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Editor-in-Chief & President
[h=1]Study: Antibiotic stewardship needs proper support[/h] Filed Under:
Antimicrobial Resistance
Natalie Vestin, MPH | News Reporter | CIDRAP
| May 20, 2016
Comprehensive antibiotic stewardship programs (ASPs) are more likely to meet national guidelines in hospitals that provide written support, dedicated staff, and an integrated teaching program, according to a study yesterday in Clinical Infectious Diseases that found about half reporting a comprehensive program.
Researchers from the US Centers for Disease Control and Prevention (CDC) evaluated data from 4,184 acute care hospitals submitted as part of the 2014 National Healthcare Safety Network Annual Hospital Survey.
More than half (51%) had implemented four of the seven CDC-recommended ASP elements?compliance tracking, treatment monitoring, prescriber feedback, and education?and were considered to have comprehensive ASPs. Only 39% of all hospitals had ASPs that included all seven elements, with the additional three features broadly defined as leadership support, prescription approval and monitoring, and education.
The study also found that 94% of hospitals reported specific practices to improve prescribing practices, most commonly specific treatment recommendations and prescription oversight of certain drugs.
[h=3]Hospital size, function plays a role[/h] Hospitals were more likely to have all seven core ASP elements if they primarily served children (50%), had more than 200 beds (56%), or served as a major teaching hospital (54%). High rates of seven-element ASPs (50% to 58%) were observed in 11 states: Arizona, California, Delaware, Idaho, Maine, Maryland, Massachusetts, Nebraska, Nevada, New York, and Utah.
Only 18% of critical-access hospitals and 22% of hospitals with 50 or fewer beds had a stewardship program. Small hospitals were less likely to report leadership support (40%) and educational opportunities (46%) compared with hospitals with more than 200 beds (69% for each category).
Hospitals in which leaders provided written support for the ASP (53% of hospitals) were seven times more likely to have a program that included all seven core elements, the authors said. Salary support for ASP staff and status as a teaching hospital were also significantly associated with CDC-compliant programs.
"Hospital leadership support for antibiotic stewardship appears to drive the establishment of ASPs," the authors said.
[h=3]Steps for raising rates[/h] In a related commentary in Clinical Infectious Diseases, David N. Schwartz, MD, of John H. Stroger, Jr. Hospital of Cook County, Ill., concurred with the study authors' recommendations to increase outreach to small and rural hospitals and to support the introduction of state mandates for prescribing practices.
Schwartz notes that because all seven CDC-recommended stewardship elements are interdependent, hospital support is critical to ensuring that prescribers have an awareness of stewardship procedures and the ability to carry them out in practice. To this end, he encourages ongoing research into evidence-based effects of stewardship on resistance rates and treatment outcomes.
See also:
May 20 Clin Infect Dis study
May 20 Clin Infect Dis commentary
http://www.cidrap.umn.edu/news-perspective/2016/05/study-antibiotic-stewardship-needs-proper-support
Antimicrobial Resistance
Natalie Vestin, MPH | News Reporter | CIDRAP
| May 20, 2016
Comprehensive antibiotic stewardship programs (ASPs) are more likely to meet national guidelines in hospitals that provide written support, dedicated staff, and an integrated teaching program, according to a study yesterday in Clinical Infectious Diseases that found about half reporting a comprehensive program.
Researchers from the US Centers for Disease Control and Prevention (CDC) evaluated data from 4,184 acute care hospitals submitted as part of the 2014 National Healthcare Safety Network Annual Hospital Survey.
More than half (51%) had implemented four of the seven CDC-recommended ASP elements?compliance tracking, treatment monitoring, prescriber feedback, and education?and were considered to have comprehensive ASPs. Only 39% of all hospitals had ASPs that included all seven elements, with the additional three features broadly defined as leadership support, prescription approval and monitoring, and education.
The study also found that 94% of hospitals reported specific practices to improve prescribing practices, most commonly specific treatment recommendations and prescription oversight of certain drugs.
[h=3]Hospital size, function plays a role[/h] Hospitals were more likely to have all seven core ASP elements if they primarily served children (50%), had more than 200 beds (56%), or served as a major teaching hospital (54%). High rates of seven-element ASPs (50% to 58%) were observed in 11 states: Arizona, California, Delaware, Idaho, Maine, Maryland, Massachusetts, Nebraska, Nevada, New York, and Utah.
Only 18% of critical-access hospitals and 22% of hospitals with 50 or fewer beds had a stewardship program. Small hospitals were less likely to report leadership support (40%) and educational opportunities (46%) compared with hospitals with more than 200 beds (69% for each category).
Hospitals in which leaders provided written support for the ASP (53% of hospitals) were seven times more likely to have a program that included all seven core elements, the authors said. Salary support for ASP staff and status as a teaching hospital were also significantly associated with CDC-compliant programs.
"Hospital leadership support for antibiotic stewardship appears to drive the establishment of ASPs," the authors said.
[h=3]Steps for raising rates[/h] In a related commentary in Clinical Infectious Diseases, David N. Schwartz, MD, of John H. Stroger, Jr. Hospital of Cook County, Ill., concurred with the study authors' recommendations to increase outreach to small and rural hospitals and to support the introduction of state mandates for prescribing practices.
Schwartz notes that because all seven CDC-recommended stewardship elements are interdependent, hospital support is critical to ensuring that prescribers have an awareness of stewardship procedures and the ability to carry them out in practice. To this end, he encourages ongoing research into evidence-based effects of stewardship on resistance rates and treatment outcomes.
See also:
May 20 Clin Infect Dis study
May 20 Clin Infect Dis commentary
http://www.cidrap.umn.edu/news-perspective/2016/05/study-antibiotic-stewardship-needs-proper-support