Changes in antimicrobial agent usage resulting from interactions among clinical pharmacy, the infectious disease division, and the microbiology laboratory

Studies have shown benefits to patients from improved interventions involving antimicrobial therapy. The purpose of the present study was to evaluate prospectively the impact of improved interventions by (i) the use of TheraTrac 2, a computer software program which electronically links susceptibility testing results immediately to the pharmacy and alerts pharmacists of potential interventions, and (ii) the education of pharmacists involving microbiologic topics. The study group had the new intervention program. The control group had interventions performed the way that they had previously been done by manually reviewing hard copies of susceptibility testing data. In a 5-month period, all inpatients whose last names began with A to K were the study group; inpatients whose last names began with L to Z were controls. Three analyses were done; one analysis (analysis A) involved only patients with interventions, one analysis (analysis B) involved all patients for whom antimicrobial testing was done and who were matched for diagnosis-related groups (DRGs), regardless of whether an intervention occurred, and one analysis (analysis C) involved these DRG-matched patients by using severity-adjusted data. In analysis A, the study group had a 4.8% decreased rate of mortality, an average of a 16.5-day decreased length of stay per patient, and $20,886 decreased variable direct costs per patient. None of these differences was statistically significant. In analysis B, the study patients had a 1.2% higher mortality rate (P ‫؍‬ 0.741), an average of a 2.7-day decreased length of stay per patient (P ‫؍‬ 0.035), and $2,626 decreased variable direct costs per patient (P ‫؍‬ 0.008). In analysis C, the study patients had a 1.4% lower mortality rate, a 1.2-day decreased length of stay per patient, and $1,466 decreased variable direct costs per patient. In conclusion, the institution of this program caused substantial cost savings.For quality assurance, many pharmacies monitor antimicrobial therapy and antimicrobial susceptibility testing (AST), potentially preventing inappropriate antimicrobial therapy by interventions with the physicians. In the past, a manual review of pertinent data sufficed, but with the advent of sophisticated computer software, there are alternatives to this. Several studies have documented the clinical and financial benefits of improved antibiotic therapy facilitated by various programs that use computer software (4-7, 9-11). In the present study, we assessed the impact of improved interventions facilitated by (i) TheraTrac 2 (bioMerieux, Hazelwood, Mo.), a computer software program which electronically notifies pharmacists of potential problems with a patient's antimicrobial therapy, and (ii) the education of pharmacists making interventions and notification of the medical staff of the program. We compared patients whose microbiologic data were processed in the normal manual manner in the pharmacy to patients whose microbiologic data were processed on a more timely basis. MATERIALS AND METHODSStudy design. Memo...

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Improved Antimicrobial Interventions Have Benefits

Barenfanger¹,

Short

Groesch

2001

“…Timely and accurate detection and reporting of bloodstream infection are therefore some of the most important functions of a clinical microbiology laboratory (2,3,5,8,11). In addition, antimicrobial susceptibility test (AST) results can affect both the clinician's choice of antimicrobial therapy and the patient's outcome (12,13). If the laboratory reports results that are erroneous, patients with bloodstream infection may not receive optimal therapy.…”

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confidence: 99%

Accuracy and Appropriateness of Antimicrobial Susceptibility Test Reporting for Bacteria Isolated from Blood Cultures

Diekema

Lee²,

Raney

et al. 2004

Accurate antimicrobial susceptibility testing (AST) and appropriate reporting of AST results for pathogens isolated from blood cultures are critical functions of the microbiology laboratory. We studied AST performance and reporting from positive blood cultures at hospital microbiology laboratories in Iowa. One hundred sixteen episodes of bacteremia from 14 participating hospitals were examined. We detected AST or identification errors for 18 episodes (16%) and judged reporting of AST results to be inappropriate for 38 episodes (33%). Further study is necessary to determine the impact of testing errors and suboptimal reporting of results on the management of bloodstream infection.Bloodstream infections cause substantial morbidity and mortality, with up to one-quarter of affected patients dying as a result of their infection (14,15). Early receipt of appropriate antimicrobial therapy has been demonstrated to improve the outcome of bloodstream infection (1, 7). Timely and accurate detection and reporting of bloodstream infection are therefore some of the most important functions of a clinical microbiology laboratory (2,3,5,8,11). In addition, antimicrobial susceptibility test (AST) results can affect both the clinician's choice of antimicrobial therapy and the patient's outcome (12,13). If the laboratory reports results that are erroneous, patients with bloodstream infection may not receive optimal therapy. In addition, reporting all AST results for an organism, rather than reporting selectively (e.g., "cascading," or only reporting the narrowest-spectrum agents to which the organism is susceptible), may encourage inappropriate antibiotic use. Thus, prompt detection of bloodstream infection, accurate microbial identification and susceptibility testing, and appropriate reporting of results are important patient safety issues (6).We assessed the preanalytical, analytical, and postanalytical errors made by microbiology laboratories related to the detection, identification, AST, and reporting of results from positive blood cultures. The goal of the study was to identify key areas for improvement in order to guide the development and implementation of an educational intervention for laboratory personnel.The microbiology laboratories of 14 Iowa hospitals participated in this study. The hospitals were all participating in the Emerging Infections and Epidemiology of Iowa Organisms study, a statewide antimicrobial resistance surveillance network (4). These hospitals were chosen based upon geographic location, population distribution, and hospital bed size. Hospital size ranged from 89 to 820 acute care beds (median of 175 beds) and included rural, rural-referral, and urban hospitals.We studied organisms from five consecutive positive blood cultures from unique patients from whom gram-positive pathogens were isolated and five consecutive positive blood cultures from unique patients from whom gram-negative pathogens were isolated. All isolates were deemed clinically significant. A research assistant, infection control profess...

“…Simply generating a computer report that conveys the results of ASTs and launching it into cyberspace does not ensure that anyone will actually see it and then process the information contained in the report. In this regard, although understandably more onerous to accomplish, it is clear that direct communication of AST results to HCPs, especially when accompanied by an explanation of what the results might mean in the care of individual patients, has been shown to have a much more compelling impact on antibiotic usage than passive reports of computerized results (9,10). This reality provides yet another rationale for active interventions by a trained clinical pharmacologist as part of a rigorous antimicrobial stewardship program.…”

Section: The Role Of the Clinical Microbiology Laboratory In Stewardshipmentioning

confidence: 99%

Antimicrobial Stewardship Programs

Leuthner

Doern

2013

The development of antimicrobial agents represents one of the most significant achievements in medicine during the past century. However, the emergence of antimicrobial resistance combined with the downturn in the development of new antimicrobial agents in the pharmaceutical industry poses unanticipated challenges in the effective management of infection. The issue of how we can most effectively utilize these invaluable resources, antimicrobials, in the face of infections that are ever more difficult to treat arises. This issue serves as the fundamental basis for the concept of antimicrobial stewardship, the topic of this minireview.