2016 Antimicrobial Stewardship Research Workshop
The first Antimicrobial Stewardship Research Workshop (ASRW) was held November 29-30, 2016, and was co-organized by Society of Healthcare Epidemiology of America, Infectious Diseases Society of America, Society of Infectious Diseases Pharmacists, Pediatric Infectious Diseases Society, and Centers for Diseases Control and Prevention and was supported by a grant from Merck. The audience was multidisciplinary with multiple backgrounds: teaching hospital, community, adult, pediatric, and industry. Additionally, the workshop had live following on Twitter, with the hashtag, #ASRW16.
The two-day workshop was filled with several topics, but gave a broad overview of the need for and challenges of studying antimicrobial stewardship. For the first half of the day, speakers set the stage of the antimicrobial stewardship research agenda: Drs. Lauri Hicks and Preeti Malani presented outpatient and inpatient stewardship research, respectively. For review of basic concepts of research, Dr. Ebbing Lautenbach provided an epidemiology toolbox presentation. Defining the right kind of question for research can be difficult and Dr. Vanessa Stevens walked the audience through various examples of good and bad research questions and the following presentation on the various areas of research in antimicrobial stewardship by Dr. Rebekah Moehring complemented it well. After this introductory morning, groups were encouraged to breakout and discuss different approached to a research question and included various themes, such as hospital vs. outpatient and internal vs. external funding of research.
For the second half of the day, the discussion focused further into the different aspects of research: Drs. Pranita Tamma and Jeffrey Linder presented on defining exposures, outcomes, and confounders of interest based on inpatient and outpatient settings, respectively. Dr. Marc Scheetz explained the nuances between research for generalized knowledge vs. quality improvement and assurances projects. The audience was introduced to how social sciences can be involved in antimicrobial stewardship, with Dr. Heather Reisinger giving an overview of implementation science and how the models may be able to be used in stewardship research. Dr. Stevens returned to discuss the pros and cons of health economics to evaluate stewardship programs and Dr. Julia Szymczak ended the evening with a vigorous reminder that there are many behavioral factors associated with antimicrobial prescribing and identification of these factors may help with implementation of stewardship interventions.
After a heavy first day, everyone returned bright-eyed for the second day, which was more concentrated on various strategies for evaluating antimicrobials stewardship interventions. Dr. Jessina McGregor explained the ins-and-outs of interrupted time series analysis and how they can be very helpful in evaluating programs; following that, Dr. Theoklis Zaoutis educated the audience of how the cohort design can be used for studying the impact of an intervention. Other assessment strategies were reviewed: Dr. Jonathon Edwards explained how the National Healthcare Safety Network (NSHN) will use the Antimicrobial Use and Resistance (AUR) report to benchmark antimicrobial usage through the standard antimicrobial administration ratio (SAAR), which was followed by Dr. Scott Fridkin’s presentation on what kind of metrics and comparisons should be used and how to include variation into assessment of programs. Dr. Deverick Anderson highlighted the pitfalls of just relying on antimicrobial consumption as a metric and discussed how desirability of outcome ranking (DOOR) and response adjusted for duration of antibiotic risk (RADAR) may be able to shine more light on specific outcomes of interest.
After lunch, the final topic was to put all the different concepts together for a successful research program. Dr. Anderson returned to the stage to discuss the details needed for data management and common issues that arise when developing the components. Dr. Elizabeth Dodds-Ashley, Jeffrey Gerber, and Fridkin led an open discussion of different funding mechanisms for research in antimicrobial stewardship (NIH, AHRQ, professional societies, foundations, industry, etc.). Lastly, Dr. Malani wrapped up the workshop with a presentation on the importance of disseminating research and various mechanisms to maximize the audience reach.
Overall, the workshop seemed highly successful; the topics were broad which provided a great base for new researchers and reinforced concepts for more advanced researchers. Additionally, it provided concrete examples of multiple concepts that are used in antimicrobial stewardship research, as well as pitfalls in the current mechanisms of evaluation (e.g. duration of therapy) and areas in need of further development. The ASRW will continue to build, with projected meetings for 2017 (in Chicago) and 2018 (in Baltimore).