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The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study

Received: 5 July 2020     Accepted: 17 July 2020     Published: 28 July 2020
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Abstract

To measure the rate of unnecessary antimicrobials (UAU), and the effect of the infectious disease consultation. A 17-week multicenter study, patients’ records were reviewed for antimicrobials. A predefined UAU definition was developed. Excluded patients were those on prophylaxis and less than 1-year-old. The outcome is the UAU rate. Confounders were adjusted by Charlson index and APACHE 2 score. The analysis was by Χ2 and Fischer's Exact Tests and multivariate analysis as appropriate. 662 records were reviewed: 169 qualified the necessary antimicrobial use (NAU) and 493 in the UAU categories. The rate of the UAU was 74.5%. The age means differed (53.85 years for the NAU versus 46.48 years for the UAU, P<0.001) without gender difference (P=0.285). The patients in the UAU category were represented more in UTI, SSTI, BSI, and no infection (P<0.05). The commonest UAU subcategory were non-infectious non-febrile conditions 36.71%, influenza-like illnesses, and viral syndromes 20.08%, combination therapy 17.6%. An infectious disease consultation was significantly associated with less UAU (P ≤ 0.004), and less mortality (P<0.05). In conclusion: UAU rate was high, and an infectious disease consultation significantly reduced the UAU rate and mortality.

Published in International Journal of Infectious Diseases and Therapy (Volume 5, Issue 3)
DOI 10.11648/j.ijidt.20200503.14
Page(s) 56-63
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Unnecessary Antimicrobial Use, Stewardship, Infectious Diseases Consult, Mortality

References
[1] Hunter, T. H. (1946). The treatment of subacute bacterial endocarditis with antibiotics. The American journal of medicine, 1 (1), 83-92.
[2] Gafter-Gvili, A., Fraser, A., Paul, M., & Leibovici, L. (2005). Meta-analysis: antibiotic prophylaxis reduces mortality in neutropenic patients. Annals of internal medicine, 142 (12_Part_1), 979-995.
[3] Moon, A. M., Dominitz, J. A., Ioannou, G. N., Lowy, E., & Beste, L. A. (2016). Use of antibiotics among patients with cirrhosis and upper gastrointestinal bleeding is associated with reduced mortality. Clinical Gastroenterology and Hepatology, 14 (11), 1629-1637.
[4] Mainous III, A. G., Hueston, W. J., & Clark, J. R. (1996). Antibiotics and upper respiratory infection: do some folks think there is a cure for the common cold?. Journal of Family Practice, 42 (4), 357-362.
[5] Magill, S. S., Edwards, J. R., Beldavs, Z. G., Dumyati, G., Janelle, S. J., Kainer, M. A.,... & Richards, K. (2014). Prevalence of antimicrobial use in US acute care hospitals, May-September 2011. Jama, 312 (14), 1438-1446.
[6] Fridkin, S., Baggs, J., Fagan, R., Magill, S., Pollack, L. A., Malpiedi, P., et al (2014). Vital signs: improving antibiotic use among hospitalized patients. MMWR. Morbidity and mortality weekly report, 63 (9), 194.
[7] Hartley, S. E., Kuhn, L., Valley, S., Washer, L. L., Gandhi, T., Meddings, J., et al (2016). Evaluating a hospitalist-based Intervention to decrease unnecessary antimicrobial use in patients with asymptomatic bacteriuria. infection control & hospital epidemiology, 37 (9), 1044-1051.
[8] Garnacho-Montero, J., Sa-Borges, M., Sole-Violan, J., Barcenilla, F., Escoresca-Ortega, A., Ochoa, M., et al (2007). Optimal management therapy for Pseudomonas aeruginosa ventilator-associated pneumonia: an observational, multicenter study comparing monotherapy with combination antibiotic therapy. Critical care medicine, 35 (8), 1888-1895.
[9] Traugott, K. A., Echevarria, K., Maxwell, P., Green, K., & Lewis, J. S. (2011). Monotherapy or combination therapy? The Pseudomonas aeruginosa conundrum. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 31 (6), 598-608.
[10] Bowers, D. R., Liew, Y. X., Lye, D. C., Kwa, A. L., Hsu, L. Y., & Tam, V. H. (2013). Outcomes of appropriate empiric combination versus monotherapy for Pseudomonas aeruginosa bacteremia. Antimicrobial agents and chemotherapy, 57 (3), 1270-1274.
[11] Hu, Y., Li, L., Li, W., Xu, H., He, P., Yan, X., & Dai, H. (2013). Combination antibiotic therapy versus monotherapy for Pseudomonas aeruginosa bacteraemia: a meta-analysis of retrospective and prospective studies. International journal of antimicrobial agents, 42 (6), 492-496.
[12] Vergidis, P., Hamer, D. H., Meydani, S. N., Dallal, G. E., & Barlam, T. F. (2011). Patterns of antimicrobial use for respiratory tract infections in older residents of long-term care facilities. Journal of the American Geriatrics Society, 59 (6), 1093-1098.
[13] Ladd, E. (2005). The use of antibiotics for viral upper respiratory tract infections: an analysis of nurse practitioner and physician prescribing practices in ambulatory care, 1997–2001. Journal of the American Academy of Nurse Practitioners, 17 (10), 416-424.
[14] Kuo, F. C., Aalirezaie, A., Goswami, K., Shohat, N., Blevins, K., & Parvizi, J. (2019). Extended Antibiotic Prophylaxis Confers No Benefit Following Aseptic Revision Total Hip Arthroplasty: A Matched Case-Controlled Study. The Journal of arthroplasty, 34 (11), 2724-2729.
[15] Berry, P. S., Rosenberger, L. H., Guidry, C. A., Agarwal, A., Pelletier, S., & Sawyer, R. G. (2019). Intraoperative versus extended antibiotic prophylaxis in liver transplant surgery: a randomized controlled pilot trial. Liver Transplantation, 25 (7), 1043-1053.
[16] Khan, F. Y., Elhiday, A., Khudair, I. F., Yousef, H., Omran, A. H., Alsamman, S. H., & Elhamid, M. (2012). Evaluation of the use of piperacillin/tazobactam (Tazocin®) at Hamad General Hospital, Qatar: are there unjustified prescriptions?. Infection and drug resistance, 5, 17.
[17] Spivak, E. S., Cosgrove, S. E., & Srinivasan, A. (2016). Measuring appropriate antimicrobial use: attempts at opening the black box. Clinical Infectious Diseases, ciw658.
[18] Ritzer, G. (Ed.). (2007). The Blackwell encyclopedia of sociology (Vol. 1479). New York, NY, USA: Blackwell Publishing.
[19] Schultz, L., Lowe, T. J., Srinivasan, A., Neilson, D., & Pugliese, G. (2014). Economic impact of redundant antimicrobial therapy in US hospitals. Infection Control & Hospital Epidemiology, 35 (10), 1229-1235.
[20] Hecker, M. T., Aron, D. C., Patel, N. P., Lehmann, M. K., & Donskey, C. J. (2003). Unnecessary use of antimicrobials in hospitalized patients: current patterns of misuse with an emphasis on the antianaerobic spectrum of activity. Archives of internal medicine, 163 (8), 972-978.
[21] Peron, E. P., Hirsch, A. A., Jury, L. A., Jump, R. L., & Donskey, C. J. (2013). Another Setting for Stewardship: High Rate of Unnecessary Antimicrobial Use in a Veterans Affairs Long-Term Care Facility. Journal of the American Geriatrics Society, 61 (2), 289-290.
[22] Al Ramahi, J. W., Al-Abdouh, A., Hasan, N., Haddad, G., Al Baba, M., Al Aaraj, A., et al (2019). Mortality and Length of Stay in Patients with Bloodstream Infections Due to Drug-Susceptible Versus Drug-Resistant Gram-Negative Bacteria. International Journal of Infectious Diseases and Therapy, 4 (3), 33.
[23] Qureshi, Z. A., Paterson, D. L., Potoski, B. A., Kilayko, M. C., Sandovsky, G., Sordillo, E.,... & Doi, Y. (2012). Treatment outcome of bacteremia due to KPC-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrobial agents and chemotherapy, 56 (4), 2108-2113.
[24] Safdar, N., Handelsman, J., & Maki, D. G. (2004). Does combination antimicrobial therapy reduce mortality in Gram-negative bacteraemia? A meta-analysis. The Lancet infectious diseases, 4 (8), 519-527.
[25] Chamot, E., El Amari, E. B., Rohner, P., & Van Delden, C. (2003). Effectiveness of combination antimicrobial therapy for Pseudomonas aeruginosa bacteremia. Antimicrobial agents and chemotherapy, 47 (9), 2756-2764.
[26] Rybak, M. J., & McGrath, B. J. (1996). Combination antimicrobial therapy for bacterial infections. Drugs, 52 (3), 390-405.
[27] Agarwal, R., & Schwartz, D. N. (2011). Procalcitonin to guide duration of antimicrobial therapy in intensive care units: a systematic review. Clinical Infectious Diseases, 53 (4), 379-387.
[28] Marra, A. R., de Almeida, S. M., Correa, L., Silva Jr, M., Martino, M. D. V., Silva, C. V., et al (2009). The effect of limiting antimicrobial therapy duration on antimicrobial resistance in the critical care setting. American journal of infection control, 37 (3), 204-209.
[29] Pinzone, M. R., Cacopardo, B., Abbo, L., & Nunnari, G. (2014). Duration of antimicrobial therapy in community acquired pneumonia: less is more. The Scientific World Journal, 2014.
[30] Rattan, R., Allen, C. J., Sawyer, R. G., Askari, R., Banton, K. L., Claridge, J. A., et al (2016). Patients with complicated intra-abdominal infection presenting with sepsis do not require longer duration of antimicrobial therapy. Journal of the American College of Surgeons, 222 (4), 440-446.
[31] Lee, R. A., Vo, D. T., Zurko, J. C., Griffin, R. L., Rodriguez, J. M., & Camins, B. C. (2020, March). Infectious Diseases Consultation Is Associated With Decreased Mortality in Enterococcal Bloodstream Infections. In Open Forum Infectious Diseases (Vol. 7, No. 3, p. ofaa064). US: Oxford University Press.
[32] Chesdachai, S., Kline, S., Helmin, D., & Rajasingham, R. (2020, January). The Effect of Infectious Diseases Consultation on Mortality in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus, Candida, and Pseudomonas Bloodstream Infections. In Open forum infectious diseases (Vol. 7, No. 1, p. ofaa010). US: Oxford University Press.
[33] Honda, H., Krauss, M. J., Jones, J. C., Olsen, M. A., & Warren, D. K. (2010). The value of infectious diseases consultation in Staphylococcus aureus bacteremia. The American journal of medicine, 123 (7), 631-637.
[34] Belongia, E. A., & Schwartz, B. (1998). Strategies for promoting judicious use of antibiotics by doctors and patients. Bmj, 317 (7159), 668-671.
[35] Bai AD, Showler A, Burry L, Steinberg M, Ricciuto DR, Fernandes T, Chiu A, Raybardhan S, Science M, Fernando E, Tomlinson G. Impact of infectious disease consultation on quality of care, mortality, and length of stay in Staphylococcus aureus bacteremia: results from a large multicenter cohort study. Clinical Infectious Diseases. 2015 May 15; 60 (10): 1451-61.
Cite This Article
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    Jamal Wadi Al Ramahi, Oday Abu Ajamieh, Nadine Marrar, Lana Alalamat, Nour Hasan, et al. (2020). The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study. International Journal of Infectious Diseases and Therapy, 5(3), 56-63. https://doi.org/10.11648/j.ijidt.20200503.14

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    ACS Style

    Jamal Wadi Al Ramahi; Oday Abu Ajamieh; Nadine Marrar; Lana Alalamat; Nour Hasan, et al. The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study. Int. J. Infect. Dis. Ther. 2020, 5(3), 56-63. doi: 10.11648/j.ijidt.20200503.14

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    AMA Style

    Jamal Wadi Al Ramahi, Oday Abu Ajamieh, Nadine Marrar, Lana Alalamat, Nour Hasan, et al. The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study. Int J Infect Dis Ther. 2020;5(3):56-63. doi: 10.11648/j.ijidt.20200503.14

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  • @article{10.11648/j.ijidt.20200503.14,
      author = {Jamal Wadi Al Ramahi and Oday Abu Ajamieh and Nadine Marrar and Lana Alalamat and Nour Hasan and Alaa Elddin Jaber and Lara Abdulhadi and Omar Dodin and Amal Matar},
      title = {The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study},
      journal = {International Journal of Infectious Diseases and Therapy},
      volume = {5},
      number = {3},
      pages = {56-63},
      doi = {10.11648/j.ijidt.20200503.14},
      url = {https://doi.org/10.11648/j.ijidt.20200503.14},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijidt.20200503.14},
      abstract = {To measure the rate of unnecessary antimicrobials (UAU), and the effect of the infectious disease consultation. A 17-week multicenter study, patients’ records were reviewed for antimicrobials. A predefined UAU definition was developed. Excluded patients were those on prophylaxis and less than 1-year-old. The outcome is the UAU rate. Confounders were adjusted by Charlson index and APACHE 2 score. The analysis was by Χ2 and Fischer's Exact Tests and multivariate analysis as appropriate. 662 records were reviewed: 169 qualified the necessary antimicrobial use (NAU) and 493 in the UAU categories. The rate of the UAU was 74.5%. The age means differed (53.85 years for the NAU versus 46.48 years for the UAU, P<0.001) without gender difference (P=0.285). The patients in the UAU category were represented more in UTI, SSTI, BSI, and no infection (P<0.05). The commonest UAU subcategory were non-infectious non-febrile conditions 36.71%, influenza-like illnesses, and viral syndromes 20.08%, combination therapy 17.6%. An infectious disease consultation was significantly associated with less UAU (P ≤ 0.004), and less mortality (P<0.05). In conclusion: UAU rate was high, and an infectious disease consultation significantly reduced the UAU rate and mortality.},
     year = {2020}
    }
    

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  • TY  - JOUR
    T1  - The Rates of the Unnecessary Antimicrobial Use (UAU) and the Effect of the Infectious Disease Consultations: A Cross-Sectional Study
    AU  - Jamal Wadi Al Ramahi
    AU  - Oday Abu Ajamieh
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    JF  - International Journal of Infectious Diseases and Therapy
    JO  - International Journal of Infectious Diseases and Therapy
    SP  - 56
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    PB  - Science Publishing Group
    SN  - 2578-966X
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    AB  - To measure the rate of unnecessary antimicrobials (UAU), and the effect of the infectious disease consultation. A 17-week multicenter study, patients’ records were reviewed for antimicrobials. A predefined UAU definition was developed. Excluded patients were those on prophylaxis and less than 1-year-old. The outcome is the UAU rate. Confounders were adjusted by Charlson index and APACHE 2 score. The analysis was by Χ2 and Fischer's Exact Tests and multivariate analysis as appropriate. 662 records were reviewed: 169 qualified the necessary antimicrobial use (NAU) and 493 in the UAU categories. The rate of the UAU was 74.5%. The age means differed (53.85 years for the NAU versus 46.48 years for the UAU, P<0.001) without gender difference (P=0.285). The patients in the UAU category were represented more in UTI, SSTI, BSI, and no infection (P<0.05). The commonest UAU subcategory were non-infectious non-febrile conditions 36.71%, influenza-like illnesses, and viral syndromes 20.08%, combination therapy 17.6%. An infectious disease consultation was significantly associated with less UAU (P ≤ 0.004), and less mortality (P<0.05). In conclusion: UAU rate was high, and an infectious disease consultation significantly reduced the UAU rate and mortality.
    VL  - 5
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Author Information
  • School of Medicine, The University of Jordan, Amman, Jordan

  • Department of Medicine, The Specialty Hospital, Amman, Jordan

  • Department of Pharmacy, The Specialty Hospital, Amman, Jordan

  • Department of Medicine, Jordan Hospital Medical Center, Amman, Jordan

  • Department of Pharmacy, Al Khalidi Hospital and Medical Center, Amman, Jordan

  • Department of Medicine, The Specialty Hospital, Amman, Jordan

  • Department of Pharmacy, Al Khalidi Hospital and Medical Center, Amman, Jordan

  • Department of Medicine, Jordan Hospital Medical Center, Amman, Jordan

  • Department of Pharmacy, Al Khalidi Hospital and Medical Center, Amman, Jordan

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