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. 2024 Feb 26;6(1):dlae026.
doi: 10.1093/jacamr/dlae026. eCollection 2024 Feb.

Effect and sustainability of a stepwise implemented multidisciplinary antimicrobial stewardship programme in a university hospital emergency department

Lukas Arenz  1   2 , Annika Porger  1 , Michaela De Michel  1 , Alexandra Weber  1   3 , Jette Jung  1   4 , Heidi Horns  1 , Sandra Gscheidle  1   3 , Tobias Weiglein  5   6 , Joachim Pircher  6   7 , Johanna Becker-Lienau  6   8 , Sophia Horster  6 , Matthias Klein  6   9 , Rika Draenert  1
Affiliations

Effect and sustainability of a stepwise implemented multidisciplinary antimicrobial stewardship programme in a university hospital emergency department

Lukas Arenz et al. JAC Antimicrob Resist. .

Abstract

Objectives: To explore effectiveness and sustainability of guideline adherence and antibiotic consumption after establishing treatment guidelines and initiating antimicrobial stewardship (AMS) ward rounds in a university hospital emergency department (ED).

Methods: Data were gathered retrospectively from 2017 to 2021 in the LMU University Hospital in Munich, Germany. Four time periods were compared: P1 (pre-intervention period); P2 (distribution of guideline pocket cards); P3 (reassessment after 3 years); and P4 (refresher of guideline pocket cards and additional daily AMS ward rounds for different medical disciplines). Primary outcome was adherence to guideline pocket cards for community-acquired pneumonia, cystitis, pyelonephritis and COVID-19-associated bacterial pneumonia. Secondary outcomes were reduction in antibiotic consumption and adherence to AMS specialist recommendations.

Results: The study included 1324 patients. Guideline adherence increased in P2 for each of the infectious diseases entities. After 3 years (P3), guideline adherence decreased again, but was mostly on a higher level than in P1. AMS ward rounds resulted in an additional increase in guideline adherence (P1/P2: 47% versus 58.6%, P = 0.005; P2/P3: 58.6% versus 57.3%, P = 0.750; P3/P4: 57.3% versus 72.5%, P < 0.001). Adherence increased significantly, not only during workdays but also on weekends/nightshifts. Adherence to AMS specialist recommendations was excellent (91.3%). We observed an increase in use of narrow-spectrum antibiotics and a decrease in the application of fluoroquinolones and cephalosporins.

Conclusions: Establishing treatment guidelines in the ED is effective. However, positive effects can be diminished over time. Daily AMS ward rounds are useful, not only to restore but to further increase guideline adherence significantly.

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Figures

Figure 1.
Figure 1.
AMS intervention timeline.
Figure 2.
Figure 2.
Percentage of guideline adherence for all infectious diseases (ID) entities as well as CAP, cystitis, pyelonephritis and COVID-19-associated bacterial pneumonia, P1–P4 (chi-squared test).
Figure 3.
Figure 3.
Percentage of guideline adherence for internal medicine, surgery and neurology, P1–P4, evaluated for all infectious diseases entities (chi-squared test).
Figure 4.
Figure 4.
Percentage of guideline adherence on AMS intervention time versus non-intervention time, P1–P4. Regular working hours: Monday to Friday 8 a.m. to 5 p.m. (chi-squared test).
Figure 5.
Figure 5.
Antibiotic consumption for the P1–P4 in the ED, evaluated as DDD/100 patients.
See this image and copyright information in PMC

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References

    1. Murray CJL, Ikuta KS, Sharara F et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 2022; 399: 629–55. 10.1016/S0140-6736(21)02724-0 - DOI - PMC - PubMed
    1. Holmes AH, Moore LSP, Sundsfjord A et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet 2016; 387: 176–87. 10.1016/S0140-6736(15)00473-0 - DOI - PubMed
    1. Yunquera-Romero L, Márquez-Gómez I, Henares-López A et al. Appropriateness of antimicrobial prescriptions in the emergency department of a tertiary hospital. [Article in Spanish]. Rev Esp Quimioter 2018; 31: 209–16. - PMC - PubMed
    1. Denny KJ, Gartside JG, Alcorn K et al. Appropriateness of antibiotic prescribing in the emergency department. J Antimicrob Chemother 2019; 74: 515–20. 10.1093/jac/dky447 - DOI - PMC - PubMed
    1. Peragine C, Walker SAN, Simor A et al. Impact of a comprehensive antimicrobial stewardship program on institutional burden of antimicrobial resistance: a 14-year controlled interrupted time-series study. Clin Infect Dis 2019; 71: 2897–904. 10.1093/cid/ciz1183 - DOI - PubMed

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