Antimicrobial Education Program Lowers Prescribing in Outpatient Hemodialysis Centers

Outpatient hemodialysis centers that took part in a study to ensure the appropriate use of antimicrobial drugs decreased the use of these medications without a negative effect on patients, an AHRQ-funded study found. Previous studies in hospital settings showed stewardship programs designed to reduce the unnecessary use of antimicrobial drugs have lowered prescribing by about 20 percent while reducing infections caused by multidrug-resistant organisms. The initiatives have also reduced adverse drug events and costs. Programs had not been developed in hemodialysis facilities, however, where infection rates were among the highest of all patient groups. The AHRQ study showed an antimicrobial stewardship program in six hemodialysis centers was associated with a 6 percent monthly average reduction in prescribing over 12 months. The stewardship program resulted in recommended changes in 30 of the 145 antimicrobial drug courses reviewed. Changes in drug use were not associated with changes in overall rates of hospital admission or of bloodstream infections. Access the abstract of the article in Infection Control & Hospital Epidemiology.

2018 Sep 26:1-6. doi: 10.1017/ice.2018.237. [Epub ahead of print]

The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities.

D'Agata EMC1, Lindberg CC2, Lindberg CM3, Downham G4, Esposito B4, Shemin D5, Rosen S6.

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Abstract

BACKGROUND:

Antimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%-35% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.

OBJECTIVE:

To quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.Study design and settingAn interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.

RESULTS:

Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (P=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible Staphylococcus aureus infections and discontinuation of antimicrobials when criteria for presumed infection were not met.

CONCLUSIONS:

Within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.