Multidisciplinary health care monitoring and training program: impact on antibiotic use
- Authors: Aleksandrova EG1, Abakumova TR1, Evstigneev SV2, Titarenko AF1, Khaziakhmetova VN1, Ziganshina LE3
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Affiliations:
- Kazan (Volga Region) Federal University
- Penza Regional Clinical Hospital named after N.N. Burdenko
- Kazan State Medical University
- Issue: Vol 101, No 3 (2020)
- Pages: 403-411
- Section: Social hygiene and healthcare management
- URL: https://journals.rcsi.science/kazanmedj/article/view/21259
- DOI: https://doi.org/10.17816/KMJ2020-403
- ID: 21259
Cite item
Abstract
Aim. To develop a program for monitoring the use of antibacterial agents and training in their rational use using the information on consumption and expenses in a multidisciplinary healthcare institution.
Methods. From 2011 to 2014, a group of clinical pharmacologists developed and implemented a monitoring program for the use of antibacterial agents using the ATC/DDD and ABC/VEN methodology in SBIH “Penza Regional Clinical Hospital named after N.N. Burdenko”. Hospital doctors were trained in the principles of rational use of drugs and antibiotics as part of continuing education in clinical pharmacology using monitoring results — analysis of the costs and consumption of antibacterial agents.
Results. Over the four years of monitoring and three years of educational activities, the most pronounced changes have occurred in the use of fluoroquinolones, aminoglycosides, macrolides and carbapenems. Fluoroquinolones consumption reduced 2 times, and it cost of purchase reduced 6 times (of total). Aminoglycosides consumption increased 3 times, primarily due to amikacin 5 times consumption increase. Macrolides consumption reduced 3 times, primarily due to clarithromycin decrease in consumption. At the same time, the antibacterial agents of the cephalosporin group leading in consumption, with their cost had decreased 2-fold. However, carbapenems consumption increased 3 times, with their costs increase 7 times.
Conclusion. Over the three years of the program, expenses and consumption of antibacterial agents of the fluoroquinolone and macrolide group were reduced, with an increase in the consumption of aminoglycosides and carbapenems without changes in the consumption of cephalosporins; costs of cephalosporins and carbapenems led to an increase in overall antibiotic costs; further efforts and studies are needed to study the use of antibacterial agents.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
E G Aleksandrova
Kazan (Volga Region) Federal University
Author for correspondence.
Email: elvira_alex_75@mail.ru
SPIN-code: 7364-8836
Russian Federation, Kazan, Russia
T R Abakumova
Kazan (Volga Region) Federal University
Email: Elvira_alex_75@mail.ru
SPIN-code: 1331-7001
Scopus Author ID: 24342667900
Russian Federation, Kazan, Russia
S V Evstigneev
Penza Regional Clinical Hospital named after N.N. Burdenko
Email: Elvira_alex_75@mail.ru
SPIN-code: 6742-4235
Russian Federation, Penza, Russia
A F Titarenko
Kazan (Volga Region) Federal University
Email: Elvira_alex_75@mail.ru
SPIN-code: 1198-5065
Russian Federation, Kazan, Russia
V N Khaziakhmetova
Kazan (Volga Region) Federal University
Email: Elvira_alex_75@mail.ru
SPIN-code: 4854-5201
Scopus Author ID: 7801668954
Russian Federation, Kazan, Russia
L E Ziganshina
Kazan State Medical University
Email: Elvira_alex_75@mail.ru
ORCID iD: 0000-0003-1999-0705
SPIN-code: 6061-7223
Scopus Author ID: 7004193381
Russian Federation, Kazan, Russia
References
- Belkova Y.A., Rachina S.A., Kozlov R.S. et al. Systemic antimicrobials consumption and expenditures in multi-profile hospitals in Russian Federation and Republic of Belarus: the results of multicenter pharmacoepidemiological trial. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2012; 14 (4): 322–341. (In Russ.)
- Friedrich M.J. Antibiotic consumption increasing globally. JAMA. 2018; 319 (19): 1973. doi: 10.1001/jama.2018.5711.
- Sukhorukova M.V., Edelshtein M.V., Skleenova E.Yu. et al. Antimicrobial resistance of nosocomial Enterobacteriaceae isolates in Russia: results of national multicenter surveillance study MARATHON 2011–2012. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2014; 16 (4): 254–265. (In Russ.)
- Sukhorukova M.V., Edelshtein M.V., Skleenova E.Yu. et al. Antimicrobial resistance of nosocomial Staphylococcus aureus isolates in Russia: results of national multicenter surveillance study MARATHON 2011–2012. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2014; 16 (4): 280–286. (In Russ.)
- Sukhorukova M.V., Edelshtein M.V., Skleenova E.Yu. et al. Antimicrobial resistance of nosocomial Acinetobacter spp. isolates in Russia: results of national multicenter surveillance study MARATHON 2011–2012. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2014; 16 (4): 266–272. (In Russ.)
- Gastmeier P., Behnke M., Breier A.C. et al. Healthcare-associated infection rates: measuring and comparing. Experiences from the German National Nosocomial Infection Surveillance System (KISS) and from other surveillance systems. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012; 55 (11–12): 1363–1369. doi: 10.1007/s00103-012-1551-y.
- Yakovlev S.V., Suvorova N.P., Beloborodov V.V. et al. Multicentre study of the prevalence and clinical value of hospital-acquired infections in emergency hospitals of Russia: ERGINI study team. Antibiotiki i khimioterapiya. 2016; 61 (5–6): 32–42. (In Russ.)
- Kraker M.E., Davey P.G., Grundmann H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLoS Medicine. 2011; 8 (10): 1001–1104. doi: 10.1371/journal.pmed.1001104.
- Carlet J., Fabry J., Amalberti R., Degos L. The “Zero Risk” Concept for hospital-acquired infections: A risky business! Clin. Infect. Dis. 2009; 49 (5): 747–749. doi: 10.1086/604720.
- Belkova Y.A., Rachina S.A., Kozlov R.S. et al. Antimicrobial stewardship: international practices and implementation prospects in the Russian hospitals. Klinicheskaya farmakologiya i terapiya. 2019; 28 (4): 4–9. (In Russ.) doi: 10.32756/0869-5490-2019-4-4-9.
- Dellit T.H., Owens R.C., McGowan J.E. et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin. Infect. Dis. 2007; 44: 159–177. doi: 10.1086/510393.
- Arnold S., Straus S. Interventions to improve antibiotic prescribing practices in ambulatory care. Cochrane Database of Systematic Reviews. 2005; 2005 (4): CD003539. doi: 10.1002/14651858.CD003539.pub2.
- Davey P., Marwick C.A., Scott C.L. et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews. 2017; 2 (2): CD003543. doi: 10.1002/14651858.CD003543.pub4.
- Programma SKAT (Strategiya Kontrolya Antimikrobnoy Terapii) pri okazanii statsionarnoy meditsinskoy pomoshchi. Rossiyskie klinicheskie rekomendatsii. (SCAT (Antimicrobial Therapy Control Strategy) program for inpatient care. Russian clinical guidelines.) M. 2017; 132 р. (In Russ.)
- Rachina S.A., Zakharenkov I.A., Belkova Yu.A. et al. Point prevalence survey of antimicrobial utilization in Russian multi-field hospitals. Klinicheskaya farmakologiya i terapiya. 2017; 26 (2): 62–69. (In Russ.)
- Ziganshina L.E., Magsumova D.R., Kuchaeva A.V. et al. ATS/DDD — klassifikatsionnaya sistema v farmakoepidemiologicheskikh issledovaniyakh. Kachestvennaya klinicheskaya praktika. 2004; (1): 28–33. (In Russ.)
- WHO Collaborating Centre for Drug Statistics Methodology. htpp://www.whocc.no/atc_ddd_index/ (access date: 10.02.2015).
- Yevstigneev S.V., Alexandrova E.G., Abakumova T.R. et al. Consumption of antimicrobials at a multi-disciplinary hospital: ATC/DDD methodology. Zhurnal nauchnykh statey zdorov'e i obrazovanie v XXI veke. 2017; 19 (7): 131–137. (In Russ.)
- Yevstigneev S.V., Titarenko A.F., Abakumova T.R. et al. Towards the rational use of medicines. Int. J. Risk Saf. Med. 2015; 27 (1): 59–60. doi: 10.3233/JRS-150690.
- Krasnozhon T.V., Dyachenko S.V., Adaev A.M., Bondarenko O.A. Pharmacoepidemiological analysis of antimicrobial drugs in a multidisciplinary surgical hospital. Dal'nevostochnyy meditsinskiy zhurnal. 2013; (3): 118–121. (In Russ.)
- Barkanova O.N., Rebrova E.V., Ilchenko O.V. et al. Analysis of antibiotic consumption in surgical departments of Volgograd hospitals in 2014. Vestnik VolGMU. 2015; (3): 93–96. (In Russ.)
- Loeb M., Salama S., Armstrong-Evans M. et al. A case-control study to detect modifiable risk factors for colonization with vancomycin-resistant enterococci. Infect. Control Hosp. Epidemiol. 1999; 20: 760–763. doi: 10.1086/501580.
- Messadi A.A., Lamia T., Kamel B., Capretta G. Association between antibiotic use and changes in susceptibility patterns of P. aeruginosa in an intensive care unit: a 5-year study, 2000–2004. Burns. 2008; 34: 1098–1102. doi: 10.1016/j.burns.2008.03.014.
- Sarma J.B., Ahmed G.U. Characterisation of methicillin resistant S. aureus strains and risk factors for acquisition in a teaching hospital in northeast India. Indian J. Med. Microbiol. 2010; 28: 127–129. doi: 10.4103/0255-0857.62489.
- Belkova Y.A., Rachina S.A., Kozlov R.S. et al. Systemic antimicrobials consumption and expenditures in intensive care units of hospitals in Russian Federation and Republic of Belarus: results of multicenter pharmacoepidemiological study. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2014; 16 (4): 294–311. (In Russ.)
- Park Y.S., Yoo S., Seo M.R. et al. Risk factors and clinical features of infections caused by plasmid-mediated AmpC beta-lactamase-producing Enterobacteriaceae. Int. J. Antimicrob. 2009; 34: 38–43. doi: 10.1016/j.ijantimicag.2009.01.009.
- Tacconelli E., De Angelis G., Cataldo M.A. et al. Does antibiotic exposure increase the risk of methicillinresistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J. Antimicrob. Chemother. 2008; 61: 26–38. doi: 10.1093/jac/dkm416.