Quantifying the Implementation and Cost of a Multisite Antibiotic Stewardship Intervention for Asymptomatic Bacteriuria

Eva Amenta, Larissa Grigoryan, Suja S Rajan, David Ramsey, Jennifer R Kramer, Annette Walder, Andrew Chou, John N Van, Sarah L Krein, Sylvia Hysong, Aanand D Naik, Barbara W Trautner, Eva Amenta, Larissa Grigoryan, Suja S Rajan, David Ramsey, Jennifer R Kramer, Annette Walder, Andrew Chou, John N Van, Sarah L Krein, Sylvia Hysong, Aanand D Naik, Barbara W Trautner

Abstract

Objective: The intensity of an antibiotic stewardship intervention to achieve clinical impact is not known. We conducted a multisite dissemination project of an intervention to reduce treatment of asymptomatic bacteriuria (ASB) and studied: (1) the association between implementation metrics and clinical outcomes and (2) the cost of implementation.

Design/setting/participants: A central site facilitated a multimodality intervention to decrease unnecessary urine cultures and antibiotic treatment in patients with ASB at 4 Veterans Affairs medical centers.

Methods: The intervention consisted of a decision support aid algorithm and interactive teaching cases that provided in the moment audit and feedback on how to manage ASB. Implementation outcomes included minutes spent in intervention delivery, number of healthcare professionals reached, and number of sessions delivered. Clinical outcomes included days of antibiotic therapy (DOT), length of antibiotic therapy (LOT), and number of urine cultures ordered per 1000 bed days. Personnel reported weekly time logs.

Results: Minutes spent in intervention delivery were inversely correlated with two clinical outcomes, DOT (R -0.3, P = .04) and LOT (R -0.3, P = .02). Number of healthcare professionals reached and number of sessions delivered were not correlated with clinical outcomes of DOT (R -0.003, P = .98, R = -0.059, P = .69) or LOT (R +0.073, P = .62, R -0.102, P = .49). Physician champions spent an average of 3.8% of effort on the intervention. The implementation cost was USD 22,299/year per site on average.

Conclusions: The amount of time local teams spent in delivery of an antibiotic stewardship intervention was correlated with the desired decrease in antibiotic use. Implementing this successful antibiotic stewardship intervention required minimal time.

Conflict of interest statement

No authors report conflict of interest.

© The Author(s) 2023.

Figures

Figure 1.
Figure 1.
Total minutes spent in delivery of the intervention across 4 intervention sites.

References

    1. Baur D, Gladstone BP, Burkert F, et al. Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: a systematic review and meta-analysis. Lancet Infect Dis 2017;17:990–1001.
    1. Davey P, Brown E, Charani E, et al. Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Datab Syst Rev 2013.
    1. Pulcini C, Binda F, Lamkang AS, et al. Developing core elements and checklist items for global hospital antimicrobial stewardship programmes: a consensus approach. Clin Microbiol Infect 2019;25:20–25.
    1. Implementation Science Aim and Scope, . Accessed October 18, 2022.
    1. Bellg AJ, Borrelli B, Resnick B, et al. Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. Health Psychol 2004;23:443–451. 10.1037/0278-6133.23.5.443.
    1. Carroll C, Patterson M, Wood S, et al. A conceptual framework for implementation fidelity. Implement Sci 2007;2:40. 10.1186/1748-5908-2-40.
    1. Livorsi DJ, Drainoni M-L, Reisinger HS, et al. Leveraging implementation science to advance antibiotic stewardship practice and research. Infect Contr Hosp Epidemiol 2022;43:139–146. 10.1017/ice.2021.480.
    1. Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Admin Policy Mental Health Mental Health Serv Res 2011;38:65–76.
    1. Lewis CC, Boyd MR, Walsh-Bailey C, et al. A systematic review of empirical studies examining mechanisms of implementation in health. Implement Sci 2020;15:1–25.
    1. Rabin BA, Purcell P, Naveed S, et al. Advancing the application, quality and harmonization of implementation science measures. Implement Sci 2012;7:119. 10.1186/1748-5908-7-119.
    1. Curran GM, Bauer M, Mittman B, et al. Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Sare 2012;50:217.
    1. Mauskopf JA, Earnshaw S, Mullins CD. Budget impact analysis: review of the state of the art. Expert Rev Pharmacoecon Outcomes Res 2005;5:65–79.
    1. Mauskopf JA, Sullivan SD, Annemans L, et al. Principles of good practice for budget impact analysis: report of the ISPOR Task Force on good research practices—budget impact analysis. Value Health 2007;10:336–347.
    1. Echevarria K, Groppi J, Kelly AA, et al. Development and application of an objective staffing calculator for antimicrobial stewardship programs in the Veterans Health Administration. Am J Health Syst Pharm 2017;74:1785–1790.
    1. Trautner BW, Prasad P, Grigoryan L, et al. Protocol to disseminate a hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of asymptomatic bacteriuria. Implement Sci 2018;13:16. 10.1186/s13012-018-0709-x.
    1. Grigoryan L, Naik AD, Lichtenberger P, et al. Analysis of an antibiotic stewardship program for asymptomatic bacteriuria in the veterans affairs health care system. JAMA Netw Open 2022;5:e2222530–e2222530. 10.1001/jamanetworkopen.2022.22530.
    1. Trautner BW, Kelly PA, Petersen N, et al. A hospital-site controlled intervention using audit and feedback to implement guidelines concerning inappropriate treatment of catheter-associated asymptomatic bacteriuria. Implement Sci 2011;6:1–12.
    1. Weinstein MC, Russell LB, Gold MR, et al. Cost-effectiveness in Health and Medicine. Oxford University Press, 1996.
    1. VA Informatics and Computing Infrastructure (VINCI).
    1. Grigoryan L, Naik AD, Lichtenberger P, et al. Analysis of an antibiotic stewardship program for asymptomatic bacteriuria in the veterans affairs health care system. JAMA Netw Open 2022;5:e2222530. 10.1001/jamanetworkopen.2022.22530.
    1. Hamlett A, Ryan L, Wolfinger R. On the use of PROC MIXED to estimate correlation in the presence of repeated measures. Proc Stat Data Anal 2004;198:29.
    1. Glasgow RE, Lichtenstein E, Marcus AC. Why don’t we see more translation of health promotion research to practice? Rethinking the efficacy-to-effectiveness transition. Am J Publ Health 2003;93:1261–1267.
    1. Phillips SD, Allred CA. Organizational management: What service providers are doing while researchers are disseminating interventions. J Behav Health Serv Res 2006;33:156–175.
    1. Rabin BA, Brownson RC, Kerner JF, et al. Methodologic challenges in disseminating evidence-based interventions to promote physical activity. Am J Prevent Med 2006;31:24–34.
    1. Sussman S, Valente TW, Rohrbach LA, et al. Translation in the health professions: converting science into action. Eval Health Professions 2006;29:7–32.
    1. Goebel MC, Trautner BW, Wang Y, et al. Organizational readiness assessment in acute and long-term care has important implications for antibiotic stewardship for asymptomatic bacteriuria. Am J Infect Control 2020;48:1322–1328. 10.1016/j.ajic.2020.04.024.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅