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: Edward B Breitschwerdt[Show abstract] [Hide abstract]
ABSTRACT: Superficial bacterial folliculitis (SBF) is usually caused by Staphylococcus pseudintermedius and routinely treated with systemic antimicrobial agents. Infection is a consequence of reduced immunity associated with alterations of the skin barrier and underlying diseases that may be difficult to diagnose and resolve; thus, SBF is frequently recurrent and repeated treatment is necessary. The emergence of multiresistant bacteria, particularly meticillin-resistant S. pseudintermedius (MRSP), has focused attention on the need for optimal management of SBF. Provision of an internationally available resource guiding practitioners in the diagnosis, treatment and prevention of SBF. The guidelines were developed by the Antimicrobial Guidelines Working Group of the International Society for Companion Animal Infectious Diseases, with consultation and advice from diplomates of the American and European Colleges of Veterinary Dermatology. They describe optimal methods for the diagnosis and management of SBF, including isolation of the causative organism, antimicrobial susceptibility testing, selection of antimicrobial drugs, therapeutic protocols and advice on infection control. Guidance is given for topical and systemic modalities, including approaches suitable for MRSP. Systemic drugs are classified in three tiers. Tier one drugs are used when diagnosis is clear cut and risk factors for antimicrobial drug resistance are not present. Otherwise, tier two drugs are used and antimicrobial susceptibility tests are mandatory. Tier three includes drugs reserved for highly resistant infections; their use is strongly discouraged and, when necessary, they should be used in consultation with specialists. Optimal management of SBF will improve antimicrobial use and reduce selection of MRSP and other multidrug-resistant bacteria affecting animal and human health.Veterinary Dermatology 04/2014; DOI:10.1111/vde.12118 · 1.99 Impact Factor
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ABSTRACT: Antimicrobial stewardship programs (ASPs) have shown to prevent the emergence of antimicrobial resistance associated with an inappropriate antimicrobial use. The primary objective of this study was to compare the prescribing appropriateness rate of the empirical antibiotic therapy before and after the ASP implementation in a tertiary care hospital. Secondary objectives include the rate of Clostridium difficile-associated diarrhea (CDAD), physicians' acceptance rate, patient's intensive care unit (ICU) course, total utilization using defined daily dose, and total direct cost of antibiotics. This is a comparative, historically controlled study. Adult medical ICU patients were enrolled in a prospective fashion under the active ASP arm and compared with historical patients who were admitted to the same unit before the ASP implementation. This study was approved by the institutional review board, and the need for informed consent was waived because the interventions and recommendations were evidence based and considered the standard of care. The study was conducted at KFSHRC, Riyadh. Adult medical ICU patients were enrolled under the active ASP arm if they were on any of the 5 targeted antibiotics (piperacillin/tazobactam, imipenem/cilastatin, meropenem, vancomycin, tigecycline), and had no official infectious disease consultation. The interventions were conducted via prospective audit and feedback. A total of 73 subjects were recruited, 49 in historical control and 24 in the active arm. The appropriateness of empirical antibiotics was improved from 30.6% (15/49) in the historical control arm to 100% (24/24) in the proactive ASP arm (P value < .05). For the ASP group, initially 79.1% (19/24) of the antibiotic uses were inappropriate and diminished by ASPs to 0% on the recommendations implementation. A total of 27 interventions were made with an acceptance rate of 96.3%. The rate of CDAD did not differ between the groups. A reduction in antibiotics utilization and direct cost were also noticed in the ASP arm. A proactive ASP is a vital approach in optimizing the appropriate empirical antibiotics utilization in an ICU setting in tertiary care hospitals. This study highlights the importance of such a program and may serve as a foundation for further ASP initiatives particularly in our region.Annals of Saudi medicine 03/2012; 33(6):547-54. DOI:10.5144/0256-4947.2013.547 · 0.71 Impact Factor
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ABSTRACT: Antimicrobial stewardship is an important component in health care outcomes of all patients. Many institutions are seeking the best methods to incorporate antimicrobial stewardship strategies into their hospitals including pharmacy services. Multiple factors should be considered when beginning or expanding an antimicrobial stewardship program. The purpose of this article is to discuss the development of basic antibiotic competencies and training for staff pharmacists in a community hospital. The article includes an assessment of pharmacists' knowledge pre education and post education, perception of benefits from an antibiotic education program, and learning needs and preferences.Hospital pharmacy 01/2014; 49(1):32-40. DOI:10.1310/hpj4901-32