A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections

May, Larissa; Nguyen, Megan; Trajano, Renee; Tancredi, Daniel J.; Aliyev, Elmar R.; Mooso, Benjamin A.; Anderson, Chance; Ondak, Susan; Yang, Nuen Tsang; Cohen, Stuart H.; Wiedeman, Jean A.; Miller, Loren G.

doi:10.1016/j.ajem.2020.10.017

Cited by 8 publications

(11 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The included studies have been classified into four groups: 13 articles involved IP settings without a pharmacist as a part of an AMS-MDT intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], 19 were carried out in IP settings with the inclusion of a pharmacist as a part of the intervention team [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], eight articles engaged OP without a pharmacist [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], while eight involved OP settings with a pharmacist [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Forty-one articles were from d...…”

Section: Resultsmentioning

confidence: 99%

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

Antimicrobial stewardship interventions are targeted efforts by healthcare organizations to optimize antimicrobial use in clinical practice. The study aimed to explore effective interventions in improving antimicrobial use in hospitals. Literature was systemically searched for interventional studies through PubMed, CINAHL, and Scopus databases that were published in the period between January 2010 to April 2022. A random-effects model was used to pool and evaluate data from eligible studies that reported antimicrobial stewardship (AMS) interventions in outpatient and inpatient settings. Pooled estimates presented as proportions and standardized mean differences. Forty-eight articles were included in this review: 32 in inpatient and 16 in outpatient settings. Seventeen interventions have been identified, and eight outcomes have been targeted. AMS interventions improved clinical, microbiological, and cost outcomes in most studies. When comparing non-intervention with intervention groups using meta-analysis, there was an insignificant reduction in length of stay (MD: −0.99; 95% CI: −2.38, 0.39) and a significant reduction in antibiotics’ days of therapy (MD: −2.73; 95% CI: −3.92, −1.54). There were noticeable reductions in readmissions, mortality rates, and antibiotic prescriptions post antimicrobial stewardship multi-disciplinary team (AMS-MDT) interventions. Studies that involved a pharmacist as part of the AMS-MDT showed more significant improvement in measured outcomes than the studies that did not involve a pharmacist.

show abstract

Section: Resultsmentioning

confidence: 99%

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

et al. 2022

View full text Add to dashboard Cite

show abstract

“…The emergency setting is imperative for efforts in antimicrobial stewardship due to the high frequency of infectious presentations and acute outpatient referrals [ 36 ]. Recent literature exploring the use of ASPs in the emergency setting have shown promise in promoting appropriate prescription of antibiotics [ 37 , 38 , 39 ]. Savoldi et al, associated a reduction in antibiotic costs and usage with the implementation of a general ED-based ASP [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

“…Further, patient outcomes were also improved with an overall reduction in patient length of stay and reduced rates of Clostridioides difficile infection in patients admitted from ED [ 38 ]. May et al, assessed the effectiveness of a multifaceted ASP for ED patients with skin and soft tissue infections (SSTI) [ 39 ]. This study found only a modest improvement in appropriate antibiotic use, with a decrease in the duration of antibiotic therapies [ 39 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

2021

View full text Add to dashboard Cite

Antimicrobial resistance occurs due to the propensity of microbial pathogens to develop resistance to antibiotics over time. Antimicrobial stewardship programs (ASPs) have been developed in response to this growing crisis, to limit unnecessary antibiotic prescription through initiatives such as education-based seminars, prescribing guidelines, and rapid respiratory pathogen (RRP) testing. Paediatric patients who present to the emergency setting with respiratory symptoms are a particularly high-risk population susceptible to inappropriate antibiotic prescribing behaviours and are therefore an ideal cohort for focused ASPs. The purpose of this systematic review was to assess the efficacy and safety of ASPs in this clinical context. A systematic search of PubMed, Medline, EMBASE and the Cochrane Database of Systematic Reviews was conducted to review the current evidence. Thirteen studies were included in the review and these studies assessed a range of stewardship interventions and outcome measures. Overall, ASPs reduced the rates of antibiotic prescription, increased the prescription of narrow-spectrum antibiotics, and shortened the duration of antibiotic therapy. Multimodal interventions that were education-based and those that used RRP testing were found to be the most effective. Whilst we found strong evidence that ASPs are effective in reducing antibiotic prescribing, further studies are required to assess whether they translate to equivalent clinical outcomes.

show abstract

“…Other individual studies conducted more recently continue to support the effectiveness of multi-faceted approaches, with one Spanish study working with primary care physicians demonstrating an overall reduction in antibiotic prescribing of 4.2% and a 9.0% decrease in the ratio of broad- versus narrow-spectrum agents attributable to the combined intervention of an hour-long educational outreach paired with an online course and clinical decision support system [ 24 ]. Another nonrandomized controlled trial conducted in academic emergency departments in the United States found an improvement in the guideline-adherent treatment of skin and soft tissue infections (SSTI) of 10% and a reduction in antibiotic duration of 26% for sites subject to a multi-faceted intervention consisting of SSTI guideline education with testing, implementation of a clinical treatment algorithm and electronic order set, and clinician audit and feedback [ 25 ].…”

Section: Stewardship Foundationsmentioning

confidence: 99%

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

2022

View full text Add to dashboard Cite

Inappropriate antibiotic use and associated consequences, including pathogen resistance and Clostridioides difficile infection, continue to serve as significant threats in the United States, with increasing incidence in the community setting. While much attention has been granted towards antimicrobial stewardship in acute care settings, the transition to the outpatient setting represents a significant yet overlooked area to target optimized antimicrobial utilization. In this article, we highlight notable areas for improved practices and present an interventional approach to stewardship tactics with a framework of disease, drug, dose, and duration. In doing so, we review current evidence regarding stewardship strategies at transitional settings, including diagnostic guidance, technological clinical support, and behavioral and educational approaches for both providers and patients.

show abstract

A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections

Cited by 8 publications

References 21 publications

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

Paediatric Antimicrobial Stewardship for Respiratory Infections in the Emergency Setting: A Systematic Review

Antimicrobial Stewardship at Transitions of Care to Outpatient Settings: Synopsis and Strategies

Contact Info

Product

Resources

About