Assessing the conversion of electronic medical record data into antibiotic stewardship indicators.

BACKGROUND Measuring the appropriateness of antibiotic use is crucial for antibiotic stewardship (ABS) programmes to identify targets for interventions. OBJECTIVES To assess the technical feasibility of converting electronic medical record (EMR) data into ABS indicators. METHODS In this observational feasibility study covering a period of 2 years, the EMRs of patients hospitalized at a large non-university hospital network and receiving at least one dose of a systemic antibiotic were included. ABS indicators measuring steps in the process of antibiotic prescription proposed by the literature were collected and rephrased or defined more specifically to be calculable if needed. Algorithms were programmed in R to convert EMR data into ABS indicators. The indicators were visualized in an interactive dashboard and the plausibility of each output value was assessed. RESULTS In total, data from 25 337 hospitalizations from 20 723 individual patients were analysed and visualized in an interactive dashboard. Algorithms could be programmed to compute 89% (25/28) of all pre-selected indicators assessing treatment decisions automatically out of EMR data, with good data quality for 46% (13/28) of these indicators. According to the data quality observed, the most important issues were (i) missing or meaningless information on indication (e.g. 'mild infection') and (ii) data processing issues such as insufficiently categorized metadata. CONCLUSIONS The calculation of indicators assessing treatment decisions from EMRs was feasible. However, better data structure and processing within EMR systems are crucial for improving the validity of the results

Comparison of hospital-wide and unit-specific cumulative antibiograms in hospital- and community-acquired infection

Background: Empirical antibacterial therapy in hospitals is usually guided by local epidemiologic features reflected by institutional cumulative antibiograms. We investigated additional information inferred by aggregating cumulative antibiograms by type of unit or according to the place of acquisition (i.e. community vs. hospital) of the bacteria. Materials and methods: Antimicrobial susceptibility rates of selected pathogens were collected over a 4-year period in an university-affiliated hospital. Hospital-wide antibiograms were compared with those selected by type of unit and sampling time (48h after hospital admission). Results: Strains isolated >48h after admission were less susceptible than those presumably arising from the community (48h after admission. When compared to hospital-wide antibiograms, susceptibility rates were lower in the ICU and surgical units for Escherichia coli to amoxicillin-clavulanate, enterococci to penicillin, and Pseudomonas aeruginosa to anti-pseudomonal beta-lactams, and in medical units for Staphylococcus aureus to oxacillin. In contrast, few differences were observed among strains isolated within 48h of admission. Conclusions: Hospital-wide antibiograms reflect the susceptibility pattern for a specific unit with respect to community-acquired, but not to hospital-acquired strains. Antibiograms adjusted to these parameters may be useful in guiding the choice of empirical antibacterial therap

Antibiotic consumption in nursing homes of the Canton of Vaud: trends over the years 2009 - 2014

Background & Objectives: Excessive use of antibiotics in nursing homes was reported in several studies1-3. Surveillance of their use in nursing homes is essential to plan interventions fostering an appropriate use and to measure the impact of these interventions. The aims of the study were to describe the antibiotic consumption in nursing homes of the Canton of Vaud and to examine whether the antibiotic consumption was correlated to the urinary catheter use and to methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods: Data on the use of systemic antibiotics (class J01 of WHO Anatomical Therapeutic Chemical (ATC) system, 2015) were collected from the community pharmacies' annual invoice data including 13 nursing homes in 2009. The number of nursing homes in the database increased to 67 in 2014, representing 46% of all nursing homes of the Canton of Vaud and 54% of the available beds. Aggregated data were converted into defined daily doses (DDD) and antibiotic consumption expressed in number of defined daily doses per 1000 beds and per day (DDD/1000B/D). Proportion of urinary catheter use and MRSA colonization data were provided through a point prevalence study. Results: The total consumption of systemic antibiotics was 52.2 DDD/1000B/D in 2009 and 48.3 in 2014. Beta-lactam antibacterials other than penicillins, macrolides and other antibacterials (including nitrofurantoin) consumption increased resp. by 80%, 45% and 187% between 2009 and 2014, while the use of sulfonamides and trimethoprim decreased by 41%. Penicillin and quinolone use remained relatively stable between 2009 and 2014. Amoxicillin and clavulanic acid (oral) was the most common antibiotic prescribed (31% of the total use), followed by ciprofloxacin (oral) (20%) and nitrofurantoin (10%). Among nursing homes, we reported a large variation in antibiotic consumption from 6.8 to 164.6 DDD/1000B/D in 2014. No correlation was found between global antibiotic consumption and urinary catheter use and between quinolone consumption and proportion of MRSA in 2010 and 2011 (p>0.05). Discussion & Conclusions: This study is the first that analyzes longitudinal data of antibiotic consumption in nursing homes of the Canton of Vaud. The findings suggest that a large variation in antibiotic consumption exists among nursing homes. Thus, antibiotic stewardship programs should be implemented to promote a more accurate use

Intra-hospital differences in antibiotic use correlate with antimicrobial resistance rate in <i>Escherichia coli</i> and <i>Klebsiella pneumoniae</i>: a retrospective observational study.

Monitoring antimicrobial use and resistance in hospitals are important tools of antimicrobial stewardship programs. We aimed to determine the association between the use of frequently prescribed antibiotics and the corresponding resistance rates in &lt;i&gt;Escherichia coli&lt;/i&gt; and &lt;i&gt;Klebsiella pneumoniae&lt;/i&gt; among the clinical departments of a tertiary care hospital. We performed a retrospective observational study to analyse the use of nine frequently prescribed antibiotics and the corresponding antimicrobial resistance rates in hospital acquired &lt;i&gt;E. coli&lt;/i&gt; and &lt;i&gt;K. pneumoniae&lt;/i&gt; isolates from 18 departments of our institution over 9 years (2008-2016). The main cross-sectional analysis assessed the hypothetical influence of antibiotic consumption on resistance by mixed logistic regression models. We found an association between antibiotic use and resistance rates in &lt;i&gt;E. coli&lt;/i&gt; for amoxicillin-clavulanic acid (OR per each step of 5 defined daily dose/100 bed-days 1.07, 95% CI 1.02-1.12; &lt;i&gt;p&lt;/i&gt;  = 0.004), piperacillin-tazobactam (OR 2.11, 95% CI 1.45-3.07; &lt;i&gt;p&lt;/i&gt;  &lt; 0.001), quinolones (OR 1.52, 95% CI 1.25-1.86; &lt;i&gt;p&lt;/i&gt;  &lt; 0.001) and trimethoprim-sulfamethoxazole (OR 1.59, 95% CI 1.19-2.13; &lt;i&gt;p&lt;/i&gt;  = 0.002). Additionally, we found a significant association when all nine antibiotics were combined in one analysis. The association between consumption and resistance rates was stronger for nosocomial than for community strains. In &lt;i&gt;K. pneumoniae,&lt;/i&gt; we found an association for amoxicillin-clavulanic acid (OR 1.07, 95% CI 1.01-1.14; &lt;i&gt;p&lt;/i&gt;  = 0.025) and for trimethoprim-sulfamethoxazole (OR 2.02, 95% CI 1.44-2.84; &lt;i&gt;p&lt;/i&gt;  &lt; 0.001). The combined analysis did not show an association between consumption and resistance (OR 1.06, 95% CI 0.99-1.14; &lt;i&gt;p&lt;/i&gt;  = 0.07). We documented an association between antibiotic use and resistance rate for amoxicillin-clavulanic acid, piperacillin-tazobactam, quinolones and trimethoprim-sulfamethoxazole in &lt;i&gt;E. coli&lt;/i&gt; and for amoxicillin-clavulanic acid and trimethoprim-sulfamethoxazole in &lt;i&gt;K. pneumoniae&lt;/i&gt; across different hospital departments. Our data will support stewardship interventions to optimize antibiotic prescribing at a department level

Data for: Decrease in antibacterial use and facility-level variability after the introduction of guidelines and implementation of physician-pharmacist-nurse quality circles in Swiss long-term care facilities

Antibacterial use in long-term care facilities in Canton VD, Switzerlan

Consumption of anti-meticillin-resistant Staphylococcus aureus antibiotics in Swiss hospitals is associated with antibiotic stewardship measures.

BACKGROUND Consumption of antibiotics active against meticillin-resistant Staphylococcus aureus (MRSA) has been described in numerous European studies. However, the underlying predictors of consumption are still poorly understood. AIM To describe the consumption of anti-MRSA antibiotics (daptomycin, intravenous glycopeptides, linezolid) in Switzerland over time and to identify underlying predictor variables. METHODS A retrospective observational multi-centre study was conducted in 21 Swiss hospitals over a period of 11 years (2009-2019). Multiple linear regression models were built to identify regional and hospital-specific predictor variables affecting the consumption of anti-MRSA antibiotics. FINDINGS Consumption of anti-MRSA antibiotics increased between 2009 and 2019 from 12.7 to 24.5 defined daily doses per 1000 bed-days (+93%). In the first model presented, which includes data of the whole study period, the following variables were associated with higher anti-MRSA antibiotic consumption: number of MRSA cases (P < 0.01), year (P < 0.01), hospital type (tertiary care university hospitals vs others, P < 0.01), hospital department (intensive care unit vs others, P < 0.01) and linguistic region (French vs German and German vs Italian, P < 0.01). In a second model including data from a query on hospital policies in place in 2019, the presence of an antibiotic stewardship group (P < 0.01) and prescription restrictions (P < 0.01) were associated with consumption of anti-MRSA antibiotics. CONCLUSION Our study shows that both the presence of an antibiotic stewardship group and the implementation of prescription restrictions, i.e. factors that can be controlled by the hospital itself, were associated with a lower consumption of anti-MRSA antibiotics

Data for: Decrease in antibacterial use and facility-level variability after the introduction of guidelines and implementation of physician-pharmacist-nurse quality circles in Swiss long-term care facilities

Antibacterial use in long-term care facilities in Canton VD, SwitzerlandTHIS DATASET IS ARCHIVED AT DANS/EASY, BUT NOT ACCESSIBLE HERE. TO VIEW A LIST OF FILES AND ACCESS THE FILES IN THIS DATASET CLICK ON THE DOI-LINK ABOV

Temporal and structural patterns of extended-spectrum cephalosporin-resistant Klebsiella pneumoniae incidence in Swiss hospitals

Background: Routine surveillance data revealed increasing rates of invasive extended-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCR-KP) in Switzerland, from 1.3% in 2004 to 8.5% in 2019 [1]. Aim: The main aim of this study was to understand the causes of this recent trend, specifically to identify predictors affecting the incidence of invasive ESCR-KP infections in Switzerland. Methods: A retrospective observational multi-centre study was conducted in 21 Swiss hospitals over a period of 11 years (2009 - 2019). Potential predictor variables for the incidence of invasive ESCR-KP infections were studied with a multiple linear regression model. In an additional analysis, the overall ESCR-KP incidence (all sample sites) was investigated. Findings: An increasing incidence of invasive ESCR-KP infections from 0.01 to 0.04 patients/1,000 bed-days was observed between 2009 and 2019 and confirmed by multiple linear regression analysis (P< 0.01). ESCR-KP incidence was higher in university hospitals (P< 0.01) and in the French-speaking region than in the German-speaking region (P< 0.01). There was no association with antibiotic consumption. Analysing the overall ESCR-KP incidence (all sample sites) revealed high variability between university hospitals, mainly due to a high proportion of patients with screening isolates at Geneva University Hospital (50% of patients with ESCR-KP). Conclusion: The incidence of invasive ESCR-KP infections increased in Switzerland between 2009 and 2019 and was not associated with antibiotic consumption. Our findings indicate that in this low-incidence setting, structural factors such as the hospital type and the linguistic region play a more important role in relation to ESCR-KP incidence than the hospital's antibiotic consumption

Hospital antibiotic consumption in Switzerland: comparison of a multicultural country with Europe.

The consumption of antibiotics in the inpatient setting of Switzerland was assessed to determine possible differences between linguistic regions, and to compare these results with European results. Data on antibiotic consumption were obtained from a sentinel network representing 54% of the national acute care hospitals, and from a private drug market monitoring company. Aggregated data were converted into defined daily doses (DDD). The total consumption density in Switzerland was close to the median consumption reported in European surveys. Between 2004 and 2008, the total consumption of systemic antibiotics rose from 46.1 to 54.0 DDD per 100 occupied bed-days in the entire hospitals, and from 101.6 to 114.3 DDD per 100 occupied bed-days in the intensive care units. Regional differences were observed for total consumption and among antibiotic classes. Hospitals in the Italian-speaking region showed a significantly higher consumption density, followed by the French- and German-speaking regions. Hospitals in the Italian-speaking region also had a higher consumption of fluoroquinolones, in line with the reported differences between Italy, Germany and France. Antibiotic consumption in acute care hospitals in Switzerland is close to the European median with a relatively low consumption in intensive care units. Some of the patterns of variation in consumption levels noticed among European countries are also observed among the cultural regions of Switzerland

Antimicrobial stewardship en pratique communautaire [Antimicrobial stewardship in primary care setting]

La consommation d’antibiotiques en ambulatoire est l’une des causes majeures de l’émergence de bactéries résistantes. Bien qu’en Suisse cette consommation soit faible par rapport aux pays voisins, des améliorations sont possibles et doivent être poursuivies. Les interventions d’antibiotic stewardship aident le médecin à mieux reconnaître les malades ne nécessitant pas d’antibiotiques (recommandations pour la pratique clinique, algorithmes informatiques et tests de laboratoire) et éduquent le patient sur l’absence de bénéfice d’un traitement antibiotique dans une situation donnée (prescription retardée et facilitation de la décision partagée). Les études cliniques ont montré leur efficacité dans la réduction de la consommation d’antibiotiques, principalement dans le cadre d’infections respiratoires, sans affecter le devenir du patient. [Antibiotic overuse in primary care setting is a major contributor to the development of resistant bacteria. Antibiotic consumption is low in Switzerland compared to neighbour countries, but improvement is possible and has to be pursued. Antibiotic stewardship helps physician to better recognize patients who need antibiotic (guidelines implementation, electronic decision support and laboratory testing) and educate patients about the uselessness of antibiotics in a given situation (delayed prescription and shared decision making). Clinical studies demonstrated the efficacy of these interventions in reducing antibiotic consumption, mainly in acute respiratory infections, without affecting patients' clinical outcome.