1
|
Casalini G, Pagani C, Giacomelli A, Galimberti L, Milazzo L, Coen M, Reato S, Caloni B, Caronni S, Pagano S, Lazzarin S, Ridolfo AL, Rimoldi SG, Gori A, Antinori S. Impact of a Bundle of Interventions on Quality-of-Care Indicators for Staphylococcus aureus Bacteraemia: A Single-Centre, Quasi-Experimental, Before-After Study. Antibiotics (Basel) 2024; 13:646. [PMID: 39061328 PMCID: PMC11273465 DOI: 10.3390/antibiotics13070646] [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: 05/31/2024] [Revised: 07/10/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Staphylococcus aureus bacteraemia (SAB) is a life-threatening bloodstream infection. Improved adherence to quality-of-care indicators (QCIs) can significantly enhance patient outcomes. This quasi-experimental study evaluated the impact of a bundle of interventions on QCI adherence in adult patients with SAB. Additionally, a molecular rapid diagnostic test (mRDT) for S. aureus and methicillin resistance was introduced during weekdays. We compared pre-intervention (January-December 2022) and post-intervention (May 2023-April 2024) data on QCI adherence and time to appropriate treatment. A total of 56 and 40 SAB episodes were included in the pre- and post-intervention periods, respectively. Full QCI adherence significantly increased from 28.6% to 67.5% in the post-intervention period (p < 0.001). The mRDT diagnosed SAB in eight cases (26.6%), but the time to achieve appropriate target therapy did not improve in the post-intervention period (54 h (IQR 30-74) vs. 72 h (IQR 51-83), p = 0.131). The thirty-day mortality rate was comparable between the two periods (17.9% vs. 12.5%, p = 0.476). This study demonstrates that a bundle of interventions can substantially improve adherence to SAB management QCIs.
Collapse
Affiliation(s)
- Giacomo Casalini
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
| | - Cristina Pagani
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Andrea Giacomelli
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Laura Galimberti
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Laura Milazzo
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Massimo Coen
- I Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy;
| | - Serena Reato
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Beatrice Caloni
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Stefania Caronni
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Simone Pagano
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Samuel Lazzarin
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| | - Anna Lisa Ridolfo
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
| | - Sara Giordana Rimoldi
- Clinical Microbiology, Virology and Bioemergency Diagnostics, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (C.P.); (L.G.); (L.M.); (S.G.R.)
| | - Andrea Gori
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
- Centre for Multidisciplinary Research in Health Science (MACH), Università degli Studi di Milano, 20122 Milan, Italy
- II Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy
| | - Spinello Antinori
- III Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Luigi Sacco Hospital, 20157 Milan, Italy; (G.C.); (S.R.); (B.C.); (S.C.); (S.P.); (S.L.); (A.L.R.); (S.A.)
- Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, 20157 Milan, Italy;
| |
Collapse
|
2
|
Vaughn VM, Krein SL, Hersh AL, Buckel WR, White AT, Horowitz JK, Patel PK, Gandhi TN, Petty LA, Spivak ES, Bernstein SJ, Malani AN, Johnson LB, Neetz RA, Flanders SA, Galyean P, Kimball E, Bloomquist K, Zickmund T, Zickmund SL, Szymczak JE. Excellence in Antibiotic Stewardship: A Mixed-Methods Study Comparing High-, Medium-, and Low-Performing Hospitals. Clin Infect Dis 2024; 78:1412-1424. [PMID: 38059532 PMCID: PMC11153329 DOI: 10.1093/cid/ciad743] [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] [Received: 07/28/2023] [Revised: 11/13/2023] [Accepted: 12/01/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND Despite antibiotic stewardship programs existing in most acute care hospitals, there continues to be variation in appropriate antibiotic use. While existing research examines individual prescriber behavior, contextual reasons for variation are poorly understood. METHODS We conducted an explanatory, sequential mixed-methods study of a purposeful sample of 7 hospitals with varying discharge antibiotic overuse. For each hospital, we conducted surveys, document analysis, and semi-structured interviews with antibiotic stewardship and clinical stakeholders. Data were analyzed separately and mixed during the interpretation phase, where each hospital was examined as a case, with findings organized across cases using a strengths, weaknesses, opportunities, and threats framework to identify factors accounting for differences in antibiotic overuse across hospitals. RESULTS Surveys included 85 respondents. Interviews included 90 respondents (31 hospitalists, 33 clinical pharmacists, 14 stewardship leaders, 12 hospital leaders). On surveys, clinical pharmacists at hospitals with lower antibiotic overuse were more likely to report feeling: respected by hospitalist colleagues (P = .001), considered valuable team members (P = .001), and comfortable recommending antibiotic changes (P = .02). Based on mixed-methods analysis, hospitals with low antibiotic overuse had 4 distinguishing characteristics: (1) robust knowledge of and access to antibiotic stewardship guidance; (2) high-quality clinical pharmacist-physician relationships; (3) tools and infrastructure to support stewardship; and (4) highly engaged infectious diseases physicians who advocated stewardship principles. CONCLUSIONS This mixed-methods study demonstrates the importance of organizational context for high performance in stewardship and suggests that improving antimicrobial stewardship requires attention to knowledge, interactions, and relationships between clinical teams and infrastructure that supports stewardship and team interactions.
Collapse
Affiliation(s)
- Valerie M Vaughn
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Health System Innovation and Research, Department of Population Health Science, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Sarah L Krein
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Adam L Hersh
- Division of Infectious Diseases, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Whitney R Buckel
- Intermountain Healthcare Pharmacy Services, Taylorsville, Utah, USA
| | - Andrea T White
- Division of General Internal Medicine, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Jennifer K Horowitz
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Payal K Patel
- Division of Infectious Diseases, Department of Medicine, Intermountain Health, Salt Lake City, Utah, USA
| | - Tejal N Gandhi
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Lindsay A Petty
- Division of Infectious Diseases, Department of Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Emily S Spivak
- Division of Infectious Diseases, Department of Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Steven J Bernstein
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
- Division of General Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Anurag N Malani
- Division of Infectious Diseases, Department of Internal Medicine, Trinity Health Michigan, Ann Arbor, Michigan, USA
| | - Leonard B Johnson
- Division of Infectious Diseases, Department of Internal Medicine, Ascension St John Hospital, Detroit, Michigan, USA
| | - Robert A Neetz
- Department of Pharmacy, MyMichigan Health, Midland, Michigan, USA
| | - Scott A Flanders
- Division of Hospital Medicine, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Patrick Galyean
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Elisabeth Kimball
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Kennedi Bloomquist
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Tobias Zickmund
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Susan L Zickmund
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Informatics, Decision-Enhancement and Analytic Sciences Center, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, Utah, USA
| | - Julia E Szymczak
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| |
Collapse
|
3
|
Barfield RK, Brown ML, Albrecht B, Barber KE, Bouchard J, Carr AL, Chahine EB, Cluck D, Covington EW, Deri CR, Durham SH, Faulkner-Fennell C, Freeman LK, Gauthier TP, Gibson GM, Green SB, Hobbs ALV, Jones BM, Jozefczyk CC, Marx AH, McGee EU, McKamey LJ, Musgrove R, Perez E, Slain D, Stover KR, Turner MS, White C, Bookstaver PB, Bland CM. A Baker's Dozen of Top Antimicrobial Stewardship Intervention Publications in 2022. Open Forum Infect Dis 2024; 11:ofad687. [PMID: 38434614 PMCID: PMC10906711 DOI: 10.1093/ofid/ofad687] [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: 11/09/2023] [Accepted: 01/02/2024] [Indexed: 03/05/2024] Open
Abstract
Keeping abreast of the antimicrobial stewardship-related articles published each year is challenging. The Southeastern Research Group Endeavor identified antimicrobial stewardship-related, peer-reviewed literature that detailed an actionable intervention during 2022. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight actionable interventions used by antimicrobial stewardship programs to capture potentially effective strategies for local implementation.
Collapse
Affiliation(s)
- Reagan K Barfield
- Department of Pharmacy, University of South Carolina College of Pharmacy, Columbia, South Carolina, USA
| | - Matthew L Brown
- Department of Pharmacy, UAB Hospital, Birmingham, Alabama, USA
| | - Benjamin Albrecht
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA
| | - Katie E Barber
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Jeannette Bouchard
- Liaison Clinical Pharmacist, Duke Antimicrobial Stewardship Outreach Network (DASON), Durham, North Carolina, USA
| | - Amy L Carr
- Department of Pharmacy, AdventHealth Orlando, Orlando, Florida, USA
| | - Elias B Chahine
- Department of Pharmacy Practice, Palm Beach Atlantic University Gregory School of Pharmacy, West Palm Beach, Florida, USA
| | - David Cluck
- Department of Pharmacy Practice, East Tennessee State University—Gatton College of Pharmacy, Johnson City, Tennessee, USA
| | - Elizabeth W Covington
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, Auburn, Alabama, USA
| | - Connor R Deri
- Department of Pharmacy, Duke University Hospital, Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina, USA
| | - Spencer H Durham
- Department of Pharmacy Practice, Auburn University Harrison College of Pharmacy, Auburn, Alabama, USA
| | | | - Lauren K Freeman
- Department of Pharmacy, McLeod Regional Medical Center, Florence, South Carolina, USA
| | - Timothy P Gauthier
- Clinical Pharmacy Enterprise, Baptist Health South Florida, Miami, Florida, USA
| | - Geneen M Gibson
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Sarah B Green
- Department of Pharmacy, Emory University Hospital, Atlanta, Georgia, USA
| | | | - Bruce M Jones
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Caroline C Jozefczyk
- Department of Pharmacy, Prisma Health Greenville Memorial Hospital, Greenville, South Carolina, USA
| | - Ashley H Marx
- Department of Pharmacy, UNC Medical Center, Chapel Hill, North Carolina, USA
| | - Edoabasi U McGee
- Department of Pharmacy Practice, Philadelphia College of Osteopathic Medicine, School of Pharmacy, GA Campus, Suwanee, Georgia, USA
| | - Lacie J McKamey
- System Pharmacy, Novant Health, Charlotte, North Carolina, USA
| | - Rachel Musgrove
- Department of Pharmacy, St. Joseph's/Candler Health System, Savannah, Georgia, USA
| | - Emily Perez
- Department of Pharmacy, ECU Health Medical Center, Greenville, North Carolina, USA
| | - Douglas Slain
- School of Pharmacy and Section of Infectious Diseases, West Virginia University, Morgantown, West Virginia, USA
| | - Kayla R Stover
- Department of Pharmacy Practice, University of Mississippi School of Pharmacy, Jackson, Mississippi, USA
| | - Michelle S Turner
- Department of Pharmacy, Cone Health, Greensboro, North Carolina, USA
| | - Cyle White
- Department of Pharmacy, Erlanger Health System, Chattanooga, Tennessee, USA
| | - P Brandon Bookstaver
- Department of Pharmacy, University of South Carolina College of Pharmacy, Columbia, South Carolina, USA
| | - Christopher M Bland
- Department of Clinical and Administrative Pharmacy, University of Georgia College of Pharmacy, Savannah, Georgia, USA
| |
Collapse
|