Antimicrobial Stewardship Programs in Florida's Acute Care Facilities

Abbo, Lilian M.; Lo, Kaming; Sinkowitz‐Cochran, Ronda L.; Burke, A.C.; Hopkins, Richard S.; Srinivasan, Arjun; Hooton, Thomas M.

doi:10.1086/670632

Cited by 17 publications

(21 citation statements)

References 9 publications

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“…However, many microbiology laboratories focus on processing specimens and providing quality results without engaging in antimicrobial stewardship programs, which are usually led by ID physicians and pharmacists (60). Studies performed in California and Florida showed that microbiologists participated in antimicrobial stewardship activities in 26% and 42% of the hospitals surveyed, respectively (61,62). A nationwide electronic survey, in which only half of the respondents reported having an institutional antimicrobial stewardship program, found similar results (63).…”

Section: Drugmentioning

confidence: 97%

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

2017

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Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.

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Section: Drugmentioning

confidence: 97%

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

2017

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“…Our study has demonstrated that the introduction of an antimicrobial decision support tool into the ICU, ensuring the pre-conditions of microbiological specimens sampling before therapeutic antimicrobials use, was associated with measurable improvements in both initial antimicrobial use and overall use. Given that it has long been recognized that the inability to easily get access on data on local antimicrobial use patterns can be a gap [39][40][41], standardized metrics to individual facilities across a healthcare system has been a major advance. CDSS linked to EMRS and other clinical systems to this computerized platform has been proved to have the potential to facilitate the dissemination of information to intensivists for optimal use in therapeutic decision-making [42][43][44][45][46].…”

Section: Primary Outcomesmentioning

confidence: 99%

Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

Song

Zhu

et al. 2020

Preprint

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Objective This study aimed to evaluate the effect of a comprehensive antimicrobial stewardship program (ASP) and provide clinical evidence for the scientific stewardship of antimicrobials in intensive care units (ICUs) of a teaching hospital.Methods Between January 2013 and December 2018, we conducted a prospective study, based on an antimicrobial computerized clinical decision support system (aCDSS) deployed in 2015 in ICUs of a tertiary and teaching hospital. The primary outcomes included initial and overall use prevalence of antimicrobials. The second outcomes were the detection rate of common clinical isolates before and after therapeutic antimicrobial use, and the change in patterns of resistance of 5 common clinical isolates in the ICU.Results Various types of broad-spectrum antimicrobial use prevalence continued to increase from 2013 to 2015, since 2016, where initial use of carbapenems and glycopeptides were counterbalanced by an increase in use of the first/second-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations and linezolid. From 2015 to 2018, the proportion of extended-broad spectrum antimicrobials alone, wide-coverage therapy and combination therapy decreased significantly (P<0.05). Similarly, where use of carbapenems, glycopeptides, third/fourth-generation cephalosporins and anti-fungi agents were counterbalanced by an increase in overall use of the first/second-generation cephalosporins and β-lactam and β-lactamase inhibitor combinations. A total of 21891 strains of bacteria and fungi were detected in ICUs from 2015 to 2018, of them, 6.5% (1426/21891) strains were detected before antimicrobial treatment. The detection proportion of Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae and fastidious bacteria were significantly higher before antimicrobial treatment (P<0.05), while Acinetobacter baumannii , Burkholderia cepacia , and Candida spp were significantly lower in all non-repetitive clinical isolates (P<0.05).Conclusions The implementation of a comprehensive ASP combining CDSS in ICUs seems to be effective to improve outcomes on antimicrobial utilization and clinical isolates distribution in critically ill patients.

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“…Similarly, a survey of ASPs in 82 acute care institutions in Florida reported the most common outcome measure by 56 facilities was drug purchasing costs (70%); only 43, 38 and 34% of facilities assessed patient outcomes, LOS, and adverse drug reactions, respectively. In addition, of perceived reasons for antimicrobial misuse, 84% of clinicians feared being sued for untreated infections [31]; further evidence of the undue pressures on prescribers promoting inappropriate antibiotic use. A recent worldwide review of studies, including many from European countries, that assessed the impact of quality measures in ASPs noted only 13 of 63 studies reported on patient outcomes such as mortality and length of stay.…”

Section: The Role Of Antimicrobial Stewardshipmentioning

confidence: 99%

Combating Resistance While Maintaining Innovation: The Future of Antimicrobial Stewardship

et al. 2019

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Antimicrobial resistance represents a significant global health threat. However, a commercial model that does not offer a return on investment resulting in a lack of investment in antibiotic R&D, means that the current pipeline of antibiotics lacks sufficient innovation to meet this challenge. Those responsible for defining, promoting and monitoring the rationale use of antibiotics (the antimicrobial stewardship programme) are key to addressing current shortcomings. In this personal perspective, we discuss the future role stewardship can play in stimulating innovation, a need to move away from a pharmacy budget dominated view of antibiotic use, and the impact of the ever-increasing sophistication and interdisciplinary nature of antimicrobial control programs. Changes are needed to optimize clinical outcomes for patients.

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Antimicrobial Stewardship Programs in Florida's Acute Care Facilities

Cited by 17 publications

References 9 publications

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

Combating Resistance While Maintaining Innovation: The Future of Antimicrobial Stewardship

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