Moving Antibiotic Stewardship from Theory to Practice

Patel, Payal; Srinivasan, Arjun

doi:10.12788/jhm.2741

Cited by 3 publications

(2 citation statements)

References 11 publications

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“…Similarly, awareness of local epidemiology and resistance patterns can empower physicians to 'narrow the spectrum' for common infections such as pneumonia, urinary tract infections and cellulitis (Elias, et al, 2017;Patel PK, 2017). Such efforts afford clinicians the opportunity to combine the application of multiple public health principlesprevention, evidence-based Similarly, clinicians are well placed to combat the impacts of common infections that cluster in vulnerable populations.…”

Section: Challenges Relating To Communicable Diseases Antimicrobial Rmentioning

confidence: 99%

The contribution of hospital doctors to public health

2018

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Section: Challenges Relating To Communicable Diseases Antimicrobial Rmentioning

confidence: 99%

The contribution of hospital doctors to public health

2018

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“…In the meantime, antibiotic stewardship programs (ASPs) have already been successful at optimizing patient outcomes while minimizing toxicity, costs, and the potential for microbial resistance within hospitals [40,41]. ASPs are coordinated programs led by an infectious disease physician and a pharmacist that promote appropriate antibiotic use, reduce microbial resistance, and improve patient outcomes.…”

Section: Ethical Dilemmas and The Origins Of Bioethicsmentioning

confidence: 99%

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Balch¹,

Schoen²,

Patel

2017

AMA Journal of Ethics

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Pharmaceuticals are beginning to receive attention as a source of pollution in aquatic environments. Yet the impact of physician prescription patterns on water resources is not often discussed in clinical decision making. Here, we comment on a case in which empiric antibiotic treatment might benefit a patient while simultaneously being detrimental to the aquatic environment. We first highlight the potential harm caused by this prescription from its production to its disposal. We then suggest that Van Rensselaer Potter's original conceptualization of bioethics can be used to balance clinicians' obligations to protect individual, public, and environmental health. CaseDr. Turner, a hospitalist, is called to assess Mr. Johnson, an elderly patient with a history of urinary tract infections (UTIs), who presented to the ER with altered mental status. Urine cultures are pending but previous cultures have grown Escherichia coli (E. coli) with an extended-spectrum beta-lactamase (ESBL) gene. Although Mr. Johnson improves with intravenous fluids, Dr. Turner plans to treat Mr. Johnson with ciprofloxacin, a broadspectrum fluoroquinolone-class antibiotic, to cover the E. coli that he has grown in the past. Dr. Turner recently read that this drug can persist, unaltered, in the hospital's wastewater collection system and in the municipal wastewater water treatment plant (WWTP). While much will be filtered, a quantifiable amount will end up in Mr. Johnson's local watershed. How should Dr. Turner, other physicians, and their institutions weigh the benefits that individual patients derive from pharmaceutical treatment with the contamination risk this treatment poses to freshwater resources used by entire communities and ecosystems?

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Implementation and Impact of an Antimicrobial Stewardship Program at a Tertiary Care Center in South India

Singh

Menon

Mohamed

et al. 2018

Open Forum Infectious Diseases

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Background Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India. Methods An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015–January 2016) and post-implementation phase (February 2016–January 2017). Results Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of “inappropriate” antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase. Conclusions Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.

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Moving Antibiotic Stewardship from Theory to Practice

Cited by 3 publications

References 11 publications

The contribution of hospital doctors to public health

The contribution of hospital doctors to public health

Should Physicians Consider the Environmental Effects of Prescribing Antibiotics?

Implementation and Impact of an Antimicrobial Stewardship Program at a Tertiary Care Center in South India

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