Use of leading practices in US hospital antimicrobial stewardship programs

Abstract

Objective: To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey. Setting: Acute-care hospitals. Participants: ASP leaders. Methods: Advance letters and electronic questionnaires were initiated February 2020. Primary outcomes were percentage of hospitals that (1) implemented facility-specific treatment guidelines (FSTG); (2) performed interactive prospective audit and feedback (PAF) either face-to-face or by telephone; (3) optimized diagnostic testing; (4) measured antibiotic utilization; (5) measured C. difficile infection (CDI); and (6) measured adherence to FSTGs. Results: Of 948 hospitals invited, 288 (30.4%) completed the questionnaire. Among them, 82 (28.5%) had <99 beds, 162 (56.3%) had 100–399 beds, and 44 (15.2%) had ≥400+ beds. Also, 230 (79.9%) were healthcare system members. Moreover, 161 hospitals (54.8%) reported implementing FSTGs; 214 (72.4%) performed interactive PAF; 105 (34.9%) implemented procedures to optimize diagnostic testing; 235 (79.8%) measured antibiotic utilization; 258 (88.2%) measured CDI; and 110 (37.1%) measured FSTG adherence. Small hospitals performed less interactive PAF (61.0%; P = .0018). Small and nonsystem hospitals were less likely to optimize diagnostic testing: 25.2% (P = .030) and 21.0% (P = .0077), respectively. Small hospitals were less likely to measure antibiotic utilization (67.8%; P = .0010) and CDI (80.3%; P = .0038). Nonsystem hospitals were less likely to implement FSTGs (34.3%; P < .001). Conclusions: Significant variation exists in the adoption of ASP leading practices. A minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs. Additional efforts are needed to expand adoption of leading practices across all acute-care hospitals with the greatest need in smaller hospitals.

Inclusion, diversity, access, and equity in antimicrobial stewardship: where we are and where we are headed

“…Inequities in antimicrobial prescribing exist in the context of race/ethnicity, rurality, socioeconomic status, and other factors Studies demonstrating inequities should interrogate upstream drivers of inequities and innovative approaches to mitigating and reducing them Considerations for approaching antimicrobial stewardship through a lens of equity include increasing access to ASPs, reducing disparities in antimicrobial prescribing, and increasing diversity in decisionmaking roles. [43]. In the ambulatory setting, more inappropriate prescribing can be seen in the Southern regions and more rural clinical practices [15 & ,20,44].…”

“…Populations in remote areas tend to experience worse health outcomes and more costly healthcare delivery [42]. Rural hospitals comprise the majority of hospitals in the USA but are the least likely to have an ASP that meets all of the CDC's core elements [43]. In the ambulatory setting, more inappropriate prescribing can be seen in the Southern regions and more rural clinical practices [15 ▪ ,20,44].…”

Diagnostic and antimicrobial stewardship workforce challenges: A crisis in combating antimicrobial resistance

“… 9 Although only one-third of hospitals in the United States report efforts to optimize diagnostic testing, this is 1 of the 6 leading stewardship practices and an area ripe for multidisciplinary improvement. 10 In collaboration with stewardship personnel, microbiologists are responsible for guiding actions like diagnostic test selection, providing input on appropriate reporting, and following up on critical results. Optimizing existing test use and rapid diagnostic testing with adjunctive reporting algorithms can be crucial in building more sustainable and resilient healthcare systems for addressing AMR.…”

“… 12 In contrast, lower-resourced facilities (eg, rural and smaller hospitals) have been associated with less prospective audit and feedback, optimized diagnostic testing, and measurement of antibiotic use, which may contribute to rural health inequities in AMR. 10 Robust and systematic investment in human resources is integral to the growth and sustainability of ASPs.…”

Asymptomatic bacteriuria in critical-access hospitals: Prevalence and patient characteristics driving treatment

“…Reports suggest that antimicrobial stewardship practices should be tailored to the local facility environment; however, published data to guide stewardship interventions are limited in rural and CAHs. 1 …”