Antimicrobial Stewardship Policies Research Articles

Antibiotic prescribing practices of Filipino Dentists

<span>There are reports that dentists overprescribe antibiotics which may contribute to antibiotic resistance. This is an exploratory study on antibiotic prescribing practices of Filipino dentists using an online platform to form a basis for antimicrobial stewardship policy for dentists. </span><span lang="EN-GB">A link to an online questionnaire using Survey Monkey was posted in a Closed Group Facebook account of Filipino dentists. Two hundred thirty (230) dentists participated. </span><span>Data was analyzed by Survey Monkey. Amoxicillin is the first choice of antibiotics(71.18%), and</span><span>clindamycin is the second (57.27%). <br /> Most respondents follow the indications for antibiotic therapy, however, some will prescribe antibiotics for conditions without indications. </span><span lang="EN-GB">For dental procedures, 88.99% will prescribe for periodontal surgery, 75.45% for endodontic surgery, 68.3% for extraction of a tooth with chronic infection, 87.17% for third molar surgery, 26.7% for routine endodontics, and 23.56% for periodontal treatment without surgery. Not all of the respondents would prescribe for medical conditions that require antibiotic prophylaxis, while</span><span> 60.36% will prescribe when in doubt in diagnosis, under time pressure (25.68%), and 48.67% considers patient preference. </span><span lang="EN-GB">Only 10.48% of the respondents are <em>very familiar</em> with antimicrobial stewardship, while majority (69.74%) have not attended a lecture for antimicrobial stewardship for dentists.</span><span lang="EN-GB">There is inappropriate antibiotic prescribing of participants on certain dental diseases, procedures, and medical conditions. <br /> Most respondents are not <em>very familiar</em> and have not attended a lecture on antimicrobial stewardship for specifically for dentists.</span>

Effectiveness of antibiotic stewardship programmes in primary health care settings in developing countries.

Despite the implementation of antimicrobial stewardship programmes (AMS), antibiotic resistance are a rising a major global concern, and the burden is estimated increase. Little is known about program effectiveness, particularly in primary care and in developing nations. To assess the effectiveness of antimicrobial stewardship programmes in primary health care. A case study assessed the effectiveness of implementation of antimicrobial stewardship at 10 primary health care facilities in Windhoek. From 1 to 31 October 2018, a SWOT analysis of each health facility was conducted through an audit and interview of infection control focal persons to assess the level of compliance to good antimicrobial stewardship practices and policies. Of the 10 facilities, 90% of the focal persons were aware of systems and polices for good AMS practice. The level of compliance at hospital-based primary health centers was 30.8% compared to clinics (9.1%-36.4%). The main challenge is lack of policies and systems specific to antimicrobial use as well as commitment of financial and human resources to implement AMS programmes in primary health care. The implementation of antimicrobial stewardship programmes in primary health care is suboptimal. This negatively affects the global efforts to control antimicrobial resistance. There is a need to institutionalise national guidelines for AMS in primary health care.

Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study.

This study explored antimicrobial stewardship programme (ASP) team members' perspectives regarding factors influencing the adoption and implementation of these programmes in Saudi hospitals. This was a qualitative study based on face-to-face semistructured interviews with healthcare professionals involved in ASPs and activities across three Ministry of Health (MoH) hospitals in Saudi Arabia (n = 18). Interviews were also conducted with two representatives of a General Directorate of Health Affairs in a Saudi region and two representatives of the Saudi MoH (n = 4) between January-February 2017. Despite the existence of a national strategy to implement ASPs in Saudi MoH hospitals, their adoption and implementation remains low. Hospitals have their own antimicrobial stewardship policies, but adherence to these is poor. ASP team members highlight that lack of enforcement of policies and guidelines from the MoH and hospital administration is a significant barrier to ASP adoption and implementation. Other barriers include disintegration of teams, poor communication, lack of recruitment/shortage of ASP team members, lack of education and training, and lack of health information technology (IT). Physicians' fears and concerns in relation to liability are also a barrier to their adoption of ASPs. This is the first qualitative study exploring barriers to ASP adoption and implementation in Saudi hospitals from the perspective of ASP team members. Formal endorsement of ASPs from the MoH as well as hospital enforcement of policies and provision of human and health IT resources would improve the adoption and implementation of ASPs in Saudi hospitals.

ESKAPE pathogens resistance from blood cultures in a social security reference hospital in Guatemala

Background: Growing rates of antimicrobial resistance limits the treatment options and poses a great challenge for public health. Major emphasis has been given to pathogens under the acronym ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanii, Pseudomonas aeruginosa, and Enterobacterium species) as the cause of the majority of nosocomial infections. Resistance in ESKAPE pathogens in blood cultures from a reference hospital could be a significant representation of the antimicrobial resistance in the region. Methods & Materials: Retrospective analysis of the microbiology results of 11,117 blood cultures registered into the database from the National Social Security Network (NSSN) from June 1st 2015 to June 30th 2016 were included. Samples from the Pediatrics (PD), Surgical (SD), Internal Medicine (IM), Pediatrics Emergency (PER), Emergency Room (ER), Pediatrics Intensive Care Unit (PICU), Intensive Care Unit (ICU) and Hemodialysis Unit (HD) were analyzed. Antimicrobial resistance profile was obtained through Vitek 2. Results: mrA total of 10.33% blood cultures (1,149/11,117) showed bacterial growth, ESKAPE pathogens were identified in 51.61% (593/1,149), 72.01% (427/593) were gram-negative bacteria. Klebsiella pneumoniae (KPC) (37.47%; 160/427) and Pseudomonas (23.88%; 102/427) were the agents more frequently found followed by E. coli (19.9%; 85/427) and Acinetobacter complex (ACBC) (18.73%; 80/427).ESBL resistance was identified in 36.25% of KPC (58/160) and 34.09% of E.coli (30/85). Resistance to Imipenem and meropenem was found in 90% and 50% of Pseudomonas respectively and 83.75% and 100% of ACBC respectively. ACBC also showed 18.75% of resistance to Tigecycline. S. aureus was found in 161 blood cultures (14.01%), 60.24% strains (97/161) were methicilline-resistant. Conclusion: The positive rate of cultures in the study is acceptable. Almost half of positive cultures isolated an ESKAPE pathogen. The incidence of Gram-negative bacilli was surprisingly high; equally alarming was the ESBL rates on both KPC and E. coli. The resistance to carbapenems found in both ACBC and Pseudomonas has practically rendered these antibiotics useless. The results of this study support the importance of an antimicrobial stewardship and stricter policies to reduce resistance and broaden therapeutic options.

Bacterial isolation and antimicrobial susceptibility trends: why these are important and how they can be used

Antibiotic resistance is a very real threat to modern standards of human and veterinary healthcare.1 This is a one health problem – we share many antimicrobials, our bacteria are closely...

SAT-262 - Impact of an antimicrobial stewardship policy on the reduction of empirical antibiotic treatment failure and the spread of multidrug-resistant organisms in hospitalized cirrhotic patients

SAT-262 - Impact of an antimicrobial stewardship policy on the reduction of empirical antibiotic treatment failure and the spread of multidrug-resistant organisms in hospitalized cirrhotic patients

PCR screening of antimicrobial resistance genes in faecal samples from Australian and Chinese children.

Recent public awareness campaigns on the risk of antibiotic resistance in pathogenic microbes has placed pressure on governments to enforce stricter antimicrobial stewardship policies on hospitals and the agricultural industry. In this study, faecal samples from Australian and Chinese children were screened for the presence of antimicrobial resistance genes (ARGs) in order to identify demographics at risk of carriage of these genes and to examine antimicrobial stewardship policies from the two countries that may influence carriage. Faecal samples from 46 Australian and 53 Chinese children were screened by PCR for the presence of six clinically relevant ARGs. Clinical and demographic data were also collected from each patient. More than 90% of faecal samples from Chinese children tested positive for β-lactam, macrolide, tetracycline and aminoglycoside resistance genes, which was substantially higher than Australian samples. Besides country of origin, no clear trend could be seen to predict carriage of ARGs. The exception to this was Chinese-born children who immigrated to Australia having higher rates of carriage of blaTEM and tetM genes than children born and still living in Australia. These data indicate that Chinese children are more likely to carry certain ARGs than Australian children. The Chinese government has recently implemented strict policies to control the overuse of antibiotics in hospitals. However, many of these policies do not extend to the agricultural industry, which could explain the differences seen in this study.

Phenotypic Detection of Metallo (3-Lactamase in Carbapenem Resistant Gram Negative Bacilli Isolates

AbstractBackground: A rising threat of the rapid spread of acquired metallo (3-lactamases (MBLs) among Gram Negative Bacilli (GNB) is a matter of public health concern worldwide. Hence, detection of MBLs producing clinical isolates via an accurate and cost effective technique is necessary to prevent their dissemination as well as regulation of antimicrobial steward-ship policy. This study aimed to detect MBLs in Carbapenem Resistant Gram Negative Bacilli (CRGNB) using two pheno-typic tests; Combined Disc Test (CDT) and Double Disc Synergy Test (DDST).Methods: We conducted a prospective study on 130 GNB isolates recovered from different clinical specimens collected from different patients. Isolates were identified then antibiotic susceptibility profile was determined by VITEK® 2 compact system. GNB which showed resistance to meropenem were screened for MBLs production by CDT and DDST.Results: Out of 36 CRGNB isolates, 23 isolates (63.9%) were MBLs positive by CDT, and 20 (55.6%) by DDST. With almost perfect agreement between CDT and DDST.Conclusion: Our study validates two phenotypic methods (CDT and DDST) for the detection of MBLs production, making them highly applicable to routine clinical laboratories.

Education and management of antimicrobials amongst nurses in Africa-a situation analysis: an Infection Control Africa Network (ICAN)/BSAC online survey.

To assess the current involvement of nurses in the use and management of antimicrobials and their training in antimicrobial stewardship (AMS) across Africa. After a pilot study, an online questionnaire (SurveyMonkey) in both French and English was circulated via the Infection Control Africa Network (ICAN) mailing list to both members and non-members in Africa. The study was conducted from 26 May to 19 August 2016. Data were summarized in proportions and bar charts; proportions were compared using the χ2 test. A multivariate logistic regression model was built to identify independent factors associated with the practice of AMS. While 96% of the 173 respondents were aware of the term 'AMS', 88.5% (146/165) undertook AMS tasks as part of their job; 91.9% (158/172) wanted to be more involved in AMS but 44.9% (71/158) reported there were barriers in doing so. AMS training was delivered to 36.7% (62/169) and 53.6% (90/168), respectively, during their undergraduate and postgraduate education. AMS training for healthcare workers in their institutions was reported by 50.3% (86/171), including training aimed at doctors (56.9%), pharmacists (76.7%), microbiologists (31.4%) and nurses (95.3%). However, 95.4% (164/172) of respondents asked for further education on AMS and the majority preferred AMS training to be part of the infection prevention curriculum (IPC) education. Three-quarters of institutions had an AMS initiative, but only ∼41% reported having seen a national AMS guideline. For Africa, we recommend AMS education at undergraduate level, AMS policies at institution and national levels and incorporating AMS training into the IPC for nurses.

Physician Perceptions Regarding Antimicrobial Use in End-of-Life Care.

BACKGROUND The decision to utilize antimicrobials in end-of-life situations is complex. Understanding the reasons why physicians prescribe antimicrobials in this patient population is important for informing the design of antimicrobial stewardship interventions. METHODS A 51-item survey containing both closed and open-ended questions on end-of-life antimicrobial use was administered to physicians affiliated with the University of Pennsylvania and Children's Hospital of Philadelphia from January through April 2017. A mixed-methods approach was used to analyze responses. RESULTS Of 637 physicians surveyed, 283 responses (44.4%) were received. Most (86.2%) physicians believed that respecting a patient's wish to continue antimicrobials was important. Approximately half of physicians (49.8%) believed that antimicrobial use at the end of life contributes to resistance. A higher proportion of pediatricians would often or always continue antimicrobial treatment for active infections and for hospice patients whose death was imminent compared to adult physicians (P<.001). Analysis of free-text responses revealed additional reasons why physicians may continue antimicrobials at end of life, including meeting family expectations, wanting to avoid the perception of "giving up," uncertainty about prognosis, and reducing patient pain or discomfort. CONCLUSIONS Physician decision making concerning antimicrobial use in patients at the end of life is multifactorial. Clinicians may overweigh the benefits of antimicrobial therapy in end-of-life situations and view the importance of adhering to stewardship policies differently. Pediatric and adult clinicians have different approaches to this patient population. Better understanding of the complex decision making that occurs in the end-of-life patient population can help guide antimicrobial stewardship policies and improve patient care. Infect Control Hosp Epidemiol 2018;39:383-390.

Microbiology in burns patients with blood stream infections: trends over time and during the course of hospitalization

Background: Bloodstream infections (BSI) are a major cause of mortality in burns patients. Knowledge of the microbiology is crucial to direct empirical therapy. We sought to determine the causative microorganisms and antibiotic resistance in burns patients with BSI.Methods: All consecutive BSI episodes in a tertiary hospital burns unit from 2000 to 2014 were included. The following three subperiods were compared: 2000–2004, 2005–2009 and 2010–2014. Changes in BSI occurring during early and late hospitalization periods were evaluated.Results: A total of 103 BSI episodes were included. The cumulative incidence was 2.4 episodes/1000 patient days. A positive trend in the frequency of Gram-negative BSI, especially in the upsurge of Pseudomonas aeruginosa and Klebsiella spp. BSI after 2004, was observed. The most common causative pathogens in early BSI were Gram-positive microorganisms. P. aeruginosa and Klebsiella spp. became the predominant aetiology in the fourth week of hospitalization and beyond. There was a progressive increase in imipenem-resistant P. aeruginosa over time (0%, 67%, 75% in 2000–2004, 2005–2009, 2010–2014, respectively) and during the hospital stay (50% vs. 85.7%, in <7 days-BSI vs. >30 days-BSI, respectively). A higher SOFA (Sepsis-related Organ Failure Assessment) score was associated with Gram-negative BSI versus non-Gram-negative BSI (median: 2.5 vs. 0; p = 0.041).Conclusions: There is a changing trend in the types of pathogens causing BSI in burns patients over the 14-year period and during the course of hospitalization. The problematic increase in carbapenem-resistance highlights the need for new antimicrobial stewardship policies and antibiotic prescribing protocols.

Data linkage of routinely collected electronic health records to characterise risk factors associated with antibiotic resistance in urinary isolates: an exemplar of NHS Scotland’s Infection Intelligence Platform

ABSTRACT&#x0D; ObjectivesUrinary tract infections (UTIs) are amongst the most common infections treated in community and hospital settings. Initial antibiotic treatment of UTI is usually empirical, that is, where the prescriber has no definitive information on the organism or its antibiotic sensitivity.. Overall the prevalence of antimicrobial resistance is increasing, and specifically so for antibiotics commonly used for UTI.&#x0D; By linking NHS surveillance data to routinely collected administrative health data this study aims to investigate risk factors for antibiotic resistance in urine samples&#x0D; ApproachAll positive urine samples included in the “Surveillance of Antimicrobial Resistance in Urinary Isolates in Scotland” dataset in the period from January 2012 to June 2015 (all NHS Health Boards in Scotland submit susceptibility data for up to eleven antibiotics on 400 positive urinary samples per quarter) were analysed. Cases were assigned a resistance status of Sensitive, Resistant or Multi-drug resistant based on the antibiotic susceptibility data recorded.&#x0D; Using the NHS Scotland Infection Intelligence Platform all cases were linked to national coverage data: (i) hospital discharge data to create the Charlson score for comorbidity and (ii) patient-level community prescribing data to measure cumulative antibiotic exposure (number of defined daily doses) in the 3 months prior to infection. Risk factors associated with the infection susceptibility to antibiotics were assessed using multivariable multinomial logistic regression.&#x0D; Results40,984 positive urine samples were examined. Overall 29.0% were sensitive, 48.1% resistant and 22.9% multi drug resistant. Around a third of the cases (33.9%) had no antibiotic prescribing in the 3 months prior to infection. Age, care home residence and increasing comorbidity were both found to be associated with resistance and multidrug resistance. Cumulative antibiotic exposure had a clear dose-response effect. Those with 1-7DDDs were 1.2 times (95% CI: 1.11-1.29) more likely to have a multidrug resistant infection (compared to a sensitive infection) rising to 7.45 times (95% CI: 95% CI 6.45-8.6) for 29+ DDDs. Similar dose response held for resistant infection but at a lesser scale (1-7DDDs OR=1.36 (95% CI: 1.2-1.5) rising to OR=3.04 (95% CI: 2.38-3.89).&#x0D; ConclusionA clear effect of cumulative antibiotic exposure in the community and multidrug resistance in UTI cases has been demonstrated. Such quantification is key to ensuring and supporting robust antimicrobial stewardship policy and will form the evidence base for development of prescribing decision support tools for more patient centred treatment of UTI.

Correlation between antibiotic consumption and resistance of bloodstream bacteria in a University Hospital in North Eastern Italy, 2008-2014.

The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year. Potential correlations between antibiotic consumption and bacteria resistance rates were investigated through the Pearson's correlation. The overall consumption of antibiotic grew from 80 to 97 DDD 100 patient/days (p=0.005) during the study period. The increased consumption of amoxicillin/clavulanate and piperacillin/tazobactam was associated with the reduction of MRSA rate from 48.5 to 25.9% (p=0.007 and p=0.04, respectively). The increased consumption of piperacillin/tazobactam was associated with the reduction of ESBL-positive Enterobacteriaceae rate from 28.9 to 20.9% (p=0.01). The increased consumption of carbapenems was associated with the increased rate of carbapenem-resistant Acinetobacter baumannii from 0 to 96.4% (p=0.03). No carbapenem-resistant Enterobacteriaceae isolates were reported. The consumption of vancomycin grew significantly (p=0.005). A dramatic spread of vancomycin-resistant Enterococcus faecium occurred in 2014. The consumption of fluoroquinolones and extended-spectrum cephalosporins remained stable. An antibiotic stewardship program targeted to limit the consumption of extended-spectrum cephalosporins and fluoroquinolones in favor of amoxicillin/clavulanate and piperacillin/tazobactam correlates with a decreasing rate of MRSA and ESBL-positive Enterobacteriaceae. The analysis of correlations between antibiotic consumption and bacterial resistance rates is a useful tool to orient antimicrobial stewardship policies at local level.

Clinical Impact of Antimicrobial Stewardship Programs in Colombian Acute Care Hospitals

BackgroundInappropriate use of antimicrobials contributes to antimicrobial resistance, which increases hospital length of stay, mortality and health care costs. Antimicrobial Stewardship Programs (ASP) are coordinated quality-improvement efforts to promote the judicious and effective use of antimicrobials to optimize clinical outcomes while minimizing adverse effects. The present study was designed to determine the clinical improvement of patients with healthcare associated infections (HAI) using antimicrobial stewardship policies in Colombian acute care hospitals.MethodsWe conducted a quasi-experimental study between January 2007 and December 2014 in four acute care hospitals in two Colombian cities. The study variables were evaluated two years before and two years after ASP implementation. Adult patients with HAI episodes in intensive care units or general wards were included. Clinical and economic patient outcomes were compared between groups. Data was analyzed using descriptive and inferential statistics.ResultsNine hundred patients with bacterial HAIs were hospitalized in four institutions. The cohort treated before the implementation of ASPs consisted of 471 patients. The cohort treated after ASP implementation consisted of 429 patients. The median age was 62; 70% of patients had at least one comorbidity. Urinary infection was the most common infection (28%), followed by bloodstream infections (26%). After the ASP was implemented, the rate of adherence to empiric treatment clinical guidelines increased from 9% to 45%, while the rate of de-escalating increased from 8% to 92%. Multivariate analysis showed that patients receiving treatment under ASP experienced 10 times clinical improvement compared with patients not treated under ASP. Septic shock after targeted therapy was observed as an independent risk for lack of clinical improvement. Compared with the pre-ASP cohort, the post-ASP cohort experienced a shorter length of stay (10.8 vs. 14 days) and lower total infection cost ($3,307 USD vs. $4,655 USD, P < 0.001).ConclusionThe use of ASPs results in substantial clinical improvement in patients and contributes to fewer infection complication, shorter length of stay, and decreased costs associated with treating patients.Disclosures C. Hernández-Gómez, Merck Sharp & Dohme: Consultant, Consulting fee; Pfizer: Consultant, Consulting fee; C. Pallares, Merck Sharp & Dohme, Pfizer: Consultant, Consulting fee; M. V. Villegas, Merck Sharp & Dohme: Consultant, Consulting fee and Research support; Pfizer: Consultant, Consulting fee and Research support

Participatory Policy Making by Dairy Producers to Reduce Anti-Microbial use on Farms.

Pressures for more responsible use of anti-microbial (AM) medicines in food animals are likely to increase from policymakers and the food industry, including retailers. To address this challenge, participatory approaches to welfare interventions and disease prevention may also be necessary alongside more conventional regulatory measures. This article describes the process of enabling groups of dairy producers to use a participatory policy making approach to develop an AM stewardship policy. The policy includes measures agreed to by all producers for more responsible use of AMs, whilst maintaining or improving dairy herd health and welfare. This process provided a unique opportunity for collaboration and dialogue between producers, veterinarians, industry and researchers. Its participatory nature encouraged comprehensive learning for all involved. This integration of science with producers' knowledge and experience led to credible and practical recommendations designed to deliver real and lasting change in AM use. The multidisciplinary nature of this research marks a significant contribution to embedding social science skills and approaches into the veterinary sphere. As an initial step in creating better understanding of how participatory approaches with farmers can be applied in a UK context and more widely, this work serves as a pilot for promoting more responsible use of veterinary medicines in other livestock species.

Community-acquired pneumonia and positive urinary antigen tests: Factors associated with targeted antibiotic therapy

BackgroundThe use of rapid microbiological tests is supported by antimicrobial stewardship policies. Targeted antibiotic therapy (TAT) for community-acquired pneumonia (CAP) with positive urinary antigen test (UAT) has been associated with a favorable impact on outcome. We aimed to determine the factors associated with TAT prescription. Patients and methodsWe conducted a retrospective multicenter study including all patients presenting with CAP and positive UAT for Streptococcus pneumoniae or Legionella pneumophila from January 2010 to December 2013. Patients presenting with aspiration pneumonia, coinfection, and neutropenia were excluded. CAP severity was assessed using the Pneumonia Severity Index (PSI). TAT was defined as the administration of amoxicillin for pneumococcal infection and either macrolides or fluoroquinolones (inactive against S. pneumoniae) for Legionella infection. ResultsA total of 861 patients were included, including 687 pneumococcal infections and 174 legionellosis from eight facilities and 37 medical departments. TAT was prescribed to 273 patients (32%). Four factors were found independently associated with a lower rate of TAT: a PSI score≥4 (OR 0.37), Hospital A (OR 0.41), hospitalization in the intensive care unit (OR 0.44), and cardiac comorbidities (OR 0.60). Four other factors were associated with a high rate of TAT: positive blood culture for S. pneumoniae (OR 2.32), Hospitals B (OR 2.34), E (OR 2.68), and H (OR 9.32). ConclusionTAT in CAP with positive UAT was related to the hospitals as well as to patient characteristics.

The Legislative Momentum of Antimicrobial Stewardship: the US Perspective

The aim of this review is to describe new and evolving legislation concerning antimicrobial stewardship at both the state and national level. Antimicrobial resistance is a challenge to health worldwide. Recently, the US federal government has issued reports recognizing it as a serious threat to public health and national security acknowledging the need for judicious antimicrobial use. California has been a pioneer in mandating and implementing antimicrobial stewardship initiatives in healthcare institutions. With the White House Executive Order 13676, a number of healthcare organizations have committed to making antimicrobial stewardship policy and regulatory changes, and it will likely soon be mandatory for all states to comply with a newly created set of standards relating to antimicrobial stewardship in US hospitals and nursing homes. With numerous changes, including governmental and organizational mandates, on the horizon, it is crucial for healthcare institutions to understand and be prepared for this new era in antimicrobial stewardship. The adoption of these new standards by institutions is of an imminent nature. Key Points:• United States federal agencies and the executive branch have recently issued reports characterizing antimicrobial resistance as threats to public health and national security.• The state of California has implemented regulations requiring the establishment of antimicrobial stewardship programs (ASPs) in all acute-care hospitals and long-term care facilities.• A goal of the National Action Plan for Combating Antimicrobial Resistance is establishment of ASPs in acute care hospitals.• Veterans Affairs and Department of Defense facilities have already adopted the ASP requirement; for non-federal hospitals, this mandate will likely be achieved through regulators such as the Centers for Medicaid and Medicare Services.

Antimicrobial Stewardship Practices Reported by California Hospitals—Annual Hospital Survey Data Submitted via the National Healthcare Safety Network, 2014

Background. Since 2008, California acute care hospitals have been required to develop processes for evaluating the judicious use of antibiotics and to report results to their quality improvement committees. A national survey conducted in 2011 found California hospitals were significantly more likely to have an antimicrobial stewardship policy than hospitals in other states. New California legislation further requires hospitals to implement an antimicrobial stewardship policy in accordance with guidelines and to establish a physician-supervised multidisciplinary committee with at least one physician or pharmacist with specific stewardship training by 1 July 2015. Methods. Beginning in 2014, the National Healthcare Safety Network (NHSN) Annual Hospital Survey included questions about antimicrobial stewardship practices. Annual Hospital Survey data submitted by California acute care hospitals via NHSN were analyzed to determine proportions of hospitals implementing specific antimicrobial stewardship practices. Results. Data were available for all 391 California hospitals reporting to NHSN: 290 (74%) reported having a statement from leadership supporting efforts to improve antibiotic use; 359 (92%) reported a physician or pharmacist leader responsible for outcomes of stewardship; 201 (51%) provide dedicated salary support for stewardship activities. Specific stewardship practices are included in the table. Conclusion. In the setting of state legislative requirements, we document that substantial numbers of California hospitals are engaged in antimicrobial stewardship. These data will be used to identify opportunities for public health to guide programs that promote and support further implementation and advancement of antimicrobial stewardship practices in California hospitals. Table. Stewardship Practice No. (%) Hospitals Responding Yes Requiring prescribers to document indication for all antibiotics 166 (42%) Facility-specific antibiotic treatment recommendations 313 (80%) Antibiotic time-out 133 (34%) Antibiotic pre-approval 275 (70%) Antimicrobial prescription audit with feedback 342 (87%) Providing feedback to prescribers regarding improving antibiotic use 288 (74%) Providing antibiotic stewardship education 278 (71%) Monitoring antibiotic use 310 (79%) View it in a separate window Disclosures. All authors: No reported disclosures.

Antimicrobial stewardship policy: time to revisit the strategy?

Recent data indicate that both the overall numbers of antibiotic prescription and the frequency of multidrug-resistant bacteria are increasing significantly. These threatening features are observed, despite national antimicrobial stewardship (AMS) policies aimed at decreasing antibiotic use. AMS should also focus on the initial steps leading to antibiotic prescription. Physicians and their patients should benefit from the structured clinical pathways, the latter being adapted to regional epidemiological data and resources. Continuous evaluation of these predefined clinical paths through a computerized medical dashboard will allow a critical review and finally the optimization of medical practices. These innovative behavioural approaches for clinicians will supply precise information on the relationship among the diagnosis, therapeutics and outcome. This changing environment will carry out the adapted therapeutic procedures, and appropriate antibiotic use will inherently improve.

English

Antimicrobial agents are reported to be the commonest prescribed medication among physicians. Studies have shown that up to 50% of antimicrobial agents prescriptions are inappropriate. The study was a retrospective cross-sectional design. Records of all patients admitted to both the medical and paediatrics wards during the period of audit were reviewed after discharge from the hospital. The appropriateness of the prescribed antimicrobial agents given to them was determined by a microbiologist who was independent of the team that managed the patients. More than 50% of antimicrobial agents prescribed for our inpatients were inappropriate. The most common test done to investigate infections in these patients was complete blood count and the most common class of antimicrobial agents prescribed was cephalosporin. Based on the outcomes of this study we recommend constituting a drug and therapeutics committee to develop an antimicrobial stewardship policy and the guideline for implementing the policy for a more rational use of these agents. Key words: Antimicrobial agents, physicians, prescriptions.