Clare Stoddart, Irene Kuo, Matthew A. Spence, Tara N. Palmore
Clostridioides difficile infection (CDI) threatens vulnerable populations in health care. Two-step testing improves specificity, avoiding over-treatment. This study analyzed inpatient records to estimate diagnostic outcomes and identify characteristics associated with treatment after discordant testing. Among discordant patients, those aged 65+ years were significantly more likely to be prescribed antibiotics (67% vs 39%).
{"title":"A retrospective chart review assessing antibiotic treatment of hospitalized patients with discordant Clostridioides difficile assays in an urban hospitalized setting","authors":"Clare Stoddart, Irene Kuo, Matthew A. Spence, Tara N. Palmore","doi":"10.1017/ash.2024.60","DOIUrl":"https://doi.org/10.1017/ash.2024.60","url":null,"abstract":"Clostridioides difficile infection (CDI) threatens vulnerable populations in health care. Two-step testing improves specificity, avoiding over-treatment. This study analyzed inpatient records to estimate diagnostic outcomes and identify characteristics associated with treatment after discordant testing. Among discordant patients, those aged 65+ years were significantly more likely to be prescribed antibiotics (67% vs 39%).","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140668683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alex M. Trzebucki, Matthew R Davis, E. McCreary, Susan Cuccaro, J. Bariola, T. Khadem
A pharmacist-driven protocol for methicillin-resistant Staphylococcus aureus nares screening and empiric vancomycin discontinuation was instituted in a community healthcare system utilizing a tele-antimicrobial stewardship program to reduce inappropriate use of vancomycin. The protocol and associated intervention resulted in a significant decrease in both vancomycin utilization and the rate of acute kidney injury.
{"title":"Impact of a pharmacy-driven MRSA nares screening protocol on vancomycin discontinuation in a tele-antimicrobial stewardship model","authors":"Alex M. Trzebucki, Matthew R Davis, E. McCreary, Susan Cuccaro, J. Bariola, T. Khadem","doi":"10.1017/ash.2024.43","DOIUrl":"https://doi.org/10.1017/ash.2024.43","url":null,"abstract":"A pharmacist-driven protocol for methicillin-resistant Staphylococcus aureus nares screening and empiric vancomycin discontinuation was instituted in a community healthcare system utilizing a tele-antimicrobial stewardship program to reduce inappropriate use of vancomycin. The protocol and associated intervention resulted in a significant decrease in both vancomycin utilization and the rate of acute kidney injury.","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140675591","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-19eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.41
David Yang, Leigh Cressman, Keith W Hamilton, Lauren Dutcher
We conducted a retrospective study to assess performance of provider-selected antibiotic indication (PSI) in identifying hospitalized adults with community-acquired pneumonia. PSI showed moderate sensitivity (64.4%) and high specificity (96.3%). PSI has potential utility for targeted real-time antibiotic stewardship interventions, though future research should investigate methods to improve sensitivity.
{"title":"Electronic health record-based identification of inpatients receiving antibiotic treatment for community-acquired pneumonia.","authors":"David Yang, Leigh Cressman, Keith W Hamilton, Lauren Dutcher","doi":"10.1017/ash.2024.41","DOIUrl":"https://doi.org/10.1017/ash.2024.41","url":null,"abstract":"<p><p>We conducted a retrospective study to assess performance of provider-selected antibiotic indication (PSI) in identifying hospitalized adults with community-acquired pneumonia. PSI showed moderate sensitivity (64.4%) and high specificity (96.3%). PSI has potential utility for targeted real-time antibiotic stewardship interventions, though future research should investigate methods to improve sensitivity.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036418/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140861640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Celidonio Gutfreund, Takaaki Kobayashi, Gustavo Yano Callado, Isabele Pardo, Mariana Kim Hsieh, Vivian Lin, Eli N Perencevich, Jorge L. Salinas, Michael B. Edmond, Eneida Mendonça, L. V. Rizzo, Alexandre R. Marra
Objective: We performed a systematic literature review and meta-analysis on the effectiveness of coronavirus disease 2019 (COVID-19) vaccination against post-COVID conditions (long COVID) in the pediatric population. Design: Systematic literature review/meta-analysis. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to August 14, 2023, for studies evaluating the COVID-19 vaccine effectiveness against post-COVID conditions among vaccinated individuals < 21 years old who received at least 1 dose of COVID-19 vaccine. A post-COVID condition was defined as any symptom that was present 4 or more weeks after COVID-19 infection. We calculated the pooled diagnostic odds ratio (DOR) (95% CI) for post-COVID conditions between vaccinated and unvaccinated individuals. Results: Eight studies with 23,995 individuals evaluated the effect of vaccination on post-COVID conditions, of which 5 observational studies were included in the meta-analysis. The prevalence of children who did not receive COVID-19 vaccines ranged from 65% to 97%. The pooled prevalence of post-COVID conditions was 21.3% among those unvaccinated and 20.3% among those vaccinated at least once. The pooled DOR for post-COVID conditions among individuals vaccinated with at least 1 dose and those vaccinated with 2 doses were 1.07 (95% CI, 0.77–1.49) and 0.82 (95% CI, 0.63–1.08), respectively. Conclusions: A significant proportion of children and adolescents were unvaccinated, and the prevalence of post-COVID conditions was higher than reported in adults. While vaccination did not appear protective, conclusions were limited by the lack of randomized trials and selection bias inherent in observational studies.
目的：我们对冠状病毒病 2019（COVID-19）疫苗接种在儿童群体中预防后冠状病毒病（长冠状病毒病）的效果进行了系统性文献综述和荟萃分析。设计：系统文献综述/荟萃分析。方法我们检索了2019年12月1日至2023年8月14日期间的PubMed、Cumulative Index to Nursing and Allied Health Literature (CINAHL)、EMBASE、Cochrane Central Register of Controlled Trials、Scopus和Web of Science，以寻找评估COVID-19疫苗对接种过至少1剂COVID-19疫苗、年龄小于21岁的接种者中出现COVID后病症的有效性的研究。COVID-19感染后4周或4周以上出现的任何症状均被定义为COVID-19感染后症状。我们计算了接种疫苗和未接种疫苗者出现 COVID 后症状的诊断几率比 (DOR) (95% CI)。结果如下共有 8 项研究（23995 人）评估了接种疫苗对 COVID 后病情的影响，其中 5 项观察性研究被纳入荟萃分析。未接种 COVID-19 疫苗的儿童发病率从 65% 到 97% 不等。在未接种疫苗的儿童中，COVID-19 疫苗接种后病症的总发病率为 21.3%，在至少接种过一次疫苗的儿童中，总发病率为 20.3%。在至少接种过 1 次疫苗和接种过 2 次疫苗的人群中，COVID 后病症的集合 DOR 分别为 1.07（95% CI，0.77-1.49）和 0.82（95% CI，0.63-1.08）。结论相当一部分儿童和青少年未接种疫苗，接种后感染的比例高于成人。虽然接种疫苗似乎没有保护作用，但由于缺乏随机试验和观察性研究固有的选择偏差，结论受到了限制。
{"title":"The effectiveness of the COVID-19 vaccines in the prevention of post-COVID conditions in children and adolescents: a systematic literature review and meta-analysis","authors":"Maria Celidonio Gutfreund, Takaaki Kobayashi, Gustavo Yano Callado, Isabele Pardo, Mariana Kim Hsieh, Vivian Lin, Eli N Perencevich, Jorge L. Salinas, Michael B. Edmond, Eneida Mendonça, L. V. Rizzo, Alexandre R. Marra","doi":"10.1017/ash.2024.42","DOIUrl":"https://doi.org/10.1017/ash.2024.42","url":null,"abstract":"Objective: We performed a systematic literature review and meta-analysis on the effectiveness of coronavirus disease 2019 (COVID-19) vaccination against post-COVID conditions (long COVID) in the pediatric population. Design: Systematic literature review/meta-analysis. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, Cochrane Central Register of Controlled Trials, Scopus, and Web of Science from December 1, 2019, to August 14, 2023, for studies evaluating the COVID-19 vaccine effectiveness against post-COVID conditions among vaccinated individuals < 21 years old who received at least 1 dose of COVID-19 vaccine. A post-COVID condition was defined as any symptom that was present 4 or more weeks after COVID-19 infection. We calculated the pooled diagnostic odds ratio (DOR) (95% CI) for post-COVID conditions between vaccinated and unvaccinated individuals. Results: Eight studies with 23,995 individuals evaluated the effect of vaccination on post-COVID conditions, of which 5 observational studies were included in the meta-analysis. The prevalence of children who did not receive COVID-19 vaccines ranged from 65% to 97%. The pooled prevalence of post-COVID conditions was 21.3% among those unvaccinated and 20.3% among those vaccinated at least once. The pooled DOR for post-COVID conditions among individuals vaccinated with at least 1 dose and those vaccinated with 2 doses were 1.07 (95% CI, 0.77–1.49) and 0.82 (95% CI, 0.63–1.08), respectively. Conclusions: A significant proportion of children and adolescents were unvaccinated, and the prevalence of post-COVID conditions was higher than reported in adults. While vaccination did not appear protective, conclusions were limited by the lack of randomized trials and selection bias inherent in observational studies.","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140684025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Darin W. Robillard, Alexander J. Sundermann, Brian R. Raux, Andrea M. Prinzi
The antimicrobial resistance (AMR) surveillance landscape in the United States consists of a data flow that starts in the clinical setting and is maintained by a network of national and state public health laboratories. These organizations are well established, with robust methodologies to test and confirm antimicrobial susceptibility. Still, the bridge that guides the flow of data is often one directional and caught in a constant state of rush hour that can only be refined with improvements to infrastructure and automation in the data flow. Moreover, there is an absence of information in the literature explaining the processes clinical laboratories use to coalesce and share susceptibility test data for AMR surveillance, further complicated by variability in testing procedures. This knowledge gap limits our understanding of what is needed to improve and streamline data sharing from clinical to public health laboratories. Successful models of AMR surveillance display attributes like 2-way communication between clinical and public health laboratories, centralized databases, standardized data, and the use of electronic health records or data systems, highlighting areas of opportunity and improvement. This article explores the roles and processes of the organizations involved in AMR surveillance in the United States and identifies current knowledge gaps and opportunities to improve communication between them through standardization, communication, and modernization of data flow.
美国的抗菌素耐药性（AMR）监测工作由一个数据流组成，该数据流始于临床环境，由国家和州公共卫生实验室网络负责维护。这些机构已经建立了完善的抗菌药物敏感性检测和确认方法。然而，引导数据流的桥梁往往是单向的，而且一直处于繁忙状态，只有通过改善基础设施和数据流的自动化才能使其更加完善。此外，文献中缺乏解释临床实验室为监测 AMR 而整合和共享药敏试验数据的流程的信息，而试验程序的多变性又使情况更加复杂。这一知识空白限制了我们对改善和简化从临床实验室到公共卫生实验室的数据共享所需条件的理解。成功的 AMR 监测模式具有临床和公共卫生实验室之间的双向交流、集中式数据库、标准化数据以及使用电子健康记录或数据系统等特点，这些都凸显了机会和改进的领域。本文探讨了美国参与 AMR 监测的机构的作用和流程，并指出了当前的知识差距以及通过数据流的标准化、交流和现代化来改善它们之间交流的机会。
{"title":"Navigating the network: a narrative overview of AMR surveillance and data flow in the United States","authors":"Darin W. Robillard, Alexander J. Sundermann, Brian R. Raux, Andrea M. Prinzi","doi":"10.1017/ash.2024.64","DOIUrl":"https://doi.org/10.1017/ash.2024.64","url":null,"abstract":"The antimicrobial resistance (AMR) surveillance landscape in the United States consists of a data flow that starts in the clinical setting and is maintained by a network of national and state public health laboratories. These organizations are well established, with robust methodologies to test and confirm antimicrobial susceptibility. Still, the bridge that guides the flow of data is often one directional and caught in a constant state of rush hour that can only be refined with improvements to infrastructure and automation in the data flow. Moreover, there is an absence of information in the literature explaining the processes clinical laboratories use to coalesce and share susceptibility test data for AMR surveillance, further complicated by variability in testing procedures. This knowledge gap limits our understanding of what is needed to improve and streamline data sharing from clinical to public health laboratories. Successful models of AMR surveillance display attributes like 2-way communication between clinical and public health laboratories, centralized databases, standardized data, and the use of electronic health records or data systems, highlighting areas of opportunity and improvement. This article explores the roles and processes of the organizations involved in AMR surveillance in the United States and identifies current knowledge gaps and opportunities to improve communication between them through standardization, communication, and modernization of data flow.","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140685488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maggie Hitchins, Jeannette L. Bouchard, Christopher W. Ingram, Alison I Orvin
[This corrects the article DOI: 10.1017/ash.2023.117.].
[此处更正了文章 DOI：10.1017/ash.2023.117.]。
{"title":"Implementation of an asymptomatic bacteriuria assessment protocol for patients discharged from the emergency department – CORRIGENDUM","authors":"Maggie Hitchins, Jeannette L. Bouchard, Christopher W. Ingram, Alison I Orvin","doi":"10.1017/ash.2024.65","DOIUrl":"https://doi.org/10.1017/ash.2024.65","url":null,"abstract":"[This corrects the article DOI: 10.1017/ash.2023.117.].","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adam L. Hersh, Edward A. Stenehjem, Nora Fino, Emily S. Spivak
We examined the antibiotic prescribing rate for respiratory diagnoses (AXR) before and after onset of the COVID-19 pandemic in urgent care clinics. At the onset, AXR declined substantially due to changes in case mix. Using AXR as a stewardship metric requires monitoring of changes in case mix.
{"title":"Impact of COVID-19 on urgent care diagnoses and the new AXR metric","authors":"Adam L. Hersh, Edward A. Stenehjem, Nora Fino, Emily S. Spivak","doi":"10.1017/ash.2024.62","DOIUrl":"https://doi.org/10.1017/ash.2024.62","url":null,"abstract":"We examined the antibiotic prescribing rate for respiratory diagnoses (AXR) before and after onset of the COVID-19 pandemic in urgent care clinics. At the onset, AXR declined substantially due to changes in case mix. Using AXR as a stewardship metric requires monitoring of changes in case mix.","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140688890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Reinaldo Perez, Jillian E Hayes, Ali R. Winters, R. Wrenn, Rebekah Moehring
We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in knowledge and practice as well as opportunities to improve communication with nursing colleagues.
{"title":"Antimicrobial stewardship knowledge, attitudes, and practices (KAP) among nurses","authors":"Reinaldo Perez, Jillian E Hayes, Ali R. Winters, R. Wrenn, Rebekah Moehring","doi":"10.1017/ash.2024.63","DOIUrl":"https://doi.org/10.1017/ash.2024.63","url":null,"abstract":"We performed a knowledge, attitudes, and practice (KAP) survey of bedside nurses to evaluate perceptions of antimicrobial use and aid in the design of nursing-based antimicrobial stewardship interventions. The survey highlighted discrepancies in knowledge and practice as well as opportunities to improve communication with nursing colleagues.","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140686790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seohyuk Lee, Jemma Benson, A. Cohen, V. Quagliarello, M. Juthani-mehta, Rupak Datta
In this single-center observational study of 118 older adults with advanced cancer who developed non-ventilator hospital-acquired pneumonia, prolonged antibiotic durations (8–14 and ≥15 vs ≤7 d) were not associated with reduced adjusted odds of 90-day all-cause readmission or death. These data may inform antimicrobial stewardship efforts in palliative care settings.
{"title":"Cohort study of patients with advanced cancer: outcomes associated with duration of antibiotic therapy for non-ventilator hospital-acquired pneumonia","authors":"Seohyuk Lee, Jemma Benson, A. Cohen, V. Quagliarello, M. Juthani-mehta, Rupak Datta","doi":"10.1017/ash.2024.54","DOIUrl":"https://doi.org/10.1017/ash.2024.54","url":null,"abstract":"In this single-center observational study of 118 older adults with advanced cancer who developed non-ventilator hospital-acquired pneumonia, prolonged antibiotic durations (8–14 and ≥15 vs ≤7 d) were not associated with reduced adjusted odds of 90-day all-cause readmission or death. These data may inform antimicrobial stewardship efforts in palliative care settings.","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140689942","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-04-18eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.52
Sara Stashluk, Michelle Ramos, Tyla Carettini, James B Cutrell, Seana Mathew, Marguerite Monogue, Jennifer Nguyen, James M Sanders, Esther Y Golnabi
Purpose: Pharmacist-led initiatives providing optimization of medications during transitions of care (TOC) have shown to have a positive impact on prescribing practices and patient outcomes. This study aims to evaluate the role and impact of TOC pharmacist review of outpatient parenteral antimicrobial therapy (OPAT) prescriptions prior to hospital discharge.
Methods: In a retrospective chart review, patients with OPAT prescriptions between November 1, 2022 and January 31, 2023 were evaluated using prescription-specific and intervention-specific data points. Prescription-specific data points included intravenous antimicrobials prescribed, indication, prescribing team, and time from OPAT prescription to TOC pharmacist review. Intervention-specific data points included antimicrobial optimization (dose/frequency, duration, and other), prescription clarification, and laboratory monitoring.
Results: Of the 137 OPAT prescriptions evaluated, 67 required intervention by TOC pharmacists (48.9%). The General Infectious Disease Consult team placed 71.5% of OPAT prescriptions and required interventions less frequently (42.9%) compared to the other teams. Antimicrobial optimization interventions accounted for 54.2% of interventions, which were primarily related to medication dose and frequency.
Conclusion: The TOC pharmacists can play a key role in the evaluation of OPAT prescriptions at hospital discharge. This intervention demonstrated how TOC pharmacists can effectively collaborate with the OPAT team, which builds on prior evidence of the role and value of pharmacists in the transitional care setting.
目的：药剂师主导的在护理过渡（TOC）期间提供药物优化的倡议已被证明对处方实践和患者预后具有积极影响。本研究旨在评估出院前药剂师对门诊肠外抗菌治疗（OPAT）处方进行 TOC 审查的作用和影响：在一项回顾性病历审查中，使用处方特异性和干预特异性数据点对 2022 年 11 月 1 日至 2023 年 1 月 31 日期间开具 OPAT 处方的患者进行了评估。处方特异性数据点包括静脉注射抗菌药物处方、适应症、处方团队以及从 OPAT 处方到 TOC 药剂师审核的时间。干预特异性数据点包括抗菌药物优化（剂量/频率、持续时间和其他）、处方澄清和实验室监测：结果：在评估的 137 份 OPAT 处方中，67 份需要 TOC 药剂师进行干预（48.9%）。普通传染病咨询团队开具了 71.5% 的 OPAT 处方，与其他团队相比，需要干预的频率较低（42.9%）。抗菌药优化干预占干预的 54.2%，主要与用药剂量和频率有关：TOC药剂师可在出院时对OPAT处方的评估中发挥关键作用。这项干预措施展示了 TOC 药剂师如何与 OPAT 团队进行有效合作，这是在之前关于药剂师在过渡性护理环境中的作用和价值的证据基础上发展而来的。
{"title":"Bridging the gap: opportunities for transitions of care pharmacist review of outpatient parenteral antimicrobial therapy prescriptions prior to hospital discharge.","authors":"Sara Stashluk, Michelle Ramos, Tyla Carettini, James B Cutrell, Seana Mathew, Marguerite Monogue, Jennifer Nguyen, James M Sanders, Esther Y Golnabi","doi":"10.1017/ash.2024.52","DOIUrl":"https://doi.org/10.1017/ash.2024.52","url":null,"abstract":"<p><strong>Purpose: </strong>Pharmacist-led initiatives providing optimization of medications during transitions of care (TOC) have shown to have a positive impact on prescribing practices and patient outcomes. This study aims to evaluate the role and impact of TOC pharmacist review of outpatient parenteral antimicrobial therapy (OPAT) prescriptions prior to hospital discharge.</p><p><strong>Methods: </strong>In a retrospective chart review, patients with OPAT prescriptions between November 1, 2022 and January 31, 2023 were evaluated using prescription-specific and intervention-specific data points. Prescription-specific data points included intravenous antimicrobials prescribed, indication, prescribing team, and time from OPAT prescription to TOC pharmacist review. Intervention-specific data points included antimicrobial optimization (dose/frequency, duration, and other), prescription clarification, and laboratory monitoring.</p><p><strong>Results: </strong>Of the 137 OPAT prescriptions evaluated, 67 required intervention by TOC pharmacists (48.9%). The General Infectious Disease Consult team placed 71.5% of OPAT prescriptions and required interventions less frequently (42.9%) compared to the other teams. Antimicrobial optimization interventions accounted for 54.2% of interventions, which were primarily related to medication dose and frequency.</p><p><strong>Conclusion: </strong>The TOC pharmacists can play a key role in the evaluation of OPAT prescriptions at hospital discharge. This intervention demonstrated how TOC pharmacists can effectively collaborate with the OPAT team, which builds on prior evidence of the role and value of pharmacists in the transitional care setting.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11036442/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140869048","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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