scholarly journals Antimicrobial Stewardship Challenges in the Deployed Setting

2019 ◽  
Vol 185 (5-6) ◽  
pp. e818-e824
Author(s):  
Alice E Barsoumian ◽  
Amanda L Roth ◽  
Steffanie L Solberg ◽  
Ashley S Hanhurst ◽  
Tamara S Funari ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Prophylaxis ◽  
Trauma System ◽  
Multidrug Resistant ◽  
National Guidelines ◽  
Survey Tool ◽  
Stewardship Program ◽  
Multidrug Resistant Organisms ◽  
Treatment Facilities

Abstract Introduction Up to 34% of combat trauma injuries are complicated by infection with multidrug-resistant organisms. Overutilization of antibiotics has been linked to increased multidrug-resistant organisms in combat-injured patients. Antimicrobial stewardship efforts at deployed medical treatment facilities have been intermittently reported; however; a comprehensive assessment of antimicrobial stewardship practices has not been performed. Materials and Methods A survey tool was modified to include detailed questions on antimicrobial stewardship practices at medical treatment facilities. A Joint Service, multidisciplinary team conducted on-site assessments and interviews to assess the status of antimicrobial stewardship best practices, with particular emphasis on antibiotic prophylaxis in combat injured, in the U.S. Central Command operational theaters. Limitations to implementing stewardship to the national standards were explored thematically. Results Nine Role 1, 2, and 3 medical facilities representing the range of care were assessed on-site. A total of 67% of the sites reported a formal antimicrobial stewardship program and 56% of the sites had an assigned head of antimicrobial stewardship. No military personnel in theater received training on antimicrobial stewardship and laboratory assets were limited. Personnel at these sites largely had access to Joint Trauma System guidelines describing antimicrobial prophylaxis for combat injured (89%), yet infrequently received feedback on their implementation and adherence to these guidelines (11%). Conclusions Antimicrobial stewardship programs in theater are in the early stages of development in theater. Areas identified for improvement are access to expertise, development of a focus on high-impact lines of effort, laboratory support, and the culture of antimicrobial prescribing. Risks can be mitigated through theater level formalization of efforts, expert mentoring through telehealth, and a focus on implementation and adherence and feedback to national guidelines.

scholarly journals Status Update on Infection Prevention and Control at Deployed Medical Treatment Facilities

2019 ◽  
Vol 185 (3-4) ◽  
pp. 451-460
Author(s):  
Alice E Barsoumian ◽  
Steffanie L Solberg ◽  
Ashley S Hanhurst ◽  
Amanda L Roth ◽  
Tamara S Funari ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Prevention And Control ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Infection Prevention And Control ◽  
Targeted Interventions ◽  
Multidrug Resistant Organisms ◽  
Treatment Facilities ◽  
Healthcare Associated ◽  
And Control

Abstract Introduction Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility. Materials and Methods A Joint Service team conducted onsite IPC reviews of MTFs in the U.S. Central Command area of operations. Self-assessments were completed by MTF personnel in anticipation of the onsite assessment, and feedback was given individually and at monthly IPC working group teleconferences. Goals of the onsite review were to assist MTF teams in conducting assessments, review practices for challenges and successes, provide on the spot education or risk mitigation, and identify common trends requiring system-wide action. Results Nine deployed MTFs participated in the onsite assessments, including four Role 3, three Role 2 capable of surgical support, and two Role 1 facilities. Seventy-eight percent of sites had assigned IPC officers although only 43% underwent required predeployment training. Hand hygiene and healthcare associated infection prevention bundles were monitored at 67% and 29% of MTFs, respectively. Several challenges including variability in practices with turnover of deployed teams were noted. Successes highlighted included individual team improvements in healthcare associated infections and mentorship of untrained personnel. Conclusions Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover.

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.

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.

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.

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.

Effects of an automatic discontinuation of antibiotics policy: A novel approach to antimicrobial stewardship

2019 ◽  
Vol 76 (Supplement_3) ◽  
pp. S85-S90 ◽  
Author(s):  
Bailey C Bolten ◽  
J Lacie Bradford ◽  
Brittany N White ◽  
Gregory W Heath ◽  
James M Sizemore ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Antibiotic Usage ◽  
Duration Of Therapy ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Before And After ◽  
The Mean

Abstract Purpose A novel automatic discontinuation policy implemented within an antimicrobial stewardship program (ASP) is described, and results of an evaluation of the policy’s effects on antibiotic usage are reported. Methods A retrospective, before-and-after study was conducted at an 800-bed, tertiary care, academic teaching hospital to evaluate selected antibiotic usage outcomes in both intensive care unit (ICU) and non-ICU adult patients targeted for ASP interventions before and after implementation of an automatic discontinuation of antibiotics policy (ADAP) authorizing the ASP team to automatically halt antibiotic therapy in cases involving inappropriate duplicate antimicrobial coverage or excess duration of therapy. The primary outcome was total days of antibiotic therapy. Secondary outcomes included excess days of therapy and rates of 30-day readmission, Clostridioides difficile infection, and multidrug-resistant infection. Results There were no statistically significant differences in group demographics or clinical characteristics. The most common indication for antibiotics was hospital-acquired pneumonia, and the most common reason for ASP intervention was excess duration of therapy. The mean total number of antibiotic days per patient was reduced from 7.6 days in the pre-ADAP group to 6.6 days in the post-ADAP group (p < 0.05). The mean number of excess days of antibiotics was similarly reduced, from 2.3 days to 1.5 days, after implementation of the ADAP (p < 0.05). Conclusion Adoption of an ADAP—a more active approach to ASP interventions—was effective in reducing overall antibiotic usage and improving the efficiency of the ASP.

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

2020 ◽  
Vol 13 (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.

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