2 results
Point Prevalence Surveys and Customized Interventions Are Good Strategies to Improve Antimicrobial Use: The Brazilian Experience
- Ana Paula Matos Porto, Icaro Boszczowski, Ann Versporten, Ines Pauwels, Thais THAIS, Evelyne Girão, Patricia Esteves, Claudia Carrilho, Tiago Luiz Ferraz, Camila Donini, Herman Goossens, Silvia Figueiredo
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, p. s523
- Print publication:
- October 2020
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Background: Although antimicrobial stewardship is recommended by Brazilian government, data regarding prescription practices in the country are scarce. Objective: To describe the impact of 2 point-prevalence surveys and customized interventions on antimicrobial consumption among 8 hospitals in 3 regions of Brazil. Method: In 2017 and 2018, 8 tertiary-care Brazilian hospitals conducted the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance (Global-PPS). All enrolled hospitals were provided the 2017 results. The group discussed intervention strategies by WhatsApp and e-mail. Hospitals customized interventions, including feedback to prescribers, discussion with pharmacists, and antimicrobial use data in accreditation process. A web-based program was used for data entry, validation, and reporting of details on AMC prescriptions. The Global-PPS was developed by the University of Antwerp and was funded by bioMérieux. The 1-day prevalences in 2017 and 2018 are presented as risk ratios. The main outcomes are whole antimicrobial use in hospitals and intensive care units (ICUs). Prevalence of infections caused by multidrug-resistant organisms (MDROs) were reported. Results: Overall, 1,716 patients were evaluated, of whom 420 (52.5%) and 429 (46.8%) were using antimicrobials in 2017 and 2018, respectively (P = .02). In 33 ICUs, 170 patients (61.4%) and 204 patients (56.8%) were on antimicrobials, in 2017 and 2018, respectively (P = .20). Significant decreases of overall use were observed for vancomycin (from 11% to 7%; P =.01), meropenem (from 12% to 9%; P = .04), and linezolid (from 1.5% to 0.33%; P =.01). There was no significant increase in any singular drug or class of drugs. Within ICUs, vancomycin use decreased significantly (from 19% to 11%; P = .005), linezolid use decreased significantly (from 2.9% to 0.3%; P = .01), colistin use decreased significantly (from 4.3% to 1.7%; P = .05), and metronidazole use decreased significantly (from 6.5% to 2.8%; P = .03). We observed a nonsignificant decrease of infections caused by MDROs across the whole hospital (from 8.7% to 6.6%; P = .10) and in the ICUs (from 15.2% to 12.3%; P = .30). The most frequent infectious diagnoses were pneumonia (27%), intra-abdominal sepsis (14%), skin and soft-tissue infection (SSTI) (9.4%), urinary tract infection (9.1%), and sepsis and septic shock with no identified focus (SSNIF) (7.4%). There was a significant increase in SST (from 7.6% to 11.4%; P = .03) and a decrease in SSNIF (from 10.7% to 4.1%; P = .00002). In 2018, there were significantly fewer antimicrobial prescriptions for healthcare-acquired infections (from 52.6% to 43.6%; P = .0007) and more antimicrobial prescriptions for community-acquired infections (from 27.4% to 34.6%; P = .003). We detected no difference for medical or surgical prophylaxis. Conclusions: Feedback of prescription practices might have had an impact on local policies of antimicrobial use, as demonstrated by an overall decrease is antimicrobial use and a decrease in the ICU.
Funding: This study was supported by Biomérieux.
Disclosures: None
Reproducibility and validity of an FFQ to assess usual intake of methyl-group donors
- Sara Pauwels, Ine Doperé, Inge Huybrechts, Lode Godderis, Gudrun Koppen, Greet Vansant
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- Journal:
- Public Health Nutrition / Volume 18 / Issue 14 / October 2015
- Published online by Cambridge University Press:
- 14 January 2015, pp. 2530-2539
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Objective
To develop and validate a novel FFQ to assess the daily intake of four methyl-group donors (methionine, choline, betaine and folate).
DesignThe relative validity of the FFQ was assessed by comparison with 7 d estimated diet records (n 80) and its reproducibility was evaluated by repeated administrations 6 weeks apart (n 92). Paired Student t tests were used to compare group means and de-attenuated intra-class correlations to investigate the ability of the FFQ to rank individuals according to their methyl-group donor intake. De-attenuated intra-class correlation coefficients were calculated between the test and reference method for methionine, choline, betaine, folate and the sum of methyl-group donors. The weighted kappa (κw) was calculated as a measure of tertile agreement.
SettingFlanders, Belgium.
SubjectsThe FFQ was validated among Flemish women of reproductive age (18–35 years).
ResultsThe questionnaire had an acceptable ranking ability (r=0·32–0·68; κw=0·10–0·35), but overestimated the daily intake of folate (280·6 μg v. 212·0 μg) and betaine (179·1 mg v. 147·0 mg) compared with the 7 d estimated diet record. Cross-classification analysis indicated that 20 % (choline) of the participants were grossly misclassified in the validation study. The correlation between repeated administrations was good (r=0·62–0·83) with a maximal misclassification of 7 % for betaine (κw=0·44–0·66).
ConclusionsThese results indicate that this newly developed FFQ is a reliable instrument with acceptable validity for ranking individuals according to methyl-group donor intake (except for a poor agreement for choline (κw=0·10) and a fair ranking ability for betaine (r=0·32)) in Flemish women of reproductive age.