https://www.cidrap.umn.edu/news-perspective/2022/06/stewardship-resistance-scan-jun-24-2022
Stewardship / Resistance Scan for Jun 24, 2022
Empiric antibiotic use in US hospitals;
Antibiotic consumption in India
Filed Under:
Antimicrobial Stewardship
High empiric antibiotic use noted for gram-negative infections in US
A study of adults discharged from more than 900 US hospitals in 2019 found that more than one-third received empiric gram-negative antibiotic therapy, with more than 1 in 5 receiving broad-spectrum antibiotics, researchers reported yesterday in Clinical Infectious Diseases.
Researchers from the University of Maryland Medical School, Johns Hopkins University, and Merck examined 2019 data from the Premier Healthcare Database on adults discharged from US hospitals, focusing on admissions that received at least one empiric gram-negative antibiotic. Empiric was defined as receipt within the first 2 days of hospital admission. They used multivariable logistic regression models to evaluate associations between patient and hospital characteristics and empiric receipt of broad-spectrum gram-negative antibiotics.
Among more than 8 million admissions across 928 hospitals in 2019, 37% of patients received gram-negative antibiotics within the first 2 days of hospitalization, and 22% received broad-spectrum gram-negative antibiotics. Among patients who received broad-spectrum therapy, 30% did not have a common infectious syndrome present on admission (pneumonia, urinary tract infection, sepsis, or bacteremia) or surgery or an intensive care unit stay during the empiric window—a finding that suggests those patients may have been exposed to broad-spectrum antibiotics unnecessarily.
The study also found gender, racial, and regional disparities. Holding other factors constant, men were 22% more likely to receive broad-spectrum therapy (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.22 to 1.23), while non-White racial groups were 6% to 13% less likely (aOR range, 0.87 to 0.94). The highest adjusted odds of receiving broad-spectrum therapy were in the West South Central US census division (Arkansas, Louisiana, Oklahoma, and Texas).
Even after adjusting for patient and hospital characteristics, there remained substantial variability among hospitals, with the probability of receiving broad-spectrum therapy differing by as much as 34 percentage points due solely to the admitting hospital (95% interval of probabilities, 43% to 77%).
"Taken together, our findings underscore the need for greater standardization of empiric antibiotic prescribing in U.S. inpatients, which may require multi-stakeholder initiatives between medical and surgical organizations and infectious disease societies," the study authors wrote.
Jun 23 Clin Infect Dis abstract
Study finds high consumption of broad-spectrum antibiotics in India
A study of antibiotic use in India found that per capita consumption of antibiotics is low relative to other countries, but use of broad-spectrum antibiotics that should be used sparingly is high, researchers reported this week in The Lancet Regional Health Southeast Asia.
Using cross-sectional data from a nationally representative private-sector drug sales database, a team of US and Indian researchers examined antibiotic consumption in the private sector in India in 2019. Private sector antibiotic consumption accounts for roughly 80% to 90% of antibiotic consumption in India, and private companies are the only entities in India that track antibiotic sales and consumption.
For their analysis, the researchers tracked consumption overall and across four dimensions: World Health Organization (WHO) AWaRe (Access, Watch, and Reserve) classification, essentiality, product type, and approval status.
The total number of defined daily doses (DDDs) of antibiotics consumed in 2019 was 5,071 million, translating to 10.4 DDD per 1,000 population per day (DID)—a number lower than previously estimated consumption rates in Brazil (22.75 DID), Pakistan (19.6 DID), Sri Lanka (16.3 DID), and Russia (14.82 DID). Access antibiotics accounted for 27% of the total DDDs consumed, while Watch group antibiotics accounted for 54.9% and Reserve antibiotics for 1%. Azithromycin was the most-consumed Watch antibiotic (22.4%).
Formulations listed in the National List of Essential Medicines accounted for 49% of consumption, fixed-dose combination (FDC) antibiotics accounted for 34%, and unapproved formulations contributed for 47.1%. Watch antibiotics constituted 72.7% of unapproved products, while combination antibiotics that are discouraged by the WHO accounted for 48.7% of FDCs.
The study authors note that the global goal is to have at least a 60% share for Access antibiotics.
"We found that even with a relatively low overall rate of consumption indicating access issues, a high proportion of broad-spectrum antibiotic use in India is a public health concern," they wrote. "With antibiotic resistance emerging as a global public health problem, it is crucial to institute new regulations and strengthen existing ones to monitor and regulate the sale and use of antibiotics while improving access to appropriate antibiotics through the public health system."
Jun 22 Lancet Reg Health Southeast Asia study
Stewardship / Resistance Scan for Jun 24, 2022
Empiric antibiotic use in US hospitals;
Antibiotic consumption in India
Filed Under:
Antimicrobial Stewardship
High empiric antibiotic use noted for gram-negative infections in US
A study of adults discharged from more than 900 US hospitals in 2019 found that more than one-third received empiric gram-negative antibiotic therapy, with more than 1 in 5 receiving broad-spectrum antibiotics, researchers reported yesterday in Clinical Infectious Diseases.
Researchers from the University of Maryland Medical School, Johns Hopkins University, and Merck examined 2019 data from the Premier Healthcare Database on adults discharged from US hospitals, focusing on admissions that received at least one empiric gram-negative antibiotic. Empiric was defined as receipt within the first 2 days of hospital admission. They used multivariable logistic regression models to evaluate associations between patient and hospital characteristics and empiric receipt of broad-spectrum gram-negative antibiotics.
Among more than 8 million admissions across 928 hospitals in 2019, 37% of patients received gram-negative antibiotics within the first 2 days of hospitalization, and 22% received broad-spectrum gram-negative antibiotics. Among patients who received broad-spectrum therapy, 30% did not have a common infectious syndrome present on admission (pneumonia, urinary tract infection, sepsis, or bacteremia) or surgery or an intensive care unit stay during the empiric window—a finding that suggests those patients may have been exposed to broad-spectrum antibiotics unnecessarily.
The study also found gender, racial, and regional disparities. Holding other factors constant, men were 22% more likely to receive broad-spectrum therapy (adjusted odds ratio [aOR], 1.22; 95% confidence interval [CI], 1.22 to 1.23), while non-White racial groups were 6% to 13% less likely (aOR range, 0.87 to 0.94). The highest adjusted odds of receiving broad-spectrum therapy were in the West South Central US census division (Arkansas, Louisiana, Oklahoma, and Texas).
Even after adjusting for patient and hospital characteristics, there remained substantial variability among hospitals, with the probability of receiving broad-spectrum therapy differing by as much as 34 percentage points due solely to the admitting hospital (95% interval of probabilities, 43% to 77%).
"Taken together, our findings underscore the need for greater standardization of empiric antibiotic prescribing in U.S. inpatients, which may require multi-stakeholder initiatives between medical and surgical organizations and infectious disease societies," the study authors wrote.
Jun 23 Clin Infect Dis abstract
Study finds high consumption of broad-spectrum antibiotics in India
A study of antibiotic use in India found that per capita consumption of antibiotics is low relative to other countries, but use of broad-spectrum antibiotics that should be used sparingly is high, researchers reported this week in The Lancet Regional Health Southeast Asia.
Using cross-sectional data from a nationally representative private-sector drug sales database, a team of US and Indian researchers examined antibiotic consumption in the private sector in India in 2019. Private sector antibiotic consumption accounts for roughly 80% to 90% of antibiotic consumption in India, and private companies are the only entities in India that track antibiotic sales and consumption.
For their analysis, the researchers tracked consumption overall and across four dimensions: World Health Organization (WHO) AWaRe (Access, Watch, and Reserve) classification, essentiality, product type, and approval status.
The total number of defined daily doses (DDDs) of antibiotics consumed in 2019 was 5,071 million, translating to 10.4 DDD per 1,000 population per day (DID)—a number lower than previously estimated consumption rates in Brazil (22.75 DID), Pakistan (19.6 DID), Sri Lanka (16.3 DID), and Russia (14.82 DID). Access antibiotics accounted for 27% of the total DDDs consumed, while Watch group antibiotics accounted for 54.9% and Reserve antibiotics for 1%. Azithromycin was the most-consumed Watch antibiotic (22.4%).
Formulations listed in the National List of Essential Medicines accounted for 49% of consumption, fixed-dose combination (FDC) antibiotics accounted for 34%, and unapproved formulations contributed for 47.1%. Watch antibiotics constituted 72.7% of unapproved products, while combination antibiotics that are discouraged by the WHO accounted for 48.7% of FDCs.
The study authors note that the global goal is to have at least a 60% share for Access antibiotics.
"We found that even with a relatively low overall rate of consumption indicating access issues, a high proportion of broad-spectrum antibiotic use in India is a public health concern," they wrote. "With antibiotic resistance emerging as a global public health problem, it is crucial to institute new regulations and strengthen existing ones to monitor and regulate the sale and use of antibiotics while improving access to appropriate antibiotics through the public health system."
Jun 22 Lancet Reg Health Southeast Asia study