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Guisado-Gil AB, Mejías-Trueba M, Peñalva G, Aguilar-Guisado M, Molina J, Gimeno A, Álvarez-Marín R, Praena J, Bueno C, Lepe JA, Gil-Navarro MV, Cisneros JM. Antimicrobial Stewardship in the Emergency Department Observation Unit: Definition of a New Indicator and Evaluation of Antimicrobial Use and Clinical Outcomes. Antibiotics (Basel) 2024; 13:356. [PMID: 38667032 PMCID: PMC11047618 DOI: 10.3390/antibiotics13040356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 03/27/2024] [Accepted: 04/10/2024] [Indexed: 04/29/2024] Open
Abstract
We aimed to define a novel indicator for monitoring antimicrobial use specifically in the Emergency Department Observation Unit (EDOU) and to assess the long-term impact of an institutional education-based antimicrobial stewardship program (ASP) on the antimicrobial prescribing pattern and clinical outcomes in this setting. A quasi-experimental interrupted time-series study was performed from 2011 to 2022. An educational ASP was implemented at the EDOU in 2015. To estimate changes in antimicrobial use, we designed an indicator adjusted for patients at risk of antimicrobial prescribing: defined daily doses (DDDs) per 100 patients transferred from the Emergency Department to the Observation Unit (TOs) per quarter. The number of bloodstream infections (BSIs) and the crude all-cause 14-day mortality were assessed as clinical outcomes. Antimicrobial use showed a sustained reduction with a trend change of -1.17 DDD per 100 TO and a relative effect of -45.6% (CI95% -64.5 to -26.7), particularly relevant for meropenem and piperacillin-tazobactam, with relative effects of -80.4% (-115.0 to -45.7) and -67.9% (-93.9 to -41.9), respectively. The incidence density of all BSIs increased significantly during the ASP period, with a relative effect of 123.2% (41.3 to 284.7). The mortality rate remained low and stable throughout the study period, with an absolute effect of -0.7% (-16.0 to 14.7). The regular monitoring of antimicrobial use in the EDOU by using this new quantitative indicator was useful to demonstrate that an institutional education-based ASP successfully achieved a long-term reduction in overall antimicrobial use, with a low and steady BSI mortality rate.
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Affiliation(s)
- Ana Belén Guisado-Gil
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Department of Pharmacy, Virgen del Rocío University Hospital, 41013 Seville, Spain
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Marta Mejías-Trueba
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Department of Pharmacy, Virgen del Rocío University Hospital, 41013 Seville, Spain
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
| | - Germán Peñalva
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Manuela Aguilar-Guisado
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Jose Molina
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Adelina Gimeno
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Rocío Álvarez-Marín
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Julia Praena
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - Claudio Bueno
- Emergency Department, Virgen del Rocío University Hospital, 41013 Seville, Spain
| | - José Antonio Lepe
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - María Victoria Gil-Navarro
- Department of Pharmacy, Virgen del Rocío University Hospital, 41013 Seville, Spain
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
| | - José Miguel Cisneros
- Department of Infectious Diseases, Microbiology and Parasitology, Virgen del Rocío University Hospital, 41013 Seville, Spain; (A.B.G.-G.)
- Institute of Biomedicine of Seville, Virgen del Rocío University Hospital/CSIC/University of Seville, 41013 Seville, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28029 Madrid, Spain
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Monari C, Onorato L, Allegorico E, Minerva V, Macera M, Bosso G, Calò F, Pagano A, Russo T, Sansone G, D'Isanto M, Casciotta A, Vanni M, Numis FG, Coppola N. The impact of a non-restrictive Antimicrobial Stewardship Program in the emergency department of a secondary-level Italian hospital. Intern Emerg Med 2024; 19:493-500. [PMID: 37700179 PMCID: PMC10954915 DOI: 10.1007/s11739-023-03418-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023]
Abstract
Evidence supporting the effectiveness of Antimicrobial Stewardship (AMS) Programs in the emergency department (ED) setting is limited. We conducted a prospective cohort study to assess the efficacy of an AMS program in an ED and a short-stay observation unit. The intervention included periodic prospective audits (twice a week), conducted by four infectious disease consultants. Primary outcomes included the difference in the hospital mortality rate, antibiotic consumption, and the incidence of bloodstream infections (BSI) caused by multidrug resistant (MDR) bacteria, before March 2020-February 2021 and after March 2021-February 2022 when the program was implemented. Interrupted time-series analysis was performed to assess the effect of our program. During the 12-month program, we performed 152 audits and evaluated 366 antibiotic therapies out of a total of 853 patients admitted. In the intervention period, we observed a non-statistically significant decrease in total antibiotic consumption, with a change in level of - 31.2 defined daily dose/100 patient-days (PD) (p = 0.71). Likewise, we found no significant variations in the rate of BSI due to MDR Gram-positive (CT - 0.02 events/PD, p = 0.84), MDR Gram-negative bacteria (CT 0.08, p = 0.71), or Candida spp. (CT 0.008, p = 0.86). Conversely, we found a significant decrease in the mortality rate between the pre- and post-intervention periods (- 1.98 deaths/100 PD, CI - 3.9 to - 0.007, p = 0.049). The Antibiotic Stewardship Program in the ED was associated with a significant decrease in the mortality rate. More high-quality studies are needed to determine the most effective ASP strategies in this unique setting.
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Affiliation(s)
- Caterina Monari
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Lorenzo Onorato
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Enrico Allegorico
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Valentina Minerva
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Margherita Macera
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Giorgio Bosso
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Federica Calò
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Antonio Pagano
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Teresa Russo
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Gennaro Sansone
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Marina D'Isanto
- Microbiology Unit, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Antonio Casciotta
- Department of Pharmacology, "Santa Maria Delle Grazie Hospital, Pozzuoli, Italy
| | | | - Fabio Giuliano Numis
- Department of Emergency and Critical Care, "Santa Maria Delle Grazie Hospital", Pozzuoli, Italy
| | - Nicola Coppola
- Infectious Diseases Unit, Section of Infectious Diseases, Department of Mental Health and Public Medicine, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
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Okere AN, Trimble ML, Sanogo V, Smith U, Brown C, Buxbaum SG. The Potential Effects of Implementing an Antibiotic Stewardship Program by Integrating It with Medication Therapy Service in a Low-Income Serving Clinic - A Single-Center Experience. Innov Pharm 2022; 13:10.24926/iip.v13i3.4997. [PMID: 36627908 PMCID: PMC9815868 DOI: 10.24926/iip.v13i3.4997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Bacterial antimicrobial resistance (AMR) is a leading cause of mortality worldwide. Although AMR is common in low-income communities, there is limited evidence of the effect of antibiotic stewardship programs in low-income communities in the United States. Objectives: Our goal is to assess the effects of implementing pharmacist-led ASP by integrating it with medication therapy management service (MTM) in a low-income serving clinic. We evaluated the following 1) antibiotic prescriptions per 1000 patients, 2) the frequency of clinic (office) visits 30-day post-index clinic visits for recurring infections. Methods: To achieve our goal, we conducted a pre-post, quasi-experimental intervention study using an interrupted time-series analysis to assess the following: 1) antibiotic prescriptions per 1000 patients and the 2) frequency of office visits (including telehealth) within 30-day post-index clinic visits associated with recurrent infection. Results: Our findings revealed that the long-term effect of our antibiotic stewardship program intervention was associated with 63.69% reduction in antibiotic prescriptions per 1000 patients (change in slope = -0.173, [95% CI: (-0.30, -0.05)], P < 0.007) and a reduction in the frequency of office visits within 30-day post-index clinic visits by 67.27% (change in slope = -2.043, [95% CI: (-3.84, -0.24)], P < 0.028). Conclusion: Implementing antibiotic stewardship programs is feasible for clinics serving low-income populations. It was associated with a reduction in antibiotic prescriptions and preventable clinic (office) visits within 30 days due to infection recurrence.
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Affiliation(s)
- Arinze Nkemdirim Okere
- Florida Agricultural and Mechanical University, College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health,Corresponding author: Arinze Nkemdirim Okere, PharmD, MS, MBA, BCPS, BCCP Professor and Director Cardiovascular Disease and Stroke Prevention Program Florida Agricultural and Mechanical University College of Pharmacy and Pharmaceutical Sciences Institute of Public Health 1415 S Martin Luther King Jr Blvd, Tallahassee, FL 32307
| | | | | | - Ukamaka Smith
- Florida Agricultural and Mechanical University, College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health
| | - Clyde Brown
- Florida Agricultural and Mechanical University, College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health
| | - Sarah G. Buxbaum
- Florida Agricultural and Mechanical University, College of Pharmacy and Pharmaceutical Sciences, Institute of Public Health
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Pin M, Somasundaram R, Wrede C, Schwab F, Gastmeier P, Hansen S. Antimicrobial resistance control in the emergency department: a need for concrete improvement. Antimicrob Resist Infect Control 2022; 11:94. [PMID: 35804401 PMCID: PMC9264623 DOI: 10.1186/s13756-022-01135-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 06/29/2022] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Rational use of antibiotics (AB) and infection prevention and control (IPC) are key measures for reducing antimicrobial resistance (AMR) in healthcare. Nonetheless, transferring evidence into clinical practice in emergency medicine has proven difficult. The extent to which structural requirements for implementing AMR control exist in German emergency departments (ED) was determined in a survey. METHODS Aspects of antimicrobial stewardship (AMS) and IPC implementation were surveyed within the German Association for Emergency Medicine (Deutsche Gesellschaft interdisziplinäre Notfall- und Akutmedizin e.V, DGINA) in 2018. Data were collected using an anonymous online questionnaire on ED characteristics, ED-based-link personnel for IPC and AMS, education and training, process monitoring and specific requirements for AMS and IPC as availability of AMR data and alcohol-based hand rub (AHR) consumption data. Data were analysed descriptively. RESULTS 66 EDs with in median [interquartile range (IQR)] of 30,900 [23,000; 40,000] patient visits participated in the survey. EDs' healthcare worker (HCW) received regular training on hand hygiene (HH) in 67% and on AMS in 20% of EDs. Surveillance of AHR consumption was performed by 73% EDs, surveillance of AB consumption by 64%. Regular audits on HH were performed in 39%. Training and audit activities, showed no significant variations according to EDs' organizational characteristics. HCWs received immediate feedback of HH performance in 29%, in 23% a regular structured feedback of HH was provided. ED-based physicians with (1) specific IPC responsibilities and training were available in 61%, with (2) AMS training and responsibility in 15%. 83% had ED based IPC link nurses with precise ICP responsibilities in place. Essentially resistance data existed at the hospital level (74%) rather than at ED- or regional level (15% and 14% respectively). CONCLUSIONS Management of AMR varies in German EDs, especially in accordance to hospital size and level of emergency care. IPC seems to receive more attention than AMS. Our data indicate the need for more implementation of regular IPC and AMS training in connection with monitoring and feedback in German EDs.
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Affiliation(s)
- Martin Pin
- Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Department of Emergency Medicine, Düsseldorf, Germany
- German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany
| | - Rajan Somasundaram
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
| | - Christian Wrede
- German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany
- Helios Hospital Berlin-Buch, Department of Emergency Medicine, Berlin, Germany
| | - Frank Schwab
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Sonja Hansen
- Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Emergency Medicine, Campus Benjamin Franklin, Berlin, Germany
- Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Hygiene and Environmental Medicine, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review. Antibiotics (Basel) 2021; 10:antibiotics10111366. [PMID: 34827304 PMCID: PMC8615165 DOI: 10.3390/antibiotics10111366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/02/2021] [Accepted: 11/05/2021] [Indexed: 11/29/2022] Open
Abstract
Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.
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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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Livorsi DJ, Suda KJ, Cunningham Goedken C, Hockett Sherlock S, Balkenende E, Chasco EE, Scherer AM, Goto M, Perencevich EN, Goetz MB, Reisinger HS. The feasibility of implementing antibiotic restrictions for fluoroquinolones and cephalosporins: a mixed-methods study across 15 Veterans Health Administration hospitals. J Antimicrob Chemother 2021; 76:2195-2203. [PMID: 34015115 DOI: 10.1093/jac/dkab138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 04/06/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The optimal method for implementing hospital-level restrictions for antibiotics that carry a high risk of Clostridioides difficile infection has not been identified. We aimed to explore barriers and facilitators to implementing restrictions for fluoroquinolones and third/fourth-generation cephalosporins. METHODS This mixed-methods study across a purposeful sample of 15 acute-care, geographically dispersed Veterans Health Administration hospitals included electronic surveys and semi-structured interviews (September 2018 to May 2019). Surveys on stewardship strategies were administered at each hospital and summarized with descriptive statistics. Interviews were performed with 30 antibiotic stewardship programme (ASP) champions across all 15 sites and 19 additional stakeholders at a subset of 5 sites; transcripts were analysed using thematic content analysis. RESULTS The most restricted agent was moxifloxacin, which was restricted at 12 (80%) sites. None of the 15 hospitals restricted ceftriaxone. Interviews identified differing opinions on the feasibility of restricting third/fourth-generation cephalosporins and fluoroquinolones. Some participants felt that restrictions could be implemented in a way that was not burdensome to clinicians and did not interfere with timely antibiotic administration. Others expressed concerns about restricting these agents, particularly through prior approval, given their frequent use, the difficulty of enforcing restrictions and potential unintended consequences of steering clinicians towards non-restricted antibiotics. A variety of stewardship strategies were perceived to be effective at reducing the use of these agents. CONCLUSIONS Across 15 hospitals, there were differing opinions on the feasibility of implementing antibiotic restrictions for third/fourth-generation cephalosporins and fluoroquinolones. While the perceived barrier to implementing restrictions was frequently high, many hospitals were effectively using restrictions and reported few barriers to their use.
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Affiliation(s)
- Daniel J Livorsi
- Center for Access & Delivery Research and 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
| | - Katie J Suda
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Health Care System, Pittsburgh, PA, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Cassie Cunningham Goedken
- Center for Access & Delivery Research and Evaluation (CADRE), Iowa City Veterans Affairs Health Care System, Iowa City, IA, USA
| | - Stacey Hockett Sherlock
- Center for Access & Delivery Research and 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
| | - Erin Balkenende
- Center for Access & Delivery Research and 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
| | - Emily E Chasco
- Center for Access & Delivery Research and 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
| | - Aaron M Scherer
- Center for Access & Delivery Research and 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 and 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 N Perencevich
- Center for Access & Delivery Research and 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
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.,David Geffen School of Medicine at the University of California in Los Angeles, CA, USA
| | - Heather Schacht Reisinger
- Center for Access & Delivery Research and 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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Linking infection control to clinical management of infections to overcome antimicrobial resistance. J Hosp Infect 2021; 114:1-9. [PMID: 33965455 DOI: 10.1016/j.jhin.2021.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
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9
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Majumder MAA, Rahman S, Cohall D, Bharatha A, Singh K, Haque M, Gittens-St Hilaire M. Antimicrobial Stewardship: Fighting Antimicrobial Resistance and Protecting Global Public Health. Infect Drug Resist 2020; 13:4713-4738. [PMID: 33402841 PMCID: PMC7778387 DOI: 10.2147/idr.s290835] [Citation(s) in RCA: 182] [Impact Index Per Article: 45.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/17/2020] [Indexed: 12/18/2022] Open
Abstract
Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Infections with multidrug-resistant (MDR) bacteria also have substantial implications on clinical and economic outcomes. Moreover, increased indiscriminate use of antibiotics during the COVID-19 pandemic will heighten bacterial resistance and ultimately lead to more deaths. This review highlights AMR's scale and consequences, the importance, and implications of an antimicrobial stewardship program (ASP) to fight resistance and protect global health. Antimicrobial stewardship (AMS), an organizational or system-wide health-care strategy, is designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness, along with the promotion and protection of public health. ASP has been very successful in promoting antimicrobials' appropriate use by implementing evidence-based interventions. The "One Health" approach, a holistic and multisectoral approach, is also needed to address AMR's rising threat. AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR. Evidence-based policies must guide the "One Health" approach, vaccination protocols, health professionals' education, and the public's awareness about AMR.
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Affiliation(s)
- Md Anwarul Azim Majumder
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Sayeeda Rahman
- School of Medicine, American University of Integrative Sciences, Bridgetown, Barbados
| | - Damian Cohall
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Ambadasu Bharatha
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Keerti Singh
- Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Bridgetown, Barbados
| | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan, Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
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