Impact of an <scp>A</scp>ntimicrobial <scp>S</scp>tewardship <scp>P</scp>rogram <scp>C</scp>omprehensive <scp>C</scp>are <scp>B</scp>undle on <scp>M</scp>anagement of <scp>C</scp>andidemia

Antworth, Allen; Collins, Curtis D.; Kunapuli, Anjly; Klein, Kristin C.; Carver, Peggy L.; Gandhi, Tejal; Washer, Laraine; Nagel, Jerod

doi:10.1002/phar.1186

Cited by 77 publications

(77 citation statements)

References 10 publications

(21 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although a few integrative data sources were described [5,6], most were not developed and individualized for antimicrobial stewardship purposes. Studies that provided mention of ASP specific systems or databases [7][8][9][10][11][12][13][14] generally offered little description of their capacity for ASP evaluation and research.…”

Section: Data Sourcesmentioning

confidence: 98%

“…As a potential prerequisite to appropriate antibiotic use, some ASPs have measured rates of chart documentation of antimicrobial regimens, indications and intended stop dates [21,34]. Finally, some ASPs have measured broader non-antimicrobial aspects of appropriateness related to infection management, such as ophthalmology consults for candidemia [14] and vaccination rates for at-risk patients [13].…”

Section: Appropriateness Of Therapymentioning

confidence: 99%

“…This tool was used to identify the levels of evidence for the publications included in this review. About half of the included studies (29/58) employed a before-and-after study design [6, 7, 9-11, 13, 14, 17-38], and 62 % (36/ 58) constituted level IV evidence [6,7,[9][10][11][12][13][14]. During the review period, there were no level I publications (systematic reviews of randomized controlled trials (RCTs)), and we identified only five (9 %) published RCTs (level II) [45, 46, 47•, 48, 49].…”

Section: Study Design Study Design and Hierarchy Of Evidencementioning

confidence: 99%

“…Another common approach has been to measure individual components of appropriateness, which can be objectively defined and quantified. Mean duration of treatment is among the most commonly studied [6, 8, 19, 47•, 48, 49, 75, 78], along with related measures such as percentage of courses exceeding a pre-defined duration [36], excess antibiotic days [14,19] or antibiotic-free days [48]. Appropriateness of antimicrobial spectrum has been operationalized as frequency of inadequate coverage [13] or redundant coverage [13,19]; appropriateness of antibiotic reassessment has been captured in rates of streamlining broad-spectrum coverage when microbiology results are avail- [19, 26, 34, 47•], converting from intravenous to oral route of administration [7, 47•] and switching classes of agents [12,24].…”

Section: Appropriateness Of Therapymentioning

confidence: 99%

See 3 more Smart Citations

Antimicrobial Stewardship Programs: A Review of Recent Evaluation Methods and Metrics

Palmay

Walker

Leis

et al. 2014

Curr Treat Options Infect Dis

View full text Add to dashboard Cite

Section: Data Sourcesmentioning

confidence: 98%

Section: Appropriateness Of Therapymentioning

confidence: 99%

Section: Study Design Study Design and Hierarchy Of Evidencementioning

confidence: 99%

Section: Appropriateness Of Therapymentioning

confidence: 99%

See 2 more Smart Citations

Antimicrobial Stewardship Programs: A Review of Recent Evaluation Methods and Metrics

Palmay

Walker

Leis

et al. 2014

Curr Treat Options Infect Dis

View full text Add to dashboard Cite

“…Collectively, these activities aim to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquired infections such as Clostridium difficile, and decrease health care costs. [1][2][3]18,19 Antimicrobial stewardship programs are interdisciplinary and may involve physicians, pharmacists, infection preventionists, nurses, other health care providers, and support personnel. [1][2][3] Interdisciplinary teams include stewards, who are knowledgeable about the relationship between antimicrobial use and resistance and who are responsible for influencing the use of these drugs.…”

Section: Résumémentioning

confidence: 99%

A Qualitative Analysis of Implementation of Antimicrobial Stewardship at 3 Academic Hospitals: Understanding the Key Influences on Success

Jeffs¹,

Thampi²,

Steinberg³

et al. 2015

CJHP

View full text Add to dashboard Cite

Background: Inappropriate use of antimicrobials is linked to the development and spread of drug-resistant pathogens and is associated with increased morbidity, mortality, lengths of hospital stay, and health care costs. "Antimicrobial stewardship" is the umbrella term for an evidencebased knowledge translation strategy involving comprehensive quality improvement activities to optimize the use of antimicrobials, improve patient outcomes, reduce the development of antimicrobial resistance and hospital-acquired infections such as Clostridium difficile, and decrease health care costs. Objective: To assess the perceptions and experiences of antimicrobial stewardship program leaders in terms of clinicians' attitudes toward and behaviours related to antimicrobial prescribing. Methods: In this qualitative study, semistructured interviews were conducted with 6 antimicrobial stewards (2 physicians and 4 pharmacists) at 3 academic hospitals between June and August 2013. Results: The following 3 key themes emerged from the interviews: getting the right people on board, building collegial relationships, and rapidly establishing a track record. The study results elucidated the role and mechanisms that the program leader and other antimicrobial stewards used to influence other clinicians to engage in effective utilization of antimicrobials. The results also highlighted the methods employed by members of the antimicrobial stewardship team to tailor their strategies to the local context and to stakeholders of participating units; to gain credibility by demonstrating the impact of the antimicrobial stewardship program on clinical outcomes and cost; and to engage senior leaders to endorse and invest in the antimicrobial stewardship program, thereby adding to the antimicrobial stewards' credibility and their ability to influence the uptake of effective antimicrobial use. Conclusions: Collectively, these results offer insight into processes and mechanisms of influence employed by antimicrobial stewards to enhance antimicrobial use among clinicians, which can in turn inform future implementation of antimicrobial stewardship and strategies for organizational change in hospitals.

show abstract

Antimicrobial stewardship without infectious disease physician for patients with candidemia: A before and after study

Murakami

Komatsu

Sugiyama

et al. 2018

J of Gen and Family Med

View full text Add to dashboard Cite

BackgroundLittle is known about the effects of antimicrobial stewardship team (AST) without infectious disease physician (IDP) on clinical outcome in patients with candidemia.MethodsWe conducted a before and after study involving patients with hospital‐acquired candidemia at a tertiary hospital without IDPs. The AST consisted of physicians, pharmacists, nurse, microbiologist, and administrative staff. A candidemia care bundle was developed based on the Infectious Disease Society of America (IDSA) guideline. The non‐IDP AST provided recommendations to the attending physicians whose patients developed candidemia during hospitalization. The primary outcome was 30‐day all‐cause mortality, while the secondary outcomes were adherence to the IDSA guidelines regarding the management of candidemia. Data of up to 3 years of preintervention and 3 years of intervention period were analyzed.ResultsBy 30 days, 11 of 46 patients (23.9%) in the intervention group and 7 of 30 patients (23.3%) in the preintervention group died (adjusted hazard ratio for the intervention group: 0.68 [95% CI 0.24‐1.91]). The non‐IDP AST was associated with appropriate empirical antifungal therapy (100% vs 60.0%; proportion ratio 1.67 [95% CI 1.24‐2.23]), appropriate duration of treatment (84.7% vs 43.3%; 1.96 [1.28‐3.00]), removal of central venous catheters (94.4% vs 70.8%; 1.33 [1.02‐1.74]), and ophthalmological examination (93.5% vs 63.3%; 1.48 [1.12‐1.96]).ConclusionsAlthough we found no significant difference in 30‐day mortality, the non‐IDP AST was associated with improved adherence to guidelines for management of candidemia.

show abstract

Impact of an Antimicrobial Stewardship Program Comprehensive Care Bundle on Management of Candidemia

Cited by 77 publications

References 10 publications

Antimicrobial Stewardship Programs: A Review of Recent Evaluation Methods and Metrics

Antimicrobial Stewardship Programs: A Review of Recent Evaluation Methods and Metrics

A Qualitative Analysis of Implementation of Antimicrobial Stewardship at 3 Academic Hospitals: Understanding the Key Influences on Success

Antimicrobial stewardship without infectious disease physician for patients with candidemia: A before and after study

Contact Info

Product

Resources

About