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Antimicrobial Stewardship—the State of the Art in 2011 Focus on Outcome and Methods

Published online by Cambridge University Press:  02 January 2015

John E. McGowan Jr
John E. McGowan Jr*
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
*
Department of Epidemiology (3041 CNR), Rollins School of Public Health of Emory University, 1518 Clifton Road NE, Atlanta, GA 30322 (jmcgowa@emory.edu)
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Abstract

Antimicrobial stewardship programs attempt to optimize prescribing of these drugs to benefit both current and future patients. Recent regulatory and other incentives have led to widespread adoption of such programs. Measurements of the success of these programs have focused primarily on process measures. However, evaluation of outcome measures will be needed to ensure sustainability of these efforts. Outcome efforts to date provide some evidence for improved care of individual patients, some evidence for minimizing emergence of resistance, and ample evidence for cost reduction. Attention to evaluation methods must be increased to provide convincing evidence for the continuation of such programs.

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 4: Special Topic Issue: Antimicrobial Stewardship , April 2012 , pp. 331 - 337
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1. McGowan, JE Jr, Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974; 130:165–168.Google Scholar
2. Hampton, JR. The end of clinical freedom. Br Med J (Clin Res Ed) 1983;287:1237–1238.Google Scholar
3. Marchaim, D, Chopra, T, Pogue, JM, et al. Outbreak of colistin-resistant, carbapenem-resistant Klebsiella pneumoniae in metropolitan Detroit, Michigan. Anrímicrob Agents Chemother 2011; 55:593–599.Google Scholar
4. Valencia, R, Arroyo, LA, Conde, M, et al. Nosocomial outbreak of infection with pan-drug-resistant Acinetobacter baumannii in a tertiary care university hospital. Infect Control Hosp Epidemiol 2009;30:257–263.CrossRefGoogle Scholar
5. Wise, R. The urgent need for new antibacterial agents. J Anti-microb Chemother 2011;66:1939–1940.Google Scholar
6. Bartlett, JG. A call to arms: the imperative for antimicrobial stewardship. Clin Infect Dis 2011;53(suppl 1):S4–S7.Google Scholar
7. Liew, YX, Lee, W, Kwa, AL, Lye, DC, Yeo, CL, Hsu, LY. Inappropriate carbapenem use in Singapore public hospitals: opportunities for antimicrobial stewardship. Int J Antimicrob Agents 2011;37:87–88.Google Scholar
8. 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.Google Scholar
9. Carlet, J, Collignon, P, Goldmann, D, et al. Society's failure to protect a precious resource: antibiotics. Lancet 2011;378:369–371.Google Scholar
10. Tamma, PD, Cosgrove, SE. Antimicrobial stewardship. Infect Dis Clin North Am 2011;25:245–260.Google Scholar
11. Ohl, CA, Luther, VP. Antimicrobial stewardship for inpatient facilities, f Hosp Med 2011;6(suppl 1):S4–S15.Google Scholar
12. McGowan, JE Jr, Gerding, DN. Does antibiotic restriction prevent resistance? New Horiz 1996;4:370–376.Google Scholar
13. Reuben, DB, Cassel, CK. Physician stewardship of health care in an era of finite resources. JAMA 2011;306:430–431.CrossRefGoogle Scholar
14. Johannsson, B, Beekmann, SE, Srinivasan, A, Hersh, AL, Laxmin-arayan, R, Polgreen, PM. Improving antimicrobial stewardship: the evolution of programmatic strategies and barriers. Infect Control Hosp Epidemiol 2011;32:367–374.Google Scholar
15. Van Schooneveld, T, Miller, H, Sayles, H, Watkins, K, Smith, PW. Survey of antimicrobial stewardship practices in Nebraska long-term care facilities. Infect Control Hosp Epidemiol 2011;32:732–734.CrossRefGoogle ScholarPubMed
16. Septimus, EJ, Owens, RC Jr. Need and potential of antimicrobial stewardship in community hospitals. Clin Infect Dis 2011; 53(suppl 1):S8–S14.Google Scholar
17. Nathwani, D, Sneddon, J, Malcolm, W, et al. Scottish Antimicrobial Prescribing Group (SAPG): development and impact of the Scottish National Antimicrobial Stewardship Programme. Int J Antimicrob Agents 2011;38:16–26.Google Scholar
18. Davey, P, Sneddon, J, Nathwani, D. Overview of strategies for overcoming the challenge of antimicrobial resistance. Expert Rev Clin Pharmacol 2010;3:667–686.CrossRefGoogle ScholarPubMed
19. Thakkar, K, Gilchrist, M, Dickinson, E, Benn, J, Franklin, BD, Jacklin, A. A quality improvement programme to increase compliance with an anti-infective prescribing policy. J Antimicrob Chemother 2011;66:1916–1920.Google Scholar
20. Toth, NR, Chambers, RM, Davis, SL. Implementation of a care bundle for antimicrobial stewardship. Am J Health Syst Pharm 2010;67:746–749.Google Scholar
21. White, AR. Effective antibacterials: at what cost? the economics of antibacterial resistance and its control. J Antimicrob Chemother 2011;66:1948–1953.Google Scholar
22. Slain, D, Sarwari, AR, Petros, KO, et al. Impact of a multimodal antimicrobial stewardship program on Pseudomonas aeruginosa susceptibility and antimicrobial use in the intensive care unit setting. Crit Care Res Pract 2011;2011:416–426.Google Scholar
23. 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.Google Scholar
24. Davey, P, Brown, E, Fenelon, L, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2005:CD003543.Google Scholar
25. 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
26. Ohl, CA, Dodds Ashley, ES. Antimicrobial stewardship programs in community hospitals: the evidence base and case studies. Clin Infect Dis 2011;53(suppl 1):S23–S28.Google Scholar
27. 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.Google Scholar
28. Fishman, N. Antimicrobial stewardship. Am J Med 2006;119: S53–S61; discussion S62-S70.Google Scholar
29. Valiquette, L, Cossette, B, Garant, MP, Diab, H, Pepin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium dijd/e-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007; 45(suppl 2):S112–S121.Google Scholar
30. White, AC Jr, Atmar, RL, Wilson, J, Cate, TR, Stager, CE, Greenberg, SB. Effects of requiring prior authorization for selected antimicrobials: expenditures, susceptibilities, and clinical outcomes. Clin Infect Dis 1997;25:230–239.Google Scholar
31. Gandhi, TN, DePestel, DD, Collins, CD, Nagel, J, Washer, LL. Managing antimicrobial resistance in intensive care units. Crit Care Med 2010;38:S315–S323.CrossRefGoogle ScholarPubMed
32. Paul, M, Andreassen, S, Tacconelli, E, et al. Improving empirical antibiotic treatment using TREAT, a computerized decision support system: cluster randomized trial. J Antimicrob Chemother 2006;58:1238–1245.Google Scholar
33. Paul, M, Shani, V, Muchtar, E, Kariv, G, Robenshtok, E, Leibovici, L. Systematic review and meta-analysis of the efficacy of appropriate empiric antibiotic therapy for sepsis. Antimicrob Agents Chemother 2010;54:4851–4863.Google Scholar
34. Joo, EJ, Kang, CI, Ha, YE, et al. Impact of inappropriate empiric antimicrobial therapy on outcome in Pseudomonas aeruginosa bacteraemia: a stratified analysis according to sites of infection. Infection 2011;39:309–318.Google Scholar
35. 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
36. Talpaert, MJ, Gopal Rao, G, Cooper, BS, Wade, P. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 2011;66:2168–2174.CrossRefGoogle ScholarPubMed
37. Chiu, CH, Michelow, IC, Cronin, J, Ringer, SA, Ferris, TG, Puopolo, KM. Effectiveness of a guideline to reduce vancomycin use in the neonatal intensive care unit. Pediatr Infect Dis J 2011;30:273–278.Google Scholar
38. Willemsen, I, Groenhuijzen, A, Bogaers, D, Stuurman, A, van Keulen, P, Kluytmans, J. Appropriateness of antimicrobial therapy measured by repeated prevalence surveys. Antimicrob Agents Chemother 2007;51:864–867.Google Scholar
39. Lan, CK, Hsueh, PR, Wong, WW, et al. Association of antibiotic utilization measures and reduced incidence of infections with extended-spectrum beta-lactamase-producing organisms. J Microbiol Immunol Infect 2003;36:182–186.Google Scholar
40. Lee, SO, Lee, ES, Park, SY, Kim, SY, Seo, YH, Cho, YK. Reduced use of third-generation cephalosporins decreases the acquisition of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae . Infect Control Hosp Epidemiol 2004;25:832–837.Google Scholar
41. Madaras-KeOy, KJ, Remington, RE, Lewis, PG, Stevens, DL. Evaluation of an intervention designed to decrease the rate of nosocomial methicillin-resistant Staphylococcus aureus infection by encouraging decreased fluoroquinolone use. Infect Control Hosp Epidemiol 2006;27:155–169.Google Scholar
42. Charbonneau, P, Parienti, JJ, Thibon, P, et al. Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: a quasi experimental study. Clin Infect Dis 2006;42:778–784.Google Scholar
43. Lipworth, AD, Hyle, EP, Fishman, NO, et al. Limiting the emergence of extended-spectrum β-lactamase-producing Enterobac-teriaceae. influence of patient population characteristics on the response to antimicrobial formulary interventions. Infect Control Hosp Epidemiol 2006;27:279–286.Google Scholar
44. Troughton, JA, Millar, G, Smyth, ET, Doherty, L, McMullan, R. Ciprofloxacin use and susceptibility of gram-negative organisms to quinolone and non-quinolone antibiotics. J Antimicrob Chemother 2011;66:2152–2158.Google Scholar
45. Cook, PP, Rizzo, S, Gooch, M, Jordan, M, Fang, X, Hudson, S. Sustained reduction in antimicrobial use and decrease in methicillin-resistant Staphylococcus aureus and Clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital. J Antimicrob Chemother 2011;66:205–209.Google Scholar
46. McGowan, JE Jr. Economic impact of antimicrobial resistance. Emerg Infect Dis 2001;7:286–292.Google Scholar
47. Harbarth, S, Graves, N. Health economic analysis in infection control. In: Scientific Programme of the First International Conference on Prevention and Infection Control. Geneva, June 30-July 2, 2011, p 29.Google Scholar
48. Harris, AD, Bradham, DD, Baumgarten, M, Zuckerman, IH, Fink, JC, Perencevich, EN. The use and interpretation of quasi-experimental studies in infectious diseases. Clin Infect Dis 2004; 38:1586–1591.Google Scholar
49. Cooke, FJ, Holmes, AH. The missing care bundle: antibiotic prescribing in hospitals. Int J Antimicrob Agents 2007;30:25–29.Google Scholar
50. Dortch, MJ, Fleming, SB, Kauffmann, RM, Dossett, LA, Talbot, TR, May, AK. Infection reduction strategies including antibiotic stewardship protocols in surgical and trauma intensive care units are associated with reduced resistant gram-negative healthcare-associated infections. Surg Infect (Larchmt) 2011;12:15–25.Google Scholar
51. Barie, PS. SCIP to the loo? Surg Infect (Larchmt) 2011; 12:161–162.Google Scholar
52. Harris, AD, McGregor, JC, Furuno, JP. What infection control interventions should be undertaken to control multidrug-resis-tant gram-negative bacteria? Clin Infect Dis 2006;43(suppl 2): S57–S61.CrossRefGoogle ScholarPubMed
53. Citrome, L. Number needed to treat: what it is and what it isn't, and why every clinician should know how to calculate it. J Clin Psychiatry 2011;72:412–413.Google Scholar
54. Martins, CL, Garly, ML, Bale, C, et al. Protective efficacy of standard Edmonston-Zagreb measles vaccination in infants aged 4.5 months: interim analysis of a randomised clinical trial. BMJ 2008;337:a661.Google Scholar
55. Haber, M, Levin, BR, Kramarz, P. Antibiotic control of antibiotic resistance in hospitals: a simulation study. BMC Infect Dis 2010; 10:254.Google Scholar
56. Vernaz, N, Huttner, B, Muscionico, D, et al. Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community. J Antimicrob Chemother 2011;66:928–935.Google Scholar
57. Regev-Yochay, G, Raz, M, Dagan, R, et al. Reduction in antibiotic use following a cluster randomized controlled multifaceted intervention: the Israeli judicious antibiotic prescription study. Clin Infect Dis 2011;53:33–41.Google Scholar
58. Pires dos Santos, R, Jacoby, T, Pires Machado, D, et al. Hand hygiene, and not ertapenem use, contributed to reduction of carbapenem-resistant Pseudomonas aeruginosa rates. Infect Control Hosp Epidemiol 2011;32:584–590.Google Scholar
59. Achhra, AC, Phanuphak, P, Amin, J. Long-term immunological outcomes in treated HIV-infected individuals in high-income and low-middle income countries. Curr Opin HIV AIDS 2011; 6:258–265.Google Scholar