Abstract
While antimicrobial stewardship programs (ASPs) are well established at most large medical centers, small or rural facilities often do not have the same resources; therefore, different methods must be developed to start or expand ASPs for these hospitals. The purpose of this quality improvement study was to describe the implementation of a pharmacist-led remote ASP and assess the effect on antimicrobial use. Antimicrobial use in days of therapy per 1000 patient days (DOT/1000 PD) was compared between the six months before and after remote ASP implementation. Changes in system-wide, facility-specific, and target antimicrobial use were evaluated. Pharmacist interventions, acceptance rates, and number of times infectious disease (ID) physician assistance was sought were also tracked. System-wide antimicrobial use was 4.6% less in the post-implementation time period than in the pre-implementation time period, with vancomycin, piperacillin/tazobactam, and fluoroquinolones having the greatest reductions in use. Ninety-one percent of interventions made during the post-implementation period were accepted. ID physician review was requested 38 times, and direct ID physician intervention was required six times. Remote ASPs delivered from a central facility to serve a larger system may reduce antimicrobial use, especially against targeted agents, with minimal increase in ID physician workload.
Highlights
Antimicrobial stewardship is defined as the systematic effort to increase appropriate use of antimicrobials to help improve patient outcomes, reduce antimicrobial resistance, and reduce cost [1].Responsible use of antibiotics is of extreme importance, especially for institutions with limited access to newer agents with activity against multidrug resistant pathogens
The present study describes that expansion, including intervention acceptance rates and antimicrobial use trends during the six months before and after program expansion
The flagship hospital of the institution, McLeod Regional Medical Center, is a 461-bed acute care, community hospital with infectious disease (ID) physician consult services consisting of two full-time equivalent (FTE)
Summary
Antimicrobial stewardship is defined as the systematic effort to increase appropriate use of antimicrobials to help improve patient outcomes, reduce antimicrobial resistance, and reduce cost [1].Responsible use of antibiotics is of extreme importance, especially for institutions with limited access to newer agents with activity against multidrug resistant pathogens. Antimicrobial stewardship is defined as the systematic effort to increase appropriate use of antimicrobials to help improve patient outcomes, reduce antimicrobial resistance, and reduce cost [1]. In a 2012 consensus statement, the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society uniformly recommended implementing antimicrobial stewardship programs (ASPs) throughout the healthcare system [2]. ASPs have been shown to effectively decrease inappropriate use of antimicrobials, antimicrobial resistance, and the occurrence of Clostridioides difficile infection, a common and serious adverse effect of antibiotic use [5]. In 2017, Libertin et al examined the effects of ASP initiation at a rural community hospital and found a statistically significant decrease in antimicrobial use, measured in days of therapy per 1000 patient days (DOT/1000 PD) [6]. Baur et al published findings that ASP implementation significantly reduced the incidence of extended-spectrum beta-lactamase-producing
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