Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update

Manning, Mary Lou; Septimus, Edward; Ashley, Elizabeth S. Dodds; Cosgrove, Sara E.; Fakih, Mohamad G.; Schweon, Steven J.; Myers, Frank Edward; Moody, Julia

doi:10.1017/ice.2018.33

Cited by 24 publications

(11 citation statements)

References 28 publications

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“…We assume that both, infection control and antibiotic stewardship measures together had an impact on the observed reduction in incidence of neonatal VAP and antibiotic use: antimicrobial stewardship measures by increasing awareness toward antibiotic therapy, and infection control measures by reducing VAP episodes and thus antibiotic therapy. A position paper published by the Association for Professionals in Infection Control and Epidemiology (APIC), the Society for Healthcare Epidemiology of America (SHEA), and the Society of Infectious Disease Pharmacists (SIDP) stated the importance of joining antimicrobial stewardship and infection control measures, as implementation of a combination of both is more effective than one measure by itself ( 10 ).…”

Section: Discussionmentioning

confidence: 99%

“…Reported frequency of neonatal VAP show a large range (2.7–10.9 cases per 1,000 ventilator days) in developed countries ( 3 ). VAP incidence can be reduced by infection control measures such as VAP-prevention-bundles ( 8 – 10 ). Epidemiologic studies demonstrated that quality improvement initiatives, not the introduction of new therapies or research approaches, resulted in a decline of mortality of neonates in the last decade ( 11 ).…”

Section: Background and Aimsmentioning

confidence: 99%

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Neonatal Ventilator Associated Pneumonia: A Quality Improvement Initiative Focusing on Antimicrobial Stewardship

et al. 2018

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Background and Aims: Neonatal ventilator associated pneumonia (VAP) is a common nosocomial infection and a frequent reason for empirical antibiotic therapy in NICUs. Nonetheless, there is no international consensus regarding diagnostic criteria and management. In a first step, we analyzed the used diagnostic criteria, risk factors and therapeutic management of neonatal VAP by a literature review. In a second step, we aimed to compare suspected vs. confirmed neonatal VAP episodes in our unit according to different published criteria and to analyze interrater-reliability of chest x-rays. Additionally, we aimed to evaluate the development of VAP incidence and antibiotic use after implementation of multifaceted quality improvement changes regarding antimicrobial stewardship and infection control (VAP-prevention-bundle, early-extubation policy, antimicrobial stewardship rounds).Methods: Neonates until 44 weeks of gestation with suspected VAP, hospitalized at our level-III NICU in Lucerne from September 2014 to December 2017 were enrolled. VAP episodes were analyzed according to 4 diagnostic frameworks. Agreement regarding chest x-ray interpretation done by 10 senior physicians was assessed. Annual incidence of suspected and confirmed neonatal VAP episodes and antibiotic days were calculated and compared for the years 2015, 2016, and 2017.Results: 17 studies were identified in our literature review. Overall, CDC-guidelines or similar criteria, requesting radiographic changes as main criteria, are mostly used. Comparison of suspected vs. confirmed neonatal VAP episodes showed a great variance (20.4 vs. 4.5/1,000 ventilator-days). The interrater-reliability of x-ray interpretation was poor (intra-class correlation 0.25). Implemented changes resulted in a gradual decline in annual VAP incidence and antibiotic days from 2015 compared with 2017 (28.8 vs. 7.4 suspected episodes/1,000 ventilator-days, 5.5 vs. 0 confirmed episodes/1,000 ventilator-days and 211 vs. 34.7 antibiotic days/1,000 ventilation-days, respectively).Conclusion: The incidence of suspected VAP and concomitant antibiotic use is much higher than for confirmed VAP, therefore inclusion of suspected episodes should be considered for accurate evaluation. There is a high diagnostic inconsistency and a low reliability of interpretation of chest x-rays regarding VAP. Implementation of combined antimicrobial stewardship and infection control measures may lead to an effective decrease in VAP incidence and antibiotic use.

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Section: Discussionmentioning

confidence: 99%

Section: Background and Aimsmentioning

confidence: 99%

Neonatal Ventilator Associated Pneumonia: A Quality Improvement Initiative Focusing on Antimicrobial Stewardship

et al. 2018

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“…169,171 Benchmarking rates of CDI across multiple hospitals, identification of the causes of inter-hospital variability in rates and the best strategies to reduce rates seem to be important areas of outcomes research in stewardship. 172 Intuitively, the strong association between antibiotic use and CDI makes it appealing to use CDI rates as a measure of the effectiveness of antimicrobial stewardship interventions. However, as outlined in the aforementioned sections of this guidance document, there are a number of potential pitfalls that must be considered prior to utilising CDI rates as a measure of ASP.…”

Section: Managing Clostridioides Difficile Infection In An Outbreak Settingmentioning

confidence: 99%

South African Society of Clinical Microbiology Clostridioides difficile infection diagnosis, management and infection prevention and control guideline

Nana

Moore²,

Boyles

et al. 2020

Southern African Journal of Infectious Diseases

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Clostridioides difficile infection (CDI) is a problem in both developed and developing countries and is a common hospital-acquired infection. This guideline provides evidence-based practical recommendations for South Africa and other developing countries. The scope of the guideline includes CDI diagnostic approaches; adult, paediatric and special populations treatment options; and surveillance and infection prevention and control recommendations.

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“…Three articles from the SHEA address the necessary infrastructures, skills, and competencies that are helpful for someone to be an effective leader in healthcare epidemiology 34– 36 . There is increased appreciation for synergies between infection prevention and antimicrobial stewardship 37 . The Veterans Affairs system is building an implementation science infrastructure for infection prevention 38 , and that is a step in the right direction.…”

Section: Leadership In Healthcare Epidemiologymentioning

confidence: 99%

Recent advances in understanding the epidemiology of healthcare-associated infections

Sreeramoju

2019

F1000Res

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Antimicrobial Stewardship and Infection Prevention—Leveraging the Synergy: A Position Paper Update

Cited by 24 publications

References 28 publications

Neonatal Ventilator Associated Pneumonia: A Quality Improvement Initiative Focusing on Antimicrobial Stewardship

Neonatal Ventilator Associated Pneumonia: A Quality Improvement Initiative Focusing on Antimicrobial Stewardship

South African Society of Clinical Microbiology Clostridioides difficile infection diagnosis, management and infection prevention and control guideline

Recent advances in understanding the epidemiology of healthcare-associated infections

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