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Published on: August 30, 2018
Poor compliance with an antibiotic directive-A call for intensified monitoring
Frederik Novak1, Jens T Hørlück2, Jacob D Redder3
1Department of Infectious Diseases, Aarhus University Hospital, Skejby, Aarhus, Denmark.
Background:
In April 2017, the Central Denmark Region Antibiotic Stewardship Committee issued a directive to reduce the general use of piperacillin-tazobactam and prescribe narrow-spectrum antibiotics for mild and moderate pneumonia. The directive was distributed to all regional hospital clinicians.
Methods:
Electronic medical records were used to obtain de-identified details of all antibiotics administered (together with diagnosis codes) to all in-hospital patients (pre-directive and post-directive) in the nine regional hospitals. Average moving range statistical process control charts were used to analyze pre-directive and post-directive variation in antibiotic usage patterns.
Results:
Upon the distribution of the directive, a period of decline of the overall usage of piperacillin-tazobactam ensued. Rather than benzylpenicillin, as recommended for pneumonia, the initial decline in piperacillin/tazobactam usage was accompanied by increased use of cefuroxime.
Conclusions:
A steward-directed reduction in piperacillin-tazobactam usage was accompanied by less desirable usage of a broad-spectrum alternative. Future antibiotic stewardship initiatives will hopefully benefit from close monitoring and timely feedback to clinicians. A dialogue with clinicians based on near real-time data is predicted to improve antibiotic stewardship actions.
Insights
Antibiotic stewardship initiatives reduced piperacillin-tazobactam use but increased broad-spectrum cefuroxime. Future efforts require close monitoring and clinician feedback for optimal antibiotic stewardship.
Area of Science:
- Infectious Diseases
- Clinical Pharmacy
- Healthcare Management
Background:
- A directive was issued in April 2017 by the Central Denmark Region Antibiotic Stewardship Committee to reduce piperacillin-tazobactam use.
- The directive recommended narrow-spectrum antibiotics for mild to moderate pneumonia and was distributed to all regional hospital clinicians.
Purpose of the Study:
- To evaluate the impact of an antibiotic stewardship directive on piperacillin-tazobactam usage.
- To assess the patterns of antibiotic prescribing following the directive.
Main Methods:
- Electronic medical records from nine regional hospitals were analyzed for antibiotic administration and diagnosis codes.
- Statistical process control charts were used to analyze antibiotic usage patterns before and after the directive.
Main Results:
- Piperacillin-tazobactam usage declined following the directive's distribution.
- Increased use of cefuroxime, a broad-spectrum antibiotic, was observed instead of the recommended benzylpenicillin for pneumonia.
Conclusions:
- Stewardship efforts successfully reduced piperacillin-tazobactam but led to the use of a less desirable alternative.
- Future antibiotic stewardship requires enhanced monitoring and timely feedback to clinicians for improved outcomes.
- Clinician dialogue based on near real-time data is crucial for effective antibiotic stewardship actions.
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