Implementing an antimicrobial stewardship program in out-patient dialysis units

Abstract

Purpose of review Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and multidrug-resistant gram-negative bacteria continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns. The purpose of this review is to highlight the key elements and interventions of ASP. Recent Findings The Infectious Disease Society of America and the Society of Healthcare Epidemiology of America have provided evidence-based guidelines for the development and implementation of an ASP. Many of their recommendations can be adapted to the out-patient dialysis setting. Summary Developing and implementing an ASP by following key elements and interventions in the out-patient dialysis setting can lead to reduced mortality, adverse events, costs and improvement in antimicrobial susceptibility rates.

Clinical and Economic Benefits of Antimicrobial Stewardship Programs in Hemodialysis Facilities

“…Substantial resources outlining the strategies toward implementing antimicrobial stewardship programs are available from the Centers for Diseases Control and Prevention, the Infectious Disease Society of America, and the Society of Healthcare Epidemiology of America (24)(25)(26). Although these resources do not specifically target the outpatient dialysis setting, many strategies can be adapted to outpatient dialysis facilities (27). Prioritizing specific interventions aimed at reducing antimicrobial use is one of the many recommendations.…”

“…Because hospitalized patients on hemodialysis incur higher total costs compared with other hospitalized patients, the estimated cost savings could be even greater (19). Fifth, the cost of implementing an antimicrobial stewardship program was not included in the model, because it was assumed that this initiative would be considered a component of quality improvement initiatives and that costs incurred would be pertaining to resources for the leader of the antimicrobial stewardship program (27).…”

Opportunities to Improve Antibiotic Prescribing in Outpatient Hemodialysis Facilities: A Report From the American Society of Nephrology and Centers for Disease Control and Prevention Antibiotic Stewardship White Paper Writing Group

“…Engaging leadership at the local facility and the larger organizational level is important to the success of antibiotic stewardship interventions in the dialysis setting. 32,61 Leadership support can…”

“…Engaging leadership at the local facility and the larger organizational level is important to the success of antibiotic stewardship interventions in the dialysis setting. 32 , 61 Leadership support can signal that antibiotic stewardship activities are an organizational priority, and ensure that needed resources are provided for antibiotic prescribing and stewardship expertise, education for staff and patients, and development and promotion of antibiotic prescribing pathways and protocols.…”

Targeting Zero Infections in Dialysis: New Devices, Yes, but also Guidelines, Checklists, and a Culture of Safety

“…These programs can reduce the incidence of multiple drug-resistant organisms that are more common in patients on hemodialysis than in the general population. 7 To accomplish this large task, NTDS believes that nephrologists must assume a major role in the responsibility to target zero preventable infections. We need a system-wide working transformation, where physicians, extenders, nurses, social workers, dieticians, administrators, and patients work collaboratively with a common patient-centered goal to target zero infections.…”