Atsushi Uda1,2, Takeshi Kimura3, Sho Nishimura1,4, Kei Ebisawa1,4, Goh Ohji1,4, Mari Kusuki1,5, Mariko Yahata1,6, Rie Izuta1,6, Tomoyuki Sakaue2, Tatsuya Nakamura7, Chihiro Koike1, Issei Tokimatsu8, Ikuko Yano2, Kentaro Iwata4, Takayuki Miyara1. 1. Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, Japan. 2. Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan. 3. Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan. kimutake@med.kobe-u.ac.jp. 4. Department of Infectious Disease, Kobe University Hospital, Kobe, Hyogo, Japan. 5. Department of Clinical Laboratory, Kobe University Hospital, Kobe, Hyogo, Japan. 6. Department of Nursing, Kobe University Hospital, Kobe, Hyogo, Japan. 7. Department of Medical Technology and Sciences, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan. 8. Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan.
Abstract
PURPOSE: This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes. METHODS: A before-after study was conducted to compare the data for 1 year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral third-generation cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of β-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillin-resistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality. RESULTS: The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5-25.1) vs. 3.7 (0.0-7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention. CONCLUSION: Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.
PURPOSE: This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes. METHODS: A before-after study was conducted to compare the data for 1 year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral third-generation cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of β-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillin-resistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficileinfection (HA-CDI), and hospital mortality. RESULTS: The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5-25.1) vs. 3.7 (0.0-7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention. CONCLUSION: Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.
Authors: Katherine E Fleming-Dutra; Adam L Hersh; Daniel J Shapiro; Monina Bartoces; Eva A Enns; Thomas M File; Jonathan A Finkelstein; Jeffrey S Gerber; David Y Hyun; Jeffrey A Linder; Ruth Lynfield; David J Margolis; Larissa S May; Daniel Merenstein; Joshua P Metlay; Jason G Newland; Jay F Piccirillo; Rebecca M Roberts; Guillermo V Sanchez; Katie J Suda; Ann Thomas; Teri Moser Woo; Rachel M Zetts; Lauri A Hicks Journal: JAMA Date: 2016-05-03 Impact factor: 56.272
Authors: H Morioka; M Iguchi; N Tetsuka; F Kinoshita; Y Tomita; D Kato; A Hirabayashi; A Matsumoto; K Oka; H Kato; T Inagaki; Y Kato; K Kitagawa; K Ichikawa; Y Kouyama; N Kawamura; Y Toyodome; N Adachi; Y Ito; T Yagi Journal: Infect Prev Pract Date: 2021-06-04