Analysis of antimicrobial consumption and cost in a teaching hospital

SummaryBackgroundThe aim of this study is to compare the periods before and after the intervention applied using the ATC/DDD method in order to ascertain the rational use of antibiotics in a newly established hospital.MethodThe appropriateness of the hospital's antibiotic use, consumption rates and the costs were calculated and compared with other hospitals. Based on these data, an intervention has been planned in order to raise the quality of antibiotic use. The periods before and after the intervention were compared. Between 16 May 2011 and 23 May 2012, data were collected from all hospital units by the infectious diseases specialists and a point prevalence survey was conducted. Anatomical therapeutic chemical classification and the defined daily dose (DDD) methodology were used to calculate the antibiotic consumption.ResultsOn two specific days in 2011 and 2012, 194 out of 307 patients (63.2%) and 224 out of 412 patients (54.4%) received antibiotic treatment, respectively. In 2011 and 2012, the percentage of appropriate antibiotic use was 51% and 64.3%, respectively. Both in 2011 and 2012, inappropriate antibiotic use was found to be significantly higher in surgical clinics in comparison to the internal diseases clinics and the ICU. This was caused by the high rates of inappropriate perioperative antimicrobial prophylaxis observed in surgical clinics. During both years, approximately one-third of the antibiotics were prescribed for the purposes of perioperative prophylaxis, while 88.5% and 43.7% of these, respectively, were inappropriate and unnecessary. Cephalosporins, fluoroquinolones, combinations of penicillins (including β-lactamase inhibitors) and carbapenems were the most frequently prescribed antibiotics during the study periods. The mean total antibiotic consumption was 93.6 DDD/100 bed-days and 63.1 DDD/100 bed-days, respectively. The cost of total antibacterial consumption was € 7901.33 for all the patients (€ 40.72 per infected patient) and € 6500.26 (€ 29.01 per infected patient), respectively.ConclusionEach hospital should follow and assess their antibiotic use expressed in DDD in order to compare their antibiotic use with national and international hospitals (WHO, 2009 [14])

Investigation of Antibiotic Susceptibilities in Carbapenem-Resistant Klebsiella pneumoniae and Escherichia coli Strains Isolated from Clinical Samples: A Four-Year Analysis in a Comprehensive Healthcare Facility

INTRODUCTION: The profile of carbapenem-resistant Enterobacterales (CRE), antibiotic susceptibilities were analyzed in our hospital providing a wide range of healthcare services in Southeastern Anatolia. METHODS: This retrospective study included carbapenem-resistant Klebsiella pneumoniae (CRKP, 1022 isolates) and carbapenem-resistant E. coli (CREC, 700 isolates) isolated from patients admitted to xxxxxx Hospital between 2019 and 2022. Isolate typing and antibiotic susceptibility profiles were determined using the BD Phoenix automated system (Becton Dickinson, USA), and the Diagnostics MIC-COL test kit (Diagnostics, Slovakia) was used to determine colistin susceptibility. RESULTS: Out of the total 1022 CRKP isolates, 663 (64.9%) were obtained from intensive care units, 207 (20.2%) from inpatient clinics, and 152 (14.9%) from outpatient clinics. The most sensitive antibiotics for CRKP isolates were found to be ceftazidime-avibactam (CZA) (57%), gentamicin (51%), and amikacin (40%), respectively. Statistically significant changes in susceptibilities to CZA, colistin, trimethoprim-sulfamethoxazole (SXT), tobramycin, meropenem, imipenem, and levofloxacin were observed over the years (p<0.05). Among the total 700 CREC isolates, 258 (36.9%) were obtained from inpatient clinics, 229 (32.7%) from intensive care units, and 213 (30.4%) from outpatient clinics. Statistically significant changes in susceptibilities to imipenem, tobramycin, SXT, levofloxacin, cefepime, ampicillin-sulbactam (AMP-SM), and cefuroxime were observed over the years (p<0.05). Over 80% of the isolates were susceptible to amikacin, and over 60% were susceptible to gentamicin, imipenem, colistin, and CZA. DISCUSSION AND CONCLUSION: Presentation of regional data on carbapenem resistance in health centers and understanding of antibiotic resistance/susceptibility specific to CSI are vital to guide empirical treatment decisions as well as provide important regional epidemiological data

Chronic Viral Hepatitis-Induced Liver Cirrhosis in a Patient with Brucellosis

Brucellosis is an endemic infectious disease in our country. Clinical signs and symptoms are spread over a wide spectrum; musculoskeletal, gastrointestinal system, cardiovascular system and the genitourinary system can be affected. Elevation of transaminases is a common finding in brucellosis due to involvement of reticuloendothelial system including the liver and spleen. In the patient presented here, hepatic cirrhosis was found due to chronic hepatitis B and delta hepatitis infection in the investigations made for not to overlook viral causes that might cause transaminase elevation and it was emphasized that these possible conditions shouldn’t be overlooked in our region where brucellosis and hepatitis B are common

HBV, HCV and HIV Seroprevalence in Soldiers Tested for Carriership

Individuals employed or recruited to work in tourism, cleaning and food sectors and the men performing their military service in the food and cleaning services in the military are requested to undergo scans for the hepatitis B (HBV), hepatitis C (HCV) and human immunodeficiency (HIV) viruses as part of the carrier testing. The aim of the present study is to evaluate the seroprevalence of HBV, HCV and HIV in the soldiers scanned in terms of carriership. The study was conducted in the Kiziltepe State Hospital through the retrospective evaluation of the records of the soldiers who presented to the infectious diseases clinic between March 2010 and December 2012 for carriership scans. The HBV, HCV, and HIV tests were carried out in the central laboratory of the Kiziltepe State Hospital through the microparticle enzyme immunoassay (MEIA) method using the Axsym Plus Immunoessay Autoanalyzer (Abbott Laboratories, Abbott Park, Illinois, USA). The records of 367 soldiers between the ages of 20-22 were included in the study. Among these, 5 (1.36%) were HBsAg and 2 (0.55%) were anti-HCV positive, while none of them were positive for HIV. In order to reduce the risk of HBV, HCV and HIV infections, which are mainly transmitted through blood and sexual intercourse, preventive measures should be taken, education should be given and awareness should be increased. Especially individuals who are employed in sectors where the transmission risk is high should be periodically scanned and monitored for infection and diseases caused by these viruses. [Med-Science 2014; 3(2.000): 1234-40

Hamsi scoring in the prediction of unfavorable outcomes from tuberculous meningitis: results of Haydarpasa-II study

Predicting unfavorable outcome is of paramount importance in clinical decision making. Accordingly, we designed this multinational study, which provided the largest case series of tuberculous meningitis (TBM). 43 centers from 14 countries (Albania, Croatia, Denmark, Egypt, France, Hungary, Iraq, Italy, Macedonia, Romania, Serbia, Slovenia, Syria, Turkey) submitted data of microbiologically confirmed TBM patients hospitalized between 2000 and 2012. Unfavorable outcome was defined as survival with significant sequela or death. In developing our index, binary logistic regression models were constructed via 200 replicates of database by bootstrap resampling methodology. The final model was built according to the selection frequencies of variables. The severity scale included variables with arbitrary scores proportional to predictive powers of terms in the final model. The final model was internally validated by bootstrap resampling. A total of 507 patients' data were submitted among which 165 had unfavorable outcome. Eighty-six patients died while 119 had different neurological sequelae in 79 (16 %) patients. The full model included 13 variables. Age, nausea, vomiting, altered consciousness, hydrocephalus, vasculitis, immunosuppression, diabetes mellitus and neurological deficit remained in the final model. Scores 1-3 were assigned to the variables in the severity scale, which included scores of 1-6. The distribution of mortality for the scores 1-6 was 3.4, 8.2, 20.6, 31, 30 and 40.1 %, respectively. Altered consciousness, diabetes mellitus, immunosuppression, neurological deficits, hydrocephalus, and vasculitis predicted the unfavorable outcome in the scoring and the cumulative score provided a linear estimation of prognosis

Management of Brucella endocarditis: results of the Gulhane study

Brucella endocarditis (BE) is a rare but life-threatening complication of human brucellosis. The aim of this study was to investigate the course of BE along with the therapeutic interrelations. A total of 53 patients with BE hospitalised in 19 health institutions between 2006 and 2011 were included in the Gulhane study. Diagnosis of brucellosis was established by either isolation of Brucella sp. or the presence of antibodies, and the definition of endocarditis was made according to Duke's criteria. There were four treatment groups: ceftriaxone combined with oral antibiotics (Group 1); aminoglycosides combined with oral antibiotics (Group 2); oral antibiotic combinations (Group 3); and aminoglycoside plus ceftriaxone combined with an oral antibiotic (Group 4). Involvement rates of the aortic, mitral and tricuspid valves were 49.1%, 43.4% and 5.7%, respectively. Thirty-two patients (60.4%) had an underlying cardiac valvular problem, including previous prosthetic valve replacement (n = 18). Medical treatment was provided to 32 patients (60.4%), whilst concordant medical and surgical approaches were provided to 21 patients (39.6%). Mortality in Group 1 was 15% (3/20), whilst in Group 2 it was 5.3% (1/19). In Group 3, 25.0% (3/12) of the cases died, whereas none of the cases in Group 4 died. In conclusion, mortality increased 47-fold with pericardial effusion and 25-fold due to congestive heart failure that developed after BE. Although mortality was lower in the aminoglycoside-containing arm (Groups 2 and 4), statistical analysis could not be performed owing to the small number of patients. (C) 2012 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved