Prescribing trends before and after implementation of an antimicrobial stewardship program

Cairns, Kelly A.; Jenney, Adam; Abbott, Iain J.; Skinner, Matthew J.; Doyle, Joseph S; Dooley, Michael; Cheng, Allen

doi:10.5694/mja12.11683

Cited by 51 publications

(54 citation statements)

References 11 publications

(10 reference statements)

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“…Even though TQC reform does not mandate early management and patient care is expected to be undertaken using the same clinical standards following complete assessment, a potential adverse effect may be rapid antibiotic prescribing without consideration to full patient assessment. Appropriateness of antibiotic prescription therefore presents another performance measure, and further improvements in both appropriateness and timing need broader evaluation and may be achieved through the use of stewardship programmes …”

Section: Discussionmentioning

confidence: 99%

Implementation of hospital‐wide reform at improving access and flow: Impact on time to antibiotics in the emergency department

Roman

Poole

Dooley

et al. 2015

Emerg Medicine Australasia

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Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements.

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Section: Discussionmentioning

confidence: 99%

Implementation of hospital‐wide reform at improving access and flow: Impact on time to antibiotics in the emergency department

Roman

Poole

Dooley

et al. 2015

Emerg Medicine Australasia

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“…Operational models of infectious diseases units vary from consultation-only to those focused on inpatients (e.g. The relatively low proportion of referrals from ICU may in part be explained by the lower number of ICU beds in hospitals in our region [11], and the provision of ID services on routine ICU rounds, which were not included in this survey [12]. In Australia, where infectious diseases services are relatively mature, most larger hospitals have a mix of both consultations and inpatients, whereas in smaller hospitals consultative services predominate.…”

Section: Discussionmentioning

confidence: 99%

What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore

Ingram

Cheng

Murray

et al. 2014

Clinical Microbiology and Infection

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The practice of an infectious diseases (ID) physician is evolving. A contemporary understanding of the frequency and variety of patients and syndromes seen by ID services has implications for training, service development and setting research priorities. We performed a 2-week prospective survey of formal ID physician activities related to direct inpatient care, encompassing 53 hospitals throughout Australia, New Zealand and Singapore, and documented 1722 inpatient interactions. Infections involving the skin and soft tissue, respiratory tract and bone/joints together accounted for 49% of all consultations. Suspected/confirmed pathogens were primarily bacterial (60%), rather than viral (6%), fungal (4%), mycobacterial (2%) or parasitic (1%). Staphylococcus aureus was implicated in 409 (24%) episodes, approximately four times more frequently than the next most common pathogen. The frequency of healthcare-related infections (35%), immunosuppression (21%), diabetes mellitus (19%), prosthesis-related infections (13%), multiresistant pathogens (13%) and non-infectious diagnoses (9%) was high, although consultation characteristics varied between geographical settings and hospital types. Our study highlights the diversity of inpatient-related ID activities and should direct future teaching and research. ID physicians' ability to offer beneficial consultative advice requires broad understanding of, and ability to interact with, a wide range of referring specialities.

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“…Of note, all nine studies applied restriction mainly in lastresort antibiotics, including third-generation or fourth-generation cephalosporins, vancomycin, tigecycline, linezolid, imipenem, meropenem, and fluoroquinolones (Table 1). If we take into consideration the three studies that we excluded since they reported exclusively the change in consumption of restricted antibiotics (53)(54)(55). the pooled decrease in the consumption was 25% (95% CI ϭ 34.2 to 15.8, 2 ϭ 0.02, Egger's bias ϭ Ϫ1.84, P ϭ 0.560).…”

Section: Resultsmentioning

confidence: 99%

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

Karanika

Paudel

Grigoras

et al. 2016

Antimicrob Agents Chemother

285

192

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bThe implementation of antimicrobial stewardship programs (ASPs) is a promising strategy to help address the problem of antimicrobial resistance. We sought to determine the efficacy of ASPs and their effect on clinical and economic parameters. We searched PubMed, EMBASE, and Google Scholar looking for studies on the efficacy of ASPs in hospitals. Based on 26 studies (extracted from 24,917 citations) with pre-and postimplementation periods from 6 months to 3 years, the pooled percentage change of total antimicrobial consumption after the implementation of ASPs was ؊19.1% (95% confidence interval [CI] ‫؍‬ ؊30.1 to ؊7.5), and the use of restricted antimicrobial agents decreased by ؊26.6% (95% CI ‫؍‬ ؊52.3 to ؊0.8). Interestingly, in intensive care units, the decrease in antimicrobial consumption was ؊39.5% (95% CI ‫؍‬ ؊72.5 to ؊6.4). ). Hospital ASPs result in significant decreases in antimicrobial consumption and cost, and the benefit is higher in the critical care setting. Infections due to specific antimicrobial-resistant pathogens and the overall hospital length of stay are improved as well. Future studies should focus on the sustainability of these outcomes and evaluate potential beneficial long-term effects of ASPs in mortality and infection rates.A bout one-third of the hospitalized patients and more than two-thirds of critically ill patients are on antimicrobial therapy at any time (1, 2), and up to half of antibiotic prescriptions are inappropriate or not necessary (3). In 2013, the Centers for Disease Control and Prevention (CDC) reported that about 2 million patients are infected yearly with antimicrobialresistant organisms in the United States, and about 23,000 deaths are directly attributed to these infections (3). This resulted in a call to action for acute care hospitals to implement antimicrobial stewardship programs (ASPs) (4, 5), a term that is used to describe the integrated strategy of improving antimicrobial use in order to enhance patient outcomes, reduce antimicrobial cost, and minimize the side effects associated with antimicrobial use, including drug resistance and nosocomial infections (4, 6, 7). Although there are studies that have already presented data on the efficacy of ASPs in the inpatient setting (8-10), limitations compromise their generalization (i.e., the studies were only conducted in the United States [8], age and study design limitations [9], a lack of clinical outcomes [10], etc.). The purpose of our systematic review and meta-analysis was to measure the efficacy of the implementation of an ASP expressed in daily defined doses (DDD) per 1,000 patient days in the hospital setting independently of the age and study design and to assess the subsequent clinical and economic outcomes. MATERIALS AND METHODSThis systematic review and meta-analysis followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol (11).Search strategy. A systematic electronic search of PubMed, EMBASE, and Google Scholar databases was performed for pertinent studies up t...

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Prescribing trends before and after implementation of an antimicrobial stewardship program

Abstract: The introduction of an antimicrobial stewardship program, including postprescription review, resulted in an immediate reduction in broad-spectrum antimicrobial use in a tertiary referral centre. However, the effect of this intervention reduced over time.

Cited by 51 publications

References 11 publications

Implementation of hospital‐wide reform at improving access and flow: Impact on time to antibiotics in the emergency department

Implementation of hospital‐wide reform at improving access and flow: Impact on time to antibiotics in the emergency department

What do infectious diseases physicians do? A 2-week snapshot of inpatient consultative activities across Australia, New Zealand and Singapore

Systematic Review and Meta-analysis of Clinical and Economic Outcomes from the Implementation of Hospital-Based Antimicrobial Stewardship Programs

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