Effect of a “handshake” stewardship program versus a formulary restriction policy on High-End antibiotic use, expenditure, antibiotic resistance, and patient outcome

Moghnieh, Rima; Awad, Lyn; Abdallah, Dania; Jadayel, Marwa; Sinno, Loubna; Tamim, Hani; Jisr, Tamima; El-Hassan, Salam; Lakkis, Rawad; Dabbagh, Rima; Bizri, Abdul Rahman

doi:10.1080/1120009x.2020.1755589

Cited by 22 publications

(46 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Notably, there was a compensatory increase in consumption of other antibiotics, like piperacillin-tazobactam and third and fourth generation cephalosporins, in the hospital as a whole. This was due to the various complicated cases frequently managed in our facility, such as neutropenic patients with cancer, bone marrow transplant recipients, and critically ill patients [10]. Piperacillin-tazobactam is a less potent inducer of antimicrobial resistance in Gram-negative bacteria compared to carbapenems, fluoroquinolones, and extended-spectrum cephalosporins [42,43].…”

Section: Discussionmentioning

confidence: 99%

“…One potential side effect of drug-oriented ASPs is that decreasing consumption of one antimicrobial can result in increased consumption of another one. Despite similar patient population complexity in our tertiary care facility before and during the intervention, decreased tigecycline use was not compensated for by increased consumption of carbapenems or colistin [ 10 ]. Implementing the handshake ASP in our facility led to an important reduction in the density and rate of prescribing other broad-spectrum antibiotics, including the antipseudomonal carbapenems imipenem and meropenem and colistimethate sodium [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…The ASP was adopted by the hospital starting in September 2016 and was based on the "handshake" strategy of prospective audit and immediate feedback to prescribers. The aims were to decrease high-end antibiotic use, namely antipseudomonal carbapenems and colistimethate sodium, and to control tigecycline use based on its utilization review [9,10].…”

Section: Setting and Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…These results indicated a need to improve tigecycline prescription procedures. Therefore, a drug-oriented antibiotic stewardship intervention was launched in our facility in 2016 as a part of a comprehensive “Handshake Antibiotic Stewardship Program” (ASP) [ 10 ]. The primary endpoints of the current study were to observe the intervention effects on: Shifting tigecycline use from the clinically vulnerable patient population toward the less critical population by avoiding its use in patients with signs of clinical severity, like hemodynamic failure and in those on mechanical ventilation.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Moghnieh

Abdallah

Awad

et al. 2020

Ann Clin Microbiol Antimicrob

Self Cite

View full text Add to dashboard Cite

Background: A drug-oriented antibiotic stewardship intervention targeting tigecycline utilization was launched at Makassed General Hospital, Beirut, Lebanon, in 2016 as a part of a comprehensive Antibiotic Stewardship Program (ASP). In this study, we evaluated the effect of this intervention on changing tigecycline prescription behavior in different types of infections, patient outcome and mortality, along with tigecycline drug use density, when compared to an earlier period before the initiation of ASP. Methods: This is a retrospective chart review of all adult inpatients who received tigecycline for more than 72 h between Jan-2012 and Dec-2013 [period (P) 1 before ASP] and between Oct-2016 and Dec-2018 [period (P) 2 during ASP]. Results: Tigecycline was administered to 153 patients during P1 and 116 patients during P2. The proportion of patients suffering from cancer, those requiring mechanical ventilation, and those with hemodynamic failure was significantly reduced between P1 and P2. The proportion of patients who received tigecycline for FDA-approved indications increased from 19% during P1 to 78% during P2 (P < 0.001). On the other hand, its use in off-label indications was restricted, including ventilator-associated pneumonia (26.1% in P1, 3.4% in P2, P < 0.001), hospital-acquired pneumonia (19.6% in P1, 5.2% in P2, P = 0.001), sepsis (9.2% in P1, 3% in P2, P = 0.028), and febrile neutropenia (15.7% in P1, 0.9% in P2, P < 0.001). The clinical success rate of tigecycline therapy showed an overall significant increase from 48.4% during P1 to 65.5% during P2 (P = 0.005) in the entire patient population. All-cause mortality in the tigecycline-treated patients decreased from 45.1% during P1 to 20.7% during P2 (P < 0.0001). In general, mean tigecycline consumption decreased by 55% between P1 and P2 (P < 0.0001). Conclusion: The drug-oriented ASP intervention targeting tigecycline prescriptions improved its use and patient outcomes, where it helped curb the over-optimistic use of this drug in off-label indications where it is not a suitable treatment option.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Setting and Study Designmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Moghnieh

Abdallah

Awad

et al. 2020

Ann Clin Microbiol Antimicrob

Self Cite

View full text Add to dashboard Cite

show abstract

Susceptibility Test Methods: General Considerations

Turnidge,

Jorgensen,

Zimmer

2023

ClinMicroNow

View full text Add to dashboard Cite

Determination of the antimicrobial susceptibilities of significant bacterial isolates is one of the most important functions of the clinical microbiology laboratory. The main objective of susceptibility testing is to predict the likely outcome of treatment with the antimicrobial agents tested. Clinical microbiology laboratories can choose from among several conventional and novel methods for the performance of routine antibacterial susceptibility testing. A laboratory may choose to perform rapid detection of some resistance mechanisms by molecular testing or by rapid phenotypic testing. Breakpoints are the values that determine the categories of susceptibility. The approach to setting breakpoints varies by organization or regulatory body. Antimicrobial resistance is becoming widespread among a variety of clinically significant bacterial species. The advent of more readily available molecular techniques, especially whole‐genome sequencing, opens up the possibility of a major shift in the diagnostic laboratory, from phenotypic susceptibility testing to genotypic prediction of resistance.

show abstract

Global resilience and new strategies needed for antimicrobial stewardship during the COVID‐19 pandemic and beyond

Goff

Gauthier

Langford

et al. 2022

J Am Coll Clin Pharm

View full text Add to dashboard Cite

Resilience is having the ability to respond to adversity proactively and resourcefully. The coronavirus disease 2019 (COVID‐19) pandemic's profound impact on antimicrobial stewardship programs (ASP) requires clinicians to call on their own resilience to manage the demands of the pandemic and the disruption of ASP activities. This article provides examples of ASP resilience from pharmacists and physicians from seven countries with different resources and approaches to ASP—The United States, The United Kingdom, Canada, Nigeria, Lebanon, South Africa, and Colombia. The lessons learned pertain to providing ASP clinical services in the context of a global pandemic, developing new ASP paradigms in the face of COVID‐19, leveraging technology to extend the reach of ASP, and conducting international collaborative ASP research remotely. This article serves as an example of how resilience and global collaboration is sustaining our ASPs by sharing new “how to” do antimicrobial stewardship practices during the COVID‐19 pandemic.

show abstract

Effect of a “handshake” stewardship program versus a formulary restriction policy on High-End antibiotic use, expenditure, antibiotic resistance, and patient outcome

Cited by 22 publications

References 33 publications

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

The effect of an antibiotic stewardship program on tigecycline use in a Tertiary Care Hospital, an intervention study

Susceptibility Test Methods: General Considerations

Global resilience and new strategies needed for antimicrobial stewardship during the COVID‐19 pandemic and beyond

Contact Info

Product

Resources

About