scholarly journals Combined influence of practice guidelines and prospective audit and feedback stewardship on antimicrobial treatment of community-acquired pneumonia and empyema in children: 2012 to 2016

2020 ◽  
Author(s):  
Nicole M A Le Saux ◽  
Jennifer Bowes ◽  
Isabelle Viel-Thériault ◽  
Nisha Thampi ◽  
Julie Blackburn ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Empiric Therapy ◽  
Community Acquired Pneumonia ◽  
Antimicrobial Treatment ◽  
Audit And Feedback ◽  
Third Generation ◽  
Prospective Audit ◽  
Stewardship Program ◽  
Prospective Audit And Feedback ◽  
Third Generation Cephalosporins

Abstract Background Aminopenicillins are recommended empiric therapy for community-acquired pneumonia (CAP). The aim of the study was to assess treatment over a 5-year period after CAP guideline publication and introduction of an antimicrobial stewardship program (ASP). Methods Using ICD-10 discharge codes for pneumonia, children less than 18 years admitted to the Children’s Hospital of Eastern Ontario January 1, 2012 and December 31, 2016 were identified. Children ≥ 2 months with consolidation were included. One day of therapy (DOT) was one or more doses of an antimicrobial given for 1 day. Results Of 1,707 patients identified, 713 met inclusion criteria. Eighteen (2.5%) had bacteria identified by culture and 79 of 265 (29.8%) had Mycoplasma pneumoniae detected. Mean DOT/1,000 patient days of aminopenicillins/penicillin (AAP) increased by 18.1% per year (95% confidence interval [CI] −0.2, 39.9%) and decreased by 37.6% per year (95% CI −56.1, −11.3%) for second- and third-generation cephalosporins in the post-ASP period. The duration of discharge antimicrobials decreased. Of 74 (10.4%) patients who had pleural fluid drained, 35 (47.3%) received more than 5 days of AAP and ≤ 5 days of second-/third-generation cephalosporins with no difference in median length of stay nor mean duration of antimicrobials. Conclusions Implementation of CAP management guidelines followed by prospective audit and feedback stewardship was associated with a sustained decrease in the use of broad-spectrum antibiotics in childhood CAP. Use of AAP should also be strongly considered in patients with effusions (even if no pathogen is identified), as clinical outcome appears similar to patients treated with broad-spectrum antimicrobials.

scholarly journals Effectiveness of prospective audit-and-feedback intervention in promoting appropriate third-generation cephalosporin use at a tertiary public hospital in Malaysia

2021 ◽  
Author(s):  
Rou Wei Tan ◽  
Kah Shuen Thong ◽  
Chee Tao Chang ◽  
Joo Thye Cheng ◽  
Huan Keat Chan ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Generation Cephalosporin ◽  
Audit And Feedback ◽  
Third Generation ◽  
Prospective Audit ◽  
Post Intervention ◽  
Feedback Intervention ◽  
Culture And Sensitivity ◽  
Prospective Audit And Feedback ◽  
Third Generation Cephalosporins

Abstract Background: Inappropriate use of broad-spectrum antibiotics accelerates the development of drug resistance in nosocomial pathogens. In Malaysia, the National Antimicrobial Guidelines (NAG), along with the feedback from antimicrobial stewardship (AMS) teams, serves as an important guide for antibiotic use in hospitals. Objectives: This study aimed to determine the effectiveness of a prospective audit-and-feedback intervention in promoting the appropriate prescribing of third-generation cephalosporins and timely culture and sensitivity (C&S) testing in patients admitted to a neurosurgical ward. Method: In the pre-intervention phase, a ward pharmacist examined medical records of the patients receiving treatment with third-generation cephalosporins. The use of a cephalosporin was deemed to be appropriate only if it was in line with either the NAG or the recommendations made by the AMS team. The laboratory reports were also checked to see if the C&S testing was performed right before the first dose of a cephalosporin was given. The findings were subsequently presented and discussed in a 2-hour feedback session. The post-intervention audit was performed in the same manner as in the pre-intervention phase. Results: Seventy cases were studied in the pre- and post-intervention phases each. The proportion of cases with appropriate use of third-generation cephalosporin increased significantly from 77.1% (54/70) to 95.8% (67/70) following the intervention (p=0.001). The proportion of cases with a C&S test performed timely also increased significantly from 38.6% (27/70) to 58.6% (41/70) (p=0.018). Conclusion: The prospective audit-and-feedback intervention was effective in improving the appropriateness of the prescribing of third-generation cephalosporins and timely culture and sensitivity testing, indicating the antimicrobial stewardship strategy had produced a positive outcome.

scholarly journals 121. Evaluation of Multifaceted Antimicrobial Stewardship in Optimizing Antimicrobial Usage in Intraabdominal Infection at a Community Hospital

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S174-S174
Author(s):  
Tho H Pham ◽  
Angela Huang ◽  
Scott T Hall ◽  
Vanthida Huang
Keyword(s):  
Antibiotic Treatment ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Antimicrobial Therapy ◽  
Empiric Therapy ◽  
Audit And Feedback ◽  
Observation Study ◽  
Collateral Consequences ◽  
Clostridioides Difficile ◽  
Prospective Audit And Feedback

Abstract Background Treatment of intraabdominal infections (IAI) commonly involves broad spectrum antimicrobials based on the severity and etiology of infections as well as the underlying medical conditions. However, the overuse of broad-spectrum agents has driven selection for Gram-negative and -positive resistance, as well as collateral consequences such as Clostridioides difficile colitis. We sought to evaluate the utilization of a pharmacy-driven multifaceted antimicrobial stewardship (AMS) intervention to optimize empiric antimicrobial therapy by risk stratification among IAI patients and reduce the number of antibiotic treatment days. Methods This is a single-center case observation study in hospitalized adult IAI patients on antimicrobial therapy from Dec 2019-Feb 2020 compared to patients from Dec 2020-Feb 2021 after initiation of AMS with daily prospective audit and feedback. The composite primary outcome is reduction of antibiotic treatment days and de-escalation from broad spectrum antibiotics (fluoroquinolones, piperacillin/tazobactam, and carbapenems) to cephalosporins. Results We identified 40 patients each in the baseline (pre-AMS group) and post-AMS group via electronic medical record. Baseline characteristics were well-matched between groups. The majority of patients were diagnosed with community-acquired IAIs such as appendicitis, diverticulitis, and cholecystitis. Fluoroquinolone use as empiric therapy was significantly lower in the post-AMS group vs. pre-AMS group (2.5% vs. 25%, p< 0.001), while non-Pseudomonas cephalosporin use was increased (25% post-AMS vs. 0% pre-AMS, p< 0.001). Oral fluoroquinolone use at discharge was significantly decreased in the post-AMS group (p< 0.001). Antibiotic treatment days remained unchanged. There was no statistical difference between the two groups in 30-day mortality, 30-day readmission, relapse, and C. difficile colitis. Conclusion A multifaceted antimicrobial therapy intervention successfully reduced the use of fluoroquinolones in patients with community-acquired IAI during hospitalization and discharge. No differences in mortality, readmission, or relapse rates were observed. Disclosures All Authors: No reported disclosures

Point Prevalence Survey of Antimicrobial Prescription Patterns in a Pediatric Tertiary-Care Unit in Thailand 2019

2021 ◽  
Vol 104 (9) ◽  
pp. 1476-1482
Keyword(s):  
Antimicrobial Stewardship ◽  
Point Prevalence ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Prospective Audit ◽  
Prevalence Survey ◽  
Prescription Patterns ◽  
Point Prevalence Survey ◽  
Stewardship Program ◽  
Prospective Audit And Feedback

Background: Surveillance data is an essential part of antimicrobial stewardship programs (ASP). Objective: To describe and compare prescription patterns of antibiotics after a 3-years implementation of an ASP using prospective audit and feedback. Materials and Methods: The authors conducted a point prevalence survey (PPS) of antibiotic prescriptions at a 200-bed pediatric unit at King Chulalongkorn Memorial Hospital. A standardized study protocol from the Global Antimicrobial Resistance, Prescribing, and the Efficacy in Neonates and Children (GARPEC) project was used. The authors reviewed medical charts of hospitalized children of less than 18 years of age, using a point prevalence method on the 15 of February, May, August, and November 2019. Endpoints measures included rate of antimicrobial prescriptions and type of antimicrobial use, stratified by neonatal and pediatric ward types. Rate of antimicrobial prescriptions will be compared with historical data form PPS in the same institute collected in 2016. Results: In 2019, the medical records of 269 neonates and 409 children hospitalized were reviewed. The proportion of children receiving antibiotics in neonatal units overall was 18.6% (95% CI 14.1 to 23.8), of which ampicillin or gentamicin (52.0%) was the most common regimen. Rate of antibiotic prescriptions in general pediatric wards was 46.5%, with third generation cephalosporins being the most used antibiotics. Prescription rate in the oncology ward was 52.9% with antipseudomonal agents or meropenem being the most prescribed antibiotics. Prescription rates in the pediatric intensive care unit (PICU) was 88.9%, with meropenem being the most used antibiotic. Compared to a previous PPS study in 2016, prevalence of antimicrobial use was higher in general pediatric wards at 46.5% versus 37.2% (p=0.02) and PICU at 88.9% versus 67.7% (p=0.007). Conclusion: The prevalence rates of antimicrobial use in pediatric wards increased despite implementation of a prospective audit and feedback antibiotic stewardship program. Other measures are needed to reduce the unnecessary prescriptions. Keywords: Antimicrobial; Antimicrobial stewardship program; Pediatric; Point prevalence survey

scholarly journals When Antimicrobial Stewardship Isn′t Watching: The Educational Impact of Critical Care Prospective Audit and Feedback

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Dimitra Fleming ◽  
Karim F. Ali ◽  
John Matelski ◽  
Ryan D'Sa ◽  
Jeff Powis
Keyword(s):  
Critical Care ◽  
Antimicrobial Stewardship ◽  
Care Setting ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Prospective Audit ◽  
Educational Impact ◽  
Antimicrobial Prescribing ◽  
Stewardship Program ◽  
Prospective Audit And Feedback

Abstract Prospective audit and feedback (PAF) is an effective strategy to optimize antimicrobial use in the critical care setting, yet whether skills gained during PAF influence future antimicrobial prescribing is uncertain. This multisite study demonstrates that knowledge learned during PAF is translated and incorporated into the practice of critical care physicians even when not supported by an antimicrobial stewardship program.

scholarly journals A Novel Metric to Monitor the Influence of Antimicrobial Stewardship Activities

2017 ◽  
Vol 38 (06) ◽  
pp. 721-723 ◽  
Author(s):  
Daniel J. Livorsi ◽  
Erin O’Leary ◽  
Tamra Pierce ◽  
Lindsey Reese ◽  
Katharina L. van Santen ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Prospective Audit ◽  
Infectious Disease Physician ◽  
Antimicrobial Prescribing ◽  
National Healthcare Safety Network ◽  
Stewardship Program ◽  
Prospective Audit And Feedback ◽  
Antimicrobial Administration

The antimicrobial use (AU) option within the National Healthcare Safety Network summarizes antimicrobial prescribing data as a standardized antimicrobial administration ratio (SAAR). A hospital’s antimicrobial stewardship program found that greater involvement of an infectious disease physician in prospective audit and feedback procedures was associated with reductions in SAAR values across multiple antimicrobial categories. Infect Control Hosp Epidemiol 2017;38:721–723

scholarly journals 1818. Characteristics of a Cohort of Patients on Broad-Spectrum Antibiotics Targeted for Prospective Audit and Feedback

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S516-S516
Author(s):  
Rachel Bystritsky ◽  
Albert T Young ◽  
Andrew Wong ◽  
Alexandra Hilts-Horeczko ◽  
Conan Macdougall ◽  
...  
Keyword(s):  
Broad Spectrum ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Broad Spectrum Antibiotics ◽  
Prospective Audit And Feedback
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