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Nelson GE, Narayanan N, Onguti S, Stanley K, Newland JG, Doernberg SB. Principles and Practice of Antimicrobial Stewardship Program Resource Allocation. Infect Dis Clin North Am 2023; 37:683-714. [PMID: 37735012 DOI: 10.1016/j.idc.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Antimicrobial Stewardship Programs (ASP) improve individual patient outcomes and clinical care processes while reducing antimicrobial-associated adverse events, optimizing operational priorities, and providing institutional cost savings. ASP composition, resources required, and priority focuses are influenced by myriad factors. Despite robust evidence and broad national support, individual ASPs still face challenges in obtaining appropriate resources. Though understanding the current landscape of ASP resource allocation, factors influencing staffing needs, and strategies required to obtain desired resources is important, acceptance of recommended staffing levels and appropriate ASP resource allocation are much needed to facilitate ASP sustainability and growth across the complex and diverse health care continuum.
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Affiliation(s)
- George E Nelson
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 MCN, Nashville, TN 37232-2582, USA.
| | - Navaneeth Narayanan
- Department of Pharmacy Practice and Administration, Rutgers University Ernest Mario School of Pharmacy, 160 Frelinghuysen Road, Piscataway, NJ 08854, USA
| | - Sharon Onguti
- Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, 1161 21st Avenue South, A2200 MCN, Nashville, TN 37232-2582, USA
| | - Kim Stanley
- Department of Quality and Patient Safety, Division of Hospital Epidemiology and Infection Prevention, University of San Francisco, California, San Francisco, CA, USA
| | - Jason G Newland
- Department of Pediatrics, Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, St Louis, MO 63110, USA
| | - Sarah B Doernberg
- Department of Medicine, Division of Infectious Diseases, University of San Francisco, California, 513 Parnassus Avenue, Box 0654, San Francisco, CA 94143, USA
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Goel D, Tin MT, Hariprasad KC, Garg DS, Besic A, Dillon TA, Masson ZR, Goralsky LA, Goralsky JA, Barron MK, Saji JA, Hobson WL, Jones TW. Deeper Pathways for Recruitment Efforts: Identifying Opportunities for Undergraduate and Medical Student Involvement in Infectious Diseases. Open Forum Infect Dis 2023; 10:ofad439. [PMID: 37779598 PMCID: PMC10538255 DOI: 10.1093/ofid/ofad439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 10/03/2023] Open
Abstract
Background Only 74% of infectious diseases (ID) training positions were filled in the 2022 fellowship match, indicating a need to find increasingly novel and creative solutions for ID recruitment and outreach. Methods The websites of 2321 universities and 181 medical schools across the United States were manually searched for the presence of undergraduate clubs and interest groups, respectively, for multiple medical specialties and subspecialties, including ID. Geographic data were used to compare the proximity of ID fellowships to undergraduate institutions. Results ID student groups were extremely rare among the categories studied throughout undergraduate institutions (6 out of 2048, or 0.29%). Only 58 of 163 (35.6%) medical schools nationwide included an ID student group. Geographic comparison found that every adult ID fellowship is in the same county and/or city as at least 1 undergraduate institution and 28.5% of adult ID fellowships are in the same zip code as at least 1 undergraduate institution. Conclusions The relative paucity of ID student interest groups presents an opportunity for the ID community to begin outreach and recruitment at the undergraduate and medical student levels, specifically through student groups.
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Affiliation(s)
- Divyam Goel
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Michelle T Tin
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Krishna C Hariprasad
- College of Natural Sciences, Department of Molecular Biosciences, University of Texas at Austin, Austin, Texas, USA
| | - Diya S Garg
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Arnel Besic
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Tilly A Dillon
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Zoe R Masson
- College of Science, University of Utah, Salt Lake City, Utah, USA
| | - Lauren A Goralsky
- Columbia College, Department of Biological Sciences, Columbia University, New York, New York, USA
| | - Julia A Goralsky
- Columbia College, Department of Biological Sciences, Columbia University, New York, New York, USA
| | - Molly K Barron
- College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
| | - Jasmine A Saji
- Armour College of Engineering, Department of Biomedical Engineering, Illinois Institute of Technology, Chicago, Illinois, USA
| | - Wendy L Hobson
- Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
| | - Trahern W Jones
- Department of Pediatrics, University of Utah Spencer Fox Eccles School of Medicine, Salt Lake City, Utah, USA
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3
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Evaluation of fidaxomicin use in community hospitals after a clinical guideline change at a large health system and opportunities for stewardship. Infect Control Hosp Epidemiol 2023; 44:312-314. [PMID: 35067241 PMCID: PMC9929706 DOI: 10.1017/ice.2021.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
After updating our health system's Clostridioides difficile treatment protocols in 2018, we reviewed 104 unique hospital encounters involving fidaxomicin at 10 community hospitals. Half (50%) of regimens were adherent to our guidelines, with infectious diseases (ID) providers were frequently nonadherent. Antimicrobial stewardship programs are important for facilitating best practices, even among ID specialists.
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Assessment of the Plans to Optimize Antimicrobial Use in the Pediatric Population in Catalan Hospitals: The VINCat Pediatric PROA SHARP Survey. Antibiotics (Basel) 2023; 12:antibiotics12020250. [PMID: 36830161 PMCID: PMC9952038 DOI: 10.3390/antibiotics12020250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 01/28/2023] Open
Abstract
In Spain, many programs have been introduced in recent years to optimize antimicrobial stewardship in pediatric care (known as pediatric PROA). However, information on the current situation of these programs is scarce. The present study assesses current antimicrobial use in pediatric care in the hospitals of Catalonia affiliated with the VINCat pediatric PROA group. Between December 2020 and January 2021, an electronic survey related to the design and use of PROA was administered to members of PROA teams in our hospital network. The survey was conducted at 26 hospitals. Twelve percent of the hospitals had pediatric PROA in operation, 42% were included in adult PROA, and 46% carried out pediatric PROA activities but not as part of an established program. At 81%, the pediatric PROA team included a pediatrician, in 58% a pharmacist, and in 54% a microbiologist. The main activities were monitoring the use of antimicrobials and bacterial resistance. Twenty-seven percent measured indicators regularly. The VINCat Pediatric PROA group's hospitals have implemented measures for optimizing antimicrobial stewardship, but few have a pediatric PROA program in place. Specific measures and indicators must be defined, and the resources available should be increased. The development of pediatric PROA should be monitored in the coming years.
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5
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Advani SD, Sickbert-Bennett E, Moehring R, Cromer A, Lokhnygina Y, Dodds-Ashley E, Kalu IC, DiBiase L, Weber DJ, Anderson DJ. The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce. Clin Infect Dis 2022; 76:e34-e41. [PMID: 35997795 PMCID: PMC9452131 DOI: 10.1093/cid/ciac684] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/26/2022] [Accepted: 08/19/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic had a considerable impact on US healthcare systems, straining hospital resources, staff, and operations. However, a comprehensive assessment of the impact on healthcare-associated infections (HAIs) across different hospitals with varying level of infectious disease (ID) physician expertise, resources, and infrastructure is lacking. METHODS This retrospective longitudinal multicenter cohort study included central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), Clostridioides difficile infections (CDIs), and ventilator-associated events (VAEs) from 53 hospitals (academic and community) in Southeastern United States from 1 January 2018 to 31 March 2021. Segmented negative binomial regression generalized estimating equations models estimated changes in monthly incidence rates in the baseline (01/2018-02/2020) compared to the pandemic period (03/2020-03/2021, further divided into three pandemic phases). RESULTS CLABSIs and VAEs increased by 24% and 34%, respectively, during the pandemic period. VAEs increased in all phases of the pandemic, while CLABSIs increased in later phases of the pandemic. CDI trend increased by 4.2% per month in the pandemic period. On stratifying the analysis by hospital characteristics, the impact of the pandemic on healthcare-associated infections was more significant in smaller sized and community hospitals. CAUTIs did not change significantly during the pandemic across all hospital types. CONCLUSIONS CLABSIs, VAEs, and CDIs increased significantly during the pandemic, especially in smaller community hospitals, most of which lack ID physician expertise. Future efforts should focus on better understanding challenges faced by community hospitals, strengthening the infection prevention infrastructure, and expanding the ID workforce, particularly to community hospitals.
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Affiliation(s)
- Sonali D Advani
- Corresponding Author: Sonali D. Advani MBBS, MPH, Assistant Professor of Medicine, Division of Infectious Diseases, Duke University School of Medicine, 315 Trent Drive, Hanes House, Room 154, Durham, NC, 27710, United States,
| | - Emily Sickbert-Bennett
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - Rebekah Moehring
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Andrea Cromer
- Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Yuliya Lokhnygina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC, US
| | - Elizabeth Dodds-Ashley
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
| | - Ibukunoluwa C Kalu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Duke University School of Medicine, Durham, NC, US
| | - Lauren DiBiase
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - David J Weber
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, US
| | - Deverick J Anderson
- Division of Infectious Diseases, Department of Medicine, Duke University School of Medicine, Durham, NC, US,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, NC, US
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6
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Doyle D, Rennert-May E, Somayaji R. Antimicrobial Stewardship in Wound Care. Adv Skin Wound Care 2022; 35:405-407. [PMID: 35723959 DOI: 10.1097/01.asw.0000831884.62594.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Daniel Doyle
- At the University of Calgary, Alberta, Canada, Department of Medicine, Daniel Doyle, MD, is Infectious Diseases Resident; Elissa Rennert-May, MD, MSc, FRCPC, is Assistant Professor, Infectious Diseases Specialist; and Ranjani Somayaji, BScPT, MD, MPH, FRCPC, is Assistant Professor, Infectious Diseases Specialist, Department of Microbiology, Immunology and Infectious Disease. Submitted August 9, 2021; accepted in revised form November 1, 2021
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Sadeq AA, Shamseddine JM, Babiker ZOE, Nsutebu EF, Moukarzel MB, Conway BR, Hasan SS, Conlon-Bingham GM, Aldeyab MA. Impact of Multidisciplinary Team Escalating Approach on Antibiotic Stewardship in the United Arab Emirates. Antibiotics (Basel) 2021; 10:antibiotics10111289. [PMID: 34827227 PMCID: PMC8614643 DOI: 10.3390/antibiotics10111289] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/02/2021] [Accepted: 10/18/2021] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial stewardship programs (ASP) are an essential strategy to combat antimicrobial resistance. This study aimed to measure the impact of an ASP multidisciplinary team (MDT) escalating intervention on improvement of clinical, microbiological, and other measured outcomes in hospitalised adult patients from medical, intensive care, and burns units. The escalating intervention reviewed the patients’ cases in the intervention group through the clinical pharmacists in the wards and escalated complex cases to ID clinical pharmacist and ID physicians when needed, while only special cases required direct infectious disease (ID) physicians review. Both non-intervention and intervention groups were each followed up for six months. The study involved a total of 3000 patients, with 1340 (45%) representing the intervention group who received a total of 5669 interventions. In the intervention group, a significant reduction in length of hospital stay (p < 0.01), readmission (p < 0.01), and mortality rates (p < 0.01) was observed. Antibiotic use of the WHO AWaRe Reserve group decreased in the intervention group (relative rate change = 0.88). Intravenous to oral antibiotic ratio in the medical ward decreased from 4.8 to 4.1. The presented ASP MDT intervention, utilizing an escalating approach, successfully improved several clinical and other measured outcomes, demonstrating the significant contribution of clinical pharmacists atimproving antibiotic use and informing antimicrobial stewardship.
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Affiliation(s)
- Ahmed A. Sadeq
- Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates; (A.A.S.); (J.M.S.); (M.B.M.)
| | - Jinan M. Shamseddine
- Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates; (A.A.S.); (J.M.S.); (M.B.M.)
| | - Zahir Osman Eltahir Babiker
- Division of Infecious Diseases, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates; (Z.O.E.B.); (E.F.N.)
| | - Emmanuel Fru Nsutebu
- Division of Infecious Diseases, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates; (Z.O.E.B.); (E.F.N.)
| | - Marleine B. Moukarzel
- Department of Pharmacy, Shaikh Shakhbout Medical City in Partnership with Mayo Clinic, Abu Dhabi P.O. BOX 11001, United Arab Emirates; (A.A.S.); (J.M.S.); (M.B.M.)
| | - Barbara R. Conway
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (B.R.C.); (S.S.H.)
- Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK
| | - Syed Shahzad Hasan
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (B.R.C.); (S.S.H.)
| | | | - Mamoon A. Aldeyab
- Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; (B.R.C.); (S.S.H.)
- Correspondence: ; Tel.: +44-01484-472825
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8
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Peiffer-Smadja N, Ardellier FD, Thill P, Beaumont AL, Catho G, Osei L, Dubée V, Bleibtreu A, Lemaignen A, Thy M. How and why do French medical students choose the specialty of infectious and tropical diseases? A national cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:397. [PMID: 33129325 PMCID: PMC7602756 DOI: 10.1186/s12909-020-02317-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 10/20/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Infectious and tropical diseases (ID) physicians are needed now more than ever to tackle existing and emerging global threats. However, in many countries, ID is not recognized as a qualifying specialty. The creation of ID residency in 2017 in France offers the opportunity to know how and why the specialty is chosen by medical students. METHODS We first analyzed the choice of specialty of all French medical students in 2017 and 2018 according to their rank at the national exam that ends medical studies. A web questionnaire was then sent in January 2019 to all ID residents in France (n = 100) to assess the factors influencing their choice of specialty and their career plan. RESULTS We analyzed the choice of 17,087 medical students. ID was the first-chosen specialty with a median national rank of 526/8539, followed by plastic surgery and ophthalmology. The questionnaire was completed by 90% of the French ID residents (n = 100). The most encouraging factors to choose ID were the multi-system approach of the specialty, the importance of diagnostic medicine and having done an internship in ID during medical school. The potential deterrents were the work-life balance, the workload and the salary. CONCLUSIONS The recent recognition of ID as a qualifying specialty in France can be considered a success insofar as the specialty is the most popular among all medical and surgical specialties. Individuals who choose ID are attracted by the intellectual stimulation of the specialty but express concerns about the working conditions and salaries.
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Affiliation(s)
- Nathan Peiffer-Smadja
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France.
- Infectious Diseases Department, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France.
- Université de Paris, INSERM, IAME, F-75006, Paris, France.
| | | | - Pauline Thill
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Anne-Lise Beaumont
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Gaud Catho
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Lindsay Osei
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Vincent Dubée
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Alexandre Bleibtreu
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Adrien Lemaignen
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
| | - Michaël Thy
- RéJIF, Young French Infectious Diseases Physicians' Network - Réseau des Jeunes Infectiologues Français, Paris, France
- Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, Assistance-Publique Hôpitaux de Paris, Paris, France
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Sears CL, File TM, Alexander BD, McQuillen DP, MacIntyre AT, Allen UD, Colasanti JA, Siddiqui J, Reveles KR, Busky C. Charting the Path Forward: Development, Goals and Initiatives of the 2019 Infectious Diseases Society of America Strategic Plan. Clin Infect Dis 2020; 69:e1-e7. [PMID: 31620782 DOI: 10.1093/cid/ciz1040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/12/2022] Open
Abstract
In October 2018, the Infectious Diseases Society of America (IDSA) Board of Directors (BOD) decided to develop a 2019 IDSA Strategic Plan. The IDSA BOD has invested in strategic planning at regular intervals as part of an ongoing process to review and to renew the vision and direction of IDSA. Herein, the 2018-2019 strategic planning process and outcomes are described. The 2019 IDSA Strategic Plan presents 4 key initiatives: (1) optimize the development, dissemination, and adoption of timely and relevant ID guidance and guidelines that improve the outcomes of clinical care; (2) quantify, communicate, and advocate for the value of ID physicians to increase professional fulfillment and compensation; (3) facilitate the growth and development of the ID workforce to meet emerging scientific, clinical, and leadership needs; and (4) develop and position a new tool to serve as the leading US benchmark to measure and drive national progress on antimicrobial resistance. The BOD looks forward to developing, implementing, assessing, and advancing the 2019 IDSA Strategic Plan working with member volunteers, Society partners, and IDSA staff.
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Affiliation(s)
- Cynthia L Sears
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | - Daniel P McQuillen
- Beth Israel Lahey Health-Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.,Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Ann T MacIntyre
- Mercy Hospital, Palmetto General Hospital, Miami, Florida, USA
| | - Upton D Allen
- Hospital for Sick Children, Toronto, Ontario, Canada
| | | | | | | | - Chris Busky
- Chief Executive Officer, Infectious Diseases Society of America and the Infectious Diseases Society of America Foundation, Arlington, Virginia, USA
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Buckel WR, Kaye KS, Patel PK. Collaborative Antimicrobial Stewardship: Working with Hospital and Health System Administration. Infect Dis Clin North Am 2019; 34:1-15. [PMID: 31836330 DOI: 10.1016/j.idc.2019.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Successful antimicrobial stewardship programs rely on engagement with hospital administrators. Antimicrobial stewards should understand the unique pressures and demands of hospital and health system administration and be familiar with key terminology and regulatory requirements. This article provides guidance on strategies for engaging hospital and health system administration to support antimicrobial stewardship, including recommendations for designing a successful antimicrobial stewardship program structure, pitching resource requests, setting meaningful and measurable goals, achieving and communicating results, and fostering ongoing relationships with hospital and health system administration.
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Affiliation(s)
- Whitney R Buckel
- Intermountain Healthcare Pharmacy Services, 4393 South Riverboat Road, Suite 100, Taylorsville, UT 84123, USA.
| | - Keith S Kaye
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Payal K Patel
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Division of Infectious Diseases, Department of Internal Medicine, Veterans Affairs Ann Arbor Healthcare System, VA Ann Arbor Healthcare System (111-I), 2215 Fuller Road, Ann Arbor, MI 48109-2399, USA
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11
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Jiménez-Aguilar P, López-Cortés LE, Rodríguez-Baño J. Impact of infectious diseases consultation on the outcome of patients with bacteraemia. Ther Adv Infect Dis 2019; 6:2049936119893576. [PMID: 31839942 PMCID: PMC6900613 DOI: 10.1177/2049936119893576] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 11/15/2019] [Indexed: 12/29/2022] Open
Abstract
Bacteraemia or bloodstream infections (BSI) are associated with much morbidity and mortality. Management of patients with bacteraemia is complex, and the increase in immunosuppressed patients and multidrug-resistant organisms poses additional challenges. The objective of this review is to assess the available published information about the impact of different aspects of management on the outcome of patients with BSI, and, specifically, the importance of infectious diseases specialists (IDS) consultation. The impact of management by IDS on different aspects, including interpretation of newer rapid techniques, early evaluation and treatment, and follow up, are reviewed. Overall, the available data suggest that IDS intervention improves the management and outcome of patients with BSI, either through consultation or structured unsolicited interventions in the context of multidisciplinary bacteraemia programmes.
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Affiliation(s)
- Patricia Jiménez-Aguilar
- Unidad Clínica de Enfermedades Infecciosas, Hospital Universitario Puerto Real, Puerto Real, Cádiz, Spain
| | - Luis Eduardo López-Cortés
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
| | - Jesús Rodríguez-Baño
- Unidad Clínica de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Hospital Universitario Virgen Macarena, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain
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12
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Anthone J, Boldt D, Alexander B, Carroll C, Ased S, Schmidt D, Vivekanandan R, Destache CJ. Implementation of a Health-System Wide Antimicrobial Stewardship Program in Omaha, NE. PHARMACY 2019; 7:E156. [PMID: 31775246 PMCID: PMC6958401 DOI: 10.3390/pharmacy7040156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 11/19/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022] Open
Abstract
The Centers for Medicare and Medicaid Services (CMS) have mandated that acute care and critical access hospitals implement an Antimicrobial Stewardship (AMS) Program. This manuscript describes the process that was implemented to ensure CMS compliance for AMS, across a 14-member health system (eight community hospitals, five critical access hospitals, and an academic medical center) in the Omaha metro area, and surrounding cities. The addition of the AMS program to the 14-member health system increased personnel, with a 0.5 full-time equivalent (FTE) infectious diseases (ID) physician, and 2.5 FTE infectious diseases trained clinical pharmacists to support daily AMS activities. Clinical decision support software had previously been implemented across the health system, which was also key to the success of the program. Overall, in its first year, the AMS program demonstrated a $1.2 million normalized reduction (21% total reduction in antimicrobial purchases) in antimicrobial expenses. The ability to review charts daily for antimicrobial optimization with ID pharmacist and physician support, identify facility specific needs and opportunities, and to collect available data endpoints to determine program effectiveness helped to ensure the success of the program.
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Affiliation(s)
- Jennifer Anthone
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Dayla Boldt
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Bryan Alexander
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Cassara Carroll
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Sumaya Ased
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - David Schmidt
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
| | - Renuga Vivekanandan
- Department of Pharmacy Services, CHI Health, Omaha, NE 68124, USA; (J.A.); (D.B.); (B.A.); (C.C.); (S.A.); (D.S.); (R.V.)
- School of Medicine, Creighton University, Omaha, NE 68178, USA
| | - Christopher J. Destache
- School of Medicine, Creighton University, Omaha, NE 68178, USA
- School of Pharmacy & Health Professions, Creighton University, Omaha, NE 68178, USA
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13
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Abstract
Antimicrobial stewardship improves patient care and reduces antimicrobial resistance, inappropriate use, and adverse outcomes. Despite high-profile mandates for antimicrobial stewardship programs across the healthcare continuum, descriptive data, and recommendations for dedicated resources, including appropriate physician, pharmacist, data analytics, and administrative staffing support, are not robust. This review summarizes the current literature on antimicrobial stewardship staffing and calls for the development of minimum staffing recommendations.
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14
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Tarrant C, Colman A, Chattoe-Brown E, Jenkins D, Mehtar S, Perera N, Krockow E. Optimizing antibiotic prescribing: collective approaches to managing a common-pool resource. Clin Microbiol Infect 2019; 25:1356-1363. [DOI: 10.1016/j.cmi.2019.03.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/18/2022]
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15
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Ostrowsky B, Banerjee R, Bonomo RA, Cosgrove SE, Davidson L, Doron S, Gilbert DN, Jezek A, Lynch JB, Septimus EJ, Siddiqui J, Iovine NM. Infectious Diseases Physicians: Leading the Way in Antimicrobial Stewardship. Clin Infect Dis 2019; 66:995-1003. [PMID: 29444247 DOI: 10.1093/cid/cix1093] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 01/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Belinda Ostrowsky
- Montefiore Medical Center, Albert Einstein Medical Center, Bronx, New York
| | - Ritu Banerjee
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert A Bonomo
- Research and Medical Services Veterans Affairs Medical Center, Ohio.,Departments of Medicine, Pharmacology, Molecular Biology and Microbiology, Case Western Reserve University, Ohio.,Cleveland Geriatric Research Education and Clinical Center, Case Western Reserve University-Cleveland Veterans Affairs Medical Center, Center for Antimicrobial Resistance and Epidemiology, Ohio
| | - Sara E Cosgrove
- Johns Hopkins University School of Medicine, Baltimore, Maryl
| | - Lisa Davidson
- Carolinas Health Care System, Charlotte, North Carolina
| | | | - David N Gilbert
- Providence-Portland Medical Center, Portl.,Oregon Health Sciences University, Portl
| | - Amanda Jezek
- Infectious Diseases Society of America, Arlington, Virginia
| | - John B Lynch
- Harborview Medical Center, University of Washington, Seattle
| | - Edward J Septimus
- HCA Healthcare, Nashville, Tennessee.,Texas A&M College of Medicine, Houston
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16
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Kim YC, Kim EJ, Heo JY, Choi YH, Ahn JY, Jeong SJ, Ku NS, Choi JY, Yeom JS, Kim HY. Impact of an Infectious Disease Specialist on an Antimicrobial Stewardship Program at a Resource-Limited, Non-Academic Community Hospital in Korea. J Clin Med 2019; 8:E1293. [PMID: 31450837 PMCID: PMC6780603 DOI: 10.3390/jcm8091293] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 08/20/2019] [Accepted: 08/22/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Implementing a successful antimicrobial stewardship program (ASP) is difficult for non-academic community (NAC) hospitals due to insufficient infrastructure. AIM We evaluated the impact of an infectious disease specialist (IDS) on implementing an ASP in a resource-limited setting in Korea. METHODS A retrospective study was performed at a NAC hospital between June 2015 and August 2018. An IDS has led an ASP at the hospital since June 2017. We used an interrupted time series analysis to evaluate longitudinal effects of the IDS-led ASP on the amount of antibiotic use and incidence of multidrug-resistant organism (MDRO) acquisition. FINDINGS Total antibiotic use changed from 698.82 ± 74.41 to 602.09 ± 69.94 defined daily dose/1000 patient-days (PDs) after intervention. An immediate reduction in the use of carbapenems, glycopeptides, penicillins, and other antibiotics followed the IDS-led ASP. The 3rd/4th generation cephalosporins and carbapenems prescription rates decreased in slope after the intervention. Incidence of MDRO acquisition changed from 1.38, 0.78, and 0.21/1000 PDs to 1.06, 0.15, and 0.32/1000 PDs in methicillin-resistant Staphylococcus aureus, multidrug-resistant Acinetobacter baumannii, and multidrug-resistant Pseudomonas aeruginosa, respectively. The incidence of methicillin-resistant Staphylococcus aureus and multidrug-resistant Acinetobacter baumannii acquisition immediately decreased following intervention. CONCLUSION An IDS can implement a successful ASP by reducing antibiotic consumption and MDRO acquisition at resource-limited NAC hospitals.
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Affiliation(s)
- Yong Chan Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea
- Department of Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Eun Jin Kim
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea
| | - Jung Yeon Heo
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea
| | - Young Hwa Choi
- Department of Infectious Diseases, Ajou University School of Medicine, Suwon 16499, Korea
| | - Jin Young Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea.
| | - Su Jin Jeong
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Nam Su Ku
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Jun Yong Choi
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Joon-Sup Yeom
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 03722, Korea
| | - Ha Yan Kim
- Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul 03722, Korea
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17
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Zahn M, Adalja AA, Auwaerter PG, Edelson PJ, Hansen GR, Hynes NA, Jezek A, MacArthur RD, Manabe YC, McGoodwin C, Duchin JS. Infectious Diseases Physicians: Improving and Protecting the Public's Health: Why Equitable Compensation Is Critical. Clin Infect Dis 2019; 69:352-356. [PMID: 30329044 PMCID: PMC7108186 DOI: 10.1093/cid/ciy888] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 10/15/2018] [Indexed: 02/07/2023] Open
Abstract
Infectious diseases (ID) physicians play a crucial role in public health in a variety of settings. Unfortunately, much of this work is undercompensated despite the proven efficacy of public health interventions such as hospital acquired infection prevention, antimicrobial stewardship, disease surveillance, and outbreak response. The lack of compensation makes it difficult to attract the best and the brightest to the field of ID, threatening the future of the ID workforce. Here, we examine compensation data for ID physicians compared to their value in population and public health settings and suggest policy recommendations to address the pay disparities that exist between cognitive and procedural specialties that prevent more medical students and residents from entering the field. All ID physicians should take an active role in promoting the value of the subspecialty to policymakers and influencers as well as trainees.
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Affiliation(s)
- Matthew Zahn
- Epidemiology and Assessment, Orange County Health Care Agency, California
| | - Amesh A Adalja
- Johns Hopkins Center for Health Security, Johns Hopkins University, Baltimore, Maryland
| | - Paul G Auwaerter
- Sherrilyn and Ken Fisher Center for Environmental Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Paul J Edelson
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - Noreen A Hynes
- Schools of Medicine and Public Health, Johns Hopkins University, Baltimore, Maryland
| | - Amanda Jezek
- Public Policy and Government Relations, Infectious Diseases Society of America, Arlington, Virginia
| | - Rodger D MacArthur
- Office of Academic Affairs, Medical College of Georgia at Augusta University
| | - Yukari C Manabe
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Colin McGoodwin
- Public Policy and Government Relations, Infectious Diseases Society of America, Arlington, Virginia
| | - Jeffrey S Duchin
- Communicable Disease Epidemiology & Immunization Section, Division of Infectious Diseases, Seattle and King County Public Health Department and University of Washington School of Public Health
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18
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Gilsdorf JR, Spearman P, Englund JA, Tan TQ, Bryant KA. Pediatric Infectious Diseases Meets the Future. J Pediatric Infect Dis Soc 2019; 8:9-12. [PMID: 29788443 DOI: 10.1093/jpids/piy042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Accepted: 04/20/2018] [Indexed: 11/13/2022]
Abstract
Pediatric infectious diseases physicians are dedicated to the diagnosis, prevention, and management of infections in children. As such, we play large, and important, roles in the clinical care of children from birth to late adolescence and in infection prevention, antimicrobial stewardship, research pertaining to infections, public health, international and global health, and advocacy for children's health. Furthermore, we are critical to the education of future physicians (in general), pediatricians, and infectious diseases doctors. In addition to diagnosing and treating bacterial, fungal, viral, and parasitic infections known through the ages, we have been at the forefront of meeting today's new infectious threats to children's health, which include the following: antibiotic-resistant organisms; hospital-acquired infections; global outbreaks such as Ebola, Zika, human immunodeficiency virus-acquired immune deficiency syndrome, and new strains of influenza; infections in immunocompromised children; vaccine-preventable infections; the inefficient use of medical resources; and the high cost of medical care.
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Affiliation(s)
- Janet R Gilsdorf
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor
| | - Paul Spearman
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Ohio
| | | | - Tina Q Tan
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristina A Bryant
- Department of Pediatrics, University of Louisville School of Medicine, Kentucky
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19
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Abstract
Objective: Most positive studies in procalcitonin (PCT) utilization were done in large, tertiary medical centers. Furthermore, there is a paucity of data describing the implementation process. This article is the first to describe in detail the implementation process and initial outcomes after 6 months of PCT testing in a rural, 65-bed, primary hospital. Methods: Education before and during PCT implementation as well as facility rollout are described. Initial outcomes were assessed using a before and after quasi-experimental study design comparing 2 identical 6-month time periods: May to October 2016 and May to October 2017. Antibiotic consumption is described with days of therapy (DOT) per 1000 patient days (PD). Antimicrobial purchasing costs, admission rates, and length of stay (LOS) are also compared. Results: Antimicrobial consumption was variable with the greatest reduction at 6 months: 856 DOT/1000 PD before versus 576 DOT/1000 PD after (P < .0001). Admission rates and LOS were unaffected. There was no associated savings in antibiotic purchasing costs: $114 189.79 before and $139 829.26 after (difference +$25 639.47). Conclusion: Although implementation of PCT testing is feasible in a rural health care facility, after 6 months, it was associated with a marginal decrease in antibiotic consumption with no decrease in admission rates, LOS, or antibiotic cost savings.
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Affiliation(s)
- Jennifer L. Cole
- Veterans Health Care System of the
Ozarks, Fayetteville, AR, USA
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20
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Morgan JR, Barlam TF, Drainoni ML. A Qualitative Study of the Real-world Experiences of Infectious Diseases Fellows Regarding Antibiotic Stewardship. Open Forum Infect Dis 2018; 5:ofy102. [PMID: 30280120 PMCID: PMC6159649 DOI: 10.1093/ofid/ofy102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/01/2018] [Indexed: 12/19/2022] Open
Abstract
Background Antibiotic-resistant bacterial infections are a major threat to public health, yet improper use of antibiotics remains high. Infectious Diseases (ID) fellows play a major role in antibiotic stewardship efforts, but there is little research on how they view stewardship activities. We performed a qualitative study to explore ID fellows’ experiences and perspectives regarding their antibiotic stewardship training and their role as future antibiotic stewards. Methods We conducted 17 in-depth interviews with ID fellows across the country. The interviews were transcribed verbatim by the study team, and we used grounded theory to generate themes from these interviews Results Fellows focused on concrete tasks of stewardship such as performing antibiotic approvals, didactic and case-based education, and interactions with other physicians and pharmacists. There was little focus on the broader public health relevance of antibiotic stewardship. Pharmacists, not ID physician leaders, were identified as fellows’ primary resource for antibiotic teaching. Several fellows suggested that stewardship programs should be led by pharmacists. Conclusions ID fellowship training is not successfully conveying the public health importance of antibiotic stewardship or the role of ID physicians as leaders of antibiotic stewardship programs. Fellows are more focused on concrete tasks related to stewardship. ID training programs and societies should consider developing robust curricula involving fellows in the operation of the stewardship program itself, not solely in antibiotic approvals, emphasizing aspects of the program such as complex problem solving that fellows find most compelling, and emphasizing the important role these programs serve in improving public health.
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Affiliation(s)
- Jake R Morgan
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts
| | - Tamar F Barlam
- Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Mari-Lynn Drainoni
- Department of Health Policy and Management, Boston University School of Public Health, Boston, Massachusetts.,Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.,Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Affairs Hospital, Bedford, Massachusetts
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21
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Vandenberg O, Kozlakidis Z, Schrenzel J, Struelens MJ, Breuer J. Control of Infectious Diseases in the Era of European Clinical Microbiology Laboratory Consolidation: New Challenges and Opportunities for the Patient and for Public Health Surveillance. Front Med (Lausanne) 2018; 5:15. [PMID: 29457001 PMCID: PMC5801420 DOI: 10.3389/fmed.2018.00015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/18/2018] [Indexed: 01/03/2023] Open
Abstract
Many new innovative diagnostic approaches have been made available during the last 10 years with major impact on patient care and public health surveillance. In parallel, to enhance the cost-effectiveness of the clinical microbiology laboratories (CMLs), European laboratory professionals have streamlined their organization leading to amalgamation of activities and restructuring of their professional relationships with clinicians and public health specialists. Through this consolidation process, an operational model has emerged that combines large centralized clinical laboratories performing most tests on one high-throughput analytical platform connected to several distal laboratories dealing locally with urgent analyses at near point of care. The centralization of diagnostic services over a large geographical region has given rise to the concept of regional-scale "microbiology laboratories network." Although the volume-driven cost savings associated with such laboratory networks seem self-evident, the consequence(s) for the quality of patient care and infectious disease surveillance and control remain less obvious. In this article, we describe the range of opportunities that the changing landscape of CMLs in Europe can contribute toward improving the quality of patient care but also the early detection and enhanced surveillance of public health threats caused by infectious diseases. The success of this transformation of health services is reliant on the appropriate preparation in terms of staff, skills, and processes that would be inclusive of stakeholders. In addition, rigorous metrics are needed to set out more concrete laboratory service performance objectives and assess the expected benefits to society in terms of saving lives and preventing diseases.
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Affiliation(s)
- Olivier Vandenberg
- Innovation and Business Development Unit, LHUB-ULB, Pôle Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Zisis Kozlakidis
- Division of Infection and Immunity, University College London, London, United Kingdom
- The Farr Institute of Health Informatics Research, University College London, London, United Kingdom
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Bacteriology Laboratory, Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Jean Struelens
- Microbiology Coordination Section, Office of the Chief Scientist, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
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22
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de Dios B, Borges M, Smith TD, del Castillo A, Socias A, Gutiérrez L, Nicolás J, Lladó B, Roche JA, Díaz MP, Lladó Y. Computerised sepsis protocol management. Description of an early warning system. Enferm Infecc Microbiol Clin 2018. [DOI: 10.1016/j.eimce.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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23
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de Dios B, Borges M, Smith TD, del Castillo A, Socias A, Gutiérrez L, Nicolás J, Lladó B, Roche JA, Díaz MP, Lladó Y. Protocolo informático de manejo integral de la sepsis. Descripción de un sistema de identificación precoz. Enferm Infecc Microbiol Clin 2018; 36:84-90. [DOI: 10.1016/j.eimc.2016.11.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Revised: 11/07/2016] [Accepted: 11/10/2016] [Indexed: 11/24/2022]
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24
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Morii D, Ichinose N, Yokozawa T, Oda T. Impact of an infectious disease specialist on antifungal use: an interrupted time-series analysis in a tertiary hospital in Tokyo. J Hosp Infect 2018; 99:133-138. [PMID: 29325870 DOI: 10.1016/j.jhin.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 01/03/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Antimicrobial stewardship programmes are considered essential for optimizing antimicrobial use in order to improve patient outcomes, reduce the number of adverse sequelae, prevent resistance, and ensure cost-effective therapy. AIM To assess the efficacy and the limitations of antifungal antimicrobial stewardship programmes. METHODS A bundle to manage infectious diseases was implemented in our hospital in October 2010. Data regarding antimicrobial use density (AUD) from April 2006 to May 2016 were collected. Trends in AUD were assessed using an interrupted time-series model for three separate periods: the pre-bundle, the bundle implementation, and the long-term follow-up periods. The primary and secondary outcomes were AUD (defined daily dose (DDD) per 1000 patient-days) of intravenous antifungals and expenditure on antifungals per fiscal year, respectively. FINDINGS The AUD for all intravenous antifungals decreased from 26.1 in 2006 to 9.9 in 2015. Whereas the change in the trend during the pre-bundle period was not significant (slope: 0.062; 95% confidence interval (CI): -0.180 to 0.305), a significant decrease was observed in the bundle implementation period (slope: -0.535; 95% CI: -0.907 to -0.164). The trend slowed during the long-term follow-up period (slope: -0.040; 95% CI: -0.218 to 0.138). Total expenditure on antifungals decreased by 73%, from ¥52,354,411 in fiscal year 2006 to ¥14,073,099 in fiscal year 2015. CONCLUSION The bundle significantly reduced the use of antifungals and decreased costs over time, but this effect was limited in that it had stabilized within three years.
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Affiliation(s)
- D Morii
- Department of Infection Control and Prevention Graduate School of Medicine, Osaka University, Osaka, Japan; Department of Infectious Diseases, Showa General Hospital, Kodaira, Tokyo, Japan.
| | - N Ichinose
- Department of Infectious Diseases, Showa General Hospital, Kodaira, Tokyo, Japan
| | - T Yokozawa
- Department of Infectious Diseases, Showa General Hospital, Kodaira, Tokyo, Japan
| | - T Oda
- Department of Infectious Diseases, Showa General Hospital, Kodaira, Tokyo, Japan
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25
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McQuillen DP, MacIntyre AT. The Value That Infectious Diseases Physicians Bring to the Healthcare System. J Infect Dis 2017; 216:S588-S593. [PMID: 28938046 PMCID: PMC7107418 DOI: 10.1093/infdis/jix326] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
While a career in infectious diseases (ID) has always been challenging and exciting, recognition of the value that ID physicians provide to the healthcare system as a whole, over and above the value they provide to individual patients, has been poor in this system. In response to this disparity, the Infectious Diseases Society of America Clinical Affairs Committee has long endeavored to quantify the value of ID physicians to the system, which is challenging in part because of the many avenues through which they influence healthcare. We discuss data showing that ID physicians improve clinical outcomes, positively impact transitions of care, and direct system-level improvements through infection prevention and antimicrobial stewardship. We identify areas where value-based care provides additional future opportunities for ID physicians. A Clinical Affairs Committee–sponsored study of ID physicians’ positive impact on patient outcomes shows that few medical specialties are better positioned to positively impact the Triple Aim approach—better health, better care, and lower per capita cost—that is the principle tenet of healthcare system reform.
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Affiliation(s)
- Daniel P McQuillen
- Center for Infectious Diseases and Prevention, Lahey Hospital and Medical Center, Burlington.,Tufts University School of Medicine, Boston, Massachusetts
| | - Ann T MacIntyre
- Palmetto General Hospital, Hialeah.,Nova Southeastern University, Fort Lauderale, Florida
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26
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Mulanovich V, Kontoyiannis DP. Acute myeloid leukemia and the infectious diseases consultant. Leuk Lymphoma 2017; 59:1284-1291. [PMID: 28914100 DOI: 10.1080/10428194.2017.1365861] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Infectious complications following treatment of acute myeloid leukemia (AML) are important causes of morbidity and mortality. The spectrum and complexity of these infections is reflected by the severe net state of immunosuppression of AML patients, that is dynamic and continuously changing, the polypharmacy, including the widespread use of anti-infectives and the complex epidemiology of severe and frequently resistant pathogens afflicting these patients. Infectious diseases (ID) consultants having a critical mass of expertise and intimate knowledge of the intricacies of leukemia care, add considerable value in improving outcomes of patients with AML who develop infections. Furthermore, pharmaco-economic considerations such as length of stay, choice of cost-effective anti-infective program, infection control and antibiotic stewardship strategies create a delicate interplay of the ID consultant and the ecosystem of care of AML patients. This is an increasingly recognized area of cross collaboration and a productive direction for future collaborative practice models and research.
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Affiliation(s)
- Victor Mulanovich
- a Department of Infectious Diseases, Infection Control and Employee Health , University of Texas, MD Anderson Cancer Center , Houston , TX , USA
| | - Dimitrios P Kontoyiannis
- a Department of Infectious Diseases, Infection Control and Employee Health , University of Texas, MD Anderson Cancer Center , Houston , TX , USA
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27
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Schaenman JM, Kumar D, Kotton CN, Danziger-Isakov L, Morris MI. Transplant center support for infectious diseases. Transpl Infect Dis 2017; 19. [PMID: 28699274 DOI: 10.1111/tid.12746] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/18/2017] [Accepted: 04/30/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transplant Infectious Diseases (TID) is a rapidly growing subspecialty, which has contributed significantly to improving patient outcomes after transplantation. Obtaining institutional support to implement programs that promote excellence in patient care remains a challenge for many non-surgical transplant-related specialties. METHOD We surveyed the membership of the American Society of Transplantation Infectious Diseases Community of Practice to assess characteristics of individual transplant programs and delineate current patterns of institutional support of TID, with a goal of facilitating the exchange of innovative funding ideas between transplant programs. RESULTS Of 53 questionnaires returned, 36 programs reported the existence of a dedicated TID service for adults. Of these, the ratio of dedicated TID providers to the number of solid organ transplant patients transplanted annually ranged from 15:1 to 259:1. A total of 21% of responding programs indicated that they received no support from their institution. Respondents from larger programs were more likely to receive some type of programmatic support. CONCLUSION Given that the presence of expert TID input into patient care can improve outcomes through direct patient management and transplant team education, we suggest that continued support of the unbillable time contributed by TID practitioners is a critical part of ensuring excellent outcomes after transplantation.
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Affiliation(s)
- Joanna M Schaenman
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Deepali Kumar
- Transplant Infectious Diseases, University Health Network, Toronto, ON, Canada
| | - Camille N Kotton
- Transplant and Immunocompromised Host Infectious Diseases, Infectious Diseases Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Michele I Morris
- Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, FL, USA
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28
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Patel D, Macdougall C. How to Make Antimicrobial Stewardship Work: Practical Considerations for Hospitals of All Sizes. Hosp Pharm 2017. [DOI: 10.1310/hpj4511-s10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Implementation of an antimicrobial stewardship program in a hospital is complicated by a variety of challenges. Key issues facing stewardship personnel include recruiting personnel and building relationships, establishing program metrics, selecting stewardship strategies, working with clinicians, reporting results, and adapting the program. These issues can present different challenges at community hospitals and academic medical centers. Strategies for overcoming these challenges require accounting for the unique characteristics of each institution.
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Affiliation(s)
- Dimple Patel
- Infectious Diseases, Comprehensive Pharmacy Services, John F. Kennedy Medical Center, Edison, New Jersey
| | - Conan Macdougall
- University of California San Francisco School of Pharmacy, San Francisco, California
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29
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Ricciardi A, Gentilotti E, Coppola L, Maffongelli G, Cerva C, Malagnino V, Mari A, Di Veroli A, Berrilli F, Apice F, Toschi N, Di Cave D, Parisi SG, Andreoni M, Sarmati L. Infectious disease ward admission positively influences P. jiroveci pneumonia (PjP) outcome: A retrospective analysis of 116 HIV-positive and HIV-negative immunocompromised patients. PLoS One 2017; 12:e0176881. [PMID: 28505159 PMCID: PMC5432209 DOI: 10.1371/journal.pone.0176881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 04/18/2017] [Indexed: 01/15/2023] Open
Abstract
P. jiroveci (Pj) causes a potentially fatal pneumonia in immunocompromised patients and the factors associated with a bad outcome are poorly understood. A retrospective analysis on Pj pneumonia (PjP) cases occurring in Tor Vergata University Hospital, Italy, during the period 2011–2015. The patients’ demographic, clinical and radiological characteristics and the Pj genotypes were considered. The study population included 116 patients, 37.9% of whom had haematological malignancy or underwent haematological stem cell transplantation (HSCT), 22.4% had HIV infection, 16.4% had chronic lung diseases (CLD), 7.8% had a solid cancer, and 3.4% underwent a solid organ transplant (SOT). The remaining 12.1% had a miscellaneous other condition. At univariate analysis, being older than 60 years was significantly correlated with a severe PjP (OR [95%CI] 2.52 [0.10–5.76]; p = 0.031) and death (OR [95%CI] 2.44 [1.05–5.70]; p = 0.036), while a previous trimethoprim/sulfamethoxazole (TMP/SMX) prophylaxis were significantly associated with a less severe pneumonia (OR[95%CI] 0.35 [0.15–0.84], p = 0.023); moreover, death due to PjP was significantly more frequent in patients with CLD (OR[95%CI] 3.26 [1.17–9.05]; p = 0.019) while, admission to the Infectious Diseases Unit was significantly associated with fewer deaths (OR[95%CI] 0.10 [0.03–0.36], p = 0.002). At multivariate analysis, a better PjP outcome was observed in patients taking TMP/SMX prophylaxis and that were admitted to the Infectious Diseases Unit (OR[95%CI] 0.27 [0.07–1.03], p = 0.055, OR[95%CI] 0.16 [0.05–0.55]; p = 0.004, respectively). In conclusion, in our study population, TMP/SMX prophylaxis and infectious disease specialist approach were variables correlated with a better PjP outcome.
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Affiliation(s)
| | | | - Luigi Coppola
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Carlotta Cerva
- Infectious Diseases, Tor Vergata University, Rome, Italy
| | | | - Alessia Mari
- Respiratory Diseases Unit, Tor Vergata University, Rome, Italy
| | - Ambra Di Veroli
- Department of Haematology, Tor Vergata University, Rome, Italy
| | - Federica Berrilli
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Fabiana Apice
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy
- Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Boston, MA, United States of America
| | - David Di Cave
- Department of Clinical Sciences and Translational Medicine, Tor Vergata University, Rome, Italy
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padua, Padua, Italy, Clinical Microbiology and Virology Unit, Padua University Hospital, Padua, Italy
| | | | - Loredana Sarmati
- Infectious Diseases, Tor Vergata University, Rome, Italy
- * E-mail:
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Brennan MB, Allen GO, Ferguson PD, McBride JA, Crnich CJ, Smith MA. The Association Between Geographic Density of Infectious Disease Physicians and Limb Preservation in Patients With Diabetic Foot Ulcers. Open Forum Infect Dis 2017; 4:ofx015. [PMID: 28480286 PMCID: PMC5413995 DOI: 10.1093/ofid/ofx015] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 01/26/2017] [Indexed: 11/20/2022] Open
Abstract
Background Avoiding major (above-ankle) amputation in patients with diabetic foot ulcers is best accomplished by multidisciplinary care teams with access to infectious disease specialists. However, access to infectious disease physicians is partially influenced by geography. We assessed the effect of living in a hospital referral region with a high geographic density of infectious disease physicians on major amputation for patients with diabetic foot ulcers. We studied geographic density, rather than infectious disease consultation, to capture both the direct and indirect (eg, informal consultation) effects of access to these providers on major amputation. Methods We used a national retrospective cohort of 56440 Medicare enrollees with incident diabetic foot ulcers. Cox proportional hazard models were used to assess the relationship between infectious disease physician density and major amputation, while controlling for patient demographics, comorbidities, and ulcer severity. Results Living in hospital referral regions with high geographic density of infectious disease physicians was associated with a reduced risk of major amputation after controlling for demographics, comorbidities, and ulcer severity (hazard ratio, .83; 95% confidence interval, .75–.91; P < .001). The relationship between the geographic density of infectious disease physicians and major amputation was not different based on ulcer severity and was maintained when adjusting for socioeconomic factors and modeling amputation-free survival. Conclusions Infectious disease physicians may play an important role in limb salvage. Future studies should explore whether improved access to infectious disease physicians results in fewer major amputations.
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Affiliation(s)
- Meghan B Brennan
- Department of Medicine, University of Wisconsin-Madison.,Health Innovation Program, University of Wisconsin-Madison
| | - Glenn O Allen
- Health Innovation Program, University of Wisconsin-Madison
| | | | | | - Christopher J Crnich
- Department of Medicine, University of Wisconsin-Madison.,Health Innovation Program, University of Wisconsin-Madison
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Sasikumar M, Boyer S, Remacle-Bonnet A, Ventelou B, Brouqui P. The value of specialist care-infectious disease specialist referrals-why and for whom? A retrospective cohort study in a French tertiary hospital. Eur J Clin Microbiol Infect Dis 2016; 36:625-633. [PMID: 27858243 DOI: 10.1007/s10096-016-2838-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/31/2016] [Indexed: 11/25/2022]
Abstract
This study evaluated the impact of infectious disease (ID) specialist referrals on outcomes in a tertiary hospital in France. This study tackled methodological constraints (selection bias, endogeneity) using instrumental variables (IV) methods in order to obtain a quasi-experimental design. In addition, we investigated whether certain characteristics of patients have a bearing on the impact of the intervention. We used the payments database and ID department files to obtain data for adults admitted with an ID diagnosis in the North Hospital, Marseille from 2012 to 2014. Comparable cohorts were obtained using coarsened exact matching and analysed using IV models. Mortality, readmissions, cost (payer perspective) and length of stay (LoS) were analysed. We recorded 15,393 (85.97%) stays, of which 2,159 (14.03%) benefited from IDP consultations. The intervention was seen to significantly lower the risk of inpatient mortality (marginal effect (M.E) = -19.06%) and cost of stay (average treatment effect (ATE) = - €5,573.39). The intervention group was seen to have a longer LoS (ATE = +4.95 days). The intervention conferred a higher reduction in mortality and cost for stays that experienced ICU care (mortality: odds ratio (OR) =0.09, M.E cost = -8,328.84 €) or had a higher severity of illness (mortality: OR=0.35, M.E cost = -1,331.92 €) and for patients aged between 50 and 65 years (mortality: OR=0.28, M.E cost = -874.78 €). This study shows that ID referrals are associated with lower risk of inpatient mortality and cost of stay, especially when targeted to certain subgroups.
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Affiliation(s)
- M Sasikumar
- SESSTIM, UMR 912 INSERM, Aix-Marseille University (Aix-Marseille School of Economics), Marseille, France.
| | - S Boyer
- SESSTIM, UMR 912 INSERM-IRD, Aix-Marseille Université, Marseille, France
| | - A Remacle-Bonnet
- Service d'Information Médicale, APHM CHU Nord Marseille, Marseille, France
| | - B Ventelou
- CNRS & EHESS, Aix-Marseille University (Aix-Marseille School of Economics), Marseille, France
| | - P Brouqui
- IHU Méditerranée Infection; URMITE; UM63; CNRS 7278; IRD 198; Inserm 1095, Aix Marseille Université, Marseille, France
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Sullivan T. Declining Interest in Infectious Diseases: An Economic Problem That Requires Economic Solutions. Clin Infect Dis 2016; 63:1677. [DOI: 10.1093/cid/ciw671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lanbeck P, Ragnarson Tennvall G, Resman F. A cost analysis of introducing an infectious disease specialist-guided antimicrobial stewardship in an area with relatively low prevalence of antimicrobial resistance. BMC Health Serv Res 2016; 16:311. [PMID: 27464508 PMCID: PMC4963928 DOI: 10.1186/s12913-016-1565-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 07/20/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Antimicrobial stewardship programs have been widely introduced in hospitals as a response to increasing antimicrobial resistance. Although such programs are commonly used, the long-term effects on antimicrobial resistance as well as societal economics are uncertain. METHODS We performed a cost analysis of an antimicrobial stewardship program introduced in Malmö, Sweden in 20 weeks 2013 compared with a corresponding control period in 2012. All direct costs and opportunity costs related to the stewardship intervention were calculated for both periods. Costs during the stewardship period were directly compared to costs in the control period and extrapolated to a yearly cost. Two main analyses were performed, one including only comparable direct costs (analysis one) and one including comparable direct and opportunity costs (analysis two). An extra analysis including all comparable direct costs including costs related to length of hospital stay (analysis three) was performed, but deemed as unrepresentative. RESULTS According to analysis one, the cost per year was SEK 161 990 and in analysis two the cost per year was SEK 5 113. Since the two cohorts were skewed in terms of size and of infection severity as a consequence of the program, and since short-term patient outcomes have been demonstrated to be unchanged by the intervention, the costs pertaining to patient outcomes were not included in the analysis, and we suggest that analysis two provides the most correct cost calculation. In this analysis, the main cost drivers were the physician time and nursing time. A sensitivity analysis of analysis two suggested relatively modest variation under changing assumptions. CONCLUSION The total yearly cost of introducing an infectious disease specialist-guided, audit-based antimicrobial stewardship in a department of internal medicine, including direct costs and opportunity costs, was calculated to be as low as SEK 5 113.
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Affiliation(s)
- Peter Lanbeck
- Infectious Diseases Research Unit, Department of Clinical Sciences, Malmö, Lund University, Rut Lundskogs gata 3, plan 6, 20502, Malmö, Sweden
| | | | - Fredrik Resman
- Infectious Diseases Research Unit, Department of Clinical Sciences, Malmö, Lund University, Rut Lundskogs gata 3, plan 6, 20502, Malmö, Sweden.
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Necessary Infrastructure of Infection Prevention and Healthcare Epidemiology Programs: A Review. Infect Control Hosp Epidemiol 2016; 37:371-80. [PMID: 26832072 DOI: 10.1017/ice.2015.333] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The scope of a healthcare institution's infection prevention and control/healthcare epidemiology program (IPC/HE) should be driven by the size and complexity of the patient population served, that population's risk for healthcare-associated infection (HAI), and local, state, and national regulatory and accreditation requirements. Essential activities of all IPC/HE programs include but are not limited to the following: ∙ Surveillance.∙ Performance improvement to reduce HAI ∙ Acute event response, including outbreak investigation ∙ Education and training of both healthcare personnel and patients ∙ Reporting of HAI to the Centers for Disease Control and Prevention's National Healthcare Safety Network as well as entities required by law.
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Day SR, Smith D, Harris K, Cox HL, Mathers AJ. An Infectious Diseases Physician-Led Antimicrobial Stewardship Program at a Small Community Hospital Associated With Improved Susceptibility Patterns and Cost-Savings After the First Year. Open Forum Infect Dis 2015; 2:ofv064. [PMID: 26110166 PMCID: PMC4473105 DOI: 10.1093/ofid/ofv064] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Accepted: 04/30/2015] [Indexed: 01/04/2023] Open
Abstract
The importance of antimicrobial stewardship is increasingly recognized, yet data from community hospitals are limited. Despite an initially low acceptance rate, an Infectious Diseases physician-led program at a 70-bed rural hospital was associated with a 42% decrease in anti-infective expenditures and susceptibility improvement in Pseudomonas aeruginosa over 3 years.
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Affiliation(s)
- Shandra R Day
- Division of Infectious Diseases and International Health, Department of Medicine ; Departments of Pharmacy
| | | | - Karen Harris
- Quality and Patient Safety , Culpeper Regional Hospital , Virginia
| | - Heather L Cox
- Division of Infectious Diseases and International Health, Department of Medicine
| | - Amy J Mathers
- Division of Infectious Diseases and International Health, Department of Medicine ; Clinical Microbiology, Department of Pathology , University of Virginia Health System , Charlottesville ; Departments of Pharmacy
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36
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The role of hematologists in a changing United States health care system. Blood 2015; 125:2467-70. [PMID: 25746327 DOI: 10.1182/blood-2014-12-615047] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/12/2015] [Indexed: 01/08/2023] Open
Abstract
Major and ongoing changes in health care financing and delivery in the United States have altered opportunities and incentives for new physicians to specialize in nonmalignant hematology. At the same time, effective clinical tools and strategies continue to rapidly emerge. Consequently, there is an imperative to foster workforce innovation to ensure sustainable professional roles for hematologists, reliable patient access to optimal hematology expertise, and optimal patient outcomes. The American Society of Hematology is building a collection of case studies to guide the creation of institutionally supported systems-based clinical hematologist positions that predominantly focus on nonmalignant hematology. These roles offer a mix of guidance regarding patient management and the appropriate use and stewardship of clinical resources, as well as development of new testing procedures and protocols.
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Valerio M, Vena A, Bouza E, Reiter N, Viale P, Hochreiter M, Giannella M, Muñoz P. How much European prescribing physicians know about invasive fungal infections management? BMC Infect Dis 2015; 15:80. [PMID: 25888028 PMCID: PMC4344747 DOI: 10.1186/s12879-015-0809-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/06/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The use of systemic antifungal agents has increased in most tertiary care centers. However, antifungal stewardship has deserved very little attention. Our objective was to assess the knowledge of European prescribing physicians as a first step of an international program of antifungal stewardship. METHODS Staff physicians and residents of 4 European countries were invited to complete a 20-point questionnaire that was based on current guidelines of invasive candidiasis and invasive aspergillosis. RESULTS 121 physicians (44.6% staff, 55.4% residents) from Spain 53.7%, Italy 17.4%, Denmark 16.5% and Germany 12.4% completed the survey. Hospital departments involved were: medical 51.2%, ICUs 43%, surgical 3.3% and pharmaceutical 2.5%. The mean score of adequate responses (± SD) was 5.8 ± 1.7 points, with statistically significant differences between study site and type of physicians. Regarding candidiasis, 69% of the physicians clearly distinguished colonization from infection and the local rate of fluconazole resistance was known by 24%. The accepted indications of antifungal prophylaxis were known by 38%. Regarding aspergillosis, 52% of responders could differentiate colonization from infection and 42% knew the diagnostic value of galactomannan. Radiological features of invasive aspergillosis were well recognized by 58% of physicians and 57% of them were aware of the antifungal considered as first line treatment. However, only 37% knew the recommended length of therapy. CONCLUSIONS This simple, easily completed questionnaire enabled us to identify some weakness in the knowledge of invasive fungal infection management among European physicians. This survey could serve as a guide to design a future tailored European training program.
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Affiliation(s)
- Maricela Valerio
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Antonio Vena
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Emilio Bouza
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
| | - Nanna Reiter
- Intensive Care Unit, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
| | - Pierluigi Viale
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Marcel Hochreiter
- Department of Anesthesiology and Intensive Care Medicine, University Hospital of Heidelberg, Heidelberg, Germany.
| | - Maddalena Giannella
- Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Patricia Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain. .,Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. .,Department of Medicine, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
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Chandrasekar P, Havlichek D, Johnson LB. Infectious diseases subspecialty: declining demand challenges and opportunities. Clin Infect Dis 2014; 59:1593-8. [PMID: 25148890 PMCID: PMC7108050 DOI: 10.1093/cid/ciu656] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent match results from the National Resident Matching Program for the subspecialty of infectious diseases show an ongoing decline in the number of fellowship positions filled, and, more important, in the number of applicants, particularly from the pool of international medical graduates. The main reasons for this declining application rate are unclear; in the absence of hard data, we present our viewpoint on this issue. Difficulties in securing visas for permanent residency in the United States, perception of a limited job market, and the explosive growth in the number of hospitalist positions may be important contributing factors. Infectious Diseases Society of America members need to focus on medical students and medical residents in their formative years. We present potential solutions to this problem of declining interest in the field of infectious diseases.
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Affiliation(s)
| | - Daniel Havlichek
- Division of Infectious Diseases, Michigan State University School of Human Medicine, Lansing
| | - Leonard B Johnson
- Division of Infectious Diseases, St John Hospital and Medical Center, Detroit, Michigan
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Denes E, Pinet P, Cypierre A, Durox H, Ducroix-Roubertou S, Genet C, Weinbreck P. Spectrum of advice and curbside consultations of infectious diseases specialists. Med Mal Infect 2014; 44:374-9. [PMID: 25149269 DOI: 10.1016/j.medmal.2014.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 05/30/2014] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Curbside consultation (CC) of infectious diseases specialists for advice is very frequent but the corresponding workload has rarely been assessed. This activity is mostly oral (phone or direct contact) and poorly quantifiable because it is not charged. We had for aim to evaluate this activity in a French teaching hospital. METHODS We recorded all CCs given during a 2.5-year period, from mid-2011 to the end of 2013. RESULTS During the study period, 6789 CCs were recorded (2715 per year), or slightly more than 10 per day. These CCs were divided in 676 travel recommendations and 6113 for other reasons. They were mostly given by phone (77.4%). Most demands came from our hospital (61.4%), followed by community family physicians and specialist (27.1%), other local hospitals (6.5%) and clinics (4.3%). All the departments in our hospital consulted us for advice at least once and answers were mainly given by phone (70.1%) and at bedside (30.5%). The answers were principally advice (50.8%), modification of antibiotic prescription (22.9%), initiation of antibiotic course (14.8%), maintaining the same treatment (6.2%), and stopping antibiotics (4.3%). CCs accounted for 20% of clinical work for 1 physician. If the CCs in our hospital had been paid, our department would have received an additional 77,000€ in revenue. CONCLUSION This curbside activity is very important and time-consuming for infectious diseases specialists, but it is currently not acknowledged or rewarded.
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Affiliation(s)
- E Denes
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France.
| | - P Pinet
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - A Cypierre
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - H Durox
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - S Ducroix-Roubertou
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - C Genet
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
| | - P Weinbreck
- Service de maladies infectieuses et tropicales, CHU Dupuytren, 2, avenue Martin-Luther-King, 87000 Limoges, France
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Pulcini C, Botelho-Nevers E, Dyar OJ, Harbarth S. The impact of infectious disease specialists on antibiotic prescribing in hospitals. Clin Microbiol Infect 2014; 20:963-72. [PMID: 25039787 DOI: 10.1111/1469-0691.12751] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Given the current bacterial resistance crisis, antimicrobial stewardship programmes are of the utmost importance. We present a narrative review of the impact of infectious disease specialists (IDSs) on the quality and quantity of antibiotic use in acute-care hospitals, and discuss the main factors that could limit the efficacy of IDS recommendations. A total of 31 studies were included in this review, with a wide range of infections, hospital settings, and types of antibiotic prescription. Seven of 31 studies were randomized controlled trials, before/after controlled studies, or before/after uncontrolled studies with interrupted time-series analysis. In almost all studies, IDS intervention was associated with a significant improvement in the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input, and with decreased antibiotic consumption. Variability in the antibiotic prescribing practices of IDSs, informal (curbside) consultations and the involvement of junior IDSs are among the factors that could have an impact on the efficacy of IDS recommendations and on compliance rates, and deserve further investigation. We also discuss possible drawbacks of IDSs in acute-care hospitals that are rarely reported in the published literature. Overall, IDSs are valuable to antimicrobial stewardship programmes in hospitals, but their impact depends on many human and organizational factors.
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Affiliation(s)
- C Pulcini
- Service de Maladies Infectieuses, CHU de Nancy, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France
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Abstract
PURPOSE OF REVIEW Traditional utilization of infectious diseases consultants by oncologists ranges from inpatient management of a variety of acute infectious syndromes to management of ambulatory patients with acute or chronic infections; however, there is a paucity of data to evaluate in which circumstances the impact of infectious diseases input may be most valuable. RECENT FINDINGS Data derived from the general population of patients emphasize the value of infectious diseases consultation in specific infections, such as Staphylococcus aureus bacteremia, candidemia, and hepatitis C virus infection. In addition, infectious diseases involvement has been associated with greater adherence to guidelines (up to 34% increase), more appropriate antibiotic utilization (up to 52% increase in appropriate duration), decreased cost and complications of care, and lower mortality (up to 17% decrease). Recent studies suggest that bedside, formal infectious diseases consultation is more optimal than informal interactions (e.g., e-mail, telephone, other). Furthermore, infectious diseases consultants play central roles in antibiotic stewardship, infection control, and quality improvement, particularly in oncology centers. SUMMARY Infectious diseases consultants contribute value in various inpatient and outpatient infections, decreasing mortality, cost, and complications.
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Schmitt S, McQuillen DP, Nahass R, Martinelli L, Rubin M, Schwebke K, Petrak R, Ritter JT, Chansolme D, Slama T, Drozd EM, Braithwaite SF, Johnsrud M, Hammelman E. Infectious diseases specialty intervention is associated with decreased mortality and lower healthcare costs. Clin Infect Dis 2013; 58:22-8. [PMID: 24072931 DOI: 10.1093/cid/cit610] [Citation(s) in RCA: 146] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies, largely based on chart reviews with small sample sizes, have demonstrated that infectious diseases (ID) specialists positively impact patient outcomes. We investigated how ID specialists impact mortality, utilization, and costs using a large claims dataset. METHODS We used administrative fee-for-service Medicare claims to identify beneficiaries hospitalized from 2008 to 2009 with at least 1 of 11 infections. There were 101 991 stays with and 170 336 stays without ID interventions. Cohorts were propensity score matched for patient demographics, comorbidities, and hospital characteristics. Regression models compared ID versus non-ID intervention and early versus late ID intervention. Risk-adjusted outcomes included hospital and intensive care unit (ICU) length of stay (LOS), mortality, readmissions, hospital charges, and Medicare payments. RESULTS The ID intervention cohort demonstrated significantly lower mortality (odds ratio [OR], 0.87; 95% confidence interval [CI], .83 to .91) and readmissions (OR, 0.96; 95% CI, .93 to .99) than the non-ID intervention cohort. Medicare charges and payments were not significantly different; the ID intervention cohort ICU LOS was 3.7% shorter (95% CI, -5.5% to -1.9%). Patients receiving ID intervention within 2 days of admission had significantly lower 30-day mortality and readmission, hospital and ICU length of stay, and Medicare charges and payments compared with patients receiving later ID interventions. CONCLUSIONS ID interventions are associated with improved patient outcomes. Early ID interventions are also associated with reduced costs for Medicare beneficiaries with select infections.
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Affiliation(s)
- Steven Schmitt
- Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Ohio
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Al-Tawfiq JA. The pattern and impact of infectious diseases consultation on antimicrobial prescription. J Glob Infect Dis 2013; 5:45-8. [PMID: 23853430 PMCID: PMC3703209 DOI: 10.4103/0974-777x.112266] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Inclusion of infectious disease (ID) physicians in the care of patients with possible infection can favorably affect antibiotic usage. The aim of this study was to evaluate the role of the ID consultations in reducing inappropriate antibiotic usage. Materials and Methods: This is a prospective study evaluating all adult ID consultations from January 2006 to December 2009. A total of 1444 consultation requests were recorded during the 4-year period. Results: The most frequent consultations were from cardiology (23.1%), orthopedics (8.2%), general medicine (7.8%), hematology-oncology (7.8%), gastroenterology (7.3%), and pulmonary/critical care (7.1%). The main reason for consultation was for the choice of antibiotics (75%). The commonest diagnoses prior to consultation were fever (14.7%), bacteremia (9.1%), and urinary tract infection (8.4%). Bacteremia was documented in 21.4% of cases and 12.9% were found to have no identifiable focus of infection. Antimicrobial therapy was changed in 58.7% and antimicrobials were discontinued in 14.7% of cases. The number of antimicrobial therapy was one (49.7% and 49.9%) and two (24% and 17.6%, P = 0.0001) before and after the consultation, respectively. In addition, 17.3% and 26.9% (P = 0.0001) received no antimicrobial agents before and after ID consultation. Conclusion: ID consultation is important to reduce inappropriate antimicrobial therapy and to limit the number of dual therapy.
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Affiliation(s)
- Jaffar A Al-Tawfiq
- Medical Department, Specialty Internal Medicine Unit, Dhahran Health Center, Saudi Aramco Medical Services Organization, Saudi Aramco, Dhahran, Saudi Arabia
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Shih CP, Lin YC, Chan YY, Hsu KH. Employing infectious disease physicians affects clinical and economic outcomes in regional hospitals: evidence from a population-based study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2013; 47:297-303. [PMID: 23523046 DOI: 10.1016/j.jmii.2013.01.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 12/19/2012] [Accepted: 01/25/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND/PURPOSE Infectious disease physicians (IDPs) play a major role in patient care, infectious disease control, and antibiotic use in hospitals. The aim of this research is to explore the effects of employment of IDPs on patients' prognosis and the related medical and antibiotic expenses in hospitals. METHODS This population-based study provides evidence-based information on IDPs' contribution to patients' prognosis and antibiotic expenditure containment with inpatient claim data from the Taiwan Bureau of National Health Insurance in 2004. We further classified regional hospitals into those with and without IDPs and analyzed patient prognosis, length of stay, total medical expenses, and antibiotic expenses to test the effects of IDPs. RESULTS The likelihood of developing a poor prognosis among patients was found to be higher in non-IDP hospitals, with an odds ratio of 1.14 and a 95% confidence interval of 1.05-1.23 (p = 0.002). Medical expenses, excluding those of nonrestricted drugs, were found to be higher in the non-IDP group than in the IDP group. The total medical expenses were also found to be 10% higher in the non-IDP group than in the IDP group (p < 0.001). CONCLUSION Employment of IDPs was likely to improve patient prognosis and reduce overall medical expenses. It is suggested that healthcare administrators consider the employment of or investment in IDPs as a cost-effective strategy for improving patient quality of care.
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Affiliation(s)
- Chia-Pang Shih
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chun Lin
- Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuk-Ying Chan
- Department of Pharmacy, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.
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Trivedi KK, Rosenberg J. The state of antimicrobial stewardship programs in California. Infect Control Hosp Epidemiol 2013; 34:379-84. [PMID: 23466911 DOI: 10.1086/669876] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess antimicrobial stewardship programs (ASPs) and strategies in California general acute care hospitals and to describe the effect of state legislation (Senate Bill 739) requiring hospitals to develop processes for evaluating the judicious use of antimicrobials. DESIGN Web-based survey of general acute care hospitals. PARTICIPANTS All 422 general acute care hospital campuses in California were invited to participate. RESULTS Responses from 223 (53%) of California's general acute care hospital campuses were included and were statistically representative of all acute care hospital campuses by region but not bed size or rurality. Community hospitals represented 73% of respondents. Fifty percent of hospitals described a current ASP and 30% reported planning an ASP; of these, 51% reported measuring outcomes. Twenty percent of hospitals reported no planned ASP or uncertainty whether an ASP existed and described barriers including staffing constraints (47%), lack of funding (42%), and lack of initiation of a formal proposal to start an ASP (42%). Of 135 responding hospitals, 22% reported that Senate Bill 739 influenced initiation of their ASP. CONCLUSIONS Although many studies have been published that describe hospital-specific ASPs, most have been described within academic centers, and there are limited assessments of ASP strategies across hospital systems. Our study verifies that many ASPs exist in California, particularly in community settings where a scarcity of antimicrobial restriction was thought to exist. Additionally, Senate Bill 739 appears to have played a role in initiating many hospital ASPs, which supports the adoption of similar legislation in other states and nationally.
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Affiliation(s)
- Kavita K Trivedi
- Healthcare-Associated Infections Program, California Department of Public Health, Richmond, CA 94804, USA.
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Nowak MA, Nelson RE, Breidenbach JL, Thompson PA, Carson PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2013; 69:1500-8. [PMID: 22899745 DOI: 10.2146/ajhp110603] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
PURPOSE A pre-post analysis of an antimicrobial stewardship program (ASP) involving the use of data-mining software to prospectively identify cases for ASP intervention was conducted. METHODS The investigators evaluated clinical outcomes and cost metrics before and after implementation of the ASP, which entailed daily physician review of summary reports on all adult inpatients receiving antimicrobial therapy. The primary outcome measures were annual antimicrobial expenditures and rates of infections due to common nosocomial pathogens; secondary outcome measures included patient survival and length of stay (LOS) in cases involving the indicator diagnoses of pneumonia and abdominal sepsis. RESULTS Antimicrobial expenditures, which had increased by an average of 14.4% annually in the years preceding ASP implementation, decreased by 9.75% in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7 million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci all decreased after ASP implementation. A pre-post comparison of survival and LOS in patients with pneumonia (n = 2186) or abdominal sepsis (n = 225) showed no significant differences in those outcomes in either patient group, possibly due to the hospital's initiation of other, concurrent infection-control programs during the study period. CONCLUSION A prospective collaborative ASP employed automated reports to efficiently identify key data for ASP review. After ASP implementation, antimicrobial expenditures and rates of nosocomial infections caused by resistant pathogens dropped without significant changes in patient survival, LOS, and readmissions for the two studied illness categories.
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Affiliation(s)
- Michael A Nowak
- College of Pharmacy, California Northstate University, Rancho Cordova, 95670, USA.
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Fariñas MC, Saravia G, Calvo-Montes J, Benito N, Martínez-Garde JJ, Fariñas-Alvarez C, Aguilar L, Agüero R, Amado JA, Martínez-Martínez L, Gómez-Fleitas M. Adherence to recommendations by infectious disease consultants and its influence on outcomes of intravenous antibiotic-treated hospitalized patients. BMC Infect Dis 2012; 12:292. [PMID: 23140210 PMCID: PMC3514236 DOI: 10.1186/1471-2334-12-292] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 11/07/2012] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Consultation to infectious diseases specialists (ID), although not always performed by treating physicians, is part of hospital's daily practice. This study analyses adherence by treating physicians to written ID recommendations (inserted in clinical records) and its effect on outcome in hospitalized antibiotic-treated patients in a tertiary hospital in Spain. METHODS A prospective, randomized, one-year study was performed. Patients receiving intravenous antimicrobial therapy prescribed by treating physicians for 3 days were identified and randomised to intervention (insertion of written ID recommendations in clinical records) or non-intervention. Appropriateness of empirical treatments (by treating physicians) was classified as adequate, inadequate or unnecessary. In the intervention group, adherence to recommendations was classified as complete, partial or non-adherence. RESULTS A total of 1173 patients were included, 602 in the non-intervention and 571 in the intervention group [199 (34.9%) showing complete adherence, 141 (24.7%) partial adherence and 231 (40.5%) non-adherence to recommendations]. In the multivariate analysis for adherence (R2 Cox=0.065, p=0.009), non-adherence was associated with prolonged antibiotic prophylaxis (p=0.004; OR=0.37, 95%CI=0.19-0.72). In the multivariate analysis for clinical failure (R2 Cox=0.126, p<0.001), Charlson index (p<0.001; OR=1.19, 95%CI=1.10-1.28), malnutrition (p=0.006; OR=2.00, 95%CI=1.22-3.26), nosocomial infection (p<0.001; OR=4.12, 95%CI=2.27-7.48) and length of hospitalization (p<0.001; OR=1.01, 95%CI=1.01-1.02) were positively associated with failure, while complete adherence (p=0.001; OR=0.35, 95%CI=0.19-0.64) and adequate initial treatment (p=0.010; OR=0.39, 95%CI=0.19-0.80) were negatively associated. CONCLUSIONS Adherence to ID recommendations by treating physicians was associated with favorable outcome, in turn associated with shortened length of hospitalization. This may have important health-economic benefits and stimulates further investigation. TRIAL REGISTRATION Current Controlled Trials ISRCTN83234896. http://www.controlled-trials.com/isrctn/sample_documentation.asp.
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Affiliation(s)
- María-Carmen Fariñas
- Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain
| | - Gabriela Saravia
- Infectious Diseases Unit, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008 Santander, Spain
| | - Jorge Calvo-Montes
- Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Natividad Benito
- Infectious Diseases Unit, Hospital Sant Pau, Sant Antoni Maria Claret, 167, 08025, Barcelona, Spain
| | - Juan-José Martínez-Garde
- Pharmacy Department, Hospital Universitario Marques de Valdecilla, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Concepción Fariñas-Alvarez
- Preventive Medicine Department, Hospital Sierrallana, Bª Ganzo s/n, 39300, Torrelavega, Cantabria, Spain
| | - Lorenzo Aguilar
- Microbiology Department, School of Medicine Universidad Complutense, Avda. Complutense s/n, 28040, Madrid, Spain
| | - Ramón Agüero
- Pneumology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - José-Antonio Amado
- Endocrinology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
| | - Luis Martínez-Martínez
- Microbiology Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
- Department of Molecular Biology, University of Cantabria, Avda. Cardenal Herrera Oria s/n, 39011, Santander, Spain
| | - Manuel Gómez-Fleitas
- General Surgery Department, Hospital Universitario Marques de Valdecilla, School of Medicine, University of Cantabria, Av. Valdecilla s/n, 39008, Santander, Spain
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Shrestha NK, Bhaskaran A, Scalera NM, Schmitt SK, Rehm SJ, Gordon SM. Contribution of infectious disease consultation toward the care of inpatients being considered for community-based parenteral anti-infective therapy. J Hosp Med 2012; 7:365-9. [PMID: 22315151 DOI: 10.1002/jhm.1902] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 10/31/2011] [Accepted: 11/15/2011] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the acute care setting in a multidisciplinary healthcare environment, the contribution of infectious disease (ID) specialists to overall patient care is difficult to measure. This study attempts to quantify the contribution of ID specialists when consulted for an activity specific to ID practice, community-based parenteral anti-infective therapy (CoPAT). METHODS In February 2010, an electronic form for requesting ID consultations was introduced in the computerized provider order entry (CPOE) system at the Cleveland Clinic. This allowed for easy identification of ID consultations for CoPAT. Hospital records for all patients with CoPAT consultation requests between February 11, 2010 and May 15, 2010 were reviewed for specific defined contributions in the domains of optimization of antimicrobial therapy, significant change in patient assessment, and additional medical care contribution. RESULTS Over a 3-month period, there were 263 CoPAT consultation requests via CPOE, of which 172 were initial consultations and 91 reconsultations. Antimicrobial treatment was optimized in 84%, a significant change in patient assessment made in 52%, and additional medical care contribution provided in 71% of consultations. In 33% of consultations, there was contribution in all 3 domains. CoPAT was deemed not to be necessary in 27%. For patients requiring CoPAT, effective care transition from the inpatient to outpatient setting was assured at least 86% of the time. CONCLUSION Infectious disease consultation before discharge on parenteral antibiotics adds value by contributing substantially to inpatient care, and providing antimicrobial stewardship and continuity of care at a critical patient care transition point.
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Affiliation(s)
- Nabin K Shrestha
- Department of Infectious Diseases, Medicine Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
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Snydman DR. Empiric antibiotic selection strategies for healthcare-associated pneumonia, intra-abdominal infections, and catheter-associated bacteremia. J Hosp Med 2012; 7 Suppl 1:S2-S12. [PMID: 23677631 DOI: 10.1002/jhm.980] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Revised: 08/22/2011] [Accepted: 08/28/2011] [Indexed: 11/10/2022]
Abstract
Initial selection and early deployment of appropriate/adequate empiric antimicrobial therapy is critical to minimize the significant morbidity and mortality associated with hospital- or healthcare-associated infections (HAIs). Initial empiric therapy that inadequately covers the pathogen(s) causing a serious HAI has been associated with increased mortality, longer hospital stay, and elevated healthcare costs. Moreover, subsequent modification of initial inadequate therapy, later in the disease process when culture results become available, may not remedy the impact of the initial choice. Because of this, it is important that initial empiric therapy covers the most likely pathogens associated with infection in a particular patient, even if this initial regimen turns out to be unnecessarily broad, based on subsequent culture results. The current paradigm for management of serious HAIs is to initiate empiric therapy with a broad-spectrum regimen covering likely pathogens, based on local surveillance and susceptibility data, and presence of risk factors for involvement of a resistant microorganism. Subsequent modification (de-escalation) of the initial regimen becomes possible later, when culture results are available and clinical status can be better assessed, 2 to 4 days after initiation of empiric therapy. When possible, de-escalation and other steps to modify antimicrobial exposure are important for minimizing risk of antimicrobial resistance development. This article examines the general process for selection of initial empiric antibiotic therapy for patients with HAIs, illustrated through 3 case studies dealing with healthcare-associated pneumonia, complicated intra-abdominal infection, and catheter-associated bacteremia, respectively.
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Affiliation(s)
- David R Snydman
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Tufts University School of Medicine, 800 Washington St,Boston, MA 02111, USA.
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Niwa T, Shinoda Y, Suzuki A, Ohmori T, Ohta H, Fukao A, Yasuda M, Kitaichi K, Matsuura K, Sugiyama T, Murakami N, Itoh Y. Outcome Measurement of the Review System forAppropriate Use of Antimicrobial Injections in All Inpatients Established by the Infection Control Team. ACTA ACUST UNITED AC 2012. [DOI: 10.5649/jjphcs.38.273] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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