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.

National Institute of Health (NIH)
Agency for Healthcare Research and Quality (AHRQ)
Clinical Investigator Award (CIA) (K08)
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HSR Health Care Research Training SS (HCRT)
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Willis, Tamara
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Duke University
Internal Medicine/Medicine
Schools of Medicine
United States
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Sexton, Daniel J; Moehring, Rebekah W (2017) Implementation of Antimicrobial Stewardship Programs in Small Community Hospitals: Recognizing the Barriers and Meeting the Challenge. Clin Infect Dis 65:697-698
Anderson, Deverick J; Rojas, Leoncio Flavio; Watson, Shera et al. (2017) Identification of novel risk factors for community-acquired Clostridium difficile infection using spatial statistics and geographic information system analyses. PLoS One 12:e0176285
Anderson, Deverick J; Chen, Luke F; Weber, David J et al. (2017) Enhanced terminal room disinfection and acquisition and infection caused by multidrug-resistant organisms and Clostridium difficile (the Benefits of Enhanced Terminal Room Disinfection study): a cluster-randomised, multicentre, crossover study. Lancet 389:805-814
Seidelman, Jessica; Dicks, Kristen V; Durkin, Michael J et al. (2017) Using Clinical Scenarios to Understand Preventability of Clostridium difficile Infections by Inpatient Antibiotic Stewardship Programs. Infect Control Hosp Epidemiol 38:747-749
Anderson, Deverick J; Addison, Rachel; Lokhnygina, Yuliya et al. (2017) The Antimicrobial Scrub Contamination and Transmission (ASCOT) Trial: A Three-Arm, Blinded, Randomized Controlled Trial With Crossover Design to Determine the Efficacy of Antimicrobial-Impregnated Scrubs in Preventing Healthcare Provider Contamination. Infect Control Hosp Epidemiol 38:1147-1154
Knelson, Lauren P; Ramadanovic, Gemila K; Chen, Luke F et al. (2017) Self-monitoring by Environmental Services May Not Accurately Measure Thoroughness of Hospital Room Cleaning. Infect Control Hosp Epidemiol 38:1371-1373
Moehring, Rebekah W; Anderson, Deverick J; Cochran, Ronda L et al. (2017) Expert Consensus on Metrics to Assess the Impact of Patient-Level Antimicrobial Stewardship Interventions in Acute-Care Settings. Clin Infect Dis 64:377-383
Dicks, Kristen V; Lofgren, Eric; Lewis, Sarah S et al. (2016) A Multicenter Pragmatic Interrupted Time Series Analysis of Chlorhexidine Gluconate Bathing in Community Hospital Intensive Care Units. Infect Control Hosp Epidemiol 37:791-7
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
Baker, Arthur W; Dicks, Kristen V; Durkin, Michael J et al. (2016) Epidemiology of Surgical Site Infection in a Community Hospital Network. Infect Control Hosp Epidemiol 37:519-26

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