Antibiotic Stewardship: The Health of the World Depends on It

A five-year quasi-experimental study to evaluate the impact of empiric antibiotic order sets on antibiotic use metrics among hospitalized adult patients

OBJECTIVE

Evaluation of adult antibiotic order sets (AOSs) on antibiotic stewardship metrics has been limited. The primary outcome was to evaluate the standardized antimicrobial administration ratio (SAAR). Secondary outcomes included antibiotic days of therapy (DOT) per 1,000 patient days (PD); selected antibiotic use; AOS utilization; Clostridioides difficile infection (CDI) cases; and clinicians' perceptions of the AOS via a survey following the final study phase.

DESIGN

This 5-year, single-center, quasi-experimental study comprised 5 phases from 2017 to 2022 over 10-month periods between August 1 and May 31.

SETTING

The study was conducted in a 752-bed tertiary care, academic medical center.

INTERVENTION

Our institution implemented AOSs in the electronic medical record (EMR) for common infections among hospitalized adults.

RESULTS

For the primary outcome, a statistically significant decreases in SAAR were detected from phase 1 to phase 5 (1.0 vs 0.90; P < .001). A statistically significant decreases were detected in DOT per 1,000 PD (4,884 vs 3,939; P = .001), fluoroquinolone orders (407 vs 175; P < .001), carbapenem orders (147 vs 106; P = .024), and clindamycin orders (113 vs 73; P = .01). No statistically significant change in mean vancomycin orders was detected (991 vs 902; P = .221). A statistically significant decrease in CDI cases was also detected (7.8, vs 2.4; P = .002) but may have been attributable to changes in CDI case diagnosis. Clinicians indicated that the AOSs were easy to use overall and that they helped them select the appropriate antibiotics.

CONCLUSIONS

Implementing AOS into the EMR was associated with a statistically significant reduction in SAAR, antibiotic DOT per 1,000 PD, selected antibiotic orders, and CDI cases.

Bacterial Infections, Antimicrobial Resistance and Antibiotic Therapy

Bacterial infections have been, and are very likely to continue to be, among the most serious problems in medicine [...].

A Scoping Review of Antimicrobial Stewardship Teaching in Pharmacy Education Curricula

Objective. To conduct a scoping review of the existing literature to identify published studies on innovative teaching and assessment practices for antimicrobial stewardship in the Doctor of Pharmacy curriculum and to provide a foundation for future scholarly research in this important area.Findings. Seven studies were found that met the inclusion criteria. Two of the studies explored the extent, content, and methods of delivery of antimicrobial stewardship, four studies described elective courses in antimicrobial stewardship, and one study described an interprofessional module. Most studies were conducted in the United States. Several pharmacy schools in the UK and the US incorporated antimicrobial stewardship teaching into their curriculum. Learning objectives for the elective courses focused on guidelines issued by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA), antimicrobial stewardship literature appraisal and principal application. The most used teaching strategy was didactic lectures, followed by case studies. Active-learning approaches like simulators, problem-based learning, and presentations were also used but to a lesser extent.Summary. Antimicrobial stewardship curricular reform may be influenced by the timing of the course, teaching approaches, and performance assessment of students. Antimicrobial stewardship learning should be a required of all pharmacy students. The scarcity of scholarly activity in the teaching of and assessment of learning in antimicrobial stewardship suggests that curricular planning should be guided by national or international organizations to ensure pharmacy students learn such important material.

Implementation of Antibiotic Stewardship in a University Hospital Setting

The article describes activities of an antibiotic center at a university hospital in the Czech Republic and presents the results of antibiotic stewardship program implementation over a period of 10 years. It provides data on the development of resistance of Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus to selected antibiotic agents as well as consumption data for various antibiotic classes. The genetic basis of resistance to beta-lactam antibiotics and its clonal spread were also assessed. The study showed significant correlations between aminoglycoside consumption and resistance of Escherichia coli and Klebsiella pneumoniae to gentamicin (r = 0.712, r = 0.869), fluoroquinolone consumption and resistance of Klebsiella pneumoniae to ciprofloxacin (r = 0.896), aminoglycoside consumption and resistance of Pseudomonas aeruginosa to amikacin (r = 0.716), as well as carbapenem consumption and resistance of Pseudomonas aeruginosa to meropenem (r = 0.855). Genotyping of ESBL- positive isolates of Klebsiella pneumoniae and Escherichia coli showed a predominance of CTX-M-type; in AmpC-positive strains, DHA, EBC and CIT enzymes prevailed. Of 19 meropenem-resistant strains of Klebsiella pneumoniae, two were identified as NDM-positive. Clonal spread of these strains was not detected. The results suggest that comprehensive antibiotic stewardship implementation in a healthcare facility may help to maintain the effectiveness of antibiotics against bacterial pathogens. Particularly beneficial is the work of clinical microbiologists who, among other things, approve administration of antibiotics to patients with bacterial infections and directly participate in their antibiotic therapy.