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Impact of a multifaceted antimicrobial stewardship program: A front-line ownership driven quality improvement project in a large urban emergency department

  • Adam Jonathan Kaufman (a1) (a2), Janine McCready (a3) (a2) and Jeff Powis (a3) (a2)

Abstract

Background

Antibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such as Clostridium difficile (C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers.

Objective

To determine whether a FLO approach to antimicrobial stewardship in the ED can alter antimicrobial usage.

Methods

Interventions were driven by ED physicians and facilitated by Infectious Diseases Division physicians from the hospital’s ASP using FLO principles. Measured end points included antibiotic usage in the ED as measured by defined daily doses, and rates of urine culture sent from the ED.

Results

There was a step-wise significant reduction in the use of azithromycin (p=0.006), ceftriaxone (p=0.045), ciprofloxacin (p=0.034), and moxifloxacin (p=0.008). There was also a significant reduction in rates of urine cultures (p<0.001) by 2.26 urine cultures per 100 ED patient visits.

Conclusions

FLO offers a promising approach to successful implementation of an ASP in the ED. Future studies would be important to evaluate the generalizability of the FLO approach to ASP development in other EDs and to determine strategies to improve the sustainability of reductions in antimicrobial use.

Contexte

L’usage abusif des antibiotiques a favorisé l’augmentation des taux de résistance aux antimicrobiens et d’infection secondaire associée à l’utilisation des antibiotiques, par exemple les infections à Clostridium difficile. Les programmes de gestion des antimicrobiens (PGA) se montrent efficaces dans la réduction de l’utilisation de ces produits en milieu hospitalier, mais l’environnement très particulier des services des urgences (SU) se prête moins bien à une mise en œuvre réussie. La méthode Front Line Ownership (FLO) pourrait se révéler une stratégie efficace dans la mise en œuvre de PGA en milieu hospitalier grâce à une méthode itérative et à multiples facettes, menée par des fournisseurs de soins de première ligne.

Objectif

L’étude visait à déterminer si l’application de la méthode FLO dans le programme de gestion des antimicrobiens pourrait modifier l’utilisation de ces produits au SU.

Méthode

Les interventions ont été menées par les médecins d’urgence, avec l’aide d’infectiologues qui participaient au PGA de l’hôpital et qui appliquaient les principes de la méthode FLO. Les critères d’évaluation comprenaient l’utilisation des antibiotiques au SU telle qu’établie par les doses thérapeutiques quotidiennes et les taux de culture d’urine envoyée depuis le SU.

Résultats

Une réduction graduelle et significative de l’utilisation des antibiotiques a été observée en ce qui concerne l’azithromycine (p=0,006), la ceftriaxone (p=0,045), la ciprofloxacine (p=0,034) et la moxifloxacine (p=0,008). Les chercheurs ont aussi enregistré une réduction significative de 2,26 (p<0,001) du taux de culture d’urine pour 100 consultations au SU.

Conclusions

La méthode FLO offre des perspectives intéressantes quant à la mise en œuvre fructueuse d’un PGA au SU. Toutefois, il serait important de mener d’autres études afin d’évaluer la possibilité de généraliser l’application de cette méthode dans l’élaboration de PGA dans d’autres SU, et d’établir des stratégies visant à améliorer le maintien de la réduction de l’utilisation des antimicrobiens.

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Copyright

Corresponding author

Correspondence to: Dr. Adam Jonathan Kaufman, Department of Emergency Medicine, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, ON M4C 3E7; Email: adam.kaufman@utoronto.ca

References

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Keywords

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Supplementary materials

Kaufman supplementary material
Appendix A

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Supplementary materials

Kaufman supplementary material
Kaufman supplementary material 1

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Impact of a multifaceted antimicrobial stewardship program: A front-line ownership driven quality improvement project in a large urban emergency department

  • Adam Jonathan Kaufman (a1) (a2), Janine McCready (a3) (a2) and Jeff Powis (a3) (a2)

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