ORCID Profile
0000-0001-5454-4300
Current Organisations
University of New South Wales
,
Saint George Hospital
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Publisher: Springer Science and Business Media LLC
Date: 29-03-2017
Publisher: Elsevier BV
Date: 06-2017
Publisher: JMIR Publications Inc.
Date: 30-03-2017
DOI: 10.2196/JMIR.6971
Publisher: JMIR Publications Inc.
Date: 19-03-2017
Publisher: JMIR Publications Inc.
Date: 26-02-2018
DOI: 10.2196/MEDEDU.7719
Publisher: Elsevier BV
Date: 04-2018
DOI: 10.1016/J.IJANTIMICAG.2018.01.017
Abstract: The long-term outcomes and sustainability of antimicrobial stewardship (AMS) in the intensive care unit (ICU) require evaluation. This study analysed the effect of a multimodal ICU AMS introduced in a 15-bed medical-surgical tertiary Australian adult ICU in November 2008, using interrupted time-series analysis of antibiotic usage, Gram-negative resistance and cost from November 2005 to October 2015, including national ICU average usage as a control. Overall ICU mortality, 30-day blood stream infection (BSI) mortality and length of stay (LOS) were compared over the same period. There were 2512 patients admitted to ICU before and 6435 after AMS intervention. Post-AMS there was a reduction in the trend of aminoglycoside usage both absolute from 63.3 DDD/1000 occupied bed days (OBD)/month (-1.1 95% confidence interval [CI] -2.2, -0.1 P = 0.033) and relative to the national trend (-1.3 95%CI -2.4, -0.3 P = 0.016). Vancomycin usage increased both absolute from 161.2 DDD/1000 OBD/month (1.8 95%CI 0.03, 3.6 P = 0.046) and relative to the national trend (1.8 95%CI -0.3, 3.9 P = 0.092). There were sustained post-AMS downward trends in carbapenem, antipseudomonal penicillin, third-generation cephalosporin and fluoroquinolone use that did not reach statistical significance. Post-AMS, antipseudomonal penicillin resistance declined (-12.8% 95%CI -24.9, -0.6 P = 0.040). Antimicrobial acquisition costs declined by AUD$0.5/OBD/month (95%CI -1.1, 0.1 P = 0.096). Over the study period, severity-adjusted ICU mortality declined from 12.9% to 10.4% risk ratio (RR) 0.92 (95%CI 0.82, 1.03) and BSI 30-day mortality from 37.9% to 26.3% RR, 0.76 (95%CI 0.56, 1.03). Median ICU LOS for ICU survivors increased from 2.3 to 2.6 days. Multimodal AMS sustainably embedded in ICU was associated with reductions in broad-spectrum Gram-negative antibiotic use, overall antibiotic costs and Gram-negative resistance, without adverse clinical impact.
Publisher: Oxford University Press (OUP)
Date: 14-03-2017
DOI: 10.1093/JAC/DKX080
Abstract: Studies evaluating antimicrobial stewardship programmes (ASPs) supported by computerized clinical decision support systems (CDSSs) have predominantly been conducted in single site metropolitan hospitals. To examine outcomes of multisite ASP implementation supported by a centrally deployed CDSS. An interrupted time series study was conducted across five hospitals in New South Wales, Australia, from 2010 to 2014. Outcomes analysed were: effect of the intervention on targeted antimicrobial use, antimicrobial costs and healthcare-associated Clostridium difficile infection (HCA-CDI) rates. Infection-related length of stay (LOS) and standardized mortality ratios (SMRs) were also assessed. Post-intervention, antimicrobials targeted for increased use rose from 223 to 293 defined daily doses (DDDs)/1000 occupied bed days (OBDs)/month (+32%, P < 0.01). Conversely, antimicrobials targeted for decreased use fell from 254 to 196 DDDs/1000 OBDs/month (-23% P < 0.01). These effects diminished over time. Antimicrobial costs decreased initially (-AUD$64551/month P < 0.01), then increased (+AUD$7273/month P < 0.01). HCA-CDI rates decreased post-intervention (-0.2 cases/10 000 OBDs/month P < 0.01). Proportional LOS reductions for key infections (respiratory from 4.8 to 4.3 days, P < 0.01 septicaemia 6.8 to 6.1 days, P < 0.01) were similar to background LOS reductions (2.1 to 1.9 days). Similarly, infection-related SMRs (observed/expected deaths) decreased (respiratory from 1.1 to 0.75 septicaemia 1.25 to 0.8 background rate 1.19 to 0.90. Implementation of a collaborative multisite ASP supported by a centrally deployed CDSS was associated with changes in targeted antimicrobial use, decreased antimicrobial costs, decreased HCA-CDI rates, and no observable increase in LOS or mortality. Ongoing targeted interventions are suggested to promote sustainability.
Publisher: Elsevier BV
Date: 05-2023
No related grants have been discovered for Suman Adhikari.