Abstract
This study aimed to evaluate the impact of the intervention targeting the redundant combination of antianaerobic antimicrobials on its incidence and associated antimicrobial consumption. To reveal the characteristics of the combination and the change in the related workload over time was an additional aim of the study. The combinations of metronidazole or clindamycin with antianaerobic antimicrobials were classified into redundant or acceptable, according to the target indications. A pharmacist-based prospective audit and feedback targeting the redundant antianaerobic combination was conducted. Segmented regression analysis was performed to evaluate the impact of the intervention. As a quantitative index of the interventional activity, the change in the number of signed consultation notes was evaluated. After the initiation of the intervention, the median monthly cumulative incidence of the redundant combination decreased from 5.29 (Interquartile range [IQR] 4.94–5.70) to 3.33 (IQR 2.87–3.71) (p < 0.001) per 1000 admissions per month. The consumption of concurrently administered metronidazole and clindamycin decreased from 3.34 (IQR 2.97–4.10) to 1.74 (IQR 1.19–1.93) (p < 0.001) per 1000 patient-days per month. Segmented regression analysis revealed that the monthly cumulative incidence decreased by 28.5% after the initiation of the intervention (change in level − 1.640, p = 0.019) and the monthly consumption decreased by 33.9% (change in level − 1.409, p = 0.009). The number of consultation notes per 1000 admissions per month decreased over time (regression coefficient − 0.004, p < 0.001). The pharmacist-based intervention significantly reduced the incidence and associated antimicrobial consumption of the redundant antianaerobic combination. The overall related workload reduced steadily over time.
Similar content being viewed by others
References
Barlam TF, Cosgrove SE, Abbo LM, Macdougall C, Schuetz AN, Septimus EJ, Srinivasan A, Dellit TH, Falck-Ytter YT, Fishman NO, Hamilton CW, Jenkins TC, Lipsett PA, Malani PN, May LS, Moran GJ, Neuhauser MM, Newland JG, Ohl CA, Samore MH, Seo SK, Trivedi KK (2016) Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62:e51–e77. https://doi.org/10.1093/cid/ciw118
Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown E, Gould IM, Ramsay CR, Michie S (2017) Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database Syst Rev 2:CD003543. https://doi.org/10.1002/14651858.CD003543.pub4
Fridkin S, Baggs J, Fagan R, Magill S, Pollack LA, Malpiedi P, Slayton R, Khader K, Rubin MA, Jones M, Samore MH, Dumyati G, Dodds-Ashley E, Meek J, Yousey-Hindes K, Jernigan J, Shehab N, Herrera R, McDonald CL, Schneider A, Srinivasan A, Centers for Disease Control and Prevention (CDC) (2014) Vital signs: improving antibiotic use among hospitalized patients. MMWR Morb Mortal Wkly Rep 63:194–200
Flanders SA, Saint S (2014) Why does antimicrobial overuse in hospitalized patients persist? JAMA Intern Med 174:661. https://doi.org/10.1001/jamainternmed.2014.897
Glowacki RC, Schwartz DN, Itokazu GS, Wisniewski MF, Kieszkowski P, Weinstein RA (2003) Antibiotic combinations with redundant antimicrobial spectra: clinical epidemiology and pilot intervention of computer-assisted surveillance. Clin Infect Dis 37:59–64. https://doi.org/10.1086/376623
Schultz L, Lowe TJ, Srinivasan A, Neilson D, Pugliese G (2014) Economic impact of redundant antimicrobial therapy in US hospitals. Infect Control Hosp Epidemiol 35:1229–1235. https://doi.org/10.1086/678066
Rattanaumpawan P, Morales KH, Binkley S, Synnestvedt M, Weiner MG, Gasink LB, Fishman NO, Lautenbach E (2011) Impact of antimicrobial stewardship programme changes on unnecessary double anaerobic coverage therapy. J Antimicrob Chemother 66:2655–2658. https://doi.org/10.1093/jac/dkr321
Huttner B, Jones M, Rubin MA, Madaras-Kelly K, Nielson C, Goetz MB, Neuhauser MM, Samore MH (2012) Double trouble: how big a problem is redundant anaerobic antibiotic coverage in veterans affairs medical centres? J Antimicrob Chemother 67:1537–1539. https://doi.org/10.1093/jac/dks074
Song YJ, Kim M, Huh S, Lee J, Lee E, Song KH, Kim ES, Kim HB (2015) Impact of an antimicrobial stewardship program on unnecessary double anaerobic coverage prescription. Infect Chemother 47:111–116. https://doi.org/10.3947/ic.2015.47.2.111
Laible BR, Nazir J, Assimacopoulos AP, Schut J (2010) Implementation of a pharmacist-led antimicrobial management team in a community teaching hospital: use of pharmacy residents and pharmacy students in a prospective audit and feedback approach. J Pharm Pract 23:531–535. https://doi.org/10.1177/0897190009358775
Apisarnthanarak A, Lapcharoen P, Vanichkul P, Srisaeng-Ngoen T, Mundy LM (2015) Design and analysis of a pharmacist-enhanced antimicrobial stewardship program in Thailand. Am J Infect Control 43:956–959. https://doi.org/10.1016/j.ajic.2015.05.011
Kim B, Kim J, Kim SW, Pai H (2016) A survey of antimicrobial stewardship programs in Korea, 2015. J Korean Med Sci 31:1553–1559. https://doi.org/10.3346/jkms.2016.31.10.1553
Penm J, Li Y, Zhai S, Hu Y, Chaar B, Moles R (2014) The impact of clinical pharmacy services in China on the quality use of medicines: a systematic review in context of China’ s current healthcare reform. 849–872. doi: https://doi.org/10.1093/heapol/czt067
Bukhsh A, Khan TM, Lee SWH, Lee L (2018) Efficacy of pharmacist based diabetes educational interventions on clinical outcomes of adults with type 2 diabetes mellitus : a network meta-analysis. Front Pharmacol 9:339. https://doi.org/10.3389/fphar.2018.00339
Malte CA, Berger D, Saxon AJ, Hagedorn HJ, Achtmeyer CE, Mariano AJ, Hawkins EJ (2018) Electronic medical record alert associated with reduced opioid and benzodiazepine coprescribing in high-risk veteran patients. Med Care 56:171–178. https://doi.org/10.1097/MLR.0000000000000861
Martin M, Wilson FP (2018) Utility of electronic medical record alerts to prevent drug nephrotoxicity. Clin J Am Soc Nephrol 13:CJN.13841217. https://doi.org/10.2215/CJN.13841217
Boyanova L, Kolarov R, Mitov I (2015) Recent evolution of antibiotic resistance in the anaerobes as compared to previous decades. Anaerobe 31:4–10. https://doi.org/10.1016/j.anaerobe.2014.05.004
Veloo ACM, van Winkelhoff AJ (2015) Antibiotic susceptibility profiles of anaerobic pathogens in The Netherlands. Anaerobe 31:19–24. https://doi.org/10.1016/j.anaerobe.2014.08.011
Park SM, Kim HS, Jeong YM, Lee JH, Lee E, Lee E, Song KH, Kim HB, Kim ES (2017) Impact of intervention by an antimicrobial stewardship team on conversion from intravenous to oral fluoroquinolones. Infect Chemother 49:31–37. https://doi.org/10.3947/ic.2017.49.1.31
Acknowledgments
We express our gratitude to the Center for Medical Informatics in Seoul National University Bundang Hospital for the cooperation in developing and maintaining the intervention.
Funding
The research was financially supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, the Republic of Korea (Grant number: HI16C0684).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
This study was approved by the Institutional Review Board of Seoul National University Bundang Hospital (IRB No. B-1502-286-113). The study was conducted after obtaining a waiver of informed consent from individual patients.
Conflict of interest
The authors declare that there is no conflict of interest.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kim, M., Kim, HS., Song, Y.J. et al. Redundant combinations of antianaerobic antimicrobials: impact of pharmacist-based prospective audit and feedback and prescription characteristics. Eur J Clin Microbiol Infect Dis 39, 75–83 (2020). https://doi.org/10.1007/s10096-019-03687-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10096-019-03687-9