Linking antimicrobial prescribing to antimicrobial resistance in the ICU: Before and after an antimicrobial stewardship program

AbstractBackgroundAntimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.ObjectiveTo quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.ResultsImplementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.ConclusionsWithin 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.

Download Full-text

Evaluation of Asymptomatic Bacteruria Management Before and After Antimicrobial Stewardship Program Implementation: Retrospective Study

10.21203/rs.3.rs-551143/v1 ◽

2021 ◽

Author(s):

Ahlam Alghamdi ◽

Majed Almajed ◽

Raneem Alalawi ◽

Amjad Alganame ◽

Shorooq Alanazi ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Program Implementation ◽

Urine Culture ◽

Asymptomatic Bacteriuria ◽

Antimicrobial Stewardship Program ◽

Positive Urine Culture ◽

Inappropriate Use ◽

Stewardship Program ◽

Positive Urine ◽

Before And After

Abstract BackgroundThe Infectious Diseases Society of America (IDSA) recommends against screening for and/or treating asymptomatic bacteriuria (ASB). This study aims to evaluate the inappropriate use of antibiotics in ASB before and after Antimicrobial Stewardship Program implementation and advance towards its appropriate use. MethodWe performed a retrospective study of patients diagnosed with ASB from 2016 to 2019 at a tertiary hospital in Saudi Arabia. This study included hospitalized patients ≥18 years old who had a positive urine culture with no signs or symptoms of urinary tract infection and were on antibiotics for asymptomatic bacteriuria. We excluded pregnant women, solid organ transplant patients, patient on active chemotherapy, and patients about to undergo urological surgery.ResultsA total of 716 patients with a positive urine culture were screened . Among these, we identified 109 patients with ASB who were enrolled in our study. The rate of inappropriate antibiotic use was 95% during the study period. The implementation of the Antimicrobial Stewardship Program was associated with a significant reduction in the use of carbapenems (P = 0.04) and an increase in the use of cephalosporins (P = .099687). However, overprescribing antimicrobial agents was a concern in both eras. Approximately 90% of the microorganisms identified were gram-negative bacteria. Of those, 38.7% were multidrug-resistant strains. ConclusionThe urine culture order in ASB is considered relatively small number; however, it showed a high rate of the inappropriate use of antibiotics when there is an order of urine culture in both era. ASP ought to focus on targeting the ordering physician, promoting awareness and/or organizational interventions that appear to reduce the incidence of overtreatment.

Download Full-text

A review on Antibiotic Policy and Antimicrobial Stewardship Program (AMSP) – Need of the hour

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v12i2.4665 ◽

2021 ◽

Vol 12 (2) ◽

pp. 1233-1237

Author(s):

Manoj Kumar ◽

Anu Sharma ◽

Yasmeen M ◽

Parwez

Keyword(s):

Public Health ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Health Problem ◽

Public Health Problem ◽

Current Situation ◽

Resistant Bacteria ◽

Antimicrobial Stewardship Program ◽

Antibiotic Policy ◽

Stewardship Program

Emerging trends of antimicrobial resistance and development of multidrug resistance and pan resistant strains have become a significant public health problem worldwide. The rate at which newer drugs are developing has slowed down and clinicians are left with only limited therapeutic options for treatment of the patient. We are heading towards the pre antibiotic discovery phase where mortality was high due to unavailability of appropriate drugs; however, in current situation due to misuse or over use of antibiotics, microbes have developed newer methods of resistance, thus rendering these antimicrobials ineffective in their action which has resulted in increased morbidity and mortality among patient and increase in the health care expenditure. Antimicrobial resistance continues to be a major public health problem of international concern. As there is alarming situation globally due to development of multi and pan resistant bacteria which are also known as superbugs, these superbugs have resulted in havoc as these infections are not treatable and is of great concern to the treating physician. Judicious use of antibiotics and implementation of antibiotic stewardship program are the only ways to combat the current situation. The present review aims to provide information on framing of antibiotic policy and implementation of antimicrobial stewardship program.

Download Full-text

Appropriateness of Gram-Negative Agent Use at a Tertiary Care Hospital in the Setting of Significant Antimicrobial Resistance

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv009 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 5

Author(s):

Neil M. Vora ◽

Christine J. Kubin ◽

E. Yoko Furuya

Keyword(s):

New York ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Categorical Variables ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Gram Negative ◽

Stewardship Program

Abstract Background. Practicing antimicrobial stewardship in the setting of widespread antimicrobial resistance among gram-negative bacilli, particularly in urban areas, is challenging. Methods. We conducted a retrospective cross-sectional study at a tertiary care hospital with an established antimicrobial stewardship program in New York, New York to determine appropriateness of use of gram-negative antimicrobials and to identify factors associated with suboptimal antimicrobial use. Adult inpatients who received gram-negative agents on 2 dates, 1 June 2010 or 1 December 2010, were identified through pharmacy records. Clinical data were collected for each patient. Use of gram-negative agents was deemed optimal or suboptimal through chart review and according to hospital guidelines. Data were compared using χ2 or Fischer's exact test for categorical variables and Student t test or Mann–Whitney U test for continuous variables. Results. A total of 356 patients were included who received 422 gram-negative agents. Administration was deemed suboptimal in 26% of instances, with the most common reason being spectrum of activity too broad. In multivariable analysis, being in an intensive care unit (adjusted odds ratio [aOR], .49; 95% confidence interval [CI], .29–.84), having an infectious diseases consultation within the previous 7 days (aOR, .52; 95% CI, .28–.98), and having a history of multidrug-resistant gram-negative bacilli within the past year (aOR, .24; 95% CI, .09–.65) were associated with optimal gram-negative agent use. Beta-lactam/beta-lactamase inhibitor combination drug use (aOR, 2.6; 95% CI, 1.35–5.16) was associated with suboptimal use. Conclusions. Gram-negative agents were used too broadly despite numerous antimicrobial stewardship program activities.

Download Full-text

Prescribing trends before and after implementation of an antimicrobial stewardship program

The Medical Journal of Australia ◽

10.5694/mja12.11683 ◽

2013 ◽

Vol 198 (5) ◽

pp. 262-266 ◽

Cited By ~ 35

Author(s):

Kelly A Cairns ◽

Adam W J Jenney ◽

Iain J Abbott ◽

Matthew J Skinner ◽

Joseph S Doyle ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Prescribing Trends ◽

Before And After

Download Full-text

An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.233 ◽

2016 ◽

Vol 38 (1) ◽

pp. 76-82 ◽

Cited By ~ 15

Author(s):

Sara Tedeschi ◽

Filippo Trapani ◽

Maddalena Giannella ◽

Francesco Cristini ◽

Fabio Tumietto ◽

...

Keyword(s):

Infectious Disease ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antibiotic Consumption ◽

Defined Daily Dose ◽

Antimicrobial Stewardship Program ◽

Rehabilitation Hospital ◽

Stewardship Program ◽

Resistance Patterns ◽

The Impact

OBJECTIVETo assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.DESIGNQuasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation.SETTING150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.INTERVENTIONBeginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation.RESULTSAntibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008).CONCLUSIONSAn ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.Infect Control Hosp Epidemiol. 2016;1–7

Download Full-text

Sustained Savings from a Longitudinal Cost Analysis of an Internet-Based Preapproval Antimicrobial Stewardship Program

Infection Control and Hospital Epidemiology ◽

10.1086/670625 ◽

2013 ◽

Vol 34 (6) ◽

pp. 573-580 ◽

Cited By ~ 40

Author(s):

Anna C. Sick ◽

Christoph U. Lehmann ◽

Pranita D. Tamma ◽

Carlton K. K. Lee ◽

Allison L. Agwu

Keyword(s):

Cost Analysis ◽

Antimicrobial Stewardship ◽

Tertiary Care ◽

Cost Savings ◽

Antimicrobial Stewardship Program ◽

Pediatric Hospital ◽

Antimicrobial Prescribing ◽

Approval Rate ◽

Stewardship Program ◽

Sustained Reduction

Objective.To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.Design.Retrospective cohort study and cost analysis.Methods.Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.Results.Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.Conclusions.A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.

Download Full-text

Corrigendum to “Combating antimicrobial resistance: Antimicrobial stewardship program in Taiwan”

Journal of Microbiology Immunology and Infection ◽

10.1016/j.jmii.2012.05.007 ◽

2012 ◽

Vol 45 (4) ◽

pp. 326-327

Author(s):

Shu-Hui Tseng ◽

Chun-Ming Lee ◽

Tzou-Yien Lin ◽

Shan-Chwen Chang ◽

Yin-Ching Chuang ◽

...

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antimicrobial Stewardship Program ◽

Stewardship Program

Download Full-text

Challenges for a sustainable financial foundation for antimicrobial stewardship

Infectious Disease Reports ◽

10.4081/idr.2017.6851 ◽

2017 ◽

Vol 9 (1) ◽

Cited By ~ 1

Author(s):

Jan-Willem H. Dik ◽

Bhanu Sinha

Keyword(s):

Antimicrobial Resistance ◽

Economic Impact ◽

Antimicrobial Stewardship ◽

Antimicrobial Stewardship Program ◽

Resistance Development ◽

Institutional Level ◽

Know How ◽

Stewardship Program ◽

Single Process ◽

Diagnostics And Therapy

Antimicrobial resistance is a worldwide threat and a problem with large clinical and economic impact. Antimicrobial Stewardship Programs are a solution to curb resistance development. A problem of resistance is a separation of actions and consequences, financial and clinical. Such a separation makes it difficult to create support among stakeholders leading to a lack of sense of responsibility. To counteract the resistance development it is important to perform diagnostics and know how to interpret the results. One should see diagnostics, therapy and resistance as one single process. Within this process all involved stakeholders need to work together on a more institutional level. We suggest therefore a solution: combining diagnostics and therapy into one single financial product. Such a product should act as an incentive to perform correct diagnostics. It also makes it easier to cover the costs of an antimicrobial stewardship program, which is often overlooked. Finally, such a product involves all stakeholders in the process and does not lay the costs at one stakeholder and the benefits somewhere else, solving the misbalance that is present nowadays.

Download Full-text