Antimicrobial stewardship

Chung, Gladys Wei-Teng; Wu, Jia En; Yeo, Cheo Lian; Chan, Douglas S.; Hsu, Li Yang

doi:10.4161/viru.21626

Cited by 82 publications

(31 citation statements)

References 57 publications

(83 reference statements)

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“… 9 One of the advantages of this intervention is that it enables real-time education of physicians without infringing upon physician autonomy to prescribe medications. 18 Some studies have demonstrated that implementation of a pharmacist-led VCM dosing protocol achieved a higher percentage of patients with VCM trough concentrations within the therapeutic range. 19 , 20 However, there are few hospitals implementing such pharmacist-managed protocol therapy, because pharmacists are not permitted to write prescriptions and perform clinical laboratory tests in Japan.…”

Section: Discussionmentioning

confidence: 99%

Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant <em>Staphylococcus aureus</em> infections: a single institution experience

Hirano¹,

Sakamoto

Kitazawa

et al. 2016

IDR

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BackgroundVancomycin (VCM) requires dose adjustment based on therapeutic drug monitoring. At Aomori Prefectural Central Hospital, physicians carried out VCM therapeutic drug monitoring based on their experience, because pharmacists did not participate in the dose adjustment. We evaluated the impact of an Antimicrobial Stewardship Program (ASP) on attaining target VCM trough concentrations and pharmacokinetics (PK)/pharmacodynamics (PD) parameters in patients with methicillin-resistant Staphylococcus aureus (MRSA) infections.Materials and methodsThe ASP was introduced in April 2012. We implemented a prospective audit of prescribed VCM dosages and provided feedback based on measured VCM trough concentrations. In a retrospective pre- and postcomparison study from April 2007 to December 2011 (preimplementation) and from April 2012 to December 2014 (postimplementation), 79 patients were treated for MRSA infection with VCM, and trough concentrations were monitored (pre, n=28; post, n=51). In 65 patients (pre, n=15; post, n=50), 24-hour area under the concentration–time curve (AUC 0–24 h)/minimum inhibitory concentration (MIC) ratios were calculated.ResultsPharmacist feedback, which included recommendations for changing dose or using alternative anti-MRSA antibiotics, was highly accepted during postimplementation (88%, 29/33). The number of patients with serum VCM concentrations within the therapeutic range (10–20 μg/mL) was significantly higher during postimplementation (84%, 43/51) than during preimplementation (39%, 11/28) (P<0.01). The percentage of patients who attained target PK/PD parameters (AUC 0–24 h/MIC >400) was significantly higher during postimplementation (84%, 42/50) than during preimplementation (53%, 8/15; P=0.013). There were no significant differences in nephrotoxicity or mortality rate.ConclusionOur ASP increased the percentage of patients that attained optimal VCM trough concentrations and PK/PD parameters, which contributed to the appropriate use of VCM in patients with MRSA infections.

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Section: Discussionmentioning

confidence: 99%

Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant <em>Staphylococcus aureus</em> infections: a single institution experience

Hirano¹,

Sakamoto

Kitazawa

et al. 2016

IDR

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“…ID physicians provide a standard referral service whereas the prospective audit and feedback system of our ASP is also standard and has been described elsewhere [4,5]. Clinical and demographic data were extracted from our ASP database as well as the hospital electronic records.…”

Section: Setting and Methodsmentioning

confidence: 99%

Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital

Yeo

Chung

Chan

et al. 2013

Antimicrob Resist Infect Control

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BackgroundThe optimal way for antimicrobial stewardship programs (ASPs) to interact with existing infectious disease physician (IDP) services within the same institution is unknown. In our institution, IDPs and our prospective audit and feedback ASP operate independently, with occasionally differing recommendations offered for the same inpatient. We performed a retrospective audit on inpatients that had been reviewed by both IDPs and ASP within a 7-day period, focusing on cases where different therapy-modifying recommendations had been offered. We analyzed the outcomes in inpatients where the ASP recommendations were accepted and compared these with the inpatients where the IDP recommendations were accepted instead. Outcomes assessed were 30-day mortality post-ASP review, unplanned re-admission within 30 days post-discharge from hospital, and clinical deterioration at 7 days post-ASP review.FindingsThere were 143 (18.9%) patients where differing recommendations had been offered, with primary physicians accepting 69.9% of ASP recommendations. No significant differences in terms of demographics, clinical characteristics, 30-day mortality, and re-admission rates were observed, although clinical deterioration rates were lower in patients where the ASP recommendation was accepted (8.0% vs. 27.9%; p = 0.002). On multivariate analysis, hematology-oncology inpatients were associated with unplanned readmission. Increasing age and hematology-oncology inpatients were associated with clinical deterioration 7 days post-recommendation, whereas acceptance of ASP recommendations was protective. No characteristic was independently associated with 30-day mortality.ConclusionIn conclusion, independent reviews by both IDPs and ASPs can be compatible within large tertiary hospitals, providing primary physicians even in situations of conflicting recommendations viable alternative antimicrobial prescribing advice.

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“…A principal component of monitoring that should be performed is daily prospective audit and feedback. This is conducted by a clinical infectious diseases pharmacist or physician and is one of the core activities undertaken by an antimicrobial stewardship program [ 25–27 ]. Hospitals can invest in pharmacosurveillance and data-mining software applications to readily identify patient cases that are candidates for stewardship interventions.…”

Section: Monitoringmentioning

confidence: 99%

The Hospital Antimicrobial Use Process: From Beginning to End

Truong

Yamaki

2018

Open Forum Infectious Diseases

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Hospital antimicrobial stewardship (AMS) programs are responsible for ensuring that all antimicrobials are utilized in the most appropriate and safe manner to improve patient outcomes, prevent adverse drug reactions, and prevent the development of antimicrobial resistance. This Perspectives article outlines the hospital antimicrobial use process (AUP), the foundational system that ensures that all antimicrobials are utilized in the most appropriate and safe manner. The AUP consists of the following steps: antimicrobial ordering, order verification, preparation and delivery, administration, monitoring, and discharge prescribing. AMS programs should determine how each step contributes to how an antimicrobial is used appropriately or inappropriately at their institution. Through this understanding, AMS programs can integrate stewardship activities at each step to ensure that every opportunity is taken to optimize antimicrobial use during a patient’s treatment course. Hence, approaching AMS through the framework of a hospital’s AUP is essential to improving appropriate antimicrobial use.

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Antimicrobial stewardship

Cited by 82 publications

References 57 publications

Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant <em>Staphylococcus aureus</em> infections: a single institution experience

Pharmacist-managed dose adjustment feedback using therapeutic drug monitoring of vancomycin was useful for patients with methicillin-resistant <em>Staphylococcus aureus</em> infections: a single institution experience

Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital

The Hospital Antimicrobial Use Process: From Beginning to End

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