Anthony Abustan, Unarose Hogan, Julie Winn, Paul Pagaran, Joan Littlefield, Ted Miles
Background: Globally, the 30-day cumulative incidence of surgical-site infections (SSI) was 11% (95% CI, 10%–13%) based on the systematic review and meta-analysis derived from 57 studies. SSIs are poorly studied in the Philippines. Americares and its hospital partner, Camarines Norte Provincial Hospital, Philippines, sought to reduce SSIs through (1) establishing SSI surveillance in the hospitals’ surgical departments, (2) implementing quality improvement processes, and (3) developing and implementing an SSI prevention care bundle. Methods: A quality improvement methodology was used to introduce SSI surveillance and care-bundle checklist in partnership with Americares. Using paired t tests, pre- and posttest scores of the SSI care bundle training were analyzed. SSI surveillance was established based on the adapted CDC criteria. All clean surgeries were monitored except orthopedic surgeries. The number of surgeries performed, monitored, and SSIs identified were documented using the surveillance forms and plotted using Microsoft Excel software. A care bundle based on WHO evidence-based interventions for SSI prevention was designed and implemented. Compliance with the SSI care bundle was documented using Microsoft Excel. The relationship between the use of a care bundle and SSIs was analyzed using the Pearson correlation coefficient. Results: An online SSI care bundle training session was conducted. Overall, 150 participants had a mean pretraining test score of +6.46. After the training was conducted, the same participants had a mean posttraining test score of + 1.76). a statistically significant increase of 5.29 (95% CI). Thereby, the mean score difference after training showed that knowledge increased overall. These findings show an average of 90.43% compliance with the SSI care-bundle checklist over the 18-month window from May 2021 to November 2022. From a baseline of 0%, compliance increased from 80% upon its introduction in May 2021. Lastly, the SSI incidence rate from May 2021to November 2022 averaged 1.89%. The days between reported SSIs averaged 16.85. No baseline was available for comparison prior to the introduction of the surveillance and care bundle. A Pearson r data analysis (n = 1,850) was used to determine the relationship between the use of the care bundle and SSIs. The data illustrated a moderate negative correlation ( r = −.31). Therefore, higher care-bundle compliance yielded fewer SSI cases. Conclusions: The use of an evidence-based care bundle paired with a local quality improvement process significantly improved SSI prevention and surveillance. Future studies are needed that include clean-contaminated, contaminated, and dirty surgical cases to test the degree of SSI reduction possible. Disclosures: None
{"title":"Quality improvement approach for surgical-site infection prevention in a Philippine provincial hospital","authors":"Anthony Abustan, Unarose Hogan, Julie Winn, Paul Pagaran, Joan Littlefield, Ted Miles","doi":"10.1017/ash.2023.368","DOIUrl":"https://doi.org/10.1017/ash.2023.368","url":null,"abstract":"Background: Globally, the 30-day cumulative incidence of surgical-site infections (SSI) was 11% (95% CI, 10%–13%) based on the systematic review and meta-analysis derived from 57 studies. SSIs are poorly studied in the Philippines. Americares and its hospital partner, Camarines Norte Provincial Hospital, Philippines, sought to reduce SSIs through (1) establishing SSI surveillance in the hospitals’ surgical departments, (2) implementing quality improvement processes, and (3) developing and implementing an SSI prevention care bundle. Methods: A quality improvement methodology was used to introduce SSI surveillance and care-bundle checklist in partnership with Americares. Using paired t tests, pre- and posttest scores of the SSI care bundle training were analyzed. SSI surveillance was established based on the adapted CDC criteria. All clean surgeries were monitored except orthopedic surgeries. The number of surgeries performed, monitored, and SSIs identified were documented using the surveillance forms and plotted using Microsoft Excel software. A care bundle based on WHO evidence-based interventions for SSI prevention was designed and implemented. Compliance with the SSI care bundle was documented using Microsoft Excel. The relationship between the use of a care bundle and SSIs was analyzed using the Pearson correlation coefficient. Results: An online SSI care bundle training session was conducted. Overall, 150 participants had a mean pretraining test score of +6.46. After the training was conducted, the same participants had a mean posttraining test score of + 1.76). a statistically significant increase of 5.29 (95% CI). Thereby, the mean score difference after training showed that knowledge increased overall. These findings show an average of 90.43% compliance with the SSI care-bundle checklist over the 18-month window from May 2021 to November 2022. From a baseline of 0%, compliance increased from 80% upon its introduction in May 2021. Lastly, the SSI incidence rate from May 2021to November 2022 averaged 1.89%. The days between reported SSIs averaged 16.85. No baseline was available for comparison prior to the introduction of the surveillance and care bundle. A Pearson r data analysis (n = 1,850) was used to determine the relationship between the use of the care bundle and SSIs. The data illustrated a moderate negative correlation ( r = −.31). Therefore, higher care-bundle compliance yielded fewer SSI cases. Conclusions: The use of an evidence-based care bundle paired with a local quality improvement process significantly improved SSI prevention and surveillance. Future studies are needed that include clean-contaminated, contaminated, and dirty surgical cases to test the degree of SSI reduction possible. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Destani Bizune, Angelina Luciano, Melinda Neuhauser, Lauri Hicks, Sarah Kabbani
Background: In 2021, the CDC awarded >$100 million to 62 state, local, and territorial health departments (SLTHDs) to expand antibiotic stewardship expertise and implement antibiotic stewardship activities in different healthcare settings. Our objective was to describe SLTHD antibiotic stewardship personnel and activities to characterize the impact of the funding. Methods: SLTHDs submitted performance measures, including quantitative and qualitative responses, describing personnel supporting antibiotic stewardship activities, types of activities, and healthcare facilities and professionals engaged from January through June 2022. A quantitative analysis of performance measures and qualitative thematic analysis of select narrative responses are reported. Results: Most SLTHDs (58 of 62, 94%) submitted performance measures. Among them, 37 (64%) reported identifying an antibiotic stewardship leader or coleader; most were pharmacists (57%) or physicians (38%) with infectious diseases training (68%) (Table 1). Of the remaining STLHDs, 20 reported barriers to identifying a leader or coleader, including hiring process delays and programmatic barriers (Table 2). SLTHDs reported 254 antibiotic stewardship activities; most reported activities involving multiple activity types (44%). Education and communication (eg, providing stewardship expertise) was the most common single activity (30%), followed by antibiotic use tracking and reporting (13%), assessment of antibiotic stewardship implementation (8%), and action and implementation (eg, audit and feedback letters) (4%). The highest number of activities were implemented in multiple healthcare settings (35%), followed by acute care (21%), outpatient (18%), long-term care (17%), and other (9%) (Fig. 1). SLTHDs reported engaging 4,970 healthcare facilities and 15,194 healthcare professionals in antibiotic stewardship activities across healthcare settings, to date, as part of this funding opportunity (Fig. 2). Conclusions: Antibiotic stewardship funding to SLTHDs allowed for increases in capacity and expanded outreach to implement a variety of antibiotic stewardship activities across multiple healthcare settings. Sustaining STLHD antibiotic stewardship activities can help increase engagement and coordination with healthcare facilities, healthcare professionals, and other partners to optimize antibiotic prescribing and patient safety. Disclosure: None
{"title":"Description of antibiotic stewardship expertise and activities among US public health departments, 2022","authors":"Destani Bizune, Angelina Luciano, Melinda Neuhauser, Lauri Hicks, Sarah Kabbani","doi":"10.1017/ash.2023.211","DOIUrl":"https://doi.org/10.1017/ash.2023.211","url":null,"abstract":"Background: In 2021, the CDC awarded >$100 million to 62 state, local, and territorial health departments (SLTHDs) to expand antibiotic stewardship expertise and implement antibiotic stewardship activities in different healthcare settings. Our objective was to describe SLTHD antibiotic stewardship personnel and activities to characterize the impact of the funding. Methods: SLTHDs submitted performance measures, including quantitative and qualitative responses, describing personnel supporting antibiotic stewardship activities, types of activities, and healthcare facilities and professionals engaged from January through June 2022. A quantitative analysis of performance measures and qualitative thematic analysis of select narrative responses are reported. Results: Most SLTHDs (58 of 62, 94%) submitted performance measures. Among them, 37 (64%) reported identifying an antibiotic stewardship leader or coleader; most were pharmacists (57%) or physicians (38%) with infectious diseases training (68%) (Table 1). Of the remaining STLHDs, 20 reported barriers to identifying a leader or coleader, including hiring process delays and programmatic barriers (Table 2). SLTHDs reported 254 antibiotic stewardship activities; most reported activities involving multiple activity types (44%). Education and communication (eg, providing stewardship expertise) was the most common single activity (30%), followed by antibiotic use tracking and reporting (13%), assessment of antibiotic stewardship implementation (8%), and action and implementation (eg, audit and feedback letters) (4%). The highest number of activities were implemented in multiple healthcare settings (35%), followed by acute care (21%), outpatient (18%), long-term care (17%), and other (9%) (Fig. 1). SLTHDs reported engaging 4,970 healthcare facilities and 15,194 healthcare professionals in antibiotic stewardship activities across healthcare settings, to date, as part of this funding opportunity (Fig. 2). Conclusions: Antibiotic stewardship funding to SLTHDs allowed for increases in capacity and expanded outreach to implement a variety of antibiotic stewardship activities across multiple healthcare settings. Sustaining STLHD antibiotic stewardship activities can help increase engagement and coordination with healthcare facilities, healthcare professionals, and other partners to optimize antibiotic prescribing and patient safety. Disclosure: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lauren DiBiase, Shelley Summerlin-Long, Lisa Stancill, Emily Sickbert-Bennett Vavalle, Lisa Teal, David Weber
Background: Central-line–associated bloodstream infections (CLABSIs) are linked to increased morbidity and mortality, longer hospital stays, and significantly higher healthcare costs. Infection prevention guidelines recommend line placement in specific insertion locations over others because of the relative risk of infection. The purpose of this study was to assess CLABSI rates by line type to determine whether some central lines had a lower risk of infection and should be recommended over others given similar clinical indications. Methods: At UNC Hospitals, data were obtained on central lines across a 3-year period (FY20–FY22) from the EMR (Epic Systems). Central lines were categorized as apheresis catheters, CVC lines (single, double, or triple lumen), hemodialysis catheters, introducer lines, pulmonary artery (PA) catheters, PICC lines (single, double, or triple lumen), port-a-catheters, trialysis catheters, or umbilical lines. The line type(s) associated with each CLABSI during the same period were recorded, and CLABSI rates by line type per 1,000 central-line days were calculated using SAS software. If an infection had >1 central-line device type associated, the infection was counted twice when calculating the CLABSI rate by line type. We calculated 95% CIs for each point estimate to assess for statistically significant differences in rates by line type. Results: During FY20–FY22, there were 264,425 central-line days and 458 CLABSIs, for an overall CLABSI rate of 1.73 CLABSIs per 1,000 central-line days. Also, 16% of patients with a CLABSI had >1 type of central line in place. Stratified data on CLABSI rates by each central-line type is presented in the Figure. CLABSI rates were highest in patients with apheresis lines (6.22; 95% CI, 3.96–9.35) and PA catheters (6.22; 95% CI, 3.54–10.20), and the lowest CLABSI rates occurred in patients with PICC lines (1.44; 95% CI, 1.19–1.73) and port-a-catheters (1.14; 95% CI, 0.89, 1.45). For both CVC and PICC lines, as the number of lumens increased from single to triple, CLABSI rates increased, from 0.91 to 2.63 and from 0.57 to 1.20, respectively. Conclusions: At our hospital, different types of central lines were associated with statistically higher CLABSI rates. Additionally, a higher number of lumens (triple vs single) in CVC and PICC lines were also associated with statistically higher CLABSI rates. These findings reinforce the importance of considering central-line type and number of lumens to minimize risk of CLABSI while ensuring that patients have the best line type based on their clinical needs. Disclosures: None
{"title":"Examining CLABSI rates by central-line type","authors":"Lauren DiBiase, Shelley Summerlin-Long, Lisa Stancill, Emily Sickbert-Bennett Vavalle, Lisa Teal, David Weber","doi":"10.1017/ash.2023.288","DOIUrl":"https://doi.org/10.1017/ash.2023.288","url":null,"abstract":"Background: Central-line–associated bloodstream infections (CLABSIs) are linked to increased morbidity and mortality, longer hospital stays, and significantly higher healthcare costs. Infection prevention guidelines recommend line placement in specific insertion locations over others because of the relative risk of infection. The purpose of this study was to assess CLABSI rates by line type to determine whether some central lines had a lower risk of infection and should be recommended over others given similar clinical indications. Methods: At UNC Hospitals, data were obtained on central lines across a 3-year period (FY20–FY22) from the EMR (Epic Systems). Central lines were categorized as apheresis catheters, CVC lines (single, double, or triple lumen), hemodialysis catheters, introducer lines, pulmonary artery (PA) catheters, PICC lines (single, double, or triple lumen), port-a-catheters, trialysis catheters, or umbilical lines. The line type(s) associated with each CLABSI during the same period were recorded, and CLABSI rates by line type per 1,000 central-line days were calculated using SAS software. If an infection had >1 central-line device type associated, the infection was counted twice when calculating the CLABSI rate by line type. We calculated 95% CIs for each point estimate to assess for statistically significant differences in rates by line type. Results: During FY20–FY22, there were 264,425 central-line days and 458 CLABSIs, for an overall CLABSI rate of 1.73 CLABSIs per 1,000 central-line days. Also, 16% of patients with a CLABSI had >1 type of central line in place. Stratified data on CLABSI rates by each central-line type is presented in the Figure. CLABSI rates were highest in patients with apheresis lines (6.22; 95% CI, 3.96–9.35) and PA catheters (6.22; 95% CI, 3.54–10.20), and the lowest CLABSI rates occurred in patients with PICC lines (1.44; 95% CI, 1.19–1.73) and port-a-catheters (1.14; 95% CI, 0.89, 1.45). For both CVC and PICC lines, as the number of lumens increased from single to triple, CLABSI rates increased, from 0.91 to 2.63 and from 0.57 to 1.20, respectively. Conclusions: At our hospital, different types of central lines were associated with statistically higher CLABSI rates. Additionally, a higher number of lumens (triple vs single) in CVC and PICC lines were also associated with statistically higher CLABSI rates. These findings reinforce the importance of considering central-line type and number of lumens to minimize risk of CLABSI while ensuring that patients have the best line type based on their clinical needs. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachel Wolansky, Patrick Burke, Ryan Miller, Thomas Fraser
Background: Patients requiring mechanical circulatory support (MCS) during episodes of cardiogenic shock are at risk for hospital-acquired bloodstream infection (HABSI). Clinically MCS devices include extracorporeal membrane oxygenation (ECMO) devices, durable and temporary left ventricular-assist devices (VADs), and intra-aortic balloon pumps (IABPs). However, the MCS exclusion to the NHSN central-line–associated bloodstream infection (CLABSI) surveillance rules in 2018 did not include IABP as a qualifying device. We have described utilization and incidence of primary HABSI (pHABSI) in our patients requiring MCS. Methods: The setting for this study was 9 cardiothoracic and heart failure intensive care units with 131 total beds at the Cleveland Clinic Main Campus. Surveillance for HABSI to include determination of CLABSI was performed prospectively. MCS-associated pHABSI were patients who had ECMO, LVAD, or IABP present for >2 calendar days with device in place on the date of infection or removed the day before. A patient with 2 device types at time of infection was counted as a pHABSI for both groups. Patient, device, and MCS days were extracted from an electronic database. Non-MCS patient days were calculated as the difference between total patient days and total MCS days. The incidence of ECMO-, VAD-, and IABP-associated pHABSI were compared to each other and to non–MCS-associated pHABSI using OpenEpi version 3.01 software. Results: Surveillance results are shown in Table 1. During the observation period, there were 221 pHABSIs and 139,013 patient days. Moreover, 67 pHABSIs were associated with an MCS device over 17,044 total MCS days: 43 ECMO days, 18 VAD days, and 13 IABP days. Also, 9 patients had >1 type of eligible device and 7 (39%) of the IABP-associated pHABSIs were CLABSIs. The cumulative incidences of pHABSI associated with ECMO, VAD, and IABP were 5.68, 4.59, and 2.34 per 1,000 MCS days, respectively. The incidence of IABP pHABSI was not significantly different from VAD pHABSI ( P = .06), but it was different from ECMO pHABSI ( P < .01). The pHABSI rate for non-MCS days was 1.26 per 1,000 patient days. Conclusions: In our patients requiring MCS, the risk of pHABSI associated with IABP was significantly greater than in patients without MCS and was similar to patients with VAD. MCS of all types should be considered a risk for HABSI in patients with cardiogenic shock beyond the presence of a central line. Protocols to further prevent HABSI morbidity in IABP patients are needed. Disclosure: None
{"title":"Relative risk of primary bloodstream infection in patients with mechanical circulatory support devices","authors":"Rachel Wolansky, Patrick Burke, Ryan Miller, Thomas Fraser","doi":"10.1017/ash.2023.216","DOIUrl":"https://doi.org/10.1017/ash.2023.216","url":null,"abstract":"Background: Patients requiring mechanical circulatory support (MCS) during episodes of cardiogenic shock are at risk for hospital-acquired bloodstream infection (HABSI). Clinically MCS devices include extracorporeal membrane oxygenation (ECMO) devices, durable and temporary left ventricular-assist devices (VADs), and intra-aortic balloon pumps (IABPs). However, the MCS exclusion to the NHSN central-line–associated bloodstream infection (CLABSI) surveillance rules in 2018 did not include IABP as a qualifying device. We have described utilization and incidence of primary HABSI (pHABSI) in our patients requiring MCS. Methods: The setting for this study was 9 cardiothoracic and heart failure intensive care units with 131 total beds at the Cleveland Clinic Main Campus. Surveillance for HABSI to include determination of CLABSI was performed prospectively. MCS-associated pHABSI were patients who had ECMO, LVAD, or IABP present for >2 calendar days with device in place on the date of infection or removed the day before. A patient with 2 device types at time of infection was counted as a pHABSI for both groups. Patient, device, and MCS days were extracted from an electronic database. Non-MCS patient days were calculated as the difference between total patient days and total MCS days. The incidence of ECMO-, VAD-, and IABP-associated pHABSI were compared to each other and to non–MCS-associated pHABSI using OpenEpi version 3.01 software. Results: Surveillance results are shown in Table 1. During the observation period, there were 221 pHABSIs and 139,013 patient days. Moreover, 67 pHABSIs were associated with an MCS device over 17,044 total MCS days: 43 ECMO days, 18 VAD days, and 13 IABP days. Also, 9 patients had >1 type of eligible device and 7 (39%) of the IABP-associated pHABSIs were CLABSIs. The cumulative incidences of pHABSI associated with ECMO, VAD, and IABP were 5.68, 4.59, and 2.34 per 1,000 MCS days, respectively. The incidence of IABP pHABSI was not significantly different from VAD pHABSI ( P = .06), but it was different from ECMO pHABSI ( P < .01). The pHABSI rate for non-MCS days was 1.26 per 1,000 patient days. Conclusions: In our patients requiring MCS, the risk of pHABSI associated with IABP was significantly greater than in patients without MCS and was similar to patients with VAD. MCS of all types should be considered a risk for HABSI in patients with cardiogenic shock beyond the presence of a central line. Protocols to further prevent HABSI morbidity in IABP patients are needed. Disclosure: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144452","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alex Zimmet, David Ha, Emily Mui, Mary Smith, William Alegria, Marisa Holubar
Background: International Classification of Diseases, Tenth Edition (ICD-10) data help track outpatient antibiotic prescribing but lack validation in immunocompromised populations or subspecialty clinics for this purpose. Asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are important stewardship targets in renal transplant (RT) patients, but they may require alternative metrics to best monitor prescribing patterns. We describe ICD-10 utilization for RT clinic encounters in which antibiotics were prescribed. We developed a metric classifying “acute urinary antibiotics” (AUA) to track antibiotic use for ASB and UTI, and we validated systematic identification of AUA to enable practical implementation. Methods: We examined RT clinic visit and telemedicine encounters from 2018 to 2021 conducted 1 month after transplant. This project was deemed non–human-subjects research by the Stanford Panel on Human Subjects in Medical Research. Results: The analytic cohort included 420 antibacterial prescriptions from 408 encounters (Fig. 1). Of 238 patients, 136 (57%) were male and 112 (47%) were Hispanic or Latino. The most common primary ICD-10 code was Z94.0 (kidney transplant status) (N = 302 of 408 encounters, 75%); 26 encounters (6%) were coded for UTI (eg, N39.0, urinary tract infection, site not specified); and 214 encounters (53%) had multiple ICD-10 codes. The R82.71 code (bacteriuria) was never used. However, 215 prescriptions (51%) were classified as AUA (Fig. 2). The validation cohort included 130 prescriptions; 59 (45%) were classified as AUA and 51 (39%) had documented intent to treat ASB or UTI (positive percent agreement, 83%; negative percent agreement, 97%) (Table 1). For patients >1 month after transplant, the positive percent agreement was 95% and the negative percent agreement was 98%. Of 51 patients receiving AUA, 32 (63%) were asymptomatic despite frequently having a code for UTI (Fig. 3). Conclusions: ICD-10 coding may not be helpful in monitoring antibiotic prescribing in RT patients. The AUA metric offers a practical alternative to track antibiotic prescribing for urinary syndromes and reliably correlates with physician intent. Monitoring AUA prescribing rates could help identify opportunities to optimize antibiotic use in this complex outpatient setting. Disclosures: None
{"title":"“Acute urinary antibiotics”—A simple metric to identify outpatient antibiotic stewardship opportunities in renal transplant","authors":"Alex Zimmet, David Ha, Emily Mui, Mary Smith, William Alegria, Marisa Holubar","doi":"10.1017/ash.2023.330","DOIUrl":"https://doi.org/10.1017/ash.2023.330","url":null,"abstract":"Background: International Classification of Diseases, Tenth Edition (ICD-10) data help track outpatient antibiotic prescribing but lack validation in immunocompromised populations or subspecialty clinics for this purpose. Asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are important stewardship targets in renal transplant (RT) patients, but they may require alternative metrics to best monitor prescribing patterns. We describe ICD-10 utilization for RT clinic encounters in which antibiotics were prescribed. We developed a metric classifying “acute urinary antibiotics” (AUA) to track antibiotic use for ASB and UTI, and we validated systematic identification of AUA to enable practical implementation. Methods: We examined RT clinic visit and telemedicine encounters from 2018 to 2021 conducted 1 month after transplant. This project was deemed non–human-subjects research by the Stanford Panel on Human Subjects in Medical Research. Results: The analytic cohort included 420 antibacterial prescriptions from 408 encounters (Fig. 1). Of 238 patients, 136 (57%) were male and 112 (47%) were Hispanic or Latino. The most common primary ICD-10 code was Z94.0 (kidney transplant status) (N = 302 of 408 encounters, 75%); 26 encounters (6%) were coded for UTI (eg, N39.0, urinary tract infection, site not specified); and 214 encounters (53%) had multiple ICD-10 codes. The R82.71 code (bacteriuria) was never used. However, 215 prescriptions (51%) were classified as AUA (Fig. 2). The validation cohort included 130 prescriptions; 59 (45%) were classified as AUA and 51 (39%) had documented intent to treat ASB or UTI (positive percent agreement, 83%; negative percent agreement, 97%) (Table 1). For patients >1 month after transplant, the positive percent agreement was 95% and the negative percent agreement was 98%. Of 51 patients receiving AUA, 32 (63%) were asymptomatic despite frequently having a code for UTI (Fig. 3). Conclusions: ICD-10 coding may not be helpful in monitoring antibiotic prescribing in RT patients. The AUA metric offers a practical alternative to track antibiotic prescribing for urinary syndromes and reliably correlates with physician intent. Monitoring AUA prescribing rates could help identify opportunities to optimize antibiotic use in this complex outpatient setting. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"214 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144455","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kristine Nguyen, Raveena Singh, Raheeb Saavedra, John Billimek, Steven Tam, Susan Huang
Background: Existing training for resident bathing in nursing homes (NHs) is brief and limited, likely because bathing is assumed to be intuitive. However, residents have complex skin issues, devices, dressings, and limited ability for self-care. We sought to assess bathing quality and to identify barriers to proper bathing techniques. Methods: We conducted a prospective observational study of bathing in 8 NHs in Orange County, California, involving a convenience sample of observed bed baths and showers conducted for quality improvement. NH staff were told that observation was occurring, and no feedback was given during or after bathing. Survey elements included cleansing of 6 specific body sites and adherence to bathing procedures (11 for bed baths and 17 for showers). Surveys also included queries to staff to further assess knowledge and perceived barriers. Observed lapses were documented, along with observer-determined reasons for noncompliance (ie, training issue, time pressure, facility issue (insufficient water temperature), resident refusal/behavior). Frequency of noncompliance with each element was tabulated for bed-baths and showers separately. Reasons for failure were displayed graphically. Results: In total, 50 bed baths (NH range, 5–8) and 50 showers (NH range, 4–7) were observed across 8 NHs. Lapses in bathing quality and process were extremely common for both bed baths and showers (Fig.). Inadequate body cleansing occurred for all observed body sites (88%–100% failure for bed baths, 58%–100% failure for showers). Most body areas were either skipped or sprayed with water without soaping. Procedural failures were high for both bed baths and showers (insufficient lather: 100% for bed bath and 40% for shower) lack of firm massage for cleaning (94% for bed bath and 90% for shower), failure to change wipes or cloths when dirty (100% for bed bath and 96% for shower), failure to follow clean-to-dirty sequence (100% for bed bath and 96% shower). In addition, failing to wrap or unwrap devices (73%) and failing to towel dry (94%) were common after showering. Reasons for failure were largely based on training or facility shortcomings (eg, insufficient hot water, inflexible showerhead attachment). Also, 86% of residents complained of being cold. Timing constraints and resident combativeness or refusal were rare. Staff-to-staff bathing advice most commonly involved competing for the “better shower” and “bathing early to get hot water.” Conclusions: Knowing how to appropriately bathe NH residents is not intuitive, and current training is brief and insufficient for high-quality resident care. Unacceptably high failures in proper bathing techniques in NHs necessitate re-evaluation of formal training and standardized practices to better cleanse residents. Moreover, common failures in facility processes for ensuring adequate water temperature and showerhead mobility for bathing or showering should be addressed. Disclosures: None
{"title":"Not as simple as it seems: Extensive facility and training gaps in nursing home bathing","authors":"Kristine Nguyen, Raveena Singh, Raheeb Saavedra, John Billimek, Steven Tam, Susan Huang","doi":"10.1017/ash.2023.333","DOIUrl":"https://doi.org/10.1017/ash.2023.333","url":null,"abstract":"Background: Existing training for resident bathing in nursing homes (NHs) is brief and limited, likely because bathing is assumed to be intuitive. However, residents have complex skin issues, devices, dressings, and limited ability for self-care. We sought to assess bathing quality and to identify barriers to proper bathing techniques. Methods: We conducted a prospective observational study of bathing in 8 NHs in Orange County, California, involving a convenience sample of observed bed baths and showers conducted for quality improvement. NH staff were told that observation was occurring, and no feedback was given during or after bathing. Survey elements included cleansing of 6 specific body sites and adherence to bathing procedures (11 for bed baths and 17 for showers). Surveys also included queries to staff to further assess knowledge and perceived barriers. Observed lapses were documented, along with observer-determined reasons for noncompliance (ie, training issue, time pressure, facility issue (insufficient water temperature), resident refusal/behavior). Frequency of noncompliance with each element was tabulated for bed-baths and showers separately. Reasons for failure were displayed graphically. Results: In total, 50 bed baths (NH range, 5–8) and 50 showers (NH range, 4–7) were observed across 8 NHs. Lapses in bathing quality and process were extremely common for both bed baths and showers (Fig.). Inadequate body cleansing occurred for all observed body sites (88%–100% failure for bed baths, 58%–100% failure for showers). Most body areas were either skipped or sprayed with water without soaping. Procedural failures were high for both bed baths and showers (insufficient lather: 100% for bed bath and 40% for shower) lack of firm massage for cleaning (94% for bed bath and 90% for shower), failure to change wipes or cloths when dirty (100% for bed bath and 96% for shower), failure to follow clean-to-dirty sequence (100% for bed bath and 96% shower). In addition, failing to wrap or unwrap devices (73%) and failing to towel dry (94%) were common after showering. Reasons for failure were largely based on training or facility shortcomings (eg, insufficient hot water, inflexible showerhead attachment). Also, 86% of residents complained of being cold. Timing constraints and resident combativeness or refusal were rare. Staff-to-staff bathing advice most commonly involved competing for the “better shower” and “bathing early to get hot water.” Conclusions: Knowing how to appropriately bathe NH residents is not intuitive, and current training is brief and insufficient for high-quality resident care. Unacceptably high failures in proper bathing techniques in NHs necessitate re-evaluation of formal training and standardized practices to better cleanse residents. Moreover, common failures in facility processes for ensuring adequate water temperature and showerhead mobility for bathing or showering should be addressed. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael Chambers, Romney Humphries, Bryan Harris, Tom Talbot
Background: Ventilator-associated pneumonia (VAP) is a significant cause of mortality in intensive care units (ICUs), but minimal research exists regarding the appropriateness of ordering endotracheal aspirate cultures (EACs). We evaluated the diagnostic utility of rationales given for EAC collection in ICUs at an academic medical center to assess potentially inappropriate EAC ordering. Methods: The study population comprised all adult patients admitted to an ICU in 2019 who underwent EAC collection. A random 10% sample from this population, stratified by ICU type, was selected. Clinical and diagnostic characteristics within 24 hours of EAC collection were identified by chart review. Clinical documentation was reviewed to identify ICU provider rationales for ordering EAC. Results: In total, 749 patients underwent EAC collection. Among them, 75 patients comprised the random sample, of whom 7 (9.3%) were excluded due to extubation before culture collection. Figure 1 shows patient distribution by ICU type. From these 68 patients, 105 EACs were collected. Of these, 41 (39%) were positive for potential pathogens, and 59 (56.2%) had explicit rationales for EAC collection, including fever (44.1%), hypoxia (18.6%), leukocytosis (16.9%), secretions (11.9%), shock (10.2%), and radiologic findings (8.5%). Also, 43.8% of EACs had no explicit rationale for collection. Table 1 shows sensitivities, specificities, positive likelihood ratios (LRs), and negative LRs for these rationales and related characteristics. Conclusions: EACs were commonly ordered without clear clinical indications. Of the noted rationales for EAC collections, most performed poorly at predicting positive cultures, which challenged common rationales for ordering EAC. This study could serve as a foundation for diagnostic stewardship interventions for EAC, potentially decreasing unnecessary cultures. Disclosures: None
{"title":"Assessment of endotracheal aspirate culture appropriateness among adult ICU patients at an academic medical center","authors":"Michael Chambers, Romney Humphries, Bryan Harris, Tom Talbot","doi":"10.1017/ash.2023.308","DOIUrl":"https://doi.org/10.1017/ash.2023.308","url":null,"abstract":"Background: Ventilator-associated pneumonia (VAP) is a significant cause of mortality in intensive care units (ICUs), but minimal research exists regarding the appropriateness of ordering endotracheal aspirate cultures (EACs). We evaluated the diagnostic utility of rationales given for EAC collection in ICUs at an academic medical center to assess potentially inappropriate EAC ordering. Methods: The study population comprised all adult patients admitted to an ICU in 2019 who underwent EAC collection. A random 10% sample from this population, stratified by ICU type, was selected. Clinical and diagnostic characteristics within 24 hours of EAC collection were identified by chart review. Clinical documentation was reviewed to identify ICU provider rationales for ordering EAC. Results: In total, 749 patients underwent EAC collection. Among them, 75 patients comprised the random sample, of whom 7 (9.3%) were excluded due to extubation before culture collection. Figure 1 shows patient distribution by ICU type. From these 68 patients, 105 EACs were collected. Of these, 41 (39%) were positive for potential pathogens, and 59 (56.2%) had explicit rationales for EAC collection, including fever (44.1%), hypoxia (18.6%), leukocytosis (16.9%), secretions (11.9%), shock (10.2%), and radiologic findings (8.5%). Also, 43.8% of EACs had no explicit rationale for collection. Table 1 shows sensitivities, specificities, positive likelihood ratios (LRs), and negative LRs for these rationales and related characteristics. Conclusions: EACs were commonly ordered without clear clinical indications. Of the noted rationales for EAC collections, most performed poorly at predicting positive cultures, which challenged common rationales for ordering EAC. This study could serve as a foundation for diagnostic stewardship interventions for EAC, potentially decreasing unnecessary cultures. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jessica Howard-Anderson, Radhika Prakash Asrani, Chris Bower, Chad Robichaux, Rishi Kamaleswaran, Jesse Jacob, Scott Fridkin
Background: Prompt identification of patients colonized or infected with carbapenem-resistant Enterobacterales (CRE) upon admission can help ensure rapid initiation of infection prevention measures and may reduce intrafacility transmission of CRE. The Chicago CDC Prevention Epicenters Program previously created a CRE prediction model using state-wide public health data (doi: 10.1093/ofid/ofz483). We evaluated how well a similar model performed using data from a single academic healthcare system in Atlanta, Georgia, and we sought to determine whether including additional variables improved performance. Methods: We performed a case–control study using electronic medical record data. We defined cases as adult encounters to acute-care hospitals in a 4-hospital academic healthcare system from January 1, 2014, to December 31, 2021, with CRE identified from a clinical culture within the first 3 hospital days. Only the first qualifying encounter per patient was included. We frequency matched cases to control admissions (no CRE identified) from the same hospital and year. Using multivariable logistic regression, we compared 2 models. The “public health model” included 4 variables from the Chicago Epicenters model (age, number of hospitalizations in the prior 365 days, mean length of stay in hospitalizations in the prior 365 days, and hospital admission with an infection diagnosis in the prior 365 days). The “healthcare system model” added 4 additional variables (admission to the ICU in the prior 365 days, malignancy diagnosis, Elixhauser score and inpatient antibiotic days of therapy in the prior 365 days) to the public health model. We used billing codes to determine Elixhauser score, malignancy status, and recent infection diagnoses. We compared model performance using the area under the receiver operating curve (AUC). Results: We identified 105 cases and 441,460 controls (Table 1). CRE was most frequently identified in urine cultures (46%). All 4 variables included in the public health model and the 4 additional variables in the healthcare system model were all significantly associated with being a case in unadjusted analyses (Table 1). The AUC for the public health model was 0.76, and the AUC for the healthcare system model was 0.79 (Table 2; Fig. 1). In both models, a prior admission with an infection diagnosis was the most significant risk factor. Conclusions: A modified CRE prediction model developed using public health data and focused on prior healthcare exposures performed reasonably well when applied to a different academic healthcare system. The addition of variables accessible in large healthcare networks did not meaningfully improve model discrimination. Disclosures: None
{"title":"Identifying patients at high risk for carbapenem-resistant Enterobacterales carriage upon admission to acute-care hospitals","authors":"Jessica Howard-Anderson, Radhika Prakash Asrani, Chris Bower, Chad Robichaux, Rishi Kamaleswaran, Jesse Jacob, Scott Fridkin","doi":"10.1017/ash.2023.339","DOIUrl":"https://doi.org/10.1017/ash.2023.339","url":null,"abstract":"Background: Prompt identification of patients colonized or infected with carbapenem-resistant Enterobacterales (CRE) upon admission can help ensure rapid initiation of infection prevention measures and may reduce intrafacility transmission of CRE. The Chicago CDC Prevention Epicenters Program previously created a CRE prediction model using state-wide public health data (doi: 10.1093/ofid/ofz483). We evaluated how well a similar model performed using data from a single academic healthcare system in Atlanta, Georgia, and we sought to determine whether including additional variables improved performance. Methods: We performed a case–control study using electronic medical record data. We defined cases as adult encounters to acute-care hospitals in a 4-hospital academic healthcare system from January 1, 2014, to December 31, 2021, with CRE identified from a clinical culture within the first 3 hospital days. Only the first qualifying encounter per patient was included. We frequency matched cases to control admissions (no CRE identified) from the same hospital and year. Using multivariable logistic regression, we compared 2 models. The “public health model” included 4 variables from the Chicago Epicenters model (age, number of hospitalizations in the prior 365 days, mean length of stay in hospitalizations in the prior 365 days, and hospital admission with an infection diagnosis in the prior 365 days). The “healthcare system model” added 4 additional variables (admission to the ICU in the prior 365 days, malignancy diagnosis, Elixhauser score and inpatient antibiotic days of therapy in the prior 365 days) to the public health model. We used billing codes to determine Elixhauser score, malignancy status, and recent infection diagnoses. We compared model performance using the area under the receiver operating curve (AUC). Results: We identified 105 cases and 441,460 controls (Table 1). CRE was most frequently identified in urine cultures (46%). All 4 variables included in the public health model and the 4 additional variables in the healthcare system model were all significantly associated with being a case in unadjusted analyses (Table 1). The AUC for the public health model was 0.76, and the AUC for the healthcare system model was 0.79 (Table 2; Fig. 1). In both models, a prior admission with an infection diagnosis was the most significant risk factor. Conclusions: A modified CRE prediction model developed using public health data and focused on prior healthcare exposures performed reasonably well when applied to a different academic healthcare system. The addition of variables accessible in large healthcare networks did not meaningfully improve model discrimination. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"253 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Swarn Arya, Xiao Wang, Sonal Patel, Stephen Saw, Mary Decena, Rebecca Hirsh, David Pegues, Matthew Ziegler
Background: Neutropenic fever management decisions are complex and result in prolonged duration of broad-spectrum antibiotics. Strategies for antibiotic stewardship in this context have been studied, including de-escalation of antibiotics prior to resolution of neutropenia, with unclear implementation. Here, we present the first survey study to describe real-world neutropenic fever management practices in US healthcare institutions, with particular emphasis on de-escalation strategies after initiation of broad-spectrum antibiotics. Methods: Using REDCap, we conducted a survey of US healthcare institutions through the SHEA Research Network (SRN). Questions pertained to antimicrobial prophylaxis and supportive care in the management of oncology patients and neutropenic fever management (including specific antimicrobial choices and clinical scenarios). Hematologic malignancy hospitalization (2020) and bone-marrow transplantation (2016–2020) volumes were obtained from CMS and Health Resources & Services Administration databases, respectively. Results: Overall, 23 complete responses were recorded (response rate, 35.4%). Collectively, these entities account for ~11.0% of hematologic malignancy hospitalizations and 13.3% bone marrow transplantations nationwide. Of 23 facilities, 19 had institutional guidelines for neutropenic fever management and 18 had institutional guidelines for prophylaxis, with similar definitions for neutropenic fever. Firstline treatment universally utilized antipseudomonal broad-spectrum IV antibiotics (20 of 23 use cephalosporin, 3 of 23 use penicillin agent, and no respondents use carbapenem). Fluoroquinolone prophylaxis was common for leukemia induction patients (18 of 23) but was mixed for bone-marrow transplantation (10 of 23). We observed significant heterogeneity in treatment decisions. For stable neutropenic fever patients with no clinical source of infection identified, 13 of 23 respondents continued IV antibiotics until ANC (absolute neutrophil count) recovery. The remainder had criteria for de-escalation back to prophylaxis prior to this (eg, a fever-free period). Respondents were more willing to de-escalate prior to ANC recovery in patients with identified clinical sources (14 of 23 de-escalations in patients with pneumonia) or microbiological sources (15 of 23 de-escalations in patients with bacteremia) after dedicated treatment courses. In free-text responses, several respondents described opportunities for more systemic de-escalation for antimicrobial stewardship in these scenarios. Conclusions: Our results illustrate the real-world management of neutropenic fever in US hospitals, including initiation of therapy, prophylaxis, and treatment duration. We found significant heterogeneity in de-escalation of empiric antibiotics relative to ANC recovery, highlighting a need for more robust evidence for and adoption of this practice. Disclosures: None
{"title":"Antibiotic practice and stewardship in the management of neutropenic fever: A survey of US institutions","authors":"Swarn Arya, Xiao Wang, Sonal Patel, Stephen Saw, Mary Decena, Rebecca Hirsh, David Pegues, Matthew Ziegler","doi":"10.1017/ash.2023.247","DOIUrl":"https://doi.org/10.1017/ash.2023.247","url":null,"abstract":"Background: Neutropenic fever management decisions are complex and result in prolonged duration of broad-spectrum antibiotics. Strategies for antibiotic stewardship in this context have been studied, including de-escalation of antibiotics prior to resolution of neutropenia, with unclear implementation. Here, we present the first survey study to describe real-world neutropenic fever management practices in US healthcare institutions, with particular emphasis on de-escalation strategies after initiation of broad-spectrum antibiotics. Methods: Using REDCap, we conducted a survey of US healthcare institutions through the SHEA Research Network (SRN). Questions pertained to antimicrobial prophylaxis and supportive care in the management of oncology patients and neutropenic fever management (including specific antimicrobial choices and clinical scenarios). Hematologic malignancy hospitalization (2020) and bone-marrow transplantation (2016–2020) volumes were obtained from CMS and Health Resources & Services Administration databases, respectively. Results: Overall, 23 complete responses were recorded (response rate, 35.4%). Collectively, these entities account for ~11.0% of hematologic malignancy hospitalizations and 13.3% bone marrow transplantations nationwide. Of 23 facilities, 19 had institutional guidelines for neutropenic fever management and 18 had institutional guidelines for prophylaxis, with similar definitions for neutropenic fever. Firstline treatment universally utilized antipseudomonal broad-spectrum IV antibiotics (20 of 23 use cephalosporin, 3 of 23 use penicillin agent, and no respondents use carbapenem). Fluoroquinolone prophylaxis was common for leukemia induction patients (18 of 23) but was mixed for bone-marrow transplantation (10 of 23). We observed significant heterogeneity in treatment decisions. For stable neutropenic fever patients with no clinical source of infection identified, 13 of 23 respondents continued IV antibiotics until ANC (absolute neutrophil count) recovery. The remainder had criteria for de-escalation back to prophylaxis prior to this (eg, a fever-free period). Respondents were more willing to de-escalate prior to ANC recovery in patients with identified clinical sources (14 of 23 de-escalations in patients with pneumonia) or microbiological sources (15 of 23 de-escalations in patients with bacteremia) after dedicated treatment courses. In free-text responses, several respondents described opportunities for more systemic de-escalation for antimicrobial stewardship in these scenarios. Conclusions: Our results illustrate the real-world management of neutropenic fever in US hospitals, including initiation of therapy, prophylaxis, and treatment duration. We found significant heterogeneity in de-escalation of empiric antibiotics relative to ANC recovery, highlighting a need for more robust evidence for and adoption of this practice. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144601","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kellie Arensman Hannan, Paul Frykman, Eric Mathiowetz, Jill Sathre, Nou Cheng Yang, Kelsey Jensen
Background: Despite guidelines recommending shorter durations of therapy and empiric coverage of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) only for patients with certain risk factors, optimizing therapy for community-acquired pneumonia (CAP) remains a challenge for antimicrobial stewardship (AMS) teams. We investigated the impact of a multimodal AMS initiative on the rate of guideline-discordant empiric antibiotic selection and total duration of therapy for CAP. Methods: A quality improvement initiative was implemented at 9 community hospitals in 2022 to optimize CAP therapy. Education was provided to pharmacists and providers. Alerts were implemented within the electronic medical record to prompt the AMS team to review fluoroquinolones, antipseudomonal β-lactams, and anti-MRSA agents ordered for CAP. Clinical pharmacists reviewed antibiotic orders for CAP at hospital discharge and encouraged providers to prescribe a total antibiotic duration of 5–7 days. For the preintervention period (July– September 2021) and the postintervention period (July to September 2022), a random sample of 320 patients with an antibiotic order for CAP were evaluated retrospectively via chart review. Patients treated for an indication other than CAP were excluded. The primary outcome was the proportion of patients with a total duration of therapy >7 days. Secondary outcomes included average duration of therapy, rate of guideline-discordant empiric therapy, and type of guideline discordance. Results: In total, 317 patients were included. The proportion of patients with a total duration of therapy >7 days decreased from 29% to 14% ( P < .01). Average duration of therapy and guideline-discordant empiric therapy also decreased significantly (Table 1). Conclusions: This multifaceted AMS initiative was associated with decreased guideline-discordant empiric therapy and decreased total duration of therapy for CAP. Disclosures: None
{"title":"Reducing the rate of guideline-discordant therapy for inpatients with community-acquired pneumonia","authors":"Kellie Arensman Hannan, Paul Frykman, Eric Mathiowetz, Jill Sathre, Nou Cheng Yang, Kelsey Jensen","doi":"10.1017/ash.2023.244","DOIUrl":"https://doi.org/10.1017/ash.2023.244","url":null,"abstract":"Background: Despite guidelines recommending shorter durations of therapy and empiric coverage of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) only for patients with certain risk factors, optimizing therapy for community-acquired pneumonia (CAP) remains a challenge for antimicrobial stewardship (AMS) teams. We investigated the impact of a multimodal AMS initiative on the rate of guideline-discordant empiric antibiotic selection and total duration of therapy for CAP. Methods: A quality improvement initiative was implemented at 9 community hospitals in 2022 to optimize CAP therapy. Education was provided to pharmacists and providers. Alerts were implemented within the electronic medical record to prompt the AMS team to review fluoroquinolones, antipseudomonal β-lactams, and anti-MRSA agents ordered for CAP. Clinical pharmacists reviewed antibiotic orders for CAP at hospital discharge and encouraged providers to prescribe a total antibiotic duration of 5–7 days. For the preintervention period (July– September 2021) and the postintervention period (July to September 2022), a random sample of 320 patients with an antibiotic order for CAP were evaluated retrospectively via chart review. Patients treated for an indication other than CAP were excluded. The primary outcome was the proportion of patients with a total duration of therapy >7 days. Secondary outcomes included average duration of therapy, rate of guideline-discordant empiric therapy, and type of guideline discordance. Results: In total, 317 patients were included. The proportion of patients with a total duration of therapy >7 days decreased from 29% to 14% ( P < .01). Average duration of therapy and guideline-discordant empiric therapy also decreased significantly (Table 1). Conclusions: This multifaceted AMS initiative was associated with decreased guideline-discordant empiric therapy and decreased total duration of therapy for CAP. Disclosures: None","PeriodicalId":7953,"journal":{"name":"Antimicrobial Stewardship & Healthcare Epidemiology","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135144608","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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