A multifaceted intervention improves antibiotic stewardship for skin and soft tissues infections.

Adult Antimicrobial Stewardship California Emergency Service, Hospital Female Guideline Adherence Humans Inappropriate Prescribing Male Practice Patterns, Physicians' / statistics & numerical data Skin Diseases, Infectious / drug therapy Soft Tissue Infections / drug therapy
Antibiotic stewardship Antibiotic stewardship programs Emergency department Skin and soft tissue infections

Journal

The American journal of emergency medicine
ISSN: 1532-8171
Titre abrégé: Am J Emerg Med
Pays: United States
ID NLM: 8309942

Informations de publication

Date de publication:
08 2021
Historique:
received: 22 08 2020
revised: 08 10 2020
accepted: 10 10 2020
pubmed: 4 11 2020
medline: 28 8 2021
entrez: 3 11 2020
Statut: ppublish

Résumé

Assess the effectiveness of a multifaceted stewardship intervention to reduce frequency and duration of inappropriate antibiotic use for emergency department (ED) patients with skin and soft tissue infections (SSTI). We hypothesized the antibiotic stewardship program would reduce antibiotic duration and improve guideline adherence in discharged SSTI patients. Nonrandomized controlled trial. Academic EDs (intervention site and control site). Attending physicians and nurse practitioners at participating EDs. Education regarding guideline-based treatment of SSTI, tests of antimicrobial treatment of SSTI, implementation of a clinical treatment algorithm and order set in the electronic health record, and ED clinicians' audit and feedback. We examined 583 SSTIs. At the intervention site, clinician adherence to guidelines improved from 41% to 51% (aOR = 2.13 [95% CI: 1.20-3.79]). At the control site, there were no changes in adherence during the "intervention" period (aOR = 1.17 [0.65-2.12]). The between-site comparison of these during vs. pre-intervention odds ratios was not different (aOR = 1.82 [0.79-4.21]). Antibiotic duration decreased by 26% at the intervention site during the intervention compared to pre-intervention (Adjusted Geometric Mean Ratio [95% CI] = 0.74 [0.66-0.84]). Adherence was inversely associated with SSTI severity (severe vs mild; adjusted OR 0.42 [0.20-0.89]) and purulence (0.32 [0.21-0.47]). Mean antibiotic prescription duration was 1.95 days shorter (95% CI: 1.54-2.33) in the time period following the intervention than pre-intervention period. A multifaceted intervention resulted in modest improvement in adherence to guidelines compared to a control site, driven by treatment duration reductions.

Identifiants

DOI: 10.1016/j.ajem.2020.10.017 PMID: 33139143
pubmed: 33139143
pii: S0735-6757(20)30903-7
doi: 10.1016/j.ajem.2020.10.017
pii:
doi:

Types de publication

Controlled Clinical Trial Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

374-381

Informations de copyright

Copyright © 2020 Elsevier Inc. All rights reserved.

Déclaration de conflit d'intérêts

Declaration of competing interest The authors have no conflicts of interest to declare.

Auteurs

Larissa May (L)

Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 96817, USA. Electronic address: lsmay@ucdavis.edu.

Megan H Nguyen (MH)

Western University of Health Sciences, Pomona, CA, United States of America; Division of Infectious Diseases, Harbor-UCLA Medical Center, 1124 West Carson Street, Torrance, CA 90502, United States of America. Electronic address: megannguyen@westernu.edu.

Renee Trajano (R)

Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 96817, USA.

Daniel Tancredi (D)

Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd., Sacramento, CA 95817, USA. Electronic address: djtancredi@ucdavis.edu.

Elmar R Aliyev (ER)

Health Economics Department, School of Pharmacy, University of Southern California, 1985 Zonal Avenue, Los Angeles, CA 90089, USA. Electronic address: aliyev@usc.edu.

Benjamin Mooso (B)

Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 96817, USA. Electronic address: bamooso@ucdavis.edu.

Chance Anderson (C)

Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 96817, USA. Electronic address: cranderson@ucdavis.edu.

Susan Ondak (S)

Department of Emergency Medicine, University of California, Davis, 2315 Stockton Blvd., Sacramento, CA 96817, USA.

Nuen Yang (N)

Division of Biostatistics, University of California, Davis, One Shields Avenue, Davis, CA 95616, USA. Electronic address: matyang@ucdavis.edu.

Stuart Cohen (S)

Division of Infectious Diseases, University of California, Davis, 4150 V Street, Sacramento, CA 95817, USA. Electronic address: stcohen@ucdavis.edu.

Jean Wiedeman (J)

Department of Pediatrics, University of California, Davis, 2516 Stockton Blvd., Sacramento, CA 95817, USA. Electronic address: jataylorwiedeman@ucdavis.edu.

Loren G Miller (LG)

Division of Infectious Diseases, UCLA Medical Center, 1000 W. Carson St. Box 466, Torrance, CA 90509, USA. Electronic address: lgmiller@ucla.edu.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › A multifaceted intervention improves...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Assurance de la qualité des soins de santé › Bilan opérationnel › Revue des pratiques de prescription des médicaments › Gestion responsable des antimicrobiens › A multifaceted intervention improves...
questionsmedicales.fr › Régions géographiques › Amériques › Amérique du Nord › États-Unis › États du Sud-Ouest des États-Unis › Californie › A multifaceted intervention improves...
questionsmedicales.fr › Administration des services de santé › Organisation et administration › Administration d'établissement de santé › Administration hospitalière › Services hospitaliers › Service hospitalier d'urgences › A multifaceted intervention improves...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Adhésion aux directives › A multifaceted intervention improves...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › A multifaceted intervention improves...
questionsmedicales.fr › Établissements, main d'oeuvre et services de soins de santé › Services de santé › Erreurs médicales › Erreurs de médication › Prescription inappropriée › A multifaceted intervention improves...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Prestations des soins de santé › Types de pratiques des médecins › A multifaceted intervention improves...
questionsmedicales.fr › Maladies de la peau et du tissu conjonctif › Maladies de la peau › Infections de la peau › A multifaceted intervention improves...
questionsmedicales.fr › Infection › Infections des tissus mous › A multifaceted intervention improves...