Hostname: page-component-586b7cd67f-t7fkt Total loading time: 0 Render date: 2024-11-28T08:52:46.994Z Has data issue: false hasContentIssue false
  • English
  • Français

Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey

Published online by Cambridge University Press:  24 February 2016

Ann F. Chou ,
Christopher J. Graber ,
Makoto Jones ,
Yue Zhang ,
Matthew Bidwell Goetz ,
Karl Madaras-Kelly ,
Matthew Samore ,
Allison Kelly  and
Peter A. Glassman
Ann F. Chou*
Affiliation:
Department of Health Administration and Policy, College of Public Health, University of Oklahoma, Oklahoma City, Oklahoma Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma, Oklahoma City, Oklahoma Veterans Affairs (VA) Greater Los Angeles Healthcare System, Los Angeles, California
Christopher J. Graber
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California
Makoto Jones
Affiliation:
Department of Medicine and Division of Epidemiology, University of Utah, Salt Lake City, Utah VA Salt Lake City Health Care System, Salt Lake City, Utah
Yue Zhang
Affiliation:
Department of Internal Medicine, University of Utah, Salt Lake City, Utah Department of Family and Preventive Medicine, University of Utah, Salt Lake City, Utah
Matthew Bidwell Goetz
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California
Karl Madaras-Kelly
Affiliation:
Veterans Affairs Medical Center, Boise, Idaho College of Pharmacy, Idaho State University, Meridian, Idaho
Matthew Samore
Affiliation:
Department of Medicine and Division of Epidemiology, University of Utah, Salt Lake City, Utah VA Salt Lake City Health Care System, Salt Lake City, Utah
Allison Kelly
Affiliation:
National Infectious Diseases Service, VA Central Office, Washington, DC
Peter A. Glassman
Affiliation:
David Geffen School of Medicine at University of California–Los Angeles (UCLA), Los Angeles, California Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, California
*
Address correspondence to Ann F. Chou, PhD, Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, 900 NE 10th St, Oklahoma City, OK 73104 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

BACKGROUND

Antimicrobial stewardship programs (ASPs) are variably implemented.

OBJECTIVE

To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage.

DESIGN

A web-based survey regarding stewardship activities was administered to each facility’s designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined.

SETTING

Total of 130 Veterans Affairs facilities with inpatient services.

RESULTS

Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03).

CONCLUSIONS

ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices.

Infect Control Hosp Epidemiol 2016;37:647–654

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 6 , June 2016 , pp. 647 - 654
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. Caliendo, AM, Gilbert, DN, Ginocchio, CC, et al. Better tests, better care: improved diagnostics for infectious diseases. Clin Infect Dis 2013;57:S139–S170.CrossRefGoogle ScholarPubMed
2. Gould, IM. Coping with antibiotic resistance: the impending crisis. Int J Antimicrob Agents 2010;36:S1–S2.CrossRefGoogle ScholarPubMed
3. Bignardi, GE. Risk factors for Clostridium difficile infection. J Hosp Infect 1998;40:1–15.CrossRefGoogle ScholarPubMed
4. 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.CrossRefGoogle ScholarPubMed
5. Dellit, TH, Owens, RC, McGowan, JE Jr, 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.CrossRefGoogle Scholar
6. Trivedi, KK, Kuper, K. Hospital antimicrobial stewardship in the nonuniversity setting. Infect Dis Clin North Am 2014;28:281–289.CrossRefGoogle ScholarPubMed
7. Transatlantic Taskforce on Antimicrobial Resistance. Recommendations for future collaborations between the U.S. and EU. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/pdf/tatfar-report.pdf. Published 2012. Accessed May 25, 2012.Google Scholar
8. National Action Plan for Combating Antibiotic-Resistant Bacteria. White House website. https://www.whitehouse.gov/sites/default/files/docs/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf. Published 2015. Accessed January 31, 2016.Google Scholar
9. Jacob, JT, Gaynes, RP. Emerging trends in antibiotic use in US hospitals: quality, quantification and stewardship. Expert Rev Anti Infect Ther 2010;8:893–902.CrossRefGoogle ScholarPubMed
10. MacDougall, C, Polk, RE. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005;18:638–656.CrossRefGoogle ScholarPubMed
11. Ohl, CA, Dodds Ashley, ES. Antimicrobial stewardship programs in community hospitals: the evidence base and case studies. Clin Infect Dis 2011;53:S23–S28.CrossRefGoogle ScholarPubMed
12. Wagner, B, Filice, GA, Drekonja, D, et al. Antimicrobial stewardship programs in inpatient hospital settings: a systematic review. Infect Control Hosp Epidemiol 2014;35:1209–1228.CrossRefGoogle ScholarPubMed
13. Society for Healthcare Epidemiology of America; Infectious Diseases Society of America; Pediatric Infectious Diseases Society. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012;33:322–327.CrossRefGoogle Scholar
14. Infectious Diseases Society of America. Combating antimicrobial resistance: policy recommendations to save lives. Clin Infect Dis 2011;52:S397–S428.CrossRefGoogle Scholar
15. Fridkin, SK, Srinivasan, A. Implementing a strategy for monitoring inpatient antimicrobial use among hospitals in the United States. Clin Infect Dis 2014;58:401–406.CrossRefGoogle ScholarPubMed
16. 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.CrossRefGoogle ScholarPubMed
17. 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
18. Davey, P, Brown, E, Fenelon, L, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005;CD003543.Google ScholarPubMed
19. Avdic, E, Cushinotto, LA, Hughes, AH, et al. Impact of an antimicrobial stewardship intervention on shortening the duration of therapy for community-acquired pneumonia. Clin Infect Dis 2012;54:1581–1587.CrossRefGoogle ScholarPubMed
20. Bosso, JA, Drew, RH. Application of antimicrobial stewardship to optimise management of community acquired pneumonia. Int J Clin Pract 2011;65:775–783.CrossRefGoogle ScholarPubMed
21. 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
22. Newman, RE, Hedican, EB, Herigon, JC, Williams, DD, Williams, AR, Newland, JG. Impact of a guideline on management of children hospitalized with community-acquired pneumonia. Pediatrics 2012;129:e597–e604.CrossRefGoogle ScholarPubMed
23. Pavese, P, Saurel, N, Labarere, J, et al. Does an educational session with an infectious diseases physician reduce the use of inappropriate antibiotic therapy for inpatients with positive urine culture results? A controlled before-and-after study. Infect Control Hosp Epidemiol 2009;30:596–599.CrossRefGoogle ScholarPubMed
24. Singh, N, Rogers, P, Atwood, CW, Wagener, MM, Yu, VL. Short-course empiric antibiotic therapy for patients with pulmonary infiltrates in the intensive care unit: a proposed solution for indiscriminate antibiotic prescription. Am J Respir Crit Care Med 2000;162:505–511.CrossRefGoogle ScholarPubMed
25. Smith, MJ, Kong, M, Cambon, A, Woods, CR. Effectiveness of antimicrobial guidelines for community-acquired pneumonia in children. Pediatrics 2012;129:e1326–e1333.CrossRefGoogle ScholarPubMed
26. Pakyz, AL, Moczygemba, LR, VanderWielen, LM, Edmond, MB, Stevens, MP, Kuzel, AJ. Facilitators and barriers to implementing antimicrobial stewardship strategies: results from a qualitative study. Am J Infect Control 2014;42:S257–S263.CrossRefGoogle ScholarPubMed
27. Jamtvedt, G, Young, JM, Kristoffersen, DT, O’Brien, MA, Oxman, AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2006;2:CD000259.Google Scholar
28. Goetz, MB, Hoang, T, Knapp, H, et al. Exportability of an intervention to increase HIV testing in the Veterans Health Administration. Jt Comm J Qual Patient Saf 2011;37:553–559.Google ScholarPubMed
29. Jain, R, Kralovic, SM, Evans, ME, et al. Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.CrossRefGoogle ScholarPubMed
30. Department of Veterans Affairs. Antimicrobial stewardship programs. VHA directive 1031. VA website. http://www.va.gov/VHAPUBLICATIONS/ViewPublication.asp?pub_ID=2964. Published 2014. Accessed January 31, 2016.Google Scholar
31. Donabedian, A. Basic approaches to assessment: structure, process, and outcome. In Donabedian A, ed. The Definition of Quality and Approaches to Its Assessment. Ann Arbor, MI: Health Administration Press, 1980:77–128.Google Scholar
32. Donabedian, A. An Introduction to Quality Assurance in Health Care. New York: Oxford University Press, 2003.Google Scholar
33. Centers for Disease Control and Prevention (CDC). Core elements of hospital antibiotic stewardship programs. CDC website. http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Accessed May 18, 2014.Google Scholar
34. Centers for Disease Control and Prevention (CDC). Antibiotic resistance threats in the United States. CDC website. http://www.cdc.gov/drugresistance/threat-report-2013/. Published 2013. Accessed August 13, 2014.Google Scholar
35. 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.CrossRefGoogle ScholarPubMed
36. Kullar, R, Goff, DA. Transformation of antimicrobial stewardship programs through technology and informatics. Infect Dis Clin North Am 2014;28:291–300.CrossRefGoogle ScholarPubMed
37. Dumartin, C, Rogues, AM, Amadeo, B, et al. Antibiotic stewardship programmes: legal framework and structure and process indicator in Southwestern French hospitals, 2005-2008. J Hosp Infect 2011;77:123–128.CrossRefGoogle ScholarPubMed
38. Dumartin, C, Rogues, AM, Amadeo, B, et al. Antibiotic usage in south-western French hospitals: trends and association with antibiotic stewardship measures. J Antimicrob Chemother 2011;66:1631–1637.CrossRefGoogle ScholarPubMed
39. Amadeo, B, Dumartin, C, Venier, AG, Fourrier-Reglat, A, Coignard, B, Rogues, AM. Factors associated with the prevalence of antibiotic use for the treatment of hospital-acquired infections at 393 French hospitals: a regional variation analysis. Infect Control Hosp Epidemiol 2011;32:155–162.CrossRefGoogle ScholarPubMed
40. Laxminarayan, R. Crafting a system-wide response to healthcare-associated infections. Proc Natl Acad Sci USA 2012;109:6364–6365.CrossRefGoogle ScholarPubMed