scholarly journals A Pathway for Community-Acquired Pneumonia With Rapid Conversion to Oral Therapy Improves Health Care Value

2020 ◽  
Vol 7 (11) ◽  
Author(s):  
Claire E Ciarkowski ◽  
Tristan T Timbrook ◽  
Polina V Kukhareva ◽  
Karli M Edholm ◽  
Nathan D Hatton ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antimicrobial Stewardship ◽  
Academic Medical Center ◽  
Community Acquired Pneumonia ◽  
Phase 2 ◽  
Intravenous Antibiotic ◽  
Phase 3 ◽  
Baseline Phase ◽  
Intravenous Antibiotic Therapy ◽  
The Impact

Abstract Background Evidence supports streamlined approaches for inpatients with community-acquired pneumonia (CAP) including early transition to oral antibiotics and shorter therapy. Uptake of these approaches is variable, and the best approaches to local implementation of infection-specific guidelines are unknown. Our objective was to evaluate the impact of a clinical decision support (CDS) tool linked with a clinical pathway on CAP care. Methods This is a retrospective, observational pre–post intervention study of inpatients with pneumonia admitted to a single academic medical center. Interventions were introduced in 3 sequential 6-month phases; Phase 1: education alone; Phase 2: education and a CDS-driven CAP pathway coupled with active antimicrobial stewardship and provider feedback; and Phase 3: education and a CDS-driven CAP pathway without active stewardship. The 12 months preceding the intervention were used as a baseline. Primary outcomes were length of intravenous antibiotic therapy and total length of antibiotic therapy. Clinical, process, and cost outcomes were also measured. Results The study included 1021 visits. Phase 2 was associated with significantly lower length of intravenous and total antibiotic therapy, higher procalcitonin lab utilization, and a 20% cost reduction compared with baseline. Phase 3 was associated with significantly lower length of intravenous antibiotic therapy and higher procalcitonin lab utilization compared with baseline. Conclusions A CDS-driven CAP pathway supplemented by active antimicrobial stewardship review led to the most robust improvements in antibiotic use and decreased costs with similar clinical outcomes.

scholarly journals Eight-Year Experience of Antimicrobial Stewardship Program and the Trend of Carbapenem Use at a Tertiary Acute-Care Hospital in Japan—The Impact of Postprescription Review and Feedback

2019 ◽  
Vol 6 (10) ◽  
Author(s):  
Tsubasa Akazawa ◽  
Yoshiki Kusama ◽  
Haruhisa Fukuda ◽  
Kayoko Hayakawa ◽  
Satoshi Kutsuna ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Phase 1 ◽  
Cost Savings ◽  
Care Hospital ◽  
Antimicrobial Stewardship Program ◽  
Phase 2 ◽  
Phase 3 ◽  
Car Use ◽  
Stewardship Program ◽  
The Impact

Abstract Objective We implemented a stepwise antimicrobial stewardship program (ASP). This study evaluated the effect of each intervention and the overall economic impact on carbapenem (CAR) use. Method Carbapenem days of therapy (CAR-DOT) were calculated to assess the effect of each intervention, and antipseudomonal DOT were calculated to assess changes in use of broad-spectrum antibiotics. We carried out segmented regression analysis of studies with interrupted time series for 3 periods: Phase 1 (infectious disease [ID] consultation service only), Phase 2 (adding monitoring and e-mail feedback), and Phase 3 (adding postprescription review and feedback [PPRF] led by ID specialist doctors and pharmacists). We also estimated cost savings over the study period due to decreased CAR use. Results The median monthly CAR-DOT, per month per 100 patient-days, during Phase 1, Phase 2, and Phase 3 was 5.46, 3.69, and 2.78, respectively. The CAR-DOT decreased significantly immediately after the start of Phase 2, but a major decrease was not observed during this period. Although the immediate change was not apparent after Phase 3 started, CAR-DOT decreased significantly over this period. Furthermore, the monthly DOT of 3 alternative antipseudomonal agents also decreased significantly over the study period, but the incidence of antimicrobial resistance did not decrease. Cost savings over the study period, due to decreased CAR use, was estimated to be US $150 000. Conclusions Adding PPRF on the conventional ASP may accelerate antimicrobial stewardship. Our CAR stewardship program has had positive results, and implementation is ongoing.

Clinical and Economic Consequences of Failure of Initial Antibiotic Therapy for Hospitalized Patients With Complicated Skin and Skin-Structure Infections

2008 ◽  
Vol 29 (2) ◽  
pp. 160-169 ◽  
Author(s):  
John Edelsberg ◽  
Ariel Berger ◽  
David J. Weber ◽  
Rajiv Mallick ◽  
Andreas Kuznik ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Failure ◽  
Intravenous Antibiotic ◽  
Skin Structure ◽  
Intravenous Antibiotic Therapy ◽  
Initial Antibiotic Therapy ◽  
Intravenous Antibiotics ◽  
Complicated Skin ◽  
Hospital Days ◽  
The Impact

Objective.To estimate the consequences of failure of initial antibiotic therapy for patients with complicated skin and skin-structure infections.Design.Retrospective cohort study.Setting.Large US multihospital database.Patients.We identified a total of 47,219 patients (age 18 years or older) who were admitted to the hospital for complicated skin and skin-structure infections from April 1, 2003, through March 31, 2004, and who received intravenous antibiotics during the first 2 hospital-days (ie, initial antibiotic therapy). Failure of therapy was defined as drainage, debridement, or receipt of other intravenous antibiotics at any subsequent time (except for changes to narrower-spectrum agents or any therapy change immediately before discharge). Predictors of failure of antibiotic therapy and mortality were examined using multivariate logistic regression. Analysis of covariance was used to estimate the impact of treatment failure on duration of intravenous antibiotic therapy, length of stay, and total inpatient charges.Results.For 10,782 admitted patients (22.8%), there was evidence of failure of initial antibiotic therapy. In multivariate analyses, treatment failure was associated with receipt of vasoactive medications during the first 2 hospital-days (odds ratio [OR], 1.66 [95% confidence interval {CI}, 1.19-2.31]), initiation of antibiotic therapy in the intensive care unit (OR, 1.53 [95% CI, 1.28-1.84]), and the patient's Charlson comorbidity index (OR per 1-point increase, 1.06 [95% CI, 1.04-1.08]); treatment failure was also was associated with a 3-fold increase in mortality (OR, 2.91 [95% CI, 2.34-3.62]). Compared with patients for whom initial treatment was successful, patients who experienced treatment failure received intravenous antibiotic therapy for a mean of 5.7 additional days, were hospitalized for a mean of 5.4 additional days, and incurred a mean of $5,285 (in 2003 dollars) in additional inpatient charges (all P <.01).Conclusion.Failure of initial antibiotic therapy in the treatment of complicated skin and skin-structure infections is associated with significantly worse clinical and economic outcomes.

Impact of ambulatory intravenous antibiotic therapy for children with pre-septal cellulitis

2010 ◽  
Vol 27 (Suppl 1) ◽  
pp. A9.2-A9
Author(s):  
Rossa Brugha
Keyword(s):  
Antibiotic Therapy ◽  
Health Economy ◽  
Study Group ◽  
Intravenous Antibiotic ◽  
Preseptal Cellulitis ◽  
Intravenous Antibiotic Therapy ◽  
Retrospective Audit ◽  
Intravenous Antibiotics ◽  
Significant Difference ◽  
The Impact

AimTo assess the impact of ambulatory intravenous antibiotic therapy for children with preseptal cellulitis.DesignRetrospective audit of 62 patients presenting with preseptal cellulitis over a 12 month period.SettingPaediatric Emergency Department, Chelsea and Westminster Hospital, London.Results62 patients identified from discharge summary coding. On review of medical notes 59 patients fulfilled criteria for preseptal cellulitis. Patients were attributed a modified severity score out of seven, based on signs and symptoms as previously1 19 patients (32%) were discharged home on oral antibiotics, one patient (2%) on topical therapy only, and 39 patients (66%) were started on intravenous antibiotics. There was a significant difference in symptom score between children started on oral versus intravenous antibiotic therapy (2.47 vs 3.21, p=0.021). Of the patients started on intravenous antibiotics, 22 children (56%) were managed on an ambulatory basis and 17 children (44%) were admitted. The management guideline allowed for ambulatory care, provided specified clinical factors were not present. The mean duration of antibiotic therapy was not different between the two groups (2.90 vs 2.75 days, p=0.79). Only three children in the study required imaging and there were no intracranial complications in either group. On a crude cost benefit analysis, the net fiscal benefit of a 3 day course of ambulatory versus inpatient intravenous therapy was calculated as £1672 per patient. For the study group, this represented a saving to the commissioning Trust of £36 784.ConclusionsIn this study group, children requiring intravenous antibiotics for uncomplicated preseptal cellulitis were safely managed on an ambulatory basis. This conveyed a considerable financial benefit to the health economy, in addition to a reduction in the burden of hospitalisation placed upon children and their families.

Home intravenous antibiotic therapy

1993 ◽  
Vol 94 (1) ◽  
pp. 114 ◽  
Author(s):  
David T. Durack ◽  
A.W. Karchmer ◽  
Ralph Blair ◽  
auWalter Wilson ◽  
William Dismukes ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy

Management of complicated shunt infections: a clinical report

2008 ◽  
Vol 1 (3) ◽  
pp. 223-228 ◽  
Author(s):  
Hector E. James ◽  
John S. Bradley
Keyword(s):  
Antibiotic Therapy ◽  
Treatment Protocol ◽  
Shunt Infection ◽  
The Body ◽  
Clinical Report ◽  
Intravenous Antibiotic ◽  
Once Daily ◽  
Intravenous Antibiotic Therapy ◽  
Shunt Infections

Object The authors present their experience with a protocol for the treatment of patients with complicated shunt infections. Methods Complicated shunt infections are defined for the purpose of this protocol as multiple compartment hydrocephalus, multiple organism shunt infection, severe peritonitis, or infections in other sites of the body. The initial treatment protocol for these patients was 3 weeks of intravenous antibiotic therapy and 2 weeks of twice daily intraventricular/intrashunt antibiotic therapy. Cerebrospinal fluid (CSF) cultures were monitored during therapy and obtained again 48 hours after completion. The shunt was completely replaced. Additionally, follow-up cultures were obtained in all patients 3–6 months after therapy was completed. Results A cure of the infection was achieved in all patients as defined by negative cultures obtained at completion of antibiotic therapy and in follow-up studies. The follow-up period was 2–11 years (mean 4.4 ± 2.5 years). The treatment protocol was modified in the patients treated after 1991, and 18 patients were treated with this modified treatment regime. In these patients, intraventricular antibiotics were administered only once daily for 14 days, and the CSF was cultured 24 hours after antibiotic therapy had been stopped instead of after 48 hours. The results were similar to those obtained with the initial protocol. Conclusions Based on their prospective nonrandomized series, the authors believe that patients with complicated shunt infections can be successfully treated with 2 weeks of intraventricular antibiotic therapy administered once daily, concurrent with 3 weeks of intravenous antibiotic therapy. This protocol reduces length of treatment and hospital stay, and avoids recurrence of infection.

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