Infection Control & Hospital Epidemiology (2018), 39, 941–946 doi:10.1017/ice.2018.121
Original Article
Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study
Bradley J. Langford BScPhm, ACPR, PharmD, BCPS1,2, Julie Hui-Chih Wu MSc1, Kevin A. Brown PhD1,3, Xuesong Wang MSc4, Valerie Leung BScPhm, ACPR, MBA1, Charlie Tan MD5,
Gary Garber MD, FRCPC, FACP, FIDSA, CCPE1,3,6,7 and Nick Daneman MD, FRCPC, MSc1,3,4,8,9 1Public Health Ontario, Toronto, Canada, 2St Joseph’s Health Center, Toronto, Canada, 3University of Toronto, Toronto, Canada, 4Institute for Clinical Evaluative Sciences, Toronto, Canada, 5London Health Sciences Center, London, Canada, 6University of Ottawa, Ottawa, Canada, 7Ottawa Hospital Research Institute, Ottawa, Canada, 8Division of Infectious Diseases, Sunnybrook Health Sciences Center, Toronto, Canada and 9Sunnybrook Research Institute, Sunnybrook Health Sciences Center, Toronto, Canada
Abstract
Objectives: Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities. Design: Observational study of acute-care hospitals in Ontario, Canada Methods: A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest. Results: Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0.87; 95% CI, 0.75–0.99), prospective audit and feedback (RRadjusted, 0.80; 95% CI, 0.67–0.96), and intravenous-to-oral conversion policies (RRadjusted, 0.79; 95% CI, 0.64–0.99) were associated with lower risk-adjusted antibiotic use. Conclusions: Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.
(Received 3 March 2018; accepted 23 April 2018; electronically published June 12, 2018)
Antimicrobial resistance is a significant threat to public health. It results in decreased effectiveness of antimicrobial therapy leading to prolonged illness, increased mortality, and increased social and economic costs.1 Antimicrobial utilization, the key driver of resistance, is highest in acute-care settings. However, up to 50% of this use is considered inappropriate.2 Implementing an anti- microbial stewardship program (ASP) is a vital intervention to address inappropriate use and prevent the negative consequences of therapy in this setting.3 Guidelines have promoted the importance of both structural
(eg, funding, staffing, leadership support) and strategic (eg, inter- ventions to improve antimicrobial utilization) ASP components.3,4 Despite recommendations to include these components in a hospital
Author for correspondence: Bradley J. Langford, Public Health Ontario, 480
University Ave, Toronto, ON, Canada, M5G 1V2. E-mail:
Bradley.langford@
oahpp.ca Cite this article: Langford B, et al. (2018). Assessing the impact of antibiotic stewardship
program elements on antibiotic use across acute-care hospitals: an observational study. Infection Control & Hospital Epidemiology 2018, 39, 941–946. doi:10.1017/ice.2018.121
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
ASP, their relative impact remains to be determined. Additionally, identifying which elements may influence antibiotic use is an important consideration in the context of finite hospital resources where prioritizing ASP activities is needed. Recent studies indicate that antimicrobial utilization varies widely
between hospital facilities even after accounting for nonmodifiable factors (eg, hospital type, patient population characteristics).5,6 Current knowledge about the drivers of such variability is limited, particularly as it relates to the impact of an ASP on antimicrobial use. The primary objective of this study was to determine whether
the following hospital ASP structural elements are associated with reduced antibiotic use: program maturity, designated funding/ resources, recognition as an organizational priority, and reporting of ASP metrics to senior administration. A secondary objective was to determine which specific strategies strongly recommended by the 2016 Infectious Diseases Society of America (IDSA)/Society for Healthcare Epidemiology of America (SHEA) guidelines are associated with reduced antibiotic use: formulary restriction with
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118 |
Page 119 |
Page 120 |
Page 121 |
Page 122 |
Page 123 |
Page 124 |
Page 125 |
Page 126 |
Page 127 |
Page 128 |
Page 129 |
Page 130 |
Page 131 |
Page 132 |
Page 133 |
Page 134 |
Page 135 |
Page 136 |
Page 137 |
Page 138 |
Page 139 |
Page 140
