The Impact of an Infectious Diseases Consultation on Antimicrobial Prescribing

Osowicki, Joshua; Gwee, Amanda; Noronha, Jesuina; Palasanthiran, Pamela; McMullan, Brendan; Britton, Philip N; Isaacs, David; Lai, Tony; Nourse, Clare; Avent, Minyon; Moriarty, Paul; Clark, Julia; Francis, Joshua; Blyth, Christopher C; Cooper, C; Bryant, Penelope A

doi:10.1097/inf.0000000000000285

Cited by 6 publications

(5 citation statements)

References 2 publications

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“…The range of gentamicin and vancomycin doses highlights continuing challenges and uncertainties in dosing and monitoring strategies for these agents in the neonatal period. 18,19 For gentamicin in particular, the diversity is similar to findings in UK neonatal units. [29][30][31] An Australasian working group, including many contributors to this study, is currently formulating consensus therapeutic guidelines for vancomycin and gentamicin dosing on the dosing in children and neonates.…”

Section: Discussionsupporting

confidence: 76%

“…We have, however, reported previously on the significant impact of ID consultation-12% fewer inappropriate prescriptions-in children, 19 and this is echoed by the Turkish study, which reported a 12% reduction in inappropriate prescribing across pediatric and neonatal units with ID consultation. 11,13,16 Overall, antimicrobial prescribing was limited to relatively few drugs, with a DU50 of only 3 agents for antimicrobial treatment.…”

Section: Discussionmentioning

confidence: 54%

See 1 more Smart Citation

Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units

Osowicki

Gwee

Noronha

et al. 2015

Pediatric Infectious Disease Journal

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 54%

Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units

Osowicki

Gwee

Noronha

et al. 2015

Pediatric Infectious Disease Journal

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“…In addition, we did not include errors in dose, duration, or route, which may inflate the appropriateness measure. A comparable appropriateness measure based on indication and selection of antimicrobial prescription was found to be 89% in a point prevalence study from 8 pediatric hospitals in Australia (12). However, there are notable differences from our study in population, location, and study design.…”

Section: Discussioncontrasting

confidence: 48%

A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

Bork

Claeys

Heil

et al. 2020

Antimicrob Agents Chemother

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Hospital-based antibiotic stewardship (AS) programs provide oversight and guidance for appropriate antimicrobial use in acute care settings. Infectious disease expertise is beneficial in the care of hospitalized patients with infections. The impact of infectious diseases consultation (IDC) on antimicrobial appropriateness in a large tertiary hospital with an established AS program was investigated. This was a cross-sectional study from October 2017 to March 2019 at a large academic hospital with an AS-directed prospective audit and feedback process and multiple IDC services. Antimicrobial appropriateness was adjudicated by an AS team member after antimicrobial start. Antimicrobial appropriateness was compared among antimicrobial orders with and without IDC using propensity score matching and multivariable logistic regression. Analyses were stratified by primary services caring for the patients. There were 10,508 antimicrobial orders from 6,165 unique patient encounters. Overall appropriateness was 92%, with higher appropriateness among patients with IDC versus without IDC (94% versus 84%; P < 0.0001). After propensity score matching and adjustment for certain antibiotics, organisms, syndromes, and locations, IDC was associated with a greater antimicrobial appropriateness odds ratio (OR) of 2.4 (95% confidence interval [CI], 1.9 to 3.0). Stratification by primary service showed an OR of 2.9 (95% CI, 2.1 to 3.8) for surgical specialties and an OR of 1.6 (95% CI, 1.1 to 2.2) for medical specialties. Even with a high overall antimicrobial appropriateness, patients with IDC had greater odds of antimicrobial appropriateness than those without IDC, and this impact was greater in surgical specialties. Infectious diseases consultation can be synergistic with antimicrobial stewardship programs.

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“…Holding other factors constant, presence of a clinical pharmacist on the ordering unit or receipt of an ID consult were associated with 17% and 56% lower odds of intervention, respectively. Our ID consult findings comport with previous research by our group linking ID consults to a higher likelihood of antibiotic appropriateness [ 4 ], as well as to research in pediatric populations [ 13 ] and in specific ID syndromes (eg, Staphylococcus aureus bacteremia) [ 14 ]. Similarly, clinical pharmacists are primed to engage in antimicrobial stewardship activities with a focus on optimization such as duration, dosing, and administration route adjustments, as well as de-escalation.…”

Section: Discussionsupporting

confidence: 75%

Real-world Antimicrobial Stewardship Experience in a Large Academic Medical Center: Using Statistical and Machine Learning Approaches to Identify Intervention “Hotspots” in an Antibiotic Audit and Feedback Program

Goodman

Heil

Claeys

et al. 2022

Open Forum Infectious Diseases

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Background Prospective audit with feedback (PAF) is an impactful strategy for antimicrobial stewardship program (ASP) activities. However, because PAF requires reviewing large numbers of antimicrobial orders on a case-by-case basis, PAF programs are highly resource-intensive. The current study aimed to identify predictors of ASP intervention (i.e., feedback), and to build models to identify orders that can be safely bypassed from review, to make PAF programs more efficient. Methods We performed a retrospective cross-sectional study of inpatient antimicrobial orders reviewed by the University of Maryland Medical Center’s PAF program between 2017–2019. We evaluated the relationship between antimicrobial and patient characteristics with ASP intervention using multivariable logistic regression models. Separately, we built prediction models for ASP intervention using statistical and machine learning approaches and evaluated performance on held-out data. Results Across 17,503 PAF reviews, 4,219 (24%) resulted in intervention. In adjusted analyses, a clinical pharmacist on the ordering unit or receipt of an ID consult were associated with 17% and 56% lower intervention odds, respectively (aORs 0.83 and 0.44, P values ≤ 0.001). Fluoroquinolones had the highest adjusted intervention odds (aOR 3.22, 95% CI: 2.63–3.96). A machine learning classifier (C-statistic 0.76) reduced reviews by 49% while achieving 78% sensitivity. A “workflow simplified” regression model that restricted to antimicrobial class and clinical indication variables, two strong machine-learning-identified predictors, reduced reviews by one-third while achieving 81% sensitivity. Conclusions Prediction models substantially reduced PAF review caseloads while maintaining high sensitivities. Our results and approach may offer a blueprint for other ASPs.

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The Impact of an Infectious Diseases Consultation on Antimicrobial Prescribing

Cited by 6 publications

References 2 publications

Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units

Australia-wide Point Prevalence Survey of Antimicrobial Prescribing in Neonatal Units

A Propensity Score Matched Study of the Positive Impact of Infectious Diseases Consultation on Antimicrobial Appropriateness in Hospitalized Patients with Antimicrobial Stewardship Oversight

Real-world Antimicrobial Stewardship Experience in a Large Academic Medical Center: Using Statistical and Machine Learning Approaches to Identify Intervention “Hotspots” in an Antibiotic Audit and Feedback Program

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