2022 Top 10 Most Influential Articles to ASP Practice
KASIC understands the difficulties in finding relevant and timely information in the ever evolving world of healthcare. For that reason, the KASIC Advisory Board has identified the top 10 articles that have had the most significant impact on the practice of antimicrobial stewardship for 2022. These articles provide insights into the best practices for antimicrobial stewardship, highlighting the need for continued research, and implementation of effective interventions, among other important changes to practice.
The KASIC Advisory Board is comprised of 26 Infectious Diseases or Antimicrobial Stewardship pharmacists, representing every region in Kentucky. Want to know more about the KASIC Advisory Board and their work? Click here.
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Article Synopsis
Gram staining is utilized universally, however its role may be understated. Researchers investigated clinical outcomes between patients receiving antibiotics directed by Gram stain versus guideline based antibiotic therapy for VAP in a non-inferiority trial. Clinical response between groups at 14 days was similar (76.7% vs 71.8%) and non-inferior. This study highlights the potential of using Gram stains to hasten optimal drug therapy and reduce unnecessary antibiotics.
Article Synopsis
Patients are commonly discharged inappropriately on more antibiotics. This study provides a pharmacist-led intervention to improve antibiotic prescribing at discharge as well as identifies the process and challenges in place. This study highlights the opportunity transitions of care has on stewardship to improve and reduce antibiotic prescribing at discharge.
Article Synopsis
Diabetic foot infections (DFIs) are commonly treated empirically to target Pseudomonas aeruginosa despite limited data to support the practice. This study aimed to describe the pathogens encountered, patient characteristics, and DFI therapies used in practice. Despite 88% of patients receiving antipseudomonal therapy, only 9% had a DFI caused by P. aeruginosa. Risk factors for P. aeruginosa included immunocompromised patients and those with outpatient DFI treatment failure. The study emphasizes the uncommon nature of P. aeruginosa DFIs and need to assess patient risk factors for P. aeruginosa.
Article Synopsis
This is the new and revised requirements for January 2023 from The Joint Commission for Antibiotic Stewardship. This update continues to highlight the importance and necessity of stewardship teams in healthcare settings.
Article Synopsis
Researchers described the impact of a robust antimicrobial stewardship program led by pharmacists on fluoroquinolone use and susceptibility at a large community healthcare system. As a result, fluoroquinolone use decreased by 74% over 5 years. Susceptibility to P. aeruginosa increased by 57% and E. coli by 15%. The study demonstrates the vital role and value an infectious diseases pharmacist-led, stewardship program provides.
Article Synopsis
Researchers conducted an RCT to determine the non-inferiority of 8 versus 15 days for the treatment of VAP caused by P. aeruginosa in terms of mortality and recurrence. Due to slow enrollment, the trial was stopped prematurely; 88 and 98 patients were included in the 8 and 15 day arms respectively for analysis. As a composite endpoint, 8 days was not non-inferior to 15 days due to high recurrence of VAP but there was no difference in mortality.
Article Synopsis
The aims of this study were to determine the probability that a patient receiving a short course would have a more desirable, overall outcome than what a longer course would provide. The study found no significant difference between groups using DOOR between groups and may be more optimal given the reduced exposure to antibiotics.
Article Synopsis
This study examined the role of low procalcitonin in pancreatitis to reduce antibiotic use. Using this approach, patients with repeated, low procalcitonin had less antibiotic use without any statistically significant increase in mortality or infections.
Article Synopsis
Researchers characterized the frequency of ASB in this study. This study characterized the prevalence of ASB treatment and serves as a reminder to stewardship programs that ASB is commonly being treated and an opportunity exists to improve antibiotic appropriateness.
