Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use

A multicenter intervention

Sara E. Cosgrove, Susan K. Seo, Maureen K. Bolon, Kent A. Sepkowitz, Michael W. Climo, Daniel J. Diekema, Kathleen Speck, Vidhya Gunaseelan, Gary A. Noskin, Loreen A. Herwaldt, Edward Wong, Trish M. Perl

Research output: Contribution to journalReview article

39 Citations (Scopus)

Abstract

objective. To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use. design. Quasi-experimental before-after study. setting. Five academic medical centers. patients. Adults receiving at least 48 hours of study-ABX. methods. The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study- ABX per 1,000 study-patient-days in the baseline and intervention periods. results. There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97;) at Pp.002 hospital B and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P<.001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses. conclusions. Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.

Original languageEnglish (US)
Pages (from-to)374-380
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume33
Issue number4
DOIs
StatePublished - Apr 1 2012

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Confidence Intervals
Incidence
Communicable Diseases
Outcome Assessment (Health Care)
Physicians
Therapeutics

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

Cite this

Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use : A multicenter intervention. / Cosgrove, Sara E.; Seo, Susan K.; Bolon, Maureen K.; Sepkowitz, Kent A.; Climo, Michael W.; Diekema, Daniel J.; Speck, Kathleen; Gunaseelan, Vidhya; Noskin, Gary A.; Herwaldt, Loreen A.; Wong, Edward; Perl, Trish M.

In: Infection Control and Hospital Epidemiology, Vol. 33, No. 4, 01.04.2012, p. 374-380.

Research output: Contribution to journalReview article

Cosgrove, SE, Seo, SK, Bolon, MK, Sepkowitz, KA, Climo, MW, Diekema, DJ, Speck, K, Gunaseelan, V, Noskin, GA, Herwaldt, LA, Wong, E & Perl, TM 2012, 'Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: A multicenter intervention', Infection Control and Hospital Epidemiology, vol. 33, no. 4, pp. 374-380. https://doi.org/10.1086/664771
Cosgrove, Sara E. ; Seo, Susan K. ; Bolon, Maureen K. ; Sepkowitz, Kent A. ; Climo, Michael W. ; Diekema, Daniel J. ; Speck, Kathleen ; Gunaseelan, Vidhya ; Noskin, Gary A. ; Herwaldt, Loreen A. ; Wong, Edward ; Perl, Trish M. / Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use : A multicenter intervention. In: Infection Control and Hospital Epidemiology. 2012 ; Vol. 33, No. 4. pp. 374-380.
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abstract = "objective. To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use. design. Quasi-experimental before-after study. setting. Five academic medical centers. patients. Adults receiving at least 48 hours of study-ABX. methods. The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study- ABX per 1,000 study-patient-days in the baseline and intervention periods. results. There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95{\%} confidence interval [CI], 0.88-0.97;) at Pp.002 hospital B and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95{\%} CI, 0.79-0.88; P<.001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3{\%}) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7{\%}) of these courses. conclusions. Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.",
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AU - Cosgrove, Sara E.

AU - Seo, Susan K.

AU - Bolon, Maureen K.

AU - Sepkowitz, Kent A.

AU - Climo, Michael W.

AU - Diekema, Daniel J.

AU - Speck, Kathleen

AU - Gunaseelan, Vidhya

AU - Noskin, Gary A.

AU - Herwaldt, Loreen A.

AU - Wong, Edward

AU - Perl, Trish M.

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N2 - objective. To evaluate the impact of postprescription review of broad-spectrum antimicrobial (study-ABX) agents on rates of antimicrobial use. design. Quasi-experimental before-after study. setting. Five academic medical centers. patients. Adults receiving at least 48 hours of study-ABX. methods. The baseline, intervention, and follow-up periods were 6 months each in 2 units at each of 5 sites. Adults receiving at least 48 hours of study-ABX entered the cohort as case-patients. During the intervention, infectious-diseases physicians reviewed the cases after 48 hours of study-ABX. The provider was contacted with alternative recommendations if antimicrobial use was considered to be unjustified on the basis of predetermined criteria. Acceptance rates were assessed 48 hours later. The primary outcome measure was days of study- ABX per 1,000 study-patient-days in the baseline and intervention periods. results. There were 1,265 patients in the baseline period and 1,163 patients in the intervention period. Study-ABX use decreased significantly during the intervention period at 2 sites: from 574.4 to 533.8 study-ABX days/1,000 patient-days (incidence rate ratio [IRR], 0.93; 95% confidence interval [CI], 0.88-0.97;) at Pp.002 hospital B and from 615.6 to 514.4 study-ABX days/1,000 patient-days (IRR, 0.83; 95% CI, 0.79-0.88; P<.001) at hospital D. Both had established antimicrobial stewardship programs (ASP). Study-ABX use increased at 2 sites and stayed the same at 1 site. At all institutions combined, 390 of 1,429 (27.3%) study-ABX courses were assessed as unjustified; recommendations to modify or stop therapy were accepted for 260 (66.7%) of these courses. conclusions. Postprescription review of study-ABX decreased antimicrobial utilization in some of the study hospitals and may be more effective when performed as part of an established ASP.

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