Clinical practice guidelines for creating an acute care hospital-based antimicrobial stewardship program: A systematic review

Rennert-May, Elissa; Chew, Derek S.; Conly, John; Guirguis, Micheal; Slobodan, Jeremy; Fryters, Susan; Bresee, Lauren

doi:10.1016/j.ajic.2019.02.010

Cited by 6 publications

(3 citation statements)

References 21 publications

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“…Antimicrobial stewardship provides an illustrative example of practices that support diagnostic excellence [ 12 – 14 ]. Antimicrobial stewardship is a system-based, multidisciplinary approach designed to facilitate the timely administration of the optimal antibiotic to a patient diagnosed with an infectious disease that fundamentally relies on accurate and timely test results available to inform clinical decision making [ 13 , 15 – 18 ].…”

Section: The Intersection Of Diagnostic Excellence and Clinical Laboratory Practicementioning

confidence: 99%

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

et al. 2021

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ObjectivesClinical laboratory testing provides essential data for making medical diagnoses. Generating accurate and timely test results clearly communicated to the treating clinician, and ultimately the patient, is a critical component that supports diagnostic excellence. On the other hand, failure to achieve this can lead to diagnostic errors that manifest in missed, delayed and wrong diagnoses.ContentInnovations that support diagnostic excellence address: 1) test utilization, 2) leveraging clinical and laboratory data, 3) promoting the use of credible information resources, 4) enhancing communication among laboratory professionals, health care providers and the patient, and 5) advancing the use of diagnostic management teams. Integrating evidence-based laboratory and patient-care quality management approaches may provide a strategy to support diagnostic excellence. Professional societies, government agencies, and healthcare systems are actively engaged in efforts to advance diagnostic excellence. Leveraging clinical laboratory capabilities within a healthcare system can measurably improve the diagnostic process and reduce diagnostic errors.SummaryAn expanded quality management approach that builds on existing processes and measures can promote diagnostic excellence and provide a pathway to transition innovative concepts to practice.OutlookThere are increasing opportunities for clinical laboratory professionals and organizations to be part of a strategy to improve diagnoses.

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Section: The Intersection Of Diagnostic Excellence and Clinical Laboratory Practicementioning

confidence: 99%

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

et al. 2021

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“…In most practice guidelines for ASP, ADE appears as a recommended stewardship objective [26]. In the US, a survey showed that prior authorisation for selected antimicrobials, antimicrobial reviews with prospective audit and feedback, and guideline development were common strategies in ASPs [27], while ADE was not explicitly reported as a major component.…”

Section: The Role Of Ade In Asp: Taking a Broader Perspectivementioning

confidence: 99%

“…Of the two most evidence-based ASP interventions (post-prescriptional review and prior authorisation [26]), post-prescriptional review (which may include ADE) gained some advantage over the latter because of its larger effect on reducing antimicrobial use [30]. In the light of pitfalls of ADE mentioned before, post-prescriptional review by an expert remains essential for good antimicrobial practice.…”

Section: The Role Of Ade In Asp: Taking a Broader Perspectivementioning

confidence: 99%

Antimicrobial de-escalation as part of antimicrobial stewardship in intensive care: no simple answers to simple questions—a viewpoint of experts

et al. 2020

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Antimicrobial de-escalation (ADE) is defined as the discontinuation of one or more components of combination empirical therapy, and/or the change from a broad-spectrum to a narrower spectrum antimicrobial. It is most commonly recommended in the intensive care unit (ICU) patient who is treated with broad-spectrum antibiotics as a strategy to reduce antimicrobial pressure of empirical broad-spectrum therapy and prevent antimicrobial resistance, yet this has not been convincingly demonstrated in a clinical setting. Even if it appears beneficial, ADE may have some unwanted side effects: it has been associated with prolongation of antimicrobial therapy and could inappropriately be used as a justification for unrestricted broadness of empirical therapy. Also, exposing a patient to multiple, sequential antimicrobials could have unwanted effects on the microbiome. For these reasons, ADE has important shortcomings to be promoted as a quality indicator for appropriate antimicrobial use in the ICU. Despite this, ADE clearly has a role in the management of infections in the ICU. The most appropriate use of ADE is in patients with microbiologically confirmed infections requiring longer antimicrobial therapy. ADE should be used as an integral part of an ICU antimicrobial stewardship approach in which it is guided by optimal specimen quality and relevance. Rapid diagnostics may further assist in avoiding unnecessary initiation of broad-spectrum therapy, which in turn will decrease the need for subsequent ADE.

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Poor compliance with an antibiotic directive—A call for intensified monitoring

Novak

Hørlück

Redder

et al. 2021

International Journal of Infectious Diseases

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Clinical practice guidelines for creating an acute care hospital-based antimicrobial stewardship program: A systematic review

Cited by 6 publications

References 21 publications

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Bringing the clinical laboratory into the strategy to advance diagnostic excellence

Antimicrobial de-escalation as part of antimicrobial stewardship in intensive care: no simple answers to simple questions—a viewpoint of experts

Poor compliance with an antibiotic directive—A call for intensified monitoring

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