scholarly journals A Culture Change: Impact of a Pediatric Antimicrobial Stewardship Program Based on Guideline Implementation and Prospective Audit with Feedback

Antibiotics ◽  
2021 ◽  
Vol 10 (11) ◽  
pp. 1307
Author(s):  
Bindiya Bagga ◽  
Jeremy S. Stultz ◽  
Sandra Arnold ◽  
Kelley R. Lee
Keyword(s):  
Antimicrobial Stewardship ◽  
Guideline Development ◽  
Guideline Implementation ◽  
Prospective Audit ◽  
Tertiary Referral Center ◽  
Antibiotic Utilization ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Key Stakeholders ◽  
The Impact

Reports analyzing the impact of pediatric antimicrobial stewardship programs (ASP) over long periods of time are lacking. We thus report our ASP experience in a pediatric tertiary referral center over a long-term period from 2011 to 2018. Our ASP was implemented in 2011. The program was based primarily on guideline development with key stakeholders, engaging and educating providers, followed by prospective audit with feedback (PAF). Monitored antibiotics included meropenem, piperacillin–tazobactam, and cefepime, followed by the addition of ceftriaxone, ceftazidime, cefotaxime, ciprofloxacin, levofloxacin, linezolid, and vancomycin at various time points. Specifically, the program did not implemented the core strategy of formulary restriction with prior authorization. Process- and outcome-related ASP measures were analyzed. We saw a 32% decrease in overall antibiotic utilization, a 51% decrease in the utilization of antibiotics undergoing PAF, and a 72% reduction in the use of broad-spectrum antibiotics such as meropenem. There was a concomitant increase in organism susceptibility and a reduction in yearly drug purchasing costs of over USD 560,000 from baseline without changes in sepsis-related mortality. Our study highlights that a pediatric ASP based primarily on the principles of guideline development and PAF can improve antibiotic utilization and institutional bacterial susceptibilities without a detrimental impact on patient outcomes by changing the culture of antimicrobial utilization within the institution.

scholarly journals 1141. Implementation of a Pediatric Handshake Antimicrobial Stewardship Program to Improve Antimicrobial Utilization

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S406-S406
Author(s):  
Amanda P Hughes ◽  
Maya Beganovic ◽  
Ronda Oram ◽  
Sarah Wieczorkiewicz ◽  
Anthony Chiang
Keyword(s):  
Antimicrobial Stewardship ◽  
Audit And Feedback ◽  
Prescribing Practices ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Days Of Therapy ◽  
Significant Difference ◽  
Acceptance Rates ◽  
Prospective Audit And Feedback ◽  
The Impact

Abstract Background Antimicrobial stewardship (AMS) programs emerged in response to rising rates of resistance and adverse effects associated with inappropriate antimicrobial utilization. Optimal metrics and strategies (e.g., preauthorization, prospective audit and feedback) for AMS remain to be elucidated. This study evaluated the impact of a multidisciplinary, rounding-based AMS strategy (i.e., Handshake Stewardship) on antimicrobial utilization and prescribing practices at a pediatric hospital. Methods This was a single-center, retrospective quality improvement study at a community, teaching children’s hospital. All pediatric and neonatal inpatients with active antimicrobial orders between July 2018 and March 2019 were included in the study, and endpoints were compared with data from July 2017- March 2018. Antimicrobial courses were prospectively audited by a multidisciplinary AMS team, and feedback was provided to the primary teams during Handshake Stewardship rounds. The primary endpoint was a number of interventions made and the corresponding acceptance rates. The secondary endpoint was days of therapy (DOT) per 1000 patient-days. Descriptive statistics were performed on all continuous and categorical data as appropriate. Results Of 2238 antimicrobial courses reviewed, 710 (32%) required intervention, and 86% of the interventions made were accepted. The top 3 indications evaluated were respiratory (n = 522, 23%), sepsis/bacteremia (n = 351, 16%), and surgical prophylaxis (n = 266, 12%). Of the respiratory courses reviewed, there were 228 opportunities for antimicrobial optimization. The most common interventions were: bug-drug optimization (n = 208, 29%), discontinuation of anti-infective (n = 136, 19%), and dose optimization (n = 120, 17%). No significant difference was observed for overall, ceftriaxone, meropenem, and vancomycin DOT pre- and post-implementation of Handshake Stewardship. However, a statistically significant reduction in DOTs was observed for piperacillin–tazobactam (15.2 vs. 7.4, P = 0.004) and a nonsignificant reduction in meropenem (9.5 vs. 6.2). Conclusion Rounding-based, Handshake AMS was associated with overall high intervention acceptance rates and a reduction in commonly utilized broad-spectrum antimicrobials. Disclosures All authors: No reported disclosures.

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 < .001) post-intervention, and median time to IPT was reduced by 21.2 hours (P < .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 < .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 Promoting Antimicrobial Stewardship Education Among Pediatricians Through a Maintenance of Certification Part 4 Quality Impro

2021 ◽  
Vol 1 (S1) ◽  
pp. s29-s29
Author(s):  
Prachi Singh ◽  
Brian Lee ◽  
Jenna Holmen
Keyword(s):  
Antimicrobial Stewardship ◽  
Transition Period ◽  
Surgical Patients ◽  
Antimicrobial Use ◽  
Maintenance Of Certification ◽  
Stewardship Program ◽  
Surgical Antibiotic Prophylaxis ◽  
Baseline Knowledge ◽  
Initial Survey ◽  
The Impact

Background: The rise of antimicrobial resistance has made it critical for clinicians to understand antimicrobial stewardship principles. We sought to determine whether the opportunity to participate in an American Board of Pediatrics Maintenance of Certification Part 4 (MOC4) quality improvement (QI) project would engage pediatricians and improve their knowledge about antimicrobial stewardship. Methods: In August 2019, a new clinical algorithm for acute appendicitis, spearheaded by the antimicrobial stewardship program (ASP), was implemented at UCSF Benioff Children’s Hospital Oakland to standardize care and optimize antimicrobial use. Medical staff were invited to participate in a QI project evaluating the impact of this algorithm. Data were collected for the 2 quarters preceding implementation (baseline), for the quarter of implementation (transition period), and for the quarter after implementation. Participants were offered MOC4 credit for reviewing these 3 cycles of data and associated materials highlighting information about antimicrobial stewardship. An initial survey was given to participants to assess their baseline knowledge via 4 questions about antimicrobial use in surgical patients (Table 1). At the conclusion of the QI project, another survey was conducted to reassess participant knowledge and to evaluate overall satisfaction with the project. Results: In total, 150 clinicians completed the initial survey. Of these, 44% were general pediatricians and 56% were pediatric subspecialists. Based on years out of training, their levels of experience varied: >20 years in 24%, 11–20 years in 32.7%, 0–10 years in 34.7%, and currently in training in 8.7%. Of the 150 initial participants, 133 (89%) completed the QI project and the second survey. Between surveys, there was significant improvement in knowledge about the appropriate timing and duration of surgical antibiotic prophylaxis (Table 1). Moreover, 88% of participants responded that the QI project was extremely effective in helping them learn about antimicrobial stewardship principles and about ASP interventions. Conclusions: Participation in this MOC4 QI project resulted in significant improvement in knowledge about antimicrobial use in surgical patients, and the activity was perceived as a highly effective way to learn about antimicrobial stewardship. QI projects that leverage MOC4 credit can be a powerful tool for engaging pediatricians and disseminating education about antimicrobial stewardship.Funding: NoDisclosures: None

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

2018 ◽  
Vol 39 (8) ◽  
pp. 941-946 ◽  
Author(s):  
Bradley J. Langford ◽  
Julie Hui-Chih Wu ◽  
Kevin A. Brown ◽  
Xuesong Wang ◽  
Valerie Leung ◽  
...  
Keyword(s):  
Observational Study ◽  
Acute Care ◽  
Antimicrobial Stewardship ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Audit And Feedback ◽  
Prospective Audit ◽  
Defined Daily Doses ◽  
Prospective Audit And Feedback ◽  
The Impact

AbstractObjectivesAntibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.DesignObservational study of acute-care hospitals in Ontario, CanadaMethodsA survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.ResultsOf 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.ConclusionsWide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

scholarly journals An evaluation of toxigenic Clostridioides difficile positivity as a patient outcome metric of antimicrobial stewardship in Saudi Arabia

2021 ◽  
Author(s):  
Christopher A. Okeahialam ◽  
Ali A. Rabaan ◽  
Albert Bolhuis
Keyword(s):  
Patient Outcome ◽  
Saudi Arabia ◽  
Antimicrobial Stewardship ◽  
Laboratory Data ◽  
Hospitalized Patients ◽  
Antimicrobial Stewardship Program ◽  
Repeated Testing ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Impact

AbstractBackgroundAntimicrobial stewardship has been associated with a reduction in the incidence of health care associated Clostridium difficile infection (HA-CDI). However, CDI remains under-recognized in many low and middle-income countries where clinical and surveillance resources required to identify HA-CDI are often lacking. The rate of toxigenic C. difficile stool positivity in the stool of hospitalized patients may offer an alternative metric for these settings, but its utlity remains largely untested.Aim/ObjectiveTo examine the impact of an antimicrobial stewardship on the rate of toxigenic C. difficile positivity among hospitalized patients presenting with diarrhoeaMethodsA 12-year retrospective review of laboratory data was conducted to compare the rates of toxigenic C. difficile in diarrhoea stool of patients in a hospital in Saudi Arabia, before and after implementation of an antimicrobial stewardship programResultThere was a significant decline in the rate of toxigenic C difficile positivity from 9.8 to 7.4% following the implementation of the antimicrobial stewardship program, and a reversal of a rising trend.DiscussionThe rate of toxigenic C. difficile positivity may be a useful patient outcome metric for evaluating the long term impact of antimicrobial stewardship on CDI, especially in settings with limited surveillance resources. The accuracy of this metric is however dependent on the avoidance of arbitrary repeated testing of a patient for cure, and testing only unformed or diarrhoea stool specimens. Further studies are required within and beyond Saudi Arabia to examine the utility of this metric.

Development of an antimicrobial stewardship program in an integrated healthcare system

2018 ◽  
Vol 76 (1) ◽  
pp. 34-43 ◽  
Author(s):  
Michael A Lane ◽  
Amanda J Hays ◽  
Helen Newland ◽  
Jeanne E Zack ◽  
Rebecca M Guth ◽  
...  
Keyword(s):  
Healthcare System ◽  
Antimicrobial Stewardship ◽  
Gap Analysis ◽  
System Level ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Integrated Healthcare ◽  
Stewardship Program ◽  
Regulatory Mandates ◽  
The Impact

Abstract Purpose The development of an inpatient antimicrobial stewardship program (ASP) in an integrated healthcare system is described. Summary With increasing national focus on reducing inappropriate antimicrobial use, state and national regulatory mandates require hospitals to develop ASPs. In 2015, BJC HealthCare, a multihospital health system, developed a system-level, multidisciplinary ASP team to assist member hospitals with ASP implementation. A comprehensive gap analysis was performed to assess current stewardship resources, activities and compliance with CDC core elements at each facility. BJC system clinical leads facilitated the development of hospital-specific leadership support statements, identification of hospital pharmacy and medical leaders, and led development of staff and patient educational components. An antimicrobial-use data dashboard was created for reporting and tracking the impact of improvement activities. Hospital-level interventions were individualized based on the needs and resources at each facility. Hospital learnings were shared at bimonthly system ASP meetings to disseminate best practices. The initial gap analysis revealed that BJC hospitals were compliant in a median of 6 ASP elements (range, 4–8) required by regulatory mandates. By leveraging system resources, all hospitals were fully compliant with regulatory requirements by January 2017. Conclusion BJC’s ASP model facilitated the development of broad-based stewardship activities, including education modules for patients and providers and clinical decision support, while allowing hospitals to implement activities based on local needs and resource availability.

Improved rates of antimicrobial stewardship interventions following implementation of the Epic antimicrobial stewardship module

2018 ◽  
Vol 39 (8) ◽  
pp. 980-982 ◽  
Author(s):  
Natasha N. Pettit ◽  
Zhe Han ◽  
Anish R. Choksi ◽  
Angella Charnot-Katsikas ◽  
Kathleen G. Beavis ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Usage ◽  
Antimicrobial Utilization ◽  
The Impact

AbstractWe evaluated the impact of the Epic antimicrobial stewardship module (EAM) on the number of interventions, antimicrobial usage, and clinical outcomes. Use of the EAM allowed us to significantly increase the number of ASP antimicrobial reviews and interventions while maintaining a sustained impact on antimicrobial utilization.

Clinical impact of a pharmacist-led antimicrobial stewardship initiative evaluating patients with Clostridioides difficile colitis

2020 ◽  
Vol 68 (4) ◽  
pp. 888-892 ◽  
Author(s):  
Paige A Bishop ◽  
Carmen Isache ◽  
Yvette S McCarter ◽  
Carmen Smotherman ◽  
Shiva Gautam ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Treatment Guidelines ◽  
Clinical Success ◽  
Audit And Feedback ◽  
Healthcare Associated Infection ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
The Usa ◽  
The Impact

Clostridioides difficile is the most common cause of healthcare-associated infection and gastroenteritis-associated death in the USA. Adherence to guideline recommendations for treatment of severe C. difficile infection (CDI) is associated with improved clinical success and reduced mortality. The purpose of this study was to determine whether implementation of a pharmacist-led antimicrobial stewardship program (ASP) CDI initiative improved adherence to CDI treatment guidelines and clinical outcomes. This was a single-center, retrospective, quasi-experimental study evaluating patients with CDI before and after implementation of an ASP initiative involving prospective audit and feedback in which guideline-driven treatment recommendations were communicated to treatment teams and documented in the electronic health record via pharmacy progress notes for all patients diagnosed with CDI. The primary endpoint was the proportion of patients treated with guideline adherent definitive regimens within 72 hours of CDI diagnosis. Secondary objectives were to evaluate the impact on clinical outcomes, including length of stay (LOS), infection-related LOS, 30-day readmission rates, and all-cause, in-hospital mortality. A total of 233 patients were evaluated. The proportion of patients on guideline adherent definitive CDI treatment regimen within 72 hours of diagnosis was significantly higher in the post-interventional group (pre: 42% vs post: 58%, p=0.02). No differences were observed in clinical outcomes or proportions of patients receiving laxatives, promotility agents, or proton pump inhibitors within 72 hours of diagnosis. Our findings demonstrate that a pharmacist-led stewardship initiative improved adherence to evidence-based practice guidelines for CDI treatment.

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