Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Recent initiatives in the Republic of Srpska to enhance appropriate use of antibiotics in ambulatory care : their influence and implications

Introduction:There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives. Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed. Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilisation principally assessed according to ESAC, ECDC and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as versus neighbouring countries. Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 DIDs to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighbouring countries. Amoxicillin and the penicillins accounted for 29%-40% and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7% - 11%), cephalosporins, macrolides and quinolones, as well as low use of third and fourth generation cephalosporins versus first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen. Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilisation of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilisation of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Kvalitet života obolelih od psorijaze

Mada ne postoji univerzalna definicija kvaliteta života u vezi sa zdravljem,postignut je konsenzus da je to širok koncept koji uključuje fizičko zdravlje,psihološko stanje i socijalne odnose. Psorijaza je hronično inflamatorno oboljenjepovezano sa socijalnom stigmatizacijom, bolom, nelagodnošću, fizičkiminvaliditetom i psihološkim distresom. Brojne studije su pokazale da imaznačajan uticaj na kvalitet života obolelih. Ovaj pregledni rad se fokusira nakoncept kvaliteta života u vezi sa zdravljem kod obolelih od psorijaze i narazličite instrumente za njegovo merenje koji se mogu klasifikovati u upitnikespecifične za psorijazu, upitnike specifične za kožne bolesti i opšte upitnike

The prevalence study of hospital-acquired infections at different surgical departments in Banjaluka

Introduction: Prevalence study is simple, cheap and fast method that provides information about hospital-acquired infections (HAI). Objective: To assess the HAI prevalence at different surgical departments in the Clinical Center of Banjaluka. Method: A point prevalence study design was used. All patients (N = 174) hospitalized on July, 1st, 1999 were included in the study. The study was performed by following the CDC guidelines. All patients with clinically manifested infections on the day of study in all surgical departments were recorded. Infections of more than one site in the same patient were considered separate infections. Results: The overall prevalence of patients with HAI was 16.1% (28/174; 95%CI = 10.4-21.6) and the overall HAI prevalence was 18.4% (32/174). Surgical-site infections were the most prevalent (6.3%) followed by skin/soft tissue infections (4.6%) and urinary tract infections (4.0%). More than two thirds (87.5%) of HAI were microbiologically documented. The most commonly isolated microorganisms were Pseudomonas aeruginosa (29.7%), Enterobacter spp. (24.3%) and Staphylococcus aureus (16.2%). Conclusion: This point prevalence study clearly showed the magnitude of HAI problem at different surgical departments in the Clinical Center of Banjaluka, the most prevalent anatomic localizations of HAI, and the most common causes

Prevalencija intrahospitalnih infekcija u istočnoj Hercegovini

Uvod. Intrahospitalne infekcije (IHI) predstavljaju globalni javno-zdravstveniproblem. Epidemiološki nadzor nad IHI podrazumijeva sistematsko prikupljanje,analiziranje i tumačenje podataka o IHI, kao i dostavljanje povratneinformacije osoblju zdravstvene ustanove u kojoj se nadzor sprovodi. Studijeprevalencije su jedna od mogućih metoda epidemiološkog nadzora. Onepredstavljaju brz, jednostavan i relativno jeftin način prikupljanja podatakao IHI. Cilj rada je da se sagleda veličina problema IHI u bolnicama istočneHercegovine u Republici Srpskoj.Metode. Studija prevalencije je sprovedena u bolnicama istočne Hercegovineu avgustu 2011. godine među 483 hospitalizovana pacijenta, od kojih su 234pacijenta uključena u studiju. Uključeni su svi pacijenti koji su bili hospitalizovaninajmanje 72 časa. Prema definicijama Centra za kontrolu i prevencijubolesti (CDC) registrovane su samo klinički manifestne IHI.Rezultati. Prevalencija pacijenata sa IHI bila je 4,2%, koliko je iznosila iprevalencija IHI. Najveća prevalencija pacijenata sa IHI registrovana je naodjeljenju neurologije (15,7%), a zatim na odjeljenju hirurške intenzivnenjege (12,5%) i ginekologije (12,5%), a najmanja na odjeljenju hirurgije (6,2%).Najveća prevalencija je registrovana u uzrastu od 40 do 59 godina. UzročnikIHI je izolovan u 40% slučajeva. Prema anatomskoj lokalizaciji najčešće subile infekcije operativnog mjesta (40%) i infekcije sistema za varenje (40%), azatim infekcije mokraćnog sistema (10%) i infekcije kože i mekih tkiva (10%)Zaključak. Rezultati studije ukazuju da se prevalencija IHI kreće u okvirimavrijednosti prevalencije u razvijenim zemljama. Međutim, njihova pojava kodpacijanata sa niskim rizikom za pojavu IHI, ukazuje da se ovom problemumora pokloniti posebna pažnja. Studija prevalencije mogla bi da bude metodizbora za nadzor nad IHI na nacionalnom nivou

Faktori rizika za nastanak bolesti povezanе sa Clostridium difficile

Clostridium difficile je Gram-pozitivni, sporogeni bacil koji se danas smatrajednim od najznačajnijih uzročnika bolnički stečenih dijareja, a sva oboljenjaizazvana ovom bakterijom poznata su pod nazivom „bolesti povezane sa C.difficile“ (engl. Clostriduim difficile–associated disease, CDAD). Iako učestalostovih oboljenja varira od zemlje do zemlje, na globalnom nivou se beleži značajanporast incidencije CDAD, što predstavlja veliki javnozdravstveni problem. Ciljovog preglednog rada je da se na osnovu novijih podataka iz literature ukažena najbitnije faktore rizika za nastanak CDAD. Faktori rizika za CDAD moguse podeliti u sledeće grupe: (1) lekovi (antibiotici, imunosupresivi, lekovi kojivrše supresiju lučenja želudačne kiseline i hemioterapija), (2) faktori rizikavezani za organizam domaćina (starost iznad 65 godina, komorbiditeti), (3)faktori povezani sa mikroorganizmom (sposobnost C. difficile da adherira zaodgovarajuće intestinalne receptore i produkuje toksine), i (4) faktori sredine(skoriji ili produžen boravak u hospitalnim uslovima, česte hospitalizacije).Poznavanje svih poznatih i potencijalnih faktora rizika za nastanak ovakvihinfekcija uz adekvatno sprovođenje nadzora nad njima, ključni su elementipreventivnih stategija koje mogu značajno da smanje incidenciju CDAD

Recent Initiatives in the Republic of Srpska to Enhance Appropriate Use of Antibiotics in Ambulatory Care; Their Influence and Implications

Introduction: There are increasing concerns world-wide with growing rates of antibiotic resistance necessitating urgent action. There have been a number of initiatives in the Republic of Srpska in recent years to address this and improve rational antibiotic prescribing and dispensing despite limited resources to fund multiple initiatives.Objective: Analyse antibiotic utilization patterns in the Republic of Srpska following these multiple initiatives as a basis for developing future programmes in the Republic if needed.Methods: Observational retrospective study of total outpatient antibiotic utilization from 2010 to 2015, based on data obtained from the Public Health Institute, alongside documentation of ongoing initiatives to influence utilization. The quality of antibiotic utilization principally assessed according to ESAC, ECDC, and WHO quality indicators and DU 90% (the drug utilization 90%) profile as well as vs. neighboring countries.Results: Following multiple initiatives, antibiotic utilization remained relatively stable in the Republic at 15.6 to 18.4 DIDs, with a decreasing trend in recent years, with rates comparable or lower than neighboring countries. Amoxicillin and the penicillins accounted for 29–40 and 50% of total utilization, respectively. Overall, limited utilization of co-amoxiclav (7–11%), cephalosporins, macrolides, and quinolones, as well as low use of third and fourth generation cephalosporins vs. first and second cephalosporins. However, increasing utilization of co-amoxiclav and azithromycin, as well as higher rates of quinolone utilization compared to some countries, was seen.Conclusions: Multiple interventions in the Republic of Srpska in recent years have resulted in one of the lowest utilization of antibiotics when compared with similar countries, acting as an exemplar to others. However, there are some concerns with current utilization of co-amoxiclav and azithromycin which are being addressed. This will be the subject of future research activities

Uticaj gojaznosti i pola na progresiju osteoartroze kuka i koljena: epidemiološka studija u opštoj populaciji

Uvod. Gojaznost je jedan od najvažnijih faktora rizika za nastanak osteoartroze(OA) koljena.Veza između OA kuka i gojaznosti, kao i pola i OA, bezobzira na brojne studije, i dalje je nedovoljno jasna. Cilj rada je bio da se utvrdipovezanost gojaznosti i pola sa degenerativnim oboljenjem kukova i koljenau odrasloj populaciji stanovnika laktaške opštine.Metode. Retrospektivnom analizom podataka iz elektronskih kartona pacijenataliječenih u periodu od 01.01.2006. do 31.12.2010. godine u 16 ambulantiporodične medicine izdvojeno je 7089 degenerativnih koštano-zglobnih oboljenjakod 5301 pacijenta starosne dobi od 18-91 godine. Među njima je bilo1169 artroza kuka i koljena. Dijagnoza OA bazirana je na kliničkim simptomima,rezultatima fizikalnog pregleda i radiološkom nalazu. U navedenomuzorku, analizirani su dob, pol, tjelesna težina, tjelesna visina i indeks tjelesnemase (ITM).Rezultati. Od ukupno 7089 degenerativnih koštano-zlobnih oboljenja kičme,kuka i koljena dijagnostikovanih kod 5301 pacijenta starosne dobi od 18-91godine, zastupljenost artroze kuka i koljena, bila je 1169. Zastupljenost artrozakuka iznosila je 5,8% (411), od toga 67,9% (279) kod žena i 32,1% (132) kodmuškaraca. Procentualna zastupljenost gonartroza bila je 10,7% (758 ), kodžena 66,1% (501) a kod muškaraca 33,9% (257). Kod gojaznih osoba, zastupljenostartroza kuka i koljena bila je 22,1% (395), od toga OA kuka 6,7% (120)(67,5% kod žena i 32,5% kod muškaraca) i 15,4% (275) OA koljena (72,4% kodžena i 27,6% kod muškaraca). Uočena je visoka, statistički značajna (p<0,01)povezanost gojaznosti i OA koljena. Ne postoji statistički značajna povezanostgojaznosti i OA kuka.Zaključak. Visok indeks tjelesne mase značajno utiče na artrozu koljena, aline i na artrozu kuka

Outcomes of intrahospital antimicrobial stewardship programs related to prevention of Clostridium difficile infection outbreaks

Aim To synthesize evidence about the influence of individual antimicrobial stewardship programs (ASP) related to the prevention of Clostridium difficile (C. difficile) infection on primary and secondary outcomes. Methods Relevant databases such as Medline, PUBMED, COCHRANE library and EBSCO were searched from 1 April to 27 April 2017. Additional studies were reached by the manual search for original articles in relevant journals. We included all randomized controlled, quasi-experimental and observational studies, published in the English language from 2007 onward, that evaluated effectiveness of ASP in preventing and controlling C. difficile associated disease (CDAD) among adult inpatients. Results Implementation of ASP interventions was associated with CDAD incidence reduction in 62.5% studies, but no significant differences were reported for the duration of hospitalization, readmission and mortality rate. Improvements in prescribing patterns (decreased antimicrobial use or increased rational use) and microbial outcomes (decreased rates of selected antimicrobial-resistant bacteria) were reported. Evidence on the effects of ASP is mainly limited to the results of studies low in methodological quality with great heterogeneity of outcomes, interventions, and units in which CDAD incidence data were reported. Conclusion Despite the low strength of evidence of reviewed studies, consistency of findings suggest the positive impact of antimicrobial stewardship programs on the prevention and control of nosocomial CDAD. The significance of this problem imposes randomized control trial use as the best instrument to provide high-quality evidence. Further studies need to systematically analyse changes in all antibiotic use and its outcomes