Impact of a mobile decision support tool on antimicrobial stewardship indicators in St. John’s, Canada

Abstract

Objectives Inappropriate antibiotic use contributes to antimicrobial resistance. The SpectrumTM app provides antibiotic decision support, based on local antimicrobial resistance rates. We determined the impact of regional implementation of the app on inpatient antimicrobial appropriateness, inpatient antimicrobial usage (AMU), population-based Clostridioides difficile infection (CDI) rates and cost, using a retrospective, before and after quasi-experimental design, including a one-year study period. Methods The SpectrumTM app was released to prescribers in February, 2019. We performed two one-day inpatient point prevalence surveys using the National Antimicrobial Prescribing Survey tool, six months before (June 25, 2018) and six months after (June 25, 2019) app dissemination. Inpatient AMU in Defined Daily Dose/1000 patient days and CDI incidence were compared, before and after app dissemination. Results The pre-survey included 184 prescriptions, and the post-survey included 197 prescriptions. Appropriateness was 97/176 (55.1%) pre, and 126/192 (65.6%) post (+10.5%, p = 0.051). Inpatient AMU declined by 6.6 DDD/1000 patient days per month, and CDI declined by 0.3 cases per month. Cost savings associated with reduced AMU were $403.98/bed/year and associated with reduced CDI were $82,078/year. Conclusion We observed improvement in antimicrobial stewardship indicators following SpectrumTM implementation. We cannot determine the cause of these improvements.

Exploring Antimicrobial Stewardship Influential Interventions on Improving Antibiotic Utilization in Outpatient and Inpatient Settings: A Systematic Review and Meta-Analysis

“…The included studies have been classified into four groups: 13 articles involved IP settings without a pharmacist as a part of an AMS-MDT intervention [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ], 19 were carried out in IP settings with the inclusion of a pharmacist as a part of the intervention team [ 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ], eight articles engaged OP without a pharmacist [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 ], while eight involved OP settings with a pharmacist [ 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 ]. Forty-one articles were from d...…”

“…Of those, seven scored high risk [ 33 , 34 , 46 , 57 , 59 , 63 , 67 ], three scored low risk [ 28 , 32 , 60 ], with one article only found to have some concerns [ 58 ]. On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , ...…”

“…On the other hand, the remaining 37 articles were non-randomized before and after methodology and were assessed using the ROBINS-1 assessment tool [ 24 , 25 , 26 , 27 , 29 , 30 , 31 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 61 , 62 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ]. Out of those 37, 29 were at moderate risk of bias [ 24 , 25 , 29 , 30 , 35 , 36 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ,…”

“…Of the identified interventions, twelve were captured in the IP setting [ 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 37 , 38 , 39 , 40 , 42 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 53 , 54 , 55 ] while 13 were in the OP setting [ 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 68 , 69 , 70 , 71 ], with 7 common interventions between the two settings. Those interventions were prospective and audit with direct intervention [ 37 , 38 , 42 , 44 , 45 , 47 , 48 , 49 , 50 , 53 , …”

“…Adherence to antimicrobial guidelines was significantly higher in the intervention group than in the non-intervention group (n = 7 studies); two in the IP setting had no pharmacist in the intervention [ 25 , 31 ], three in the IP setting included a pharmacist [ 37 , 45 , 53 ], and two studies were in the OP setting and involved a pharmacist [ 64 , 65 ]. No significant changes were seen in terms of adherence to guidelines in 2 studies where a pharmacist was engaged in the intervention, one was in the IP [ 39 ] and the other one was in the OP setting [ 69 ]. The pooled proportion of patients who were prescribed antibiotics in accordance with hospital antimicrobial guidelines in IP groups was 55% (95% CI: 43%, 68%) in the non-intervention group compared with 50% (95% CI: 39–64%) in the intervention group ( Figure 7 a).…”