تعیین میزان تجویز و مصرف کلیستین در کنترل عفونت های رایج باکتریایی
محورهای موضوعی : پاتوبیولوژی مقایسه ایمحمد طهماسبی فر 1 , سید رضا ابطحی 2 , محمد درویشی 3
1 - کمیته تحقیقات دانشجويی، دانشگاه علوم پزشكی اجا، تهران، ايران
2 - گروه فارماکولوژی و سم شناسی، دانشکده پزشکی، دانشگاه علوم پزشكی اجا، تهران، ايران
3 - دانشیار بیماری‌های عفونی، گروه آموزشی بالینی در طب هوافضا و زیرسطحی، دانشکده طب هوافضا و زیرسطحی، مرکز تحقیقات بیماری های عفونی، دانشگاه علوم پزشکی اجا، تهران، ایران
کلید واژه: کلیستین, آنتی¬بیوتیک, بخش¬های ویژه,
چکیده مقاله :
در این مطالعه پرونده¬های بیماران تحت درمان با کلیستین بخش¬های مراقبت-های ویژه، داخلی، ارتوپدی و نفرولوژی بیمارستان بعثت نهاجا بررسی شد. 65 پرونده در سال 1398 قبل از اجرای طرح مدیریت تجویز منطقی کلیستین و 65 پرونده بعد از اجرای طرح در سال 1399 ارزیابی و بررسی اندیکاسیون¬های تجویز، دوز تجویزی، تداخلات دارویی، تجویز دارو براساس حساسیت میکروبی به کلیستین انجام گرفت. داده¬ها توسط نرم افزار SPSS نسخه 26 آنالیز شد. تجویز کلیستین قبل از اجرای طرح در 1/23% موارد قبل از کشت و تعیین حساسیت انجام شد. در طول طرح در 2/9% موارد تجویز کلیستین بدون درخواست کشت بوده است (027/0=p). قبل از اجرای طرح، اندیکاسیون تجویز کلیستین در 2/26% بیماران وجود نداشت و در طول طرح، اندیکاسیون تجویز در 7/7% بیماران وجود نداشت (004/0=p). قبل از اجرای طرح، دوز کلیستین 1/23% بیشتر از استاندارد بود. در طول طرح، دوز کلیستین در 2/9% موارد بیشتر از استاندارد بوده است (032/0=p). قبل از اجرای طرح، تجویز همزمان کلیستین با سایر داروهای نفروتوکسیک در 8/10% موارد و در طول اجرای طرح تداخل دارویی کلیسیتین با داروهای نفروتوکسیک 6/4% بود (16/0=p). بعد از تجویز منطقی آنتی¬بیوتیک، تداخلات دارویی کلیستین با داروهای نفروتوکسیک، تنظیم دوز صحیح، شناسایی اندیکاسیون¬های تجویز و تجویز براساس نتایج کشت تفاوت معنی¬داری با قبل از اجرای طرح داشت.
Colistin is used in antimicrobial resistance. The use of colistin has increased with the rise in antibiotic resistant infections. The aim of this study is the investigation of colistin consumption patterns before and after the implementation of the stewardship plan. Records of patients treated with colistin in the intensive care unit, internal, orthopedics and nephrology wards of Besat Hospital were reviewed. 65 cases before the implementation of the plan and 65 cases after the implementation were evaluated and checked for prescription indications, prescribed dosage, drug interactions, prescription based on microbial sensitivity to colistin. Data were analyzed using SPSS version 26. Colistin was prescribed before the plan in 23.1% of cases before microbial sensitivity assay. During the plan, in 9.2% of cases, colistin was prescribed without a culture request (p=0.027). Before the plan, there was no indication for prescribing colistin in 26.2% of patients, and during the plan, there was no indication for prescribing in 7.7% of patients (p=0.004). Before the plan, the dose of colistin was 23.1% more than the standard. During the plan, the dose of colistin was higher than the standard in 9.2% of cases (p=0.032). Before the plan, simultaneous administration of colistin with nephrotoxic drugs was in 10.8% of cases and during the plan, interaction between colistin and nephrotoxic drugs was 4.6% (p=0.16). After the plan, interactions of colistin with nephrotoxic drugs, dosage adjustment, identification of prescription indications and prescription based on culture were significantly different from before the implementation of the plan.
1. Mahmoudi L, Sepasian A, Firouzabadi D, Akbari A. The impact of an antibiotic stewardship program on the consumption of specific antimicrobials and their cost burden: a hospital-wide intervention. Risk Management and Healthcare Policy. 2020:1701-9.
2. Vahidi G, Mohammadi M, Shojaei L, Ramezani M, Jafari S, Khalili H. Antibiotic stewardship program in intensive care unit: first report from Iran. International Journal of Critical Illness and Injury Science. 2018;8(2):83.
3. Fateh Dizji P, Khosravy M, Saeedi AA, Asli M, Sepahvand S, Darvishi M. Prevalence of Clindamycin-resistant Staphylococcus aureus Induced by Macrolide Resistance,
Iran, 2019-2021. Iranian Journal of Medical Microbiology. 2023;17(2):256-61.
4. Sepahvand S, Darvishi M, Mokhtari M, Ali Davarpanah M. Evaluation of genetic diversity of colistin-resistant Acinetobacter baumannii by BOX-PCR and ERIC-PCR: the first report. Future Microbiology. 2022;17(12):917-30.
5. Mancuso G, Midiri A, Gerace E, Biondo C. Bacterial antibiotic resistance: The most critical pathogens. Pathogens. 2021;10(10):1310.
6. Darvishi M, Nojoomi F, Abtahi SR, Mirzaii Dizgah I, Asgari A. tudy of fluoroquinolones consumption pattern in patients admitted to Imam Reza hospital from march to september 2018. Nurse and Physician Within War. 2020;8(29):22-31.
7. Smith RA, M’ikanatha NM, Read AF. Antibiotic resistance: a primer and call to action. Health communication. 2015;30(3):309-14.
8. Darvishi M. Virulence factors profile and antimicrobial resistance of Acinetobacter baumannii strains isolated from various infections recovered from immunosuppressive patients. Biomedical and Pharmacology Journal. 2016;9(3):1057-62.
9. Abbasian H, Hajimolaali M, Yektadoost A, Zartab S. Antibiotic utilization in Iran 2000–2016: pattern analysis and benchmarking with organization for economic co-operation and development countries. Journal of research in pharmacy practice. 2019;8(3):162.
10. Founou RC, Founou LL, Essack SY. Clinical and economic impact of antibiotic resistance in developing countries: A systematic review and meta-analysis. PloS one. 2017;12(12):e0189621.
11. Nazer MR, Darvishi M. Prescribe and use of antibiotics and its role in microbial resistance and its effects on resistance economy. Yafteh. 2017;19(3):49-62.
12. Nazer MR, Darvishi M, Fouladvand HR. The pattern of antibiotic resistance of Streptococcus pneumoniae isolated from sputum of patients with respiratory infection. Journal of Advanced Pharmacy Education & Research| Apr-Jun. 2019;9(S2).
13. Hormozi SF, Vasei N, Aminianfar M, Darvishi M, Saeedi AA. Antibiotic resistance in patients suffering from nosocomial infections in Besat Hospital. European journal of translational myology. 2018;28(3).
14. Despotovic A, Milosevic B, Milosevic I, Mitrovic N, Cirkovic A, Jovanovic S, et al. Hospital-acquired infections in the adult intensive care unit—Epidemiology, antimicrobial resistance patterns, and risk factors for acquisition and mortality. American journal of infection control. 2020;48(10):1211-5.
15. Hormozi SF, Saeedi AA, Aminianfar M, Alishah MS, Darvishi M. Studying the frequency of nosocomial infection and its relative factors in the intensive care unit of hospitals based upon NNI system. Eurasian Journal Of Analytical Chemistry. 2018;13(3):1-7.
16. Uc-Cachón AH, Gracida-Osorno C, Luna-Chi IG, Jiménez-Guillermo JG, Molina-Salinas GM. High prevalence of antimicrobial resistance among gram-negative isolated bacilli in intensive care units at a tertiary-care hospital in Yucatán Mexico. Medicina. 2019;55(9):588.
17. Harris PN, Tambyah PA, Paterson DL. β-lactam and β-lactamase inhibitor combinations in the treatment of extended-spectrum β-lactamase producing Enterobacteriaceae: time for a reappraisal in the era of few antibiotic options? The Lancet Infectious Diseases. 2015;15(4):475-85.
18. Darvishi M. Antibiotic resistance pattern of uropathogenic methicillin-resistant staphylococcus aureus isolated from immunosuppressive patients with pyelonephritis. Journal of Pure and Applied Microbiology. 2016;10(4):2663-7.
19. Rahbarimanesh A, Mojtahedi SY, Sadeghi P, Ghodsi M, Kianfar S, Khedmat L, et al. Antimicrobial stewardship program (ASP): an effective implementing technique for the therapy efficiency of meropenem and vancomycin antibiotics in Iranian pediatric patients. Annals of clinical microbiology and antimicrobials. 2019;18:1-7.
20. Mahmoudi L, Ghouchani M, Mahi-Birjand M, Bananzadeh A, Akbari A. Optimizing compliance with surgical antimicrobial prophylaxis guidelines in patients undergoing gastrointestinal surgery at a referral teaching hospital in southern Iran: clinical and economic impact. Infection and drug resistance. 2019:2437-44.
21. Sharland M, Pulcini C, Harbarth S, Zeng M, Gandra S, Mathur S, et al. Classifying antibiotics in the WHO Essential Medicines List for optimal use—be AWaRe. The Lancet Infectious Diseases. 2018;18(1):18-20.
22. Heidari L, Sepahvand S, Darvishi M, Jafari R. Molecular analysis of PmrA and PmrB genes in colistin-resistant Pseudomonas aeruginosa strains via PCR method. Pakistan Journal of Pharmaceutical Sciences. 2019;32(3 (Supplementary)):1175-7.
23. Bialvaei AZ, Samadi Kafil H. Colistin, mechanisms and prevalence of resistance. Current medical research and opinion. 2015;31(4):707-21.
24. Hosseinzadeh K, Azimian J. Iranians’ self-report knowledge and practice about arbitrary use of antibiotics. Journal of clinical and diagnostic research: JCDR. 2017;11(8):FC06.
25. Nazari E, Bakhshandeh Abkenar H, Karimi A, Yousofi Yeganeh B, Namdari A, Kamali M. Investigating the compliance of Carbapenem antibiotics (Meropenem and Imipenem) administration in patients undergoing open heart surgery with the standard guidelines of antibiotic stewardship. Iranian Journal of Cardiovascular Nursing. 2022;11(1):218-27.
26. Keramat F, Ghasemi Basir HR, Taher A, Moradi A, Saadatmand A, Owji Nejad P. Evaluation of Antibiotic Resistance to Colistin in Nosocomial Infections with Multidrug-Resistant Acinetobacter. Avicenna Journal of Clinical Medicine. 2021;27(4):211-6.
27. Esmaili F, Ashouri N, Hosseini Zare SM. The Relationship between Experimental Use of Antibiotics and Length of Stay in Premature Infants Admitted to NICU of one of Educational Hospitals in Tehran. Payavard Salamat. 2023;17(1):24-33.
28. Elyasi S, Ezat Rahimi P, Mohammad Pour AH, Naderi H. The Pattern of In-patient Colistin Prescription for Patients Admitted to Imam Reza Hospital at Mashhad. medical journal of mashhad university of medical sciences. 2020;63(2):2271-91.
29. Rezaie N, Farasatinasab M, Vaiszadeh N, Jamshidi M, Ranjbar M, Yasin Z, et al. Colistin utilization evaluation in a major teaching hospital in Iran. Journal of Pharmaceutical Care. 2018:19-22.
30. Vazin A, Karimzadeh I, Zand A, Hatami-Mazinani N, Firouzabadi D. Evaluating adherence of health-care team to standard guideline of colistin use at intensive care units of a referral hospital in Shiraz, Southwest of Iran. Advanced Pharmaceutical Bulletin. 2017;7(3):391.
31. Rafati MR, Sahraee S, Zamani Z, Irvash M. Antibiotics usage in intensive care unit in sari bouali sina hospital. Journal of Mazandaran University of Medical Sciences. 2015;24(122):12-21.
32. Iosifidis E, Antachopoulos C, Ioannidou M, Mitroudi M, Sdougka M, Drossou-Agakidou V, et al. Colistin administration to pediatric and neonatal patients. European journal of pediatrics. 2010;169:867-74.