Syndrome-specific versus prospective audit and feedback interventions for reducing use of broad-spectrum antimicrobial agents

Mediwala, Krutika N; Kohn, Joseph; Bookstaver, P. Brandon; Justo, Julie Ann; Rac, Hana; Tucker, Kendall; Lashkova, Lora; Dash, Sangita; Al-Hasan, Majdi N.

doi:10.1016/j.ajic.2019.04.175

Cited by 12 publications

(13 citation statements)

References 13 publications

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“…In order to use appropriateness of empirical therapy as a metric for ASP performance, it would require identification of every patient with a particular clinical syndrome (e.g., bloodstream infections, sepsis, or pneumonia) or a representative random sample. Although this may be time-consuming and labor-intensive, many ASPs are currently monitoring the appropriateness of empirical therapy, particularly in patients with bloodstream infections [66,69,70,71,72].…”

Section: Comparison Of Various Antimicrobial Stewardship Metricsmentioning

confidence: 99%

Section: Comparison Of Various Antimicrobial Stewardship Metricsmentioning

confidence: 99%

“…A reduction in antimicrobial use of antipseudomonal beta-lactams and other broad-spectrum agents is possible through syndrome-specific and other ASP interventions [72]. In addition, monitoring antimicrobial use is also rewarding for an ASP as a decline in antimicrobial use of broad-spectrum agents may be observed as early as 6 months following a successful intervention [72,77,78]. In the long-term, reduction in antimicrobial use of broad-spectrum agents will result in a decline in HO-CDI and antimicrobial resistance assuming there are no major changes in the healthcare system (e.g., referral patterns, outpatient antimicrobial prescription rates, clusters of HO-CDI or MDR bacteria).…”

Section: Comparison Of Various Antimicrobial Stewardship Metricsmentioning

confidence: 99%

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Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

et al. 2019

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For decades, the performance of antimicrobial stewardship programs (ASPs) has been measured by incidence rates of hospital-onset Clostridioides difficile and other infections due to multidrug-resistant bacteria. However, these represent indirect and nonspecific ASP metrics. They are often confounded by factors beyond an ASP’s control, such as changes in diagnostic testing methods or algorithms and the potential of patient-to-patient transmission. Whereas these metrics remain useful for global assessment of healthcare systems, antimicrobial use represents a direct metric that separates the performance of an ASP from other safety and quality teams within an institution. The evolution of electronic medical records and healthcare informatics has made measurements of antimicrobial use a reality. The US Centers for Disease Control and Prevention’s initiative for reporting antimicrobial use and standardized antimicrobial administration ratio in hospitals is highly welcomed. Ultimately, ASPs should be evaluated based on what they do best and what they can control, that is, antimicrobial use within their own institution. This narrative review critically appraises existing stewardship metrics and advocates for adopting antimicrobial use as the primary performance measure. It proposes novel formulas to adjust antimicrobial use based on quality of care and microbiological burden at each institution to allow for meaningful inter-network and inter-facility comparisons.

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Section: Comparison Of Various Antimicrobial Stewardship Metricsmentioning

confidence: 99%

Section: Comparison Of Various Antimicrobial Stewardship Metricsmentioning

confidence: 99%

Section: Comparison Of Various Antimicrobial Stewardship Metricsmentioning

confidence: 99%

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Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

et al. 2019

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“…The benefit of this type of intervention is likely a result of targeting the appropriate treatment of the syndrome itself, either FN or sepsis, rather than directing interventions at specific antibiotics. 27…”

Section: Sepsis Managementmentioning

confidence: 99%

“…• Examining differences between syndrome-specific compared with drug-targeted interventions in PAF 27 • Safety of preauthorization strategy, such as during a drug shortage 77…”

Section: Dose Optimizationmentioning

confidence: 99%

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

et al. 2019

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Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on “Implementing an Antibiotic Stewardship Program” were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

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Divide and conquer: Feasibility and Impact of antimicrobial stewardship in a safety‐net community hospital after a syndrome‐based education initiative for pharmacists

Lora

Ali³

et al. 2021

J Am Coll Clin Pharm

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IntroductionAntimicrobial stewardship programs (ASP) have been shown to reduce antimicrobial utilization (AU) and cost. ASP has been required by the Joint Commission for hospital accreditation since 2017. Community hospitals with limited pharmacy staffing and infectious diseases (ID)‐trained pharmacists may have barriers for implementing and sustaining comprehensive ASP.ObjectivesOur objective was to assess the feasibility and impact of syndrome‐based ASP training on pharmacist knowledge, perceptions, and AU in a community hospital with limited pharmacy staff.MethodsA quasi‐experimental study at a 151‐bed hospital was conducted. Pharmacist training on syndrome‐based guidelines was developed by an ID physician. A qualitative cross‐sectional survey to assess pharmacist knowledge and perceptions of ASP was administered before and 3 months after ASP training. Prospective audit and feedback (PAF) were deployed with responsibilities divided between shifts. The Centers for Disease Control and Prevention (CDC) checklist of core elements was done quarterly for 12 months. AU, Clostridium difficile rates, and cost were compared for 12 months before and after implementation.ResultsMost pharmacists did not feel comfortable managing infections before ASP training. All pharmacists found the guidelines helpful and felt more comfortable managing infections at 3 months. ASP was successfully deployed by dividing tasks between shifts. Days of therapy per 1000 patient days increased from 355.5 to 376. The proportion of parenteral antimicrobials decreased from 71% to 65%.Total antimicrobial expenditures decreased by 23%. C. difficile rates decreased by 21% (3.27 vs 2.56) per 10 000 patient days.ConclusionASP was successfully implemented in a safety‐net community hospital without ID‐trained pharmacists using a syndrome‐based education initiative. This strategy improved pharmacist knowledge and perceptions of ID syndromes and ASP. Dividing tasks between shifts can leverage existing resources to fulfill all core elements. Clear guidelines and access to an ID physician are necessary to develop materials and provide support for pharmacists without ID‐specific training and can help curb costs and optimize AU.

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Syndrome-specific versus prospective audit and feedback interventions for reducing use of broad-spectrum antimicrobial agents

Cited by 12 publications

References 13 publications

Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature

Divide and conquer: Feasibility and Impact of antimicrobial stewardship in a safety‐net community hospital after a syndrome‐based education initiative for pharmacists

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