title: Impact of different methods of feedback to clinicians after postprescription antimicrobial review based on the Centers For Disease Control and Prevention's 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults.
abstract: OBJECTIVE
  To evaluate (1) the framework of the 12 Steps to Prevent Antimicrobial Resistance Among Hospitalized Adults that is part of the Centers for Disease Control and Prevention (CDC) Campaign to Prevent Antimicrobial Resistance in Healthcare Settings, with regard to steps addressing antimicrobial use; and (2) methods of feedback to clinicians regarding antimicrobial use after postprescription review.
  
  
  METHODS
  Prospective intervention to identify and modify inappropriate antimicrobial therapy.
  
  
  METHODS
  A 1,000-bed, tertiary care teaching hospital.
  
  
  METHODS
  Inpatients in selected medicine and surgery units receiving broad-spectrum antimicrobials for 48-72 hours.
  
  
  METHODS
  We created a computer-based clinical-event detection system that automatically identified inpatients taking broad-spectrum and "reserve" antimicrobials for 48-72 hours. Although prior approval was required for initial administration of broad-spectrum and reserve antimicrobials, once approval was obtained, therapy with the antimicrobials could be continued indefinitely at the discretion of the treating clinician. Therapy that was ongoing at 48-72 hours was reviewed by an infectious diseases pharmacist or physician, and when indicated feedback was provided to clinicians to modify or discontinue therapy. Feedback was provided via a direct telephone call, a note on the front of the medical record, or text message sent to the clinician's pager. The acceptance rate of feedback was recorded and recommendations were categorized according to the 12 steps recommended by the CDC.
  
  
  RESULTS
  Interventions were recommended for 334 (30%) of 1,104 courses of antimicrobial therapy reviewed. A total of 87% of interventions fit into one of the CDC's 12 steps of prevention: 39% into step 3 ("target the pathogen"), 1% into step 4 ("access experts"), 3% into steps 7 and 8 ("treat infection, not colonization or contamination"), 18% into step 9 ("say ;no' to vancomycin"), and 26% into step 10 ("stop treatment when no infection"). The rate of compliance with recommendations to improve antimicrobial use was 72%. No differences in compliance were seen with the different methods of feedback.
  
  
  CONCLUSIONS
  Nearly one-third of antimicrobial courses did not follow the CDC's recommended 12 steps for prevention of antimicrobial resistance. Clinicians demonstrated high compliance with following suggestions made after postprescription review, suggesting that it is a useful approach to decreasing and improving antimicrobial use among inpatients.
authors.affiliation: Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA. scosgro1@jhmi.edu
authors.forename: Sara E
authors.initials: SE
authors.lastname: Cosgrove
authors.forename: Alpa
authors.initials: A
authors.lastname: Patel
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Song
authors.forename: Robert E
authors.initials: RE
authors.lastname: Miller
authors.forename: Kathleen
authors.initials: K
authors.lastname: Speck
authors.forename: Amy
authors.initials: A
authors.lastname: Banowetz
authors.forename: Rachel
authors.initials: R
authors.lastname: Hadler
authors.forename: Ronda L
authors.initials: RL
authors.lastname: Sinkowitz-Cochran
authors.forename: Denise M
authors.initials: DM
authors.lastname: Cardo
authors.forename: Arjun
authors.initials: A
authors.lastname: Srinivasan
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use*; D015142:Baltimore; D002487:Centers for Disease Control and Prevention, U.S.; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000517:prevention & control; D004352:Drug Resistance, Microbial; D017723:Drug Utilization Review; D005246:Feedback; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching; D006801:Humans; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011446:Prospective Studies; D014481:United States
chemical_list: D000900:Anti-Bacterial Agents