# Optimizing Antimicrobial Use in Maintenance Dialysis Units (OPTIMUS)

> **NIH AHRQ R01** · RHODE ISLAND HOSPITAL · 2022 · $27,840

## Abstract

Rates of multidrug-resistant organisms (MDRO) are among the highest in persons requiring maintenance
hemodialysis (MHD). Antimicrobial exposure is the main risk factor for the emergence and spread of MDRO. Up
to 30% of antimicrobials administered in out-patient dialysis facilities are not indicated. Decreasing inappropriate,
unnecessary or suboptimal antimicrobial use in dialysis facilities is therefore crucial. We recently published a
decision analytic model on the clinical and economic consequences of implementing antimicrobial stewardship
programs (ASP) in out-patient dialysis facilities nation-wide. The model predicted a 4.8% reduction in infections
caused by MDRO and Clostridium difficile; a 4.6% reduction in infection-related deaths and a 5.0% reduction in
costs. In 2017, the PI completed an AHRQ-funded study of an ASP in out-patient dialysis facilities. The program,
which focused on educational and behavioral strategies, resulted in a reduction in antimicrobial use (P=0.02).
Although successful, three barriers to even greater effective prescribing were identified. First, our initial ASP
method could not fully identify inappropriate doses, administered after the empiric doses, in a timely manner.
Thus, opportunities for improving prescribing were missed. Second, approximately 55% of doses prescribed
were from orders received from the transferring hospital upon hospital discharge. Data pertaining to the
indications for and choice of antimicrobial therapy were minimal and thereby limited the number of opportunities
to improve antimicrobial prescribing. Third, engagement from unit medical directors was minimal. Lack of
leadership support likely prevented the ASP to be more effective. With this foundation and leveraging a research
infrastructure established during our previous AHRQ grant, this proposal, entitled OPTIMUS (Optimizing
Antimicrobial Use In Maintenance Dialysis UnitS), will develop and implement an improved ASP. In addition to
the previous educational and behavioral components, specific tools and strategies to overcome the three barriers
mentioned above will be developed and implemented in this improved ASP. These tools include an antimicrobial
hospital transfer report and an evidence-based checklist for antimicrobial prescribing in the dialysis facilities. We
will enroll DaVita dialysis units and have already obtained leadership support. Our interdisciplinary team includes
investigators with expertise in ASP and implementation science, senior nephrologists with experience in quality
improvement initiatives and our CDC consultant, with expertise in MHD healthcare quality. An interrupted time
series design will be used in 8 intervention and 8 control units. Specific aims are:1] To develop and implement
an improved ASP in out-patient hemodialysis units, 2] To demonstrate the effectiveness of this ASP in reducing
antimicrobial use, and 3] To develop a dialysis setting specific-antimicrobial prescribing audit tool and
demonstrate improv...

## Key facts

- **NIH application ID:** 10436161
- **Project number:** 5R01HS026895-03
- **Recipient organization:** RHODE ISLAND HOSPITAL
- **Principal Investigator:** ERIKA M D'AGATA
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2022
- **Award amount:** $27,840
- **Award type:** 5
- **Project period:** 2020-07-01 → 2023-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10436161

## Citation

> US National Institutes of Health, RePORTER application 10436161, Optimizing Antimicrobial Use in Maintenance Dialysis Units (OPTIMUS) (5R01HS026895-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10436161. Licensed CC0.

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