Journal of Infection and Public Health (Dec 2020)

Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany

  • Irit Nachtigall,
  • Sascha Tafelski,
  • Edwin Heucke,
  • Oliver Witzke,
  • Annedore Staack,
  • Sabine Recknagel-Friese,
  • Christine Geffers,
  • Marzia Bonsignore

DOI
https://doi.org/10.1016/j.jiph.2020.10.001
Journal volume & issue
Vol. 13, no. 12
pp. 1946 – 1950

Abstract

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Background: In order to control their anti-infectives consumption, hospitals are required to provide multidisciplinary teams comprising among others an infectiologist, a microbiologist and a pharmacist. Small hospitals though often do not dispose of the defaulted personnel. This study illustrates a solution for an antimicrobial stewardship program (ASP) in small community hospitals in a rural area in Germany. Methods: Four hospitals of ca. 200 beds each, jointly hired an antimicrobial stewardship expert to start a common ASP. This expert did rounds on every ward once a week, mostly as chard reviews with the physician in charge. Outside the rounds, he could be consulted by mail. Working time and number of visited patients were documented. Anti-infectives consumption, incidence of Clostridioides difficile infections (CDI) and mortality rates were retrieved from routinely collected data. The intervention period (01/2018–12/2018) was compared to the preintervention period (01/2017–12/2017). Results: 3321 patients were visited in the intervention period. In average, 20 patients were seen per day and 20 min were needed per patient/ chard. About 65% of the expert’s working time was needed for rounds, 15% for driving between the hospitals. The anti-infectives consumption of the 4 hospitals in the preintervention period amounted to 50 defined daily doses per 100 occupied bed days. The total consumption was reduced by 10% and of quinolones by 36%. The incidence of hospital-acquired CDI receded from 0.14 to 0.07 cases per 100 patient days (−50%, p = 0.001). The overall in-hospital mortality did not change. Conclusions: A single expert was able to implement a successfull ASP in 4 hospitals. While multidisciplinary antimicrobial stewardship teams are ideal for tertiary care hospitals, small hospitals need a more practical solution. This survey shows that one expert can be sufficient for several small hospitals even with the distances in a rural setting.

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