Skip to main content Accessibility help
×
Home
Hostname: page-component-cf9d5c678-m9wwp Total loading time: 0.265 Render date: 2021-07-27T13:20:37.436Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Improving Antimicrobial Stewardship The Evolution of Programmatic Strategies and Barriers

Published online by Cambridge University Press:  02 January 2015

Birgir Johannsson
Affiliation:
Carver College of Medicine, University of Iowa, Iowa City, Iowa
Susan E. Beekmann
Affiliation:
Carver College of Medicine, University of Iowa, Iowa City, Iowa
Arjun Srinivasan
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Adam L. Hersh
Affiliation:
Department of Pediatrics, University of Utah, Salt Lake City, Utah
Ramanan Laxminarayan
Affiliation:
Center for Disease Dynamics, Economics and Policy, Washington, DC, and Princeton University, Princeton, New Jersey
Philip M. Polgreen
Affiliation:
Carver College of Medicine, University of Iowa, Iowa City, Iowa College of Public Health, University of Iowa, Iowa City, Iowa
Corresponding
E-mail address:

Abstract

Objective.

To describe the prevalence and characteristics of antimicrobial stewardship programs (ASPs) in hospitals across the United States and to describe financial support provided for these programs.

Design.

Electronic and paper 14-question survey of infectious diseases physician members of the Infectious Diseases Society of America Emerging Infections Network (IDSA EIN).

Participants.

All 1,044 IDSA EIN members who care for adult patients were invited to participate.

Results.

Five hundred twenty-two (50%) members responded. Seventy-three percent of respondents reported that their institutions had or were planning an ASP, compared with 50% reporting the same thing in an EIN survey 10 years before. A shift was noted from formulary restriction alone to use of a set of tailored strategies designed to provide information and feedback to prescribers, particularly in community hospitals. Lack of funding and lack of personnel were reported as major barriers to implementing a program. Fifty-two percent of respondents with an ASP reported that infectious diseases physicians do not receive direct compensation for their participation in the ASP, compared with 18% 10 years ago.

Conclusions.

The percentage of institutions reporting ASPs has increased over the last decade, although small community hospitals were least likely to have these programs. In addition, ASP strategies have shifted dramatically. Lack of funding remains a key barrier for ASPs, and administrators need additional cost savings data in order to support ASPs. Interestingly, while guidelines and editorials regard compensated participation by an infectious diseases physician in these programs as critical, we found that more than half of the respondents reported no direct compensation for ASP activities.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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.)

Footnotes

a

5th Decennial International Conference on Healthcare-Associated Infection; Atlanta, Georgia; March 2010.

References

1. Maragakis, LL, Perencevich, EN, Cosgrove, SE. Clinical and economic burden of antimicrobial resistance. Expert Rev Anti Infect Ther 2008;6:751763.CrossRefGoogle ScholarPubMed
2. Roberts, RR, Hota, B, Ahmad, I, et al. Hospital and societal costs of antimicrobial-resistant infections in a Chicago teaching hospital: implications for antibiotic stewardship. Clin Infect Dis 2009;49:11751184.CrossRefGoogle Scholar
3. Lipsitch, M, Samore, MH. Antimicrobial use and antimicrobial resistance: a population perspective. Emerg Infect Dis 2002;8:347354.CrossRefGoogle ScholarPubMed
4. McGowan, JE Jr. Finland, M. Usage of antibiotics in a general hospital: effect of requiring justification. J Infect Dis 1974;130:165168.CrossRefGoogle Scholar
5. Scheckler, WE, Bennett, JV. Antibiotic usage in seven community hospitals. JAMA 1970;213:264267.CrossRefGoogle ScholarPubMed
6. 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;44:159177.CrossRefGoogle Scholar
7. The Research Committee of SHEA. Enhancing patient safety by reducing healthcare-associated infections: the role of discovery and dissemination. Infect Control Hosp Epidemiol 2010;31:118123.CrossRefGoogle Scholar
8. Sunenshine, RH, Liedtke, LA, Jernigan, DB, Strausbaugh, LJ. Role of infectious diseases consultants in management of antimicrobial use in hospitals. Clin Infect Dis 2004;38:934938.CrossRefGoogle ScholarPubMed
9. Executive Committee of the Infectious Diseases Society of America Emerging Infections Network. The emerging infections network: a new venture for the Infectious Diseases Society of America. Clin Infect Dis 1997;25:3436.CrossRefGoogle Scholar
10. Lawton, RM, Fridkin, SK, Gaynes, RP, McGowan, JE Jr. Practices to improve antimicrobial use at 47 US hospitals: the status of the 1997 SHEA/IDSA position paper recommendations. Society for Healthcare Epidemiology of America/Infectious Diseases Society of America. Infect Control Hosp Epidemiol 2000;21:256259.CrossRefGoogle ScholarPubMed
11. Weinstein, RA. Controlling antimicrobial resistance in hospitals: infection control and use of antibiotics. Emerg Infect Dis 2001;7:188192.CrossRefGoogle Scholar
12. Zaoutis, TE. Antibiotic resistance: who will pay the bills? Clin Infect Dis 2009;49:11851186.CrossRefGoogle ScholarPubMed
13. McGowan, JE Jr. Minimizing antimicrobial resistance: the key role of the infectious diseases physician. Clin Infect Dis 2004;38:939942.CrossRefGoogle ScholarPubMed
14. McQuillen, DP, Petrak, RM, Wasserman, RB, Nahass, RG, Scull, JA, Martinelli, LP. The value of infectious diseases specialists: non-patient care activities. Clin Infect Dis 2008;47:10511063.CrossRefGoogle ScholarPubMed
15. Zillich, AJ, Sutherland, JM, Wilson, SJ, et al. Antimicrobial use control measures to prevent and control antimicrobial resistance in US hospitals. Infect Control Hosp Epidemiol 2006;27:10881095.CrossRefGoogle ScholarPubMed
16. Nault, V, Beaudoin, M, Thirion, DJ, Gosselin, M, Cossette, B, Va-liquette, L. Antimicrobial stewardship in acute care centres: a survey of 68 hospitals in Quebec. Can J Infect Dis Med Microbiol 2008;19:237242.CrossRefGoogle ScholarPubMed
17. Pope, SD, Dellit, TH, Owens, RC, Hooton, TM. Results of survey on implementation of Infectious Diseases Society of America and Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship. Infect Control Hosp Epidemiol 2009;30:9798.CrossRefGoogle Scholar
18. Hersh, AL, Beekmann, SE, Polgreen, PM, Zaoutis, TE, Newland, JG. Antimicrobial stewardship programs in pediatrics. Infect Control Hosp Epidemiol 2009;30:12111217.CrossRefGoogle Scholar
19. Drew, RH, White, R, MacDougall, C, Hermsen, ED, Owens, RC Jr. Insights from the Society of Infectious Diseases Pharmacists on antimicrobial stewardship guidelines from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Pharmacotherapy 2009;29:593607.CrossRefGoogle Scholar
20. Owens, RC Jr. Antimicrobial stewardship: concepts and strategies in the 21st century. Diagn Microbiol Infect Dis 2008;61:110128.CrossRefGoogle ScholarPubMed
21. Arnold, FW, McDonald, LC, Smith, RS, Newman, D, Ramirez, JA. Improving antimicrobial use in the hospital setting by providing usage feedback to prescribing physicians. Infect Control Hosp Epidemiol 2006;27:378382.CrossRefGoogle ScholarPubMed
22. Cosgrove, SE, Patel, A, Song, X, et al. Impact of different methods of feedback to clinicians after postprescription antimicrobial review based on the Centers for Disease Control and Prevention's 12 steps to prevent antimicrobial resistance among hospitalized adults. Infect Control Hosp Epidemiol 2007;28:641646.CrossRefGoogle ScholarPubMed
23. Di Pentima, MC, Chan, S. Impact of antimicrobial stewardship program on vancomycin use in a pediatric teaching hospital. Pediatr Infect Dis J 2010;29:707711.CrossRefGoogle Scholar
24. Agwu, AL, Lee, CK, Jain, SK, et al. A World Wide Web-based antimicrobial stewardship program improves efficiency, communication, and user satisfaction and reduces cost in a tertiary care pediatric medical center. Clin Infect Dis 2008;47:747753.CrossRefGoogle Scholar
25. John, JF Jr., Fishman, NO. Programmatic role of the infectious diseases physician in controlling antimicrobial costs in the hospital. Clin Infect Dis 1997;24:471485.CrossRefGoogle ScholarPubMed
26. Bannan, A, Buono, E, McLaws, ML, Gottlieb, T. A survey of medical staff attitudes to an antibiotic approval and stewardship programme. Intern Med J 2009;39:662668.CrossRefGoogle Scholar
27. Wright, SB, Ostrowsky, B, Fishman, N, Deloney, VM, Mermel, L, Perl, TM. Expanding roles of healthcare epidemiology and infection control in spite of limited resources and compensation. Infect Control Hosp Epidemiol 2010;31:127132.CrossRefGoogle ScholarPubMed
28. Frank, MO, Batteiger, BE, Sorensen, SJ, et al. Decrease in expenditures and selected nosocomial infections following implementation of an antimicrobial-prescribing improvement program. Clin Perform Qual Health Care 1997;5:180188.Google ScholarPubMed
29. Fraser, GL, Stogsdill, P, Dickens, JD Jr, Wennberg, DE, Smith, RP Jr, Prato, BS. Antibiotic optimization: an evaluation of patient safety and economic outcomes. Arch Intern Med 1997;157:16891694.CrossRefGoogle ScholarPubMed
30. Gross, R, Morgan, AS, Kinky, DE, Weiner, M, Gibson, GA, Fishman, NO. Impact of a hospital-based antimicrobial management program on clinical and economic outcomes. Clin Infect Dis 2001;33:289295.CrossRefGoogle ScholarPubMed
31. Ng, CK, Wu, TC, Chan, WM, et al. Clinical and economic impact of an antibiotics stewardship programme in a regional hospital in Hong Kong. Qual Saf Health Care 2008;17:387392.CrossRefGoogle Scholar
32. Kuntz, JL, Cavanaugh, JE, Becker, LK, et al. Clostridium difficile-associated disease in patients in a small rural hospital. Infect Control Hosp Epidemiol 2007;28:12361239.CrossRefGoogle Scholar
33. Sintchenko, V, Coiera, E, Gilbert, GL. Decision support systems for antibiotic prescribing. Curr Opin Infect Dis 2008;21:573579.CrossRefGoogle ScholarPubMed
95
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Improving Antimicrobial Stewardship The Evolution of Programmatic Strategies and Barriers
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Improving Antimicrobial Stewardship The Evolution of Programmatic Strategies and Barriers
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Improving Antimicrobial Stewardship The Evolution of Programmatic Strategies and Barriers
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *