The impact of infectious disease specialists on antibiotic prescribing in hospitals
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Published on: August 30, 2018
C Pulcini1, E Botelho-Nevers, O J Dyar
1Service de Maladies Infectieuses, CHU de Nancy, Nancy, France; Université de Lorraine, EA 4360 APEMAC, Nancy, France.
Abstract:
Given the current bacterial resistance crisis, antimicrobial stewardship programmes are of the utmost importance. We present a narrative review of the impact of infectious disease specialists (IDSs) on the quality and quantity of antibiotic use in acute-care hospitals, and discuss the main factors that could limit the efficacy of IDS recommendations. A total of 31 studies were included in this review, with a wide range of infections, hospital settings, and types of antibiotic prescription. Seven of 31 studies were randomized controlled trials, before/after controlled studies, or before/after uncontrolled studies with interrupted time-series analysis. In almost all studies, IDS intervention was associated with a significant improvement in the appropriateness of antibiotic prescribing as compared with prescriptions without any IDS input, and with decreased antibiotic consumption. Variability in the antibiotic prescribing practices of IDSs, informal (curbside) consultations and the involvement of junior IDSs are among the factors that could have an impact on the efficacy of IDS recommendations and on compliance rates, and deserve further investigation. We also discuss possible drawbacks of IDSs in acute-care hospitals that are rarely reported in the published literature. Overall, IDSs are valuable to antimicrobial stewardship programmes in hospitals, but their impact depends on many human and organizational factors.
Insights
Infectious disease specialists (IDSs) significantly improve antibiotic prescribing quality and reduce consumption in hospitals. However, factors like variability in practice and junior staff involvement can impact their effectiveness in antimicrobial stewardship programmes.
Area of Science:
- Infectious Diseases
- Hospital Pharmacy
- Antimicrobial Stewardship
Background:
- The escalating crisis of bacterial resistance necessitates robust antimicrobial stewardship programmes.
- Infectious disease specialists (IDSs) play a crucial role in optimizing antibiotic use within healthcare settings.
Purpose of the Study:
- To conduct a narrative review on the impact of IDSs on antibiotic prescribing quality and quantity in acute-care hospitals.
- To identify factors influencing the efficacy of IDS recommendations and antibiotic stewardship.
Main Methods:
- A narrative review synthesizing findings from 31 studies.
- Included studies encompassed diverse infections, hospital settings, and antibiotic prescription types.
- Seven studies employed rigorous designs like RCTs or interrupted time-series analysis.
Main Results:
- IDS intervention consistently correlated with improved antibiotic prescribing appropriateness compared to no IDS input.
- Antibiotic consumption significantly decreased following IDS involvement.
- Variability in IDS prescribing practices, informal consultations, and junior staff involvement were noted as potential limiting factors.
Conclusions:
- IDSs are integral to successful antimicrobial stewardship programmes in hospitals.
- The impact of IDSs is modulated by various human and organizational factors requiring further investigation.
- Optimizing IDS integration and addressing practice variations can enhance stewardship outcomes.
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