Threshold Modeling for Antibiotic Stewardship in Oman.

Autor: Al-Hashimy ZS; Department of Clinical Pharmacy, Directorate of Pharmaceutical Care and Medical Stores, Khawlah Hospital, Muscat, Oman; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK., Al-Yaqoobi M; Department of Microbiology, Directorate of Laboratories, Khawlah Hospital, Muscat, Oman., Jabari AA; Department of Microbiology, Directorate of Laboratories, Khawlah Hospital, Muscat, Oman., Kindi NA; Department of Microbiology, Directorate of Laboratories, Khawlah Hospital, Muscat, Oman; Directorate of infection prevention and occupational safety, Khawlah Hospital, Muscat, Oman., Kazrooni ASA; Department of Microbiology, Directorate of Laboratories, Khawlah Hospital, Muscat, Oman; Directorate of infection prevention and occupational safety, Khawlah Hospital, Muscat, Oman., Conway BR; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK; Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK., Elhajji FD; Faculty of Pharmacy, Applied Science Private University, Amman, Jordan., Bond SE; Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK., Lattyak WJ; Statistical Consulting Department, Scientific Computing Associates Corp, River Forest, IL, USA., Aldeyab MA; Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK; Pharmacy Department, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK. Electronic address: m.aldeyab@hud.ac.uk.
Jazyk: angličtina
Zdroj: American journal of infection control [Am J Infect Control] 2024 Nov 14. Date of Electronic Publication: 2024 Nov 14.
DOI: 10.1016/j.ajic.2024.11.005
Abstrakt: Background: Antimicrobial stewardship supports rational antibiotic use. However, balancing access to antibiotic treatment while controlling resistance is challenging. This research used a threshold logistic modelling approach to identify targets for antibiotic usage associated with carbapenem-resistant Acinetobacter baumannii (CRAb), carbapenem-resistant Klebsiella pneumonia (CRKP), and extended-spectrum β-lactamases- producing Escherichia coli (ESBL-producing E. coli) incidence in hospitals.
Methods: This study utilises an ecological population-level design. Monthly pathogen cases and antibiotic use were retrospectively determined for inpatients between January 2015 and December 2023. The hospital pharmacy and microbiology information systems were used to obtain this data. Thresholds were identified by applying nonlinear modelling and logistic regression.
Results: Incidence rates of 0.199, 0.175, and 0.146 cases/100 occupied bed-days (OBD) for CRAb, CRKP, and ESBL-producing E. coli, respectively, were determined as the cutoff values for high (critical) incidence rates. Thresholds for aminoglycosides (0.59 defined daily dose (DDD)/100 OBD), carbapenems (6.31 DDD/100 OBD), piperacillin-tazobactam (3.71 DDD/100 OBD), third-generation cephalosporins (3.71 DDD/100 OBD), and fluoroquinolones (1.91 DDD/100 OBD), were identified. Exceeding these thresholds would accelerate the gram-negative pathogens' incidence rate above the critical incidence levels. Employing the threshold logistic approach enabled near real-time performance monitoring feedback, risk scores and alert signals for when the incidence of the selected pathogens are entering critical levels.
Conclusion: Threshold logistic models can help inform and implement effective antimicrobial stewardship interventions to manage resistance within hospital settings.
(Copyright © 2024. Published by Elsevier Inc.)
Databáze: MEDLINE
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