Phuong-Tan Nguyen-Ha1, Denise Howrie1, Kelli Crowley1, Carol G Vetterly1, William McGhee1, Donald Berry1, Elizabeth Ferguson1, Emily Polischuk1, Maria Mori Brooks2, Jeffrey Goff1, Terri Stillwell3, Toni Darville4, Ann E Thompson5, James E Levin6, Marian G Michaels7, Michael Green8. 1. Department of Pharmacy, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania; 2. Division of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania; 3. Department of Pediatrics, University of Michigan, Ann Arbor, Michigan; 4. Department of Pediatrics, University of North Carolina School of Medicine, Chapel Hill, North Carolina; and. 5. Departments of Critical Care Medicine. 6. Surgery, and. 7. Surgery, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 8. Surgery, and Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Michael.green@chp.edu.
Abstract
BACKGROUND: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model. METHODS: The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time. RESULTS: Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change -12%) and use (-25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (-31%, P = .021) and a nonsignificant decline in drug starts (-21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively. CONCLUSIONS: This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants.
BACKGROUND: Infectious Diseases Society of America guidelines recommend that key antimicrobial stewardship program (ASP) personnel include an infectious disease (ID) physician leader and dedicated ID-trained clinical pharmacist. Limited resources prompted development of an alternative model by using ID physicians and service-based clinical pharmacists at a pediatric hospital. The aim of this study was to analyze the effectiveness and impact of this alternative ASP model. METHODS: The collaborative ASP model incorporated key strategies of education, antimicrobial restriction, day 3 audits, and practice guidelines. High-use and/or high-cost antimicrobial agents were chosen with audits targeting vancomycin, caspofungin, and meropenem. The electronic medical record was used to identify patients requiring day 3 audits and to communicate ASP recommendations. Segmented regression analyses were used to analyze quarterly antimicrobial agent prescription data for the institution and selected services over time. RESULTS: Initiation of ASP and day 3 auditing was associated with blunting of a preexisting increasing trend for caspofungin drug starts and use and a significant downward trend for vancomycin drug starts (relative change -12%) and use (-25%), with the largest reduction in critical care areas. Although meropenem use was already low due to preexisting requirements for preauthorization, a decline in drug use (-31%, P = .021) and a nonsignificant decline in drug starts (-21%, P = .067) were noted. A 3-month review of acceptance of ASP recommendations found rates of 90%, 93%, and 100% for vancomycin, caspofungin, and meropenem, respectively. CONCLUSIONS: This nontraditional ASP model significantly reduced targeted drug usage demonstrating acceptance of integration of service-based clinical pharmacists and ID consultants.
Authors: Katharina Kreitmeyr; Ulrich von Both; Alenka Pecar; Johannes P Borde; Rafael Mikolajczyk; Johannes Huebner Journal: Infection Date: 2017-04-10 Impact factor: 3.553
Authors: Matthew P Kronman; Ritu Banerjee; Jennifer Duchon; Jeffrey S Gerber; Michael D Green; Adam L Hersh; David Hyun; Holly Maples; Colleen B Nash; Sarah Parker; Sameer J Patel; Lisa Saiman; Pranita D Tamma; Jason G Newland Journal: J Pediatric Infect Dis Soc Date: 2018-08-17 Impact factor: 3.164
Authors: D Donà; E Barbieri; M Daverio; R Lundin; C Giaquinto; T Zaoutis; M Sharland Journal: Antimicrob Resist Infect Control Date: 2020-01-03 Impact factor: 4.887