Abstract
Regulatory agencies and professional organizations recommend antibiotic stewardship programs (ASPs) in US hospitals. The optimal approach to establish robust, sustainable ASPs across diverse hospitals is unknown. To assess whether the Agency for Healthcare Research and Quality Safety Program for Improving Antibiotic Use is associated with reductions in antibiotic use across US hospitals. A pragmatic quality improvement program was conducted and evaluated over a 1-year period in US hospitals. A total of 437 hospitals were enrolled. The study was conducted from December 1, 2017, to November 30, 2018. Data analysis was performed from March 1 to October 31, 2019. The Safety Program assisted hospitals with establishing ASPs and worked with frontline clinicians to improve their antibiotic decision-making. All clinical staff (eg, clinicians, pharmacists, and nurses) were encouraged to participate. Seventeen webinars occurred over 12 months, accompanied by additional durable educational content. Topics focused on establishing ASPs, the science of safety, improving teamwork and communication, and best practices for the diagnosis and management of infectious processes. The primary outcome was overall antibiotic use (days of antibiotic therapy [DOT] per 1000 patient days [PD]) comparing the beginning (January-February 2018) and end (November-December 2018) of the Safety Program. Data analysis occurred using linear mixed models with random hospital unit effects. Antibiotic use from 614 hospitals in the Premier Healthcare Database from the same period was analyzed to evaluate contemporary US antibiotic trends. Quarterly hospital-onset Clostridioides difficile laboratory-identified events per 10 000 PD were a secondary outcome. Of the 437 hospitals enrolled, 402 (92%) remained in the program until its completion, including 28 (7%) academic medical centers, 122 (30%) midlevel teaching hospitals, 167 (42%) community hospitals, and 85 (21%) critical access hospitals. Adherence to key components of ASPs (ie, interventions before and after prescription of antibiotics, availability of local antibiotic guidelines, ASP leads with dedicated salary support, and quarterly reporting of antibiotic use) improved from 8% to 74% over the 1-year period (P < .01). Antibiotic use decreased by 30.3 DOT per 1000 PD (95% CI, -52.6 to -8.0 DOT; P = .008). Similar changes in antibiotic use were not observed in the Premier Healthcare Database. The incidence rate of hospital-onset C difficile laboratory-identified events decreased by 19.5% (95% CI, -33.5% to -2.4%; P = .03). The Agency for Healthcare Research and Quality Safety Program appeared to enable diverse hospitals to establish ASPs and teach frontline clinicians to self-steward their antibiotic use. Safety Program content is publicly available.
Highlights
Antibiotic stewardship programs (ASPs) are being established across the US in response to the negative consequences associated with antibiotic overuse.[1,2] ASPs have been successful in reducing antibiotic use within institutions,[3] their ability to train clinicians to self-steward their antibiotic use on an ongoing basis has been less of a focus
Adherence to key components of ASPs improved from 8% to 74% over the 1-year period (P < .01)
Antibiotic use decreased by 30.3 days of antibiotic therapy (DOT) per 1000 patient days (PD)
Summary
Antibiotic stewardship programs (ASPs) are being established across the US in response to the negative consequences associated with antibiotic overuse.[1,2] ASPs have been successful in reducing antibiotic use within institutions,[3] their ability to train clinicians to self-steward their antibiotic use on an ongoing basis has been less of a focus. Teaching clinicians to incorporate stewardship concepts into their clinical practice supports the durability of stewardship principles in daily patient care. In response to drawbacks of the traditional top-down ASP approach, the Agency for Healthcare Research and Quality (AHRQ) established the AHRQ Safety Program for Improving Antibiotic Use (ie, the Safety Program). In addition to assisting hospitals with establishing sustainable ASPs, an overarching goal of the Safety Program is to provide frontline clinicians with tools to incorporate stewardship principles into routine decision-making by underscoring the importance of communication around antibiotic prescribing and equipping frontline clinicians with best practices in the diagnosis and treatment of common infectious processes. Implementation, and outcomes of the Safety Program in 402 hospitals across the US
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