Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED

Percival, Kelly M; Valenti, Kristine M.; Schmittling, Stacy E.; Strader, Brandi D.; Lopez, Rebecka R; Bergman, Scott

doi:10.1016/j.ajem.2015.04.067

Cited by 56 publications

(32 citation statements)

References 11 publications

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“…Just 5.6% of studies were focused on perioperative prophylaxis, 16.8% on EDs, 37.4% on outpatient settings, and 6.5% on parental education activities. It is notable that results from the Weddle et al study based on education intervention for prescribers in the ED [145] showing a 2% decrease in inappropriate antimicrobial prescribing were consistent with results from a study in the USA based on an adult population, which showed increased consistency of therapy choice from 44.8 to 83% [159]. ASPs implemented in outpatient settings, mainly involving audit and feedback and education, also seemed effective in reducing antimicrobial prescriptions.…”

Section: Main Findingssupporting

confidence: 66%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

108

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Background: Antibiotics are the most common medicines prescribed to children in hospitals and the community, with a high proportion of potentially inappropriate use. Antibiotic misuse increases the risk of toxicity, raises healthcare costs, and selection of resistance. The primary aim of this systematic review is to summarize the current state of evidence of the implementation and outcomes of pediatric antimicrobial stewardship programs (ASPs) globally. Methods: MEDLINE, Embase and Cochrane Library databases were systematically searched to identify studies reporting on ASP in children aged 0-18 years and conducted in outpatient or in-hospital settings. Three investigators independently reviewed identified articles for inclusion and extracted relevant data. Results: Of the 41,916 studies screened, 113 were eligible for inclusion in this study. Most of the studies originated in the USA (52.2%), while a minority were conducted in Europe (24.7%) or Asia (17.7%). Seventy-four (65.5%) studies used a before-and-after design, and sixteen (14.1%) were randomized trials. The majority (81.4%) described in-hospital ASPs with half of interventions in mixed pediatric wards and ten (8.8%) in emergency departments. Only sixteen (14.1%) studies focused on the costs of ASPs. Almost all the studies (79.6%) showed a significant reduction in inappropriate prescriptions. Compliance after ASP implementation increased. Sixteen of the included studies quantified cost savings related to the intervention with most of the decreases due to lower rates of drug administration. Seven studies showed an increased susceptibility of the bacteria analysed with a decrease in extended spectrum beta-lactamase producers E. coli and K. pneumoniae; a reduction in the rate of P. aeruginosa carbapenem resistance subsequent to an observed reduction in the rate of antimicrobial days of therapy; and, in two studies set in outpatient setting, an increase in erythromycin-sensitive S. pyogenes following a reduction in the use of macrolides. Conclusions: Pediatric ASPs have a significant impact on the reduction of targeted and empiric antibiotic use, healthcare costs, and antimicrobial resistance in both inpatient and outpatient settings. Pediatric ASPs are now widely implemented in the USA, but considerable further adaptation is required to facilitate their uptake in Europe, Asia, Latin America and Africa.

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Section: Main Findingssupporting

confidence: 66%

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Donà

Barbieri

Daverio

et al. 2020

Antimicrob Resist Infect Control

108

View full text Add to dashboard Cite

show abstract

“…It is disappointing, however, that adherence with the guidelines did not improve during the intervention period in the present study, which is in contrast with other intervention studies aimed at improving antibiotic prescription, including the previous Dutch checklist study (Hecker et al, 2014;Percival et al, 2015;Popovski et al, 2015;Guanche Garcell et al, 2011). The main difference between these previous studies and the present study is that improvement in adherence with the guidelines was actually one of seven aims in the present study, while others focused only on the antibiotic prescription (Hecker et al, 2014;Percival et al, 2015;Popovski et al, 2015;Guanche Garcell et al, 2011). Obviously the Dutch checklist study also aimed to improve performance on the seven checklist items, but an important difference is the lack of an easily accessible digital version of the guidelines on Aruba, 8 (5.4) 9 (8.2) 2 (5.7) 2 (7.1) 13 (7.5) 5 2 (1.3) 0 (0) 0 (0) 0 (0) 0 (0) 6 1 (0.7) 3 (2.7) 1 (2.9) 0 (0) 4 (2.3) !7…”

Section: Discussioncontrasting

confidence: 99%

“…For example, an observational study in a teaching hospital in Brazil concluded that 65.4% of the parenteral antimicrobial prescriptions were appropriate according to the local guidelines (Kawanami and Fortaleza, 2011). It is disappointing, however, that adherence with the guidelines did not improve during the intervention period in the present study, which is in contrast with other intervention studies aimed at improving antibiotic prescription, including the previous Dutch checklist study (Hecker et al, 2014;Percival et al, 2015;Popovski et al, 2015;Guanche Garcell et al, 2011). The main difference between these previous studies and the present study is that improvement in adherence with the guidelines was actually one of seven aims in the present study, while others focused only on the antibiotic prescription (Hecker et al, 2014;Percival et al, 2015;Popovski et al, 2015;Guanche Garcell et al, 2011).…”

Section: Discussioncontrasting

confidence: 81%

Implementation of an antibiotic checklist increased appropriate antibiotic use in the hospital on Aruba

Daalen

Lagerburg

Kort

et al. 2017

International Journal of Infectious Diseases

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“…[6][7][8] Consequently, multiple organizations and societies have emphasized the need for antimicrobial stewardship programs (ASP) in the ED. 9 In the inpatient settings, ASPs have reduced unnecessary antibiotic use by as much as 36%, [10][11][12][13] and produced institutional cost savings of up to $900,000 per year. 14 Failure to implement ASPs in EDs has been, in large part, the result of challenges unique to this setting and failure to consider clinical context during implementation.…”

Section: Background and Significancementioning

confidence: 99%

Considerations for Designing EHR-Embedded Clinical Decision Support Systems for Antimicrobial Stewardship in Pediatric Emergency Departments

et al. 2020

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Objective This study was aimed to explore the intersection between organizational environment, workflow, and technology in pediatric emergency departments (EDs) and how these factors impact antibiotic prescribing decisions. Methods Semistructured interviews with 17 providers (1 fellow and 16 attending faculty), and observations of 21 providers (1 physician assistant, 5 residents, 3 fellows, and 12 attendings) were conducted at three EDs in the United States. We analyzed interview transcripts and observation notes using thematic analysis. Results Seven themes relating to antibiotic prescribing decisions emerged as follows: (1) professional judgement, (2) cognition as a critical individual resource, (3) decision support as a critical organizational resource, (4) patient management with imperfect information, (5) information-seeking as a primary task, (6) time management, and (7) broad process boundaries of antibiotic prescribing. Discussion The emerging interrelated themes identified in this study can be used as a blueprint to design, implement, and evaluate clinical decision support (CDS) systems that support antibiotic prescribing in EDs. The process boundaries of antibiotic prescribing are broader than the current boundaries covered by existing CDS systems. Incongruities between process boundaries and CDS can under-support clinicians and lead to suboptimal decisions. We identified two incongruities: (1) the lack of acknowledgment that the process boundaries go beyond the physical boundaries of the ED and (2) the lack of integration of information sources (e.g., accessibility to prior cultures on an individual patient outside of the organization). Conclusion Significant opportunities exist to improve appropriateness of antibiotic prescribing by considering process boundaries in the design, implementation, and evaluation of CDS systems.

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Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED

Cited by 56 publications

References 11 publications

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

Implementation of an antibiotic checklist increased appropriate antibiotic use in the hospital on Aruba

Considerations for Designing EHR-Embedded Clinical Decision Support Systems for Antimicrobial Stewardship in Pediatric Emergency Departments

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