Pub Date : 2024-05-08eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.55
Matthew Linam, Lisette Wannemacher, Angela Hawthorne, Christina Calamaro, Patrick Spafford, Karen Walson
Objective: Central line-associated bloodstream infections (CLABSIs) harm children. Insertion and maintenance bundles have significantly reduced CLABSIs, but infections still occur. The objective was to develop bedside infection prevention (IP) rounds and evaluate their impact on CLABSI rates.
Methods: This quality improvement project was initiated sequentially in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) of a large academic children's hospital. IP rounds, interdisciplinary discussions led by the hospital epidemiologist and unit nursing leader with the bedside nurse, occurred weekly for patients with central lines. Discussions included strategies to optimize line maintenance and identify and mitigate patient-specific infection risks. Concerns and recommendations were communicated with the clinician. CLABSIs were identified by prospective surveillance using standard definitions. The change in CLABSIs over time was analyzed using days-between-events charts (g chart).
Results: IP rounds included 3,832 patients in the NICU and 1,322 patients in the PICU. Opportunities were identified to reduce line access and protect the dressing from contamination. The average days between CLABSIs in the NICU increased from 41 days to 54 days after IP rounds began. The longest time between CLABSIs was 362 days. In the PICU, the average days between CLABSIs increased from 53 to 91 days. The longest time between CLABSIs was 398 days.
Conclusion: IP rounds reduced CLABSIs in the NICU and PICU by reinforcing best practices, encouraging proactive strategies, and fostering communication between members of the healthcare team.
{"title":"Initiation of interdisciplinary prevention rounds: decreasing CLABSIs in critically ill children.","authors":"Matthew Linam, Lisette Wannemacher, Angela Hawthorne, Christina Calamaro, Patrick Spafford, Karen Walson","doi":"10.1017/ash.2024.55","DOIUrl":"10.1017/ash.2024.55","url":null,"abstract":"<p><strong>Objective: </strong>Central line-associated bloodstream infections (CLABSIs) harm children. Insertion and maintenance bundles have significantly reduced CLABSIs, but infections still occur. The objective was to develop bedside infection prevention (IP) rounds and evaluate their impact on CLABSI rates.</p><p><strong>Methods: </strong>This quality improvement project was initiated sequentially in the neonatal intensive care unit (NICU) and pediatric intensive care unit (PICU) of a large academic children's hospital. IP rounds, interdisciplinary discussions led by the hospital epidemiologist and unit nursing leader with the bedside nurse, occurred weekly for patients with central lines. Discussions included strategies to optimize line maintenance and identify and mitigate patient-specific infection risks. Concerns and recommendations were communicated with the clinician. CLABSIs were identified by prospective surveillance using standard definitions. The change in CLABSIs over time was analyzed using days-between-events charts (g chart).</p><p><strong>Results: </strong>IP rounds included 3,832 patients in the NICU and 1,322 patients in the PICU. Opportunities were identified to reduce line access and protect the dressing from contamination. The average days between CLABSIs in the NICU increased from 41 days to 54 days after IP rounds began. The longest time between CLABSIs was 362 days. In the PICU, the average days between CLABSIs increased from 53 to 91 days. The longest time between CLABSIs was 398 days.</p><p><strong>Conclusion: </strong>IP rounds reduced CLABSIs in the NICU and PICU by reinforcing best practices, encouraging proactive strategies, and fostering communication between members of the healthcare team.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077607/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.45
Dimitri M Drekonja, Peyton Smith
{"title":"<i>Clostridioides difficile</i> infection in trials of short versus long duration of antimicrobials.","authors":"Dimitri M Drekonja, Peyton Smith","doi":"10.1017/ash.2024.45","DOIUrl":"10.1017/ash.2024.45","url":null,"abstract":"","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891569","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.49
Sagar Kothari, Syed Z Ahmad, Michelle T Zhao, Abbigayle Teixeira-Barreira, Miranda So, Shahid Husain
Background: Post-transplant infections remain a leading cause of morbidity and mortality in solid organ transplant recipients (SOTRs) and local standardized antimicrobial treatment guidelines may contribute to improved clinical outcomes. Our study assessed the rate of therapeutic compliance with local standard guidelines in the treatment of common infections in SOTR, and their associated outcomes.
Methods: Consecutive adult SOTRs admitted to the transplant floor from January-September 2020 and were treated for an infectious syndrome were followed until discharge or for 30 days following the date of diagnosis, whichever was shorter. Data was extracted from electronic medical records. Guideline compliance was characterized as either appropriate, effective but unnecessary, undertreatment, or inappropriate.
Results: Nine hundred and thirty-six SOTR were admitted to the transplant ward, of which 328 patients (35%) received treatment for infectious syndromes. Guidelines were applicable to 252 patients, constituting 275 syndromes: 86 pneumonias; 82 urinary tract infections; 40 intra-abdominal infections; 38 bloodstream infections; and 29 C. difficile infections. 200/246 (81%) of infectious syndromes received appropriate or effective but unnecessary empiric treatment. In addition, appropriate tailoring of antimicrobials resulted in a significant difference in 30-day all-cause mortality (adjusted OR of 0.07, 95% CI 0.01-0.38; P = .002). Lastly, we found that guideline-compliant empiric therapy was found to prevent the development of multi-drug resistance in a time-dependent analysis (adjusted HR of 0.21, 95% CI 0.08-0.52; P = .001).
Conclusion: Our data show that adherence to locally developed guidelines was associated with reduced mortality and resistant-organism development in our cohort of SOTR.
{"title":"Assessing the quality of antimicrobial prescribing in solid organ transplant recipients: a new frontier in antimicrobial stewardship.","authors":"Sagar Kothari, Syed Z Ahmad, Michelle T Zhao, Abbigayle Teixeira-Barreira, Miranda So, Shahid Husain","doi":"10.1017/ash.2024.49","DOIUrl":"10.1017/ash.2024.49","url":null,"abstract":"<p><strong>Background: </strong>Post-transplant infections remain a leading cause of morbidity and mortality in solid organ transplant recipients (SOTRs) and local standardized antimicrobial treatment guidelines may contribute to improved clinical outcomes. Our study assessed the rate of therapeutic compliance with local standard guidelines in the treatment of common infections in SOTR, and their associated outcomes.</p><p><strong>Methods: </strong>Consecutive adult SOTRs admitted to the transplant floor from January-September 2020 and were treated for an infectious syndrome were followed until discharge or for 30 days following the date of diagnosis, whichever was shorter. Data was extracted from electronic medical records. Guideline compliance was characterized as either appropriate, effective but unnecessary, undertreatment, or inappropriate.</p><p><strong>Results: </strong>Nine hundred and thirty-six SOTR were admitted to the transplant ward, of which 328 patients (35%) received treatment for infectious syndromes. Guidelines were applicable to 252 patients, constituting 275 syndromes: 86 pneumonias; 82 urinary tract infections; 40 intra-abdominal infections; 38 bloodstream infections; and 29 <i>C. difficile</i> infections. 200/246 (81%) of infectious syndromes received appropriate or effective but unnecessary empiric treatment. In addition, appropriate tailoring of antimicrobials resulted in a significant difference in 30-day all-cause mortality (adjusted OR of 0.07, 95% CI 0.01-0.38; <i>P</i> = .002). Lastly, we found that guideline-compliant empiric therapy was found to prevent the development of multi-drug resistance in a time-dependent analysis (adjusted HR of 0.21, 95% CI 0.08-0.52; <i>P</i> = .001).</p><p><strong>Conclusion: </strong>Our data show that adherence to locally developed guidelines was associated with reduced mortality and resistant-organism development in our cohort of SOTR.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11094401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140945786","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.36
Geneva M Wilson, Margaret Fitzpatrick, Katie J Suda, Linda Poggensee, Makoto Jones, Martin E Evans, Charlesnika T Evans
Decreasing the time to contact precautions (CP) is critical to carbapenem-resistant Enterobacterales (CRE) prevention. Identifying factors associated with delayed CP can decrease the spread from patients with CRE. In this study, a shorter length of stay was associated with being placed in CP within 3 days.
{"title":"Facility- and patient-level factors associated with implementation of contact precautions in hospitalized VA patients with positive CRE cultures.","authors":"Geneva M Wilson, Margaret Fitzpatrick, Katie J Suda, Linda Poggensee, Makoto Jones, Martin E Evans, Charlesnika T Evans","doi":"10.1017/ash.2024.36","DOIUrl":"10.1017/ash.2024.36","url":null,"abstract":"<p><p>Decreasing the time to contact precautions (CP) is critical to carbapenem-resistant Enterobacterales (CRE) prevention. Identifying factors associated with delayed CP can decrease the spread from patients with CRE. In this study, a shorter length of stay was associated with being placed in CP within 3 days.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077592/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.67
Daniel T Halperin, Shira Doron, Stephen Hodgins, Robert C Bailey, Stefan Baral, Rajiv Bhatia, Jeanne Noble, Monica Gandhi, Norman Hearst
The use of face masks has been widely promoted and at times mandated to prevent coronavirus disease 2019 (COVID-19). The 2023 publication of an updated Cochrane review on mask effectiveness for respiratory viruses as well as the unfolding epidemiology of COVID-19 underscore the need for an unbiased assessment of the current scientific evidence. It appears that the widespread promotion, adoption, and mandating of masking for COVID-19 were based not primarily on the strength of evidence for effectiveness but more on the imperative of decision-makers to act in the face of a novel public health emergency, with seemingly few good alternatives. Randomized clinical trials of masking for prevention of COVID-19 and other respiratory viruses have so far shown no evidence of benefit (with the possible exception of continuous use of N95 respirators by hospital workers). Observational studies provide lower-quality evidence and do not convincingly demonstrate benefit from masking or mask mandates. Unless robust new evidence emerges showing the effectiveness of masks in reducing infection or transmission risks in either trials or real-world conditions, mandates are not warranted for future epidemics of respiratory viral infections.
{"title":"Masking for COVID-19 and other respiratory viral infections: implications of the available evidence.","authors":"Daniel T Halperin, Shira Doron, Stephen Hodgins, Robert C Bailey, Stefan Baral, Rajiv Bhatia, Jeanne Noble, Monica Gandhi, Norman Hearst","doi":"10.1017/ash.2024.67","DOIUrl":"10.1017/ash.2024.67","url":null,"abstract":"<p><p>The use of face masks has been widely promoted and at times mandated to prevent coronavirus disease 2019 (COVID-19). The 2023 publication of an updated Cochrane review on mask effectiveness for respiratory viruses as well as the unfolding epidemiology of COVID-19 underscore the need for an unbiased assessment of the current scientific evidence. It appears that the widespread promotion, adoption, and mandating of masking for COVID-19 were based not primarily on the strength of evidence for effectiveness but more on the imperative of decision-makers to act in the face of a novel public health emergency, with seemingly few good alternatives. Randomized clinical trials of masking for prevention of COVID-19 and other respiratory viruses have so far shown no evidence of benefit (with the possible exception of continuous use of N95 respirators by hospital workers). Observational studies provide lower-quality evidence and do not convincingly demonstrate benefit from masking or mask mandates. Unless robust new evidence emerges showing the effectiveness of masks in reducing infection or transmission risks in either trials or real-world conditions, mandates are not warranted for future epidemics of respiratory viral infections.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077603/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-03eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.69
Jacinda C Abdul-Mutakabbir, Karen K Tan, Candace L Johnson, Caitlin L McGrath, Danielle M Zerr, Jasmine R Marcelin
Health equity gaps persist across minoritized groups due to systems of oppression affecting health-related social needs such as access to transportation, education and literacy, or food and housing security. Consequently, disparities in the prevalence of multidrug-resistant infections, infectious disease outcomes, and inappropriate antimicrobial use have been reported across minoritized populations. The Joint Commission and Centers for Medicare and Medicaid Services (CMS) have formally acknowledged the importance of integrating health equity-focused initiatives into existing hospital quality improvement (QI) programs. Here, we review documented disparities in antimicrobial stewardship and offer a framework, derived from components of existing health equity and QI tools, to guide clinicians in prioritizing equity in antimicrobial stewardship efforts (EASE).
{"title":"Prioritizing Equity in Antimicrobial Stewardship Efforts (EASE): a framework for infectious diseases clinicians.","authors":"Jacinda C Abdul-Mutakabbir, Karen K Tan, Candace L Johnson, Caitlin L McGrath, Danielle M Zerr, Jasmine R Marcelin","doi":"10.1017/ash.2024.69","DOIUrl":"10.1017/ash.2024.69","url":null,"abstract":"<p><p>Health equity gaps persist across minoritized groups due to systems of oppression affecting health-related social needs such as access to transportation, education and literacy, or food and housing security. Consequently, disparities in the prevalence of multidrug-resistant infections, infectious disease outcomes, and inappropriate antimicrobial use have been reported across minoritized populations. The Joint Commission and Centers for Medicare and Medicaid Services (CMS) have formally acknowledged the importance of integrating health equity-focused initiatives into existing hospital quality improvement (QI) programs. Here, we review documented disparities in antimicrobial stewardship and offer a framework, derived from components of existing health equity and QI tools, to guide clinicians in prioritizing equity in antimicrobial stewardship efforts (EASE).</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077597/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-02eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.59
Christopher M Rooney, Rebecca Lancaster, Liz McKechnie, Kavita Sethi
Methicillin-resistant Staphylococcus aureus (MRSA) infections in neonates can result in significant morbidity and mortality. However, comparatively to adults, neonatal MRSA data remains relatively scarce. Additionally, while evidence-driven practices for adults have seen considerable progress, neonatal infection prevention strategies remain poorly described. The Leeds Newborn Service adopted a series of infection prevention and control (IPC) measures following a rise in MRSA cases in 2008-2009. This narrative review presents IPC measures for neonatal MRSA and methicillin-sensitive Staphylococcus aureus (MSSA) infections and reflects upon local challenges and successes of these interventions. Our experience underscores the importance of an adaptive, evidence-based strategy, tailored to the neonatal population. Effectively addressing MRSA/MSSA requires continuous monitoring with sustained targeted interventions. Our key learning points highlight the intertwined difficulties of specific neonatal requirements and lack of definitive IPC guidance, suggesting a holistic approach is key for successful IPC outcomes in the neonatal intensive care unit setting.
{"title":"<i>Staphylococcal aureus</i> outbreaks in neonatal intensive care units: strategies, nuances, and lessons learned from the frontline.","authors":"Christopher M Rooney, Rebecca Lancaster, Liz McKechnie, Kavita Sethi","doi":"10.1017/ash.2024.59","DOIUrl":"10.1017/ash.2024.59","url":null,"abstract":"<p><p>Methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) infections in neonates can result in significant morbidity and mortality. However, comparatively to adults, neonatal MRSA data remains relatively scarce. Additionally, while evidence-driven practices for adults have seen considerable progress, neonatal infection prevention strategies remain poorly described. The Leeds Newborn Service adopted a series of infection prevention and control (IPC) measures following a rise in MRSA cases in 2008-2009. This narrative review presents IPC measures for neonatal MRSA and methicillin-sensitive <i>Staphylococcus aureus</i> (MSSA) infections and reflects upon local challenges and successes of these interventions. Our experience underscores the importance of an adaptive, evidence-based strategy, tailored to the neonatal population. Effectively addressing MRSA/MSSA requires continuous monitoring with sustained targeted interventions. Our key learning points highlight the intertwined difficulties of specific neonatal requirements and lack of definitive IPC guidance, suggesting a holistic approach is key for successful IPC outcomes in the neonatal intensive care unit setting.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077608/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-02eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.25
Zachary M Most, John J Hanna, Alexander P Radunsky, Lauren N Cooper, Christoph U Lehmann, Trish M Perl, Richard J Medford
Analyzing data from a national deidentified electronic health record-based data set using a matched case-control study design, we found that antibiotic use and severity of illness were independent risk factors for healthcare-associated candidemia in adult patients hospitalized with SARS-CoV-2 infection. Interleukin-6 inhibitor and corticosteroid use were not independent risk factors.
{"title":"Risk factors for healthcare-associated candidemia in adults hospitalized with SARS-CoV-2 infection.","authors":"Zachary M Most, John J Hanna, Alexander P Radunsky, Lauren N Cooper, Christoph U Lehmann, Trish M Perl, Richard J Medford","doi":"10.1017/ash.2024.25","DOIUrl":"10.1017/ash.2024.25","url":null,"abstract":"<p><p>Analyzing data from a national deidentified electronic health record-based data set using a matched case-control study design, we found that antibiotic use and severity of illness were independent risk factors for healthcare-associated candidemia in adult patients hospitalized with SARS-CoV-2 infection. Interleukin-6 inhibitor and corticosteroid use were not independent risk factors.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077599/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-02eCollection Date: 2024-01-01DOI: 10.1017/ash.2024.27
Michela Cipriani, Matthias Schlegel, Marianne Schwark-Bähler, Samuel Henz, Philipp Kohler, Werner C Albrich
The prospective before-after quality improvement study was to assess bundle effectiveness to reduce urinary catheter days and prevent associated complications. All patients with preexisting or new urinary catheters in a regional hospital in Switzerland were included. We showed a reduction of catheter days, incorrect urinary catheter indications, and most strikingly formally correct indications.
{"title":"Successful reduction of urinary catheter placement for correct and incorrect indications after introduction of a prevention bundle.","authors":"Michela Cipriani, Matthias Schlegel, Marianne Schwark-Bähler, Samuel Henz, Philipp Kohler, Werner C Albrich","doi":"10.1017/ash.2024.27","DOIUrl":"10.1017/ash.2024.27","url":null,"abstract":"<p><p>The prospective before-after quality improvement study was to assess bundle effectiveness to reduce urinary catheter days and prevent associated complications. All patients with preexisting or new urinary catheters in a regional hospital in Switzerland were included. We showed a reduction of catheter days, incorrect urinary catheter indications, and most strikingly formally correct indications.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11077593/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A beta-lactam antibiotics (BLA) allergy label is common, resulting in disadvantageous outcomes due to the usage of second-line antimicrobial agents. Noncontrolled case-series analyses report low rates of hypersensitivity reactions, following intentional/non-intentional BLA challenges among labeled inpatients. The study aims were to explore predictors and outcomes associated with hypersensitivity reactions following BLA challenge among BLA-allergic labeled inpatients.
Methods: Retrospective cohort study (2019-2020) of adult (≥18 years) inpatients (Shamir Medical Center, Israel), labeled as allergic to ≥1 BLA, who received ≥1 dose/s of BLA during their stay. Independent predictors to develop allergic reactions and the independent associations of allergic reactions with clinical outcomes were queried by logistic and Cox regressions.
Results: Of 9,670 inpatients (14,088 hospitalizations), 3,570 (37%) were labeled as allergic to ≥1 BLA. Of those, 1,171 (33%) patients received ≥1 BLA. The majority were women (67%), and the mean age was 69.3 ± 19.4 years. Only 30 patients (2.6%) developed a reaction, all mild. Independent predictors to develop an allergic reaction were documented reactions in the past, atopic background, antihistamines administration prior to the BLA challenge, and high risk for cross-reactivity, based on the BLA side chains, between the labeled and the challenged agents. Reaction upon the BLA challenge was not independently associated with any worse outcome.
Conclusions: Despite the commonality of allergy labeling, and the commonality of BLA administration to labeled inpatients, hypersensitivity reactions were mild and rare. Interventional stewardship strategies for active BLA de-labeling among low-risk patients should be promoted, to improve patients' and institutional health and fiscal outcomes.
背景:β-内酰胺类抗生素(BLA)过敏标签很常见,这导致了使用二线抗菌药物的不利结果。非对照病例系列分析报告称,贴有标签的住院患者在有意/无意挑战 BLA 后发生超敏反应的比例较低。本研究旨在探讨对 BLA 过敏的贴标住院患者在接受 BLA 挑战后发生超敏反应的相关预测因素和结果:回顾性队列研究(2019-2020 年),研究对象为(以色列沙米尔医疗中心)成年(≥18 岁)住院患者,这些患者被标记为对≥1 种 BLA 过敏,且在住院期间接受了≥1 剂/秒的 BLA。通过逻辑回归和考克斯回归对发生过敏反应的独立预测因素以及过敏反应与临床结果的独立关联进行了查询:在 9,670 名住院患者(14,088 次住院)中,3,570 人(37%)被诊断为对≥1 次 BLA 过敏。其中,1,171 名(33%)患者接受了≥1 BLA。大多数患者为女性(67%),平均年龄为 69.3 ± 19.4 岁。只有 30 名患者(2.6%)出现反应,且均为轻度。发生过敏反应的独立预测因素包括:既往有过敏反应记录、特应性背景、BLA 挑战前服用抗组胺药,以及根据 BLA 侧链,标记药物和挑战药物之间存在交叉反应的高风险。BLA挑战后的反应与任何较差的结果无关:结论:尽管过敏标签和对标签住院患者使用 BLA 的情况很常见,但超敏反应却很轻微且罕见。应在低风险患者中推广主动去除 BLA 标签的干预管理策略,以改善患者和医疗机构的健康和财务状况。
{"title":"Beta-lactam antibiotics administration among adult inpatients with a beta-lactam allergy label: incidence, predictors, and outcomes.","authors":"Naama Epstein-Rigbi, Sharon Ziv, Marina Bulanenkova, Ruth Bouganim, Ruthy Tal-Jasper, Dror Marchaim","doi":"10.1017/ash.2024.68","DOIUrl":"https://doi.org/10.1017/ash.2024.68","url":null,"abstract":"<p><strong>Background: </strong>A beta-lactam antibiotics (BLA) allergy label is common, resulting in disadvantageous outcomes due to the usage of second-line antimicrobial agents. Noncontrolled case-series analyses report low rates of hypersensitivity reactions, following intentional/non-intentional BLA challenges among labeled inpatients. The study aims were to explore predictors and outcomes associated with hypersensitivity reactions following BLA challenge among BLA-allergic labeled inpatients.</p><p><strong>Methods: </strong>Retrospective cohort study (2019-2020) of adult (≥18 years) inpatients (Shamir Medical Center, Israel), labeled as allergic to ≥1 BLA, who received ≥1 dose/s of BLA during their stay. Independent predictors to develop allergic reactions and the independent associations of allergic reactions with clinical outcomes were queried by logistic and Cox regressions.</p><p><strong>Results: </strong>Of 9,670 inpatients (14,088 hospitalizations), 3,570 (37%) were labeled as allergic to ≥1 BLA. Of those, 1,171 (33%) patients received ≥1 BLA. The majority were women (67%), and the mean age was 69.3 ± 19.4 years. Only 30 patients (2.6%) developed a reaction, all mild. Independent predictors to develop an allergic reaction were documented reactions in the past, atopic background, antihistamines administration prior to the BLA challenge, and high risk for cross-reactivity, based on the BLA side chains, between the labeled and the challenged agents. Reaction upon the BLA challenge was not independently associated with any worse outcome.</p><p><strong>Conclusions: </strong>Despite the commonality of allergy labeling, and the commonality of BLA administration to labeled inpatients, hypersensitivity reactions were mild and rare. Interventional stewardship strategies for active BLA de-labeling among low-risk patients should be promoted, to improve patients' and institutional health and fiscal outcomes.</p>","PeriodicalId":72246,"journal":{"name":"Antimicrobial stewardship & healthcare epidemiology : ASHE","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11062790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871615","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}