{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T02:56:47Z","timestamp":1792033007405,"version":"4.4.0"},"reference-count":38,"publisher":"Cambridge University Press (CUP)","issue":"12","license":[{"start":{"date-parts":[[2018,9,26]],"date-time":"2018-09-26T00:00:00Z","timestamp":1537920000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X18002374_abs1\" sec-type=\"general\"><jats:title>Background<\/jats:title><jats:p>Antimicrobial stewardship programs are effective in optimizing antimicrobial prescribing patterns and decreasing the negative outcomes of antimicrobial exposure, including the emergence of multidrug-resistant organisms. In dialysis facilities, 30%\u201335% of antimicrobials are either not indicated or the type of antimicrobial is not optimal. Although antimicrobial stewardship programs are now implemented nationwide in hospital settings, programs specific to the maintenance dialysis facilities have not been developed.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002374_abs2\" sec-type=\"general\"><jats:title>Objective<\/jats:title><jats:p>To quantify the effect of an antimicrobial stewardship program in reducing antimicrobial prescribing.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002374_abs3\" sec-type=\"general\"><jats:title>Study design and setting<\/jats:title><jats:p>An interrupted time-series study in 6 outpatient hemodialysis facilities was conducted in which mean monthly antimicrobial doses per 100 patient months during the 12 months prior to the program were compared to those in the 12-month intervention period.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002374_abs4\" sec-type=\"results\"><jats:title>Results<\/jats:title><jats:p>Implementation of the antimicrobial stewardship program was associated with a 6% monthly reduction in antimicrobial doses per 100 patient months during the intervention period (<jats:italic>P<\/jats:italic>=.02). The initial mean of 22.6 antimicrobial doses per 100 patient months decreased to a mean of 10.5 antimicrobial doses per 100 patient months at the end of the intervention. There were no significant changes in antimicrobial use by type, including vancomycin. Antimicrobial adjustments were recommended for 30 of 145 antimicrobial courses (20.6%) for which there were sufficient clinical data. The most frequent reasons for adjustment included de-escalation from vancomycin to cefazolin for methicillin-susceptible <jats:italic>Staphylococcus aureus<\/jats:italic> infections and discontinuation of antimicrobials when criteria for presumed infection were not met.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X18002374_abs5\" sec-type=\"conclusions\"><jats:title>Conclusions<\/jats:title><jats:p>Within 6 hemodialysis facilities, implementation of an antimicrobial stewardship was associated with a decline in antimicrobial prescribing with no negative effects.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2018.237","type":"journal-article","created":{"date-parts":[[2018,9,26]],"date-time":"2018-09-26T07:32:40Z","timestamp":1537947160000},"page":"1400-1405","source":"Crossref","is-referenced-by-count":21,"title":["The positive effects of an antimicrobial stewardship program targeting outpatient hemodialysis facilities"],"prefix":"10.1017","volume":"39","author":[{"given":"Erika M. 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Centers for Disease Control and Prevention website. https:\/\/www.cdc.gov\/getsmart\/healthcare\/implementation\/core-elements.html. Updated 2017. Accessed March 21, 2018."},{"key":"S0899823X18002374_ref17","doi-asserted-by":"publisher","DOI":"10.1086\/511159"},{"key":"S0899823X18002374_ref16","doi-asserted-by":"publisher","DOI":"10.1086\/427507"},{"key":"S0899823X18002374_ref15","doi-asserted-by":"publisher","DOI":"10.1053\/j.ajkd.2006.04.040"},{"key":"S0899823X18002374_ref13","unstructured":"Central line-associated bloodstream infection (CLABSI) event. Centers for Disease Control and Prevention website. http:\/\/www.cdc.gov\/nhsn\/TOC_PSCManual.html. Published 2012. 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