Is the "Low-Hanging Fruit" Worth Picking for Antimicrobial Stewardship Programs?

Abstract

A new antimicrobial stewardship program can be overwhelmed at the breadth of interventions and education required to conduct a successful program. The expression "low-hanging fruit," in reference to stewardship, refers to selecting the most obtainable targets rather than confronting more complicated management issues. These targets include intravenous-to-oral conversions, batching of intravenous antimicrobials, therapeutic substitutions, and formulary restriction. These strategies require fewer resources and less effort than other stewardship activities; however, they are applicable to a variety of healthcare settings, including limited-resource hospitals, and have demonstrated significant financial savings. Our stewardship program found that staged and systematic interventions that focus on obvious areas of need, that is, low hanging fruit, provided early successes in our expanded program with a substantial cumulative cost savings of $832,590.

Antimicrobial stewardship across 47 South African hospitals: an implementation study

“…Third, the low-hanging fruit concept used in this study represented only the most basic interventions, but their implementation could nevertheless make a difference. 7 One of these interventions was to ensure that cultures were taken before initiation of empirical antibiotics, a practice that is poorly performed in South Africa and elsewhere. 9 ; 21 Although not a target in the present study, increased compliance with this intervention facilitates de-escalation and reassessment of treatment.…”

Implementing criteria-based early switch/early discharge programmes: a European perspective

“…In terms of prioritizing the most cost-effective stewardship interventions, ES has been seen as a 'low-hanging fruit', which in reference to stewardship, refers to selecting the most obtainable targets rather than confronting more complicated management issues [28]. These strategies require fewer resources and less effort than other stewardship activities; however, they are applicable to a variety of healthcare settings, including limited-resource hospitals, and have demonstrated significant financial savings.…”

The Evolving Role of Antimicrobial Stewardship in Management of Multidrug Resistant Infections

“…These programs can improve patient outcomes, reduce adverse events (including Clostridium difficile infection), reduce readmission rates, and reduce antibiotic resistance. [2][3][4][5][6] The proven benefits of ASPs have led to increasing calls for their implementation in all hospitals.…”