Reducing Antibiotic Use in Respiratory Syncytial Virus-A Quality Improvement Approach to Antimicrobial Stewardship
| Autor: | Gladys M. El-Chaar, Leonard R. Krilov, Maria Lyn Quintos-Alagheband, Sejal Makvana, Rose Calixte, Shan Wang, Estela Noyola |
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| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Quality management medicine.drug_class business.industry Incidence (epidemiology) Antibiotics Psychological intervention Building and Construction Emergency department medicine.disease Virus 03 medical and health sciences 0302 clinical medicine Bronchiolitis 030225 pediatrics Emergency medicine medicine Antimicrobial stewardship 030212 general & internal medicine business |
| Zdroj: | Pediatric qualitysafety. 2(6) |
| ISSN: | 2472-0054 |
| Popis: | Objective The increased incidence of multidrug-resistant organisms is associated with increased morbidity, mortality, hospital length of stay, and cost. Estimates show that up to 50% of antimicrobial use is inappropriate. This initiative focuses on inappropriate use of antibiotics in respiratory syncytial virus (RSV) infections. This virus is the most common cause of bronchiolitis during childhood. Methods Baseline data from the 2011-2012 RSV season showed that 56.2% of our RSV-positive patients received antibiotics. To decrease inappropriate antibiotic use in RSV infections, we established an antimicrobial stewardship program (ASP). This process improvement initiative aimed to decrease exposure to antibiotics and days of antibiotic therapy per 1,000 patient days (DOT/1000PD) in hospitalized RSV-positive patients by 25%. Key drivers included building health-care knowledge, proactive interventions using prospective audit and feedback, emergency department engagement, and performance dashboards. Results We included a total of 290 children in the final analysis. After full implementation of the ASP, there was a significant reduction of antibiotic exposure from 56.2% to 30.9% (P < 0.001), an absolute reduction of 25% and a relative reduction of 45%. There was also a significant decrease in DOT/1000PD from 432.7 to 268.1 days (P = 0.017). This change represents a reduction of 164.6 DOT/1000PD from baseline after full ASP implementation. Conclusion Despite the lack of a unified hospitalist group in our institution, we were successful in reducing inappropriate antibiotic use by focusing on standardizing care among different private pediatricians in the community. A multifaceted strategy and well-designed quality improvement methodology led to a sustained reduction in antibiotic use. |
| Databáze: | OpenAIRE |
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