Evaluation of dedicated infectious diseases pharmacists on antimicrobial stewardship teams

Yu, Kalvin; Rho, Jay P.; Morcos, M B; Nomura, Jim; Kaplan, Donald M.; Sakamoto, Keith; Bui, Doan; Yoo, Sandy; Jones, Jason P.

doi:10.2146/ajhp130612

Cited by 33 publications

(19 citation statements)

References 21 publications

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“…is a significant concern across the US. We hope the data reported here contribute to a broader view of the population affected by antibiotic resistance and help support measures that may be required to combat antimicrobial resistance, including coordinated infection control efforts, antimicrobial stewardship initiatives, and development of new antibiotics and diagnostics (Anon, 2015b;Barlam et al, 2016;Hill et al, 2018;Messacar et al, 2017;Morgan et al, 2017;Pogue et al, 2015;Spellberg et al, 2016;Yu et al, 2014;Hagiwara et al, 2018).…”

Section: Discussionmentioning

confidence: 91%

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

Gupta

Olesky

et al. 2019

International Journal of Infectious Diseases

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A B S T R A C TObjectives: To determine antimicrobial nonsusceptibility rates for Enterobacteriaceae and Acinetobacter spp. in US hospitals. Methods: We analyzed antimicrobial susceptibilities of non-duplicate Enterobacteriaceae and Acinetobacter spp. isolates reported in 2017 from 375 US hospitals in the BD Insights Research Database. Logistic and Poisson regression modeling methods were used to estimate proportions of resistant isolates and rates per 1000 hospital admissions. National projections were generated based on raking (weighting) methods. Results: The nationwide proportions of resistant isolates in inpatients were an estimated 12.6%, 6.6%, and 1.2% for Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL), multidrug resistant (MDR), and carbapenem-nonsusceptible (Carb-NS) phenotypes, respectively, and 42.4% and 34.5% for Acinetobacter spp. with MDR and Carb-NS phenotypes. Resistance varied by geographic region and hospital size/type. Estimated nationwide rates per 1000 hospital admissions ranged from a high of 7.1 for ESBL Enterobacteriaceae to a low of 0.3 for Carb-NS Acinetobacter spp. The estimated number of isolates occurring in US inpatients each year was 290,220 ESBL, 173,984 MDR, and 30,274 MDR and 9,991 Carb-NS for Acinetobacter spp. Conclusions: National prevalence estimates suggest high levels of antimicrobial resistance and a substantial number of patients with resistant Enterobacteriaceae and Acinetobacter spp. in US hospitals.

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Section: Discussionmentioning

confidence: 91%

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

Gupta

Olesky

et al. 2019

International Journal of Infectious Diseases

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“…Persons with expertise might include pharmacists or medical and surgical consultants who can assist clinicians in improving antibiotic prescribing for patients with conditions requiring specialty care. For example, in hospitals, pharmacists with infectious disease training have been effective and important members of antibiotic stewardship programs, and in hospital stewardship programs these types of pharmacists have been associated with improved patient outcomes and overall cost savings for the hospital (73). The expertise needed might differ among outpatient facilities and can be determined by each facility.…”

Section: • Provide Continuing Education Activities For Cliniciansmentioning

confidence: 99%

Core Elements of Outpatient Antibiotic Stewardship

Sánchez¹,

Fleming-Dutra²,

Roberts³

et al. 2016

MMWR Recomm. Rep.

446

503

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The Core Elements of Outpatient Antibiotic Stewardship provides a framework for antibiotic stewardship for outpatient clinicians and facilities that routinely provide antibiotic treatment. This report augments existing guidance for other clinical settings. In 2014 and 2015, respectively, CDC released the Core Elements of Hospital Antibiotic Stewardship Programs and the Core Elements of Antibiotic Stewardship for Nursing Homes. Antibiotic stewardship is the effort to measure and improve how antibiotics are prescribed by clinicians and used by patients. Improving antibiotic prescribing involves implementing effective strategies to modify prescribing practices to align them with evidence-based recommendations for diagnosis and management. The four core elements of outpatient antibiotic stewardship are commitment, action for policy and practice, tracking and reporting, and education and expertise. Outpatient clinicians and facility leaders can commit to improving antibiotic prescribing and take action by implementing at least one policy or practice aimed at improving antibiotic prescribing practices. Clinicians and leaders of outpatient clinics and health care systems can track antibiotic prescribing practices and regularly report these data back to clinicians. Clinicians can provide educational resources to patients and families on appropriate antibiotic use. Finally, leaders of outpatient clinics and health systems can provide clinicians with education aimed at improving antibiotic prescribing and with access to persons with expertise in antibiotic stewardship. Establishing effective antibiotic stewardship interventions can protect patients and improve clinical outcomes in outpatient health care settings.

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“…The remaining studies consisted of those with a medium risk of bias: nonrandomized pretest‐posttest (5%) and nonrandomized posttest (5%). Five studies evaluated pharmacist antimicrobial stewardship programs . These studies typically measured costs related to antimicrobial utilization or length of stay.…”

Section: Resultsmentioning

confidence: 99%

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

Talon

Pérez

Yan

et al. 2019

J Am Coll Clin Pharm

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Studies evaluating the cost-effectiveness of clinical pharmacy services (CPS) are needed to justify implementation and reimbursement. Through a systematic review, we describe services provided by pharmacists and their economic outcomes. We conducted a literature search of published studies in PubMed, Ovid, and Embase from January 2011 through December 2017. Manuscripts evaluating a CPS with patient-level economic outcomes and conducted in the United States were included. Study risks of bias were classified by study design characteristics. Economic evaluations were classified according to the presence of a comparator, and cost and outcome measures included. The quality of full economic evaluations was assessed using the Quality of Health Economic Studies (QHES) instrument. Descriptive statistics were used to summarize CPS characteristics. After screening, 115 studies wereincluded. Type of service provided included general pharmacotherapy (41%), disease management (30%), and targeted drug program (17%). Settings included hospital (34%), ambulatory care (28%), and community pharmacy (17%). Study designs were considered high risk of bias (use of a historical control group or no control group) in 69% of cases while 25% were medium risk of bias (non-randomized with a concurrent control group) and 6% were low risk of bias (randomized experimental or multigroup interrupted time series). Economic evaluation types were descriptive studies that measured cost and/or outcomes of a CPS (55%), comparative studies that measured cost or outcomes of a CPS and a comparator (37%), and full evaluations that measured cost and outcomes of a CPS and a comparator (8%). Among nine full evaluations, the median (range) QHES score was 74 (59-95) and four reported the CPS as being more effective at a lower cost. Few full economic evaluations were conducted, but supported the cost-effectiveness of CPS. Use of a comparator group and measurement of economic inputs and outcomes would strengthen the body of evidence. K E Y W O R D Scost-benefit analysis, health services research, pharmacoeconomics, pharmacy

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Evaluation of dedicated infectious diseases pharmacists on antimicrobial stewardship teams

Cited by 33 publications

References 21 publications

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

National prevalence estimates for resistant Enterobacteriaceae and Acinetobacter species in hospitalized patients in the United States

Core Elements of Outpatient Antibiotic Stewardship

Economic evaluations of clinical pharmacy services in the United States: 2011‐2017

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