Effect of an antimicrobial stewardship bundle for patients with<i>Clostridium difficile</i>infection

Brumley, Paul E.; Malani, Anurag N.; Kabara, Jared J; Pisani, Jennifer; Collins, Curtis D.

doi:10.1093/jac/dkv404

Cited by 28 publications

(25 citation statements)

References 24 publications

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“…Antimicrobial stewardship programs have been shown to be beneficial in numerous health care settings, from small community health care centers to nursing homes and academic urban hospitals (13,14). Reported benefits include, but are not limited to (15), reduction of C. difficile infection incidence (16)(17)(18)(19), reduction of antimicrobial resistance (20)(21)(22)(23)(24), improving antimicrobial dosing in renally impaired patients (25,26), improving the use of surgical antimicrobial prophylaxis (27)(28)(29), improved infection cure rates (30,31), decreased mortality rates (14), more rapid administration of effective antimicrobial therapy and appropriate de-escalation in critical infections (32)(33)(34)(35), and hospital cost savings (36)(37)(38)(39)(40)(41).…”

Section: Antimicrobial Stewardship At the Helmmentioning

confidence: 99%

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

2017

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Antimicrobial stewardship is a bundle of integrated interventions employed to optimize the use of antimicrobials in health care settings. While infectious-disease-trained physicians, with clinical pharmacists, are considered the main leaders of antimicrobial stewardship programs, clinical microbiologists can play a key role in these programs. This review is intended to provide a comprehensive discussion of the different components of antimicrobial stewardship in which microbiology laboratories and clinical microbiologists can make significant contributions, including cumulative antimicrobial susceptibility reports, enhanced culture and susceptibility reports, guidance in the preanalytic phase, rapid diagnostic test availability, provider education, and alert and surveillance systems. In reviewing this material, we emphasize how the rapid, and especially the recent, evolution of clinical microbiology has reinforced the importance of clinical microbiologists' collaboration with antimicrobial stewardship programs.

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Section: Antimicrobial Stewardship At the Helmmentioning

confidence: 99%

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

2017

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“…The leading cause of CDI is antibiotic treatment, most likely leading to severe alterations in the intestinal microbiome. There have been multiple studies showing that antibiotic stewardship (ABS) programs can reduce CDI rates [ 66 ]. The main targets for modifying antibiotic prescription habits are often the prophylactic antibiotic schemes.…”

Section: Preventionmentioning

confidence: 99%

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

et al. 2017

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Over the last years, there was an increase in the number and severity of Clostridium difficile infections (CDI) in all medical settings, including the intensive care unit (ICU). The current prevalence of CDI among ICU patients is estimated at 0.4–4% and has severe impact on morbidity and mortality. An estimated 10–20% of patients are colonized with C. difficile without showing signs of infection and spores can be found throughout ICUs. It is not yet possible to predict whether and when colonization will become infection. Figuratively speaking, our patients are sleeping with the enemy and we do not know when this enemy awakens.Most patients developing CDI in the ICU show a mild to moderate disease course. Nevertheless, difficult-to-treat severe and complicated cases also occur. Treatment failure is particularly frequent in ICU patients due to comorbidities and the necessity of continued antibiotic treatment. This review will give an overview of current diagnostic, therapeutic, and prophylactic challenges and options with a special focus on the ICU patient.First, we focus on diagnosis and prognosis of disease severity. This includes inconsistencies in the definition of disease severity as well as diagnostic problems. Proceeding from there, we discuss that while at first glance the choice of first-line treatment for CDI in the ICU is a simple matter guided by international guidelines, there are a number of specific problems and inconsistencies. We cover treatment in severe CDI, the problem of early recognition of treatment failure, and possible concepts of intensifying treatment. In conclusion, we mention methods for CDI prevention in the ICU.

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“…Antimicrobial stewardship programs (ASPs) have an essential role in improving patient outcomes, reducing antimicrobial adverse events, decreasing antimicrobial resistance, and optimizing resource utilization. [1][2][3][4][5] The Joint Commission Antimicrobial Stewardship Standard for hospitals mandates establishing an ASP as an organizational priority. 6 Dedicated medical and pharmacy staff with antimicrobial expertise are critical for ASP success.…”

Section: Introductionmentioning

confidence: 99%

Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center

et al. 2017

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Leveraging pharmacy personnel resources for the purpose of antimicrobial stewardship program (ASP) operations presents a challenging task. We describe our experience integrating all pharmacists into an ASP, and evaluate the impact on ASP interventions, antimicrobial utilization, rate of selected hospital-onset infections and readmission. During a study period (January 1 to December 31, 2015), a total of 14 552 ASP-related pharmacy interventions were performed (ASP clinical pharmacotherapy specialists [CPS] n = 4025; non-ASP CPS n = 4888; hospital pharmacists n = 5639). Sixty percent of interventions by ASP CPS were initiated utilizing the dedicated ASP phone, and 40% through prospective audit and feedback. Non-ASP CPS performed interventions during bedside rounds (dose adjustment 23%, initiate new or alternative anti-infective 21%, discontinue antibiotic(s) 12%, therapeutic drug monitoring 11%, de-escalation 4%), whereas hospital pharmacists participated at the point of verification (dose adjustment 75%, restricted antibiotic verification 15%, and reporting major drug-drug interactions 4%). The acceptance rate of interventions by providers and clinicians was>90% for all groups. Annual aggregate antimicrobial use decreased by 6.4 days of therapy/1000 patient-days (DOT/1000 PD; = 1.0). Ceftriaxone use increased by 8.4 DOT/1000 PD ( = .029) without a significant compensatory increase in the use of antipseudomonal agents. Sustained low rates of hospital-onset (CDI) and carbapenem-resistant (CRE) infections were observed in 2015 compared with the prior year (1.1 and 1.2 cases/1000 PD, 0.2 and 0.1 cases/1000 PD, respectively). Thirty-day readmission rate decreased by 0.6% ( = .019). Integration of all pharmacists into ASP activities based on the level of patient care and responsibilities is an effective strategy to expand clinical services provided by ASP.

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Effect of an antimicrobial stewardship bundle for patients withClostridium difficileinfection

Abstract: Introduction of an antimicrobial stewardship bundle for CDI significantly improved adherence to institutional treatment recommendations and overall management of patients with CDI.

Cited by 28 publications

References 24 publications

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

Antimicrobial Stewardship: How the Microbiology Laboratory Can Right the Ship

Sleeping with the enemy: Clostridium difficile infection in the intensive care unit

Multilayer Model of Pharmacy Participation in the Antimicrobial Stewardship Program at a Large Academic Medical Center

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