Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions

Stenehjem, Edward; Hyun, David Y.; Septimus, Ed; Yu, Kalvin; Meyer, Marc; Raj, Deepa; Srinivasan, Arjun

doi:10.1093/cid/cix407

Cited by 84 publications

(68 citation statements)

References 37 publications

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“…In turn, little has been reported on AMS practices in small cities where hospitals may have < 50 beds and where, in some countries, two-thirds of the health care force is engaged ( 22 ). AMS implementation may encounter difficulties in hospitals with limited financial and human resources, few training opportunities, and other factors ( 3 , 23 ); however, ASPs can be tailored to the context, so long as comparable metrics are used ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

Hegewisch-Taylor

Dreser

Romero-Mónico

et al. 2020

Revista Panamericana De Salud Pública

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Objectives. To examine published antimicrobial stewardship (AMS) initiatives in hospitals in Latin America and the Caribbean (LAC) in order to characterize AMS terminology usage, geotemporality, and elements of structure (human resources), process (interventions), and outcomes, and to set priority areas for improving AMS reporting. Methods. This was a scoping review that searched PubMed, LILACS, EMBASE, and 12 other databases, along with a manual search for academic and grey literature to identify documents on AMS initiatives in hospitals in 33 countries of LAC, up to August 2019. Keywords included ‘antibiotic’ or ‘antimicrobial’ AND ‘stewardship, policy, strategies, management, control, rational use, appropriate use, surveillance, or interventions’ and 33 country names. Results. Selected articles totalled 147 studies published in 1985 – 2019; of those, 22% used ‘antimicrobial stewardship’ in the title. Eighteen countries published AMS hospital initiatives, one-half of which were implemented in capital cities. Brazil, Argentina, Colombia, Cuba, Mexico, and Chile, in descending frequency, made up > 59% of published initiatives. Educational interventions were the most frequently reported, followed by persuasive and restrictive strategies. Antimicrobial consumption was the most common outcome measure reported. About one-third of the studies (35%) referred to baseline measures-only in preparation for AMS interventions. Fifty-nine studies from 6 countries reported AMS comprehensively, using structure, process, and outcome (SPO) elements. Conclusions. Published hospital AMS initiatives have increased over time and have expanded across LAC. However, more programs need to be developed. Complete reporting of SPO elements is imperative to evaluating and replicating AMS actions.

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Section: Discussionmentioning

confidence: 99%

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

Hegewisch-Taylor

Dreser

Romero-Mónico

et al. 2020

Revista Panamericana De Salud Pública

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“…Es importante mencionar que para fortalecer los programas de uso racional de antimicrobianos es necesario integrar al equipo a farmacéuticos para mejorar el apego a las recomendaciones de la terapéutica antimicrobiana. Los farmacéuticos tienen un papel importante en la optimización de los recursos a través de una mejor prescripción, en el monitoreo del uso de antimicrobianos, en el control de infecciones y en la educación del personal de salud ( 4 , 12 ). Este punto también es importante generar información nacional sobre la integración de los farmacéuticos a las instituciones nacionales integrados a los programas de uso racional de antimicrobianos y su impacto en este tipo de fármacos…”

Section: Discussionunclassified

Resultados del Programa de Uso Racional de Antimicrobianos en un hospital de México, 2013-2018

Sosa-Hernández

Vázquez-Zamora

Gutiérrez-Muñoz

et al. 2020

Revista Panamericana De Salud Pública

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Objetivo. Describir los resultados del Programa de Uso Racional de Antimicrobianos en el Hospital Juárez de México. Métodos. Se diseñó un estudio de tipo observacional, transversal, retrospectivo y descriptivo. Se analizó el consumo de antimicrobianos de enero de 2013 a diciembre de 2018 a través del cálculo de la dosis diaria definida (DDD); para el análisis de costos se realizó un cálculo de costeo tradicional. Resultados. En el grupo de los carbapenémicos, es notable la reducción en el consumo de imipenem/cilastina: se pasó de una DDD en el 2013 de 2,3 a 0,7 en el 2018, con una reducción de 70%. En cambio, en los otros dos fármacos, se ha observado un incremento. En meropenem se registró de 2% (de 2,4 en 2013 a 2,5 en 2018); en el consumo de ertapenem el incremento es de 75% (de 1 en 2013 a 1,8 en 2018). En total, el gasto de antimicrobianos durante 2013 fue de $930 556,46, mientras que en 2018 fue de $856 079,10, con una diferencia de 8%, lo que equivale a $74 905,61 del gasto total (los valores se expresan en dólares estadounidenses). Conclusiones. Se necesita evaluar de manera constante los programas para el uso racional de antimicrobianos, mediante el monitoreo del consumo y el gasto derivado.

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“…66,72 Selain itu, kerjasama antarinstitusi dapat dilakukan untuk mengatasi keterbatasan dalam mengimplementasikan ASP, dan kerjasama tersebut tidak terbatas antarinstitusi kesehatan saja, tetapi juga dapat berupa kerjasama antara institusi kesehatan dan institusi pendidikan. 73 Proses identifikasi bentuk dan teknis kerjasama antarinstitusi perlu dilakukan agar implementasi ASP dapat memberikan manfaat bagi seluruh pihak yang terlibat dalam kerja sama.…”

Section: Upper-middle-income Economies (N) High-income Economies (N)unclassified

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis

Setiawan

Wibowo

Setiadi

et al. 2019

ijcp

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AbstrakAntimicrobial Stewardship Program (ASP) merupakan salah satu program yang direkomendasikan untuk meningkatkan ketepatan penggunaan antibiotik, khususnya pada setting rumah sakit. Keberhasilan implementasi program tersebut ditentukan oleh banyak faktor, antara lain komunikasi antartenaga kesehatan dan ketersediaan sumber daya manusia maupun sarana-prasarana. Sampai saat ini, bukti penelitian terkait implementasi ASP di Asia, khususnya di negara low-dan lower-middle-income economies, masih terbatas. Tujuan kajian sistematik ini adalah mengidentifikasi jenis strategi ASP yang diimplementasikan di berbagai negara Asia dengan berbagai income status, dan memberikan gambaran dampak dari implementasi ASP terhadap luaran klinis, mikrobiologis, dan finansial. Proses penelusuran pustaka dilakukan dengan menggunakan basis data PUBMED dan kata kunci "antimicrobial stewardship" dan "Asia" yang dikombinasikan dengan Boolean operator yaitu "AND". Total terdapat 28 penelitian dari sembilan negara diikutsertakan dalam kajian akhir. Belum ditemukan bukti penelitian terpublikasi terkait ASP di Indonesia. Hanya terdapat satu penelitian berasal dari negara lower-middle-income economies dan penelitian tersebut dilakukan pada institusi kesehatan tersier. Sebagian besar penelitian, yakni 22, berasal dari negara high-middle-income economies, dan 18 dari antaranya dilakukan di rumah sakit tersier atau rumah sakit yang berafiliasi pada institusi pendidikan tinggi. Jenis intervensi ASP yang paling banyak diimplementasikan adalah audit peresepan antibiotik secara prospektif dan disertai dengan pemberian umpan balik, dan penerapannya terbukti dapat menghasilkan luaran yang positif baik secara klinis, mikrobiologis, maupun finansial. Dengan mempertimbangkan dampak positif tersebut, sangat diharapkan agar ASP dapat diimplementasikan pada institusi kesehatan di Indonesia dengan memperhatikan ketersediaan sumber daya dan konteks budaya lokal. AbstractAntimicrobial Stewardship Program (ASP) is one of the recommended programs to optimize the prudent use of antimicrobials, particularly in the hospital settings. The successful ASP implementation is determined by numerous factors, including communication among healthcare workers, and the availability of human resources and facilities. There is limited evidence available regarding the ASP implementation in Asia, particularly in the low-and lower-middle income countries. This systematic review aimed to identify the type of ASP interventions implemented in Asian countries according to the income status and to describe the impact of ASP implementation on the clinical, microbiological, and financial outcomes. The search strategy was undertaken using PUBMED, and the search terms were "antimicrobial stewardship" and "Asia" which were combined with the use of a Boolean operator "AND". In total, 28 articles from nine countries were included in the final review. No article from Indonesia could be found in this systematic review. There was only an article from a lower-middle income country that was conduct...

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Antibiotic Stewardship in Small Hospitals: Barriers and Potential Solutions

Cited by 84 publications

References 37 publications

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

Antimicrobial stewardship in hospitals in Latin America and the Caribbean: a scoping review

Resultados del Programa de Uso Racional de Antimicrobianos en un hospital de México, 2013-2018

Implementasi Antimicrobial Stewardship Program di Kawasan Asia: Sebuah Kajian Sistematis

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