A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department

Losier, Mia; Ramsey, Tasha D; Wilby, Kyle John; Black, Emily

doi:10.1177/1060028017709820

Cited by 40 publications

(46 citation statements)

References 56 publications

(200 reference statements)

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“…feedback on behaviour) have shown more promise. For example, a systematic review exploring effectiveness of antimicrobial stewardship interventions within the emergency department found that studies which employed audit and feedback strategies achieved statistically significant increases in appropriateness of antimicrobial prescribing and adherence to guidelines, as well as decreases in antimicrobial use [74]. Similarly, primary research exploring audit and feedback interventions in settings such as a tertiary care hospital [75] and an intensive care unit [76] found reduced use of antibiotics such as fluoroquinolones by 2.3 defined daily doses/1000 patient-days [95% CI − 3.97 to − 0.63] and significant reductions of antimicrobial use by 24.3% (87.3 defined daily doses/100 beds vs. 66.1 defined daily doses/100 beds; P < 0.001) respectively.…”

Section: Discussionmentioning

confidence: 99%

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

et al. 2020

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Background: Overuse of antibiotics has contributed to antimicrobial resistance; a growing public health threat. In long-term care facilities, levels of inappropriate prescribing are as high as 75%. Numerous interventions targeting long-term care facilities' antimicrobial stewardship have been reported with varying, and largely unexplained, effects. Therefore, this review aimed to apply behavioural science frameworks to specify the component behaviour change techniques of stewardship interventions in long-term care facilities and identify those components associated with improved outcomes. Method: A systematic review (CRD42018103803) was conducted through electronic database searches. Two behavioural science frameworks, the Behaviour Change Wheel and Behaviour Change Technique Taxonomy were used to classify intervention descriptions into intervention types and component behaviour change techniques used. Study design and outcome heterogeneity prevented meta-analysis and meta-regression. Interventions were categorised as 'very promising' (all outcomes statistically significant), 'quite promising' (some outcomes statistically significant), or 'not promising' (no outcomes statistically significant). 'Promise ratios' (PR) were calculated for identified intervention types and behaviour change techniques by dividing the number of (very or quite) promising interventions featuring the intervention type or behaviour change technique by the number of interventions featuring the intervention type or behaviour change technique that were not promising. Promising intervention types and behaviour change techniques were defined as those with a PR ≥ 2. Results: Twenty studies (of19 interventions) were included. Seven interventions (37%) were 'very promising', eight 'quite promising' (42%) and four 'not promising' (21%). Most promising intervention types were 'persuasion' (n = 12; promise ratio (PR) = 5.0), 'enablement' (n = 16; PR = 4.33) and 'education' (n = 19; PR = 3.75). Most promising behaviour change techniques were 'feedback on behaviour' (n = 9; PR = 8.0) and 'restructuring the social environment' (e.g. staff role changes; n = 8; PR = 7.0).

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Section: Discussionmentioning

confidence: 99%

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

et al. 2020

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“…Also relevant to ambulatory patients in the ED, multiple studies identified in the review demonstrated that clinical pharmacists reviewing culture results after discharge have improved appropriateness of antibiotic prescribing. Regarding the quality of the available evidence, all but one of the studies assessed had a high risk of bias or failed to provide sufficient methodologic information to complete the assessment . This highlights the need for improved study design including reporting antibiotic utilization and clinical outcomes by age group in future ED‐based antibiotic stewardship intervention studies.…”

Section: Ambulatory Care Stewardship Interventionsmentioning

confidence: 99%

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

Pulia

Keller

Crnich

et al. 2019

J American Geriatrics Society

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Inappropriate antibiotic use is common in older adults (aged >65 y), and they are particularly vulnerable to serious antibiotic-associated adverse effects such as cardiac arrhythmias, delirium, aortic dissection, drug-drug interactions, and Clostridioides difficile. Antibiotic prescribing improvement efforts in older adults have been primarily focused on inpatient and long-term care settings. However, the ambulatory care setting is where the vast majority of antibiotic prescribing to older adults occurs. To help improve the clinical care of older adults, we review drivers of antibiotic prescribing in this population, explore systems aspects of ambulatory care that can create barriers to optimal antibiotic use, discuss existing stewardship interventions, and provide guidance on priority areas for future inquiry. J Am Geriatr Soc 68:244-249, 2020.

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“…Although data exists demonstrating the benefit of stewardship initiatives in the ED, there are still a multitude of disease states where additional opportunities exist for stewardship. Losier et al conducted a systematic review including 43 studies, which also concluded that antimicrobial stewardship interventions in the ED may improve patient care [34]. The authors focused more specifically on pharmacist involvement in stewardship efforts within the ED, however, they acknowledged that the optimal combination of interventions is still unclear.…”

Section: Discussionmentioning

confidence: 99%

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

et al. 2019

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Antimicrobial stewardship (ASP) is becoming an increasingly high priority worldwide, yet the emergency department (ED) is an area where stewardship is often neglected. Implementing care bundles, guidelines, and protocols appears to be a rational strategy for ED stewardship given the inherently dynamic and hectic environment of care. Multiple questions still exist such as whether to target certain disease states, optimal implementation of ASP interventions in the ED, and the benefit of unique ED-specific guidelines and protocols. A narrative review was performed on interventions, guidelines, and bundles implemented in the ED setting, in an effort to improve ASP or management of infectious diseases. This review is meant to serve as a framework for the reader to implement these practices at their own institution. We examined various studies related to ASP interventions or care bundles in the ED which included: CNS infections (one study), skin and soft-tissue infections (one study), respiratory infections (four studies), urinary tract infections and sexually transmitted infections (eight studies), sepsis (two studies), culture follow-up programs (four studies), and stewardship in general or multiple infection types (five studies). The interventions in this review were diverse, yet the majority showed a benefit in clinical outcomes or a decrease in antimicrobial use. Care bundles, guidelines, and antimicrobial stewardship interventions can streamline care and improve the management of common infectious diseases seen in the ED.

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A Systematic Review of Antimicrobial Stewardship Interventions in the Emergency Department

Abstract: AMS interventions in the ED may improve patient care. However, the optimal combination of interventions is unclear. Additional studies with more rigorous design evaluating core components of AMS programs, including prospective audit and feedback are needed.

Cited by 40 publications

References 56 publications

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

Interventions to improve appropriate antibiotic prescribing in long-term care facilities: a systematic review

Antibiotic Stewardship for Older Adults in Ambulatory Care Settings: Addressing an Unmet Challenge

BundlED Up: A Narrative Review of Antimicrobial Stewardship Initiatives and Bundles in the Emergency Department

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