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Predictors of Antimicrobial Stewardship Program Recommendation Disagreement

Published online by Cambridge University Press:  30 April 2018

Laura L. Bio ,
Jenna F. Kruger ,
Betty P. Lee ,
Matthew S. Wood  and
Hayden T. Schwenk
Laura L. Bio
Affiliation:
Lucile Packard Children’s Hospital Stanford, Stanford, California
Jenna F. Kruger
Affiliation:
Lucile Packard Children’s Hospital Stanford, Stanford, California
Betty P. Lee
Affiliation:
Lucile Packard Children’s Hospital Stanford, Stanford, California
Matthew S. Wood
Affiliation:
Lucile Packard Children’s Hospital Stanford, Stanford, California
Hayden T. Schwenk*
Affiliation:
Lucile Packard Children’s Hospital Stanford, Stanford, California Department of Pediatrics, Stanford University School of Medicine, Stanford, California
*
Address correspondence to Hayden T. Schwenk, MD, MPH, Division of Infectious Diseases, Department of Pediatrics, 300 Pasteur Dr, Room G312, Stanford, CA, 94305 (hschwenk@stanford.edu).
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Abstract

OBJECTIVE

To identify predictors of disagreement with antimicrobial stewardship prospective audit and feedback recommendations (PAFR) at a free-standing children’s hospital.

DESIGN

Retrospective cohort study of audits performed during the antimicrobial stewardship program (ASP) from March 30, 2015, to April 17, 2017.

METHODS

The ASP included audits of antimicrobial use and communicated PAFR to the care team, with follow-up on adherence to recommendations. The primary outcome was disagreement with PAFR. Potential predictors for disagreement, including patient-level, antimicrobial, programmatic, and provider-level factors, were assessed using bivariate and multivariate logistic regression models.

RESULTS

In total, 4,727 antimicrobial audits were performed during the study period; 1,323 PAFR (28%) and 187 recommendations (15%) were not followed due to disagreement. Providers were more likely to disagree with PAFR when the patient had a gastrointestinal infection (odds ratio [OR], 5.50; 95% confidence interval [CI], 1.99–15.21), febrile neutropenia (OR, 6.14; 95% CI, 2.08–18.12), skin or soft-tissue infections (OR, 6.16; 95% CI, 1.92–19.77), or had been admitted for 31–90 days at the time of the audit (OR, 2.08; 95% CI, 1.36–3.18). The longer the duration since the attending provider had been trained (ie, the more years of experience), the more likely they were to disagree with PAFR recommendations (OR, 1.02; 95% CI, 1.01–1.04).

CONCLUSIONS

Evaluation of our program confirmed patient-level predictors of PAFR disagreement and identified additional programmatic and provider-level factors, including years of attending experience. Stewardship interventions focused on specific diagnoses and antimicrobials are unlikely to result in programmatic success unless these factors are also addressed.

Infect Control Hosp Epidemiol 2018;806–813

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 7 , July 2018 , pp. 806 - 813
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

PREVIOUS PRESENTATION: A previous iteration of this data was presented at the Eighth Annual International Pediatric Antimicrobial Stewardship Conference on June 2, 2017, in St Louis Missouri.

References

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