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Kourbeti I, Kamiliou A, Samarkos M. Antibiotic Stewardship in Surgical Departments. Antibiotics (Basel) 2024; 13:329. [PMID: 38667005 PMCID: PMC11047567 DOI: 10.3390/antibiotics13040329] [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: 01/21/2024] [Revised: 03/31/2024] [Accepted: 03/31/2024] [Indexed: 04/29/2024] Open
Abstract
Antimicrobial resistance (AMR) has emerged as one of the leading public health threats of the 21st century. New evidence underscores its significance in patients' morbidity and mortality, length of stay, as well as healthcare costs. Globally, the factors that contribute to antimicrobial resistance include social and economic determinants, healthcare governance, and environmental interactions with impact on humans, plants, and animals. Antimicrobial stewardship (AS) programs have historically overlooked surgical teams as they considered them more difficult to engage. This review aims to summarize the evolution and significance of AS in surgical wards, including the surgical intensive care unit (SICU) and the role of diagnostic stewardship (DS). The contribution of AS team members is presented. The new diagnostic modalities and the new technologies including artificial intelligence (AI) are also reviewed.
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Affiliation(s)
- Irene Kourbeti
- Department of Internal Medicine, School of Medicine, National and Kapodistrian, University of Athens, 11527 Athens, Greece; (A.K.); (M.S.)
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2
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Khalfan MA, Sasi P, Mugusi S. Factors influencing receipt of an antibiotic prescription among insured patients in Tanzania: a cross-sectional study. BMJ Open 2022; 12:e062147. [PMID: 36332955 PMCID: PMC9639089 DOI: 10.1136/bmjopen-2022-062147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES There are limited data on factors influencing antibiotic prescription among insured patients. We assessed for correlates of an antibiotic prescription among insured patients. DESIGN A cross-sectional study. SETTING The study was conducted at the National Health Insurance Fund offices, Dar es Salaam, Tanzania. DATA SOURCE We captured data from the claim forms, containing inpatient and outpatient treatment information for insured patients, for the month of September 2019. OUTCOME VARIABLE Receipt of an antibiotic prescription. EXPOSURE VARIABLES Age, sex, diagnosis, prescriber qualification, health facility level, ownership and department were exposure variables. Predictors of receipt of an antibiotic prescription were determined by Poisson regression analysis. RESULTS Of 993 analysed patients, the mean (±SD) age was 36.3 (±23.2) years, 581 (58.5%) were females and 535 (53.9%) were adults. The prevalence of antibiotic prescription was 46.4% (95% CI 42.8% to 50.0%). Strong predictors of an antibiotic prescription were being a child (1.7, 95% CI 1.3 to 2.2); acute upper respiratory tract infection (URTI) of multiple and unspecified sites (1.6, 95% CI 1.3 to 1.4); chronic rhinitis, nasopharyngitis and pharyngitis (4.0, 95% CI 2.4 to 6.4); being attended by a clinical officer (1.9, 95% CI 1.2 to 3.0); attending a health centre (1.5, 95% CI 1.1 to 2.0); attending a public facility (1.2, 95% CI 1.0 to 1.4) and visiting an inpatient department (2.0, 95% CI 1.2 to 3.4). CONCLUSIONS Among insured patients, being a child, acute URTI, being attended by a clinical officer or dental therapist, being attended by an assistant medical/dental officer, attending a health centre or a district hospital, attending a public health facility and visiting an inpatient department predicted an antibiotic prescription. Incorporation of these findings in revisions or establishment of targeted antimicrobial stewardship programmes may lead to better antibiotic prescribing practices that are critical for combating antibiotic resistance.
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Affiliation(s)
- Mohamed Ally Khalfan
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Philip Sasi
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
| | - Sabina Mugusi
- Department of Clinical Pharmacology, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania, United Republic of
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Lim SYC, Zhou YP, Yii D, Chin DZ, Hung KC, Lee LW, Lim JL, Loo LW, Koomanan N, Chua NG, Liew Y, Cherng BPZ, Thien SY, Lee WHL, Kwa ALH, Chung SJ. Stemming the Rise of Antibiotic Use for Community-Acquired Acute Respiratory Infections during COVID-19 Pandemic. Antibiotics (Basel) 2022; 11:antibiotics11070846. [PMID: 35884100 PMCID: PMC9312342 DOI: 10.3390/antibiotics11070846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 01/08/2023] Open
Abstract
At the start of the COVID-19 pandemic, there was an increase in the use of antibiotics for the treatment of community-acquired respiratory tract infection (CA-ARI) in patients admitted for suspected or confirmed COVID-19, raising concerns for misuse. These antibiotics are not under the usual purview of the antimicrobial stewardship unit (ASU). Serum procalcitonin, a biomarker to distinguish viral from bacterial infections, can be used to guide antibiotic recommendations in suspected lower respiratory tract infection. We modified our stewardship approach, and used a procalcitonin-guided strategy to identify “high yield” interventions for audits in patients admitted with CA-ARI. With this approach, there was an increase in the proportion of patients with antibiotics discontinued within 4 days (16.5% vs. 34.9%, p < 0.001), and the overall duration of antibiotic therapy was significantly shorter [7 (6−8) vs. 6 (3−8) days, p < 0.001]. There was a significant decrease in patients with intravenous-to-oral switch of antibiotics to “complete the course” (45.3% vs. 34.4%, p < 0.05). Of the patients who had antibiotics discontinued, none were restarted on antibiotics within 48 h, and there was no-30-day readmission or 30-day mortality attributed to respiratory infection. This study illustrates the importance of the antimicrobial stewardship during the pandemic and the need for ASU to remain attuned to prescriber’s practices, and adapt accordingly to address antibiotic misuse to curb antimicrobial resistance.
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Affiliation(s)
- Shena Y. C. Lim
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Yvonne P. Zhou
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Daphne Yii
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - De Zhi Chin
- Department of Clinical Quality and Performance Management, Singapore General Hospital, Singapore 169608, Singapore;
| | - Kai Chee Hung
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Lai Wei Lee
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Jia Le Lim
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Li Wen Loo
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Narendran Koomanan
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Nathalie Grace Chua
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Yixin Liew
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Benjamin P. Z. Cherng
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore; (B.P.Z.C.); (S.Y.T.)
| | - Siew Yee Thien
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore; (B.P.Z.C.); (S.Y.T.)
| | - Winnie H. L. Lee
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Andrea L. H. Kwa
- Department of Pharmacy, Singapore General Hospital, Singapore 169608, Singapore; (S.Y.C.L.); (Y.P.Z.); (D.Y.); (K.C.H.); (L.W.L.); (J.L.L.); (L.W.L.); (N.K.); (N.G.C.); (Y.L.); (W.H.L.L.); (A.L.H.K.)
| | - Shimin J. Chung
- Department of Infectious Diseases, Singapore General Hospital, Singapore 169608, Singapore; (B.P.Z.C.); (S.Y.T.)
- Correspondence:
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Chok L, Kusejko K, Eberhard N, Chaudron SE, Saleschus D, Kocher C, Kouyos RD, Weber R, Kuster SP. Impact of an electronic alert on prescription patterns of meropenem, voriconazole and caspofungin. BMC Infect Dis 2021; 21:1263. [PMID: 34930162 PMCID: PMC8686259 DOI: 10.1186/s12879-021-06980-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/15/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Antimicrobial stewardship programs promote the appropriate use of antimicrobial substances through the implementation of evidence-based, active and passive interventions. We analyzed the effect of a computer-assisted intervention on antimicrobial use in a tertiary care hospital. METHODS Between 2011 and 2016 we introduced an electronic alert for patients being prescribed meropenem, voriconazole and caspofungin. At prescription and at day 3 of treatment, physicians were informed about the risk related to these antimicrobial substances by an electronic alert in the medical records. Physicians were invited to revoke or confirm the prescription and to contact the infectious disease (ID) team. Using interrupted time series regression, the days of therapy (DOTs) and the number of prescriptions before and after the intervention were compared. RESULTS We counted 64,281 DOTs for 5549 prescriptions during 4100 hospital stays. Overall, the DOTs decreased continuously over time. An additional benefit of the alert could not be observed. Similarly, the number of prescriptions decreased over time, without significant effect of the intervention. When considering the three drugs separately, the alert impacted the duration (change in slope of DOTs/1000 bed days; P = 0.0017) as well as the number of prescriptions (change in slope of prescriptions/1000 bed days; P < 0.001) of voriconazole only. CONCLUSIONS The introduction of the alert lowered prescriptions of voriconazole only. Thus, self-stewardship alone seems to have a limited impact on electronic prescriptions of anti-infective substances. Additional measures such as face-to-face prompting with ID physicians or audit and feedback are indispensable to optimize antimicrobial use.
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Affiliation(s)
- Lionel Chok
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland.
| | - Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Nadia Eberhard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Sandra E Chaudron
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Dirk Saleschus
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Claudine Kocher
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Roger D Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Rainer Weber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Rämistrasse 100, Zurich, Switzerland
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5
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Beahm NP, Smyth DJ, Tsuyuki RT. Antimicrobial utilization and stewardship in patients with uncomplicated urinary tract infections managed by pharmacists in the community: A sub-study of the R xOUTMAP trial. JOURNAL OF THE ASSOCIATION OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASE CANADA = JOURNAL OFFICIEL DE L'ASSOCIATION POUR LA MICROBIOLOGIE MEDICALE ET L'INFECTIOLOGIE CANADA 2021; 6:205-212. [PMID: 36337761 PMCID: PMC9615465 DOI: 10.3138/jammi-2020-0047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 06/16/2023]
Abstract
BACKGROUND Urinary tract infections (UTIs) often lead to suboptimal antibacterial use. Pharmacists are accessible primary care professionals who have an important role to play in antimicrobial stewardship. Our objective was to evaluate the appropriateness of pharmacists' antibacterial prescribing for patients with uncomplicated UTI. METHODS We conducted a prospective registry trial with 39 community pharmacies in New Brunswick, Canada. Adult patients were enrolled if they presented to the pharmacy with either symptoms of UTI with no current antibacterial treatment (pharmacist-initial arm) or an antibacterial prescription for UTI from a physician (physician-initial arm). Pharmacists assessed patients; patients with complicating factors or red flags for systemic illness or pyelonephritis were excluded. Pharmacists prescribed antibacterial therapy or modified antibacterial therapy, provided education only, or referred to a physician, as appropriate. Antibacterial therapy prescribed was compared between study arms. RESULTS Seven hundred fifty patients were enrolled (87% pharmacist-initial arm). The most commonly prescribed agents in the pharmacist-initial arm were nitrofurantoin (88.4%), sulfamethoxazole-trimethoprim (TMP-SMX) (7.8%), and fosfomycin (2.1%); in the physician-initial arm, nitrofurantoin (55.3%), TMP-SMX (25.5%), and fluoroquinolones (10.6%) were prescribed. Therapy was guideline concordant for 95.1% of patients in the pharmacist-initial arm and 35.1% of patients in the physician-initial arm (p < 0.001). For guideline-discordant therapy from physicians, pharmacists prescribed to optimize therapy for 45.9% of patients. CONCLUSION Treatment was highly guideline concordant when pharmacist initiated, with physicians prescribing longer treatment durations and more fluoroquinolones. This represents an important opportunity for antimicrobial stewardship interventions by pharmacists in the community.
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Affiliation(s)
- Nathan P Beahm
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel J Smyth
- Division of Infectious Diseases, Department of Internal Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Horizon Health Network, Moncton, New Brunswick, Canada
| | - Ross T Tsuyuki
- Departments of Pharmacology and Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Shafat T, Shimoni O, Nikonov A, Nesher L. The Kinetics of an Antibiotic Stewardship Intervention: A Quasi-Experimental Study. Infect Dis Ther 2021; 10:613-619. [PMID: 33515415 PMCID: PMC7954991 DOI: 10.1007/s40121-021-00403-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/13/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Little is known about the kinetics and different phases of a successful antibiotic stewardship program (ASP) intervention. Methods We analyzed the trends of quarterly antibiotic use measured in defined daily dose (DDD)/100 days hospitalization using the Joinpoint Regression Program and interrupted time series analysis to objectively identify shifts in the trends of antibiotic use. We correlated these changes in trends with the introduction of a hospital-wide ASP intervention. Results The ASP intervention reduced the overall antibiotic use by 33%, from a prior steady state of 76.5 DDD/100 days hospitalization to a post-intervention steady state of 51.2 DDD/100 days hospitalization (p < 0.001). We identified four distinct phases in the trends: prior steady state (A), early intervention (B), accelerated phase (C), and post steady state (D). From A to B a change of slope (−1.46) [SE 0.37, 95% CI −2.23, −0.69 (p = 0.002)]; B to C, a further decrease of slope (−4.70) [SE 0.64, 95% CI −6.03, −3.37 (p = 0.001)]; between periods C and D, straightening out of the slope (+ 6.84) [SE 0.55, 95% CI 5.70, 7.98 (p < 0.001)] to a new post-intervention steady state. It took 1.5 years after completion of the intervention to reach the new steady state. Conclusions We demonstrate that ASP interventions require time to achieve the maximal effect. Successful interventions require physicians to adapt new prescribing behaviors and gain confidence in the change; this adaptation can be a prolonged process and might even take years after the introduction of the ASP. These factors should be considered when planning and implementing ASP interventions.
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Affiliation(s)
- Tali Shafat
- Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.,Clinical Research Center, Soroka University Medical Center, Beer Sheba, Israel
| | - Orly Shimoni
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.,Pharmacy Services, Soroka University Medical Center, Beer Sheba, Israel
| | - Anna Nikonov
- Pharmacy Services, Soroka University Medical Center, Beer Sheba, Israel
| | - Lior Nesher
- Infectious Disease Institute, Soroka University Medical Center, Beer Sheba, Israel. .,Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheba, Israel.
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Simó S, Velasco-Arnaiz E, Ríos-Barnés M, López-Ramos MG, Monsonís M, Urrea-Ayala M, Jordan I, Casadevall-Llandrich R, Ormazábal-Kirchner D, Cuadras-Pallejà D, Tarrado X, Prat J, Sánchez E, Noguera-Julian A, Fortuny C. Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections. Antibiotics (Basel) 2020; 10:antibiotics10010005. [PMID: 33374676 PMCID: PMC7822420 DOI: 10.3390/antibiotics10010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 11/16/2022] Open
Abstract
The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.
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Affiliation(s)
- Sílvia Simó
- Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain; (S.S.); (E.V.-A.); (M.R.-B.); (C.F.)
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
| | - Eneritz Velasco-Arnaiz
- Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain; (S.S.); (E.V.-A.); (M.R.-B.); (C.F.)
| | - María Ríos-Barnés
- Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain; (S.S.); (E.V.-A.); (M.R.-B.); (C.F.)
| | | | - Manuel Monsonís
- Clinical Microbiology Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain;
| | - Mireia Urrea-Ayala
- Patient Safety Area—Infection Control Unit, Sant Joan de Déu Hospital, 08950 Barcelona, Spain;
| | - Iolanda Jordan
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Pediatric Intensive Care Unit, Sant Joan de Déu Hospital, 08950 Barcelona, Spain
- Department of Paediatrics, University of Barcelona, 08007 Barcelona, Spain
| | | | | | | | - Xavier Tarrado
- Paediatric Surgery Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (X.T.); (J.P.)
| | - Jordi Prat
- Paediatric Surgery Department, Sant Joan de Déu Hospital, 08950 Barcelona, Spain; (X.T.); (J.P.)
| | - Emília Sánchez
- Blanquerna School of Health Science, Ramon Llull University, 08022 Barcelona, Spain;
| | - Antoni Noguera-Julian
- Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain; (S.S.); (E.V.-A.); (M.R.-B.); (C.F.)
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Statistics Department, Sant Joan de Déu Research Foundation, 08950 Barcelona, Spain;
- Translational Research Network in Paediatric Infectious Diseases (RITIP), 28009 Madrid, Spain
- Correspondence: ; Tel.: +34-932-804-000 (ext. 80063); Fax: +34-932-033-959
| | - Clàudia Fortuny
- Infectious Diseases and Systemic Inflammatory Response in Paediatrics, Infectious Diseases Unit, Department of Paediatrics, Sant Joan de Déu Hospital Research Foundation, 08950 Barcelona, Spain; (S.S.); (E.V.-A.); (M.R.-B.); (C.F.)
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain;
- Statistics Department, Sant Joan de Déu Research Foundation, 08950 Barcelona, Spain;
- Translational Research Network in Paediatric Infectious Diseases (RITIP), 28009 Madrid, Spain
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Nguyen CT, Olson G, Pho MT, Lew AK, Pitrak D, Saltzman J, Hazra A, Pursell K, Pettit NN. Automatic ID Consultation for Inpatients With COVID-19: Point, Counterpoint, and a Single-Center Experience. Open Forum Infect Dis 2020; 7:ofaa318. [PMID: 33117849 PMCID: PMC7454912 DOI: 10.1093/ofid/ofaa318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/27/2020] [Indexed: 01/18/2023] Open
Abstract
There are many unknowns with regard to COVID-19 clinical management, including the role of Infectious Diseases Consultation (IDC). As hospitalizations for COVID-19 continue, hospitals are assessing how to optimally and efficiently manage COVID-19 inpatients. Typically, primary teams must determine when IDC is appropriate, and ID clinicians provide consultation upon request of the primary team. IDC has been shown to be beneficial for many conditions; however, the impact of IDC for COVID-19 is unknown. Herein, we discuss the potential benefits and pitfalls of automatic IDC for COVID-19 inpatients. Important considerations include the quality of care provided, allocation and optimization of resources, and clinician satisfaction. Finally, we describe how automatic IDC changed throughout the COVID-19 pandemic at a single academic medical center.
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Affiliation(s)
- Cynthia T Nguyen
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - Gregory Olson
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mai T Pho
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Alison K Lew
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
| | - David Pitrak
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Jina Saltzman
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Aniruddha Hazra
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Kenneth Pursell
- Department of Medicine, Section of Infectious Diseases and Global Health, University of Chicago Medicine, Chicago, Illinois, USA
| | - Natasha N Pettit
- Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois, USA
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Bauer KA, Kullar R, Gilchrist M, File TM. Antibiotics and adverse events: the role of antimicrobial stewardship programs in 'doing no harm'. Curr Opin Infect Dis 2020; 32:553-558. [PMID: 31567566 DOI: 10.1097/qco.0000000000000604] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Antimicrobial resistance (AMR) is a global threat worldwide, with deaths associated with AMR infections projected to exceed 10 million per year by the year 2050. The overuse and misuse of antibiotics is the primary driver of this resistance, with up to 50% of antibiotics prescribed in the hospital setting being either unnecessary or inappropriate. Antimicrobial stewardship (AMS) programs (ASPs) can mitigate some of this resistance, with the benefits well recognized; however, if we are to truly advance the state of AMS, the principles and practices should align with patient safety. RECENT FINDINGS In a recent evaluation, among 1488 adult patients receiving systemic antibiotic therapy, 298 (20%) experienced at least one antibiotic-associated adverse drug event (ADE). Fifty-six (20%) nonclinically indicated antibiotic regimens were associated with an ADE. It is also well recognized that besides ADEs, the inappropriate use of antibiotics is associated the development of multidrug-resistant infections and Clostridium difficile infection. SUMMARY Currently, there is a significant gap in ASPs correlating initiatives with patient safety goals, including reductions in antibiotic-associated ADEs and multidrug-resistant infections. Therefore, in this article, we provide the rationale for why ASPs are best suited to lead a collaborative effort to prevent antibiotic-associated ADEs and multidrug-resistant infections.
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Affiliation(s)
| | | | - Mark Gilchrist
- Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
| | - Thomas M File
- Department of Internal Medicine, Northeast Ohio Medical University, Rootstown.,Division of Infectious Diseases, Summa Health, Akron, Ohio, USA
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10
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Kullar R, Nagel J, Bleasdale SC, Sutton SH, Naumovski S, Rodriguez A, Smith C, Leggett J, Goldstein EJC. Going for the Gold: A Description of the Centers of Excellence Designation by the Infectious Diseases Society of America. Clin Infect Dis 2020; 68:1777-1782. [PMID: 30239608 DOI: 10.1093/cid/ciy797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022] Open
Abstract
Antimicrobial stewardship programs (ASPs) are recommended by the Centers for Disease Control and Prevention and World Health Organization and mandated by the Joint Commission to curb antimicrobial resistance. However, <50% of institutions have optimal ASPs in place. Building on its experience of antimicrobial stewardship (AMS) advocacy, the Infectious Diseases Society of America (IDSA) developed the AMS Centers of Excellence (CoE) program, which will serve as a conduit to share best practices and highlight the standards for other hospitals to achieve in order to advance the field of AMS. A designation of CoE signifies that these institutions deliver high-quality care consistently, serve as the "gold" standard for executing novel AMS principles, and demonstrate commitment to their ASP. Here, we describe the process and purpose of designating institutions as AMS CoEs, provide awareness to clinicians on opportunities available through IDSA with this CoE designation, and discuss the evolution of the program.
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Affiliation(s)
| | - Jerod Nagel
- University of Michigan Health System, College of Pharmacy, University of Michigan, Ann Arbor
| | - Susan C Bleasdale
- Division of Infectious Diseases, College of Medicine, University of Illinois at Chicago
| | - Sarah H Sutton
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Snezana Naumovski
- Department of Pharmacy, Providence Saint Johns' Health Center, Santa Monica, California
| | - Andres Rodriguez
- Clinical Affairs and Practice Guidelines, Infectious Diseases Society of America, Arlington, Virginia
| | - Cheryl Smith
- Clinical Affairs and Practice Guidelines, Infectious Diseases Society of America, Arlington, Virginia
| | - James Leggett
- Providence Portland Medical Center, Oregon Health & Sciences University, Portland.,Division of Infectious Diseases, Oregon Health & Sciences University, Portland
| | - Ellie J C Goldstein
- Infectious Diseases Division, Providence Saint Johns' Health Center.,RM Alden Research Laboratory, Santa Monica, California
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11
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Antifungal stewardship: Still catching up? Commentary on "Variability in antifungal stewardship strategies among Society for Healthcare Epidemiology of America (SHEA) Research Network facilities". Infect Control Hosp Epidemiol 2020; 41:590-591. [PMID: 32364492 DOI: 10.1017/ice.2020.85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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12
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Improving Antimicrobial Use in Adult Outpatient Clinics: the New Frontier for Antimicrobial Stewardship Programs. Curr Infect Dis Rep 2020. [DOI: 10.1007/s11908-020-00722-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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13
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Roger PM, Peyraud I, Vitris M, Romain V, Bestman L, Blondel L, Gras H, Hauchart C, Morandi V, Rancezot A, Borredon G, Dautezac V. Impact of simplified therapeutic guidelines on antibiotic prescriptions: a prospective multicentre comparative study. J Antimicrob Chemother 2020; 75:747-755. [PMID: 31851314 DOI: 10.1093/jac/dkz490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 10/07/2019] [Accepted: 10/25/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We studied the impact of simplified therapeutic guidelines (STGs) associated with accompanied self-antibiotic reassessment (ASAR) on antibiotic use. METHODS Prospective antibiotic audits and feedback took place at 15 hospitals for 12 months, allowing STGs with ≤15 drugs to be devised. STGs were explained to prescribers through sessions referred to as ASAR. Optimal therapy was defined by the conjunction of a diagnosis and the drug specified in the STGs. Analysis of consumption focused on critical drugs: amoxicillin/clavulanic acid, third-generation cephalosporins and fluoroquinolones. RESULTS We compared prescriptions in five hospitals before (n = 179) and after (n = 168) the implementation of STGs + ASAR. These tools were associated with optimal therapies and amoxicillin/clavulanic acid prescriptions [adjusted odds ratio (AOR) 3.28, 95% CI 1.82-5.92 and 2.18, 95% CI 1.38-3.44, respectively] and fewer prescriptions for urine colonization [AOR 0.20 (95% CI 0.06-0.61)]. Comparison of prescriptions (n = 1221) from 10 departments of three clinics with STGs + ASAR for the first quarters of 2018 and 2019 revealed that the prescriptions by 23 ASAR participants more often complied with STGs than those by 28 other doctors (71% versus 60%, P = 0.003). STGs alone were adopted by 10 clinics; comparing the prescriptions (n = 311) with the 5 clinics with both tools, we observed fewer unnecessary therapies in the latter [AOR 0.52 (95% CI 0.34-0.80)]. The variation in critical antibiotic consumption between 2017 and 2018 was -16% for the 5 clinics with both tools and +20% for the other 10 (P = 0.020). CONCLUSIONS STGs + ASAR promote optimal antibiotic therapy and reduce antibiotic use.
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Affiliation(s)
- Pierre-Marie Roger
- Infectiologie, Clinique Les Fleurs, 332 ave Frédéric Mistral, 83110 Ollioules, France.,Faculté de Médecine, Université Côte d'Azur, Nice, France
| | - Ingrid Peyraud
- Pharmacie, Clinique Inkermann, 84 Rte d'Aiffres, 79000 Niort, France
| | - Michel Vitris
- Hygiène, Clinique du Pont de Chaume, 330 ave Marcel Unal, 82000, Montauban, France
| | - Valérie Romain
- Anesthésie-Réanimation et Hygiène, Pôle Santé Atlantique, Ave Claude Bernard, 44819 St Herblain, France
| | - Laura Bestman
- Service Qualité, Clinique St Louis, 1 rue Basset, 78300 Poissy, France
| | - Lionel Blondel
- Hygiène, Clinique l'Orangerie, 29 allée de la Robertsau, 67000 Strasbourg, France
| | - Hélène Gras
- Pharmacie, Clinique Les Lauriers, 147 rue Jean Giono, 83600 Fréjus, France
| | - Christine Hauchart
- Pharmacie, Clinique St Claude, 1, Bd du Dr Schweitzer, 02100 Saint Quentin, France
| | - Véronique Morandi
- Pharmacie et Hygiène, Clinique St Roch, rue Ambroise Croizat, 66330 Cabestany, France
| | - Agnès Rancezot
- Pharmacie, Clinique Médicale et Cardiologique d'Aressy, rue de Lourdes, 64320 Aressy, France
| | - Gaelle Borredon
- Pharmacie, Clinique Ormeau, 12 chemin de l'Ormeau, 65000 Tarbes, France
| | - Véronique Dautezac
- Pharmacie, Clinique du Sidobre, chemin de St Hyppolyte, 81100 Castres, France
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14
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Affiliation(s)
- Lindsay E Nicolle
- Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
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15
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The role of electronic health record and "add-on" clinical decision support systems to enhance antimicrobial stewardship programs. Infect Control Hosp Epidemiol 2019; 40:501-511. [PMID: 31020944 DOI: 10.1017/ice.2019.51] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Increasingly, demands are placed on healthcare systems to meet antimicrobial stewardship standards and reporting requirements. This trend, combined with reduced financial and personnel resources, has created a need to adopt information technology (IT) to help ease these burdens and facilitate action. The incorporation of IT into an antimicrobial stewardship program can help improve stewardship intervention efficiencies and facilitate the tracking and reporting of key metrics, including outcomes. This paper provides a review of the stewardship-related functionality within these IT systems, describes how these platforms can be used to improve antimicrobial use, and identifies how they can support current and potential future antimicrobial stewardship regulatory and accreditation standards. Finally, recommendations to help close the gaps in existing systems are provided and suggestions for future areas of development within these programs are delineated.
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16
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Hattori H, Maeda M, Nagatomo Y, Takuma T, Niki Y, Naito Y, Sasaki T, Ishino K. Epidemiology and risk factors for mortality in bloodstream infections: A single-center retrospective study in Japan. Am J Infect Control 2018; 46:e75-e79. [PMID: 30172607 DOI: 10.1016/j.ajic.2018.06.019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/26/2018] [Accepted: 06/26/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Few published data are available on the morbidity and mortality of bloodstream infections (BSIs) in Japan. We sought to investigate the epidemiology of BSIs, the involvement of antimicrobial resistance, and the factors that influence patient prognosis. METHODS This single-center study retrospectively evaluated patients who were found to have positive blood cultures at a tertiary teaching hospital between January 2012 and December 2016. RESULTS A total of 2,105 patients with BSIs were included; 1,786 survived and 319 died, and the 30-day mortality rate was 15.2% over the 5-year study period. BSIs caused by yeasts were independently associated with 30-day mortality. The 30-day mortality rate of BSIs caused by extended-spectrum beta lactamase-producing gram-negative bacteria was significantly higher than that of BSIs caused by nonproducing bacteria. DISCUSSION The differences in mortality may be caused by differences in the distribution of pathogens and in the delivery of health care. CONCLUSIONS This study reported epidemiology and antimicrobial resistance data of BSIs in Japan and identified several risk factors associated with 30-day mortality. National surveillance of BSIs is required in Japan for comparison with other countries.
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Affiliation(s)
- Haruka Hattori
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan; Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Masayuki Maeda
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan.
| | - Yasuhiro Nagatomo
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Takahiro Takuma
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yoshihito Niki
- Division of Clinical Infectious Diseases, Department of Medicine, School of Medicine, Showa University, Tokyo, Japan
| | - Yuika Naito
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Tadanori Sasaki
- Department of Hospital Pharmaceutics, School of Pharmacy, Showa University, Tokyo, Japan
| | - Keiko Ishino
- Division of Infection Control Sciences, Department of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan
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