Implementation of a care bundle for antimicrobial stewardship
ABSTRACT The impact of an antibiotic-use care bundle on compliance with quality indicators was evaluated.
Patients admitted to the internal medicine or surgery floor of a tertiary care center who were receiving an anti-pseudomonal beta-lactam, vancomycin, a fluoroquinolone, linezolid, an amino-glycoside, or any combination of these agents were included in the study. The study consisted of two phases: intervention (when a stewardship pharmacist was involved in patient care) and control (when no stewardship pharmacist was involved). The stewardship pharmacist completed interventions via prospective audit and suggested changes to empirical and definitive antimicrobials, monitored patients' cultures and antimicrobial therapy daily, and provided education on the institution's antibiogram. The primary outcome measured was compliance with the care bundle's quality indicators, which included documentation of treatment rationale, collection of appropriate culture specimens according to institutional and national guidelines, appropriate empirical selection of antibiotics according to institutional and national guidelines at initiation of antibiotic therapy and deescalation, and selection of appropriate agents for definitive therapy during antimicrobial therapy.
A total of 160 patients and 442 antibiotic orders were evaluated. During the intervention phase, 168 interventions were made, with an acceptance rate of 91%. The rate of appropriate deescalation rose from 72% to 90% (p = 0.01). Compliance with all quality indicators rose from 16% to 43% (p < 0.001).
Implementation of an antimicrobial stewardship program care bundle on two patient care units was associated with improved rates of compliance with quality indicators.
- SourceAvailable from: Shelley Rankin
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- "Such guidelines can be directly used or form the basis of hospital-level antimicrobial use guidelines. The impact of national or international guidelines is difficult to assess, but implementation of antimicrobial use guidelines at the hospital level has been shown to significantly improve antimicrobial prescribing practices, either alone or as part of a broader antimicrobial stewardship program [3–5]. "
ABSTRACT: Urinary tract disease is a common reason for use (and likely misuse, improper use, and overuse) of antimicrobials in dogs and cats. There is a lack of comprehensive treatment guidelines such as those that are available for human medicine. Accordingly, guidelines for diagnosis and management of urinary tract infections were created by a Working Group of the International Society for Companion Animal Infectious Diseases. While objective data are currently limited, these guidelines provide information to assist in the diagnosis and management of upper and lower urinary tract infections in dogs and cats.06/2011; 2011:263768. DOI:10.4061/2011/263768
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ABSTRACT: French hospitals are urged by health authorities to develop antibiotic stewardship (ABS) programmes in order to improve antibiotic use and to decrease their consumption. We performed a longitudinal survey to describe ABS measures implementation and antibiotic use and to study relationships between ABS measures and trends in antibiotic use between 2005 and 2009. Data on ABS, antibiotic use and activity were retrospectively collected by questionnaires sent to hospitals voluntarily participating in the south-western France network. ABS measures covered organization, resources, restrictive and persuasive actions. Antibiotic use was retrieved from pharmacy records and expressed as the number of defined daily doses/1000 patient-days according to national and WHO guidelines using 2009 defined daily dose values to monitor trends. Relationships between ABS measures and antibiotic use were studied by multivariate logistic regression. Between 2005 and 2009, the degree of implementation of ABS increased in the 74 participating hospitals. Antibiotic use remained stable, with variations according to hospital groups and antibiotic classes. In hospitals with more ABS measures, antibiotic use in general and fluoroquinolone use tended to remain stable or to decrease. Educational activities were associated with a decrease in fluoroquinolone use in the univariate analysis. In the multivariate analysis, practice audits and time dedicated by the antibiotic advisor were significantly associated with a decrease in total antibiotic use and fluoroquinolone use, respectively. This first longitudinal study, in 74 hospitals, showed that human resources and persuasive ABS measures, in the context of a multidisciplinary approach, are helpful in controlling total antibiotic and fluoroquinolone use.Journal of Antimicrobial Chemotherapy 07/2011; 66(7):1631-7. DOI:10.1093/jac/dkr179 · 5.44 Impact Factor
Article: The case for antifungal stewardship[Show abstract] [Hide abstract]
ABSTRACT: Antimicrobial stewardship (AMS) has overwhelmingly focussed on antibiotics while antifungal agents have been largely neglected despite the few published audits of antifungal drug use demonstrating clear deficiencies in prescribing behaviour. In this review, we outline not only the elements of antifungal stewardship (AFS) in common with AMS but also features specific to antifungal drugs, combined with insights from our experience in AFS. Invasive fungal diseases (IFDs) have a lower institutional incidence relative to infections caused by multiresistant bacteria, but their health and economic burden are substantial. Pharmacy costs inclusive of antifungal agents are a major determinant of IFD-attributable hospital cost. High drug costs and the toxicities of antifungal agents are the principal rationale for AFS while antifungal resistance is an emerging but less prevalent issue. The high mortality/morbidity associated with IFDs, including adverse impact on curative chemotherapy, combined with suboptimal diagnostic tools, has driven the overuse of antifungal drugs. De-escalation of empiric therapy is one of the most challenging aspects of AFS to implement. Nonculture-based tests may enhance AFS, but refinement of both target populations and clinical pathways incorporating their use is required. Performance indicators including structural, process and outcome measures are integral for demonstrating the value of AFS programmes. Practice guidelines adapted to the local context are the cornerstone of AFS. Local epidemiology informs the choice of antifungal agents for the prevention and management of IFDs, underscoring the need for surveillance. Adherence to minimum standards of prescribing ensures that clinical outcomes are optimized and drug toxicities minimized, thus meeting healthcare quality and safety goals.Current Opinion in Infectious Diseases 11/2011; 25(1):107-15. DOI:10.1097/QCO.0b013e32834e0680 · 5.03 Impact Factor