Antimicrobial stewardship & healthcare epidemiology : ASHE最新文献

This quasi-experimental before-and-after intervention study evaluated an indication-based electronic prescribing alert in a 450-bed tertiary care hospital. Implementation reduced meropenem use by 41% without compromising patient safety, demonstrating the effectiveness of this targeted antimicrobial stewardship strategy.

[This corrects the article DOI: 10.1017/ash.2024.75.].

Objective: This paper describes a health-system's experience incorporating Standardized Antimicrobial Administration Ratio (SAAR) data to optimize the existing antimicrobial use module within the electronic health record. We describe the design and implementation via a standard operating procedure (SOP), which incorporates SAAR and the optimized dashboards into the health-system's antimicrobial stewardship program.

Design: This is a descriptive study outlining our process of optimizing the electronic health records default antimicrobial use dashboard into a dual-purpose dashboard, SAAR and Antimicrobial Use (AU) dashboard, to be used across a health-system.

Setting: 10-hospital health-system.

Intervention: For adult and pediatric populations, a pre-populated dashboard was created for each SAAR antimicrobial category using the existing EHR application. For adult, pediatric, and neonatal populations, improvements were made to visualize AU data in the dashboards. We created the framework for a standardized metric for our health-system's antimicrobial stewardship program (ASP). An SOP was developed to establish an expectation for SAAR data analysis at the site level of our health-system's ASP. The dashboards and SOP were created to evolve with the AUR protocol and health-system.

Results: Pre-populated dashboards for adult and pediatric SAAR antimicrobial categories are configurable within existing electronic health-records, requiring minimal manipulation from the user to view which antimicrobials are driving a location's SAAR.

Conclusion: In anticipation of required AUR reporting, other health-systems using the same EHR can utilize this approach to integrate the SAAR into their health-system's antimicrobial stewardship programs. Collaboration between antimicrobial stewardship clinicians, pharmacist information technology (IT) analysts and infection preventionists are essential to accomplish this endeavor.

We evaluated the impact of a web-based quiz on prescribing guideline-concordant antibiotic duration for pediatric acute otitis media. Adjusted for baseline prescribing, participants increased mean guideline-concordant prescribing by 9.6% compared to nonparticipants; those who took an enhanced quiz increased 17.1%. QuizTime may be a low-effort intervention to increase stewardship education.

In a U.S. veteran cohort (2014 - 2024) with a listed penicillin allergy, we studied the characteristics of 616 veterans that underwent an inpatient oral penicillin challenge. Notably, almost half of these challenges occurred in 2023 and 2024, suggesting recent uptake of this penicillin allergy evaluation modality within the Veterans Health Administration.

Background: Invasive candidiasis including candidemia is a common healthcare-associated infections with significant morbidity and mortality. The USA does not have mandatory national surveillance for mucocutaneous or invasive candidiasis which complicates estimation of epidemiology and outcomes. The aim of this project was to describe the epidemiology, mortality, and Candida-associated hospital readmissions in hospitalized patients with Candida species infections.

Methods: This secondary database analysis used clinical microbiology data from adults hospitalized at three large health systems (25-hospitals) in the Greater Houston area totaling over 1.6 million hospitalization days per year from 2018 to 2023. Proportion and rates of Candida cultures per 10,000 hospitalization days were calculated. Risk factors for mortality and Candida-associated readmissions were assessed by multivariable logistic regression.

Results: Within the study period, 7514 hospitalized patients aged 64 ± 16 years (mean± standard deviation (SD)) with 10,183 unique Candida cultures were identified. Majority of Candida cultures were nosocomial (59%) with wide variability in mean time to positive culture (9 ± 44 days) after admission. Candida specimens were from blood (32%), abdomen (29%), or mucocutaneous (24%) cultures and most commonly C. albicans (44%) or C. glabrata (21%). C. auris increased significantly from 2% of cultures from 2018-20 to 5% in 2021-23 (p < 0.0001). Length of hospital stay was 21 ± 34 days and inpatient mortality was 17%. Multivariable analyses identified hospitalization variables and Candida species predictive of inpatient all-cause mortality and Candida-associated readmissions after initial hospitalization.

Conclusion: These analyses highlight the significant burden of candidiasis and the emergence of new strains, including C. auris. Ongoing surveillance can refine burden estimates and assess the impact of stewardship and infection control interventions.

Objective: Burn injuries result in loss of skin barrier and altered immune responses that in turn make patients especially vulnerable to healthcare-associated infections. Despite prolonged exposures of these patients to hospital environments, burn-specific infection prevention strategies are understudied. We present a research agenda identifying key research gaps and organizing them into priority areas to guide future investigations in this high-risk population.

Design: Members of the Society for Healthcare Epidemiology of America (SHEA) Burn Infection Prevention and Control Special Interest Group and the American Burn Association (ABA) collaborated to develop this research agenda, combining expertise in infection prevention, antimicrobial stewardship, and burn care.

Results: We identified five priority areas: (1) improving surveillance and epidemiologic data on burn infections; (2) better understanding of microbiology, including biofilms and the microbiome; (3) evaluating wound healing strategies; (4) refining infection prevention and control practices unique to burn units; and (5) building burn patient specific risk assessment and predictive models. The agenda highlights the need for standardized definitions and shared data platforms. It calls for evaluation of practical strategies for infection prevention, stewardship, and environmental control.

Conclusions: This research agenda intends to help guide future studies aimed at furthering knowledge and improving outcomes in burn care.

Objective: To describe the screening practice of nasal methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) among nine health organizations in Kentucky.

Methods: The Kentucky Antimicrobial Stewardship Innovation Consortium (KASIC) invited its Advisory Board members to share their nasal MRSA PCR protocols and guidelines. The documents were examined to highlight institutional similarities and differences.

Results: Nine health systems, including both community hospitals and academic medical centers, responded to the KASIC request. Most systems with nasal MRSA PCR testing capacity had established protocols or guidelines to support its appropriate use. All institutions recommended nasal MRSA PCR for pneumonia indications while three organizations also used it for non-pneumonia indications. None of these institutions permitted pharmacists to discontinue anti-MRSA antibiotics per protocol.

Conclusions: This study provides the first statewide overview of nasal MRSA PCR screening practices, offering stewardship programs a framework to customize their own protocols and guidelines.

We implemented a policy to discontinue empiric antibiotics after 48 hours of defervescence in neutropenic fever with no identified clinical/microbiologic infection. Among patients with acute myeloid leukemia or hematopoietic stem cell transplant, early de-escalation was not associated with increased subsequent infection, decompensation, or mortality, supporting its safety and feasibility.