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Article contents
Impact of unit-specific metrics and prescribing tools on a family medicine ward
Published online by Cambridge University Press: 01 July 2020
Abstract
Objective:
Prescribing metrics, cost, and surrogate markers are often used to describe the value of antimicrobial stewardship (AMS) programs. However, process measures are only indirectly related to clinical outcomes and may not represent the total effect of an intervention. We determined the global impact of a multifaceted AMS initiative for hospitalized adults with common infections.
Design:
Single center, quasi-experimental study.
Methods:
Hospitalized adults with urinary, skin, and respiratory tract infections discharged from family medicine and internal medicine wards before (January 2017–June 2017) and after (January 2018–June 2018) an AMS initiative on a family medicine ward were included. A series of AMS-focused initiatives comprised the development and dissemination of: handheld prescribing tools, AMS positive feedback cases, and academic modules. We compared the effect on an ordinal end point consisting of clinical resolution, adverse drug events, and antimicrobial optimization between the preintervention and postintervention periods.
Results:
In total, 256 subjects were included before and after an AMS intervention. Excessive durations of therapy were reduced from 40.3% to 22% (P < .001). Patients without an optimized antimicrobial course were more likely to experience clinical failure (OR, 2.35; 95% CI, 1.17–4.72). The likelihood of a better global outcome was greater in the family medicine intervention arm (62.0%, 95% CI, 59.6–67.1) than in the preintervention family medicine arm.
Conclusion:
Collaborative, targeted feedback with prescribing metrics, AMS cases, and education improved global outcomes for hospitalized adults on a family medicine ward.
- Type
- Original Article
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- © 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.
References
Wiskirchen, DE, Summa, M, Perrin, A. Antibiotic stewardship: The FP’s role. J Fam Pract 2016;65:876–885.Google ScholarPubMed
Roberts, RM, Hicks, LA. Appropriate antibiotic use: family physicians have the power of the pen. Am Fam Physician 2012;86:810.Google ScholarPubMed
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.CrossRefGoogle Scholar
McGregor, JC, Furuno, JP. Optimizing research methods used for the evaluation of antimicrobial stewardship programs. Clin Infect Dis 2014;59 suppl 3:S185–S192.CrossRefGoogle ScholarPubMed
Evans, SR, Rubin, D, Follmann, D, et al. Desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR). Clin Infect Dis 2015;61:800–806.CrossRefGoogle Scholar
van Duin, D, Lok, JJ, Earley, M, et al. Colistin versus ceftazidime-avibactam in the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Clin Infect Dis 2018;66:163–171.CrossRefGoogle ScholarPubMed
Cabellos, C, Pelegrin, I, Benavent, E, et al. Invasive meningococcal disease: impact of short course therapy. A DOOR/RADAR study. J Infect 2017;75:420–425.10.1016/j.jinf.2017.08.009CrossRefGoogle ScholarPubMed
Comstedt, P, Storgaard, M, Lassen, AT. The systemic inflammatory response syndrome (SIRS) in acutely hospitalised medical patients: a cohort study. Scand J Trauma Resusc Emerg Med 2009;17:67.CrossRefGoogle ScholarPubMed
Charlson, M, Szatrowski, TP, Peterson, J, Gold, J. Validation of a combined comorbidity index. J Clin Epidemiol 1994;47:1245–1251.CrossRefGoogle ScholarPubMed
Shindo, Y, Ito, R, Kobayashi, D, et al. Risk factors for drug-resistant pathogens in community-acquired and healthcare-associated pneumonia. Am J Respir Crit Care Med 2013;188:985–995.CrossRefGoogle ScholarPubMed
Rubin, LG, Levin, MJ, Ljungman, P, et al. 2013 IDSA clinical practice guideline for vaccination of the immunocompromised host. Clin Infect Dis 2014;58:309–318.CrossRefGoogle ScholarPubMed
van Santen, KL, Edwards, JR, Webb, AK, et al. The standardized antimicrobial administration ratio: a new metric for measuring and comparing antibiotic use. Clin Infect Dis 2018;67:179–185.CrossRefGoogle ScholarPubMed
Antimicrobial resistant phenotype definitions: NHSN analysis output options for HAI data. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/ps-analysis-resources/phenotype_definitions.pdf. Updated 2020. Accessed June 12, 2020.Google Scholar
Kaye, KS, Vazquez, J, Mathers, A, D’aikos, G. Meropenem-vaborbactam (Vabomere) vs. best available therapy for CRE infections: TANGO II randomized, controlled phase 3 study results. Paper presented at IDWeek 2017, October 4–6, 2019; San Diego, CA.CrossRefGoogle Scholar
Tamma, PD, Avdic, E, Li, DX, Dzintars, K, Cosgrove, SE. Association of adverse events with antibiotic use in hospitalized patients. JAMA Intern Med 2017;177:1308–1315.CrossRefGoogle ScholarPubMed
Spivak, ESC, Cosgrove, SE, Srinivasan, A. Measuring appropriate antimicrobial use: attempts at opening the black box. Clin Infect Dis 2016;63:1639–1644.Google ScholarPubMed
Wu, H, Webb, A, O’Leary, E, et al. 1861. National Healthcare Safety Network’s electronic antimicrobial use and resistance surveillance: first cohort of hospital reporters, 2011–2017. Open Forum Infect Dis 2018;5:S531–S532.CrossRefGoogle Scholar
Hurst, AL, Child, J, Pearce, K, Palmer, C, Todd, JK, Parker, SK. Handshake stewardship: a highly effective rounding-based antimicrobial optimization service. Pediatr Infect Dis J 2016;35:1104–1110.CrossRefGoogle ScholarPubMed
Molina, J, Cisneros, JM. Editorial commentary: a chance to change the paradigm of outcome assessment of antimicrobial stewardship programs. Clin Infect Dis 2015;61:807–808.CrossRefGoogle ScholarPubMed
McCabe, C, Kirchner, C, Zhang, H, Daley, J, Fisman, DN. Guideline-concordant therapy and reduced mortality and length of stay in adults with community-acquired pneumonia: playing by the rules. Arch Intern Med 2009;169:1525–1531.CrossRefGoogle ScholarPubMed
Branch-Elliman, W, O’Brien, W, Strymish, J, Itani, K, Wyatt, C, Gupta, K. Association of duration and type of surgical prophylaxis with antimicrobial-associated adverse events. JAMA Surg 2019;154:590–598.CrossRefGoogle ScholarPubMed
Nicolle, LE, Gupta, K, Bradley, SF, et al. Clinical practice guideline for the management of asymptomatic bacteriuria: 2019 update by the Infectious Diseases Society of Americaa. Clin Infect Dis 2019;68:e83–e110.CrossRefGoogle Scholar
Cai, T, Mazzoli, S, Mondaini, N, et al. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Clin Infect Dis 2012;55:771–777.CrossRefGoogle ScholarPubMed
Seddon, MM, Bookstaver, PB, Justo, JA, et al. Role of early de-escalation of antimicrobial therapy on risk of Clostridioides difficile infection following Enterobacteriaceae bloodstream infections. Clin Infect Dis 2018;69:414–420.CrossRefGoogle Scholar
Keller, SC, Williams, D, Gavgani, M, et al. Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy. Clin Infect Dis 2018;66:11–19.CrossRefGoogle ScholarPubMed
Lodise, TP, Rosenkranz, SL, Finnemeyer, M, et al. The emperor’s new clothes: prospective observational evaluation of the association between initial vancomycin exposure and failure rates among adult hospitalized patients with MRSA bloodstream infections (PROVIDE). Clin Infect Dis 2020;70:1536–1545.CrossRefGoogle Scholar
Celestin, AR, Odom, SR, Angelidou, K, et al. Novel method suggests global superiority of short-duration antibiotics for intra-abdominal infections. Clin Infect Dis 2017;65:1577–1579.CrossRefGoogle ScholarPubMed
Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004;38:1586–1591.Google ScholarPubMed
Mercuro et al. supplementary material
Mercuro et al. supplementary material
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