Antimicrobial stewardship through telemedicine and its impact on multi-drug resistance

Abstract

Introduction Telemedicine technologies are increasingly being incorporated into infectious disease practice. We aimed to demonstrate the impact of antimicrobial stewardship through telemedicine on bacterial resistance rates. Methods We conducted a quasi-experimental study in a 220-bed hospital in southern Brazil. An antimicrobial stewardship program incorporating the use of telemedicine was implemented. Resistance and antimicrobial consumption rates were determined and analysed using a segmented regression model. Results After the intervention, the rate of appropriate antimicrobial prescription increased from 51.4% at baseline to 81.4%. Significant reductions in the consumption of fluoroquinolones (level change, β = -0.80; P < 0.01; trend change, β = -0.01; P = 0.98), first-generation cephalosporins (level change, β = -0.91; P < 0.01; trend change, β = +0.01; P = 0.96), vancomycin (level change, β = -0.47; P = 0.04; trend change, β = +0.17; P = 0.66) and polymyxins (level change, β = -0.15; P = 0.56; trend change, β = -1.75; P < 0.01) were identified. There was an increase in the consumption of amoxicillin + clavulanate (level change, β = +0.84; P < 0.01; trend change, β = +0.14; P = 0.41) and cefuroxime (level change, β = +0.21; P = 0.17; trend change, β = +0.66; P = 0.02). A significant decrease in the rate of carbapenem-resistant Acinetobacter spp. isolation (level change, β = +0.66; P = 0.01; trend change, β = -1.26; P < 0.01) was observed. Conclusions Telemedicine, which provides a tool for decision support and immediate access to experienced specialists, can promote better antibiotic selection and reductions in bacterial resistance.

Changes in antibiotic use following implementation of a telehealth stewardship pilot program

“…Three publications have described successful tele-stewardship programs in which specialists reviewed antibiotic prescriptions and communicated recommendations via secure websites, secure messaging systems, or the electronic medical record. [7][8][9] Moreover, 4 reports have described tele-consultation interventions that used secure videoconference technology to bring individuals from remote locations together for regularly scheduled, multidisciplinary team meetings. [10][11][12][13] An additional publication describes an on-demand approach in which providers requested advice from an on-call infectious disease expert and received real-time feedback over the telephone and through the electronic medical record.…”

“…14 Of these 8 programs, 5 detailed quantifiable decreases in the use of antibiotics and prevalence of multidrugresistant pathogens or Clostridiodes difficile. [7][8][9][10][11] Additionally, with the exception of a single report that reported an intervention in a long-term acute-care hospital, 7 the remaining programs focused on acute-care settings.…”

Tele‐antimicrobial stewardship programs: A review of the literature and the role of the pharmacist

“…Fully remote TASPs include an offsite ID specialist conducting PAIF on individual patient cases and directly contacting prescribers through various telehealth delivery systems. Examples include on‐demand review of antibiotic prescriptions facilitated by requests through a secure web application 19,20 or telephone hotline, 21 or TASP‐driven PAIF with a shared EHR and/or clinical decision support software (CDSS) 22,29 . These models may or may not include engagement of on‐site pharmacists, and only some were able to demonstrate measurable decreases in antimicrobial consumption, prevalence of multidrug‐resistant organisms (MDRO), or declining CDI rates as a proof of concept for TASP 20,22,23 .…”

“…Examples include on‐demand review of antibiotic prescriptions facilitated by requests through a secure web application 19,20 or telephone hotline, 21 or TASP‐driven PAIF with a shared EHR and/or clinical decision support software (CDSS) 22,29 . These models may or may not include engagement of on‐site pharmacists, and only some were able to demonstrate measurable decreases in antimicrobial consumption, prevalence of multidrug‐resistant organisms (MDRO), or declining CDI rates as a proof of concept for TASP 20,22,23 . Most of these studies focused on acute care settings, whereas one uniquely focused on a long‐term acute care hospital (LTACH) 23 .…”

“…Dos Santos et al described a fully remote TASP to support remote small community hospitals in Brazil with no on‐site clinicians performing stewardship activities 19,20 . A secure, web‐based portal (http://www.portalqualis.com.br) was created to facilitate requests for an on‐demand second opinion for antimicrobial prescriptions by remote ID physicians practicing at a 250‐bed tertiary hospital.…”