Antimicrobial Management Team Research Articles

Antimicrobial Stewardship and Dose Adjustment of Restricted Antimicrobial Drugs in Hospital Setting.

Antimicrobial consumption is increasing. In order to maximize the effectiveness of antimicrobial stewardship and provide safe and optimal use of restricted antimicrobial drugs, renal dosing should be evaluated. The aim of this study was to determine the prevalence of restricted antimicrobial drugs that required dose adjustment according to renal function. A retrospective, consecutive study was conducted at University Hospital Dubrava. This study analyzed requests for restricted antimicrobial drugs (n = 2890) during a 3-month period. Requests for antimicrobial agents were evaluated by the antimicrobial therapy management team (A-team). This study included 412 restricted antimicrobial drug requests requiring dose adjustment, of which 39.1% did not have an adjusted dose. Meropenem, Ciprofloxacin, Piperacillin/Tazobactam, Vancomycin, Colistin and the antimycotic Fluconazole were the most frequent restricted antimicrobial drugs that required dose adjustment according to impaired renal function. The results of this research highlight the importance of the A-team in the optimization of restricted antimicrobial therapy. Non-adjusted doses of restricted antimicrobial drugs increase the possibility of adverse drug reactions and therefore jeopardize pharmacotherapy outcomes and patient safety.

Factors influencing the stewardship activities of Antimicrobial Management Teams: a national cross-sectional survey

The link between inappropriate antibiotic prescribing and the global threat of antimicrobial resistance is well documented. International strategies recommend antimicrobial stewardship (AMS) programmes, with improvement interventions to safeguard antibiotics. This study sought to systematically evaluate the impact of multi-professional Antimicrobial Management Team (AMT) staff resource availability on stewardship activities. We conducted an on-line, cross-sectional survey of AMTs in each regional Health Board and the national specialist hospital in Scotland (N= 15). Responses were analysed descriptively, exploring observed relationships between variables to identify patterns. Results highlighted apparent variation in the levels of AMT resource availability across Scotland, not directly influenced by Health Board size, with some larger Health Boards having proportionately poorer AMT resource allocation. However, the range and frequency of activities to support AMS was not directly linked to either Health Board size or staff resource allocation, indicating a more complex inter-relationship between factors. There is apparent inequity in staff resource available for AMTs across Scotland, with significantly lower resource allocation in comparison with recommendations from other international studies. However, considering these survey findings with our earlier qualitative research indicates that leadership style and team member enthusiasm may be as, if not more, influential than resource availability on the scope of AMT activities. These findings have international relevance for hospital service managers considering the recruitment, training and ongoing support of AMTs, in order to maximize impact from a limited resource.

55. Ertapenem for surgical prophylaxis: the impact of antimicrobial stewardship interventions on inappropriate carbapenem utilization at a community teaching hospital

BackgroundInternal analysis of ertapenem utilization revealed overuse for surgical prophylaxis in intra-abdominal (IA) procedures. Our Antimicrobial Management Team (AMT) initiated a multimodal intervention to promote the appropriate use of ertapenem. The primary objective of this study is to describe and evaluate the impact of our interventions targeting ertapenem utilization for IA surgical prophylaxis.MethodsFrom March to October 2019, a pre-post study was performed to evaluate ertapenem utilization for surgical prophylaxis. Our AMT interventions which were formally implemented in June 2019 included the following: targeted provider feedback, review and update of our surgical prophylactic antibiotic protocol (SPAP), policy, and order set addition of Cefoxitin to formulary, extensive provider education, and monitoring of SPAP compliance. Data was abstracted from the electronic medical record for IA cases and included antibiotics prescribed, procedure type, and prescriber information. In addition, surgical site infection (SSI) rates and Clostridium difficile infection rates were monitored throughout the study period.ResultsIn total, 1,080 IA surgical cases were reviewed. The set quality measure of less than 5 percent ertapenem utilization was achieved each month after AMT interventions in June 2019, as demonstrated by monthly ertapenem use for surgical prophylaxis: 13.7 percent in March, 13.4 percent in April, 4.9 percent in May, 8.9 percent in June, 3.1 percent in July, 2.2 percent in August, 4.5 percent in September, and 3.4 percent in October. Overall, the number of ertapenem cases was 58 pre-study (March to June) versus 16 post-study (July to October), accounting for a 72.4 percent reduction in ertapenem utilization for IA surgical prophylaxis. The rate of SSI among IA surgeries and Clostridium difficile infection did not increase as a consequence of our interventionsConclusionCarbapenem use for surgical prophylaxis was consistently within threshold limits following the stewardship interventions. Incidence of surgical site infections and Clostridium difficile infection did not increase during the interventions suggesting that alternate antimicrobial agents in the SPAP are safe and effective for IA surgeries in our patient population.Disclosures All Authors: No reported disclosures

Management and outcome of bloodstream infections: a prospective survey in 121 French hospitals (SPA-BACT survey).

BackgroundBloodstream infections (BSIs) are severe infections that can be community or hospital acquired. Effects of time to appropriate treatment and impact of antimicrobial management team are discussed in terms of outcome of BSI. We sought to evaluate the impact of initial BSI management on short-term mortality.Patients and methodsA prospective, multicenter survey was conducted in 121 French hospitals. Participants declaring BSI during a 1-month period were included consecutively. Data on patient comorbidities, illness severity, BSI management, and resistance profile of bacterial strains were collected. Predictors of 10-day mortality were identified by multivariate regression for overall BSI, health care-related and hospital-acquired BSI.ResultsWe included 1,952 BSIs. More than a third of them were hospital acquired (39%). Multidrug resistance was identified in 10% of cases, mainly in health care-related BSI. Empirical therapy and targeted therapy were appropriate for 61% and 94% of cases, respectively. Increased 10-day mortality was associated with severe sepsis, septic shock, increasing age, and any focus other than the urinary tract. Decreased mortality was associated with receiving at least one active antibiotic within the first 48 hours. Intervention of antimicrobial management team during the acute phase of BSI was associated with a decreased mortality at day 10 in the overall population and in health care-related BSI.ConclusionOptimizing BSI management by increasing rapidity of appropriate treatment initiation may decrease short-term mortality, even in countries with low rate of multidrug-resistant organisms. Early intervention of antimicrobial management team is crucial in terms of mortality.

Evaluation of broad-spectrum beta-lactam prescriptions (except carbapenems) in a French teaching hospital

ObjectivesWe aimed to assess broad-spectrum beta-lactam prescriptions (except carbapenems) in a French teaching hospital and the impact of controlled dispensing, antimicrobial management team, and antibiotic treatment reassessment on Day 2–3. Patients and methodsWe performed a point-prevalence study in all hospital units and analyzed curative antibiotic broad-spectrum beta-lactam prescriptions. The assessment focused on indication, dosing, combinations, revaluation on Day 2–3, and treatment duration. ResultsSixty-seven broad-spectrum beta-lactam prescriptions were identified. The main prescriptions were amoxicillin-clavulanic acid (37%, n=25), ceftriaxone (36%, n=24), and piperacillin-tazobactam (16%, n=11). Indications, doses, combinations, and reassessment on Day 2–3 were appropriate, respectively 90% (n=60), 96% (n=64), 94% (33/35 combinations), and 88% (n=59). However, appropriate treatment durations amounted to only 63% (n=42). The benefit of controlled dispensing was observed in terms of overall antibiotic treatment duration: 86% versus 51% adequacy for uncontrolled dispensing of beta-lactams (P=0.02). The antimicrobial management team improved the antibiotic treatment duration: 73% of appropriate durations versus 44% for beta-lactams not monitored by the team, but this difference was not significant. ConclusionBroad-spectrum beta-lactams were usually well prescribed but the adequacy of treatment duration could be improved, especially by reinforcing the monitoring of prescriptions.

Evaluating antimicrobial therapy: How reliable are remote assessors?

Abstract Introduction Assessing the quality of antimicrobial prescribing provides hospitals with a means of targeting and measuring the impact of antimicrobial stewardship interventions. There are limited data available on the reliability of these assessments among different types of hospital assessors deployed away from the bedside (ie remotely). Importantly, it is unclear if assessors inexperienced in clinical infectious diseases can reliably evaluate the quality of antimicrobial prescriptions. This study sought to determine the reliability of assessments made by remote hospital assessors with different levels of clinical infectious diseases experience. These assessments were based on (1) concordance with national prescribing guidelines and (2) ‘overall appropriateness'. Methods 180 prescriptions were assessed for ‘concordance with guidelines' and ‘overall appropriateness' at the bedside (ie locally). Prescription data were then given to fifteen remote assessors. These assessors were blinded to local assessments. Inter-rater reliability was calculated using Fleiss' kappa statistics. Results Higher levels of agreements were achieved for ‘concordance with guidelines' assessments. Local and remote antimicrobial management teams had the highest level of agreement and this improved when looking at antimicrobial treatment used to treat respiratory tract infections (kappa score = 0.67). Reliability in assessments was moderate for local pharmacist assessments and fair to slight for local infection control assessments. Conclusions There is scope to develop tools that will improve assessment reliability of antimicrobial therapy among remote assessors. Clinical pharmacists provide reliability comparable to infectious diseases experts, however, infection control practitioners may require further education and training to improve reliability in assessments.

Six years of a national antimicrobial stewardship programme in Scotland: where are we now?

BackgroundThe Scottish Antimicrobial Prescribing Group (SAPG) was established in 2008 to lead delivery of the national antimicrobial stewardship programme. We performed a national self-reported survey in 2014 to evaluate stewardship activities delivered by regional Antimicrobial Management Teams (AMTs). An on-line survey was developed utilising validated indicators from a published European study along with questions specific to the Scottish context. Descriptive statistics were used to evaluate the responses received.FindingsThe survey was completed by 14 of the 15 AMTs (response rate 93 %). Results demonstrated good compliance with 9 of the 10 key European indicators included in the survey; 7 (50 %) of AMTs achieved all 9 indicators and 14 (100 %) of AMTs achieved at least 6 out of 9 indicators (67 %). Progress was also demonstrated across a range of stewardship activities and areas for further work were identified.ConclusionsThe survey results suggest the national stewardship programme in Scotland has reached maturity but consolidation and ongoing development are required. Collaborative working between SAPG and AMTs together with central funding has been key to achieving this level of success.

The Belgian policy of funding antimicrobial stewardship in hospitals and trends of selected quality indicators for antimicrobial use, 1999–2010: a longitudinal study

ObjectivesIn order to improve antimicrobial (AM) use, a policy of providing technical and financial support to AM management teams (AMTs) was rolled out in all Belgian hospitals between 2002 and...

Implementation of a multidisciplinary infectious diseases team in a tertiary hospital within an Antimicrobial Stewardship Program

Background:In January 2011, as part of an antimicrobial stewardship program the Antimicrobial Management Team (AMT) at the Ghent University Hospital initiated a multidisciplinary Infectious Diseases Team (MIT) consisting of infectious diseases physicians, clinical microbiologists, and clinical pharmacists. The aim of this study is to describe the type and acceptance rate of recommendations provided by the MIT.Method:Prospective, observational study in a tertiary care, university teaching hospital with 1062 beds in non-consecutive hospitalized adult patients, excluding intensive care units and paediatrics.Results:The MIT communicated 432 recommendations in 87 days observed. Of the 293 patients for whom a recommendation was made, the median age was 57 years (range: 16–91 years) and 169 (57·7%) were male. Skin or soft tissue infections (14%), respiratory tract infections (13%), infections without known focus (11%), abdominal infections (11%), and bone infections (8%) were most common. Recommendations were made to perform additional clinical investigation(s) [N = 137 (27%)], to adjust the dose of an antimicrobial drug [N = 42 (8%)], to stop an antimicrobial drug [N = 104 (21%)], to switch from a parenteral to an oral drug [N = 39 (8%)] or to initiate an antimicrobial drug [N = 178 (36%)], with an acceptance rate of 73·0%, 83·3%, 81·7%, 76·9%, and 84·0%, respectively.Conclusions:The MIT formulated about five recommendations a day primarily focusing on pharmacotherapy, but also on clinical investigations. In both fields, a high acceptance rate was observed.

CP-139 A cross-sectional survey of antimicrobial stewardship strategies in UK hospitals

BackgroundTo improve prescribing and reduce antimicrobial resistance, antimicrobial stewardship programmes have been implemented in hospitals, usually led by antimicrobial management teams (AMTs). Many of these teams include a hospital pharmacist.PurposeThe...

CP-061 A cross-sectional survey of the profile and activities of Antimicrobial Management Teams in Irish hospitals

BackgroundSurveillance of antimicrobial prescribing, in order to control the increase in antimicrobial resistance, is recommended by the Guidelines for Antimicrobial Stewardship in Hospitals in Ireland.PurposeTo determine the profile and activities...

A cross-sectional survey of the profile and activities of Antimicrobial Management Teams in Irish Hospitals

Surveillance of antimicrobial prescribing, in order to control the increase in antimicrobial resistance, is recommended by the Guidelines for Antimicrobial Stewardship in Hospitals in Ireland. The objective of the study is to determine the profile and activities of Antimicrobial Management Teams (AMTs) in Irish Hospitals by surveying hospital pharmacists. Hospitals in Ireland. A self-completion postal questionnaire was developed from a recent study conducted by members of the authoring team in the United Kingdom, adapted for the Irish context. It was issued to all hospitals in Ireland (n = 70). Differences in responses, using Pearson's Chi squared tests, were evaluated between public and private hospitals to determine whether the funding category had an effect on activities. (1) A profile of AMTs in Ireland. (2) The presence and content of antimicrobial prescribing policies and how adherence to the policies is measured. The response rate was 73 % (n = 51, 71 % public). 57 % (29/51) of hospitals have an antimicrobial management team in place with 93 % (27/29) having a Consultant Medical Microbiologist, 24 % (7/29) having a Consultant in Infectious Diseases and 69 % (20/29) having an Antimicrobial Pharmacist. There is an antimicrobial prescribing policy in place in 88 % (45/51) of hospitals responding. 80 % (36/51) of replies report that the volume of antibiotics prescribed is monitored, 47 % (24/51) conduct audits to measure appropriateness of all antibiotics prescribed and 43 % (22/51) conduct audits of appropriate prescribing of restricted antibiotics. Public hospitals were significantly more likely than private hospitals to review the volume of antibiotics prescribed (p = 0.021) and to audit the appropriateness of restricted antibiotics use (p = 0.003). A lack of resources was reported as the main barrier to antimicrobial surveillance by hospital pharmacists. Around half of Irish hospitals do not have an antimicrobial management team in place but most hospitals have an antimicrobial prescribing policy. Most AMTs have representation by Consultants and Pharmacists, but audit and feedback of antibiotic prescribing activities is limited. Significant differences in audit activities were found between public and private hospitals, with private hospitals performing less well.

Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: Results of a multicenter survey

BackgroundAntibiotic resistance has been recognized as a worldwide problem. Our aim was to assess the perceptions of Spanish residents about antibiotic use and resistance. MethodsAn online cross-sectional survey was conducted on all resident doctors in five teaching hospitals (September to November 2010). A link to the questionnaire was e-mailed to 844 doctors. The questionnaire collected demographical characteristics, residents’ knowledge about microorganisms of known clinical relevance, their habits in the antibiotic prescription process, and their perceptions on the activities aimed to improve antibiotic use. ResultsWe received 279 responses corresponding to 33.05% of all targeted residents. The response rate was higher among junior than among senior residents (39.95% vs. 26.12%; p<0.05). Residents of all hospitals, specialties and seniority mostly considered that antimicrobial resistance was a significant problem at national level (94.3%), at their institution (91.3%), and for their daily practice (83.8%). Residents considered their training regarding antibiotics insufficient, although up to 86.5% had prescribed antibiotics in the last month. They preferred the availability of local antibiotic guidelines (65%), specific teaching sessions, specific antimicrobial management teams or readily accessible advice from a group or an infectious diseases specialist, to improve antibiotic prescribing, rather than other restrictive interventions. ConclusionsMost residents at the hospitals surveyed believed that antibiotic resistance was a serious problem. The results of this survey provided very important information to optimize adherence to Antimicrobial Stewardship Programs (ASPs). Educational strategies and non-restrictive aids are the most valuable interventions, which ASPs should capitalize on to improve antimicrobial prescription.

Hospital pharmacy resident collaboration in a clinical infectious diseases unit (CIDU))

BackgroundThere are some hospitals in Spain where a pharmacist already belongs to a Antimicrobial Management Team (AMT), thus it is important and necessary that the Pharmacy Residency Program includes a...

P224 The impact of implementing a collaborative antimicrobial ward round model within the Respiratory Directorate of a large university teaching hospital

<h3>Introduction</h3> Clostridium difficile Infection (CDI) remains a considerable source of healthcare associated infection. A Department of Health briefing recommends all Trusts establish an antimicrobial management team (AMT) to develop an antibiotic stewardship programme aiming to reduce CDI rates through appropriate antibiotic prescribing.1 As a result, collaborative antimicrobial ward rounds were initiated in the Trust in May 2009. <h3>Aim</h3> To study the impact of collaborative ward rounds on antibiotic prescribing within the Respiratory Directorate. <h3>Method</h3> A weekly collaborative ward round model comprising of a Consultant microbiologist, Respiratory pharmacist and the Consultant Infection Control lead for the Respiratory Directorate was implemented across three acute respiratory wards (comprising 90 beds) in March 2011. Data were collected prospectively over a 6-week period between March and May 2011 using a standardised pro-forma. Patients prescribed antibiotics were identified using the Trust9s electronic prescribing system. During ward rounds, case notes and microbiology data including resistance patterns were reviewed. Treatment plans were discussed with respective clinical teams to facilitate the learning of junior medical staff. Each prescription was reviewed and recorded as appropriate if compliant with the following parameters; indication recorded, correct route, correct dose, course length documented, compliance with hospital formulary or microbiology results. <h3>Results</h3> A total of 156 antibiotic prescriptions were reviewed during the study period; 96 (62%) prescriptions were appropriate, 60 (38%) required intervention. Course lengths were documented for 29 (19%) prescriptions, 11 (7%) antibiotic prescriptions were discontinued, 9 (6%) antibiotic prescriptions were changed to more appropriate therapy and 6 (4%) intravenous antibiotics were switched to oral therapy and 5 (3%) antibiotic course lengths were extended. The defined daily doses (DDD) of antibiotics/1000 bed days over the two periods were 3544 in 2011 and 4335 in 2010 respectively (see Abstract P224 figure 1). <h3>Conclusion</h3> Implementation of a collaborative AMT was associated with an 18% reduction in antibiotic consumption (DDD/1000 bed days) between the two periods within the respiratory directorate of a large urban university teaching hospital.

Development of national prescribing indicators for antimicrobials to support reduction in Clostridium difficile infection: Category: Scientific free paper

The Scottish Antimicrobial Prescribing Group (SAPG) is a national multi-disciplinary clinical forum formed by the Scottish Government and hosted by the Scottish Medicines Consortium to implement the recommendations of Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP). SAPG directs national improvement initiatives via a network of NHS Board Antimicrobial Management Teams (AMTs).

Antibiotic stewardship

Antimicrobial stewardship is now recognized as a formal strategy for curbing the upward trend in antibiotic resistance. Literature on antimicrobial stewardship has focused on areas of strategic importance and operational delivery. A number of barriers have been recognized in the implementation of successful programs. These include lack of physician participation, lack of diagnostic facility, absence of formal mechanism of data collection, variation between countries, and lack of cooperative strategies. In this review, we suggest strategies to overcome these barriers. In the last few years, it has been recognized that an executive program is necessary for successful implementation of strategies to control the growing antibiotic resistance. Efforts have been made at higher levels of government through organizations such as the European Centre for Disease Prevention and Control. The need for community healthcare involvement has also been recognized. At a local level, strategies to promote cooperation between various committees (e.g. infection control and antimicrobial management teams) have been proposed and adopting antibiotic care bundles as part of patient safety and healthcare is being explored. We suggest that executive level planning, local cooperation, sustained education, emphasis on de-escalation, and use of care bundles could stem the tide of growing resistance.

Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme

In 2008, the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) was published by the Scottish Government. One of the key actions was initiation of the Scottish Antimicrobial Prescribing Group (SAPG), hosted within the Scottish Medicines Consortium, to take forward national implementation of the key recommendations of this action plan. The primary objective of SAPG is to co-ordinate and deliver a national framework or programme of work for antimicrobial stewardship. This programme, led by SAPG, is delivered by NHS National Services Scotland (Health Protection Scotland and Information Services Division), NHS Quality Improvement Scotland, and NHS National Education Scotland as well as NHS board Antimicrobial Management Teams. Between 2008 and 2010, SAPG has achieved a number of early successes, which are the subject of this review: (i) through measures to optimise prescribing in hospital and primary care, combined with infection prevention measures, SAPG has contributed significantly to reducing Clostridium difficile infection rates in Scotland; (ii) there has been engagement of all key stakeholders at local and national levels to ensure an integrated approach to antimicrobial stewardship within the wider healthcare-associated infection agenda; (iii) development and implementation of data management systems to support quality improvement; (iv) development of training materials on antimicrobial stewardship for healthcare professionals; and (v) improving clinical management of infections (e.g. community-acquired pneumonia) through quality improvement methodology. The early successes achieved by SAPG demonstrate that this delivery model is effective and provides the leadership and focus required to implement antimicrobial stewardship to improve antimicrobial prescribing and infection management across NHS Scotland.

Les référents en antibiothérapie et leurs fonctions. Résultats d’une enquête menée lors de la 5 e Journée des référents en antibiothérapie

We conducted a survey among participants to a French ID Society sponsored meeting for antimicrobial management teams (AMT). We analysed 115 responses. Respondents were mostly physicians (79 %) followed by microbiologists (11 %), infection control practitioners (9 %) and hospital pharmacists (7 %). Only 43 % were ID board certified while 47 % had a university degree on antibiotic use. AMT activities concerning diagnostic and therapeutic advice, residents training and antibiotic use audit were mostly managed by physicians. Antimicrobial resistance and antibiotic consumption were managed, respectively, by the microbiologist and the hospital pharmacist. This survey shows the interest of a multidisciplinary antimicrobial management team. However, the cornerstone of the AMR is clearly the physician. Small hospital could contract part time physician and work through regional teams.

P01.10 Developing an antimicrobial management team within a department of medicine for the elderly

P01.10 Developing an antimicrobial management team within a department of medicine for the elderly