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The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities

Published online by Cambridge University Press:  26 September 2018

Erika M. C. D’Agata*
Affiliation:
Division of Infectious Diseases, Rhode Island Hospital, Brown University, Providence, Rhode Island
Curt C. Lindberg
Affiliation:
Billings Clinic, Billings, Montana
Claire M. Lindberg
Affiliation:
Department of Nursing, The College of New Jersey, Ewing Township, New Jersey
Gemma Downham
Affiliation:
AtlantiCare Regional Medical Center, Pomona, New Jersey
Brandi Esposito
Affiliation:
AtlantiCare Regional Medical Center, Pomona, New Jersey
Douglas Shemin
Affiliation:
Division of Nephrology, Rhode Island Hospital, Brown University, Providence, Rhode Island
Sophia Rosen
Affiliation:
Fresenius Medical Care North America, Burlington, Massachusetts
*
Author for correspondence: Erika M.C. D’Agata MD, MPH, Division of Infectious Diseases, Brown University, 593 Eddy Street, Aldrich 720, Providence, RI. E-mail: edagata@lifespan.org

Abstract

Background

Antimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%–35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.

Objective

To quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.

Study design and setting

An interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.

Results

Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.

Conclusions

Within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.

Type
Original Article
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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Footnotes

Cite this article: D’Agata EMC, et al. (2018). The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities. Infection Control & Hospital Epidemiology 2018, 39, 1400–1405. doi: 10.1017/ice.2018.237

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