Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Livorsi, Daniel J; Nair, Rajeshwari; Lund, Brian C.; Alexander, Bruce; Beck, Brice; Goto, Michihiko; Ohl, Michael; Vaughan-Sarrazin, Mary; Goetz, Matthew Bidwell; Perencevich, Eli N.

doi:10.1093/cid/ciaa388

Cited by 18 publications

(19 citation statements)

References 28 publications

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“…These non-ID hospitals, which tend to be small in size and rural in location, have been shown to have antibiotic use that is similar, if not higher, than hospitals with ID support. 8,28 Ultimately, these hospitals will need to tailor their antibiotic stewardship processes according to their local needs, resources and personnel. 29 Our study has a few limitations that should be acknowledged.…”

Section: Discussionmentioning

confidence: 99%

“…7 Finally, observational data from the Veterans' Health Administration (VHA) demonstrated that patients at hospitals with on-site ID support received antibiotics in a way more consistent with stewardship principles than patients at hospitals without such support. 8 Despite its benefits, many hospitals do not have access to ID expertise. Prior surveys have found that 41%-50% of US community hospitals lack an ID physician, whereas 93% lack an IDtrained pharmacist.…”

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confidence: 99%

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Antibiotic stewardship implementation at hospitals without on-site infectious disease specialists: A qualitative study

Livorsi

Steffensmeier

Perencevich

et al. 2021

Infect. Control Hosp. Epidemiol.

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Background: Hospitals are required to have antibiotic stewardship programs (ASPs), but there are few models for implementing ASPs without the support of an infectious disease (ID) specialist, defined as an ID physician and/or ID pharmacist. Objective: In this study, we sought to understand ASP implementation at hospitals that lack on-site ID support within the Veterans’ Health Administration (VHA). Methods: Using a mandatory VHA survey, we identified acute-care hospitals that lacked an on-site ID specialist. We conducted semistructured interviews with personnel involved in ASP activities. Setting: The study was conducted across 7 VHA hospitals. Participants: In total, 42 hospital personnel were enrolled in the study. Results: The primary responsibility for ASPs fell on the pharmacist champions, who were typically assigned multiple other non-ASP responsibilities. The pharmacist champions were more successful at gaining buy-in when they had established rapport with clinicians, but at some sites, the use of contract physicians and frequent staff turnover were potential barriers. Some sites felt that having access to an off-site ID specialist was important for overcoming institutional barriers and improving the acceptance of their stewardship recommendations. In general, stewardship champions struggled to mobilize institutional resources, which made it difficult to advance their programmatic goals. Conclusion: In this study of 7 hospitals without on-site ID support, we found that ASPs are largely a pharmacy-driven process. Remote ID support, if available, was seen as helpful for implementing stewardship interventions. These findings may inform the future implementation of ASPs in settings lacking local ID expertise.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Antibiotic stewardship implementation at hospitals without on-site infectious disease specialists: A qualitative study

Livorsi

Steffensmeier

Perencevich

et al. 2021

Infect. Control Hosp. Epidemiol.

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“…In the OPTIMIST multicenter randomized study, an extended PI based on medication review, motivational interview, and follow-up after discharge reduces the readmission rate to 30 and 180 days, from 22.3 to 14.3%, and from 48.8 to 39.7%, respectively ( Ravn-Nielsen et al, 2018 ). The role of the pharmacist in the correct use of medicines is recognized in various medical specialties, such as geriatrics ( Martin et al, 2018 ), infectious disease ( Livorsi et al, 2020 ), intensive care ( Lee et al, 2019 ), surgery ( Neville et al, 2014 ), and cardiology ( Zhai et al, 2016 ).…”

Section: Introductionmentioning

confidence: 99%

Acceptance Factors for In-Hospital Pharmacist Interventions in Daily Practice: A Retrospective Study

et al. 2022

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Introduction: Performing pharmacist interventions (PIs) during the medication review helps to improve the quality of care. The acceptance by the physician of these PIs is a good indicator of the quality of this clinical pharmacy activity. The objective of this study was to determine, in the Amiens-Picardie teaching hospital (France), factors of acceptance in a variable environment of activity (central pharmacy, in the care units, computer assisted).Methods: All PIs transcribed by pharmacists on the Act-IP© site between November 2018 and April 2019 were analyzed using a complementary search in patient records. The environment, type, and clinical impact on patient health of each PI was collected. Linear mixed-effects models with a random pharmacist intercept were used to investigate the relationship between PI modalities and their chance of being accepted.Results: A total of 3,100 PIs were traced, of which 2,930 had been followed over time. Of these, 2,930 PIs, 1,504 (51.3%) were performed by a postgraduate pharmacist and 1,426 (48.7%) by a pharmacy resident, 1,623 (55.4%) were performed by verbal exchange, 455 (15.5%) by telephone, 846 (28.9%) by computer software, and 6 (0.2%) by paper. The clinical impact on patient health was major for 976 PIs (33.3%) and vital for 26 PIs (0.9%). According to the Anatomical Therapeutic Chemical Classification (ATC), they were mainly related to anti-infectives (30.3%), the nervous system (18.7%), and blood and blood-forming organs (17.3%). In total, 2,415 PIs (82.4%) were accepted. According to the multivariate model, a PI was more often accepted when it was transmitted orally rather than by software (+27.7%, 95% CI: +23.2 to +32.1%) and when it was transmitted to a medical resident rather than a postgraduate physician (+4.4%, 95% CI: 1.2–7.6%). In these cases, there was a major rather than a moderate clinical impact on patient health (+4.3%, 95% CI: +1.1–+7.6%).Conclusion: This study highlights the importance of the quality of the exchange with the prescriber and the prioritization of high-risk interventions as key points of medication review to improve rate of pharmacist interventions accepted by physician.

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“…It has been reported that in pharmacist‐driven ASPs for adult patients, days of therapy (DOT) with antibiotics reduced and antibiotic prescription improved 2,3 . Furthermore, the inclusion of infectious diseases pharmacists or physicians in ASPs was associated with reduced total antibiotic use and exposure among in‐patients 4 . Proper antibiotic use is important in neonates.…”

Section: What Is Known and Objectivementioning

confidence: 99%

“…2,3 Furthermore, the inclusion of infectious diseases pharmacists or physicians in ASPs was associated with reduced total antibiotic use and exposure among in-patients. 4 Proper antibiotic use is important in neonates. Prolonged antibiotic use in neonates is associated with an increased incidence of necrotizing enterocolitis, grade 3 or 4 intraventricular haemorrhage, chronic lung disease, retinopathy of prematurity, and death.…”

Section: What Is K Nown and Objec Tivementioning

confidence: 99%

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

Lee

2021

Clinical Pharmacy Therapeu

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What is known and objective Antibiotic stewardship programmes (ASPs) are introduced to ensure effective antibiotic use. Pharmacists can be involved in ASPs to facilitate the appropriate antibiotic use. Prolonged use of antibiotics causes adverse events in critically ill neonates. Hence, this systematic review and meta‐analysis was aimed at investigating pharmacists’ functions in ASPs in critically ill neonates and the effect of ASP implementation on antibiotic use. Methods A comprehensive search of PubMed/Medline, Embase, and Cochrane Library databases until January 2021 was conducted and studies that reported the functions of pharmacists in ASPs for critically ill neonates and the results of ASP implementation were included in this review. All processes were performed by two reviewers independently, and any discordance between the two was resolved by discussion. Results and discussion In all, 19 studies were included in this review. Pharmacists were found to have various functions in ASPs, such as participating in the development of antibiotic use guidelines, auditing antibiotic prescriptions, participating in multidisciplinary ward rounds, educating other ASP team members, checking blood culture or laboratory data, and monitoring antibiotic use. A meta‐analysis revealed that ASP implementation in critically ill neonates was significantly associated with a 23% reduction in the overall antibiotic use rate (ratio of means: 0.77, 95% confidence interval: 0.69–0.87, p < 0.001). Moreover, the overall duration of antibiotic therapy significantly reduced by 15% with ASP implementation (ratio of means: 0.85, 95% confidence interval: 0.78–0.91, p < 0.001). What is new and conclusion The implementation of ASPs involving pharmacists, especially in critically ill neonates, was associated with the reduced use and duration of antibiotic treatment. Thus, pharmacists played a key role in ASPs in critically ill neonates.

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Antibiotic Stewardship Implementation and Antibiotic Use at Hospitals With and Without On-site Infectious Disease Specialists

Cited by 18 publications

References 28 publications

Antibiotic stewardship implementation at hospitals without on-site infectious disease specialists: A qualitative study

Antibiotic stewardship implementation at hospitals without on-site infectious disease specialists: A qualitative study

Acceptance Factors for In-Hospital Pharmacist Interventions in Daily Practice: A Retrospective Study

Impact of pharmacist intervention in antibiotic stewardship programmes for critically ill neonates: A systematic review and meta‐analysis

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