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Antimicrobial stewardship by academic detailing improves antimicrobial prescribing in solid organ transplant patients

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European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

We implemented twice-weekly academic detailing rounds in 2015 as an antimicrobial stewardship (AMS) intervention in solid organ transplant (SOT) patients, led by an AMS pharmacist and a transplant infectious diseases physician. They reviewed SOT patients’ antimicrobials and made recommendations to prescribers on antimicrobial regimens, diagnostics investigations, and appropriate referrals for transplant infectious diseases consultation. To determine the impact of the intervention, we adjudicated antimicrobials prescriptions using established AMS principles, and compared the proportion of AMS-concordance regimens pre-intervention (2013) with post-intervention (2016) via 4-point-prevalence surveys conducted in each period. All admitted SOT patients who were receiving antimicrobial treatment on survey days were included. Primary outcome was the percentage of antimicrobial regimen adjudicated as AMS concordant. Secondary outcomes were percentage of AMS concordance in patients consulted by transplant infectious diseases; categories of AMS discordance; antimicrobial consumption in defined daily dose/100 patient-days (DDD/100PD); antimicrobial cost in CAD$/PD; and C. difficile infections. Balancing measures were length of stay, 30-day readmission, and in-hospital mortality. We compared outcomes using χ2 test or t-test; significant difference was defined as p < 0.05. Pre-intervention surveys included 139 patients, post-intervention, 179 patients, with 62.3% vs. 56.6% receiving antimicrobials, respectively (p = 0.27). AMS concordance increased from 69% (60/87) to 83.7% (93/111), p = 0.01. Not tailoring antimicrobials was the most common discordance category. AMS concordance under transplant infectious diseases was 82.5% (33/40) pre-intervention vs. 76.6% (36/47) post-intervention, p = 0.5. Antimicrobial consumption increased by 15.3% (140.9 vs.162.4 DDD/100PD, p = 0.001). Antimicrobial cost, C. difficile infection rates and balancing measures remained stable. Academic detailing increased appropriate antimicrobial use in SOT patients without untoward effects.

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Abbreviations

ASP:

antimicrobial stewardship programs

AMS:

antimicrobial stewardship

SOT:

solid organ transplant

UHN:

University Health Network

TID:

transplant infectious diseases

SHS-UHN ASP:

Sinai Health System-University Health Network Antimicrobial Stewardship Program

AD:

academic detailing

DDD/100 PD:

defined daily dose per 100 patient-days

C$/PD:

cost in Canadian dollar per patient-day

CDI/1000 PD:

Clostridium difficile infection per 1000 patient-days

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Acknowledgments

We are grateful for the collaboration of clinicians in the Multi-Organ Transplant Program, Transplant Infectious Disease Team, and the MOT Pharmacy Team at the University Health Network. We would like to acknowledge the contribution from Claire Aguilar, MD, Mohammed AlAbdulla, MD, Yamama Aljishi, MD, Daisy Yang, PharmD, and Jam Bravo, PharmD.

Author information

Authors and Affiliations

  1. University Health Network, Toronto, Ontario, M5G 2N2, Canada

    Miranda So, Andrew M. Morris, Chaim M. Bell & Shahid Husain

  2. Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada

    Miranda So

  3. Sinai Health System, Toronto, Canada

    Andrew M. Morris, Sandra Nelson, Chaim M. Bell & Shahid Husain

  4. Department of Medicine, University of Toronto, Toronto, Canada

    Andrew M. Morris, Chaim M. Bell & Shahid Husain

  5. Institute of Clinical Evaluative Sciences, Toronto, Canada

    Chaim M. Bell

  6. Institute of Health Policy, Management and Evaluation, Dalla Lana Faculty of Public Health, University of Toronto, Toronto, Canada

    Chaim M. Bell

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  1. Miranda So
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Corresponding author

Correspondence to Miranda So.

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Ethics Statement

The study was approved by the Research Ethics Board at UHN (CAPCR ID 17-5742).

Conflict of interest

Miranda So, Andrew Morris, Chaim Bell, and Sandra Nelson have no disclosures. Shahid Husain has the following disclosures: grants from Pfizer, Merck, Astellas, Cidara.

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So, M., Morris, A.M., Nelson, S. et al. Antimicrobial stewardship by academic detailing improves antimicrobial prescribing in solid organ transplant patients. Eur J Clin Microbiol Infect Dis 38, 1915–1923 (2019). https://doi.org/10.1007/s10096-019-03626-8

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