Impact Of Stewardship Research Articles

Influence of Antibiotic Exposure Intensity on the Risk of Clostridioides difficile Infection.

Antibiotics are a strong risk factor for Clostridioides difficile infection (CDI), and CDI incidence is often measured as an important outcome metric for antimicrobial stewardship interventions aiming to reduce antibiotic use. However, risk of CDI from antibiotics varies by agent and dependent on the intensity (i.e., spectrum and duration) of antibiotic therapy. Thus, the impact of stewardship interventions on CDI incidence is variable, and understanding this risk requires a more granular measure of intensity of therapy than traditionally used measures like days of therapy (DOT). We performed a retrospective cohort study to measure the independent association between intensity of antibiotic therapy, as measured by the antibiotic spectrum index (ASI), and hospital-associated CDI (HA-CDI) at a large academic medical center between January 2018 and March 2020. We constructed a marginal Poisson regression model to generate adjusted relative risks for a unit increase in ASI per antibiotic day. We included 35,457 inpatient encounters in our cohort. Sixty-eight percent of patients received at least one antibiotic. We identified 128 HA-CDI cases, which corresponds to an incidence rate of 4.1 cases per 10,000 patient-days. After adjusting for known confounders, each additional unit increase in ASI per antibiotic day is associated with 1.09 times the risk of HA-CDI (Relative Risk = 1.09, 95% Confidence Interval: 1.06 to 1.13). ASI was strongly associated with HA-CDI and could be a useful tool in evaluating the impact of antibiotic stewardship on HA-CDI rates, providing more granular information than the more commonly used days of therapy.

A stewardship perspective in family firms: A new perspective for altruism and social capital

This research aims to investigate the impact of stewardship in family firms compared to non-family firms. Family firms are typically the dominant business in many countries, yet, the nature, structure, and management can lead to unique behavioural variations compared to non-family firms. This study empirically tests a sample of 316 firms (163 family firms and 153 non-family firms) in Iran. The findings empirically support that stewardship is significantly higher in family firms, and highlights stewardship capabilities as a unique competitive advantage. In this way, the study makes an essential contribution to both theory and practice. For theory, the study has added weight to the importance of the stewardship theory for family businesses. For practice, the study highlights how encouraging and developing stewardship capabilities in family firms offers a unique strategic competitive advantage.

149. Impact of Stewardship on Antibiotic Utilization Rates During the COVID-19 Pandemic: Successes and Challenges in a Regional Hospital

BackgroundAntibiotic stewardship (AS) is at the core of patient safety and prevention of antimicrobial resistance. Healthcare providers prescribe antibiotics for COVID-19 despite low rates of bacterial co-infection. Our regional hospital had antibiotic utilization (AU) rates higher than other health systems even prior to the emergence of SARS-Cov2. We analyzed the effect AS on AU during the pandemic.Total Antibiotic Utilization Rates Before and During COVID-19 Pandemic MethodsTotal and specific AU rates were benchmarked using BD MedMined’s medication analytics system from 2nd quarter 2019 to 1st quarter 2021. The AS team released yearly antibiogram and individual prescriber’s AU rates and performed weekly, and as needed, review of antibiotic ordering and feedback. To assist in appropriate prescribing decisions, remote educational sessions or mini-lectures and local antibiotic guidelines were developed during the pandemic period. AU rates were monitored quarterly to determine the effects of the AS interventions to prescribing practices.ResultsTotal and specific AU rates were higher (up to 34% and 80%, respectively) in our index hospital compared to other non-teaching hospitals nationally prior to the pandemic. Total antibiotic utilization increased by only 5.5% in the 2nd quarter 2020, peak of AU during the pandemic. Total, vancomycin, piperacillin-tazobactam and quinolone utilization rates decreased by 19%, 41%, 38%, and 52%, respectively, at 1st quarter 2021 compared to 4th quarter 2019. Steeper decreases were noted with implementation of educational activities. Ceftriaxone use remained high and was 50% greater than comparator hospitals at 1st quarter 2021.ConclusionAlthough problematic during the COVID-19 pandemic, AS can have significant impact on provider prescribing practices and decrease total and specific antibiotic utilization rates. The use of ceftriaxone, an antibiotic commonly used for empiric bacterial coverage for community acquired pneumonia, presents as a continuing challenge.Disclosures All Authors: No reported disclosures

The Impact of Social Role Identity on Communication in Hospital-Based Antimicrobial Stewardship

Background: Evidence-based hospital antimicrobial stewardship interventions, such as postprescription review with feedback, prior authorization, and handshake stewardship, involve communication between stewards and frontline prescribers. Hierarchy, asymmetric responsibility, prescribing etiquette, and autonomy can obstruct high-quality communication in stewardship. Little is known about the strategies that stewards use to overcome these barriers. The objective of this study was to identify how stewards navigate communication challenges when interacting with prescribers. Methods: We conducted semistructured interviews with antimicrobial stewards recruited from hospitals across the United States. Interviews were audio recorded, transcribed, and analyzed using a flexible coding approach and the framework method. Social identity theory and role theory were used to interpret framework matrices. Results: Interviews were conducted with 58 antimicrobial stewards (25 physicians and 33 pharmacists) from 10 hospitals (4 academic medical centers, 4 community hospitals, and 2 children’s hospitals). Respondents who felt empowered in their interactions with prescribers explicitly adopted a social identity that conceptualized stewards and prescribers as being on the “same team” with shared goals (in-group orientation). Drawing on the meaning conferred via this social role identity, respondents engaged in communication strategies to build and maintain common bonds with prescribers. These strategies included moderating language to minimize defensive recommendations when delivering stewardship recommendations, aligning the goals of stewardship with the goals of the clinical team, communicating with prescribers about things other than stewardship, compromising for the sake of future interactions, and engaging in strategic face-to-face interaction. Respondents who felt less empowered in their interactions thought of themselves as outsiders to the clinical team and experienced a heightened sense of “us versus them” mentality with the perception that stewards primarily serve a gate-keeping function (ie, outgroup orientation). These respondents expressed deference to hierarchy, a reluctance to engage in face-to-face interaction, a feeling of cynicism about the impact of stewardship, and a sense of low professional accomplishment within the role. Respondents who exhibited an in-group orientation were more likely than those who did not to describe the positive impact of stewardship mentors or colleagues on their social role identity. Conclusions: The way antimicrobial stewards perceive their role and identity within the social context of their healthcare organization influences how they approach communication with prescribers. Social role identity in stewardship is shaped by the influence of mentors and colleagues, indicating the importance of supportive relationships for the development of steward skill and confidence.Funding: NoDisclosures: None

The Impact of Antimicrobial Stewardship Program on Injudicious Use of Cefuroxime.

Antimicrobial stewardship (AMS) program promotes the judicious use of antimicrobials. Hence, this study was conducted to analyze the impact of stewardship on the prescribing pattern of cefuroxime injection among the surgeons as perioperative antimicrobial prophylaxis (PAP). This study was conducted retrospectively in Malaysia. Various outcomes were measured including cefuroxime usage, compliance with the guidelines, surgical site infections, and cost savings. A total of 1,601 patients were recruited in the study. In terms of usage, the total defined daily dose (DDD) prior to the intervention was 202 DDD/100 procedures compared to that after intervention which was 144 DDD/100 procedures (p < 0.05). On the other hand, the excessively long administration of PAP dropped from 94.4 to 30.3% (p < 0.001). Focusing on the compliance with the newly developed local guidelines, it has increased from 53 to 94.3% after the interventions were made (p < 0.001), whereas the rate of surgical site infections was reduced from 17.0 to 9.0%. The cost of antibiotic being used has significantly reduced after the study intervention (p = 0.007). The quality of PAP directly impacts the antimicrobial usage, the surgical site infections, and the total cost involved. Thus, it is crucial to maintain the standard of PAP at all times in healthcare settings.

Public Governance in the Public Sector: Literature review

The study aims to investigate the impact of public governance on the implementation of the National Audit Office’s recommendations in the Kingdom of Bahrain. It measures the impact of public governance on reducing the total violation of government entities. The study finds that there is a significant impact of stewardship and rule of law principle on reducing the total violations. The study comes out with important recommendations to the executive bodies concerned with addressing the deficiencies in the governmental system and raising the level of public governance to assist in implementing the auditors’ recommendations and avoid violations.

Reduced Incidence of Carbapenem-Resistant Klebsiella pneumoniae Infections in Cardiac Surgery Patients after Implementation of an Antimicrobial Stewardship Project.

Infections due to carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are associated with increased mortality in cardiac surgery patients. In this short communication, we report on the changes in the incidence of CR-Kp colonization and CR-Kp infection in cardiac surgery patients from 2014 to 2018 in a teaching hospital in Italy, after the implementation of an antimicrobial stewardship project in 2014. During the study period, 2261 patients underwent open-heart surgery. Of them, 130 were found to be colonized by CR-Kp (5.7%) and 52 developed a postoperative CR-Kp infection (2.3%). The crude in-hospital mortality in patients with CR-Kp infections was 48% (25/52). The incidences of both CR-Kp colonization (incidence rate ratio (IRR) 0.82, 95% confidence intervals (CI) 0.78–0.86, p < 0.001) and CR-Kp infection (IRR 0.76, 95% CI 0.69–0.83, p < 0.001) considerably decreased over the study period. This encouraging result should prompt further concerted efforts, directed towards retaining the positive impact of stewardship and infection-control interventions on CR-Kp-related morbidity in the long term.

2111. Changing the Culture: A Quasi-Experimental Study Assessing the Burden of Urine Cultures and the Impact of Stewardship of Testing in an Urban Community Hospital

BackgroundIndwelling urinary catheters (IUC) may cause inflammation and colonization, decreasing the diagnostic yield of urinalysis and urine cultures (UC). Indiscriminate testing can lead to misinterpretation of positive results as a catheter associated urinary tract infection (CAUTI), increasing antibiotic use and CAUTI rates. We studied the burden of UC and implemented a UC stewardship initiative (UCSI) as part of a comprehensive CAUTI reduction program.MethodsA retrospective review of cases with IUC and positive UC in 2014 was performed. UCSI was implemented in March 2017 (Figure 1). Nursing staff were instructed to contact the infectious diseases physician when UC from IUC were ordered. Cases were reviewed and, if no UC indication based on IDSA guidelines was met, cultures were discontinued after conferring with ordering physician. Twelve months pre- and post-intervention data were collected; including case description, catheter days, UC ordered, alternative cause of fever, and recommendations.ResultsThe pre-USCI cohort had 23 UC in 19 cases. One UC (4%) met indication (Figure 2). Three (16%) met NHSN criteria for CAUTI and did not meet UC indication. The USCI cohort had 21 UC orders in 13 cases. Most UC did not meet indication and were cancelled (90%, 19/21). Alternative causes for fever were found in all cases with cancelled UC orders (19/19), including pneumonitis, pneumonia, pancreatitis and tuberculosis. Antimicrobials were used in 53% (7/13). UC orders per hospitalization ranged 1–4 (average 1.7). IUC days ranged from 3 to 18 days (average 8). In both cohorts, UC with indication (3) did not meet NHSN criteria for CAUTI and did not receive antimicrobials.Figure 1.UCSI Implementation.Figure 2.Characteristics of cohorts pre and post-USCI.ConclusionPatients with IUC frequently underwent UC without evidence-based indications. This may lead clinicians down the wrong diagnostic path and contribute to antimicrobial use. Critically ill patients with inflammatory conditions are at high risk of UC testing. USCI is a cost-effective intervention that reduced indiscriminate testing, antibiotic use and CAUTIs. USCI can play an important role in CAUTI prevention strategies and antibiotic stewardship programs.Disclosures All authors: No reported disclosures.

Impact of Stewardship on Inhaled Nitric Oxide Utilization in a Neonatal ICU.

Inhaled nitric oxide (iNO) remains the "gold standard" therapy for hypoxemic respiratory failure in newborns. Despite good quality evidence to guide iNO use in this population, we observed considerable practice variation, particularly in timing and rate of weaning. To promote evidence-based practice, we launched an iNO stewardship program in April 2013. Our objective was to determine whether iNO stewardship led to changes in iNO utilization and weaning. We conducted a quality improvement project in an outborn quaternary NICU, targeting improved iNO guideline compliance. We compared patterns of iNO utilization between 2 cohorts: prestewardship (April 2011-March 2013; retrospective data collection) and poststewardship (April 2013-March 2015; prospective data collection). Eighty-seven neonates received 88 courses of iNO in the 2 years prestewardship, and 64 neonates received 64 courses of iNO in the 2 years poststewardship. There were no significant differences (P > .05) in patient demographics, in the proportion of patients receiving iNO "off-label," in proportion initiated at the referring hospital, or in outcomes (death or extracorporeal membrane oxygenation). There were significant (P < .05) reductions in median total hours on iNO per patient (47 vs 20; P < .001), in iNO hours per patient from maximum dose to initial wean (28 vs 9; P < .01), and in hours from initial wean to discontinuation (14 vs 8; P < .05). The introduction of iNO stewardship was associated with improved adherence to evidence-based guidelines and an overall reduction in total and per-patient iNO use.

Sweat the Small Stuff: Understanding the Essence and Impact of Stewardship in Kinesiology

ABSTRACTWhat is thought of when hearing the word stewardship? Many people would need clarification for what this term means and in what context it is being applied. How is stewardship perceived in relation to kinesiology? The content of this lecture will be contextualized with the author’s story. The stewardship of Delphine Hanna will be reviewed, as well as that of a few of the 2016 National Association of Kinesiology in Higher Education Conference attendees. The author will attempt to impart that the power of good stewardship lies in the small stuff of what people do in their lives. More specifically, good stewardship begins with establishing honest relationships with those whom one is to be a steward. Attempts toward stewardship are incomplete unless there is commitment to recognizing the importance of those entrusted to a steward’s care. Stewardship in relation to the role of an administrator will be reviewed, as well as the role of faculty and the members of the National Association of Kinesiology in Higher Education.

The Impact of Stewardship on Antimicrobial Use and Resistance Rates at a Veterans Affairs Medical Center

The Impact of Stewardship on Antimicrobial Use and Resistance Rates at a Veterans Affairs Medical Center

Can public relations improve the workplace? Measuring the impact of stewardship on the employer-employee relationship

Purpose – The purpose of this paper is to use relationship management theory to measure the impact of relationship cultivation on the employer-employee relationship. Specifically, the paper examines how well Kelly's (2001) conceptualization of stewardship can impact internal stakeholders. Design/methodology/approach – Through intercept surveys of 421 adults, the paper used existing scales to measure dimensions of the employer-employee relationship and the participants’ perceptions of stewardship in the workplace. Findings – This study found that the four dimensions of stewardship significantly impact feelings of trust, commitment, satisfaction, and balanced power between the employer and the employee. Additionally, increased use of stewardship resulted in increased involvement by employees. Practical implications – The results of the paper offer several specific suggestions employers can do to communicate more effectively with their employees so that they are not only more informed but also feel more positively about the relationship they have with the employer. Originality/value – Original stewardship scales were developed for the paper so that they can be tested in domains outside the nonprofit sector, where they have been routinely tested with donors and volunteers.

The Role of Antimicrobial Stewardship in Curbing Carbapenem Resistance

Antimicrobial resistance is a continuing, growing, worldwide iatrogenic complication of modern medical care. Carbapenem resistance among certain pathogens poses a significant challenge. In order to reduce the spread of these nearly untreatable pathogens, preventative efforts should be directed at reducing patient-to-patient transmission and preventing the emergence of resistance among susceptible strains. One theoretical intervention to reduce the emergence of resistance is establishing and strictly adhering to an antimicrobial stewardship program. However, data pertaining to the direct effect of stewardship in curtailing carbapenem resistance among epidemiologically significant organisms are scarce. In this report, we review the potential biases associated with data interpretation in this research field, and we review the data pertaining to the impact of stewardship in curbing carbapenem resistance in three significant groups of pathogens: Pseudomonas aeruginosa, Enterobacteriaceae and Acinetobacter baumannii.