Impact of an Antimicrobial Utilization Program on Antimicrobial Use at a Large Teaching Hospital A Randomized Controlled Trial

Abstract

Background Multidisciplinary antimicrobial utilization teams (AUT) have been proposed as a mechanism for improving antimicrobial use, but data on their efficacy remain limited. Objective To determine the impact of an AUT on antimicrobial use at a teaching hospital. Design Randomized controlled intervention trial. Setting A 953-bed public university-affiliated urban teaching hospital. Patients Patients who were prescribed selected antimicrobial agents (piperacillin-tazobactam, levofloxacin, or vancomycin) by internal medicine ward teams. Intervention Twelve internal medicine teams were randomized monthly: 6 teams to intervention group (academic detailing by the AUT), and 6 teams to a control group given indication-based guidelines for prescription of broad spectrum antimicrobials (standard of care) during a 10-month study period. Measurements Proportion of appropriate empiric, definitive (therapeutic), and end antimicrobial (overall) usage. Results A total of 784 new prescriptions of piperacillin-tazobactam, levofloxacin, and vancomycin were reviewed. The proportion of appropriate antimicrobial prescriptions written by the intervention teams was significantly higher than prescribed by the control teams: 82% vs. 73% for empiric (RR=1.14, 95% CI 1.04–1.24), 82% vs. 43% for definitive (RR=1.89, 95% CI 1.53–2.33), and 94% vs. 70% for end antimicrobial usage (RR=1.34, 95% CI 1.25–1.43). In a multivariate analysis, teams that received feedback from the AUT alone (aRR=1.37, 95% CI 1.27–1.48) or from both the AUT and the ID consult service (aRR=2.28, 95% CI 1.64–3.19) were significantly more likely to prescribe end antimicrobial usage appropriately compared to control teams. Conclusions A multidisciplinary AUT which provides feedback to prescribing physicians was an effective method in improving antimicrobial use.

Prediction of Patient Outcome from Acinetobacter baumannii Bacteremia with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation (APACHE) II Scores

“…A patient was considered to have shock (defined according to the ACCP-SCCM consensus conference) if there was evidence of organ hypoperfusion, if the systolic blood pressure was <90 or >30 mmHg relative to baseline, or if the patient needed vasopressor/inotropes to maintain blood pressure despite adequate fluid resuscitation (29). Appropriate empirical antibiotics use was defined as treatment with at least one antibiotic that had in vitro activity against the pathogen and administered at the onset of A. baumannii bacteremia, with correct dosage, and with the use of at least 48 hours; otherwise, the empirical antibiotic treatment was defined as inappropriate (30). Death of a patient was considered directly related to the bacteremia if it occurred during the phase of active infection, with no evidence of another cause (31).…”

Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern Taiwan

“…In previous research, a decrease in resistant pathogens, such as Clostridium difficile [18], extended-spectrum β-lactamase-producing E. coli and K. pneumonia [19], and methicillin-resistant Staphylococcus aureus (MRSA) [21] was noted. Decreases in hospital stays [22] and improvements in successful treatments [20] have also been reported.…”

Effectiveness of a program to improve antibiotic use in children hospitalized in a children’s tertiary care facility in Argentina

“…Based on bibliographic evidence [24][25][26][27] the intervention implemented in this hospital was of an educational nature.…”