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Pitiriga V, Kanellopoulos P, Kampos E, Panagiotakopoulos G, Tsakris A, Saroglou G. Antimicrobial stewardship program in a Greek hospital: implementing a mandatory prescription form and prospective audits. Future Microbiol 2018; 13:889-896. [DOI: 10.2217/fmb-2018-0020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Antimicrobial stewardship programs (ASPs) are urgently needed for Greek hospitals in order to improve antibiotic usage. Patients & methods: An ASP was implemented to a Greek hospital since February 2014. A mandatory order form was introduced for five antimicrobials; colistin, tigecycline, daptomycin, doripenem and linezolid. Prospective audits allowed for feedback to the prescribers without direct prescribing restriction. Results: Antimicrobials’ consumption at the baseline year and the 3 years of ASP implementation was 93.7, 99.1, 156.1 and 105.9 defined daily doses/1000 patient days, respectively (p > 0.05). No statistically significant difference in isolation rates of multidrug-resistant pathogens was detected. Conclusion: Efforts are required to demonstrate the long-term impact of our program on antibiotic prescription attitudes as well as antimicrobial resistance rates.
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Affiliation(s)
- Vassiliki Pitiriga
- Department of Microbiology, Medical School, National & Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Goudi, Athens, Greece
| | - Petros Kanellopoulos
- Metropolitan Hospital, 9 Ethnarchou Makariou & 1 Eleftheriou Venizelou, 18547 Neo Faliro, Piraeus, Greece
| | - Elsa Kampos
- Metropolitan Hospital, 9 Ethnarchou Makariou & 1 Eleftheriou Venizelou, 18547 Neo Faliro, Piraeus, Greece
| | - George Panagiotakopoulos
- Metropolitan Hospital, 9 Ethnarchou Makariou & 1 Eleftheriou Venizelou, 18547 Neo Faliro, Piraeus, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National & Kapodistrian University of Athens, 75 Mikras Asias Street, 11527 Goudi, Athens, Greece
| | - George Saroglou
- Metropolitan Hospital, 9 Ethnarchou Makariou & 1 Eleftheriou Venizelou, 18547 Neo Faliro, Piraeus, Greece
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Sartelli M, Labricciosa FM, Scoccia L, Bellesi J, Mazzoccanti MR, Scaloni G, Gentilozzi B, Chiodera A. Non-Restrictive Antimicrobial Stewardship Program in a General and Emergency Surgery Unit. Surg Infect (Larchmt) 2016; 17:485-90. [PMID: 27135794 DOI: 10.1089/sur.2016.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The goal of an antimicrobial stewardship program (ASP) is to prevent the emergence of antimicrobial drug resistance and reduce adverse drug events, optimizing the selection, dosing, and duration of therapy in individual patients. METHODS This retrospective study evaluated changes in antimicrobial agent use associated with implementation of an ASP in a general and emergency unit. The pre-intervention and post-intervention periods were defined as July 1, 2013, to December 31, 2013 (pre-intervention) and January 1, 2014, to June 30, 2014 (post-intervention). RESULTS The mean total monthly antimicrobial use decreased by 18.8%, from 1,074.9 defined daily doses (DDD) per 1,000 patient-days to 873.0 DDD per 1,000 patient-days after the intervention. There was a significant reduction in the use of piperacillin-tazobactam, by 33.7% (p < 0.05), in imipenem/cilastatin, by 63.9% (p < 0.05), in meropenem by 68.0% (p < 0.05), and in levofloxacin by 45.0% (p < 0.05) without any negative effect on patient susceptibility to infections. Indeed, patient outcomes, including deaths, length of stay in the hospital, and re-admission within 30 days were not affected. CONCLUSIONS The implementation of an education-based ASP achieved a significant improvement in all antimicrobial agent prescriptions in the surgical unit and a reduction in antimicrobial drug consumption, even when no restrictive measures were implemented.
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Affiliation(s)
| | - Francesco Maria Labricciosa
- 2 Department of Biomedical Sciences and Public Health, Unit of Hygiene, Preventive Medicine and Public Health , UNIVPM, Ancona, Italy
| | - Loredana Scoccia
- 3 Unit of Hospital Pharmacy, Macerata Hospital , Macerata, Italy
| | - Jessica Bellesi
- 4 Unit of Laboratory Medicine, Macerata Hospital , Macerata, Italy
| | | | - Giorgia Scaloni
- 5 Clinical Administration, Macerata Hospital , Macerata, Italy
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Van Parys J, Stevens MP, Moczygemba LR, Pakyz AL. Antimicrobial Stewardship Program Members' Perspectives on Program Goals and National Metrics. Clin Ther 2016; 38:1914-9. [PMID: 27392717 DOI: 10.1016/j.clinthera.2016.06.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/27/2016] [Accepted: 06/08/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE This study compares antimicrobial stewardship program (ASP)-stated goals and outcomes collected as well as opinions regarding national metric establishment. METHODS Twenty-one ASP members underwent telephone interviews answering open-ended questions about ASP goals, outcomes collected, and opinions about national metrics. Content analysis was used to code responses into predefined ASP-metric categories. FINDINGS The most common ASP goal was antimicrobial appropriateness (76%), outcomes tracked were use and microbial outcomes (both 71%), and desired national metric was use (67%). IMPLICATIONS Stated-goals, outcomes tracked, and opinions regarding national metric establishment did not fully align. With ASP-related regulations looming, it is important that alignment is increased.
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Affiliation(s)
- Jacob Van Parys
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Michael P Stevens
- Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Leticia R Moczygemba
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
| | - Amy L Pakyz
- Department of Pharmacotherapy and Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, Virginia
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Sikkens JJ, van Agtmael MA, Peters EJG, Vandenbroucke-Grauls CMJE, Kramer MHH, de Vet HCW. Assessment of appropriate antimicrobial prescribing: do experts agree? J Antimicrob Chemother 2016; 71:2980-7. [PMID: 27287237 DOI: 10.1093/jac/dkw207] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/03/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Little is known about the validity and reliability of expert assessments of the quality of antimicrobial prescribing, despite their importance in antimicrobial stewardship. We investigated how infectious disease doctors' assessments compared with a reference standard (modal expert opinion) and with the assessments of their colleagues. METHODS Twenty-four doctors specialized in infectious diseases or clinical microbiology (16 specialists and 8 residents) from five hospitals were asked to assess the appropriateness of antimicrobial agents prescribed for a broad spectrum of indications in 56 paper cases. They were instructed how to handle guideline applicability and deviations. We created a reference standard of antimicrobial appropriateness using the modal assessment of 16 specialists. We calculated criterion validity and interrater and intrarater overall and specific agreement with an index expert (senior infectious disease physician) and analysed the influence of doctor characteristics on validity. RESULTS Specialists agreed with the reference standard in 80% of cases (range 75%-86%), with a sensitivity and specificity of 75% and 84%, respectively. This did not differ by clinical specialty, hospital or years of experience, and residents had similar results. Specialists agreed with the index expert in 76% of cases and the index expert agreed with his previous assessments in 71% of cases. CONCLUSIONS Doctors specialized in infectious diseases and clinical microbiology assess the appropriateness of antimicrobials prescribed for a broad spectrum of indications with acceptable agreement and validity, regardless of their experience or hospital of employment. However, there is room for improvement, which merits attention in multidisciplinary discussions and education.
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Affiliation(s)
- Jonne J Sikkens
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands EMGO Institute for Health and Care Research, Amsterdam, The Netherlands Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Michiel A van Agtmael
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands Research and Expertise Centre in Pharmacotherapy Education (RECIPE), Amsterdam, The Netherlands
| | - Edgar J G Peters
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Mark H H Kramer
- Department of Internal Medicine, VU University Medical Centre, Amsterdam, The Netherlands
| | - Henrica C W de Vet
- EMGO Institute for Health and Care Research, Amsterdam, The Netherlands Department of Epidemiology and Biostatistics, VU University Medical Centre, Amsterdam, The Netherlands
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The Role of Mathematical Modeling in Designing and Evaluating Antimicrobial Stewardship Programs. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2016. [DOI: 10.1007/s40506-016-0074-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Taggart LR, Leung E, Muller MP, Matukas LM, Daneman N. Differential outcome of an antimicrobial stewardship audit and feedback program in two intensive care units: a controlled interrupted time series study. BMC Infect Dis 2015; 15:480. [PMID: 26511839 PMCID: PMC4625716 DOI: 10.1186/s12879-015-1223-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/15/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Antimicrobial decision making in intensive care units (ICUs) is challenging. Unnecessary antimicrobials contribute to the development of resistant pathogens, Clostridium difficile infection and drug related adverse events. However, inadequate antimicrobial therapy is associated with mortality in critically ill patients. Antimicrobial stewardship programs are increasingly being implemented to improve antimicrobial prescribing, but the optimal approach in the ICU setting is unknown. We assessed the impact of an audit and feedback antimicrobial stewardship intervention on antimicrobial use, antimicrobial costs, clinical outcomes and microbiologic outcomes in two ICUs with different patient populations. METHODS The audit and feedback intervention was implemented in a trauma and neurosurgery ICU (TNICU) and a medical surgical ICU (MSICU) at a 465-bed teaching hospital in Toronto, Canada. ICU patients were reviewed Monday to Friday by a physician and pharmacist with infectious diseases training. Recommendations related to appropriate antimicrobial use were presented to ICU teams during a dedicated daily meeting. A controlled interrupted time series analysis was used to compare outcomes in the 12 months before and after the intervention. Cardiovascular and coronary care ICUs served as control units. RESULTS Mean total monthly antimicrobial use in defined daily doses (DDD) per 1000 patient days was reduced 28% in the TNICU (1433 vs. 1037) but increased 14% in the MSICU (1705 vs. 1936). In the time series analysis, total monthly antimicrobial use in the TNICU decreased by 375 DDD per 1000 patient days (p < 0.0009) immediately following the intervention, followed by a non-significant downward trend in use of -9 DDD per 1000 patient days (p = 0.56). No significant changes in antimicrobial use were identified in the MSICU. Antimicrobial use temporarily increased in one control unit and remained unchanged in the other. There were no changes in mortality, length of stay, readmission rate, incidence of C. difficile infection or resistance patterns of E. coli and P. aeruginosa in either intervention unit. CONCLUSIONS Audit and feedback antimicrobial stewardship programs can lead to significant reductions in total antimicrobial use in the ICU setting. However, this effect may be context-dependent and further work is needed to determine the ingredients necessary for success.
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Affiliation(s)
- Linda R Taggart
- Division of Infectious Diseases, Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Elizabeth Leung
- Department of Pharmacy, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Matthew P Muller
- Division of Infectious Diseases, Department of Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Medicine, University of Toronto, Toronto, Canada.
| | - Larissa M Matukas
- Division of Microbiology, Department of Laboratory Medicine, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.
| | - Nick Daneman
- Department of Medicine, University of Toronto, Toronto, Canada.
- Division of Infectious Diseases, Department of Medicine, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.
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Nagel JL, Stevenson JG, Eiland EH, Kaye KS. Demonstrating the value of antimicrobial stewardship programs to hospital administrators. Clin Infect Dis 2015; 59 Suppl 3:S146-53. [PMID: 25261541 DOI: 10.1093/cid/ciu566] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The movement away from fee-for-service models to those that emphasize quality of care and patient outcomes affords a unique opportunity for antimicrobial stewardship programs to expand their value for hospital administration. Antimicrobial stewardship participants must collaborate with administrators and key stakeholders to position themselves to improve economic, process, and outcomes measures. This will allow the establishment of antimicrobial stewardship programs as essential components of the present and future healthcare quality journey.
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Affiliation(s)
- Jerod L Nagel
- University of Michigan Hospitals and Health System, Ann Arbor
| | | | | | - Keith S Kaye
- Division of Infectious Diseases, Wayne State University School of Medicine, Detroit, Michigan
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