Approaches to Modifying the Behavior of Clinicians Who Are Noncompliant With Antimicrobial Stewardship Program Guidelines

Goldstein, Ellie J. C.; Goff, Debra A.; Reeve, William; Naumovski, Snezana; Epson, Erin; Zenilman, Jonathan M.; Kaye, Keith S.; File, Thomas M.

doi:10.1093/cid/ciw247

Cited by 33 publications

(18 citation statements)

References 14 publications

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“…Continual provider-level education combined with effective communication strategies by the ASST were essential for compliance with recommendations. Managing provider perceptions of and potential biases against complying with institutional guidelines or stewardship recommendations is a key element to a successful ASP (22,23).…”

Section: Discussionmentioning

confidence: 99%

Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

Bookstaver

Nimmich

Smith³

et al. 2017

Antimicrob Agents Chemother

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The use of rapid diagnostic tests (RDTs) enhances antimicrobial stewardship program (ASP) interventions in optimization of antimicrobial therapy. This quasi-experimental cohort study evaluated the combined impact of an ASP/RDT bundle on the appropriateness of empirical antimicrobial therapy (EAT) and time to de-escalation of broad-spectrum antimicrobial agents (BSAA) in Gram-negative bloodstream infections (GNBSI). The ASP/RDT bundle consisted of system-wide GNBSI treatment guidelines, prospective stewardship monitoring, and sequential introduction of two RDTs, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and the FilmArray blood culture identification (BCID) panel. The preintervention period was January 2010 through December 2013, and the postintervention period followed from January 2014 through June 2015. The postintervention period was conducted in two phases; phase 1 followed the introduction of MALDI-TOF MS, and phase 2 followed the introduction of the FilmArray BCID panel. The interventions resulted in significantly improved appropriateness of EAT (95% versus 91%; = 0.02). Significant reductions in median time to de-escalation from combination antimicrobial therapy (2.8 versus 1.5 days), antipseudomonal beta-lactams (4.0 versus 2.5 days), and carbapenems (4.0 versus 2.5 days) were observed in the postintervention compared to the preintervention period ( < 0.001 for all). The reduction in median time to de-escalation from combination therapy (1.0 versus 2.0 days; = 0.03) and antipseudomonal beta-lactams (2.2 versus 2.7 days; = 0.04) was further augmented during phase 2 compared to phase 1 of the postintervention period. Implementation of an antimicrobial stewardship program and RDT intervention bundle in a multihospital health care system is associated with improved appropriateness of EAT for GNBSI and decreased utilization of BSAA through early de-escalation.

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Section: Discussionmentioning

confidence: 99%

Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

Bookstaver

Nimmich

Smith³

et al. 2017

Antimicrob Agents Chemother

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“…19 ASPs in community hospitals have unique challenges as compared with those at large academic medical centers. 20 The current study demonstrates that the use of prescriber peer comparison reports to reduce FQ use in a community hospital setting of various bed sizes is feasible and can be effective at altering prescribing habits.…”

Section: Discussionmentioning

confidence: 78%

“…One particular strength of the current study is its completion in a community hospital setting, which have historically been underrepresented in published literature on antimicrobial stewardship interventions . ASPs in community hospitals have unique challenges as compared with those at large academic medical centers . The current study demonstrates that the use of prescriber peer comparison reports to reduce FQ use in a community hospital setting of various bed sizes is feasible and can be effective at altering prescribing habits.…”

Section: Discussionmentioning

confidence: 96%

Effect of prescriber peer comparison reports on fluoroquinolone use across a 16‐facility community hospital system

Allen

Dunn²,

Bush³

2019

J Am Coll Clin Pharm

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Introduction Antimicrobial stewardship programs (ASPs) continuously strive to optimize antibiotic use, while minimizing antibiotic‐associated adverse events. Among potential targets for antibiotic use reduction, fluoroquinolones (FQs) are an attractive drug class for ASPs due to their wide spectrum of activity, known adverse event profile, and availability of less toxic therapeutic options. The use of peer comparison on antibiotic use by ASPs has been described but is limited primarily to the outpatient setting. Objectives To assess the impact of peer comparison using prescriber‐specific reports on FQ use and hospital‐acquired Clostridioides difficile rates across a 16‐facility community hospital system. Methods In January 2017, we began providing quarterly facility‐specific peer comparison reports to high‐volume antibiotic prescribers in three different medical specialties across our health‐system: Internal Medicine/Hospitalists/Family Medicine, Intensivists/Pulmonologists, and infectious diseases (ID). We completed a quasi‐experimental study designed to assess aggregated hospital data, evaluating FQ days of therapy/1000 patient days (DOT/1000 PD) in the intervention period (January‐December 2017), and compared with the baseline period (January‐December 2016). Additional outcomes that were evaluated include total antibiotic consumption (DOT/1000 PD), total percentage of antibiotics attributable to FQs, and cases of hospital‐acquired C. difficile/10000 PD (HA‐CD). Results Compared with the baseline period, FQ use decreased by 29% (baseline—83.9 DOT/1000 PD; intervention—58.5 DOT/1000 PD; P < 0.001). The overall percentage of antibiotics that were attributable to FQs also decreased in the intervention period (baseline—15.4%; intervention—11.3%; P < 0.001). During the intervention period, there were no significant increases in other key antibiotic classes, including antipseudomonal beta‐lactams and third‐generation cephalosporins. The rate of HA‐CD decreased by 20% in the intervention period compared with baseline. Conclusion In a large community hospital system, the use of peer comparison reports based on prescriber specialty reduced FQ use, and may potentially reduce adverse events associated with FQ use.

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“…A major core ASP strategy supported by the IDSA and CDC is prospective audit and feedback (PAF). While effective, PAF is typically labor-intensive, difficult to implement in resource- and/or workforce-limited settings, and relies on provider acceptance of recommendations [ 31 , 35 ]. The current literature describes a wide variation in PAF designs that have attempted to overcome these disadvantages.…”

Section: Resultsmentioning

confidence: 99%

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

Stover

Chahine

Cluck

et al. 2020

Open Forum Infectious Diseases

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Staying current on literature related to antimicrobial stewardship can be challenging given the ever-increasing number of published articles. The Southeastern Research Group Endeavor (SERGE-45) identified antimicrobial stewardship-related peer-reviewed literature that detailed an actionable intervention for 2019. The top 13 publications were selected using a modified Delphi technique. These manuscripts were reviewed to highlight the actionable intervention used by antimicrobial stewardship programs to provide key stewardship literature for teaching and training as well as to identify potential intervention opportunities within one’s institution

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Approaches to Modifying the Behavior of Clinicians Who Are Noncompliant With Antimicrobial Stewardship Program Guidelines

Cited by 33 publications

References 14 publications

Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

Cumulative Effect of an Antimicrobial Stewardship and Rapid Diagnostic Testing Bundle on Early Streamlining of Antimicrobial Therapy in Gram-Negative Bloodstream Infections

Effect of prescriber peer comparison reports on fluoroquinolone use across a 16‐facility community hospital system

A Baker’s Dozen of Top Antimicrobial Stewardship Intervention Publications in 2019

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