The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities.

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  • Additional Information
    • Source:
      Publisher: Cambridge University Press Country of Publication: United States NLM ID: 8804099 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1559-6834 (Electronic) Linking ISSN: 0899823X NLM ISO Abbreviation: Infect Control Hosp Epidemiol Subsets: MEDLINE
    • Publication Information:
      Publication: Jan. 2015- : Cambridge : Cambridge University Press
      Original Publication: [Thorofare, N.J. ] : SLACK Inc., c1988-
    • Subject Terms:
      Hemodialysis Units, Hospital*; Anti-Bacterial Agents/*therapeutic use ; Antimicrobial Stewardship/*organization & administration ; Bacterial Infections/*drug therapy ; Drug Utilization/*standards; Aged ; Bacterial Infections/prevention & control ; Drug Utilization/statistics & numerical data ; Female ; Humans ; Interrupted Time Series Analysis ; Male ; Middle Aged ; New Jersey ; Outpatients ; Renal Dialysis
    • Abstract:
      Background: Antimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%-35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.
      Objective: To quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.
      Results: Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.
      Conclusions: Within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.
    • Grant Information:
      R18 HS021666 United States HS AHRQ HHS; K24 AI119158 United States AI NIAID NIH HHS
    • Accession Number:
      0 (Anti-Bacterial Agents)
    • Publication Date:
      Date Created: 20180927 Date Completed: 20190909 Latest Revision: 20190909
    • Publication Date:
      20221213
    • Accession Number:
      10.1017/ice.2018.237
    • Accession Number:
      30253815