An antimicrobial stewardship program improves antimicrobial treatment by culture site and the quality of antimicrobial prescribing in critically ill patients

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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The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.237 ◽

2018 ◽

Vol 39 (12) ◽

pp. 1400-1405 ◽

Cited By ~ 9

Author(s):

Erika M. C. D’Agata ◽

Curt C. Lindberg ◽

Claire M. Lindberg ◽

Gemma Downham ◽

Brandi Esposito ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Interrupted Time Series ◽

Multidrug Resistant ◽

Prescribing Patterns ◽

Antimicrobial Stewardship Program ◽

Intervention Period ◽

Positive Effects ◽

Antimicrobial Prescribing ◽

Stewardship Program ◽

Dialysis Facilities

AbstractBackgroundAntimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.ObjectiveTo quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.ResultsImplementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.ConclusionsWithin 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.

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Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

10.21203/rs.2.20643/v1 ◽

2020 ◽

Author(s):

Jiaojiao Song ◽

Rongsheng Zhu ◽

Leiqing Li ◽

Lingcheng Xu ◽

Quan Zhou ◽

...

Keyword(s):

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Second Generation ◽

Antimicrobial Treatment ◽

Clinical Isolates ◽

Antimicrobial Use ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Antimicrobial Utilization ◽

Lactamase Inhibitor

Abstract Objective This study aimed to evaluate the effect of a comprehensive antimicrobial stewardship program (ASP) and provide clinical evidence for the scientific stewardship of antimicrobials in intensive care units (ICUs) of a teaching hospital.Methods Between January 2013 and December 2018, we conducted a prospective study, based on an antimicrobial computerized clinical decision support system (aCDSS) deployed in 2015 in ICUs of a tertiary and teaching hospital. The primary outcomes included initial and overall use prevalence of antimicrobials. The second outcomes were the detection rate of common clinical isolates before and after therapeutic antimicrobial use, and the change in patterns of resistance of 5 common clinical isolates in the ICU.Results Various types of broad-spectrum antimicrobial use prevalence continued to increase from 2013 to 2015, since 2016, where initial use of carbapenems and glycopeptides were counterbalanced by an increase in use of the first/second-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations and linezolid. From 2015 to 2018, the proportion of extended-broad spectrum antimicrobials alone, wide-coverage therapy and combination therapy decreased significantly (P<0.05). Similarly, where use of carbapenems, glycopeptides, third/fourth-generation cephalosporins and anti-fungi agents were counterbalanced by an increase in overall use of the first/second-generation cephalosporins and β-lactam and β-lactamase inhibitor combinations. A total of 21891 strains of bacteria and fungi were detected in ICUs from 2015 to 2018, of them, 6.5% (1426/21891) strains were detected before antimicrobial treatment. The detection proportion of Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae and fastidious bacteria were significantly higher before antimicrobial treatment (P<0.05), while Acinetobacter baumannii , Burkholderia cepacia , and Candida spp were significantly lower in all non-repetitive clinical isolates (P<0.05).Conclusions The implementation of a comprehensive ASP combining CDSS in ICUs seems to be effective to improve outcomes on antimicrobial utilization and clinical isolates distribution in critically ill patients.

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Sustained Savings from a Longitudinal Cost Analysis of an Internet-Based Preapproval Antimicrobial Stewardship Program

Infection Control and Hospital Epidemiology ◽

10.1086/670625 ◽

2013 ◽

Vol 34 (6) ◽

pp. 573-580 ◽

Cited By ~ 40

Author(s):

Anna C. Sick ◽

Christoph U. Lehmann ◽

Pranita D. Tamma ◽

Carlton K. K. Lee ◽

Allison L. Agwu

Keyword(s):

Cost Analysis ◽

Antimicrobial Stewardship ◽

Tertiary Care ◽

Cost Savings ◽

Antimicrobial Stewardship Program ◽

Pediatric Hospital ◽

Antimicrobial Prescribing ◽

Approval Rate ◽

Stewardship Program ◽

Sustained Reduction

Objective.To evaluate an internet-based preapproval antimicrobial stewardship program for sustained reduction in antimicrobial prescribing and resulting cost savings.Design.Retrospective cohort study and cost analysis.Methods.Review of all doses and charges of antimicrobials dispensed to patients over 6 years (July 1, 2005–June 30, 2011) at a tertiary care pediatric hospital.Results.Restricted antimicrobials account for 26% of total doses but 81% of total antimicrobial charges. Winter months (November–February) and the oncology and infant and toddler units were associated with the highest antimicrobial charges. Five restricted drugs accounted for the majority (54%) of charges but only 6% of doses. With an average approval rate of 91.5% (95% confidence interval [CI], 91.1%–91.9%), the preapproval antibiotic stewardship program saved $103,787 (95% CI, $98,583–$109,172) per year, or $14,156 (95% CI, $13,446–$14,890) per 1,000 patient-days.Conclusions.A preapproval antimicrobial stewardship program effectively reduces the number of doses and subsequent charges due to restricted antimicrobials years after implementation. Hospitals with reduced resources for implementing postprescription review may benefit from a preapproval antimicrobial stewardship program. Targeting specific units, drugs, and seasons may optimize preapproval programs for additional cost savings.

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Antimicrobial Stewardship in Pediatrics

Handbook of Pediatric Infection Prevention and Control ◽

10.1093/med/9780190697174.003.0013 ◽

2019 ◽

pp. 291-322

Author(s):

Emily A. Thorell ◽

Jared Olson

Keyword(s):

Antimicrobial Stewardship ◽

Multidrug Resistant ◽

Antimicrobial Treatment ◽

Antimicrobial Stewardship Program ◽

Global Public Health ◽

Healthcare Facilities ◽

Stewardship Program ◽

Healthcare Program ◽

Core Elements ◽

Control And Prevention

The rapid emergence of multidrug-resistant bacteria has become a global public health crisis. As antibiotics are the only class of medications where use in one patient can compromise their efficacy in another patient, stewardship is critical to preserve this shared resource. The Centers for Disease Control and Prevention (CDC) have focused on improving antimicrobial use for many years. One effective strategy used to decrease the emergence of multi‐drug-resistant organisms (MDROs) is the antimicrobial stewardship program (ASP): a coordinated healthcare program that seeks to provide optimal antimicrobial treatment to patients to reduce the emergence of MDROs, improve patient outcomes, and decrease cost. This chapter reviews the importance of an antimicrobial stewardship program, reviews core elements of a pediatric hospital ASP, and provides guidance on tracking and reporting antimicrobial prescribing in pediatric healthcare facilities.

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