Evaluation of an Antimicrobial Stewardship Approach to Minimize Overuse of Antibiotics in Patients with Asymptomatic Bacteriuria

2014 ◽  
Vol 35 (2) ◽  
pp. 193-195 ◽  
Author(s):  
Denise Kelley ◽  
Patrick Aaronson ◽  
Elaine Poon ◽  
Yvette S. McCarter ◽  
Ben Bato ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Treatment ◽  
Antimicrobial Use ◽  
Educational Initiative ◽  
Educational Initiatives ◽  
Academic Medical ◽  
Inappropriate Treatment

An antimicrobial stewardship educational initiative provided to physicians and pharmacists was evaluated at an academic medical center to minimize inappropriate treatment of asymptomatic bacteriuria (ASB). A significant decrease in empirical antimicrobial use for ASB was observed after education. Multifaceted educational initiatives can reduce inappropriate antimicrobial treatment of ASB.

The Implementation and Effect of Weekend Pharmacy-Driven Antimicrobial Stewardship Services at a Large Academic Medical Center

2021 ◽  
pp. 089719002199700
Author(s):  
Brian C. Bohn ◽  
Elizabeth A. Neuner ◽  
Vasilios Athans ◽  
Kaitlyn R. Rivard ◽  
Allison R. Riffle ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Audit And Feedback ◽  
Antimicrobial Use ◽  
Post Intervention ◽  
Academic Medical ◽  
Quasi Experimental ◽  
Prospective Audit And Feedback

Background: In September 2018, pharmacy antimicrobial stewardship (AMS) services were expanded to include weekends at this academic medical center. Activities performed by AMS pharmacists on the weekends include blood culture rapid diagnostic (RDT) review, antiretroviral therapy (ART) review, prospective audit and feedback (PAF) utilizing clinical decision support, vancomycin dosing, and operational support. The purpose of this study was to assess the operational and clinical impact of these expanded AMS services. Methods: This single-center, quasi-experimental study included data from weekends before (9/2017–11/2017) and after (9/2018–11/2018) implementation. The descriptive primary outcome was the number of activities completed for each AMS activity type in the post-implementation group only. Secondary outcomes were time to AMS opportunity resolution, time to escalation or de-escalation following PAF or RDT alert, time to resolution of miscellaneous AMS related opportunities, length of stay (LOS), and antimicrobial use outcomes. Results: During the post-implementation period 1258 activities were completed, averaging 97/weekend. Inclusion criteria for time to resolution outcomes were met by 72 patients pre-implementation and 59 patients post. The median (IQR) time to AMS opportunity resolution decreased from 18.5 hours pre-intervention (7.7-35.7) to 8.5 hours post-intervention (IQR 1.8-14.0), p < 0.01. Time to escalation was 11.6 hours compared to 1.7 hours (p = 0.1), de-escalation 16.7 hours compared to 10.8 hours (p = 0.03), and miscellaneous opportunity 40.8 hours compared to 13.2 hours (p = 0.01). No differences were observed in LOS or antimicrobial use outcomes. Conclusion: Presence of pharmacist-driven weekend AMS services significantly reduced time to resolution of AMS opportunities. These data support the value of weekend AMS services.

scholarly journals 482. Time Series Analysis of Antimicrobial Consumption and Pseudomonas aeruginosa Resistance in an Academic Medical Center in the United States (2013–2018)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S236-S236
Author(s):  
Courtney M Dewart ◽  
Courtney Hebert ◽  
Preeti Pancholi ◽  
Kurt Stevenson
Keyword(s):  
Antimicrobial Stewardship ◽  
Transfer Functions ◽  
Medical Center ◽  
Academic Medical Center ◽  
The United States ◽  
Antimicrobial Use ◽  
Antimicrobial Consumption ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Healthcare Associated

Abstract Background Monitoring antimicrobial use and resistance are key components of initiatives to promote antimicrobial stewardship and prevent antimicrobial-resistant infections. In this surveillance study, we evaluated trends in resistance among healthcare-associated P. aeruginosa isolates and potential associations with antimicrobial consumption. Methods We established a retrospective cohort of P. aeruginosa isolates collected ≥48 hours after inpatient admission at a 1,300-bed academic medical center from July 1, 2013 to July 31, 2018. We included isolates from all clinical cultures and retained the first isolate for a patient encounter. We defined the multidrug-resistant (MDR) status in accordance with the phenotype definitions established by the Centers for Disease Control and Prevention. We calculated the monthly percentage of class-specific resistance and MDR status among isolates. We measured monthly antimicrobial consumption as days of therapy per 1,000 patient-days. To evaluate potential associations between identified trends in resistance and antimicrobial use, we constructed autoregressive integrated moving average models (ARIMA) with transfer functions. Results Of 1,897 isolates included in the analysis, 303 (16.0%) were classified as MDR P. aeruginosa. The rate of healthcare-associated P. aeruginosa infections and percent of MDR isolates remained stable over the five-year study period. However, we identified trends in resistance to specific antimicrobial classes: there was a significant increase in resistance to antipseudomonal carbapenems, while resistance to aminoglycosides and extended-spectrum cephalosporins decreased. Using the ARIMA modeling strategy, bivariable analyses of resistance and antimicrobial use revealed that carbapenem-resistant P. aeruginosa was positively correlated with the use of antipseudomonal carbapenems at a 1-month lag and ertapenem at a 5-month lag. Conclusion Risk assessments that only measure rates of MDR organisms may miss underlying trends in class resistance. Increasing carbapenem resistance despite a stable proportion of MDR isolates highlights a critical area for continued monitoring and antimicrobial stewardship initiatives targeted at carbapenem use in our hospital. Disclosures All authors: No reported disclosures.

scholarly journals 164. Avoiding Complacency: Assessing the Perceived Impact and Value of Antimicrobial Stewardship at a Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S90-S91
Author(s):  
Matthew S Lee ◽  
Christopher McCoy
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Clinical Decision ◽  
Team Members ◽  
Academic Medical ◽  
Support Tools ◽  
Educational Engagement ◽  
Similar Survey ◽  
Perceived Impact

Abstract Background Multi-disciplinary engagement and education remain key measures for Antimicrobial Stewardship Programs (ASPs). Over 3 years, our ASP has undergone key changes to pre-authorization review, post-prescriptive activities, and core team members, coinciding with a 30% increase in stewardship interventions. The objectives of this study were to evaluate the familiarity of Nursing, Pharmacy and Prescribers at our academic medical center regarding ASP activities and services, as well as perceived impact on patient care and value. Secondary objectives were to determine what resources are currently utilized and areas for improvement. Methods Distinct surveys were distributed to three participant groups: Nurses, Pharmacists, and Prescribers (Housestaff, Advanced Practice Providers, and staff physicians). Questions were developed to assess familiarity, perceived value, and overall satisfaction with the ASP. Additional items included questions on the current use of ASP resources and educational engagement. Survey results were compared to a similar survey conducted 3 years amongst the same participant groups. Results The survey was delivered electronically to 3367 Prescribers, Nurses and Pharmacists. 403 responders completed the survey (208 Nurses, 181 Prescribers, and 18 Pharmacists). Familiarity was lowest amongst Nurses, but almost doubled compared to 2016 (Figure). Prescribers cited “restricted antibiotic approval”, “de-escalation”, and “alternative therapies relative to allergies” as the three most common interaction types, similar to 2016. ASP interactions continued to be rated “moderate” or “high” value (88.4% vs 89.15% in 2016), however, face-to-face interactions were preferred by only 4% of responders (unchanged compared to 2016). Prescribers also responded uncommon use of ASP online resources (20%) and clinical decision support tools (34%). 78% of responders expressed desire for increased ASP-related education. Conclusion As ASPs evolve, it is important to constantly evaluate impact and value, and identify areas for growth. Despite ASP familiarity being high and interactions valued, we need to further optimize ASP provided resources, clinical support tools, and educational offerings. Disclosures All Authors: No reported disclosures

Role of postgraduate year 2 pharmacy residents in providing weekend antimicrobial stewardship coverage in an academic medical center

2017 ◽  
Vol 74 (6) ◽  
pp. 417-423 ◽  
Author(s):  
Justin Siegfried ◽  
Cristian Merchan ◽  
Marco R. Scipione ◽  
John Papadopoulos ◽  
Arash Dabestani ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Medical Center ◽  
Academic Medical Center ◽  
Academic Medical

scholarly journals 183. Optimization of an Outpatient Antimicrobial Stewardship Process for Patients Discharged from the Emergency Department at an Academic Medical Center

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S98-S98
Author(s):  
Hannah Kafisheh ◽  
Matthew Hinton ◽  
Amanda Binkley ◽  
Christo Cimino ◽  
Christopher Edwards
Keyword(s):  
Emergency Department ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Positive Culture ◽  
Culture Result ◽  
Academic Medical ◽  
Positive Culture Result ◽  
Therapy Modification

Abstract Background Suboptimal antimicrobial therapy has resulted in the emergence of multi-drug resistant organisms. The objective of this study was to optimize the time to antimicrobial therapy modification for patients discharged from the emergency department (ED) of an academic medical center through implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative (ASI). Methods This was a pre-post, quasi-experimental study that evaluated the impact of a pharmacist-driven outpatient antimicrobial stewardship initiative at a single academic medical center. The pre-cohort was evaluated through manual electronic medical record (EMR) review, while the post-cohort involved a real-time notification alert system through an electronic clinical surveillance application. The difference in time from positive culture result to antimicrobial therapy optimization before and after implementation of the pharmacist-driven ASI was collected and analyzed. Results A total of 166 cultures were included in the analysis. Of these, 12/72 (16%) in the pre-cohort and 11/94 (12%) in the post-cohort required antimicrobial therapy modification, with a 21.9-hour reduction in median time from positive culture result to antimicrobial optimization in the post-cohort (43 h vs. 21.1 h; p &lt; 0.01). Similarly, the median time from positive culture result to review was reduced by 20 hours with pharmacist-driven intervention (21.1 h vs. 1.4 h; p &lt; 0.01). Conclusion The implementation of a pharmacist-driven outpatient antimicrobial stewardship initiative resulted in a significant reduction in time to positive culture review and therapy optimization for patients discharged from the ED of an academic medical center set in Philadelphia, PA. Disclosures All Authors: No reported disclosures

Sign in / Sign up

Export Citation Format

Share Document