ArticleCureus2024
Pathogen-Directed Antimicrobial Stewardship Audit Rounds: Evaluation of an Objectively Planned, Clinical Microbiology-Driven Antimicrobial Stewardship Approach to Influence Antimicrobial Prescriptions of Prescribers.
Article in Cureus, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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4 authors.
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Abstract
introductionCorrect and prompt antimicrobial prescription modifications by the treating team based on the culture and antimicrobial susceptibility test (AST) reports are crucial. Pathogen-directed antimicrobial stewardship (PD-AMS) audit rounds are a clinical microbiology-driven approach to combine prompt appropriate patient management goals with goals of preventing irrational and improper use of antimicrobials.
methodsThe study was a prospective before-after interventional study to evaluate the effectiveness of PD-AMS audit rounds in modifying antimicrobial usage by prescribers on an individual patient basis. It is divided into a two-month pre-intervention phase (no active advice is given with passive monitoring) and an intervention phase for four months, with antimicrobial therapy-related advice during PD-AMS rounds taken as "Intervention." Antimicrobial advice was objectively classified into various categories. The PD-AMS audit round was conducted for all inpatients with a culture-proven bloodstream infection with a pathogen, and objectively classified antimicrobial advice was given through bedside rounds, telephonically, and/or written advice forms. Compliance with the advice was monitored on the next day (or at the end of 24 hours) of the PD-AMS round.
resultsThe compliance with culture AST report regarding antimicrobial prescription modifications improved significantly in the intervention phase compared to the pre-intervention phase as follows: overall (83.8% (612/730) vs. 56.7% (242/427)); medicine alliance (87.4% (263/301) vs. 57.8% (115/199)); surgery alliance (87.2% (170/195) vs. 54.0% (87/161)); pediatric alliance (87.3% (138/158) vs. 66.7% (26/39)); oncology alliance (53.9% (41/76) vs. 28.6% (8/28)); critical care locations (82.0% (260/317) vs. 62.7% (89/142)); and in-patient departments (85.2% (352/413) vs. 53.7% (153/285)).
conclusionThe clinical microbiology team should mandatorily conduct an objectively planned PD-AMS audit round to improve patient care and management and antimicrobial prescriptions through a mutual discussion with prescribers and to help address their doubts.
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