Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

Multiple modes of interventions are available when implementing an antibiotic stewardship program (ASP), however, their complementarity has not yet been assessed. In a 938-bed hospital, we sequentially implemented four combined modes of interventions over one year, centralized by one infectious diseases specialist (IDS): (1) on-request infectious diseases specialist consulting service (IDSCS), (2) participation in intensive care unit meetings, (3) IDS intervention triggered by microbiological laboratory meetings, and (4) IDS intervention triggered by pharmacist alert. We assessed the complementarity of the different cumulative actions through quantitative and qualitative analysis of all interventions traced in the electronic medical record. We observed a quantitative and qualitative complementarity between interventions directly correlating to a decrease in antibiotic use. Quantitatively, the number of interventions has doubled after implementation of IDS intervention triggered by pharmacist alert. Qualitatively, these kinds of interventions led mainly to de-escalation or stopping of antibiotic therapy (63%) as opposed to on-request IDSCS (32%). An overall decrease of 14.6% in antibiotic use was observed (p = 0.03). Progressive implementation of the different interventions showed a concrete complementarity of these actions. Combined actions in ASPs could lead to a significant decrease in antibiotic use, especially regarding critical antibiotic prescriptions, while being well accepted by prescribers.

Download Full-text

Impact of Antibiotic Stewardship Program on Prescribing Pattern of Antimicrobials in Patients of Medical Intensive Care Unit

JOURNAL FOR CLINICAL AND DIAGNOSTIC RESEARCH ◽

10.7860/jcdr/2017/27171.10237 ◽

2017 ◽

Cited By ~ 1

Author(s):

Nishal Shah

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Stewardship ◽

Medical Intensive Care Unit ◽

Prescribing Pattern ◽

Stewardship Program ◽

Medical Intensive Care

Download Full-text

Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia

Annals of Saudi Medicine ◽

10.5144/0256-4947.2013.547 ◽

2013 ◽

Vol 33 (6) ◽

pp. 547-554 ◽

Cited By ~ 19

Author(s):

Marwa R. Amer ◽

Nathem S. Akhras ◽

Wafeeq A. Mahmood ◽

Abdulrazaq S. Al-Jazairi

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Program Implementation ◽

Tertiary Care Hospital ◽

Medical Intensive Care Unit ◽

Tertiary Care ◽

Care Hospital ◽

Antimicrobial Stewardship Program ◽

Stewardship Program ◽

Medical Intensive Care

Download Full-text

Impact of a Multimodal Antimicrobial Stewardship Program onPseudomonas aeruginosaSusceptibility and Antimicrobial Use in the Intensive Care Unit Setting

Critical Care Research and Practice ◽

10.1155/2011/416426 ◽

2011 ◽

Vol 2011 ◽

pp. 1-5 ◽

Cited By ~ 6

Author(s):

Douglas Slain ◽

Arif R. Sarwari ◽

Karen O. Petros ◽

Richard L. McKnight ◽

Renee B. Sager ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antimicrobial Stewardship ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Resistance Rate ◽

Defined Daily Doses ◽

Stewardship Program ◽

Resistance Patterns ◽

The Impact

Objective. To study the impact of our multimodal antibiotic stewardship program onPseudomonas aeruginosasusceptibility and antibiotic use in the intensive care unit (ICU) setting.Methods. Our stewardship program employed the key tenants of published antimicrobial stewardship guidelines. These included prospective audits with intervention and feedback, formulary restriction with preauthorization, educational conferences, guidelines for use, antimicrobial cycling, and de-escalation of therapy. ICU antibiotic use was measured and expressed as defined daily doses (DDD) per 1,000 patient-days.Results. Certain temporal relationships between antibiotic use and ICU resistance patterns appeared to be affected by our antibiotic stewardship program. In particular, the ICU use of intravenous ciprofloxacin and ceftazidime declined from 148 and 62.5 DDD/1,000 patient-days to 40.0 and 24.5, respectively, during 2004 to 2007. An increase in the use of these agents and resistance to these agents was witnessed during 2008–2010. Despite variability in antibiotic usage from the stewardship efforts, we were overall unable to show statistical relationships withP. aeruginosaresistance rate.Conclusion. Antibiotic resistance in the ICU setting is complex. Multimodal stewardship efforts attempt to prevent resistance, but such programs clearly have their limits.

Download Full-text

1995. Serial Procalcitonin Measurement in a Community Intensive Care Unit: Is There Value in the Setting of an Established Antibiotic Stewardship Program?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.1675 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S669-S669

Author(s):

Jenny Seah ◽

Daniel Beriault ◽

Bradley Langford ◽

Kevin L Schwartz ◽

Robert Cirone ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Antibiotic Therapy ◽

Antibiotic Stewardship ◽

Community Hospital ◽

Absolute Threshold ◽

Antibiotic Use ◽

Stewardship Program ◽

Days Of Therapy ◽

Relative Threshold

Abstract Background Procalcitonin (PCT) monitoring has been shown to result in reduced antibiotic use without an impact on patient outcomes. However, the real-world value of this biomarker has yet to be determined, particularly when efforts to optimize antibiotic use are already in place. We evaluated the feasibility and impact of PCT-guided antibiotic duration combined with an established antibiotic stewardship program (ASP) in a community hospital intensive care unit (ICU) in Toronto, Canada. Methods We conducted a quality improvement initiative in our ICU from November 2017 to October 2018 measuring daily PCT levels for immunocompetent patients receiving antibiotic therapy for suspected or proven bacterial infection with an expected duration between 48 hours and 21 days. Our protocol recommended stopping antibiotic therapy if PCT fell below 0.5 μg/L (absolute threshold) or if it dropped more than 80% from its peak value (relative threshold). ASP rounds took place twice weekly since 2013, integrating a regular discussion about PCT levels once this initiative was implemented. We evaluated the adherence to stopping criteria within 48h, antibiotic use (days of therapy per 1,000 patient-days), length of stay, 48h re-admission, and ICU-mortality. Interrupted time series with segmented regression was performed to evaluate pre-post intervention differences compared with the 12-months prior to implementation. Results A total of 297 antibiotic courses were monitored with PCT in 217 patients. Respiratory (62%), unknown infection (11%), and intra-abdominal infection (7%) were the most common reasons for antibiotics. Protocol adherence was 34% (absolute threshold: 39%, relative threshold: 12%). Adherence by ICU physician varied widely between 24% and 52%. Antibiotic use pre-PCT was 1,002 DOTs/1,000 PDs and post-PCT was 817 DOTs/1,000 PDs (adjusted change −15%, 95% CI: −28% to +8%) (Figure 1). No statistically significant changes in clinical outcomes were noted. Conclusion In the context of an active ASP in a community hospital ICU, PCT monitoring was associated with a non-significant decrease in antibiotic use. Further evaluation of reasons for inter-physician variability in adherence and opportunities for improved and sustained overall adherence should be explored. Disclosures All authors: No reported disclosures.

Download Full-text