Strategies of hospital antimicrobial stewardship associated with different health outcomes

Okumura, Lucas Miyake; Riveros, Bruno Salgado; Silva, Monica Maria Gomes da; Veroneze, Izelandia

doi:10.1016/s1473-3099(16)30263-8

Cited by 4 publications

(3 citation statements)

References 6 publications

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“…At the time of writing, the optimal approach to antibiotic stewardship has yet to be defined. Both restrictive and persuasive strategies have been advocated to improve antimicrobial use in the hospital setting [24][25][26]. However, research suggests that "active strategy-based" antibiotic stewardship programs [27], which define care plans with hospital prescribers, might be associated with superior clinical [28] and health-economic [29] outcomes.…”

Section: Discussionmentioning

confidence: 99%

Day 10 Post-Prescription Audit Optimizes Antibiotic Therapy in Patients with Bloodstream Infections

et al. 2020

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This study aimed to investigate the clinical and organizational impact of an active re-evaluation (on day 10) of patients on antibiotic treatment diagnosed with bloodstream infections (BSIs). A prospective, single center, pre-post quasi-experimental study was performed. Patients were enrolled at the time of microbial BSI confirmation. In the pre-intervention phase (August 2014–August 2015), clinical status and antibiotic regimen were re-evaluated at day 3. In the intervention phase (January 2016–January 2017), clinical status and antibiotic regimen were re-evaluated at day 3 and day 10. Primary outcomes were rate of optimal therapy, duration of antibiotic therapy, length of hospitalization, and 30-day mortality. A total of 632 patients were enrolled (pre-intervention period, n = 303; intervention period, n = 329). Average duration of therapy reduced from 18.1 days (standard deviation (SD), 11.4) in the pre-intervention period to 16.8 days (SD, 12.7) in the intervention period (p < 0.001). Similarly, average length of hospitalization decreased from 24.1 days (SD, 20.8) to 20.6 days (SD, 17.7) (p = 0.001). No inter-group difference was found for the rate of 30-day mortality. In patients with BSI, re-evaluation of clinical status and antibiotic regimen at day 3 and 10 after microbiological diagnosis was correlated with a reduction in the duration of antibiotic therapy and hospital stay. The intervention is simple and has a low impact on overall costs.

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Section: Discussionmentioning

confidence: 99%

Day 10 Post-Prescription Audit Optimizes Antibiotic Therapy in Patients with Bloodstream Infections

et al. 2020

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“…Erlöseffekte durch kürzere Liegedauern sowie erhöhte Fallzahlen sind in dieser Berechnung jedoch noch gar nicht berücksichtigt [7]. Insofern erscheint der höhere Bedarf von 2 Vollzeitstellen/500 Betten der australischen ABS-Empfehlung nicht unrealistisch [8], zumal in einer brasilianischen Studie gezeigt wurde: Eine (personalintensivere) Visitenbegleitung durch das ABS-Team hat einen deutlich höheren Einfluss auf die 30-Tage-Mortalität und die Reduktion der Antibiotika-Verbrauchsdichte als eine telefonische Beratung [9]. Mit geringeren Stellenanteilen, wie in vielen Häusern üblich, können ABS-Maßnahmen weder sinnvoll noch kostenneutral durchgeführt werden.…”

Section: Merkeunclassified

“…B. absetzen, deeskalieren, oralisieren eines Antibiotikums[18]. Eine aktive Visitenbegleitung kann zu einer signifikanten Reduktion der Tag-30-Mortalität sowie zu einer signifikanten Reduktion des Antibiotikaverbrauchs in DDD/1000 Patiententage führen[9]. Fachpersonal für Infektiologie kann im klinischen Alltag eine wichtige Führungsrolle für die Patientensicherheit bekommen durch ▪ effektive Kommunikation und ▪ Überwinden bestehender "Barrieren", wie z.…”

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Antibiotic Stewardship im Alltag – „Fragen Sie Ihren Arzt und Apotheker!“

Friedrichs¹,

Steinborn²,

Eisend³

2017

Anästhesiol Intensivmed Notfallmed Schmerzther

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Antimicrobial Stewardship (AMS) cannot be practised as a one-man show. A well-established AMS-team with formal authority and dedicated time given by the hospital management can manage its tasks also in exceptional situations as for example an outbreak due to a multi-drug-resistant pathogen. Know-how of clinical infectious diseases is mandatory for all members of the AMS-team. The AMS-team plays various roles in an outbreak situation with the rational use of last-resort antibiotics and optimization of the dosage by therapeutic drug monitoring being most important. Restrictive usage of antibiotics can decrease the antibiotic selection pressure and counteract with the development of new bacterial resistances. Usage of last-resort antibiotics in an outbreak situation leads to an exceptional increase of therapeutic costs with fewer patients at the same time. Interdisciplinary work of infection control, the AMS-team, the different clinical departments and the hospital management are important for the prevention and the management of outbreak situations due to multi-drug-resistant pathogens.

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A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections

Murri

Taccari

Spanu

et al. 2017

Eur J Clin Microbiol Infect Dis

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Antimicrobial stewardship programs are implemented to optimize the use of antibiotics and control the spread of antibiotic resistance. Many antimicrobial stewardship interventions have demonstrated significant efficacy in reducing unnecessary prescriptions of antibiotics, the duration of antimicrobial therapy, and mortality. We evaluated the benefits of a combination of rapid diagnostic tests and an active re-evaluation of antibiotic therapy 72 h after the onset of bloodstream infection (BSI). All patients with BSI from November 2015 to November 2016 in a 1100-bed university hospital in Rome, where an Infectious Disease Consultancy Unit (Unità di Consulenza Infettivologica, UDCI) is available, were re-evaluated at the bedside 72 h after starting antimicrobial therapy and compared to two pre-intervention periods: the UDCI was called by the ward physician for patients with BSI and the UDCI was called directly by the microbiologist immediately after a pathogen was isolated from blood cultures. Recommendations for antibiotic de-escalation or discontinuation significantly increased (54%) from the two pre-intervention periods (32% and 27.2%, p < 0.0001). Appropriate escalation also significantly increased (22.5%) from the pre-intervention periods (8.1% and 8.2%, p < 0.0001). The total duration of antibiotic therapy decreased with intervention (from 21.9 days [standard deviation, SD 15.4] in period 1 to 19.3 days [SD 13.3] in period 2 to 17.7 days in period 3 [SD 11.5]; p = 0.002) and the length of stay was significantly shorter (from 29.7 days [SD 29.3] in period 1 to 26.8 days [SD 24.7] in period 2 to 24.2 days in period 3 [SD 20.7]; p = 0.04) than in the two pre-intervention periods. Mortality was similar among the study periods (31 patients died in period 1 (15.7%), 39 (16.7%) in period 2, and 48 (15.3%) in period 3; p = 0.90). Rapid diagnostic tests and 72 h re-evaluation of empirical therapy for BSI significantly correlated with an improved rate of optimal antibiotic therapy and decreased duration of antibiotic therapy and length of stay.

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Strategies of hospital antimicrobial stewardship associated with different health outcomes

Cited by 4 publications

References 6 publications

Day 10 Post-Prescription Audit Optimizes Antibiotic Therapy in Patients with Bloodstream Infections

Day 10 Post-Prescription Audit Optimizes Antibiotic Therapy in Patients with Bloodstream Infections

Antibiotic Stewardship im Alltag – „Fragen Sie Ihren Arzt und Apotheker!“

A 72-h intervention for improvement of the rate of optimal antibiotic therapy in patients with bloodstream infections

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