Prospective Audit and Feedback of Antimicrobial Stewardship in Critical Care: Program Implementation, Experience, and Challenges

Elligsen, Marion; Walker, Sandra A N; Simor, Andrew E.; Daneman, Nick

doi:10.4212/cjhp.v65i1.1101

Cited by 37 publications

(32 citation statements)

References 5 publications

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“…It has a capacity of about 500 inpatient beds, with an approximate average of 13 507 patient-days per month at the time of this study. 13 Potential participants for the current study were identified through the SPIRIT database 14 of the Antimicrobial Stewardship Program at Sunnybrook Health Sciences Centre.…”

Section: Study Design Setting and Data Sourcementioning

confidence: 99%

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

Walker

Elligsen

et al. 2015

CJHP

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Section: Study Design Setting and Data Sourcementioning

confidence: 99%

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

Walker

Elligsen

et al. 2015

CJHP

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“…Study data were extracted from the Stewardship Program Integrated Resource Information Technology (SPIRIT) database. This relational database, described previously, is automatically populated by health level 7 (HL7) messages from SHSC microbiology, pharmacy, and electronic patient care databases for all admitted patients (6,7). The database is stored on a secure server and includes information on all microbiology cultures, pharmacological treatments (including anti-infectives), and an array of other clinical, administrative, and laboratory variables.…”

Section: Methodsmentioning

confidence: 99%

Duration of Hospital Admission and the Need for Empirical Antipseudomonal Therapy

et al. 2012

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fTo reduce selective pressure for antimicrobial resistance, empirical use of antipseudomonal antibiotics is often reserved for patients with late-onset hospital-acquired infections. We examined the likelihood of isolating Pseudomonas aeruginosa as a function of time from hospital admission. We conducted a retrospective cohort study of all positive bacterial cultures in a tertiarycare hospital between March 2010 and November 2011. The primary outcome was the proportion of positive cultures yielding P. aeruginosa. Multivariable logistic regression was employed to assess the impact of time from admission on the likelihood of isolating P. aeruginosa, after adjusting for other important risk factors. A total of 7,668 positive cultures were obtained from 4,108 unique patients during the study interval, including 633 (8.3%) yielding P. aeruginosa. The probability of isolating P. aeruginosa increased linearly from 79/2,044 (3.9%) positive cultures obtained on admission to 153/664 (23%) in the 10th week of admission or beyond. The unadjusted odds ratio was 1.002/day (95% confidence interval [CI], 1.0016 to 1.0028; P < 0.0001); the adjusted odds ratio (aOR) was 1.0007/day (95% CI, 1.0001 to 1.0013; P ‫؍‬ 0.02). Other important predictors of P. aeruginosa isolation included respiratory specimen type (aOR, 13.8; 95% CI, 9.1 to 21.1), recent hospital admission (aOR,1.8; 95% CI, 1.4 to 2.3), prior P. aeruginosa isolation during current admission (aOR, 4.9; 95% CI, 3.7 to 6.4), and prior antipseudomonal (aOR, 1.9; 95% CI, 1.4 to 2.5) or nonantipseudomonal (aOR, 1.8; 95% CI, 1.4 to 2.4) antibiotic exposure. It was determined that as time from admission increases, there is a linear increase in the likelihood of P. aeruginosa isolation. Any guidelines which distinguish early from late hospital-acquired infection must consider the implications of time point selection on the likelihood of inadequate P. aeruginosa empirical coverage. P seudomonas aeruginosa is a prototypic nosocomial pathogen. It is among the most common causes of hospital-acquired infections (17), while it is infrequently responsible for communityacquired disease (20). P. aeruginosa is also a prototypic resistant pathogen, intrinsically resistant to most antibacterial agents and able to acquire almost all known mechanisms of antibacterial resistance (21). Very few available antibacterial agents offer reliable antipseudomonal activity. Therefore, as a general principle, use of these drugs is spared, if possible, to avoid driving further increases in resistance. However, minimization of empirical antimicrobials is challenging, because the adequacy of early antibiotic therapy (before microbiological results are available) is strongly associated with patient survival in critically ill patients (8,11,12). The stakes of failing to adequately cover P. aeruginosa during the empirical window may be particularly high (10), since this organism possesses a vast array of virulence factors (23) and is associated with higher clinical failure, relapse, and mortality rates than mos...

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“…30,31 Including prescribers in the development of a program before implementation can effectively overcome these barriers. 32 A previous audit and feedback pilot study of antimicrobial stewardship in the critical care setting demonstrated that a formal, prospective audit and feedback program led to more appropriate use of broad-spectrum antimicrobial agents and illustrated that pharmacists can play a pivotal role in promoting appropriate antimicrobial utilization. 32,33 Goal 3, objective 3.9 of the Canadian Society of Hospital Pharmacy 2015 initiative-"…pharmacists will be actively involved in medication-and vaccination-related infection control programs"-further supports the proposition that pharmacists should actively apply evidence-based methods to the improvement of antimicrobial treatment.…”

Section: Antimicrobial Stewardship and Audit And Feedback Programsmentioning

confidence: 99%

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

Halpape

Sulz

Schuster

et al. 2014

CJHP

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Prospective Audit and Feedback of Antimicrobial Stewardship in Critical Care: Program Implementation, Experience, and Challenges

Cited by 37 publications

References 5 publications

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

Antibiotic Use and Need for Antimicrobial Stewardship in Long-Term Care

Duration of Hospital Admission and the Need for Empirical Antipseudomonal Therapy

Audit and Feedback-Focused approach to Evidence-based Care in Treating patients with pneumonia in hospital (AFFECT Study)

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