scholarly journals An innovative Antimicrobial Stewardship Program for children in remote and regional areas in Queensland, Australia: optimizing antibiotic use through timely intravenous-to-oral conversion

2021 ◽  
Author(s):  
M.L. Avent ◽  
X.J. Lee ◽  
A.D. Irwin ◽  
N. Graham ◽  
D. Brain ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program

scholarly journals Long-Term Outcomes of an Antimicrobial Stewardship Program Implemented in a Hospital with Low Baseline Antibiotic Use

2015 ◽  
Vol 36 (6) ◽  
pp. 664-672 ◽  
Author(s):  
Timothy C. Jenkins ◽  
Bryan C. Knepper ◽  
Katherine Shihadeh ◽  
Michelle K. Haas ◽  
Allison L. Sabel ◽  
...  
Keyword(s):  
Time Series ◽  
Outcome Measures ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Safety Net ◽  
Antimicrobial Stewardship Program ◽  
Long Term Outcomes ◽  
Patient Centered ◽  
Stewardship Program

OBJECTIVETo evaluate the long-term outcomes of an antimicrobial stewardship program (ASP) implemented in a hospital with low baseline antibiotic use.DESIGNQuasi-experimental, interrupted time-series study.SETTINGPublic safety net hospital with 525 beds.INTERVENTIONImplementation of a formal ASP in July 2008.METHODSWe conducted a time-series analysis to evaluate the impact of the ASP over a 6.25-year period (July 1, 2008–September 30, 2014) while controlling for trends during a 3-year preintervention period (July 1, 2005–June 30, 2008). The primary outcome measures were total antibacterial and antipseudomonal use in days of therapy (DOT) per 1,000 patient-days (PD). Secondary outcomes included antimicrobial costs and resistance, hospital-onset Clostridium difficile infection, and other patient-centered measures.RESULTSDuring the preintervention period, total antibacterial and antipseudomonal use were declining (−9.2 and −5.5 DOT/1,000 PD per quarter, respectively). During the stewardship period, both continued to decline, although at lower rates (−3.7 and −2.2 DOT/1,000 PD, respectively), resulting in a slope change of 5.5 DOT/1,000 PD per quarter for total antibacterial use (P=.10) and 3.3 DOT/1,000 PD per quarter for antipseudomonal use (P=.01). Antibiotic expenditures declined markedly during the stewardship period (−$295.42/1,000 PD per quarter, P=.002). There were variable changes in antimicrobial resistance and few apparent changes in C. difficile infection and other patient-centered outcomes.CONCLUSIONIn a hospital with low baseline antibiotic use, implementation of an ASP was associated with sustained reductions in total antibacterial and antipseudomonal use and declining antibiotic expenditures. Common ASP outcome measures have limitations.Infect Control Hosp Epidemiol 2015;00(0): 1–9

scholarly journals The outcome of implementing antimicrobial stewardship program for hospitalized children

2018 ◽  
Vol 5 (9) ◽  
pp. 3737
Author(s):  
Ahmed A. El-Nawawy ◽  
Reham M. Wagdy ◽  
Ahmed Kh. Abou Ahmed ◽  
Marwa A. Moustafa
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Hospitalized Children ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Group I ◽  
Significant Difference ◽  
Patient’S Outcome ◽  
The Impact

Background: An effective approach to improve antimicrobial use for hospitalized patients is an antimicrobial stewardship program (ASP). The present study aimed to implement ASP for inpatient children based on prospective-audit-with-feedback intervention in order to evaluate the impact on patient’s outcome, antimicrobial use, and the hospital cost.Methods: The study was conducted throughout 6 months over 275 children admitted with different infections at Main Children’s hospital in Alexandria included; group I (with ASP) and group II (standard antimicrobials as controls).Results: The study revealed that on patient’s admission, single antibiotic use was higher among the ASP group while double antimicrobial therapy was higher among the non-ASP with significant difference (p=0.001). Less percentage of patients who consumed vancomycin, meropenem amoxicillin-clavulanic and metronidazole was observed among ASP group with a significant difference of the last two drugs when compared to controls (p=<0.001, 0.011, respectively). The study reported the higher percent of improved ASP patient’s after 72 hours of admission with a significant difference to controls (73.2% versus 62.5%, p=0.038). Complications occurred more likely for the non-ASP group (odds ratio 7.374 with 95% CI 1.68-32.33). In general, there was a clear reduction of the patient antibiotic cost/day and overall cost per patient, however, it was not significant among the studied patients.Conclusions:  Our local ASP model provided a high quality of care for hospitalized children and effectively reduced the antimicrobial consumption.

scholarly journals An Audit-Based, Infectious Disease Specialist-Guided Antimicrobial Stewardship Program Profoundly Reduced Antibiotic Use Without Negatively Affecting Patient Outcomes

2015 ◽  
Vol 2 (2) ◽  
Author(s):  
Hannah Nilholm ◽  
Linnea Holmstrand ◽  
Jonas Ahl ◽  
Fredrik Månsson ◽  
Inga Odenholt ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Control Period ◽  
Length Of Hospital Stay ◽  
Antibiotic Use ◽  
Infectious Disease Specialist ◽  
Antimicrobial Stewardship Program ◽  
Intervention Period ◽  
Stewardship Program ◽  
Disease Specialist

Abstract Background.  Antimicrobial stewardship programs are increasingly implemented in hospital care. They aim to simultaneously optimize outcomes for individual patients with infections and reduce financial and health-associated costs of overuse of antibiotics. Few studies have examined the effects of antimicrobial stewardship programs in settings with low proportions of antimicrobial resistance, such as in Sweden. Methods.  An antimicrobial stewardship program was introduced during 5 months of 2013 in a department of internal medicine in southern Sweden. The intervention consisted of audits twice weekly on all patients given antibiotic treatment. The intervention period was compared with a historical control consisting of patients treated with antibiotics in the same wards in 2012. Studied outcome variables included 28-day mortality and readmission, length of hospital stay, and use of antibiotics. Results.  A reduction of 27% in total antibiotic use (2387 days of any antibiotic) was observed in the intervention period compared with the control period. The reduction was due to fewer patients started on antibiotics as well as to significantly shorter durations of antibiotic courses (P &lt; .001). An earlier switch to oral therapy and a specific reduction in use of third-generation cephalosporins and fluoroquinolones was also evident. Mortality, total readmissions, and lengths of stay in hospital were unchanged compared with the control period, whereas readmissions due to a nonresolved infection were fewer during the intervention of 2013. Conclusions.  This study demonstrates that an infectious disease specialist-guided antimicrobial stewardship program can profoundly reduce antibiotic use in a low-resistance setting with no negative effect on patient outcome.

scholarly journals Evaluation of the Impact of Antimicrobial Stewardship Program (ASP) on Unrestricted Use of Meropenem at an Academic Medical Center

2019 ◽  
Vol 66 (1) ◽  
pp. 29-33
Author(s):  
Priyam Mithawala ◽  
Edo-abasi McGee
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Intervention Group ◽  
Antibiotic Use ◽  
Control Group ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Significant Difference ◽  
The Impact

Objective The primary objectives were to evaluate the prescriber acceptance rate of Antimicrobial Stewardship Program (ASP) pharmacist recommendation to de-escalate/discontinue meropenem, and estimate the difference in duration of meropenem therapy. The secondary objective was to determine incidence of adverse events in the two groups. Methods It was a retrospective study. All patients admitted to Gwinnett Medical Center and receiving meropenem from January–November 2015 were included in the study. Exclusion criteria were: patients admitted to intensive care unit, one-time dose, infectious disease consultation, and age <18 years. Electronic medical records were reviewed for data collection. The control group consisted of patients from January–July 2015 when there was no ASP pharmacist. The intervention group consisted of patients from August–November 2015 during which period the ASP pharmacist recommended de-escalation/discontinuation of meropenem based on culture and sensitivity results. Results A total of 41 patients were studied, 21 in the control group and 20 in the intervention group. There was no significant difference in baseline characteristics in the two groups and in terms of prior hospitalization or antibiotic use (within 90 days) and documented or suspected MDRO infection at the time of admission. De-escalation/discontinuation was suggested in 16/20 patients in the intervention group (80%), and intervention was accepted in 68%. The mean duration of therapy was significantly decreased in the intervention group (5.6 days vs. 8.1 days, p =0.0175). Two patients had thrombocytopenia (unrelated to meropenem), and none of the patients had seizure. Conclusion Targeted antibiotic review is an effective ASP strategy, which significantly decreases the duration of meropenem therapy.

scholarly journals 1035. Implementation of an Antimicrobial Stewardship Program-Led, Multifactorial Pneumonia Diagnosis and Treatment Bundle

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S364-S364
Author(s):  
Jefferson L Cua ◽  
Ryan L Crass ◽  
Vince Marshall ◽  
Mohammad Ateya ◽  
Jerod Nagel ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Surveillance Culture ◽  
Antimicrobial Stewardship Program ◽  
Intervention Period ◽  
Surveillance Cultures ◽  
Stewardship Program ◽  
The Impact ◽  
Suspected Pneumonia ◽  
Pneumonia Diagnosis

Abstract Background Pneumonia remains a leading cause of hospitalization and accounts for significant antibiotic use. This study aims to evaluate the impact of bundled antimicrobial stewardship program (ASP) interventions, including procalcitonin and surveillance cultures, on broad-spectrum antimicrobial use in patients with suspected pneumonia. Methods This is a pre-post, quasi-experimental study conducted at Michigan Medicine. During the intervention period, an ASP member reviewed adult patients admitted to 3-floor medical services with antibiotics initiated for suspected pneumonia. The ASP member (1) recommended the use of procalcitonin when clinically appropriate, (2) used institutional guidelines to guide empiric antibiotic selection based on risk for drug-resistant pathogens, and (3) ordered a methicillin-resistant Staphylococcus aureus (MRSA) surveillance culture in patients receiving empiric anti-MRSA therapy. The primary endpoint was anti-MRSA and anti-pseudomonal (PSA) antibiotic use measured as days of therapy (DOT) per 1000 days-present on the services of interest. Antibiotic use and clinical data were extracted from an electronic database. Pneumonia diagnosis codes were used to identify the study population. Results A total of 549 patients were included: 310 in the pre-intervention (December 1/2017 - 3/31/2018) and 239 in the intervention (December 1/2018 - 3/31/2019) periods. Baseline demographics were similar between groups (Table 1). Less than 15% of patients had a microbiological diagnosis via respiratory culture in both study periods (Table 2). Respiratory cultures were ordered less commonly in the intervention period; however, the rate of culture positivity was higher (28% vs. 48%, P < 0.01). Process measures improved in the intervention period with an increase in the proportion of patients with MRSA surveillance cultures (13% vs. 39%, P < 0.01) and procalcitonin monitoring (77% vs. 83%, P = 0.07). Compared with the pre-intervention period, anti-MRSA antibiotic use decreased from 172 to 158 DOT per 1000 days-present (Δ -8%) and the use of anti-PSA antibiotics decreased from 348 to 316 DOT per 1000 days present (Δ -9%). Conclusion The implementation of an ASP-led pneumonia bundle led to reductions in anti-MRSA and anti-PSA antibiotic use. Disclosures All authors: No reported disclosures.

scholarly journals 31. Stepwise Expansion of Antimicrobial Stewardship Program and Its Impact on Antibiotic Use and Resistance Rates in a Tertiary Care Hospital in Korea

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S138-S138
Author(s):  
Dong Hoon Shin ◽  
Hyung-sook kim ◽  
Eunjeong Heo ◽  
Myoung Jin Shin ◽  
Nak-Hyun Kim ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Third Generation ◽  
Antimicrobial Stewardship Program ◽  
The Core ◽  
Stewardship Program ◽  
National University

Abstract Background The U.S. Centers for Disease Control and Prevention released the core elements of antimicrobial stewardship program (ASP). In some countries, however, they may be difficult to apply in countries with limited resources. In this study, we evaluated the impact of successful ASP implementation on antibiotic use and resistance rates in an institution with limited infrastructural support. Methods A series of ASP activities were reviewed according to the core elements of ASP. The retrospective data of all hospitalized patients at a tertiary care teaching hospital was collected from January 2010 to December 2019, including antibiotic prescription data and culture results of all clinical specimens. The trends of the antibiotic-resistant rates were compared with nationwide data in Korea. The trend analyses were performed with 2-sided correlated seasonal Mann-Kendall nonparametric tests. Results The ASP activities over the past decade were summarized in Table. After activities such as preauthorization were achieved, other ASP activities were added one by one. Also, the infectious disease pharmacists, as ASP co-leaders, mainly carried out the following activities: reducing redundant anti-anaerobic antimicrobials and intravenous fluoroquinolones, and advised the physicians to discontinue the antibiotic prescription in cases when the intervention was plausible. After the ASP implementation, total antibacterial use significantly decreased (P &lt; 0.01; Figure). The use of glycopeptides (P &lt; 0.01) and fluoroquinolones (P &lt; 0.01) gradually decreased, while the use of third-generation cephalosporines did not significantly change (P=0.48). There was no significant change in total carbapenems use, but ertapenem use increased (P=0.02). Compared with the nationwide data, methicillin-resistant Staphylococcus aureus was on a decreasing trend consistently. Although third-generation cephalosporin-resistant Escherichia coli increased, third-generation cephalosporin resistant-Klebsiella pneumoniae and carbapenem resistant-Pseudomonas aeruginosa did not increase. Table. Antimicrobial stewardship activities for hospitalized patients over the past decade in Seoul National University Bundang Hospital. ASP: antimicrobial stewardship; ID: infectious disease; CDSS: Clinical decision support system Figure. DOT per 1,000 patient-days in Seoul National University Bundang Hospital and implemented actions of antimicrobial stewardship program. DOT: days of therapy; ID: infectious disease; PCR: polymerase chain reaction; GPC: gram positive cocci; Group 1 carbapenem: ertapenem Conclusion A stepwise implementation of the core ASP elements was effective in improving the appropriate use of antibiotics and reducing the antibiotic resistant organisms, even with limited human resources. Disclosures All Authors: No reported disclosures

scholarly journals A Survey on Knowledge Attitude and Practices among Dental Faculty towards Antimicrobial Stewardship Program in Maharashtra

2021 ◽  
pp. 444-451
Author(s):  
Shivani Kalmegh ◽  
Saima Siddique ◽  
Priyanka Paul Madhu ◽  
Kumar Gaurav Chhabra ◽  
Amit Reche ◽  
...  
Keyword(s):  
Antibiotic Resistance ◽  
Antimicrobial Stewardship ◽  
Antibiotic Stewardship ◽  
Dental Health ◽  
Antibiotic Use ◽  
Antimicrobial Stewardship Program ◽  
Online Questionnaire ◽  
Clinical Patient ◽  
Stewardship Program ◽  
Study Participants

Background: Antibiotic resistance makes to the top ten threats to global health in 2019. It is important for dental faculty to make efforts to improve the quality of services provided; As a result the study of awareness of the dental faculty regarding antibiotic resistance and antibiotic stewardship program was undertaken. Objectives: Assessment of the knowledge, attitude and practices of the dental faculty towards Antibiotic stewardship program through a questionnaire study in Maharashtra. Methodology: The dental faculty in dental institutes located in Maharashtra will be the study participants. The questionnaire will be sent to all the faculty members as an online questionnaire survey. Expected Results: Evaluating the need of Implementation of antimicrobial stewardship program in institutions which will reduce the profuse use of unnecessary antibiotic prescription and improve the appropriateness of the antibiotic use by the dental health faculty working in a dental college without compromising the clinical patient outcome. Conclusion: The present study will assess the knowledge, attitude and practices of the dental faculty towards Antibiotic stewardship program.

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