Stuart E Bond, Adriana J Chubaty1, Suman Adhikari2,3, Spiros Miyakis4,5,6, Craig S Boutlis6, Wilfred W Yeo4,5,7, Marijka J Batterham8, Cara Dickson9, Brendan J McMullan10, Mona Mostaghim11, Samantha Li-Yan Hui12, Kate R Clezy13, Pamela Konecny3,14. 1. Department of Pharmacy, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia. 2. Department of Pharmacy, St George Hospital, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia. 3. St George Clinical School, Faculty of Medicine, University of New South Wales, Sydney, Australia. 4. School of Medicine, University of Wollongong, Wollongong, New South Wales, Australia. 5. Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia. 6. Department of Infectious Diseases, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. 7. Division of Medicine, Illawarra Shoalhaven Local Health District, Wollongong, New South Wales, Australia. 8. School of Mathematics and Applied Statistics, University of Wollongong, New South Wales, Australia. 9. Performance Unit, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia. 10. Department of Immunology and Infectious Diseases, Sydney Children's Hospital, Randwick, New South Wales, Australia. 11. Department of Pharmacy, Sydney Children's Hospital, Randwick, New South Wales, Australia. 12. Information Management Services Directorate, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia. 13. Department of Infectious Diseases, Prince of Wales Hospital, South Eastern Sydney Local Health District, Randwick, New South Wales, Australia. 14. Department of Infectious Diseases, Immunology & Sexual Health, St George Hospital, South Eastern Sydney Local Health District, Kogarah, New South Wales, Australia.
Abstract
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.
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 difficileinfection (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.
Authors: Tina M Khadem; Howard J Ergen; Heather J Salata; Christina Andrzejewski; Erin K McCreary; Rima C Abdel Massih; J Ryan Bariola Journal: Open Forum Infect Dis Date: 2022-05-09 Impact factor: 4.423
Authors: Tat Ming Ng; Shi Thong Heng; Boon Hou Chua; Li Wei Ang; Sock Hoon Tan; Hui Lin Tay; Min Yi Yap; Jason Quek; Christine B Teng; Barnaby E Young; Ray Lin; Brenda Ang; Tau Hong Lee; David C Lye Journal: JAMA Netw Open Date: 2022-05-02