Hospital Antimicrobial Stewardship in the Nonuniversity Setting

Trivedi, Kavita K.; Kuper, Kristi

doi:10.1016/j.idc.2014.01.007

Cited by 24 publications

(25 citation statements)

References 24 publications

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“…[2][3][4] These simple and effective interventions have been shown to improve patient outcomes, to reduce costs, and to decrease the development of antimicrobial resistance. [2][3][4] To our knowledge, only 1 study to date has evaluated the use of rapid diagnostics in a community hospital setting using the Nanosphere Verigene test to evaluate Grampositive bacteremia in conjunction with ASP. Box et al 20 illustrated a similar decrease in time to therapy adjustment along with decreased LOS and hospital costs.…”

Section: Discussionmentioning

confidence: 99%

“…However, many community hospitals lack administrative or financial support, or the expertise, such as dedicated infectious diseases specialists, to successfully implement these strategies. [1][2][3][4] While the impact of ASPs is often benchmarked on antimicrobial utilization data, disease state-driven approaches targeting timely antibiotic therapy for patients with bloodstream infections (BSIs) are essential. Delays in treatment have been associated with increased morbidity and mortality resulting in detrimental outcomes for patients.…”

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confidence: 99%

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Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Lockwood

Perez

Musick

et al. 2016

Infect. Control Hosp. Epidemiol.

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objective. To assess the impact of Matrix-Assisted Laser Desorption/Ionization Time-of-Flight (MALDI-TOF) mass spectrometry for rapid pathogen identification directly from early-positive blood cultures coupled with an antimicrobial stewardship program (ASP) in two community hospitals. Process measures and outcomes prior and after implementation of MALDI-TOF/ASP were evaluated.design. Multicenter retrospective study.setting. Two community hospitals in a system setting, Houston Methodist (HM) Sugar Land Hospital (235 beds) or HM Willowbrook Hospital (241 beds).patients. Patients ≥18 years of age with culture-proven Gram-negative bacteremia.intervention. Blood cultures from both hospitals were sent to and processed at our central microbiology laboratory. Clinical pharmacists at respective hospitals were notified of pathogen ID and susceptibility results.results. We evaluated 572 patients for possible inclusion. After pre-defined exclusion criteria, 151 patients were included in the pre-intervention group and 242 were included in the intervention group. After MALDI-TOF/ASP implementation, the mean identification time after culture positivity was significantly reduced from 32 hours (±16 hours) to 6.5 hours (±5.4 hours) (P < .001); mean time to susceptibility results was significantly reduced from 48 (±22) hours to 23 (±14) hours (P < .001); and time to therapy adjustment was significantly reduced from 75 (±59) hours to 30 (±30) hours (P < .001). Mean hospital costs per patient were $3,411 less in the intervention group compared with the pre-intervention group ($18,645 vs $15,234; P = .04).conclusion. This study is the first to analyze the impact of MALDI-TOF coupled with an ASP in a community hospital setting. Time to results significantly differed with the use of MALDI-TOF, and time to appropriate therapy was significantly improved with the addition of ASP.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Lockwood

Perez

Musick

et al. 2016

Infect. Control Hosp. Epidemiol.

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“…1,2 Approximately 30%-50% of inpatient antimicrobial use is inappropriate, needlessly contributing to increased adverse events, most notably Clostridium difficile-associated colitis, 3 and escalating healthcare costs. [4][5][6] The US Centers for Disease Control and Prevention and professional societies 7 have strongly recommended that hospitals implement antimicrobial stewardship programs (ASPs) to promote appropriate antimicrobial prescribing. 6 More recently, the White House established a national plan to combat antimicrobial resistance through antimicrobial stewardship (AS).…”

mentioning

confidence: 99%

“…[4][5][6] The US Centers for Disease Control and Prevention and professional societies 7 have strongly recommended that hospitals implement antimicrobial stewardship programs (ASPs) to promote appropriate antimicrobial prescribing. 6 More recently, the White House established a national plan to combat antimicrobial resistance through antimicrobial stewardship (AS). 8 Broadly, ASPs seek to optimize antimicrobial use to maximize therapeutic success, improve patient outcomes, and minimize costs.…”

mentioning

confidence: 99%

“…8 Broadly, ASPs seek to optimize antimicrobial use to maximize therapeutic success, improve patient outcomes, and minimize costs. 5,6,[9][10][11][12] Effective ASPs should include a multidisciplinary team of healthcare providers to implement evidence-based practice through education, decision support, antimicrobial restrictions, and other interventions. ASPs should also engage in data collection and reporting to guide their activities, as well as support audit and feedback interventions.…”

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confidence: 99%

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Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Chou

Graber

Jones

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUNDAntimicrobial stewardship programs (ASPs) are variably implemented.OBJECTIVETo characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage.DESIGNA web-based survey regarding stewardship activities was administered to each facility’s designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined.SETTINGTotal of 130 Veterans Affairs facilities with inpatient services.RESULTSOf 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03).CONCLUSIONSASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices.Infect Control Hosp Epidemiol 2016;37:647–654

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Predictors of Clostridium difficile infection–related mortality among older adults

Chopra

Awali

Biedron

et al. 2016

American Journal of Infection Control

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Hospital Antimicrobial Stewardship in the Nonuniversity Setting

Cited by 24 publications

References 24 publications

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Integrating Rapid Diagnostics and Antimicrobial Stewardship in Two Community Hospitals Improved Process Measures and Antibiotic Adjustment Time

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Predictors of Clostridium difficile infection–related mortality among older adults

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