scholarly journals Impact of a Diagnosis-Centered Antibiotic Stewardship on Incident Clostridioides difficile Infections in Older Inpatients: An Observational Study

Antibiotics ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 303
Author(s):  
Alain Putot ◽  
Karine Astruc ◽  
Jeremy Barben ◽  
Anca Maria Mihai ◽  
Valentine Nuss ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Bacterial Infections ◽  
Antibiotic Consumption ◽  
Geriatric Rehabilitation ◽  
Full Time ◽  
Rehabilitation Unit ◽  
Clostridioides Difficile ◽  
Geriatric Unit ◽  
Bed Days ◽  
The Impact

In 2015, a major increase in incident hospital-onset Clostridioides difficile infections (HO-CDI) in a geriatric university hospital led to the implementation of a diagnosis-centered antibiotic stewardship program (ASP). We aimed to evaluate the impact of the ASP on antibiotic consumption and on HO-CDI incidence. The intervention was the arrival of a full-time infectiologist in the acute geriatric unit in May 2015, followed by the implementation of new diagnostic procedures for infections associated with an antibiotic withdrawal policy. Between 2015 and 2018, the ASP was associated with a major reduction in diagnoses for inpatients (23% to 13% for pneumonia, 24% to 13% for urinary tract infection), while median hospital stays and mortality rates remained stable. The reduction in diagnosed bacterial infections was associated with a 45% decrease in antibiotic consumption in the acute geriatric unit. HO-CDI incidence also decreased dramatically from 1.4‰ bed-days to 0.8‰ bed-days in the geriatric rehabilitation unit. The ASP focused on reducing the overdiagnosis of bacterial infections in the acute geriatric unit was successfully associated with both a reduction in antibiotic use and a clear reduction in the incidence of HO-CDI in the geriatric rehabilitation unit.

scholarly journals Surgeon-led 7-VINCut Antibiotic Stewardship Intervention Decreases Duration of Treatment and Carbapenem Use in a General Surgery Service

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 11
Author(s):  
Josep M. Badia ◽  
Maria Batlle ◽  
Montserrat Juvany ◽  
Patricia Ruiz-de León ◽  
Maria Sagalés ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Sharp Decrease ◽  
Antibiotic Consumption ◽  
Source Control ◽  
Duration Of Treatment ◽  
Development Of Resistance ◽  
Multiresistant Bacteria ◽  
The Impact ◽  
Improve Patient ◽  
Therapy Treatment

Antibiotic stewardship programs optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. In this prospective interventional study, a multidisciplinary team led by surgeons implemented a program aimed at shortening the duration of antibiotic treatment <7 days. The impact of the intervention on antibiotic consumption adjusted to bed-days and discharges, and the isolation of multiresistant bacteria (MRB) was also studied. Furthermore, the surgeons were surveyed regarding their beliefs and feelings about the program. Out of 1409 patients, 40.7% received antibiotic therapy. Treatment continued for over 7 days in 21.5% of cases, and, as can be expected, source control was achieved in only 48.8% of these cases. The recommendations were followed in 90.2% of cases, the most frequent being to withdraw the treatment (55.6%). During the first 16 months of the intervention, a sharp decrease in the percentage of extended treatments, with R2 = 0.111 was observed. The program was very well accepted by surgeons, and achieved a decrease in both the consumption of carbapenems and in the number of MRB isolations. Multidisciplinary stewardship teams led by surgeons seem to be well received and able to better manage antibiotic prescription in surgery.

scholarly journals Staphylococcus aureus - selective reporting of antibiogram results and its impact on antibiotic use: Interventional study with a reference group on the effect of switching from non-selective to selective antibiotic reporting

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Franka Lestin-Bernstein ◽  
Ramona Harberg ◽  
Ingo Schumacher ◽  
Lutz Briedigkeit ◽  
Oliver Heese ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Selective Reporting ◽  
Beta Lactams ◽  
Interventional Study ◽  
Patient Level ◽  
Narrow Spectrum ◽  
Bed Days ◽  
The Impact

Abstract Background Antimicrobial stewardship (AMS) strategies worldwide focus on optimising the use of antibiotics. Selective susceptibility reporting is recommended as an effective AMS tool although there is a lack of representative studies investigating the impact of selective susceptibility reporting on antibiotic use. The aim of this study was to investigate the impact of selective susceptibility reporting of Staphylococcus aureus (S. aureus) on antibiotic consumption. Enhancing the use of narrow-spectrum beta-lactam antibiotics such as flucloxacillin/cefazolin/cefalexin is one of the main goals in optimising antibiotic therapy of S. aureus infections. Methods This interventional study with control group was conducted at a tertiary care hospital in Germany. During the one-year interventional period susceptibility reports for all methicillin-sensitive S. aureus (MSSA) were restricted to flucloxacillin/cefazolin/cefalexin, trimethoprim-sulfamethoxazole, clindamycin, gentamicin and rifampin/fosfomycin, instead of reporting all tested antibiotics. The impact of implementing selective reporting was analysed by monitoring total monthly antibiotic consumption in our hospital and in a reference hospital (recommended daily dose/100 occupied bed days: RDD/100 BD), as well as on an individual patient level by analysing days of therapy adjusted for bed days (DOT/ 100 BD) for patients with S. aureus bacteremia (SAB) and respectively skin and soft tissue infections (SSTI). Results MSSA-antibiograms were acquired for 2836 patients. The total use of narrow-spectrum beta-lactams more than doubled after implementing selective reporting (from 1.2 to 2.8 RDD/100 BD, P < 0.001). The use of intravenous flucloxacillin/cefazolin for SAB rose significantly from 52 to 75 DOT/100 BD (plus 42%), just as the use of oral cefalexin for SSTI (from 1.4 to 9.4 DOT/100 BD, from 3 to 17 of 85/88 patients). Considering the overall consumption, there was no decrease in antibiotics omitted from the antibiogram. This was probably due to their wide use for other infections. Conclusions As narrow-spectrum beta-lactams are not widely used for other infections, their increase in the overall consumption of the entire hospital was a strong indicator that selective reporting guided clinicians to an optimised antibiotic therapy of S. aureus infections. On a patient level, this assumption was verified by a significant improved treatment of S. aureus infections in the subgroups of SAB and SSTI. As useful AMS tool, we recommend implementing selective reporting rules into the national/international standards for susceptibility reporting.

scholarly journals Risk-adjusted antibiotic consumption in 34 public acute hospitals in Ireland, 2006 to 2014

2016 ◽  
Vol 21 (32) ◽  
Author(s):  
Ajay Oza ◽  
Fionnuala Donohue ◽  
Howard Johnson ◽  
Robert Cunney
Keyword(s):  
Administrative Data ◽  
Risk Adjustment ◽  
Antibiotic Consumption ◽  
Factors Affecting ◽  
Defined Daily Doses ◽  
Acute Hospitals ◽  
Consumption Rates ◽  
Hospital Antibiotic Consumption ◽  
Bed Days ◽  
The Impact

As antibiotic consumption rates between hospitals can vary depending on the characteristics of the patients treated, risk-adjustment that compensates for the patient-based variation is required to assess the impact of any stewardship measures. The aim of this study was to investigate the usefulness of patient-based administrative data variables for adjusting aggregate hospital antibiotic consumption rates. Data on total inpatient antibiotics and six broad subclasses were sourced from 34 acute hospitals from 2006 to 2014. Aggregate annual patient administration data were divided into explanatory variables, including major diagnostic categories, for each hospital. Multivariable regression models were used to identify factors affecting antibiotic consumption. Coefficient of variation of the root mean squared errors (CV-RMSE) for the total antibiotic usage model was very good (11%), however, the value for two of the models was poor (> 30%). The overall inpatient antibiotic consumption increased from 82.5 defined daily doses (DDD)/100 bed-days used in 2006 to 89.2 DDD/100 bed-days used in 2014; the increase was not significant after risk-adjustment. During the same period, consumption of carbapenems increased significantly, while usage of fluoroquinolones decreased. In conclusion, patient-based administrative data variables are useful for adjusting hospital antibiotic consumption rates, although additional variables should also be employed.

scholarly journals Modelling the impact of curtailing antibiotic usage in food animals on antibiotic resistance in humans

2017 ◽  
Vol 4 (4) ◽  
pp. 161067 ◽  
Author(s):  
B. A. D. van Bunnik ◽  
M. E. J. Woolhouse
Keyword(s):  
Bacterial Infections ◽  
Antibiotic Consumption ◽  
Antibiotic Usage ◽  
Model Parameters ◽  
Simple Mathematical Model ◽  
Quantitative Evidence ◽  
Wide Range ◽  
Food Animals ◽  
The Impact ◽  
Equivalent Reduction

Consumption of antibiotics in food animals is increasing worldwide and is approaching, if not already surpassing, the volume consumed by humans. It is often suggested that reducing the volume of antibiotics consumed by food animals could have public health benefits. Although this notion is widely regarded as intuitively obvious there is a lack of robust, quantitative evidence to either support or contradict the suggestion. As a first step towards addressing this knowledge gap, we develop a simple mathematical model for exploring the generic relationship between antibiotic consumption by food animals and levels of resistant bacterial infections in humans. We investigate the impact of restricting antibiotic consumption by animals and identify which model parameters most strongly determine that impact. Our results suggest that, for a wide range of scenarios, curtailing the volume of antibiotics consumed by food animals has, as a stand-alone measure, little impact on the level of resistance in humans. We also find that reducing the rate of transmission of resistance from animals to humans may be more effective than an equivalent reduction in the consumption of antibiotics in food animals. Moreover, the response to any intervention is strongly determined by the rate of transmission from humans to animals, an aspect which is rarely considered.

scholarly journals Impact and Sustainability of Antibiotic Stewardship on Antibiotic Prescribing in Visceral Surgery

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1518
Author(s):  
Magdalena Monika Gruber ◽  
Alexandra Weber ◽  
Jette Jung ◽  
Jens Werner ◽  
Rika Draenert
Keyword(s):  
Patient Outcomes ◽  
Antibiotic Stewardship ◽  
Clinical Care ◽  
Antibiotic Consumption ◽  
Visceral Surgery ◽  
Antibiotic Prescribing ◽  
Core Element ◽  
Days Of Therapy ◽  
Ward Rounds ◽  
The Impact

Background: Antibiotic stewardship (AS) ward rounds are a core element in clinical care for surgical patients. Therefore, we aimed to analyze the impact of surgical AS ward rounds on antibiotic prescribing, and the sustainability of the effect after the AS interventions are no longer provided. Methods: On four wards of the department of visceral surgery, we conducted two independent retrospective prescribing analyses (P1, P2) over three months each. During the study periods, the level of AS intervention differed for two of the four wards (ward rounds/no ward rounds). Results: AS ward rounds were associated with a decrease in overall antibiotic consumption (91.1 days of therapy (DOT)/100 patient days (PD) (P1), 70.4 DOT/100PD (P2)), and improved de-escalation rates of antibiotic therapy (W1/2: 25.7% (P1), 40.0% (P2), p = 0.030; W3: 15.4 (P1), 24.2 (P2), p = 0.081). On the ward where AS measures were no longer provided, overall antibiotic usage remained stable (71.3 DOT/100PD (P1), 74.4 DOT/100PD (P2)), showing the sustainability of AS measures. However, the application of last-resort compounds increased from 6.4 DOT/100PD to 12.1 DOT/100PD (oxazolidinones) and from 10.8 DOT/100PD to 13.2 DOT/100PD (carbapenems). Conclusions: Antibiotic consumption can be reduced without negatively affecting patient outcomes. However, achieving lasting positive changes in antibiotic prescribing habits remains a challenge.

scholarly journals 50. Impact of Antibiotic Stewardship Interventions on Colistin Use and Acinetobacter Resistance

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S145-S145
Author(s):  
Khalid Eljaaly
Keyword(s):  
Antibiotic Stewardship ◽  
Medical Center ◽  
Antibiotic Consumption ◽  
Tertiary Hospital ◽  
Stewardship Program ◽  
Before And After ◽  
Consultant Physician ◽  
Acinetobacter Spp ◽  
The Impact ◽  
Before And After Study

Abstract Background Our hospital had a widespread use of colistin and tigecycline, and very high resistance of Acinetobacter Spp. to colistin. The hospital did not have any infectious disease (ID) pharmacist and had only one ID consultant physician. The objective of this study was to evaluate the impact of our intervention on the utilization of colistin and tigecycline and resistance of Acinetobacter Spp. Methods This was a before an observational before-and-after study at a tertiary medical center. An ID pharmacist trained in antibiotic stewardship program (ASP) was invited by a tertiary hospital to help create an ASP. The hospital also hired four ID assistant consultants to help the primary ID consultant and pharmacists. The ASP started by restriction of colistin and tigecycline. The study outcomes were antibiotic consumption and resistance of Acinetobacter spp. Results Colistin utilization decreased by 60%, and the resistance of Acinetobacter spp. to colistin significantly decreased from 31% to 3% in a year. In addition, tigecycline utilization decreased by 46%. On the other hand, there were no significant changes in carbapenem utilization and resistance, which could be explained by switching from colistin and tigecycline to carbapenems. Conclusion Adding an ID pharmacist and ID assistant consultants to the ASP team, and the strict restriction of colistin use was associated with significant reduction in colistin use and Acinetobacter resistance. Disclosures All Authors: No reported disclosures

Scope of Antibiotic Stewardship Programs in Pediatrics

2019 ◽  
Vol 58 (11-12) ◽  
pp. 1291-1301 ◽  
Author(s):  
Leslie Grammatico-Guillon ◽  
Lukman Abdurrahim ◽  
Kimberley Shea ◽  
Pascal Astagneau ◽  
Stephen Pelton
Keyword(s):  
Antimicrobial Resistance ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Consumption ◽  
Antibiotic Prescribing ◽  
Large Variability ◽  
Search Terms ◽  
Inpatient Settings ◽  
Meta Analyses ◽  
The Impact

This review of pediatric antibiotic stewardship programs (ASPs) summarized the antibiotic prescribing interventions and their impact on antibiotic use and antimicrobial resistance. We reviewed studies of pediatric ASP, including the search terms “antimicrobial stewardship,” “antibiotic stewardship,” “children,” and “pediatric.” The articles’ selection and review were performed independently by 2 investigators, according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Twenty-one studies were included, from the past 15 years, increasing after the 2007 IDSA (Infectious Diseases Society of America) guidelines for ASP with a large variability of the programs, and the virtual exclusive focus on inpatient settings (90%): 16 formalized ASP and 5 non-ASP actions. A reduction in antibiotic prescribing in ASP has been demonstrated in the studies reporting pediatric ASP, but only one ASP showed a significant impact on antimicrobial resistance. However, the impact on antibiotic consumption in pediatrics demonstrated the important contribution of these strategies to improve antibiotic use in children, without complications or negative issues.

scholarly journals Impact of an antimicrobial stewardship program in the antimicrobial-resistant and prevalence of clostridioides difficile infection and amount of antimicrobial consumed in cancer patients

2020 ◽  
Vol 13 (1) ◽  
Author(s):  
Masoud Mardani ◽  
Sara Abolghasemi ◽  
Shiva Shabani
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Consumption ◽  
Multidrug Resistant ◽  
Marrow Transplant ◽  
Blood Cultures ◽  
University Hospital ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Quasi Experimental ◽  
The Impact

Abstract Objective The The impact of a hospital antimicrobial stewardship was determined on antimicrobial-resistant, Clostridioides difficile rates and the amount of antimicrobial consumed in cancer patients.The intervention effects of antimicrobial stewardship (ASP) plans in 2017–2018 and 2018–2019 were respectively evaluated among hematology/oncology and bone marrow transplant patients in Ayatollah Taleghani University Hospital, Tehran, Iran. In this interventional quasi-experimental study, the ASP repository was utilized to capture four survey questions encompassed in these immunocompromised patients: amount of antibiotics (meropenem and vancomycin) consumption gr-year, the number of positive Clostridioides difficile infection and multidrug-resistant positive cases in blood cultures. Results The number of MDR cases in the periods of 2017–2018 and 2018–2019 were 145 and 75, respectively (p = 0.011). A significant reduction in all positive blood cultures from 2017–2018 to 2018–2019 was found (p = 0.001). 574 patients admitted to our hospital in these periods of 2017- 2018 and 2018- 2019were assessed for MPM and VMN use. The amounts of MPM prescriptions in 2018–2019 was significantly decreased from 22464 to 17262 g (p = 0.043). The significant reduction in antibiotic consumption, MDR organisms, and CDI can highly promote patients’ health and decreasing medical costs and long-term defects for patients.

scholarly journals Antibiotic Consumption and Stewardship at a Hospital outside of an Early Coronavirus Disease 2019 Epicenter

2020 ◽  
Vol 64 (11) ◽  
Author(s):  
Deanna J. Buehrle ◽  
Brooke K. Decker ◽  
Marilyn M. Wagener ◽  
Amesh Adalja ◽  
Nina Singh ◽  
...  
Keyword(s):  
Antibiotic Consumption ◽  
Days Of Therapy ◽  
Hospital Antibiotic Consumption ◽  
Bed Days ◽  
The Impact

ABSTRACT There are scant data on the impact of coronavirus disease 2019 (COVID-19) on hospital antibiotic consumption, and no data from outside epicenters. At our nonepicenter hospital, antibiotic days of therapy (DOT) and bed days of care (BDOC) were reduced by 151.5/month and 285/month, respectively, for March to June 2020 compared to 2018–2019 (P = 0.001 and P < 0.001). DOT per 1,000 BDOC was increased (8.1/month; P = 0.001). COVID-19 will impact antibiotic consumption, stewardship, and resistance in ways that will likely differ temporally and by region.

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