Inappropriate Antibiotic Use Due to Decreased Compliance with a Ventilator‐Associated Pneumonia Computerized Clinical Pathway: Implications for Continuing Education and Prospective Feedback

Abstract

These data highlight the importance of continued stewardship resources after CCP implementation to ensure compliance and to maximize antibiotic stewardship outcomes.

Antimicrobial Stewardship Programs: A Review of Recent Evaluation Methods and Metrics

“…The most common clinical outcomes reported by ASP evaluations are mortality [7,8,10,18,20,22,26,30,33,35,39,46,47 [5,7,10,19,20], and clinical success/failure [24, 49, 55•]. A handful of programs were able to measure infection-attributable clinical outcomes, with respect to length of stay [6] or readmission [8, 31, 47•].…”

“…The definition of DOT varied between studies with some considering the administration of multiple antimicrobials in one day to represent one day of therapy [27], and others considering each additional antimicrobial given in the same day as an additional day of therapy [35, 56•]. Another common drug utilization measure was the total duration of therapy (ten studies) [6, 8, 19, 26, 39, 47•, 48, 49, 74•, 75] or duration lasting longer than a particular threshold (five studies) [26,28,29,48,77]. Other measures included antibiotic-free days [48], proportion of patients given antibiotics [32,48,49], number of antimicrobials given [33], and proportion of ICU days on antibiotics [46].…”

“…Appropriateness of antimicrobial spectrum has been operationalized as frequency of inadequate coverage [13] or redundant coverage [13,19]; appropriateness of antibiotic reassessment has been captured in rates of streamlining broad-spectrum coverage when microbiology results are avail- [19, 26, 34, 47•], converting from intravenous to oral route of administration [7, 47•] and switching classes of agents [12,24]. There has been very little recent work regarding improving the time to adequate treatment [26]. As a potential prerequisite to appropriate antibiotic use, some ASPs have measured rates of chart documentation of antimicrobial regimens, indications and intended stop dates [21,34].…”

Ventilator-Associated Pneumonia: Overdiagnosis and Treatment Are Common in Medical and Surgical Intensive Care Units

“…Because of challenges associated with making the diagnosis of VAP, IDSA/ATS guidelines highlight the importance of reassessing patients after 48-72 hours to determine whether antibiotic therapy for VAP is needed or whether an alternative diagnosis should be pursued. Thus far, most studies have focused on optimizing appropriate antimicrobial choice for VAP; [11][12][13] however, data examining the excessive use of antibiotics for VAP in patients without VAP are limited. In 1 study, Swoboda et al 14 found that half of the empiric antibiotic use for VAP in 2 surgical ICUs was prescribed for patients without pneumonia.…”

What’s new in antimicrobial use and resistance in critically ill patients?

“…The strategy consists of improved diagnostic methods, PD optimized regimens for aminoglycosides and vancomycin, both continuous and prolonged infusion regimens in addition to providing guidance on de-escalation strategies, and duration of therapy. While this infection-based strategy reduced related morbidity, mortality, length of stay, superinfections, cost of care and improved efficacy towards high MIC pathogens, it is recognized that without a consistent implementation across the care continuum these benefits would have not been achieved [17].…”