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Antimicrobial stewardship program

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https://www.readbyqxmd.com/read/28630187/cumulative-effect-of-an-antimicrobial-stewardship-and-rapid-diagnostic-testing-bundle-on-early-streamlining-of-antimicrobial-therapy-in-gram-negative-bloodstream-infections
#1
P B Bookstaver, E B Nimmich, T J Smith, J A Justo, J Kohn, K L Hammer, C Troficanto, H A Albrecht, M N Al-Hasan
OBJECTIVES: The use of rapid diagnostic tests (RDT) enhances antimicrobial stewardship programs (ASP) interventions in optimization of antimicrobial therapy. This quasi-experimental cohort study evaluates the combined impact of an ASP/RDT bundle on appropriateness of empirical antimicrobial therapy (EAT) and time to de-escalation of broad-spectrum agents (BSAA) in gram-negative bloodstream infections (GNBSI). METHODS: ASP/RDT bundle consisted of a system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, Matrix Assisted Laser Desorption Ionization Time-of-Flight (MALDI-TOF) and FilmArray® Blood Culture Identification (BCID) panel...
June 19, 2017: Antimicrobial Agents and Chemotherapy
https://www.readbyqxmd.com/read/28629754/improving-compliance-with-surgical-antibiotic-prophylaxis-guidelines-a-multicenter-evaluation
#2
Cristiane Schmitt, Rubia Aparecida Lacerda, Ruth Natalia Teresa Turrini, Maria Clara Padoveze
BACKGROUND: Improving surgical antibiotic prophylaxis (SAP) use is an important element in the control of antimicrobial resistance. However, compliance with SAP guidelines is unsatisfactory. This study investigated the level of compliance with SAP guidelines in neurosurgery, and institutional characteristics associated with compliance. METHODS: This study assessed surgeries in 9 Brazilian hospitals. Medical record reviews and a structured questionnaire were used to assess compliance and to describe institutional characteristics...
June 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28629753/active-identification-of-patients-who-are-methicillin-resistant-staphylococcus-aureus-colonized-is-not-associated-with-longer-duration-of-vancomycin-therapy
#3
Carlos Acuna-Villaorduna, Westyn Branch-Elliman, Judith Strymish, Kalpana Gupta
BACKGROUND: Excessive prescribing of vancomycin among patients admitted to inpatient wards is a challenge for antimicrobial stewardship programs, especially in the setting of expanded screening programs for methicillin-resistant Staphylococcus aureus (MRSA). Studies examining factors associated with longer duration of vancomycin use are limited. METHODS: We conducted a retrospective cohort study to assess the impact of universal MRSA admission screening on duration of vancomycin use at the VA Boston Healthcare System during the period from January 2013-November 2015...
June 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28626539/resistance-to-colistin-in-klebsiella-pneumoniae-a-4-0-strain
#4
REVIEW
Guido Granata, Nicola Petrosillo
The global rise of multidrug-resistant gram-negative bacteria represents an increasing threat to patient safety. From the first observation of a carbapenem-resistant gram-negative bacteria a global spread of extended-spectrum beta-lactamases and carbapenemases producing Klebsiella pneumoniae has been observed. Treatment options for multidrug-resistant K. pneumoniae are actually limited to combination therapy with some aminoglycosides, tigecycline and to older antimicrobial agents. Unfortunately, the prevalence of colistin-resistant and tigecycline-resistant K...
May 31, 2017: Infectious Disease Reports
https://www.readbyqxmd.com/read/28608289/-antibiotic-stewardship-a%C3%A2-programmatic-approach-to-improved-antimicrobial-management
#5
REVIEW
Martin Müller, Patrick Lehmann, Christian Willy
Due to the increasing selection and prevalence of multidrug-resistant gram-negative bacteria and the insufficient development of novel antibiotics, the responsible and prudent use of the available antimicrobial drugs is of major importance. In Germany the rational use of anti-infectives considering the local antimicrobial resistance situation is defined in the infection protection act of 2011. An important tool to follow legal regulations and to improve the treatment of bacterial infections is the antimicrobial stewardship (AMS) concept...
June 12, 2017: Der Unfallchirurg
https://www.readbyqxmd.com/read/28597623/-impact-of-a-stewardship-program-on-bacteraemia-in-adult-inpatients
#6
E Merino, E Caro, J R Ramos, V Boix, A Gimeno, J C Rodríguez, G Riera, P Más-Serrano, J Sanchéz-Paya, S Reus, D Torrús, J Portilla
OBJECTIVE: Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia. METHODS: Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200)...
June 8, 2017: Revista Española de Quimioterapia: Publicación Oficial de la Sociedad Española de Quimioterapia
https://www.readbyqxmd.com/read/28596021/pharmacist-driven-antimicrobial-stewardship-in-intensive-care-units-in-east-china-a-multicenter-prospective-cohort-study
#7
Zhongwang Li, Baoli Cheng, Kai Zhang, Guohao Xie, Yan Wang, Jinchao Hou, Lihua Chu, Jialian Zhao, Zhijun Xu, Zhongqiu Lu, Huaqin Sun, Jian Zhang, Zhiyi Wang, Haiya Wu, Xiangming Fang
BACKGROUND: Antimicrobial stewardship programs, particularly pharmacist-driven programs, help reduce the unnecessary use of antimicrobial agents. The objective of this study was to assess the influence of pharmacist-driven antimicrobial stewardship on antimicrobial use, multidrug resistance, and patient outcomes in adult intensive care units in China. METHOD: We conducted a multicenter prospective cohort study with a sample of 577 patients. A total of 353 patients were included under a pharmacist-driven antimicrobial stewardship program, whereas the remaining 224 patients served as controls...
June 5, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28596018/considering-a-new-domain-for-antimicrobial-stewardship-topical-antibiotics-in-the-open-surgical-wound
#8
Charles E Edmiston, David Leaper, Maureen Spencer, Karen Truitt, Loretta Litz Fauerbach, Denise Graham, Helen Boehm Johnson
The global push to combat the problem of antimicrobial resistance has led to the development of antimicrobial stewardship programs (ASPs), which were recently mandated by The Joint Commission and the Centers for Medicare and Medicaid Services. However, the use of topical antibiotics in the open surgical wound is often not monitored by these programs nor is it subject to any evidence-based standardization of care. Survey results indicate that the practice of using topical antibiotics intraoperatively, in both irrigation fluids and powders, is widespread...
June 5, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28588766/how-externalities-impact-an-evaluation-of-strategies-to-prevent-antimicrobial-resistance-in-health-care-organizations
#9
REVIEW
Jenine R Leal, John Conly, Elizabeth Ann Henderson, Braden J Manns
BACKGROUND: The rates of antimicrobial-resistant organisms (ARO) continue to increase for both hospitalized and community patients. Few resources have been allocated to reduce the spread of resistance on global, national and local levels, in part because the broader economic impact of antimicrobial resistance (i.e. the externality) is not fully considered when determining how much to invest to prevent AROs, including strategies to contain antimicrobial resistance, such as antimicrobial stewardship programs...
2017: Antimicrobial Resistance and Infection Control
https://www.readbyqxmd.com/read/28575226/point-of-care-beta-lactam-allergy-skin-testing-by-antimicrobial-stewardship-programs-a-pragmatic-multicenter-prospective-evaluation
#10
Jerome A Leis, Lesley Palmay, Grace Ho, Sumit Raybardhan, Suzanne Gill, Tiffany Kan, Jackie Campbell, Alex Kiss, Janine B McCready, Pavani Das, Brian Minnema, Jeff E Powis, Sandra A N Walker, Heather Ferguson, Benny Wong, Elizabeth Weber
Background: Beta-lactam allergy skin testing (BLAST) is recommended by antimicrobial stewardship program (ASP) guidelines, yet few studies have systematically evaluated its impact when delivered at point-of-care. Methods.: We conducted a pragmatic multicenter prospective evaluation of the use of point-of-care BLAST by ASPs. In staggered 3-month intervals, ASP teams at three hospitals received training by allergists to offer BLAST for eligible patients with infectious diseases receiving non-preferred beta-lactam therapy due to severity of their allergy...
June 1, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28562638/every-antibiotic-every-day-maximizing-the-impact-of-prospective-audit-and-feedback-on-total-antibiotic-use
#11
Tonya J Campbell, Melissa Decloe, Suzanne Gill, Grace Ho, Janine McCready, Jeff Powis
BACKGROUND: The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. METHODS: Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively...
2017: PloS One
https://www.readbyqxmd.com/read/28549165/impact-of-antimicrobial-stewardship-for-pediatric-outpatient-parenteral-antibiotic-therapy
#12
Adam L Hersh, Jared Olson, Chris Stockmann, Emily A Thorell, Elizabeth D Knackstedt, Lawanda Esquibel, Susan Sanderson, Andrew T Pavia
We developed an outpatient parenteral antibiotic therapy (OPAT) stewardship program in a freestanding children's hospital to improve the appropriateness of OPAT prescribing. Introduction of the program enabled expert review of nearly 90% of the patients being prepared for discharge with OPAT and was associated with a 24% reduction in OPAT use.
May 26, 2017: Journal of the Pediatric Infectious Diseases Society
https://www.readbyqxmd.com/read/28542111/clostridium-difficile-infection-in-solid-organ-transplant-recipients
#13
Deepa Nanayakkara, Neha Nanda
PURPOSE OF REVIEW: Clostridium difficile infection (CDI) is a major healthcare-associated infection that causes significant morbidity and an economic impact in the United States. In this review, we provide an overview of Clostridium difficile infection in solid organ transplant recipients with an emphasis on recent literature. RECENT FINDINGS: C. difficile in solid organ transplant population has unique risk factors. Fecal microbiota transplantation has shown favorable results in treatment of recurrent C...
May 24, 2017: Current Opinion in Organ Transplantation
https://www.readbyqxmd.com/read/28542093/feasibility-and-applicability-of-antimicrobial-stewardship-in-immunocompromised-patients
#14
Elizabeth Robilotti, Marisa Holubar, Susan K Seo, Stan Deresinski
PURPOSE OF REVIEW: Antimicrobial stewardship is the primary intervention in the battle against antimicrobial resistance, but clinicians do not always apply many key antimicrobial stewardship principles to patients with significant immune defects due to lack of data and fear of bad outcomes. We review evidence regarding the application of stewardship principles to immunocompromised patients, with a focus on solid organ and hematopoietic stem cell transplant recipients. RECENT FINDINGS: Antimicrobial stewardship programs (ASPs), targeting immunocompromised patient populations such as oncology and transplant, are gaining traction...
May 24, 2017: Current Opinion in Infectious Diseases
https://www.readbyqxmd.com/read/28539060/a-systematic-review-of-antimicrobial-stewardship-interventions-in-the-emergency-department
#15
Mia Losier, Tasha D Ramsey, Kyle John Wilby, Emily K Black
BACKGROUND/OBJECTIVE: To improve antimicrobial utilization, development and implementation of antimicrobial stewardship programs in the emergency department (ED) has been recommended. The primary objective of this review was to characterize antimicrobial stewardship (AMS) in the ED and to identify interventions that improve patient outcomes or process of care and/or reduce consequences of antimicrobial use. METHODS: This study was completed as a systematic review...
May 1, 2017: Annals of Pharmacotherapy
https://www.readbyqxmd.com/read/28532194/cost-effectiveness-of-ceftolozane-tazobactam-plus-metronidazole-compared-with-piperacillin-tazobactam-as-empiric-therapy-for-the-treatment-of-complicated-intra-abdominal-infections-based-on-the-in-vitro-surveillance-of-bacterial-isolates-in-the-uk
#16
Vimalanand Prabhu, Jason Foo, Harblas Ahir, Eric Sarpong, Sanjay Merchant
AIMS: An increase in the prevalence of antimicrobial resistance among gram-negative pathogens has been noted recently. A challenge in empiric treatment of complicated intra-abdominal infection (cIAI) is identifying initial appropriate antibiotic therapy, which is associated with reduced length of stay and mortality compared with inappropriate therapy. The objective of this study was to assess the cost-effectiveness of ceftolozane/tazobactam + metronidazole compared with piperacillin/tazobactam (commonly used in this indication) in the treatment of patients with cIAI in UK hospitals...
June 8, 2017: Journal of Medical Economics
https://www.readbyqxmd.com/read/28526402/outpatient-antibiotic-stewardship-interventions-and-opportunities
#17
Erica L Dobson, Michael E Klepser, Jason M Pogue, Matthew J Labreche, Alex J Adams, Timothy P Gauthier, R Brigg Turner, Christy P Su, David M Jacobs, Katie J Suda
Improving the use of antibiotics across the continuum of care is a national priority. Data outlining the misuse of antibiotics in the outpatient setting justify the expansion of antibiotic stewardship programs (ASPs) into this health care setting; however, best practices for outpatient antibiotic stewardship (AS) are not yet defined. In a companion article, we focused on recommendations to overcome challenges related to the implementation of an outpatient ASP (e.g., building the AS team and defining program metrics)...
May 16, 2017: Journal of the American Pharmacists Association: JAPhA
https://www.readbyqxmd.com/read/28526311/dramatic-effects-of-a-new-antimicrobial-stewardship-program-in-a-rural-community-hospital
#18
Claudia R Libertin, Stephanie H Watson, William L Tillett, Joy H Peterson
BACKGROUND: New Joint Commission antimicrobial stewardship requirements took effect on January 1, 2017, promoted as a central strategy for coping with the emerging problems of antimicrobial resistance and Clostridium difficile infection. Our objective was to measure the effects of a new antimicrobial stewardship program (ASP) in a rural community hospital with no prior ASP, in the context of having a new infectious disease specialist on staff. METHODS: An ASP team was formed to implement a prospective audit with health care provider feedback and targeting 12 antimicrobial agents in a rural hospital in Georgia...
May 16, 2017: American Journal of Infection Control
https://www.readbyqxmd.com/read/28520865/impact-of-an-integrated-antibiotic-allergy-testing-program-on-antimicrobial-stewardship-a-multicenter-evaluation
#19
Jason A Trubiano, Karin A Thursky, Andrew J Stewardson, Karen Urbancic, Leon J Worth, Cheryl Jackson, Wendy Stevenson, Michael Sutherland, Monica A Slavin, M Lindsay Grayson, Elizabeth J Phillips
Background.: Despite the high prevalence of patient-reported antibiotic allergy (so-called antibiotic allergy labels [AALs]) and their impact on antibiotic prescribing, incorporation of antibiotic allergy testing (AAT) into antimicrobial stewardship (AMS) programs (AAT-AMS) is not widespread. We aimed to evaluate the impact of an AAT-AMS program on AAL prevalence, antibiotic usage, and appropriateness of prescribing. Methods.: AAT-AMS was implemented at two large Australian hospitals during a 14-month period beginning May 2015...
May 18, 2017: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
https://www.readbyqxmd.com/read/28499717/a-call-to-action-for-outpatient-antibiotic-stewardship
#20
Michael E Klepser, Erica L Dobson, Jason M Pogue, Matthew J Labreche, Alex J Adams, Timothy P Gauthier, R Brigg Turner, Christy P Su, David M Jacobs, Katie J Suda
OBJECTIVES: To address the public health threat of antibiotic resistance, there has been an enhanced call for antibiotic stewardship programs throughout the health care continuum. SUMMARY: While antibiotic stewardship programs have been well described in the inpatient setting, data on effectiveness and guidance on implementing outpatient programs is scarce. Establishing stewardship practices in the outpatient setting is necessary because more than 60% of human antibiotic use occurs in this setting...
May 9, 2017: Journal of the American Pharmacists Association: JAPhA
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