title: Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey.
abstract: BACKGROUND Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING Total of 130 Veterans Affairs facilities with inpatient services. RESULTS Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician (P=.03), an ID fellowship program (P=.003), and a clinical pharmacist with formal ID training (P=.006) as well as frequency of systematic patient-level reviews of antimicrobial use (P=.01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection (P=.01). Stop orders for antimicrobial duration were associated with increased use (P=.03). CONCLUSIONS ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647-654.
authors.affiliation: 1Department of Health Administration and Policy,College of Public Health,University of Oklahoma,Oklahoma City,Oklahoma.
authors.forename: Ann F
authors.initials: AF
authors.lastname: Chou
authors.affiliation: 4David Geffen School of Medicine at University of California-Los Angeles (UCLA),Los Angeles,California.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Graber
authors.affiliation: 6Department of Medicine and Division of Epidemiology,University of Utah,Salt Lake City,Utah.
authors.forename: Makoto
authors.initials: M
authors.lastname: Jones
authors.affiliation: 8Department of Internal Medicine,University of Utah,Salt Lake City,Utah.
authors.forename: Yue
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: 4David Geffen School of Medicine at University of California-Los Angeles (UCLA),Los Angeles,California.
authors.forename: Matthew Bidwell
authors.initials: MB
authors.lastname: Goetz
authors.affiliation: 10Veterans Affairs Medical Center,Boise,Idaho.
authors.forename: Karl
authors.initials: K
authors.lastname: Madaras-Kelly
authors.affiliation: 6Department of Medicine and Division of Epidemiology,University of Utah,Salt Lake City,Utah.
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
authors.affiliation: 12National Infectious Diseases Service,VA Central Office,Washington,DC.
authors.forename: Allison
authors.initials: A
authors.lastname: Kelly
authors.affiliation: 4David Geffen School of Medicine at University of California-Los Angeles (UCLA),Los Angeles,California.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Glassman
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000073602:Antimicrobial Stewardship / Q000379:methods / Q000458:organization & administration* / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration
chemical_list: D000900:Anti-Bacterial Agents