Effects of a bundled Antimicrobial Stewardship Program on mortality: a cohort study

Okumura, Lucas Miyake; Silva, Monica Maria Gomes da; Veroneze, Izelandia

doi:10.1016/j.bjid.2015.02.005

Cited by 30 publications

(29 citation statements)

References 25 publications

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“…The tremendous variability inherent in many studies on antimicrobial stewardship limits interpretation of mortality benefits attributable to specific interventions (4,(20)(21)(22), but pharmacist-led interventions in China and in Brazil have been associated with a 10% reduction in mortality (23,24). In our study, all cause in-hospital mortality was 2-fold higher post-intervention compared to the intervention phase.…”

Section: Discussionmentioning

confidence: 64%

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

Gebretekle

Mariam

Taye

et al. 2020

Front. Public Health

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Conclusions: A pharmacist-led AMS intervention focused on duration of antibiotic treatment was feasible and had good acceptability in our setting. Cessation of audit-feedback activities was associated with immediate and sustained increases in antibiotic consumption reflecting a rapid return to baseline (pre-intervention) prescribing practices, and worse clinical outcomes (increased length of stay and in-hospital mortality). Pharmacist-led audit-feedback activities can effectively reduce antimicrobial consumption and result in better-quality care, but require organizational leadership's commitment for sustainable benefits.

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Section: Discussionmentioning

confidence: 64%

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

Gebretekle

Mariam

Taye

et al. 2020

Front. Public Health

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“…Thirteen studies [ 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ] were identified that reported impact on patient outcomes. Gums et al .…”

Section: Resultsmentioning

confidence: 99%

A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

et al. 2016

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The growing problem of antimicrobial resistance (AMR) has led to calls for antimicrobial stewardship programs (ASP) to control antibiotic use in healthcare settings. Key strategies include prospective audit with feedback and intervention, and formulary restriction and preauthorization. Education, guidelines, clinical pathways, de-escalation, and intravenous to oral conversion are also part of some programs. Impact and quality of ASP can be assessed using process or outcome measures. Outcome measures are categorized as microbiological, patient or financial outcomes. The objective of this review was to provide an overview of quality measures for assessing ASP and the reported impact of ASP in peer-reviewed studies, focusing particularly on patient outcomes. A literature search of papers published in English between 1990 and June 2015 was conducted in five databases using a combination of search terms. Primary studies of any design were included. A total of 63 studies were included in this review. Four studies defined quality metrics for evaluating ASP. Twenty-one studies assessed the impact of ASP on antimicrobial utilization and cost, 25 studies evaluated impact on resistance patterns and/or rate of Clostridium difficile infection (CDI). Thirteen studies assessed impact on patient outcomes including mortality, length of stay (LOS) and readmission rates. Six of these 13 studies reported non-significant difference in mortality between pre- and post-ASP intervention, and five reported reductions in mortality rate. On LOS, six studies reported shorter LOS post intervention; a significant reduction was reported in one of these studies. Of note, this latter study reported significantly (p < 0.001) higher unplanned readmissions related to infections post-ASP. Patient outcomes need to be a key component of ASP evaluation. The choice of metrics is influenced by data and resource availability. Controlling for confounders must be considered in the design of evaluation studies to adequately capture the impact of ASP and it is important for unintended consequences to be considered. This review provides a starting point toward compiling standard outcome metrics for assessing ASP.

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“…Besides, as salaries of the 3 ID specialists involved in control reached US$ 130 000 per year and savings were of a higher magnitude the program itself was sustainable. This information is useful to convince hospital administrators in order to support initial hiring of dedicated human resources dedicated to ASP as has been shown in other reports 5,7,8,[13][14][15][16][17][18][19][20][21][22] . To the best of our knowledge, this is the first report that analyzes the contributory role of bidding and ASP at the same time.…”

Section: Discussionmentioning

confidence: 80%

Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile

et al. 2018

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Background: The long-term effect of an antimicrobial stewardship program (ASP) and its integrated impact with competitive biddings have been seldom reported. Aim: To evaluate the long-term effect of an ASP on antimicrobial consumption, expenditure, antimicrobial resistance and hospital mortality. To estimate the contribution of competitive biddings on cost-savings. Material and Methods: A comparison of periods prior (2005-2008) and posterior to ASP initiation (2009 and 2015) was done. An estimation of cost savings attributable to ASP and to competitive biddings was also performed. Results: Basal median antimicrobial consumption decreased from 221.3 to 170 daily defined doses/100 beds after the start of the ASP. At the last year, global antimicrobial consumption declined by 28%.

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Effects of a bundled Antimicrobial Stewardship Program on mortality: a cohort study

Abstract: Bundled ASP was the most effective strategy, with reduced mortality and Defined Daily Doses per 1000 patient-days.

Cited by 30 publications

References 25 publications

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

Half of Prescribed Antibiotics Are Not Needed: A Pharmacist-Led Antimicrobial Stewardship Intervention and Clinical Outcomes in a Referral Hospital in Ethiopia

A Review of Quality Measures for Assessing the Impact of Antimicrobial Stewardship Programs in Hospitals

Long-term impact of competitive biddings and an antimicrobial stewardship program in a general hospital in Chile

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