Antimicrobial resistance is one of the three greatest threats to human health, according to the World Health Organization. This threat results from the increasing incidence of multidrug-resistant pathogens, diminishing development of new antimicrobials, and the inappropriate use of antimicrobials. In light of this urgent threat and the potential to improve the use of antimicrobials, the CDC recommends that US acute care hospitals support an antimicrobial stewardship program (ASP). ASPs are quality improvement initiatives with the goal of optimizing antimicrobial use to achieve best clinical outcomes, improve patient safety, limit the selective pressure that drives the development of resistance, and reduce excessive costs. However, it is unclear how to effectively evaluate, and therefore optimize, an antimicrobial stewardship program. Outcome measures for antimicrobial stewardship efforts have not been well-defined or tested. No multicenter, longitudinal studies of ASP optimization exist. The Duke Antimicrobial Stewardship Outreach Network (DASON), a collaborative group of community hospitals that share data, educational materials, and consultative services, provides a unique opportunity to study how programmatic development evolves in community hospitals. The goal of the proposed study is to develop, implement, and evaluate the utility of measures of impact important in assessing the success of ASPs.
The specific aims of the proposal are the following: 1a) Define antimicrobial stewardship measures of impact to identify areas in need of intervention at community hospitals, 1b) Define the current state of antimicrobial utilization, antimicrobial resistance, and existing antimicrobial stewardshi activities in a cohort of community hospitals, and 2) Quantitatively assess the effect of data feedback on patient outcomes, ASP goals, and activities. Completion of these aims will provide 1) the most complete analysis of antimicrobial use, resistance, and ASP activities in community hospitals to date, and 2) measures of impact for ASPs that have demonstrated utility and effect on program development. Measures developed during this study will be used in future investigations of specific stewardship interventions as well as national efforts to optimize antimicrobial use. The PI's long-term goal is to become an independent clinician-scientist performing health services research in antimicrobial stewardship. To achieve this goal, the PI will acquire advanced statistical skills and knowledge of health services research methods that will enhance her existing expertise in healthcare epidemiology. Close oversight from her co-mentors, didactic coursework, tutorials with two internal advisors in areas of need, two external expert collaborators in antimicrobial stewardship, and completion of the proposed study will provide the necessary elements for her to achieve this goal.

Public Health Relevance

Antimicrobial use errors are common and result in negative patient outcomes such as development of drug- resistant infections, infection recurrence, C. difficile infection, adverse drug events, and death. Antimicrobial stewardship programs (ASPs) are nationally recommended quality improvement initiatives focused on optimizing antimicrobial use in acute care hospitals; however, how to effectively evaluate and, therefore, optimize ASPs is unknown. Using a unique resource in the Duke Antimicrobial Stewardship Outreach Network cohort of community hospitals, the current study will 1) define known and novel antimicrobial stewardship measures of impact to identify areas in need of stewardship interventions, and 2) quantitatively assess the effect of data feedback on patient outcomes, ASP goals, and activities.

Agency
National Institute of Health (NIH)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HS023866-03
Application #
9231445
Study Section
HSR Health Care Research Training SS (HCRT)
Program Officer
Willis, Tamara
Project Start
Project End
Budget Start
Budget End
Support Year
3
Fiscal Year
2017
Total Cost
Indirect Cost
Name
Duke University
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
044387793
City
Durham
State
NC
Country
United States
Zip Code
27705
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Heath, Barbara; Bernhardt, Jaime; Michalski, Thomas J et al. (2016) Results of a Veterans Affairs employee education program on antimicrobial stewardship for older adults. Am J Infect Control 44:349-51
Durkin, Michael J; Dicks, Kristen V; Baker, Arthur W et al. (2015) Seasonal Variation of Common Surgical Site Infections: Does Season Matter? Infect Control Hosp Epidemiol 36:1011-6
Hamilton, Keith W; Gerber, Jeffrey S; Moehring, Rebekah et al. (2015) Point-of-prescription interventions to improve antimicrobial stewardship. Clin Infect Dis 60:1252-8
Dicks, Kristen V; Baker, Arthur W; Durkin, Michael J et al. (2015) Short Operative Duration and Surgical Site Infection Risk in Hip and Knee Arthroplasty Procedures. Infect Control Hosp Epidemiol 36:1431-6
Garner, Bronwen; Lokhnygina, Yuliya; Dodds-Ashley, Elizabeth et al. (2015) Harvesting the Low Hanging Fruit: A Benchmarking Tool for Implementation of Intravenous to Oral Antibiotic Switch Programs in 14 Southeastern Community Hospitals. Open Forum Infect Dis 2:150
Boggan, Joel C; Baker, Arthur W; Lewis, Sarah S et al. (2015) An Automated Surveillance Strategy to Identify Infectious Complications After Cardiac Implantable Electronic Device Procedures. Open Forum Infect Dis 2:ofv128
Lewis, Sarah S; Dicks, Kristen V; Chen, Luke F et al. (2015) Delay in diagnosis of invasive surgical site infections following knee arthroplasty versus hip arthroplasty. Clin Infect Dis 60:990-6

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