Measuring the impact of varying denominator definitions on standardized antibiotic consumption rates: implications for antimicrobial stewardship programmes

As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed.

Download Full-text

Effectiveness of antimicrobial stewardship programmes in neonatology: a systematic review

Archives of Disease in Childhood ◽

10.1136/archdischild-2019-318026 ◽

2020 ◽

Vol 105 (6) ◽

pp. 563-568

Author(s):

André Ricardo Araujo da Silva ◽

Amanda Marques ◽

Clara Di Biase ◽

Monique Faitanin ◽

Indah Murni ◽

...

Keyword(s):

Antibiotic Resistance ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Neonatal Intensive Care ◽

Antiviral Agents ◽

Final Analysis ◽

Antibiotic Use ◽

Antibiotic Consumption ◽

Multi Centre Study ◽

The Impact

IntroductionAntimicrobial stewardship programmes (ASPs) are recommended to improve antibiotic use in healthcare and reduce antimicrobial resistance (AMR). Our aim was to investigate the effectiveness of ASPs in reducing antibiotic consumption, use of broad-spectrum/restricted antibiotics, antibiotic resistance and healthcare-associated infections (HAIs) in neonates.MethodsWe searched PUBMED, SCIELO, EMBASE and the Cochrane Database (January 2000–April 2019) to identify studies on the effectiveness of ASPs in neonatal wards and/or neonatal intensive care units (NICUs). Outcomes were as follows: reduction of antibiotic consumption overall and of broad-spectrum/target antibiotics, inappropriate antibiotic use, antibiotic resistance and HAIs. ASPs conducted in settings other than acute care hospitals, for children older than 1 month, and ASPs addressing antifungal and antiviral agents, were excluded.ResultsThe initial search identified 53 173 titles and abstracts; following the application of filters and inclusion criteria, a total of six publications were included in the final analysis. All studies, of which one was multi-centre study, were published after 2010. Five studies were conducted exclusively in NICUs. Four articles applied multimodal interventions. Reduction of antibiotic consumption overall and/or inappropriate antibiotic use were reported by four articles; reduction of broad-spectrum/targeted antibiotics were reported by four studies; No article evaluated the impact of ASPs on AMR or the incidence of HAI in neonates.ConclusionASPs can be effectively applied in neonatal settings. Limiting the use of broad-spectrum antibiotics and shorting the duration of antibiotic treatment are the most promising approaches. The impact of ASPs on AMR and HAI needs to be evaluated in long-term studies.

Download Full-text

An Antimicrobial Stewardship Program Based on Systematic Infectious Disease Consultation in a Rehabilitation Facility

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.233 ◽

2016 ◽

Vol 38 (1) ◽

pp. 76-82 ◽

Cited By ~ 15

Author(s):

Sara Tedeschi ◽

Filippo Trapani ◽

Maddalena Giannella ◽

Francesco Cristini ◽

Fabio Tumietto ◽

...

Keyword(s):

Infectious Disease ◽

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antibiotic Consumption ◽

Defined Daily Dose ◽

Antimicrobial Stewardship Program ◽

Rehabilitation Hospital ◽

Stewardship Program ◽

Resistance Patterns ◽

The Impact

OBJECTIVETo assess the impact of an antimicrobial stewardship program (ASP) on antibiotic consumption, Clostridium difficile infections (CDI), and antimicrobial resistance patterns in a rehabilitation hospital.DESIGNQuasi-experimental study of the periods before (from January 2011 to June 2012) and after (from July 2012 to December 2014) ASP implementation.SETTING150-bed rehabilitation hospital dedicated to patients with spinal-cord injuries.INTERVENTIONBeginning in July 2012, an ASP was implemented based on systematic bedside infectious disease (ID) consultation and structural interventions (ie, revision of protocols for antibiotic prophylaxis and education focused on the appropriateness of antibiotic prescriptions). Antibiotic consumption, occurrence of CDI, and antimicrobial resistance patterns of selected microorganisms were compared between periods before and after the ASP implementation.RESULTSAntibiotic consumption decreased from 42 to 22 defined daily dose (DDD) per 100 patient days (P<.001). The main reductions involved carbapenems (from 13 to 0.4 DDD per 100 patient days; P=.01) and fluoroquinolones (from 11.8 to 0.99 DDD per 100 patient days; P=.006), with no increases in mortality or length of stay. The incidence of CDI decreased from 3.6 to 1.2 cases per 10,000 patient days (P=.001). Between 2011 and 2014, the prevalence of extensively drug-resistant (XDR) strains decreased from 55% to 12% in P. aeruginosa (P<.001) and from 96% to 73% in A. baumannii (P=.03). The prevalence of ESBL-producing strains decreased from 42% to 17% in E. coli (P=.0007) and from 62% to 15% in P. mirabilis (P=.0001). In K. pneumoniae, the prevalence of carbapenem-resistant strains decreased from 42% to 17% (P=.005), and the prevalence of in methicillin-resistant S. aureus strains decreased from 77% to 40% (P<.0008).CONCLUSIONSAn ASP based on ID consultation was effective in reducing antibiotic consumption without affecting patient outcomes and in improving antimicrobial resistance patterns in a rehabilitation hospital.Infect Control Hosp Epidemiol. 2016;1–7

Download Full-text

Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance

Journal of Telemedicine and Telecare ◽

10.1177/1357633x18767702 ◽

2018 ◽

Vol 25 (5) ◽

pp. 294-300 ◽

Cited By ~ 3

Author(s):

Rodrigo P dos Santos ◽

Camila H Dalmora ◽

Stephani A Lukasewicz ◽

Otávio Carvalho ◽

Caroline Deutschendorf ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Bacterial Resistance ◽

Multi Drug Resistance ◽

Level Change ◽

Stewardship Program ◽

Consumption Rates ◽

Quasi Experimental ◽

Amoxicillin Clavulanate ◽

Resistance Rates ◽

The Impact

Introduction Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. Methods We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. Results After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = −0.80; P < 0.01; trend change, β = −0.01; P = 0.98), first-generation cephalosporins (level change, β = −0.91; P < 0.01; trend change, β = +0.01; P = 0.96), vancomycin (level change, β = −0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = −0.15; P = 0.56; trend change, β = −1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, β = +0.84; P < 0.01; trend change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = −1.26; P < 0.01) was observed. Conclusions Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.

Download Full-text

1979. Five-Year Impact of an Antimicrobial Stewardship Program on Nosocomial Candidemia: An Interrupted Time-Series Analysis Study

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1659 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S662-S662

Author(s):

Andrea Bedini ◽

Marianna Meschiari ◽

Erica Franceschini ◽

Cristina Mussini

Keyword(s):

Time Series ◽

Antimicrobial Stewardship ◽

Interrupted Time Series ◽

Antibiotic Consumption ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Number Of Patients ◽

Nosocomial Candidemia ◽

The Impact

Abstract Background Antimicrobial stewardship programs allow a reduction in antibiotic prescription and, consequently, in the incidence of multidrug-resistance infections. However, the impact on nosocomial candidemia is still unclear. Methods The present study is an interrupted time-series (ITS) before-after study, based on an ecological time-trend analysis. Since 2014, an antimicrobial stewardship program (ASP) has been implemented at an Italian tertiary-care hospital. The first objective of the program was to reduce carbapenem consumption, through an active and computerized surveillance of all carbapenem prescriptions, each of which was checked and validated by ID specialists always after audit of the cases with treating physicians. We retrospectively evaluated the changing in the consumption of antimicrobials, carbapenems, and in the incidence of candidemia, during two study periods: before (2007–2013) and after (2014–2018) the implementation of the ASP. Results The implementation of ASP was followed by a significant decrease in antibiotic consumption, which was consistent through the following 5 years. At the end of the study, total antibiotic consumption has decreased by 38.476 DDDs per 100 patient-days (PDs) per quarter (95% CI: −21.784 to −55.168; P < 0.001) and carbapenems decreased by 4.452 DDD per 100 PDs per quarter (95% CI: −3.658 to −5.246; P = 0.001). After 5 years of ASP, incidence of candidemia decreased by 2.034 episodes per 1,000 PDs per quarter (95% CI: −0.738 to −3.330; P = 0.003), decreasing, at the end of 2018, by 53% compared with the expected value if the program had not been implemented. Conclusion At our Institution, the ASP had a positive impact on the consumption of carbapenems, and antimicrobials. The incidence of candidemia was also favorably affected by the program, reversing the trend after 2014. The ASP, even if not directly targeted to fungal infections, indirectly caused a reduction in the incidence of candidemia, probably reducing the number of patients colonized by Candida spp. Disclosures All authors: No reported disclosures.

Download Full-text

Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

BMC Research Notes ◽

10.1186/s13104-020-05085-3 ◽

2020 ◽

Vol 13 (1) ◽

Cited By ~ 1

Author(s):

Masoud Mardani ◽

Sara Abolghasemi ◽

Shiva Shabani

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Consumption ◽

Multidrug Resistant ◽

Marrow Transplant ◽

Blood Cultures ◽

University Hospital ◽

Clostridioides Difficile ◽

Stewardship Program ◽

Quasi Experimental ◽

The Impact

Abstract Objective The The impact of a hospital antimicrobial stewardship was determined on antimicrobial-resistant, Clostridioides difficile rates and the amount of antimicrobial consumed in cancer patients.The intervention effects of antimicrobial stewardship (ASP) plans in 2017–2018 and 2018–2019 were respectively evaluated among hematology/oncology and bone marrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (meropenem and vancomycin) consumption gr-year, the number of positive Clostridioides difficile infection and multidrug-resistant positive cases in blood cultures. Results The number of MDR cases in the periods of 2017–2018 and 2018–2019 were 145 and 75, respectively (p = 0.011). A significant reduction in all positive blood cultures from 2017–2018 to 2018–2019 was found (p = 0.001). 574 patients admitted to our hospital in these periods of 2017- 2018 and 2018- 2019were assessed for MPM and VMN use. The amounts of MPM prescriptions in 2018–2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms, and CDI can highly promote patients’ health and decreasing medical costs and long-term defects for patients.

Download Full-text

The Impact of the SARS-Cov2 Pandemic on a Persuasive Educational Antimicrobial Stewardship Program in a University Hospital in Southern Italy: A Pre-Post Study

Antibiotics ◽

10.3390/antibiotics10111405 ◽

2021 ◽

Vol 10 (11) ◽

pp. 1405

Author(s):

Margherita Macera ◽

Lorenzo Onorato ◽

Federica Calò ◽

Caterina Monari ◽

Rosa Annibale ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Southern Italy ◽

Average Length ◽

Antibiotic Consumption ◽

University Hospital ◽

Fourth Generation ◽

Antimicrobial Stewardship Program ◽

Interrupted Time Series Analysis ◽

Stewardship Program ◽

The Impact

Objectives: We evaluated the effect of the pandemic on the disruption of a persuasive educational antimicrobial stewardship program (ASP) conducted in a university hospital in southern Italy. Methods: In March 2020, the ASP, which began in January 2017 and was carried out at different times in 10 wards, was stopped due to the COVID-19 pandemic. We conducted an observational study with interrupted time series analysis to compare the antibiotic consumption and costs, average length of hospital stay and in-hospital mortality between 12 months before and 9 months after the interruption. Results: Four medical, four surgical wards and two ICUs were included in the study, for a total of 35,921 patient days. Among the medical wards we observed after the interruption a significant increase in fluoroquinolone use, with a change in trend (CT) of 0.996, p = 0.027. In the surgical wards, we observed a significant increase in the overall consumption, with a change in level (CL) of 24.4, p = 0.005, and in the use of third and fourth generation cephalosporins (CL 4.7, p = 0.003). In two ICUs, we observed a significant increase in piperacillin/tazobactam and fluoroquinolone consumption (CT 9.28, p = 0.019, and 2.4, p = 0.047). In the wards with a duration of ASP less than 30 months, we observed a significant increase in antibiotic consumption in the use of piperacillin/tazobactam and fluoroquinolones (CT 12.9, p = 0.022: 4.12, p = 0.029; 1.004, p = 0.011). Conclusions: The interruption of ASP during COVID-19 led to an increase in the consumption of broad-spectrum antibiotics, particularly in surgical wards and in those with a duration of ASP less than 30 months.

Download Full-text

Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridium difficile infection and amount of antimicrobial consumed in cancer patients

10.21203/rs.2.17475/v1 ◽

2019 ◽

Author(s):

Masoud Mardani ◽

Sara Abolghasemi ◽

Shiva Shabani

Keyword(s):

Clostridium Difficile ◽

Cancer Patients ◽

Clostridium Difficile Infection ◽

Antimicrobial Stewardship ◽

Antibiotic Consumption ◽

Epidemiological Studies ◽

Blood Cultures ◽

University Hospital ◽

Stewardship Program ◽

The Impact

Abstract Objective: The objective of this study was to determine the impact of a hospital antimicrobial stewardship on antimicrobial resistant, clostridium difficile rates and amount of antimicrobial consumed in cancer patients. The intervention effects of ASP plans in 2017–2018 and 2018–2019 were respectively evaluated among hematology/oncology and bone morrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (MPM and VMN) consumption gr-year, number of positive clostridium difficile infection and multidrug resistant positive cases in blood cultures. Results: The number of MDR cases in the time periods of 2017–2018 and 2018–2019 were 145 and 75, respectively (p = 0.011). A significant reduction in positive blood cultures from 2017–2018 to 2018–2019 was found (p = 0.001).The amount of MPM prescriptions in 2018–2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms and CDI can highly promote patients’ health and decreasing medical costs and long-term defects for patients. Finally, future stewardship studies should made efforts for joining clinical and epidemiological studies.

Download Full-text

Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

10.21203/rs.2.17475/v2 ◽

2020 ◽

Author(s):

Masoud Mardani ◽

Sara Abolghasemi ◽

shiva shabani

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Consumption ◽

Multidrug Resistant ◽

Marrow Transplant ◽

Blood Cultures ◽

University Hospital ◽

Clostridioides Difficile ◽

Stewardship Program ◽

Quasi Experimental ◽

The Impact

Abstract Objective: The The impact of a hospital antimicrobial stewardship was determined on antimicrobial-resistant, Clostridioides difficile rates and the amount of antimicrobial consumed in cancer patients.The intervention effects of antimicrobial stewardship (ASP) plans in 2017–2018 and 2018–2019 were respectively evaluated among hematology/oncology and bone marrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (meropenem and vancomycin) consumption gr-year, the number of positive Clostridioides difficile infection and multidrug-resistant positive cases in blood cultures. Results: The number of MDR cases in the periods of 2017–2018 and 2018–2019 were 145 and 75, respectively (p = 0.011). A significant reduction in all positive blood cultures from 2017–2018 to 2018–2019 was found (p = 0.001). 574 patients admitted to our hospital in these periods of 2017- 2018 and 2018- 2019were assessed for MPM and VMN use. The amounts of MPM prescriptions in 2018–2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms, and CDI can highly promote patients’ health and decreasing medical costs and long-term defects for patients.

Download Full-text

Impact of removing ESBL designation from culture reports on the selection of antibiotics for the treatment of infections associated with ESBL-producing organisms

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.46 ◽

2020 ◽

Vol 41 (5) ◽

pp. 604-607 ◽

Cited By ~ 1

Author(s):

Mark D. Lesher ◽

Cory M. Hale ◽

Dona S. S. Wijetunge ◽

Matt R. England ◽

Debra S. Myers ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Prescribing ◽

The Impact ◽

Inhibitor Combination ◽

Lactamase Inhibitor ◽

Selection Of

AbstractWe characterized the impact of removal of the ESBL designation from microbiology reports on inpatient antibiotic prescribing. Definitive prescribing of carbapenems decreased from 48.4% to 16.1% (P = .01) and β-lactam–β-lactamase inhibitor combination increased from 19.4% to 61.3% (P = .002). Our findings confirm the importance of collaboration between microbiology and antimicrobial stewardship programs.

Download Full-text