Syndrome-specific versus prospective audit and feedback interventions for reducing use of broad-spectrum antimicrobial agents

被引:9
作者
Mediwala, Krutika N. [1 ]
Kohn, Joseph E. [2 ]
Bookstaver, P. Brandon [2 ,3 ]
Justo, Julie Ann [2 ,3 ]
Rac, Hana [3 ]
Tucker, Kendall [4 ]
Lashkova, Lora [4 ]
Dash, Sangita [5 ,6 ]
Al-Hasan, Majdi N. [5 ,6 ]
机构
[1] Prisma Hlth Baptist Parkridge Hosp, Dept Pharm, Columbia, SC USA
[2] Prisma Hlth Richland Hosp, Dept Pharm, Columbia, SC USA
[3] Univ South Carolina, Dept Clin Pharm & Outcomes Sci, Coll Pharm, Columbia, SC 29203 USA
[4] Univ South Carolina, Coll Pharm, Columbia, SC 29203 USA
[5] Univ South Carolina, Dept Med, Sch Med, Columbia, SC 29203 USA
[6] Palmetto Hlth Univ South Carolina Med Grp, Dept Med, Div Infect Dis, Columbia, SC USA
关键词
Antibiotics; Bacteremia; Peritonitis; SAAR; Meropenem; Cefepime; BLOOD-STREAM INFECTIONS; STEWARDSHIP; RISK; EPIDEMIOLOGY; PREDICTION; GUIDELINES;
D O I
10.1016/j.ajic.2019.04.175
中图分类号
R1 [预防医学、卫生学];
学科分类号
1004 ; 120402 ;
摘要
Background: Antimicrobial use (AU) of antipseudomonal beta-lactams (APBL) has significantly increased over the past decade in US hospitals. This retrospective cohort study compares 2 common antimicrobial stewardship strategies, syndrome-specific interventions and antimicrobial postprescription prospective audit and feedback (PAF), in reducing AU of APBL at a large community-teaching hospital. Methods: Four antimicrobial stewardship interventions targeting APBL were serially introduced, including 2 syndrome-specific interventions (bloodstream and intra-abdominal infections) and 2 PAF interventions (carbapenems and piperacillin/tazobactam). Multivariable linear regression was used to examine overall AU of APBL and audited antimicrobial agents. Results: Overall AU of APBL declined from 92.4-69.1 days of therapy (DOT) per 1,000 patient-days between February 2013 and July 2017 (P < .001). Both syndrome-specific interventions were associated with significant reduction in AU of APBL (-7.7 [95% confidence interval (CI): -11.5, -4.0] and -6.0 [95% CI: -9.7, -2.3] DOT per 1,000 patient-days) for bloodstream and intra-abdominal infections, respectively). No significant change in overall AU of APBL was observed after implementation of PAF interventions for carbapenems (-1.4 [95% CI: -7.4, 4.6] DOT per 1,000 patient-days) or piperacillin/tazobactam (0.9 [95% CI: -3.7, 5.4] DOT per 1,000 patient-days). Conclusions: Implementation of syndrome-specific interventions was followed by significant reduction in AU of APBL in this population. Despite reducing AU of targeted agents, neither PAF intervention contributed to overall observed decline in APBL use, likely due to compensatory increase in using other APBL. (C) 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
引用
收藏
页码:1284 / 1289
页数:6
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