Impact of Different Methods of Feedback to Clinicians After Postprescription Antimicrobial Review Based on the Centers for Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults

2007 ◽  
Vol 28 (6) ◽  
pp. 641-646 ◽  
Author(s):  
Sara E. Cosgrove ◽  
Alpa Patel ◽  
Xiaoyan Song ◽  
Robert E. Miller ◽  
Kathleen Speck ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Disease Control ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Detection System ◽  
Tertiary Care ◽  
Clinical Event ◽  
Antimicrobial Use ◽  
12 Steps ◽  
Centers For Disease Control

Objectives.To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review.Design.Prospective intervention to identify and modify inappropriate antimicrobial therapy.Setting.A 1,000-bed, tertiary care teaching hospital.Patients.Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours.Interventions.We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and “reserve” antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC.Results.Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 (“target the pathogen”), 1% into step 4 (“access experts”), 3% into steps 7 and 8 (“treat infection, not colonization or contamination”), 18% into step 9 (“say ‘no’ to vancomycin”), and 26% into step 10 (“stop treatment when no infection”). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback.Conclusions.Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.

scholarly journals Physicians' Perspective on Prescribing Patterns and Knowledge on Antimicrobial Use and Resistance in Penang, Malaysia: A Qualitative Study

2020 ◽  
Vol 8 ◽  
Author(s):  
Ali Akhtar ◽  
Amer Hayat Khan ◽  
Hadzliana Zainal ◽  
Mohamed Azmi Ahmad Hassali ◽  
Irfhan Ali ◽  
...  
Keyword(s):  
Health Care ◽  
Antimicrobial Resistance ◽  
Qualitative Study ◽  
Health Care System ◽  
Tertiary Care ◽  
Prescribing Patterns ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
The Impact ◽  
Care System

Background: Unnecessary antimicrobial use is an emerging problem throughout the world. To design future interventions to ensure rational antimicrobial use and decrease the risk of antimicrobial resistance, physician's knowledge and prescribing practices of antimicrobials should be assessed. Therefore, the main objective of this study is to investigate the physician's knowledge along with their prescribing patterns of antimicrobials in their health care system.Methods: The present qualitative study was conducted in a tertiary care public hospital located at Penang island, situated in Northwest of Malaysia. A total of 12 semi-structured, face to face interviews were conducted with purposive sampling technique. Physicians recruited had different specialties. All interviews were audio recorded, then transcribed into English language and analyze by thematic content analysis.Results: Four major themes were identified: (1) prescribing patterns of physicians regarding antimicrobials; (2) physician's knowledge about antimicrobials; (3) antimicrobial resistance; (4) satisfaction with management of infections. Physicians believed in regular educational activities and updates about the latest antimicrobial guidelines may change the prescribing behavior of physicians to optimize the use of antimicrobials. This may lead to decrease in burden of antimicrobial resistance in their health care system. Physicians emphasized that stricter rules and regular monitoring of antimicrobial use should be implemented to overcome the main challenges of antimicrobial resistance.Conclusion: Different factors were identified to assist optimized use of antimicrobials and decrease the risk of antimicrobial resistance. The present study helps to design targeted future interventions to ensure rational antimicrobial use and decrease the impact of antimicrobial resistance in Malaysia.

scholarly journals P32 An audit to assess the suitability of patients at a tertiary/quaternary paediatric hospital to switch from intravenous (IV) to oral (PO) antimicrobial therapy

2020 ◽  
Vol 105 (9) ◽  
pp. e23.1-e23
Author(s):  
Orlagh McGarrity ◽  
Aliya Pabani
Keyword(s):  
High Risk ◽  
Antimicrobial Resistance ◽  
Blood Culture ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Blood Cultures ◽  
Antimicrobial Use ◽  
List Type ◽  
Paediatric Hospital ◽  
Oral Agents

Introduction, Aims and ObjectivesIn 2011 the Start Smart then Focus campaign was launched by Public Health England (PHE) to combat antimicrobial resistance.1 The ‘focus’ element refers to the antimicrobial review at 48–72 hours, when a decision and documentation regarding infection management should be made. [OM1] At this tertiary/quaternary paediatric hospital we treat, immunocompromised, high risk patients. In a recent audit it was identified that 80% of antimicrobial use is IV, this may be due to several factors including good central access, centrally prepared IV therapy and oral agents being challenging to administer to children. The aim of the audit was to assess if patient have a blood culture prior to starting therapy, have a senior review at 48–72 hours, and thirdly if our high proportion of intravenous antimicrobial use is justified.MethodElectronic prescribing data from JAC was collected retrospectively over an 8 day period. IV antimicrobials for which there is a suitable oral alternative, this was defined as >80% bioavailability, were included. Patients were excluded in the ICU, cancer and transplant setting, those with absorption issues and with a high risk infection, such as endocarditis or bacteraemia. Patient were assessed against a set criteria to determine if they were eligible to switch from IV to PO therapy; afebrile, stable blood pressure, heart rate <90/min, respiratory rate < 20/min for 24 hours. Reducing CRP, reducing white cell count, blood cultures negative or sensitive to an antibiotic that can be given orally.Results100% of patients (11) had a blood cultures taken within 72 hours of starting therapy55% of patients had a positive blood culture82% of patients had a senior review at 48–72 hours46% of patients were eligible to switch from IV to PO therapy at 72 hours33% of eligible patients were switched from IV to PO therapy at 72 hoursConclusion and RecommendationsThis audit had a low sample size due to the complexity of the inclusion and exclusion criteria, and the difficulty in reviewing patient parameters on many different hospital interfaces. It is known that each patient is reviewed at least 24 hourly on most wards and therefore there is a need for improved documentation of prescribing decisions. Implementation of an IV to oral switch guideline is recommended to support prescribing decisions and educate and reassure clinicians on the bioavailability and benefits of PO antimicrobial therapy where appropriate. Having recently changed electronic patient management systems strategies to explore include hard stops on IV antimicrobial therapies, however this will require much consideration. Education of pharmacist and nurses is required to raise awareness about antimicrobial resistance and the benefits of IV to PO switches, despite the ease of this therapy at out Trust. This will promote a culture in which all healthcare professionals are active antimicrobial guardians, leading to better patient outcomes, less service pressures, and long term financial benefit.ReferenceGOV.UK. 2019. Antimicrobial stewardship: Start smart - then focus. [ONLINE]Available at: https://www.gov.uk/government/publications/antimicrobial-stewardship-start-smart-then-focus [Accessed 3 July 2019]

scholarly journals 244. The Double-Edged Sword of Cost Effectiveness in Evaluating Antimicrobial Stewardship Interventions

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S121-S122
Author(s):  
Omar Zmerli ◽  
Amanda Chamieh ◽  
Sanaa Saliba ◽  
Claude Afif ◽  
Eid Azar
Keyword(s):  
Cost Effectiveness ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Tertiary Care ◽  
High Price ◽  
Gram Negative ◽  
Stewardship Program ◽  
Yearly Average ◽  
The Impact

Abstract Background The multiple classical benefits of reducing antimicrobial consumption extend beyond the impact on rates of antimicrobial resistance and infections to include a cost-saving effect of 100,000$-300,000$ per intervention as estimated by the CDC. However, the recent introduction of novel antimicrobial molecules with a high price tag and the fall in the prices of older agents presents a substantial challenge in maintaining cost-effectiveness. Methods We retrieved from the antimicrobial stewardship program(ASP) database the consumption of the Gram-negative broad-spectrum antibacterial agents (GNBS): imipenem, meropenem, ertapenem, piperacillin-tazobactam, amikacin, colistin, ceftazidime, ceftolozane-tazobactam and cefepime from January 2015-August 2019 at Saint George Hospital(SGH), a 333-bed tertiary care center in Lebanon. The yearly cost of all antibacterials consumed during this period were obtained from SGH billing records. GNBS consumption was calculated as Daily Defined Doses (DDD)/1000 Patient Days(PD) per WHO guidelines. Results The carbapenem consumption significantly dropped from a peak of 205 DDD/1000PD in 2015 to 33 DDD/1000PD in 2019. This drop was not accompanied by an increase in the consumption of other GNBS. The total use of GNBS dropped by 54% from 288 DDD/1000PD in 2015 to 132 DDD/1000PD by August 2019. Currently, SGH serves a yearly average of 82,000 patient-days. Hence, this reduction in total GNBS consumption corresponds to 12,792 fewer daily defined doses of antimicrobial therapy per year. The average annual cost of all antibacterials at SGH is 1,100,000 $ (U.S. Dollars), ranging from 955679 $ to 1340109 $ for the period 2015–2019. (Table 1) Consumption of Gram-negative Broad-Spectrum Antimicrobial Agents and Cost of Antibiotics at Saint George Hospital, Lebanon Conclusion The striking decrease in GNBS consumption, namely carbapenems, was not mirrored with a reduction of total antibacterial cost. Although novel antimicrobials carry great potential, they come at a significant increase in overall cost. Modeling ASP interventions solely around cost-effectiveness will limit the better placement of these new agents in institutional therapeutic guidelines. Strict continuous analysis of consumption, antimicrobial resistance, and cost within an ASP provides a proactive and vigilant approach to navigate through the complexity of difficult to treat bacterial infections. Disclosures All Authors: No reported disclosures

scholarly journals How the COVID-19 Pandemic Affected Antimicrobial Prescribing Practices at a Tertiary-Care Healthcare System in Detroit, Michigan

2021 ◽  
Vol 1 (S1) ◽  
pp. s37-s38
Author(s):  
Angela Beatriz Cruz ◽  
Jennifer LeRose ◽  
Avnish Sandhu ◽  
Teena Chopra
Keyword(s):  
Broad Spectrum ◽  
Treatment Guidelines ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Modern Medicine ◽  
Antimicrobial Use ◽  
Prescribing Practices ◽  
Primary Object ◽  
Antibiotics Use ◽  
Over Time

Background: Inappropriate antimicrobial use continues to threaten modern medicine. The ongoing pandemic likely exacerbated this problem because COVID-19 presents similarly to bacterial pneumonia, confusion exists regarding treatment guidelines, and testing turnaround times (TATs) are slow. Our primary object was to quantify antimicrobial use changes during the pandemic to rates before the crisis. A subanalysis within the COVID-19 cohort was completed based on SARS-CoV-2 status. Methods: The pre–COVID-19 period was January–May 2019 and the COVID-19 period was January–May 2020. Subanalyses were used to explore differences in antibiotics use between persons not under investigation (non-PUIs), SARS-CoV-2–negative PUIs, and SARS-CoV-2–positive PUIs. Non-PUI patients were those without respiratory symptoms and/or fever. The χ2 and Wilcoxon signed rank-sum tests were used for analysis. Results: During the 2019 and 2020 study periods, 7,909 and 7,283 patients received >1 antimicrobial, respectively (Figure 1). Overall, antibiotic therapy per 1,000 patient days increased from 633.1 before COVID-19 to 678.5 during COVID-19, a 7.2% increase (Table 1). Notably, broad-spectrum respiratory antibiotics demonstrated a significant increase between pre–COVID-19 and COVID-19 cohorts (p < 0.001). Of the 7,283 patients within the COVID-19 cohort, 34.7% (n = 2,532) were PUI and 13.8% (n = 1,002) of these patients tested SARS-CoV-2 positive. Again, broad-spectrum respiratory antibiotics use was significantly increased for COVID-19 patients (p < 0.001). Of note, the proportion of patients receiving respiratory antibiotics steadily decreased over time (R2 = 0.99). Conclusions: There was a significant increase in antibiotic use during the COVID-19 pandemic. Encouragingly, antimicrobial use decreased over time, likely due to (1) faster TATs, (2) real-time education to clinicians and subsequent de-escalation of unnecessary antimicrobials, and (3) development of treatment guidelines as new research emerged.Funding: NoDisclosures: None

scholarly journals Antimicrobial use and antimicrobial resistance in nosocomial pathogens at a tertiary care hospital in Pune

2015 ◽  
Vol 71 (2) ◽  
pp. 112-119 ◽  
Author(s):  
Velu Nair ◽  
Dinesh Sharma ◽  
A.K. Sahni ◽  
Naveen Grover ◽  
S. Shankar ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Nosocomial Pathogens

scholarly journals Effects of the cefazolin shortage on the sales, cost, and appropriate use of other antimicrobials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ryuji Koizumi ◽  
Yoshiki Kusama ◽  
Yusuke Asai ◽  
Gu Yoshiaki ◽  
Yuichi Muraki ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Prediction Model ◽  
Broad Spectrum ◽  
Early Recognition ◽  
Antimicrobial Use ◽  
Appropriate Use ◽  
Sales Data ◽  
Defined Daily Doses ◽  
Before And After ◽  
Appropriate Antimicrobial Use

Abstract Background Shortages of antimicrobials lead to treatment failures, increase medical costs, and accelerate the development of antimicrobial resistance. We evaluated the effects of the serious cefazolin shortage in 2019 in Japan on the sales, costs, and appropriate use of other antimicrobials. Methods We evaluated monthly defined daily doses/1000 inhabitants/day (DID) values of antimicrobial sales from January 2016 to December 2019 using wholesaler’s sales databases. Using 2016–2018 sales data, we generated a prediction model of DID in 2019 under the assumption that the cefazolin shortage did not occur. We then compared the predicted DID and actual DID. Cefazolin, government-recommended alternatives, and government-not-recommended broad-spectrum alternatives were assessed. Antimicrobial groups according to the AWaRe classification were also assessed to evaluate the effect on appropriate antimicrobial use. In addition, we evaluated changes in costs between 9 months before and after the cefazolin shortage. Results DID values of total antimicrobials increased sharply 1 month before the decrease in cefazolin. Actual DIDs were higher than predicted DIDs for ceftriaxone, flomoxef, clindamycin, cefotiam, piperacillin/tazobactam, and meropenem. Actual DID values were higher than the predicted DID values in the Watch group. The costs of antimicrobials between pre- and post- cefazolin shortage were unchanged. Conclusion The cefazolin shortage brought confusion to the antimicrobial market and led to a setback in the appropriate use of antimicrobials. Early recognition and structures for prompt reactions to antimicrobial shortages are needed. Moreover, development of a system to secure the supply of essential antimicrobials is required.

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