scholarly journals Does electronic stewardship work?

2017 ◽  
Vol 24 (5) ◽  
pp. 981-985 ◽  
Author(s):  
Barbara B Lambl ◽  
Nathan Kaufman ◽  
Janice Kurowski ◽  
W O’Neill ◽  
Frederick Buckley Jr ◽  
...  
Keyword(s):  
Decision Support ◽  
High Risk ◽  
Clostridium Difficile ◽  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Drug Resistant ◽  
Community Hospitals ◽  
Hospital Acquired ◽  
Electronic Order

Abstract Faced with national requirements to promote antimicrobial stewardship and reduce drug-resistant infections, community hospitals are challenged to make the best use of existing resources. Eighteen months after building antibiotic decision support into our electronic order platform, high-risk antibiotic use decreased by 83% (P < .001) at our community hospital. Hospital-acquired Clostridium difficile infections declined 24% (P = .07).

scholarly journals Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

PLoS ONE ◽  
2021 ◽  
Vol 16 (6) ◽  
pp. e0252407
Author(s):  
Daniel Doyle ◽  
Gerald McDonald ◽  
Claire Pratt ◽  
Zahra Rehan ◽  
Tammy Benteau ◽  
...  
Keyword(s):  
Decision Support ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Cost Savings ◽  
Antibiotic Use ◽  
Defined Daily Dose ◽  
Support Tool ◽  
Survey Tool ◽  
Before And After ◽  
The Impact

Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

scholarly journals The Current State of Antifungal Stewardship in Immunocompromised Populations

2021 ◽  
Vol 7 (5) ◽  
pp. 352
Author(s):  
William Alegria ◽  
Payal K. Patel
Keyword(s):  
Antimicrobial Stewardship ◽  
Healthcare Costs ◽  
Adverse Drug Events ◽  
Immunocompromised Patient ◽  
Antibiotic Use ◽  
Drug Resistant ◽  
Antifungal Stewardship ◽  
Current State ◽  
Complex Population ◽  
Antifungal Use

Inappropriate antifungal use is prevalent and can lead to drug-resistant fungi, expose patients to adverse drug events, and increase healthcare costs. While antimicrobial stewardship programs have traditionally focused on antibiotic use, the need for targeted antifungal stewardship (AFS) intervention has garnered interest in recent years. Despite this, data on AFS in immunocompromised patient populations is limited. This paper will review the current state of AFS in this complex population and explore opportunities for multidisciplinary collaboration.

scholarly journals Reflex Urine Culture Practices in a Regional Community Hospital Network

2020 ◽  
Vol 41 (S1) ◽  
pp. s370-s370
Author(s):  
Dorothy Ling ◽  
Jessica Seidelman ◽  
Elizabeth Dodds Ashley ◽  
Sarah Lewis ◽  
Rebekah Moehring ◽  
...  
Keyword(s):  
Epithelial Cells ◽  
Community Hospital ◽  
Antibiotic Use ◽  
Multiple Criteria ◽  
Exclusion Criterion ◽  
Community Hospitals ◽  
Indwelling Catheter ◽  
Specific Patient ◽  
Wide Variability ◽  
True Infection

Background: Reflex urine cultures (RUCs) have the potential to reduce unnecessary urine cultures and antibiotic use. However, urinalysis parameters that best predict true infection are unknown. In this study, we surveyed different RUC practices in laboratories across a regional network of community hospitals. Methods: We conducted a voluntary electronic survey of infection preventionists to describe laboratory practices relating to RUCs across 51 community hospitals in the Duke Infection Control Outreach Network (DICON) between May 15, 2019, and July 3, 2019. Results: We received 51 responses (response rate, 100%). Most hospital laboratories were located in North Carolina (n = 25, 49%) and Georgia (n = 18, 35%); 28 laboratories (55%) incorporated RUCs. Surveyed laboratories accepted urine samples from any source and various collection methods (eg, indwelling catheter specimens, clean catch specimens). Moreover, 24 laboratories (86%) offered RUCs for all patients, whereas 4 laboratories (14%) restricted RUCs to specific populations (ie, outpatient, emergency room or children). We observed wide variability in the urinalysis criteria used for RUCs (Table 1); 26 unique approaches were used among 28 laboratories. Also, 24 laboratories (86%) used multiple criteria and 4 (14%) used 1 criterion. Of those that used multiple criteria, all 24 proceeded to RUC if at least 1 UA criterion was met. Furthermore, 22 laboratories (79%) incorporated the presence of nitrites as a urinalysis criterion; 21 laboratories (75%) incorporated white blood cell count (WBC) as a criterion. The most frequent WBC cutoffs were “≥5” (n = 11, 39%) and “≥10” (n = 7, 25%). In addition, 21 laboratories (75%) incorporated leukocyte esterase as a urinalysis criterion, with criteria including “positive” (n = 15, 54%), “trace” (n = 4, 14%), “moderate” (n = 1, 4%), and “large” (n = 1, 4%). Also, 17 (61%) laboratories incorporated magnitude of bacteriuria as a urinalysis criterion. The cutoff ranged from “few” (n = 8, 29%), “moderate” (n = 7, 25%), to “many” (n = 2, 7%). Another 3 (11%) laboratories incorporated other criteria: presence of blood (n = 2, 7%) and presence of fungal elements (n = 1, 4%). Only 3 (11%) laboratories utilized epithelial cells as an exclusion criterion where urinalysis would not proceed to culture if epithelial cells in urinalysis samples exceeded the designated limit, ranging from “>5” to “>15”. Conclusions: More than half of the hospitals in our community hospital network utilize RUCs, but criteria varied widely. Future epidemiological research should aim to identify ideal urinalysis parameters as well as specific patient populations that safely benefit from RUC strategies.Funding: NoneDisclosures: None

scholarly journals 1031. Effect of On-Site ID Specialist Led, Antimicrobial Stewardship Pharmacist Driven Program on Provider Acceptance, Antimicrobial Utilization and Clostridoides Infection Rates In a Community Hospital / Rural Regional Referral Center

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S363-S363
Author(s):  
Daniel Brailita ◽  
Justin Lane
Keyword(s):  
Community Hospital ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Referral Center ◽  
Clostridioides Difficile ◽  
Antimicrobial Utilization ◽  
Core Elements ◽  
Implementation Guidelines ◽  
Hospital Acquired ◽  
Direct Feedback

Abstract Background Antibiotic Stewardship (ASP) standards for hospitals became effective January 1, 2017. Core Elements implementation guidelines have been challenging for rural hospitals usually lacking on-site expertise. Our 170-bed Community Hospital / rural referral center has dedicated resources for on-site ASP. Our team includes on-site Infectious Disease (ID) Specialist and dedicated ASP pharmacist. Over first 2 years, our model shows very high provider acceptance, improvement in antimicrobial use pattern and reduction in the number of Clostridioides difficile infections (CDI). Methods The ASP Pharmacist conducted a daily review of ASP targets. He met with on-site ID Physician 3 days weekly to discuss interventions and review complex cases. The ASP team - ID Medical Director, ASP Pharmacist, Microbiologist, Invention Preventionist and Hospitalist met monthly to discuss outcomes and facility-wide interventions. ASP audit included: positive cultures, patients on multiple or broad-spectrum antimicrobials, patients receiving dual nephrotoxic drugs, carbapenems, fluoroquinolones, candidates for IV to PO conversion The audit results were communicated in-person to attending physician and documented in electronic medical record. Results ASP team recommendations were accepted in 94% of cases ID consult was recommended in 4.69% and was accepted 100%. Top 20 IV antimicrobial use decreased by 10%. Fluoroquinolones (29%) and carbapenems (28%) showed highest decrease. Cephalosporins showed small increase. Hospital-acquired CDI rate decreased from 0.83 cases/ 1000 patient-days (PD) pre-ASP to 0.53 cases/ 1000 PD post-ASP. General CDI diagnosis decreased from 3.21 cases/1000 PD pre-ASAP to 2.23 cases/ 1000 PD post-ASP Conclusion An on-site, ID Specialist reviewed and dedicated ASP Pharmacist driven program at a rural referral center/ Community Hospital significantly improved antibiotic use and decreased Clostridium Difficile Infections in the first 2 years. Direct feedback of ASP review to providers resulted in an excellent acceptance rate. On-site ID and ASP Pharmacist collaboration is logistically difficult to achieve but expanding our model to rural referral centers should be considered. More research is needed to determine the cost-effectiveness of onsite, dual led programs. Disclosures All authors: No reported disclosures.

scholarly journals 39. Impact of Antimicrobial Stewardship Interventions in a Community Hospital setting: An Interrupted Times Analysis

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S141-S142
Author(s):  
Jason Li ◽  
Ken Chan ◽  
Hina Parvez ◽  
Margaret Gorlin ◽  
Miriam A Smith
Keyword(s):  
Antimicrobial Stewardship ◽  
Community Hospital ◽  
Hospital Setting ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Intervention Period ◽  
Prospective Audit ◽  
Post Intervention ◽  
The Impact

Abstract Background Community hospitals have fewer resources for antimicrobial stewardship programs (ASP) compared to larger tertiary hospitals. At our 312-bed community hospital, Long Island Jewish Forest Hills/Northwell, a combination of modified preauthorization, prospective audit feedback, and ASP education was implemented starting in August 2019 (Monday through Friday 9 am to 5 pm). Methods This retrospective study evaluated the impact of ASP interventions on the rate of targeted antimicrobial use over a 7 month pre- vs 7 month post- intervention period (Aug 2018 to Feb 2019 vs Aug 2019 to Feb 2020). Targeted antimicrobials included piperacillin-tazobactam, vancomycin, daptomycin, and carbapenems. The primary outcome was the monthly mean for overall targeted antimicrobial use measured by the rate of antimicrobial days per 1000 days present. Secondary outcomes were the individual rates of antimicrobial days per 1000 days present for each of the targeted antimicrobials, and the hospital’s overall standardized antimicrobial administration ratio (SAAR). Data were analyzed as a segmented regression of interrupted time series. Results Pre-intervention, there was an increasing trend (positive slope, p< 0.05) in the monthly mean, hospital SAAR, vancomycin and piperacillin-tazobactam use. Post-intervention, there was a significant change in slope for these same metrics, indicating a decrease in the mean use. Immediate impact of ASP interventions, measured by the difference in antibiotic use between the end of each intervention period, was visually evident in all cases except carbapenems (Fig. 1 through 4). The immediate impact on the overall monthly mean represented a significant reduction in the rate of antimicrobial days per 1000 days present, -12.72 (CI -21.02 to -4.42, P < 0.0066). The pre- vs post- ASP gap for all measures was negative and consistent with fewer days of antibiotic use immediately following intervention. Conclusion A targeted, multifaceted ASP intervention utilizing modified preauthorization, prospective audit feedback, and education significantly reduced antibiotic use in a community hospital. Disclosures All Authors: No reported disclosures

Community-acquired Clostridium difficile infection and Australian food animals

2015 ◽  
Vol 36 (3) ◽  
pp. 111 ◽  
Author(s):  
Michele M Squire ◽  
Daniel R Knight ◽  
Thomas V Riley
Keyword(s):  
High Risk ◽  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Animal Husbandry ◽  
Gram Positive ◽  
Hospital Acquired Infection ◽  
Infectious Diarrhoea ◽  
Food Animal ◽  
Risk Practices ◽  
Hospital Acquired

Clostridium difficile is an anaerobic Gram positive spore-forming bacterium, the leading cause of infectious diarrhoea (C. difficile infection; CDI) in hospitalised humans. The assumption that CDI is primarily a hospital-acquired infection is being questioned. Community-acquired CDI (CA-CDI) is increasing1 particularly in groups previously considered at low risk2,3. In Australia, CA-CDI rates doubled during 2011 and increased by 24% between 2011 and 20124. Two potentially high-risk practices in Australian food animal husbandry may present a risk for CA-CDI: slaughtering of neonatal animals for food, and effluent recycling to agriculture.

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