title: Antimicrobial Stewardship in a Long-Term Acute Care Hospital Using Offsite Electronic Medical Record Audit.
abstract: OBJECTIVE To offer antimicrobial stewardship to a long-term acute care hospital using telemedicine. METHODS We conducted an uninterrupted time-series analysis to measure the impact of antimicrobial stewardship on hospital-acquired Clostridium difficile infection (CDI) rates and antimicrobial use. Simple linear regression was used to analyze changes in antimicrobial use; Poisson regression was used to estimate the incidence rate ratio in CDI rates. The preimplementation period was April 1, 2010-March 31, 2011; the postimplementation period was April 1, 2011-March 31, 2014. RESULTS During the preimplementation period, total antimicrobial usage was 266 defined daily doses (DDD)/1,000 patient-days (PD); it rose 4.54 (95% CI, -0.19 to 9.28) per month then significantly decreased from preimplementation to postimplementation (-6.58 DDD/1,000 PD [95% CI, -11.48 to -1.67]; P=.01). The same trend was observed for antibiotics against methicillin-resistant Staphylococcus aureus (-2.97 DDD/1,000 PD per month [95% CI, -5.65 to -0.30]; P=.03). There was a decrease in usage of anti-CDI antibiotics by 50.4 DDD/1,000 PD per month (95% CI, -71.4 to -29.2; P<.001) at program implementation that was maintained afterwards. Anti-Pseudomonas antibiotics increased after implementation (30.6 DDD/1,000 PD per month [95% CI, 4.9-56.3]; P=.02) but with ongoing education this trend reversed. Intervention was associated with a decrease in hospital-acquired CDI (incidence rate ratio, 0.57 [95% CI, 0.35-0.92]; P=.02). CONCLUSION Antimicrobial stewardship using an electronic medical record via remote access led to a significant decrease in antibacterial usage and a decrease in CDI rates.
authors.affiliation: 1Department of Pharmacy,Tufts Medical Center,Boston,Massachusetts.
authors.forename: Kirthana
authors.initials: K
authors.lastname: Beaulac
authors.affiliation: 2Division of Geographic Medicine and Infectious Diseases,Tufts Medical Center,Boston,Massachusetts.
authors.forename: Silvia
authors.initials: S
authors.lastname: Corcione
authors.affiliation: 2Division of Geographic Medicine and Infectious Diseases,Tufts Medical Center,Boston,Massachusetts.
authors.forename: Lauren
authors.initials: L
authors.lastname: Epstein
authors.affiliation: 4Division of Infectious Diseases,Carolinas Medical Center,Charlotte,North Carolina.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Davidson
authors.affiliation: 2Division of Geographic Medicine and Infectious Diseases,Tufts Medical Center,Boston,Massachusetts.
authors.forename: Shira
authors.initials: S
authors.lastname: Doron
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology; D017723:Drug Utilization Review; D057286:Electronic Health Records; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D016014:Linear Models; D008134:Long-Term Care; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008485:Medical Audit; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology; D017216:Telemedicine
chemical_list: D000890:Anti-Infective Agents