ASP in rehab facility reduces antibiotic use and resistance
The results of a small, single-center study suggest that implementing an antibiotic stewardship program (ASP) based on infectious disease (ID) consultation in a rehabilitation facility can reduce antibiotic use and antimicrobial resistance without affecting patient outcomes.
The quasi-experimental study, reported in Infection Control and Hospital Epidemiology, compared the periods before and after an ASP was implemented at a 150-bed rehabilitation facility in northern Italy specializing in spinal cord injuries (SCI). The authors note that patients cared for in SCI rehab hospitals are prone to infections dues to several factors—including bladder catheterization, invasive procedures, and pressure sores—and that antibiotic over-prescribing in these facilities is a recognized problem.
The ASP, which was implemented in July 2012, had two elements: Systematic bedside ID consultation with a dedicated ID consultant who visited patients and discussed antibiotic prescribing with their doctors, and regular structural interventions. The interventions included revisions of internal protocol for antibiotic prophylaxis and educational sessions on the appropriateness of antibiotic treatment.
During the study period (January 2011 to December 2014), overall antibiotic consumption at the facility decreased by 48%, dropping from 42 defined daily doses (DDD) per 100 patient days in 2011 to 22 DDD in 2014. Specifically, the use of carbapenems dropped by 97% and fluoroquinolone use dropped by 92%. The use of aminoglycosides, tetracycline, clindamycin, and macrolides also declined. The consumption of third-generation cephalosporins remained stable.
At the same time, the researchers found that the incidence of Clostridium difficile fell from 3.6 cases per 10,000 patient days in 2011 to 1.2 cases in 2014. In addition, they observed a significant decrease in drug-resistant bacteria. The prevalence of extensively drug-resistant (XDR) strains declined from 55% to 12% in Pseudomonas aeruginosa and from 96% to 73% in Acinetobacter baumanni; the prevalence of extended-spectrum beta-lactamase (ESBL) producing strains dropped from 42% to 17% in Escherichia coli and from 62% to 15% in Proteus mirabilis; carbapenem-resistant strains fell from 42% to 17% in Klebsiella pneumoniae; and methicillin-resistant strains of Staphylococcus aureus decreased from 77% to 40%.
The authors note that while their study is limited by the single-center design and long-term monitoring is needed, the results suggest that an ASP based on systematic ID consultation can be effective outside of acute-care hospitals.
Oct 17 Infect Control Hosp Epidemiol study
HHS gives Johns Hopkins $16 million to improve antibiotic use in US healthcare
The US Department of Health and Human Services (HHS) on Tuesday awarded $16 million to Johns Hopkins University to help reduce unnecessary antibiotic use and fight antibiotic resistance in the healthcare system.
The contract awarded to the Johns Hopkins Armstrong Institute for Patient Safety and Quality will be spread out over 5 years and will fund the development of tools and educational modules to help healthcare providers make better decisions about antibiotic treatment. Johns Hopkins researchers will also be developing tools to help educate patients about antibiotics and when they are—and aren't—necessary.
"It's important for everyone, from health care providers to patients and families, to understand the importance of properly prescribing antibiotics," Johns Hopkins Univeristy assistant professor of pediatrics Pranita Tamma, MD, said in a news release. "We want to ensure each person involved in the care process is aware that antibiotics are essential for certain infections, but they can actually do more harm than good if they are improperly prescribed."
Oct 18 Johns Hopkins Univeristy press release
