A5055359789- Antibiotic Use and Resistance
- Patient Satisfaction in Healthcare
- Bacterial Identification and Susceptibility Testing
- Healthcare Systems and Technology
- Antibiotics Pharmacokinetics and Efficacy
- Pharmaceutical Practices and Patient Outcomes
- Clostridium difficile and Clostridium perfringens research
- Complementary and Alternative Medicine Studies
- Pharmacovigilance and Adverse Drug Reactions
- Urinary Tract Infections Management
- Antifungal resistance and susceptibility
- Sepsis Diagnosis and Treatment
- Pharmaceutical studies and practices
- Clinical practice guidelines implementation
- Biosimilars and Bioanalytical Methods
- Primary Care and Health Outcomes
- Emergency and Acute Care Studies
- Drug-Induced Adverse Reactions
- Clinical Laboratory Practices and Quality Control
- Clinical Reasoning and Diagnostic Skills
- Antimicrobial Resistance in Staphylococcus
- Data-Driven Disease Surveillance
- Nosocomial Infections in ICU
- Medical Coding and Health Information
- Nail Diseases and Treatments
Duke University
2017-2025
Duke Medical Center
2016-2023
Duke University Hospital
2022-2023
New York Proton Center
2023
Communities In Schools of Orange County
2023
Manhattan Institute for Policy Research
2023
Oregon Medical Research Center
2023
Lindsay Unified School District
2023
WellStar Health System
2018
We provide an overview of diagnostic stewardship with key concepts that include the pathway and multiple points where interventions can be implemented, strategies for interventions, importance multidisciplinary collaboration, microbiologic tests should considered stewardship. The document focuses on laboratory testing adult pediatric patients is intended a target audience healthcare workers involved in all affected by any step (ie, ordering, collecting, processing, reporting, interpreting...
Antimicrobials are commonly prescribed and often misunderstood. With more than 50% of hospitalized patients receiving an antimicrobial agent at any point in time, judicious optimal use these drugs is paramount to advancing patient care. This narrative will focus on myths relevant nuanced consultation from infectious diseases specialists, particularly surrounding specific considerations for a variety antibiotics.
Guidance on the recommended durations of antibiotic therapy, use oral and need for repeat blood cultures remain incomplete gram-negative bloodstream infections. We convened a panel infectious diseases specialists to develop consensus definition uncomplicated infections assist clinicians with management decisions.Panelists, who were all blinded identity other members panel, used modified Delphi technique list statements describing preferred approaches Panelists provided level agreement...
Abstract Background Drivers of inappropriate antimicrobial use (AU) and resistance (AMR) can be linked to deficiencies in prescribers’ knowledge, attitude, practice (KAP) regarding antibiotics. Currently, KAP information community hospitals throughout the United States (US) is not well known, survey standardized. Understanding clinicians’ AU AMR may provide valuable for improving stewardship (AS) efforts.Figure 1 Methods Prescribers, pharmacists, nurses, administrators at 40 within Duke...
Abstract Background Antibiotic use (AU) at hospital discharge is often inappropriate and can account for the majority of antibiotic exposure attributed to an admission. Tracking optimizing prescriptions (Rx) be challenging antimicrobial stewardship programs (ASPs), as inpatient outpatient AU are not linked in many electronic health records. Our aim was establish a routine metric total durations across network hospitals comprising Duke Antimicrobial Stewardship Outreach Network (DASON)...
Abstract We analyzed antibiotic use data from 29 southeastern US hospitals over a 5-year period to determine changes in after the fluoroquinolone Food and Drug Administration (FDA) advisory update 2016. Fluoroquinolone declined both before FDA announcement, of select, alternative antibiotics increased announcement. Fluoroquinolones are among 4 most commonly prescribed classes. 1,2 Postmarketing reports serious adverse events linked fluoroquinolones include tendonitis, neuropathy,...
Abstract Background Antimicrobial stewardship programs (ASPs) promote the principle of de-escalation: moving from broad- to narrow-spectrum agents and stopping antibiotics when no longer indicated. A standard, objective definition de-escalation applied electronic data could be useful for ASP assessments. Methods We derived an antibiotic performed a retrospective study among 5 hospitals. Antibiotics were ranked into 4 categories: narrow-spectrum, broad-spectrum, extended-spectrum, targeted...
Abstract Background Individual hospitals may lack expertise, data resources, and educational tools to support antimicrobial stewardship programs (ASP). Methods We established a collaborative, consultative network focused on hospital ASP implementation. Services included on-site expert consultation, shared database for routine feedback benchmarking, programs. performed retrospective, longitudinal analysis of use (AU) in 17 that participated at least 36 months during 2013–2018. practice was...
Sepsis guidelines recommend daily review to de-escalate or stop antibiotics in appropriate patients. This randomized, controlled trial evaluated an opt-out protocol decrease unnecessary patients with suspected sepsis.We non-intensive care adults on broad-spectrum despite negative blood cultures at 10 US hospitals from September 2018 through May 2020. A 23-item safety check excluded ongoing signs of systemic infection, concerning inadequate microbiologic data, high-risk conditions. Eligible...
OBJECTIVE To determine the feasibility and value of developing a regional antibiogram for community hospitals. DESIGN Multicenter retrospective analysis antibiograms. SETTING AND PARTICIPANTS A total 20 hospitals in central eastern North Carolina south Virginia participated this study. METHODS We combined data from participating 13 clinically relevant gram-negative pathogen–antibiotic combinations. From antibiogram, we developed based on mean susceptibilities data. RESULTS 69,778 bacterial...
Abstract Policies that promote conversion of antibiotics from intravenous to oral route administration are considered “low hanging fruit” for hospital antimicrobial stewardship programs. We developed a simple metric based on digestive days therapy divided by total targeted agents and method comparisons. External comparisons may help identify opportunities improving prospective implementation.
Abstract Background DASON is a 30-member, community hospital network in the southeastern United States that supports development and growth of local antibiotic stewardship programs (ASPs). Collaborative activities include on-site visits from liaison clinical pharmacists, data sharing for routine feedback benchmarking, educational programs. Methods We performed retrospective cohort analysis use (AU) 17 hospitals participated minimum 42 months during 2013–2018. Segmented negative binomial...
Clostridium difficile-associated diarrhea (CDAD) is a major public health threat that results in increased length of stay, hospital readmissions, deaths, and economic burden. CDAD treatment often guided by severity disease. Although various tools exist to determine severity, real-world data evaluating the use such algorithms are sparse.A local pathway was developed independently guide fidaxomicin prescribing at wellStar Health System (WellStar) Lee (LH) Sarasota Memorial Hospital (SMH). Each...
Background. Intravenous to oral (IV-PO) switch policies are a simple antimicrobial stewardship intervention designed improve patient care and save money. Comparison of measurements total utilization targeted, high bioavailability antimicrobials in individual hospitals may help implementation IV-PO policies. Methods. We performed retrospective cohort analysis 14 enrolled the Duke Antibiotic Stewardship Outreach Network evaluate efficiency for targeted drugs: azithromycin, ciprofloxacin,...
Antimicrobials are frequently administered in the Emergency Department (ED), and there unique challenges to implementing antimicrobial stewardship this setting. Benchmarking use (AU) ED may assist hospitals identifying areas target interventions. EDs not currently included standardized antibiotic administration ratios calculated by CDC Module. Therefore, we aimed establish a method compare AU among across our network. This descriptive cohort participating Duke Antimicrobial Stewardship...
Abstract Background Antimicrobial stewardship programs promote de-escalation: moving from broad to narrow spectrum agents and/or stopping antibiotics as more clinical data return. A standard definition of de-escalation objectively applied electronic could provide a means assess improvement opportunities. Methods We performed retrospective cohort study events among five hospitals the Duke Health System and Stewardship Outreach Network using 2016 medication administration record data....
Abstract Background Provider-selected antibiotic indications are a measure to help track use, and facilitate stewardship activities. International Classification of Diseases 10th version (ICD-10) codes have been widely used in the medical field for variety purposes, including billing reimbursement, disease epidemiology, administration, research. The ability these accurately describe true diagnosis has questioned. purpose this study is provide insight into correlation between ICD-10...
Abstract Background COVID-19 shifted antibiotic stewardship program resources and changed use (AU). Shifts in patient populations with COVID surges, including pauses to surgical procedures, dynamic practice changes makes temporal associations difficult interpret. Our analysis aimed address the impact of on AU after adjusting for other shifts. Methods We performed a longitudinal data from 30 Southeast US hospitals. Three pandemic phases (1: 3/20–6/20; 2: 7/20–10/20; 3: 11/20–2/21) were...
Abstract Background The COVID-19 pandemic placed a strain on inpatient clinical and hospital programs due to increased patient volume rapidly evolving data best management strategies. However, the impact of ASPs has not been well described. Methods We performed cross-sectional electronic survey stewardship pharmacy physician leaders in 37 hospitals within Duke Antimicrobial Stewardship Outreach Network (DASON) (community) Duke/UNC Health systems (academic) April-May 2021. included 60...