Sarah B Doernberg1, Lilian M Abbo2, Steven D Burdette3, Neil O Fishman4, Edward L Goodman5, Gary R Kravitz6, James E Leggett7, Rebekah W Moehring8, Jason G Newland9, Philip A Robinson10, Emily S Spivak11, Pranita D Tamma12, Henry F Chambers1. 1. Department of Internal Medicine, Division of Infectious Diseases, University of California, San Francisco. 2. Division of Infectious Diseases, University of Miami Miller School of Medicine, Florida. 3. Boonshoft School of Medicine, Wright State University, Dayton, Ohio. 4. Infectious Diseases Division, Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia. 5. Department of Internal Medicine, Texas Health Presbyterian Hospital of Dallas. 6. St Paul Infectious Disease Associates, Minnesota. 7. Providence Portland Medical Center, Oregon. 8. Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, North Carolina. 9. Division of Pediatric Infectious Diseases, Washington University, St Louis, Missouri. 10. Hoag Memorial Hospital Presbyterian, Newport Beach, California. 11. Division of Infectious Diseases, University of Utah School of Medicine, Salt Lake City. 12. Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Abstract
Background: Antibiotic stewardship programs improve clinical outcomes and patient safety and help combat antibiotic resistance. Specific guidance on resources needed to structure stewardship programs is lacking. This manuscript describes results of a survey of US stewardship programs and resultant recommendations regarding potential staffing structures in the acute care setting. Methods: A cross-sectional survey of members of 3 infectious diseases subspecialty societies actively involved in antibiotic stewardship was conducted. Survey responses were analyzed with descriptive statistics. Logistic regression models were used to investigate the relationship between stewardship program staffing levels and self-reported effectiveness and to determine which strategies mediate effectiveness. Results: Two-hundred forty-four respondents from a variety of acute care settings completed the survey. Prior authorization for select antibiotics, antibiotic reviews with prospective audit and feedback, and guideline development were common strategies. Eighty-five percent of surveyed programs demonstrated effectiveness in at least 1 outcome in the prior 2 years. Each 0.50 increase in pharmacist and physician full-time equivalent (FTE) support predicted a 1.48-fold increase in the odds of demonstrating effectiveness. The effect was mediated by the ability to perform prospective audit and feedback. Most programs noted significant barriers to success. Conclusions: Based on our survey's results, we propose an FTE-to-bed ratio that can be used as a starting point to guide discussions regarding necessary resources for antibiotic stewardship programs with executive leadership. Prospective audit and feedback should be the cornerstone of stewardship programs, and both physician leadership and pharmacists with expertise in stewardship are crucial for success.
Background: Antibiotic stewardship programs improve clinical outcomes and patient safety and help combat antibiotic resistance. Specific guidance on resources needed to structure stewardship programs is lacking. This manuscript describes results of a survey of US stewardship programs and resultant recommendations regarding potential staffing structures in the acute care setting. Methods: A cross-sectional survey of members of 3 infectious diseases subspecialty societies actively involved in antibiotic stewardship was conducted. Survey responses were analyzed with descriptive statistics. Logistic regression models were used to investigate the relationship between stewardship program staffing levels and self-reported effectiveness and to determine which strategies mediate effectiveness. Results: Two-hundred forty-four respondents from a variety of acute care settings completed the survey. Prior authorization for select antibiotics, antibiotic reviews with prospective audit and feedback, and guideline development were common strategies. Eighty-five percent of surveyed programs demonstrated effectiveness in at least 1 outcome in the prior 2 years. Each 0.50 increase in pharmacist and physician full-time equivalent (FTE) support predicted a 1.48-fold increase in the odds of demonstrating effectiveness. The effect was mediated by the ability to perform prospective audit and feedback. Most programs noted significant barriers to success. Conclusions: Based on our survey's results, we propose an FTE-to-bed ratio that can be used as a starting point to guide discussions regarding necessary resources for antibiotic stewardship programs with executive leadership. Prospective audit and feedback should be the cornerstone of stewardship programs, and both physician leadership and pharmacists with expertise in stewardship are crucial for success.
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