Impact of Antimicrobial Stewardship on Outcomes in Hospitalized Veterans With Pneumonia

Kurtzhalts, Kari; Sellick, John A.; Ruh, Christine; Carbo, James F.; Ott, Michael; Mergenhagen, Kari A.

doi:10.1016/j.clinthera.2016.06.004

Cited by 13 publications

(9 citation statements)

References 31 publications

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“…Those findings are consistent with the previous study in South Africa 2011 [18]. Conversely, Kari E. Kurtzhalts et al, 2015, studied 174 patients being treated for community acquired and healthcare-associated pneumonia and found a comorbid disease such as chronic obstructive pulmonary disease 43.68% (76), diabetes 32.76% (57), and heart failure 27.01% (47), respectively [19]. The proportion of converted patients 20.8% (20/96) in this study was higher from that reported by Van Niekerk et al 2012 (13%) [18].…”

Section: Discussionsupporting

confidence: 89%

Current Practice and Barriers to an Early Antimicrobial Conversion from Intravenous to Oral among Hospitalized Patients at Jimma University Specialized Hospital: Prospective Observational Study

Berha

Kassie

2019

Interdisciplinary Perspectives on Infectious Diseases

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Objective. The aim of the present study was to explore the current practice and its barriers to an early antimicrobial conversion from intravenous (IV) to oral (PO) therapy among hospitalized patients.Method. Hospital based prospective observational study was conducted to assess the practice of an early antimicrobial IV to PO conversion and its barriers using medical chart and case-specific physicians’ interviews, respectively, from February to September, 2014. Patient charts and medication records were reviewed for appropriateness of IV to PO conversion program every 24hrs using a pretested data collection abstraction format. Independent samplest-test was used to compare the duration of therapy and time to clinical stability between converted and nonconverted patients. Two-tailed P values of < 0.05 were regarded as statistically significant.Results. One hundred forty-two patients were included in the study, of whom two-thirds (67.6%) of the patients were eligible for IV to PO antimicrobial conversion. However, only 20.9% of patients’ timely conversion was made. A shorter duration of IV therapy was recorded for converted (2.80±1.87) versus nonconverted patients (8.50±6.32), (P=0.009). The most important barriers of not converting IV to PO in clinically stable patients were presence of comorbidity; clinicians perceived that the patient should always complete IV course of antimicrobials as a standard practice.Conclusion. Conversion from IV to PO antimicrobials was found to be unnecessarily delayed in a significant proportion of patients hospitalized with moderate to severe infection due to a range of different barriers. Addressing these issues has the potential to reduce inappropriate antimicrobial use and resistance.

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Section: Discussionsupporting

confidence: 89%

Current Practice and Barriers to an Early Antimicrobial Conversion from Intravenous to Oral among Hospitalized Patients at Jimma University Specialized Hospital: Prospective Observational Study

Berha

Kassie

2019

Interdisciplinary Perspectives on Infectious Diseases

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“…In the older cohort, the census of Medicare beneficiaries with traditional fee-for-service plus Part D coverage were represented, tallying to 130 746 patients across 3227 hospitals in 50 states plus the District of Columbia. Previous studies have been limited to predominantly male patients admitted to VA hospitals [8, 9], single hospitals [6–8], or international studies not separately reporting the findings of US hospitals [10]. Despite differences in study design, the findings of this study corroborate with those of the smaller, less representative studies.…”

Section: Discussionsupporting

confidence: 77%

“…Approaches used in single-center antibiotic stewardship interventions have reported average LOT drops of 3 days from baseline among patients treated for CAP [6, 8, 11], which may be a feasible and effective ways to reduce LOT. These interventions include provision of education and direct feedback to medical staff and hospital attending physicians [6]; development of new guidelines with computer support promoted to hospitalists, other clinicians, and pharmacists [11]; and implementation of a patient-centered antimicrobial stewardship program [8].…”

Section: Discussionmentioning

confidence: 99%

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Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States

Hatfield

Baggs

et al. 2017

Clinical Infectious Diseases

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“…Antibiotic stewardship programs (ASPs) play a critical role in improving prescribing practices and promoting more judicious antimicrobial utilization. Numerous reports have shown a reduction in CDI incidence and decreased hospital LOS following implementation of ASPs or specific antimicrobial restriction policies [ 46 – 53 ]. ASPs have been a priority among national health care systems, including the VHA.…”

Section: Discussionmentioning

confidence: 99%

National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014

et al. 2017

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IntroductionPrior studies demonstrated marked increases in Clostridium difficile infection (CDI) in the United States (U.S.) in recent years. The objective of this study was to describe the epidemiology of initial and recurrent CDI in a national Veterans Health Administration (VHA) cohort over a 12-year period.MethodsThis was a retrospective cohort study of all adult VHA beneficiaries with CDI (ICD-9-CM code 008.45) plus a positive CDI stool test between October 1, 2002 and September 30, 2014. Data were obtained from the VA Informatics and Computing Infrastructure. Recurrence was defined as a second ICD-9-CM code plus a new course of CDI therapy following a minimum three-day gap after the initial therapy was completed. CDI incidence and outcomes were presented descriptively and longitudinally.ResultsOverall, 30,326 patients met study inclusion criteria. CDI incidence increased from FY 2003 (1.6 per 10,000) to FY 2013 (5.1 per 10,000). Thereafter, CDI incidence decreased through FY 2014 (4.6 per 10,000). A total of 5,011 patients (17%) experienced a first recurrence and, of those, 1,713 (34%) experienced a second recurrence. Recurrence incidence increased 10-fold over the study period, from (0.1 per 10,000) in FY 2003, to (1.0 per 10,000) in FY 2014. Overall, 30-day mortality and median hospital length of stay (LOS) decreased among initial episodes over the study period. Mortality was higher for initial episodes (21%) compared to first recurrences (11%) and second recurrences (7%). Median hospital LOS was longer for first episodes (13 days) compared to first (9 days) and second recurrences (8 days).ConclusionsInitial and recurrent CDI episodes increased among veterans over a 12-year period. Outcomes, such as mortality and hospital LOS improved in recent years; both of these outcomes are worse for initial CDI episodes than recurrent episodes.

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Impact of Antimicrobial Stewardship on Outcomes in Hospitalized Veterans With Pneumonia

Cited by 13 publications

References 31 publications

Current Practice and Barriers to an Early Antimicrobial Conversion from Intravenous to Oral among Hospitalized Patients at Jimma University Specialized Hospital: Prospective Observational Study

Current Practice and Barriers to an Early Antimicrobial Conversion from Intravenous to Oral among Hospitalized Patients at Jimma University Specialized Hospital: Prospective Observational Study

Duration of Antibiotic Use Among Adults With Uncomplicated Community-Acquired Pneumonia Requiring Hospitalization in the United States

National epidemiology of initial and recurrent Clostridium difficile infection in the Veterans Health Administration from 2003 to 2014

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