Cargando…

Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study

BACKGROUND: Given global issues with antimicrobial resistance and a need to optimize antimicrobial usage, antimicrobial stewardship (AS) programs are becoming a necessary component of hospitals and are increasingly mandated worldwide. It is important to evaluate these programs with respect to releva...

Descripción completa

Detalles Bibliográficos
Autores principales: Rennert-May, E., Conly, J., Chen, G., Dalton, B.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534861/
https://www.ncbi.nlm.nih.gov/pubmed/31149332
http://dx.doi.org/10.1186/s13756-019-0542-2
_version_ 1783421495128621056
author Rennert-May, E.
Conly, J.
Chen, G.
Dalton, B.
author_facet Rennert-May, E.
Conly, J.
Chen, G.
Dalton, B.
author_sort Rennert-May, E.
collection PubMed
description BACKGROUND: Given global issues with antimicrobial resistance and a need to optimize antimicrobial usage, antimicrobial stewardship (AS) programs are becoming a necessary component of hospitals and are increasingly mandated worldwide. It is important to evaluate these programs with respect to relevant clinical outcomes. METHODS: An AS program with a prospective audit and feedback service (PAF) of antimicrobial usage was initiated May 11, 2015 at our tertiary care center, for patients admitted under the hospitalist service. We conducted a retrospective matched cohort study. Patients assessed during the first year of this PAF were considered to be the exposed cohort and were compared to unexposed controls matched on gender, age and infectious diagnosis selected from patients who had been admitted under the hospitalist service prior to initiation of the PAF. Descriptive analysis was completed and a multivariate conditional logistic regression was performed to analyze differences between the exposed and control groups in terms of a composite endpoint of 30 day mortality, 30 day post hospital discharge mortality and hospital re-admission. RESULTS: A total of 348 patients were assessed and received PAF suggestions during the first year were compared to 827 matched control patients who did not receive PAF suggestions. Of 707 PAF suggestions made, the most common was to stop an antimicrobial (23%). A significantly lower (20.7% vs 28.8%, p = 0.008) composite endpoint was found in the group exposed to the PAF (OR 0.71 95%CI 0.52–0.97). This difference persisted when only patients with PAF suggestions that were completely or partially accepted were considered (18.6% vs 28.5%, p = 0.001) but was no longer significant when patients who had their ASP suggestions declined were analyzed (30.2% vs 26.7%, p = 0.610). CONCLUSIONS: In this retrospective cohort study, patient admissions in which PAF recommendations were accepted had better clinical outcomes than matched historical controls managed in the absence of this AS service.
format Online
Article
Text
id pubmed-6534861
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-65348612019-05-30 Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study Rennert-May, E. Conly, J. Chen, G. Dalton, B. Antimicrob Resist Infect Control Research BACKGROUND: Given global issues with antimicrobial resistance and a need to optimize antimicrobial usage, antimicrobial stewardship (AS) programs are becoming a necessary component of hospitals and are increasingly mandated worldwide. It is important to evaluate these programs with respect to relevant clinical outcomes. METHODS: An AS program with a prospective audit and feedback service (PAF) of antimicrobial usage was initiated May 11, 2015 at our tertiary care center, for patients admitted under the hospitalist service. We conducted a retrospective matched cohort study. Patients assessed during the first year of this PAF were considered to be the exposed cohort and were compared to unexposed controls matched on gender, age and infectious diagnosis selected from patients who had been admitted under the hospitalist service prior to initiation of the PAF. Descriptive analysis was completed and a multivariate conditional logistic regression was performed to analyze differences between the exposed and control groups in terms of a composite endpoint of 30 day mortality, 30 day post hospital discharge mortality and hospital re-admission. RESULTS: A total of 348 patients were assessed and received PAF suggestions during the first year were compared to 827 matched control patients who did not receive PAF suggestions. Of 707 PAF suggestions made, the most common was to stop an antimicrobial (23%). A significantly lower (20.7% vs 28.8%, p = 0.008) composite endpoint was found in the group exposed to the PAF (OR 0.71 95%CI 0.52–0.97). This difference persisted when only patients with PAF suggestions that were completely or partially accepted were considered (18.6% vs 28.5%, p = 0.001) but was no longer significant when patients who had their ASP suggestions declined were analyzed (30.2% vs 26.7%, p = 0.610). CONCLUSIONS: In this retrospective cohort study, patient admissions in which PAF recommendations were accepted had better clinical outcomes than matched historical controls managed in the absence of this AS service. BioMed Central 2019-05-24 /pmc/articles/PMC6534861/ /pubmed/31149332 http://dx.doi.org/10.1186/s13756-019-0542-2 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Rennert-May, E.
Conly, J.
Chen, G.
Dalton, B.
Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
title Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
title_full Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
title_fullStr Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
title_full_unstemmed Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
title_short Clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
title_sort clinical outcomes in patients admitted to a hospitalist service exposed to an antimicrobial stewardship program – a retrospective matched cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6534861/
https://www.ncbi.nlm.nih.gov/pubmed/31149332
http://dx.doi.org/10.1186/s13756-019-0542-2
work_keys_str_mv AT rennertmaye clinicaloutcomesinpatientsadmittedtoahospitalistserviceexposedtoanantimicrobialstewardshipprogramaretrospectivematchedcohortstudy
AT conlyj clinicaloutcomesinpatientsadmittedtoahospitalistserviceexposedtoanantimicrobialstewardshipprogramaretrospectivematchedcohortstudy
AT cheng clinicaloutcomesinpatientsadmittedtoahospitalistserviceexposedtoanantimicrobialstewardshipprogramaretrospectivematchedcohortstudy
AT daltonb clinicaloutcomesinpatientsadmittedtoahospitalistserviceexposedtoanantimicrobialstewardshipprogramaretrospectivematchedcohortstudy