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03999nam a2200661Ia 4500 |
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10.1007-s11096-021-01257-8 |
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220427s2021 CNT 000 0 und d |
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|a 22107703 (ISSN)
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|a Short and long term impact of combining restrictive and enabling interventions to reduce aztreonam consumption in a community hospital
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260 |
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|b Springer Science and Business Media Deutschland GmbH
|c 2021
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|z View Fulltext in Publisher
|u https://doi.org/10.1007/s11096-021-01257-8
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|a Background Antimicrobial stewardship initiatives combining restrictive and enabling components may be an effective strategy to achieve short- and long-term objectives. Aztreonam, a relatively high-cost antipseudomonal antibiotic, is an appropriate target for stewardship initiatives based on propensity for overuse in penicillin allergy, an activity profile often warranting additional empiric gram-negative and gram-positive coverage, and a unique durability to Ambler class B metallo-beta-lactamases. Objective Analyze the immediate and long-term impact on aztreonam prescribing of combining restrictive and enabling interventions. Setting Single 233-bed community hospital with 45 adult intensive care unit beds in Nashville, Tennessee. Method Retrospective, interrupted time series analysis comparing all patients receiving aztreonam prior to intervention between January 1, 2010 and September 30, 2011 and following intervention between October 1, 2011 and September 30, 2019. Quarterly defined daily doses/1000 adjusted patient days and microbiology laboratory annual surveillance data were utilized for analysis. Main outcome measure Post-intervention change in trend of aztreonam consumption. Results Following intervention, a significant decline in aztreonam consumption was observed (− 1.97 defined daily doses/1000 adjusted patient days; p = 0.003) resulting in a sustained decrease in aztreonam consumption from 2011 (3rd quarter) to 2019 (3rd quarter) from 15.2 to 0.26 defined daily doses/1000 adjusted patient days. Short-term group 2 carbapenem consumption increased (p = 0.044). Pseudomonas aeruginosa susceptibility to aztreonam improved from 2011 to 2018 (72% vs. 84%; p = 0.0004) without deleterious effects to alternative antipseudomonal beta-lactams. Conclusion Combining restrictive and enabling interventions had immediate and sustained impact on aztreonam consumption with P. aeruginosa susceptibility improvement. © 2021, The Author(s), under exclusive licence to Springer Nature Switzerland AG.
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650 |
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|a adult
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|a Adult
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|a aged
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|a Anti-Bacterial Agents
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|a antibiotic sensitivity
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|a antiinfective agent
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|a antimicrobial stewardship
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|a Antimicrobial stewardship
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|a Antimicrobial Stewardship
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|a Article
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|a aztreonam
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0 |
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|a Aztreonam
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0 |
4 |
|a Aztreonam
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0 |
4 |
|a beta lactam antibiotic
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650 |
0 |
4 |
|a carbapenem
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0 |
4 |
|a cephalosporin
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|a community hospital
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|a community hospital
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|a Community hospitals
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|a controlled study
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|a doripenem
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4 |
|a drug hypersensitivity
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|a drug use
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|a drug utilization
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|a Enabling restriction
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|a female
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|a Hospitals, Community
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|a human
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|a Humans
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|a intensive care unit
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|a Interrupted time-series analysis
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|a major clinical study
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|a male
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4 |
|a meropenem
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0 |
4 |
|a nonhuman
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|a penicillin derivative
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|a Penicillins
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|a prescription
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|a Pseudomonas aeruginosa
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|a Retrospective Studies
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|a retrospective study
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|a Tennessee
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1 |
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|a Burke, C.
|e author
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1 |
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|a Minson, Q.
|e author
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1 |
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|a Mody, D.
|e author
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773 |
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|t International Journal of Clinical Pharmacy
|