Clinical impact of pharmacist-directed antimicrobial stewardship guidance following blood culture rapid diagnostic testing

Mahrous, Ahmad Jamal; Thabit, Abrar K.; Elarabi, Salwa; Fleisher, Jorge

doi:10.1016/j.jhin.2020.09.010

Cited by 17 publications

(14 citation statements)

References 20 publications

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“…The diagnostic microbiology laboratory has a vital role to play in facilitating AMS, termed diagnostic stewardship. Timely reporting of results increases the confidence of prescribers that they are treating infection appropriately with empirical antibiotics, and allows treatment to be focussed, as reported in this issue by Mahrous et al who report an AMS benefit in their hospital from rapid-diagnostic testing in combination with pharmacist intervention [16]. Whilst new technology is attractive, and can facilitate a considerable reduction in reporting time for antimicrobial resistance genes in some settings [17], Weinbren et al have demonstrated that existing blood culture pathways can often be optimised, reducing turnaround times without necessarily requiring investment in new equipment [18].…”

mentioning

confidence: 99%

Antimicrobial stewardship: a COVID casualty?

Lynch

Mahida

Gray

2020

Journal of Hospital Infection

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mentioning

confidence: 99%

Antimicrobial stewardship: a COVID casualty?

Lynch

Mahida

Gray

2020

Journal of Hospital Infection

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“…The current study also found that the implementation of antibiotic stewardship interventions led to cost savings of antibiotics, which was similar to that found in prior studies ( Butt et al, 2019 ; Xin et al, 2019 ). Some studies reported that the length of hospital stay significantly was shortened after the intervention of a pharmacist-directed antimicrobial stewardship ( Mahmoudi et al, 2019 ; Xin et al, 2019 ; Arensman et al, 2020 ; Mahrous et al, 2020 ), while some studies indicated that the intervention had no effect on the length of stay ( Wenzler et al, 2017 ; Abubakar et al, 2019 ; Monmaturapoj et al, 2021 ), which may be related to differences in the study design and analytical methods.…”

Section: Discussionmentioning

confidence: 99%

The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital

Huang

et al. 2022

Front. Pharmacol.

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Objective: The objective of the study was to assess the impact of multifaceted clinical pharmacist-led antimicrobial stewardship (AMS) program on the rational use of antibiotics for patients who receive vascular and interventional radiology therapies.Methods: A quasi-experimental retrospective intervention design with a comparison group was applied to the practice of antibiotic use in the department of vascular and interventional radiology in a Chinese tertiary hospital. We used difference-in-differences (DID) analysis to compare outcomes before and after the AMS intervention between the intervention group and control group, to determine whether intervention would lead to changes in irrationality of antibiotic prescribing, antibiotic utilization, cost of antibiotics, and length of hospital stay.Results: The DID results showed that the intervention group was associated with a reduction in the average consumption of antibiotics (p = 0.017) and cost of antibiotics (p = 0.006) and cost per defined daily dose (DDD) (p = 0.000). There were no significant differences in the mean change of total costs and length of stay between the two groups (p > 0.05). The average inappropriate score of perioperative antimicrobial prophylaxis in the intervention group declined by 0.23, while it decreased by 0.02 in the control group [0.21 (95% CI, −0.271 to −0.143); p = 0.000]. The average inappropriate score of non-surgical antimicrobial prophylaxis in the intervention group declined by 0.14, while it increased by 0.02 in the control group [0.16 (95% CI, −0.288 to −0.035); p = 0.010]. The average inappropriate score of the therapeutic use of antibiotics in the intervention group declined by 0.07, while it decreased by 0.01 in the control group [0.06 (95% CI, −0.115 to −0.022); p = 0.003].Conclusions: This study provides evidence that implementation of AMS interventions was associated with a marked reduction of antibiotic use, cost of antibiotics, and irrationality of antibiotic prescribing in China.

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“…12 However, stewardship initiatives differ in processes between institutions, and the best practice for reporting and responding to positive culture results has yet to be determined. [13][14][15] Furthermore, familiarity with rapid diagnostic technologies and level of formal infectious diseases or antimicrobial stewardship training may have differed among staff and Oxacillin-resistant coagulase-negative staphylococci 30 (…”

Section: Discussionmentioning

confidence: 99%

A comparison of active versus passive methods of responding to rapid diagnostic blood culture results

Chandler

Wallace

Palavecino

et al. 2022

ASHE

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Objective: To compare 2 methods of communicating polymerase chain reaction (PCR) blood-culture results: active approach utilizing on-call personnel versus passive approach utilizing notifications in the electronic health record (EHR). Design: Retrospective observational study. Setting: A tertiary-care academic medical center. Patients: Adult patients hospitalized with ≥1 positive blood culture containing a gram-positive organism identified by PCR between October 2014 and January 2018. Methods: The standard protocol for reporting PCR results at baseline included a laboratory technician calling the patient’s nurse, who would report the critical result to the medical provider. The active intervention group consisted of an on-call pager system utilizing trained pharmacy residents, whereas the passive intervention group combined standard protocol with real-time in-basket notifications to pharmacists in the EHR. Results: Of 209 patients, 105, 61, and 43 patients were in the control, active, and passive groups, respectively. Median time to optimal therapy was shorter in the active group compared to the passive group and control (23.4 hours vs 42.2 hours vs 45.9 hours, respectively; P = .028). De-escalation occurred 12 hours sooner in the active group. In the contaminant group, empiric antibiotics were discontinued faster in the active group (0 hours) than in the control group and the passive group (17.7 vs 7.2 hours; P = .007). Time to active therapy and days of therapy were similar. Conclusions: A passive, electronic method of reporting PCR results to pharmacists was not as effective in optimizing stewardship metrics as an active, real-time method utilizing pharmacy residents. Further studies are needed to determine the optimal method of communicating time-sensitive information.

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Clinical impact of pharmacist-directed antimicrobial stewardship guidance following blood culture rapid diagnostic testing

Cited by 17 publications

References 20 publications

Antimicrobial stewardship: a COVID casualty?

Antimicrobial stewardship: a COVID casualty?

The Impact of a Multifaceted Pharmacist-Led Antimicrobial Stewardship Program on Antibiotic Use: Evidence From a Quasi-Experimental Study in the Department of Vascular and Interventional Radiology in a Chinese Tertiary Hospital

A comparison of active versus passive methods of responding to rapid diagnostic blood culture results

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