[Show abstract][Hide abstract] ABSTRACT: Background
Antimicrobial stewardship has not always prevailed in a wide variety of medical institutions in Japan.
The infection control team was involved in the review of individual use of antibiotics in all inpatients (6348 and 6507 patients/year during the first and second annual interventions, respectively) receiving intravenous antibiotics, according to the published guidelines, consultation with physicians before prescription of antimicrobial agents and organisation of education programme on infection control for all medical staff. The outcomes of extensive implementation of antimicrobial stewardship were evaluated from the standpoint of antimicrobial use density, treatment duration, duration of hospital stay, occurrence of antimicrobial-resistant bacteria and medical expenses.
Prolonged use of antibiotics over 2 weeks was significantly reduced after active implementation of antimicrobial stewardship (2.9% vs. 5.2%, p < 0.001). Significant reduction in the antimicrobial consumption was observed in the second-generation cephalosporins (p = 0.03), carbapenems (p = 0.003), aminoglycosides (p < 0.001), leading to a reduction in the cost of antibiotics by 11.7%. The appearance of methicillin-resistant Staphylococcus aureus and the proportion of Serratia marcescens to Gram-negative bacteria decreased significantly from 47.6% to 39.5% (p = 0.026) and from 3.7% to 2.0% (p = 0.026), respectively. Moreover, the mean hospital stay was shortened by 2.9 days after active implementation of antimicrobial stewardship.
Extensive implementation of antimicrobial stewardship led to a decrease in the inappropriate use of antibiotics, saving in medical expenses, reduction in the development of antimicrobial resistance and shortening of hospital stay.
International Journal of Clinical Practice 07/2012; 66(10):999-1008. DOI:10.1111/j.1742-1241.2012.02999.x · 2.54 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Linezolid is an oxazolidinone antibiotic agent active against Gram-positive bacteria. It has been associated with hematologic adverse effects such as thrombocytopenia. Little is known about the mechanism underlying thrombocytopenia in patients who receive intravenous linezolid.
The aim of the present study was to investigate the risk factors associated with the development of thrombocytopenia in adult Japanese patients who received intravenous linezolid therapy.
This was a retrospective review of the medical charts of patients who were treated with linezolid 600 mg IV BID (q12h) between June 2006 and March 2008 at Gifu University Hospital in Gifu, Japan. Data were extracted from the electronic medical records obtained from a central database in the hospital. Thrombocytopenia was defined as a decrease in platelet count of > or = 25% and a final platelet count of <100 x 10(3)/mm3. Risk factors associated with thrombocytopenia in patients who received linezolid were identified via logistic regression analysis.
In total, 42 patients (31 men and 11 women; mean [SD] age, 59.6 [12.8] years [range, 33-85 years]) were included in the study. The mean duration of linezolid therapy was 13.6 (10.1) days, with a range of 3 to 48 days. Seven patients with renal insufficiency received hemodialysis before linezolid infusion. Thrombocytopenia occurred in 7 patients (16.7%). Among the 7 patients with renal insufficiency, 2 patients (28.6%) developed severe thrombocytopenia, requiring platelet transfusion. In univariate analysis, a high daily dose of > or = 22 mg/kg (odds ratio [OR] = 20.25; 95% CI, 2.115-193.9; P = 0.009), low baseline platelet count of <200 x 10(3)/mm3 (OR = 8.437; 95% CI, 1.367-52.06), and lowered creatinine clearance of <30 mL/min (OR = 6.444; 95% CI, 1.136-36.57) were significant factors for thrombocytopenia associated with linezolid therapy; however, in multivariate analysis, only daily dose (> or = 22 mg/kg) was a significant risk factor for thrombocytopenia associated with linezolid therapy.
The daily dose of > or = 22 mg/kg was a significant risk factor associated with thrombocytopenia in patients who received linezolid therapy. Prospective studies comparing the efficacy and safety profile of linezolid in patients receiving a conventional dose (600 mg q12h) and those receiving a weight-adjusted dose are needed to determine an adequate dose of linezolid, particularly in patients with renal insufficiency or low baseline platelet count.