Designing antimicrobial stewardship initiatives to enhance scientific dissemination

Abstract

Antimicrobial overuse and resistance pose an immediate threat to human health. Antimicrobial stewardship (AMS) refers to efforts designed to improve antimicrobial use and optimize associated outcomes across health care settings. Pharmacists are integral leaders of AMS teams and are increasingly engaged in AMS research. However, AMS scholarship often lacks scientific rigor and subsequently, representative evidence in AMS guidelines is low quality. Because pharmacists are often on the front lines of AMS in health care systems, they must be cognizant of robust AMS study design to increase both quality and generalizability of their AMS interventions and observations. Sustainability of AMS interventions is equally important. This paper provides a primer for pharmacists engaged in AMS on fundamental AMS scholarship concepts including defining the study objective, study design, study methodology, data analysis, and promoting sustainability of the intervention. Recommendations are made for pharmacists across the spectrum of AMS, from new to well‐established programs. Additional AMS training and AMS scholarship is needed to support both the profession and pharmacists engaged in AMS. A concerted effort by pharmacists to enhance the quality of AMS research may improve AMS scholarship impact and further enhance outcomes throughout the continuum of care.

Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

“…Interpretation of the literature is difficult, due to use of different definitions and inconsistent methodology. To increase sample size and power, community-onset and HO-CDI were merged despite vast differences in the spectrum of activity of oral and intravenous antimicrobials used in the two respective settings [28]. Moreover, all penicillins were classified in one category, despite the huge difference in the spectrum of activity of piperacillin-tazobactam and penicillin G, for example [29].…”

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

“…However, there remains a need for additional high-quality data in the areas of diagnostic stewardship, dose optimization, PAF, and preauthorization as well as the impact of multimodal approaches or stewardship bundles. 70 Furthermore, exploration of the impact on specific patient populations, such as acute leukemia patients or HCT recipients, with various levels of immunosuppression is also needed.…”

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2018

“…The scholarship highlighted in this review demonstrates a continued commitment to novel models of stewardship interventions, value assessment of mRDT implementation, and integration of stewardship into areas outside the traditional inpatient walls of an academic medical center (eg, community hospitals, LTC facilities). As the quantity of stewardship publications increases, it is important that the quality and scientific rigor of research increases as well [13]. For many inpatient institutions, antimicrobial stewardship is not a new concept; thus scholarship demonstrating sustainability is important.…”

“…Many questions on the optimal execution of antimicrobial stewardship activities still remain. Given the variability in institutional settings, local epidemiologic patterns, patient mix, and available resources, continued research on successful and optimal ASP interventions is needed [13].…”