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Heil EL, Justo JA, Bork JT. Improving the Efficiency of Antimicrobial Stewardship Action in Acute Care Facilities. Open Forum Infect Dis 2023; 10:ofad412. [PMID: 37674632 PMCID: PMC10478156 DOI: 10.1093/ofid/ofad412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 07/28/2023] [Indexed: 09/08/2023] Open
Abstract
Inpatient antimicrobial stewardship (AS) programs are quality improvement programs tasked with improving antibiotic practices by augmenting frontline providers' antibiotic prescription. Prospective audit and feedback (PAF) and preauthorization (PRA) are essential activities in the hospital that can be resource intensive for AS teams. Improving efficiency in AS activities is needed when there are limited resources or when programs are looking to expand tasks beyond PAF and PRA, such as broad education or guideline development. Guidance on the creation and maintenance of alerts for the purpose of PAF reviews, modifications of antibiotic restrictions for PRA polices, and overall initiative prioritization strategies are reviewed. In addition, daily prioritization tools, such as the tiered approach, scoring systems, and regression modeling, are available for stewards to prioritize their daily workflow. Using these tools and guidance, AS programs can be productive and impactful in the face of resource limitation or competing priorities in the hospital.
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Affiliation(s)
- Emily L Heil
- Department of Practice, Sciences and Health Outcomes Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA
| | - Julie Ann Justo
- Department of Clinical Pharmacy and Outcomes Sciences, College of Pharmacy, University of South Carolina, Columbia, South Carolina, USA
- Department of Pharmacy, Prisma Health Richland Hospital, Columbia, South Carolina, USA
| | - Jacqueline T Bork
- Division of Infectious Diseases, Institute of Human Virology, Department of Medicine, School of Medicine, University of Maryland, Baltimore, Maryland, USA
- Veterans Affairs (VA) Maryland Health Care System, Baltimore, Maryland, USA
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Economos ET, Goedken CC, Sherlock SH, Suda KJ, Goetz M, Balkenende E, Chasco EE, Scherer AM, Goto M, Perencevich EN, Schacht Reisinger H, Livorsi DJ. Investigation of factors influencing inpatient antibiotic prescribing decisions in the Veterans' Health Administration. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2022; 2:e99. [PMID: 36483404 PMCID: PMC9726494 DOI: 10.1017/ash.2022.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 06/17/2023]
Abstract
To investigate factors that influence antibiotic prescribing decisions, we interviewed 49 antibiotic stewardship champions and stakeholders across 15 hospitals. We conducted thematic analysis and subcoding of decisional factors. We identified 31 factors that influence antibiotic prescribing decisions. These factors may help stewardship programs identify educational targets and design more effective interventions.
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Affiliation(s)
| | - Cassie Cunningham Goedken
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Stacey Hockett Sherlock
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Katie J. Suda
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Matthew Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, California
- David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California
| | - Erin Balkenende
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Emily E. Chasco
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Aaron M. Scherer
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Michihiko Goto
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Eli N. Perencevich
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
| | - Heather Schacht Reisinger
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
- Institute for Clinical and Translational Science, University of Iowa, Iowa City, Iowa
| | - Daniel J. Livorsi
- Uiversity of Iowa Carver College of Medicine, Iowa City, Iowa
- Center for Access & Delivery Research & Evaluation (CADRE), Iowa City Veterans’ Affairs (VA) Health Care System, Iowa City, Iowa
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Bose D, Chatterjee S, Older E, Seth R, Janulewicz P, Saha P, Mondal A, Carlson JM, Decho AW, Sullivan K, Klimas N, Lasley S, Li J, Chatterjee S. Host gut resistome in Gulf War chronic multisymptom illness correlates with persistent inflammation. Commun Biol 2022; 5:552. [PMID: 35672382 PMCID: PMC9174162 DOI: 10.1038/s42003-022-03494-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 05/17/2022] [Indexed: 11/29/2022] Open
Abstract
Chronic multisymptom illness (CMI) affects a subsection of elderly and war Veterans and is associated with systemic inflammation. Here, using a mouse model of CMI and a group of Gulf War (GW) Veterans' with CMI we show the presence of an altered host resistome. Results show that antibiotic resistance genes (ARGs) are significantly altered in the CMI group in both mice and GW Veterans when compared to control. Fecal samples from GW Veterans with persistent CMI show a significant increase of resistance to a wide class of antibiotics and exhibited an array of mobile genetic elements (MGEs) distinct from normal healthy controls. The altered resistome and gene signature is correlated with mouse serum IL-6 levels. Altered resistome in mice also is correlated strongly with intestinal inflammation, decreased synaptic plasticity, reversible with fecal microbiota transplant (FMT). The results reported might help in understanding the risks to treating hospital acquired infections in this population.
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Affiliation(s)
- Dipro Bose
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Somdatta Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ethan Older
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, USA
| | - Ratanesh Seth
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Patricia Janulewicz
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Punnag Saha
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Ayan Mondal
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Jeffrey M Carlson
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Alan W Decho
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Kimberly Sullivan
- Department of Environmental Health, Boston University School of Public Health, Boston, MA, USA
| | - Nancy Klimas
- Department of Clinical Immunology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Stephen Lasley
- Department of Cancer Biology and Pharmacology, University of Illinois College of Medicine, Peoria, IL, USA
| | - Jie Li
- Department of Chemistry and Biochemistry, University of South Carolina, Columbia, SC, USA
| | - Saurabh Chatterjee
- Environmental Health and Disease Laboratory, Department of Environmental Health Sciences, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
- Columbia VA Medical Center, Columbia, SC, USA.
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