The Role of an Antimicrobial Stewardship Team in the Use of Rapid Diagnostic Testing in Acute Care: An Official Position Statement of the Society of Infectious Diseases Pharmacists

2018 ◽  
Vol 39 (4) ◽  
pp. 473-475 ◽  
Author(s):  
Brandon Hill ◽  
Navaneeth Narayanan ◽  
Elizabeth Palavecino ◽  
Katherine K. Perez ◽  
Sasha Premraj ◽  
...  
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Diagnostic Testing ◽  
Position Statement ◽  
Antibiotic Prescribing ◽  
Official Position ◽  
Essential Components ◽  
Reduction Strategies ◽  
Diagnostic Technologies

Rapid diagnostic technologies can assist Antimicrobial Stewardship Programs (ASPs) in achieving the goals of reducing unnecessary antimicrobial exposure and optimizing patient care. The Society of Infectious Diseases Pharmacists supports all members of the ASP team as essential components of optimal use of these technologies for management of antibiotic prescribing and cost-reduction strategies.Infect Control Hosp Epidemiol 2018;39:473–475

scholarly journals 1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S398
Author(s):  
Natalie Tucker ◽  
Ezzeldin Saleh ◽  
Marcela Rodriguez
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Custom Made ◽  
Days Of Therapy ◽  
Before And After ◽  
The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

scholarly journals Infectious Diseases Society of America Position Statement on the Role of Hospital Pharmacists

1998 ◽  
Vol 27 (1) ◽  
pp. 228-228
Author(s):  
Walter R. Wilson ◽  
James M. Steckelberg ◽  
Michael R. Keating
Keyword(s):  
Infectious Diseases ◽  
Position Statement ◽  
Hospital Pharmacists

scholarly journals Intensivists’ beliefs about rapid multiplex molecular diagnostic testing and its potential role in improving prescribing decisions and antimicrobial stewardship: a qualitative study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Alyssa M. Pandolfo ◽  
Robert Horne ◽  
Yogini Jani ◽  
Tom W. Reader ◽  
Natalie Bidad ◽  
...  
Keyword(s):  
Molecular Diagnostics ◽  
Antimicrobial Stewardship ◽  
Diagnostic Tests ◽  
Pathogenic Bacteria ◽  
Point Of Care ◽  
Diagnostic Testing ◽  
Molecular Diagnostic ◽  
Antibiotic Prescribing ◽  
Test Results ◽  
Structured Interviews

Abstract Background Rapid molecular diagnostic tests to investigate the microbial aetiology of pneumonias may improve treatment and antimicrobial stewardship in intensive care units (ICUs). Clinicians’ endorsement and uptake of these tests is crucial to maximise engagement; however, adoption may be impeded if users harbour unaddressed concerns or if device usage is incompatible with local practice. Accordingly, we strove to identify ICU clinicians’ beliefs about molecular diagnostic tests for pneumonias before implementation at the point-of-care. Methods We conducted semi-structured interviews with 35 critical care doctors working in four ICUs in the United Kingdom. A clinical vignette depicting a fictitious patient with signs of pneumonia was used to explore clinicians’ beliefs about the importance of molecular diagnostics and their concerns. Data were analysed thematically. Results Clinicians’ beliefs about molecular tests could be grouped into two categories: perceived potential of molecular diagnostics to improve antibiotic prescribing (Molecular Diagnostic Necessity) and concerns about how the test results could be implemented into practice (Molecular Diagnostic Concerns). Molecular Diagnostic Necessity stemmed from beliefs that positive results would facilitate targeted antimicrobial therapy; that negative results would signal the absence of a pathogen, and consequently that having the molecular diagnostic results would bolster clinicians’ prescribing confidence. Molecular Diagnostic Concerns included unfamiliarity with the device’s capabilities, worry that it would detect non-pathogenic bacteria, uncertainty whether it would fail to detect pathogens, and discomfort with withholding antibiotics until receiving molecular test results. Conclusions Clinicians believed rapid molecular diagnostics for pneumonias were potentially important and were open to using them; however, they harboured concerns about the tests’ capabilities and integration into clinical practice. Implementation strategies should bolster users’ necessity beliefs while reducing their concerns; this can be accomplished by publicising the tests’ purpose and benefits, identifying and addressing clinicians’ misconceptions, establishing a trial period for first-hand familiarisation, and emphasising that, with a swift (e.g., 60–90 min) test, antibiotics can be started and refined after molecular diagnostic results become available.

Pharmacists’ Familiarity with and Institutional Utilization of Rapid Diagnostic Technologies for Antimicrobial Stewardship

2017 ◽  
Vol 38 (7) ◽  
pp. 863-866 ◽  
Author(s):  
Rachel A. Foster ◽  
Kristi Kuper ◽  
Z. Kevin Lu ◽  
P. Brandon Bookstaver ◽  
Christopher M. Bland ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Stewardship Program ◽  
Chain Reaction ◽  
Electronic Survey ◽  
Stewardship Program ◽  
Polymerase Chain ◽  
Organism Identification ◽  
Diagnostic Technologies

Rapid diagnostic technologies (RDTs) significantly reduce organism identification time and can augment antimicrobial stewardship program (ASP) activities. An electronic survey quantified familiarity with and utilization of RDTs by clinical pharmacists participating in ASPs. Familiarity was highest with polymerase chain reaction (PCR). Formal infectious diseases training was the only significant factor influencing RDT familiarity.Infect Control Hosp Epidemiol 2017;38:863–866

scholarly journals Policy Statement on Antimicrobial Stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS)

2012 ◽  
Vol 33 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Neil Fishman ◽  
◽  
◽  
Keyword(s):  
United States ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Safety Issue ◽  
The United States ◽  
Position Statement ◽  
Policy Statement ◽  
Antimicrobial Use ◽  
Patient Safety Issue ◽  
Healthcare Epidemiology

Antimicrobial resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care. This position statement of the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society of America outlines recommendations for the mandatory implementation of antimicrobial stewardship throughout health care, suggests process and outcome measures to monitor these interventions, and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States.

scholarly journals 977. An Innovative 3-Year Medical Student Spiral Curriculum in Antimicrobial Stewardship and Infectious Diseases

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S40-S40
Author(s):  
Peter Chin-Hong ◽  
Arianne Teherani ◽  
David Irby ◽  
Brian Schwartz
Keyword(s):  
Medical Student ◽  
Medical Students ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Prescribing Patterns ◽  
Similar Proportion ◽  
Antibiotic Prescribing ◽  
Medicine Clerkship ◽  
Spiral Curriculum ◽  
Clinical Preparation

Abstract Background By 2050, infections due antimicrobial-resistant organisms are predicted to account for 10 million deaths/year worldwide. Physician antibiotic prescribing patterns are a significant factor in the development of antibiotic resistance organisms. Early, continual, and integrated medical student education may help students develop a framework for responsible antimicrobial use as they develop prescribing patterns. Methods We designed a spiral antimicrobial stewardship curriculum (defined as revisiting the same concept but with increasing complexity) for medical students in years 2–4. Data provided by the Graduation Questionnaire (GQ) administered by the US Association of American Colleges were used. We compared student responses during the curriculum rollout in 2013–2015 between students at our institution and other schools. We also surveyed graduating seniors in 2015 about antimicrobial stewardship training. Results Using GQ data for the class of 2013 (preintervention), a similar proportion of UCSF medical students compared with other US medical students rated microbiology clinical preparation as excellent (43.6% vs. 45.1%, P > 0.20). For the 2014 class, we developed interactive case-based sessions at the beginning of years 3 and 4. After this first intervention, a higher proportion of UCSF students rated the microbiology clinical preparation as excellent (51.3%) compared with responses at all schools (39.8%, odds ratio [OR] 1.59, 95% confidence interval [CI] 1.1–2.3, P = 0.013). For the class of 2015, we added content during the medicine clerkship and 1 week before graduation. For the 2015 class, an even higher proportion of UCSF students rated microbiology preparation as excellent (57.6%), compared with all schools (41.2%, OR 2.23, 95% CI 1.54–3.22, P < 0.0001). From our survey, 88% were very or extremely satisfied with antimicrobial stewardship training. Conclusion A spiral curriculum focusing on antimicrobial stewardship and infectious diseases increases student perception of clinical preparation prior to graduation. As the curriculum was incrementally introduced, students’ knowledge increased indicating a dose–response pattern. Based on these positive results, we plan to introduce more content throughout UME, and link to curriculum for GME and practicing clinicians. Disclosures All authors: No reported disclosures.

scholarly journals Feasibility and Validity of a Framework for Antimicrobial Stewardship in General Practice: Key Stakeholder Interviews

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 900
Author(s):  
Lesley A. Hawes ◽  
Jaclyn Bishop ◽  
Kirsty Buising ◽  
Danielle Mazza
Keyword(s):  
General Practice ◽  
Antimicrobial Stewardship ◽  
Antibiotic Prescribing ◽  
Community Based ◽  
The Public ◽  
Professional Groups ◽  
Key Stakeholders ◽  
Secondary Objective ◽  
Further Development

There is little guidance about developing systems for antimicrobial stewardship (AMS) for general practice. A literature review identified six key components: governance, monitoring of antibiotic prescribing and resistance with feedback to prescribers, consultation support, education of the public and general practitioners, pharmacist and nurse involvement, and research, which were incorporated into a potential framework for the general practice context. Objectives: to determine the feasibility and validity of the proposed AMS framework. A secondary objective was to identify likely bodies responsible for implementation in Australia. We undertook interviews with 12 key stakeholders from government, research, and professional groups. Data were analysed with a thematic approach. The framework was considered valid and feasible. No clear organisation was identified to lead AMS implementation in general practice. The current volume-based antibiotic prescription monitoring system was considered insufficient. AMS education for the public, further development of GP education, and improved consultation support were strongly recommended. The role of community-based pharmacists and nurses is largely unexplored, but their involvement was recommended. A clear leader to drive AMS in general practice is essential for an action framework to gain traction. Monitoring and feedback of antibiotic prescribing require urgent development to include monitoring of prescribing appropriateness and patient outcomes.

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