Skip to main content

Advertisement

SpringerLink
Log in

Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins

  • Original Paper
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

This study aimed to evaluate the efficacy of an educational intervention on reducing the inappropriate use of oral third-generation cephalosporins, the prevalence of resistant bacteria, and clinical outcomes.

Methods

A before-after study was conducted to compare the data for 1 year before and after intervention at a Japanese university hospital. Educational intervention included lectures for all medical staff on oral antibiotics and educational meetings with each medical department. The primary outcome was the use of oral third-generation cephalosporins in inpatients as measured by the monthly median days of therapy (DOTs) per 1000 patient days. Secondary outcomes included the use of each oral antibiotic in inpatients and outpatients, proportion of β-lactamase-nonproducing ampicillin-resistant Haemophilus influenzae (BLNAR), penicillin-resistant Streptococcus pneumoniae (PRSP) and extended-spectrum β-lactamase producing Escherichia coli (ESBLEC), the incidence of hospital-acquired Clostridioides difficile infection (HA-CDI), and hospital mortality.

Results

The use of oral third-generation cephalosporins in inpatients was significantly decreased after intervention [DOTs (interquartile range): 24.2 (23.5–25.1) vs. 3.7 (0.0–7.1), P < 0.001], and the value in outpatients was also decreased significantly. The use of fluoroquinolones and macrolides did not increase after intervention. The proportion of BLNAR, PRSP and ESBLEC did not change significantly during the study period. The incidence of HA-CDI was significantly decreased, and hospital mortality did not change after intervention.

Conclusion

Educational intervention was effective in reducing the use of oral third-generation cephalosporins without increasing the use of broad-spectrum antibiotics and worsening clinical outcome. The prevalence of resistant bacteria did not change during the study period.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. World Health Organization. Global action plan on antimicrobial resistance. https://www.who.int/antimicrobial-resistance/global-action-plan/en/. 2015. Accessed 8 June 2019.

  2. Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013 United States, 2013. https://www.cdc.gov/drugresistance/threat-report-2013/pdf/ar-threats-2013-508.pdf. 2013. Accessed 8 June 2019.

  3. Weiner LM, Fridkin SK, Aponte-Torres Z, et al. Vital signs: preventing antibiotic-resistant infections in hospitals—United States, 2014. Morb Mortal Wkly Rep. 2016;65:235–41.

    Article  Google Scholar 

  4. Fleming-Dutra KE, Hersh AL, Shapiro DJ, et al. Prevalence of inappropriate antibiotic prescriptions among US ambulatory care visits, 2010–2011. JAMA. 2016;315:1864–73.

    Article  CAS  Google Scholar 

  5. Chua KP, Fischer MA, Linder JA. Appropriateness of outpatient antibiotic prescribing among privately insured US patients: ICD-10-CM based cross sectional study. BMJ. 2019;364:k5092. https://doi.org/10.1136/bmj.k5092.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Olesen SW, Barnett ML, MacFadden DR, Lipsitch M, Grad YH. Trends in outpatient antibiotic use and prescribing practice among US older adults, 2011–15: observational study. BMJ. 2018;362:k3155. https://doi.org/10.1136/bmj.k3155.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Sanchez GV, Fleming-Dutra KE, Roberts RM, Hicks LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep. 2016;65:1–12.

    Article  Google Scholar 

  8. Meeker D, Linder JA, Fox CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA. 2016;315:562–70.

    Article  CAS  Google Scholar 

  9. Hallsworth M, Chadborn T, Sallis A, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet. 2016;387:1743–52. https://doi.org/10.1016/S0140-6736(16)00215-4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Regev-Yochay G, Raz M, Dagan R, et al. Reduction in antibiotic use following a cluster randomized controlled multifaceted intervention: the Israeli judicious antibiotic prescription study. Clin Infect Dis. 2011;53:33–41. https://doi.org/10.1093/cid/cir272.

    Article  PubMed  Google Scholar 

  11. Butler CC, Simpson SA, Dunstan F, et al. Effectiveness of multifaceted educational programme to reduce antibiotic dispensing in primary care: practice based randomised controlled trial. BMJ. 2012;344:d8173. https://doi.org/10.1136/bmj.d8173.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Drekonja DM, Filice GA, Greer N, et al. Antimicrobial stewardship in outpatient settings: a systematic review. Infect Control Hosp Epidemiol. 2015;36:142–52. https://doi.org/10.1017/ice.2014.41.

    Article  PubMed  Google Scholar 

  13. Klein EY, Van Boeckel TP, Martinez EM, et al. Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. Proc Natl Acad Sci USA. 2018;115:E3463–70.

    Article  CAS  Google Scholar 

  14. Centers for Disease Control and Prevention. Outpatient Antibiotic Prescriptions, United States, 2016. https://www.cdc.gov/antibiotic-use/community/programs-measurement/state-local-activities/outpatient-antibiotic-prescriptions-US-2016.html. 2018. Accessed 8 June 2019.

  15. Muraki Y, Yagi T, Tsuji Y, et al. Japanese antimicrobial consumption surveillance: first report on oral and parenteral antimicrobial consumption in Japan (2009–2013). J Glob Antimicrob Resist. 2016;7:19–23.

    Article  Google Scholar 

  16. The European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2012. https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/antimicrobial-consumption-europe-esac-net-2012.pdf. 2014. Accessed 8 June 2019.

  17. Goossens H, Ferech M, Coenen S, Stephens P, European Surveillance of Antimicrobial Consumption Project Group. Comparison of outpatient systemic antibacterial use in 2004 in the United States and 27 European countries. Clin Infect Dis. 2007;44:1091–5.

    Article  CAS  Google Scholar 

  18. Lindsay Grayson M, Crowe SM, McCarthy JS, et al. Kucers’ the use of antibiotics. 6th ed. USA: ASM Press; 2010.

    Google Scholar 

  19. Hasegawa K, Yamamoto K, Chiba N, et al. Diversity of ampicillin resistance genes in Haemophilus influenzae in Japan and the United States. Microb Drug Resist. 2003;9:39–46.

    Article  CAS  Google Scholar 

  20. Shiro H, Sato Y, Toyonaga Y, Hanaki H, Sunakawa K. Nationwide survey of the development of drug resistance in the pediatric field in 2000-2001, 2004, 2007, 2010, and 2012: evaluation of the changes in drug sensitivity of Haemophilus influenzae and patients’ background factors. J Infect Chemother. 2015;21:247–56. https://doi.org/10.1016/j.jiac.2014.11.012.

    Article  PubMed  Google Scholar 

  21. Honda H, Sato T, Shinagawa M, et al. Multiclonal expansion and high prevalence of β-lactamase-negative haemophilus influenzae with high-level ampicillin resistance in japan and susceptibility to quinolones. Antimicrob Agents Chemother. 2018;62:e00851-18. https://doi.org/10.1128/aac.00851-18pii.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Karlowsky JA, Critchley IA, Blosser-Middleton RS, et al. Antimicrobial surveillance of Haemophilus influenzae in the United States during 2000–2001 leads to detection of clonal dissemination of a beta-lactamase-negative and ampicillin-resistant strain. J Clin Microbiol. 2002;40:1063–6.

    Article  CAS  Google Scholar 

  23. Dabernat H, Delmas C. Epidemiology and evolution of antibiotic resistance of Haemophilus influenzae in children 5 years of age or less in France, 2001-2008: a retrospective database analysis. Eur J Clin Microbiol Infect Dis. 2012;31:2745–53.

    Article  CAS  Google Scholar 

  24. Okada T, Sato Y, Toyonaga Y, Hanaki H, Sunakawa K. Nationwide survey of Streptococcus pneumoniae drug resistance in the pediatric field in Japan. Pediatr Int. 2016;58:192–201. https://doi.org/10.1111/ped.12781.

    Article  PubMed  Google Scholar 

  25. The Government of Japan. National Action Plan on Antimicrobial Resistance (AMR) 2016–2020. https://www.mhlw.go.jp/file/06-Seisakujouhou-10900000-Kenkoukyoku/0000138942.pdf. 2016. Accessed 8 June 2019.

  26. World Health Organization. Antimicrobial resistance: global report on surveillance 2014. https://apps.who.int/iris/bitstream/handle/10665/112642/9789241564748_eng.pdf;jsessionid=15655CCA02D5864D4E8BB41CA697CE76?sequence=1. 2014. Accessed 8 June 2019.

  27. Chong Y, Shimoda S, Yakushiji H, et al. Community spread of extended-spectrum β-lactamase-producing Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis: a long-term study in Japan. J Med Microbiol. 2013;62:1038–43.

    Article  Google Scholar 

  28. Hayakawa K, Nagamatsu M, Mezaki K, et al. Epidemiology of extended-spectrum beta-lactamase (ESBL) producing Escherichia coli in Japan: Characteristics of community-associated versus healthcare-associated ESBL E. coli. J Infect Chemother. 2017;23:117–9.

    Article  Google Scholar 

  29. Makino Y, Sugiura T, Ito T, Sugiyama N, Koyama N. Carnitine-associated encephalopathy caused by long-term treatment with an antibiotic containing pivalic acid. Pediatrics. 2007;120:e739–41.

    Article  Google Scholar 

  30. Nasu T, Suzuki M, Uetake K, Kubota M. Newborn hypocarnitinemia due to long-term transplacental pivalic acid passage. Pediatr Int. 2014;56:772–4. https://doi.org/10.1111/ped.12305.

    Article  PubMed  Google Scholar 

  31. Ito M, Fukuda M, Suzuki Y, Wakamoto H, Ishii E. Carnitine-related hypoglycemia caused by 3 days of pivalate antibiotic therapy in a patient with severe muscular dystrophy: a case report. BMC Pediatr. 2017;17:73. https://doi.org/10.1186/s12887-017-0835-7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Dial S, Kezouh A, Dascal A, Barkun A, Suissa S. Patterns of antibiotic use and risk of hospital admission because of Clostridium difficile infection. CMAJ. 2008;179:767–72. https://doi.org/10.1503/cmaj.071812.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kimura T, Uda A, Sakaue T, et al. Long-term efficacy of comprehensive multidisciplinary antibiotic stewardship programs centered on weekly prospective audit and feedback. Infection. 2018;46:215–24. https://doi.org/10.1007/s15010-017-1099-8.

    Article  PubMed  Google Scholar 

  34. Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70:195–283. https://doi.org/10.2146/ajhp120568.

    Article  CAS  Google Scholar 

  35. Wilson W, Taubert KA, Gewitz M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2007;116:1736–54.

    Article  Google Scholar 

  36. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing, M100-S22. Wayne: CLSI; 2012.

    Google Scholar 

  37. Kinoshita N, Morisaki N, Uda K, Kasai M, Horikoshi Y, Miyairi I. Nationwide study of outpatient oral antimicrobial utilization patterns for children in Japan (2013–2016). J Infect Chemother. 2019;25:22–7. https://doi.org/10.1016/j.jiac.2018.10.002.

    Article  PubMed  Google Scholar 

  38. Barlam TF, Cosgrove SE, Abbo LM, et al. Implementing an Antibiotic Stewardship Program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016;62:e51–77.

    Article  Google Scholar 

  39. Ministry of Health, Labour and Welfare. Japan Nosocomial Infections Surveillance (JANIS): annual open report. 2016. https://janis.mhlw.go.jp/english/report/open_report/2016/3/1/ken_Open_Report_Eng_201600_clsi2012.pdf. 2017. Accessed 8 June 2019.

  40. Baur D, Gladstone BP, Burkert F, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis. 2017;17:990–1001. https://doi.org/10.1016/S1473-3099(17)30325-0.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Atsushi Uda and Takeshi Kimura contributed equally to this work.

Authors and Affiliations

  1. Department of Infection Control and Prevention, Kobe University Hospital, Kobe, Hyogo, Japan

    Atsushi Uda, Sho Nishimura, Kei Ebisawa, Goh Ohji, Mari Kusuki, Mariko Yahata, Rie Izuta, Chihiro Koike & Takayuki Miyara

  2. Department of Pharmacy, Kobe University Hospital, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Hyogo, Japan

    Atsushi Uda, Takeshi Kimura, Tomoyuki Sakaue & Ikuko Yano

  3. Department of Infectious Disease, Kobe University Hospital, Kobe, Hyogo, Japan

    Sho Nishimura, Kei Ebisawa, Goh Ohji & Kentaro Iwata

  4. Department of Clinical Laboratory, Kobe University Hospital, Kobe, Hyogo, Japan

    Mari Kusuki

  5. Department of Nursing, Kobe University Hospital, Kobe, Hyogo, Japan

    Mariko Yahata & Rie Izuta

  6. Department of Medical Technology and Sciences, Faculty of Health Sciences, Kyoto Tachibana University, Kyoto, Japan

    Tatsuya Nakamura

  7. Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan

    Issei Tokimatsu

Authors
  1. Atsushi Uda
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takeshi Kimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sho Nishimura
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kei Ebisawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Goh Ohji
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mari Kusuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Mariko Yahata
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Rie Izuta
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tomoyuki Sakaue
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Tatsuya Nakamura
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Chihiro Koike
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Issei Tokimatsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Ikuko Yano
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Kentaro Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Takayuki Miyara
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Takeshi Kimura.

Ethics declarations

Conflict of interest

T. Miyara has received grant support from Shionogi & Co., Ltd. The other authors reported no conflicts of interest relevant to this article.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Uda, A., Kimura, T., Nishimura, S. et al. Efficacy of educational intervention on reducing the inappropriate use of oral third-generation cephalosporins. Infection 47, 1037–1045 (2019). https://doi.org/10.1007/s15010-019-01362-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-019-01362-x

Keywords

Search

Navigation