Antimicrobial stewardship: we know it works; time to make sure it is in place everywhere

Plachouras, Diamantis; Hopkins, Susan

doi:10.1002/14651858.ed000119

Cited by 20 publications

(15 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Political commitment and adequate funding were identified as essential prerequisites for improvement in a Cochrane review of antimicrobial stewardship interventions [19]. This observation was in accordance with the expressed views of the MCMOs in our study.…”

Section: Prerequisites For Quality Improvementsupporting

confidence: 90%

Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study

Høye

Brænd

Spehar

2020

Scandinavian Journal of Primary Health Care

View full text Add to dashboard Cite

Aims: This study aimed to explore the conditions for the Municipal Chief Medical Officers' (MCMOs) involvement in quality improvement in general practice, specifically concerning antibiotic prescribing practices. Methods: This qualitative study consisted of semi-structured in-depth telephone interviews and group interviews with MCMOs (n ¼ 12). The interview guide aimed to explore the MCMOs' views on their role and responsibilities regarding the quality of care in general practice. The data were analysed using systematic text condensation. Results: Three main themes were identified: 1) the relationship between the municipality and the general practitioner (GP), with the MCMO acting as an intermediary, 2) influencing the GPs' work and 3) antibiotic use and infection control. The MCMOs perceived themselves as liaisons between the municipalities and the GPs. They emphasized building trust, showing respect and sharing common values in their interactions with the GPs, upholding the GPs' professional autonomy. Working for quality improvement was considered a priority; however, MCMOs expressed a need for external support to establish a permanent quality improvement framework. The informants were positive about engaging in improving antibiotic prescribing practices because this combined the municipality's responsibilities for quality improvement and communicable disease control. Conclusions: The MCMOs considered themselves as well-suited agents for quality improvement in general practice, as liaisons between the municipalities and the GPs. Quality improvement in general practice would benefit from a clearer structure in terms of the MCMOs' roles and responsibilities. Within communicable diseases control, the MCMOs have a clear mandate, which places antimicrobial stewardship initiatives in a favourable position amongst other areas of quality improvement.

show abstract

Section: Prerequisites For Quality Improvementsupporting

confidence: 90%

Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study

Høye

Brænd

Spehar

2020

Scandinavian Journal of Primary Health Care

View full text Add to dashboard Cite

show abstract

“…It should be noted, however, that although PHD is largely representative of the US hospitals, the southern portion of the country is overrepresented in the database 13 . This may have an impact on the generalizability of our results to the entire US population, as the frequency with which physicians prescribe antibiotics vary greatly from state to state, with southern states showing increased prescription trends 15 . Another limitation of the dataset is the lack of sufficient data regarding patient treatment effectiveness.…”

Section: Discussionmentioning

confidence: 99%

Impact of Incremental Delays in Appropriate Therapy on the Outcomes of Hospitalized Adult Patients with Gram‐negative Bloodstream Infections: “Every day matters”

Lodise

Kanakamedala²,

Hsu³

et al. 2020

Pharmacotherapy

View full text Add to dashboard Cite

Background Serious bloodstream infections (BSIs) are often caused by Gram‐negative (GN) bacteria in hospitalized patients. Treatment of these infections has been further complicated by the continued rise and spread of drug‐resistant pathogens, including carbapenem resistant (CR) strains of Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Methods This retrospective cohort analysis used real‐world data from a large United States hospital‐based database to examine the association between key clinical outcomes and different lengths of time to appropriate treatment between October 2010 and September 2015. Results Of 40,549 patients with GN‐BSIs who were identified, 1117 (2.8%) had a CR GN‐BSI. Overall, outcomes of hospitalized adult patients with GN‐BSIs incrementally worsened the longer appropriate therapy was delayed. Patients with CR GN‐BSIs had a median infection‐associated length of stay (LOS) of 8, 9, 10, and 13 days, whereas patients with CS GN‐BSIs had a median infection‐associated LOS of 6, 7, 8, and 11 days for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Among patients with CR GN‐BSIs, the percentage of patients discharged home was 38%, 33%, 35%, and 31%, whereas in patients with CS GN‐BSIs, the percentage of patients discharged home was 58%, 53%, 48%, and 43% for patients with days to appropriate therapy of 0, 1–2, 3–4, and ≥ 5 days, respectively. Conclusion The findings from this study highlight the clear need to deliver appropriate therapy more expeditiously in patients with CS and CR GN‐BSIs.

show abstract

“…17,18 We know ASP works but we also know that changing behavior remains a challenge. 19,20,21 Regarding all guidelines, meta-analyses, the international literature and the results of this retrospective observational study we can reason that a change of antimicrobial choice from Cefuroxime to Cefazolin as a perioperative antibiotic prophylaxis in cardiac surgery might not increase the rates of overall wound infections, including deep sternal wound infections as well as leg infections.…”

Section: Discussionmentioning

confidence: 90%

Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

Surat¹,

Bernsen²,

Schimmer³

2020

Preprint

View full text Add to dashboard Cite

Objectives:The goal of this study was to evaluate the impact on a protocol change of surgical antimicrobial prophylaxis in cardiac surgery comparing the new in hospital prophylactic agent cefazolin versus the former standard antibiotic cefuroxime, initiated by the antimicrobial stewardship team. Methods: This retrospective observational study was performed in a tertiary care hospital in collaboration with the department of cardiothoracic surgery and the antimicrobial stewardship team following a new recommendation of the surgical antimicrobial prophylaxis and included 1029 patients who underwent cardiac surgery. Two patient groups including 582 patients receiving Cefuroxime and 447 patients receiving Cefazolin respectively were compared without altering any other preventative perioperative measures. Adherence, overall infection rates, leg wound infections and deep sternal wound infections were compiled and analysed as well as a broad profile of preoperative, intraoperative and postoperative patient data. Results:A complete adherence on the change of the agent was achieved.Overall surgical site infections occurred in 37 (6.6%) of the cases, with 20 (3,4%) SSI in cefuroxime patients and 17 (3,8%) in cefazolin patients (p-value=0,754). No statistically significant differences could be found in any of the primary and secondary endpoints including DSWI (2,1% for cefuroxime, 1,3% for cefazolin), vein harvesting site infections (1,2% for cefuroxime, 2,2% for cefazolin) as well as urinary tract infections, pneumonia, sepsis and overall mortality of all causes. Conclusions:These results demonstrate that compliance to antimicrobial stewardship standards is not associated with more surgical site infections.

show abstract

Antimicrobial stewardship: we know it works; time to make sure it is in place everywhere

Cited by 20 publications

References 10 publications

Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study

Quality improvement and antimicrobial stewardship in general practice – the role of the municipality chief medical officer. A qualitative study

Impact of Incremental Delays in Appropriate Therapy on the Outcomes of Hospitalized Adult Patients with Gram‐negative Bloodstream Infections: “Every day matters”

Implementation of Antimicrobial Stewardship Measures in Cardiac Surgery: Change of Protocol for Surgical Antibiotic Prophylaxis and Its Impact on Surgical Site Infections

Contact Info

Product

Resources

About