospital, the prescribed daily doses (PDD) with the DDD. METHODS: Data were extracted from the pharmacy computer system. Antibiotic use was expressed in DDD per 1000 patient days. We also calculated the ratio of number of DDD:number of treatment-days and estimated the average PDD for each antibiotic and route of administration. RESULTS: The average PDD did not correspond to the DDD for many classes of antibiotics. If fluoroquinolones and cephalosporins were prescribed at a dosage close to the DDD, other antimicrobial classes such as penicillins, aminoglycosides or macrolides were not. Overall, the number of DDD overestimated the number of treatment days by 40%. For the most consumed antibiotic at our hospital, i.e. oral amoxicillin-clavulanic acid, the PDD was three times the DDD. CONCLUSIONS: Our study shows that, except for the fluoroquinolones and the cephalosporins, the number of DDD did not correctly reflect the number of antibiotic treatment days at our hospital. This does not invalidate the systematic approach of the WHO and hospitals should use the DDDs to make national and international comparisons of their antibiotic use. However, each hospital should define and validate its own indicators to describe the local exposures to antibiotics and to study the relationship with resistance.     

Associations among impulsivity,trauma history,and alcohol misuse within a young adult sample

ObjectiveYoung adult alcohol misuse is associated with numerous long-term adverse outcomes. Given the link between impulsivity and alcohol use, we examined whether three impulsivity-related traits differentially predicted number of drinks per drinking day (DDD). We also examined whether these effects varied for those with different trauma histories.MethodThe current study (n = 254) examined motor, non-planning, and attentional impulsivity as predictors of DDD. It also examined whether impulsivity was differentially predictive of DDD across individuals in: a control group (non-trauma exposed), a trauma exposed but non-PTSD group, and a PTSD group.ResultsRegardless of group, more motor impulsivity was associated with more DDD. The effect of non-planning impulsivity varied according to trauma history. Specifically, more non-planning impulsivity predicted more DDD for those without PTSD. Finally, attentional impulsivity was not predictive of DDD.ConclusionsYoung adults with high levels of motor impulsivity, regardless of trauma history, may be a particularly high-risk group in terms of propensity for alcohol use/misuse. Additionally, high levels of non-planning impulsivity may signify those at greater risk for alcohol misuse, among those without PTSD. Motor impulsivity and non-planning impulsivity may serve as useful intervention targets in alcohol misuse prevention efforts. Implications for future research in this area are discussed.