Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

{"title":"Assessing the impact of discontinuation of formulary prior authorization on antibiotic prescribing.","authors":"Teagan Zeggil, Tony Nickonchuk, Elissa Rennert-May, Irina Rajakumar","doi":"10.1017/ash.2024.92","DOIUrl":"https://doi.org/10.1017/ash.2024.92","url":null,"abstract":"<p><strong>Objective: </strong>To compare prescribing patterns of restricted antimicrobials before and after the removal of prior authorization and to develop a prospective audit and feedback program to mitigate the potential inappropriate prescribing of these antimicrobials.</p><p><strong>Methods: </strong>An interrupted time-series analysis assessing the trends in antibiotic use was conducted between May 2020 and February 2023 in large urban hospitals, where all ASP activities were discontinued in May 2022 and a pilot prospective audit and feedback (PAF) program was initiated in January 2023.</p><p><strong>Results: </strong>The collective change in restricted antibiotic utilization after the removal of prior authorization was trending towards increased utilization but was not statistically significant. With the PAF program, 9.8% of patients were identified by the antimicrobial stewardship pharmacists as requiring intervention. Within these patients, 19 different recommendations were made, with the most common being to narrow the therapeutic spectrum (47.4%). Stewardship interventions suggestions were accepted (full and partial) 69.2% of the time.</p><p><strong>Conclusions: </strong>Although there were some small statistically significant changes detected for a few antibiotics, there were no situations where those changes remained significant after appropriate controls were added to the analyses. As such, the intervention may not have had any statistically significant impact on DDDs of the studied antibiotics.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427963/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333596","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}

{"title":"Application of center for disease control and prevention standardized antimicrobial administration ratio to an Indian hospital.","authors":"Smita Sarma, Kalyani Borde, Matthew Robinson, Neelam Rawat, Prerna Khurana, Vyoma Singh, Padam Singh, Yatin Mehta","doi":"10.1017/ash.2024.396","DOIUrl":"10.1017/ash.2024.396","url":null,"abstract":"<p><strong>Background: </strong>Rigorous antibiotic stewardship is advised by international societies to combat rising antibiotic resistance. A major component of these programs is the metric used for antibiotic consumption measurement. A method for standardized antimicrobial administration ratio (SAAR) is suggested by the Centre for Disease Control & Prevention-National Healthcare Safety Network (NHSN).</p><p><strong>Objectives: </strong>We applied the SAAR method to calculate antibiotic consumption in a tertiary care hospital in India. We also validated a limited sampling approach to calculate SAAR.</p><p><strong>Method: </strong>The prospective study was conducted in three medical intensive care units over a period of 12 months. Monthly antibiotic consumption was measured by the hospital electronic records. Limited sampling was performed by weekly bedside review of the antibiotic orders. Formulae for SAAR calculation were derived from the NHSN guide. SAAR obtained by electronic records and limited sampling were compared to validate this approach.</p><p><strong>Results: </strong>SAAR was calculated as >1 for an Indian hospital (1.49 by electronic records and 1.43 by limited sampling approach). The difference between the two ratios was not statistically significant (<i>P</i> = .47).</p><p><strong>Conclusions: </strong>SAAR in our setting is 1.49, which is slightly higher than the NHSN benchmark. Antibiotic usage (AU) risk adjustment based on data from the NHSN might not be adequate for calculating SAAR for Indian hospitals. There is a need to perform AU risk factor analysis for Indian settings for better defining SAAR in Indian context. The limited sampling approach can be adapted for calculation of SAAR in settings with limited resources.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11440567/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333586","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}

{"title":"Reducing catheter-associated urinary tract infections in a large health system: a quality improvement approach using a fractal management system.","authors":"Elie A Saade, Esther J Thatcher, Tina Lewis, Susan Carr, Marcia Cornell, Rachel Arnold, Zainab Albar, Peter Pronovost","doi":"10.1017/ash.2024.386","DOIUrl":"https://doi.org/10.1017/ash.2024.386","url":null,"abstract":"<p><strong>Objective: </strong>Although preventable through established infection control practices, catheter-associated urinary tract infections (CAUTIs) remain prevalent in acute-care settings. Our goal was to improve the CAUTI rates through multiple hospitals through implementing sustainable practices, including enhancing communication, provider engagement, accountability, and transparency in reporting to achieve long-term improvements.</p><p><strong>Design: </strong>Quality improvement with multiple levels of interventions.</p><p><strong>Setting: </strong>A health system in northern Ohio with 21 affiliated hospitals across 16 counties.</p><p><strong>Patients: </strong>Adult patients admitted to the hospital between June 2020 and June 2023.</p><p><strong>Methods: </strong>A broad set of quality improvement (QI) strategies was developed by an interdisciplinary team and guided by the Fractal Management System framework to ensure accountability, communication, and alignment across teams and facilities. Key drivers were indwelling urinary catheter (IUC) alternatives, insertion, maintenance, removal, and smart diagnostics. The main outcome measures were standardized infection ratios (SIR) and standardized utilization ratio (SUR), comparing period 1 (P1, June 2020 to December 2021) and period 2 (P2, January 2022 to June 2023).</p><p><strong>Results: </strong>Enhanced communication and management played crucial roles in minimizing IUC placement. Updated policies and protocols, coupled with clear guidelines and decision support tools, facilitated effective urinary management. Performance tracking and visual management boards provided real-time insights, while collaborative efforts, including staff huddles and multidisciplinary teamwork, ensured consistent adherence to best practices.</p><p><strong>Conclusions: </strong>A systemwide QI initiative focused on enhanced communication, management, and collaboration contributed to improved SIR and reduced CAUTI rates across multiple hospitals, highlighting the impact of strong communication and proactive management in healthcare settings.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333620","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}

{"title":"The impact of hospital-specific guidelines on carbapenem use and patient outcomes in a setting for high endemicity with multidrug-resistant gram-negative bacilli.","authors":"Cemre Boşnak, Şeyda Betül Fındık, Muhammed Atay, Ward Fakhouri, Sada Babazade, Eda Karadoğan, Gökhan Metan, Ömrüm Uzun","doi":"10.1017/ash.2024.415","DOIUrl":"https://doi.org/10.1017/ash.2024.415","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to assess the impact of hospital-specific guidelines on the optimal utilization of carbapenems and to examine their effects on patient outcomes.</p><p><strong>Design: </strong>Quasi-experimental study.</p><p><strong>Setting: </strong>Tertiary care hospital in Turkey where infectious diseases (IDs) consultation and antibiotic approval are mandatory for carbapenem use.</p><p><strong>Participants: </strong>All inpatients ≥18 years of age who received a carbapenem for at least 24 hours during the study periods were enrolled.</p><p><strong>Intervention: </strong>Hospital-specific treatment guidelines were introduced in April 2019. The control group was the year 2018, when there were no guidelines (pre-GP). The year 2020 was analyzed as the intervention period (post-GP).</p><p><strong>Results: </strong>A total of 678 patients were analyzed, 326 in the pre-GP period and 352 in the post-GP period. Following guideline implementation, there was a significant increase in appropriate carbapenem use (49.1% in pre-GP vs 71.9% in post-GP, <i>P</i> < .001). The duration of carbapenem use decreased significantly (<i>P</i> = .019). However, there was no significant change in the incidence of new infection episodes within the subsequent 30 days (27.6% in pre-GP vs 28.3% in post-GP), or in the length of hospitalization [median (25%-75%) = 28 (16-46) in pre-GP, 28 (15-47.5) in post-GP, <i>P</i> = .678]. Mortality rates were similar at day 7 post-GP (1.7%) compared to pre-GP (0.03%) (<i>P</i> = .125).</p><p><strong>Conclusions: </strong>The implementation of guidelines increased the appropriate utilization of carbapenems, without resulting in extended hospital stays or recurrent episodes. Despite an increased number of patients admitted to the ICU during the latter period, infection-related mortality rates remained comparable.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428004/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333622","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}

{"title":"Diagnostic stewardship for blood cultures in the pediatric intensive care unit: lessons in implementation from the BrighT STAR Collaborative.","authors":"Charlotte Z Woods-Hill, Danielle W Koontz, Anping Xie, Elizabeth A Colantuoni, Anna Sick-Samuels, Marlene R Miller, Abigail Arthur, Anushree Aneja, Urmi Kumar, Aaron M Milstone","doi":"10.1017/ash.2024.416","DOIUrl":"https://doi.org/10.1017/ash.2024.416","url":null,"abstract":"<p><strong>Objective: </strong>BrighT STAR was a diagnostic stewardship collaborative of 14 pediatric intensive care units (PICUs) across the United States designed to standardize and reduce unnecessary blood cultures and study the impact on patient outcomes and broad-spectrum antibiotic use. We now examine the implementation process in detail to understand how sites facilitated this diagnostic stewardship program in their PICUs.</p><p><strong>Design: </strong>A multi-center electronic survey of the 14 BrighT STAR sites, based on qualitative data about the implementation process collected during the primary phase of BrighT STAR.</p><p><strong>Setting: </strong>14 PICUs enrolled in BrighT STAR.</p><p><strong>Participants: </strong>Site leads at each enrolled site.</p><p><strong>Methods: </strong>An electronic survey guided by implementation science literature and based on data collected during BrighT STAR was administered to all 14 sites after completion of the primary phase of the collaborative.</p><p><strong>Results: </strong>10 specific tasks appear critical to implementing blood culture diagnostic stewardship, with variability in site-level strategies employed to accomplish those tasks. Sites rated certain tasks and strategies as highly important. Strategies used in top-performing sites were distinct from those used in lower-performing sites. Certain strategies may link to drivers of culture overuse and represent key targets for changing clinician behavior.</p><p><strong>Conclusions: </strong>BrighT STAR offers important insights into the tasks and strategies used to facilitate successful diagnostic stewardship in the PICU. More work is needed to compare specific strategies and optimize stewardship outcomes in this complex environment.</p><p><strong>Clinical trial registry information: </strong>Blood Culture Improvement Guidelines and Diagnostic Stewardship for Antibiotic Reduction in Critically Ill Children (Bright STAR). NCT03441126. https://www.clinicaltrials.gov/study/NCT03441126?term=Bright%20STAR&aggFilters=status:com&checkSpell=false&rank=1.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333598","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}

{"title":"Ten sustainable steps infectious diseases professionals can take to mitigate the climate crisis.","authors":"Shreya M Doshi, Pamela Lee, Saul Hymes, Judith A Guzman-Cottrill, Preeti Jaggi","doi":"10.1017/ash.2024.394","DOIUrl":"https://doi.org/10.1017/ash.2024.394","url":null,"abstract":"<p><p>Climate change and pollution harm the public. The healthcare industry disproportionately contributes to greenhouse gas emissions. Infection diseases professionals including infection preventionists and antimicrobial stewards are uniquely positioned to mitigate the environmental impact of our daily practices. We highlight 10 actionable steps that infectious disease professionals can incorporate into daily practices, thereby mitigating the impact of climate change.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333621","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}

{"title":"Incubation period of <i>Clostridioides difficile</i> infection in hospitalized patients and long-term care facility residents: a prospective cohort study.","authors":"Scott R Curry, Michelle T Hecker, Justin O'Hagan, Preeta K Kutty, Yilen K Ng-Wong, Jennifer L Cadnum, Heba Alhmidi, Melany I Gonzalez-Orta, Carlos Saldana, Brigid M Wilson, Curtis J Donskey","doi":"10.1017/ash.2024.392","DOIUrl":"https://doi.org/10.1017/ash.2024.392","url":null,"abstract":"<p><strong>Background: </strong>The incubation period for <i>Clostridioides difficile</i> infection (CDI) is generally considered to be less than 1 week, but some recent studies suggest that prolonged carriage prior to disease onset may be common.</p><p><strong>Objective: </strong>To estimate the incubation period for patients developing CDI after initial negative cultures.</p><p><strong>Methods: </strong>In 3 tertiary care medical centers, we conducted a cohort study to identify hospitalized patients and long-term care facility residents with negative initial cultures for <i>C. difficile</i> followed by a diagnosis of CDI with or without prior detection of carriage. Cases were classified as healthcare facility-onset, community-onset, healthcare facility-associated, or community-associated and were further classified as probable, possible, or unlikely CDI. A parametric accelerated failure time model was used to estimate the distribution of the incubation period.</p><p><strong>Results: </strong>Of 4,179 patients with negative enrollment cultures and no prior CDI diagnosis within 56 days, 107 (2.6%) were diagnosed as having CDI, including 19 (17.8%) with and 88 (82.2%) without prior detection of carriage. When the data were censored to only include participants with negative cultures collected within 14 days, the estimated median incubation period was 6 days with 25% and 75% of estimated incubation periods occurring within 3 and 12 days, respectively. The observed estimated incubation period did not differ significantly for patients classified as probable, possible, or unlikely CDI.</p><p><strong>Conclusion: </strong>Our findings are consistent with the previous studies that suggested the incubation period for CDI is typically less than 1 week and is less than 2 weeks in most cases.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11428016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333604","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}

{"title":"Evidence gaps among systematic reviews examining the relationship of race, ethnicity, and social determinants of health with adult inpatient quality measures.","authors":"Sonali D Advani, Alison G Smith, Ibukunoluwa C Kalu, Reinaldo Perez, Stephanie Hendren, Raymund B Dantes, Jonathan R Edwards, Minn Soe, Sarah H Yi, Janine Young, Deverick J Anderson","doi":"10.1017/ash.2024.397","DOIUrl":"https://doi.org/10.1017/ash.2024.397","url":null,"abstract":"<p><strong>Background: </strong>The field of healthcare epidemiology is increasingly focused on identifying, characterizing, and addressing social determinants of health (SDOH) to address inequities in healthcare quality. To identify evidence gaps, we examined recent systematic reviews examining the association of race, ethnicity, and SDOH with inpatient quality measures.</p><p><strong>Methods: </strong>We searched Medline via OVID for English language systematic reviews from 2010 to 2022 addressing race, ethnicity, or SDOH domains and inpatient quality measures in adults using specific topic questions. We imported all citations to Covidence (www.covidence.org, Veritas Health Innovation) and removed duplicates. Two blinded reviewers assessed all articles for inclusion in 2 phases: title/abstract, then full-text review. Discrepancies were resolved by a third reviewer.</p><p><strong>Results: </strong>Of 472 systematic reviews identified, 39 were included. Of these, 23 examined all-cause mortality; 6 examined 30-day readmission rates; 4 examined length of stay, 4 examined falls, 2 examined surgical site infections (SSIs) and one review examined risk of venous thromboembolism. The most evaluated SDOH measures were sex (n = 9), income and/or employment status (n = 9), age (n = 6), race and ethnicity (n = 6), and education (n = 5). No systematic reviews assessed medication use errors or healthcare-associated infections. We found very limited assessment of other SDOH measures such as economic stability, neighborhood, and health system access.</p><p><strong>Conclusion: </strong>A limited number of systematic reviews have examined the association of race, ethnicity and SDOH measures with inpatient quality measures, and existing reviews highlight wide variability in reporting. Future systematic evaluations of SDOH measures are needed to better understand the relationships with inpatient quality measures.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333600","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}

{"title":"A pandemic of COVID-19 mis- and disinformation: manual and automatic topic analysis of the literature.","authors":"Abdi D Wakene, Lauren N Cooper, John J Hanna, Trish M Perl, Christoph U Lehmann, Richard J Medford","doi":"10.1017/ash.2024.379","DOIUrl":"https://doi.org/10.1017/ash.2024.379","url":null,"abstract":"<p><strong>Objective: </strong>Social media's arrival eased the sharing of mis- and disinformation. False information proved challenging throughout the coronavirus disease 2019 (COVID-19) pandemic with many clinicians and researchers analyzing the \"infodemic.\" We systemically reviewed and synthesized COVID-19 mis- and disinformation literature, identifying the prevalence and content of false information and exploring mitigation and prevention strategies.</p><p><strong>Design: </strong>We identified and analyzed publications on COVID-19-related mis- and disinformation published from March 1, 2020, to December 31, 2022, in PubMed. We performed a manual topic review of the abstracts along with automated topic modeling to organize and compare the different themes. We also conducted sentiment (ranked -3 to +3) and emotion analysis (rated as predominately happy, sad, angry, surprised, or fearful) of the abstracts.</p><p><strong>Results: </strong>We reviewed 868 peer-reviewed scientific publications of which 639 (74%) had abstracts available for automatic topic modeling and sentiment analysis. More than a third of publications described mitigation and prevention-related issues. The mean sentiment score for the publications was 0.685, and 56% of studies had a negative sentiment (fear and sadness as the most common emotions).</p><p><strong>Conclusions: </strong>Our comprehensive analysis reveals a significant proliferation of dis- and misinformation research during the COVID-19 pandemic. Our study illustrates the pivotal role of social media in amplifying false information. Research into the infodemic was characterized by negative sentiments. Combining manual and automated topic modeling provided a nuanced understanding of the complexities of COVID-19-related misinformation, highlighting themes such as the source and effect of misinformation, and strategies for mitigation and prevention.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427977/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333585","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}

{"title":"Impact of tele-antimicrobial stewardship at two small community hospitals in partnership with an academic medical center: two years of experience.","authors":"Jennifer K Ross, Aditya A Chandorkar","doi":"10.1017/ash.2024.418","DOIUrl":"https://doi.org/10.1017/ash.2024.418","url":null,"abstract":"<p><strong>Objective: </strong>To analyze the impact of a fully remote tele-antimicrobial stewardship program (TASP) at two small community hospitals in partnership with an academic medical center.</p><p><strong>Design: </strong>Retrospective survey from August 1, 2020, to July 31, 2022.</p><p><strong>Setting: </strong>A TASP, co-led by an infectious diseases (ID) physician and ID pharmacist, was implemented at M Health Fairview (MHF) Northland, a 21-bed hospital, and at MHF Lakes, a 49-bed hospital. The ID physician and ID pharmacist are located at the University of Minnesota Medical Center.</p><p><strong>Methods: </strong>Antimicrobial stewardship interventions were tracked monthly. Restricted antimicrobial days of therapy per 1000 patient days (DOT/1000 PD) were also tracked monthly and two years pre and postimplementation data were compared. All annual antimicrobial expenditures were followed.</p><p><strong>Results: </strong>For the first two TASP years, a total of 789 antimicrobial interventions were made with 85.6% being accepted. Restricted antimicrobial use trended down from 142.93 to 113.97 DOT/1000 PD at MHF Northland. A smaller decrease from 106.31 to 103.12 DOT/1000 PD was seen at MHF Lakes. Annual antimicrobial costs per total patient days decreased. MHF Northland hospital's annual antimicrobial expenditures per total patient days fell from $18.89 in 2019 (preimplementation) to $6.64. MHF Lakes followed a similar trend, decreasing from $11.20 to $5.36.</p><p><strong>Conclusions: </strong>A fully remote TASP in partnership with an academic medical center for two small community hospitals resulted in high rates of accepted interventions sustained over two years. Restricted antimicrobial use and antimicrobial costs trended down.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11427976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142333602","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}