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Antibiotics
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Antimicrobial Stewardship Program (ASP) in General Hospital: An Essential Practice
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Antimicrobial Stewardship Program (ASP) in General Hospital: An Essential Practice

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotics Use and Antimicrobial Stewardship".

Deadline for manuscript submissions: 15 July 2024 | Viewed by 9403

Special Issue Editor

Dr. Michael Samarkos

E-Mail Website1 Website2
Guest Editor
1st Department of Internal Medicine & Infectious Diseases Unit, General Hospital of Athens Laikon, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece
Interests: antimicrobial stewardship; gram positive infections; vascular catheter infections; C. difficile infection

Special Issue Information

Dear Colleagues,

Antimicrobial drugs are unique in that through the development of resistance, any misuse might affect not only the patients who receive them but future patients as well. Thus, when we prescribe an antimicrobial course, we should be thinking in a context broader than the patient before us.

Although the bulk of antimicrobial prescribing occurs in the community, it is in the hospital where one faces the consequences of antimicrobial drug misuse, i.e., multi-drug resistant pathogens. In addition, hospitals are the settings where new antimicrobials are mostly used.

This Special Issue aims to highlight the challenges that the Antimicrobial Stewardship Program (ASP) of General Hospitals must tackle, such as selection of empirical antimicrobial therapy in settings of endemic multi-drug resistant pathogens, management of perioperative prophylaxis, use of antifungal drugs, use of novel laboratory techniques, and management of resources, especially during the CVID-19 pandemic.

We invite you to submit articles for this Special Issue. We welcome original research articles, reviews, or meta-analyses, related but not limited to the above challenges that the ASP of a General Hospital must address.

Dr. Michael Samarkos
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antimicrobial stewardship
  • anti-infective agent
  • surgical wound infection
  • antibiotic prophylaxis
  • drug resistance
  • microbial
  • health care rationing
  • molecular diagnostic techniques

Published Papers (4 papers)

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Research

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14 pages, 832 KiB  
Article
Effect of an E-Prescription Intervention on the Adherence to Surgical Chemoprophylaxis Duration in Cardiac Surgery: A Single Centre Experience
by Sofia Kostourou, Ilias Samiotis, Panagiotis Dedeilias, Christos Charitos, Vasileios Papastamopoulos, Dimitrios Mantas, Mina Psichogiou and Michael Samarkos
Antibiotics 2023, 12(7), 1182; https://doi.org/10.3390/antibiotics12071182 - 13 Jul 2023
Viewed by 829
Abstract
In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial [...] Read more.
In our hospital, adherence to the guidelines for peri-operative antimicrobial prophylaxis (PAP) is suboptimal, with overly long courses being common. This practice does not offer any incremental benefit, and it only adds to the burden of antimicrobial consumption, promotes the emergence of antimicrobial resistance, and it is associated with adverse events. Our objective was to study the effect of an electronic reminder on the adherence to each element of PAP after cardiac surgery. We conducted a single center, before and after intervention, prospective cohort study from 1 June 2014 to 30 September 2017. The intervention consisted of a reminder of the hospital guidelines when ordering PAP through the hospital information system. The primary outcome was adherence to the suggested duration of PAP, while secondary outcomes included adherence to the other elements of PAP and incidence of surgical site infections (SSI). We have studied 1080 operations (400 pre-intervention and 680 post-intervention). Adherence to the appropriate duration of PAP increased significantly after the intervention [PRE 4.0% (16/399) vs. POST 15.4% (105/680), chi-square p < 0.001]; however, it remained inappropriately low. Factors associated with inappropriate duration of PAP were pre-operative hospitalization for <3 days, and duration of operation >4 h, while there were significant differences between the chief surgeons. Unexpectedly, the rate of SSIs increased significantly during the study (PRE 2.8% (11/400) vs. POST 5.9% (40/680), chi-square p < 0.019). The implemented intervention achieved a relative increase in adherence to the guideline-recommended PAP duration; however, adherence was still unacceptably low and further efforts to improve adherence are needed. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Program (ASP) in General Hospital: An Essential Practice)
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11 pages, 973 KiB  
Article
Provision of Microbiology, Infection Services and Antimicrobial Stewardship in Intensive Care: A Survey across the Critical Care Networks in England and Wales
by Tim Catton, Helen Umpleby, Ahilanandan Dushianthan and Kordo Saeed
Antibiotics 2023, 12(4), 768; https://doi.org/10.3390/antibiotics12040768 - 17 Apr 2023
Viewed by 1668
Abstract
Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads [...] Read more.
Infection rounds in Intensive Care Units (ICU) can impact antimicrobial stewardship (AMS). The aim of this survey was to assess the availability of microbiology, infection, AMS services, and antimicrobial prescribing practices in the UK ICUs. An online questionnaire was sent to clinical leads for ICUs in each region listed in the Critical Care Network for the UK. Out of 217 ICUs, 87 deduplicated responses from England and Wales were analyzed. Three-quarters of those who responded had a dedicated microbiologist, and 50% had a dedicated infection control prevention nurse. Infection rounds varied in their frequency, with 10% providing phone advice only. Antibiotic guidance was available in 99% of the units; only 8% of those were ICU-specific. There were variations in the availability of biomarkers & the duration of antibiotics prescribed for pneumonia (community, hospital, or ventilator), urinary, intra-abdominal, and line infections/sepsis. Antibiotic consumption data were not routinely discussed in a multi-disciplinary meeting. The electronic prescription was available in ~60% and local antibiotic surveillance data in only 47% of ICUs. The survey highlights variations in practice and AMS services and may offer the opportunity to further collaborations and share learnings to support the safe use of antimicrobials in the ICU. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Program (ASP) in General Hospital: An Essential Practice)
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10 pages, 262 KiB  
Article
Antimicrobial Prescribing before and after the Implementation of a Carbapenem-Focused Antimicrobial Stewardship Program in a Greek Tertiary Hospital during the COVID-19 Pandemic
by Nikolaos Spernovasilis, Evangelos I. Kritsotakis, Anna Mathioudaki, Alexandra Vouidaski, Ioulia Markaki, Despoina Psaroudaki, Petros Ioannou and Diamantis P. Kofteridis
Antibiotics 2023, 12(1), 39; https://doi.org/10.3390/antibiotics12010039 - 27 Dec 2022
Cited by 5 | Viewed by 2397
Abstract
Background: Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality [...] Read more.
Background: Irrational use of antimicrobials poses a significant risk for public health by aggravating antimicrobial resistance. The aim of this repeated point prevalence survey (PPS) was to evaluate the impact of a carbapenem-focused antimicrobial stewardship program (ASP) on overall antimicrobial use and quality of antimicrobial prescribing during the COVID-19 pandemic. Methods: All adult inpatients in the University Hospital of Heraklion in Greece were audited twice, before and after the implementation of the ASP, in October 2019 and October 2020, respectively. Patient characteristics, indications and diagnoses for antimicrobial administration, antimicrobials prescribed, and compliance with treatment guidelines were recorded. Results: Of 743 adult inpatients on the days of the two surveys, 398 (53.6%) were on antimicrobials for 437 diagnoses. Following implementation of the ASP, there was substantial decrease in the utilization of carbapenems (4.9% of all antibacterials prescribed in the second PPS compared to 10.3% in the first PPS). A significant improvement was observed for all indicators of the quality of antimicrobial prescribing. Conclusions: Our study demonstrated a positive impact of an ASP implementation during the first stages of the COVID-19 pandemic on reducing the use of last-line antimicrobials and improving overall quality of antimicrobial prescribing. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Program (ASP) in General Hospital: An Essential Practice)

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15 pages, 1290 KiB  
Perspective
Challenges and Opportunities in Antimicrobial Stewardship among Hematopoietic Stem Cell Transplant and Oncology Patients
by Anjali Majumdar, Mansi R. Shah, Jiyeon J. Park, Navaneeth Narayanan, Keith S. Kaye and Pinki J. Bhatt
Antibiotics 2023, 12(3), 592; https://doi.org/10.3390/antibiotics12030592 - 16 Mar 2023
Cited by 2 | Viewed by 3713
Abstract
Antimicrobial stewardship programs play a critical role in optimizing the use of antimicrobials against pathogens in the era of growing multi-drug resistance. However, implementation of antimicrobial stewardship programs among the hematopoietic stem cell transplant and oncology populations has posed challenges due to multiple [...] Read more.
Antimicrobial stewardship programs play a critical role in optimizing the use of antimicrobials against pathogens in the era of growing multi-drug resistance. However, implementation of antimicrobial stewardship programs among the hematopoietic stem cell transplant and oncology populations has posed challenges due to multiple risk factors in the host populations and the infections that affect them. The consideration of underlying immunosuppression and a higher risk for poor outcomes have shaped therapeutic decisions for these patients. In this multidisciplinary perspective piece, we provide a summary of the current landscape of antimicrobial stewardship, unique challenges, and opportunities for unmet needs in these patient populations. Full article
(This article belongs to the Special Issue Antimicrobial Stewardship Program (ASP) in General Hospital: An Essential Practice)
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