Antimicrobial Stewardship Activities Research Articles

Operationalizing an adverse event detection surveillance system to support antimicrobial stewardship activities: perceptions and insights from the SHEA research network.

A surveillance system for measuring patient-level antimicrobial adverse drug events (ADE) may support stewardship activities, however, design and implementation questions remain. In this national survey, stewardship experts favored simple, laboratory-based ADE definitions although there were tensions between feasibility, ability to identify attribution without chart review, and importance of specific ADE.

Knowledge, Awareness and Attitude of Pharm.D. Students on Antimicrobial Stewardship: A Report

Antimicrobial Stewardship (AMS) is a strategy to optimize antimicrobials and prevent the emergence of antimicrobial resistance (AMR). Pharm.D. students are future Clinical pharmacists who play a key role in promoting rational use and implementing AMS programs. Only a few studies about their knowledge, awareness and attitude regarding AMS exist. A cross-sectional study was conducted in the middle of December 2023, among Pharm.D. students of different academic years from three Pharmacy colleges and Pharm.D. graduates in South India. The survey was conducted online using a validated questionnaire and Pharm.D. students audited the results under the guidance of an Infectious disease specialist. The survey comprised 17 questions covering demographic information, AMS knowledge, attitude and awareness questionnaires. This study included a total of 190 respondents. However, only 32.11% reported having participated in any AMS activity during their period of pharmacy education. Pharm.D. students have a positive attitude (72.48%) and optimal awareness (65.13%) but they lack sufficient knowledge (45.19%) towards AMS, specifically regarding surgical prophylaxis and antibiotic allergy testing. It serves as a valuable resource for educators, policymakers and stakeholders involved in shaping the curricula of Pharm.D. programs to enhance the training and preparedness of students in AMS practices. In the future, AMS education programs should target not only clinicians but also Pharm.D. students and interns.

Application of the Hub-and-Spoke Model in Antimicrobial Stewardship Programmes: A Scoping Review

Background: The hub-and-spoke model (HSM) offers a framework for efficient healthcare service delivery. This scoping review seeks to explore the implementation and effectiveness of the HSM in antimicrobial stewardship (AMS) programmes. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) reporting guideline was followed. A systematic search was conducted in four electronic databases (PubMed, Medline, Cochrane Library, and Google Scholar) from inception until January 2024. Studies where the HSM was used for delivering any AMS activity, intervention, or action, were included. No study-specific filters were applied and all populations, study designs, and health settings were included. Data screening and selection were achieved using Rayyan. Three authors independently screened studies, with conflicts resolved by a fourth author. Data were narratively synthesised. Standard appraisal tools were impractical; however, critical evaluation of data collection and outcome reporting was ensured. Results: Out of 1438 articles, three were included in the scoping review. The primary interventions utilising the HSM in AMS involved reducing antibiotic misuse, training healthcare professionals, case-based learning, establishing AMS programmes, developing antibiograms, and formulating policies or guidelines pertinent to AMS. The studies demonstrated significant clinical improvements in AMS. Clinical outcomes from the studies include a significant reduction in antimicrobial usage and improved antibiotic management, with a notable decrease in days on antimicrobial therapy and increased antibiotic de-escalation. Key facilitators for AMS programme success were tailored education, collaborative learning, strong leadership, strategic practices, and data-driven decisions. Key barriers were leadership challenges, change resistance, knowledge gaps, inadequate data systems, resource limitations, and technological constraints. Conclusions: The review identified a literature gap in HSM use in AMS programmes. Further studies are needed to assess HSM’s effectiveness, feasibility, and cost-effectiveness in AMS contexts.

Extended and expanded role of nurses in antimicrobial stewardship program: A review

Antimicrobial resistance is a significant healthcare concern in this century, marked by the emergence of multidrug-resistant microorganisms. An antimicrobial stewardship program, while an innovative approach to mitigating the global threat of antimicrobial resistance and its effects on public health, is also an absolute need of the hour. When implemented effectively, such a program, in conjunction with selecting the appropriate drug, determining the correct dosage and route of administration, and integrating with an infection control program, has proven to be an effective method for curbing the rapid emergence and transmission of antimicrobial-resistant pathogens. Partnerships with nurses to strengthen antimicrobial stewardship programs in healthcare have recently gained recognition, especially in the backdrop of increased antimicrobial resistance in developing countries. Traditionally, stewardship activities have involved only prescribers and pharmacists, but including nurses in these efforts has become increasingly important. Highlights of nurse-driven antimicrobial stewardship activities include effective assessment of allergies, meticulous sampling for blood and urine cultures, antibiotic de-escalation, and 24-hour monitoring of patient status. Antibiotic or general ward rounds provide unique opportunities for nurses to influence the indication and duration of antimicrobial treatment. Including nurses in antimicrobial stewardship programs will make the management of antimicrobial therapy robust and empower healthcare institutions to approach the prevention of AMR with truly multi-disciplinary strategies. Antimicrobial stewardship is often redundant and centered around doctors in tertiary care centers. However, active participation by nurses in both healthcare facilities and community settings is crucial for making Antimicrobial stewardship practice (AMSP) a reality. Scalable nursing involvement in antimicrobial stewardship is essential for developing and developed nations to combat AMR effectively.

“Antimicrobial utilization in a paediatric intensive care unit in India: A step towards strengthening antimicrobial stewardship practices"

Antimicrobials are frequently used in critically ill children admitted to the Paediatric Intensive Care Unit (PICU). The antimicrobial use data from Indian PICUs is limited using standard metrics such as Days of therapy (DOT). This study aimed to determine the baseline trend of antimicrobial use in PICU of a tertiary care teaching hospital of Raipur district of Chhattisgarh, India using standard metrics with the goal of developing facility-wide antibiotic policy and strengthening the antimicrobial stewardship activities. This active surveillance was conducted over a period of 18 months, from November 1, 2019, to March 21, 2021, in patients aged one month to 14 years who were admitted for ≥ 48 hours to the PICU at a tertiary care teaching hospital of Raipur District. Data on patient characteristics, antimicrobial indications, antimicrobial prescription information, and clinical outcomes were collected using pre-designed data abstraction forms. The descriptive statistic was used to represent the results. The antimicrobial consumption was analyzed according to the WHO AWaRe Class (Access, Watch, and Reserve groups) of antibiotics. The antimicrobial consumption was expressed as DOT/1000 patient-days (PD). A total of 216 patients were surveyed during the study period. The average number of antimicrobials prescribed per hospitalisation was 2.60 (range: 1–12), with 97.22% administered via parenteral route. Overall, DOT/1000-PD was 1318. The consumption of Watch Group antimicrobials was highest with 949 DOT/1000-PD, followed by Access (215) and Reserve Group (154), respectively. Ceftriaxone (208 DOT/1000 PD) was the most commonly prescribed antimicrobial agent, followed by Vancomycin (201), Meropenem (175), Piperacillin-Tazobactam (122) and Colistin (91). The patients who were escalated (28.24%) from empirical antimicrobial therapy had longer median PICU stay (8 days) compared those who were de-escalated (23.6%). Targeted therapy was given in 10.2% patients. The overall mortality rate was 14.35% and was higher (29.3%) in patients in whom empirical therapy was escalated compared to those who were de-escalated or continued. The study established a benchmark for antimicrobials use in the PICU and highlighted priority areas for antimicrobial stewardship intervention to enhance de-escalation rates, enhance targeted therapy, and reduce the overuse of antimicrobials especially belonging to the reserve group.

Variability in Antimicrobial Prescribing Across Five Ambulatory Settings Within a Large Integrated Health System.

Background: Lack of access to timely, detailed antibiotic use data has limited ambulatory antibiotic stewardship efforts. Antibiotic utilization is tracked across ambulatory care sites and emergency departments (ED) within a large integrated health system. Methods: This is a retrospective cohort analysis from June 1, 2019 to May 31, 2020 comparing antibiotic prescribing for all patients with ICD-10 diagnosis codes for cystitis, otitis media, pharyngitis, sinusitis, and upper respiratory tract infections (URTIs) among five ambulatory care departments across northeast Ohio and southeast Florida locations: ED, Urgent Care (UC), On-Demand Telehealth (TEL), Pediatrics (PED), and Primary Care (PC). Results: A total of 261,947 encounters were included (ED:56,766, UC:92,749, TEL:8,783, PED:29,151, PC:74,498) for the treatment of cystitis (30,932), otitis media (22,094), pharyngitis (59,964), sinusitis (53,693), or URTI (95,264). The population was 63% female with a median age of 34.2 years [12.8-56.3]. A total of 17% of patients had documented penicillin allergies and 18% of patients with pharyngitis received Group A Streptococcus (GAS) testing. Antibiotics were prescribed in 44% of encounters (ED:21,746 [38%], UC:45,652 [49%], TEL:4,622 [53%], PED:10,909 [37%], PC:33,547 [45%]; P < 0.001). Guideline concordant antibiotics were prescribed in 65% of encounters (ED:14,338 [66%], UC:31,532 [69%], TEL:3,869 [84%], PED:8,212 [75%], PC:17,263 [51%]; P < 0.001). Conclusions: Observed rates of antibiotic and guideline concordant antibiotic prescribing were similar to national published rates of antibiotic prescribing in the ambulatory setting. The variability in antibiotic prescribing demonstrates opportunities for targeted outpatient stewardship efforts. Timely antibiotic tracking tools can facilitate ambulatory antimicrobial stewardship activities.

Effects of a Pharmacist-Designed Clinical Decision Support System on Antimicrobial Stewardship.

Clinical decision support systems (CDSSs) are computer applications, which can be applied to give guidance to practitioners in antimicrobial stewardship (AS) activities; however, further information is needed for their optimal use. Our objective was to analyze the implementation of a CDSS program in a second-level hospital, describing alerts, recommendations, and the effects on consumption and clinical outcomes. In October 2020, a pharmacist-driven CDSS designed for AS was implemented in a second-level hospital. The program provides a list of alerts related to antimicrobial treatment and microbiology, which were automatized for revision by the AS professionals. To analyze the implementation of the CDSS, a pre-post-intervention, retrospective study was designed. AS-triggered alerts and recommendations (total number and rate of acceptance) were compiled. The effect of the CDSS was measured using antimicrobial consumption, duration of antimicrobial treatments, in-hospital mortality, and length of stay (LOS) for patients admitted for infectious causes. The AS team revised a total of 7,543 alerts and 772 patients had at least one recommendation, with an acceptance rate of 79.3%. Antimicrobial consumption decreased from 691.1 to 656.8 defined daily doses (DDD)/1,000 beds-month (p = 0.04) and the duration of antimicrobial treatment from 3.6 to 3.3 days (p < 0.01). In-hospital mortality decreased from 6.6 to 6.2% (p = 0.46) and mean LOS from 7.2 to 6.2 days (p < 0.01). The implementation of a CDSS resulted in a significant reduction of antimicrobial DDD, duration of antimicrobial treatments, and hospital LOS. There was no significant difference in mortality.

Building an antimicrobial stewardship model for a public-sector hospital: a pre-implementation study.

Introduction. Antimicrobial resistance (AMR) is recognized as an important global health risk, associated with increased mortality, morbidity and healthcare costs. Antimicrobial stewardship (AMS) involves a coherent set of processes that promote the rational use of antimicrobials.Gap statement. An AMS programme should be adapted and developed according to the available resources of a facility. This requires an analysis of the core AMS elements that are already in place and the resources available.Aim. This study aimed to assess the readiness of a tertiary healthcare facility and staff towards implementing an antimicrobial stewardship programme (ASP).Methodology. This study focused on two aspects during an AMS pre-implementation phase. A situational or strengths, weaknesses, opportunities, and threats analysis was conducted based on (1) a questionnaire on attitudes and perceptions of pharmacists, clinicians and nurses towards AMR and AMS and (2) a situational analysis on the readiness of the facility.Results. The questionnaire, which was available for completion between September 2021 and December 2021, was sent to a total of 3100 healthcare professionals (HCPs). Thirty-two (1.0 %) HCPs comprising 2 pharmacists, 16 clinicians and 14 nurses completed the questionnaire. Of the total participants, 31 (96.9 %) viewed AMR as a problem in South African hospitals and 29 (90.6 %) perceived AMR as a problem at their facility. The majority (n = 29, 90.6 %) of the participants were familiar with the term AMS, and 26 (81.3 %) participants agreed to willingly participate in any initiatives involving antimicrobial use at the facility. The situational analysis depicted existing strengths in terms of AMS structures such as the formation of an AMS committee and information and technology systems at the HCP's disposal. Weaknesses included the limited number of AMS activities being carried out and poor participation from HCPs within the AMS team.Conclusion. A pre-implementation phase in the building of an ASP can greatly assist in finding gaps for improvement, which can then be addressed in the implementation phase. Furthermore, the pre-implementation phase provides a baseline to measure improvements once the implementation phase has been instituted.

Implementation of the pharmacovigilance database in the usage of antibiotics in a tertiary care hospital: A pilot study.

Antimicrobial resistance (AMR) has evolved into a severe public health issue that defies all current control strategies and needs multidisciplinary, creative solutions. Antimicrobial stewardship (AMS) activities demand a set of tools and abilities that can be used by health systems. In view of the growing AMR and the difficulty for the surveillance of it in the developing country, this study was conducted to incorporate pharmacovigilance (PV) in the AMS program. A cross-sectional pilot study was conducted to collect the PV database of antimicrobials induced adverse drug reactions (ADR) from the Adverse Drug Reactions Monitoring Center (AMC) of the institute for a period of 2 months from August 2022 to September 2022. The information from the database was analyzed to estimate the usage of antibiotics from the PV database from AMC and classified it under the Anatomical Therapeutic Chemical, to assess the rationality of the antimicrobial's usage based on "Access," "Watch," and "Reserve" (AWaRe) classification, and to assess the ADR of the antibiotics. The analysis was done by using the SPSS version 20.0 for Windows. The results showed that the prevalence of ADRs were more in adults' population with preponderance in female. The antibiotics usage was as per with World Health Organization standard and most of the antibiotics used were from the Access group of AWaRe classifications. Tetracyclines and penicillins were the most used antibiotic group of drugs. The number of patients included in the study was 70. Most of the causality assessment was "possible" (62.85%). In the study, almost 90% of the drug was withdrawn and 70% of the patients were in the recovering stage. Using existing PV approaches to address usage of antibiotics and AMR issues would allow PV to progress as a field, and governments will get a stronger return on their PV investments.

Two Novel Antibiotic Use Metrics for Facilities and Individual Prescribers in Post-Acute and Long-Term Care Settings

Background: Measuring and reporting antibiotic use are essential to antimicrobial stewardship activities. The most common metric to assess facility-level use is days of antibiotic therapy per 1000 days of care (DOT/1000 DOC). This metric may be difficult to calculate, not be readily comparable, or not provide actionable data to individual prescribers, particularly those that work in post-acute and long-term care (PALTC) settings. Here we use data from a centralized dispensing pharmacy to develop antibiotic use metrics suitable for offering individualized feedback to prescribers working in PALTC settings. Methods: We obtained medication dispensing data and resident census data for 13 PALTC settings within the same network. After omitting non-pharmacologic items and limiting the data to medications dispensed from 1/2020 – 12/2022, we determined the following metrics by month: days of antibiotic therapy (DOT), number of medications prescribed, number of antibiotic courses prescribed (antibiotic starts), and the number of individual residents issued a prescription for any medication (unique residents). These metrics were assessed for each facility (2020 – 2022) and for prescribers responsible for &gt; 1% of prescriptions within that facility (2022 only). Prescriber-level unique residents was the number of residents issued a prescription by the given provider. We obtained facility-level census data to calculate antibiotic DOT/1000 resident days of care (DOC) as a standard to which we compared novel metrics. Results: During the 3-year study period, 1718 prescribers at 13 PALTC settings wrote for 672256 medications, including 31087 antibiotic courses. At the facility level, the correlation between monthly antibiotic starts (courses)/unique residents and antibiotic DOT/1000 DOC was 0.83 (p &lt; 0 .0001). The correlation between monthly antibiotic DOT/unique residents and antibiotic DOT/1000 DOC was 0.98 (p &lt; 0 .0001). Trends in monthly values of both novel metrics and DOT/1000 DOC were consistent across the examined period (Figure 1). For individual prescribers, both novel metrics permit assessment and comparison of antibiotic prescription rates over time (Figure 2). Conclusions: Pharmacy dispensing data can be used to determine antibiotic DOT/unique residents and antibiotic starts/unique residents at the facility level and for individual providers. The novel metric antibiotic DOT/unique residents demonstrated strong correlation with antibiotic DOT/1000 DOC at the facility level. In addition to supporting tracking and reporting of antibiotic use among PALTC settings, these new metrics permit visualization of the antibiotic prescribing rates of individuals prescribers, as well as peer comparison, which in turn can lead to actionable feedback that helps improve antibiotic use in the care of PALTC.

A Questionnaire Based Study to Assess the Antimicrobial Stewardship Practices in the Tertiary Care Hospitals in India

Background: Due to emergence of antimicrobial-resistant healthcare associated infections (HAIs), the implementation of antimicrobial stewardship programs (AMSP) is the need of hour at institutional and national levels. We conducted an assessment of the current status of infrastructure, manpower, and education and training (E&amp;T) in relation to Antimicrobial Stewardship (AMS) in the tertiary care hospitals of India. Methods: Healthcare professionals from 30 tertiary care hospitals in North-western India (public &amp; private) were invited to participate in online survey from Nov 2022 to Apr 2023 by sending a pre-designed questionnaire about the current existing antimicrobial stewardship (AMS) practices at their hospitals through email. The answers received on various parameters of AMS were analyzed using descriptive statistics. Results: 72 healthcare professionals from 30 hospitals responded to the survey. 63% of the respondents had received education and training (E&amp;T) on AMS during undergraduate or postgraduate training. 65% had not received any E&amp;T at induction to the hospital. The positive responses were 36%, 47% and 33% for leadership support, accountability and availability of drug expertise in form of pharmacologist/pharmacist respectively. A policy to support optimal antibiotic use was present in 25% of respondents. Broad interventions to improve antibiotic use were scored as 28%, 7% and 6% for antibiotic time out, pre-authorization and prospective audit with feedback respectively. Conclusion: The findings reveal the enablers and barriers to implementation of antimicrobial stewardship and highlighted the need for establishing a framework for stricter implementation and monitoring of antimicrobial stewardship in Indian tertiary care hospitals. Few key areas which require immediate attention are: need for government level endorsement and leadership support of antimicrobial stewardship (AMS) activities; lack of AMS programs in hospitals; and lack of undergraduate/ postgraduate/at induction education and training in AMS for staff.

Evaluation of antimicrobial stewardship activities using antibiotic spectrum coverage

Recently, the days of antibiotic spectrum coverage (DASC) using the antibiotic spectrum coverage (ASC) score was reported as a new tool for measuring antimicrobial use. The days of therapy (DOT) are required to calculate the DASC, making it impossible to use when patient-level information is unavailable. Therefore, we have defined a new measure of antimicrobial use for antimicrobial spectrum coverage (AUSC) using antimicrobial use density (AUD) and ASC scores. In this study, we have investigated the use of antimicrobial agents retrospectively examined for monthly prescriptions between 2016 and 2022, and whether the AUSC could be used as a new measure. Our data showed that the AUD, AUSC, DOT, and DASC increased, whereas AUSC/AUD and DASC/DOT decreased over the study period. In addition, no correlation was found between DOT and DASC/DOT (ρ = − 0.093, p = 0.399), whereas there was a weak correlation between AUD and AUSC/AUD (ρ = − 0.295, p = 0.006). Therefore, in this study, the use of AUSC is considered less beneficial when DASC can be calculated based on DOT. On the other hand, in institutional settings where DOT cannot be calculated, AUSC may be useful as a new measure to evaluate antimicrobial use.

Exploring Prescription Practices: Insights from an Antimicrobial Stewardship Program at a Tertiary Healthcare Facility, Rwanda.

Antimicrobial resistance (AMR) is a major public health threat linked to increased morbidity and mortality. It has the potential to return us to the pre-antibiotic era. Antimicrobial stewardship (AMS) programs are recognized as a key intervention to improve antimicrobial use and combat AMR. However, implementation of AMS remains limited in Africa, particularly in Rwanda. This study aimed to assess prescription practices, identify areas for improvement, and promote adherence to AMS principles. Conducted at King Faisal Hospital in Rwanda, this qualitative study used semi-structured interviews with eight participants until saturation was reached. The interviews were recorded, transcribed, and thematically analyzed, revealing four emerging themes. The first theme was on AMS activities that were working well based on availability of microbiology laboratory results and prescription guidelines as factors influencing antibiotic prescription adjustments. The second theme was related to challenges during the implementation of the AMS program, including the prescription of broad-spectrum antibiotics, limited local data on AMR patterns, and stock-outs of essential antibiotics. The third theme was on the importance of adhering to AMR management guidelines at KFH. The last emerged on recommendations from participants centered on regular training for healthcare workers, widespread dissemination of AMR findings across departments, and the enforcement of antibiotic restriction policies. These actions can improve prescription behaviors, upholding the highest standards of patient care, and strengthening the nascent AMS program.

Overview of the Participation of Nurses in Antimicrobial Stewardship Activities

Antibiotic resistance is a planetary threat demanding the maximum attention from health and social care services worldwide due to the clinical, economic, and human cost. Interventions to address resistance –antimicrobial stewardship programmes, AMS– are multipronged and require close collaboration of all healthcare workers involved in antimicrobial decisions and use. Nurses have been traditionally absent from such engagement. This Commentary highlights existing evidence about the need and impact of nursing involvement and leadership in AMS.Additionally, four barriers to the increased involvement of nurses in AMS are discussed (foundational, ownership, education, and leadership), with implications and potential solutions.

Pharmacist-Led Antimicrobial Stewardship Programme in Two Tertiary Hospitals in Malawi.

The ultimate goal of antimicrobial stewardship (AMS) programmes is to decrease the occurrence and spread of antimicrobial resistance (AMR). In response to this, a pharmacist partnership was established between Malawi and Wales (UK) with the aim of strengthening antimicrobial stewardship (AMS) activities in Malawi, with the initial project focusing on two tertiary referral hospitals. The Global Point Prevalence Survey (GPPS) was undertaken for the first time in Malawi at these sites and demonstrated a prescribing rate slightly lower than the African average, with ceftriaxone indicated for almost every bacterial infection. An educational intervention was also delivered, with a train-the-trainer approach upskilling pharmacists at the two sites, who then cascaded co-produced training sessions to an additional 120 multidisciplinary health professionals. A toolkit to support AMS at an individual patient level was also developed and disseminated to provide an ongoing reference to refer to. Both the trainings and toolkit were well received. Over the course of this project, significant progress has been made with the AMS programmes at the two sites, with local staff empowered to implement AMS activities. These interventions could be easily replicated and scaled and support the delivery of some of the AMS elements of the Malawi Ministry of Health National Action Plan for Antimicrobial Resistance.

Pharmacovigilance Strategies to Address Resistance to Antibiotics and Inappropriate Use-A Narrative Review.

The spread of antimicrobial resistance (AMR) is a global challenge. Close and continuous surveillance for quick detection of AMR can be difficult, especially in remote places. This narrative review focuses on the contributions of pharmacovigilance (PV) as an auxiliary tool for identifying and monitoring the ineffectiveness, resistance, and inappropriate use of antibiotics (ABs). The terms "drug ineffective", "therapeutic failure", "drug resistance", "pathogen resistance", and "multidrug resistance" were found in PV databases and dictionaries, denoting ineffectiveness. These terms cover a range of problems that should be better investigated because they are useful in warning about possible causes of AMR. "Medication errors", especially those related to dose and indication, and "Off-label use" are highlighted in the literature, suggesting inappropriate use of ABs. Hence, the included studies show that the terms of interest related to AMR and use are not only present but frequent in PV surveillance programs. This review illustrates the feasibility of using PV as a complementary tool for antimicrobial stewardship activities, especially in scenarios where other resources are scarce.

Impact of COVID-19 on antimicrobial stewardship activities in Italy: a region-wide assessment

BackgroundIn the region of Piedmont, in Northern Italy, formal monitoring of antimicrobial stewardship (AMS) programs has been in place since 2012. The objective of our study was to provide an updated assessment of AMS programs operating in our region, and to assess the impact of the COVID-19 pandemic on stewardship activities.MethodsA retrospective observational study was conducted to investigate AMS programs implemented in acute-care trusts participating in a broader healthcare-associated infections and antimicrobial resistance (AMR) prevention and control program, promoted by the regional health department. Within this program, structure, process, and outcome indicators of AMS programs were investigated, using a previously developed scoring system. Differences between scores prior to (2019) and during the pandemic (2021) were assessed. Linear regression was used to assess whether the 5-year trends (2017–2021) in outcome measures in relation to structure and process scores were statistically significant. Compound annual growth rates (CAGR) for each outcome were calculated to illustrate changes in outcome rates over time.ResultsAll public trusts in the Region (20) and a small number of private institutions (3) provided data for this study. A modest, non-significant improvement was found for 2021 structure, process, and total scores compared to respective 2019 scores. A significant improvement was found concerning the definition of a formal mission statement, whereas significantly less trusts included monitoring adherence to antimicrobial policy or treatment guidelines in their programs. Overall consumption of antibiotics for systemic use saw an increase in 2021, with 2021 recording the highest median overall consumption compared to all previous years considered in this study. Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) rates decreased over the 5-year period. Significant downwards trends in MRSA rates were identified for high-outlier structure and process groups.ConclusionsResults of this study suggest AMS programs in Piedmont were not set back following the pandemic. This outcome was possible thanks to well-established programs, coordinated within a regional framework. Continued efforts should be dedicated to supporting AMS programs and contrasting AMR, even when the focus is shifted towards other public health emergencies.

Knowledge, awareness and practices of healthcare workers regarding antimicrobial use, resistance and stewardship in Zambia: a multi-facility cross-sectional study.

Antimicrobial resistance (AMR) poses a threat to public health globally. Despite its consequences, there is little information about the knowledge, awareness, and practices towards AMR among healthcare workers (HCWs). Therefore, this study assessed the knowledge, awareness and practices regarding antimicrobial use (AMU), AMR and antimicrobial stewardship (AMS) among HCWs who are involved in the implementation of AMS activities across eight hospitals in Zambia. A cross-sectional study was conducted among 64 HCWs from October to December 2023 using a semi-structured questionnaire. Data were analysed using IBM SPSS version 25.0. Of the 64 HCWs, 59.4% were females, 60.9% were aged between 25 and 34 years, 37.5% were nurses, 18.7% were pharmacists, 17.2% were medical doctors and only one was a microbiologist. Overall, 75% of the HCWs had good knowledge, 84% were highly aware and 84% had good practices regarding AMU, AMR and AMS. Most of the HCWs (90.6%) responded that they had a multidisciplinary AMS team at their hospitals and were implementing the use of the WHO AWaRe classification of antibiotics. This study found good knowledge levels, high awareness and good practices regarding AMU, AMR and AMS among HCWs who were involved in the implementation of AMS activities in hospitals in Zambia. Additionally, most hospitals have been conducting AMS training and implementing the use of the WHO AWaRe classification of antibiotics. However, there is still a need to address some identified gaps in AMU and AMR through the strengthening of AMS activities in hospitals.

Oral antibacterial drug prescribing in primary care out-of-hours services in Wales: a secondary analysis study

Abstract Introduction Antibacterial drug consumption is posing significant threats and contributing to antimicrobial resistance.[1] Individuals are frequently exposed to antibacterials, either with intentional use or unintentionally through environmental contamination, such as when drug residues are excreted into water resources.[2] To address these concerns and promote sustainability in human health and the environment, adopting rational prescribing practices is essential, especially in primary care (PC) settings where antibacterial prescribing is high. Healthcare practitioners often face various challenges when prescribing these drugs. The challenges are more pronounced in out-of-hours (OOH) encounters, where additional factors, including managing unfamiliar patients and limited safety netting, further complicate their prescribing decisions. Limited research has been conducted in these settings until recently, and the evidence in Wales is lacking. Aim Investigate oral antibacterial drug prescribing volume over time in PC, focusing on OOH services. Methods Retrospective descriptive analyses on All-Wales antibacterial prescriptions were carried out using longitudinal secondary data that were readily available when data was accessed, i.e., between the financial years 2015-16 and 2021-22. National Health Service financial years cover the period from April to March. These routinely collected data, which are not publicly available, were requested from All-Wales Therapeutics and Toxicology Centre and extracted from the Comparative Analysis System for Prescribing Audit (CASPA), an electronic-based system used by Wales Shared Services Partnership to maintain records of PC prescriptions dispensed in the community. Number of items prescribed during daytime and OOH services was obtained for all antibacterials and the 4Cs associated with Clostridioides difficile infections (co-amoxiclav, clindamycin, cephalosporins, quinolones). Data were processed and adjusted per 100,000 population using mid-year estimates, and the overall percentage changes in volumes were calculated. Results The total number of items prescribed in PC was 14,997,291, of which 1,265,499 (8.44%) were 4Cs. For OOH services, the total number of items was 445,339 (3% of PC); 4Cs accounted for 50,527 (11.35% of OOH, 4% of PC 4Cs). OOH antibacterial and 4Cs prescribing represented relatively small proportions over the 7-year period in relation to PC, ranging between 2.7%-3.2% and 3.6%-4.2%, respectively. Data revealed a decline in prescribing in PC as a whole and OOH services, reaching its lowest in 2020-21 when COVID-19 hit. Throughout the study, prescribing volume per 100,000 population decreased by 20.7% in PC and 31.2% in OOH services when examining all oral antibacterials, and by 40.9% and 38.5%, respectively, when examining 4Cs. Data from 2021-22 indicated a rise (14% in PC; 19% in OOH) in total antibacterial prescriptions from the previous year. Conclusion To our knowledge, this study is the first to examine oral antibacterial prescribing volume in Wales OOH services, revealing downward trends of prescribing in PC generally and OOH services. The reduction in PC was primarily driven by daytime prescribing, where most consultations usually take place. Various factors may contribute to this reduction, warranting further exploration of antimicrobial stewardship activities. Additionally, investigating COVID-19 potential impact on prescribing and its sustainability is crucial. Qualitative interviews are ongoing with lead antimicrobial pharmacists in Wales, to understand the observed trends and uncover their underlying driving causes.

The application of antimicrobial stewardship knowledge to nursing practice: A national survey of United Kingdom pre-registration nursing students.

To assess student nurses understanding and skills in the application of antimicrobial stewardship knowledge to practice. Quantitative. Cross-sectional survey. Five hundred and twenty three student nurses responded across 23 UK universities. Although students felt prepared in competencies in infection prevention and control, patient-centred care and interprofessional collaborative practice, they felt less prepared in competencies in which microbiological knowledge, prescribing and its effect on antimicrobial stewardship is required. Problem-based learning, activities in the clinical setting and face-to-face teaching were identified as the preferred modes of education delivery. Those who had shared antimicrobial stewardship teaching with students from other professions reported the benefits to include a broader understanding of antimicrobial stewardship, an understanding of the roles of others in antimicrobial stewardship and improved interprofessional working. There are gaps in student nurses' knowledge of the basic sciences associated with the antimicrobial stewardship activities in which nurses are involved, and a need to strengthen knowledge in pre-registration nurse education programmes pertaining to antimicrobial management, specifically microbiology and antimicrobial regimes and effects on antimicrobial stewardship. Infection prevention and control, patient-centred care and interprofessional collaborative practice are areas of antimicrobial stewardship in which student nurses feel prepared. Interprofessional education would help nurses and other members of the antimicrobial stewardship team clarify the role nurses can play in antimicrobial stewardship and therefore maximize their contribution to antimicrobial stewardship and antimicrobial management. There is a need to strengthen knowledge from the basic sciences, specifically pertaining to antimicrobial management, in pre-registration nurse education programmes. No patient or public contribution. What Problem Did the Study Address? Nurses must protect health through understanding and applying antimicrobial stewardship knowledge and skills (Nursing and Midwifery Council 2018); however, there is no research available that has investigated nurses understanding and skills of the basic sciences associated with the antimicrobial stewardship activities in which they are involved. What Were the Main Findings? There are gaps in student nurses' knowledge of the basic sciences (specifically microbiology and prescribing) associated with the antimicrobial stewardship activities in which nurses are involved. Problem-based learning, and activities in the clinical setting, were reported as useful teaching methods, whereas online learning, was seen as less useful. Where and on Whom Will the Research Have an Impact? Pre-registration nurse education programmes. The relevant reporting method has been adhered to, that is, STROBE.