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Antimicrobial stewardship in the outpatient setting: A review and proposed framework

Published online by Cambridge University Press:  28 April 2020

Jasmine R. Marcelin Open the ORCID record for Jasmine R. Marcelin [Opens in a new window] ,
Philip Chung  and
Trevor C. Van Schooneveld Open the ORCID record for Trevor C. Van Schooneveld [Opens in a new window]
Jasmine R. Marcelin*
Affiliation:
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
Philip Chung
Affiliation:
Department of Pharmacy, Nebraska Medicine, Omaha, Nebraska
Trevor C. Van Schooneveld
Affiliation:
Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, Nebraska
*
Author for correspondence: Jasmine R Marcelin, E-mail: [email protected]
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Abstract

Antimicrobial misuse is still a significant problem, and most inappropriate use occurs in the outpatient setting. In this article, we provide a review of available literature on outpatient antimicrobial stewardship in primary care settings, and we propose a novel implementation framework.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 7 , July 2020 , pp. 833 - 840
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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References

Antibiotic resistance threats in the United States, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/biggest-threats.html. Accessed November 18, 2019.Google Scholar
Fleming-Dutra, KE, Hersh, AL, Shapiro, DJ, et al. Prevalence of inappropriate antibiotic prescriptions among us ambulatory care visits, 2010–2011. JAMA 2016;315:1864–1873.CrossRefGoogle ScholarPubMed
Shively, NR, Buehrle, DJ, Clancy, CJ, Decker, BK. Prevalence of inappropriate antibiotic prescribing in primary care clinics within a Veterans’ Affairs health care system. Antimicrob Agents Chemother 2018;62(8): pii: e00337-18.CrossRefGoogle Scholar
Jenkins, TC, Sabel, AL, Sarcone, EE, Price, CS, Mehler, PS, Burman, WJ. Skin and soft-tissue infections requiring hospitalization at an academic medical center: opportunities for antimicrobial stewardship. Clin Infect Dis 2010;51:895–903.CrossRefGoogle ScholarPubMed
Suda, KJ, Hicks, LA, Roberts, RM, Hunkler, RJ, Matusiak, LM, Schumock, GT. Antibiotic expenditures by medication, class, and healthcare setting in the United States, 2010–2015. Clin Infect Dis 2018;66:185–190.10.1093/cid/cix773CrossRefGoogle ScholarPubMed
Drekonja, DM, Filice, GA, Greer, N, et al. Antimicrobial stewardship in outpatient settings: a systematic review. Infect Control Hosp Epidemiol 2015;36:142–152.CrossRefGoogle ScholarPubMed
Zetts, RM, Stoesz, A, Smith, BA, Hyun, DY. Outpatient antibiotic use and the need for increased antibiotic stewardship efforts. Pediatrics 2018;141(6): pii: e20174124.10.1542/peds.2017-4124CrossRefGoogle ScholarPubMed
National action plan for combating antibiotic-resistant bacteria. The White House website. http://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Accessed May 19, 2018.Google Scholar
Durkin, MJ, Jafarzadeh, SR, Hsueh, K, et al. Outpatient antibiotic prescription trends in the United States: a national cohort study. Infect Control Hosp Epidemiol 2018;39:584–589.CrossRefGoogle ScholarPubMed
Kohut, MR, Keller, SC, Linder, JA, et al. The inconvincible patient: how clinicians perceive demand for antibiotics in the outpatient setting. Fam Pract 2020;37:276–282.Google ScholarPubMed
McNulty, CAM, Nichols, T, French, DP, Joshi, P, Butler, CC. Expectations for consultations and antibiotics for respiratory tract infection in primary care: the RTI clinical iceberg. Brit J Gen Pract 2013;63:e429–e436.CrossRefGoogle ScholarPubMed
Mangione-Smith, R, McGlynn, EA, Elliott, MN, McDonald, L, Franz, CE, Kravitz, RL. Parent expectations for antibiotics, physician-parent communication, and satisfaction. Arch Pediatr Adolesc Med 2001;155:800–806.CrossRefGoogle ScholarPubMed
Klein, EY, Martinez, EM, May, L, Saheed, M, Reyna, V, Broniatowski, DA. Categorical risk perception drives variability in antibiotic prescribing in the emergency department: a mixed methods observational study. J Gen Intern Med 2017;32:1083–1089.10.1007/s11606-017-4099-6CrossRefGoogle ScholarPubMed
Szymczak, JE, Klieger, SB, Miller, M, Fiks, AG, Gerber, JS. What parents think about the risks and benefits of antibiotics for their child’s acute respiratory tract infection. J Pediatric Infect Dis Soc 2018;7:303–309.10.1093/jpids/pix073CrossRefGoogle ScholarPubMed
Hicks, LA, Bartoces, MG, Roberts, RM, et al. US outpatient antibiotic prescribing variation according to geography, patient population, and provider specialty in 2011. Clin Infect Dis 2015;60:1308–1316.Google Scholar
Kabbani, S, Palms, D, Bartoces, M, Stone, N, Hicks, LA. Outpatient antibiotic prescribing for older adults in the United States: 2011 to 2014. J Am Geriatr Soc 2018;66:1998–2002.10.1111/jgs.15518CrossRefGoogle ScholarPubMed
FDA updates warnings for fluoroquinolone antibiotics on risks of mental health and low blood sugar adverse reactions. US Food and Drug Administration website. https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm612995.htm. Accessed November 5, 2018.Google Scholar
Hersh, AL, Shapiro, DJ, Pavia, AT, Fleming-Dutra, KE, Hicks, LA. Geographic variability in diagnosis and antibiotic prescribing for acute respiratory tract infections. Infect Dis Ther 2018;7:171–174.10.1007/s40121-017-0181-yCrossRefGoogle ScholarPubMed
Barlam, TF, Soria-Saucedo, R, Cabral, HJ, Kazis, LE. Unnecessary antibiotics for acute respiratory tract infections: association with care setting and patient demographics. Open Forum Infect Dis 2016;3(1):ofw045.CrossRefGoogle ScholarPubMed
Barlam, TF, Morgan, JR, Wetzler, LM, Christiansen, CL, Drainoni, M-L. Antibiotics for respiratory tract infections: a comparison of prescribing in an outpatient setting. Infect Control Hosp Epidemiol 2015;36:153–159.10.1017/ice.2014.21CrossRefGoogle Scholar
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(10):e51–e77.10.1093/cid/ciw118CrossRefGoogle Scholar
Sanchez, GV FK, Roberts, RM, Hicks, LA. Core elements of outpatient antibiotic stewardship. MMWR Recomm Rep 2016;65(No. RR-6):1–12.10.15585/mmwr.rr6506a1CrossRefGoogle ScholarPubMed
Antimicrobial stewardship in ambulatory health care. The Joint Commission website. https://www.jointcommission.org/assets/1/18/R3_23_Antimicrobial_Stewardship_AMB_6_14_19_FINAL2.pdf. Accessed August 7, 2019.Google Scholar
Ostrowsky, B, Banerjee, R, Bonomo, RA, et al. Infectious diseases physicians: leading the way in antimicrobial stewardship. Clin Infect Dis 2018;66:995–1003.CrossRefGoogle ScholarPubMed
Day, SR, Smith, D, Harris, K, Cox, HL, Mathers, AJ. An infectious diseases physician-led antimicrobial stewardship program at a small community hospital associated with improved susceptibility patterns and cost-savings after the first year. Open Forum Infect Dis 2015;2(2):ofv064–ofv.CrossRefGoogle Scholar
Essack, S, Bell, J, Shephard, A. Community pharmacists—leaders for antibiotic stewardship in respiratory tract infection. J Clin Pharm Ther 2018;43:302–307.10.1111/jcpt.12650CrossRefGoogle ScholarPubMed
Dodds Ashley, E, Davis, SL, Heil, EL, LaPlante, KL, Chahine, EB, Bosso, JA. Best care for patients achieved through multidisciplinary stewardship. Clin Infect Dis 2018;67:1637.10.1093/cid/ciy392CrossRefGoogle ScholarPubMed
Blanchette, L, Gauthier, T, Heil, E, et al. The essential role of pharmacists in antibiotic stewardship in outpatient care: an official position statement of the Society of Infectious Diseases Pharmacists. J Am Pharm Assoc (2003) 2018;58:481–484.CrossRefGoogle Scholar
Klepser, ME, Adams, AJ, Klepser, DG. Antimicrobial stewardship in outpatient settings: leveraging innovative physician-pharmacist collaborations to reduce antibiotic resistance. Health Secur 2015;13:166–173.10.1089/hs.2014.0083CrossRefGoogle ScholarPubMed
Ilett, KF, Johnson, S, Greenhill, G, et al. Modification of general practitioner prescribing of antibiotics by use of a therapeutics adviser (academic detailer). Br J Clin Pharmacol 2000;49:168–173.CrossRefGoogle Scholar
Saha, SK, Hawes, L, Mazza, D. Effectiveness of interventions involving pharmacists on antibiotic prescribing by general practitioners: a systematic review and meta-analysis. J Antimicrob Chemother 2019;74:1173–1181.CrossRefGoogle ScholarPubMed
Eudaley, ST, Mihm, AE, Higdon, R, Jeter, J, Chamberlin, SM. Development and implementation of a clinical decision support tool for treatment of uncomplicated urinary tract infections in a family medicine resident clinic. J Am Pharm Assoc 2019;59:579–585.10.1016/j.japh.2019.03.006CrossRefGoogle Scholar
Klepser, ME, Klepser, DG, Dering-Anderson, AM, Morse, JA, Smith, JK, Klepser, SA. Effectiveness of a pharmacist-physician collaborative program to manage influenza-like illness. J Am Pharm Assoc 2016;56:14–21.CrossRefGoogle ScholarPubMed
D’Agata, EMC, Lindberg, CC, Lindberg, CM, et al. The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities. Infect Control Hosp Epidemiol 2018;39:1400–1405.CrossRefGoogle ScholarPubMed
Saha, D, Patel, J, Buckingham, D, Thornton, D, Barber, T, Watson, JR. Urine culture follow-up and antimicrobial stewardship in a pediatric urgent care network. Pediatrics 2017;139(4):e20162103.CrossRefGoogle Scholar
American Nurses Association and Centers for Disease Control & Prevention. Redefining the antibiotic stewardship team: recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/ANA-CDC-whitepaper.pdf. Accessed June 14, 2019.Google Scholar
Livorsi, DJ, Linn, CM, Alexander, B, Heintz, BH, Tubbs, TA, Perencevich, EN. The value of electronically extracted data for auditing outpatient antimicrobial prescribing. Infect Control Hosp Epidemiol 2018;39:64–70.CrossRefGoogle ScholarPubMed
Havers, FP, Hicks, LA, Chung, JR, et al. Outpatient antibiotic prescribing for acute respiratory infections during influenza seasons. JAMA Network Open 2018;1(2):e180243.CrossRefGoogle ScholarPubMed
Durkin, MJ, Keller, M, Butler, AM, et al. An assessment of inappropriate antibiotic use and guideline adherence for uncomplicated urinary tract infections. Open Forum Infect Dis 2018;5(9):ofy198–ofy.CrossRefGoogle ScholarPubMed
Jaggi, P, Wang, L, Gleeson, S, Moore-Clingenpeel, M, Watson, JR. Outpatient antimicrobial stewardship targets for treatment of skin and soft-tissue infections. Infect Control Hosp Epidemiol 2018;39:936–940.10.1017/ice.2018.124CrossRefGoogle ScholarPubMed
Drekonja, DM, Filice, GA, Greer, N, et al. Antimicrobial stewardship in outpatient settings: a systematic review. Infect Control Hosp Epidemiol 2015;36:142–152.CrossRefGoogle ScholarPubMed
Meeker, D, Knight, TK, Friedberg, MW, et al. Nudging guideline-concordant antibiotic prescribing: a randomized clinical trial. JAMA Intern Med 2014;174:425–431.10.1001/jamainternmed.2013.14191CrossRefGoogle ScholarPubMed
Choosing Wisely initiative of American Board of Internal Medicine. Bagging Antibiotics in Maine. Choosling Wiselt website. http://www.choosingwisely.org/resources/updates-from-the-field/bagging-antibiotics-in-maine/. Accessed November 14, 2018.Google Scholar
Jenkins, TC, Knepper, BC, Sabel, AL, et al. Decreased antibiotic utilization after implementation of a guideline for inpatient cellulitis and cutaneous abscess. Arch Intern Med 2011;171:1072–1079.CrossRefGoogle ScholarPubMed
Meeker, D, Linder, JA, Fox, CR, et al. Effect of behavioral interventions on inappropriate antibiotic prescribing among primary care practices: a randomized clinical trial. JAMA 2016;315:562–570.CrossRefGoogle ScholarPubMed
Linder, JA, Meeker, D, Fox, CR, et al. Effects of behavioral interventions on inappropriate antibiotic prescribing in primary care 12 months after stopping interventions. JAMA 2017;318:1391–1392.CrossRefGoogle ScholarPubMed
Clegg, HW, Bean, RA, Ezzo, SJ, Hoth, AN, Sheedy, DJ, Anderson, WE. Impact of education and peer comparison on antibiotic prescribing for pediatric respiratory tract infections. Pediatr Qual Safety 2019;4(4):e195.CrossRefGoogle ScholarPubMed
CMS value-based programs. Centers for Medicare and Medicaid Services website. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/Value-Based-Programs.html. Accessed November 9, 2018.Google Scholar
Quality premium 2015/16. England National Health Services website. https://www.england.nhs.uk/wp-content/uploads/2013/12/qual-prem-guid.pdf. Accessed November 12, 2018.Google Scholar
Balinskaite, V, Johnson, AP, Holmes, A, Aylin, P. The impact of a national antimicrobial stewardship programme on antibiotic prescribing in primary care: an interrupted time series analysis. Clin Infect Dis 2018:ciy902-ciy.Google Scholar
Balinskaite, V, Bou-Antoun, S, Johnson, AP, Holmes, A, Aylin, P. An assessment of potential unintended consequences following a national antimicrobial stewardship program in England: an interrupted time series analysis. Clin Infect Dis 2018;69:233–242.CrossRefGoogle Scholar
Cals, JWL, Butler, CC, Hopstaken, RM, Hood, K, Dinant, G-J. Effect of point of care testing for C reactive protein and training in communication skills on antibiotic use in lower respiratory tract infections: cluster randomised trial. BMJ 2009;338:b1374.10.1136/bmj.b1374CrossRefGoogle ScholarPubMed
Cals, JWL, Schot, MJC, de Jong, SAM, Dinant, G-J, Hopstaken, RM. Point-of-care C-reactive protein testing and antibiotic prescribing for respiratory tract infections: a randomized controlled trial. Ann Fam Med 2010;8:124–133.CrossRefGoogle ScholarPubMed
Little, P, Stuart, B, Francis, N, et al. Effects of internet-based training on antibiotic prescribing rates for acute respiratory-tract infections: a multinational, cluster, randomised, factorial, controlled trial. Lancet 2013;382:1175–1182.CrossRefGoogle ScholarPubMed
Briel, M, Schuetz, P, Mueller, B, et al. Procalcitonin-guided antibiotic use vs a standard approach for acute respiratory tract infections in primary care. Arch Intern Med 2008;168:2000–2007.10.1001/archinte.168.18.2000CrossRefGoogle Scholar
Wattengel, BA, Sellick, JA, Mergenhagen, KA. Outpatient antimicrobial stewardship: Optimizing patient care via pharmacist led microbiology review. Am J Infect Control 2020;48:189–193.10.1016/j.ajic.2019.07.018CrossRefGoogle ScholarPubMed
Gerber, JS, Prasad, PA, Fiks, AG, et al. Effect of an outpatient antimicrobial stewardship intervention on broad-spectrum antibiotic prescribing by primary care pediatricians: a randomized trial. JAMA 2013;309:2345–2352.10.1001/jama.2013.6287CrossRefGoogle ScholarPubMed
Hallsworth, M, Chadborn, T, Sallis, A, et al. Provision of social norm feedback to high prescribers of antibiotics in general practice: a pragmatic national randomised controlled trial. Lancet 2016;387:1743–1752.CrossRefGoogle ScholarPubMed
Gerber, JS, Prasad, PA, Fiks, AG, et al. Durability of benefits of an outpatient antimicrobial stewardship intervention after discontinuation of audit and feedback. JAMA 2014;312:2569–70.CrossRefGoogle ScholarPubMed
Klepser, ME, Dobson, EL, Pogue, JM, et al. A call to action for outpatient antibiotic stewardship. J Am Pharm Assoc 2017;57:457–463.10.1016/j.japh.2017.03.013CrossRefGoogle Scholar
Hermsen, ED, MacGeorge, EL, Andresen, M-L, Myers, LM, Lillis, CJ, Rosof, BM. Decreasing the peril of antimicrobial resistance through enhanced health literacy in outpatient settings: an underrecognized approach to advance antimicrobial stewardship. Adv Ther 2020;37:918–932.10.1007/s12325-019-01203-1CrossRefGoogle ScholarPubMed
A field guide to antibiotic stewardship in outpatient settings (July 2018). Quality Innovation Network National Coordinating Center (QIN NCC) website. https://qioprogram.org/sites/default/files/editors/141/C310_Field_Guide_20180730_FNL.pdf. Accessed November 18, 2019.Google Scholar
May, Larissa, Yadav, Kabir, Gaona, Samuel D., et al. mitigate antimicrobial stewardship toolkit. SHEA website. http://shea-online.org/images/priority-topics/MITIGATE_TOOLKIT_final.pdf. Accessed November 18, 2019.Google Scholar
Core elements of outpatient antimicrobial stewardship. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/core-elements/outpatient.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fantibiotic-use%2Fcommunity%2Fimproving-prescribing%2Foutpatient-stewardship.html. Accessed November 18, 2019.Google Scholar
Outpatient antibiotic stewardship. Health Services Advisory Group (HSAG) website. https://www.hsag.com/en/medicare-providers/antibiotic-stewardship/. Accessed November 18, 2019.Google Scholar
Agency for Healthcare Research and Quality (AHRQ). AHRQ Safety Program for Improving Antibiotic Use. Agency for Healthcare Research and Quality (AHRQ) website. https://safetyprogram4antibioticstewardship.org/page/AHRQ-Safety-Program-for-Improving-Antibiotic-Use. Accessed November 18, 2019.Google Scholar
Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP). Nebraska ASAP Ambulatory Stewardship. Nebraska Medicine website. https://asap.nebraskamed.com/ambulatory-care/. Accessed November 18, 2019.Google Scholar
Antimicrobial stewardship toolkit: implementing the core elements of outpatient antibiotic stewardship into your facility. Health Quality Innovators (HQI) website. http://www.hqi.solutions/wp-content/uploads/2017/11/Antibiotic-Stewardship-Toolkit_04172019-1_508.pdf. Accessed November 18, 2019.Google Scholar
Logan, AY, Williamson, JE, Reinke, EK, Jarrett, SW, Boger, MS, Davidson, LE. Establishing an antimicrobial stewardship collaborative across a large, diverse health care system. Joint Comm J Qual Patient Safety 2019;45:591–599.CrossRefGoogle ScholarPubMed
Comagine Health. Tools and resources: outpatient antibiotic stewardship. Health Insight website. https://healthinsight.org/tools-and-resources/category/167-outpatient-antibiotic-stewardship. Accessed November 18, 2019.Google Scholar