Dataset Information

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage.

ABSTRACT:

Objectives

To determine whether an antimicrobial stewardship 'intensity' score predicts hospital antimicrobial usage.

Methods

An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy programmes, de-escalation of therapy, antimicrobial order forms and dose optimization). Multiple regression analyses were used to assess whether the composite score and also the categories were associated with either total or antimicrobial stewardship programme-target antimicrobial use as measured in days of therapy.

Results

The mean antimicrobial stewardship programme score was 55 (SD 21); the total composite score was not significantly associated with total or target antimicrobial use [estimate -0.49 (95% CI -2.30 to 0.89)], while the category strategies was significantly and negatively associated with target antimicrobial use [-5.91 (95% CI -9.51 to -2.31)].

Conclusions

The strategy component of a score developed to measure the intensity of antimicrobial stewardship was associated with the amount of antimicrobials used. Thus, the number and types of strategies employed by antimicrobial stewardship programmes may be of particular importance in programme effectiveness.

SUBMITTER: Pakyz AL

PROVIDER: S-EPMC4481682 | biostudies-literature | 2015 May

REPOSITORIES: biostudies-literature

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Publications

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage.

Pakyz Amy L AL Moczygemba Leticia R LR Wang Hui H Stevens Michael P MP Edmond Michael B MB

The Journal of antimicrobial chemotherapy 20150121 5

<h4>Objectives</h4>To determine whether an antimicrobial stewardship 'intensity' score predicts hospital antimicrobial usage.<h4>Methods</h4>An antimicrobial stewardship score for 44 academic medical centres was developed that comprised two main categories: resources (antimicrobial stewardship programme personnel and automated surveillance software) and strategies (preauthorization, audit with intervention and feedback, education, guidelines and clinical pathways, parenteral to oral therapy prog ...[more]

PMID: 25614043

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Project description:ImportanceAntimicrobial resistance continues to spread rapidly at a global scale. Little evidence exists on the association of antimicrobial stewardship programs (ASPs) with the consumption of antibiotics across health care and income settings.ObjectiveTo synthesize current evidence regarding the association between antimicrobial stewardship programs and the consumption of antibiotics globally.Data sourcesPubMed, Web of Science, and Scopus databases were searched from August 1, 2010, to Aug 1, 2020. Additional studies from the bibliography sections of previous systematic reviews were included.Study selectionOriginal studies of the association of ASPs with antimicrobial consumption across health care and income settings. Animal and environmental studies were excluded.Data extraction and synthesisFollowing the Preferred Reporting Items in Systematic Reviews and Meta-Analyses guideline, the pooled association of targeted ASPs with antimicrobial consumption was measured using multilevel random-effects models. The Effective Public Health Practice Project quality assessment tool was used to assess study quality.Main outcomes and measuresThe main outcome measures were proportion of patients receiving an antibiotic prescription and defined daily doses per 100 patient-days.ResultsOverall, 52 studies (with 1 794 889 participants) measured the association between ASPs and antimicrobial consumption and were included, with 40 studies conducted in high-income countries and 12 in low- and middle-income countries (LMICs). ASPs were associated with a 10% (95% CI, 4%-15%) reduction in antibiotic prescriptions and a 28% reduction in antibiotic consumption (rate ratio, 0.72; 95% CI, 0.56-0.92). ASPs were also associated with a 21% (95% CI, 5%-36%) reduction in antibiotic consumption in pediatric hospitals and a 28% reduction in World Health Organization watch groups antibiotics (rate ratio, 0.72; 95% CI, 0.56-0.92).Conclusions and relevanceIn this systematic review and meta-analysis, ASPs appeared to be effective in reducing antibiotic consumption in both hospital and nonhospital settings. Impact assessment of ASPs in resource-limited settings remains scarce; further research is needed on how to best achieve reductions in antibiotic use in LMICs.

Project description:BackgroundAntimicrobial usage in food producing animals is of major concern. A clear link between the extent of use and the development of antimicrobial resistance has already been demonstrated. To evaluate strategies that may reduce the antimicrobial usage while assuring pig health and welfare, it requires profound knowledge of factors that are associated with antimicrobial usage. Data on biosecurity and herd management practices are important parameters to identify risk factors which are related to a higher antimicrobial usage. To investigate between-farm variations of high and low usage the treatment incidence (TI) per age group in 60 German farrow-to-finish herds was qualitatively and quantitatively analysed and linked to biosecurity measures, and herd management characteristics.ResultsWeaned pigs received most of the treatments (median TI?=?487.6), followed by suckling pigs (median TI?=?138.9). Suckling pigs were treated with critically important antimicrobials (3rd and 4th generation cephalosporines) to a remarkable extent. The number of sows present at site (p?<?0.01) and a low score for external biosecurity (p?=?0.06) were associated with a higher antimicrobial usage in pigs from birth till slaughter. Herds with a higher treatment incidence in growing pigs (TI 200?days): i) were located in a region with a high pig density (p?<?0.01), ii) had a less strict access check for visitors and personnel (p?<?0.01) and iii) scored lower in the subcategory ‘cleaning and disinfection’ (internal biosecurity) (p?<?0.01). Herds with a higher treatment incidence in breeding pigs weaned more piglets per sow and year and scored better in the internal biosecurity level (p?=?0.02).ConclusionsWith the main focus on the treatment incidence in pigs from birth till slaughter and in breeding pigs risk factors for a high usage in these age groups were identified. The level of biosecurity of a herd was associated with the amount of antimicrobials used. Therefore, the findings in this study indicate possible points of action in the reduction and prudent use of antimicrobials in Germany. The active improvement of biosecurity measures could be a promising alternative to reduce antimicrobial usage on herd level.Electronic supplementary materialThe online version of this article (10.1186/s40813-018-0106-5) contains supplementary material, which is available to authorized users.

Dataset Information

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage.

Objectives

Methods

Results

Conclusions

Publications

An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage.

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