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Lapin JS, Smith RD, Hornback KM, Johnson JK, Claeys KC. From bottle to bedside: Implementation considerations and antimicrobial stewardship considerations for bloodstream infection rapid diagnostic testing. Pharmacotherapy 2023; 43:847-863. [PMID: 37158053 DOI: 10.1002/phar.2813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/31/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023]
Abstract
Antimicrobial stewardship (AMS) programs have been quick to adopt novel molecular rapid diagnostic technologies (mRDTs) for bloodstream infections (BSIs) to improve antimicrobial management. As such, most of the literature demonstrating the clinical and economic benefits of mRDTs for BSI is in the presence of active AMS intervention. Leveraging mRDTs to improve antimicrobial therapy for BSI is increasingly integral to AMS program activities. This narrative review discusses available and future mRDTs, the relationship between the clinical microbiology laboratory and AMS programs, and practical considerations for optimizing the use of these tools within a health system. Antimicrobial stewardship programs must work closely with their clinical microbiology laboratories to ensure that mRDTs are used to their fullest benefit while remaining cognizant of their limitations. As more mRDT instruments and panels become available and AMS programs continue to expand, future efforts must consider the expansion beyond traditional settings of large academic medical centers and how combinations of tools can further improve patient care.
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Affiliation(s)
- Jonathan S Lapin
- Department of Pharmacy Practice, University of Maryland Medical Center, Baltimore, Maryland, USA
| | - Richard D Smith
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Krutika M Hornback
- Department of Pharmacy Practice, Medical University of South Carolina (MUSC) Health, Charleston, South Carolina, USA
| | - J Kristie Johnson
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Kimberly C Claeys
- Department of Pharmacy Science and Health Outcomes Research, University of Maryland School of Pharmacy, Baltimore, Maryland, USA
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2
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Hayes JF. Fighting Back against Antimicrobial Resistance with Comprehensive Policy and Education: A Narrative Review. Antibiotics (Basel) 2022; 11:antibiotics11050644. [PMID: 35625288 PMCID: PMC9137785 DOI: 10.3390/antibiotics11050644] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/07/2022] [Accepted: 05/09/2022] [Indexed: 12/15/2022] Open
Abstract
Globally, antimicrobial resistance has emerged as a significant threat. A comprehensive plan is required to combat antimicrobial resistance. There have been national and international efforts to address this global health problem, but much work remains. Enhanced funding and regulations to support antimicrobial stewardship policy and program development, reforms to incentivize drug development to treat resistant pathogens, and efforts to strengthen One Health programs are areas for collaboration and innovation. Finally, implementation of educational interventions for trainees encompassing these key areas along with training on policy and leadership development is critical to enable sustainability of these efforts to fight back against antimicrobial resistance.
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Affiliation(s)
- Justin F Hayes
- Department of Medicine, Division of Infectious Diseases, Banner University Medical Center-Tucson and South, University of Arizona College of Medicine, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA
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3
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Herawati F, Jaelani AK, Wijono H, Rahem A, Setiasih, Yulia R, Andrajati R, Soemantri D. Antibiotic stewardship knowledge and belief differences among healthcare professionals in hospitals: A survey study. Heliyon 2021; 7:e07377. [PMID: 34222701 PMCID: PMC8243519 DOI: 10.1016/j.heliyon.2021.e07377] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/25/2021] [Accepted: 06/18/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Collaborative practice in healthcare has been recommended to improve the quality of antimicrobial stewardship interventions, a behavioral change in antimicrobial use. Insufficient knowledge regarding antibiotic resistance, the fear of complications from infections, and how providers perceive antibiotic use and resistance are likely to influence prescribing behavior. This study's objective was to identify the knowledge and belief healthcare professionals' differences about antibiotic stewardship. METHODS This cross-sectional survey study of three hospitals in the East Java province, Indonesia utilized a 43-item questionnaire to assess antimicrobial stewardship knowledge and belief. There were 12 knowledge questions (total possible score: 12) and 31 belief questions (total possible score: 155). The Kuder Richardson 20 (KR-20) and Cronbach alpha values of the questionnaire were 0.54 and 0.92, respectively. RESULTS Out of the 257 respondents, 19% (48/257) had a low scores of knowledge, and 39% (101/257) had low scores on belief about antibiotic stewardship (101/257). Most midwives had a low scores on knowledge (25/61) and low scores on belief (46/61). Respondents with high scores on belief were 17% (10/59) physicians, 15% (4/27) pharmacists, 8% (5/65) nurses, and 3% (2/61) midwives. CONCLUSION Among healthcare professionals, knowledge and belief differences concerning antibiotic stewardship vary widely. These differences will affect their capability, behavior, and contribution to the healthcare team collaboration and performance. Further studies are needed to evaluate the correlation between the level of inter-professional collaboration and the quality of the antibiotic stewardship implementation.
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Affiliation(s)
- Fauna Herawati
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, 60293, Indonesia
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia
| | | | - Heru Wijono
- Faculty of Medicine, Universitas Surabaya, Surabaya, 60293, Indonesia
| | - Abdul Rahem
- Community Pharmacy Department, Faculty of Pharmacy, Airlangga University, Surabaya, 60115, Indonesia
| | - Setiasih
- Laboratory for Developmental Psychology, Faculty of Psychology, Universitas Surabaya, Surabaya, 60293, Indonesia
| | - Rika Yulia
- Department of Clinical and Community Pharmacy, Faculty of Pharmacy, Universitas Surabaya, Surabaya, 60293, Indonesia
| | - Retnosari Andrajati
- Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Indonesia, Depok, 16424, Indonesia
| | - Diantha Soemantri
- Department of Medical Education, Faculty of Medicine, Universitas Indonesia, Depok, 16424, Indonesia
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4
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Tamma PD, Miller MA, Dullabh P, Ahn R, Speck K, Gao Y, Scherpf E, Cosgrove SE. Association of a Safety Program for Improving Antibiotic Use With Antibiotic Use and Hospital-Onset Clostridioides difficile Infection Rates Among US Hospitals. JAMA Netw Open 2021; 4:e210235. [PMID: 33635327 PMCID: PMC7910818 DOI: 10.1001/jamanetworkopen.2021.0235] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
IMPORTANCE Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. OBJECTIVE To assess whether the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use is associated with reductions in antibiotic use across US hospitals. DESIGN, SETTING, AND PARTICIPANTS A pragmatic quality improvement program was conducted and evaluated over a 1-year period in US hospitals. A total of 437 hospitals were enrolled. The study was conducted from December 1, 2017, to November 30, 2018. Data analysis was performed from March 1 to October 31, 2019. INTERVENTIONS The Safety Program assisted hospitals with establishing ASPs and worked with frontline clinicians to improve their antibiotic decision-making. All clinical staff (eg, clinicians, pharmacists, and nurses) were encouraged to participate. Seventeen webinars occurred over 12 months, accompanied by additional durable educational content. Topics focused on establishing ASPs, the science of safety, improving teamwork and communication, and best practices for the diagnosis and management of infectious processes. MAIN OUTCOMES AND MEASURES The primary outcome was overall antibiotic use (days of antibiotic therapy [DOT] per 1000 patient days [PD]) comparing the beginning (January-February 2018) and end (November-December 2018) of the Safety Program. Data analysis occurred using linear mixed models with random hospital unit effects. Antibiotic use from 614 hospitals in the Premier Healthcare Database from the same period was analyzed to evaluate contemporary US antibiotic trends. Quarterly hospital-onset Clostridioides difficile laboratory-identified events per 10 000 PD were a secondary outcome. RESULTS Of the 437 hospitals enrolled, 402 (92%) remained in the program until its completion, including 28 (7%) academic medical centers, 122 (30%) midlevel teaching hospitals, 167 (42%) community hospitals, and 85 (21%) critical access hospitals. Adherence to key components of ASPs (ie, interventions before and after prescription of antibiotics, availability of local antibiotic guidelines, ASP leads with dedicated salary support, and quarterly reporting of antibiotic use) improved from 8% to 74% over the 1-year period (P < .01). Antibiotic use decreased by 30.3 DOT per 1000 PD (95% CI, -52.6 to -8.0 DOT; P = .008). Similar changes in antibiotic use were not observed in the Premier Healthcare Database. The incidence rate of hospital-onset C difficile laboratory-identified events decreased by 19.5% (95% CI, -33.5% to -2.4%; P = .03). CONCLUSIONS AND RELEVANCE The Agency for Healthcare Research and Quality Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use. Safety Program content is publicly available.
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Affiliation(s)
- Pranita D. Tamma
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Melissa A. Miller
- Center for Quality Improvement and Patient Safety, Agency for Healthcare Research and Quality, Rockville, Maryland
| | | | - Roy Ahn
- NORC at the University of Chicago, Chicago, Illinois
| | - Kathleen Speck
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yue Gao
- NORC at the University of Chicago, Bethesda, Maryland
| | - Erik Scherpf
- NORC at the University of Chicago, Chicago, Illinois
| | - Sara E. Cosgrove
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Ramakrishnan A, Patel PK. How Far We've Come, How Far We Have to Go: a Review of Advances in Antimicrobial Stewardship in the Veterans Health Administration. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020; 12:275-284. [PMID: 33244296 PMCID: PMC7688065 DOI: 10.1007/s40506-020-00221-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW This review highlights several of the successes in antimicrobial stewardship seen in the largest integrated healthcare system in the USA, the Veterans Health Administration. RECENT FINDINGS Since deploying antimicrobial stewardship programs on a national scale in the Veterans Health Administration, decreases in overall antimicrobial use and Clostridioides difficile infections have been observed. Concurrent infection prevention initiatives have also contributed to these improvements in the Veterans Health Administration. SUMMARY By embracing multidisciplinary stewardship teams, focusing on education and research in the field of antimicrobial stewardship, and leveraging the vast data available within the national system, the Veterans Health Administration has made substantial advances in antimicrobial stewardship.
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Affiliation(s)
- Aditi Ramakrishnan
- Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA, 30303, USA
| | - Payal K. Patel
- Division of Infectious Diseases, Ann Arbor VA Healthcare System and the University of Michigan Medical School, Ann Arbor, MI, USA
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6
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Team V, Tuck M, Reeves J, Way M, Enticott J, Evans S, Weller CD. Pressure injury data in Australian acute care settings: A comparison of three data sets. Int Wound J 2020; 17:578-586. [PMID: 32027094 PMCID: PMC7948723 DOI: 10.1111/iwj.13320] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 01/27/2020] [Indexed: 12/22/2022] Open
Abstract
Hospital-acquired pressure injuries (HAPIs) represent a serious clinical and economic problem. The cost of treating HAPIs in Australian public hospitals was recently reported at AUS$983 million per annum. There are three main sources of data for documenting pressure injury (PI) occurrence in Australian hospitals: incident reporting, medical record coded data, and real-time surveys of pressure injury. PI data reported at hospital level and to external agencies using these three different sources are variable. This reporting issue leads to inaccurate data interpretation and hinders improvement in accuracy of PI identification and PI prevention. This study involved a comparison of the three different data sources in selected Australian hospitals, to improve the accuracy and comparability of data. Findings from this study provide benchmark areas for improvement in PI documenting and reporting. Better understanding the agreement between the three data sets could lead to a more efficient and effective sharing of data sources.
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Affiliation(s)
- Victoria Team
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
| | - Michelle Tuck
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Judy Reeves
- Nursing ServicesAlfred CentreMelbourneVictoriaAustralia
| | - Margaret Way
- Safety and QualityBarwon HealthGeelongVictoriaAustralia
| | - Joanne Enticott
- Monash Partners Academic Health Science CentreMonash PartnersMelbourneVictoriaAustralia
- Department of General Practice, School of Primary and Allied Health Care, Southern Synergy, Department of PsychiatryMonash UniversityMelbourneVictoriaAustralia
| | - Susan Evans
- Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
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Antimicrobial stewardship in the outpatient setting: A review and proposed framework. Infect Control Hosp Epidemiol 2020; 41:833-840. [PMID: 32342826 DOI: 10.1017/ice.2020.94] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Antimicrobial misuse is still a significant problem, and most inappropriate use occurs in the outpatient setting. In this article, we provide a review of available literature on outpatient antimicrobial stewardship in primary care settings, and we propose a novel implementation framework.
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Vaughn VM, Petty LA, Flanders SA, Malani AN, Patel T, Bernstein SJ, Hsaiky LM, Thyagarajan R, Osterholzer D, McLaughlin E, Horowitz JK, Gandhi TN. A Deeper Dive Into Antibiotic Stewardship Needs: A Multihospital Survey. Open Forum Infect Dis 2020; 7:ofaa007. [PMID: 32128340 PMCID: PMC7047227 DOI: 10.1093/ofid/ofaa007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 01/08/2020] [Indexed: 11/14/2022] Open
Abstract
In a 2016 survey of 46 Michigan hospitals, we identified four key needs for antibiotic stewardship: clinically-relevant antibiotic data, monitoring compliance, syndrome-specific interventions, and discharge stewardship. A stewardship initiative now addresses these needs within the Michigan Hospital Medicine Safety Consortium.
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Affiliation(s)
- Valerie M Vaughn
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.,VA/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
| | - Lindsay A Petty
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Scott A Flanders
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
| | - Anurag N Malani
- Department of Internal Medicine, Division of Infectious Diseases, St. Joseph Mercy Health System, Ann Arbor, Michigan, USA.,Department of Infection Prevention and Control, St. Joseph Mercy Health System, Ann Arbor, Michigan, USA
| | - Twisha Patel
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Steven J Bernstein
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,Center for Clinical Management Research, Veterans Affairs (VA) Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
| | - Lama M Hsaiky
- Department of Pharmaceutical Services, Beaumont Hospital, Dearborn, Michigan, USA
| | - Rama Thyagarajan
- Department of Internal Medicine, Infectious Diseases Division, Beaumont Hospital, Dearborn, Michigan, USA
| | - Danielle Osterholzer
- Department of Internal Medicine, Division of Infectious Diseases, Hurley Medical Center, Flint, Michigan, USA.,Michigan State University, College of Human Medicine, East Lansing, Michigan, USA
| | - Elizabeth McLaughlin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer K Horowitz
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA.,VA/University of Michigan Patient Safety Enhancement Program, Ann Arbor, Michigan, USA
| | - Tejal N Gandhi
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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