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Impact of Two Different Antimicrobial Stewardship Methods on Frequency of Streamlining Antimicrobial Agents in Patients with Bacteremia

Published online by Cambridge University Press:  09 November 2016

Jennifer Lukaszewicz Bushen ,
Jimish M. Mehta ,
Keith W. Hamilton ,
Shawn Binkley ,
Daniel R. Timko ,
Ebbing Lautenbach  and
David A. Pegues
Jennifer Lukaszewicz Bushen*
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Jimish M. Mehta
Affiliation:
Teqqa, LLC
Keith W. Hamilton
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
Shawn Binkley
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Daniel R. Timko
Affiliation:
Department of Pharmacy, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
David A. Pegues
Affiliation:
Division of Infectious Diseases, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
*
Address correspondence to Jennifer Lukaszewicz Bushen, 3400 Spruce Street, Philadelphia, PA19104, 856-904-0979 (JenniferMBushen@gmail.com).
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Abstract

OBJECTIVE

To assess the likelihood of antimicrobial streamlining between 2 antimicrobial stewardship methods.

DESIGN

Retrospective cohort study.

SETTING

Large academic medical center.

METHODS

Frequency and time to antimicrobial streamlining were compared during a prior authorization and a prospective audit period. Streamlining was defined as an antimicrobial change to a narrower agent if available or to a broader agent if the isolate was resistant to empiric therapy. Patients included were ≥18 years old with monomicrobial bacteremia with S. aureus, Enterococcus spp., or any aerobic Gram-negative organism.

RESULTS

A total of 665 cases of bacteremia met inclusion criteria. Frequency of streamlining was similar between periods for all cases of bacteremia (audit vs restriction: 60.7% vs 53.2%; P=.12), S. aureus bacteremia (73.2% vs 76.9%; P=.671), and Enterococcus bacteremia (81.6% vs 71.9%; P=.335). Compared to restriction, the audit period was associated with an increased frequency of streamlining for cases of Gram-negative bacteremia (51.4% vs 35.6%; odds ratio [OR], 1.85; 95% confidence interval [CI], 1.06–3.25), those on the medical service (67.9% vs 53.1%; OR, 1.86; 95% CI, 1.09–3.16), and those admitted through the emergency department (71.6% vs 51.4%; OR, 2.32; 95% CI, 1.24–4.34). Characteristics associated with increased streamlining included: absence of β-lactam allergy (P<.001), Gram-negative bacteremia (P<.001), admission through the emergency department (P=.001), and admission to a medical service (P=.011).

CONCLUSIONS

Compared with prior authorization, prospective audit increased antimicrobial streamlining for cases of Gram-negative bacteremia, those admitted through the emergency department, and those admitted to a medical but not surgical service.

Infect Control Hosp Epidemiol 2016:1–7

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 1 , January 2017 , pp. 89 - 95
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. The data included in this article were presented at IDWeek 2013 in San Francisco, California, on October 2, 2013.

References

REFERENCES

1. Maki, DG, Schuna, AA. A study of antimicrobial misuse in a university hospital. Am J Med Sci 1978;275:271–281.Google Scholar
2. Scheckler, WE, Bennett, JV. Antibiotic usage in seven community hospitals. JAMA 1970;213:264–267.Google Scholar
3. Castle, M, Wilfert, CM, Cate, TR, Osterhout, S. Antibiotic use at Duke University Medical Center. JAMA 1977;237:2819–2822.CrossRefGoogle ScholarPubMed
4. Kunin, CM, Tupasi, T, Craig, WA. Use of antibiotics: a brief exposition of the problem and some tentative solutions. Ann Intern Med 1973;79:555–560.Google Scholar
5. Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.CrossRefGoogle Scholar
6. Chung, GW, Wu, JE, Yeo, CL, Chan, D, Hsu, LY. Antimicrobial stewardship: a review of prospective audit and feedback systems and an objective evaluation of outcomes. Virulence 2013;4:151–157.Google Scholar
7. Reed, EF, Stevenson, KB, West, JE, Bauer, KA, Goff, DA. Impact of formulary restriction with prior authorization by an antimicrobial stewardship program. Virulence 2013;4:158–162.Google Scholar
8. Seto, WH, Ching, TY, Kou, M, Chiang, SC, Lauder, IJ, Kumana, CR. Hospital antibiotic prescribing successfully modified by ‘immediate concurrent feedback.’ Br J Clin Pharmacol 1996;41:229–234.CrossRefGoogle ScholarPubMed
9. White, AC Jr, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230–239.CrossRefGoogle ScholarPubMed
10. John, JF, Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471–485.Google Scholar
11. Fraser, GL, Stogsdill, P, Dickens, JD Jr, Wennberg, DE, Smith, RP, Prato, S. Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1981;157:1689–1694.Google Scholar
12. Gross, R, Morgan, AS, Kinky, DE, Weinder, M, Gibson, GA, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289–295.Google Scholar
13. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.Google Scholar
14. Mehta, JM, Haynes, K, Wileyto, EP, et al. Comparison of prior authorization and prospective audit with feedback for antimicrobial stewardship. Infect Control Hosp Epidemiol 2014;35:1092–1099.Google Scholar
15. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 18th informational supplement. CLSI document M100-18. Wayne, PA: Clinical and Laboratory Standards Institute. 2008.Google Scholar
16. Clinical Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 19th informational supplement. CLSI document M100-S19. Wayne, PA: Clinical Laboratory Standards Institute. 2009.Google Scholar
17. EUCAST breakpoint tables v 1.3. European Committee on Antimicrobial Susceptibility Testing website. http://www.eucast.org/ast_of_bacteria/previous_versions_of_documents/. Published 2011. Accessed May 11, 2016.Google Scholar
18. EUCAST breakpoint tables v 1.1. European Committee on Antimicrobial Susceptibility Testing website. http://www.eucast.org/ast_of_bacteria/previous_versions_of_documents/. Published 2010. Accessed May 11, 2016.Google Scholar
19. Shen, Y. Applying the 3M All patient refined diagnosis related groups grouper to measure inpatient severity in the VA. Medical Care 2003;41:II-103–II-110.Google Scholar
20. All Patient Refined Diagnosis Related Groups (APR-DRGs). Version 30.0. Wallingford, CT: 3M Health Information Systems; 2012.Google Scholar
21. Aung, AK, Skinner, MJ, Lee, FJ, Cheng, AC. Changing epidemiology of bloodstream infection pathogens over time in adult non-specialty patients at an Australian tertiary hospital. Communicable Dis Intel Qtr Rep 2012;36:E333–E341.Google ScholarPubMed
22. Guidry, CA, Rosenberger, LH, Petroze, RT, et al. Temporal trends in blood stream infection isolates from surgical patients. Surg Infect 2015;16:388–395.Google Scholar
23. Dantes, R, Mu, Y, Belflower, R, et al. National burden of invasive methicillin-resistant Staphylococcus aureus infections, United States, 2011. JAMA Intern Med 2013;173:1970–1978.Google Scholar
24. Health Research & Education Trust of the American Hospital Association. Eliminating CLABSI, a national patient safety imperative. Agency for Healthcare Research and Quality website http://www.ahrq.gov/sites/default/files/publications/files/clabsifinal.pdf. Published 2011. Accessed May 8, 2016.Google Scholar
25. O’Grady, NP, Alexander, M, Burns, LA, et al. Guidelines for the prevention of intravascular catheter-related infections, 2011. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf. Published 2011. Accessed April 4, 2016.Google Scholar
26. Siegel, JD, Rhinehard, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in healthcare settings, 2006. Centers for Disease Control and Prevention website. http://www.cdc.gov/hicpac/pdf/guidelines/MDROGuideline2006.pdf. Published 2006. Accessed April 4, 2016.Google Scholar
27. Kumar, A, Roberts, D, Wood, KE, et al. Duration of hypotension before initiation of effective antimicrobial therapy is the critical determinant of survival in human septic shock. Crit Care Med 2006;34:1589–1596.Google Scholar
28. Kuti, EL, Patel, AA, Coleman, CI. Impact of inappropriate antibiotic therapy on mortality in patients with ventilator-associated pneumonia and blood stream infection: a meta-analysis. J Crit Care 2008;23:91–100.CrossRefGoogle Scholar
29. May, L, Cosgrove, S, L’Archeveque, M, et al. Antimicrobial stewardship in the emergency department and guidelines for development. Ann Emerg Med 2013;62:69–77.Google Scholar