Implementing an antibiotic stewardship program at a long-term acute care hospital in Detroit, Michigan

Mushtaq, Ammara; Awali, Reda; Chandramohan, Suganya; Krishna, Amar; Biedron, Caitlin; Jegede, Olufemi; Chopra, Teena

doi:10.1016/j.ajic.2017.07.028

Cited by 12 publications

(10 citation statements)

References 9 publications

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“…This information was not enough to provide an improvement to create an effective ABC bundle. Another form of stewardship is by educating medical providers to change their behavior towards antibiotic resistance (Mushtaq et al, 2017).…”

Section: Stewardship Programs In Hospitalsmentioning

confidence: 99%

Implementation of Stewardship Programs in Hospitals: Systematic Review

Funes¹

2019

UCMURJ

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Antimicrobial resistance is a pandemic issue affecting hospital patients.There are many studies showing what can be done to decrease the resistance of many microbes, but there is not one complete method. This review indicates the effective methods that can be used to prevent resistance from spreading in hospitals. The review was set to focus on antimicrobial resistance, misuse, and overuse of antimicrobials, what doctors are doing that influences resistance and stewardship programs. Articles published from 2008-2018 were found using Web of Science, ScienceDirect, and PLOS. Out of the 15 articles found, 7 articles met the ideal selection criteria and were included in the review. All articles demonstrated the importance of antimicrobial resistance and provided ways in which resistance can be decreased. All studies reported the use of stewardship programs were necessary, but only three articles demonstrated its effectiveness. This review demonstrates a high need for antimicrobial stewardship programs to decrease the evolution of antimicrobial resistance. However, there is a problem with individual medical providers not complying to such programs due to the restrictions they say it creates. The results state otherwise and in fact demonstrate how a medical provider's behavior must change to provide significance on the implementation of successful stewardship programs.

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Section: Stewardship Programs In Hospitalsmentioning

confidence: 99%

Implementation of Stewardship Programs in Hospitals: Systematic Review

Funes¹

2019

UCMURJ

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“…Antibiotic stewardship initiatives aimed at reducing inappropriate antibiotic selection, and restricting exposure to CDI high-risk antibiotics when lower risk antibiotics are appropriate, have proven effective in preventing CDI within STACHs [15]. Although emerging evidence documents the impact of antibiotic stewardship initiatives in LTCFs and in outpatient settings, the effects of specific interventions in these settings on CDI incidence are not well understood [16,17].…”

Section: Introductionmentioning

confidence: 99%

Modeling inpatient and outpatient antibiotic stewardship interventions to reduce the burden of Clostridioides difficile infection in a regional healthcare network

et al. 2020

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Antibiotic exposure can lead to unintended outcomes, including drug-drug interactions, adverse drug events, and healthcare-associated infections like Clostridioides difficile infection (CDI). Improving antibiotic use is critical to reduce an individual's CDI risk. Antibiotic stewardship initiatives can reduce inappropriate antibiotic prescribing (e.g., unnecessary antibiotic prescribing, inappropriate antibiotic selection), impacting both hospital (healthcare)-onset (HO)-CDI and community-associated (CA)-CDI. Previous computational and mathematical modeling studies have demonstrated a reduction in CDI incidence associated with antibiotic stewardship initiatives in hospital settings. Although the impact of antibiotic stewardship initiatives in long-term care facilities (LTCFs), including nursing homes, and in outpatient settings have been documented, the effects of specific interventions on CDI incidence are not well understood. We examined the relative effectiveness of antibiotic stewardship interventions on CDI incidence using a geospatially explicit agent-based model of a regional healthcare network in North Carolina. We simulated reductions in unnecessary antibiotic prescribing and inappropriate antibiotic selection with intervention scenarios at individual and network healthcare facilities, including short-term acute care hospitals (STACHs), nursing homes, and outpatient locations. Modeled antibiotic prescription rates were calculated using patient-level data on antibiotic length of therapy for the 10 modeled network STACHs. By simulating a 30% reduction in antibiotics prescribed across all inpatient and outpatient locations, we found the greatest reductions on network CDI incidence among tested scenarios, namely a 17% decrease in HO-CDI incidence and 7% decrease in CA-CDI. Among intervention scenarios of reducing inappropriate antibiotic selection, we found a greater impact on network CDI incidence when modeling this reduction in nursing

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“…ASPs are efficient measures to foster prudent antimicrobial use in human and veterinary medicine. [3][4][5][6][7][8][9][10][11][12][13] This study evaluates the effects Substantial changes in prescribing were seen in dogs presented for AD (Table 5). For this subgroup, the prescription of antimicrobials decreased significantly, and a significantly higher proportion of dogs was prescribed in accordance with guidelines, which recommend the use of antimicrobials only in cases with suspected sepsis.…”

Section: Discussionmentioning

confidence: 99%

“…[3][4][5][6][7][8][9] Antimicrobial stewardship provided via national and local guidelines positively influences antimicrobial prescribing habits in human and veterinary medicine leading to both a decreased and more appropriate use as well as a reduction in resistance. [3][4][5][6][7][8][9][10][11][12][13] In 2015, the Swiss National Strategy on Antibiotic Resistance (StAR) was passed by the federal council. As part of its implementation, an online tool (AntibioticScout.ch) assisting veterinarians in the selection of prudent empirical antimicrobial treatment based on international guidelines was created.…”

Section: Introductionmentioning

confidence: 99%

Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland

Lehner

Hubbuch

Schmitt

et al. 2020

Veterinary Internal Medicne

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Background: Antimicrobial stewardship programs (ASPs) are important tools to foster prudent antimicrobial use. Objective: To evaluate antimicrobial prescriptions by Swiss veterinarians before and after introduction of the online ASP AntibioticScout.ch in December 2016. Animals: Dogs presented to 2 university hospitals and 14 private practices in 2016 or 2018 for acute diarrhea (AD; n = 779), urinary tract infection (UTI; n = 505), respiratory tract infection (RTI; n = 580), or wound infection (WI; n = 341). Methods: Retrospective study. Prescriptions of antimicrobials in 2016 and 2018 were compared and their appropriateness assessed by a justification score. Results: The proportion of dogs prescribed antimicrobials decreased significantly between 2016 and 2018 (74% vs 59%; P < .001). The proportion of prescriptions in complete agreement with guidelines increased significantly (48% vs 60%; P < .001) and those in complete disagreement significantly decreased (38% vs 24%; P < .001) during this time. Antimicrobial prescriptions for dogs with AD were significantly correlated with the presence of hemorrhagic diarrhea in both years, but a significantly lower proportion of dogs with hemorrhagic diarrhea were unnecessarily prescribed antimicrobials in 2018 (65% vs 36%; P < .001). In private practices, in 2018 a bacterial etiology of UTI was confirmed in 16% of dogs. Prescriptions for fluoroquinolones significantly decreased (29% vs 14%; P = .002). Prescriptions for antimicrobials decreased significantly in private practices for RTI (54% vs 31%; P < .001).

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Implementing an antibiotic stewardship program at a long-term acute care hospital in Detroit, Michigan

Cited by 12 publications

References 9 publications

Implementation of Stewardship Programs in Hospitals: Systematic Review

Implementation of Stewardship Programs in Hospitals: Systematic Review

Modeling inpatient and outpatient antibiotic stewardship interventions to reduce the burden of Clostridioides difficile infection in a regional healthcare network

Effect of antimicrobial stewardship on antimicrobial prescriptions for selected diseases of dogs in Switzerland

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