Antimicrobial resistance (AMR) is one of today's most urgent public health problems. Antimicrobial stewardship programs (ASPs) can optimize antimicrobial-prescribing, thereby reducing the emergence of AMR while improving patient safety. VHA Directive 1031 mandated that every VHA facility establish and maintain an ASP, and similar regulations have been implemented in non-VHA settings. However, widespread ASP implementation will be challenging. Many ASPs lack access to Infectious Disease (ID) specialists, including 23% of VHA-ASPs. It is unclear how ASPs can be effective in such resource-limited settings. This application will begin to address this problem through an ambitious but achievable Research Plan.
The objective of the proposal is to evaluate and improve antimicrobial stewardship processes at VHA hospitals lacking local ID support. The specific aims are to: 1) identify structural factors and processes associated with facility-level ASP performance; 2) determine provider attitudes and organizational factors that impede or foster antimicrobial stewardship at VHA hospitals lacking ID support, and 3) conduct a pilot intervention to bolster antimicrobial stewardship at VHA hospitals that have low-performing ASPs and lack local ID support. The design of this pilot intervention will be informed by the findings of Aims 1 and 2.
This study will use multilevel regression techniques to evaluate antimicrobial-prescribing across a large cohort of VHA inpatients. Qualitative assessments will also be conducted to understand local barriers and facilitators to antimicrobial stewardship. Finally, a pilot intervention will be implemented at 2 sites to augment local stewardship efforts. The model of Physician Mentored Implementation will guide this intervention, and a pretest-posttest design will be used to assess the effect of the intervention at the 2 intervention hospitals compared to 2 control hospitals.
Not yet available.
Due to the crisis of AMR, there will be an ongoing need to improve antimicrobial use. For this reason, all VHA medical facilities are now mandated to have an active ASP. However, it's unclear how VHA-ASPs without ID support have implemented stewardship processes and whether these processes are effective. The findings from Aim 1 and Aim 2 should address this critical gap in the literature. Our work in Aim 3 will trial novel strategies for improving antimicrobial use in these settings.
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- Chandra S, Klair JS, Soota K, Livorsi DJ, Johlin FC. Endoscopic Retrograde Cholangio-Pancreatography-Obtained Bile Culture Can Guide Antibiotic Therapy in Acute Cholangitis. Digestive diseases (Basel, Switzerland). 2018 Oct 3; 1-6.
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- Livorsi DJ, Chorazy ML, Schweizer ML, Balkenende EC, Blevins AE, Nair R, Samore MH, Nelson RE, Khader K, Perencevich EN. A systematic review of the epidemiology of carbapenem-resistant Enterobacteriaceae in the United States. Antimicrobial resistance and infection control. 2018 Apr 24; 7:55.
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- Livorsi DJ, Reisinger HS, Stenehjem E. Adapting Antibiotic Stewardship to the Community Hospital. JAMA Network Open. 2019 Aug 2; 2(8):e199356.
- Hoff BM, Ford DC, Ince D, Ernst EJ, Livorsi DJ, Heintz BH, Masse V, Brownlee MJ, Ford BA. Implementation of a Mobile Clinical Decision Support Application to Augment Local Antimicrobial Stewardship. Journal of pathology informatics. 2018 Apr 2; 9:10.
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Health Systems, Infectious Diseases