Suchergebnisse

IntroductionInappropriate antibiotic prescribing, such as that for viral illness, is common in primary care. This is of growing interest given concerns around antimicrobial resistance and harms associated with unnecessary treatment; however, current data limitations have hindered population-based estimates of the proportion of community-prescribed antibiotics attributable to common respiratory viruses.
Objectives and ApproachTo estimate the proportion of antibiotics prescribed in primary care to young children attributable to common respiratory viruses, including respiratory syncytial virus (RSV), influenza, human metapneumovirus (HuMPV) and parainfluenza. We leveraged two unique sources of comprehensive, linked population-based administrative data on dispensed antibiotic prescriptions and laboratory tests for respiratory viruses for all Scottish children (<5 years). We fit time series negative binomial models to predict weekly antibiotic prescribing rates from positive viral tests rates for the period April 1, 2009 through Dec 27, 2017. Using linked demographic and hospitalization data, we stratified our analysis by age, presence of high-risk chronic medical conditions, and antibiotic class.
ResultsWe included data on over 6 million antibiotic prescriptions among nearly 800,000 children. An estimated 6.9% (95% CI: 5.6,8.3), 2.4% (1.7,3.1), and 2.3% (0.8,3.9) of prescribed antibiotics were attributable to RSV, influenza and HuMPV, respectively. RSV was consistently associated with the highest proportion of antibiotics prescribed across all analyses but particularly among children without chronic conditions [4.30% (3.19, 5.41)] and for amoxicillin [8.10% (6.43, 9.76)] and macrolide prescriptions [7.65% (6.14, 9.16)].
Conclusion / ImplicationsNearly 14% of antibiotics prescribed to Scottish children in this study were attributable to common viral pathogens such as RSV for which antibiotics are not recommended. This highlights clear targets for antibiotic stewardship programs and suggests antibiotic prescribing could be reduced once an RSV vaccine is introduced.

ABSTRACT
ObjectivesUrinary tract infections (UTIs) are amongst the most common infections treated in community and hospital settings. Initial antibiotic treatment of UTI is usually empirical, that is, where the prescriber has no definitive information on the organism or its antibiotic sensitivity.. Overall the prevalence of antimicrobial resistance is increasing, and specifically so for antibiotics commonly used for UTI.
By linking NHS surveillance data to routinely collected administrative health data this study aims to investigate risk factors for antibiotic resistance in urine samples
ApproachAll positive urine samples included in the "Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland" dataset in the period from January 2012 to June 2015 (all NHS Health Boards in Scotland submit susceptibility data for up to eleven antibiotics on 400 positive urinary samples per quarter) were analysed. Cases were assigned a resistance status of Sensitive, Resistant or Multi-drug resistant based on the antibiotic susceptibility data recorded.
Using the NHS Scotland Infection Intelligence Platform all cases were linked to national coverage data: (i) hospital discharge data to create the Charlson score for comorbidity and (ii) patient-level community prescribing data to measure cumulative antibiotic exposure (number of defined daily doses) in the 3 months prior to infection. Risk factors associated with the infection susceptibility to antibiotics were assessed using multivariable multinomial logistic regression.
Results40,984 positive urine samples were examined. Overall 29.0% were sensitive, 48.1% resistant and 22.9% multi drug resistant. Around a third of the cases (33.9%) had no antibiotic prescribing in the 3 months prior to infection. Age, care home residence and increasing comorbidity were both found to be associated with resistance and multidrug resistance. Cumulative antibiotic exposure had a clear dose-response effect. Those with 1-7DDDs were 1.2 times (95% CI: 1.11-1.29) more likely to have a multidrug resistant infection (compared to a sensitive infection) rising to 7.45 times (95% CI: 95% CI 6.45-8.6) for 29+ DDDs. Similar dose response held for resistant infection but at a lesser scale (1-7DDDs OR=1.36 (95% CI: 1.2-1.5) rising to OR=3.04 (95% CI: 2.38-3.89).
ConclusionA clear effect of cumulative antibiotic exposure in the community and multidrug resistance in UTI cases has been demonstrated. Such quantification is key to ensuring and supporting robust antimicrobial stewardship policy and will form the evidence base for development of prescribing decision support tools for more patient centred treatment of UTI.

This study aimed to ascertain the reliability of the McCabe score in a healthcare-associated infection point prevalence survey. ¿¿A 10 European Union Member States survey in 20 hospitals (n = 1912) indicated that there was a moderate level of agreement (¿ = 0.57) with the score. The reliability of the application of the score could be increased by training data collectors, particularly with reference to the ultimately fatal criteria. This is important if the score is to be used to risk adjust data to drive infection prevention and control interventions.

International audience ; In 2008, the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was published by the Scottish Government. One of the key actions was initiation of the Scottish Antimicrobial Prescribing Group (SAPG), hosted within the Scottish Medicines Consortium, to take forward national implementation of the key recommendations of this action plan. The primary objective of SAPG is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. This programme, led by SAPG, is delivered by NHS National Services Scotland (Health Protection Scotland and Information Services Division), NHS Quality Improvement Scotland, and NHS National Education Scotland as well as NHS board Antimicrobial Management Teams. Between 2008 and 2010, SAPG has achieved a number of early successes, which are the subject of this review: (i) through measures to optimise prescribing in hospital and primary care, combined with infection prevention measures, SAPG has contributed significantly to reducing infection rates in Scotland; (ii) there has been engagement of all key stakeholders at local and national levels to ensure an integrated approach to antimicrobial stewardship within the wider healthcare-associated infection agenda; (iii) development and implementation of data management systems to support quality improvement; (iv) development of training materials on antimicrobial stewardship for healthcare professionals; and (v) improving clinical management of infections (e.g. community-acquired pneumonia) through quality improvement methodology. The early successes achieved by SAPG demonstrate that this delivery model is effective and provides the leadership and focus required to implement antimicrobial stewardship to improve antimicrobial prescribing and infection management across NHS Scotland.