Major articleProspective audit for antimicrobial stewardship in intensive care: Impact on resistance and clinical outcomes
Section snippets
Setting
Grady Memorial Hospital is a 1,000-bed, community teaching hospital in Atlanta, GA. An antimicrobial stewardship program was established at Grady Memorial Hospital in 2001. Since then, both an ID physician and an ID clinical pharmacist have been core members of the program. PAIF for the ICUs is performed by the ID physician with the support of the critical care (non-ID) pharmacists. In general, audit is triggered by the prescription of targeted antimicrobials, which is followed by case
Results
A total of 692 patients was prospectively included in the study: 194 during the baseline period, 415 during M1, and 83 during M2. During M1, 196 patients (47%) were evaluated by the antimicrobial utilization physician. Although imipenem and piperacillin-tazobactam were the antibiotics targeted for determining patient eligibility, 90% of included patients were concurrently exposure to other antimicrobial classes (75%, 26%, and 23% were coexposed to vancomicin, amikacin, and fluoroquinolones,
Discussion
Both M1 and M2 are in line with the recommendations by the Society of Critical Care Medicine Outcomes Task Force guidelines on how to implement, evaluate, and maintain an interdisciplinary quality improvement program in the intensive care unit.11 According to these guidelines, leadership, motivation, and teamwork are the foundation for a successful quality improvement intervention, which should introduce strategies likely to change behavior. Behavioral change in physicians is difficult to
Acknowledgment
The author thanks Stephanie Burton, Evan Tiderington, Stephen Causey, and Scott Dahlgren (MPH) for their assistance in data collection, entry, and management; Prasad Abrams, PharmD, and Marina Rabinovich, PharmD, for their assistance with AS in the ICUs; and Henry M. Blumberg, MD, for scientific and operational advice.
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Cited by (0)
This study was funded by the Emory Medical Care Foundation and the Emory University Research Committee.
Conflicts of interest: None to report.