A Survey of Antimicrobial Stewardship Practices in the Western United States: Successes and Challenges
Creators: name: Allenback, Gayle Louise
Publisher: name: University of Nevada, Las Vegas
Year: 2014

description: Antibiotics are one of the most important developments in medicine, and their ability to prevent and control infections has had a major impact in clinical medicine. However, the past three decades have shown an increase in multidrug-resistant organisms (MDROs) in both hospital patients and in the community, decreasing our ability to successfully control infection. Complicating the depletion of effective antimicrobials is the fact that, in the last 10 years, there has also been a decrease in the development of new antibacterial agents. Resistant infections have resulted in increased morbidity and mortality, with a consequential increase in healthcare costs. The utilization of antimicrobial stewardship strategies in hospitals has been shown to decrease antimicrobial use, decrease antimicrobial resistance patterns, decrease the development of secondary infections, reduce adverse medication effects, and consequently decrease healthcare costs. In 2007, the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America published the Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship, encouraging hospitals to implement antimicrobial stewardship programs and presenting a blueprint for their development. After the Guidelines were published, several surveys of current antimicrobial stewardship practices ensued, including ones specific to certain states, ones geared towards the members of certain infectious disease professional societies, and even one attempting to assess antimicrobial stewardship practices nationally. For the most part, these surveys have found fairly widespread implementation of antimicrobial stewardship strategies, even in the absence of formal antimicrobial stewardship programs. However, these surveys have also found that barriers to implementation of stewardship programs are common. Because the Western United States has been relatively under-represented in these surveys, this project aimed to determine to what degree hospitals in western states are engaging in stewardship strategies. Additional aims were to further elucidate the barriers to antimicrobial stewardship, and to identify factors associated with the number of antimicrobial stewardship strategies in use in a facility. A web-based antimicrobial stewardship survey was disseminated via email to pharmacy directors, medical directors, infection control professionals, and other healthcare professionals at general acute care and critical access hospitals in 19 states. Responses (n=105) were summarized using descriptive statistics and univariate analyses of associations between survey respondents and hospital characteristics and the reported usage of the various antimicrobial stewardship strategies. Results demonstrated the widespread use of antimicrobial stewardship strategies, even in spite of simultaneous reports of barriers to the establishment of formal antimicrobial stewardship programs. A multivariate model was developed via multiple linear regression, which identified six predictors of the number of antimicrobial stewardship strategies in use at a hospital. This model can be utilized to guide the further development of antimicrobial stewardship in facilities that are struggling with MDROs.