Antimicrobial Stewardship in the Emergency Department

2011 ◽  
Vol 24 (2) ◽  
pp. 196-202 ◽  
Author(s):  
Nicole M. Acquisto ◽  
Stephanie N. Baker
Keyword(s):  
Emergency Department ◽  
Emergency Medicine ◽  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Antimicrobial Stewardship Program ◽  
Implementation Outcomes ◽  
Stewardship Program ◽  
Assessment Skills ◽  
Barriers To Implementation

The practice of antimicrobial stewardship can be defined as optimizing clinical outcomes while minimizing the consequences of antimicrobial therapy such as resistance and superinfection. Antimicrobial stewardship can be difficult to transition to the emergency department (ED) since the traditional activities include the evaluation of broad-spectrum antimicrobial regimens at 72 and 96 hours and intravenous to oral medication conversion. The emergency medicine clinical pharmacist (EPh) has the knowledge and clinical assessment skills to manage an antimicrobial stewardship program focused on culture follow-up for patients discharged from the ED. This paper summarizes the experiences of developing an EPh-managed antimicrobial stewardship and culture follow-up program in the ED from 2 separate institutions. Specifically, the focus is on the steps for establishing an EPh-managed antimicrobial stewardship program, a description of the culture follow-up process, managing the culture data and cultures that require emergent notification and review, medical/legal concerns, and barriers to implementation. Outcomes data available from institutions with similar ED based antimicrobial stewardship programs are also discussed.

scholarly journals Pharmacist-Managed Antimicrobial Stewardship Program for Patients Discharged From the Emergency Department

2011 ◽  
Vol 25 (2) ◽  
pp. 190-194 ◽  
Author(s):  
Stephanie N. Baker ◽  
Nicole M. Acquisto ◽  
Elizabeth Dodds Ashley ◽  
Rollin J. Fairbanks ◽  
Suzanne E. Beamish ◽  
...  
Keyword(s):  
Emergency Department ◽  
Median Time ◽  
Antimicrobial Stewardship ◽  
Positive Culture ◽  
Inpatient Setting ◽  
Antimicrobial Stewardship Program ◽  
Retrospective Case ◽  
Stewardship Program ◽  
Control Study

Positive outcomes of antimicrobial stewardship programs in the inpatient setting are well documented, but the benefits for patients not admitted to the hospital remain less clear. This report describes a retrospective case–control study of patients discharged from the emergency department (ED) with subsequent positive cultures conducted to determine whether integrating antimicrobial stewardship responsibilities into practice of the emergency medicine clinical pharmacist (EPh) decreased times to positive culture follow-up, patient or primary care provider (PCP) notification, and appropriateness of antimicrobial therapy. Pre- and post-implementation groups of an EPh-managed antimicrobial stewardship program were compared. Positive cultures were identified in 177 patients, 104 and 73 in pre- and post-implementation groups, respectively. Median time to culture review in the pre-implementation group was 3 days (range 1-15) and 2 days (range 0-4) in the post-implementation group ( P = .0001). There were 74 (71.2%) and 36 (49.3%) positive cultures that required notification in the pre- and post-implementation groups, respectively, and the median time to patient or PCP notification was 3 days (range 1-9) and 2 days (range 0-4) in the 2 groups ( P = .01). No difference was seen in the appropriateness of therapy. In conclusion, EPh involvement reduced time to positive culture review and time to patient or PCP notification when indicated.

scholarly journals Impact of a comprehensive antimicrobial stewardship program on antimicrobial utilization and clinical isolates distribution in ICUs

2020 ◽  
Author(s):  
Jiaojiao Song ◽  
Rongsheng Zhu ◽  
Leiqing Li ◽  
Lingcheng Xu ◽  
Quan Zhou ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Second Generation ◽  
Antimicrobial Treatment ◽  
Clinical Isolates ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Stewardship Program ◽  
Antimicrobial Utilization ◽  
Lactamase Inhibitor

Abstract Objective This study aimed to evaluate the effect of a comprehensive antimicrobial stewardship program (ASP) and provide clinical evidence for the scientific stewardship of antimicrobials in intensive care units (ICUs) of a teaching hospital.Methods Between January 2013 and December 2018, we conducted a prospective study, based on an antimicrobial computerized clinical decision support system (aCDSS) deployed in 2015 in ICUs of a tertiary and teaching hospital. The primary outcomes included initial and overall use prevalence of antimicrobials. The second outcomes were the detection rate of common clinical isolates before and after therapeutic antimicrobial use, and the change in patterns of resistance of 5 common clinical isolates in the ICU.Results Various types of broad-spectrum antimicrobial use prevalence continued to increase from 2013 to 2015, since 2016, where initial use of carbapenems and glycopeptides were counterbalanced by an increase in use of the first/second-generation cephalosporins, β-lactam and β-lactamase inhibitor combinations and linezolid. From 2015 to 2018, the proportion of extended-broad spectrum antimicrobials alone, wide-coverage therapy and combination therapy decreased significantly (P<0.05). Similarly, where use of carbapenems, glycopeptides, third/fourth-generation cephalosporins and anti-fungi agents were counterbalanced by an increase in overall use of the first/second-generation cephalosporins and β-lactam and β-lactamase inhibitor combinations. A total of 21891 strains of bacteria and fungi were detected in ICUs from 2015 to 2018, of them, 6.5% (1426/21891) strains were detected before antimicrobial treatment. The detection proportion of Staphylococcus aureus , Escherichia coli , Klebsiella pneumoniae and fastidious bacteria were significantly higher before antimicrobial treatment (P<0.05), while Acinetobacter baumannii , Burkholderia cepacia , and Candida spp were significantly lower in all non-repetitive clinical isolates (P<0.05).Conclusions The implementation of a comprehensive ASP combining CDSS in ICUs seems to be effective to improve outcomes on antimicrobial utilization and clinical isolates distribution in critically ill patients.

scholarly journals 1055. Addition of Antimicrobial Stewardship Program Weekend Coverage Increases Interventions while Reducing Antimicrobial Duration and Cost

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S372-S373
Author(s):  
Natasha N Pettit ◽  
Jennifer Pisano ◽  
Cynthia T Nguyen
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Total Duration ◽  
Time Frame ◽  
Antimicrobial Stewardship Program ◽  
Clinical Pharmacists ◽  
Duration Of Therapy ◽  
Stewardship Program ◽  
Secondary Outcomes ◽  
The Impact

Abstract Background Expansion of Antimicrobial Stewardship Program (ASP) activities to include coverage of weekends has been shown to facilitate further optimization of antimicrobial usage. Beginning July 2018, we implemented full ASP coverage on weekends from 0700–1530 by infectious diseases (ID) clinical pharmacists and pharmacy residents. We sought to evaluate the impact of the addition of weekend ASP coverage on the number of interventions, antimicrobial duration and cost of target broad-spectrum antimicrobials. Methods Antimicrobials reviewed by ASP on a weekend day between July 14, 2018 and December 16, 2018 were included in the analysis. The primary outcome was the number and type of documented interventions associated with the antimicrobials reviewed. Secondary outcomes included the total duration of meropenem, daptomycin, and micafungin initiated on a weekend, estimated expenditures on these target broad-spectrum antimicrobials, and comparison of the average number of interventions performed per day by ID clinical pharmacists vs. pharmacy residents. For comparison, we also evaluated these secondary outcomes prior to ASP weekend coverage, between July 16, 2017 and December 9, 2017. Results A total of 688 antimicrobials were reviewed on weekend days during the included time-frame with 753 interventions (average number of interventions/day: 37). Table 1 summarizes the type of interventions. The acceptance rate for interventions was 99%. The average number of interventions per day for ID clinical pharmacists vs. pharmacy residents was 57.9 and 26.2, respectively. Table 2 shows the total duration of therapy (DOT) and total expenditures on target antimicrobials before and after ASP weekend coverage. The total DOT of target antimicrobials agents decreased from 21 days to 7 days, with an estimated 3,165 dollar decrease in expenditures during the included time-frame. Conclusion Expansion of ASP coverage to include weekends allowed us to provide 753 interventions over 4 months that would not otherwise have been made when no ASP coverage was available. This was associated with a reduction in broad-spectrum antimicrobial duration of therapy and expenditures when compared with weekends where ASP weekend coverage was not available. Disclosures All authors: No reported disclosures.

Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

2018 ◽  
Vol 39 (07) ◽  
pp. 806-813 ◽  
Author(s):  
Laura L. Bio ◽  
Jenna F. Kruger ◽  
Betty P. Lee ◽  
Matthew S. Wood ◽  
Hayden T. Schwenk
Keyword(s):  
Antimicrobial Stewardship ◽  
Primary Outcome ◽  
Audit And Feedback ◽  
Antimicrobial Stewardship Program ◽  
Free Standing ◽  
Logistic Regression Models ◽  
Patient Level ◽  
Stewardship Program ◽  
Prospective Audit And Feedback

OBJECTIVETo identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children’s hospital.DESIGNRetrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.METHODSThe ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.RESULTSIn total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99–15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08–18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92–19.77), or had been admitted for 31–90 days at the time of the audit (OR, 2.08; 95% CI, 1.36–3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01–1.04).CONCLUSIONSEvaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.Infect Control Hosp Epidemiol 2018;806–813

scholarly journals 109. Develop and Implement a Novel Pediatric Antimicrobial Stewardship Program in a Non-Freestanding Children’s Hospital Located in an Adult-Centered Community Hospital in San Joaquin Valley, California

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S168-S169
Author(s):  
Tsung-Chi Lien ◽  
Laurie Covarrubias ◽  
Alice Ip ◽  
Harlan Husted ◽  
Emi Suzuki ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Medical Center ◽  
Antimicrobial Use ◽  
Antimicrobial Stewardship Program ◽  
Broad Spectrum Antibiotic ◽  
Children's Hospital ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Children’S Hospital

Abstract Background A pediatric-specific antimicrobial stewardship program (Ped ASP) has been shown to optimize antimicrobial use, improve patient outcomes, and reduce healthcare expenditures in this population. Opportunities and challenges exist when developing a Ped ASP for a children’s hospital within an adult-centered medical center primarily due to mixed infrastructure. The objective of this study is to provide process and outcome data of a new Ped ASP in a non-freestanding children’s hospital within an adult-centered tertiary hospital. Methods A pediatric infectious disease physician and four pediatric pharmacists designed a Ped ASP utilizing direct and indirect patient care activities to optimize pediatric antimicrobial use in 21 bed-pediatric services within a 685-bed, adult-centered medical center. Implemented in 2020, Ped ASP activities include thrice weekly chart reviews followed by handshake rounds and quarterly reviews of documented interventions. The Ped ASP team also developed policies, education, and other resources to further guide appropriate antimicrobial use, in collaboration with the adult team. Results Ped ASP was initiated on general pediatric (PED) and pediatric intensive care (PICU) units. In 2020, a total of 286 charts were reviewed with 199 antibiotic interventions provided, including optimization of antimicrobial selection (23%), IV-to-PO conversion (15%), and antimicrobial dosage adjustment (13%). Annual average antibiotic length and days of therapy per 1000 patient-days were 241 and 290 respectively in PED, and 388 and 432 in PICU. The overall trend from 2020 to 2021 decreased in PED but increased in PICU (Fig. 1). The ratio of narrow to broad spectrum antibiotic use increased for both PED and PICU (Fig. 2). Simultaneously, a pediatric-specific antibiogram, extended-infusion protocol of beta-lactams, and neonatal sepsis treatment algorithm were developed and implemented. Antibiotic Days of Therapy per 1000 Patient Days Ratio of Narrow: Broad Spectrum Antibiotic Usage Conclusion A Ped ASP was successfully developed in a non-freestanding children’s hospital. Continual metrics served as an important tool to identify areas for improvement. Future goals include expansion of Ped ASP to other service lines, enhanced ASP education and development of additional pediatric antimicrobial treatment pathways. Disclosures All Authors: No reported disclosures

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