scholarly journals Decreased Outpatient Fluoroquinolone Prescribing Using a Multimodal Antimicrobial Stewardship Initiative

2020 ◽  
Vol 7 (6) ◽  
Author(s):  
Kevin Lin ◽  
Yorgo Zahlanie ◽  
Jessica K Ortwine ◽  
Norman S Mang ◽  
Wenjing Wei ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Multidrug Resistant ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Hospital System ◽  
Inappropriate Use ◽  
History Of ◽  
Outpatient Settings ◽  
The Impact

Abstract Background Fluoroquinolones are antibiotics prescribed in the outpatient setting, though they have serious side effects. This study evaluates the impact of stewardship interventions on total and inappropriate prescribing of fluoroquinolones in outpatient settings in a large county hospital and health system. Methods In an effort to decrease inappropriate outpatient fluoroquinolone usage, a multimodal antimicrobial stewardship initiative was implemented in November 2016. Education regarding the risks, benefits, and appropriate uses of fluoroquinolones was provided to providers in different outpatient settings, Food and Drug Administration warnings were added to all oral fluoroquinolone orders, an outpatient order set for cystitis treatment was created, and fluoroquinolone susceptibilities were suppressed when appropriate. Charts from October 2016, 2017, and 2018 were retrospectively reviewed if the patient encounter occurred in primary care clinics, emergency departments, or urgent care centers within Parkland Health & Hospital System and a fluoroquinolone was prescribed. Inappropriate use was defined as a fluoroquinolone prescription for cystitis, bronchitis, or sinusitis in a patient without a history of Pseudomonas aeruginosa or multidrug-resistant organisms and without drug allergies that precluded use of other oral antibiotics. Results Total fluoroquinolone prescriptions per 1000 patient visits decreased significantly by 39% (P < .01), and inappropriate fluoroquinolone use decreased from 53% to 34% (P < .01). More than 90% of inappropriate fluoroquinolone prescriptions were given for cystitis, while bronchitis and sinusitis accounted for only 4.4% and 1.6% of inappropriate indications, respectively. Conclusion A multimodal stewardship initiative appears to effectively reduce both total and inappropriate outpatient fluoroquinolone prescriptions.

scholarly journals 142. Implementing an Antimicrobial Stewardship Program in the Outpatient Setting

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S82-S82
Author(s):  
Travis B Nielsen ◽  
Maressa Santarossa ◽  
Beatrice D Probst ◽  
Laurie Labuszewski ◽  
Jenna Lopez ◽  
...  
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
The United States ◽  
Outpatient Setting ◽  
Urgent Care ◽  
Antibiotic Prescribing ◽  
Antimicrobial Stewardship Program ◽  
Post Intervention ◽  
Stewardship Program

Abstract Background Antimicrobial-resistant infections lead to increased morbidity, mortality, and healthcare costs. Among the most facile modifiable risk factors for developing resistance is inappropriate prescribing. The CDC estimates that 47 million (or ≥30% of) outpatient antibiotic prescriptions in the United States are unnecessary. This has provided impetus for expanding our antimicrobial stewardship program (ASP) into the outpatient setting. Initial goals included the following: continuous evaluation and reporting of antibiotic prescribing compliance; minimize underuse of antibiotics from delayed diagnoses and misdiagnoses; ensure proper drug, dose, and duration; improve the percentage of appropriate prescriptions. Methods To achieve these goals, we first sent a baseline survey to outpatient prescribers, assessing their understanding of stewardship and antimicrobial resistance. Questions were modeled from the Illinois Department of Public Health (IDPH) Precious Drugs & Scary Bugs Campaign. The survey was sent to prescribers at 19 primary care and three immediate/urgent care clinics. Compliance rates for prescribing habits were subsequently tracked via electronic health records and reported to prescribers in accordance with IRB approval. Results Prescribers were highly knowledgeable about what constitutes appropriate prescribing, with verified compliance rates highly concordant with self-reported rates. However, 74% of respondents reported intense pressure from patients to inappropriately prescribe antimicrobials. Compliance rates have been tracked since December 2018 and comparing pre- with post-intervention rates shows improvement in primary care since reporting rates to prescribers in August 2019. Conclusion Reporting compliance rates has been helpful in avoiding inappropriate antimicrobial therapy. However, the survey data reinforce the importance of behavioral interventions to bolster ASP efficacy in the outpatient setting. Going forward, posters modeled off of the IDPH template will be conspicuously exhibited in exam rooms, indicating institutional commitment to the enumerated ASP guidelines. Future studies will allow for comparison of pre- and post-intervention knowledge and prescriber compliance. Disclosures All Authors: No reported disclosures

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

scholarly journals The high volume of patients admitted during the SARS-CoV-2 pandemic has an independent harmful impact on in-hospital mortality from COVID-19

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0246170
Author(s):  
Alessandro Soria ◽  
Stefania Galimberti ◽  
Giuseppe Lapadula ◽  
Francesca Visco ◽  
Agata Ardini ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
High Volume ◽  
Hospitalized Patients ◽  
Urgent Care ◽  
Calendar Period ◽  
Cox Models ◽  
Hospital System ◽  
Risk Of Death ◽  
The Impact ◽  
Age And Sex

Background During the Coronavirus disease 2019 (COVID-19) pandemic, advanced health systems have come under pressure by the unprecedented high volume of patients needing urgent care. The impact on mortality of this “patients’ burden” has not been determined. Methods and findings Through retrieval of administrative data from a large referral hospital of Northern Italy, we determined Aalen-Johansen cumulative incidence curves to describe the in-hospital mortality, stratified by fixed covariates. Age- and sex-adjusted Cox models were used to quantify the effect on mortality of variables deemed to reflect the stress on the hospital system, namely the time-dependent number of daily admissions and of total hospitalized patients, and the calendar period. Of the 1225 subjects hospitalized for COVID-19 between February 20 and May 13, 283 died (30-day mortality rate 24%) after a median follow-up of 14 days (interquartile range 5–19). Hospitalizations increased progressively until a peak of 465 subjects on March 26, then declined. The risk of death, adjusted for age and sex, increased for a higher number of daily admissions (adjusted hazard ratio [AHR] per an incremental daily admission of 10 patients: 1.13, 95% Confidence Intervals [CI] 1.05–1.22, p = 0.0014), and for a higher total number of hospitalized patients (AHR per an increase of 50 patients in the total number of hospitalized subjects: 1.11, 95%CI 1.04–1.17, p = 0.0004), while was lower for the calendar period after the peak (AHR 0.56, 95%CI 0.43–0.72, p<0.0001). A validation was conducted on a dataset from another hospital where 500 subjects were hospitalized for COVID-19 in the same period. Figures were consistent in terms of impact of daily admissions, daily census, and calendar period on in-hospital mortality. Conclusions The pressure of a high volume of severely ill patients suffering from COVID-19 has a measurable independent impact on in-hospital mortality.

Antimicrobial stewardship in the outpatient setting: A review and proposed framework

2020 ◽  
Vol 41 (7) ◽  
pp. 833-840 ◽  
Author(s):  
Jasmine R. Marcelin ◽  
Philip Chung ◽  
Trevor C. Van Schooneveld
Keyword(s):  
Primary Care ◽  
Antimicrobial Stewardship ◽  
Outpatient Setting ◽  
Significant Problem ◽  
Implementation Framework ◽  
Inappropriate Use ◽  
Primary Care Settings

AbstractAntimicrobial misuse is still a significant problem, and most inappropriate use occurs in the outpatient setting. In this article, we provide a review of available literature on outpatient antimicrobial stewardship in primary care settings, and we propose a novel implementation framework.

scholarly journals Impact of the COVID-19 Pandemic on Antimicrobial Consumption and Hospital-Acquired Candidemia and Multidrug-Resistant Bloodstream Infections

Antibiotics ◽  
2020 ◽  
Vol 9 (11) ◽  
pp. 816
Author(s):  
Ana Guisado-Gil ◽  
Carmen Infante-Domínguez ◽  
Germán Peñalva ◽  
Julia Praena ◽  
Cristina Roca ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Incidence Density ◽  
Antimicrobial Consumption ◽  
Global Trend ◽  
Long Term Impact ◽  
Hospital Acquired ◽  
The Impact

During the COVID-19 pandemic, the implementation of antimicrobial stewardship strategies has been recommended. This study aimed to assess the impact of the COVID-19 pandemic in a tertiary care Spanish hospital with an active ongoing antimicrobial stewardship programme (ASP). For a 20-week period, we weekly assessed antimicrobial consumption, incidence density, and crude death rate per 1000 occupied bed days of candidemia and multidrug-resistant (MDR) bacterial bloodstream infections (BSI). We conducted a segmented regression analysis of time series. Antimicrobial consumption increased +3.5% per week (p = 0.016) for six weeks after the national lockdown, followed by a sustained weekly reduction of −6.4% (p = 0.001). The global trend for the whole period was stable. The frequency of empirical treatment of patients with COVID-19 was 33.7%. No change in the global trend of incidence of hospital-acquired candidemia and MDR bacterial BSI was observed (+0.5% weekly; p = 0.816), nor differences in 14 and 30-day crude death rates (p = 0.653 and p = 0.732, respectively). Our work provides quantitative data about the pandemic effect on antimicrobial consumption and clinical outcomes in a centre with an active ongoing institutional and education-based ASP. However, assessing the long-term impact of the COVID-19 pandemic on antimicrobial resistance is required.

scholarly journals IMPACT OF ANTIMICROBIAL STEWARDSHIP PROGRAM ON THE USE OF ANTIBIOTICS IN PNEUMONIA PATIENTS AT TEACHING HOSPITAL IN SURAKARTA INDONESIA

2021 ◽  
pp. 20-23
Author(s):  
HIDAYAH KARUNIAWATI ◽  
TRI YULIANTI ◽  
DEWI KUROTA AINI ◽  
FINISHIA ISNA NURWIENDA
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Study Data ◽  
Defined Daily Dose ◽  
Inappropriate Use ◽  
Stewardship Program ◽  
Daily Dose ◽  
The Impact ◽  
Method Show

Objective: Antibiotic resistance is a serious problem worldwide. One cause of antibacterial resistance is the inappropriate use of antibiotics. Thestudy of antibiotic use in hospitals found that 30–80% were not based on indications. Antimicrobial Stewardship Programs (ASP) was developed tocontrol antimicrobial resistance. This study aims to evaluate the impact of ASP in pneumonia patients qualitatively and quantitatively pre-post ASPapplied.Methods: This research is a non-experimental study. Data were taken from the medical records of pneumonia patients and analyzed qualitativelyusing the Gyssens method and quantitatively using the Defined Daily Dose (DDD) method. Sampling was conducted through purposive sampling andresults were described descriptively.Results: During the study period, 96 samples were obtained with 48 data pre-ASP and 48 data post-ASP. The results of the qualitative analysis usingthe Gyssens method show an increase in the prudent use of antibiotics from 31.25% to 62.5% pre-post ASP, respectively. Quantitative evaluationshows a decrease of antibiotic use pre-post ASP from 90.84 DDD/100 patients-days to 61.42 DDD/100 patients-days.Conclusion: The ASP can improve the quality of antibiotic use in pneumonia patients quantitatively and qualitatively.

scholarly journals Doctors, Dioceses, and Decisions: Examining the Impact of the Catholic Hospital System and Federal Conscience Clauses on Medical Education

2012 ◽  
Vol 6 (2) ◽  
Author(s):  
Stephanie M. Wurdock
Keyword(s):  
Health Care ◽  
Medical Education ◽  
Medical Students ◽  
Human Life ◽  
Hospital System ◽  
Medical Education And Training ◽  
Practice Of Medicine ◽  
History Of ◽  
Catholic Hospital ◽  
The Impact

In a time when health care reform and the limits on First Amendment freedom of religion are persistent subjects of debate, Catholic restrictions on health care have made it to the forefront of public concern. Catholic providers prohibit a variety of medical procedures traditionally viewed by the Church as contrary to the tenet of respect for human life and dignity. Many Americans view this as an unconstitutional restriction on care. As a result, the growing presence of Catholic providers, namely hospitals, has become a major point of contention in many communities. The potential barrier to medical services raises concern not only for potential patients, but also for medical students whose chosen specialty may include a prohibited service. This article identifies some difficulties that may emerge for current and prospective medical students and advocates that both groups should be required to contemplate (1) their personal beliefs as they pertain to religiously-restricted care, and (2) the effects those beliefs will have on their medical education and training. This article also gives a comprehensive background of the history of the Catholic hospital system in America and analyzes the federal "conscience clauses" and their implications for the instruction and practice of medicine. Finally, this article concludes that a mandatory bioethics curriculum is absolutely crucial to ensure adequate ethics training for medical students.

scholarly journals Kajian Sistematik: Strategi Pembelajaran Klinik di Setting Rawat Jalan

2015 ◽  
Vol 4 (2) ◽  
pp. 43
Author(s):  
Ova Emilia
Keyword(s):  
Pattern Recognition ◽  
Learning Strategies ◽  
Clinical Education ◽  
Learning Process ◽  
Learning Strategy ◽  
Learning Outcome ◽  
Outpatient Setting ◽  
Pubmed Database ◽  
Outpatient Settings ◽  
The Impact

Background: Clinical education in outpatient settings acknowledged as a challange for clinical instructors, which they had to provide efficient and qualified service to the patients while also including educational components that significantly handful for clinical students. We recognized many learning strategies to encounter those challanges, but only few of them that had been evaluated. This systematic review were provided to compare various clinical learning strategies which are useful in outpatient setting.Method: Literature searching has done according PubMed database that related in topics such the impact of clinical education in outpatient setting on learning, outcome, and also efficiency of the outpatient clinics. There were no boundary setting that cone in this systematic review.Results: There were two learning strategy: “One Minute Perceptor” (OMP) and SNAPPS has been showed to be effective in increasing educational-learning process and service outcome. Another two strategies such as “Aunt Minnie” pattern recognition and “Active Demonstration” were also promising but hadn’t been sufficiently studied. There weren’t any of those strategies showed their impact in outpatient clinic setting efficiency.Conclusion: OMP and SNAPPS may be used for clinical mentoring in outpatient settings to increase learning process and learning outcome, while pattern recognition and activated demonstration hadn’t show any promising evidence.

Policy to encourage the development of antimicrobials

2018 ◽  
Vol 23 (2) ◽  
pp. 101-110
Author(s):  
Ayman Chit ◽  
Paul Grootendorst
Keyword(s):  
Antimicrobial Stewardship ◽  
Market Failure ◽  
Public Investment ◽  
Multidrug Resistant ◽  
Investment Incentives ◽  
Policy Makers ◽  
Content Type ◽  
Emergency Situations ◽  
The Impact ◽  
The Eu

Purpose Antimicrobial resistance is a public health threat even in countries exercising aggressive antimicrobial stewardship. A market failure is also causing lackluster innovation in antimicrobial medicines development. At the heart of the issue are antimicrobial stewardship guidelines that, rightfully, reserve innovative antimicrobials for emergency situations that arise due to multidrug-resistant organisms. This suppresses revenues and research and development (R&D) investment incentives of manufacturers. The public policy makers and researchers have taken aim at the problem. The researchers have published strategies to encourage the production of innovative antimicrobials, while policy makers have taken legislative steps to address the issue. Most notably, the USA enacted the Generating Antibiotic Incentives Now (GAIN) act in 2012 and the EU created a commission to formally study possible policy solutions. The paper aims to discuss these issues. Design/methodology/approach In this paper, the authors describe incentives that drive pharmaceutical R&D and review the impact of a number of R&D stimulus policies in other pharmaceutical markets. The authors also discuss which policy levers are useful to boost R&D of new antimicrobials. Findings The authors find that a policy focused on extending intellectual property rights, as implemented in the GAIN act, are unlikely to be impactful. Instead, the authors see a need for the revision of the procurement policy to move away from paying per prescription and toward licenses and advanced market commitment models. Further, the authors note that the importance of steadfast public investment in basic biomedical research as it has been repeatedly shown to boost innovation. Originality/value The authors hope that the work can support the refinement of the GAIN act and the EU efforts.

scholarly journals The use of bloodstream infection mortality to measure the impact of antimicrobial stewardship interventions: assessing the evidence

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Sonali Coulter ◽  
Jason A. Roberts ◽  
Krispin Hajkowicz ◽  
Kate Halton
Keyword(s):  
Antimicrobial Stewardship ◽  
Inappropriate Prescribing ◽  
Bloodstream Infections ◽  
Fold Increase ◽  
Included Study ◽  
Current Evidence ◽  
Inappropriate Therapy ◽  
Prescribing Practices ◽  
Definition Of ◽  
The Impact

This review sets out to evaluate the current evidence on the impact of inappropriate therapy on bloodstream infections (BSI) and associated mortality. Based on the premise that better prescribing practices should result in better patient outcomes, BSI mortality may be a useful metric to evaluate antimicrobial stewardship (AMS) interventions. A systematic search was performed in key medical databases to identify papers published in English between 2005 and 2015 that examined the association between inappropriate prescribing and BSI mortality in adult patients. Only studies that included BSIs caused by ESKAPE (<em>Enterococcus faecium/faecalis, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa</em> and <em>Enterobacter</em> species) organisms were included. Study quality was assessed using the GRADE criteria and results combined using a narrative synthesis. We included 46 studies. Inappropriate prescribing was associated with an overall increase in mortality in BSI. In BSI caused by resistant gram positive organisms, such as methicillin resistant <em>S. aureus</em>, inappropriate therapy resulted in up to a 3-fold increase in mortality. In BSI caused by gram negative (GN) resistant organisms a much greater impact ranging from 3 to 25 fold increase in the risk of mortality was observed. While the overall quality of the studies is limited by design and the variation in the definition of appropriate prescribing, there appears to be some evidence to suggest that inappropriate prescribing leads to increased mortality in patients due to GN BSI. The highest impact of inappropriate prescribing was seen in patients with GN BSI, which may be a useful metric to monitor the impact of AMS interventions.

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