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Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship

OBJECTIVE: The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory sy...

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Autores principales: Quintos-Alagheband, Maria Lyn, Noyola, Estela, Makvana, Sejal, El-Chaar, Gladys, Wang, Shan, Calixte, Rose, Krilov, Leonard R.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132889/
https://www.ncbi.nlm.nih.gov/pubmed/30229182
http://dx.doi.org/10.1097/pq9.0000000000000046
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author Quintos-Alagheband, Maria Lyn
Noyola, Estela
Makvana, Sejal
El-Chaar, Gladys
Wang, Shan
Calixte, Rose
Krilov, Leonard R.
author_facet Quintos-Alagheband, Maria Lyn
Noyola, Estela
Makvana, Sejal
El-Chaar, Gladys
Wang, Shan
Calixte, Rose
Krilov, Leonard R.
author_sort Quintos-Alagheband, Maria Lyn
collection PubMed
description OBJECTIVE: The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory syncytial virus (RSV) infections. This virus is the most common cause of bronchiolitis during childhood. METHODS: Baseline data from the 2011–2012 RSV season showed that 56.2% of our RSV-positive patients received antibiotics. To decrease inappropriate antibiotic use in RSV infections, we established an antimicrobial stewardship program (ASP). This process improvement initiative aimed to decrease exposure to antibiotics and days of antibiotic therapy per 1,000 patient days (DOT/1000PD) in hospitalized RSV-positive patients by 25%. Key drivers included building health-care knowledge, proactive interventions using prospective audit and feedback, emergency department engagement, and performance dashboards. RESULTS: We included a total of 290 children in the final analysis. After full implementation of the ASP, there was a significant reduction of antibiotic exposure from 56.2% to 30.9% (P < 0.001), an absolute reduction of 25% and a relative reduction of 45%. There was also a significant decrease in DOT/1000PD from 432.7 to 268.1 days (P = 0.017). This change represents a reduction of 164.6 DOT/1000PD from baseline after full ASP implementation. CONCLUSION: Despite the lack of a unified hospitalist group in our institution, we were successful in reducing inappropriate antibiotic use by focusing on standardizing care among different private pediatricians in the community. A multifaceted strategy and well-designed quality improvement methodology led to a sustained reduction in antibiotic use.
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spelling pubmed-61328892018-09-18 Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship Quintos-Alagheband, Maria Lyn Noyola, Estela Makvana, Sejal El-Chaar, Gladys Wang, Shan Calixte, Rose Krilov, Leonard R. Pediatr Qual Saf Individual QI Projects from Single Institutions OBJECTIVE: The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory syncytial virus (RSV) infections. This virus is the most common cause of bronchiolitis during childhood. METHODS: Baseline data from the 2011–2012 RSV season showed that 56.2% of our RSV-positive patients received antibiotics. To decrease inappropriate antibiotic use in RSV infections, we established an antimicrobial stewardship program (ASP). This process improvement initiative aimed to decrease exposure to antibiotics and days of antibiotic therapy per 1,000 patient days (DOT/1000PD) in hospitalized RSV-positive patients by 25%. Key drivers included building health-care knowledge, proactive interventions using prospective audit and feedback, emergency department engagement, and performance dashboards. RESULTS: We included a total of 290 children in the final analysis. After full implementation of the ASP, there was a significant reduction of antibiotic exposure from 56.2% to 30.9% (P < 0.001), an absolute reduction of 25% and a relative reduction of 45%. There was also a significant decrease in DOT/1000PD from 432.7 to 268.1 days (P = 0.017). This change represents a reduction of 164.6 DOT/1000PD from baseline after full ASP implementation. CONCLUSION: Despite the lack of a unified hospitalist group in our institution, we were successful in reducing inappropriate antibiotic use by focusing on standardizing care among different private pediatricians in the community. A multifaceted strategy and well-designed quality improvement methodology led to a sustained reduction in antibiotic use. Wolters Kluwer Health 2017-12-01 /pmc/articles/PMC6132889/ /pubmed/30229182 http://dx.doi.org/10.1097/pq9.0000000000000046 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CC-BY-NC-ND) (https://creativecommons.org/licenses/by-nc-nd/4.0/) , where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.
spellingShingle Individual QI Projects from Single Institutions
Quintos-Alagheband, Maria Lyn
Noyola, Estela
Makvana, Sejal
El-Chaar, Gladys
Wang, Shan
Calixte, Rose
Krilov, Leonard R.
Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
title Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
title_full Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
title_fullStr Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
title_full_unstemmed Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
title_short Reducing Antibiotic Use in Respiratory Syncytial Virus—A Quality Improvement Approach to Antimicrobial Stewardship
title_sort reducing antibiotic use in respiratory syncytial virus—a quality improvement approach to antimicrobial stewardship
topic Individual QI Projects from Single Institutions
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132889/
https://www.ncbi.nlm.nih.gov/pubmed/30229182
http://dx.doi.org/10.1097/pq9.0000000000000046
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