{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,27]],"date-time":"2026-03-27T13:27:58Z","timestamp":1774618078369,"version":"3.50.1"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T00:00:00Z","timestamp":1708905600000},"content-version":"vor","delay-in-days":60,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100010345","name":"B. Braun Foundation","doi-asserted-by":"publisher","award":["BBST-D-20-00030"],"award-info":[{"award-number":["BBST-D-20-00030"]}],"id":[{"id":"10.13039\/100010345","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,28]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To explore effectiveness and sustainability of guideline adherence and antibiotic consumption after establishing treatment guidelines and initiating antimicrobial stewardship (AMS) ward rounds in a university hospital emergency department (ED).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>Data were gathered retrospectively from 2017 to 2021 in the LMU University Hospital in Munich, Germany. Four time periods were compared: P1 (pre-intervention period); P2 (distribution of guideline pocket cards); P3 (reassessment after 3\u2005years); and P4 (refresher of guideline pocket cards and additional daily AMS ward rounds for different medical disciplines). Primary outcome was adherence to guideline pocket cards for community-acquired pneumonia, cystitis, pyelonephritis and COVID-19-associated bacterial pneumonia. Secondary outcomes were reduction in antibiotic consumption and adherence to AMS specialist recommendations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The study included 1324 patients. Guideline adherence increased in P2 for each of the infectious diseases entities. After 3\u2005years (P3), guideline adherence decreased again, but was mostly on a higher level than in P1. AMS ward rounds resulted in an additional increase in guideline adherence (P1\/P2: 47% versus 58.6%, P\u200a=\u200a0.005; P2\/P3: 58.6% versus 57.3%, P\u200a=\u200a0.750; P3\/P4: 57.3% versus 72.5%, P\u200a&amp;lt;\u200a0.001). Adherence increased significantly, not only during workdays but also on weekends\/nightshifts. Adherence to AMS specialist recommendations was excellent (91.3%). We observed an increase in use of narrow-spectrum antibiotics and a decrease in the application of fluoroquinolones and cephalosporins.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Establishing treatment guidelines in the ED is effective. However, positive effects can be diminished over time. Daily AMS ward rounds are useful, not only to restore but to further increase guideline adherence significantly.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/jacamr\/dlae026","type":"journal-article","created":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T11:49:53Z","timestamp":1708948193000},"source":"Crossref","is-referenced-by-count":5,"title":["Effect and sustainability of a stepwise implemented multidisciplinary antimicrobial stewardship programme in a university hospital emergency department"],"prefix":"10.1093","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2682-2523","authenticated-orcid":false,"given":"Lukas","family":"Arenz","sequence":"first","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Department of Medicine II, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Porger","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michaela","family":"De Michel","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Weber","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Department of Hospital Pharmacy, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jette","family":"Jung","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Max-von-Pettenkofer-Institute Munich, LMU Munich , Elisabeth-Winterhalter-Weg 6, 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heidi","family":"Horns","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sandra","family":"Gscheidle","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Department of Hospital Pharmacy, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tobias","family":"Weiglein","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Emergency Department, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joachim","family":"Pircher","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Department of Medicine I, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna","family":"Becker-Lienau","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Department of Orthopedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sophia","family":"Horster","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthias","family":"Klein","sequence":"additional","affiliation":[{"name":"Emergency Department, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"},{"name":"Department of Neurology, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rika","family":"Draenert","sequence":"additional","affiliation":[{"name":"Antibiotic Stewardship Programme, University Hospital, LMU Munich , Marchioninistra\u00dfe 15 , 81377 M\u00fcnchen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,2,26]]},"reference":[{"key":"2024022611493966600_dlae026-B1","doi-asserted-by":"crossref","first-page":"629","DOI":"10.1016\/S0140-6736(21)02724-0","article-title":"Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis","volume":"399","author":"Murray","year":"2022","journal-title":"Lancet"},{"key":"2024022611493966600_dlae026-B2","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"key":"2024022611493966600_dlae026-B3","first-page":"209","article-title":"Appropriateness of antimicrobial prescriptions in the emergency department of a tertiary hospital. [Article in Spanish]","volume":"31","author":"Yunquera-Romero","year":"2018","journal-title":"Rev Esp Quimioter"},{"key":"2024022611493966600_dlae026-B4","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1093\/jac\/dky447","article-title":"Appropriateness of antibiotic prescribing in the emergency department","volume":"74","author":"Denny","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2024022611493966600_dlae026-B5","doi-asserted-by":"crossref","first-page":"2897","DOI":"10.1093\/cid\/ciz1183","article-title":"Impact of a comprehensive antimicrobial stewardship program on institutional burden of antimicrobial resistance: a 14-year controlled interrupted time-series study","volume":"71","author":"Peragine","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2024022611493966600_dlae026-B6","doi-asserted-by":"crossref","first-page":"4840","DOI":"10.1128\/AAC.00825-16","article-title":"Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs","volume":"60","author":"Karanika","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"2024022611493966600_dlae026-B7","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.cmi.2020.10.028","article-title":"Antimicrobial stewardship in the emergency department: characteristics and evidence for effectiveness of interventions","volume":"27","author":"May","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2024022611493966600_dlae026-B8","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.annemergmed.2012.09.002","article-title":"A call to action for antimicrobial stewardship in the emergency department: approaches and strategies","volume":"62","author":"May","year":"2013","journal-title":"Ann Emerg Med"},{"key":"2024022611493966600_dlae026-B9","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1016\/j.cmi.2020.11.015","article-title":"Antibiotic stewardship in the emergency department: not to be overlooked","volume":"27","author":"Paul","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2024022611493966600_dlae026-B10","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.jhin.2017.07.005","article-title":"Impact of an antimicrobial stewardship programme to optimize antimicrobial use for outpatients at an emergency department","volume":"97","author":"Dinh","year":"2017","journal-title":"J Hosp Infect"},{"key":"2024022611493966600_dlae026-B11","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1136\/emermed-2014-204067","article-title":"Implementation of an intensified antibiotic stewardship programme targeting third-generation cephalosporin and fluoroquinolone use in an emergency medicine department","volume":"32","author":"Borde","year":"2015","journal-title":"Emerg Med J"},{"key":"2024022611493966600_dlae026-B12","doi-asserted-by":"crossref","first-page":"839","DOI":"10.1016\/j.ajem.2018.07.052","article-title":"Impact of an emergency medicine pharmacist on empiric antibiotic prescribing for pneumonia and intra-abdominal infections","volume":"37","author":"Kulwicki","year":"2019","journal-title":"Am J Emerg Med"},{"key":"2024022611493966600_dlae026-B13","doi-asserted-by":"crossref","first-page":"441","DOI":"10.1017\/cem.2017.11","article-title":"Impact of a multifaceted antimicrobial stewardship program: a front-line ownership driven quality improvement project in a large urban emergency department","volume":"19","author":"Kaufman","year":"2017","journal-title":"CJEM"},{"key":"2024022611493966600_dlae026-B14","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1016\/j.idc.2019.10.004","article-title":"Collaborative antimicrobial stewardship in the emergency department","volume":"34","author":"Acquisto","year":"2020","journal-title":"Infect Dis Clin North Am"},{"key":"2024022611493966600_dlae026-B15","doi-asserted-by":"crossref","first-page":"867","DOI":"10.3390\/antibiotics9120867","article-title":"Impact and sustainability of antibiotic stewardship in pediatric emergency departments: why persistence is the key to success","volume":"9","author":"Barbieri","year":"2020","journal-title":"Antibiotics (Basel)"},{"key":"2024022611493966600_dlae026-B16","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.3390\/antibiotics10121518","article-title":"Impact and sustainability of antibiotic stewardship on antibiotic prescribing in visceral surgery","volume":"10","author":"Gruber","year":"2021","journal-title":"Antibiotics"},{"key":"2024022611493966600_dlae026-B17","doi-asserted-by":"crossref","first-page":"1860.e1","DOI":"10.1016\/j.cmi.2021.07.019","article-title":"Effect of discontinuation of an antimicrobial stewardship programme on the antibiotic usage pattern","volume":"27","author":"Jang","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2024022611493966600_dlae026-B18","doi-asserted-by":"crossref","first-page":"774","DOI":"10.1177\/1060028017709820","article-title":"A systematic review of antimicrobial stewardship interventions in the emergency department","volume":"51","author":"Losier","year":"2017","journal-title":"Ann Pharmacother"},{"key":"2024022611493966600_dlae026-B19","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1093\/cid\/ciy844","article-title":"The differences in antibiotic decision-making between acute surgical and acute medical teams: an ethnographic study of culture and team dynamics","volume":"69","author":"Charani","year":"2019","journal-title":"Clin Infect Dis"},{"key":"2024022611493966600_dlae026-B20","doi-asserted-by":"crossref","first-page":"843","DOI":"10.3390\/antibiotics10070843","article-title":"Antimicrobial prescribing in the emergency department; who is calling the shots?","volume":"10","author":"Hamill","year":"2021","journal-title":"Antibiotics"},{"key":"2024022611493966600_dlae026-B21","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1016\/j.medmal.2018.09.003","article-title":"Perceptions, attitudes, and practices of French junior physicians regarding antibiotic use and resistance","volume":"49","author":"L\u00e9vin","year":"2019","journal-title":"Med Mal Infect"},{"key":"2024022611493966600_dlae026-B22","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1111\/j.1469-0691.2010.03179.x","article-title":"Junior doctors\u2019 knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland","volume":"17","author":"Pulcini","year":"2011","journal-title":"Clin Microbiol Infect"},{"key":"2024022611493966600_dlae026-B23","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.eimc.2012.05.016","article-title":"Knowledge and perceptions of junior and senior Spanish resident doctors about antibiotic use and resistance: results of a multicenter survey","volume":"31","author":"Navarro-San Francisco","year":"2013","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"2024022611493966600_dlae026-B24","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1111\/1742-6723.13251","article-title":"Attitudes and beliefs of Australian emergency department clinicians on antimicrobial stewardship in the emergency department: a qualitative study","volume":"31","author":"Goulopoulos","year":"2019","journal-title":"Emerg Med Australas"},{"key":"2024022611493966600_dlae026-B25","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/resp.12978","article-title":"Seasonality of pathogens causing community-acquired pneumonia","volume":"22","author":"Cilloniz","year":"2017","journal-title":"Respirology"},{"key":"2024022611493966600_dlae026-B26","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.ijantimicag.2012.10.013","article-title":"Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum \u03b2-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus","volume":"41","author":"Dancer","year":"2013","journal-title":"Int J Antimicrob Agents"},{"key":"2024022611493966600_dlae026-B27","doi-asserted-by":"crossref","first-page":"1283","DOI":"10.5811\/westjem.2020.7.48848","article-title":"COVID-19: an emerging threat to antibiotic stewardship in the emergency department","volume":"21","author":"Pulia","year":"2020","journal-title":"West J Emerg Med"},{"key":"2024022611493966600_dlae026-B28","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1016\/j.cmi.2020.04.024","article-title":"COVID-19: don't neglect antimicrobial stewardship principles!","volume":"26","author":"Huttner","year":"2020","journal-title":"Clin Microbiol Infect"},{"key":"2024022611493966600_dlae026-B29","doi-asserted-by":"crossref","first-page":"e0203316","DOI":"10.1371\/journal.pone.0203316","article-title":"Emergency department crowding: a systematic review of causes, consequences and solutions","volume":"13","author":"Morley","year":"2018","journal-title":"PLoS One"},{"key":"2024022611493966600_dlae026-B30","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1007\/s00134-015-4115-4","article-title":"Night shift decreases cognitive performance of ICU physicians","volume":"42","author":"Maltese","year":"2016","journal-title":"Intensive Care Med"}],"container-title":["JAC-Antimicrobial Resistance"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/6\/1\/dlae026\/56755964\/dlae026.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jacamr\/article-pdf\/6\/1\/dlae026\/56755964\/dlae026.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,26]],"date-time":"2024-02-26T11:50:05Z","timestamp":1708948205000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jacamr\/article\/doi\/10.1093\/jacamr\/dlae026\/7614077"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,28]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023,12,28]]}},"URL":"https:\/\/doi.org\/10.1093\/jacamr\/dlae026","relation":{},"ISSN":["2632-1823"],"issn-type":[{"value":"2632-1823","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2024,2]]},"published":{"date-parts":[[2023,12,28]]},"article-number":"dlae026"}}