scholarly journals 43. Impact of a Five-Year Intervention of an Antimicrobial Stewardship Program on the Optimal Antibiotic Prophylaxis Selection in Surgery in a Hospital without Restrictions on Antibiotics Prescription in Costa Rica

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S143-S143
Author(s):  
José P Díaz-Madriz ◽  
Esteban Zavaleta-Monestel ◽  
Jorge A Villalobos-Madriz ◽  
Alison V Meléndez-Alfaro ◽  
Priscilla Castrillo-Portillo ◽  
...  
Keyword(s):  
Antibiotic Prophylaxis ◽  
Antimicrobial Stewardship ◽  
Bacterial Resistance ◽  
Positive Impact ◽  
Surgical Site Infections ◽  
Antimicrobial Stewardship Program ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Impact ◽  
Selection Of

Abstract Background In a private hospital without restrictions on antibiotic prescription, the success of an Antimicrobial Stewardship Program (ASP) depends mainly on prospective feedback and education. Previously, the ASP of this hospital (PROA-HCB) managed to achieve a positive impact on the antibiotic prophylaxis in cesarean delivery. The purpose of this study is to characterize the impact after implementing the PROA-HCB on the optimal prophylaxis selection of all the procedures included in the clinical guideline for surgical antibiotic prophylaxis in adult patients. Methods A retrospective observational study that compares the selection, duration, antibiotic consumption, bacterial resistance profiles and patient’s safety outcomes regarding antibiotic use for all surgical prophylaxis prescription over six months for the periods before (pre-ASP) and after a five-year intervention of PROA-HCB (post-ASP). Results After a five-year intervention, the percentage of optimal selection of antibiotic prophylaxis in Surgery was 21.0% (N=1598) in the pre-ASP period and 80.0% (N=841) in the post-ASP period (59% absolute improvement, p < 0.001). Percentage of optimal duration was 69,1% (N=1598) in the pre-ASP period and 78.0% (N=841) in the post-ASP period (8.9% absolute improvement, p < 0.001). Mean ceftriaxone utilization was 217.7 defined daily doses (DDD) per 1,000 patient days DDD for the pre-ASP period and 139.8 DDD per 1,000 patient days for the ASP period (35.8% decrease; p = 0.019). Mean cefazolin utilization was 14.9 DDD per 1,000 patient days for the pre-ASP period and 153.3 DDD per 1,000 patient days for the ASP period (928.6% increase; p = 0.021). Regarding percentage of bacterial resistance, there was detected an improvement in some isolates like Escherichia coli with a decrease of ESBL detection (11% decrease; p = 0.007). In addition, no serious adverse reactions or an increase in surgical site infections were detected after the intervention. Conclusion The implementation of an ASP in the surgical ward showed an overall positive impact on selection and duration of antibiotic prophylaxis. Furthermore, this intervention could have had a positive impact on antimicrobial resistance and at the same time had no negative effects on the patients. Disclosures All Authors: No reported disclosures

scholarly journals Impact of a pharmacist-driven antimicrobial stewardship program in a private hospital in Costa Rica

2020 ◽  
Vol 44 ◽  
pp. 1
Author(s):  
José Pablo Díaz-Madriz ◽  
Eugenia Cordero-García ◽  
José Miguel Chaverri-Fernández ◽  
Esteban Zavaleta-Monestel ◽  
Josué Murillo-Cubero ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Private Hospital ◽  
Bacterial Resistance ◽  
Defined Daily Dose ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Daily Dose ◽  
Resistance Patterns ◽  
The Impact

Objective. To measure the impact generated by the implementation of the pharmacy-driven antimicrobial stewardship program of the Clínica Bíblica Hospital. Methods. This is a retrospective observational study that evaluates the consumption of antibiotics for the periods before and during implementation of the Clínica Bíblica Hospital antimicrobial stewardship program, calculated by means of defined daily dose per 1 000 patient-days and days of therapy per 1 000 patient-days. In addition, bacterial resistance patterns for the periods 2014–2015 and 2016–2017 were compared. Results. Consumption of most-used antibiotics was calculated, looking for trends that might be associated with the activities implemented by the Clínica Bíblica Hospital antimicrobial stewardship program. Comparing some of the antibiotics with the highest consumption in periods I and II, use of levofloxacin and ceftriaxone showed a decrease of 54.0% (p < 0.001) and 14.6% (p = 0.003), respectively, whereas there was an increase in the use of cefazolin of 4 539.3% (p < 0.001). Regarding percentage of bacterial resistance, in most bacterial isolates no statistically significant changes were observed between the two periods. Conclusions. A reduction in the overall consumption of antibiotics has been achieved over time, most likely attributable to the antimicrobial stewardship program. However, this trend was not observed for all the antibiotics studied. The pattern of resistance among the commonly isolated microorganisms did not vary greatly between the periods studied, which suggests that either the antimicrobial stewardship program may have prevented an increase in bacterial resistance since its implementation, or that it is too soon to see impact on bacterial resistance.

scholarly journals Second-year Outcomes of Implementing Antimicrobial Stewardship Program in a Tertiary Pediatric Hospital

2021 ◽  
Vol 14 (8) ◽  
Author(s):  
Iman Khorshidi-Malahmadi ◽  
Setareh Sima ◽  
Najmeh Ansari ◽  
Azadeh Moghaddas
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
T Test ◽  
Antimicrobial Stewardship Program ◽  
Pediatric Hospital ◽  
Hospital Data ◽  
Post Intervention ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
The Impact

Background: The increasing use of antimicrobial agents and resistance is becoming a serious problem in pediatric patients. Hence, antimicrobial stewardship program (ASP) is implemented to lessen the consequences. Objectives: This report aimed to demonstrate the impact of ASP on antimicrobials utilization in a referral and tertiary pediatric hospital in Isfahan, Iran. Methods: We launched an ASP for inpatients in March 2018 at the Imam Hussain Hospital, which is a 186-bed pediatrics hospital. Data was collected by ASP multidisciplinary team and using hospital records during February 2017-January 2018 (pre-intervention) and February 2019-January 2020 (post-intervention) periods. Consumption data were expressed as defined daily doses (DDDs) per 100 patient-days (PD). Independent sample t-test and paired t-test were used to assess the significance of differences. The rates of antimicrobials resistance for the most common hospital pathogens were also tracked. Results: Utilization of total antimicrobials decreased meaningfully by 12.41% (from 62.11 DDDs/100 PD in February 2017-January 2018 to 54.40 DDDs/100 PD in February 2019-January 2020; P = 0.024). The results showed that the reduction in non-restricted antimicrobials was less (5.43%) than restricted antimicrobials (27.6%). Conclusions: According to our results, the use of antimicrobials, especially the broad-spectrum ones, and the health burden costs significantly decreased after implementing ASP. Thus, continuous monitoring and educational programs are recommended to reduce the negative effects of using antimicrobials.

scholarly journals An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia

2021 ◽  
Author(s):  
Christopher A. Okeahialam ◽  
Ali A. Rabaan ◽  
Albert Bolhuis
Keyword(s):  
Patient Outcome ◽  
Saudi Arabia ◽  
Antimicrobial Stewardship ◽  
Laboratory Data ◽  
Hospitalized Patients ◽  
Antimicrobial Stewardship Program ◽  
Repeated Testing ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Impact

AbstractBackgroundAntimicrobial stewardship has been associated with a reduction in the incidence of health care associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognized in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalized patients may offer an alternative metric for these settings, but its utlity remains largely untested.Aim/ObjectiveTo examine the impact of an antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalized patients presenting with diarrhoeaMethodsA 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programResultThere was a significant decline in the rate of toxigenic C difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship program, and a reversal of a rising trend.DiscussionThe rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is however dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.

Development of an antimicrobial stewardship program in an integrated healthcare system

2018 ◽  
Vol 76 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Michael A Lane ◽  
Amanda J Hays ◽  
Helen Newland ◽  
Jeanne E Zack ◽  
Rebecca M Guth ◽  
...  
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Gap Analysis ◽  
System Level ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Integrated Healthcare ◽  
Stewardship Program ◽  
Regulatory Mandates ◽  
The Impact

Abstract Purpose The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. Summary With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4–8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. Conclusion BJC’s ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.

scholarly journals 2025. Evaluation of the Impact of an Antimicrobial Stewardship Program in a Tertiary Hospital in Northern Italy: Efficacy of a Persuasive Approach on Antibiotics Consumption and Rate of Clostridium difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S679-S680
Author(s):  
Erika Chiari ◽  
Davide Mangioni ◽  
Ester Pollastri ◽  
Liana Signorini ◽  
Giovanni Moioli ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Epidemiological Data ◽  
Tertiary Hospital ◽  
Northern Italy ◽  
Stewardship Program ◽  
Bed Days ◽  
The Impact

Abstract Background Antimicrobial resistance (AMR) situation in Italian hospitals and regions represents a major public health threat [ECDC, 2017]. Antimicrobial stewardship programs (ASPs), particularly when based on local epidemiology, have been beneficial in optimizing antibiotic therapy as well as reducing hospital rates of Clostridium difficile infection (CDI) and AMR [Akpan MR, Antibiotics 2016].. Methods Our ASP program has been conducted at Spedali Civili General Hospital of Brescia, Northern Italy (1300-bed tertiary hospital), between the beginning of 2016 and the end of 2017. A preliminary analysis of local epidemiological data was performed (Table 1). Seven groups (“districts”) were identified according to microbiological and clinical similarities. This was a persuasive-based ASP. First, we trained physicians on general principles of AS, then guidelines for the management of “difficult-to-handle” infections were drafted based on international guidelines and local microbiological data (Table 2).. Results Here we show the results of pre-ASP (2015) vs. post-ASP (2018) analysis on antibiotic consumption (AC) and CDI rates. AC is expressed in DDD/100 bed-days. The overall hospital AC decreased from 84.31 to 76.84 (−9%), consistently with national recommendations [Italian National Plan against AMR, 2017]. In accordance with the local guidelines developed within our ASP, carbapenem consumption decreased from 5.77 to 4.87 (−16%) and fluoroquinolones (FLQ) from 14.45 to 9.94 (−31%). At the same time piperacillin/tazobactam use increased from 5.53 to 8.46 (53%). 3°–4°G cephalosporins and glycopeptides consumption slightly reduced from 11.78 to 11.42 (−3%) and from 4.07 to 3.83 (−6%), respectively. AC of the different districts involved is reported in Table 3. CDI rates decreased from 0.0434/100 bed-days in 2015 to 0.0315/100 bed-days in 2018 (−27%) (Figure 1). Conclusion Our ASP was a persuasive-based program in a setting of high AMR rates. In the short term, it has shown a positive impact in improving AC (in particular of broad-spectrum antibiotics with a high risk of resistance selection and CDI) and CDI rates. Audits for local guidelines adherence and the evaluation of AC, AMR and CDI rates are ongoing as long-term quality measures for assessing the impact of our ASP. Disclosures All authors: No reported disclosures.

scholarly journals 63. Impact of Infectious Disease Fellow-Driven Antimicrobial Stewardship Interventions on Inpatient Fluoroquinolone Use

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S150-S150
Author(s):  
Carlos M Nunez ◽  
Arun Mattappallil ◽  
Katie A McCrink ◽  
Debbie Rybak ◽  
Basil Taha ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Phase 1 ◽  
Clinical Indication ◽  
Phase 2 ◽  
Intervention Phase ◽  
Stewardship Program ◽  
Wide Range ◽  
The Impact

Abstract Background Fluoroquinolone (FQ) antibiotics are frequently used in hospitalized patients to treat a wide range of infections but are often misused and implicated in antibiotic-associated adverse events. The purpose of this study is to evaluate the impact of Infectious Disease fellow (IDF)-driven antimicrobial stewardship program (ASP) interventions on inpatient FQ use. Methods This is a retrospective study of all admitted patients who received a FQ for greater than 48 hours from 01/01/2019 -12/31/2020 in an urban academic center. “Phase 1” (pre-intervention phase) covered 01/1/2019- 03/31/2019. “Phase 2” (intervention phase) covered 03/03/2020- 12/23/2020. In “Phase 2”, our ASP reviewed FQ use 2-3 days per week and an IDF provided feedback interventions that averaged 30-60 minutes of IDF time spent per day. We categorized FQ use as either: “appropriate”, “appropriate but not preferred”, or “inappropriate”, as determined by local clinical guidelines and ASP team opinion. We compared FQ use in both phases, indications for FQ use, and new Clostridioides difficile infections (CDI). Results A total of 386 patients are included (76 in “Phase 1”and 310 in “Phase 2”). Patient characteristics are similar (Table 1). Overall, 63 % of FQ use was empiric, and 50% FQ use was deemed “appropriate”, 28% “appropriate but not preferred”, and 22% “inappropriate”. In “Phase 2”, 126 interventions were conducted, with 86% of these accepted. Appropriate FQ use increased significantly in “Phase 2” vs. “Phase 1” (53.5% vs 35.5%, p = 0.008), with decrease in mean days of FQ use (4.38 days vs 5.87 days, p =.021). Table 2 shows “appropriate” FQ use by clinical indication. New CDIs occurred more in “Phase 1” vs. “Phase 2” (6.6% vs 0.6%, p=.001). Conclusion An IDF-driven ASP intervention has a positive impact on appropriate inpatient use of FQs in our hospital. This highlights a promising ASP model which not only improves appropriate use of FQ, but also offers an opportunity for IDF mentorship and use of available resources to promote ASPs. Disclosures Katie A. McCrink, PharmD, ViiV Healthcare (Employee)

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