The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities

2018 ◽  
Vol 39 (12) ◽  
pp. 1400-1405 ◽  
Author(s):  
Erika M. C. D’Agata ◽  
Curt C. Lindberg ◽  
Claire M. Lindberg ◽  
Gemma Downham ◽  
Brandi Esposito ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Prescribing Patterns ◽  
Antimicrobial Stewardship Program ◽  
Intervention Period ◽  
Positive Effects ◽  
Antimicrobial Prescribing ◽  
Stewardship Program ◽  
Dialysis Facilities

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.

scholarly journals Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities

2018 ◽  
Vol 13 (9) ◽  
pp. 1389-1397 ◽  
Author(s):  
Erika M.C. D’Agata ◽  
Diana Tran ◽  
Josef Bautista ◽  
Douglas Shemin ◽  
Daniel Grima
Keyword(s):  
Antimicrobial Stewardship ◽  
The United States ◽  
Multidrug Resistant ◽  
Economic Benefits ◽  
Decision Analytic Model ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Multidrug Resistant Organisms ◽  
Dialysis Facilities

Background and objectivesInfections caused by multidrug-resistant organisms and Clostridium difficile are associated with substantial morbidity and mortality as well as excess costs. Antimicrobial exposure is the leading cause for these infections. Approximately 30% of antimicrobial doses administered in outpatient hemodialysis facilities are considered unnecessary. Implementing an antimicrobial stewardship program in outpatient hemodialysis facilities aimed at improving prescribing practices would have important clinical and economic benefits.Design, setting, participants, & measurementsWe developed a decision analytic model of antimicrobial use on the clinical and economic consequences of implementing a nationwide antimicrobial stewardship program in outpatient dialysis facilities. The main outcomes were total antimicrobial use, infections caused by multidrug-resistant organisms and C. difficile, infection-related mortality, and total costs. The analysis considered all patients on outpatient hemodialysis in the United States. The value of implementing antimicrobial stewardship programs, assuming a 20% decrease in unnecessary antimicrobial doses, was calculated as the incremental differences in clinical end points and cost outcomes. Event probabilities, antimicrobial regimens, and health care costs were informed by publicly available sources.ResultsOn a national level, implementation of antimicrobial stewardship programs was predicted to result in 2182 fewer infections caused by multidrug-resistant organisms and C. difficile (4.8% reduction), 629 fewer infection-related deaths (4.6% reduction), and a cost savings of $106,893,517 (5.0% reduction) per year. The model was most sensitive to clinical parameters as opposed to antimicrobial costs.ConclusionsThe model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and C. difficile, infection-related deaths, and costs.

scholarly journals Long-Term Impact of an Educational Antimicrobial Stewardship Program on Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections: A Quasi-Experimental Study of Interrupted Time-Series Analysis

2017 ◽  
Vol 65 (12) ◽  
pp. 1992-1999 ◽  
Author(s):  
José Molina ◽  
Germán Peñalva ◽  
María V Gil-Navarro ◽  
Julia Praena ◽  
José A Lepe ◽  
...  
Keyword(s):  
Bloodstream Infections ◽  
Interrupted Time Series ◽  
Antibiotic Consumption ◽  
Multidrug Resistant ◽  
Incidence Density ◽  
Antimicrobial Stewardship Program ◽  
Interrupted Time Series Analysis ◽  
Stewardship Program ◽  
Quasi Experimental ◽  
Hospital Acquired

Abstract Background The global crisis of bacterial resistance urges the scientific community to implement intervention programs in healthcare facilities to promote an appropriate use of antibiotics. However, the clinical benefits or the impact on resistance of these interventions has not been definitively proved. Methods We designed a quasi-experimental intervention study with an interrupted time-series analysis. A multidisciplinary team conducted a multifaceted educational intervention in our tertiary-care hospital over a 5-year period. The main activity of the program consisted of peer-to-peer educational interviews between counselors and prescribers from all departments to reinforce the principles of the proper use of antibiotics. We assessed antibiotic consumption, incidence density of Candida and multidrug-resistant (MDR) bacteria bloodstream infections (BSIs) and their crude death rate per 1000 occupied bed days (OBDs). Results A quick and intense reduction in antibiotic consumption occurred 6 months after the implementation of the intervention (change in level, −216.8 defined daily doses per 1000 OBDs; 95% confidence interval, −347.5 to −86.1), and was sustained during subsequent years (average reduction, −19,9%). In addition, the increasing trend observed in the preintervention period for the incidence density of candidemia and MDR BSI (+0.018 cases per 1000 OBDs per quarter; 95% confidence interval, −.003 to .039) reverted toward a decreasing trend of −0.130 per quarter (change in slope, −0.029; −.051 to −.008), and so did the mortality rate (change in slope, −0.015; −.021 to −.008). Conclusions This education-based antimicrobial stewardship program was effective in decreasing the incidence and mortality rate of hospital-acquired candidemia and MDR BSI through sustained reduction in antibiotic use.

Impact of a Comprehensive Antimicrobial Stewardship Program on Institutional Burden of Antimicrobial Resistance: A 14-Year Controlled Interrupted Time-series Study

2019 ◽  
Vol 71 (11) ◽  
pp. 2897-2904 ◽  
Author(s):  
Christine Peragine ◽  
Sandra A N Walker ◽  
Andrew Simor ◽  
Scott E Walker ◽  
Alexander Kiss ◽  
...  
Keyword(s):  
Time Series ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Interrupted Time Series ◽  
Multidrug Resistant ◽  
Audit And Feedback ◽  
Time Series Study ◽  
Stewardship Program ◽  
Hospital Acquired ◽  
Series Study

Abstract Background Antimicrobial resistance (AMR) constitutes an international public health threat widely believed to result from excessive antimicrobial use (AMU). Numerous authorities have recommended antimicrobial stewardship programs (ASPs) to curb the selection of AMR, but there is a lack of data confirming this benefit. Methods A controlled interrupted time-series study spanning 14 years was performed to assess impact of a comprehensive hospital-based ASP that included pharmacist-led audit and feedback on institutional AMR. Patient-level microbiologic and AMU data were obtained from October 2002 to September 2016. Poisson regression models were used to identify changes in the incidence and trend of hospital-acquired (HA) antibiotic-resistant organisms (AROs) and multidrug-resistant organisms (MDROs). Changes in community-acquired (CA)–ARO, CA-MDRO, and inpatient AMU were assessed as controls and process outcomes. Results Statistically significant shifts in AMU, HA-ARO, and HA-MDRO trends coinciding with ASP implementation were observed, corresponding with a 9% reduction in HA-ARO burden (incidence rate ratio [IRR], 0.91 [95% confidence interval {CI}, .83–.99]; P = .03) and a 13% reduction in HA-MDRO burden (IRR, 0.87 [95% CI, .73–1.04]; P = .13) in the intervention period. In contrast, CA-ARO and CA-MDRO incidence continued to rise, with 40% (IRR, 1.40 [95% CI, 1.28–1.54]; P < .0001) and 68% (IRR, 1.68 [95% CI, 1.57–1.82]; P < .0001) increases in burden found, respectively. Conclusions Implementation of a comprehensive ASP resulting in reduced AMU was associated with a significant reduction in institutional AMR, even though community AMR increased during the same period. These results confirm that ASPs play an important role in the fight against AMR.

Implementation of an Antimicrobial Stewardship Program in a Neonatal Intensive Care Unit

2017 ◽  
Vol 38 (10) ◽  
pp. 1137-1143 ◽  
Author(s):  
Nneka I. Nzegwu ◽  
Michelle R. Rychalsky ◽  
Loren A. Nallu ◽  
Xuemei Song ◽  
Yanhong Deng ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Time Series ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Late Onset ◽  
Interrupted Time Series ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Late Onset Sepsis

OBJECTIVETo evaluate antimicrobial utilization and prescription practices in a neonatal intensive care unit (NICU) after implementation of an antimicrobial stewardship program (ASP).DESIGNQuasi-experimental, interrupted time-series study.SETTINGA 54-bed, level IV NICU in a regional academic and tertiary referral center.PATIENTS AND PARTICIPANTSAll neonates prescribed antimicrobials from January 1, 2011, to June 30, 2016, were eligible for inclusion.INTERVENTIONImplementation of a NICU-specific ASP beginning July 2012.METHODSWe convened a multidisciplinary team and developed guidelines for common infections, with a focus on prescriber audit and feedback. We conducted an interrupted time-series analysis to evaluate the effects of our ASP. Our primary outcome measure was days of antibiotic therapy (DOT) per 1,000 patient days for all and for select antimicrobials. Secondary outcomes included provider-specific antimicrobial prescription events for suspected late-onset sepsis (blood or cerebrospinal fluid infection at >72 hours of life) and guideline compliance.RESULTSAntibiotic utilization decreased by 14.7 DOT per 1,000 patient days during the stewardship period, although this decrease was not statistically significant (P=.669). Use of ampicillin, the most commonly antimicrobial prescribed in our NICU, decreased significantly, declining by 22.5 DOT per 1,000 patient days (P=.037). Late-onset sepsis evaluation and prescription events per 100 NICU days of clinical service decreased significantly (P<.0001), with an average reduction of 2.65 evaluations per year per provider. Clinical guidelines were adhered to 98.75% of the time.CONCLUSIONSImplementation of a NICU-specific antimicrobial stewardship program is feasible and can improve antibiotic prescribing practices.Infect Control Hosp Epidemiol 2017;38:1137–1143

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.

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

2013 ◽  
Vol 34 (6) ◽  
pp. 573-580 ◽  
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.

Antimicrobial Stewardship in Pediatrics

2019 ◽  
pp. 291-322
Author(s):  
Emily A. Thorell ◽  
Jared Olson
Keyword(s):  
Antimicrobial Stewardship ◽  
Multidrug Resistant ◽  
Antimicrobial Treatment ◽  
Antimicrobial Stewardship Program ◽  
Global Public Health ◽  
Healthcare Facilities ◽  
Stewardship Program ◽  
Healthcare Program ◽  
Core Elements ◽  
Control And Prevention

The rapid emergence of multidrug-resistant bacteria has become a global public health crisis. As antibiotics are the only class of medications where use in one patient can compromise their efficacy in another patient, stewardship is critical to preserve this shared resource. The Centers for Disease Control and Prevention (CDC) have focused on improving antimicrobial use for many years. One effective strategy used to decrease the emergence of multi‐drug-resistant organisms (MDROs) is the antimicrobial stewardship program (ASP): a coordinated healthcare program that seeks to provide optimal antimicrobial treatment to patients to reduce the emergence of MDROs, improve patient outcomes, and decrease cost. This chapter reviews the importance of an antimicrobial stewardship program, reviews core elements of a pediatric hospital ASP, and provides guidance on tracking and reporting antimicrobial prescribing in pediatric healthcare facilities.

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.

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