Antimicrobial Use-Related Problems and Predictors among Hospitalized Medical In-Patients in Southwest Ethiopia: Prospective Observational Study

Background

The spread of antimicrobial resistance in developing countries is associated with complex and interconnected factors, such as excessive and unnecessary prescribing of antimicrobials, increased self-prescribing by the people and poor quality of available antimicrobials. Moreover, the failure to implement infection control practices and the dearth of routine susceptibility testing and surveillance magnify the problems. This may spread the inappropriateness of prescribing, ending up with the spread of antimicrobial resistance.

Objective

The aim of this study was to assess antimicrobial use related problems and associated factors among patients admitted at Jimma University specialized hospital.

Methods

A hospital based prospective observational study design was employed at medical wards of Jimma University specialized hospital, Ethiopia. Data collected from patient medication charts and from the patients was analyzed using SPSS, version 16.0. Logistic regression was used to determine the associations between variables. Statistical significance was considered at p-value <0.05.

Results

Out of 152 study participants, at least one antimicrobial use problem was identified among 115(75.7%). Accordingly, additional antimicrobials were needed by 45(29.6%) of the patients, whereas they were unnecessary among 44(28.9%). Similarly, 17% of the patients were noncompliant to at least one antimicrobial therapy, while 8.6% experienced at least one type of adverse drug reaction. On the other hand, the coverage of the infectious medical condition in the national guidelines (AOR = 4.888) and the duration of hospital stay (AOR = 3.086) were the determinants of the antimicrobial use problems.

Conclusion

Most of the antimicrobial use problems identified were related to delay of initiation of effective antimicrobials and excessive use; use without indication or using duplicates of broad spectrum antimicrobials or use for longer duration than recommended. The coverage of the infectious medical condition in the national treatment guidelines and the duration of hospital stay were the determinants of the antimicrobial use problems.     

Evaluation of Antimicrobial Therapy of Blood Culture Positive Healthcare-Associated Infections in Children

Aim

Knowledge of the quality of antimicrobial therapy (AMT) used for invasive healthcare-associated infections (HAIs) in paediatrics is scarce. Influence of the final information about the isolated pathogen on the subsequent targeted AMT was investigated in our study.

Methods

Data on 149 children (0–17 years) with blood culture positive HAIs were collected. The causative microbes under investigation were Staphylococcus aureus, Staphylococcus epidermidis, streptococci, Gram negative rods, and mixed infections were likewise included. For adjusting the antimicrobial regimen, an expert panel evaluated the quality of the targeted AMT and the delay of 72 hours after final microbiology results. AMT was regarded as inappropriate if the pathogen was totally resistant to the used antimicrobials (i) or if the chosen therapy was of not optimal efficacy against the pathogen (ii).

Results

17% of the patients received inappropriate AMT. Half of these infections 13/26 (50%) were treated with an antimicrobial to which the isolate was resistant. Three (3/13, 23%) of these patients received antimicrobials which were totally ineffective according to in vitro data. Suboptimal or too broad spectrum AMT was administered to 13/26 (50%) patients. The most common causes of inappropriate use were the use of beta-lactams in oxacillin-resistant Staphylococcus epidermidis infections and vancomycin given in oxacillin-sensitive Staphylococcus aureus infections.

Conclusion

Approximately 17% of the selected cohort received inappropriate AMT. More attention should be paid to the appropriate use of antimicrobials, and training of prescribers should be urgently provided.     

Timing of Antimicrobial Therapy after Identification of Ventilator-Associated Condition Is Not Associated with Mortality in Patients with Ventilator-Associated Pneumonia: A Cohort Study

Purpose

Delays in antimicrobial therapy increase mortality in ventilator-associated pneumonia (VAP). The more objective ventilator-associated complications (VAC) are increasingly used for quality reporting. It is unknown if delays in antimicrobial administration, after patients meet VAC criteria, leads to worse outcomes.

Materials and Methods

Cohort of 81 episodes of antimicrobial treatment for VAP. We compared mortality, superinfections and treatment failures conditional on the timing of identification of VAC.

Results

60% of patients with VAC had an identifiable episode at least 48 before the initiation of antimicrobials. Antimicrobial administration after the identification of VAC was not associated with intensive care unit (ICU) mortality (OR 0.71, 95% CI 0.11–4.48, p = 0.701) compared to immediate antimicrobial administration. Similarly, the risk of treatment failure or superinfection was not affected by the timing of administration of antimicrobials in VAC (HR 0.95, 95% CI 0.42–2.19, p = 0.914).

Conclusions

We observed no signal of harm associated with the timing to initiate antimicrobials after the identification of a VAC. The identification of VAC should not lead clinicians to start antimicrobials before a diagnosis of VAP can be established.     

Long Term Effect on Professionals’ Knowledge,Practice and Attitudes towards User Involvement Four Years after Implementing an Organisational Development Plan: A Controlled Study

Background

Health service organisations are increasingly implementing user involvement initiatives according to requirements from governments, such as user representation in administrational boards, better information to users, and more involvement of the users during treatment. Professionals are vital in all initiatives to enhance user involvement, and initiatives to increase involvement should influence the professionals’ practice and attitudes. The implementation of a development plan intending to enhance user involvement in a mental health hospital in Central Norway had no effect on the professionals after 16 months. The objective was therefore to investigate the long term effect on the professionals’ knowledge, practice and attitudes towards user involvement after four years.

Methods

This was a non-randomized controlled study including professionals from three mental health hospitals in Central Norway. A development plan intended to enhance user participation was implemented in one of the hospitals, including establishing a patient education centre and a user office, purchasing of user expertise, appointing contact professionals for next of kin, and improving of the centre’s information and the professional culture. The professionals at two other hospitals constituted the control group. All professionals were invited to answer the Consumer Participation Questionnaire (CPQ) and additional questions, at a four year interval.

Results

A total of 399 professionals participated (43% response rate). Comparing the changes in the intervention group with the changes in the control group, the results showed that the plan had improved some aspects of the professionals’ knowledge about the user involvement taking place in the hospital. In addition, some parts of the professionals’ practice of providing information to the service users was improved, and the development plan might have raised their awareness about insufficient involvement of next of kin.

Conclusions

This is the first controlled study on the long term effect on professionals from implementing a development plan to enhance user participation in a mental health hospital. Since there was more effect after four years than after 16 months, this study indicates that it takes time before the effect of complex interventions to enhance patient participation in organisations can be detected among the professionals. More long-term studies are thus warranted.     

Use of an Electronic Medication Administration Record (eMAR) for Surveillance of Medication Omissions: Results of a One Year Study of Antimicrobials in the Inpatient Setting

Introduction

Medication administration omissions (MAO) are usually considered medication errors but not all MAO are clinically relevant. We determined the frequency of clinically relevant MAO of antimicrobial drugs in adult hospitals in Calgary, Alberta, Canada based on electronic medication administration record (eMAR).

Methods

We examined 2011 data from eMAR records on medical wards and developed a reproducible assessment scheme to categorize and determine clinical relevance of MAO. We applied this scheme to records from 2012 in a retrospective cohort study to quantify clinically relevant MAO. Significant predictors of clinically relevant MAO were identified.

Results

A total of 294,718 dose records were assessed of which 10,282 (3.49%) were for doses not administered. Among these 4903 (1.66% of total); 47.68% of MAO were considered clinically relevant. Significant positive predictors of clinically relevant MAO included inhaled (OR 4.90, 95% CI 3.54-6.94) and liquid oral (OR 1.32, 95% CI 1.18-1.47) route of medication compared to solid oral and irregular dose schedules. Evening nursing shift compared to night shift (OR 0.77 95% CI 0.70-0.85) and parenteral (OR 0.50, 95% CI 0.46-0.54) were negative predictors, The commonest reasons for relevant MAO were patient preference, unspecified reason, administration access issues, drug not available or patient condition.

Conclusion

Assessment of MAO by review of computer records provides a greater scope and sample size than directly observed medication administration assessments without “observer” effect. We found that MAO of antimicrobials in inpatients were uncommon but were seen more frequently with orally administered antimicrobials which may have significance to antimicrobial stewardship initiatives.     

Diffusion of Messages from an Electronic Cigarette Brand to Potential Users through Twitter

Objective

This study explores the presence and actions of an electronic cigarette (e-cigarette) brand, Blu, on Twitter to observe how marketing messages are sent and diffused through the retweet (i.e., message forwarding) functionality. Retweet networks enable messages to reach additional Twitter users beyond the sender’s local network. We follow messages from their origin through multiple retweets to identify which messages have more reach, and the different users who are exposed.

Methods

We collected three months of publicly available data from Twitter. A combination of techniques in social network analysis and content analysis were applied to determine the various networks of users who are exposed to e-cigarette messages and how the retweet network can affect which messages spread.

Results

The Blu retweet network expanded during the study period. Analysis of user profiles combined with network cluster analysis showed that messages of certain topics were only circulated within a community of e-cigarette supporters, while other topics spread further, reaching more general Twitter users who may not support or use e-cigarettes.

Conclusions

Retweet networks can serve as proxy filters for marketing messages, as Twitter users decide which messages they will continue to diffuse among their followers. As certain e-cigarette messages extend beyond their point of origin, the audience being exposed expands beyond the e-cigarette community. Potential implications for health education campaigns include utilizing Twitter and targeting important gatekeepers or hubs that would maximize message diffusion.     

Road Traffic Injury Trends in the City of Valledupar,Colombia. A Time Series Study from 2008 to 2012

Objective

To analyze the behavior temporal of road-traffic injuries (RTI) in Valledupar, Colombia from January 2008 to December 2012.

Methodology

An observational study was conducted based on records from the Colombian National Legal Medicine and Forensic Sciences Institute regional office in Valledupar. Different variables were analyzed, such as the injured person’s sex, age, education level, and type of road user; the timeframe, place and circumstances of crashes and the vehicles associated with the occurrence. Furthermore, a time series analysis was conducted using an auto-regressive integrated moving average.

Results

There were 105 events per month on an average, 64.9% of RTI involved men; 82.3% of the persons injured were from 18 to 59 years of age; the average age was 35.4 years of age; the road users most involved in RTI were motorcyclists (69%), followed by pedestrians (12%). 70% had up to upper-secondary education. Sunday was the day with the most RTI occurrences; 93% of the RTI occurred in the urban area. The time series showed a seasonal pattern and a significant trend effect. The modeling process verified the existence of both memory and extrinsic variables related.

Conclusions

An RTI occurrence pattern was identified, which showed an upward trend during the period analyzed. Motorcyclists were the main road users involved in RTI, which suggests the need to design and implement specific measures for that type of road user, from regulations for graduated licensing for young drivers to monitoring road user behavior for the promotion of road safety.