Hospital Infection Control

The first of many? Antibiotic stewardship research takes a baby step

April 23, 2012 – 9:05 am | By Gary Evans | No comments yet

The suddenly white-hot issue of antibiotic stewardship is not a new idea by any means, so it comes as something of a surprise to note that the first multicenter study testing a single intervention was recently published.(1) The first of many we can only hope, as stewardship and infection control have become the last, best options against rising drug resistant pathogens. The study showed that antimicrobial stewardship expressed as a post-prescription review and feedback intervention can decrease antimicrobial use, especially when it’s part of an established antimicrobial program.1 This was the first study to look at performing the same antimicrobial stewardship intervention at multiple academic hospitals, says Sara Cosgrove, MD, MS, an associate professor of medicine in the division of infectious diseases at Johns Hopkins University School of Medicine in Baltimore, MD. “We took five different academic medical centers and came up with standardized data collection materials and interventions,” Cosgrove explains. “The intervention was that at 48-72 hours we had an infectious disease physician review the use of broad spectrum antibiotic use on some medical and surgical floors of the hospital.” If the ID physician did not believe broad spectrum antibiotics was appropriate, the doctor would call the medical teams to recommend stopping the antibiotic. The study’s end point was to see if antibioticuse changed from the baseline, before calls were made, to the time after the intervention occurred. “There was a mixed benefit,” Cosgrove says. “In hospitals where there was an established antimicrobial program that included salary support and intellectual support of stewardship, there was a decrease in antimicrobial use in the follow-up period,” she says. “In other hospitals, where programs had just started or did not exist, we didn’t see any reduction in antibiotic use.” For more on this story see the May issue of Hospital Infection Control & Prevention. Reference 1. Evaluation of postprescription review and feedback as a method of promoting rational antimicrobial use: a multicenter intervention. Infect Cont Hosp Epi 2012;33(4):374-380.