Antimicrobial stewardship in Australian hospitals: how does compliance with antimicrobial stewardship standards compare across key hospital classifications?
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ABSTRACT: Background
There is little information on the prevalence and type of antimicrobial stewardship (AMS) activities that are currently occurring in Australian hospitals.Objectives
To determine what AMS activities are currently occurring in Australian hospitals, identify gaps in compliance with the Australian Commission on Safety and Quality in Health Care (ACSQHC) standards and determine perceived barriers and enablers for implementing AMS programmes.Methods
A cross-sectional survey open to all Australian hospitals, conducted online and available to hospitals between November 2016 and July 2017.Results
Responses were received from 254 hospitals. Compliance with ACSQHC AMS essential activities was high, except for essential activity 3 (post-prescription reviews), which was conducted by only 39% of respondent hospitals. Importantly, compliance varied by hospital remoteness classification for all activities except essential activity 1 (availability and endorsement of guidelines) and additional activity 4 (publishing antimicrobial susceptibility data annually), with major city hospitals having the highest compliance across all activities. The three most frequently reported barriers to implementing AMS programmes were a lack of training and education, lack of pharmacy resources and a lack of willingness from medical officers to change.Conclusions
Due to low response rates from certain hospital groups, the survey results are not generalizable to all Australia hospitals. This survey has identified that several gaps in compliance still exist and outlines the need to address lower AMS compliance in hospitals located outside major cities. The key barriers and enablers for AMS programme implementation identified should be used to inform future strategies.
SUBMITTER: Jones R
PROVIDER: S-EPMC8210182 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundHospital antimicrobial stewardship (AMS) programmes are multidisciplinary initiatives to optimize antimicrobial use. Most hospitals depend on time-consuming manual audits to monitor clinicians' prescribing. But much of the information needed could be sourced from electronic health records (EHRs).ObjectivesTo develop an informatics methodology to analyse characteristics of hospital AMS practice using routine electronic prescribing and laboratory records.MethodsFeasibility study using electronic prescribing, laboratory and clinical coding records from adult patients admitted to six specialities at Queen Elizabeth Hospital, Birmingham, UK (September 2017-August 2018). The study involved: (i) a review of AMS standards of care; (ii) their translation into concepts measurable from commonly available EHRs; and (iii) a pilot application in an EHR cohort study (n = 61679 admissions).ResultsWe developed data modelling methods to characterize antimicrobial use (antimicrobial therapy episode linkage methods, therapy table, therapy changes). Prescriptions were linked into antimicrobial therapy episodes (mean 2.4 prescriptions/episode; mean length of therapy 5.8 days), enabling several actionable findings. For example, 22% of therapy episodes for low-severity community-acquired pneumonia were congruent with prescribing guidelines, with a tendency to use broader-spectrum antibiotics. Analysis of therapy changes revealed IV to oral therapy switching was delayed by an average 3.6 days (95% CI: 3.4-3.7). Microbial cultures were performed prior to treatment initiation in just 22% of antibacterial prescriptions. The proposed methods enabled fine-grained monitoring of AMS practice down to specialities, wards and individual clinical teams by case mix, enabling more meaningful peer comparison.ConclusionsIt is feasible to use hospital EHRs to construct rapid, meaningful measures of prescribing quality with potential to support quality improvement interventions (audit/feedback to prescribers), engagement with front-line clinicians on optimizing prescribing, and AMS impact evaluation studies.
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Project description:Antimicrobial resistance is increasing; however, antimicrobial drug development is slowing. Now more than ever before, antimicrobial stewardship is of the utmost importance as a way to optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. This review describes the why, what, who, how, when, and where of antimicrobial stewardship. Techniques of stewardship are summarized, and a plan for implementation of a stewardship program is outlined.
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Project description:BackgroundThe Infectious Diseases Society of America recommends pneumococcal urinary antigen testing (UAT) when identifying pneumococcal infection would allow for antibiotic de-escalation. However, the frequencies of UAT and subsequent antibiotic de-escalation are unknown.MethodsWe conducted a retrospective cohort study of adult patients admitted with community-acquired or healthcare-associated pneumonia to 170 US hospitals in the Premier database from 2010 to 2015, to describe variation in UAT use, associations of UAT results with antibiotic de-escalation, and associations of de-escalation with outcomes.ResultsAmong 159 894 eligible admissions, 24 757 (15.5%) included UAT performed (18.4% of intensive care unit [ICU] and 15.3% of non-ICU patients). Among hospitals with ≥100 eligible patients, UAT proportions ranged from 0% to 69%. Compared to patients with negative UAT, 7.2% with positive UAT more often had a positive Streptococcus pneumoniae culture (25.4% vs 1.9%, P < .001) and less often had resistant bacteria (5.2% vs 6.8%, P < .05). Of patients initially treated with broad-spectrum antibiotics, most were still receiving broad-spectrum therapy 3 days later, but UAT-positive patients more often had coverage narrowed (38.4% vs 17.0% UAT-negative and 14.6% untested patients, P < .001). Hospital rate of UAT was strongly correlated with de-escalation following a positive test. Only 3 patients de-escalated after a positive UAT result were subsequently admitted to ICU.ConclusionsUAT is not ordered routinely in pneumonia, even in ICU. A positive UAT result was associated with less frequent resistant organisms, but usually did not lead to antibiotic de-escalation. Increasing UAT and narrowing therapy after a positive UAT result are opportunities for improved antimicrobial stewardship.
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