Impact Of Antimicrobial Stewardship Program Research Articles

Impact of an antimicrobial stewardship programme on antibiotic utilization and resistance burden in patients with acute leukaemia: an 11-year longitudinal cohort study using interrupted time-series analysis.

Antimicrobial resistance (AMR), driven by inappropriate and overuse of antibiotics, poses a significant threat, especially to patients with acute leukaemia. To evaluate the impact of antimicrobial stewardship programmes (ASPs) on antibiotic use and analyse temporal changes in bloodstream infections (BSI) caused by AMR organisms. We performed a retrospective, interventional, longitudinal cohort study spanning an 11-year period. ASPs included optimizing antibiotic use, enhancing tracking and reporting systems and delineating leadership and accountability. A segmented regression model of interrupted time series was used to evaluate the trend of antibiotic consumption and BSI with AMR organisms after the interventions. A total of 3296 BSI episodes with 454 419 days of therapy (DOT) from 7754 patients were obtained. ASPs were significantly associated with an immediate reduction [-70.03 DOT/1000 patient-days (PD), P = 0.036] and a decreasing trend (-11.65 DOT/1000 PD per quarter, P < 0.001) in overall antibiotic use. The increasing incidence of BSI with AMR before ASP intervention was notably curbed and revealed a decreasing trend (slope change: -0.06 BSI/1000 PD per quarter, P = 0.002). The decreasing trend was more significant for Enterobacterales: ciprofloxacin-resistant and ESBL-producing isolates showed a slope change of -0.06 BSI/1000 PD and -0.08 BSI/1000 PD per quarter, respectively (all P < 0.05). However, Pseudomonas aeruginosa BSI increased. Multidimensional ASPs effectively reduced both the immediate and trends in overall antibiotic usage even in patients with acute leukaemia. Additionally, there was a notable decrease in the incidence of BSI caused by AMR organisms, particularly among Enterobacterales.

Point prevalence surveys of antibiotic prescribing in children at a tertiary hospital in a resource constraint, low-income sub-Saharan African country—the impact of an antimicrobial stewardship program

BackgroundResistance to multiple antibiotics by several pathogens has been widely described in children and has become a global health emergency. This is due to increased use by parents, caregivers, and healthcare providers. This study aims to describe the prevalence rates of antibiotic prescribing, ascertain the impact of antimicrobial stewardship programs, and target improving the quality of antibiotic prescribing in the paediatric population over time in a hospital.MethodA point prevalence survey of antibiotic use was performed yearly for 4 years to monitor trends in antibiotic prescribing. Data from all patients admitted before 8 a.m. on the day of the PPS were included. A web-based application designed by the University of Antwerp was used for data entry, validation, and analysis (http://www.global-pps.com).ResultsA total of 260 children, including 90 (34.6%) neonates and 170 (65.4%) older children, were admitted during the four surveys. Overall, 179 (68.8%) patients received at least one antibiotic. In neonates, the prevalence of antibiotic use increased from 78.9 to 89.5% but decreased from 100 to 58.8% in older children. There was a reduction in the use of antibiotics for prophylaxis from 45.7 to 24.6%. The most frequently prescribed antibiotic groups were third generation cephalosporins and aminoglycosides. The most common indications for antibiotic prescription were sepsis in neonates and central nervous system infection in older children. The documentation of reason in notes increased from 33 to 100%, while the stop-review date also increased from 19.4 to 70%.ConclusionThe indicators for appropriate antibiotic prescription improved over time with the introduction of antibiotic stewardship program in the department.

Assessing the impact of antimicrobial stewardship programs in tertiary hospitals for UTI: does it work alone?

Antibiotic resistance is currently an emergent global challenge. Urinary tract infection (UTI), one of the most commonly reported infections, are is becoming a difficult case to treat considering the increasing prevalence of antimicrobial resistance (AMR). The objective of this study was to assess the impact of a hospital antibiotic stewardship program on AMR in managing UTI at a tertiary referral hospital in Yogyakarta, Indonesia, while considering the absence of the program in lower-tier referral hospitals. A retrospective cross-sectional study was conducted from January 2017 to December 2020, classified into pediatric and adult samples. Urine samples were collected and cultured from all patients with UTI hospitalized in the Dr. Sardjito General Hospital, Yogyakarta. The UTI causative bacteria and antibiotic susceptibilities were investigated in the comparison of the first 2 years (2017-2018, prior to the hospital antibiotic stewardship program) and the last 2 years (2019-2020, following the implementation of the hospital antibiotic stewardship program). The isolates from 717 adult urine samples were cultured. Escherichia coli (39.1%), Acitenobacter baumanii (9.3%), and Pseudomonas aeruginosa (8.5%) were identified as the most common bacteria prior to the hospital antibiotic stewardship program. Extended-spectrum β-lactamase-producing E. coli and Burkholderia cepacia were still increasing in the following the implementation of the hospital antibiotic stewardship program. Our study indicated that the stewardship program does not exhibit a significant change during the first two years considering the absence of the program in lower-tier referral hospitals.

Short-term effects of antimicrobial stewardship programs on antibiotics usage, clinical outcomes, and multidrug resistant organisms in the post COVID-19 era

BackgroundAntimicrobial resistance is associated with increasing mortality rates and the emergence of multidrug-resistant (MDR) organisms. There is scarcity of data on the short-term impact of Antimicrobial Stewardship Programs (ASP) on antibiotic usage, clinical outcome and MDR organisms’ pattern following the COVID-19 pandemic. This study evaluated the short-term effects of ASP on antibiotic usage, clinical outcomes and MDR organisms’ pattern in the post COVID-19 era. MethodsConducted at a tertiary academic health center, this observational study involved adult patients (≥18 years) in the general medical unit, treated with oral or intravenous antibiotics from May 1, 2021, to April 30, 2022. The applied ASP strategy was a prospective audit and feedback where a weekly meeting was held to discuss the antimicrobial therapy of admitted patient, after which recommendations were made regarding antimicrobial use. ResultsThe study included 301 patients with 166 (55.1%) pre-ASP and 135 (44.9%) post-ASP. The median (IQR) age was 69 (55−77) years with 56.1% were female. Antibiotic usage dropped by 25.2% post-ASP. The length of hospital stay (LOS) was longer post-ASP (7 days vs. 7.9 days, p = 0.001), with MDR infections being a significant predictor (OR: 0.486, p < 0.001). There were no significant differences in 28-day readmission, recurrence of infections and all-cause mortality. Post-ASP, MDR pathogens increased (17.0% vs. 6.6%, p = 0.013), however, after separating post-ASP into two three-months periods, MDROs numbers decreased slightly (13 vs. 10). ConclusionShort-term ASP implementation post COVID-19 reduced antibiotic usage while other clinical outcomes remained unchanged. Nonetheless an increase in MDR pathogens and LOS was observed. Further research is required to assess ASP’s long-term impact on MDR infections rates and specific patient group outcomes.

Improving diagnostic accuracy of blood culture-positive cases in a cancer center via an antimicrobial stewardship program and infectious disease consultations

The direct impact of antimicrobial stewardship programs (ASP) and infectious disease (ID) consultations on patients' clinical diagnoses remains unknown. We assessed their influence on improving the diagnostic accuracy of blood culture-positive inpatients at a Japanese cancer center. Our single-center, retrospective observational study was conducted from April 1, 2018 to March 31, 2022 to evaluate two phases: pre-intervention (notification of antimicrobials by the infection control team) and post-intervention (ASP implementation and ID consultation service establishment). There were 42,514 inpatients: 22,096 during the pre-intervention and 20,418 during the intervention periods. A total of 939 blood culture-positive episodes (pre-intervention, n = 434; post-intervention, n = 505) were analyzed. During the pre-intervention period, 28.1% of the patients had an unknown diagnosis, which decreased significantly to 1.2% post-intervention. Furthermore, hepatobiliary tract and other infections increased significantly post-intervention, and the mortality rate due to Staphylococcus aureus infection decreased from 28.6% pre-intervention to 10.4% post-intervention. The trend and level of the total number of culture specimens submitted per 1000 patient days for all culture specimens increased significantly post-intervention. Notably, the two-set rate of monthly blood cultures increased significantly. In conclusion, improving the overall diagnostic process with ASP and ID consultations at cancer centers could lead to the optimization of patient care.

EE242 The Economic Impact of Antimicrobial Stewardship Program in the Adults’ General Medicine Setting in Qatar

Antimicrobial stewardship programs (ASPs) have shown to minimize the emergence of antimicrobial resistance and healthcare costs associated with an inappropriate use of antimicrobials. This study sought to evaluate the economic benefit of the mature ASP use compared to premature ASP use in the adults’ general medicine settings in Qatar.

Impact of Antimicrobial Stewardship Programme on Antimicrobial Utilisation, Cost and Bacterial Resistance in a Malaysian Public Tertiary Hospital

Antimicrobial stewardship programme (ASP) was introduced as one of the strategies to curb the rise of multi-drug resistant (MDR) organism. The findings on the programme establishment are important in strengthening ASP measures. This study aimed to assess the impact of ASP implementation on the antimicrobial utilisation, antimicrobial cost and the MDR bacterial resistant rate before and after the programme initiation. A retrospective cohort study involving adult inpatient in a public tertiary hospital was conducted between pre-ASP implementation in year 2015 and post-ASP implementation from year 2016 to 2019. The statistical analysis of Student t-test or Mann-Whitney U test was used depending on the data distribution. The mean defined daily dose (DDD) per 1,000 patient days for ASP targeted antibiotics was significantly decreased by 17% from 161.52 DDD per 1,000 patient days in pre-ASP period to 134.49 DDD per 1,000 patient days in post-ASP period mainly from the usage of third generation cephalosporin, carbapenem and colistin. The annual expenditure for ASP targeted antibiotics had significant monetary reduction from RM30,580.50 in pre-ASP period to RM20,590.60 during post-ASP period. Significant reduction in the mean MDR bacterial resistant rate were notable for extended spectrum beta-lactamase E. coli (27.48%–17.85%), methicillin-resistant Staphylococcus aureus (22.25%–15.73%) and MDR Acinetobacter spp. (71.46%–49.34%). The implementation of ASP leads to significant reduction on the ASP targeted antibiotics utilisation, antimicrobial cost and MDR bacterial resistance rate. These outcomes are beneficial in justification and expansion of ASP activities in Malaysia.

Antimicrobial Stewardship on Patients with Neutropenia: A Narrative Review Commissioned by Microorganisms.

The emergence of antibiotic resistance poses a global health threat. High-risk patients such as those with neutropenia are particularly vulnerable to opportunistic infections, sepsis, and multidrug-resistant infections, and clinical outcomes remain the primary concern. Antimicrobial stewardship (AMS) programs should mainly focus on optimizing antibiotic use, decreasing adverse effects, and improving patient outcomes. There is a limited number of published studies assessing the impact of AMS programs on patients with neutropenia, where early appropriate antibiotic choice can be the difference between life and death. This narrative review updates the current advances in strategies of AMS for bacterial infections among high-risk patients with neutropenia. Diagnosis, drug, dose, duration, and de-escalation (5D) are the core variables among AMS strategies. Altered volumes of distribution can make standard dose regimens inadequate, and developing skills towards a personalized approach represents a major advance in therapy. Intensivists should partner antibiotic stewardship programs to improve patient care. Assembling multidisciplinary teams with trained and dedicated professionals for AMS is a priority.

The impact of Antimicrobial Stewardship Programmes in paediatric emergency departments and primary care: a systematic review.

Antibiotics remain the most prescribed medicine in children worldwide, but half of the prescriptions are unnecessary or inappropriate, leading to an increase in antibiotic resistance. This study aims to systemically review the effects of different Antimicrobial Stewardship Programmes (ASPs) on reducing the rates of both antibiotic prescriptions and changes in antimicrobial resistance, and on the economic impact in paediatric emergency departments (PED) and primary care settings. Embase, MEDLINE, and Cochrane Library were systematically searched, combining Medical Subject Heading and free-text terms for 'children' and 'antimicrobial' and 'stewardship'. The search strategy involved restrictions on dates (from 1 January 2007 to 30 December 2020) but not on language. Randomized controlled trials, controlled and non-controlled before and after studies, controlled and non-controlled interrupted time series, and cohort studies were included for review. The review protocol was registered at the PROSPERO International Prospective Register of Systematic Reviews: Registration Number CRD42021270630. Of the 47,158 articles that remained after removing duplicates, 59 were eligible for inclusion. Most of the studies were published after 2015 (37/59, 62.7%) and in high-income countries (51/59, 86.4%). Almost half of the studies described the implementation of an ASP in the primary care setting (28/59, 47.5%), while 15 manuscripts described the implementation of ASPs in EDs (15/59, 25.4%). More than half of the studies (43/59, 72.9%) described the implementation of multiple interventions, whereas few studies considered the implementation of a single intervention. Antibiotic prescriptions and compliance with guidelines were the most frequent outcomes (47/59, 79.7% and 20/59, 33.9%, respectively). Most of the articles reported an improvement in these outcomes after implementing an ASP. Meanwhile, only very few studies focused on health care costs (6/59, 10.2%) and antimicrobial resistance (3/59 5.1%). The implementation of ASPs has been proven to be feasible and valuable, even in challenging settings such as Emergency Departments and Primary care.

Impact of antimicrobial stewardship program on clinical outcomes in multidrug-resistant Gram-negative bacterial infections at a tertiary care hospital from South India

Background: Increasing bacterial resistance to antimicrobial agents is resulting in high morbidity and mortality. Antimicrobial stewardship (AMS) programs aim at rationale use of antimicrobial agents in clinical settings by development and implementation of antibiotic policy. As the patterns of antimicrobial resistance vary with organism and time, there is a need for periodic surveillance. Aims and Objectives: The aim of the study was to study the impact of AMS program on appropriate use of antimicrobial agents and clinical outcomes in patients with multidrug-resistant Gram-negative bacterial (MDR GNB) infections. Materials and Methods: This is a prospective observational study that included patients diagnosed with multidrug-resistance Gram-negative bacterial infections during June to July 2019. Identification of multidrug-resistant organisms was performed as per clinical and laboratory standards institute guidelines 2016. Information on the use of empirical antibiotic and other antimicrobial agents after culture and sensitivity report were collected and assessed for appropriateness. All the patients were followed up till discharge. Results: From 170 patients, there were 211 specimens sent for culture and sensitivity and 249 pathogens were isolated. The most frequent pathogen isolated was Escherichia coli (42.6%) followed by Klebsiella spp. (22.9%). Isolates were most resistant to cefazolin (86.7%) and ceftriaxone (83.9%), and most sensitive to polymyxin B (100%) and tigecycline (97.2%). All patients were administered antimicrobial agents as per antibiotic policy of the institute and 154 (90.6%) patients have recovered from illness with a mean length of hospital stay of 19.4 ± 6.6 days. Conclusion: Adherence to antimicrobial policy helps in improved outcomes in patients with MDR GNB infections. Hence, the need to implement AMS program in all hospitals.

The impact of pharmacist-led antimicrobial stewardship program on antibiotic use in a county-level tertiary general hospital in China: A retrospective study using difference-in-differences design.

BackgroundInappropriate use of antibiotics has become a major driver for the spread of antimicrobial resistance globally, particularly common in China. Antimicrobial stewardship programs are effective in optimizing antimicrobial use and decreasing the emergence of multi-drug-resistant organisms, and the pharmacist has performed a leading role in this program.ObjectiveTo evaluate the impact of antimicrobial stewardship programs driven by pharmacists on antibiotic consumption and costs and the appropriateness of antibiotic use.MethodsA single-center retrospective quasi-experimental design was conducted in two independent hepatobiliary surgery wards and two independent respiratory wards in a county-level tertiary general hospital in Jiangsu, China. Each intervention group was served with antimicrobial stewardship programs with prescriptions audit and feedback, antibiotics restriction, education, and training. The propensity score matching method was employed to balance confounding variables between the intervention group and control group, and a difference-in-differences analysis was used to evaluate the impact of antimicrobial stewardship programs. The primary outcome was measured by scores of rationality evaluation of antibiotics.ResultsThe DID results demonstrated that the implementation of the antimicrobial stewardship programs was associated with a reduction in the average length of hospital stay (coefficient = −3.234, p = 0.006), DDDs per patient (coefficient = −2.352, p = 0.047), and hospitalization costs (coefficient = −7745.818, p = 0.005) in the hepatobiliary surgery ward, while it was associated with a decrease in DDDs per patient (coefficient = −3.948, p = 0.029), defined daily doses per patient day (coefficient = −0.215, p = 0.048), and antibiotic costs (coefficient = −935.087, p = 0.014) in the respiratory ward. The program was also associated with a decrease in rationality evaluation scores (p < 0.001) in two wards.ConclusionThe result reveals that the implementation of the antimicrobial stewardship programs is effective in reducing the length of hospital stay, decreasing antibiotics consumption and costs, and improving the appropriateness of antimicrobial use such as decreasing irrational use of cephalosporins, reducing combinations, and improving timely conversion. However, great attention ought to be paid to the improper use of broad-spectrum antibiotics. The government is responsible for providing sustainable formal education for pharmacists, and more funding and staff support to promote antimicrobial stewardship programs.

Antibiotic Consumption and Deviation of Prescribed Daily Dose From the Defined Daily Dose in Critical Care Patients: A Point-Prevalence Study.

Background: The consumption of antibiotics is one of the metrics used to evaluate the impact of antimicrobial stewardship programs (ASP). The aim of this study was to determine the prevalence of antibiotic consumption in Brazilian intensive care units (ICUs) and estimate the deviation of the prescribed daily dose (PDD) from the defined daily dose (DDD). Methods: This is a multicenter, observational, point-prevalence study carried out in adult ICUs of 8 Brazilian hospitals from August 2019, to February 2020. We collected data on the patient’s demographic and clinical characteristics, antibiotic therapy, classification and site of infections. The DU90 (antibiotic accounting for 90% of the volume utilized) was calculated, and the antibiotics were classified by the Anatomical Therapeutic Chemical (ATC) Index and the World Health Organization (WHO) Access, Watch, Reserve (AWaRe) groups. For the most prevalent antibiotics, the deviation of PDD from DDD was determined. Results: Three hundred thirty-two patients from 35 ICUs were analyzed. The prevalence of antibiotic use was 52.4%. The patients in use of antibiotics were predominantly over 60 years of age (81.6%) with pulmonary infections (45.8%). A predominance of empirical regimens was observed (62.6%) among antibiotic therapies. The highest frequencies of prescriptions observed were for piperacillin + tazobactam (16.1%), meropenem (13.3%), amoxicillin + clavulanate (7.2%), azithromycin (7.2%), and teicoplanin (6.1%). The watch (64.2%) and reserve (9.6%) categories of the AWaRe classification accounted for 73.8% of all antibiotics, and they were prescribed alone or in combinations. High variability of doses was observed for the most prescribed antibiotics, and large deviations of PDD from the DDD were observed for meropenem, teicoplanin, and tigecycline. Conclusions: The high prevalence of antibiotic prescription was related to a predominance of empirical regimens and antibiotics belonging to the WHO Watch classification. High variability of doses and large deviations of PDD from DDD for meropenem, teicoplanin, and tigecycline was observed, suggesting that DDD may be insufficient to monitor the consumption of these antibiotics in the ICU population. The variability of doses found for the most prescribed antibiotics suggests the need for monitoring and intervention targets for antibiotic stewardship teams.

Performance of infectious diseases specialists, hospitalists, and other internal medicine physicians in antimicrobial case-based scenarios: Potential impact of antimicrobial stewardship programs at 16 Veterans' Affairs medical centers.

As part of a project to implement antimicrobial dashboards at select facilities, we assessed physician attitudes and knowledge regarding antibiotic prescribing. An online survey explored attitudes toward antimicrobial use and assessed respondents' management of four clinical scenarios: cellulitis, community-acquired pneumonia, non-catheter-associated asymptomatic bacteriuria, and catheter-associated asymptomatic bacteriuria. This study was conducted across 16 Veterans' Affairs (VA) medical centers in 2017. Physicians working in inpatient settings specializing in infectious diseases (ID), hospital medicine, and non-ID/hospitalist internal medicine. Scenario responses were scored by assigning +1 for answers most consistent with guidelines, 0 for less guideline-concordant but acceptable answers and -1 for guideline-discordant answers. Scores were normalized to 100% guideline concordant to 100% guideline discordant across all questions within a scenario, and mean scores were calculated across respondents by specialty. Differences in mean score per scenario were tested using analysis of variance (ANOVA). Overall, 139 physicians completed the survey (19 ID physicians, 62 hospitalists, and 58 other internists). Attitudes were similar across the 3 groups. We detected a significant difference in cellulitis scenario scores (concordance: ID physicians, 76%; hospitalists, 58%; other internists, 52%; P = .0087). Scores were numerically but not significantly different across groups for community-acquired pneumonia (concordance: ID physicians, 75%; hospitalists, 60%; other internists, 56%; P = .0914), for non-catheter-associated asymptomatic bacteriuria (concordance: ID physicians, 65%; hospitalists, 55%; other internists, 40%; P = .322), and for catheter-associated asymptomatic bacteriuria (concordance: ID physicians, 27% concordant; hospitalists, 8% discordant; other internists 13% discordant; P = .12). Significant differences in performance regarding management of cellulitis and low overall performance regarding asymptomatic bacteriuria point to these conditions as being potentially high-yield targets for stewardship interventions.

Impact of antimicrobial stewardship programs on antibiotic consumption and antimicrobial resistance in four Colombian healthcare institutions

BackgroundAntimicrobial stewardship programs (ASPs) have become a fundamental pillar in optimizing antimicrobial usage, improving patient care, and reducing antimicrobial resistance (AMR). Herein we evaluated the impact of an ASP on antimicrobial consumption and AMR in Colombia.MethodsWe designed a retrospective observational study and measured trends in antibiotic consumption and AMR before and after the implementation of an ASP using interrupted time series analysis over a 4-year period (24 months before and 24 months after ASP implementation).ResultsASPs were implemented according to the available resources in each of the institutions. Before ASP implementation, there was a trend toward an increase in the antibiotic consumption of all measured antimicrobials selected. Afterward, an overall decrease in antibiotic consumption was observed. The use of ertapenem and meropenem decreased in hospital wards, while a decrease in the use of ceftriaxone, cefepime, piperacillin/tazobactam, meropenem, and vancomycin was observed in intensive care units. After ASP implementation, the trend toward an increase of oxacillin-resistant Staphylococcus aureus, ceftriaxone-resistant Escherichia coli, and meropenem-resistant Pseudomonas aeruginosa was reversed.ConclusionsIn our study, we showed that ASPs are a key strategy in tackling the emerging threat of AMR and have a positive impact on antibiotic consumption and resistance.

Impact of antimicrobial stewardship program on antibiotic resistance and length of hospital stay of patients at Bicol regional training and teaching hospital: A retrospective descriptive study

Impact of antimicrobial stewardship program on antibiotic resistance and length of hospital stay of patients at Bicol regional training and teaching hospital: A retrospective descriptive study

The impact of antimicrobial stewardship program designed to shorten antibiotics use on the incidence of resistant bacterial infections and mortality

Reassessing the continuing need for and choice of antibiotics by using an antibiotic “time out’’ program may reduce unnecessary treatment. This study aimed to explore the effect of an antibiotic stewardship program (ASP) on the antibiotics consumption, incidence of resistant bacterial infections and overall hospital mortality in a tertiary medical center during the study period 2012–2014. An ASP composed of multidisciplinary strategies including pre-prescription approval and post-approval feedback and audit, and a major “time out’’ intervention (shorten the default antibiotic prescription duration) usage was introduced in year 2013. Consumption of antibiotics was quantified by calculating defined daily doses (DDDs). Interrupted time series (ITS) analysis was used to explore the changes of antibiotics consumption before and after intervention, accounting for temporal trends that may be unrelated to intervention. Our results showed that following the intervention, DDDs showed a decreased trend in overall (in particular the major consumed penicillins and cephalosporins), in both intensive care unit (ICU) and non-ICU, and in non-restrictive versus restrictive antibiotics. Importantly, ITS analysis showed a significantly slope change since intervention (slope change p value 0.007), whereas the incidence of carbapenem-resistant and vancomycin-resistant pathogens did not change significantly. Moreover, annual overall mortality rates were 3.0%, 3.1% and 3.1% from 2012 to 2014, respectively. This study indicates that implementing a multi-disciplinary strategy to shorten the default duration of antibiotic prescription can be an effective manner to reduce antibiotic consumption while not compromising resistant infection incidence or mortality rates.

Comparison between antimicrobial stewardship program and intervention by infection control team for managing antibiotic use in neurogenic bladder-related urinary tract infection patients: A retrospective chart audit

BackgroundAntimicrobial prescriptions are relatively common in urologic outpatients. Therefore, it is necessary to investigate the impact of antimicrobial stewardship program (ASP) interventions. MethodsIn urology outpatients, antimicrobial use density (AUD), antimicrobial agent costs, isolation of urinary tract infection (UTI)-causing organisms and their antimicrobial susceptibilities were compared between intervention by infection control team (ICT) era (pre-2014) and ASP era (post-2014) in 2739 patients with lower urinary tract symptoms, including neurogenic bladder patients with UTI or suspected UTI, from 2011 to 2020. ResultsIn the ASP, overall AUD (P<.001), cefotiam (CTM) (P=.0013), 2nd-generation cephalosporins (P=.026), cefdinir (CFDN) (P<.001), levofloxacin (LVFX) (P<.001), sitafloxacin (STFX) (P=.0016), and tosufloxacin (TFLX) (P=.0044) showed a significant decrease, but cefaclor (P=.019) showed a significant increase. Regarding antimicrobial agent costs, overall (P=.016), CTM (P=.021), 2nd-generation cephalosporins (P=.033), CFDN (P=.016), LVFX (P=.016), STFX (P=.033), and TFLX (P=.033) showed a significant decrease in the ASP. UTI-causing antimicrobial susceptibilities, CTM (P=.035), LVFX (P=.026) and sulfamethoxazole/trimethoprim (P=.048) in E. coli, and minocycline (P=.026) in K. pneumoniae showed a significant improve in the ASP. ConclusionASP contributed to decrease AUD and antimicrobial agent costs, and to improve antimicrobial susceptibilities of E. coli and K. pneumoniae to several antibiotics, compared to ICT. Further prospective studies are necessary for definitive conclusions.

SIGNIFICANT REDUCTION IN CARBAPENEM AND FLUOROQUINOLONE USE WITH IMPLEMENTATION OF MULTIFACETED ANTIBIOTIC STEWARDSHIP PROGRAM (ASP) INTERVENTIONS

TOPIC: Critical Care TYPE: Original Investigations PURPOSE: To study the impact of antimicrobial stewardship program (ASP) interventions on carbapenem and fluoroquinolone (FQ) use at our tertiary care center. METHODS: A multifaceted antimicrobial stewardship program (ASP) was implemented in July 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem and FQ use during pre-ASP intervention period (P1: 12/01/2016-6/30/2018) was compared with ASP-intervention period (P2: 07/01/2018-1/31/2020). ASP interventions included: stewardship educational pearls in monthly physician newsletters; educational posters in high-traffic provider areas; suppression of carbapenem results on microbiology susceptibility reports; distributing monthly carbapenem and FQ use data to providers; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; generating pharmacy decision-support software algorithms to aid in identifying intervention opportunities; removing FQ from HAP/VAP ordersets and carbapenems from order-sets where appropriate; default antibiotic stop dates changed to 7 days in EMR (Epic); adverse effects warning fired as an alert when ordering FQ. Additional ASP pharmacist interventions included procalcitonin protocol allowing pharmacists to reorder follow-up procalcitonin and make recommendations to discontinue therapy where appropriate. RESULTS: Carbapenem use declined significantly from a mean of 64.81 days of therapy (DOT) per 1000 patient days during P1 to 8.91 DOT per 1000 patient days in P2 (p< 0.001). FQ use declined from a mean of 133 DOT per 1000 days in P1 to 46 DOT per 1000 patient days (p< 0.0001) during P2. All hospital units showed a significant decrease in carbapenem and FQ use, with intensive care step-down unit noting 85.7% reduction (p< 0.00001) and intensive care units (ICUs, medical and surgical) noting 52% reduction (p< 0.00001) during P2 compared to P1. During P2, 55% of orders for carbapenems and FQ were found to be appropriate compared to only 39% in P1 (p< 0.0001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2. No Carbapenem-Resistant Enterobacteriaceae isolates were identified during the study period. FQ sensitivity remained stable at 81%. Cost savings of $757 per 1000 patient days were recognized during P2 as a result of reduced carbapenem and FQ use. CONCLUSIONS: A significant decline in total carbapenem and FQ utilization with ICUs showing >50% decline, an increase in proportion of appropriate use as well as cost savings were observed as a result of ASP interventions. CLINICAL IMPLICATIONS: According to the CDC, carbapenems and fluoroquinolones should be key targets for stewardship programs and reducing inappropriate antibiotic use is imperative to preventing emergence of multidrug resistance and potentially improving bacterial antimicrobial susceptibility patterns. With our multifaceted ASP interventions, we demonstrated a significant decrease in the utilization of these two classes of broad-spectrum antibiotics, notably in the intensive care step-down unit and the ICUs. We also noted significant increase in appropriate use; improved carbapenem sensitivity profile for Pseudomonas aeruginosa as well as considerable cost savings. DISCLOSURES: No relevant relationships by Sandeep Gupta, source=Web Response No relevant relationships by Ashlesha Kaushik, source=Web Response No relevant relationships by Michael Padomek, source=Web Response No relevant relationships by Corey Thieman, source=Web Response

Impact of Antimicrobial Stewardship Program on Vancomycin Usage: Costs and Outcomes at Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam.

BackgroundNowadays, with the emergence of vancomycin-resistant strains, the clinical use of vancomycin has been followed closely by applying the antimicrobial stewardship program (ASP) to enhance effectiveness in treatment and reduce cost burden for patients.MethodsA descriptive cross-sectional study at the Hospital for Tropical Diseases was conducted to assess the inpatient status assigned to intravenous vancomycin and factors associated with the cost of treatment during two periods of implementing ASP, which were i) from April 1, 2016 to March 31, 2018 (previous ASP-pASP) and ii) from June 1, 2018 to March 31, 2020 (new ASP-nASP).ResultsAmong 1375 patients who met the sampling criteria, there were 601 and 774 patients in pASP and nASP, respectively. The rate of no improvement/mortality in the pASP was higher than that in nASP (37.10% vs 25.98%, p <0.05). The proportion of patients with two or more infection episodes in nASP is lower than that in pASP (9.83% vs 18.64%, p<0.05). Besides, nASP has higher length of therapy (LOT) and higher day of therapy (DOT). The average treatment cost in the pASP is higher than that in the nASP, 1891.22 (95% CI, 1713.46–2068.98) USD vs 1775.55 (95% CI, 1576.22–1974.88) USD. There are seven factors (p<0.05) that associate with the total cost of treatment (age, number of infection episodes, length of stay, discharge status, clinical department, LOT, DOT) in pASP. On the other hand, the nASP has five factors (p<0.001), in which the log(LOT) and age are not as statistically significant (p=0.5127 and 0.3852, respectively) as in the pASP model.ConclusionThe implementation and improvement of the ASP at the Hospital for Tropical Diseases have initially shown benefits for patients using intravenous vancomycin. Specifically, the ASP helps to reduce treatment costs, improve patient outcomes, reduce length of stay and decrease the average daily dose of vancomycin.

Antimicrobial stewardship programs in adult intensive care units in Latin America: Implementation, assessments, and impact on outcomes.

To assess the impact of antimicrobial stewardship programs (ASPs) in adult medical-surgical intensive care units (MS-ICUs) in Latin America. Quasi-experimental prospective with continuous time series. The study included 77 MS-ICUs in 9 Latin American countries. Adult patients admitted to an MS-ICU for at least 24 hours were included in the study. This multicenter study was conducted over 12 months. To evaluate the ASPs, representatives from all MS-ICUs performed a self-assessment survey (0-100 scale) at the beginning and end of the study. The impact of each ASP was evaluated monthly using the following measures: antimicrobial consumption, appropriateness of antimicrobial treatments, crude mortality, and multidrug-resistant microorganisms in healthcare-associated infections (MDRO-HAIs). Using final stewardship program quality self-assessment scores, MS-ICUs were stratified and compared among 3 groups: ≤25th percentile, >25th to <75th percentile, and ≥75th percentile. In total, 77 MS-ICU from 9 Latin American countries completed the study. Twenty MS-ICUs reached at least the 75th percentile at the end of the study in comparison with the same number who remain within the 25th percentile (score, 76.1 ± 7.5 vs 28.0 ± 7.3; P < .0001). Several indicators performed better in the MS-ICUs in the 75th versus 25th percentiles: antimicrobial consumption (143.4 vs 159.4 DDD per 100 patient days; P < .0001), adherence to clinical guidelines (92.5% vs 59.3%; P < .0001), validation of prescription by pharmacist (72.0% vs 58.0%; P < .0001), crude mortality (15.9% vs 17.7%; P < .0001), and MDRO-HAIs (9.45 vs 10.96 cases per 1,000 patient days; P = .004). MS-ICUs with more comprehensive ASPs showed significant improvement in antimicrobial utilization.