Discontinuation of antibiotic therapy within 24 hours of treatment initiation for patients with no clinical evidence of bacterial infection: a 5-year safety and outcome study from Singapore General Hospital Antimicrobial Stewardship Program

Abstract Background Treatment of serious bacterial infections with Outpatient Parenteral Antibiotic Therapy (OPAT) has provided patients (patients) the opportunity to complete treatment safely and effectively, while avoiding complications, and prolonged hospitalization. Despite the benefits, considerable risks with drug-related and central venous catheter (CVC)-related complications exist. We sought to improve clinical outcomes of our program by implementing intensive monitoring in partnership with our antimicrobial stewardship program (ASP) with a goal of decreasing the frequency of complications as well as hospital readmission rates and lengths of stay (LOS). Methods A retrospective study was conducted including all patients discharged from the Birmingham VA Medical Center on OPAT from January 1, 2015 to December 31, 2016. The start date coincides with ASP development of a physician and pharmacist led OPAT program, working closely with home health agencies. Data collection included baseline demographics, antibiotic indication, antibiotic therapy received, and laboratory monitoring. Clinical outcomes included frequency and types of drug-related complications, CVC complications, hospital admission rate due to complications, and hospital days avoided. Results In the study period, 299 patients were discharged on OPAT. They were 96.9% male, and the average age was 64 (Table 1). The average number of hospital days avoided was 32.1. The most common indication was osteomyelitis (Table 1). There were 82 complications in 78 (26%) patients, almost half were acute kidney injury, defined as a rise in serum creatinine requiring a change in antibiotic dosing (Table 2). These led to 25 hospitalizations (32% of patients with complications, 8.3% overall) with another 5 patients being hospitalized for unrelated reasons. Conclusion Our medical center instituted an ASP led practice of closely monitoring and directing care with the local home health agencies due to concerns about patient safety. In doing so, we have realized a low rate of complications and an ability to manage the majority while remaining as an outpatient, with the exceptions of CVC-related complications and encephalopathy. Our data supports the center’s efforts and choice to dedicate resources to improving this increasingly popular treatment. Disclosures All authors: No reported disclosures.

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Long-Term Effects of Antimicrobial Stewardship Program in A Chinese Tertiary General Hospital: An Interrupted Time-Series Analysis

Value in Health ◽

10.1016/j.jval.2018.07.385 ◽

2018 ◽

Vol 21 ◽

pp. S50-S51

Author(s):

J Wang ◽

X Li

Keyword(s):

Time Series ◽

Time Series Analysis ◽

General Hospital ◽

Antimicrobial Stewardship ◽

Interrupted Time Series ◽

Antimicrobial Stewardship Program ◽

Interrupted Time Series Analysis ◽

Long Term Effects ◽

Stewardship Program

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Impact of an Education-Based Antimicrobial Stewardship Program on the Appropriateness of Antibiotic Prescribing: Results of a Multicenter Observational Study

Antibiotics ◽

10.3390/antibiotics10030314 ◽

2021 ◽

Vol 10 (3) ◽

pp. 314

Author(s):

Federica Calò ◽

Lorenzo Onorato ◽

Margherita Macera ◽

Giovanni Di Caprio ◽

Caterina Monari ◽

...

Keyword(s):

Observational Study ◽

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Case Report Form ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Campania Region ◽

Multicenter Observational Study ◽

Stewardship Program ◽

Number Of Patients

To evaluate the effect that an education-based Antimicrobial stewardship program (ASP) implemented in two hospitals in southern Italy had on the quality and appropriateness of antibiotic prescription. We conducted a multicenter observational study in two hospitals in the Campania region. Only some departments of both hospitals were already participating in the ASP. We collected data on all patients admitted on the day of evaluation in antibiotic therapy or prophylaxis through a case report form. The primary outcome was to investigate the difference in the appropriateness of the antibiotic prescriptive practice in the departments that had joined the ASP and in those that had not participated in the project (non-ASP). The total number of patients assessed was 486. Of these, 78 (16.05%) were in antibiotic prophylaxis and 130 (26.7%) in antibiotic therapy. The prescriptive appropriateness was better in the units that had joined ASP than in those that had not, with respectively 65.8% versus 22.7% (p < 0.01). Patients in the non-ASP units more frequently received unnecessary antibiotics (44.9% versus 0%, p = 0.03) and, as surgical prophylaxis, the use of antibiotics not recommended by the guidelines (44.2% versus 0%, p = 0.036). Multivariable analysis of the factors associated with prescriptive appropriateness identified ASP units (p = 0.02) and bloodstream or cardiovascular infections (p = 0.03) as independent predictors of better prescriptive appropriateness. The findings of the present study reinforce the importance of adopting an educational ASP to improve the quality of antimicrobial prescription in clinical practice.

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Antimicrobial stewardship program in COVID-19 era: Ruin of the reign?

Journal of Biomedical and Pharmaceutical Research ◽

10.32553/jbpr.v9i6.822 ◽

2021 ◽

Vol 9 (6) ◽

pp. 31-33

Author(s):

Arash Eatemadi ◽

Sirous Golchinheydari ◽

Mohammed Al Reesi ◽

Majid Al Maqbali ◽

Talib Al Maqbali Maqbali ◽

...

Keyword(s):

Bacterial Infection ◽

Antimicrobial Stewardship ◽

Strong Evidence ◽

Antibiotic Stewardship ◽

Antibiotic Prescription ◽

Viral Disease ◽

Antimicrobial Stewardship Program ◽

Medical Field ◽

Stewardship Program

COVID-19 is the most important matter in the medical field worldwide in 2020. Although COVID-19 is a viral disease, the threshold to antibiotic prescription for COVID-19 patients is low, partly because of WHO recommendations and previous experiences from influenza, despite the lack of strong evidence of co-infection or superimposed bacterial infection in COVID-19 patients. Antibiotic stewardship program (ASP) could play an important role in this period, otherwise, we will face a crisis of superbugs in the early future. Keywords: COVID-19, Antibiotic stewardship program (ASP), Superbugs

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Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile

Revista médica de Chile ◽

10.4067/s0034-98872018000900968 ◽

2018 ◽

Vol 146 (9) ◽

pp. 968-977

Author(s):

Alberto Fica ◽

Claudia Valenzuela ◽

Ignacio Leiva ◽

Teresa Vergara ◽

Andrés Soto ◽

...

Keyword(s):

General Hospital ◽

Antimicrobial Stewardship ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Long Term Impact

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Validation of a Questionnaire for Patient Awareness and the Need for a Community-Based Outpatient Antimicrobial Stewardship Program (O-ASP): A Pilot Study

Antibiotics ◽

10.3390/antibiotics10040441 ◽

2021 ◽

Vol 10 (4) ◽

pp. 441

Author(s):

Sohyun Park ◽

Min Jeong Geum ◽

Hee Jung Choi ◽

Chung-Jong Kim ◽

Won Gun Kwack ◽

...

Keyword(s):

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Survey Study ◽

Antimicrobial Stewardship Program ◽

Cronbach’S Alpha ◽

Patient Awareness ◽

Cronbach's Alpha ◽

Care Services ◽

Validated Questionnaire ◽

Stewardship Program

An outpatient antimicrobial stewardship program (O-ASP) was developed and implemented to promote appropriate antibiotic therapy in outpatient settings. As active patient involvement is a critical component of an effective O-ASP, this study aimed to develop and validate a questionnaire addressing patient awareness for appropriate antibiotic therapy and the need for pharmaceutical care services (PCS) in the O-ASP in Korea. The questionnaire was drafted based on ASPs and PCS guidelines and validated for content and construct validity using the item-content validity index (I-CVI) and Cronbach’s alpha, respectively. The estimated I-CVI and Cronbach’s alpha were considered excellent or adequate (≥0.8 and 0.70–0.90, respectively) for most of the survey items (17 out of 23 items). The validated questionnaire was utilized in a pilot survey study, including 112 individuals (37% male) with the mean ± SD age of 37 ± 13 years. Among the survey participants, 68% responded that antibiotics had been prescribed appropriately; however, ≥50% showed a lack of knowledge regarding their antibiotic therapy. The participants expressed the need for PCS as part of an O-ASP in the questionnaire (average Likert score ≥3.4/5). In conclusion, our newly validated questionnaire successfully measured patient awareness and knowledge of antimicrobial use and the need for PCS in the O-ASP.

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IMPLEMENTING AN ANTIMICROBIAL STEWARDSHIP PROGRAM IN A TERTIARY UNIVERSITY PEDIATRIC HOSPITAL IN SPAIN

10.26226/morressier.58fa1764d462b80290b509f8 ◽

2017 ◽

Author(s):

Maria Fernanda Guzman Monagas

Keyword(s):

Antimicrobial Stewardship ◽

Antimicrobial Stewardship Program ◽

Pediatric Hospital ◽

Stewardship Program

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Sustainability Failure in the Antimicrobial Stewardship Program in a Secondary Care Hospital from Cuba: A Historical Review of 30 Years and 3 Shots

Anti-Infective Agents ◽

10.2174/2211352518999200706014401 ◽

2020 ◽

Vol 18 ◽

Author(s):

Humberto Guanche Garcell ◽

Juan José Pisonero Socias ◽

Gilberto Pardo Gómez

Keyword(s):

Antimicrobial Stewardship ◽

Historical Review ◽

Original Data ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Continuous Quality ◽

Stewardship Program ◽

History Of ◽

Health Organization

Background: During the last 30 years an antimicrobial stewardship program (ASP) was implemented in a facility with periods of weakness. We aim to describe the history of the sustainability failure in the local ASP. Methods: A historical review was conducted using original data from the facility library and papers published. An analysis of factors related to the failure was conducted based on the Doyle approach. Results: The first ASP was implemented from 1989 to 1996 based on the international experiences and contributes to the improvement in the quality of prescription, reduction of 52% in cost and in the incidence of nosocomial infection. The second program restarts in 2008 and decline in 2015, while the third program was guided by the Pan-American Health Organization from 2019. This program, in progress, is more comprehensive than previous ones and introduced as a novel measure the monitoring of antibiotic prophylaxis in surgery. The factors related to the sustainability were considered including the availability of antimicrobials, the leader´s support, safety culture, and infrastructure. Conclusions: The history behind thirty years of experiences in antimicrobial stewardship programs has allowed us to identify the gaps that require proactive strategies and actions to achieve sustainability and continuous quality improvement.

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