Antibiotic Stewardship Grows Up

Antibiotic Prevalence Study and Factors Influencing Prescription of WHO Watch Category Antibiotic Ceftriaxone in a Tertiary Care Private Not for Profit Hospital in Uganda

Background: Excessive use of ceftriaxone contributes to the emergence and spread of antimicrobial resistance (AMR). In low and middle-income countries, antibiotics are overused but data on consumption are scarcely available. We aimed to determine the prevalence and factors influencing ceftriaxone prescription in a tertiary care private not-for-profit hospital in Uganda. Methods: A cross-sectional study was carried out from October 2019 through May 2020 at Mengo Hospital in Uganda. Patients admitted to the medical ward and who had been prescribed antibiotics were enrolled. Sociodemographic and clinical data were recorded in a structured questionnaire. Bivariate and adjusted logistic regression analyses were performed to determine factors associated with ceftriaxone prescription. Results: Study participants were mostly female (54.7%). The mean age was 56.2 years (SD: 21.42). The majority (187, 73.3%) presented with fever. Out of the 255 participants included in this study, 129 (50.6%) participants were prescribed ceftriaxone. Sixty-five (25.5%) and forty-one (16.0%) participants had a prescription of levofloxacin and metronidazole, respectively. Seven participants (2.7%) had a prescription of meropenem. Out of 129 ceftriaxone prescriptions, 31 (24.0%) were in combination with other antibiotics. Overall, broad-spectrum antibiotic prescriptions accounted for 216 (84.7%) of all prescriptions. Ceftriaxone was commonly prescribed for pneumonia (40/129, 31%) and sepsis (38/129, 29.5%). Dysuria [OR = 0.233, 95% CI (0.07-0.77), p = 0.017] and prophylactic indication [OR = 7.171, 95% CI (1.36-37.83), p = 0.020] were significantly associated with ceftriaxone prescription. Conclusions: Overall, we observed a high prevalence of prescriptions of ceftriaxone at the medical ward of Mengo Hospital. We recommend an antibiotic stewardship program (ASP) to monitor antibiotic prescription and sensitivity patterns in a bid to curb AMR.

Bedside Nurses: Champions of Antimicrobial Stewardship

TOPIC

Microbial organisms include bacteria, viruses, fungi, and parasites. Antimicrobial medications are currently overused or misused, which has resulted in multidrug resistance. Hospitalized patients in the intensive care unit have the highest risk for infections leading to poor outcomes and require successful treatment options.

CLINICAL RELEVANCE

Inappropriate prescription of antimicrobials places patients and the community at risk for more resistant infections in the future. To prevent misapplication of these important medications, interdisciplinary antimicrobial stewardship programs promote appropriate and safe antimicrobial medication use. Members of these programs are called to be good stewards of antimicrobial medications, incorporating the scope of practice and knowledge of each specialty and the evidence from the literature to develop strategies and protocols for safe and effective antimicrobial medication use.

PURPOSE OF PAPER

Nurse involvement in antimicrobial stewardship programs is inadequate, limiting the programs' potential. Support for increased direct-care nurse participation in antimicrobial stewardship programs is key to improve program targets and patient outcomes.

CONTENT COVERED

This article calls for increased nursing awareness of the importance of antimicrobial stewardship programs in clinical practice and greater direct-care nurse involvement in these programs.

Geographic Mapping of Escherichia coli Susceptibility To Develop a Novel Clinical Decision Support Tool

Antimicrobial resistance (AMR) varies regionally. This study longitudinally maps Escherichia coli susceptibility leveraging Wisconsin antibiograms (n = 202) collected from 2009, 2013, and 2015 to inform the development of a novel clinical decision support tool. Spatial interpolation methods were tested with E. coli susceptibilities to create geographic AMR visualizations and to estimate susceptibility in areas without AMR data. These visualizations and an interactive mapping tool, the AMR Tracker, provide a proof of concept for empirical antibiotic treatment decisions.

A Multidisciplinary Approach to Incorporate Bedside Nurses into Antimicrobial Stewardship and Infection Prevention

BACKGROUND

Antimicrobial stewardship programs exist to promote appropriate antimicrobial use. The Joint Commission has reported that although many US hospitals have implemented basic components of antimicrobial stewardship programs, there now exists a need for innovative, multidisciplinary approaches, including involving frontline clinicians such as bedside nurses.

METHODS

A retrospective evaluation of bedside nurse-driven antimicrobial stewardship and infection prevention rounds was conducted on a 31-bed telemetry unit of a community regional medical center. Rounds were managed by a nurse coordinator and attended by an infectious diseases pharmacist, an infection preventionist, and a nurse practitioner. Primary outcome measures were antimicrobial and acid suppressant medication and invasive catheter use.

RESULTS

In the 12-month intervention period the nurse-driven rounds team reviewed of a total of 472 antimicrobial medication, 480 acid suppressant medication, 321 urinary catheter, and 61 central venous catheter therapies over 867 total patient encounters. Compared with the 12-month preintervention period, significant reductions in unit antimicrobial use (791.2 vs. 697.1 days of therapy per 1,000 patient-days; p = 0.03), acid suppressant medication use (708.1 vs. 372.4 days of therapy per 1,000 patient-days; p = 0.0001), and urinary catheter use (0.3 vs. 0.2 catheter-days per patient-day; p = 0.002) were observed.

CONCLUSION

This study demonstrates successful engagement of bedside nurses in antimicrobial stewardship and infection prevention activities and a measurable impact on meaningful outcomes. More studies of strategies to integrate bedside nurses in antimicrobial stewardship are needed.