Community pharmacist prescribing of antimicrobials: A systematic review from an antimicrobial stewardship perspective.

BACKGROUND: Pharmacist prescribing authority is expanding, while antimicrobial resistance is an increasing global concern. We sought to synthesize the evidence for antimicrobial prescribing by community pharmacists to identify opportunities to advance antimicrobial stewardship in this setting. METHODS: We conducted a systematic review to characterize the existing literature on community pharmacist prescribing of systemic antimicrobials. We searched MEDLINE, EMBASE and International Pharmaceutical Abstracts for English-language articles published between 1999 and June 20, 2019, as well as hand-searched reference lists of included articles and incorporated expert suggestions. RESULTS: Of 3793 articles identified, 14 met inclusion criteria. Pharmacists are most often prescribing for uncomplicated urinary tract infection (UTI), acute pharyngitis and cold sores using independent and supplementary prescribing models. This was associated with high rates of clinical improvement (4 studies), low rates of retreatment and adverse effects (3 studies) and decreased health care utilization (7 studies). Patients were highly satisfied (8 studies) and accessed care sooner or more easily (7 studies). Seven studies incorporated antimicrobial stewardship into study design, and there was overlap between study outcomes and those relevant to outpatient antimicrobial stewardship. Pharmacist intervention reduced unnecessary prescribing for acute pharyngitis (2 studies) and increased the appropriateness of prescribing for UTI (3 studies). CONCLUSION: There is growing evidence to support the role of community pharmacists in antimicrobial prescribing. Future research should explore additional opportunities for pharmacist antimicrobial prescribing and ways to further integrate advanced antimicrobial stewardship strategies in the community setting. Can Pharm J (Ott) 2021;154:xx-xx.

Development of a provincial interactive antibiogram tool for Ontario.

Background: Antimicrobial resistance (AMR) is a public health issue with significant impact on health care. Antibiogram development and deployment is a key strategy for managing and preventing AMR. Our objective was to develop an Ontario antibiogram as part of a larger provincial initiative aimed at advancing antimicrobial stewardship in the province. Methods: As part of a voluntary provincial online survey, antibiogram data from 100 of 201 (49.8%) Ontario hospitals were collected and included. All hospitals in Ontario were eligible to participate except those providing only mental health or ambulatory services. Weighted provincial and regional antibiotic susceptibilities (percentages) were conducted using descriptive statistical analyses, and an interactive antibiogram spreadsheet was developed. Respondent-identified barriers to collecting and interpreting antibiogram data are presented descriptively. Results: There was wide regional variability in antimicrobial-resistant organisms across Ontario. Provincial methicillin-resistant Staphylococcus aureus prevalence was 24.6%, ranging from 5.9% to 43.7% regionally. Provincial Escherichia coli resistance to ceftriaxone and ciprofloxacin was 13.8% (regional range 6.0%-25.1%) and 22.5% (regional range 9.8-37.8%), respectively. Klebsiella spp resistance to ceftriaxone and ciprofloxacin was similar across all health regions, with overall provincial rates of 7.5% and 5.6%, respectively. Conclusions: We have demonstrated that integrating hospital AMR tracking and reporting as part of a larger voluntary provincial antimicrobial stewardship program initiative is a feasible approach to capturing AMR data. The provincial antibiogram serves as a benchmark for the current state of AMR provincially and across health regions.

Historique: La résistance antimicrobienne (RAM) est un enjeu sanitaire aux conséquences importantes sur les soins. La création et le déploiement d'antibiogrammes sont une stratégie essentielle pour gérer et prévenir la RAM. Les chercheurs s'étaient donné l'objectif de créer un antibiogramme ontarien dans le cadre d'une initiative provinciale plus vaste visant à faire progresser la gestion antimicrobienne dans la province. Méthodologie: Dans le cadre d'un sondage provincial volontaire en ligne, les chercheurs ont colligé et inclus les données d'antibiogrammes de 100 des 201 hôpitaux ontariens (49,8 %). Tous les hôpitaux de l'Ontario étaient admissibles à participer, sauf ceux qui ne donnaient que des services en santé mentale ou des services ambulatoires. Les chercheurs ont établi les susceptibilités antibiotiques provinciales et régionales pondérées (en pourcentage) d'après les analyses statistiques descriptives et ont créé un chiffrier interactif de l'antibiogramme. Ils ont fait une interprétation descriptive des obstacles indiqués par les participants à la collecte et à l'interprétation des données de l'antibiogramme. Résultats: La variabilité régionale des organismes résistants aux antimicrobiens est importante en Ontario. La prévalence de Staphylococcus aureus résistant à la méthicilline s'élevait à 24,6 %, et variait entre 5,9 % et 43,7 % selon les régions. La résistance provinciale de l'Escherichia coli à la ceftriaxone et à la ciprofloxacine correspondait à 13,8 % (plage régionale de 6,0 % à 25,1 %) et à 22,5 % (plage régionale de 9,8 % à 37,8 %), respectivement. La résistance des espèces de Klebsiella à la ceftriaxone et à la ciprofloxacine était semblable dans toutes les régions sanitaires, les taux provinciaux globaux s'établissant à 7,5 % et 5,6 %, respectivement. Conclusion: Les auteurs ont démontré que l'intégration d'une fonction de traçage et de déclaration de la RAM aux hôpitaux dans le cadre d'un plus vaste programme provincial de gestion antimicrobienne volontaire est une démarche faisable pour saisir les données de RAM. L'antibiogramme provincial sert de référence pour obtenir un portrait à jour de la RAM dans la province et les régions sanitaires.

The Association Between High and Unnecessary Antibiotic Prescribing: A Cohort Study Using Family Physician Electronic Medical Records.

BACKGROUND: Approximately 25% of outpatient antibiotic prescriptions are unnecessary among family physicians in Canada. Minimizing unnecessary antibiotics is key for community antibiotic stewardship. However, unnecessary antibiotic prescribing is much harder to measure than total antibiotic prescribing. We investigated the association between total and unnecessary antibiotic use by family physicians and evaluated inter-physician variability in unnecessary antibiotic prescribing. METHODS: This was a cohort study based on electronic medical records of family physicians in Ontario, Canada, between April 2011 and March 2016. We used predefined expected antibiotic prescribing rates for 23 common primary care conditions to calculate unnecessary antibiotic prescribing rates. We used multilevel Poisson regression models to evaluate the association between total antibiotic volume (number of antibiotic prescriptions per patient visit), adjusted for multiple practice- and physician-level covariates, and unnecessary antibiotic prescribing. RESULTS: There were 499 570 physician-patient encounters resulting in 152 853 antibiotic prescriptions from 341 physicians. Substantial inter-physician variability was observed. In the fully adjusted model, we observed a significant association between total antibiotic volume and unnecessary prescribing rate (adjusted rate ratio 2.11 per 10% increase in total use; 95% CI 2.05-2.17), and none of the practice- and physician-level variables were associated with unnecessary prescribing rate. CONCLUSIONS: We demonstrated substantial inter-physician variability in unnecessary antibiotic prescribing in this cohort of family physicians. Total antibiotic use was strongly correlated with unnecessary antibiotic prescribing. Total antibiotic volume is a reasonable surrogate for unnecessary antibiotic use. These results can inform community antimicrobial stewardship efforts.

Defining appropriate antibiotic prescribing in primary care: A modified Delphi panel approach.

Background: Antimicrobial overuse contributes to antimicrobial resistance. In the ambulatory setting, where more than 90% of antibiotics are dispensed, there are no Canadian benchmarks for appropriate use. This study aims to define the expected appropriate outpatient antibiotic prescribing rates for three age groups (<2, 2-18, >18 years) using a modified Delphi method. Methods: We developed an online questionnaire to solicit from a multidisciplinary panel (community-academic family physicians, adult-paediatric infectious disease physicians, and antimicrobial stewardship pharmacists) what percentage of 23 common clinical conditions would appropriately be treated with systemic antibiotics followed with in-person meetings to achieve 100% consensus. Results: The panelists reached consensus for one condition online and 22 conditions face-to-face, which took an average of 2.6 rounds of discussion per condition (range, min-max 1-5). The consensus for appropriate systemic antibiotic prescribing rates were, for pneumonia, pyelonephritis, non-purulent skin and soft tissue infections (SSTI), other bacterial infections, and reproductive tract infections, 100%; urinary tract infections, 95%-100%; prostatitis, 95%; epididymo-orchitis, 85%-88%; chronic obstructive pulmonary disease, 50%; purulent SSTI, 35%-50%; otitis media, 30%-40%; pharyngitis, 18%-40%; acute sinusitis, 18%-20%; chronic sinusitis, 14%; bronchitis, 5%-8%; gastroenteritis, 4%-5%; dental infections, 4%; eye infections, 1%; otitis externa, 0%-1%; and asthma, common cold, influenza, and other non-bacterial infections (0%). (Note that some differed by age group.). Conclusions: This study resulted in expert consensus for defined levels of appropriate antibiotic prescribing across a broad set of outpatient conditions. These results can be applied to community antimicrobial stewardship initiatives to investigate the level of inappropriate use and set targets to optimize antibiotic use.

Historique: La surutilisation d'antimicrobiens contribue à la résistance antimicrobienne. Il n'y a pas de normes canadiennes pour en établir l'utilisation appropriée en milieu ambulatoire, où plus de 90 % des antibiotiques sont prescrits. La présente étude vise à définir le taux de prescription approprié et anticipé d'antibiotiques en milieu ambulatoire dans trois groupes d'âge (moins de 2 ans, de 2 à 18 ans, plus de 18 ans) au moyen de la méthode Delphi modifiée. Méthodologie: Les auteurs ont préparé un questionnaire en ligne pour demander à un groupe multidisciplinaire (médecins de famille en milieu communautaire et universitaire, infectiologues pour adultes et pour enfants et pharmaciens en gestion des antimicrobiens) le pourcentage de 23 affections cliniques courantes qui serait traité correctement par des antibiotiques systémiques et l'ont fait suivre de rencontres en salle pour obtenir un consensus à 100 %. Résultats: Le groupe est parvenu à un consensus en ligne à l'égard d'une affection et à un consensus en salle à l'égard de 22 affections, ce qui a exigé une moyenne de 2,6 séries de discussions par affection (plage minimum-maximum de 1 à 5). Le consensus relatif aux taux de prescription appropriés d'antibiotiques systémiques était de 100 % pour la pneumonie, la pyélonéphrite, les infections non purulentes de la peau et des tissus mous, les autres infections bactériennes et les infections de l'appareil reproducteur; de 95 % à 100 % pour les infections urinaires; de 95 % pour la prostatite; de 85 % à 88 % pour l'épididymo-orchite; de 50 % pour la maladie pulmonaire obstructive chronique; de 35 % à 50 % pour les ITS purulentes; de 30 % à 40 % pour l'otite moyenne; de 18 % à 40 % pour la pharyngite; de 18 % à 20 % pour la sinusite aiguë; de 14 % pour la sinusite chronique; de 5 % à 8 % pour la bronchite; de 4 % à 5 % pour la gastroentérite; de 4 % pour les infections dentaires; de 1 % pour les infections oculaires; de 0 % à 1 % pour l'otite externe et de 0 % pour l'asthme, le rhume banal, la grippe et les autres infections non bactériennes. Il est à souligner que certains pourcentages différaient en fonction des groupes d'âge. Conclusions: La présente étude a suscité un consensus d'experts à l'égard de degrés définis de prescription appropriée d'antibiotiques pour un large éventail d'affections ambulatoires. Ces résultats peuvent être appliqués aux initiatives de gestion des antimicrobiens en milieu communautaire afin d'explorer le degré d'utilisation appropriée et de fixer des objectifs d'optimisation de l'utilisation d'antibiotiques.

Antimicrobial Stewardship Programs in Long-Term Care Settings: A Meta-Analysis and Systematic Review.

BACKGROUND: Antimicrobial stewardship programs have been established in hospitals, but less studied in long-term care facilities (LTCFs), a setting with unique challenges related to patient populations and available resources. This systematic review sought to provide a comprehensive assessment of antimicrobial stewardship interventions implemented in LTCFs, using meta-analysis to examine their impact on overall antimicrobial use. METHODS: Electronic searches of MEDLINE, Embase, and CINAHL (1990 to July 2018) identified any antimicrobial stewardship interventions in LTCFs, with no restriction on patient population, study design, or outcomes. Intervention components were categorized using the Cochrane Effective Practice and Organization of Care taxonomy on implementation strategies. Random-effects meta-analysis used ratio of means to facilitate pooling of different metrics of antimicrobial use. RESULTS: Eighteen studies (one randomized controlled trial [RCT], four cluster RCTs, four controlled pre/post studies, and nine uncontrolled pre/post studies) met inclusion, using 13 different antimicrobial stewardship intervention strategies; 15 studies used multifaceted (maximum, seven; median, four) interventions. The three most commonly implemented strategies were educational materials, educational meetings, and guideline implementation. Intervention labor intensity and resource requirements varied considerably among interventions. Meta-analysis of 11 studies demonstrated that antimicrobial stewardship strategies were associated with a 14% reduction in overall antimicrobial use (95% confidence interval = -8% to -20%; P < .0001), with similar results by study design but high heterogeneity (I2 = 86%) for the uncontrolled pre/post study subgroup and no heterogeneity (I2 = 0%) for the cluster RCT and controlled pre/post study subgroups. Funnel plot analysis suggested publication bias, with a lack of publication of smaller studies showing increased antibiotic use. CONCLUSION: Antimicrobial stewardship strategies implemented in long-term care vary considerably in design and resource intensity, but collectively suggest potential to reduce antimicrobial use in this challenging setting. J Am Geriatr Soc 67:392-399, 2019.

Pilot study of an online hospital antibiotic use tracking and reporting system.

Background: Antimicrobial use (AMU) varies widely among hospitals, suggesting a need to better monitor usage and evaluate the effectiveness of antimicrobial stewardship programs (ASPs). Our objective was to assess the feasibility of implementing an online voluntary hospital antibiotic use tracking and reporting system. Methods: An online survey was sent to ASP clinicians representing hospitals across Ontario. Hospitals that tracked total hospital-wide inpatient antibiotic use in 2017 were asked to submit either days of therapy (DOT) or defined daily doses (DDD), along with separate inpatient days (PD), which were used as the denominator. Respondents who indicated no hospital-wide AMU tracking were asked to describe the barriers to its use. Antibiotic use was displayed on a public website for consenting hospitals. Results: Of 201 eligible hospitals, 66 (33%) provided AMU data representing 10,634 of 25,208 (43%) eligible inpatient beds in the province. DOT and DDD data were provided by 36 hospitals, each. Weighted average antibiotic use was highest in acute teaching hospitals (513 DOT/1,000 PD, 709 DDD/1,000 PD) and lowest in complex continuing care and rehabilitation facilities (158 DOT/1,000 PD, 159 DDD/1,000 PD). Barriers cited for providing hospital-wide AMU data include lack of time and resources to collect and evaluate AMU data and technological limitations preventing data collection. Conclusion: Integrating hospital AMU tracking and reporting as part of a voluntary initiative is feasible, with relatively broad participation. Short of a legislative mandate for participation, opportunities still exist to increase representation, including provision of guidance and technical support to help hospitals track and share AMU.

Historique: L'utilisation d'antimicrobiens (UAM) varie énormément d'un hôpital à l'autre, ce qui laisse supposer la nécessité de mieux surveiller l'usage et d'évaluer l'efficacité des programmes de gestion des antimicrobiens (PGA). Les auteurs avaient l'objectif d'évaluer la faisabilité d'adopter un système électronique volontaire de suivi et de déclaration de l'utilisation des antibiotiques en milieu hospitalier. Méthodologie: Les cliniciens représentant les hôpitaux de l'Ontario dotés d'un PGA ont reçu un sondage en ligne. Les hôpitaux qui suivaient l'utilisation totale d'antibiotiques par les patients hospitalisés en 2017 ont été invités à soumettre les jours de traitement (JDT) ou les doses quotidiennes définies (DQD), de même que les journées d'hospitalisation distinctes (JH), qui ont servi de dénominateur. Les répondants dont l'hôpital ne recourait pas à l'UAM ont été invités à décrire les obstacles à son utilisation. L'utilisation d'antibiotiques des hôpitaux consentants a été affichée dans un site Web public. Résultats: Des 201 hôpitaux admissibles, 66 (33 %) ont fourni des données sur l'UAM, ce qui représente 10 634 des 25 208 (43 %) lits d'hospitalisation admissibles de la province. Les données sur les JDT et les DQD ont été fournies par 36 hôpitaux, respectivement. L'utilisation moyenne pondérée d'antibiotiques était plus élevée dans les hôpitaux universitaires de soins aigus (513 JDT/1 000 JH, 709 DQD/1 000 JH) et plus faible dans les établissements de soins continus complexes et de réadaptation (158 JDT/1 000 JH, 159 DQD/1 000 JH). Les obstacles cités pour fournir des données sur l'UAM dans l'ensemble de l'hôpital incluaient le manque de temps et de ressources pour les colliger et les évaluer et les limites technologiques en empêchant la collecte. Conclusion: L'intégration d'un système hospitalier de suivi et de déclaration de l'UAM dans le cadre d'une initiative volontaire est faisable, et obtient une participation relativement généralisée. Avant d'obtenir un mandat législatif pour obliger la participation, il y a des façons d'accroître la représentation, y compris la remise de conseils et de soutien technique pour aider les hôpitaux à suivre et transmettre leur UAM.

Evaluating Antimicrobial Use and Spectrum of Activity in Ontario Hospitals: Feasibility of a Multicentered Point Prevalence Study.

BACKGROUND: Antimicrobial stewardship, a key component of an overall strategy to address antimicrobial resistance, has been recognized as a global priority. The ability to track and benchmark antimicrobial use (AMU) is critical to advancing stewardship from an organizational and provincial perspective. As there are few comprehensive systems in Canada that allow for benchmarking, Public Health Ontario conducted a pilot in 2016/2017 to assess the feasibility of using a point prevalence methodology as the basis of a province-wide AMU surveillance program. METHODS: Three acute care hospitals of differing sizes in Ontario, Canada, participated. Adults admitted to inpatient acute care beds on the survey date were eligible for inclusion; a sample size of 170 per hospital was targeted, and data were collected for the 24-hour period before and including the survey date. Debrief sessions at each site were used to gather feedback about the process. Prevalence of AMU and the Antimicrobial Spectrum Index (ASI) was reported for each hospital and by indication per patient case. RESULTS: Participants identified required improvements for scalability including streamlining ethics, data sharing processes, and enhancing the ability to compare with peer organizations at a provincial level. Of 457 patients, 172 (38%) were receiving at least 1 antimicrobial agent. Beta-lactam/beta-lactamase inhibitors were the most common (18%). The overall mean ASI per patient was 6.59; most cases were for treatment of infection (84%). CONCLUSIONS: This pilot identified factors and features required for a scalable provincial AMU surveillance program; future efforts should harmonize administrative processes and enable interfacility benchmarking.

Assessing the impact of antibiotic stewardship program elements on antibiotic use across acute-care hospitals: an observational study.

OBJECTIVES: Antibiotic use varies widely between hospitals, but the influence of antimicrobial stewardship programs (ASPs) on this variability is not known. We aimed to determine the key structural and strategic aspects of ASPs associated with differences in risk-adjusted antibiotic utilization across facilities. DESIGN: Observational study of acute-care hospitals in Ontario, Canada METHODS: A survey was sent to hospitals asking about both structural (8 elements) and strategic (32 elements) components of their ASP. Antibiotic use from hospital purchasing data was acquired for January 1 to December 31, 2014. Crude and adjusted defined daily doses per 1,000 patient days, accounting for hospital and aggregate patient characteristics, were calculated across facilities. Rate ratios (RR) of defined daily doses per 1,000 patient days were compared for hospitals with and without each antimicrobial stewardship element of interest. RESULTS: Of 127 eligible hospitals, 73 (57%) participated in the study. There was a 7-fold range in antibiotic use across these facilities (min, 253 defined daily doses per 1,000 patient days; max, 1,872 defined daily doses per 1,000 patient days). The presence of designated funding or resources for the ASP (RRadjusted, 0·87; 95% CI, 0·75-0·99), prospective audit and feedback (RRadjusted, 0·80; 95% CI, 0·67-0·96), and intravenous-to-oral conversion policies (RRadjusted, 0·79; 95% CI, 0·64-0·99) were associated with lower risk-adjusted antibiotic use. CONCLUSIONS: Wide variability in antibiotic use across hospitals may be partially explained by both structural and strategic ASP elements. The presence of funding and resources, prospective audit and feedback, and intravenous-to-oral conversion should be considered priority elements of a robust ASP.

Potential Negative Effects of Antimicrobial Allergy Labelling on Patient Care: A Systematic Review.

BACKGROUND: Antimicrobial allergy labels, either self-reported or placed in a patient's medical record, are common, but in many cases they are not associated with a true immunoglobulin E-mediated allergic response. OBJECTIVE: To assess the impact of antimicrobial allergy labels on antimicrobial prescribing, resource utilization, and clinical outcomes. DATA SOURCES: The MEDLINE, Embase, CINAHL, and Scopus electronic databases were searched for the period 1990 to January 2016. STUDY SELECTION: Controlled studies with the objective of assessing antimicrobial prescribing, resource utilization, and/or clinical outcomes associated with antimicrobial allergy labels were included. RESULTS: The search identified 560 unique citations, of which 7 articles met the inclusion criteria. One additional article identified by an expert in the field was also included. Four of the identified papers were limited to penicillin or other ß-lactam allergies. Six studies noted differences in antibiotic selection between patients with allergy labels and those without such labels. Broader-spectrum or second-line agents (e.g., vancomycin, clindamycin, and fluoroquinolones) were more commonly prescribed for patients with penicillin allergy labels. Antibiotic therapy costs were significantly higher for patients with allergy labels than for those without. The impact of allergy labels on clinical outcomes was mixed. One study indicated a longer length of hospital stay, 2 studies reported higher readmission rates, and 1 study reported a higher rate of antibiotic-resistant organisms for patients with allergy labels. CONCLUSIONS: Most of the available literature is limited to penicillin or ß-lactam allergy. The growing body of knowledge supports the concept that ß-lactam allergy labels are not benign and that labelling in the absence of a true allergy has a negative effect on patient care. Allergy labelling appears to be associated with suboptimal antibiotic selection, greater treatment costs, prolonged length of stay, greater readmission rates, and higher prevalence of antibiotic-resistant organisms. There is an opportunity for antimicrobial stewardship programs to implement systematic allergy verification to optimize antimicrobial therapy and improve patient care.

CONTEXTE: Les mentions d'allergies aux antimicrobiens, soit autodéclarées soit consignées dans un dossier médical, sont fréquentes, mais dans bien des cas elles ne signalent pas une véritable réaction allergique à médiation par l'immunoglobuline E. OBJECTIF: Évaluer l'effet des mentions d'allergie aux antimicrobiens sur les habitudes de prescription d'antimicrobiens, l'utilisation des ressources et les résultats cliniques. SOURCES DES DONNÉES: Les bases de données numériques MEDLINE, Embase, CINAHL et Scopus ont été interrogées pour la période allant de 1990 à janvier 2016. SÉLECTION DES ÉTUDES: Les essais cliniques comparatifs dont l'objectif était d'évaluer les habitudes de prescription d'antimicrobiens, l'utilisation des ressources ou les résultats cliniques associés aux mentions d'allergie aux antimicrobiens ont été inclus. RÉSULTATS: La recherche a permis de trouver 560 citations distinctes et ainsi de repérer sept articles qui répondaient aux critères d'inclusion. Un article supplémentaire signalé par un expert du domaine a été inclus à l'analyse. Quatre de ces articles se limitaient aux allergies à la pénicilline ou à d'autres ß-lactamines. Six études ont noté des différences dans le choix des antibiotiques entre les patients ayant une mention d'allergie à leur dossier et ceux n'en ayant pas. Des antibiotiques à plus large spectre ou des médicaments de deuxième intention (comme la vancomycine, la clindamycine et les fluoroquinolones) étaient plus souvent prescrits pour les patients ayant une mention d'allergie à la pénicilline. Les coûts des antibiothérapies étaient significativement plus élevés pour les patients ayant une mention d'allergie que pour ceux n'en ayant pas à leur dossier. L'effet des mentions d'allergie sur les résultats cliniques était inégal. Une étude indiquait un séjour plus long à l'hôpital, deux études indiquaient des taux de réadmission plus élevés et une étude indiquait un taux plus élevé d'organismes résistants aux antibiotiques pour les patients ayant une mention d'allergie comparativement à ceux n'en ayant pas. CONCLUSIONS: La majeure partie des articles disponibles se limitent aux allergies à la pénicilline ou à d'autres ß-lactamines. De plus en plus, le savoir vient appuyer le concept voulant que les mentions d'allergies aux ß-lactamines ne soient pas bénignes et que leur emploi en l'absence d'une allergie réelle ait un effet négatif sur les soins aux patients. Les mentions d'allergie semblent être associées à un choix sous-optimal d'antibiotiques, des coûts de traitement plus élevés, des séjours plus longs, des taux de réadmission plus élevés et une plus grande prévalence d'organismes résistants aux antibiotiques. Or, les programmes de gérance des antimicrobiens pourraient permettre de mettre en œuvre des procédures de vérification systématique des allergies afin d'optimiser l'antibiothérapie et d'améliorer les soins aux patients.

Landscape of antimicrobial stewardship programs in Ontario: a survey of hospitals.

BACKGROUND: Antimicrobial resistance is an important public health issue globally and in Canada. To understand the current state of antimicrobial stewardship programs in Ontario health care facilities, Public Health Ontario conducted a voluntary survey of hospitals in the province. METHODS: The Ontario Antimicrobial Stewardship Program Landscape Survey was distributed online to hospitals, targeting front-line antimicrobial stewardship clinicians. The survey was open for 5 weeks in fall 2016. We used email and telephone reminders to encourage response. We performed descriptive and inferential statistical analyses at an aggregate level and by hospital type. Mental health and ambulatory sites were excluded. RESULTS: The response rate was 74.0% (97/131 organizations). Of the 97, 90 (93%) reported having a formal antimicrobial stewardship program or were in the process of implementing a formal program. Just over half (50 [56%]) identified appropriate antibiotic use as part of the organization's quality-improvement plan, strategic goal or priority. Half (45 [50%]) of programs did not have designated resources; those that did are underresourced with respect to physician and pharmacist staffing. The scope of implementation of program strategies was variable. Fifty hospitals (56%) reported tracking antimicrobial expenditures, 47 (52%) reported tracking defined daily dose, and 35 (39%) reported tracking days of therapy. INTERPRETATION: Most Ontario hospitals have a formal antimicrobial stewardship program, but there are opportunities for improvement. Future efforts should increase the priority of and improve resource allocation for antimicrobial stewardship programs so that programs can continue to grow in scope and impact.