Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit

Price, Jacob; Ekleberry, Ann; Grover, Amelia; S, Melendy; Baddam, Kavitha; McMahon, James M.; Villalba, Mario; Johnson, Matthew H.; Zervos, Marcus J.

doi:10.1097/00003246-199910000-00007

Cited by 69 publications

(30 citation statements)

References 40 publications

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“…These components include audits [57] , infectious disease specialist or senior clinician input [58][59][60][61][62][63][64] , or planned discontinuation/deescalation of treatment in response to clinical and microbiological outcome data [65] . Other components include rotating antibiotic schedules [57,[66][67][68][69][70] changes in prescribing policies involving antibiotic restriction, different dosing regimens or prophylaxis protocols [57,62,65,67,[71][72][73][74][75][76][77][78][79][80][81][82][83][84] and a multi-disciplinary team (MDT) approach in treatment initiation and discontinuation, often emphasising feedback and non-punitive atmosphere among staff members [83,85] . Some programmes also encompassed staff education [57,74,76] and computerised decision support platforms [86][87][88][89][90][91] .…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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Antibiotic usage and increasing antimicrobial resistance (AMR) mount significant challenges to patient safety and management of the critically ill on intensive care units (ICU). Antibiotic stewardship programmes (ASPs) aim to optimise appropriate antibiotic treatment whilst minimising antibiotic resistance. Different models of ASP in intensive care setting, include "standard" control of antibiotic prescribing such as "de-escalation strategies" through to interventional approaches utilising biomarkerguided antibiotic prescribing. A systematic review of outcomes related studies for ASPs in an ICU setting was conducted. Forty three studies were identified from MEDLINE between 1996 and 2014. Of 34 nonprotocolised studies, [1 randomised control trial (RCT), 22 observational and 11 case series], 29 (85%) were positive with respect to one or more outcome: These were the key outcome of reduced antibiotic use, or ICU length of stay, antibiotic resistance, or prescribing cost burden. Limitations of non-standard antibiotic initiation triggers, patient and antibiotic selection bias or baseline demographic variance were identified. All 9 protocolised studies were RCTs, of which 8 were procalcitonin (PCT) guided antibiotic stop/start interventions. Five studies addressed antibiotic escalation, 3 de-escalation and 1 addressed both. Six studies reported positive outcomes for reduced antibiotic use, ICU length of stay or antibiotic resistance. PCT based ASPs are effective as antibiotic-stop (de-escalation) triggers, but not as an escalation trigger alone. PCT has also been effective in reducing antibiotic usage without worsening morbidity or mortality in ventilator associated pulmonary infection. No study has demonstrated survival benefit of ASP. Ongoing challenges to infectious disease management, reported by the World Health Organisation global report 2014, are high AMR to newer antibiotics, and regional knowledge gaps in AMR surveillance. Improved AMR surveillance data, identifying core aspects of successful ASPs that are transferable, and further well-conducted trials will be necessary if ASPs are to be an effective platform for delivering desired patient outcomes and safety through best antibiotic policy.

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Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Zhang

Singh

2015

WJCCM

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“…Multidisciplinary development of evidence-based treatment guidelines incorporating local microbiology and resistance patterns can improve antimicrobial utilization [21][22][23] . Guides may sometimes be mere documented procedures, not clinical practice guidelines such as a systematically developed statement designed to assist practitioner and patient to make a decisions about appropriate health care for specific clinical circumstances.…”

Section: Guide For Antibiotic Treatmentmentioning

confidence: 99%

Optimization of Antibiotic Use in Hospitals – Antimicrobial Stewardship and the EU Project ABS International

Allerberger¹,

Lechner²,

Wechsler-Fördös³

et al. 2008

Chemotherapy

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Background: The problem of antimicrobial resistance requires common strategies at the European level. Methods: We report on an EU initiative fostering antibiotic (AB) stewardship (ABS) in hospitals. Results: The project ‘ABS International: implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the EU’ started in September 2006 in Austria, Belgium, the Czech Republic, Germany, Hungary, Italy, Poland, Slovenia and Slovakia. A training program for national ABS trainers was prepared and standard templates for ABS tools (AB list, guidelines for AB treatment and surgical prophylaxis, and AB-related organization) and valid process measures as well as quality indicators for AB use were developed. Specific ABS tools are being implemented in up to five health care facilities per country. Conclusion: ABS International is the first EU-funded initiative focusing on the implementation of structural measures in hospitals to promote the prudent use of ABs.

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“…(5,6) Prescription of antimicrobial agents should follow priorities such as severity of the disease, drug efficacy, previous use of antibiotics, presence of comorbidities, resistance patterns of in-hospital microorganisms, duration of hospital stay, epidemiological impact, and costs. (7) Therefore, in order to guide physicians in the treatment of patients with ICU-acquired pneumonia and avoid the excessive use of antibiotics, with the consequent increase in resistant microorganisms responsible for more severe infections, (8) it is important to adopt therapeutic guidelines. These therapeutic guidelines should be based on the current situation (population and institution), evidence-based data, and the experience of health professionals specializing in the area.…”

Section: Introductionmentioning

confidence: 99%

“…(9) Despite the relevance of their use and the fact that they are widely studied in the literature, therapeutic guidelines have yet to gain acceptance, because physicians are afraid of losing their autonomy, as well as because there are no conclusive data regarding their efficacy. (8) The principal objective of this study was to evaluate the impact of the use of therapeutic guidelines on overall infection-related mortality in patients with ICU-acquired pneumonia. Other objectives were to evaluate the duration of hospital stays and of treatment.…”

Section: Introductionmentioning

confidence: 99%

Impacto da implantação de um guia terapêutico para o tratamento de pneumonia nosocomial adquirida na unidade de terapia intensiva em hospital universitário

et al. 2007

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Objective: To evaluate the impact that the implementation of therapeutic guidelines has on the empirical treatment of nosocomial pneumonia. Methods: A clinical trial, using historical controls and involving current ICU patients who had acquired nosocomial pneumonia, was carried out from June of 2002 to June of 2003. All were treated according to therapeutic guidelines developed by the Commission for Nosocomial Infection Control of the institution (group with intervention). As controls, the medical charts of the patients who acquired nosocomial pneumonia between June of 2000 and June of 2001 (group without intervention) were analyzed. Mortality and mean treatment period, as well as the length of hospital and ICU stays, were determined for the patients who acquired nosocomial pneumonia. Results: Mortality associated with pneumonia was lower in the group treated according to the therapeutic guidelines (26 vs. 53.6%; p = 0.00). As for overall mortality, there was no statistically significant difference between the two periods (51 vs. 57.9%; p = 0.37). There was also no difference in the type of microorganisms isolated, treatment period, length of hospital stay or length of ICU stay. Conclusion: The implementation of therapeutic guidelines for the treatment of nosocomial pneumonia acquired in the ICU can be efficacious in decreasing mortality rates.

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Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit

Cited by 69 publications

References 40 publications

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Antibiotic stewardship programmes in intensive care units: Why, how, and where are they leading us

Optimization of Antibiotic Use in Hospitals – Antimicrobial Stewardship and the EU Project ABS International

Impacto da implantação de um guia terapêutico para o tratamento de pneumonia nosocomial adquirida na unidade de terapia intensiva em hospital universitário

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