Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach

Pulcini, Céline; Binda, Francesca; Lamkang, Anjana Sankhil; Trett, Anna; Charani, Esmita; Goff, Debra A.; Harbarth, Stéphan Juergen; Hinrichsen, Sylvia Lemos; Levy-Hara, Gabriel; Mendelson, Marc; Nathwani, Dilip; Gunturu, Revathi; Singh, Sanjeev; Srinivasan, Arjun; Thamlikitkul, Visanu; Thursky, Karin; Vlieghe, Erika; Wertheim, Heiman; Zeng, Mei; Gandra, Sumanth; Laxminarayan, Ramanan

doi:10.1016/j.cmi.2018.03.033

Cited by 143 publications

(133 citation statements)

References 29 publications

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“…Define a list of stewardship activities based on: a. A (systematic) review of the literature (e.g., [22,23]). b.…”

Section: Boxmentioning

confidence: 99%

“…It is currently unclear how adding such expertise influences staffing figures. With regard to improvement strategies, our study differs from a publication about core elements of ASP [22]. We explicitly mention stewardship improvement interventions in general and leave it to stewardship teams to choose the best behavioural change interventions on the basis of the determinants of poor antimicrobial use [2], in line with the US Centers for Disease Control and Prevention (CDC) core elements of hospital ASPs [23] and a French study on the human resources that are required [16].…”

Section: Boxmentioning

confidence: 99%

“…An advantage of our list of stewardship activities is that it is detailed. A recent publication [22] as well as the CDC core elements of hospital ASP also include structural prerequisites, such as leadership, accountability, responsibilities and available expertise, whereas we focused on activities only.…”

Section: Boxmentioning

confidence: 99%

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Human resources required for antimicrobial stewardship teams: a Dutch consensus report

Oever

Harmsen²,

Schouten

et al. 2018

Clinical Microbiology and Infection

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The hours needed each year are dependent on hospital size and number of stewardship objectives monitored. If all activities are performed at a minimal base (one stewardship objective; minimal staffing standard), time investment was estimated to be 1393 to 2680 hours annually in the early phase, corresponding with 0.87 (300 beds) to 1.68 FTE (1200 beds), with a further increase to minimally 1.25 to 3.18 FTE in the following years with three stewardship objectives monitored (optimal staffing standards during the first few years of implementing an ASP). This consensus on required human resources provides a directive for structural financial support of stewardship teams in the Dutch context. Some stewardship activities (and related time investments) might be specific to the Dutch context and hospital setting. To develop standards for other settings, our methodology could be applied.

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“…Define a list of stewardship activities based on: a. A (systematic) review of the literature (e.g., [22,23]). b.…”

Section: Boxmentioning

confidence: 99%

Section: Boxmentioning

confidence: 99%

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Human resources required for antimicrobial stewardship teams: a Dutch consensus report

Oever

Harmsen²,

Schouten

et al. 2018

Clinical Microbiology and Infection

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“…Antimicrobial stewardship (AMS) aims ' rst, to ensure effective treatment of patients with infection, and second, to minimise collateral damage from antimicrobial use' [1]. Clinical guidelines [2][3][4][5][6][7] advocate regular clinical audits of prescriptions and feedback of results to prescribers by infection specialists. Determining prescribing quality, for example by assessing compliance with guidelines, is both labour-intensive and dependent on specialist expertise [8].…”

Section: Introductionmentioning

confidence: 99%

Towards Data-Driven Hospital Antimicrobial Stewardship: Secondary use of Routine Electronic Care and Prescribing Records to Inform Antimicrobial Stewardship Programmes

Dutey-Magni¹,

Gill²,

McNulty³

et al. 2020

Preprint

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Background Hospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimise the use of antimicrobials. Most AMS programmes rely on time-consuming manual audits to monitor clinicians’ antibiotic prescribing practice. Much of the information needed is already contained within electronic health records (EHRs) and could be used to inform AMS programmes. The objective of this study was to evaluate the feasibility of building analytics from hospital EHRs to facilitate AMS interventions. Methods This study used electronic prescribing, laboratory and clinical coding records of adult patients admitted to six specialties at Queen Elizabeth Hospital, Birmingham, UK between September 2017 and August 2018 (n = 61,679 admissions). Duration of prescribing, compliance with clinical guidelines, and timing of switch from intravenous to oral antibiotics in relation to clinical progression were assessed. Outputs were visualised at ward, specialty and consultant levels. Results A total of 59,884 antibacterial prescription records were linked into 24,653 therapy episodes. Among the 35% of admissions prescribed an antibacterial, the mean days of therapy per admission was 4.3 days and 9.9 days in elective and emergency hospitalisations respectively. Twenty-two percent (207/997) of therapy episodes for low-severity community-acquired pneumonia were initiated with the antibiotic recommended by locally-approved prescribing guidelines. Data suggested average delays in switching from intravenous to oral therapy of up to 3.6 days [95% CI: 3.4; 3.7]. Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. Conclusions Hospital EHRs can be used to construct meaningful measures of antibiotic stewardship, demonstrating potential value for audit and feedback interventions.

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“…AMS setups in hospitals are often heterogeneous but audit and feedback to assess the goals are an essential part of most programmes and are included in international guidelines and reviews (2)(3)(4)(5)(6)(7) . Important data for AMS programmes include for example days of therapy (DOT), daily defined doses (DDD), admission dates, length of stay (LOS) and adherence to local or national treatment guidelines (1) .…”

Section: Introductionmentioning

confidence: 99%

Development of an interactive open source software application (RadaR) for infection management / antimicrobial stewardship

Luz

Berends

Dik

et al. 2018

Preprint

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ObjectivesAnalysing process and outcome measures for patients suspected of or having an infection in an entire hospital requires processing large datasets and accounting for numerous patient parameters and treatment guidelines. Rapid, reproducible and adaptable analyses usually need substantial technical expertise but can yield valuable insight for infection management and antimicrobial stewardship (AMS) teams. We describe a software application (RadaR -Rapid analysis of diagnostic and antimicrobial patterns in R) for infection management allowing user-friendly, intuitive and interactive analysis of large datasets without prior in-depth statistical or software knowledge. Methods and ResultsRadaR was built in R, an open source programming language, making it free to use and adaptable to different settings. Shiny, an additional open source package to implement web-application frameworks in R, was used to develop the application. RadaR was developed in the context of a 1339-bed academic tertiary referral hospital to handle data of more than 180,000 admissions.RadaR visualizes analytical graphs and statistical summaries in an interactive manner within seconds. Users can filter large patient groups by 17 different criteria and investigate antimicrobial use, microbiological diagnostic use and results, and outcome in length of stay.Results can easily be stratified and grouped to compare individually defined patient groups.Finally, datasets of identified patients / groups can be downloaded for further analyses. ConclusionRadaR facilitates understanding and communication of trends in antimicrobial use, diagnostic use and patient outcome by linking and aggregating individual patient data in one user-friendly application. RadaR can produce aggregated data analysis while preserving patients' features in the data to adjust and stratify results in detail. AMS teams can use RadaR to identify areas, both for diagnostic and therapeutic procedures, within their institutions that might benefit from increased support and to target their interventions.

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Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach

Abstract: This consensus on core elements for hospital AMS programmes is relevant to both high- and low-to-middle-income countries and could facilitate the development of national AMS stewardship guidelines and adoption by healthcare settings worldwide.

Cited by 143 publications

References 29 publications

Human resources required for antimicrobial stewardship teams: a Dutch consensus report

Human resources required for antimicrobial stewardship teams: a Dutch consensus report

Towards Data-Driven Hospital Antimicrobial Stewardship: Secondary use of Routine Electronic Care and Prescribing Records to Inform Antimicrobial Stewardship Programmes

Development of an interactive open source software application (RadaR) for infection management / antimicrobial stewardship

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