Journal articles: 'Antibiotic stewardship'

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Simonson, William. "Antibiotic stewardship: Revisiting quinolone antibiotics." Geriatric Nursing 38, no. 2 (March 2017): 152–53. http://dx.doi.org/10.1016/j.gerinurse.2017.03.008.

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Coffey, KC, Daniel J. Morgan, and Kimberly C. Claeys. "Diagnostic stewardship: what impacts antibiotics use?" Current Opinion in Infectious Diseases 36, no. 4 (June 19, 2023): 270–75. http://dx.doi.org/10.1097/qco.0000000000000927.

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Purpose of review The aim of this study was to review recently published diagnostic stewardship studies of common clinical infectious syndromes and the impact on antibiotic prescribing. Recent findings Diagnostic stewardship can be implemented within healthcare systems and tailored to infectious syndromes, including urinary tract, gastrointestinal, respiratory and bloodstream infections. In urinary syndromes, diagnostic stewardship can decrease unnecessary urine culturing and associated antibiotic prescribing. Diagnostic stewardship of Clostridium difficile testing can decrease antibiotics and test ordering with a reduction in healthcare-associated C. difficile infections. Respiratory syndrome multiplex arrays can decrease time to results and increase detection of clinically relevant pathogens but may not decrease antibiotics use, or worse, could increase over-prescribing if diagnostic stewardship of ordering practices is not exercised. Lastly, blood culturing practices can be improved by clinical decision support to safely decrease collection and broad-spectrum antibiotic use. Summary Diagnostic stewardship decreases unnecessary antibiotic use in a way that is different from and complementary to antibiotic stewardship. Further studies are needed to quantify the full impact on antibiotic use and resistance. Future considerations should be to institutionalize diagnostic stewardship in patient care activities to leverage integration into systems-based interventions.

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Uddin, Mashuk. "Antibiotic Stewardship." Bangladesh Journal of Medical Microbiology 6, no. 2 (July 1, 2012): 1. http://dx.doi.org/10.3329/bjmm.v6i2.19366.

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Same, Rebecca G., and Pranita D. Tamma. "Antibiotic Stewardship." Pediatrics in Review 42, no. 4 (April 2021): 218–20. http://dx.doi.org/10.1542/pir.2020-000885.

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Hand, Kieran. "Antibiotic stewardship." Clinical Medicine 13, no. 5 (October 2013): 499–503. http://dx.doi.org/10.7861/clinmedicine.13-5-499.

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Lim, Victor. "Antibiotic Stewardship." International e-Journal of Science, Medicine & Education 6, Suppl1 (2012): S75—S79. http://dx.doi.org/10.56026/imu.6.suppl1.s75.

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Smith, Robert G., and Warren S. Joseph. "Antibiotic Stewardship." Journal of the American Podiatric Medical Association 104, no. 1 (January 1, 2014): 77–84. http://dx.doi.org/10.7547/0003-0538-104.1.77.

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The discovery of antibiotic drugs was one of the most significant medical achievements of the 20th century. The improper use of antibiotic drugs to prevent and treat infections has resulted in the emergence of resistance. Antimicrobic stewardship programs are becoming a mainstay in the fight against multidrug-resistant organisms. Individual clinicians should be encouraged to adopt the principles of antibiotic stewardship when treating lower-extremity infections in their scope of practice. First, a review of the available literature outlining the concept and practice of antibiotic stewardship is offered. Second, a discussion describing how to adopt and apply these principles to the individual clinician's practice as it applies to lower-extremity infections is offered. Finally, specific antimicrobial pharmacologic spectra and antibiogram information are offered.

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Wlodaver, Clifford G., and Christopher May. "Antibiotic Stewardship." Infectious Diseases in Clinical Practice 20, no. 1 (January 2012): 12–17. http://dx.doi.org/10.1097/ipc.0b013e31822e9bba.

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Cunha, Cheston B., and Steven M. Opal. "Antibiotic Stewardship." Medical Clinics of North America 102, no. 5 (September 2018): 831–43. http://dx.doi.org/10.1016/j.mcna.2018.04.006.

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Bal, Abhijit M., and Ian M. Gould. "Antibiotic stewardship." Current Opinion in Infectious Diseases 24, no. 4 (August 2011): 357–62. http://dx.doi.org/10.1097/qco.0b013e3283483262.

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Azria, R., B. Barry, E. Bingen, J. D. Cavallo, C. Chidiac, M. Francois, E. Grimprel, et al. "Antibiotic stewardship." Médecine et Maladies Infectieuses 42, no. 10 (October 2012): 460–87. http://dx.doi.org/10.1016/j.medmal.2012.02.004.

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Hunt, Summer, and Jennifer P. Hellwig. "Antibiotic Stewardship." Nursing for Women's Health 20, no. 4 (August 2016): 351. http://dx.doi.org/10.1016/j.nwh.2016.07.007.

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Hellwig, Jennifer P. "Antibiotic Stewardship." Nursing for Women's Health 21, no. 1 (February 2017): 17. http://dx.doi.org/10.1016/s1751-4851(17)30041-7.

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Müller, Martin, Patrick Lehmann, and Christian Willy. "„Antibiotic Stewardship“." Der Unfallchirurg 120, no. 7 (June 12, 2017): 540–48. http://dx.doi.org/10.1007/s00113-017-0365-7.

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de With, K. "Antibiotic Stewardship." Der Internist 56, no. 11 (October 21, 2015): 1264–70. http://dx.doi.org/10.1007/s00108-015-3706-z.

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Nalliah, Romesh P. "Antibiotic Stewardship." Journal of the American Dental Association 152, no. 1 (January 2021): 8–9. http://dx.doi.org/10.1016/j.adaj.2020.11.006.

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Lanckohr, C., and H. Bracht. "„Antibiotic Stewardship“." Der Anaesthesist 67, no. 1 (January 2018): 3–8. http://dx.doi.org/10.1007/s00101-017-0398-x.

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Crighton, Dr Alexander. "Antibiotic stewardship." British Dental Journal 211, no. 10 (November 2011): 443. http://dx.doi.org/10.1038/sj.bdj.2011.967.

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Cotten, C. Michael. "Antibiotic Stewardship." Clinics in Perinatology 42, no. 1 (March 2015): 195–206. http://dx.doi.org/10.1016/j.clp.2014.10.007.

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Barnes, Joy M., and Pamela Bradshaw. "Interventions to Decrease Inappropriate Antibiotic Use for Non-acute Respiratory Illness in Long-Term Care Settings." International Journal of Studies in Nursing 4, no. 3 (June 21, 2019): 28. http://dx.doi.org/10.20849/ijsn.v4i3.599.

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Background: The life-saving power of antibiotics could be lost forever if leaders fail to implement effective antibiotic stewardship programs at all healthcare levels. Grahams’ Knowledge to Action theory guided the development of an antibiotic stewardship program in a long-term care facility that had received a citation for having no active antibiotic stewardship program as required by federal regulations. Purpose: The purpose of this project was to develop and implement an evidence-based antibiotic stewardship program into one long-term care facility. Methods and Materials: This quality improvement project was a population-based systems charter development. The implementation intervention was designed to change the way health care professionals treat non-acute episodes of upper respiratory infections in a long-term care setting. This project utilized the suspected lower respiratory infection (LRI) Situation, Background, Assessment, Recommendation (SBAR) form to reduce the number of antibiotics given during the early part of cold and influenza season of 2018. An antibiotic stewardship policy was developed by multidisciplinary team members and then implemented into the facilities daily practice. Results: The point-prevalence rate of antibiotics within this facility dropped from 24% in 2017 to 6% in 2018 after implementation of the antibiotic stewardship program. Conclusion: This project demonstrates how long-term care facilities can successfully implement an antibiotic stewardship program and potentially improve overall healthcare outcomes for the residents.

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Hussain, Mazhar, Moazzam Ali Atif, and Lubna Akhtar. "IMPACT OF ANTIBIOTIC STEWARDSHIP LEARNING SESSION ON KNOWLEDGE AND ATTITUDE OF UNDERGRADUATE MEDICAL STUDENTS." KHYBER MEDICAL UNIVERSITY JOURNAL 13, no. 3 (September 30, 2021): 152–6. http://dx.doi.org/10.35845/kmuj.2021.21286.

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OBJECTIVE: To investigate the impact of antibiotic stewardship session on knowledge and attitude of 3rd year medical and allied health sciences students of Sheikh Zayed Medical College (SZMC) Rahim Yar Khan, Pakistan. METHODS: This cross-sectional study was conducted on 3rd year undergraduate medical students of SZMC Rahim Yar Khan, Pakistan. Knowledge of antibiotic stewardship was given to them through lectures, tutorials and small group discussion from May 2019 to December 2020. A structured proforma with questionnaires about antibiotic stewardship was given to them to fill in before and after the learning session. RESULTS: Out of 585, 500 students completed the proforma before and after the antibiotic stewardship session and the response rate was 85%. Although more than 80% of the students had significant knowledge pre- and post-antibiotic stewardship session but only 6% of students were familiar with term antibiotic stewardship pre-session as compared to 93% post-session (p <0.005). After the learning session more than 85% of students significantly agreed that antibiotic stewardship improve patient care, reduce bacterial resistance, decrease hospital stay and cost (p <0.005). Similarly, after session there was significant improvement regarding collaborative approaches for the appropriate use of antibiotics, work with inter professional team, role of each profession for appropriate use of antibiotics, collaboration with microbiologist and pharmacist (p<0.005). There was significant improvement to use broad and narrow spectrum antibiotics on the basis of definite and provisional diagnosis after session (p <0.005). CONCLUSION: Antibiotic stewardship session has positive impact on knowledge and attitude of undergraduate medical students.

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Pillinger, Kelly E., Jeannette Bouchard, Sarah T. Withers, Krutika Mediwala, Edoabasi U. McGee, Geneen M. Gibson, Christopher M. Bland, and P. Brandon Bookstaver. "Inpatient Antibiotic Stewardship Interventions in the Adult Oncology and Hematopoietic Stem Cell Transplant Population: A Review of the Literature." Annals of Pharmacotherapy 54, no. 6 (November 26, 2019): 594–610. http://dx.doi.org/10.1177/1060028019890886.

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Objective: To review the use of antibiotic stewardship interventions in the adult oncology and hematopoietic cell transplantation (HCT) populations. Data Sources: A literature search of PubMed was performed from inception to October 31, 2019. The general search terms used were oncology, cancer, hematologic malignancy, antimicrobial stewardship, antibiotic stewardship, febrile neutropenia, neutropenic fever, de-escalation, discontinuation, prophylaxis, practice guidelines, clinical pathway, rapid diagnostics, Filmarray, Verigene, MALDI-TOF, antibiotic allergy, and antimicrobial resistance. Study Selection and Data Extraction: Relevant English-language studies describing interventions supported by the Infectious Diseases Society of America guidelines on “Implementing an Antibiotic Stewardship Program” were included. Data Synthesis: Antibiotic stewardship publications in the oncology population have increased in recent years. Studies have described the impact of stewardship interventions, including preauthorization, prospective audit and feedback, implementation of clinical pathways, de-escalation of empirical antibiotics for febrile neutropenia (FN) prior to neutrophil recovery, allergy assessments, and use of rapid diagnostic testing. Many of these interventions have been shown to decrease antibiotic use without increased negative consequences, such as affecting length of stay or mortality. Relevance to Patient Care and Clinical Practice: This review synthesizes available evidence for implementing antibiotic stewardship interventions, particularly de-escalation of antibiotics for FN and implementation of clinical pathways for FN and sepsis, in oncology patients and HCT recipients. Summary tables highlight studies and specific research needs for clinicians. Conclusions: Immunocompromised populations, including oncology patients, have often been excluded from stewardship studies. Antibiotic stewardship is effective in reducing antibiotic consumption and improving outcomes in this patient population, although more quality data are needed.

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Nasim, Julio, Christopher Ohl, Sean Hernandez, John Williamson, James Beardsley, James Johnson, Werner Bischoff, Tyler Stone, and Vera Luther. "A Self-Reflection Stewardship Workshop Improves Resident Physician Understanding of Ambulatory Antibiotic Stewardship." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s103. http://dx.doi.org/10.1017/ice.2020.605.

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Background: Antibiotic stewardship programs (ASPs) have traditionally focused on inpatient prescribing, but they are now mandated to involve ambulatory settings. We developed and tested an educational tool in resident physicians to empower outpatient providers to perform self-reflection stewardship (SRS) to improve their antibiotic use. Results of the first SRS workshop are reported. Methods: A 90-minute SRS workshop focusing on the evaluation and management of sinusitis in ambulatory care was developed for PGY 2-3 internal medicine residents. Participants received a 15-minute didactic on the evaluation and management of adults with sinusitis, including typical microbiology, differentiation of bacterial sinusitis, and guideline recommendations on antibiotic treatment. In a computer lab, participants were instructed how to review charts of patients they had treated with antibiotics for sinusitis during the past year using the SlicerDicer application in Epic. Over 1 hour, they worked in pairs to complete and discuss a self-reflection inventory for 5 patients from each of their respective reviews. They evaluated pertinent history, comorbidities, presenting symptoms and signs, diagnostic testing performed, and a self-assessment of the subsequent antibiotic prescribing, including appropriateness of using an antibiotic, antibiotic choice and duration. In addition, they reflected on potential patient and prescriber challenges. Residents then identified common themes and developed a personal improvement plan for antibiotic prescribing for sinusitis. The last 15 minutes were spent debriefing with ASP faculty on reasons for overprescription of antibiotics for URIs and individual improvement plans. Residents completed workshop evaluations using a Likert scale and open-ended comments. Results: In total, 26 residents participated. All (100%) agreed or strongly agreed that the SRS workshop improved their understanding of how to obtain data on their own practice habits. Moreover, 23 (88%) agreed or strongly agreed that the workshop improved their understanding of when to prescribe antibiotics and how to practice antibiotic stewardship in the outpatient setting. Also, 20 participants (77%) agreed or strongly agreed that the SRS workshop helped them gain insight into reasons why they might overprescribe antibiotics in the outpatient setting. Furthermore, 25 (96%) agreed or strongly agreed that the SRS workshop helped them identify at least 1 way they could improve their antibiotic prescribing in the outpatient setting. Conclusions: The SRS workshop was well received by residents and offers a tool to empower primary care resident physicians to access their own antibiotic prescribing data, perform a structured self-reflection, and enhance their understanding of antibiotic stewardship in the ambulatory setting. SRS is a potential tool to improve ambulatory antibiotic use.Disclosures: NoneFunding: None

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Marineci, Cristian Daniel, and Cornel Chiriţă. "Antimicrobial stewardship (I)." Farmacist.ro 1, no. 1 (March 24, 2023): 6–9. http://dx.doi.org/10.26416/farm.210.1.2023.7756.

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Antimicrobial stewardship is one of the current challenges in pharmacotherapy, mainly due to the development of antimicrobial resistance. The paper discusses the current principles of antibiotic therapy, starting from the classification of germs, types of antibiotics and mechanisms of action of antibiotics.

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Villanueva, Juan, David Nix, Rachana Bhattarai, Kenneth Komatsu, and Elizabeth Kim. "Antimicrobial Stewardship Approach: Strategy to Enhance Antimicrobial Stewardship Programs in Arizona Long-Term Care." Infection Control & Hospital Epidemiology 41, S1 (October 2020): s122—s123. http://dx.doi.org/10.1017/ice.2020.631.

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Background: Implementing robust antimicrobial stewardship programs within long-term care facilities (LTCFs) presents unique challenges not typically seen in other healthcare settings. These facilities tend to care for older adults, rely on limited on-site clinician availability and experience higher-than-normal staff turnover. Many LTCFs lack the resources and expertise to track and analyze antibiotics usage. Through a collaborative effort between the Arizona Department of Health Services and the University of Arizona College of Pharmacy, support for carrying out stewardship activities was provided to these healthcare facilities. Our objective was to assess the viability of using pharmacy prescribing data to evaluate antibiotics usage among LTCFs throughout Arizona to assist in development of antimicrobial stewardship interventions. Methods: We invited interested LTCFs to participate in the development and enhancement of antimicrobial stewardship programs. We analyzed antibiotic prescribing data from November 2017 through November 2018 to assess the types and quantities of antibiotics prescribed. We worked with pharmacies to obtain a deidentified dataset that included unique patient identifiers, transaction (start) date, agent name, directions for use, route of administration, quantity dispensed, and stop dates. We estimated duration of treatment by assessing antibiotic starts using the number of transaction dates and unique patient identifiers for repeat prescriptions. Each agent was evaluated individually and assigned to an antibiotic category to better assess cumulative prescribing. Results: Through assistance from our community partners, we recruited 11 facilities to participate and worked with 5 servicing pharmacies to obtain a complete dataset for 6 LTCFs. For the facilities evaluated, there were a total of 4,654 antibiotic prescriptions. The most commonly prescribed antibiotic categories were fluroquinolones (24.3% of prescriptions) and oral β-lactams (17.8% of prescriptions). The third most commonly prescribed antibiotics were agents utilized against methicillin-resistant Staphylococcus aureus (MRSA) (13.7% of prescriptions). Antibiotic duration ranged from 1 to 304 days of therapy. Conclusions: Working directly with servicing pharmacies is an efficient way to obtain antibiotic prescribing data for LTCFs. During the 1-year period evaluated, antibiotic prescription rates varied between LTCFs. Despite numerous warnings, the fluroquinolone class continue to be among the most commonly prescribed antibiotics. Visualizing trends in LTCFs antibiotic data is an optimal way to develop and enhance antimicrobial stewardship programs in LTCFs. This fundamental information can help identify areas in which a facility can focus their stewardship efforts and provide a baseline for monitoring progress over time.Funding: NoneDisclosures: None

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Thabit, Abrar K., Nourah M. Aljereb, Omnia M. Khojah, Hanan Shanab, and Arwa Badahdah. "Towards Wiser Prescribing of Antibiotics in Dental Practice: What Pharmacists Want Dentists to Know." Dentistry Journal 12, no. 11 (October 29, 2024): 345. http://dx.doi.org/10.3390/dj12110345.

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Antibiotics have various indications for treatment and prophylaxis in dental practice. While only a handful of antibiotics are typically prescribed in dentistry, unlike in medicine, clear indications and appropriate dosing and duration remain controversial among antibiotic-prescribing dentists, which may result in inappropriate or excessive antibiotic prescriptions. This practice can increase the risk of antibiotic resistance and expose patients to unnecessary side effects. Moreover, the concept of antibiotic stewardship in dental practice remains in its early stages. This review was developed by pharmacists (general and infectious disease pharmacists) in collaboration with a periodontist and a maxillofacial surgeon to provide an antibiotic prescription guide for dentists who frequently prescribe antibiotics. It also sheds light on antibiotic stewardship. The review discusses in detail antibiotic indications for treatment and prophylaxis in dental practice and provides tables that can be used by dentists in their everyday practice. It also discusses the concept of antibiotic stewardship and provides recommendations that can be applied to the practice of antibiotic prescribing in dentistry. Antibiotic prescribing in dental practice should be limited to cases with documented infections or when indicated for prophylaxis. Every dentist can act as an antibiotic steward by prescribing antibiotics wisely and only when necessary, using their discernment to identify appropriate cases and exclude those that do not meet infection criteria. Collaboration with pharmacists is encouraged to provide such recommendations and implement antibiotic stewardship interventions, such as developing antibiotic prescription protocols.

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Ha, David R., Nina M. Haste, and Daniel P. Gluckstein. "The Role of Antibiotic Stewardship in Promoting Appropriate Antibiotic Use." American Journal of Lifestyle Medicine 13, no. 4 (April 4, 2017): 376–83. http://dx.doi.org/10.1177/1559827617700824.

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Antibiotics are one of the most significant medical discoveries in human history. The widespread use of antibiotics has resulted in the emergence of antibiotic-resistant pathogens. This fact, coupled with the paucity of new antibiotic developments, has spurred efforts to combat antibiotic resistance. One of the most critical components of these efforts is antibiotic stewardship, a multidisciplinary endeavor, employing a collection of interventions in a variety of health care settings with the aim of promoting appropriate utilization of antibiotics. This article describes antibiotic stewardship programs and key practices used to minimize the development and spread of antibiotic-resistant pathogens including the optimization of antibiotic pharmacokinetics and pharmacodynamics, the application of rapid diagnostic tools, and the use of computerized provider order entry tools.

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Zetts, Rachel M., Andrea Garcia, Jason Doctor, Jeffrey Gerber, Jeffrey A. Linder, and David Y. Hyun. "2070. Assessing Primary Care Physicians’ Attitudes and Perceptions Toward Antibiotic Resistance and Outpatient Antibiotic Stewardship: A National Survey." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S698. http://dx.doi.org/10.1093/ofid/ofz360.1750.

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Abstract Background At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship can improve prescribing and minimize the threat of antibiotic resistance. We assessed primary care physicians’ (PCPs) perceptions of antibiotic resistance, inappropriate antibiotic use, and the need for and impact of antibiotic stewardship activities. Methods We conducted a national survey of 1,550 internal and family medicine physicians and pediatricians recruited from a medical market research panel. Quotas were established to recruit participants by geographic region and specialty. For sample representativeness, survey weights were generated according to these characteristics using the American Medical Association’s Masterfile. Results Among respondents, 94% agreed that resistance is a problem in the United States, but only 55% felt it was a problem for their practice; 65% of respondents agreed they had seen an increase in resistant infections in their patients over the past 5 years. Responses about inappropriate antibiotic use were similar: 91% agreed that it was a problem, but 37% agreed that it is a problem in their practice. Additionally, 60% felt they prescribed antibiotics more appropriately than their peers. For antibiotic stewardship, 91% felt it was appropriate for office-based practices, but 53% believed that discussions with patients on the appropriate use of antibiotics is sufficient to address the problem. The majority of respondents indicated they were likely, very likely, or extremely likely to implement stewardship interventions in response to feedback or incentives from payers or health departments. The activities with the strongest likelihood to spur stewardship adoption included the state health department publishing local resistance patterns (82%), a payer creating a stand-alone incentive program for stewardship (80%), or a payer including it in a broader quality incentive program (76%). Conclusion PCPs feel that antibiotic resistance, inappropriate prescribing, and stewardship are important in the United States, but not for their own practices. This disconnect poses a challenge for the success of outpatient stewardship programs. Incentive or data feedback activities may help encourage stewardship uptake. Disclosures All authors: No reported disclosures.

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Vaughn, Valerie, David Ratz, M. Todd Greene, Scott Flanders, Tejal Gandhi, Lindsay Petty, Sean Huls, Xiaomei Feng, Andrea White, and Adam Hersh. "Antibiotic stewardship strategies and antibiotic overuse after hospital discharge: Analysis of the ROAD Home Framework." Antimicrobial Stewardship & Healthcare Epidemiology 2, S1 (May 16, 2022): s16—s17. http://dx.doi.org/10.1017/ash.2022.84.

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Background: Antibiotics are frequently prescribed–and overprescribed–at hospital discharge, leading to adverse-events and patient harm. Our understanding of how to optimize prescribing at discharge is limited. Recently, we published the ROAD (Reducing Overuse of Antibiotics at Discharge) Home Framework, which identified potential strategies to improve antibiotic prescribing at discharge across 3 tiers: Tier 1–Critical infrastructure, Tier 2–Broad inpatient interventions, Tier 3–Discharge-specific strategies. Here, we used the ROAD Home Framework to assess the association of stewardship strategies with antibiotic overuse at discharge and to describe pathways toward improved discharge prescribing. Methods: In fall 2019, we surveyed 39 Michigan hospitals on their antibiotic stewardship strategies. For patients hospitalized at participating hospitals July 1, 2017, through July 30, 2019, and treated for community-acquired pneumonia (CAP) and urinary tract infection (UTI), we assessed the association of reported strategies with days of antibiotic overuse at discharge. Days of antibiotic overuse at discharge were defined based on national guidelines and included unnecessary therapy, excess duration, and suboptimal fluoroquinolone use. We evaluated the association of stewardship strategies with days of discharge antibiotic overuse 2 ways: (1) all stewardship strategies were assumed to have equal weight, and (2) strategies weighted using the ROAD Home Framework with tier 3 (discharge-specific) strategies had the highest weight. Results: Overall, 39 hospitals with 20,444 patients (56.5% CAP; 43.5% UTI) were included. The survey response rate was 100% (39 of 39). Hospitals reported a median of 12 (IQR, 9–14) of 33 possible stewardship strategies (Fig. 1). On bivariable analyses, review of antibiotics prior to discharge was the only strategy consistently associated with lower antibiotic overuse at discharge (aIRR, 0.543; 95% CI, 0.335–0.878). On multivariable analysis, weighting by ROAD Home tier predicted antibiotic overuse at discharge for both CAP and UTI. For diseases combined, having more weighted strategies was associated with lower antibiotic overuse at discharge (aIRR per weighted intervention, 0.957; 95% CI, 0.927–0.987). Discharge-specific stewardship strategies were associated with a 12.4% relative decrease in antibiotic overuse days at discharge. Based on these findings, 3 pathways emerged to improve antibiotic use at discharge (Fig. 2): inpatient-focused strategies, “doing it all,” and discharge-focused strategies. Conclusions: The more stewardship strategies reported, the lower a hospitals’ antibiotic overuse at discharge. However, different pathways to improve discharge antibiotic use exist. Thus, discharge stewardship strategies should be tailored. Specifically, hospitals with limited stewardship resources and infrastructure should consider implementing a discharge-specific strategy straightaway. In contrast, hospitals that already have substantial inpatient infrastructure may benefit from proactively incorporating discharge into their existing strategies.Funding: NoneDisclosures: None

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Mendonca, Viola. "A Review on Rational Use of Antibiotics: Strategies and Interventions." International Journal of Research and Review 10, no. 7 (July 10, 2023): 298–306. http://dx.doi.org/10.52403/ijrr.20230741.

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The rational use of antibiotics is essential to combat the growing threat of anti-microbial resistance, improve patient outcomes, and optimize healthcare resources. Effective antibiotic stewardship programs play a crucial role in guiding healthcare professionals and patients towards appropriate antibiotic use. These programs encompass a range of interventions, including education and training, clinical guidelines, antimicrobial stewardship teams, and surveillance systems. By implementing these strategies, healthcare facilities can enhance antibiotic prescribing practices, reduce unnecessary antibiotic use, and prevent the emergence and spread of antibiotic-resistant bacteria. Additionally, public awareness campaigns are vital in empowering individuals to understand the appropriate use of antibiotics, emphasizing the importance of completing prescribed courses, and discouraging self-medication. Promoting awareness among the general population helps mitigate misconceptions and misuse, ensuring antibiotics are used judiciously and only when necessary. Keywords: AMR (Anti-microbial resistance), Anti-microbial Stewardship, rational use, health care professionals.

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Chauhan, Janki, Raja Chakraverty, and Saman Pathan. "Antimicrobial stewardship program activities in India: an appraisal." International Journal of Basic & Clinical Pharmacology 11, no. 6 (October 27, 2022): 676. http://dx.doi.org/10.18203/2319-2003.ijbcp20222756.

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Human antimicrobial misuse/overuse/irrational use is one of the main drivers of antimicrobial resistance (AMR) and in the presence of a rapidly drying up antibiotic pipeline, it becomes imperative that we learn to use antibiotics judiciously and responsibly. In 2010, India was adjudicated to be the world’s largest consumer of antibiotics and hence curbing injudicious use of antibiotics is a must. Antibiotic abuse happens due to common fallacies such as a belief that broad spectrum antibiotics are “safer” and failure to distinguish between bacterial infections and non-bacterial infections and non-infectious syndromes. In addition, antibiotics for durations longer than necessary, redundant cover (like double gram negative or double anaerobic cover) or treatment of colonizers or contaminants also constitute inappropriate antibiotic use. A stewardship program implementing rational antibiotic use is mandatory to curb irrational antibiotic use. Antimicrobial stewardship is defined as a set of coordinated interventions designed to measure and improve the appropriate use of antibiotics by promoting the selection of the optimal choice, dose, duration and route of the antibiotic which in turn lead to improved patient outcomes and decreased adverse effects.

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Drees, Marci, Kimberly Fischer, Loretta Consiglio-Ward, Janelle Caruano, Shannon Chan, William Chasanov, Jami Jones, et al. "Statewide Antibiotic Stewardship:." Delaware Journal of Public Health 5, no. 2 (May 2019): 50–58. http://dx.doi.org/10.32481/djph.2019.05.009.

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Kreitmeyr, Katharina, Alenka Pecar, Rafael Mikolajczyk, Ulrich von Both, and Johannes Huebner. "Pediatric Antibiotic Stewardship." Pediatric Infectious Disease Journal 40, no. 6 (May 10, 2021): 556–62. http://dx.doi.org/10.1097/inf.0000000000003058.

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Braxton, Carla C., Patricia A. Gerstenberger, and Glendon G. Cox. "Improving Antibiotic Stewardship." Journal of Ambulatory Care Management 33, no. 2 (April 2010): 131–40. http://dx.doi.org/10.1097/jac.0b013e3181d91680.

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Lesprit, Philippe, and Christian Brun-Buisson. "Hospital antibiotic stewardship." Current Opinion in Infectious Diseases 21, no. 4 (August 2008): 344–49. http://dx.doi.org/10.1097/qco.0b013e3283013959.

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Kerwat, Klaus, and Hinnerk Wulf. "Krankenhaushygiene – Antibiotic Stewardship." AINS - Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie 49, no. 09 (September 19, 2014): 520–21. http://dx.doi.org/10.1055/s-0034-1390054.

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Pletz, M. W., E. Tacconelli, and T. Welte. "Antibiotic Stewardship 2.0." Der Internist 58, no. 7 (June 1, 2017): 657–65. http://dx.doi.org/10.1007/s00108-017-0258-4.

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Walger, Peter. "Krankenhaushygiene - Antibiotic Stewardship." kma - Klinik Management aktuell 22, no. 12 (December 2017): 64–66. http://dx.doi.org/10.1055/s-0036-1594978.

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Hygienemaßnahmen sind wichtig, richtig und unbedingt notwendig. Aber sie sind nur eine Seite der Medaille, um Infektionen zu verhindern. Die andere Seite ist die optimale Therapie von Infektionen. Unter dem Strategiebegriff „Antibiotic Stewardship“ (ABS) gibt es inzwischen zahlreiche Leitlinien und Empfehlungen für einen sinnvollen Antibiotikagebrauch. Eine Klinik ist gut beraten, in ABS zu investieren, denn die positiven Effekte auf das klinische und ökonomische Outcome sind nicht von der Hand zu weisen.

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gvg. "Antibiotic Stewardship konkret." Pneumo News 11, no. 5 (August 27, 2019): 29. http://dx.doi.org/10.1007/s15033-019-1236-4.

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Schneidewind, L., J. Kranz, K. Boehm, P. Spachmann, F. Siegel, N. Huck, and H. M. Fritsche. "Antibiotic Stewardship (ABS)." Der Urologe 55, no. 4 (December 8, 2015): 489–93. http://dx.doi.org/10.1007/s00120-015-0012-2.

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Pletz, Mathias W., Evelina Tacconelli, and Tobias Welte. "Antibiotic Stewardship 2.0." Wiener klinisches Magazin 20, no. 5 (September 14, 2017): 180–87. http://dx.doi.org/10.1007/s00740-017-0192-z.

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gvg. "Antibiotic Stewardship konkret." CME 16, no. 11 (November 2019): 31. http://dx.doi.org/10.1007/s11298-019-7374-5.

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Yock-Corrales, Adriana, and Gabriela Naranjo-Zuñiga. "Regional Perspective of Antimicrobial Stewardship Programs in Latin American Pediatric Emergency Departments." Antibiotics 12, no. 5 (May 16, 2023): 916. http://dx.doi.org/10.3390/antibiotics12050916.

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Antibiotic stewardship (AS) programs have become a priority for health authorities to reduce the number of infections by super-resistant microorganisms. The need for these initiatives to minimize the inadequate use of antimicrobials is essential, and the election of the antibiotic in the emergency department usually impacts the choice of treatment if the patients need hospital admission, becoming an opportunity for antibiotic stewardship. In the pediatric population, broad-spectrum antibiotics are more likely to be overprescribed without any evidence-based management, and most of the publications have focused on the prescription of antibiotics in ambulatory settings. Antibiotic stewardship efforts in pediatric emergency departments in Latin American settings are limited. The lack of literature on AS programs in the pediatric emergency departments in Latin America (LA) limits the information available. The aim of this review was to give a regional perspective on how pediatric emergency departments in LA are working towards antimicrobial stewardship.

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Barot, Varshal J., and Krupa A. Pandya. "Antibiotic stewardship in health care facilities across Gujarat: A cross-sectional descriptive study." IP International Journal of Periodontology and Implantology 6, no. 3 (October 15, 2021): 165–70. http://dx.doi.org/10.18231/j.ijpi.2021.028.

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Irrational use of antibiotics is the key contributor to antibiotic resistance. To improve the administration of antibiotics, many programs have been designed at national and international levels; and antibiotic stewardship (ABS) is one of them.The aim of this study was to create awareness and understanding of antibiotic stewardship by estimating its knowledge, attitude and practice (K.A.P) among health care professionals in health care facilities across Gujarat. A cross-sectional descriptive study was carried out among health care professionals in health care facilities across Gujarat. For which a self-administered questionnaire with 15 closed-ended questions with two sections: “Optimal antibiotic use” (no.1-7 questions); and “Responsible antibiotic use” (no.8-15 questions) was disseminated online/ in electronic form. In Dental practitioners, mean scores of knowledge, attitude, practice (K.A.P) regarding “Optimal antibiotic use” and “Responsible antibiotic use” are 6.3682 ± 0.96, 6.2139 ± 1.07, 4.5672 ± 1.51 and 7.1692 ± 1.09, 6.9104 ± 1.25, 5.1443 ± 1.81 respectively.In Medical practitioners, mean scores of knowledge, attitude, practice (K.A.P) regarding “Optimal antibiotic use” and “Responsible antibiotic use” are 6.8201 ± 0.41, 6.7090 ± 0.56, 5.1270 ± 1.62 and 7.6032 ± 0.69, 7.4233 ± 0.82, 5.3492 ± 1.94 respectively.Between the groups, knowledge and attitude regarding “Optimal antibiotic use” and “Responsible antibiotic use” are statistically highly significant (p-value = <0.001). Health care professionals showed higher knowledge as compared to attitude with least practice (K>A>P) regarding antibiotic stewardship in health care facilities across Gujarat. Antibiotic stewardship is fulcrum for the dual face of antibiotics. Equilibrium between individual and societal benefit/risk ratio while making clinical antibiotic decisions will benefit both; individual patients as well as the community.

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Lou Manning, Mary, Monika Pogorzelska-Maziarz, David Jack, and Lori Wheeler. "Assessing Baccalaureate Nursing Students’ Antibiotic Stewardship Knowledge Using Virtual Standardized Patient Simulations." Antimicrobial Stewardship & Healthcare Epidemiology 1, S1 (July 2021): s37. http://dx.doi.org/10.1017/ash.2021.68.

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Background: According to the Centers for Disease Control and Prevention, the single most important factor leading to the development of antibiotic resistance (AMR) is the use of antibiotics. Studies indicate that up to 50% of hospitalized patients receive at least 1 antibiotic, half of which are inappropriate. The outpatient setting accounts for >60% of antibiotic use and over half of these prescriptions are inappropriate. Antibiotic stewardship programs improve appropriate antibiotic use, reduce AMR, decrease complications of antibiotic use, and improve patient outcomes. Building a nursing workforce with necessary AMR and antibiotic stewardship knowledge and skill is critical. Nursing graduates can translate knowledge into practice, promoting the judicious use of antibiotics to keep patients safe from antibiotic harm. Methods: Third-year baccalaureate nursing students enrolled in a fall 2020 health promotion course at an urban university affiliated with an academic medical center participated. Students received a 3-hour lecture on antibiotics, AMR and antibiotic stewardship nursing practices and actively engaged in antibiotic stewardship simulations using standardized patient (SP) encounters. The SP participants were specifically trained for these activities. Simulations included a 30-minute brief before and a 60-minute briefing after the activities. All activities occurred via video conferencing. Case scenarios, developed by the authors, focused on penicillin-allergy delabeling of an adolescent prior to elective surgery and appropriate use of antibiotics in managing pediatric urinary tract infections and acute otitis media (AOM). Before-and-after tests were used to assess the impact on AMR and antibiotic stewardship knowledge. Results: Over a period of 4 days, all enrolled students (n = 165) participated in 1 three-hour virtual simulation session. Using Zoom video conferencing with multiple breakout rooms, the activities were easily managed. During the simulations, students often struggled with reading an antibiogram and applying the concept of “watchful waiting” in AOM management. Significant differences were found in before-and-after test results, with significant improvement in students’ general and specific knowledge and awareness of antibiotics (P < .01). During the debriefing sessions, students reported increased awareness related to their role in advancing the judicious use of antibiotics. Conclusions: Initially, we planned to conduct in-person SP simulations. Due to the COVID-19 pandemic, faculty and students demonstrated remarkable flexibility and resilience as we successfully converted to a virtual format. Virtual lecture and SP simulations, followed by debriefing, was an effective approach to educate baccalaureate nursing students about AMR and their role in antibiotic stewardship. Areas for course content improvement were identified.Funding: NoDisclosures: None

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Chu, Meiyan, Jing Lin, Mingjie Wang, Zhengchang Liao, Chuanding Cao, Ming Hu, Ying Ding, Yang Liu, and Shaojie Yue. "Restrictive Use of Empirical Antibiotics Is Associated with Improved Short Term Outcomes in Very Low Birth Weight Infants: A Single Center, Retrospective Cohort Study from China." Antibiotics 12, no. 4 (April 12, 2023): 741. http://dx.doi.org/10.3390/antibiotics12040741.

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Antibiotics are essential for treating neonatal sepsis, but abuse or inappropriate use of antibiotics have harmful adverse effects. The inappropriate use of antibiotics has led to the significant increase in bacterial antimicrobial resistance in the neonatal intensive care unit (NICU). The aim of this study was to retrospectively analyze the changes in antibiotic usages in a NICU after the implementation of an antibiotic stewardship program and to determine the impact of this implementation on the short-term clinical outcomes of very low birth weight (VLBW) infants. The antibiotic stewardship program was initiated in the NICU in early 2015. For analysis, all eligible VLBW infants born from 1 January 2014 to 31 December 2016 were enrolled, and we classified the year 2014 as pre-stewardship, 2015 as during stewardship, and 2016 as post-stewardship. A total of 249 VLBW infants, including 96 cases in the 2014 group, 77 cases in the 2015 group, and 76 cases in the 2016 group, were included for final analysis. Empirical antibiotics were used in over 90% of VLBW infants in all three groups during their NICU stay. Over the 3-year period, the duration of an initial antibiotic course was significantly reduced. The proportion of patients receiving an initial antibiotic course for ≤3 days gradually increased (2.1% vs. 9.1% vs. 38.2%, p < 0.001), while the proportion of babies treated with an initial antibiotic course >7 days significantly decreased (95.8% vs. 79.2% vs. 39.5%, p < 0.001). The total days of antibiotic usage during the entire NICU stay also showed a significant reduction (27.0 vs. 21.0 vs. 10.0, p < 0.001). After adjusting for confounders, the reduction in antibiotic usage was associated with decreased odds of having an adverse composite short-term outcome (aOR = 5.148, 95% CI: 1.598 to 16.583, p = 0.006). To assess the continuity of antibiotic stewardship in the NICU, data from 2021 were also analyzed and compared to 2016. The median duration of an initial antibiotic course further decreased from 5.0 days in 2016 to 4.0 days in 2021 (p < 0.001). The proportion of an initial antibiotic course in which antibiotics were used for ≤3 days increased (38.2% vs. 56.7%, p = 0.022). Total antibiotic usage days during the entire NICU stay also decreased from 10.0 days in 2016 to 7.0 days in 2021 (p = 0.010). The finding of this study strongly suggests that restricting antibiotic use in VLBW infants is beneficial and can be achieved safely and effectively in China.

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Outterson, Kevin, John H. Powers, Enrique Seoane-Vazquez, Rosa Rodriguez-Monguio, and Aaron S. Kesselheim. "Approval and Withdrawal of New Antibiotics and other Antiinfectives in the U.S., 1980–2009." Journal of Law, Medicine & Ethics 41, no. 3 (2013): 688–96. http://dx.doi.org/10.1111/jlme.12079.

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Antibiotic use triggers evolutionary and ecological responses from bacteria, leading to antibiotic resistance and harmful patient outcomes. Two complementary strategies support long-term antibiotic effectiveness: conservation of existing therapies and production of novel antibiotics. Conservation encompasses infection control, antibiotic stewardship, and other public health interventions to prevent infection, which reduce antibiotic demand. Production of new antibiotics allows physicians to replace existing drugs rendered less effective by resistance.In recent years, physicians and policymakers have raised concerns about the pipeline for new antibiotics, pointing to a decline in the number of antibiotics approved since the 1980s. This trend has been attributed to high research and development costs, low reimbursement for antibiotics, and regulatory standards for review and approval. Professional societies and researchers around the world have called for renewed emphasis on antimicrobial stewardship, while also supporting antibiotic research and development through grants, changes to intellectual property laws to extend market exclusivity periods, and modification of premarket testing regulations to reduce antibiotic development time and expenses.

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Hayat, Khezar, Shazia Jamshed, Meagen Rosenthal, Noman Ul Haq, Jie Chang, Muhammad Fawad Rasool, Usman Rashid Malik, Anees Ur Rehman, Kashif Maqbool Khan, and Yu Fang. "Understanding of Pharmacy Students towards Antibiotic Use, Antibiotic Resistance and Antibiotic Stewardship Programs: A Cross-Sectional Study from Punjab, Pakistan." Antibiotics 10, no. 1 (January 12, 2021): 66. http://dx.doi.org/10.3390/antibiotics10010066.

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Antibiotic resistance (ABR) is a significant issue for public health globally. An adequate understanding of ABR and the approaches used to tackle ABR, including antibiotic stewardship programs, are vital. This study aimed to get an insight into antibiotic use, ABR, and antibiotic stewardship programs among pharmacy students of Punjab, Pakistan. This multicenter study was undertaken among final (fifth) year undergraduate pharmacy students of 7 universities of Punjab, Pakistan. A paper-based self-administered questionnaire comprising 48-items was utilized for data collection. Descriptive and inferential statistics were employed for data analysis. This study included a total of 296 respondents with a response rate of 85.8%. Most of the students had an average understanding of antibiotic use (59.8%), ABR (42.6%), ABR mechanisms (48.0%), and factors of ABR (51.7%). Only 21.6% of students have heard about antibiotic stewardship programs. More than half of the students believed that educating and training healthcare professionals (53.4%) and medical students (57.8%) about the prescribing and judicial usage of antibiotics could reduce the ABR burden. The awareness of most of the pharmacy students about certain aspects of antibiotic use, ABR, and stewardship programs was suboptimal.

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English, B., and Rebecca Schein. "Antimicrobial Stewardship for Newborns in the Neonatal Intensive Care Unit." Journal of Pediatric Infectious Diseases 12, no. 03 (May 17, 2017): 171–75. http://dx.doi.org/10.1055/s-0037-1602828.

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AbstractOveruse of antibiotics causing antibiotic resistance, an increase in Clostridium difficile infections, and increased adverse drug reactions is a growing problem. To combat this growing threat, the Centers for Disease Control started a program to improve the appropriate use of antimicrobials that focuses on antimicrobial stewardship. In the neonatal intensive care unit (NICU) medically fragile infants are commonly exposed to antibiotics resulting in a growing interest in applying antimicrobial stewardship principles in this patient population. The lack of treatment guidelines and the relatively narrow spectrum of individual antibiotics used to make the NICU a unique environment requiring a specialized approach to antimicrobial stewardship. This article examines the current antibiotic treatment data for common NICU illnesses including early and late-onset sepsis, pneumonia, and necrotizing enterocolitis, then reviews current recommendations for antimicrobial stewardship.

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Teoh, Leanne, Alastair J. Sloan, Michael J. McCullough, and Wendy Thompson. "Measuring Antibiotic Stewardship Programmes and Initiatives: An Umbrella Review in Primary Care Medicine and a Systematic Review of Dentistry." Antibiotics 9, no. 9 (September 16, 2020): 607. http://dx.doi.org/10.3390/antibiotics9090607.

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Antibiotic stewardship aims to tackle the global problem of drug-resistant infections by promoting the responsible use of antibiotics. Most antibiotics are prescribed in primary care and widespread overprescribing has been reported, including 80% in dentistry. This review aimed to identify outcomes measured in studies evaluating antibiotic stewardship across primary healthcare. An umbrella review was undertaken across medicine and a systematic review in dentistry. Systematic searches of Ovid Medline, Ovid Embase and Web of Science were undertaken. Two authors independently selected and quality assessed the included studies (using Critical Appraisal Skills Programme for the umbrella review and Quality Assessment Tool for Studies with Diverse Designs for the systematic review). Metrics used to evaluate antibiotic stewardship programmes and interventions were extracted and categorized. Comparisons between medical and dental settings were made. Searches identified 2355 medical and 2704 dental studies. After screening and quality assessment, ten and five studies, respectively, were included. Three outcomes were identified across both medical and dental studies: All focused on antibiotic usage. Four more outcomes were found only in medical studies: these measured patient outcomes, such as adverse effects. To evaluate antibiotic stewardship programmes and interventions across primary healthcare settings, measures of antibiotic use and patient outcomes are recommended.

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Journal articles on the topic 'Antibiotic stewardship'

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