Be antibiotic aware during the antibiotic awareness week

World antibiotic awareness week is observed each November to increase global awareness about antibiotic resistance and unnecessary use of antibiotics among physicians, public and policymakers. This year the launch day is November 12 and various campaign and activities are planned globally to make the healthcare professionals and consumers aware of antimicrobial resistance (AMR.) 

AMR is an ever-rising menace and an urgent threat to public health. Antibiotic-resistant bacteria cause nearly one in five infections in developed countries. At least, 23,000 people die as a result of antibiotic resistance and nearly 2 million people get infected with antibiotic-resistant bacteria in the US alone.

If nothing is done, it is estimated that by 2050, more people will die because of bacterial infections that are resistant to available antibiotics as compared to cancer deaths. Besides promoting research and stricter prescribing laws, encouraging positive behavioral change to reduce the misuse of antibiotics remains one of the priorities in mitigating the spread of antibiotic resistance bacteria.

WHO has gathered information from 65 countries to track and document the consumption pattern of antibiotics around the world. The report notes that amoxicillin and amoxicillin/clavulanic acid – first or second-line treatments for common infections – are the most frequently used antibiotics worldwide.

Here are some of the key CDC messages for healthcare professionals to bring down the development of antibiotic resistance:

Always follow the clinical guidelines and remember the three “rights” for the antibiotic prescription–right antibiotic in the right dose for the right duration.

Shorten the antibiotic therapy to minimum effective duration to maximize the patient benefits and minimizing the side effects and development of resistance.

Protect your patient by only prescribing antibiotics when needed.

Educate your patients about the side effects and harms of antibiotic, their ineffectiveness in viral infection, what to do to feel better and when to contact your physician if they are not feeling good.

Make the patients and their caregiver aware of the signs and symptoms of sepsis.

Practice hand-hygiene at the clinics and hospitals to reduce cross infections.

If the patient is admitted, review the antibiotic regimen 48 to 72 hours after it is started based on the patient’s/resident’s clinical condition and microbiology culture results, and stop or change antibiotic orders as needed—a critical step in care.

Know about antibiotic resistance patterns in your practice areas and use the latest data to make informed prescribing decisions.

CDC antibiotic awareness page

WHO antibiotic awareness campaign  

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Prophylactic negative pressure wound therapy may help cut down surgical wound infections after cesarean

Prophylactic negative pressure wound therapy (NPWT) at cesarean delivery may reduce the surgical site infections (SSI) and overall wound complications says the results of a systematic review and meta-analysis published ahead of print in American journal of obstetrics and gynecology.

Morbidly obese women have a very high rate of SSIs and readmission to hospitals.

The researchers conducted a literature review and included RCTs and observational studies comparing surgical outcome between prophylactic negative pressure wound closure and standard cesarean wound closure.  

The investigators were mainly looking at difference in SSI because of NPWT besides other minor outcomes like composite wound complications, wound gaping, hematoma, endometritis and readmission to the hospital.

Six RCTs and three cohort study met the inclusion criteria. It was seen that women with NPWT faced a 55% lower risk of SSI as compared to women with standard dressing (pooled RR 0.45; 95% CI 0.31- 0.66). The Number Need to Treat (NNT) was 17.

Women with NPWT also had a 22 lower risk of composite wound complications, while the other minor outcomes were comparable in both the groups.

The authors concluded that although the studies were heterogenous, use of NPWT decreases the SSIs after  cesarean, larger clinical trials are awaited to fully understand the impact of the intervention.

Abstract

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Antibiotic Associated adverse drug events very common in hospitalized patients.

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One in five hospitalized patients will experience adverse drug event (ADEs) reports a study published online June 12, 2017 in JAMA Internal Medicine.

The researchers looked at records of 1488 adult inpatients admitted at John Hopkins hospital between September 2013 and June 2014. The cohort received antibiotics for at least 24 hours for infectious indication.

Patients on antituberculous regimen or on topical or inhaled antibiotics were excluded from the study.

The researchers examined immediate adverse effects within 30 days of treatment or delayed effects consisting of Clostridium difficile infection (CDI) or incident multidrug-resistant organism infection(MDRO) at 90 days of starting the drugs.

The researchers looked at gastrointestinal, dermatologic, musculoskeletal, hematologic, hepatobiliary, renal, cardiac, and neurologic events.

The median age of patients was 59 years (interquartile range, 49-69 years) and nearly 50% were women. The median hospital stay was 4 days and the most common group of antibiotics were third-generation cephalosporins, parenteral vancomycin, and cefepime.

A total of 324 ADEs occurred overall; of which 186 (57%) happened within 30 days and 138 occurred within 90 days.

The most common ADEs were gastrointestinal, renal, and hematologic abnormalities. Of the 138 adverse events occurring with 90 days, 54 (39%) were cases of CDI and 84 (61%) were MDRO infections.

About 287 patients were receiving antibiotics regimen that was not clinically indicated. Furthermore, every 10 days of additional antibiotics increased the ADEs by 3%.

The authors acknowledge that their study has limitation because different hospitals have different antibiotic regimen in use, so the incidence of ADEs may vary. Also, the study did not include outpatients who are receiving broad spectrum antibiotics for long period of time.

“Unnecessary use of antibiotics is particularly concerning because antibiotics may be associated with a number of [adverse drug events (ADEs)] ... Estimates of the incidence of antibiotic-associated ADEs in hospitalized patients are generally unavailable,” Pranita D. Tamma, MD, MHS, from the division of pediatric infectious diseases at the Johns Hopkins University School of Medicine and colleagues wrote. “A comparative analysis of the incidence of ADEs across all classes of antibiotics has yet to be performed.”

“Our findings provide quantitative data about the risk of ADEs that clinicians should consider when weighing decisions to initiate or discontinue antibiotic therapy and lend further credence to the importance of antibiotic stewardship to optimize patient safety,” added Dr. Tamma.