Hostname: page-component-586b7cd67f-rcrh6 Total loading time: 0 Render date: 2024-11-30T20:09:53.911Z Has data issue: false hasContentIssue false
  • English
  • Français

Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit

Published online by Cambridge University Press:  11 January 2016

Kirthana Beaulac ,
Silvia Corcione ,
Lauren Epstein ,
Lisa E. Davidson  and
Shira Doron
Kirthana Beaulac
Affiliation:
Department of Pharmacy, Tufts Medical Center, Boston, Massachusetts
Silvia Corcione
Affiliation:
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, Italy
Lauren Epstein
Affiliation:
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
Lisa E. Davidson
Affiliation:
Division of Infectious Diseases, Carolinas Medical Center, Charlotte, North Carolina
Shira Doron*
Affiliation:
Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
*
Address correspondence to Shira Doron, MD, Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA 02111 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To offer antimicrobial stewardship to a long-term acute care hospital using telemedicine.

METHODS

We conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010–March 31, 2011; the postimplementation period was April 1, 2011–March 31, 2014.

RESULTS

During the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, −0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (−6.58 DDD/1,000 PD [95% CI, −11.48 to −1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (−2.97 DDD/1,000 PD per month [95% CI, −5.65 to −0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, −71.4 to −29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9–56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35–0.92]; P=.02).

CONCLUSION

Antimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.

Infect. Control Hosp. Epidemiol. 2016;37(4):433–439

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 433 - 439
Copyright
© 2016 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

REFERENCES

1. Davey, P, Brown, E, Charani, E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2013;4:CD003543.Google Scholar
2. Malani, AN, Richards, PG, Kapila, S, Otto, MH, Czerwinski, J, Singal, B. Clinical and economic outcomes from a community hospital’s antimicrobial stewardship program. Am J Infect Control 2013;41:145–148.Google Scholar
3. Stach, LM, Hedican, EB, Herigon, JC, Jackson, MA, Newland, JG. Clinicians’ attitudes towards an antimicrobial stewardship program at a children’s hospital. J Pediatric Infect Dis Soc 2012;1:190–197.Google Scholar
4. Kaki, R, Elligsen, M, Walker, S, Simor, A, Palmay, L, Daneman, N. Impact of antimicrobial stewardship in critical care: a systematic review. J Antimicrob Chemother 2011;66:1223–1230.Google Scholar
5. Nowak, MA, Nelson, RE, Breidenbach, JL, Thompson, PA, Carson, PJ. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69:1500–1508.Google Scholar
6. Fridkin, SK, Baggs, J, Fagan, R, et al. Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 2014;63:194–200.Google Scholar
7. Carling, P, Fung, T, Killion, A, Terrin, N, Barza, M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol 2003;24:699–706.CrossRefGoogle Scholar
8. LaRocco, A. Concurrent antibiotic review programs: a role for infectious diseases specialists at small community hospitals. Clin Infect Dis 2003;37:742–743.CrossRefGoogle ScholarPubMed
9. Yam, P, Fales, D, Jemison, J, Gillum, M, Bernstein, M. Implementation of an antimicrobial stewardship program in a rural hospital. Am J Health Syst Pharm 2012;69:1142–1148.CrossRefGoogle Scholar
10. Bakken, JS. Medicare and Medicaid programs: reform of requirements for long-term care facilities. Infectious Diseases Society of America website. https://idsocietyorg.app.box.com/s/espr2a4ghuospufcufahupy7hdjfvson. Published October 14, 2015. Accessed December 6, 2015.Google Scholar
11. Dos Santos, RP, Deutschendorf, C, Carvalho, OF, Timm, R, Sparenberg, A. Antimicrobial stewardship through telemedicine in a community hospital in Southern Brazil. J Telemed Telecare 2013;19:1–4.Google Scholar
12. Eskildsen, MA. Long-term acute care: a review of the literature. J Am Geriatr Soc 2007;55:775–779.Google Scholar
13. Munoz-Price, LS, Hota, B, Nimon, NA, et al. Effect of a ventilator associated pneumonia (VAP) infection control bundle for the prevention of VAP in a long-term care acute hospital (LTACH). In: Program and abstracts of the 18th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; April 5-8, 2008; Orlando, FL. Abstract 379. Arlington, VA: Society for Healthcare Epidemiology of America, 2008.Google Scholar
14. Wolfenden, LL, Anderson, G, Veledar, E, Srinivasan, A. Catheter-associated bloodstream infections in 2 long-term acute care hospitals. Infect Control Hosp Epidemiol 2007;28:105–106.Google Scholar
15. Pawar, D, Tsay, R, Nelson, DS, et al. Burden of Clostridium difficile infection in long-term care facilities in Monroe County, New York. Infect Control Hosp Epidemiol 2012;33:1107–1112.Google Scholar
16. Rhee, SM, Stone, ND. Antimicrobial stewardship in long-term care facilities. Infect Dis Clin N Am 2014;28:237–246.Google Scholar
17. Nicolle, LE. Infection prevention issues in long-term care. Curr Opin Infect Dis 2014;27:363–369.CrossRefGoogle ScholarPubMed
18. Pate, PG, Sotrey, DF, Baum, DL. Implementation of an antimicrobial stewardship program at a 60-bed long-term acute care hospital. Infect Control Hosp Epidemiol 2012;33:405–408.Google Scholar
19. Nelson, S. How to calculate antimicrobial defined daily doses (DDDs) and DDDs per 1000 patient days. Mount Sinai Hospital and University Health Network website. http://www.antimicrobialstewardship.com/sites/default/files/article_files/how_to_calculate_ddds_final.pdf. Published April 2012. Accessed December 6, 2015.Google Scholar
20. Yeo, CL, Wu, JE, Chung, GW, Chan, DS, Chen, HH, Hsu, LY. Antimicrobial stewardship auditing of patients reviewed by infectious diseases physicians in a tertiary university hospital. Antimicrob Resist Infect Control 2013;2:29.Google Scholar
21. Yeo, CL, Wu, JE, Chung, GW, Chan, DS, Fisher, D, Hsu, LY. Specialist trainees on rotation cannot replace dedicated consultant clinicians for antimicrobial stewardship of specialty disciplines. Antimicrob Resist Infect Control 2012;1:36.Google Scholar
22. Hermsen, ED, VanSchooneveld, TC, Sayles, H, Rupp, ME. Implementation of a clinical decision support system for antimicrobial stewardship. Infect Control Hosp Epidemiol 2012;33:412–415.Google Scholar
23. Cook, PP, Gooch, M. Long-term effects of an antimicrobial stewardship programme at a tertiary-care teaching hospital. Int J Antimicrob Agents 2015;45:262–267.Google Scholar
24. Gould, CV, Rothenberg, R, Steinberg, JP. Antibiotic resistance in long-term acute care hospitals: the perfect storm. Infect Control Hosp Epidemiol 2006;27:920–925.Google Scholar
25. Dubberke, ER, Carling, P, Carrico, R , et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:628–645.Google Scholar