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Antibiotic Stewardship Programs in the Hospital Setting: Guidance from the Centers for Disease Control and Prevention

AUG 18, 2016 | KRISTEN ZEITLER, BS, PHARMD, BCPS

Tracking & Reporting:

Measurement of antibiotic prescribing is critical to identify opportunities for improvement and assess the impact of a programs efforts. For ASPs, this may involve evaluation of both process and outcome. ASPs should perform periodic assessments of the use of antibiotics or treatment of infections to determine the quality of antibiotic use. Standardized tools, such as drug use evaluations or antibiotic audit forms, can assist in these reviews.
 
Measurement of antibiotic use may be done through days of therapy (DOT) or defined daily dose (DDD). Compared to DOT, DDD estimates are not appropriate for children, are problematic for patients with reduced drug excretion (i.e., renal impairment), and are less accurate for between-facility benchmarking. However, DDDs can be a useful measure of progress when tracked using a consistent methodology over time. Finally, ASPs should track clinical outcomes measuring the impact of interventions to improve antibiotic use. Improving antibiotic use has a significant impact on rates of hospital onset CDI. Reducing antibiotic resistance should be another important goal of efforts to improve antibiotic use. 

Education:

ASPs should provide regular updates on antibiotic prescribing, resistance trends, and infectious disease management addressing national and local issues.facility-specific information on antibiotic use to be available for staff members can motivate improvements in prescribing patterns. Education may include didactic presentations, messaging through flyers and newsletters or electronic communication to staff groups. Education has been found to be most effective when paired with corresponding interventions and measurement of outcomes5.
 
ASPs should use these elements as guidance at their individual institution. CDC’s guidance document also includes a checklist that ASPs can use to assess the current state of their program. Advancements in antibiotic stewardship continue to grow, including rapid diagnostic testing technology in the laboratory. We should all expect to hear more on the value of ASPs and best practice elements in the coming months and years.
 
Dr. Zeitler received her Bachelor of Science degree in Chemistry from Fairfield University, CT in 2007 followed by her Doctor of Pharmacy degree from the University at Buffalo, NY
in 2011. For post-graduate residency training, she completed both a pharmacy practice residency and Infectious Diseases Specialty Residency at the Hospital of the University of Pennsylvania (Philadelphia, PA). She joined Tampa General Hospital (Tampa, FL) in 2013 to further develop and grow the Antimicrobial Stewardship Program (ASP). Her current practice includes supporting stewardship services throughout the hospital, collaborating with ID and non-ID services, and providing education related to ID and ASP. She also serves as a co-chair of the Tampa General Hospital Antimicrobial Subcommittee. Dr. Zeitler is a current member of ASHP, ACCP and SIDP.
 
References:
  1. CDC. Core Elements of Hospital Antibiotic Stewardship Programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available at http://www.cdc.gov/getsmart/healthcare/implementation/core-elements.html. Accessed 4 August 2016.
  2. Camins BC, King MD, Wells JB, et al. Impact of an antimicrobial utilization program on antimicrobial use at a large teaching hospital: a randomized controlled trial. Infection Control and Hospital Epidemiology. 2009; 30 (10): 931–938.
  3. Ingram PR, Seet JM, Budgeon CA, Murray R. Point-prevalence study of inappropriate antibiotic use at a tertiary Australian hospital. Internal Medicine Journal. 2012; 42 (6): 719–721.
  4. Fridkin SK, Baggs J, Fagan R, et al. Vital Signs: Improving Antibiotic Use Among Hospitalized Patients. MMWR. Morbidity and Mortality Weekly Report. 2014; 63.
  5. 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. Clinical Infectious Diseases. 2007; 44 (2): 159–177.
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