Hostname: page-component-8448b6f56d-gtxcr Total loading time: 0 Render date: 2024-04-18T09:36:17.567Z Has data issue: false hasContentIssue false
  • English
  • Français

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study

Published online by Cambridge University Press:  12 June 2018

Bradley J. Langford Open the ORCID record for Bradley J. Langford [Opens in a new window] ,
Julie Hui-Chih Wu ,
Kevin A. Brown ,
Xuesong Wang ,
Valerie Leung ,
Charlie Tan ,
Gary Garber  and
Nick Daneman
Bradley J. Langford*
Affiliation:
Public Health Ontario, Toronto, Canada St Joseph’s Health Center, Toronto, Canada
Julie Hui-Chih Wu
Affiliation:
Public Health Ontario, Toronto, Canada
Kevin A. Brown
Affiliation:
Public Health Ontario, Toronto, Canada University of Toronto, Toronto, Canada
Xuesong Wang
Affiliation:
Institute for Clinical Evaluative Sciences, Toronto, Canada
Valerie Leung
Affiliation:
Public Health Ontario, Toronto, Canada
Charlie Tan
Affiliation:
London Health Sciences Center, London, Canada
Gary Garber
Affiliation:
Public Health Ontario, Toronto, Canada University of Toronto, Toronto, Canada University of Ottawa, Ottawa, Canada Ottawa Hospital Research Institute, Ottawa, Canada
Nick Daneman
Affiliation:
Public Health Ontario, Toronto, Canada University of Toronto, Toronto, Canada Institute for Clinical Evaluative Sciences, Toronto, Canada Division of Infectious Diseases, Sunnybrook Health Sciences Center, Toronto, Canada Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Canada
*
Author for correspondence: Bradley J. Langford, Public Health Ontario, 480 University Ave, Toronto, ON, Canada, M5G 1V2. E-mail: Bradley.langford@oahpp.ca
Get access Rights & Permissions [Opens in a new window]

Abstract

Objectives

Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities.

Design

Observational study of acute-care hospitals in Ontario, Canada

Methods

A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest.

Results

Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75–0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67–0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64–0·99) were associated with lower risk-adjusted antibiotic use.

Conclusions

Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 941 - 946
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Antimicrobial resistance global report on surveillance: 2014 summary. World Health Organization website. http://apps.who.int/iris/bitstream/10665/112647/1/WHO_HSE_PED_AIP_2014.2_eng.pdf. Published 2014. Accessed December 19, 2017.Google Scholar
2. Dellit, TH, Owens, RC, McGowan, JE, et al. Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Clin Infect Dis 2007;44:159–177.Google Scholar
3. Barlam, TF, Cosgrove, SE, Abbo, LM, et al. Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 2016;62:e51–e77.Google Scholar
4. US Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.html. Published 2015. Accessed February 24, 2018.Google Scholar
5. Tan, C, Vermeulen, M, Wang, X, Zvonar, R, Garber, G, Daneman, N. Variability in antibiotic use across Ontario acute care hospitals. J Antimicrob Chemother 2016;72:554–563.Google Scholar
6. MacDougall, C, Polk, RE. Variability in rates of use of antibacterials among 130 US hospitals and risk-adjustment models for interhospital comparison. Infect Control Hosp Epidemiol 2008;29:203–211.Google Scholar
7. World Health Organization Collaborating Center for Drug Statistics Methodology. ATC DDD Index 2018. https://www.whocc.no/atc_ddd_index/. Published 2014. Accessed February 24, 2018.Google Scholar
8. Tan, C, Ritchie, M, Alldred, J, Daneman, N. Validating hospital antibiotic purchasing data as a metric of inpatient antibiotic use. J Antimicrob Chemother 2015;71:547–553.Google Scholar
9. Pakyz, AL, Moczygemba, LR, Wang, H, Stevens, MP, Edmond, MB. An evaluation of the association between an antimicrobial stewardship score and antimicrobial usage. J Antimicrob Chemother 2015;70:1588–1591.Google Scholar
10. Amadeo, B, Dumartin, C, Parneix, P, Fourrier-Réglat, A, Rogues, AM. Relationship between antibiotic consumption and antibiotic policy: an adjusted analysis in the French healthcare system. J Antimicrob Chemother 2010;66:434–442.Google Scholar
11. Cosgrove, SE, Seo, SK, Bolon, MK, et al. Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: a multicenter intervention. Infect Control Hosp Epidemiol 2012;33:374–380.Google Scholar
12. Davey, P, Marwick, CA, Scott, CL, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2017;2:CD003543.Google Scholar
13. Elligsen, M, Walker, SA, Pinto, R, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients a controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354–361.Google Scholar
14. Newland, JG, Stach, LM, De Lurgio, SA, et al. Impact of a prospective-audit-with-feedback antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc 2012;1:179–186.Google Scholar
15. Carratalà, J, Garcia-Vidal, C, Ortega, L, et al. Effect of a 3-step critical pathway to reduce duration of intravenous antibiotic therapy and length of stay in community-acquired pneumonia: a randomized controlled trial. Arch Intern Med 2012;172:922–928.Google Scholar