scholarly journals A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

2018 ◽  
Vol 62 (4) ◽  
Author(s):  
Francisco Álvarez-Lerma ◽  
Santiago Grau ◽  
Daniel Echeverría-Esnal ◽  
Montserrat Martínez-Alonso ◽  
María Pilar Gracia-Arnillas ◽  
...  
Keyword(s):  
Time Series ◽  
Critical Care ◽  
Antimicrobial Stewardship ◽  
Mean Difference ◽  
Series Data ◽  
Care Practice ◽  
Defined Daily Doses ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Before And After

ABSTRACT We evaluated the use of antimicrobials expressed as defined daily doses (DDDs) per 1,000 patient days and days of therapy (DOT) per 100 occupied bed-days in a intensive care unit (ICU) of a general hospital in Barcelona, Spain, before and after implementation of an antimicrobial stewardship (AMS) program (2007 to 2010 versus 2011 to 2015). The quarterly costs of antimicrobials used in the ICU and its weight in the overall hospital costs of antimicrobials were calculated. The effect of the applied AMS program on DDDs and DOT time series data was analyzed by means of intervention time series analysis. A total of 5,002 patients were included (1,971 for the first [before] period and 3,031 for the second [after] period). The percentage of patients treated with one or more antimicrobials decreased from 88.6 to 77.2% ( P < 0.001). DDDs decreased from 246.8 to 192.3 (mean difference, −54.5; P = 0.001) and DOT from 66.7 to 54.6 (mean difference, −12.1; P = 0.066). The mean cost per trimester decreased from €115,543 to €73,477 (mean difference, −42,065.4 euros; P < 0.001), and the percentage of ICU antimicrobials cost with respect to the total cost of hospital antimicrobials decreased from 28.5 to 22.8% (mean difference, −5.59; P = 0.023). Implementation of an AMS program in the ICU was associated with a marked reduction in the use of antimicrobials, with cost savings close to one million euros since its implementation. An AMS program can have a significant impact on optimizing antimicrobial use in critical care practice.

scholarly journals Effects of a Remote Antimicrobial Stewardship Program on Antimicrobial Use in a Regional Hospital System

Pharmacy ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. 41 ◽  
Author(s):  
Joshua Knight ◽  
Jessica Michal ◽  
Stephanie Milliken ◽  
Jenna Swindler
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Use ◽  
Hospital System ◽  
Physician Review ◽  
Stewardship Program ◽  
Time Period ◽  
Days Of Therapy ◽  
Before And After ◽  
Implementation Time ◽  
Acceptance Rates

While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.

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 Implementation of a Rapid Phenotypic Susceptibility Platform for Gram-Negative Bloodstream Infections With Paired Antimicrobial Stewardship Intervention: Is the Juice Worth the Squeeze?

2021 ◽  
Author(s):  
Evan D Robinson ◽  
Allison M Stilwell ◽  
April E Attai ◽  
Lindsay E Donohue ◽  
Megan D Shah ◽  
...  
Keyword(s):  
Median Time ◽  
Antimicrobial Stewardship ◽  
A Priori ◽  
Bloodstream Infections ◽  
Standard Of Care ◽  
Post Intervention ◽  
Gram Negative ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Implementation of the Accelerate PhenoTM Gram-negative platform (RDT) paired with antimicrobial stewardship program (ASP) intervention projects to improve time to institutional-preferred antimicrobial therapy (IPT) for Gram-negative bacilli (GNB) bloodstream infections (BSIs). However, few data describe the impact of discrepant RDT results from standard of care (SOC) methods on antimicrobial prescribing. Methods A single-center, pre-/post-intervention study of consecutive, nonduplicate blood cultures for adult inpatients with GNB BSI following combined RDT + ASP intervention was performed. The primary outcome was time to IPT. An a priori definition of IPT was utilized to limit bias and to allow for an assessment of the impact of discrepant RDT results with the SOC reference standard. Results Five hundred fourteen patients (PRE 264; POST 250) were included. Median time to antimicrobial susceptibility testing (AST) results decreased 29.4 hours (P &lt; .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P &lt; .001). Utilization (days of therapy [DOTs]/1000 days present) of broad-spectrum agents decreased (PRE 655.2 vs POST 585.8; P = .043) and narrow-spectrum beta-lactams increased (69.1 vs 141.7; P &lt; .001). Discrepant results occurred in 69/250 (28%) post-intervention episodes, resulting in incorrect ASP recommendations in 10/69 (14%). No differences in clinical outcomes were observed. Conclusions While implementation of a phenotypic RDT + ASP can improve time to IPT, close coordination with Clinical Microbiology and continued ASP follow up are needed to optimize therapy. Although uncommon, the potential for erroneous ASP recommendations to de-escalate to inactive therapy following RDT results warrants further investigation.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

The Impact of a National Antimicrobial Stewardship Program on Antibiotic Prescribing in Primary Care: An Interrupted Time Series Analysis

2018 ◽  
Vol 69 (2) ◽  
pp. 227-232 ◽  
Author(s):  
Violeta Balinskaite ◽  
Alan P Johnson ◽  
Alison Holmes ◽  
Paul Aylin
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Broad Spectrum ◽  
Interrupted Time Series ◽  
Series Data ◽  
Antibiotic Prescribing ◽  
Segmented Regression ◽  
Broad Spectrum Antibiotic ◽  
Stewardship Program ◽  
The Impact

Abstract Background The Quality Premium was introduced in 2015 to financially reward local commissioners of healthcare in England for targeted reductions in antibiotic prescribing in primary care. Methods We used a national antibiotic prescribing dataset from April 2013 until February 2017 to examine the number of antibiotic items prescribed, the total number of antibiotic items prescribed per STAR-PU (specific therapeutic group age/sex-related prescribing units), the number of broad-spectrum antibiotic items prescribed, and broad-spectrum antibiotic items prescribed, expressed as a percentage of the total number of antibiotic items. To evaluate the impact of the Quality Premium on antibiotic prescribing, we used a segmented regression analysis of interrupted time series data. Results During the study period, over 140 million antibiotic items were prescribed in primary care. Following the introduction of the Quality Premium, antibiotic items prescribed decreased by 8.2%, representing 5933563 fewer antibiotic items prescribed during the 23 post-intervention months, as compared with the expected numbers based on the trend in the pre-intervention period. After adjusting for the age and sex distribution in the population, the segmented regression model also showed a significant relative decrease in antibiotic items prescribed per STAR-PU. A similar effect was found for broad-spectrum antibiotics (comprising 10.1% of total antibiotic prescribing), with an 18.9% reduction in prescribing. Conclusions This study shows that the introduction of financial incentives for local commissioners of healthcare to improve the quality of prescribing was associated with a significant reduction in both total and broad-spectrum antibiotic prescribing in primary care in England.

scholarly journals 2044. An Assessment and Feedback Model Bringing Antimicrobial Stewardship Program Expertise to Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S687
Author(s):  
Philip Chung ◽  
Kate Tyner ◽  
Scott Bergman ◽  
Teresa Micheels ◽  
Mark E Rupp ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Rank Test ◽  
Post Intervention ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Care Facilities

Abstract Background Long-term care facilities (LTCF) often struggle with implementation of antimicrobial stewardship programs (ASP) that meet all CDC core elements (CE). The CDC recommends partnership with infectious diseases (ID)/ASP experts to guide ASP implementation. The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is an initiative funded by NE DHHS via a CDC grant to assist healthcare facilities with ASP implementation. Methods ASAP performed on-site baseline evaluation of ASP in 5 LTCF (42–293 beds) in the spring of 2017 using a 64-item questionnaire based on CDC CE. After interviewing ASP members, ASAP provided prioritized facility-specific recommendations for ASP implementation. LTCF were periodically contacted in the next 12 months to provide implementation support and evaluate progress. The number of CE met, recommendations implemented, antibiotic starts (AS) and days of therapy (DOT)/1000 resident-days (RD), and incidence of facility-onset Clostridioides difficile infections (FO-CDI) were compared 6 to 12 months before and after on-site visits. Paired t-test and Wilcoxon signed rank test were used for statistical analyses. Results Multidisciplinary ASP existed in all 5 facilities at baseline with medical directors (n = 2) or directors of nursing (n = 3) designated as team leads. Median CE implemented increased from 3 at baseline to 6 at the end of follow-up (P = 0.06). No LTCF had all 7 CE at baseline. By the end of one year, 2 facilities implemented all 7 CE with the remaining implementing 6 CE. LTCF not meeting all CE were only deficient in reporting ASP metrics to providers and staff. Among the 38 recommendations provided by ASAP, 82% were partially or fully implemented. Mean AS/1000 RD reduced by 19% from 10.1 at baseline to 8.2 post-intervention (P = 0.37) and DOT/1000 RD decreased by 21% from 91.7 to 72.5 (P = 0.20). The average incidence of FO-CDI decreased by 75% from 0.53 to 0.13 cases/10,000 RD (P = 0.25). Conclusion Assessment of LTCF ASP along with feedback for improvement by ID/ASP experts resulted in more programs meeting all 7 CE. Favorable reductions in antimicrobial use and CDI rates were also observed. Moving forward, the availability of these services should be expanded to all LTCFs struggling with ASP implementation. Disclosures All authors: No reported disclosures.

scholarly journals 1059. Impact of a Syndrome-Based Antimicrobial Stewardship Intervention on Anti-Pseudomonal β-Lactam Use, C. difficile Rates and Cost in an Urban Community Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S374-S375
Author(s):  
Alfredo J Mena Lora ◽  
Martin Cortez ◽  
Ella Li ◽  
Lawrence Sanchez ◽  
Rochelle Bello ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Treatment Guidelines ◽  
Urban Community ◽  
Audit And Feedback ◽  
Evidence Based ◽  
Days Of Therapy ◽  
Before And After ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background The use of anti-Pseudomonal β-lactam (APBL) agents has significantly increased in the past decade, carrying higher costs and contributing to antimicrobial pressure. Antimicrobial stewardship (ASP) can promote evidence-based antimicrobial selection and mitigate excess APBL use. We implemented a comprehensive ASP with syndrome-based prospective audit and feedback (PAF) at an urban community hospital. The goal of this study is to assess the impact of syndrome-based PAF on APBL use, C. difficile rates and cost. Methods ASP with all CDC core elements was implemented at a 151-bed community hospital in October 2017. Syndrome-based guidelines and PAF was established and overseen via direct communication with an ID physician. Days of therapy (DOT), cost and C. difficile rates were assessed 12 months before and after ASP. DOT for APBL and non-APBL utilization was tabulated by unit and paired t-test performed. Results Most cases reviewed by PAF (51%) were represented in our syndrome-based treatment guidelines (Figure 1). Soft tissue (33%) and intra-abdominal (24%) infections were the most common syndromes. Change to guideline was the most common PAF intervention (62%) followed by de-escalation (30%). At 12 months, total DOT/1,000 increased (392.5 vs. 404) while the proportion of parenteral antimicrobials used decreased (71% vs. 65%). Antibiotic expenditures decreased by 23%, with a reduction in APBL of 20% and non-APBL of 10% (Table 1). Statistically significant reductions APBL use in non-ICU settings (P = 0.0139) and statistically significant increases in non-APBL in ICU settings occurred (P = 0.0001) (Figure 2 and 3). C difficile rates decreased from 21% (3.27 vs. 2.56). Conclusion Syndrome-based PAF was successfully implemented. A reduction in APBL use was seen in non-ICU settings, where evidence-based de-escalation may be more feasible. APBL use remained high in the ICU but was guideline consistent. A rise in non-APBL use also occurred. Certain critical illness syndromes warrant APBLs, but PAF may promote culture-directed and syndrome-specific treatments. ASP increased guideline-based therapy and contributed to decreased broad-spectrum antimicrobial use, antimicrobial expenditures and C difficile rates. Syndrome based PAF can be successfully implemented in community settings. Disclosures All authors: No reported disclosures.

scholarly journals Communicating Microbiology Results. It’s Not Just What You Say, But How You Say It

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S28-S28
Author(s):  
Mary Musgrove ◽  
Rachel M Kenney ◽  
Ronald Kendall ◽  
Robert Tibbetts ◽  
Linoj Samuel ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Respiratory Infection ◽  
Kidney Injury ◽  
Resistant Organism ◽  
Antibiotic Prescribing ◽  
Culture Result ◽  
Commensal Flora ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Before And After

Abstract Background Gaps in microbiology communication can lead to suboptimal antibiotic prescribing. In May 2016, our laboratory modified reporting of respiratory cultures growing commensal flora only to specify “no methicillin-resistant Staphylococcus aureus/MRSA or Pseudomonas aeruginosa” (PA). The purpose of this study was to compare MRSA and PA antibiotic therapy utilization before and after the change. Methods IRB approved, quasi-experiment at four hospitals with an antimicrobial stewardship program. Dates: August 1, 2015–January 31, 2016 and August 1, 2016–January 31, 2017. Included: ≥18 years, commensal flora only respiratory culture, empiric MRSA and PA antibiotic for treatment of lower respiratory infection. Excluded: non-respiratory infection. Primary outcome: MRSA or PA therapy de-escalated. Secondary outcomes: time to culture result, MRSA and PA antibiotic days of therapy, length of stay. Safety outcomes: acute kidney injury (AKI), C. difficile (CDI), subsequent multi-drug-resistant organism (MDRO), in-hospital all-cause mortality. Results Two hundred and ten patients included, 105 per group. Median age 64 and 61 years, male sex 52% and 56% in pre- and post-group, respectively. Empiric antibiotics, pre vs. post: vancomycin 94% vs. 95%; cefepime 66% vs. 36%; piperacillin–tazobactam 10% vs. 46%. MRSA or PA antibiotics de-escalated: 39% pre and 73% post (P &lt; 0.001). See Table 1 for variables associated with antibiotic de-escalation. Days of therapy: 7 vs. 5 days (P &lt; 0.001). AKI 31% vs. 14% (P = 0.003). Eight subsequent MDRO in pre and one in post (P = 0.035). No differences: time to culture result, length of stay, mortality, CDI. Conclusion Improved microbiology communication to assist prescriber interpretation of commensal respiratory flora was associated with a reduction in the proportion of patients that received antibiotics targeting MRSA and PA. Disclosures S. Davis, Merck: Received grant through college that I’m faculty for, Grant recipient; Allergan: Speaker’s Bureau, Consulting fee; Allergan: Consultant and Scientific Advisor, Consulting fee; Medicines Company: Consultant and Scientific Advisor, Consulting fee; Zavante: Consultant and Scientific Advisor, Consulting fee.

scholarly journals 1119. Implementation of Pediatric Antimicrobial Stewardship Rounds in a Children’s Hospital

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S397-S398
Author(s):  
Natalie Tucker ◽  
Ezzeldin Saleh ◽  
Marcela Rodriguez
Keyword(s):  
Infectious Diseases ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Successful Implementation ◽  
Custom Made ◽  
Days Of Therapy ◽  
Before And After ◽  
The Individual

Abstract Background Antimicrobial stewardship programs (ASP) are required in all acute care hospitals per The Joint Commission. ASP must adhere to the recommendations laid out by the Centers for Disease Control and Prevention, but how each ASP chooses to implement these recommendations is left to the individual program. In January 2018, we began formal antimicrobial stewardship (AMS) walking rounds, led by infectious diseases trained physician and pharmacist, in our 99-bed pediatric hospital. Methods In January 2018, we started twice-weekly AMS rounds on the pediatric hospitalist service. A custom-made “Antimicrobial Stewardship Patient List” was designed in our electronic medical record (EMR) to generate a list of all patients receiving antibiotics. The ASP team (comprised of an infectious diseases pharmacist and a pediatric infectious diseases physician) reviewed EMR charts to determine antibiotic prescribing appropriateness and design recommended interventions. Any recommendations and teaching points were then discussed with the hospitalist team in person. After piloting the hospitalist service, AMS rounds were extended to include the general surgery patients and finally the intensive care unit. Data on number of charts reviewed, proposed interventions, and acceptance rates were collected throughout the process. Descriptive statistics were used to assess the intervention data. Results In the first year of the program, 427 patient charts were reviewed with 186 identified interventions. In total, 156 (84.3%) of the interventions were accepted and implemented by the primary team. The most common types of interventions were the duration of therapy (29%), antibiotic discontinuation (16.7%), intravenous to oral conversion (11.3%), de-escalation (10.2%), and infectious diseases consult (5.9%). Conclusion Pediatric AMS rounds led to the successful implementation of the majority of recommended interventions. Future goals of the program include calculating days of therapy per 1000 patient-days to assess antibiotic consumption before and after AMS rounds and to expand into other services to further promote appropriate antibiotic use in hospitalized pediatric patients. Disclosures All authors: No reported disclosures.

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