Outcomes of multisite antimicrobial stewardship programme implementation with a shared clinical decision support system

被引：34

作者：

Bond, Stuart E. ^{[1
,2
,3
]}

Chubaty, Adriana J. ^{[4
]}

Adhikari, Suman ^{[5
,6
]}

Miyakis, Spiros ^{[2
,3
,7
]}

Boutlis, Craig S. ^{[7
]}

Yeo, Wilfred W. ^{[2
,3
,8
]}

Batterham, Marijka J. ^{[9
]}

Dickson, Cara ^{[10
]}

McMullan, Brendan J. ^{[11
]}

Mostaghim, Mona ^{[12
]}

Hui, Samantha Li-Yan ^{[13
]}

Clezy, Kate R. ^{[14
]}

Konecny, Pamela ^{[6
,15
]}

机构：

[1] Illawarra Shoalhaven Local Hlth Dist, Wollongong Hosp, Dept Pharm, Wollongong, NSW, Australia

[2] Univ Wollongong, Sch Med, Wollongong, NSW, Australia

[3] Univ Wollongong, Illawarra Hlth & Med Res Inst, Wollongong, NSW, Australia

[4] South Eastern Sydney Local Hlth Dist, Prince Wales Hosp, Dept Pharm, Randwick, NSW, Australia

[5] South Eastern Sydney Local Hlth Dist, St George Hosp, Dept Pharm, Kogarah, NSW, Australia

[6] Univ New South Wales, St George Clin Sch, Fac Med, Sydney, NSW, Australia

[7] Illawarra Shoalhaven Local Hlth Dist, Wollongong Hosp, Dept Infect Dis, Wollongong, NSW, Australia

[8] Illawarra Shoalhaven Local Hlth Dist, Div Med, Wollongong, NSW, Australia

[9] Univ Wollongong, Sch Math & Appl Stat, Wollongong, NSW, Australia

[10] South Eastern Sydney Local Hlth Dist, Performance Unit, Kogarah, NSW, Australia

[11] Sydney Childrens Hosp, Dept Immunol & Infect Dis, Randwick, NSW, Australia

[12] Sydney Childrens Hosp, Dept Pharm, Randwick, NSW, Australia

[13] South Eastern Sydney Local Hlth Dist, Informat Management Serv Directorate, Randwick, NSW, Australia

[14] South Eastern Sydney Local Hlth Dist, Prince Wales Hosp, Dept Infect Dis, Randwick, NSW, Australia

[15] South Eastern Sydney Local Hlth Dist, St George Hosp, Dept Infect Dis Immunol & Sexual Hlth, Kogarah, NSW, Australia

来源：

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY | 2017年 / 72卷 / 07期

关键词：

CLOSTRIDIUM-DIFFICILE INFECTION; INTERRUPTED TIME-SERIES; ANTIBIOTIC STEWARDSHIP; COST-ANALYSIS; CARE; MANAGEMENT; RESISTANCE; HOSPITALS; FEEDBACK; IMPACT;

D O I：

10.1093/jac/dkx080

中图分类号：

R51 [传染病];

学科分类号：

100401 ;

摘要：

Background: Studies evaluating antimicrobial stewardship programmes (ASPs) supported by computerized clinical decision support systems (CDSSs) have predominantly been conducted in single site metropolitan hospitals. Objectives: To examine outcomes of multisite ASP implementation supported by a centrally deployed CDSS. Methods: An interrupted time series study was conducted across five hospitals in New South Wales, Australia, from 2010 to 2014. Outcomes analysed were: effect of the intervention on targeted antimicrobial use, antimicrobial costs and healthcare-associated Clostridium difficile infection (HCA-CDI) rates. Infection-related length of stay (LOS) and standardized mortality ratios (SMRs) were also assessed. Results: Post-intervention, antimicrobials targeted for increased use rose from 223 to 293 defined daily doses (DDDs)/1000 occupied bed days (OBDs)/month (+32%, P < 0.01). Conversely, antimicrobials targeted for decreased use fell from 254 to 196 DDDs/1000 OBDs/month (-23%; P < 0.01). These effects diminished over time. Antimicrobial costs decreased initially (-AUD$64551/month; P < 0.01), then increased (+AUD$7273/month; P < 0.01). HCA-CDI rates decreased post-intervention (-0.2 cases/10 000 OBDs/month; P < 0.01). Proportional LOS reductions for key infections (respiratory from 4.8 to 4.3 days, P < 0.01; septicaemia 6.8 to 6.1 days, P < 0.01) were similar to background LOS reductions (2.1 to 1.9 days). Similarly, infection-related SMRs (observed/expected deaths) decreased (respiratory from 1.1 to 0.75; septicaemia 1.25 to 0.8; background rate 1.19 to 0.90. Conclusions: Implementation of a collaborative multisite ASP supported by a centrally deployed CDSS was associated with changes in targeted antimicrobial use, decreased antimicrobial costs, decreased HCA-CDI rates, and no observable increase in LOS or mortality. Ongoing targeted interventions are suggested to promote sustainability.

引用

页码：2110 / 2118

页数：9