scholarly journals Adherence to Antibiotic Stewardship Program Associated with Shorter Course of Treatment and Fewer Adverse Events

2021 ◽  
Vol 1 (S1) ◽  
pp. s30-s31
Author(s):  
Patrick Mulligan ◽  
Nirav Shah ◽  
Mary Acree ◽  
Jennfer Grant ◽  
Urmila Ravichandran ◽  
...  
Keyword(s):  
Adverse Events ◽  
Bacterial Infection ◽  
Antibiotic Stewardship ◽  
Adverse Drug Events ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Treatment Team ◽  
Duration Of Treatment ◽  
Stewardship Program ◽  
Significant Difference

Group Name: NorthShore University HealthSystemBackground: Prolonged antibiotic use has been attributed to an increased incidence of adverse drug events (ADEs). Cessation of unnecessary antibiotics would decrease length of treatment and may help prevent these adverse events. We evaluated whether an antibiotic stewardship intervention aimed at stopping unnecessary antibiotic usage would both shorten the duration of treatment and reduce ADEs. Methods: At NorthShore University HealthSystem, a 4-hospital, 832-bed system, we identified patients who were started on empiric antibiotics during a hospital admission between May 2, 2016, and June 30, 2018. Within 24 hours of antibiotic initiation, an infectious disease (ID) physician reviewed each patient chart. If the patient was unlikely to have a symptomatic bacterial infection, the ID physician left a note in the electronic medical record (EMR) recommending antibiotic cessation. Two physician reviewers retrospectively reviewed whether the treatment team accepted these recommendations and assessed potential ADEs for 30 days after the recommendation through inpatient and outpatient notes in the EMR. These ADEs were defined using previously published criteria. If the 2 reviewers disagreed on the presence of an ADE, an ID physician acted as the tie breaker. We compared the number of antibiotic days and the number of ADEs between cases in which the recommendations were followed and cases in which they were not. Results: We reviewed 168 cases: 78 (46.43%) followed recommendations and 90 (53.57%) did not. There were no significant differences in baseline patient characteristics between the 2 groups. There was a significant difference in total ADEs between the 2 groups: in 6 cases (7.69%) the recommendations were followed, and 21 (23.33%) they were not followed (P = .011). There was also a significant difference in antibiotic days between cases in which recommendations were followed (1.40 days) versus those in which they were not followed (1.99 days) (p < 0.001). Conclusions: Antibiotic-associated adverse events can cause harm to patients and increase healthcare costs, particularly when used for patients who are unlikely to have a bacterial infection. An antibiotic stewardship program to identify patients in an EMR who are unlikely to benefit from antibiotic use can decrease the length of total antibiotic usage and help prevent adverse events.Funding: NoDisclosures: None

scholarly journals Antibiotic Use during the COVID-19 Pandemic in a Tertiary Hospital with an Ongoing Antibiotic Stewardship Program

Antibiotics ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 1056
Author(s):  
Oryan Henig ◽  
Orli Kehat ◽  
Suzy E. Meijer ◽  
Amanda Chikly ◽  
Ahuva Weiss-Meilik ◽  
...  
Keyword(s):  
Bacterial Infection ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Viral Disease ◽  
Antibiotic Consumption ◽  
Tertiary Hospital ◽  
Bacterial Sepsis ◽  
Stewardship Program ◽  
Low Rate ◽  
Over Time

During the recent pandemic, the fact that the clinical manifestation of COVID-19 may be indistinguishable from bacterial infection, as well as concerns of bacterial co-infection, have been associated with an increased use of antibiotics. The objective of this study was to assess the effect of targeted antibiotic stewardship programs (ASP) on the use of antibiotics in designated COVID-19 departments and to compare it to the antibiotic use in the equivalent departments in the same periods of 2018 and 2019. Antibiotic consumption was assessed as days of treatment (DOT) per 1000 patient days (PDs). The COVID-19 pandemic was divided into three periods (waves) according to the pandemic dynamics. The proportion of patients who received at least one antibiotic was significantly lower in COVID-19 departments compared to equivalent departments in 2018 and 2019 (Wave 2: 30.2% vs. 45.6% and 44.9%, respectively; Wave 3: 30.5% vs. 47.8% and 50.1%, respectively, p < 0.001). The DOT/1000PDs in every COVID-19 wave was lower than during similar periods in 2018 and 2019 (179-282 DOT/1000PDs vs. 452-470 DOT/1000PDs vs. 426-479 DOT/1000PDs, respectively). Moreover, antibiotic consumption decreased over time during the pandemic. In conclusion, a strong ASP is effective in restricting antibiotic consumption, particularly for COVID-19 which is a viral disease that may mimic bacterial sepsis but has a low rate of concurrent bacterial infection.

scholarly journals Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bongyoung Kim ◽  
◽  
Myung Jin Lee ◽  
Se Yoon Park ◽  
Song Mi Moon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Quality Indicators ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Republic Of Korea ◽  
Cochrane Library ◽  
Surgical Prophylaxis ◽  
Modified Delphi ◽  
Stewardship Program ◽  
The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

scholarly journals 180. Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
Christina M Kaul ◽  
Eric Molina ◽  
Donna Armellino ◽  
Mary Ellen Schilling ◽  
Mark Jarrett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
P Value ◽  
Inpatient Setting ◽  
Post Intervention ◽  
Paired Samples ◽  
Viable Method

Abstract Background Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored. Methods We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis. Example of Ordering an Antibiotic Prior to Intervention Example of Ordering an Antibiotic After Intervention Results Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted. Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit Conclusion Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems. Disclosures All Authors: No reported disclosures

Antimicrobial Stewardship Interventions to Optimize Treatment of Infections in Nursing Home Residents: A Systematic Review and Meta-Analysis

2021 ◽  
pp. 073346482110182
Author(s):  
Sainfer Aliyu ◽  
Jasmine L. Travers ◽  
S. Layla Heimlich ◽  
Joanne Ifill ◽  
Arlene Smaldone
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Meta Analysis ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Meta Analyses

Effects of antibiotic stewardship program (ASP) interventions to optimize antibiotic use for infections in nursing home (NH) residents remain unclear. The aim of this systematic review and meta-analysis was to assess ASPs in NHs and their effects on antibiotic use, multi-drug-resistant organisms, antibiotic prescribing practices, and resident mortality. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we conducted a systematic review and meta-analysis using five databases (1988–2020). Nineteen articles were included, 10 met the criteria for quantitative synthesis. Inappropriate antibiotic use decreased following ASP intervention in eight studies with a pooled decrease of 13.8% (95% confidence interval [CI]: [4.7, 23.0]; Cochran’s Q = 166,837.8, p < .001, I2 = 99.9%) across studies. Decrease in inappropriate antibiotic use was highest in studies that examined antibiotic use for urinary tract infection (UTI). Education and antibiotic stewardship algorithms for UTI were the most effective interventions. Evidence surrounding ASPs in NH is weak, with recommendations suited for UTIs.

Changes in antibiotic use following implementation of a telehealth stewardship pilot program

2019 ◽  
Vol 40 (7) ◽  
pp. 810-814 ◽  
Author(s):  
Brigid M. Wilson ◽  
Richard E. Banks ◽  
Christopher J. Crnich ◽  
Emma Ide ◽  
Roberto A. Viau ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Term Care ◽  
Medical Centers ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Veterans Affairs Medical Centers

AbstractStarting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

Impact of an Antibiotic Stewardship Program on Antibiotic Prescription for Acute Respiratory Tract Infections in Children: A Prospective Before-After Study

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1166-1174 ◽  
Author(s):  
Nalinee Aoybamroong ◽  
Worawit Kantamalee ◽  
Kunlawat Thadanipon ◽  
Chonnamet Techasaensiri ◽  
Kumthorn Malathum ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Antibiotic Stewardship ◽  
Respiratory Tract Infections ◽  
Instant Messaging ◽  
Antibiotic Prescription ◽  
Antibiotic Use ◽  
Acute Respiratory Tract Infection ◽  
Stewardship Program ◽  
Tract Infections ◽  
E Mail

We assessed the effectiveness of an antibiotic stewardship program (ASP) on antibiotic prescriptions for acute respiratory tract infection (ARTI) in a medical school. Our ASP included delivering an antibiotic use guideline via e-mail and LINE (an instant messaging app) to faculty staff, fellows, and residents, and posting of the guideline in examination rooms. Medical records of pediatric patients diagnosed with ARTI were reviewed to assess the appropriateness of antibiotic prescription. ASP could increase the rate of appropriateness from 78% (1979 out of 2553 visits) to 83.4% (2449 out of 2935 visits; P < .001). The baseline of appropriateness was higher in residents (95%) compared with fellows (82%) and faculty staff (75%). The ASP significantly increased the appropriateness only in faculty staff, especially in semiprivate clinics (75% to 83%, P < .001). In conclusion, our ASP increased appropriateness of antibiotic prescriptions for ARTI, with the greatest impact among faculty staff in semiprivate clinics.

scholarly journals 285. Outcomes and Antibiotic Use in Patients with COVID-19 Admitted to an Intensive Care Unit

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S248-S249
Author(s):  
Megan Petteys ◽  
Leigh Ann Medaris ◽  
Julie E Williamson ◽  
Travis Denmeade ◽  
Rohit Soman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Adverse Events ◽  
Clinical Success ◽  
Antibiotic Use ◽  
World Health ◽  
Icu Patients ◽  
Significant Difference ◽  
Research Grant

Abstract Background Studies have shown the proportion of critically ill patients with COVID-19 receiving empiric antibiotics (ABX) greatly exceeds those with culture-proven bacterial co-infections. However, the benefits of continuing ABX in culture-negative (CxN) cases is unknown; this practice may increase the risks associated with ABX overuse. The purpose of this study was to evaluate outcomes and antibiotic use (AU) in intensive care unit (ICU) patients with COVID-19 based on culture results. Methods This was a multicenter, retrospective cohort study evaluating adults in an ICU for the first episode of ABX initiated following a confirmed COVID-19 diagnosis between September to December 2020. Blood and/or respiratory cultures must have been obtained within 24 hours (h) of ABX initiation. Patients were categorized into three groups: 1) CxN, ABX discontinued ≤ 72 h, 2) CxN, ABX continued &gt; 72 h, or 3) Culture-positive (CxP). Data on AU was obtained from electronic medication administration records. The primary outcome was clinical success, defined as being discharged alive or &gt; 2-point decrease in the World Health Organization Clinical Progression Scale score from day of ABX initiation to day 30. Results A total of 65 patients were included with 35.4% being CxP. ABX were discontinued ≤ 72 h in 23.8% of CxN patients. Methicillin-susceptible Staphylococcus aureus was the most common organism in 52.2% of CxP patients (66.7% respiratory; 16.7% blood; 16.7% both). Anti-methicillin-resistant Staphylococcus aureus and anti-pseudomonal antibiotics were the most prescribed for the initial regimen (Table 1). ABX de-escalation occurred in 58.5% of patients. Initial ABX duration was significantly longer in the CxP group (P &lt; 0.01). No significant difference in clinical success was observed (Table 2). Although not significantly different, the highest rate of adverse events occurred in the CxN and ABX continued &gt; 72 h group (40.6%). Table 1. Antibiotic Use in ICU Patients with COVID-19 Table 2. Clinical Outcomes and Adverse Events in ICU Patients with COVID-19 Conclusion In ICU patients with COVID-19, empiric broad-spectrum ABX are often overutilized with an inertia to de-escalate despite negative culture results, potentially increasing the risk of adverse events. This remains an important area for focused antimicrobial stewardship efforts to mitigate the development of multidrug resistance. Disclosures Christopher Polk, MD, Atea (Research Grant or Support)Gilead (Advisor or Review Panel member, Research Grant or Support)Humanigen (Research Grant or Support)Regeneron (Research Grant or Support)

scholarly journals Implementation and Impact of an Antimicrobial Stewardship Program at a Non-freestanding Children's Hospital

2018 ◽  
Vol 23 (2) ◽  
pp. 84-91 ◽  
Author(s):  
J. Michael Klatte ◽  
Kathleen Kopcza ◽  
Alexander Knee ◽  
Evan R. Horton ◽  
Erica Housman ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Control Group ◽  
Children's Hospital ◽  
Hospital Readmission Rates ◽  
Stewardship Program ◽  
Children’S Hospital ◽  
Acceptance Rates

OBJECTIVES Pediatric Antimicrobial Stewardship Programs (ASP) have been associated with improvements in antibiotic utilization and patient outcomes; however, ASP studies originating from non-freestanding children's hospitals are lacking. In this study, we present the implementation and impact of a multidisciplinary ASP that employs a collaborative physician and pharmacist driven thrice-weekly prospective audit-with-feedback approach at a non-freestanding children's hospital. METHODS Implementation was assessed via descriptive design. Pediatric inpatients maintained on predefined targeted antibiotics of interest for 48 to 72 hours preceding ASP review were eligible for inclusion. Outcomes evaluated included ASP recommendation and provider acceptance rates (overall and by antibiotic and provider specialty). Impact was examined using an interrupted time series design (with a preimplementation period of August 1, 2013, to July 31, 2014 and postimplementation period of December 1, 2014 to May 31, 2016). Eligibility included all targeted antibiotic usage among pediatric inpatients, with a control group comprising those who received antibiotics requiring preauthorization. Outcomes analyzed included days of antibiotic therapy per 1000 patient days (DOT/1000 PD) and 30-day hospital readmission rates over time. RESULTS Postimplementation, 882 antibiotic reviews were performed on 637 patients, with 327 recommendations generated. Reviews of patients maintained on vancomycin and clindamycin, and of those under care of intensivist and hospitalist physicians, were most likely to prompt recommendations. A mean targeted antibiotic usage decrease of 24.8 DOT/1000 PD (95% confidence interval, −62 to 14) was observed postimplementation, with no change in 30-day readmissions (0.64% during both periods). CONCLUSIONS ASP implementation at a non-freestanding children's hospital was feasible and allowed for identification of areas for targeted quality improvement, while demonstrating modest antibiotic use reduction without adversely impacting patient care.

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 Causal Conditions Supporting Antibiotic Stewardship Information Dashboards

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S326-S327
Author(s):  
Jacob Kean ◽  
Jorie Butler ◽  
Lisa Bunker ◽  
Matthew Goetz ◽  
Peter Glassman ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Antibiotic Stewardship ◽  
Critical Incident ◽  
Sufficient Conditions ◽  
Population Data ◽  
Population Level ◽  
Antibiotic Use ◽  
User Centered Design ◽  
Program Structure ◽  
Stewardship Program

Abstract Background Antibiotic stewardship is key to minimizing antibiotic resistance. To assist antibiotic stewards in dissecting population-level antibiotic use patterns, our study group developed a dashboard that displays consolidated patterns, supports data exploration, and compares facility-level antibiotic use to others. We report fuzzy set qualitative comparative analyses (QCA) of interviews designed to elicit user experiences to uncover different combinations of causal conditions supporting dashboard use. Methods Dashboards were iteratively designed based upon longitudinal feedback from stewards. Views include antibiotic use stratified by diagnoses and duration of therapy. Eight VAMCs, each with 0.5 to 2.0 FTE stewards, used the dashboard. One to 2 stewards from each site were interviewed using a structured script that focused on: 1) structure (i.e., program FTE) and functions of the local stewardship program; 2) critical incident or usage story; and 3) perceived knowledge and efficacy. Results Qualitative codes were developed from the interviews and were scaled in a fuzzy logic framework (i.e., between 0 and 1) to reflect the degree to which the qualitative theme was present in the stewardship program at participating clinical sites. The scaling was assigned using prior knowledge external to the data. The most parsimonious QCA solution identified just the absence of program structure (program FTE) a sufficient causal configuration to the frequency of dashboard use (coverage = 0.612, consistency = 0.813). Intermediate solutions added stewardship activities, dashboard self-efficacy, and trust in the data (coverage = 0.502, consistency = 0.952) as sufficient conditions. The coverage for both solutions exceeded 0.75, which was the lower bound of acceptability. Conclusion The dashboard may be successfully integrated into institutions based on the complicated interplay between program structure (e.g., # FTE) and dashboard self-efficacy, experience with data-activities, and trust of population data. Incorporating user-centered design of dashboards supports the development of fully functional teams and has the potential for important population health impact. Disclosures All authors: No reported disclosures.

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