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Updated: Aug 5, 2026
Multiplex Therapeutic Drug Monitoring by Isotope-dilution HPLC-MS/MS of Antibiotics in Critical Illnesses
Published on: August 30, 2018
Impact of a multifaceted antimicrobial stewardship program: A front-line ownership driven quality improvement project
Adam Jonathan Kaufman1, Janine McCready2, Jeff Powis2
1*Department of Emergency Medicine,Michael Garron Hospital,Toronto,ON.
Background:
Antibiotic overuse has promoted growing rates of antimicrobial resistance and secondary antibiotic-associated infections such as Clostridium difficile (C. difficile). Antimicrobial stewardship programs (ASPs) are effective in reducing antimicrobial use in the inpatient setting; however, the unique environment of the emergency department (ED) lends itself to challenges for successful implementation. Front-line ownership (FLO) methodology has been shown to be a potentially effective strategy for the implementation of inpatient ASPs through an iterative multi-pronged approach driven by front-line providers.
Objective:
To determine whether a FLO approach to antimicrobial stewardship in the ED can alter antimicrobial usage.
Methods:
Interventions were driven by ED physicians and facilitated by Infectious Diseases Division physicians from the hospital's ASP using FLO principles. Measured end points included antibiotic usage in the ED as measured by defined daily doses, and rates of urine culture sent from the ED.
Results:
There was a step-wise significant reduction in the use of azithromycin (p=0.006), ceftriaxone (p=0.045), ciprofloxacin (p=0.034), and moxifloxacin (p=0.008). There was also a significant reduction in rates of urine cultures (p<0.001) by 2.26 urine cultures per 100 ED patient visits.
Conclusions:
FLO offers a promising approach to successful implementation of an ASP in the ED. Future studies would be important to evaluate the generalizability of the FLO approach to ASP development in other EDs and to determine strategies to improve the sustainability of reductions in antimicrobial use.
Insights
Front-line ownership (FLO) successfully reduced antibiotic use and urine cultures in the emergency department (ED). This approach shows promise for antimicrobial stewardship programs (ASPs) in the ED setting.
Area of Science:
- Infectious Diseases
- Public Health
- Healthcare Management
Background:
- Antibiotic overuse drives antimicrobial resistance and C. difficile infections.
- Antimicrobial stewardship programs (ASPs) are effective but face challenges in emergency departments (EDs).
- Front-line ownership (FLO) methodology offers a potential solution for inpatient ASP implementation.
Purpose of the Study:
- To evaluate the impact of a FLO approach on antimicrobial usage within an ED setting.
- To assess the feasibility of implementing an ED-based ASP using FLO principles.
Main Methods:
- ED physicians led interventions, supported by Infectious Diseases Division physicians and ASP.
- Interventions were guided by FLO principles.
- Measured outcomes included antibiotic usage (defined daily doses) and ED urine culture rates.
Main Results:
- Significant reductions observed in azithromycin, ceftriaxone, ciprofloxacin, and moxifloxacin use.
- A notable decrease of 2.26 urine cultures per 100 ED visits was recorded.
- The study demonstrated a step-wise reduction in specific antibiotic categories.
Conclusions:
- FLO presents a promising strategy for implementing effective ASPs in EDs.
- Further research is needed to assess the generalizability and long-term sustainability of FLO in diverse ED settings.
- The FLO approach can potentially improve antimicrobial prescribing practices in the ED.
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