Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities

Abstract

The model suggests that implementation of antimicrobial stewardship programs in outpatient dialysis facilities would result in substantial reductions in infections caused by multidrug-resistant organisms and , infection-related deaths, and costs.

Antimicrobial Stewardship and Its Impact on the Changing Epidemiology of Polymyxin Use in a South Indian Healthcare Setting

“…The predominance of Klebsiella pneumoniae and Pseudomonas species observed in our study cohort mirrored the high prevalence of Gram Negative Bacteria (GNB) reported in the Indian population, warranting the use of reserved drugs like polymyxins in healthcare settings across the country [ 4 , 20 ]. Our study emphasizes the importance and effectiveness of ASP initiatives in improving the indiscriminate prescription patterns of last resort antimicrobials used in the treatment of MDR organisms and potential survival benefits [ 21 ].…”

Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group

“…11 Optimizing antibiotic use can play an important role in improving infection cure rates, preventing sepsis, reducing the unintended negative consequences of antibiotic use and possibly reducing costs. 12 The Antibiotic Stewardship in Hemodialysis (ASHD) White Paper Writing Group is a collaboration between CDC and the American Society of Nephrology (ASN). Given nationwide interest in optimizing antibiotic use in various patient populations, the objectives of the workgroup were to summarize current literature on antibiotic use in the outpatient hemodialysis setting and highlight strategies to improve antibiotic prescribing in hemodialysis.…”

“… 11 Optimizing antibiotic use can play an important role in improving infection cure rates, preventing sepsis, reducing the unintended negative consequences of antibiotic use and possibly reducing costs. 12 …”

“… 57.5% of new outpatient IV antibiotic starts were classified as inappropriate, using an unvalidated application of surveillance data to estimate appropriateness. Other Studies D’Agata/2018 12 - Model the clinical and economic consequences of implementing a nationwide antibiotic stewardship program in outpatient dialysis facilities in the U.S. Decision analytical model and cost consequence analysis in a given year Implementation of a nationwide antibiotic stewardship program for dialysis patients is predicted to result in decreased infections caused by C. difficile and multi-drug resistant organisms, and cost savings to society (107 million USD). Abbreviations: AV, arteriovenous; AVF, arteriovenous fistula; CVC, central venous catheter; HD, hemodialysis; ID, infectious diseases; IV, intravenous; NHSN, National Healthcare Safety Network; PD, peritoneal dialysis; VICNISS, Victorian Healthcare Associated Infection Surveillance System; USRDS, United States Renal Data System.…”

“…On a national level, antibiotic stewardship programs in outpatient hemodialysis facilities may be cost effective. 12 Dialysis organizations with strong clinical infrastructure provide an opportunity to evaluate the effectiveness of existing and novel antibiotic stewardship interventions in a formal and robust fashion. Several aspects of stewardship initiatives may be overlapping with infection surveillance, sepsis prevention and management efforts, improving care transitions, and other quality improvement efforts.…”