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Prospective monitoring of carbapenem use and pseudomonal resistance across pediatric institutions

Published online by Cambridge University Press:  02 June 2020

Isao Miyairi Open the ORCID record for Isao Miyairi [Opens in a new window] ,
Kensuke Shoji ,
Noriko Kinoshita ,
Junpei Saitoh ,
Yoshie Sugahara ,
Yasushi Watanabe ,
Makoto Komura ,
Masashi Kasai ,
Yuho Horikoshi  and
Masayoshi Shinjoh
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Isao Miyairi*
Affiliation:
Division of Infectious Diseases, National Center for Child Health and DevelopmentTokyo, Japan
Kensuke Shoji
Affiliation:
Division of Infectious Diseases, National Center for Child Health and DevelopmentTokyo, Japan
Noriko Kinoshita
Affiliation:
Division of Infectious Diseases, National Center for Child Health and DevelopmentTokyo, Japan
Junpei Saitoh
Affiliation:
Department of Pharmacy, National Center for Child Health and DevelopmentTokyo, Japan
Yoshie Sugahara
Affiliation:
Department of Nursing, National Center for Child Health and Development, Tokyo, Japan
Yasushi Watanabe
Affiliation:
Department of Clinical Laboratory, National Center for Child Health and Development, Tokyo, Japan
Makoto Komura
Affiliation:
Department of Pharmacy, National Center for Child Health and DevelopmentTokyo, Japan
Masashi Kasai
Affiliation:
Division of Infectious Diseases, Department of Pediatrics, Hyogo Prefectural Kobe Children Hospital, Kobe, Japan
Yuho Horikoshi
Affiliation:
Department of Infectious Diseases and Immunology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan
Masayoshi Shinjoh
Affiliation:
Department of Pediatrics, Keio University School of Medicine, Tokyo, Japan
Takashi Igarashi
Affiliation:
National Center for Child Health and Development, Tokyo, Japan
*
Author for correspondence: Isao Miyairi, E-mail: miyairi-i@ncchd.go.jp
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Abstract

Objective:

To determine whether carbapenem consumption and Pseudomonas aeruginosa resistance rates can be used as benchmarks to compare and improve antimicrobial stewardship programs across multiple pediatric hospitals.

Design:

A prospective study.

Setting and participants:

Healthcare institutions in Japan with >100 pediatric beds.

Methods:

An annual survey of the total days of therapy (DOT) per 1,000 patient days for carbapenem antibiotics (meropenem, imipenem-cilastatin, panipenem-betamipron, doripenem) and susceptibility rates of Pseudomonas aeruginosa to meropenem and imipenem-cilastatin from each institution was conducted over a 7-year period. Data were reported to the administration, as well as to the infection control team, of each institution annually.

Results:

Data were obtained from 32 facilities. The median total carbapenem DOT per 1,000 patient days was 16.6 and varied widely, with a range of 2.7 to 59.0. The median susceptibility to meropenem was 86.6%, ranging from 78.6% to 96.6%. We detected an inverse correlation between total carbapenem DOT versus susceptibility (r = – 0.36; P < .01). Over the 7-year period, the DOT per 1,000 patient days of carbapenem decreased by 27% from a median of 16.0 to 11.7 (P < .01). We also observed an improvement in susceptibility to meropenem from a median of 87% to 89.7% (P = .01) and to imipenem-cilastatin from 79% to 85% (P < .01). The decreases in the use of carbapenem were greater in institutions with antimicrobial stewardship programs led by pediatric infectious disease specialists.

Conclusions:

Antimicrobial use and resistance, targeting carbapenems and P. aeruginosa, respectively, can serve as benchmarks that can be utilized to promote antimicrobial stewardship across pediatric healthcare institutions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 9 , September 2020 , pp. 1042 - 1047
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

The Government of Japan. National Action Plan on Antimicrobial Resistance (AMR) 2016–2020. Tokyo: Government of Japan; 2016.Google Scholar
Horikoshi, Y, Suwa, J, Higuchi, H, et al.Sustained pediatric antimicrobial stewardship program with consultation to infectious diseases reduced carbapenem resistance and infection-related mortality. Int J Infect Dis 2017;64:69–73.CrossRefGoogle ScholarPubMed
Pluss-Suard, C, Pannatier, A, Kronenberg, A, Muhlemann, K, Zanetti, G. Impact of antibiotic use on carbapenem resistance in Pseudomonas aeruginosa: is there a role for antibiotic diversity? Antimicrob Agents Chemother 2013;57:1709–1713.CrossRefGoogle Scholar
Newland, JG, Gerber, JS, Kronman, MP, et al.Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS): a quality improvement collaborative. J Pediatr Infect Dis Soc 2018;7:124–128.CrossRefGoogle ScholarPubMed
Hersh, AL, De Lurgio, SA, Thurm, C, et al.Antimicrobial stewardship programs in freestanding children’s hospitals. Pediatrics 2015;135:33–39.CrossRefGoogle ScholarPubMed
Smith, MJ, Gerber, JS, Hersh, AL. inpatient antimicrobial stewardship in pediatrics: a systematic review. J Pediatr Infect Dis Soc 2015;4:e127–e135.CrossRefGoogle ScholarPubMed
Patel, SV, Vergnano, S. The impact of paediatric antimicrobial stewardship programmes on patient outcomes. Curr Opin Infect Dis 2018;31:216–223.CrossRefGoogle ScholarPubMed
Araujo da Silva, AR, Albernaz de Almeida Dias, DC, Marques, AF, et al.Role of antimicrobial stewardship programmes in children: a systematic review. J Hosp Infect 2018;99:117–123.CrossRefGoogle ScholarPubMed
Polk, RE, Fox, C, Mahoney, A, Letcavage, J, MacDougall, C. Measurement of adult antibacterial drug use in 130 US hospitals: comparison of defined daily dose and days of therapy. Clin Infect Dis 2007;44:664–670.CrossRefGoogle ScholarPubMed
Coffin, SE, Lee, GM. Mind the gap: spanning the great divide between perceived and measured value of infectious disease physicians. J Pediatr Infect Dis Soc 2019;8:276–278.CrossRefGoogle ScholarPubMed
Schuster, JE, Newland, JG. An enterovirus D68 outbreak highlights the value of pediatric infectious disease specialists. J Pediatr Infect Dis Soc 2015;4:87–88.CrossRefGoogle ScholarPubMed
Furuichi, M, Furuichi, M, Horikoshi, Y, Miyairi, I. Infectious diseases consultation improves treatment and decreases mortality by enterococcal bacteremia in children. Pediatr Infect Dis J 2018;37:856–860.CrossRefGoogle ScholarPubMed
Mano, Y, Saga, T, Ishii, Y, et al.Molecular analysis of the integrons of metallo-beta-lactamase–producing Pseudomonas aeruginosa isolates collected by nationwide surveillance programs across Japan. BMC Microbiol 2015;15:41.CrossRefGoogle ScholarPubMed
D’Agata, E. Pseudomonas aeruginosa and other Pseudomonas species. In: Bennett, JE, Dolin, R, Blaser, MJ, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, eighth edition. Philadelphia: Saunders; 2015. Pp. 2518–2538.Google Scholar
Gravatt, LA, Pakyz, AL. Challenges in measuring antibiotic consumption. Curr Infect Dis Rept 2013;15:559–563.10.1007/s11908-013-0374-9CrossRefGoogle ScholarPubMed
Guidelines for ATC classification and DDD assignment 2018. WHO Collaborating Centre for Drug Statistics Methodology website. https://www.whocc.no/atc_ddd_index_and_guidelines/guidelines/. Updated December 12, 2019. Accessed May 18, 2020.Google Scholar
Pakyz, AL, Gurgle, HE, Ibrahim, OM, Oinonen, MJ, Polk, RE. Trends in antibacterial use in hospitalized pediatric patients in United States academic health centers. Infect Control Hosp Epidemiol 2009;30:600–603.CrossRefGoogle ScholarPubMed
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