Favorable Impact of a Multidisciplinary Antibiotic Management Program Conducted During 7 Years

Carling, Philip; Fung, Teresa T.; Killion, Ann; Terrin, Norma; Barza, Michael

doi:10.1086/502278

Cited by 361 publications

(247 citation statements)

References 49 publications

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“…Most such analyses have examined patient demographics [7][8][9], comorbid conditions [10][11][12], clinical variables [7,8], and antibiotic treatment characteristics [7,8,13]. Patient-level risk factors have been used to help develop treatment algorithms [14], and may also be useful in developing prevention and control measures.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Clostridium difficile colitis infections in hospitals

et al. 2007

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Hospital-level predictors of high rates of 'Clostridium difficile-associated disease' (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with 'high CDAD' rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies. KeywordsArizona, California, clostridium difficile, cross infection, enterocolitis, pseudomembranous, geography, hospitals, humans, Minnesota, risk factors, urban population SUMMARYHospital-level predictors of high rates of ' Clostridium difficile-associated disease ' (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD ; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with 'high CDAD ' rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies.

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Section: Introductionmentioning

confidence: 99%

Predictors of Clostridium difficile colitis infections in hospitals

et al. 2007

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“…In previous research, a decrease in resistant pathogens, such as Clostridium difficile [18], extended-spectrum β-lactamase-producing E. coli and K. pneumonia [19], and methicillin-resistant Staphylococcus aureus (MRSA) [21] was noted. Decreases in hospital stays [22] and improvements in successful treatments [20] have also been reported.…”

Section: Discussionmentioning

confidence: 95%

“…Prospective antimicrobial audits and feedback systems have also shown benefits such as cost-effectiveness [17], reductions in the inappropriate antibiotic prescriptions [10], decreases in antimicrobial consumption [18][19] and "bug-drug" mismatch [20].…”

Section: Discussionmentioning

confidence: 99%

Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern Taiwan

Cheng

Lee

et al. 2016

J Infect Dev Ctries

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Introduction: Although a prospective antimicrobial audit and feedback is an effective strategy in an antibiotic stewardship program, previous researchers have not adequately demonstrated a successful impact on patient outcomes. In this study, the causes of fatalities associated with a prospective antimicrobial audit and feedback were analyzed. Methodology: Between June and September 2014, applications for 16 target parenteral formulas (including ceftriaxone, ceftazidime, cefepime, piperacillin/tazobactam, vancomycin, teicoplanin, ertapenem, imipenem/cilastatin, meropenem, levofloxacin, moxifloxacin, ciprofloxacin, tigecycline, linezolid, daptomycin, and amikacin), which were not approved by infectious diseases (ID) specialists, were followed up until patients were either discharged or passed away. Results: Of the 292 cases studied, 193 (66%) were male, with a mean age (standard deviation) of 65.5 (19.3) years. There were five reasons for rejection, including dosage adjustments (37%), no evidence of bacterial infection (28.8%), modifications according to antimicrobial susceptibility (18.8%), target pathogens not being covered (7.2%), and redundant therapy (4.1%). Multiple logistic regression analysis demonstrated that an age greater than 75 years (odds ratio [OR]: 2.58; 95% confidence interval [CI]: 1.32-5.50; p = 0.005) was associated with significant mortality, while urinary tract (OR: 0.26; 95% CI: 0.09-0.70; p = 0.013) and soft tissue/bone infections (OR: 0.18; 95% CI: 0.05-0.61; p = 0.006) were associated with survival. Adjustments according to ID physicians' recommendations were not statistically significant (OR: 0.53; 95% CI: 0.27-1.06; p = 0.074). Conclusions: Antimicrobial adjustments according to ID physicians' recommendations showed only marginally preventative effects against fatalities.

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“…5 By intervening and providing expert consultation, ASPs can guide clinicians in practices that reduce antimicrobial selective pressure and improve the appropriate use of antimicrobial drugs.…”

Section: E T T E R S To T H E E D I T O R An Examination Of Stewardmentioning

confidence: 99%

“…CPOE allows direct entry of medical orders by authorized healthcare providers; this has the benefit of reducing errors by minimizing the ambiguity of handwritten orders, with greater benefits seen with the combination of CPOE and clinical decision support tools. 5 In order to assess the potential impact of physician intervention on our community hospital-based, pharmacydirected ASP, we undertook a prospective evaluation of linezolid use following the addition of an infectious diseases (ID) physician to the program. The subsequent addition of a customized CPOE-ASP order entry template incorporating a linezolid decision algorithm provided an opportunity to monitor its potential additional impact over the subsequent 16 months.…”

Section: The Impact Of An Infectious Diseases Specialist-directed Commentioning

confidence: 99%

An Examination of Stewardship Interventions by Major Category in an Urban Academic Medical Center

Pellerin

Edmond

Bearman

et al. 2012

Infect. Control Hosp. Epidemiol.

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Favorable Impact of a Multidisciplinary Antibiotic Management Program Conducted During 7 Years

Abstract: These results suggest that an ongoing multidisciplinary antibiotic management program may have a sustained beneficial impact on both expenditures for antibiotics and the incidence of nosocomial infection by C. difficile and resistant bacterial pathogens.

Cited by 361 publications

References 49 publications

Predictors of Clostridium difficile colitis infections in hospitals

Predictors of Clostridium difficile colitis infections in hospitals

Prospective antimicrobial audit and feedback did not decrease case fatality: Experiences from a hospital in northern Taiwan

An Examination of Stewardship Interventions by Major Category in an Urban Academic Medical Center

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