Effect of a “handshake” stewardship program versus a formulary restriction policy on High-End antibiotic use, expenditure, antibiotic resistance, and patient outcome

Moghnieh, Rima; Awad, Lyn; Abdallah, Dania; Jadayel, Marwa; Sinno, Loubna; Tamim, Hani; Jisr, Tamima; El-Hassan, Salam; Lakkis, Rawad; Dabbagh, Rima; Bizri, Abdul Rahman

doi:10.1080/1120009x.2020.1755589

Cited by 21 publications

(46 citation statements)

References 33 publications

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“…Notably, there was a compensatory increase in consumption of other antibiotics, like piperacillin-tazobactam and third and fourth generation cephalosporins, in the hospital as a whole. This was due to the various complicated cases frequently managed in our facility, such as neutropenic patients with cancer, bone marrow transplant recipients, and critically ill patients [10]. Piperacillin-tazobactam is a less potent inducer of antimicrobial resistance in Gram-negative bacteria compared to carbapenems, fluoroquinolones, and extended-spectrum cephalosporins [42,43].…”

Section: Discussionmentioning

confidence: 99%

“…One potential side effect of drug-oriented ASPs is that decreasing consumption of one antimicrobial can result in increased consumption of another one. Despite similar patient population complexity in our tertiary care facility before and during the intervention, decreased tigecycline use was not compensated for by increased consumption of carbapenems or colistin [ 10 ]. Implementing the handshake ASP in our facility led to an important reduction in the density and rate of prescribing other broad-spectrum antibiotics, including the antipseudomonal carbapenems imipenem and meropenem and colistimethate sodium [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ASP was adopted by the hospital starting in September 2016 and was based on the "handshake" strategy of prospective audit and immediate feedback to prescribers. The aims were to decrease high-end antibiotic use, namely antipseudomonal carbapenems and colistimethate sodium, and to control tigecycline use based on its utilization review [9,10].…”

Section: Setting and Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…These results indicated a need to improve tigecycline prescription procedures. Therefore, a drug-oriented antibiotic stewardship intervention was launched in our facility in 2016 as a part of a comprehensive “Handshake Antibiotic Stewardship Program” (ASP) [ 10 ]. The primary endpoints of the current study were to observe the intervention effects on: Shifting tigecycline use from the clinically vulnerable patient population toward the less critical population by avoiding its use in patients with signs of clinical severity, like hemodynamic failure and in those on mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

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The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Moghnieh

Abdallah

Awad

et al. 2020

Ann Clin Microbiol Antimicrob

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Background: A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods: This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results: Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion: The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Setting and Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Moghnieh

Abdallah

Awad

et al. 2020

Ann Clin Microbiol Antimicrob

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Global resilience and new strategies needed for antimicrobial stewardship during the COVID‐19 pandemic and beyond

Goff

Gauthier

Langford

et al. 2022

J Am Coll Clin Pharm

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Resilience is having the ability to respond to adversity proactively and resourcefully. The coronavirus disease 2019 (COVID‐19) pandemic's profound impact on antimicrobial stewardship programs (ASP) requires clinicians to call on their own resilience to manage the demands of the pandemic and the disruption of ASP activities. This article provides examples of ASP resilience from pharmacists and physicians from seven countries with different resources and approaches to ASP—The United States, The United Kingdom, Canada, Nigeria, Lebanon, South Africa, and Colombia. The lessons learned pertain to providing ASP clinical services in the context of a global pandemic, developing new ASP paradigms in the face of COVID‐19, leveraging technology to extend the reach of ASP, and conducting international collaborative ASP research remotely. This article serves as an example of how resilience and global collaboration is sustaining our ASPs by sharing new “how to” do antimicrobial stewardship practices during the COVID‐19 pandemic.

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Optimizing rapid diagnostics and diagnostic stewardship in Gram‐negative bacteremia

et al. 2021

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Antimicrobial resistance remains a high global concern, as it is associated with prolonged hospitalizations, increased morbidity and mortality, and escalating healthcare‐related costs. Rapid diagnostic technology (RDT) has become the cornerstone in achieving prompt blood culture results providing a quicker initiation of optimal therapy, decreased mortality, and decreased spread of resistance. To maximize the benefits of RDTs, antimicrobial stewardship programs must implement a diagnostic stewardship (DS) subgroup to optimize communication, education, and interpretation of RDT results within the healthcare system. The DS subgroup is necessary to evaluate the technologies available, better integrate the selected technologies into the healthcare system, and develop innovative and appropriate use to improve patient outcomes.

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Effect of a “handshake” stewardship program versus a formulary restriction policy on High-End antibiotic use, expenditure, antibiotic resistance, and patient outcome

Cited by 21 publications

References 33 publications

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Global resilience and new strategies needed for antimicrobial stewardship during the COVID‐19 pandemic and beyond

Optimizing rapid diagnostics and diagnostic stewardship in Gram‐negative bacteremia

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