Rapid identification technologies and phenotypic methods, new therapeutic strategies, and novel treatment paradigms have evolved in an attempt to improve treatment outcomes for VAP; however, clinical data supporting alternative treatment strategies and adjunctive therapies remain sparse. Importantly, new classes of antimicrobials, novel virulence factor inhibitors, and beta-lactam/beta-lactamase inhibitor combinations are currently in development. Conscientious stewardship of new and emerging therapeutic agents will be needed to ensure they remain effective well into the future.
This study sought to characterize the impact of 3 types of variation on the Standardized Antimicrobial Administration Ratio (SAAR) utilizing local National Healthcare Safety Network (NHSN) data. SAAR and antimicrobial days per 1,000 days present (AD/1000DP) were compiled monthly for Northwestern Memorial Hospital from 2014 to 2016. Antimicrobial consumption was aggregated into agent categories (via NHSN criteria). Month-to-month changes in SAAR and AD/1000DP were evaluated. Azithromycin and oseltamivir AD/1000DP from 2012 through 2017 were explored for seasonal variation. A sensitivity analysis was performed to explore the effect of seasonality and altered consumption at other hypothetical hospitals on the SAAR. Across agent categories for both the intensive care unit (n = 4) and general wards (n = 4), the average matched-month percent change in AD/1000DP was correlated with the corresponding change in SAAR (coefficient of determination of 0.99). The monthly mean ± standard deviation (SD) AD/1000DP was 235 (range, 47.2 to 661.5), and the mean ± SD SAAR was 1.09 ± 0.26 (range, 0.79 to 1.09) across the NHSN agent categories. Five seasons exhibited seasonal variation in AD/1000DP for azithromycin with a mean percent change of 26.76% (range, 22.27 to 30.69). Eight seasons exhibited seasonal variation in AD/1000DP for oseltamivir with a mean percent change of 129.1% (range, 32.01 to 352.74). The sensitivity analyses confirm that antimicrobial usage at comparator hospitals does not impact the local SAAR, and seasonal variation of antibiotics has the potential to impact SAAR. Month-to-month changes in the SAAR mirror monthly changes in an institution’s AD/1000DP. Seasonal variation is an important variable for future SAAR consideration, and the variable antibiotic use at peer hospitals is not currently captured by the SAAR methodology.
BackgroundAn antibiotic timeout (ATO) provides a potential opportunity to improve antibiotic utilization and decrease inappropriate antibiotic prescribing. The CDC and Joint Commission suggest ATO as an antimicrobial stewardship program (ASP) action to support optimal antibiotic use. Unfortunately, little is known about the design and implementation of an ATO. Our primary objective was to describe different ATO models established by hospitals across the United States.MethodsData describing ATO strategies and ASP efforts were collected via a Qualtrics survey as a part of a multicenter study conducted by Vizient™ member hospitals to research the impact of an ATO on various ASP reporting metrics.ResultsSeventy-one hospitals responded to the survey. Twenty (28%) had a formalized ATO. Most institutions utilizing an ATO were community hospitals (60%) and had formalized ASPs (95%). Hospitals with an ATO program trended toward a higher average combined number of ASP physician and pharmacist FTEs than those without a formalized ATO (1.72 vs. 1.2, P = 0.28). Prescribers were responsible for the ATO in 40% of programs (N = 8), 30% were pharmacist-led, and the remainder were multidisciplinary. ATOs were most commonly performed daily (75%) as opposed to on select days of the week and targeted patients receiving antibiotics for 72 hours. Electronic medical record (EMR)-based ATOs (where the EMR prompted the responsible personnel to respond) existed at 14 programs, whereas 4 programs performed an ATO manually through chart review. Forty percent of hospitals conducted ATO on all antibiotics and antifungals; 20% included only antibiotics in their ATO. For the remaining 40% of institutions, only select drugs were included in the ATO.ConclusionMultiple ATO strategies are used in the United States. Most ATOs are electronic-based, performed at 72 hours of antibiotic therapy, inclusive of all antibiotics, and supported by established ASPs. To our knowledge, this is the largest descriptive study on ATO implementation in the United States.Figure 1.Distribution of hospital type and duration of ASPs by the presence of ATOFigure 2.Personnel responsible for conducting ATOsDisclosures All authors: No reported disclosures.
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