Role of Technology in Antimicrobial Stewardship

Bremmer, Derek N.; Trienski, Tamara L.; Walsh, Thomas; Moffa, Matthew

doi:10.1016/j.mcna.2018.05.007

Cited by 24 publications

(19 citation statements)

References 36 publications

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“…In hospitals, EHRs and clinical decision-support systems for antibiotic stewardship data are associated with a reduction of use of broad-spectrum antibiotics. 33 Lacking EHRs and support systems for antibiotic stewardship, champions could not efficiently manage and analyze antibiotic stewardship data without the support of the HBT.…”

Section: Discussionmentioning

confidence: 99%

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

Seshadri

Felsen

Sellers

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: To describe nursing home staff experiences and perceptions of the factors that impact the sustainability of an antibiotic stewardship program (ASP). Methods: Using a qualitative descriptive design, semistructured interviews with staff at 9 not-for-profit nursing homes with an established ASP were conducted and audio recorded. De-identified transcriptions of the interviews were coded using a sustainability framework and were analyzed to identify themes. Results: Interviews were conducted with 48 clinical and administrative staff to elicit their perceptions of the ASPs, and 7 themes were identified. ASPs were perceived to be resource intensive and “data driven,” requiring access to and interpretation of data that are not readily available at many nursing homes. Though motivated and committed, ASP champions felt that they could not single-handedly sustain the program. Attending to daily clinical needs (ie, “fires”) made it hard to progress beyond implementation and to reach step 2 of sustainability. Longstanding treatment habits by external prescribers and regulations were believed to impede ASP efforts. Partnerships with an external consultant with antibiotic stewardship expertise were considered important, as was the need for internal leadership support and collaboration across disciplinary boundaries. Participants felt that consistent and ongoing education on antibiotic stewardship at all staff levels was important. Conclusions: Although many interconnected factors impact the sustainability of an ASP, nursing homes may be able to sustain an ASP by focusing on 3 critical areas: (1) explicit support by nursing home leadership, (2) external partnerships with professionals with antibiotic stewardship expertise and internal interprofessional collaborations, and (3) consistent education and training for all staff.

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Section: Discussionmentioning

confidence: 99%

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

Seshadri

Felsen

Sellers

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…CDSSs can be seen as very useful tools for improving guideline adherence, particularly regarding antibiotic use for respiratory infections, especially when considering both the significant room for improvement and the high heterogeneity of clinical practices. With the increase in newly available information on antibiotic use, a multiplicity of modalities for educating and informing both patients and health professionals can be employed to supplement traditional educational methods [20]. The focus of this systematic review is to assess the influence of e-health tools, namely, CDSSs, on antibiotic use.…”

Section: Introductionmentioning

confidence: 99%

E-Health Tools to Improve Antibiotic Use and Resistances: A Systematic Review

et al. 2020

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(1) Background: e-Health tools, especially in the form of clinical decision support systems (CDSSs), have been emerging more quickly than ever before. The main objective of this systematic review is to assess the influence of these tools on antibiotic use for respiratory tract infections. (2) Methods: The scientific databases, MEDLINE-PubMed and EMBASE, were searched. The search was conducted by two independent researchers. The search strategy was mainly designed to identify relevant studies on the effectiveness of CDSSs in improving antibiotic use, as a primary outcome, and on the acceptability and usability of CDSSs, as a secondary outcome. (3) Results: After the selection, 22 articles were included. The outcomes were grouped either into antibiotics prescription practices or adherence to guidelines concerning antibiotics prescription. Overall, 15 out of the 22 studies had statistically significant outcomes related to the interventions. (4) Conclusions: Overall, the results show a positive impact on the prescription and conscientious use of antibiotics for respiratory tract infections, both with respect to patients and prescribing healthcare professionals. CDSSs have been shown to have great potential as powerful tools for improving both clinical care and patient outcomes.

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“…4). Although studies demonstrating the efficacy of such dashboards in reducing resistance have not been published so far, these tools could allow a structured audit-feedback approach that is one of the cornerstones of ASP implementation in the ICU [164][165][166].…”

Section: The Appropriate Dashboard In the Icumentioning

confidence: 99%

Rationalizing antimicrobial therapy in the ICU: a narrative review

et al. 2019

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The massive consumption of antibiotics in the ICU is responsible for substantial ecological side effects that promote the dissemination of multidrug-resistant bacteria (MDRB) in this environment. Strikingly, up to half of ICU patients receiving empirical antibiotic therapy have no definitively confirmed infection, while de-escalation and shortened treatment duration are insufficiently considered in those with documented sepsis, highlighting the potential benefit of implementing antibiotic stewardship programs (ASP) and other quality improvement initiatives. The objective of this narrative review is to summarize the available evidence, emerging options, and unsolved controversies for the optimization of antibiotic therapy in the ICU. Published data notably support the need for better identification of patients at risk of MDRB infection, more accurate diagnostic tools enabling a rule-in/rule-out approach for bacterial sepsis, an individualized reasoning for the selection of single-drug or combination empirical regimen, the use of adequate dosing and administration schemes to ensure the attainment of pharmacokinetics/pharmacodynamics targets, concomitant source control when appropriate, and a systematic reappraisal of initial therapy in an attempt to minimize collateral damage on commensal ecosystems through de-escalation and treatment-shortening whenever conceivable. This narrative review also aims at compiling arguments for the elaboration of actionable ASP in the ICU, including improved patient outcomes and a reduction in antibiotic-related selection pressure that may help to control the dissemination of MDRB in this healthcare setting.

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Role of Technology in Antimicrobial Stewardship

Cited by 24 publications

References 36 publications

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

“There is no one to pick up the pieces”: Sustainability of antibiotic stewardship programs in nursing homes

E-Health Tools to Improve Antibiotic Use and Resistances: A Systematic Review

Rationalizing antimicrobial therapy in the ICU: a narrative review

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