Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Chou, Ann F.; Graber, Christopher J.; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras‐Kelly, Karl; Samore, Matthew H.; Kelly, Allison; Glassman, Peter

doi:10.1017/ice.2016.26

Cited by 48 publications

(55 citation statements)

References 37 publications

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“…Underlining the importance of a multidisciplinary approach to antimicrobial stewardship, a recent study showed the importance of infectious disease (ID) fellowship programs, full-time ID physicians, and clinical pharmacists with ID training in reducing antimicrobial use [54]. …”

Section: Antibiotic Stewardshipmentioning

confidence: 99%

The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship

et al. 2017

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Purpose: To concisely describe the current standards of care, major recent advances, common beliefs that have been contradicted by recent trials, areas of uncertainty, and clinical studies that need to be performed over the next decade and their expected outcomes with regard to the management of multidrug-resistant (MDR) bacteria, antibiotic use, and antimicrobial stewardship in the intensive care unit (ICU) setting. Methods: Narrative review based on a systematic analysis of the medical literature, national and international guidelines, and expert opinion. Results: The prevalence of infection of critically ill patients by MDR bacteria is rapidly evolving. Clinical studies aimed at improving understanding of the changing patterns of these infections in ICUs are urgently needed. Ideal antibiotic utilization is another area of uncertainty requiring additional investigations aimed at better understanding of dose optimization, duration of therapy, use of combination treatment, aerosolized antibiotics, and the integration of rapid diagnostics as a guide for treatment. Moreover, there is an imperative need to develop non-antibiotic approaches for the prevention and treatment of MDR infections in the ICU. Finally, clinical research aimed at demonstrating the beneficial impact of antimicrobial stewardship in the ICU setting is essential. Conclusions: These and other fundamental questions need to be addressed over the next decade in order to better understand how to prevent, diagnose, and treat MDR bacterial infections. Clinical studies described in this research agenda provide a template and set priorities for investigations that should be performed in this field.

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Section: Antibiotic Stewardshipmentioning

confidence: 99%

The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship

et al. 2017

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“…Antimicrobial stewardship programs led by infectious disease (ID) specialists (physicians and/ or pharmacists) have been successful at reducing unnecessary antimicrobial use and in improving appropriate use. 2,6,13 However, due to staffing limitations, the implementation of stewardship across the continuum of health care is not feasible if an ID specialist must be the leader of every program. Many hospitals and nonacute residential care settings (eg, long-term care) lack and/or cannot afford ID specialists to assist with stewardship.…”

Section: Inpatient Antimicrobial Stewardshipmentioning

confidence: 99%

Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

Suda

Livorsi

Goto

et al. 2018

Infect. Control Hosp. Epidemiol.

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See introductory commentary by Livorsi et al, pages 186-188.) Antimicrobial use is a key contributor to increasing antimicrobial resistance. 1 Antimicrobial stewardship has been shown to decrease inappropriate antimicrobial use and, in turn, may reduce antimicrobial resistance and Clostridium difficile infection (CDI). 2 Antimicrobial stewardship can also improve clinical outcomes for patients. 3 The Veterans Health Administration (VHA) is a leader in promoting antimicrobial stewardship. 4-7 Since 2011, the VHA National Antimicrobial Stewardship Taskforce (ASTF) has provided guidelines and resources for stewardship implementation at individual VHA facilities. In 2014, the VHA mandated that every facility develop and maintain an antimicrobial stewardship program (ASP). The VHA ASP Directive tasked every VHA facility to have an ASP policy, to conduct an annual evaluation of ASP activities, and to have a provider and a pharmacist champion. 6 There were no requirements for facilities to adopt any specific set of ASP activities, allowing individual facilities to decide which elements to implement based on their own focus areas and available resources. This mandate was among the first in the United States, preceding similar directives from the Joint Commission and the Centers for Medicare and Medicaid Services. 8,9 Recently, VHA investigators have partnered with the Centers for Disease Control and Prevention (CDC) to make use of novel antimicrobial usage metrics, including the standardized antimicrobial administration ratio (SAAR). They have also utilized the robust VA Corporate Data Warehouse (CDW) to determine the effectiveness of ASPs, to evaluate outcomes, and to identify high-impact targets. 6,7,10-12 As the largest integrated healthcare system in the United States, the VHA provides a unique opportunity to study a Authors with equal contribution.

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“…Although systematic evaluation of de-escalation opportunities is recommended and generally results in decreased overall antimicrobial use, most evidence describing outcomes associated with de-escalation are reported from retrospective single-center studies of poor design [5, 6]. A systematic review only identified 2 open-label randomized studies and 12 small cohort studies that evaluated clinical outcomes associated with de-escalation [7].…”

mentioning

confidence: 99%

Outcomes Associated With Antimicrobial De-escalation of Treatment for Pneumonia Within the Veterans Healthcare Administration

Bohan¹,

Remington

Jones

et al. 2016

Open Forum Infectious Diseases

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De-escalation, an antimicrobial stewardship concept, involves narrowing broad-spectrum empiric antimicrobial therapy based on clinical data. Current health outcomes evidence is lacking to support de-escalation. Studying Veterans Healthcare Administration pneumonia patients, de-escalation was associated with improved length of stay without affecting 30-day readmission or 30-day Clostridium difficile infection rates.

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Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Cited by 48 publications

References 37 publications

The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship

The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship

Research Agenda for Antimicrobial Stewardship in the Veterans Health Administration

Outcomes Associated With Antimicrobial De-escalation of Treatment for Pneumonia Within the Veterans Healthcare Administration

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