This study suggests that the ASP-guided de-escalation of carbapenems led to comparable clinical success, fewer adverse effects and a lower incidence of the development of resistance. This approach is safe and practicable, and should be a key component of an ASP.
Introduction: Antimicrobial stewardship programmes (ASP) can reduce antibiotic use but patient safety concerns exist. We evaluated the safety of prospective carbapenem review and feedback and its impact on carbapenem use and patient outcomes. Materials and Methods: After 3 months implementation of our ASP, we compared patients with and without acceptance of ASP recommendations on the use of carbapenems. Primary outcome was 30-day mortality. Secondary outcomes included duration of carbapenem use, length of hospitalisation, clinical response, microbiological clearance, 30-day re-admission and mortality at discharge. Results: Of 226 recommendations for 183 patients, 59.3% was accepted. De-escalation, switching to oral antibiotics and antibiotic cessation comprised 72% of recommendations. Patients with acceptance of ASP recommendations had lower 30-day mortality and higher end-of-therapy clinical response despite shorter carbapenem duration (P <0.05). Predictors of 30-day mortality were Pitt bacteraemia score (adjusted odds ratio [aOR] 1.39, 95% confidence interval [CI], 1.11 to 1.74; P = 0.004) and non-acceptance of ASP recommendations (aOR 2.84, 95% CI, 1.21 to 6.64; P = 0.016). Conclusion: Our prospective carbapenem review and feedback mainly comprising of reducing carbapenem use is safe.
Key words: De-escalation, Multifaceted strategies, Pharmacists
Conclusion:No significant exposure to MRSA and therefore no indication of related adverse health effects from dog ownership or occupational exposure of small animal veterinarians were identified. However, we only considered a 24h-time period of potential exposure. In a scenario of prolonged colonization of an animal the repeated daily contact will result in cumulative exposure. Also, exposure does not necessarily mean risk. More work is needed to understand the health consequences of exposure to resistance genes, particularly MRSA.
BackgroundAntibiotic clinical decision support systems (CDSS) were implemented to provide stewardship at the point of ordering of broad-spectrum antibiotics (piperacillin-tazobactam and carbapenems). We postulated that a YouTube based educational video package (EP) with quizzes can help to improve CDSS acceptance.MethodsA before-after study was conducted in general wards at Tan Tock Seng Hospital from April 2016 to March 2017. Baseline data were collected for 6 months before EP was implemented and during the next 6 months with EP dissemination to all doctors. Acceptance of CDSS recommendations between both phases were compared. Independent factors associated with acceptance of specific CDSS recommendations were identified by logistic regression.ResultsPatients recruited before and after EP was 1642 and 1313 respectively. Overall CDSS acceptance rate was similar before and after EP. There was improved acceptance for recommendations for dose optimizaton, antibiotic optimization and set duration (Figures 1 and 2). Independent factors of CDSS acceptance for dose optimizaton, antibiotic optimization and set duration are shown in Table 1. EP implementation was independently associated with acceptance of recommendations to set duration and optimize antibiotics.ConclusionEP was independently associated with increased CDSS acceptance on antibiotic duration and antibiotic optimization. Although acceptance of dose optimization was improved, EP was not associated independently with acceptance of the recommendations.Figure 2Acceptance of CDSS recommendations by classifications of recommendationsTable 13 multivariate models of acceptance of CDSS recommendations on antibiotic optimization, dose optimization and duration settingSet durationAntibiotic optimizationDose optimizationFactorOdds ratio [95% CI]Lung infection2.71[2.13–3.45]2.08[1.71–2.52]2.79[2.19-3.55]Unknown sepsis source1.73[1.27–2.35] –1.44[1.05-1.96]Piperacillin-tazobactam use3.02[2.17–4.19] – –Temperature during initiation of antibiotics0.86[0.79–0.94] – –The presence of oxygen supplementation during initiation of antibiotics –0.76[0.64–0.91]0.76[0.64–0.91]EP implementation1.38[1.18–1.62]1.21[1.02–1.43] -Disclosures
All authors: No reported disclosures.
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