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Kassamali Escobar Z, Shively NR. Health System and Tele-Antimicrobial Stewardship: The Role of Building Networks. Infect Dis Clin North Am 2023; 37:873-900. [PMID: 37657974 DOI: 10.1016/j.idc.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
Abstract
Tele-antimicrobial stewardship programs (tele-ASPs) use technology and remote access to resources and clinical expertise to expand antimicrobial services within and outside of health systems. Models of tele-ASPs are workforce multiplying and workforce extending, depending on how they are structured. Building rapport and strong interpersonal networks are essential for successful ASPs. The available evidence suggests that an optimal model for tele-ASP includes hands-on involvement from remote infectious disease (ID) expertise with implementation by local pharmacists. However, this model remains limited by the available time and cost of ID-trained specialists.
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Affiliation(s)
- Zahra Kassamali Escobar
- University of Washington Center for Stewardship in Medicine, Seattle, WA, USA; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Center, 825 Eastlake Avenue, Mail Stop G5-900, P.O. Box 19023, Seattle, WA 98109, USA
| | - Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network, 320 E North Avenue, Fourth Floor, East Wing, Suite 406, Pittsburgh, PA 15212, USA.
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Yoon YK, Kwon KT, Jeong SJ, Moon C, Kim B, Kiem S, Kim HS, Heo E, Kim SW. Guidelines on Implementing Antimicrobial Stewardship Programs in Korea. Infect Chemother 2021; 53:617-659. [PMID: 34623784 PMCID: PMC8511380 DOI: 10.3947/ic.2021.0098] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/17/2021] [Indexed: 12/11/2022] Open
Abstract
These guidelines were developed as a part of the 2021 Academic R&D Service Project of the Korea Disease Control and Prevention Agency in response to requests from healthcare professionals in clinical practice for guidance on developing antimicrobial stewardship programs (ASPs). These guidelines were developed by means of a systematic literature review and a summary of recent literature, in which evidence-based intervention methods were used to address key questions about the appropriate use of antimicrobial agents and ASP expansion. These guidelines also provide evidence of the effectiveness of ASPs and describe intervention methods applicable in Korea.
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Affiliation(s)
- Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.,Korean Society for Antimicrobial Therapy, Seoul, Korea
| | - Ki Tae Kwon
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.,Korean Society of Infectious Diseases, Seoul, Korea
| | - Chisook Moon
- Korean Society of Infectious Diseases, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
| | - Bongyoung Kim
- Korean Society of Infectious Diseases, Seoul, Korea.,Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Sungmin Kiem
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Chungnam National University, Daejeon, Korea
| | - Hyung-Sook Kim
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Eunjeong Heo
- Department of Pharmacy, Seoul National University Bundang Hospital, Seongnam, Korea.,Korean Society of Health-System Pharmacist, Seoul, Korea
| | - Shin-Woo Kim
- Korean Society for Antimicrobial Therapy, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
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Suzuki H, Perencevich E, Goto M, Alexander B, Nair R, Puig-Asensio M, Ernst E, Livorsi DJ. A comprehensive assessment of carbapenem use across 90 Veterans Health Administration hospitals with defined stewardship strategies for carbapenems. J Antimicrob Chemother 2021; 76:1358-1365. [PMID: 33523128 DOI: 10.1093/jac/dkab008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 12/29/2020] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Carbapenems are an important target for antimicrobial stewardship (AS) efforts. In this study, we sought to compare different hospital-based strategies for improving carbapenem use. METHODS We analysed a cohort of all patients hospitalized at Veterans Health Administration (VHA) acute care hospitals during 2016 and a mandatory survey that characterized each hospital's carbapenem-specific AS strategy into one of three types: no strategy (NS), prospective audit and feedback (PAF) or restrictive policies (RP). Carbapenem use was compared using risk-adjusted generalized estimating equations that accounted for clustering within hospitals. Two infectious disease (ID) physicians independently performed manual chart reviews in 425 randomly selected cases. Auditors assessed carbapenem appropriateness with an assessment score on Day 4 of therapy. RESULTS There were 429 062 admissions in 90 sites (24 NS, 8 PAF, 58 RP). Carbapenem use was lower at PAF than NS sites [rate ratio (RR) 0.6 (95% CI 0.4-0.9); P = 0.01] but similar between RP and NS sites. Carbapenem prescribing was considered appropriate/acceptable in 215 (50.6%) of the reviewed cases. Assessment scores were lower (i.e. better) at RP than NS sites (mean 2.3 versus 2.7; P < 0.01) but did not differ significantly between NS and PAF sites. ID consultations were more common at PAF/RP than NS sites (51% versus 29%; P < 0.01). ID consultations were associated with lower (i.e. better) assessment scores (mean 2.3 versus 2.6; P < 0.01). CONCLUSIONS In this VHA cohort, PAF strategies were associated with lower carbapenem use and ID consultation and RP strategies were associated with more appropriate carbapenem prescribing. AS and ID consultations may work complementarily and hospitals could leverage both to optimize carbapenem use.
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Affiliation(s)
- Hiroyuki Suzuki
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Eli Perencevich
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Michihiko Goto
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Bruce Alexander
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Rajeshwari Nair
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.,Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Erika Ernst
- University of Iowa College of Pharmacy, Iowa City, IA, USA
| | - Daniel J Livorsi
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA.,Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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Vento TJ, Veillette JJ, Gelman SS, Adams A, Jones P, Repko K, Stenehjem EA. Implementation of an Infectious Diseases Telehealth Consultation and Antibiotic Stewardship Program for 16 Small Community Hospitals. Open Forum Infect Dis 2021; 8:ofab168. [PMID: 34141816 PMCID: PMC8205263 DOI: 10.1093/ofid/ofab168] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/01/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Telehealth improves access to infectious diseases (ID) and antibiotic stewardship (AS) services in small community hospitals (SCHs), but the optimal model has not been defined. We describe implementation and impact of an integrated ID telehealth (IDt) service for 16 SCHs in the Intermountain Healthcare system. METHODS The Intermountain IDt service included a 24-hour advice line, eConsults, telemedicine consultations (TCs), daily AS surveillance, long-term AS program (ASP) support by an IDt pharmacist, and a monthly telementoring webinar. We evaluated program measures from November 2016 through April 2018. RESULTS A total of 2487 IDt physician interactions with SCHs were recorded: 859 phone calls (35% of interactions), 761 eConsults (30%), and 867 TCs (35%). Of 1628 eConsults and TCs, 1400 (86%) were SCH provider requests, while 228 (14%) were IDt pharmacist generated. Six SCHs accounted for >95% of interactions. Median consultation times for each initial telehealth interaction type were 5 (interquartile range [IQR], 5-10) minutes for phone calls, 20 (IQR, 15-25) minutes for eConsults, and 50 (IQR, 35-60) minutes for TCs. Thirty-two percent of consults led to in-person ID clinic follow-up. Bacteremia was the most common reason for consultation (764/2487 [31%]) and Staphylococcus aureus the most common organism identified. ASPs were established at 16 facilities. Daily AS surveillance led to 2229 SCH pharmacist and 1305 IDt pharmacist recommendations. Eight projects were completed with IDt pharmacist support, leading to significant reductions in meropenem, vancomycin, and fluoroquinolone use. CONCLUSIONS An integrated IDt model led to collaborative ID/ASP interventions and improvements in antibiotic use at 16 SCHs. These findings provide insight into clinical and logistical considerations for IDt program implementation.
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Affiliation(s)
- Todd J Vento
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
| | - John J Veillette
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
- Department of Pharmacy, Intermountain Medical Center, Murray, Utah, USA
| | - Stephanie S Gelman
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
| | - Angie Adams
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
| | - Peter Jones
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
| | - Katherine Repko
- Intermountain Healthcare TeleHealth Services, Murray, Utah, USA
| | - Edward A Stenehjem
- Division of Infectious Diseases and Clinical Epidemiology, Intermountain Medical Center, Murray, Utah, USA
- Office of Patient Experience, Intermountain Healthcare, Salt Lake City, Utah, USA
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Shively NR, Moffa MA, Paul KT, Wodusky EJ, Schipani BA, Cuccaro SL, Harmanos MS, Cratty MS, Chamovitz BN, Walsh TL. Impact of a Telehealth-Based Antimicrobial Stewardship Program in a Community Hospital Health System. Clin Infect Dis 2021; 71:539-545. [PMID: 31504367 DOI: 10.1093/cid/ciz878] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 09/03/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Data on antimicrobial stewardship programs (ASPs) facilitated via telehealth in the community hospital setting are limited. METHODS A telehealth-based ASP was implemented in 2 community hospitals (285 and 176 beds). Local pharmacists without residency or prior antimicrobial stewardship training were trained to conduct prospective audit and feedback. For approximately 60 minutes 3 times weekly at the 285-bed hospital and 2 times weekly at the 176-bed hospital, infectious diseases (ID) physicians remotely reviewed patients on broad-spectrum antibiotics and those admitted with lower respiratory tract infections and skin and soft tissue infections with local pharmacists. Recommendations for ASP interventions made by ID physicians were relayed to primary teams and tracked by local pharmacists. Antimicrobial utilization was collected in days of therapy (DOT) per 1000 patient-days (PD) for a 12-month baseline and 6-month intervention period, and analyzed with segmented linear regression analysis. Local ID consultations were tracked and antimicrobial cost savings were estimated. RESULTS During the 6-month intervention period, 1419 recommendations were made, of which 1262 (88.9%) were accepted. Compared to the baseline period, broad-spectrum antibiotic utilization decreased by 24.4% (342.1 vs 258.7 DOT/1000 PD; P < .001) during the intervention period. ID consultations increased by 40.2% (15.4 consultations per 1000 PD vs 21.5 consultations per 1000 PD; P = .001). Estimated annualized savings on antimicrobial expenditures were $142 629.83. CONCLUSIONS An intense ASP model, facilitated in the community hospital setting via telehealth, led to reduced broad-spectrum antimicrobial utilization, increased ID consultations, and reduced antimicrobial expenditures.
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Affiliation(s)
- Nathan R Shively
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Matthew A Moffa
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Kathleen T Paul
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Eric J Wodusky
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Beth Ann Schipani
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Susan L Cuccaro
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Mark S Harmanos
- Department of Pharmacy, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Michael S Cratty
- Department of Medicine, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Bruce N Chamovitz
- Division of Infectious Diseases, Heritage Valley Health System, Beaver and Sewickley, Pennsylvania, USA
| | - Thomas L Walsh
- Division of Infectious Diseases, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
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Opportunities and challenges in improving antimicrobial use during the era of telehealth expansion: A narrative review. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e26. [PMID: 36168461 PMCID: PMC9495641 DOI: 10.1017/ash.2021.191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/11/2021] [Indexed: 11/24/2022]
Abstract
Efforts to improve antimicrobial prescribing are occurring within a changing healthcare landscape, which includes the expanded use of telehealth technology. The wider adoption of telehealth presents both challenges and opportunities for promoting antimicrobial stewardship. Telehealth provides 2 avenues for remote infectious disease (ID) specialists to improve inpatient antimicrobial prescribing: telehealth-supported antimicrobial stewardship and tele-ID consultations. Those 2 activities can work separately or synergistically. Studies on telehealth-supported antimicrobial stewardship have reported a reduction in inpatient antimicrobial prescribing, cost savings related to less antimicrobial use, a decrease in Clostridioides difficile infections, and improved antimicrobial susceptibility patterns for common organisms. Tele-ID consultation is associated with fewer hospital transfers, a shorter length of hospital stay, and decreased mortality. The implementation of these activities can be flexible depending on local needs and available resources, but several barriers may be encountered. Opportunities also exist to improve antimicrobial use in outpatient settings. Telehealth provides a more rapid mechanism for conducting outpatient ID consultations, and increasing use of telehealth for routine and urgent outpatient visits present new challenges for antimicrobial stewardship. In primary care, urgent care, and emergency care settings, unnecessary antimicrobial use for viral acute respiratory tract infections is common during telehealth encounters, as is the case for fact-to-face encounters. For some diagnoses, such as otitis media and pharyngitis, antimicrobials are further overprescribed via telehealth. Evidence is still lacking on the optimal stewardship strategies to improve antimicrobial prescribing during telehealth encounters in ambulatory care, but conventional outpatient stewardship strategies are likely transferable. Further work is warranted to fill this knowledge gap.
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Bouchet F, Le Moing V, Dirand D, Cros F, Lienard A, Reynes J, Giraudon L, Morquin D. Effectiveness and Acceptance of Multimodal Antibiotic Stewardship Program: Considering Progressive Implementation and Complementary Strategies. Antibiotics (Basel) 2020; 9:antibiotics9120848. [PMID: 33260815 PMCID: PMC7760905 DOI: 10.3390/antibiotics9120848] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 11/19/2020] [Accepted: 11/25/2020] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Flavien Bouchet
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, 34000 Montpellier, France; (V.L.M.); (J.R.); (D.M.)
- Pôle Appui aux Fonctions Cliniques, Département de la Pharmacie, Hôpitaux du Bassin de Thau, 34200 Sète, France; (D.D.); (L.G.)
- Correspondence:
| | - Vincent Le Moing
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, 34000 Montpellier, France; (V.L.M.); (J.R.); (D.M.)
| | - Delphine Dirand
- Pôle Appui aux Fonctions Cliniques, Département de la Pharmacie, Hôpitaux du Bassin de Thau, 34200 Sète, France; (D.D.); (L.G.)
| | - François Cros
- Département Informatique, Hôpitaux du Bassin de Thau, 34200 Sète, France;
| | - Alexi Lienard
- Département de Biologie Médicale, Hôpitaux du Bassin de Thau, 34200 Sète, France;
| | - Jacques Reynes
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, 34000 Montpellier, France; (V.L.M.); (J.R.); (D.M.)
| | - Laurent Giraudon
- Pôle Appui aux Fonctions Cliniques, Département de la Pharmacie, Hôpitaux du Bassin de Thau, 34200 Sète, France; (D.D.); (L.G.)
| | - David Morquin
- Service de Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Montpellier, Université de Montpellier, 34000 Montpellier, France; (V.L.M.); (J.R.); (D.M.)
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The impact of dispatching infectious diseases physicians for infection control. Interrupted time-series analysis on carbapenem use and blood cultures. J Hosp Infect 2019; 103:110-111. [PMID: 31251948 DOI: 10.1016/j.jhin.2019.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/19/2019] [Indexed: 11/21/2022]
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Antimicrobial stewardship program (ASP): an effective implementing technique for the therapy efficiency of meropenem and vancomycin antibiotics in Iranian pediatric patients. Ann Clin Microbiol Antimicrob 2019; 18:6. [PMID: 30696456 PMCID: PMC6352345 DOI: 10.1186/s12941-019-0305-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/21/2019] [Indexed: 11/25/2022] Open
Abstract
Background Antimicrobial stewardship program (ASP) is a distinguished method to improve the prescription and efficacy of antibiotics. Aim The efficacy of ASP and conventional methods was compared to measure the effectiveness of meropenem (MPM) and vancomycin (VMN) antibiotics in pediatric patients. Design In an interventional quasi-experimental study, 135 children admitted in Children’s Hospital affiliated to University of Medical Sciences in time periods of 2014–2015 and 2015–2016 were assessed. Methods The conventional and ASP methods in 2014–2015 and 2015–2016 were respectively utilized to provide the best antimicrobial therapy of MPM and VMN antibiotics in patient children. The data of mortality rate (MR), antibiotic prescription (AP), antibiotic dose (ADe), antibiotic duration (ADn), length of hospital stay (LOHS), and blood cultures (BCs) were compared across the years using the Chi square, independent t test, and Fisher’s exact test. Results The levels of MR, AP, ADe, ADn, LOHS, and positive BCs using the ASP method in 2015–2016 were significantly lower those of in 2014–2015 using the conventional one (p < 0.05). Conclusions The ASP method versus conventional one with a better efficacy can be employed as an antibiotic administration guide for MPM and VMN in the therapy of patients in community-based hospitals.
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Abstract
The goals of antimicrobial stewardship are to optimize antimicrobial use to improve patient outcomes and minimize adverse consequences. A successful antimicrobial stewardship program is one that is multidisciplinary. Pharmacists are core members of antimicrobial stewardship and undertake multiple roles to accomplish the goals of the program. As antimicrobial stewardship continues to expand across the patient care continuum, pharmacists will serve a vital role in preserving the armamentarium of antimicrobials and improving quality of patient care.
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Affiliation(s)
- Diane M Parente
- Infectious Diseases and Antimicrobial Stewardship, Department of Pharmacy, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA.
| | - Jacob Morton
- Infectious Diseases, Department of Pharmacy, Saint Vincent Hospital, 123 Summer Street, Worcester, MA 01608, USA
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Messacar K, Campbell K, Pearce K, Pyle L, Hurst AL, Child J, Parker SK. A Handshake From Antimicrobial Stewardship Opens Doors for Infectious Disease Consultations. Clin Infect Dis 2018; 64:1449-1452. [PMID: 28186533 DOI: 10.1093/cid/cix139] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/07/2017] [Indexed: 11/12/2022] Open
Abstract
Implementation of a unique in-person pediatric antimicrobial stewardship program was associated with a significant increase in infectious disease consultations at a quaternary care children's hospital. This study demonstrates that antimicrobial stewardship programs support, and do not compete with, infectious disease programs.
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Affiliation(s)
- Kevin Messacar
- Sections of Hospital Medicine and.,Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado/University of Colorado School of Medicine
| | - Kristen Campbell
- Department of Biostatistics and Informatics, University of Colorado School of Public Health
| | | | - Laura Pyle
- Department of Biostatistics and Informatics, University of Colorado School of Public Health
| | - Amanda L Hurst
- Department of Pharmacy, Children's Hospital Colorado, Aurora
| | - Jason Child
- Department of Pharmacy, Children's Hospital Colorado, Aurora
| | - Sarah K Parker
- Infectious Diseases, Department of Pediatrics, Children's Hospital Colorado/University of Colorado School of Medicine.,Infection Prevention and Control and
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12
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Clinical impact of non-antibiotic recommendations by a multi-disciplinary antimicrobial stewardship team. Int J Antimicrob Agents 2017. [PMID: 28625717 DOI: 10.1016/j.ijantimicag.2017.01.046] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The multi-disciplinary antimicrobial stewardship team at the study hospital conducts prospective review and feedback on all inpatient orders of piperacillin-tazobactam and carbapenems. In addition, the team provides non-antibiotic recommendations (i.e. additional investigations and infectious disease reviews). This study aimed to describe the impact of these recommendations on patient outcomes. METHODS Patients on carbapenem and piperacillin-tazobactam who received at least one non-antibiotic recommendation between January 2012 and August 2014 were included in this study. Acceptance and rejection of non-antibiotic recommendations by the managing physician were compared. The primary outcome was 30-d mortality. RESULTS Non-antibiotic recommendations were made in 166 patients. There were no differences in baseline characteristics between patients for whom recommendations were accepted and patients for whom recommendations were rejected. Thirty-day mortality (18.0% vs. 34.5%, P = 0.02) was significantly lower in patients who had at least one non-antibiotic recommendation accepted. Multi-variate analysis found that Charlson's comorbidity score [odds ratio (OR) 1.20, 95% confidence interval (CI) 1.03-1.42, P = 0.03], APACHE II score (OR 1.10, 95% CI 1.01-1.19, P < 0.01), hepatobiliary source of infection (OR 10.19, 95% CI 1.44-72.13, P = 0.02) and acceptance of at least one non-antibiotic recommendation (OR 0.39, 95% CI 0.17-0.88, P = 0.02) were independently associated with 30-d mortality. CONCLUSIONS During prospective review and feedback of piperacillin-tazobactam and carbapenems, acceptance of non-antibiotic recommendations was found to be associated with a reduction in 30-d mortality.
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Parente DM, Timbrook TT, Caffrey AR, LaPlante KL. Inappropriate prescribing in outpatient healthcare: an evaluation of respiratory infection visits among veterans in teaching versus non-teaching primary care clinics. Antimicrob Resist Infect Control 2017; 6:33. [PMID: 28360995 PMCID: PMC5371270 DOI: 10.1186/s13756-017-0190-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 03/17/2017] [Indexed: 11/25/2022] Open
Abstract
A recent study led by the Centers for Disease Control and Prevention (CDC) revealed at least 30% of antibiotic prescriptions in the outpatient setting were inappropriate. In this study of all ages, among adult patients, results were similar to the overall population, with the majority of inappropriate prescribing relating to respiratory infections. We applied the same methodology to investigate rates of antibiotic prescribing for respiratory tract infections in outpatient primary care clinics at the Providence Veterans Affairs Medical Center. The results of our evaluation reflected comparable rates of inappropriate prescribing, but when stratified by teaching versus non-teaching primary care clinics, inappropriate prescribing was significantly higher in non-teaching clinics (17.6% vs 44.0%, p < .0001). Respiratory infection visits in non-teaching outpatient clinics may be a pragmatic target for antimicrobial stewardship programs.
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Affiliation(s)
- Diane M Parente
- Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908 USA.,Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI 02881 USA
| | - Tristan T Timbrook
- Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908 USA.,Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI 02881 USA
| | - Aisling R Caffrey
- Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908 USA.,Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI 02881 USA.,Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908 USA
| | - Kerry L LaPlante
- Rhode Island Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908 USA.,Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, 7 Greenhouse Road, Kingston, RI 02881 USA.,Center of Innovation in Long Term Services and Supports, Providence Veterans Affairs Medical Center, 830 Chalkstone Avenue, Providence, RI 02908 USA.,Infectious Diseases Division, Warren Alpert Medical School of Brown University, 222 Richmond Street, Providence, RI 02903 USA
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Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action. J Am Med Dir Assoc 2016; 17:183.e1-16. [PMID: 26778488 DOI: 10.1016/j.jamda.2015.11.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/11/2015] [Accepted: 11/11/2015] [Indexed: 11/20/2022]
Abstract
Antimicrobial resistance is a global public health crisis and a national security threat to the United States, as stated in an executive order signed by the president in September 2014. This crisis is a result of indiscriminant antimicrobial use, which promotes selection for resistant organisms, increases the risk of adverse drug events, and renders patients vulnerable to drug-resistant infections. Antimicrobial stewardship is a key measure to combat antimicrobial resistance and specifically seeks to do this by improving antimicrobial use. Antimicrobial stewardship compliments infection control practices and it is important to note that these 2 disciplines are distinct and cannot be discussed interchangeably. Antimicrobial stewardship promotes the appropriate diagnosis, drug, dose, and duration of treatment. The appropriate diagnosis falls into the hands of the prescriber and clinical staff. Optimal antimicrobial drug selection, dosing strategy, and duration of treatment, however, often require expertise in antimicrobial therapy, such as an infectious disease-trained physician or pharmacist. Therefore, successful antimicrobial stewardship programs must be comprehensive and interdisciplinary. Most antimicrobial stewardship programs focus on hospitals; yet, in long-term care, up to 75% of antimicrobial use is inappropriate or unnecessary. Thus, one of the most pressing areas in need for antimicrobial stewardship is in long-term care facilities. Unfortunately, there is little evidence that describes effective antimicrobial stewardship interventions in this setting. This review discusses the need for and barriers to antimicrobial stewardship in long-term care facilities. Additionally, this review describes prior interventions that have been implemented and tested to improve antimicrobial use in long-term care facilities.
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