Retrospective surveillance of antibiotic use in maternity wards and neonatal intensive care units in Saint Petersburg, Russia
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Antibiotic overuse in infants is associated with an increased risk of serious adverse events. Development of antibiotic stewardship programs aimed at reducing overall antibiotic consumption requires epidemiological surveillance. Retrospective surveillance and evaluation of all antibiotics provided to every infant admitted to maternal wards or neonatal intensive care units (NICUs) from 01 January 2014 to 31 December 2014 were performed in five medical centers of Saint Petersburg, Russia. Types of antibiotics and dates of administration were recorded. Antibiotic use was quantified by length of therapy (length of therapy, LOT, per 1000 patient-days, PD) and days of therapy (DOT/1000 PD). An additional parameter named “instant DOT/1000 PD” was introduced by authors for assessment of longitudinal patterns of administrations. Antibiotic load was 825.6 DOT/1000 PD in maternity wards and 1425.8 DOT/1000 PD in the NICUs. These levels are two to four times higher than DOTs reported in the USA for a level III NICU (348 DOT/1000PD). Antibiotic load was associated with the length of hospital stay (LOS) and birth weight. These associations were distorted when assessed using the conventional parameters, LOT and DOT, because they do not reflect the longitudinal component of treatment and underestimate antibiotic load when a patient stays in hospital without treatment. The proposed additional parameter successfully overcame these flaws and uncovered hidden associations. Severe overuse of antibiotics may be taking place in Russia and antibiotic stewardship development should be urged. Instant DOT/1000 PD is a more powerful tool in assessing treatment patterns than DOT/1000 PD.
KeywordsAntibiotic Neonate Stewardship Days of treatment
The study was sponsored by the Local Compulsory Medical Insurance Fund of Saint Petersburg, Russia.
Compliance with ethical standards
Publication of the materials
T. Galankin, A. Kolbin, S. Sidorenko, Y. Lobzin, D. Ivanov, N. Shabalov, A. Mikhailov, N. Klimko, G. Dolgov, A. Shmidt, A. Kurylev, E. Malikova. Pharmacoepidemiology of Antimicrobials in Neonatology in Russia, Retrospective Analysis of Medical Records. Clinical Theraputics, August 2017, Volume 39, Issue 8, Pages e1–e2. DOI: https://doi.org/10.1016/j.clinthera.2017.07.019.
Conflict of interest
Alexey S. Kolbin participates in research and development with subsequent preparation of reports, writing articles and preparing presentations for the following companies (in alphabetical order): Allergen, Amgen, Astellas, Boehringer Ingelheim, Novartis, Novo Nordisk, Pfizer, Rosh, R-Pharma, and Sanofi-Aventis. None of these companies are involved in this study.
The other co-authors confirm the absence of any conflict of interest which must be reported.
Children’s Hospital No. 1, Saint Petersburg, Russia: adjudication reference number 5/15, June 30, 2015.
S.M. Kirov Military Medical Academy, Saint Petersburg, Russia: adjudication reference number 167, October 20, 2015.
Maternity Hospital No. 16, Saint Petersburg, Russia; Maternity Hospital No. 17, Saint Petersburg, Russia; Children’s Hospital No. 17, Saint Petersburg, Russia, have a joint ethics committee that is located at LLC “PharmNadzor” (“Pharmacovigilance”), adjudication reference number 31, June 16, 2015.
The data collection was retrospective, no special informed consent was needed, taking into account that any personal identifiers of the patients were removed from any study files. The standard consent to the processing of personal data signed by mothers on admission to hospital was considered sufficient by the local ethics committees.
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