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A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)

BACKGROUND: ASPs continue to investigate novel ways to improve appropriate antibiotic utilization. The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. METHODS: A single-center, pre-post quasi-experimental study was conduc...

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Autores principales: Boyd, Anthony M, Nagel, Jerod, Eschenauer, Gregory, Marshall, Vincent D, Gandhi, Tejal, Chenoweth, Carol, Petty, Lindsay, McClung, Daniel, Patel, Twisha S
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630711/
http://dx.doi.org/10.1093/ofid/ofx163.1239
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author Boyd, Anthony M
Nagel, Jerod
Eschenauer, Gregory
Marshall, Vincent D
Gandhi, Tejal
Chenoweth, Carol
Petty, Lindsay
McClung, Daniel
Patel, Twisha S
author_facet Boyd, Anthony M
Nagel, Jerod
Eschenauer, Gregory
Marshall, Vincent D
Gandhi, Tejal
Chenoweth, Carol
Petty, Lindsay
McClung, Daniel
Patel, Twisha S
author_sort Boyd, Anthony M
collection PubMed
description BACKGROUND: ASPs continue to investigate novel ways to improve appropriate antibiotic utilization. The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. METHODS: A single-center, pre-post quasi-experimental study was conducted with a four-month historical control period (11/2016–2/2017) and four-month intervention period (4/2016–7/2016) to reduce the use of ceftriaxone, fluoroquinolones, and clindamycin. Clinical pharmacists were responsible for ensuring the appropriate use of these restricted antimicrobials with limited guidance by the ASP in the historical control period. The intervention was multi-faceted: ASP pharmacists provided daily coaching and feedback on use of targeted agents to the clinical pharmacists, clinical pharmacists made recommendations to optimize therapy, and in-person monthly sessions were held where a dashboard consisting of aggregated utilization data and HA-CDI rates was discussed by the ASP pharmacist. Segmented regression analysis was used to determine the significance of this intervention on the utilization of the antibiotics, measured by days of therapy (DOT) per 1000 patient-days (PD). Rates of HA-CDI were also compared between the groups. RESULTS: The use of fluoroquinolones (34.4 vs. 26.2 DOT/1000 PD; Δ -23.9%), ceftriaxone (17.7 vs.. 13.6 DOT/1000 PD; ∆ -23.2%), and clindamycin (18.7 vs.. 13.3 DOT/1000 PD; ∆ -28.9%) decreased during the intervention period. Using segmented regression analysis, a significant decreasing rate of antibiotic use of all three agents was observed during the intervention period (Table). A significant decreasing rate of HA-CDI was also seen (rate ratio (RR): 0.787, 95% CI: 0.743–0.833, P < 0.001). CONCLUSION: A multi-faceted coaching and feedback intervention targeting clinical pharmacists with substantial ASP oversight can significantly reduce inappropriate antibiotic use and HA-CDI in a large hospital. DISCLOSURES: G. Eschenauer, Merck: Grant Investigator, Research grant; V. D. Marshall, Merck: Grant Investigator, Research grant
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spelling pubmed-56307112017-11-07 A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI) Boyd, Anthony M Nagel, Jerod Eschenauer, Gregory Marshall, Vincent D Gandhi, Tejal Chenoweth, Carol Petty, Lindsay McClung, Daniel Patel, Twisha S Open Forum Infect Dis Abstracts BACKGROUND: ASPs continue to investigate novel ways to improve appropriate antibiotic utilization. The impact of an ASP-led, multi-faceted coaching and real-time feedback model directed towards clinical pharmacists was evaluated. METHODS: A single-center, pre-post quasi-experimental study was conducted with a four-month historical control period (11/2016–2/2017) and four-month intervention period (4/2016–7/2016) to reduce the use of ceftriaxone, fluoroquinolones, and clindamycin. Clinical pharmacists were responsible for ensuring the appropriate use of these restricted antimicrobials with limited guidance by the ASP in the historical control period. The intervention was multi-faceted: ASP pharmacists provided daily coaching and feedback on use of targeted agents to the clinical pharmacists, clinical pharmacists made recommendations to optimize therapy, and in-person monthly sessions were held where a dashboard consisting of aggregated utilization data and HA-CDI rates was discussed by the ASP pharmacist. Segmented regression analysis was used to determine the significance of this intervention on the utilization of the antibiotics, measured by days of therapy (DOT) per 1000 patient-days (PD). Rates of HA-CDI were also compared between the groups. RESULTS: The use of fluoroquinolones (34.4 vs. 26.2 DOT/1000 PD; Δ -23.9%), ceftriaxone (17.7 vs.. 13.6 DOT/1000 PD; ∆ -23.2%), and clindamycin (18.7 vs.. 13.3 DOT/1000 PD; ∆ -28.9%) decreased during the intervention period. Using segmented regression analysis, a significant decreasing rate of antibiotic use of all three agents was observed during the intervention period (Table). A significant decreasing rate of HA-CDI was also seen (rate ratio (RR): 0.787, 95% CI: 0.743–0.833, P < 0.001). CONCLUSION: A multi-faceted coaching and feedback intervention targeting clinical pharmacists with substantial ASP oversight can significantly reduce inappropriate antibiotic use and HA-CDI in a large hospital. DISCLOSURES: G. Eschenauer, Merck: Grant Investigator, Research grant; V. D. Marshall, Merck: Grant Investigator, Research grant Oxford University Press 2017-10-04 /pmc/articles/PMC5630711/ http://dx.doi.org/10.1093/ofid/ofx163.1239 Text en © The Author 2017. Published by Oxford University Press on behalf of Infectious Diseases Society of America. http://creativecommons.org/licenses/by-nc-nd/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Abstracts
Boyd, Anthony M
Nagel, Jerod
Eschenauer, Gregory
Marshall, Vincent D
Gandhi, Tejal
Chenoweth, Carol
Petty, Lindsay
McClung, Daniel
Patel, Twisha S
A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
title A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
title_full A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
title_fullStr A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
title_full_unstemmed A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
title_short A Multi-Faceted Antimicrobial Stewardship Program (ASP) Intervention Using Clinical Pharmacists Reduces Antibiotic Use and Hospital-Acquired Clostridium difficile Infection (HA-CDI)
title_sort multi-faceted antimicrobial stewardship program (asp) intervention using clinical pharmacists reduces antibiotic use and hospital-acquired clostridium difficile infection (ha-cdi)
topic Abstracts
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5630711/
http://dx.doi.org/10.1093/ofid/ofx163.1239
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