scholarly journals Use of monitoring indicators in hospital management of antimicrobials

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Ravena Melo Ribeiro da Silva ◽  
Simonize Cunha B. de Mendonça ◽  
Ingrid Novaes Leão ◽  
Quesia Nery dos Santos ◽  
Alessandra Macedo Batista ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Analytical Study ◽  
University Hospital ◽  
Medical Clinic ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Surgical Clinic ◽  
Gathering Data

Abstract Background According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials. Methods This is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018. Results During the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days. Conclusions The results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program.

scholarly journals Effects of a Paediatric Antimicrobial Stewardship Program on Antimicrobial Use and Quality of Prescriptions in Patients with Appendix-Related Intraabdominal Infections

Antibiotics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 5
Author(s):  
Sílvia Simó ◽  
Eneritz Velasco-Arnaiz ◽  
María Ríos-Barnés ◽  
María Goretti López-Ramos ◽  
Manuel Monsonís ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Broad Spectrum ◽  
Case Fatality ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Length Of Therapy ◽  
Intraabdominal Infections

The effectiveness of antimicrobial stewardship programs (ASP) in reducing antimicrobial use (AU) in children has been proved. Many interventions have been described suitable for different institution sizes, priorities, and patients, with surgical wards being one of the areas that may benefit the most. We aimed to describe the results on AU and length of stay (LOS) in a pre-post study during the three years before (2014–2016) and the three years after (2017–2019) implementation of an ASP based on postprescription review with feedback in children and adolescents admitted for appendix-related intraabdominal infections (AR-IAI) in a European Referral Paediatric University Hospital. In the postintervention period, the quality of prescriptions (QP) was also evaluated. Overall, 2021 AR-IAIs admissions were included. Global AU, measured both as days of therapy/100 patient days (DOT/100PD) and length of therapy (LOT), and global LOS remained unchanged in the postintervention period. Phlegmonous appendicitis LOS (p = 0.003) and LOT (p < 0.001) significantly decreased, but not those of other AR-IAI diagnoses. The use of piperacillin–tazobactam decreased by 96% (p = 0.044), with no rebound in the use of other Gram-negative broad-spectrum antimicrobials. A quasisignificant (p = 0.052) increase in QP was observed upon ASP implementation. Readmission and case fatality rates remained stable. ASP interventions were safe, and they reduced LOS and LOT of phlegmonous appendicitis and the use of selected broad-spectrum antimicrobials, while increasing QP in children with AR-IAI.

scholarly journals Use of Monitoring Indicators in Hospital Management of Antimicrobials

2020 ◽  
Author(s):  
Ravena Silva ◽  
Ravena Silva ◽  
Simonize Mendonça ◽  
Ingrid Leão ◽  
Quesia Santos ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Management Program ◽  
Hospital Environment ◽  
Antimicrobial Use ◽  
Medical Clinic ◽  
National Data ◽  
Duration Of Therapy ◽  
Stewardship Program ◽  
Great Relevance ◽  
Surgical Clinic

Abstract Background: It is described in the literature that between 25% to 50% of antimicrobial prescriptions, in the hospital environment, are unnecessary or inadequate, directly impacting antimicrobial resistance. The National Health Surveillance Agency launched the “Brazil Stewardship Project” to assess the national panorama of antimicrobial use management programs, therefore, it is expected that managers will be encouraged to implement the antimicrobial use management program, with the publication of the results, enabling the comparison of national data. In this context, measures and indicators of antimicrobial use will be particularly important. We demonstrate the application of the indicators DOT, LOT e DOT/LOT ratio to explore and monitor antimicrobials use. Methods: This is an observational, analytical and prospective study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology (PNE/INF) and pediatrics (PED). Results: During the study period, a total of 11,634 patient-days were followed up and an average of 50.4% of patients were exposed to some antimicrobial, showing significant reduction throughout the year. In 376 days, for every 1,000 days of hospitalization, patients were receiving antimicrobial therapy (LOT = 376/1000pd). Overall, the 1st generation cephalosporins and fluoroquinolones were highlighted both in the number of prescriptions and in the duration of therapy. The calculated global DOT / LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both Methicillin R and Carbapenem R , was 1 per 1000 patient-days. Conclusions: The indicators addressed in this study proved to be of great relevance for obtaining data regarding the use of antimicrobials, contributing to the initiatives to be taken by the Stewardship program. This study is expected to encourage other hospitals to monitor the use of antimicrobials, allowing comparison of data.

scholarly journals 1878. Title: Impact of Antibiotic Stewardship Rounds in the Intensive Care Setting: A Prospective Cluster-Randomized Crossover Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S48-S49
Author(s):  
Jessica Seidelman ◽  
Nicholas A Turner ◽  
Rebekah Wrenn ◽  
Christina Sarubbi ◽  
Deverick J Anderson ◽  
...  
Keyword(s):  
Intensive Care ◽  
Usual Care ◽  
Primary Outcome ◽  
Negative Binomial ◽  
University Hospital ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Intervention Impact ◽  
Cluster Randomized ◽  
The Impact

Abstract Background The impact of formalized, interdisciplinary antimicrobial stewardship program (ASP) rounds in the intensive care unit (ICU) setting has not been well described. Methods We performed a two-arm, cluster-randomized, crossover quality improvement study over 8 months to compare the impact of weekly ICU rounds with an ASP team vs. usual care. The primary outcome was antibiotic use (AU) in days of therapy (DOT) per 1,000 days present during and following ICU exposure. Our cohort consisted of ICU patients in 5 ICUs in Duke University Hospital. The unit of randomization was rounding team, which corresponded to half of the ICU beds in each unit. Each team was randomized to the intervention for 4 months followed by usual care for 4 months (or vice versa). The intervention involved multidisciplinary review of eligible patients to discuss antibiotic optimization. Patients not on antibiotics, followed by infectious diseases, post-transplant, on ECMO, or with a ventricular assist device were excluded from review. Intervention impact was assessed with multivariable negative binomial regression rate ratios (RR). AU was assessed over time before and after the study period to assess global and unit-level trends. Results We had 4,683 ICU-exposed patients. Intervention effect was not significant for the primary outcome (table). The intervention order was not significant in the model. Eligible patients were lower in the cardiothoracic ICU (CTICU) compared with other units (table); the intervention led to a significant decrease in AU when the CTICU was removed (RR = 0.93 [0.89–0.98], P = 0.0025). Intervention impact was differential among ICUs, with the greatest effect in surgical and least in CTICU (table). nit-level AU decreased in all ICUs, driven by 4 of the 5 ICUs (table, figure). Conclusion The effect of ASP rounds on AU was mixed for different types of ICUs. The direct effect on AU (intervention vs. control) was small because the analysis addressed the whole ICU population and thus was subject to biases from exposures after an ICU stay, ineligible patients, and lack of blinding. However, we observed an overall decline in AU during the study period, which we believe represents indirect effects of increased ASP activity and awareness. Additional ASP resources to round more than weekly may result in greater effect. Disclosures All Authors: No reported Disclosures.

scholarly journals Profile of Antimicrobial Use in the Pediatric Population of a University Hospital Centre, 2015/16 to 2018/19

2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Lydia R Rahem ◽  
Bénédicte Franck ◽  
Hélène Roy ◽  
Denis Lebel ◽  
Philippe Ovetchkine ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Antimicrobial Agents ◽  
Pediatric Population ◽  
University Hospital ◽  
Antimicrobial Use ◽  
Defined Daily Dose ◽  
Centre Hospitalier ◽  
Stewardship Program ◽  
Centre Hospitalier Universitaire ◽  
Days Of Therapy

Background: Antimicrobial stewardship is a standard practice in health facilities to reduce both the misuse of antimicrobials and the risk of resistance. Objective: To determine the profile of antimicrobial use in the pediatric population of a university hospital centre from 2015/16 to 2018/19. Methods: In this retrospective, descriptive, cross-sectional study, the pharmacy information system was used to determine the number of days of therapy (DOTs) and the defined daily dose (DDD) per 1000 patient-days (PDs) for each antimicrobial and for specified care units in each year of the study period. For each measure, the ratio of 2018/19 to 2015/16 values was also calculated (and expressed as a proportion); where the value of this proportion was ≤ 0.8 or ≥ 1.2 (indicating a substantial change over the study period), an explanatory rating was assigned by consensus. Results: Over the study period, 94 antimicrobial agents were available at the study hospital: 70 antibiotics (including antiparasitics and antituberculosis drugs), 14 antivirals, and 10 antifungals. The total number of DOTs per 1000 PDs declined from 904 in 2015/16 to 867 in 2018/19. The 5 most commonly used antimicrobials over the years, expressed as minimum/maximum DOTs per 1000 PDs, were piperacillin-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicillin (51/69), vancomycin (53/68), and cefotaxime (55/58). In the same period, the care units with the most antimicrobial use (expressed as minimum/ maximum DOTs per 1000 PDs) were hematology-oncology (2529/2723), pediatrics (1006/1408), and pediatric intensive care (1328/1717). Conclusions: This study showed generally stable consumption of antimicrobials from 2015/16 to 2018/19 in a Canadian mother-and-child university hospital centre. Although consumption was also stable within drug groups (antibiotics, antivirals, and antifungals), there were important changes over time for some individual drugs. Several factors may explain these variations, including disruptions in supply, changes in practice, and changes in the prevalence of infections. Surveillance of antimicrobial use is an essential component of an antimicrobial stewardship program. RÉSUMÉ Contexte : La gestion des antimicrobiens est une pratique courante dans les centres hospitaliers afin de réduire l’utilisation inappropriée des antimicrobiens et le risque de résistance. Objectif : Décrire l’évolution de l’utilisation des antimicrobiens dans un centre hospitalier universitaire de 2015-16 à 2018-19. Méthodes : Dans cette étude rétrospective, descriptive et transversale, les dossiers pharmacologiques ont servi à déterminer le nombre de jours de traitement (NJT) et la dose définie journalière (DDD) par 1000 jours-présence (JP) pour chaque antimicrobien et pour chaque unité de soins par année de l’étude. Pour chaque mesure, on a également comparé le ratio de 2018-19 à celui de 2015-16, qui est exprimé en proportion; lorsque la valeur de cette proportion était ≤ 0,8 ou ≥ 1,2, ce qui indiquait un changement important durant la période de l’étude, une note explicative a été attribuée par consensus. Résultats : Durant la période à l’étude, 94 antimicrobiens ont été disponibles dans notre centre : 70 antibiotiques (dont les antiparasitaires et les antituberculeux), 14 antiviraux et 10 antifongiques. Le nombre total de NJT par 1000 JP a diminué de 904 en 2015-16 à 867 en 2018-19. Les cinq antimicrobiens utilisés le plus fréquemment et présentés en minimum / maximum de NJT par 1000 JP étaient les suivants : piperacilline-tazobactam (78/105), trimethoprim-sulfamethoxazole (74/84), ampicilline (51/69), vancomycine (53/68) et cefotaxime (55/58). Pendant la même période, les unités de soins qui faisaient la plus grande utilisation d’antimirobiens (exprimée en minimum / maximum de NJT par 1000 JP) étaient hématologie-oncologie (2529/2723), pédiatrie (1006/1408) et soins intensifs pédiatriques (1328/1717). Conclusions : Cette étude démontre une consommation stable d’antimicrobiens entre 2015-16 et 2018-19 dans un centre hospitalier universitaire mère-enfant canadien. Malgré le fait que la consommation entre les groupes d’antimicrobiens (antibiotiques, antiviraux, antifongiques) était stable, on a constaté d’importantes variations concernant certains médicaments individuels. Plusieurs facteurs peuvent expliquer cette variation, notamment des ruptures d’approvisionnement, des changements de pratique et des changements dans la prévalence d’infections. La surveillance de la consommation des antimicrobiens est une partie essentielle de tout programme d’antibiogouvernance.

scholarly journals Implementation and Evaluation of Antimicrobial Stewardship Program in Medical ICU in Cairo University Specialized Pediatric Hospital

2020 ◽  
Vol 8 (B) ◽  
pp. 716-722
Author(s):  
Mona Abdel Aziz Wassef ◽  
Amal Mohamed Sayed ◽  
Heba Sherif Abdel Aziz ◽  
Bassant Meligy ◽  
Mona Mohiedden Abdel Halim
Keyword(s):  
Length Of Stay ◽  
Clinical Outcome ◽  
Hospital Stay ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Stewardship Program ◽  
Pediatric Hospital ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Antibiotics Use ◽  
Length Of Therapy

BACKGROUND: High antibiotics use in pediatric intensive care units (PICUs) results in antibiotic resistance, the unfavorable clinical outcome of patients, increase the length of hospital stay, and drug expenditure. AIM: This study aimed at setting clinical guidelines customized according to local diseases epidemiology and local cumulative antimicrobial susceptibility, implementing, and evaluating the Antimicrobial Stewardship Program (ASP) effect in; optimizing antibiotics use, decreasing antibiotics expenditure, decreasing the length of therapy and stay in hospitals, and improving patients’ clinical outcomes. METHODS: A prospective study was conducted at a PICU of the Specialized Pediatric Hospital, Cairo University. Facility-specific guidelines were set, and the ASP was implemented and evaluated through the following indicators; adherence of physicians to the guidelines, ASP recommendations and acceptance of them, the rate of mortality, length of stay, drug costs, antibiotics days of therapy, and length of therapy. RESULTS: The adherence to the ASP guidelines was positively correlated to the patient’s clinical outcome (p = 0.018). In post ASP period, the average length of stay and the length of therapy significantly decreased (p = 0.047, p = 0.001, respectively), the rate of adherence to the ASP guidelines was (91.9%), the days of therapy of ceftazidime, ceftriaxone, and amikacin decreased significantly (p = 0.041, p = 0.026, p = 0.004, respectively). The most common ASP recommendation was drug schedule/frequency change (26.1%) followed by drug discontinuation (17.8%) and the most common antibiotic required intervention was ampicillin-sulbactam (21.6%). CONCLUSION: The antimicrobial stewardship is very effective in optimizing antibiotics use and leads to favorable outcomes in terms of decreased length of therapy, hospital stay, and mortality rate of the patients.

scholarly journals Care Facilitator Cart: a product technology built with nursing professionals

2020 ◽  
Vol 73 (suppl 6) ◽  
Author(s):  
Elisabeta Albertina Nietsche ◽  
Liege Gonçalves Cassenote ◽  
Cléton Salbego ◽  
Tiérle Kosloski Ramos ◽  
Nara Marilene Oliveira Girardon Perlini ◽  
...  
Keyword(s):  
Participant Observation ◽  
University Hospital ◽  
Medical Clinic ◽  
Rio Grande Do Sul ◽  
Methodological Research ◽  
Business Model Canvas ◽  
Product Technology ◽  
Nursing Professionals ◽  
Surgical Clinic ◽  
Safe Care

ABSTRACT Objectives: to describe a product technology building (Care Facilitator Cart) with nursing professionals working in surgical clinic and medical clinic at a university hospital in Rio Grande do Sul. Methods: a qualitative, methodological research guided by the Business Model Canvas, with 52 nursing professionals, through non-participant observation and brainstorming, carried out from April to October 2016. The records were analyzed through content analysis. Results: the product was built with two floors, a retractable table, a removable compartment for disposal and separation of infectious, recyclable and sharps waste, lid opening by a sensor, among others. Final Considerations: the invention unleashes possibilities to be an innovative instrument aimed at performing safe care in hospital institutions, with a view to reducing professional wear, rework, infection control, and effectiveness of procedures and techniques.

scholarly journals 45. Significantly Decreased Broad Spectrum Antimicrobial Use (Carbapenems And Fluoroquinolones) with Implementation of Antibiotic Stewardship Program (ASP) and Pharmacist Interventions

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S144-S144
Author(s):  
Ashlesha Kaushik ◽  
Sandeep Gupta ◽  
Corey Thieman ◽  
Michael Padomek
Keyword(s):  
Care Center ◽  
Tertiary Care ◽  
Cost Savings ◽  
Intervention Period ◽  
Hospital Units ◽  
Carbapenem Resistant ◽  
Pharmacist Interventions ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Discontinue Therapy

Abstract Background According to the WHO, carbapenems and fluoroquinolones (FQ) should be key targets for stewardship programs. Methods A multifaceted antimicrobial stewardship program (ASP) was implemented in July 2018 at a 160-bed tertiary care center serving the tristate area of Iowa, South Dakota and Nebraska. Carbapenem and FQ use during pre-ASP intervention period (P1: 12/01/2016-6/30/2018) was compared with ASP-intervention period (P2: 07/01/2018-1/31/2020). ASP interventions included: stewardship educational pearls in monthly physician newsletters; educational posters in provider areas; suppression of carbapenem results on microbiology susceptibility reports; provider counseling for appropriate ordering; creating carbapenem alternative alert in order-entry software; removing FQ and carbapenems from order-sets where appropriate; default antibiotic stop dates changed to 7 days in EMR (Epic); adverse effects warning fired as an alert when ordering FQ. Pharmacist interventions: procalcitonin protocol allowing pharmacists to reorder follow-up procalcitonin and make recommendations to discontinue therapy where appropriate. Results FQ use declined significantly from a mean of 133 days of therapy (DOT) per 1000 days to 46 DOT per 1000 patient days during P2 (p&lt; 0.0001). Carbapenem use declined significantly from a mean of 65 DOT per 1000 patient days during P1 to 9 DOT per 1000 patient days in P2 (p&lt; 0.001). All hospital units showed a significant decrease in use, with intensive care units (ICUs) noting 56% reduction (p&lt; 0.00001) during P2 compared to P1. During P2, 55% of orders for carbapenems and FQ during P2 were found to be appropriate compared to 39% in P1 (p&lt; 0.0001). Sensitivity profile for Pseudomonas aeruginosa improved from 86% carbapenem sensitivity during P1 to 89% in P2 and no Carbapenem-Resistant Enterobacteriaceae isolates were identified during the study period; FQ sensitivity remained stable at 81%. Cost savings of &757 per 1000 patient days were recognized in P2 as a result of reduced use. Conclusion With ASP and pharmacist interventions, a significant decline in total utilization of carbapenem and FQ, considerable cost savings and an increase in proportion of appropriate use were observed. Disclosures All Authors: No reported disclosures

scholarly journals Application of Monitoring Indicators in The Management of Hospital Use of Antimicrobials

2020 ◽  
Author(s):  
Ravena Silva ◽  
Ravena Silva ◽  
Quesia Santos ◽  
Alessandra Batista ◽  
Matheus Melo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Management Program ◽  
Health Surveillance ◽  
Hospital Environment ◽  
Antimicrobial Use ◽  
Medical Clinic ◽  
National Data ◽  
Stewardship Program ◽  
Great Relevance ◽  
Surgical Clinic

Abstract Background It is described in the literature that between 25–50% of antimicrobial prescriptions, in the hospital environment, are unnecessary or inadequate. The National Health Surveillance Agency launched the “Brazil Stewardship Project”, in order to assess the national panorama of antimicrobial use management programs, therefore, it is expected that managers will be encouraged to implement the antimicrobial use management program, with publication of the results, enabling the confrontation of national data.Methods This is an observational, analytical and prospective study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology (PNE/INF) and pediatrics (PED).Results During the study period, a total of 11,628 patient-days were followed up and an average of 58.3% of patients were exposed to some antimicrobial. In 376 days, for every 1,000 days of hospitalization, patients were receiving antimicrobial therapy (LOT = 376/1000pd). The calculated global DOT / LOT ratio showed that each patient received an average of 1.5 antimicrobials during hospital stay.Conclusions The indicators addressed in this study proved to be of great relevance for obtaining data regarding the use of antimicrobials, contributing to the initiatives to be taken by the Stewardship program. This study is expected to encourage other hospitals to monitor the use of antimicrobials, allowing comparison of data.

scholarly journals Occurrence of pressure injury in patients hospitalized in a school hospital

2018 ◽  
Author(s):  
Juliana Barbosa ◽  
Geraldo Salomé
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Emergency Room ◽  
University Hospital ◽  
Medical Clinic ◽  
Moderate Risk ◽  
Cross Sectional ◽  
Braden Scale ◽  
Pressure Injury ◽  
Surgical Clinic

Objective: to evaluate the occurrence and risk factors for the development of pressure injury (PI) in patients admitted in medical and surgical clinics and in observation at the emergency room of a university hospital. Methods: Cross-sectional, descriptive-exploratory, epidemiological study. Patients were assessed by physical examination three times a week for two consecutive months between June and November 2016. Results: the frequency of PI was 29% (n = 9) in the medical clinic, 16% (n = 4) in the surgical clinic and 53.8% (n = 7) in observation at the emergency room. According to the Braden scale, seven (30.4%) patients in the medical clinic presented high risk and two (25%) moderate risk; three (27.3%) patients from the surgical clinic presented a high risk and one (7.1%) moderate risk; and seven (58.3%) patients in observation at the emergency room were high risk. The risk factors associated with the participants who developed PI were: restriction in the bed, use of catheters or devices, vasoactive drug, diaper, mechanical ventilation, sedatives, unconsciousness, food fasting and hospitalization time over 10 days. Conclusion: there was a high frequency of PI in the medical and surgical clinics and in observation at the emergency room. Most patients were high risk for developing PI.

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