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Antimicrobial stewardship interventions reported feasible

NEW ORLEANS — Core antimicrobial stewardship strategies were viable and well-received in small, community hospitals, according to recent findings presented at ID Week 2016.

“Antimicrobial stewardship is one of the key strategies that we have in preventing the emerging spread of multidrug resistant organisms,” Deverick Anderson, MD, MPH, associate professor of medicine at Duke University Medical Center, said during his presentation. “In fact, in the last couple iterations of IDSA guidelines, there have been a couple of core strategies that have been recommended, such as antimicrobial restriction — also called preauthorization of prospective audit with intervention and feedback.”

“When you think about stewardship, it’s important to consider the community hospital setting because more than 50% of health care in the U.S. is provided in this setting,” he said. “But, it is often resource limited, particularly when it comes to setting aside resources specifically for antimicrobial stewardship. In fact, some recent data from the CDC suggests that this might actually be a source within the relatively more antimicrobial prescriptions happening. If we’re thinking of ways to improve stewardship, first it may be useful to think of how well we may be able to introduce the core strategies as recommended.” 

Anderson and colleagues performed a multicenter randomized historically-controlled crossover trial to determine the feasibility and outcomes of implementing two standard antimicrobial stewardship interventions in four community hospitals participating in Duke Antimicrobial Stewardship Outreach Network (DASON).

The two core strategies included antimicrobial pre-authorization and post-antibiotic review, targeting vancomycin, piperacillin-tazobactam and carbapenems. Pharmacists performed each strategy for 6 months, with a 1-month wash out period in between. Secondary outcomes included intervention results and days of therapy in each arm.

They found that participating hospitals approved both strategies for implementation. Out of 14,812 eligible patients, 1,119 received a targeted antibiotic during a pre-authorization period compared to 1,022 out of 14,090 during a post-antibiotic review period. Pharmacists were more likely to recommend antibiotic changes during post-antibiotic review, but the recommendations were less likely to be followed. The mean days of therapy of piperacillin-tazobactam was lower in the post-antibiotic review arm (0.45 vs. 0.56, difference = 0.1; 95% CI 0.05-0.15).

“We believe that active core stewardship interventions are indeed feasible in small community hospitals,” Anderson said. “Although it’s worth noting that I’m not certain that true restriction, meaning no antibiotic being given, is going to be quite as easy to pull off. It’s also worth noting that each community hospital had slight variations that they used, so perhaps we need to be mindful that you’re going to have to shape stewardship teams and plans based on the local context.

“The data we have suggests there’s enough of a signal that these interventions may decrease utilization and that it’s worth pursuing with a subsequent, larger trial,” Anderson conclude. “At this point, I would certainly say there’s not enough data to conclude one of these interventions is necessarily better than the other in this setting.”

Reference:

Anderson D, et al. Abstract 1673. Presented at: IDWeek; October 25-30, 2016; New Orleans.

Disclosure: The researchers report no relevant financial disclosures.