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Antimicrobial resistance and antimicrobial stewardship in a Hong Kong teaching hospital.

Thilani Indunika Udayanthi Ahangama Marasinghe. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2008. / Includes bibliographical references (leaves 156-168). / Abstracts in English and Chinese. / ABSTRACT (ENGLISH VERSION) --- p.I / ABSTRACT (CHINESE VERSION) --- p.IV / DECLARATION --- p.VI / ACKNOWLEDGEMENTS --- p.VII / TABLE OF CONTENTS --- p.IX / LIST OF TABLES --- p.XIII / LIST OF FIGURES --- p.XVI / LIST OF APPENDICES --- p.XVIII / LIST OF ABBREVIATIONS --- p.XIX / Chapter CHAPTER 1 - --- INTRODUCTION --- p.1 / Chapter 1.1 --- Antimicrobial resistance --- p.1 / Chapter 1.1.1 --- Global emergence of drug-resistant organisms --- p.1 / Chapter 1.1.2 --- Resistance problem in Hong Kong --- p.5 / Chapter 1.1.2.1 --- Antimicrobial resistance of bacterial isolates in hospital --- p.5 / Chapter 1.1.2.2 --- Antimicrobial resistance of bacterial isolates from community --- p.8 / Chapter 1.1.3 --- Dynamics of resistance --- p.11 / Chapter 1.1.4 --- Mechanisms of antimicrobial resistance --- p.12 / Chapter 1.1.4.1 --- Enzymatic inactivation or modification --- p.12 / Chapter 1.1.4.2 --- Alteration of target site --- p.13 / Chapter 1.1.4.3 --- Impaired permeability --- p.13 / Chapter 1.1.4.4 --- Efflux pumps --- p.14 / Chapter 1.1.4.5. --- Alteration of metabolic pathway --- p.14 / Chapter 1.1.5 --- Association between antimicrobial use and resistance --- p.16 / Chapter 1.1.6 --- Clinical and economic impact of resistance --- p.17 / Chapter 1.1.7 --- Measures to minimize resistance in healthcare setting --- p.19 / Chapter 1.2 --- Antimicrobial classes --- p.21 / Chapter 1.2.1 --- β-Lactams --- p.21 / Chapter 1.2.2 --- Glycopeptides --- p.23 / Chapter 1.2.3 --- Quinolones --- p.24 / Chapter 1.2.4 --- Oxazolidinones-Linezolid --- p.25 / Chapter 1.3 --- Antimicrobial Stewardship Program (ASP) --- p.26 / Chapter 1.3.1 --- Definition --- p.26 / Chapter 1.3.2 --- Strategies --- p.27 / Chapter 1.3.3 --- Multidisciplinary Antimicrobial Management Team --- p.29 / Chapter 1.3.4 --- Limitations --- p.30 / Chapter 1.3.5 --- Experience in ASP --- p.30 / Chapter 1.4 --- ASP in Hong Kong --- p.36 / Chapter 1.4.1 --- Implementation at Prince of Wales Hospital --- p.36 / Chapter 1.4.2 --- Targeted antimicrobials --- p.38 / Chapter 1.5 --- Extended-Spectrum β-Lactamases (ESBLs) --- p.40 / Chapter 1.5.1 --- Classification of β-lactamases --- p.40 / Chapter 1.5.2 --- Definition of ESBLs --- p.42 / Chapter 1.5.3 --- Types of ESBLs --- p.42 / Chapter 1.5.4 --- Epidemiology of ESBLs --- p.44 / Chapter 1.5.5 --- ESBL detection --- p.46 / Chapter 1.5.6 --- Risk factors for acquisition of ESBL-producing organisms --- p.49 / Chapter 1.5.7 --- Clinical and economic impact of infections caused by ESBL- producing organisms --- p.50 / Chapter 1.5.8 --- Treatment options for infections caused by ESBL-producing organisms --- p.51 / Chapter 1.5.8.1 --- Carbapenems --- p.52 / Chapter 1.5.8.2 --- Noncarbapenems --- p.54 / Chapter 1.5.8.2.1 --- "Quinolones, aminoglycosides and sulfonamides" --- p.54 / Chapter 1.5.8.2.2 --- Cephalosporins --- p.55 / Chapter 1.5.8.2.3 --- β-Lactam/β-lactamase inhibitor combinations --- p.56 / Chapter 1.6. --- Objectives of the study --- p.58 / Chapter CHAPTER 2 - --- METHODS --- p.60 / Chapter 2.1 --- Data collection --- p.60 / Chapter 2.2 --- ESBL detection at PWH --- p.60 / Chapter CHAPTER 3 - --- OBJECTIVE 1 --- p.62 / Chapter 3.1 --- Title:-The impact of an Antimicrobial Stewardship Program on broad spectrum antimicrobials within a Medical Department in a Hong Kong tertiary care hospital --- p.62 / Chapter 3.2 --- Method --- p.62 / Chapter 3.2.1 --- Study setting --- p.62 / Chapter 3.2.2 --- Study design and sample --- p.62 / Chapter 3.2.3 --- Definitions --- p.63 / Chapter 3.2.4 --- Data collection --- p.64 / Chapter 3.2.5 --- Data analysis --- p.65 / Chapter 3.2.5.1 --- Outcome measures --- p.65 / Chapter 3.2.5.2 --- Statistical analysis --- p.65 / Chapter 3.3 --- Results --- p.66 / Chapter 3.3.1 --- Patient characteristics --- p.66 / Chapter 3.3.2 --- Clinical characteristics --- p.66 / Chapter 3.3.2.1 --- Source of infection --- p.66 / Chapter 3.3.2.2 --- Severity of infection-Intervention period --- p.69 / Chapter 3.3.2.3 --- Healthcare-associated infections (HAIs) --- p.69 / Chapter 3.3.3 --- Prescribing practices --- p.71 / Chapter 3.3.3.1 --- Prescriptions reviewed and pattern of antibiotic prescription --- p.71 / Chapter 3.3.3.2 --- Indication --- p.73 / Chapter 3.3.3.2.1 --- Appropriateness of indication --- p.73 / Chapter 3.3.3.2.2 --- Appropriate indications of use-Individual targeted antimicrobials --- p.75 / Chapter 3.3.3.2.3 --- Inappropriate antimicrobial use --- p.77 / Chapter 3.3.4 --- Recommendations made and acceptance --- p.79 / Chapter 3.3.5 --- Outcome measures --- p.81 / Chapter 3.3.5.1 --- Multivariate model of appropriate antimicrobial use --- p.81 / Chapter 3.3.5.2 --- Multivariate model of all-cause mortality --- p.82 / Chapter 3.3.5.3 --- Treatment outcome-intervention period --- p.85 / Chapter 3.3.6 --- Antimicrobial consumption --- p.86 / Chapter 3.3.6.1 --- Targeted antimicrobials --- p.86 / Chapter 3.3.6.2 --- Other antimicrobials --- p.86 / Chapter 3.3.7 --- Bacterial susceptibility --- p.89 / Chapter 3.3.7.1 --- Escherichia coli --- p.89 / Chapter 3.3.7.1.1 --- Resistance rates to amoxicillin/clavulanate --- p.89 / Chapter 3.3.7.1.2 --- ESBL-producing Escherichia coli --- p.89 / Chapter 3.3.7.2 --- Methicillin resistant-Staphylococcus aureus (MRSA) --- p.92 / Chapter 3.3.7.3 --- Pseudomonas aeruginosa --- p.93 / Chapter 3.3.7.3.1 --- Susceptibility rates to targeted antimicrobials --- p.93 / Chapter 3.3.7.3.2 --- Susceptibility rates to other antimicrobials --- p.93 / Chapter 3.4 --- Discussion --- p.97 / Chapter 3.4.1 --- Background characteristics of patients who were prescribed targeted antimicrobials --- p.97 / Chapter 3.4.2 --- Healthcare-associated infections (HAIs) --- p.98 / Chapter 3.4.3 --- Impact of ASP on appropriateness of antimicrobial prescription --- p.99 / Chapter 3.4.4 --- Compliance to recommendations --- p.101 / Chapter 3.4.5 --- Clinical impact of ASP --- p.101 / Chapter 3.4.6 --- Impact of ASP on antimicrobial consumptions --- p.103 / Chapter 3.4.7 --- Impact of ASP on antimicrobial resistance --- p.105 / Chapter 3.4.8 --- Influential factors associated with appropriate antimicrobial use --- p.108 / Chapter 3.4.9 --- Limitations --- p.109 / Chapter 3.4.10 --- Areas for further evaluation --- p.111 / Chapter CHAPTER 4 - --- OBJECTIVE II --- p.114 / Chapter 4.1 --- Title:-Treatment outcome and factors affecting treatment outcome of patients with bacteremia due to extended-spectrum β-lactamases-producing organisms receiving carbapenems or β-lactam/β-lactamase inhibitor combinations --- p.114 / Chapter 4.2 --- Method --- p.114 / Chapter 4.2.1 --- Study setting --- p.114 / Chapter 4.2.2 --- Study design and sample --- p.114 / Chapter 4.2.3 --- Definitions --- p.115 / Chapter 4.2.4 --- Data collection --- p.117 / Chapter 4.2.5 --- Data analysis --- p.118 / Chapter 4.2.5.1 --- Outcome measures: --- p.118 / Chapter 4.2.5.2 --- Statistical analysis: --- p.118 / Chapter 4.3 --- Results --- p.119 / Chapter 4.3.1 --- Patient characteristics --- p.120 / Chapter 4.3.2 --- Predisposing factors --- p.120 / Chapter 4.3.3 --- Clinical characteristics --- p.122 / Chapter 4.3.3.1 --- Type and source of infection --- p.123 / Chapter 4.3.3.2 --- Severity of illness markers --- p.123 / Chapter 4.3.4 --- Outcome measures --- p.125 / Chapter 4.3.4.1 --- Treatment outcome and reasons for therapeutic failure --- p.125 / Chapter 4.3.4.2 --- Factors associated with therapeutic failure --- p.127 / Chapter 4.3.4.2.1 --- Univariate analysis of variables to be associated with therapeutic failure --- p.127 / Chapter 4.3.4.2.2 --- Multivariate model of treatment failure --- p.129 / Chapter 4.3.4.3 --- Factors associated with all-cause mortality --- p.130 / Chapter 4.3.4.3.1 --- Univariate analysis of variables to be associated with all-cause mortality --- p.130 / Chapter 4.3.4.3.2 --- Multivariate model of all-cause mortality --- p.133 / Chapter 4.3.5 --- Subgroup analysis --- p.134 / Chapter 4.3.5.1 --- Carbapenem versus Cefoperazone/sulbactam --- p.134 / Chapter 4.3.5.2 --- Carbapenem versus Piperacillin/tazobactam --- p.141 / Chapter 4.3.5.3 --- Carbapenem versus Amoxicillin/clavulanate --- p.144 / Chapter 4.3.5.4 --- Comparison of treatment outcome --- p.147 / Chapter 4.4 --- Discussion --- p.148 / Chapter 4.4.1 --- Predisposing factors --- p.148 / Chapter 4.4.2 --- Treatment outcome --- p.149 / Chapter 4.4.3 --- Limitations and areas for further study --- p.153 / Chapter CHAPTER 5 - --- CONCLUSIONS --- p.154 / REFERENCES --- p.156 / APPENDICES --- p.169

Identiferoai:union.ndltd.org:cuhk.edu.hk/oai:cuhk-dr:cuhk_326435
Date January 2008
ContributorsMarasinghe, Thilani Indunika Udayanthi Ahangama., Chinese University of Hong Kong Graduate School. Division of Microbiology.
Source SetsThe Chinese University of Hong Kong
LanguageEnglish, Chinese
Detected LanguageEnglish
TypeText, bibliography
Formatprint, xix, 183 leaves : ill. ; 30 cm.
CoverageChina, Hong Kong, China, Hong Kong, China, Hong Kong, Hong Kong, Hong Kong, Hong Kong
RightsUse of this resource is governed by the terms and conditions of the Creative Commons “Attribution-NonCommercial-NoDerivatives 4.0 International” License (http://creativecommons.org/licenses/by-nc-nd/4.0/)

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