The “July Effect” on Antibiotic Prescribing in the Setting of an Antimicrobial Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

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The Implementation of a Unit-Based Antimicrobial Stewardship Program Using a Consultative Approach to Improve Antibiotic Prescribing Practices

American Journal of Infection Control ◽

10.1016/j.ajic.2017.04.039 ◽

2017 ◽

Vol 45 (6) ◽

pp. S19-S20

Author(s):

Frances Edwards ◽

Jodi Galaydick ◽

Bernard Nash ◽

Michael McDonough ◽

James Parrott ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Prescribing Practices ◽

Stewardship Program

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Outcomes of an ambulatory care pharmacist-led antimicrobial stewardship program within a family medicine resident clinic

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1275 ◽

2020 ◽

pp. 1-7

Author(s):

Lindsey R. Westerhof ◽

Lisa E. Dumkow ◽

Tarajo L. Hanrahan ◽

Samantha V. McPharlin ◽

Nnaemeka E. Egwuatu

Keyword(s):

Family Medicine ◽

Ambulatory Care ◽

Antimicrobial Stewardship ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Upper Respiratory Tract ◽

Family Medicine Residency ◽

Medicine Resident ◽

Stewardship Program ◽

Tract Infections

Abstract Objective: To determine whether an ambulatory care pharmacist (AMCP)-led intervention improved outpatient antibiotic prescribing in a family medicine residency clinic (FMRC) for upper respiratory tract infections (URIs), urinary tract infections (UTIs), and skin and soft-tissue infections (SSTIs). Design: Retrospective, quasi-experimental study comparing guideline-concordant antibiotic prescribing before and after an antimicrobial stewardship program (ASP) intervention. Setting: Family medicine residency clinic affiliated with a community teaching hospital. Participants: Adult and pediatric patients prescribed antibiotics for URI, UTI, or SSTI between November 1, 2017, and April 31, 2018 (pre-ASP group), or October 1, 2018, and March 31, 2019 (ASP group), were eligible for inclusion. Methods: The health-system ASP physician and pharmacist provided live education and pocket cards to FMRC staff with local guidelines as a quick reference. Audit with feedback was delivered every other week by the clinic’s AMCP. Guideline-concordance was determined based on the institution’s outpatient ASP guidelines. Results: Overall, 525 antibiotic prescriptions were audited (pre-ASP n = 90 and ASP n = 435). Total guideline-concordant antibiotic prescribing at baseline was 38.9% (URI, 53.3%; SSTI, 16.7%; UTI, 46.7%) and improved across all 3 infection types to 57.9% (URI, 61.2%; SSTI, 57.6%; UTI, 53.5%; P = .001). Significant improvements were seen in guideline-concordant antibiotic selection (68.9% vs 80.2%; P = .018), dose (76.7% vs 86.2%; P = .023), and duration of therapy (73.3% vs 86.2%; P = .02). Conclusions: An AMCP-led outpatient ASP intervention significantly improved guideline-concordant antibiotic prescribing for common infections within a FMRC.

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Impact of an Education-Based Antimicrobial Stewardship Program on the Appropriateness of Antibiotic Prescribing: Results of a Multicenter Observational Study

Antibiotics ◽

10.3390/antibiotics10030314 ◽

2021 ◽

Vol 10 (3) ◽

pp. 314

Author(s):

Federica Calò ◽

Lorenzo Onorato ◽

Margherita Macera ◽

Giovanni Di Caprio ◽

Caterina Monari ◽

...

Keyword(s):

Observational Study ◽

Antibiotic Therapy ◽

Antimicrobial Stewardship ◽

Case Report Form ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Campania Region ◽

Multicenter Observational Study ◽

Stewardship Program ◽

Number Of Patients

To evaluate the effect that an education-based Antimicrobial stewardship program (ASP) implemented in two hospitals in southern Italy had on the quality and appropriateness of antibiotic prescription. We conducted a multicenter observational study in two hospitals in the Campania region. Only some departments of both hospitals were already participating in the ASP. We collected data on all patients admitted on the day of evaluation in antibiotic therapy or prophylaxis through a case report form. The primary outcome was to investigate the difference in the appropriateness of the antibiotic prescriptive practice in the departments that had joined the ASP and in those that had not participated in the project (non-ASP). The total number of patients assessed was 486. Of these, 78 (16.05%) were in antibiotic prophylaxis and 130 (26.7%) in antibiotic therapy. The prescriptive appropriateness was better in the units that had joined ASP than in those that had not, with respectively 65.8% versus 22.7% (p < 0.01). Patients in the non-ASP units more frequently received unnecessary antibiotics (44.9% versus 0%, p = 0.03) and, as surgical prophylaxis, the use of antibiotics not recommended by the guidelines (44.2% versus 0%, p = 0.036). Multivariable analysis of the factors associated with prescriptive appropriateness identified ASP units (p = 0.02) and bloodstream or cardiovascular infections (p = 0.03) as independent predictors of better prescriptive appropriateness. The findings of the present study reinforce the importance of adopting an educational ASP to improve the quality of antimicrobial prescription in clinical practice.

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To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center

International Journal of Research Foundation of Hospital and Health Care Administration ◽

10.5005/jp-journals-10035-1031 ◽

2015 ◽

Vol 3 (1) ◽

pp. 13-24

Author(s):

YK Gupta ◽

Shakti Kumar Gupta ◽

Madhav Madhusudan Singh ◽

DK Sharma ◽

Aarti Kapil

Keyword(s):

Antimicrobial Resistance ◽

Antimicrobial Stewardship ◽

Antibiotic Stewardship ◽

Tertiary Care ◽

Antibiotic Prescribing ◽

Antimicrobial Stewardship Program ◽

Prescribing Practices ◽

Care Teaching ◽

Stewardship Program ◽

Large Tertiary Care

ABSTRACT Introduction As antimicrobial resistance continues to increase and new antimicrobial development stagnates, antimicrobial stewardship programs are being implemented worldwide. The goal of antimicrobial stewardship is to optimize antimicrobial therapy with maximal impact on subsequent development of resistance. Thirty to fifty percent of hospitalized patients receive antimicrobial therapy. Previous data suggest that inappropriate use results in higher mortality rates, longer lengths of stay, and increased medical costs. Antimicrobial stewardship programs (ASPs) reduce the improper use of antimicrobials and improve patient safety. Despite increased awareness about the benefits of these programs, few medical and surgical ASPs exist and fewer comprehensive studies evaluate their effects. Aim To study the antimicrobial stewardship program in a large tertiary care teaching center. Objectives • To study the antibiotic prescribing practices in a tertiary care government hospital • To compare the antibiotic prescribing practices with the standard guidelines available with the hospital • To make recommendation if any for rational use of antibiotics. Materials and methods • Review of literature • Prospective study of 15 days in selected general medicine and general surgery ward in which 5 to 6 reading will be taken in to know the antibiotic prescribed to patients. • Retrospective study of 15 days for study of patient records to know the antibiotic prescribed to patients. • Interaction with faculty and senior residents of general medicine and surgery to know about the pattern of infection and antibiotic prescription. • Interaction with microbiology department and their faculty to know the microbial resistance pattern and possible suggestion which need to be incorporated in antibiotic Stewardship program. Results The present study on antibiotic prescribing practices was undertaken in a super specialty hospital at New Delhi. A sample size of 100 case records was considered. There is no such stewardship program in tertiary care hospital, although it was demanded in various forum and meetings. There are no recommendations available either for patients of renal failure or other such compromised metabolic or immune states in the form of written antibiotic stewardship program of the hospital. The appropriateness of antibiotics prescribed in the case records was examined in light of the antibiotic stewardship program of the hospital. It was found that the overall adherence to antibiotic stewardship program was nil as no existing antibiotic stewardship program is exiting in this hospital. Gautum Dey in a study conducted at this hospital in New Delhi found that in 40.7% preoperative cases and 60.3% postoperative cases two or more than two antibiotics were given. The author has also commented that there was no evidence of adhering to antibiotic stewardship program or utilising culture and sensitivity reports to guide the therapy. The data obtained from the present study on further analysis has shown that in seven cases, the antibiotics prescribed were inadequate in terms of dose and duration. Thus resulting in an apparently lower cost of treatment than what was recommended by the antibiotic stewardship program of the hospital. Although such inappropriate prescription results in increased chances of antibiotic resistance, the immediate or short-term effects are not very conclusive. It is observed that there were 26 (26%) cases in medical and 12 (12%) cases in surgery disciplines in which the initial and final diagnosis was different. Uncertainty about the final diagnosis promotes empirical prescribing practices. Conclusion Antimicrobial stewards are a prominent part of local and national efforts to contain and reverse antimicrobial resistance. A range of intervention options is available with varying levels of resources and can yield substantial improvements in morbidity, mortality, quality of care, and cost. The cost of delivering such programs is dwarfed by the benefits and provides an opportunity for hospital epidemiologists to garner support. This suggests that antimicrobial management programs belong to the rarefied group of truly cost saving quality improvement initiatives. Considering the enormous implications of antibiotic resistance, it is necessary that we act in haste, lest our wonder drugs and magic bullets become ineffectual. Future systems promise greater integration and analysis of data, facilitated delivery of information to the clinician, and rapid and expert decision support that will optimize patient outcomes while minimizing antimicrobial resistance. They may also offer our best hope for avoiding an ‘Antibiotic armageddon’. In addition, the ASP plays an integral role in providing guidance to clinicians and ensures that the appropriate antimicrobial agents are used. How to cite this article Singh MM, Gupta SK, Gupta YK, Sharma DK, Kapil A. To Study the Antimicrobial Stewardship Program in a Large Tertiary Care Teaching Center. Int J Res Foundation Hosp Healthc Adm 2015;3(1):13-24.

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IMPLEMENTING AN ANTIMICROBIAL STEWARDSHIP PROGRAM IN A TERTIARY UNIVERSITY PEDIATRIC HOSPITAL IN SPAIN

10.26226/morressier.58fa1764d462b80290b509f8 ◽

2017 ◽

Author(s):

Maria Fernanda Guzman Monagas

Keyword(s):

Antimicrobial Stewardship ◽

Antimicrobial Stewardship Program ◽

Pediatric Hospital ◽

Stewardship Program

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Sustainability Failure in the Antimicrobial Stewardship Program in a Secondary Care Hospital from Cuba: A Historical Review of 30 Years and 3 Shots

Anti-Infective Agents ◽

10.2174/2211352518999200706014401 ◽

2020 ◽

Vol 18 ◽

Author(s):

Humberto Guanche Garcell ◽

Juan José Pisonero Socias ◽

Gilberto Pardo Gómez

Keyword(s):

Antimicrobial Stewardship ◽

Historical Review ◽

Original Data ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Continuous Quality ◽

Stewardship Program ◽

History Of ◽

Health Organization

Background: During the last 30 years an antimicrobial stewardship program (ASP) was implemented in a facility with periods of weakness. We aim to describe the history of the sustainability failure in the local ASP. Methods: A historical review was conducted using original data from the facility library and papers published. An analysis of factors related to the failure was conducted based on the Doyle approach. Results: The first ASP was implemented from 1989 to 1996 based on the international experiences and contributes to the improvement in the quality of prescription, reduction of 52% in cost and in the incidence of nosocomial infection. The second program restarts in 2008 and decline in 2015, while the third program was guided by the Pan-American Health Organization from 2019. This program, in progress, is more comprehensive than previous ones and introduced as a novel measure the monitoring of antibiotic prophylaxis in surgery. The factors related to the sustainability were considered including the availability of antimicrobials, the leader´s support, safety culture, and infrastructure. Conclusions: The history behind thirty years of experiences in antimicrobial stewardship programs has allowed us to identify the gaps that require proactive strategies and actions to achieve sustainability and continuous quality improvement.

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