P92 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS): RESULTS OF ANTIMICROBIAL PRESCRIBING FOR A GENERAL HOSPITAL IN URMIA, IRAN
C. Alinia1, S. Gheibi2, A. Versporten3, I. Pauwels3, H. Goossens3
1Public health; 2Maternal and Childhood Obesity Research Center, Urmia University of Medical Sciences, Urmia, Iran, Islamic Republic Of; 3Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium
Correspondence: C. Alinia
Introduction: This study has done to monitor antimicrobial prescribing and resistance rates in Iran
Objectives: To measure the prevalence rate of antimicrobial prescription at hospital level
To address the quality of antibiotics prescription
Methods: A uniform and standardized method for surveillance of antimicrobial use in hospitals was used to assess the variation in antimicrobial prescribing in West Azerbaijan province, Iran. PPS was conducted in 2018, in child and neonatal wards in a teaching and general hospital. The survey included all inpatients receiving an antimicrobial on the day of the PPS. Data collected included details on the antimicrobial agents, reasons and indications for treatment as well as a set of quality indicators. A web-based application was used for data-entry, validation and reporting as designed by the University of Antwerp (www.global-pps.com). bioMérieux provided unrestricted funding support for the survey.
Results: The overall prevalence rate was achieved as 60.6%. Among the different specialized wards, the lowest and highest prevalence rates was related to Haematology−Oncology Medical (30%) and Neonatal Medical (77.8%) Wards, respectively. The most antibiotic use in Pediatric and neonatals wards were other beta-lactams and Penicillins, respectively. Pneumonia, prophylactic urinary tract infection, and prophylaxis of central nervous system infections, were the three most common diagnosis treated with therapeutic antibiotics. Overall, the reason for treatment was recorded in 84.97% of antimicrobial prescriptions, and a stop or review date in 3%. Local antibiotic guidelines were missing for 88.6% of the prescriptions. None of the patients received a targeted antibacterial treatment for systemic use.
Conclusion: The findings indicate that Iran has the highest prevalence rate of antibiotic prescription related to child and neonatal wards among all countries studied in Global PPS study. In addition to, the indicators confirmed the low quality of antibiotic prescription.
Disclosure of Interest: None declared
P93 BITTER OR SWEET: THE INCREASING USAGE OF ANTIBIOTICS OVER THE GLOBE
H. K. Lam1, K. Rajwinder2
1Clinical Operations, Matilda International Hospital, Hong Kong; 241 mount kellett road, matilda international hospital, the peak, Hong Kong
Correspondence: H. K. Lam
Introduction: Antibiotic is a sugarcoating poison as it saves many lives from fatal infections. It can also be a potential bomb if it is being misused and will lead to the growth of antibiotic-resistance in human.
Objectives: To prevent most infections from being incurable in the future, our hospital has set up an Antibiotic Stewardship Programme (ASP) with a team to monitor the usage of Big Gun (BG) antibiotics. Our ASP team is composed of the executive medical director (EMD), infection control officer (ICO), pharmacist, infection control coordinator(ICC) with a microbiologist as our honorably consultant.
Methods: In hardware, we have a BG Prescribing form. In software, we have a computer system which audits on the usage of BG antibiotics with indication, patient’s diagnosis, medical history, culture result, inflammation markers recorded. Once a BG antibiotic is prescribed, pharmacist will attach the form together with MAR in the dispensing process. The physician has to complete the form before ICC’s collection who will then input the data into the system. Afterwards, an email will automatically be sent to the case physician and the ASP team. EMD and ICO act as auditors and will send feedback to the physician on the appropriateness of the prescription with reference to IMPACT, a local antibiotic guideline, and according to patient’s information given.
Results: From September 2018 to March 2019, 54 BG was antibiotics have been recorded. Most (44%) were prescribed by family doctors. Among the types of BG prescribed, Piperacillin & Tazobactam (25%) is mostly prescribed. Most indications are respiratory infection(36%) followed by orthopaedic(20%). The purpose of prescription are recorded as 55% empirical, 27% pathogenic and 18% prophylactic. 67% are regarded “appropriate”, with 24% “not-appropriate” and 9% “don’t know”. 9% of physicians replied disagree to the audit outcome with the remaining either agree or no comment.
Conclusion: Seeing the high prescription rate from family doctors, the issue has been discussed and evaluated in doctors’ meeting. Physicians are open to feedback the rational for their prescription if it is regarded as Not Appropriate or Don’t Know. The audit allows for discussions between the auditors prior to finalizing a ‘verdict’ which reduces the likelihood of wrongly affecting clinical practice. ASP raised physicians’ awareness and a decrease of BG prescription is noted.
Disclosure of Interest: None declared
P94 POINT PREVALENCE STUDY OF ANTIBIOTIC COMPLIANCE ACROSS DISCIPLINES AT A TERTIARY MALAYSIAN HOSPITAL
M. K. Yin, C. L. Lau
Pharmacy, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia
Correspondence: M. K. Yin
Introduction: Point prevalence study of antibiotics is the audit of judicious antibiotic use in accordance to local and national antibiotic guidelines. Inappropriate antibiotic use is associated with prolonged hospitalization, increased healthcare costs and development of antimicrobial resistance.
Objectives: To determine the rate of antibiotic compliance in accordance to local and national antibiotic guidelines across various disciplines in a tertiary hospital.
Methods: All antibiotic prescriptions from 43 wards of various disciplines were audited daily over a span of 2 weeks. Screening of prescriptions started at 8am using information obtained from case notes for indication and diagnosis pertaining to each antibiotic. Any discrepancies were discussed with the primary discipline team and infectious disease consultant. Data collected was then analyzed for compliance to local therapeutic guidelines, appropriateness of therapy in terms of dosage, spectrum of coverage, duration and choice by a team of pharmacists and infectious disease consultant.
Results: Of the 346 cases screened, obstetric and gynaecology was shown to have the lowest level of compliance to local guidelines for empirical antibiotic use (33.3%, n=15), followed by orthopedics (36.0%, n=25), surgery (42.4%, n=59), medical (52.6%, n=95), pediatrics (54.2%, n = 35), and intensive care (60.0%, n =5).
Conclusion: Compliance to local and national antibiotic guidelines was seen to be lowest among obstetricians for empirical use. Lack of up to date knowledge on antibiotic guidelines was seen as the possible barrier for appropriate antibiotic use.
Disclosure of Interest: None declared
P95 POINT PREVALENCE SURVEY OF ANTIMICROBIAL USE IN A TERTIARY TEACHING HOSPITAL IN THE PHILIPPINES
A. F. G. Malundo1, F. A. R. Palabrica1, R. P. Berba2
1Philippine General Hospital, Manila, Philippines; 2Hospital Infection Control Unit, Philippine General Hospital, Manila, Philippines
Correspondence: A. R. Palabrica
Introduction: The overuse and misuse of antimicrobials drives antimicrobial resistance.
Objectives: This study aimed to evaluate antimicrobial prescribing practices and determine areas for quality improvement.
Methods: A point prevalence survey of antimicrobial use among patients admitted in the Philippine General Hospital was conducted in 2017 and 2018 using the Global Point Prevalence Survey protocol. The study was conducted as part of a nationwide project headed by the Philippine Antimicrobial Point Prevalence Survey team. A descriptive analysis of the prevalence of antimicrobial use was reported along with relative frequencies of antimicrobials. Findings were compared using chi-square test.
Results: The prevalence of antimicrobial use was 49.83% and 47.73% in 2017 and 2018, respectively (p=0.21). A significant decline in antimicrobial use was noted in the neonatal and pediatric ICU (p<0.05), while usage increased in the neonatal medical ward (p=0.02). Antimicrobials were prescribed mostly for community-acquired infections, and as empiric therapy, with pneumonia being the most common infection requiring antimicrobials. About three fourths of antibiotics for surgical prophylaxis were given for >24 hours, with cefuroxime being the preferred agent. In 2017, cefuroxime was the most prescribed antibiotic, but was surpassed by meropenem in 2018. Broad-spectrum antibiotics were used often in critically-ill, and in medical patients.
Physician documentation of indication for antimicrobials improved from 68.80% in 2017 to 74.74% in 2018 (p<0.05). Guideline compliance increased from 63.50% to 74.96%, though not statistically significant (p=0.40). Nearly half of noncompliant prescriptions were for surgical prophylaxis. Documentation of antibiotic stop-date was not common practice, that is <30% in two years of survey.
Conclusion: Overall prevalence of antimicrobial use did not change from 2017 to 2018, however was evident in specific areas. Antimicrobial use varied depending on hospital area, patient profile, and indication. Interventions should focus on (1) improving physician awareness of guidelines, (2) education on appropriate surgical prophylaxis, (3) antibiotic deescalation, and (4) proper documentation.
Disclosure of Interest: None declared
P96 HEALTHCARE ASSOCIATED INFECTIONS (HAI) AND ANTIBIOTIC USE SURVEY AT FOUR REGIONAL HOSPITALS IN SIERRA LEONE
A. Maruta1, H. Benya2, N. S. Kamara3
1IPC, World health organisation, 2IPC, CDC, 3IPC, Ministry of Health and Sanitation, Freetown, Sierra Leone
Correspondence: A. Maruta
Introduction: Healthcare-associated infections (HAI) are a safety concern globally for both patients and healthcare providers. Healthcare-associated infections are a major threat for patient safety and the impact on health and well-being are longer duration of illness, longer treatment, higher mortality, treatment with expensive medicines, increased burden on the health system and huge economic impact. Surveillance of HAIs is an important infection control activity and also an indicator of quality patient outcomes. Knowledge of the prevalence of antibiotic resistance is a pre-requisite for infection prevention and control and is essential for healthcare policy makers to conduct effective responses.
Objectives: The main aim was to gather baseline data and information required for the development of an HAI and AMR strategy in Sierra Leone and to determine the prevalence of healthcare-associated infections
Methods: The point prevalence survey was conducted at four regional hospitals in Sierra Leone. A questionnaire-based survey was designed to collect information on the prevalence of HAI, antibiotic prescribing patterns and capacity of the health facility to promote an antibiotic stewardship program. The multi-disciplinary surveillance team included doctors, nurses, pharmacists and laboratory personnel. A questionnaire-based survey was designed to collect information on the prevalence of HAI, antibiotic prescribing patterns and capacity of the health facility to promote an antibiotic stewardship program.
Results: Data from 327 patients were collected out of 441 inpatients. About 114 patients were not included in the survey as they did not meet the inclusion criteria. The most common type of antibiotic prescribed was Ceftriaxone (54%) followed by Metronidazole (49%). Overall the prevalence of antibiotic use was 73.7% (95% CI: 69.3-77.7). Highest antibiotic use was in neonatal unit followed by ICU and paediatric wards across all hospitals
Conclusion: The survey has demonstrated that a point-prevalence survey methodology can be applied successfully to surveillance of HAI and antibiotic use across hospitals in Sierra Leone and the results can identify targets for patient safety and quality improvement.
Disclosure of Interest: None declared
P97 EVALUATION OF ANTIBIOTIC PRESCRIPTION IN A GENERAL HOSPITAL OF DR CONGO: SPECIFIC CASE OF NYANKUNDE HOSPITAL
E. K. Kabululu1, K. Mutendela2, S. Linda3, M. Jeanne4, G. Ray-Barruel5
1Infection control, CME Nyankunde, Beni, Congo, The Democratic Republic of the; 2Medecine interne, Hopitaux de lannemezan, lannemezan, France; 3communication, UCB, Bukavu; 4Gynecology, CME nyankunde, Beni, Congo, The Democratic Republic of the; 5Research, Griffith University, Bisbane, Australia
Correspondence: E. K. Kabululu
Introduction: Antibiotic overuse or misuse is one of the main antimicrobial drug prescription problems in low income countries, which leads to substantial modification of the bacterial ecology in health care facilities. In African hospitals, the list of essential antibiotics available is very restricted and contains less than ten antibiotics. However, resistance to older antibiotics is increasing and the development of new molecules has stalled.
Objectives: To monitor the using of antimicrobial in the D R C facility
Methods: We conducted a cross-sectional study to determine the prevalence of patients who received one or more antibiotics during their hospitalization. Data were collected on two different days in a 2-week period at Nyankunde Hospital, Beni city, in the province of North Kivu, DR Congo.
Results: In this study, the overall antibiotherapy rate was 43.2% (59/137 inpatients). Patients with antimicrobial therapy were aged between 4 months and 84 years; gender included 29 women and 30 men. Patients receiving antimicrobial therapy were admitted to different wards, as follows: Surgery (5%), Obstetrics (9%), Pediatrics (18%), Internal Medicine (30%), VIP ward (18%), Emergencies (11%) and Intensive care (6%). The common first diagnosis was sepsis syndrome (59%), and 47% of inpatients had also a second associated diagnosis. No bacterial culture tests were performed on any patient. However, 19% of patients had positive Widal Felix serodiagnosis testing and 15% had positive malaria rapid diagnostic tests (RDT). For those receiving single antibiotics (n=27), patients received mainly ceftriaxone (n=22, 37%) or ampicillin (n=20, 34%). Those receiving two antibiotics (n=32) usually had gentamicin (n=21, 35%) added, and for those who received three antibiotics (n=6) metronidazole (n=5, 8%) was the most common addition.
Conclusion: At this DR Congo hospital, 43.2% of inpatients had antibiotic therapy. The main reason was sepsis (proven or suspected), either as first or second syndrome. Microbial cultures are not feasible, and only RDTs of malaria and Salmonella infectious diseases are available. In these conditions, it is not possible to monitor antimicrobial resistance
Disclosure of Interest: None declared
P98 EVALUATION OF INJECTABLE ANTIBIOTICS RECONSTITUTION AND ADMINISTRATION IN THE PEDIATRIC SERVICE OF GABRIEL TOURÉ UNIVERSITY HOSPITAL
L. Bengaly1, A. T. Traoré2, A. Fané1
1Pharmacie, Hôpital Universitaire Gabriel Touré; 2Pharmacie, Hôpital du Mali, Bamako, Mali
Correspondence: L. Bengaly
Introduction: Bacterial resistance to antibiotics is a public health problem that spares no health system in the world. Antibiotics misuse in health facilities is one of the main factors behind the emergence of this antimicrobial resistance. Good reconstitution practices contribute to the proper use of injectable antibiotics in hospitals.
Objectives: The aim was to evaluate antibiotic dilution and administration techniques in the pediatric service and specifically to identify dilution solvents, their volumes and modes of administration.
Methods: The study was prospective and focused on children hospitalized in the pediatric service between March and September, 2016. Data were collected by direct observations of care practices associated with additional informations by interviewing care staff.
Results: A total of 2737 replenishment and administration sessions were collected. Distilled water was the most used solvent (87.9%) followed by sodium chloride 0.9% injectable solution (with 6.60%), glucose 5% injectable solution (2.10%), glucose 10%solution (with 1.7%) and sodium lactate, compound injectable solution (1.5%). Solvent volumes between 2.5ml and 10ml were the most used for reconstitution and were used for direct intravenous administration. The prescribed dilution volumes and dosages were respected in 77.34% of cases. Ceftriaxone was the most reconstituted antibiotic (65.07%) followed by amoxicillin (12.46%). Combinations of antibiotics or with other products in the same syringe have been reported (495 cases or 18.08%): ceftriaxone + gentamicin (96.16%) Ceftriaxone + Gentamicin + dexametaxone (2.22%) Cefotaxime + Gentamicin + Methylprednisolone (0.81%). Combinations of drugs in the same administration syringe were contrary to medical prescription guidelines. A single vial of solution (sodium chloride 0.9%, glucose 5% or glucose 10%) was used to reconstitute the several antibiotics for different children and was used by all teams with risks of contamination.
Conclusion: The shortcomings identified made it possible to formulate recommendations for better patient care, which will enhance the care quality.
Disclosure of Interest: None declared
P99 PREVALENCE OF ANTIBIOTIC USE AND ADMINISTRATION AMONG HOSPITALIZED ADULT PATIENTS AT A TERTIARY CARE HOSPITAL IN KILIMANJARO TANZANIA
F. J. Muro1,2,3, F. Lyamuya2,3,4, R. Mallya3,5, B. Mmbaga2,3,6,7, G. Tillekeratne 6
1Community Health, Kilimanjaro Christian Medical Centre; 2Faculty of Medicine, Kilimanjaro Christian Medical University College; 3Research, Kilimanjaro Clinical Research Institute; 4Faculty of Medicine; 5Maternal and Child Health, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of; 6Global Health, Duke Global Health Institute, Durham, United States; 7Paediatric, Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of
Correspondence: F. J. Muro
Introduction: Antimicrobial stewardship programs (ASPs) have been shown to improve the appropriate use of antimicrobials, especially in high-income countries. However, ASPs are relatively less well implemented in low-or-middle income countries. To improve the effectiveness of ASPs in these settings, it is important to determine the core actions and targets for improving antimicrobial use.
Objectives: To describe the prevalence and patterns of antibiotic use at a tertiary care hospital in Tanzania.
Methods: Consecutive patients admitted to an adult medical ward at a tertiary care hospital, Kilimanjaro Christian Medical Centre in Moshi, Tanzania were enrolled from June 2018 to March 2019. The medical record was reviewed for data regarding antibiotics prescribed, indications for use, and microbiologic testing ordered.
Results: Of 1103 patient’s enrolled majority were males (663, 60.1%), with the median age being 54 years (IQR 39-70). About one-third (390, 35.4%) of the patients received antimicrobials during hospitalization, with pneumonia being the leading indication for antimicrobial use (158, 40.5%). Most commonly used antibiotics included ceftriaxone 285 (73.1%), metronidazole 155 (39.7%), and amoxicillin/ampicillin 46 (11.8%) patients. Median duration of antimicrobial use was 5 days (IQR 3-7). Few patients on antimicrobials (27, 6.9%) had culture results, of which half (15, 55.6%) were positive for an organism and a minority (8, 29.6%) were susceptible to the antibiotics being used. Overall mortality in the cohort was 22.7% and median duration of hospitalization was 5 days (IQR 3-8).
Conclusion: Antibiotics were used in a substantial proportion of admitted patients. However, in most cases, treatment was empirical with limited use of culture results. Future ASP efforts can target the improved use of microbiologic cultures to target antimicrobial use.
Disclosure of Interest: None declared
P100 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS) IN TOGO
M. Salou1, F. Nounhou1, A. Versporten2, I. Pauwels2, K. D. Ekouevi3, H. Goossens2, A. Y. Dagnra1
1Laboratory of Medical Microbiology, University of Lomé, Lomé, Togo; 2Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium; 3Public health department, University of Lomé, Lomé, Togo
Correspondence: A. Versporten
Introduction: The Global-PPS is a standardized tool to assess antimicrobial use (AMU) and resistance and helps to establish antibiotic stewardship programs.
Objectives: We aim to report results of the survey in 9 hospitals in Togo.
Methods: The standardized Global-PPS method was used to assess variation in antimicrobial prescribing in 9 hospitals in December 2018. The survey included all inpatients receiving an antimicrobial on the day of the PPS. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality indicators. bioMérieux provided unrestricted funding support for the survey.
Results: Of the 9 hospitals, 2 were tertiary care hospitals. The survey included 713 patients of which 89.8% were treated with at least one antimicrobial. Top 3 indications for AMU were malaria (32.2%), other undefined (17%) and gastro-intestinal infections (6.3%). Out of 1062 antimicrobials, 16.9% were antimalarials and 74.7% antibacterials for systemic use of which ceftriaxone (27.2%), amoxicillin (17.8%) and metronidazole (11.7%) were most frequent prescribed. Therapeutic prescribing (n=716) accounted for 67.4% of which 95.8% for a community and 4.2% for a hospital acquired infection. Antimicrobials used for medical or surgical prophylaxis (SP) accounted for 13.8% and 17.4%. Ceftriaxone, ciprofloxacin and amoxicillin were most often prescribed for SP (30.2%, 19.2%, 17.4% respectively). Prolonged SP (≥1 day) in adults and children was common (69%). The reason for antimicrobial prescription was documented in 83.3% of cases while a stop/review date was only documented in 25.0% of cases. Guideline compliance reached 98.1%. No patients were reported to have received a microbiology−based treatment.
Conclusion: This survey was the first conducted in the country. It is important setting-up a tailored antimicrobial stewardship program in each hospital. The challenge remains reinforcement of infection prevention and the medical bacteriology lab capacity by offering antimicrobial susceptibility testing to monitor prescription.
Disclosure of Interest: None declared
P101 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS) IN BURKINA FASO
A.-S. Ouedraogo1, A. Versporten2, A. Nagalo3, I. Pauwels2, H. Goossens2, A. Ouedraogo3, A. Poda4
1Department of Medical Bacteriology and Virology Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso, Bobo Dioulasso, Burkina Faso; 2Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium; 3Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso; 41Souro Sanou Teaching Hospital, Bobo-Dioulasso, Burkina Faso , Bobo Dioulasso, Burkina Faso
Correspondence: A.-S. Ouedraogo
Introduction: Burkina Faso experiences difficulties in the management of increased antimicrobial resistance.
Objectives: We aimed to assess for the first time, antimicrobial use in hospitals in Burkina Faso.
Methods: The standardized Global-PPS method assessed antimicrobial prescribing in 7 hospitals in Burkina Faso in February-March 2019. The survey included all inpatients receiving an antimicrobial on the day of the PPS. Data included details on the antimicrobial agents, reasons and indications as well as a set of quality indicators. bioMérieux provided unrestricted funding support for the survey.
Results: The survey included 1190 inpatients. Overall antimicrobial (AM) prescription rate was 71.8% with highest rates found in newborn wards (89.2%). Prophylaxis in neonates (12.4%) and digestive tract infections (11.9%) were the most common indications. Out of 1080 AMs, systemic antibacterials (78.9% of which 26.8% ceftriaxone), antiparasitics (13.4% of which 9.5% artesunate), and antimycobacterials (3.2%) were the most prescribed antimicrobial classes. Community acquired infections were common (85.2%). Healthcare-associated infections accounted for less than 5% of antimicrobials and included mainly surgical site infections (55.6%) and infections on invasive materials (27.8%). Surgical prophylaxis (n=62 antibiotics; 5.7%) lasted mostly for more than 2 days (87.1%). The reason for the antimicrobial prescription was documented in 82% of cases, but this corresponded only half to national or international guidelines (52.9%). A stop/review date was rarely reported (6.2%). Most antimicrobials were prescribed empirically (99%). Antimicrobial therapy was oriented towards ESBL (3 cases/7), MRSA (2cases/7) and non-fermenter gram negative bacilli producer of ESBL (1case/7) only.
Conclusion: Antimicrobial prevalence in hospitals in Burkina Faso is high. Continued education of caregivers on rational antimicrobial use and improved access to microbiological investigations is needed. We will expand the study to all health regions to provide a picture of the national situation and needs.
Disclosure of Interest: None declared
P102 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE: 2018-2019 RESULTS FOR HOSPITAL-ACQUIRED PNEUMONIA IN 8 MEXICAN HOSPITALS
E. Gonzalez-Diaz1, A. Versporten2, S. Loza3, J. Corona4, I. Pauwels2, J. Araujo5, D. Basurto6, N. Hernández7, M. Almaraz8, J. Molina9, D. Torres10, H. Goossens2
1Unidad de Vigilancia Epidemiologica Hospitalaria & Medicina Preventiva, Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Mexico; 2Laboratory of Medical Microbiology, Vaccine and Infectious Diseases Institute, University of Antwerp, Antwerp, Belgium; 3Hospital de Especialidades CMN Siglo XXI , IMSS, Mexico City; 4Hospital Angeles del Carmen, Guadalajara; 5Hospital Central Dr. Morones Prieto, San Luis Potosí; 6Hospital General Regional 200 IMSS, Estado de Mexico; 7bioMerieux, Guadalajara; 8HGR 1 IMSS Dr. Carlos McGregor Sánchez, HGR 1 IMSS Dr. Carlos McGregor Sánchez, Ciudad de Mexico; 9Hospital Cardiología IMSS, Monterrey; 10HR de Alta Especialidad de la Península de Yucatán, Mérida, Mexico
Correspondence: I. Pauwels
Introduction: Despite advances in HAP and VAP, they continue to account for 22% of all HAIs. In an effort to minimize patient harm and unnecessary antibiotics and reduce antibiotic resistance development a recommendation is generate local antibiograms to guide healthcare professionals to the optimal choice of antibiotics and antimicrobial stewardships programs be implemented.
Objectives: The Global-PPS (www.global-pps.com) [G-PPS] aims to assess variation of antimicrobial prescribing worldwide. We describe antibiotic treatment for Hospital-Acquired Pneumonia (HAP) in Mexico.
Methods: A standardized surveillance of antimicrobial use assessed HAP prevalence and variation in antimicrobial therapy in 8 Mexican hospitals. The G-PPS was conducted from May 2018 and April 2019, in 6 tertiary and 2 secondary care hospitals. Data collected included antimicrobials, indications for treatment and quality indicators.
Results: The G-PPS included 2,181 patients on antimicrobials, 1,930 on adult, 193 on pediatric and 58 on neonatal wards.Of all treated adults, 315 patients (16.3%) were diagnosed with pneumonia, 57.5% (n=181) had HAP.For adult HAP patients, 36.5%of prescriptions were targeted, of which 49.1% against at least one multidrug resistant organism (MDRO). Of all targeted prescriptions, 37% were targeting ESBL Gram-negatives and 18.5% targeted other MDROs. In the adult ward,reason for prescription was documented in 95.6% of cases and 83%complied with local guidelines. Biomarkers were used to progress treatment in 41.4% of cases. Overall, the most commonly prescribed antibiotics were meropenem (23%), linezolid (8.8%) and vancomycin (7.4%).
Conclusion: These finding show the need to implement antimicrobial stewardship in all hospitals to improve antibiotic prescribing by reducing carbapenem use, enhancing compliance to guidelines and performing post-prescription review.
Disclosure of Interest: None declared
P103 ANTIBIOTIC USE TRENDS IN A PEDIATRIC HEART SURGERY HOSPITAL IN GUATEMALA
H. G. Maldonado1, J. Guerra1, G. Calvimontes2, R. Mack3, J. Barnoya4
1Control y Prevención de Infecciones Intrahospitalarias; 2Departamento de Cirugía Cardiovascular Pediátrica y Cardiología Pediátrica “Dr. Aldo Castañeda”; 3Unidad de Terapia Intensiva Cardiovascular; 4Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala, Guatemala, Guatemala
Correspondence: H. G. Maldonado
Introduction: Hospitalized children often receive inappropriate antibiotics. However, scant data are available on antibiotic use in congenital heart surgery (CHS), particularly from low-middle income countries (LMICs).
Objectives: We assessed antibiotic use trends in patients undergoing CHS in Guatemala, a LMIC.
Methods: From Jan 2015 to Mar 2019 we measured days of therapy (DOT), length of treatment (LOT), and antibiotic-free days (AFD). All rates were adjusted to 1000 patient-days. Trends for DOT rate per antibiotic family type and quarterly series were analyzed using Pearson correlation. Analyses were done in STATA.
Results: 1335 children underwent to CHS, using a total of 11351 days of antibiotic therapy in 14172 patient-days. Mean rates were 801 DOT, 477 LOT, and 523 AFD per 1000 patient-days. DOT (r = -0.25, p= 0.32), and LOT (r = -0.49, p= 0.04) rates showed a downward trend. The observed mean DOT rates by antibiotic family per 1000 patient-days were: 167 for anti-pseudomonal penicillins, 148 carbapenems, 136 vancomycin, 85 amynoglucosides, 84 cephalosporins, 44 fluoroquinolones, and 32 fosfomycin. A downward trend was observed for piperacillin-tazobactam (r = -0.50, p = 0.03), aminoglycosides (r = -0.48, p = 0.049) and fluoroquinolones (r = -0.41, p = 0.04). An upward trend was observed for cephalosporins (r = 0.54, p = 0.02), and fosfomycin (r = 0.6, p = 0.01). Carbapenems (r = -0.12, p = 0.63), and vancomycin (r = 0.07, p = 0.78) maintained a stationary trend.
Conclusion: Our findings suggest that DOT rates are similar in Guatemala to those reported in high-income countries, however carbapenems and vancomycin had greater DOT rates. Interventions are needed in order to decrease inappropriate antibiotic prescription in this resource-limited setting.
Disclosure of Interest: None declared
P104 QUANTITY AND QUALITY OF ANTIBIOTIC PRESCRIBING FOR SEPSIS IN HOSPITALISED ADULTS: RESULTS OF THE 2015, 2017 AND 2018 GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS)
I. Pauwels1, A. Versporten1, S. Le Page2, H. Goossens1, on behalf of the Global-PPS network
1Laboratory of Medical Microbiology, University of Antwerp, Wilrijk, Belgium; 2bioMérieux, Marcy l’Etoile, France
Correspondence: I. Pauwels
Introduction: Sepsis is a severe condition, requiring rapid initiation of antimicrobial therapy.
Objectives: We aimed to describe the quantity and quality of hospital antibiotic prescribing in adult sepsis patients in five continental regions.
Methods: The Global-PPS assessed hospital antimicrobial prescribing patterns using a standardised method. A total of 662 hospitals in 67 countries participated in a PPS of antimicrobial use at least once in 2015, 2017 or 2018. We descriptively analysed data on adult patients receiving a systemic antibiotic (ATC J01) on the day of the survey. bioMérieux provided unrestricted funding support for the survey.
Results: Of 73,080 adults on systemic antibiotics, 2.6% were being treated for sepsis, 51.7% of which were on antibiotics for a healthcare-associated (HA) sepsis, ranging from 38.5% in Africa to 77% in South America. Overall, 21.7% of HA sepsis cases were related to the use of invasive devices. Microbiological results were used to inform treatment in 26.7% of prescriptions. Of all patients, 69.3% were on single-agent therapy, ranging from 48.7% in South America to 80.4% in Europe. A penicillin/β-lactamase-inhibitor was the most common regimen (25.7%), followed by a carbapenem (12.1%) and a 3rd generation cephalosporin (10.1%). Overall, 12.1% of sepsis patients were being treated with one or more Reserve antibiotic, ranging from 7.7% in Africa to 25.6% in South America. Stop/review date and reason for treatment were documented in 35.9% and 80.7% of prescriptions respectively. Guideline compliance was reported to be up to 79.8%, yet guidelines were missing in 22.9% of prescriptions.
Conclusion: These data illustrate challenges related to antibiotic prescribing for sepsis patients, such as the use of broad-spectrum agents, low documentation of stop/review date, sub-optimal use of microbiology to inform treatment and a high proportion of Reserve prescribing. The use of Reserve antibiotics was particularly high in South America, with 1 in 4 sepsis patients exposed to these last-resort drugs. PPS results can support local stewardship teams in designing contextualised interventions, even for critical conditions such as sepsis.
Disclosure of Interest: None declared
P105 POINT PREVALENCE SURVEY OF ANTIMICROBIAL USE AND RESISTANCE IN THE INTENSIVE CARE UNITS OF GEORGIA
M. Tsereteli1,2, G. Chakhunashvili2, O. Tsagareishvili2, D. Tsereteli2
1High Technology Medical Center, University Clinic; 2Communicable Disease, National Center for Disease Control and Public Health, Tbilisi, Georgia
Correspondence: M. Tsereteli
Introduction: Antimicrobial resistance (AMR) is predominantly due to inappropriate use of antibiotics, so it is mandatory for healthcare facilities to monitor antimicrobial consumption.
Objectives: Assessment of antibiotic use and AMR in intensive care units (ICUs) of Georgian hospitals through point-prevalence survey.
Methods: Point Prevalence Survey (PPS) of Antimicrobial Consumption and Resistance was conducted according to the Global-PPS protocol in ICUs of 10 multi-profile hospitals of three biggest cities of Georgia (Tbilisi, Kutaisi, and Batumi). PPS was performed in June, 2018.
Results: On the day of the survey, total number of beds at the ICUs was 176, with 119 patients (bed occupancy percentage of 67.6%).
Antibiotics were administered to 74 patients (62.2%). 46 (62.2%) patients received empirical antibiotic therapy. Among them, 16 (34.8%) had administered two or more antibiotics. Empirically, the following antibiotics were used most frequently: Ceftriaxone – 17 (37.0%), Vancomycin – 8 (17.4%) and Carbapenems 6 (13.0%).
Only 28 (37.8%) patients have received etiotropic antibiotics therapy, moreover, 15 (53.8%) patients have received it with two or more antibiotics.
Healthcare-associated infections were seen in 34 patients (28.6% of ICU patients), including: ventilator-associated pneumonia - 22 cases (64.7% of all nosocomial infections), surgical site infection - 7 cases (20.6%), catheter-associated bloodstream infection – 2 cases (5.9%), catheter-associated urinary tract infection – 2 cases (5.9%), C. difficile-associated infection - 1 case (2.9%).
Among enrolled patients, following multi-resistant strains were isolated and identified from clinical samples: 5 ESBL-producing non-fermenting gram negative bacilli, 4 ESBL-producing Enterobacteriaceae, 3 carbapenem-resistant Enterobacteriaceae, 3 carbapenem-resistant non-fermenting gram negative bacilli, 1 methicillin-resistant Staphylococcus aureus.
Conclusion: PPS revealed the necessity of interventions in several directions in order to improve quality of antibiotic prescriptions. In the future PPS can be used as a forceful tool to monitor appropriate use of antibiotics.
Disclosure of Interest: None declared
P106 THE GLOBAL POINT PREVALENCE SURVEY OF ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS): 2015, 2017 AND 2018 RESULTS OF ANTIBIOTIC PRESCRIBING FOR PNEUMONIA IN GEORGIA
I. Korinteli, I. Pauwels2, A. Versporten2, H. Goossens2, H. Phagava1, K. Pagava1
1Tbilisi state medical university, Tbilisi, Georgia; 2University of Antwerp, Antwerp, Belgium
Correspondence: I. Korinteli
Introduction: Pneumonia is a frequent reason for antibiotic use and a common cause for hospitalisation, both in children and adults.
Objectives: We aimed to assess antibiotic prescribing patterns for pneumonia in Georgian hospitals to identify potential targets for antimicrobial stewardship.
Methods: The Global-PPS was conducted in 18 Georgian hospitals in 2015, 2017 and 2018. The survey included all inpatients receiving an antimicrobial on the day of PPS. Data included details on antimicrobial agents, reasons and indications for treatment and a set of quality indicators.
Results: In total 79 wards with 895 inpatients were surveyed of which 77.8% were admitted to hospitals in Tbilisi. Of all patients on antibiotics, 29.8% were treated for pneumonia, with the highest rates on paediatric intensive care units (18.9%) and paediatric medical wards (45.3%). Up to 98.6% of pneumonia, cases were community-acquired infections (CAI). Regarding the antimicrobial quality indicators, documentation of the reason of prescription was 100%, yet the stop/review date was missing in 93.1% of cases. Overall compliance to antibiotic guidelines was 91.9% and treatment was mostly empiric (87.0%). Of targeted prescriptions, 75.0% was for treatment of MRSA. CRP was used in the decision to treat in 98.1% of patients. CRP levels in blood were 123 mg/L on average. For adults, commonly prescribed antibacterial drugs for systemic use (ATC J01) were ceftriaxone (26.4%), followed by cefepime (10.7%) and meropenem (9.1%). In paediatric and neonatal units, the top 3 consisted of ceftriaxone (31.0%) ampicillin/enzyme inhibitor (25.4%) and meropenem (14.3%).
Conclusion: The high proportion of CAI pneumonia, empirical prescribing and the use of broad-spectrum antibiotics are worrisome findings. In addition, documentation of the stop/review date is remarkably low, yet high use of CRP in the decision to treat indicates an attempt to rationalise antibiotic use. For optimisation it is essential to plan specific stewardship interventions such as introduction of a cut off policy after 72 hours, increase of targeted treatment and availability of updated guidelines.
Disclosure of Interest: None declared
P107 ASSESSING THE LEARNING NEEDS AND BARRIERS FOR IMPLEMENTATION OF ANTIMICROBIAL STEWARDSHIP IN HOSPITALS THAT HAVE PARTICIPATED IN THE GLOBAL POINT PREVALENCE SURVEY ON ANTIMICROBIAL CONSUMPTION AND RESISTANCE (GLOBAL-PPS)
I. Pauwels1, A. Versporten1, E. Vlieghe2, H. Goossens1
1Laboratory of Medical Microbiology, University of Antwerp, Wilrijk; 2Department of General Internal Medicine, Infectious Diseases and Tropical Medicine, University Hospital Antwerp, Edegem, Belgium
Correspondence: I. Pauwels
Introduction: Point prevalence surveys (PPS) have proven to be instrumental in informing antimicrobial stewardship (AMS) activities, yet translating PPS findings into contextualised interventions can be challenging.
Objectives: We aim to evaluate the impact of the Global-PPS on local AMS programmes and assess health care professionals’ educational needs and barriers for implementing AMS.
Methods: An internet-based survey containing 24 questions was disseminated within the Global-PPS network, including contacts from participating and non-participating hospitals. Responses were collected from February up to May 2019 and were descriptively analysed.
Results: A total of 250 respondents from 73 different countries completed the survey, 198 of which were Global-PPS participants. Up to 70% (n=176) of responses were from low-and middle-income (LMIC) countries. When asked which AMS components were present in their hospital, 69.2% (HIC 89.2%; LMIC 60.8%) replied they had local prescribing guidelines and 50% (HIC 70.3%; LMIC 41.5%) reported the presence of an AMS committee. Of the Global-PPS participants who reported AMS activities (n=187), 69% stated that one or more of those activities was initiated as a result of PPS findings. Prolonged surgical antibiotic prophylaxis was the most common (63.6%; n=126) target for improvement, identified from Global-PPS findings. Out of 18 possible barriers, a lack of time was most commonly (33.8%) reported as the number one barrier for implementation of AMS in HIC, as compared to a lack of cooperation from prescribers (13.1%), time (12.5%) and qualified personnel (12.5%) in LMIC. Overall learning needs were: skills to optimise therapeutic (62%) and prophylactic antibiotic use (54.8%), followed by the design of PPS-based interventions (52.7%) in HIC and the management of multidrug-resistant infections (44.3%) in LMIC.
Conclusion: These results will inform the development of a dedicated e-learning course, targeting Global-PPS participants worldwide and focused at the translation of PPS-findings into locally tailored AMS interventions, thus contributing to a sustained response to AMR in hospitals worldwide.
Disclosure of Interest: None declared
P108 SURVEILLANCE OF ANTIMICROBIAL STEWARDSHIP PROGRAM AND ANTIMICROBIAL CONSUMPTION: PILOT SURVEILLANCE OF JAPAN SURVEILLANCE FOR INFECTION PREVENTION AND HEALTHCARE EPIDEMIOLOGY (J-SIPHE)
M. Endo1, K. Hayakawa1,2, T. Tajima1, K. Suzuki1, T. Suzuki1,2, S. Tsuzuki1, N. Matsunaga1, N. Ohmagari,1,2
1AMR Clinical Reference Center; 2Disease Control and Prevention Center, National Center for Global Health and Medicine Hospital, Tokyo, Japan
Correspondence: M. Endo
Introduction: We constructed J-SIPHE system to facilitate AMR measures in Japan. Along with other AMR related parameters, J-SIPHE collects data on antimicrobial stewardship program (ASP) as well as antimicrobial use (AMU) at healthcare facilities.
Objectives: We evaluated the data of ASP and AMU during the J-SIPHE pilot surveillance period.
Methods: From April to November 2018, 28 facilities provided data on ASP and AMU. AMU data (such as Antimicrobial Use Density [AUD] and Days of Therapy [DOT]) can be registered semi-automatically using the medical fee statement (receipt) file at each facility. Both AMU and ASP data (such as available antibiotics and ASP practice) were registered by the online surveillance system. ASP data were required for targeted antibiotics classes (anti-P. aeruginosa [anti-PA] penicillins/cephalosporins, carbapenems, anti-MRSA agents, fluoroquinolones, colistin, tigecycline, antifungal agents).
Results: The median number of beds at participating facilities were 396 (IQR: 309–496) and the median average hospital stay was 12.3 days (IQR: 9.9–14.6). Carbapenems and linezolid were the most commonly targeted antibiotics by ASP (carbapenems: 15 [53.6%] required notification [RN], 13 [46.4%] RN and prospective audit and feedback [PAF]; linezolid: 13 [46.4%] RN, 11 [39.3%] RN and PAF, 4 [14.3%] pre-authorization), followed by other anti-MRSA agents. Among ASP targeted antibiotics, anti-PA penicillin was the most prescribed (median AUD: 2.4 [IQR: 1.7–2.7], median DOT: 3.1 [IQR: 2.4–3.7]), followed by carbapenems (median AUD: 2.2 [IQR: 1.7–2.9], median DOT: 2.3 [IQR: 1.9–3.9]). For anti-MRSA agents, glycopeptides (median AUD: 0.7 [IQR: 0.4–1.2], median DOT: 1.0 [0.6–1.7]) were mainly used.
Conclusion: Our system combined ASP practice with semi-automated AMU surveillance enabling comparison among facilities and monitoring trends of ASP targeted antibiotics. Widespread use of J-SIPHE could provide useful information on the current status of ASP/AMU and on high priority targets of ASP in Japan.
Disclosure of Interest: None declared
P109 INFLUENCE OF ANTIMICROBIAL STEWARDSHIP IN THE ADEQUACY OF ANTIMICROBIAL PRESCRIPTION - A CROSS-SECTIONAL SURVEY
A. Silva-Pinto, R. Duro, N. Rocha-Pereira, P. Andrade, J. Mourato-Torres, C. Lima-Alves
Infection Control and Antimicrobial Stewardship Unit, CENTRO HOSPITALAR UNIVERSITÁRIO SÃO JOÃO, Porto, Portugal
Correspondence: A. Silva-Pinto
Introduction: Antimicrobial stewardship is a multimodal strategy to optimize adequacy of antimicrobial prescription, crucial in the approach to decrease antimicrobial resistance.
Objectives: To assess the adequacy of antimicrobial prescription in a university hospital and to compare the adequacy in departments with or without antimicrobial stewardship interventions.
Methods: We performed a cross-sectional study based on the point prevalence survey rules from WHO. One third of the patients in each department were randomly selected. After selection, we classified the adequacy of each antimicrobial prescribed (considering necessity of treatment, spectrum, dose, administration route and duration of therapy), according to local recommendations and, in its absence, national/international guidelines. We compared antimicrobial prescription adequacy in departments with specific ongoing antimicrobial stewardship interventions (Cardiothoracic Surgery, Haematology, Orthopaedics, Plastic Surgery, Urology, Vascular Surgery) and those without such interventions.
Results: On the day of the study, 898 patients were hospitalized. We randomly included 316 (35%). Of those, 119 had at least one antimicrobial prescription (37,7%), corresponding to 172 antimicrobials (33 (19,2%) were prescribed as prophylaxis and 139 (80,8%) as treatment). Table 1 depicts some variables of interest. We considered antimicrobial prescription as adequate in 107 patients (62,2%). Comparing departments with and without antimicrobial stewardship interventions, we noticed a statistically significant difference: 76,6% vs. 56,8% (p=0,021; Chi Squared test).
Conclusion: Antimicrobial stewardship is a multimodal strategy with a positive impact in the adequacy of antimicrobial prescriptions.
Disclosure of Interest: None declared
P110 SECONDARY ANALYSIS OF THE HALT STUDY DATA IRELAND
A. Vellinga1, K. Burns2, H. Murphy2, M. Tandan1
1National University of Ireland, Galway, Galway; 2Health Protection and Surveillance Centre, Dublin, Ireland
Correspondence: A. Vellinga
Introduction: Ireland participated in repeated point prevalence surveys (PPS) of healthcare-associated infections (HAI) and antimicrobial use (AMU) in long-term care facilities (LTCF) in 2012 and 2016, known as the HALT surveys.
Objectives: To explore risk factors of AMU and HAI in Irish LTCF.
Methods: Data for the HALT study are collected at institutional level, which provides aggregated prevalence and makes in-depth analysis difficult due to low numbers. To increase the power of the study, all LTCF participating in HALT 2016 were contacted to ask for additional data on all current residents; age, sex, urinary catheter use and presence of disorientation. The individual data was matched to the existing 2016 HALT database and multilevel analyses were performed.
Results: The prevalence of AMU and HAI in Irish LTCF in 2016 was 9.8% and 4.4% respectively
Prophylactic AMU (40%) was identified as a particular concern in the LTCF setting, more often recorded for females, residents living in LTCFs for more than one year, residents with an intellectual disability, and residents with a urinary catheter.
Additional data was obtained from 80 LTCF (out of 224) and 3,816 residents. Analyses showed that decreased AMU was associated with the number of health care assistants, presence of a coordinating physician in the LTFC, an antimicrobial stewardship committee, feedback on antimicrobial consumption, and medical care by residents’ personal GP. Less HAI was associated with feedback on surveillance of infection prevention & control practices in LTCF.
Almost half of the antimicrobials prescribed were second-line choices, with substantial inter-facility variation. In LTCF that provided education on antimicrobial prescribing, significantly less second-line antimicrobials were prescribed.
Conclusion: With limited additional data, important risk factors of AMU and HAI could be identified which help to target AMU stewardship and infection prevention and control programs in LTCF.
Disclosure of Interest: None declared
P111 ANTIMICROBIAL PRESCRIBING PATTERN IN HEALTHCARE-ASSOCIATED INFECTIONS IN 26 BRAZILIAN HOSPITALS: 2017 AND 2018 POINT PREVALENCE SURVEYS
A. P. Matos Porto1, on behalf of Brazilian Global PPS group, I. Pauwels2, A. Versporten3, H. Goossens3, S. F. Costa1, on behalf of Brazilian Global PPS group: Thais Guimarães (Instituto Central-HC-FMUSP and Hospital do Servidor Publico Estadual de São Paulo, São Paulo, Brazil), Evelyne Girão (Hospital Universitário Walter Cantídio UFC, Hospital Regional Unimed Fortaleza and Hospital
1Faculty of Medicine, University of São Paulo, São Paulo, Brazil; 2Faculty of Medicine and Health Science, University of Antwerp; 3Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
Correspondence: I. Pauwels
Introduction: Healthcare-associated infections (HAI) are a common indication for the prescription of antimicrobials (ATM) and the inappropriate use of ATM is a key driver of ATM resistance.
Objectives: The aim of this study was to evaluate the ATM prescribing pattern in HAI in 26 Brazilian hospitals using the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global PPS) 2017 and 2018 data (www.global-pps.com).
Methods: 18 Brazilian hospitals conducted the PPS in 2017 and 17 in 2018 (9 hospitals participated in both years). The study included inpatients on antimicrobials on the day of the PPS. Data collection included details on the ATM prescriptions and a set of quality indicators. A web-based program was used for data-entry, validation and reporting. The Global PPS was developed by the University of Antwerp and bioMérieux provided funding support.
Results: 1801 patients were evaluated in 2017 and 2433 in 2018, of which 941 (52.2%) and 1168 (48%) were on ATM. HAI was the indication for ATM in 328 (34.8%) and 377 (32.3%) patients in 2017 and 2018, respectively. Surgical site infection and device related infection together accounted for 50.6% of the prescriptions in 2017 and 44.6% in 2018. Pneumonia (2017-24.3%; 2018-25.1%) was by far the most common specific diagnosis in the surveys. Both in 2017 and 2018, the most frequent ATM prescribed were meropenem (2017-22.1%; 2018-21.9%), vancomycin (2017-16.6%; 2018-14.8%) and piperacillin-tazobactam (2017-11.2%; 2018-11.7%). About 95% of the drugs were given parenterally. The use of biomarkers to guide therapy was observed in 33.3% of the prescriptions in 2017 and 39.9% in 2018. Empiric use accounted for 65.7% and 69.7% of all ATM prescriptions for HAI in 2017 and 2018, respectively. Out of all the targeted therapies, most were aimed at multidrug-resistant (77.7 to 82.6%), mainly gram-negative bacteria.
Conclusion: HAI were the indication for ATM use in about one third of patients and pneumonia was the most common diagnosis. ATM were prescribed mainly empirically and there was a low use of biomarkers to guide ATM therapy. Three broad-spectrum ATM accounted for about half of the prescriptions for HAI showing that reinforcement of de-escalation strategy is needed in Brazilian hospitals.
Disclosure of Interest: None declared
P112 THE BASIC PRINCIPLES OF ANTIMICROBIAL STEWARDSHIP IN DUTCH LONG-TERM CARE FACILITIES
A. Eikelenboom-Boskamp1,2, M. van Loosbroek2, E. Lutke-Schipholt3, M. Nelissen4, M. Verkaaik2, P. Geels4, S. Natsch5,6, A. Voss1,7
1Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Ziekenhuis; 2ZZG Zorggroep; 3Canisius Wilhelmina Ziekenhuis, Nijmegen; 4Dutch Institute for Rational Use of Medicine, Utrecht; 5The Dutch Working Party on Antibiotic Policy, Leiden; 6Department of Pharmacy; 7Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, Netherlands
Correspondence: A. Eikelenboom-Boskamp
Introduction: As residents in long-term care (LTC) settings increasingly suffer from multiresistant microorganisms, adequate use of antibiotics is of outmost importance.
Objectives: Adaptation and implementation of 'hospital' Antimicrobial Stewardship (AMS) into the LTC setting.
Methods: A project was launched within one of the providers of LTC in the South-east of the Netherlands to set up an AMS program. The antibiotic treatment protocol for urinary tract infection (UTI), lower respiratory tract infections and skin infections have been revised. Score-lists for data collection were created. New rules about applying urine dipstick test and culturing were implemented. The A-team monitored all antibiotic descriptions during a period of 5 months in 4 nursing homes. For nurses, e-learning was developed and tested. A focus group for patients/family members was organized to find out more about their needs.
Results: In total, 75 antibiotics prescriptions were reviewed of which 73.3% were assessed as correct. The e-learning needed minor adjustments after testing in 29 nurses. For the most important item UTI indicated by patients/family members, we contributed to an informative flyer developed by the association of elderly care physicians.
Conclusion: We recommend collecting periodic retrospective data for discussion in the A-team, prior to pharmacotherapeutic consultations to achieve a learning effect for future quality of the antibiotic prescriptions overall. In addition to the A-team activities, it's essential to involve nurses and patients/family members in the AMS program. As our project was limited to 4 locations, the generalizability and expected workload need further evaluation.
Disclosure of Interest: None declared
P113 PROPHYLACTIC ANTIMICROBIAL USE IS COMMON IN FINNISH LONG-TERM CARE FACILITIES: RESULTS OF A POINT PREVALENCE SURVEY, 2017
S. Toura, D. Arifulla, E. Sarvikivi, J. Ollgren, O. Lyytikäinen
National Institute for Health and Welfare, Helsinki, Finland
Correspondence: S. Toura
Introduction: Antimicrobials are commonly used in long-term care facilities (LTCFs) and may contribute development of antimicrobial resistance. Particular concern is inappropriate use of prophylactic antimicrobials.
Objectives: We investigated current use of antimicrobials in LTCFs in Finland, with special emphasis in prophylaxis.
Methods: Antimicrobial use of LTCFs was investigated as a part of the third European point prevalence survey (HALT) coordinated by European Centre for Disease Prevention and Control. All residents present in LTCFs and receiving at least one systemic antimicrobial on the day of the survey were included. Local data collectors completed questionnaires including data on resident characteristics, antimicrobials and their indications. Information on antimicrobial policy was gathered using institutional questionnaire. To identify factors associated for prophylactic antimicrobial use, we conducted a multivariate beta-binomial regression model with logit link.
Results: In total, 175 LTCFs with 6762 eligible residents participated in the survey during September-November 2017. On the day of the survey, 462 residents received at least one antimicrobial agent (6.8%; range by LTCFs, 0–42%). Antimicrobials were more frequently prescribed for prophylaxis than for treatment (62% vs. 38%) and vast majority (88%) for prophylaxis of urinary tract infection (UTI). Methenamine (43%) was the most common UTI prophylaxis, followed by trimethoprim (38%) and nitrofurantoin (11%). There was no documented end date for 77% of prophylactic agents; 72% were prescribed in the current facility. Presence of written guideline for appropriate antimicrobial use (odds ratio (OR), 0.34; 95% confidence interval (CI), 0.16–0.73) and therapeutic guideline for UTIs (OR, 0.69; 95% CI, 0.47–0.99) were associated with less use of prophylactic antimicrobials.
Conclusion: Prophylactic antimicrobial use was common in Finnish LTCFs and most were prescribed for UTI prophylaxis. Increasing awareness and easy access to the national Current Care Guidelines for UTI could decrease inappropriate UTI prophylaxis and the use of methenamine.
Disclosure of Interest: None declared
P114 PARTICIPATORY-ACTION RESEARCH FOR DESIGNING A GLOBAL ANTIBIOTIC STEWARDSHIP NETWORK IN THE PORTUGUESE-SPEAKING COUNTRIES' CONTEXT: A MIXED-METHOD STUDY IN CAPE VERDE
M. R. Maia, L. V. Lapão
Global Health and Tropical Medicine, NOVA IHMT, Lisboa, Portugal
Correspondence: L. V. Lapão
Introduction: The antibiotic stewardship services (ABS) contribute to healthcare-associated infections and antibiotic resistance (AR) global monitoring, providing clinical decision-support, through multidisciplinary team-work.
Objectives: Aiming at co-implement an ABS network within the Portuguese-speaking setting (CPLP), by enabling the evidence translation and second opinion between the countries, we surveyed Cape Verdean (CV) health professionals' (HP) perceptions about AR prevention and control, assessing ABS opportunities.
Methods: A Design Science Research Methodology under a Participatory Action Research approach establishes a contextualized ABS participatory process1. This mixed-method study addressed the first 2 stages, the problem and objectives. Quantitative study considered the HP’s answers (56 HP; 2 hospitals) to a questionnaire, about their perception on AR and ABS. Qualitative study set-up 10 open-ended structured interviews, clinical shift observation in 2 pilot-services (1 hospital), and meetings with key-elements for ABS, including leadership.
Results: Key-stakeholders for ABS multidisciplinary teamwork were identified. Preliminary results are:
1. HP reveal some knowledge but lack of awareness on AR and ABS (eg. 34% don’t recognize the AR local threat);
2. The absence of guidelines and lack of access to key-information affect prescribing confidence (eg. only 46% HP consider microbiology results in deciding antibiotherapy);
3. Priorities for a pilot service are the lack of qualified HP, the need to optimize material resources management and stock procurement, and the need for better access to patient's clinical and prescription information;
4. Digital resources and telemedicine system can be facilitators. Top-down communication and support are essential for the ABS process sustainability.
Conclusion: A Global (Portuguese-speaking) ABS network can be important in promoting prevention and effective control of AR, reducing differences between the CPLP countries. In CV, an educational program to support the co-design of ABS service and a decision-support information system are identified priorities. Digital health, like telemedicine, can be ABS facilitators.
References
1. Simões AS, Maia MR, Gregório J, Couto I, Asfeldt AM, Simonsen GS, et al. Journal of Hospital Infection 2018. doi:10.1016/j.jhin.2018.07.034.
Disclosure of Interest: M. Maia Grant/Research support from: FCT-POCH, L. Lapão Employee of: NOVA IHMT
P115 ANTIMICROBIAL USE GUIDELINES IN LARGE HOSPITALS IN SWITZERLAND: AN ANALYSIS OF DIFFERENCES AMONG CENTERS
V. Naef1, G. Catho2, A. Ranzani2, B. Huttner2, S. Tschudin-Sutter3
1University of Geneva; 2Hôpitaux Universitaires de Genève, Geneva; 3University Hospital Basel, Basel, Switzerland
Correspondence: V. Naef
Introduction: Clear and consistent guidelines for the improvement of the antibiotic use are a key element for antibiotic stewardship (ABS). International ABS guidance documents recommend that all hospitals should regularly update the treatment guidelines.
Objectives: In this study we aimed to review the recommendations for antibiotic use for 3 commons infectious pathologies in Swiss academic hospitals and to explore the differences among these guidelines.
Methods: We reviewed the treatment recommendations for community-acquired pneumonia requiring hospitalization (CAP), hospital-acquired pneumonia and uncomplicated urinary tract infections (UTI). We analyzed the guidelines from the 6 largest hospitals in Switzerland, which consider all the university hospitals and the largest non-university hospital. Further, we have take into account aspects such as molecules recommended, dose, administration mode and duration.
Results: The preliminary analysis of our data reveals significant differences among the guidelines. Although the antibiotic regimens are often similar, other parameters, such as the recommended dose, duration and the degree of detail of the recommendations (e.g. differentiating between different subsets of pneumonia or taking into account allergies) show considerable variability. Furthermore, the number of subcategories within an infectious syndrome varied widely. With regard to CAP, we have observed 13 different categories (ranging from 3 to 7) increasing the complexity of the comparison. With the exception of lower uncomplicated UTI, institutional guidelines are not always aligned with the corresponding Swiss and/or Europeans guidelines.
Conclusion: Our data show that there is a significant heterogeneity in the antibiotic treatment recommendations in large hospitals in Switzerland. This feature is not justified by differences in the epidemiology of infectious diseases. Efforts should be undertaken to harmonize the treatment recommendations in Swiss hospitals.
Disclosure of Interest: None declared
P116 USE OF ANTIBIOTICS AMONG END-OF-LIFE HOSPITALIZED PATIENTS WITH ADVANCED CARE DIRECTIVES: INVESTIGATION OF FACTORS RELATED TO PHYSICIANS BEHAVIORAL INTENTIONS
R. Fedorowsky1, Y. Bachner2, A. Borer2, P. Ciobotaro3, T. Kushnir2
1Infection Control Unit, Rabin Medical Center, Hasharon Hospital, Petach Tikva; 2Ben-Gurion University, Beer-Sheva; 3Infection Control Unit, Kaplan medical center, Rehovot, Israel
Correspondence: R. Fedorowsky
Introduction: over-use of antibiotics by physicians at the end of life (EOL) in patients with advance care directives (ADs) contributes to the evolution of antibiotic resistance bacteria (ARB) which increases mortality, and healthcare costs. The present study investigated factors related to physician use of antibiotics, based on the Theory of Planned Behavior, which predicts an individual's intention to engage in a behavior.
Objectives: 1. to investigate several factors (socio-demographic/organizational, motivational, infectious disease physicians (IDP) consultation, burnout) associated with physician behavioral intentions (PBI) to withhold antibiotics in EOL patients with ADs 2. to compare study variables across medical specialties and professional status.
Methods: a descriptive-correlational research in which 213 physicians were sampled in 27 wards, in acute and post acute-care hospitals.
Results: PBI to withhold antibiotics in EOL patient with and without ADs was rated "sometimes"/"rarely" respectively. Mean positive attitudes towards withholding antibiotics in EOL patients with ADs, awareness of ARB, system-related barriers (lack of guidelines) and mean pressure from families to prescribe antibiotic, were above the average. Physicians reported fewer IDP consultations in EOL patients than in other patients. The overall rate of burnout among all physicians was 44.5%.
Predictive/related factors for PBI were: managerial positions, seniority, board certification, type of hospitalization, system-related barrier, positive attitudes and consultations with IDP demanded by physicians, in EOL patient.
IDP reported the highest levels of: awareness of ARB, positive attitudes, PBI, barriers and burnout. Physicians in post acute-care reported the lowest levels of awareness of ARB, and PBI. Physicians in oncology reported the lowest positive attitudes levels. Attending compared to other physicians, reported the highest level of patient pressure, barriers and respectively the lowest positive attitudes and PBI.
Conclusion: IDPs are the potential change agents to improve antibiotics use in EOL patients with ADs. Intervention programs should be focused on oncology, post acute-care hospitals and attending physicians.
Disclosure of Interest: None declared
P117 THEORETICAL APPROACHES IN THE DEVELOPMENT AND EVALUATION OF BEHAVIOUR CHANGE INTERVENTIONS THAT IMPROVE CLINICIANS’ ANTIMICROBIAL PRESCRIBING: A SYSTEMATIC REVIEW
H. Talkhan1, D. Stewart1, T. McIntosh1, M. Al Hail2, P. Abdulrouf2, H. Ziglam2, S. Cunningham1
1School of Pharmacy and life sciences, Robert Gordon University, Aberdeen, United Kingdom; 2Hamad Medical Corporation, Doha, Qatar
Correspondence: P. Abdulrouf
Introduction: Antimicrobial resistance (AMR) and its threats have long been recognised. Many countries have developed antimicrobial stewardship programmes with strategies to optimise antimicrobial prescribing, minimise AMR and improve outcomes. There remains a need for behaviour change interventions at clinician level to promote appropriate prescribing practice.
Objectives: The aim of this review was to critically appraise, synthesise and present the available evidence for theoretical approaches in the development and evaluation of behaviour change interventions that improve clinicians' antimicrobial prescribing.
Methods: Eleven electronic databases and search engines were searched for peer-reviewed, English language studies investigating theoretically based behaviour change interventions that improve clinicians’ antimicrobial prescribing in any healthcare setting. The Theory Coding Scheme was utilised to evaluate the methods by which theories have been used. Clinical and methodological heterogeneity limited data synthesis.
Results: The searches resulted in 4227 potentially relevant papers after duplicates removal. Screening of titles/abstracts led to retrieval and dual assessment of 38 full-text papers. Of those, 12 studies met the inclusion criteria and were included in the systematic review. Most of studies included were from the UK (n = 8) and most were published in 2012 (n = 3); none was published before 2008. The majority of studies were carried out in primary care settings (n = 10) targeting upper respiratory tract infections (n = 9). Theoretical approaches used to inform the design and choice of intervention varied across included studies. The most common included: Theory of Planned Behaviour, Social Cognitive Theory and Operant Learning Theory.
Conclusion: This systematic review is the first to investigate theoretically based behaviour change interventions for antimicrobial prescribing. Only a small number of primary research studies involving theory in intervention development and evaluation were identified. There is a need for further research in this area.
Disclosure of Interest: None declared
