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The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study.
Annals of Clinical Microbiology and Antimicrobials ( IF 5.7 ) Pub Date : 2020-08-06 , DOI: 10.1186/s12941-020-00377-9
Rima Moghnieh 1, 2 , Dania Abdallah 3 , Lyn Awad 3 , Marwa Jadayel 4 , Nicholas Haddad 5 , Hani Tamim 6 , Aline Zaiter 7 , Diana-Caroline Awwad 7 , Loubna Sinno 8 , Salam El-Hassan 9 , Rawad Lakkis 10 , Rabab Khalil 11 , Tamima Jisr 12
Affiliation  

A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

中文翻译:

一项干预研究表明,三级医院的抗生素管理计划对替加环素的使用具有影响。

作为全面的抗生素管理计划(ASP)的一部分,2016年在黎巴嫩贝鲁特的望加锡综合医院启动了以替加环素利用为目标的面向药物的抗生素管理干预措施。在这项研究中,与ASP开始之前的早期相比,我们评估了该干预措施对改变不同类型感染中替加环素处方行为,患者预后和死亡率以及替加环素药物使用密度的影响。这是回顾性图表回顾,回顾了2012年1月至2013年12月[ASP前的期间(P)1]和2016年10月至2018年12月[期间(P)2]之间接受替加环素治疗超过72小时的所有成年住院患者在ASP中]。在P1期间对153例患者给予Tigecycline,在P2期间对116例患者给予了替加环素。罹患癌症的患者比例,在P1和P2之间,那些需要机械通气的患者和那些有血液动力学衰竭的患者显着减少。接受替加环素用于FDA批准适应症的患者比例从P1期间的19%增加到P2期间的78%(P <0.001)。另一方面,其在标签外适应症中的使用受到限制,包括呼吸机相关性肺炎(P1为26.1%,P2为3.4%,P <0.001),医院获得性肺炎(P1为19.6%,P2为5.2%) ,P = 0.001),败血症(P1为9.2%,P2为3%,P = 0.028)和发热性中性粒细胞减少症(P1为15.7%,P2为0.9%,P <0.001)。替加环素治疗的临床成功率显示,在整个患者人群中,总体上从P1期间的48.4%显着提高到P2期间的65.5%(P = 0.005)。替加环素治疗的患者的全因死亡率从P1期间的45.1%降低至20岁。P2期间为7%(P <0.0001)。通常,在P1和P2之间,平均替加环素的消耗量减少了55%(P <0.0001)。针对替加环素处方的以药物为导向的ASP干预改善了其使用和患者预后,从而在不适合治疗的适应症以外的适应症中帮助遏制了该药物的过度乐观使用。
更新日期:2020-08-06
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