Effectiveness of antimicrobial stewardship interventions on early switch from intravenous-to-oral antimicrobials in hospitalized adults: A systematic review

Garwan, Yusuf M.; Alsalloum, Muath A.; Thabit, Abrar K.; José, Jimmy; Eljaaly, Khalid

doi:10.1016/j.ajic.2022.05.017

Cited by 15 publications

(7 citation statements)

References 67 publications

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“…The standardisation of healthcare practice benefits patient safety and outcomes, however, it must be evidence-based 37. While other studies have focused on interventions to promote IVOS,38 39 this study focused on developing IVOS criteria with national consensus which can be promoted for use in clinical practice. The literature was systematically searched and 33 IVOS criteria were identified as part of a five-section framework.…”

Section: Discussionmentioning

confidence: 99%

Criteria to achieve safe antimicrobial intravenous-to-oral switch in hospitalised adult populations: a systematic rapid review

Harvey¹,

McLeod

Brún³

et al. 2023

BMJ Open

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ObjectivesThis rapid review aimed to assess and collate intravenous-to-oral switch (IVOS) criteria from the literature to achieve safe and effective antimicrobial IVOS in the hospital inpatient adult population.DesignThe rapid review follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Data sourcesOVID Embase and Medline databases.Eligibility criteriaArticles of adult populations published globally between 2017 and 2021 were included.Data extraction and synthesisAn Excel spreadsheet was designed with specific column headings. IVOS criteria from UK hospital IVOS policies informed the framework synthesis.ResultsIVOS criteria from 45/164 (27%) local IVOS policies were categorised into a five-section framework: (1) timing of IV antimicrobial review, (2) clinical signs and symptoms, (3) infection markers, (4) enteral route and (5) infection exclusions. The literature search identified 477 papers, of which 16 were included. The most common timing for review was 48–72 hours from initiation of intravenous antimicrobial (n=5, 30%). Nine studies (56%) stated clinical signs and symptoms must be improving. Temperature was the most frequently mentioned infection marker (n=14, 88%). Endocarditis had the highest mention as an infection exclusion (n=12, 75%). Overall, 33 IVOS criteria were identified to go forward into the Delphi process.ConclusionThrough the rapid review, 33 IVOS criteria were collated and presented within five distinct and comprehensive sections. The literature highlighted the possibility of reviewing IVOS before 48–72 hours and of presenting heart rate, blood pressure and respiratory rate as a combination early warning score criterion. The criteria identified can serve as a starting point of IVOS criteria review for any institution globally, as no country or region limits were applied. Further research is required to achieve consensus on IVOS criteria from healthcare professionals that manage patients with infections.PROSPERO registration numberCRD42022320343.

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Section: Discussionmentioning

confidence: 99%

Criteria to achieve safe antimicrobial intravenous-to-oral switch in hospitalised adult populations: a systematic rapid review

Harvey¹,

McLeod

Brún³

et al. 2023

BMJ Open

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“…In this study, there was no significant difference in the type of de-escalation between the intervention and nonintervention groups. Although switching to oral antibiotics may be beneficial in reducing medical costs [ 24 ], the proportion of patients with an oral switch was not different between the two groups. Furthermore, “shorter is better” is now a common suggestion in relation to antimicrobial use [ 25 ], but shortening the duration of antimicrobial therapy was not observed in the current study (14.5 days in the preintervention group and 13.9 days in the intervention group).…”

Section: Discussionmentioning

confidence: 99%

Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection

et al. 2022

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Evidence for the utility of pharmacist-driven antimicrobial stewardship programs remains limited. This study aimed to evaluate the usefulness of our institutional pharmacist-driven prospective audit with intervention and feedback (PAF) on the treatment of patients with bloodstream infections (BSIs). The effect of pharmacist-driven PAF was estimated using an interrupted time series analysis with a quasi-experimental design. The proportion of de-escalation during BSI treatment increased by 44% after the implementation of pharmacist-driven PAF (95% CI: 30–58, p < 0.01). The number of days of therapy decreased by 16 per 100 patient days for carbapenem (95% CI: −28 to −3.5, p = 0.012) and by 15 per 100 patient days for tazobactam/piperacillin (95% CI: −26 to −4.9, p < 0.01). Moreover, the proportion of inappropriate treatment in empirical and definitive therapy was significantly reduced after the implementation of pharmacist-driven PAF. Although 30-day mortality did not change, compliance with evidenced-based bundles in the BSI of Staphylococcus aureus significantly increased (p < 0.01). In conclusion, our pharmacist-driven PAF increased the proportion of de-escalation and decreased the use of broad-spectrum antibiotics, as well as the proportion of inappropriate treatment in patients with BSI. This indicates that pharmacist-driven PAF is useful in improving the quality of antimicrobial treatment and reducing broad-spectrum antimicrobial use in the management of patients with BSI.

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“…For AS activities, the role of the CDSS has turned into an area of great interest with a wide variety of interventions such as helping clinicians in selecting appropriate antimicrobial therapy for various infections and avoiding preventable errors, or decreasing targeted antimicrobial use, antimicrobial drug acquisition costs and healthcare-associated Clostridioides difficile infection rates [13][14][15] . However, the major disadvantages of those systems include the financial resources needed for development and maintenance 16 , they are labor intensive for the information technology personnel and not easily shared between institutions that are not part of the same network 7 . Furthermore, information to guide clinicians on those types of alerts that necessitate an intervention is strongly demanded due to the amount of time required by the AS team reviewing alerts and documenting the This article is protected by copyright.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Effects of a Pharmacist-Designed Clinical Decision Support System on Antimicrobial Stewardship

Amor-García,

Chamorro-de-Vega,

Rodríguez-González

et al. 2024

Appl Clin Inform

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Background Clinical decision support systems (CDSS) are computer applications, which can be applied to give guidance to practitioners in antimicrobial stewardship (AS) activities, however, further information is needed for their optimal use. Objectives To analyze the implementation of a CDSS program in a primary-care hospital, describing alerts, recommendations, and the effect on consumption and clinical outcomes. Methods In October 2020, a pharmacist-driven CDSS designed for AS was implemented in a second-level hospital. The program provides a list of alerts related to antimicrobial treatment and microbiology, which were automatized for revision by the AS professionals. To analyze the implementation of the CDSS, a pre-post intervention, retrospective study was designed. AS triggered alerts and recommendations (total number and rate of acceptance) were compiled. The effect of the CDSS was measured using antimicrobial consumption, duration of antimicrobial treatments, in-hospital mortality and length of stay (LOS) for patients admitted for infectious causes. Results The AS team revised a total of 7,543 alerts and 772 patients had at least one recommendation, with an acceptance rate of 79.3%. Antimicrobial consumption decreased from 691.1 to 656.8 daily defined doses (DDD)/1,000 beds-month (P = 0.04) and the duration of antimicrobial treatment from 3.6 to 3.3 days (P <0.01). In-hospital mortality decreased from 6.6% to 6.2% (P=0.46) and mean LOS from 7.2 to 6.2 days (P<0.01) Conclusion The implementation of a CDSS resulted in a significant reduction of antimicrobial DDD, duration of antimicrobial treatments and hospital LOS. There was no significant difference in mortality.

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Effectiveness of antimicrobial stewardship interventions on early switch from intravenous-to-oral antimicrobials in hospitalized adults: A systematic review

Cited by 15 publications

References 67 publications

Criteria to achieve safe antimicrobial intravenous-to-oral switch in hospitalised adult populations: a systematic rapid review

Criteria to achieve safe antimicrobial intravenous-to-oral switch in hospitalised adult populations: a systematic rapid review

Clinical Impact of a Pharmacist-Driven Prospective Audit with Intervention and Feedback on the Treatment of Patients with Bloodstream Infection

Effects of a Pharmacist-Designed Clinical Decision Support System on Antimicrobial Stewardship

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