scholarly journals Evaluation of a Multidisciplinary Antimicrobial Stewardship Program in a Saudi Critical Care Unit: A Quasi-Experimental Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Abdul Haseeb ◽  
Hani Saleh Faidah ◽  
Manal Al-Gethamy ◽  
Muhammad Shahid Iqbal ◽  
Abrar Mohammed Barnawi ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Defined Daily Dose ◽  
Daily Dose ◽  
Quasi Experimental ◽  
Bed Days

Background: Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. With regard to critically ill patients, appropriate antimicrobial usage is of significance, and any delay in therapy increases their risk of mortality. Therefore, the implementation of structured multidisciplinary ASPs in critical care settings is of the utmost importance to promote the judicious use of antimicrobials.Methods: This quasi-experimental study evaluating a multidisciplinary ASP in a 20-bed critical care setting was conducted from January 1, 2016 to July 31, 2017. Outcomes were compared nine months before and after ASP implementation. The national antimicrobial stewardship toolkit by Ministry of health was reviewed and the hospital antibiotic prescribing policy was accordingly modified. The antimicrobial stewardship algorithm (Start Smart and Then Focus) and an ASP toolkit were distributed to all intensive care unit staff. Prospective audit and feedback, in addition to prescribing forms for common infectious diseases and education, were the primary antimicrobial strategies.Results: We found that the mean total monthly antimicrobial consumption measured as defined daily dose per 100 bed days was reduced by 25% (742.86 vs. 555.33; p = 0.110) compared to 7% in the control condition (tracer medications) (35.35 vs. 38.10; p = 0.735). Interestingly, there was a negative impact on cost in the post-intervention phase. Interestingly, the use of intravenous ceftriaxone measured as defined daily dose per 100 bed days was decreased by 82% (94.32 vs. 16.68; p = 0.008), whereas oral levofloxacin use was increased by 84% (26.75 vs. 172.29; p = 0.008) in the intensive care unit.Conclusion: Overall, involvement of higher administration in multidisciplinary ASP committees, daily audit and feedback by clinical pharmacists and physicians with infectious disease training, continuous educational activities about antimicrobial use and resistance, use of local antimicrobial prescribing guidelines based on up-to-date antibiogram, and support from the intensive care team can optimize antibiotic use in Saudi healthcare institutions.

scholarly journals Antibiotic Utilization Pattern in the Intensive Care Unit of Tertiary Hospital in West Java, Indonesia

2019 ◽  
Vol 7 (2) ◽  
pp. 81-87
Author(s):  
Taradharani Wikantiananda ◽  
Adi Imam Tjahjadi ◽  
Reza Widianto Sudjud
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Anatomical Therapeutic Chemical ◽  
Antibiotic Use ◽  
Tertiary Hospital ◽  
Defined Daily Dose ◽  
Antibiotic Utilization ◽  
Daily Dose ◽  
Bed Days ◽  
International Measurement

Objective: To find out the pattern of antibiotic utilization in intensive care unit (ICU). The high use of antibiotics in intensive care may increase antibiotic resistance. Methods: This was a retrospective study with total sampling method from patients who were treated in ICU in the period of January to June 2016. Selected data is processed using the Anatomical Therapeutic Chemical (ATC) Classification/Defined Daily Dose (DDD) system as an international measurement standard for analyzing and comparing usage applied by the WHO. Results: The results showed that of the 57 medical records collected, the total antibiotic use was 295.72 DDD/100 bed-days. Levofloxacin, meropenem, ceftriaxone, ceftazidime, and metronidazole were the five maximally utilized antibiotics with 143.18, 49.88, 30.62, 19.74, dan 16.99 DDD/100 bed-days respectively. Conclusion: The most frequently used of antibiotics is ceftriaxone, used in 54.39% of patients. Whereas in number, the most widely used antibiotic is levofloxacin with a total of 143.18 DDD/100 bed-days.

Comparison of the defined daily dose and days of treatment methods for evaluating the consumption of antibiotics and antifungals in the intensive care unit

2020 ◽  
Vol 44 (5) ◽  
pp. 294-300 ◽  
Author(s):  
J. Vallès ◽  
S. Fernández ◽  
E. Cortés ◽  
A. Morón ◽  
E. Fondevilla ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Defined Daily Dose ◽  
Treatment Methods ◽  
Daily Dose

scholarly journals Application of an antibiotic spectrum index in the neonatal intensive care unit

2019 ◽  
Vol 40 (10) ◽  
pp. 1181-1183 ◽  
Author(s):  
Alexandra C. Lahart ◽  
Christopher C. McPherson ◽  
Jeffrey S. Gerber ◽  
Barbara B. Warner ◽  
Brian R. Lee ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Antimicrobial Stewardship ◽  
Neonatal Intensive Care ◽  
Very Low Birth Weight ◽  
Antimicrobial Use ◽  
Low Birth Weight Infants ◽  
Antimicrobial Spectrum ◽  
Days Of Therapy ◽  
The Impact

AbstractAntimicrobial stewardship programs typically use days of therapy to assess antimicrobial use. However, this metric does not account for the antimicrobial spectrum of activity. We applied an antibiotic spectrum index to a population of very-low-birth-weight infants to assess its utility to evaluate the impact of antimicrobial stewardship interventions.

scholarly journals 1894. Antimicrobial Stewardship in the Intensive Care Unit: Survey of Critical Care and Infectious Diseases Physicians

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S543-S543
Author(s):  
M Cristina Vazquez Guillamet ◽  
Jason Burnham ◽  
Maria Perez ◽  
Marin Kollef ◽  
Constantine Manthous ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Infectious Diseases ◽  
Antimicrobial Stewardship

scholarly journals 1091. An Ethnographic Approach to Interrogating Antimicrobial Stewardship at US Teaching Hospitals

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S388-S388
Author(s):  
Katharina Rynkiewich ◽  
David Schwartz ◽  
Sarah Y Won ◽  
Mikhail Heber ◽  
Kavya Timmireddy ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Direct Observation ◽  
Antimicrobial Stewardship ◽  
Teaching Hospitals ◽  
Surgical Intensive Care Unit ◽  
Antimicrobial Use ◽  
Surgical Intensive Care ◽  
Antimicrobial Prescribing ◽  
Institutional Determinants

Abstract Background Hospital antimicrobial stewardship programs (ASPs) deploy variably evidence-based interventions aimed at improving antimicrobial use and reducing antimicrobial resistance. Little is known about how ASPs are perceived by hospital clinicians or how such data might inform ASP improvement. We conducted an ethnographic study of hospital ASPs and infectious diseases (ID), surgical intensive care unit (SICU) and medical intensive care unit (MICU) practitioners to identify how ASPs are understood and integrated into everyday practice by hospital staff. Methods A medical anthropologist performed direct observation of patient care and semi-structured interviews with ID (N = 29), SICU (N = 10), and MICU (N = 19) practitioners at two affiliated teaching hospitals in Chicago, IL, between July 2017 and September 2018, accruing >576 hours of direct observations and 48 hours of semi-structured interview data. Data collection and analysis centered on explicating the understandings and interpretations of ASPs present in diverse practice groups. Transcriptions of the data were analyzed using thematic coding aided by MAXQDA qualitative analysis software. Results Understandings and interpretations of ASPs varied greatly between the practice groups. ID practitioners commonly focused on “changing prescribing behavior” and “restricting inappropriate usage,” while MICU and SICU practitioners more often emphasized “following guidelines” and maintaining clinical “balance.” Additionally, direct observation data demonstrate that MICU and SICU practitioners are bounded by social and institutional determinants of antimicrobial prescribing (Table 1) that affect the pursuit of “appropriate antimicrobial use.” Conclusion Ethnographic interrogation found that practice groups understand and integrate ASPs differently according to everyday encounters with the social and institutional determinants of antimicrobial prescribing. ASP effectiveness might be enhanced by adopting a more mindful approach to accounting for and addressing the distinct understandings and interpretations of ASPs among diverse practice groups operating within the same institution. Disclosures All authors: No reported disclosures.

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 Cost analysis of critical patient care at a pediatric intensive care unit of a tertiary care public hospital in an urban metropolis of India

2021 ◽  
Vol 10 (7) ◽  
pp. 834
Author(s):  
Renuka P. Munshi ◽  
Alisha Dhiman ◽  
Sushma U. Save
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Patient Care ◽  
Public Hospital ◽  
Tertiary Care ◽  
Pediatric Intensive Care ◽  
Allocation Of Resources ◽  
Bed Days ◽  
The Cost

Background: The cost of critical care is widely recognized as being high. However, it remains a challenge to accurately assess the cost of intensive care due to a lack of standardized methodology. There is also considerable heterogeneity with regard to allocation of resources and distribution of critical care services.Methods: We conducted a prospective study to analyse diagnosis-based costs of paediatric patient care at a pediatric intensive care unit (PICU) in a public hospital in Mumbai on the basis of identified cost components; direct (fixed and variable) and indirect costs.Results: Out of 167 (102 boys, 61%) patients enrolled, 65 (39%) were aged 1-7 months. They spent an average of 4±1.46 bed days in the PICU. The cost of direct fixed components (salaries, capital equipment, disposables) was Rs. 64,48,200 for six months. The maximum cost of direct variable components spent by the hospital (physiotherapy intervention, expert opinion, investigations, medicines, blood products, piped gases) amounted to Rs. 548.63/patient/day for treatment of non-infectious diseases. Cost of indirect components (building maintenance) was Rs. 12,500/six months. Linear regression analysis showed 83-99.99% dependency of treatment cost to diagnosis and bed days. The average cost of treatment of infectious and non-infectious diagnoses/patient/day spent by the hospital was Rs. 260 and Rs. 548.63 respectively as compared to Rs. 169.96 and Rs. 356.21 spent by the patients.Conclusions: Our study showed that majority of the treatment costs depended on the diagnosis and number of bed days of the patients. Also being a tertiary care public hospital, 60% of the treatment costs were borne by the hospital. Thus, our study attempts to quantify, in financial terms, the expenditure involved in running a paediatric ICU in a tertiary care public hospital so as to assist doctors and healthcare decision makers in the allocation of resources.

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

2021 ◽  
pp. 089719002199700
Author(s):  
Brian C. Bohn ◽  
Elizabeth A. Neuner ◽  
Vasilios Athans ◽  
Kaitlyn R. Rivard ◽  
Allison R. Riffle ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Academic Medical ◽  
Quasi Experimental ◽  
Prospective Audit And Feedback

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.

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