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4. Antimicrobial consumption and resistance in adult hospital inpatients in 53 countries: results of an internet-based global point prevalence survey

Author

Koraqi, Andi, Hoxha, Iris, Tafaj, Silva, Lacej, Denada, Hojman, Martin, Quiros, Rodolfo Ernesto, Ghazaryan, Lilit, Cairns, Kelly A, Cheng, Allen, Horne, Kylie C, Doukas, Fiona F, Gottlieb, Thomas, Alsalman, Jameela, Magerman, Koen, Marielle, Gounongbe YT, Ljubovic, Amela Dedeic, Coelho, André Afonso Machado, Gales, Ana Cristina, Keuleyan, Emma, Sabuda, Deana, Boswell, Jennifer Lee, Conly, John M, Rojas, Alvaro, Carvajal, Camila, Labarca, Jaime, Solano, Antonio, Valverde, Carlos Ramírez, Villalobos-Vindas, Juan M, Pristas, Irina, Plecko, Vanda, Paphitou, Niki, Shaqiri, Erjona, Rummukainen, Maija-Liisa, Pagava, Karaman, Korinteli, Irma, Brandt, Tobias, Messler, Sabine, Enimil, Anthony, Iosifidis, Elias, Roilides, Emmanuel, Sow, Mamadou Saliou, Sengupta, Sharmila, George, Joby V, Poojary, Aruna, Patil, Priyanka, Soltani, Jafar, Jafarpour, Zahra, Ameen, Hadi, Fitzgerald, David, Maor, Yasmin, Chowers, Michal, Temkin, Elizabeth, Esposito, Susanna, Arnoldo, Luca, Brusaferro, Silvio, Gu, Yoshiaki, El-Hajji, Feras Darwish, Kim, Nam Joong, Kambaralieva, Baktygul, Pavare, Jana, Zarakauska, Lelde, Usonis, Vytautas, Burokiene, Sigita, Ivaskeviciene, Inga, Mijovic, Gordana, Duborija-Kovacevic, Natasa, Bondesio, Kristen, Iregbu, Kenneth, Oduyebo, Oyinlola, Raka, Denis, Raka, Lul, Rachina, Svetlana, Enani, Mushira Abdulaziz, Al Shehri, Mohamed, Carevic, Biljana, Dragovac, Gorana, Obradovic, Dusanka, Stojadinovic, Aleksandra, Radulovic, Lili, Wu, Jia EN, Wei Teng Chung, Gladys, Chen, Hui Hiong, Tambyah, Paul Anantharajah, Lye, David, Tan, Sock Hoon, Ng, Tat Ming, Tay, Hui Lin, Ling, Moi Lin, Chlebicki, Maciej Piotr, Kwa, Andrea L, Lee, Winnie, Beović, Bojana, Dramowski, Angela, Finlayson, Heather, Taljaard, Jantjie, Ojeda-Burgos, Guillermo, Retamar, Pilar, Lucas, Johan, Pot, Wolter, Verduin, Cees, Kluytmans, Jan, Scott, Michael, Aldeyab, Mamoon A, McCullagh, Bernadette, Gormley, Cairine, Sharpe, David, Gilchrist, Mark, Whitney, Laura, Laundy, Matthew, Lockwood, Debbie, Drysdale, Simon B, Boudreaux, Jennifer, Septimus, Edward J, Greer, Nickie, Gawrys, Gerard, Rios, Edgar, May, Suzanne, Versporten, Ann, Zarb, Peter, Caniaux, Isabelle, Gros, Marie-Françoise, Drapier, Nico, Miller, Mark, Jarlier, Vincent, Nathwani, Dilip, and Goossens, Herman

Published
2018
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20. Contributors

Author

Akova, Murat, primary, Altiner, Attila, additional, Andrašević, Arjana T., additional, Azap, Ozlem K., additional, Bavestrello, Luis, additional, Beović, Bojana, additional, Böhmer, Femke, additional, Béraud, Guillaume, additional, Buising, Kirsty, additional, Can, Füsun, additional, Castro, José L., additional, Čižman, Milan, additional, Cosgrove, Sara E., additional, Cotta, Menino O., additional, de Kraker, Marlieke E.A., additional, de With, Katja, additional, De Waele, Jan, additional, Dyar, Oliver J., additional, Ergönül, Önder, additional, Erntell, Mats, additional, Ghafur, Abdul, additional, Gyssens, Inge C., additional, Harbarth, Stephan, additional, Hedin, Katarina, additional, Hernández-Gómez, Cristhian, additional, Howard, Philip, additional, Hulscher, Marlies E.J.L., additional, Karatuna, Onur, additional, Kern, Winfried V., additional, Keuleyan, Emma, additional, Kofteridis, Diamantis P., additional, Kostyanev, Tomislav, additional, Lacor, Patrick, additional, Levy-Hara, Gabriel, additional, Li, David X., additional, Markou, Theodore I., additional, Mendelson, Marc, additional, Messiaen, Peter, additional, Nathwani, Dilip, additional, Pagani, Leonardo, additional, Paño Pardo, José R., additional, Pluss-Suard, Catherine, additional, Prins, Jan, additional, Pulcini, Céline, additional, Ramón-Pardo, Pilar, additional, Roberts, Jason A., additional, Rodríguez-Baño, Jesús, additional, Schouten, Jeroen, additional, Schwaber, Mitchell J., additional, Senn, Laurence, additional, Shibayama, Keigo, additional, Sinnollareddy, Mahipal G., additional, Sneddon, Jacqueline, additional, Lundborg, Cecilia Stålsby, additional, Tacconelli, Evelina, additional, Thursky, Karin, additional, Valachis, Antonis, additional, Viale, Pierluigi, additional, Villegas, María V., additional, Vlahović-Palčevski, Vera, additional, Wechsler-Fördös, Agnes, additional, Wollny, Anja, additional, and Zanetti, Giorgio, additional

Published
2017
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23. Changes in resistance among coliform bacteraemia associated with a primary care antimicrobial stewardship intervention: A population-based interrupted time series study

Author

Hernandez-Santiago, Virginia, Davey, Peter G., Nathwani, Dilip, Marwick, Charis A., and Guthrie, Bruce

Subjects
Anti-infective agents -- Dosage and administration -- Usage, Bacteremia -- Drug therapy, Microbial drug resistance -- Forecasts and trends, Primary health care -- Forecasts and trends, Hospital admission and discharge, Cephalosporins, Escherichia coli, Pharmacy, Antibacterial agents, Medical research, Socialized medicine, Infection control, Infection, Prescription writing, Regression analysis, General practitioners, Market trend/market analysis, Biological sciences
Abstract

Background Primary care antimicrobial stewardship interventions can improve antimicrobial prescribing, but there is less evidence that they reduce rates of resistant infection. This study examined changes in broad-spectrum antimicrobial prescribing in the community and resistance in people admitted to hospital with community-associated coliform bacteraemia associated with a primary care stewardship intervention. Methods and findings Segmented regression analysis of data on all patients registered with a general practitioner in the National Health Service (NHS) Tayside region in the east of Scotland, UK, from 1 January 2005 to 31 December 2015 was performed, examining associations between a primary care antimicrobial stewardship intervention in 2009 and primary care prescribing of fluoroquinolones, cephalosporins, and co-amoxiclav and resistance to the same three antimicrobials/classes among community-associated coliform bacteraemia. Prescribing outcomes were the rate per 1,000 population prescribed each antimicrobial/class per quarter. Resistance outcomes were proportion of community-associated (first 2 days of hospital admission) coliform (Escherichia coli, Proteus spp., or Klebsiella spp.) bacteraemia among adult (18+ years) patients resistant to each antimicrobial/class. 11.4% of 3,442,205 oral antimicrobial prescriptions dispensed in primary care over the study period were for targeted antimicrobials. There were large, statistically significant reductions in prescribing at 1 year postintervention that were larger by 3 years postintervention when the relative reduction was -68.8% (95% CI -76.3 to -62.1) and the absolute reduction -6.3 (-7.6 to -5.2) people exposed per 1,000 population per quarter for fluoroquinolones; relative -74.0% (-80.3 to -67.9) and absolute reduction -6.1 (-7.2 to -5.2) for cephalosporins; and relative -62.3% (-66.9 to -58.1) and absolute reduction -6.8 (-7.7 to -6.0) for co-amoxiclav, all compared to their prior trends. There were 2,143 eligible bacteraemia episodes involving 2,004 patients over the study period (mean age 73.7 [SD 14.8] years; 51.4% women). There was no increase in community-associated coliform bacteraemia admissions associated with reduced community broad-spectrum antimicrobial use. Resistance to targeted antimicrobials reduced by 3.5 years postintervention compared to prior trends, but this was not statistically significant for co-amoxiclav. Relative and absolute changes were -34.7% (95% CI -52.3 to -10.6) and -63.5 (-131.8 to -12.8) resistant bacteraemia per 1,000 bacteraemia per quarter for fluoroquinolones; -48.3% (-62.7 to -32.3) and -153.1 (-255.7 to -77.0) for cephalosporins; and -17.8% (-47.1 to 20.8) and -63.6 (-206.4 to 42.4) for co-amoxiclav, respectively. Overall, there was reversal of a previously rising rate of fluoroquinolone resistance and flattening of previously rising rates of cephalosporin and co-amoxiclav resistance. The limitations of this study include that associations are not definitive evidence of causation and that potential effects of underlying secular trends in the postintervention period and/or of other interventions occurring simultaneously cannot be definitively excluded. Conclusions In this population-based study in Scotland, compared to prior trends, there were very large reductions in community broad-spectrum antimicrobial use associated with the stewardship intervention. In contrast, changes in resistance among coliform bacteraemia were more modest. Prevention of resistance through judicious use of new antimicrobials may be more effective than trying to reverse resistance that has become established., Author(s): Virginia Hernandez-Santiago 1, Peter G. Davey 2, Dilip Nathwani 3, Charis A. Marwick 2,*, Bruce Guthrie 4 Introduction Increasing antimicrobial resistance (AMR) is a major global public health threat [...]

Published
2019
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24. Some clinical data

Author

Barlow, Gavin, Lillie, Patrick, Nathwani, Dilip, and Davey, Peter

Published
2010

33. Preface

Author

Nathwani, Dilip, Jamieson, Conor, Peel, Trisha, Retamar Gentil, Pilar, and Universidad de Sevilla. Departamento de Medicina

Abstract

As this is the first Supplement produced by JAC-Antimicrobial Resistance (JAC-AMR) we thought it would be helpful for readers for us to briefly outline our vision and intention for these Supplements. (extract)

Published
2021

34. Current Antimicrobial Stewardship Practice and Education in Russian Hospitals: Results of a Multicenter Survey

Author

Palagin, Ivan, primary, Rachina, Svetlana, additional, Sukhorukova, Marina, additional, Nizhegorodtseva, Irina, additional, Portnyagina, Ulyana, additional, Gordeeva, Svetlana, additional, Burasova, Elena, additional, Bagin, Vladimir, additional, Domanskaya, Olga, additional, Nathwani, Dilip, additional, and Kozlov, Roman, additional

Published
2021
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36. Preface

Author

Universidad de Sevilla. Departamento de Medicina, Nathwani, Dilip, Jamieson, Conor, Peel, Trisha, Retamar Gentil, Pilar, Universidad de Sevilla. Departamento de Medicina, Nathwani, Dilip, Jamieson, Conor, Peel, Trisha, and Retamar Gentil, Pilar

Abstract

As this is the first Supplement produced by JAC-Antimicrobial Resistance (JAC-AMR) we thought it would be helpful for readers for us to briefly outline our vision and intention for these Supplements. (extract)

Published
2021

37. An international inventory of antimicrobial stewardship (AMS) training programmes for AMS teams

Author

Weier, Naomi, Nathwani, Dilip, Thursky, Karin, Tängdén, Thomas, Vlahović-Palčevski, Vera, Dyar, Oliver, Beović, Bojana, Levy Hara, Gabriel, Patel, Rahul, Pulcini, Céline, Zaidi, Syed Tabish R., Weier, Naomi, Nathwani, Dilip, Thursky, Karin, Tängdén, Thomas, Vlahović-Palčevski, Vera, Dyar, Oliver, Beović, Bojana, Levy Hara, Gabriel, Patel, Rahul, Pulcini, Céline, and Zaidi, Syed Tabish R.

Abstract

BACKGROUND: Healthcare professionals are increasingly expected to lead antimicrobial stewardship (AMS) initiatives. This role in complex healthcare environments requires specialized training. OBJECTIVES: Little is known about the types of AMS training programmes available to clinicians seeking to play a lead role in AMS. We aimed to identify clinicians' awareness of AMS training programmes, characteristics of AMS training programmes available and potential barriers to participation. METHODS: AMS training programmes available were identified by members of the ESCMID Study Group for Antimicrobial Stewardship (ESGAP) via an online survey and through an online search in 2018. Individual training programme course coordinators were then contacted (September-October 2018) for data on the target audience(s), methods of delivery, intended outcomes and potential barriers to accessing the training programme. RESULTS: A total of 166/250 ESGAP members (66%) responded to the survey, nominating 48 unique AMS training programmes. An additional 32 training programmes were identified through an online search. AMS training programmes were from around the world. Less than half (44.4%) of respondents were aware of one or more AMS training programmes available, with pharmacists more aware compared with medical doctors and other professionals (73% versus 46% and 25%, respectively). AMS training programmes were most commonly delivered online (59%) and aimed at medical doctors (46%). Training costs and a lack of recognition by health professional societies were the most frequently cited barriers to participation in AMS training programmes. CONCLUSIONS: The development of a systematic inventory of AMS training programmes around the globe identifies opportunities and limitations to current training available. Improving access and increasing awareness amongst target participants will support improved education in AMS.

Published
2021
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43. Developing the first national antimicrobial prescribing and stewardship competences

Author

Ashiru-Oredope, D., Cookson, B., Fry, C., Cookson, Barry, Ashiru-Oredope, Diane, Avery, Tony, Baudouin, Simon, Brown, Jane, Cooke, Jonathan, Cooper, Tracey, Crighton, Alexander, Davey, Peter, Duerden, Brian, Doherty, Lorraine, Drabu, Yasmin, Fitzpatrick, Matthew, Fry, Carole, Gallagher, Rose, Howard, Philip, Howe, Robin, Kerr, Kevin, Johnson, Trevor, Khoda, Hiral, Leaper, David, McNulty, Cliodna, Nathwani, Dilip, Sharland, Mike, Stockley, Jane, Thomson, Alastair, Wellsteed, Sally, and White, Pip

Published
2014
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44. Preface

Author

Nathwani, Dilip, primary, Jamieson, Conor, additional, Peel, Trisha, additional, and Retamar-Gentil, Pilar, additional

Published
2021
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46. Advocacy for Increased International Efforts for Antimicrobial Stewardship Actions in Low-and Middle-Income Countries on Behalf of Alliance for the Prudent Use of Antimicrobials (APUA), Under the Auspices of the International Society of Antimicrobial Chemotherapy (ISAC)

Author

Tattevin, Pierre, Levy Hara, Gabriel, Toumi, Adnene, Enani, Mushira, Coombs, G.W., Voss, A., Wertheim, H.F.L., Nathwani, Dilip, and Gould, Ian

Subjects
All institutes and research themes of the Radboud University Medical Center, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4]
Abstract

Contains fulltext : 226149.pdf (Publisher’s version ) (Open Access)

Published
2020

47. Do medical students feel prepared to prescribe antibiotics responsibly? Results from a cross-sectional survey in 29 European countries

Author

Dyar, Oliver, Nathwani, Dilip, Monnet, Dominique L., Gyssens, Inge, Stålsby Lundborg, Cecilia, Pulcini, Céline, Wechsler-Fördös, Agnes, Kostyanev, Tomislav, Vlahović-Palčevski, Vera, Kolar, Milan, Jensen, Ulrich, Barlow, Gavin, Lutsar, Irja, Tamm, Liina, Vuopio, Jaana, Kern, Winfried, Kofteridis, Diamantis, Emese, Szilágyi, Kristinsson, Karl, Bergin, Colm, Pagani, Leonardo, Viale, Pierluigi, Dumpis, Uga, Matulionytė, Raimonda, Zarb, Peter, Simonsen, Gunnar, Deptula, Aleksander, Paiva, José-Artur, Florea, Dragos, Siegfried, Leonard, Beović, Bojana, Paño-Pardo, José Ramón, Lindsjö, Cecilia, Huttner, Benedikt, Karolinska Institutet [Stockholm], Ninewells Hospital and Medical School [Dundee], European Centre for Disease Prevention and Control (ECDC), Radboud University Medical Center [Nijmegen], Hasselt University (UHasselt), Service des Maladies Infectieuses et Tropicales [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Maladies chroniques, santé perçue, et processus d'adaptation (APEMAC), Université de Lorraine (UL), University Hospital Rijeka, University of Rijeka, Department of Microbiology, University of Tartu, Department of Medicine II, University of Freiburg [Freiburg], St James's Hospital, Dublin, Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois], Department of Internal Medicine, Geriatrics and Nephrologic Diseases, Section of Infectious Diseases, S.Orsola-Malpighi Hospital, Alma Mater Studiorum University of Bologna (UNIBO), Centro Hospitalar Universitário São João - Faculty of Medicine - University of Porto - Grupo de Infecção e Sepsis, Porto, University Medical Center Ljubljana, Department of Infectious Diseases and Infection Control [Geneva, Switzerland], and Hôpitaux Universitaires de Genève (HUG)

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Further education, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Students, Medical, Medical psychology, Cross-sectional study, education, 030106 microbiology, lnfectious Diseases and Global Health Radboud Institute for Molecular Life Sciences [Radboudumc 4], Self-concept, MEDLINE, Prevalence, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Professional Competence, All institutes and research themes of the Radboud University Medical Center, Antibiotic resistance, Surveys and Questionnaires, Humans, Medicine, Pharmacology (medical), 030212 general & internal medicine, ComputingMilieux_MISCELLANEOUS, Pharmacology, business.industry, Bacterial Infections, Self Concept, Anti-Bacterial Agents, 3. Good health, Europe, Cross-Sectional Studies, Infectious Diseases, Preparedness, Family medicine, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, Female, antibiotics schools, medical students, medical self-report, Psychology, business
Abstract

International audience; Background: In an era of antibiotic resistance, medical students must be prepared to prescribe antibiotics responsibly.Objectives: To assess self-reported preparedness among final-year medical students at European universities, using a comprehensive set of topics related to prudent antibiotic use.Methods: We conducted a cross-sectional, multicentre, web-based survey. All medical-degree students in their final year of studies at European universities were eligible to participate. A preparedness score was calculated for each student and mean scores were compared at medical school and country levels. Comparisons were made with national-level data on resistance among four common bacterial pathogens.Results: In total, 7328 responses were included from 179/296 eligible medical schools in 29/29 countries. Students felt at least sufficiently prepared on a mean of 71.2% of topics assessed, ranging from 54.8% (Portugal) to 84.8% (Latvia). The proportion of students wanting more education on prudent antibiotic use or general antibiotic use ranged from 20.3% (Sweden) to 94.3% (Slovakia), with a mean of 66.1%, and was strongly inversely correlated with preparedness scores (Spearman's ρ = -0.72, n = 29, P < 0.001). Higher prevalence rates of antibiotic-non-susceptible bacteria were associated with lower preparedness scores and higher self-reported needs for further education (P < 0.01).Conclusions: Most final-year European medical students feel they still need more education on antibiotic use for their future practice as junior doctors. Patterns of preparedness on specific topics were identified, were highly consistent across countries, and correlated with both perceived need for further education and levels of antibiotic resistance among common bacteria.

Published
2018
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