Evaluating a Hospitalist-Based Intervention to Decrease Unnecessary Antimicrobial Use in Patients With Asymptomatic Bacteriuria

2016 ◽  
Vol 37 (9) ◽  
pp. 1044-1051 ◽  
Author(s):  
Sarah E. Hartley ◽  
Latoya Kuhn ◽  
Staci Valley ◽  
Laraine L. Washer ◽  
Tejal Gandhi ◽  
...  
Keyword(s):  
Educational Intervention ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Hospital Setting ◽  
Signs And Symptoms ◽  
Treatment Rate ◽  
Duration Of Treatment ◽  
Academic Center ◽  
Positive Urine ◽  
The Impact

OBJECTIVEInappropriate treatment of asymptomatic bacteriuria (ASB) in the hospital setting is common. We sought to evaluate the treatment rate of ASB at the 3 hospitals and assess the impact of a hospitalist-focused improvement intervention.DESIGNProspective, interventional trial.SETTINGTwo community hospitals and a tertiary-care academic center.PATIENTSAdult patients with a positive urine culture admitted to hospitalist services were included in this study. Exclusions included pregnancy, intensive care unit admission, history of a major urinary procedure, and actively being treated for a urinary tract infection (UTI) at the time of admission or >48 hours prior to urine collection.INTERVENTIONSAn educational intervention using a pocket card was implemented at all sites followed by a pharmacist-based intervention at the academic center. Medical records of the first 50 eligible patients at each site were reviewed at baseline and after each intervention for signs and symptoms of UTI, microbiological results, antimicrobials used, and duration of treatment for positive urine cultures. Diagnosis of ASB was determined through adjudication by 2 hospitalists and 2 infectious diseases physicians.RESULTSTreatment rates of ASB decreased (23.5%; P=.001) after the educational intervention. Reductions in treatment rates for ASB differed by site and were greatest in patients without classic signs and symptoms of UTI (34.1%; P<.001) or urinary catheters (31.2%; P<.001). The pharmacist-based intervention was most effective at reducing ASB treatment rates in catheterized patients.CONCLUSIONSA hospitalist-focused educational intervention significantly reduced ASB treatment rates. The impact varied across sites and by patient characteristics, suggesting that a tailored approach may be useful.Infect Control Hosp Epidemiol 2016;37:1044–1051

scholarly journals Assessment of Reflex Urine Culture Criteria Changes and its Impact on Treatment of Asymptomatic Bacteriuria

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S346-S346 ◽  
Author(s):  
Kirre Wold ◽  
Jeff Brock ◽  
Kelly Percival ◽  
Lindsey Rearigh ◽  
Lucas Vocelka ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Signs And Symptoms ◽  
Hospital Data ◽  
Post Intervention ◽  
Number Of Patients ◽  
Positive Urine ◽  
Before And After ◽  
Implementation Period ◽  
Inappropriate Antibiotics ◽  
The Impact

Abstract Background Asymptomatic bacteriuria (ASB) is a common clinical condition identified by the presence of bacteria in the urine of a patient without signs and symptoms of a urinary tract infection (UTI). Treatment of ASB leads to unnecessary antimicrobial use and can cause more harm than benefit in many patients. This study is to determine the impact of more stringent criteria for urinalysis with culture if indicated (UAC), implemented in September 2016, on the treatment of asymptomatic bacteriuria. Methods A pre-post descriptive study of patients was conducted with an order placed for UAC in the Emergency Department (ED) or hospital. Data was collected retrospectively via chart reviews. The data on ASB patients from November 2015 to April 2016 was compared with the post-implementation period October 2016 to January 2017. The number of UAC orders and cultures were averaged for 6 months pre and post implementation of the criteria change. Results A total of 580 patient charts were assessed post-implementation of the UAC criteria change. A majority of the orders originated from the ED, (N = 430, 72.8%). ASB was treated inappropriately at a rate of 60.4% (N = 64/106) pre-implementation and a rate of 65% (N = 41/63) post implementation, P = 0.542. The total number of UAC ordered before and after implementation did not change, (N = 2852 pre-intervention vs N = 2825 post-intervention, P = 0.744), as seen in Figure 1. However, the number of reflexed urine cultures did significantly decrease post criteria change,&#x2028; (N = 1056 pre-intervention vs. N = 603 post-intervention, P &lt; 0.0001). In addition, the number of positive urine cultures also significantly decreased, (N = 378 pre-intervention vs. N = 289 post-intervention, P = 0.0447). The impact the criteria change had on patient care is the number of potential antibiotic courses saved by reflexing fewer urine cultures off the UAC. Based on the decrease in positive urine cultures, it is estimated 702 courses of inappropriate antibiotics for ASB could be saved per year (59/month). Conclusion More stringent criteria for reflex urine cultures significantly decreases the number of urine cultures performed, therefore decreasing the number of patients treated with ASB. Additional stewardship measures are necessary to reduce the treatment of ASB for patients who have cultures performed. Disclosures All authors: No reported disclosures.

Antimicrobial use for asymptomatic bacteriuria—First, do no harm

2020 ◽  
Vol 42 (1) ◽  
pp. 37-42
Author(s):  
Yana Shpunt ◽  
Inna Estrin ◽  
Yossef Levi ◽  
Hodaya Saadon ◽  
Galit Ben-Yossef ◽  
...  
Keyword(s):  
Functional Status ◽  
Medical Center ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Antimicrobial Use ◽  
Renal Transplant Recipients ◽  
Common Error ◽  
Positive Urine ◽  
Male Sex ◽  
The Impact

AbstractObjective:Administration of antimicrobials to patients with asymptomatic bacteriuria (ASB) is a common error that can lead to worse outcomes. However, controlled analyses quantifying the commonality and impact of this practice are lacking. We analyzed the independent predictors for antimicrobials misuse in ASB and quantified the impact of this practice on clinical outcomes.Design:Retrospective case-control and cohort analyses for calendar year 2017.Setting:Tertiary-care, university-affiliated medical center.Patients:The study included adult (>18 years) patients with positive urine culture. Pregnant women, renal transplant recipients, and patients who underwent urologic procedures were excluded.Methods:ASB was determined according to US Centers for Disease Control and Prevention (CDC) criteria. Multivariable logistic regression models were constructed to analyze predictors and outcomes associated with antimicrobial use for patients with ASB.Results:The study included 1,530 patient-unique positive urine cultures. Among these patients, 610 patients (40%) were determined to have ASB. Of the 696 isolates, 219 (36%) were multidrug-resistant organisms (MDROs). Also, 178 (29%) patients received antimicrobials specifically due to the ASB. Independent predictors for improper administration of antimicrobials were dependent functional status (adjusted odds ratio [aOR], 2.3; 95% CI, 1.4–3.6) and male sex (aOR, 2; 95% CI, 1.25–2.6). Use of antimicrobials was independently associated with re-hospitalizations (aOR, 1.7; 95% CI, 1.1–2.6) and later, acute Clostridioides difficile infections (CDI) in the following 90 days (aOR, 4.5; 95% CI, 2–10.6).Conclusions:ASB is a common condition, frequently resulting from an MDRO. Male sex and poor functional status were independent predictors for mistreatment, and this practice was independently associated with rehospitalizations and CDI in the following 90 days.

Modified reporting of positive urine cultures to reduce inappropriate antibiotic treatment of catheter-associated asymptomatic bacteriuria (CA-ASB) among inpatients, a randomized controlled trial

2021 ◽  
pp. 1-7
Author(s):  
Claire L. Pratt ◽  
Zahra Rehan ◽  
Lydia Xing ◽  
Laura Gilbert ◽  
Brenda Fillier ◽  
...  
Keyword(s):  
Adverse Events ◽  
Antibiotic Treatment ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Asymptomatic Bacteriuria ◽  
Treatment Rate ◽  
Indwelling Catheters ◽  
Appropriate Treatment ◽  
Positive Urine ◽  
Standard Report

Abstract Objective: To determine whether modified reporting of positive urine cultures collected from indwelling catheters improved treatment decisions without causing harm. Design: Prospective, unblinded, randomized control trial. Setting: Two tertiary-care hospitals. Participants: Overall, 100 consecutive positive urine cultures collected from catheterized inpatients were randomized between standard and modified laboratory reporting between November 2018 and June 2019. Exclusion criteria were pregnancy, current antibiotic treatment, ICU or urology admission, or neutropenia. Intervention: The modified report included significant growth without providing identification, quantification, or susceptibility. The standard report included identification, quantitation and susceptibility. Diagnosis of catheter-associated asymptomatic bacteriuria (CA-ASB) and catheter-associated urinary tract infection (CA-UTI) followed published criteria, using prospective chart review. The appropriate antibiotic treatment was defined as treatment of CA-UTI, and no treatment of CA-ASB. Patients were followed for 7 days. Results: Of 543 urine cultures, 443 (82%) were excluded. Of 100 patients, 75 (75%) had CA-ASB and 25 (25%) had CA-UTI. Treatment was given to 45 of 75 CA-ASB patients (60%) and all 25 CA-UTI patients (100%). Appropriate treatment rate was higher in the modified reporting arm than in the standard reporting arm: 57% vs 50% (+7.4%; relative risk [RR], 1.15; P = .45). Untreated CA-ASB was higher in the modified reporting arm: 45% vs 33% (+12%; RR, 1.36; P = .30). The standard report was requested for 33% of modified reports. Furthermore, 4 deaths and 26.9% adverse events occurred in the modified reporting arm, and 3 deaths and 41.3% adverse events occurred in the standard reporting arm. Conclusions: Modified reporting increased the appropriateness of treatment, and may be safe. Clinical trials identifier: ClinicalTrials.gov#NCT03488355.

scholarly journals Impact of Antimicrobial Stewardship Interventions on Antimicrobial Utilization in Asymptomatic Bacteriuria

2019 ◽  
pp. 001857871988891 ◽  
Author(s):  
Punit J. Shah ◽  
Chiamaka Ike ◽  
Meghan Thibeaux ◽  
Emilyn Rodriguez ◽  
Shermel-Edwards Maddox ◽  
...  
Keyword(s):  
Real Time ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Asymptomatic Bacteriuria ◽  
Control Phase ◽  
Clinical Pharmacists ◽  
Antimicrobial Utilization ◽  
Positive Urine ◽  
Interdisciplinary Interventions ◽  
The Impact

Background: Antimicrobial therapy for asymptomatic bacteriuria (ASB) is often unnecessary and is a common reason for inappropriate antimicrobial use in hospitalized patients. Unnecessary ASB treatment leads to collateral damage such as resistance, and Clostridium difficile infections. This study evaluated the impact of interdisciplinary antimicrobial stewardship interventions on antimicrobial utilization in ASB. Methods: This was a quasi-experimental institutional review board (IRB)-approved study evaluating the impact of antimicrobial stewardship on antibiotic utilization for ASB in a pilot medical-surgical unit. The control phase was from August-October 2017 and the postintervention phase was from December-March 2018. In the control phase, electronic medical records of patients with positive urine cultures were retrospectively reviewed. Patients were classified as either having ASB or urinary tract infection (UTI) based on the absence or presence of UTI symptoms documented in the medical record. The intervention phase consisted of educational in-services to providers, nurses, and pharmacists. Clinical pharmacists for the pilot unit utilized an electronic real-time surveillance system to identify patients with positive urine cultures. With nurses’ collaboration, clinical pharmacists classified these patients as either having UTI or ASB. Stewardship interventions were made in real-time to discontinue antibiotics in patients with ASB. Results: There were 65 and 77 patients with bacteriuria in the pre- and postintervention phases. Among these, ASB was present in 29 (45%) and 27 (35%) patients, respectively. After excluding those receiving antibiotics for concurrent nonurinary indications, the combination of education with pharmacist and nursing interventions decreased unnecessary ASB treatment from 18 (62%) to 6 (22%) patients (relative risk: 0.36, 95% confidence interval: 0.16-0.72, P = .003). Conclusion: The findings of this study highlight the importance of interdisciplinary interventions in reducing unnecessary antimicrobial therapy for the treatment of ASB. With increasing antimicrobial resistance, healthcare institutions should evaluate the role of these interdisciplinary interventions to reduce unnecessary treatment for ASB.

scholarly journals Smoking Cessation Intervention in a Cardiovascular Hospital Based Clinical Setting

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Zainab Samaan ◽  
Barb Nowacki ◽  
Karleen Schulze ◽  
Patrick Magloire ◽  
Sonia S. Anand
Keyword(s):  
Smoking Cessation ◽  
Tertiary Care ◽  
Hospital Setting ◽  
Morbidity And Mortality ◽  
Care Hospital ◽  
Smoking Reduction ◽  
Quit Smoking ◽  
The Impact ◽  
Cessation Clinic ◽  
Smoking Cessation Clinic

Introduction. Smoking is a leading cause of morbidity and mortality globally and it is a significant modifiable risk factor for cardiovascular disease (CVD) and other chronic diseases. Efforts to encourage and support smokers to quit are critical to prevent premature smoking-associated morbidity and mortality. Hospital settings are seldom equipped to help patients to quit smoking thus missing out a valuable opportunity to support patients at risk of smoking complications. We report the impact of a smoking cessation clinic we have established in a tertiary care hospital setting to serve patients with CVD. Methods. Patients received behavioural and pharmacological treatments and were followed up for a minimum of 6 months (mean 541 days, SD 197 days). The main study outcome is ≥50% reduction in number of cigarettes smoked at followup. Results. One hundred and eighty-six patients completed ≥6 months followup. More than half of the patients (52.7%) achieved ≥50% smoking reduction at follow up. Establishment of a plan to quit smoking and use of nicotine replacement therapy (NRT) were significantly associated with smoking reduction at followup. Conclusions. A hospital-based smoking cessation clinic is a beneficial intervention to bring about smoking reduction in approximately half of the patients.

scholarly journals Predictors of slow clinical response and extended treatment in patients with extra-pulmonary tuberculosis in Pakistan, A hospital-based prospective study

PLoS ONE ◽  
2021 ◽  
Vol 16 (11) ◽  
pp. e0259801
Author(s):  
Atiqa Ambreen ◽  
Sabira Tahseen ◽  
Ahmad Wali ◽  
Muhammad Jamil ◽  
Syed Zeeshan Haider Naqvi ◽  
...  
Keyword(s):  
Clinical Response ◽  
Extrapulmonary Tuberculosis ◽  
Tertiary Care ◽  
Signs And Symptoms ◽  
Multivariate Regression Analysis ◽  
Care Hospital ◽  
Duration Of Treatment ◽  
Extended Treatment ◽  
Tb Treatment ◽  
Optimal Duration

The optimal duration of treatment in different forms of extrapulmonary tuberculosis (EPTB) is not clearly defined. This study aimed to identify predictors of slow clinical response and extended anti-TB treatment in EPTB patients. Socio-demographic, clinical, and microbiological characteristics of EPTB patients registered for anti-TB treatment at a tertiary care hospital, were analysed for identification of predictors of extended treatment. A total of 251 patients (137 lymphadenitis, and 114 pleuritis) were included in the analysis. Treatment was extended to more than 6 months in 58/251 (23%) patients. In the multivariate regression analysis, culture-positive EPTB (p = 0.007) [OR (95% CI) = 3.81 (1.43, 10.11)], history of diabetes (p = 0.014) [OR (95% CI) = 25.18 (1.94, 325.83)], smokeless tobacco use (p = 0.002) [OR (95% CI) = 17.69 (2.80, 111.72)], and slow regression of local signs and symptoms after 2 months of treatment (p < 0.001) [OR (95% CI) = 17.09 [(5.79, 50.39)] were seen to be significantly associated with treatment extension. Identification of predictors of extended treatment can help clinical decisions regarding optimal duration of treatment. Further studies are needed to identify subgroups of EPTB patients who can benefit from a shorter or longer treatment regimen.

scholarly journals A study to assess knowledge and skill among doctors about hand hygiene, WHO five moments, personal protective equipment’s and assess the impact of educational intervention, in tertiary care hospital, Al Qassim provenance of Saudi Arabia

2018 ◽  
Vol 5 (9) ◽  
pp. 3796
Author(s):  
Sanjay Kumar Gupta ◽  
Fahd Khaleefah Al Khaleefah ◽  
Ibrahim Saifi Al Harbi ◽  
Sinimol Jabar ◽  
Marilou A. Torre ◽  
...  
Keyword(s):  
Hand Hygiene ◽  
Educational Intervention ◽  
Tertiary Care ◽  
Educational Interventions ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Effective Measure ◽  
Knowledge And Skills ◽  
Study Results ◽  
The Impact

Background: Hand hygiene (HH) is now to be considered as one of the most important effective measure of infection control activities. This is because enough scientific evidence suggested the observation that if properly implemented, hand hygiene alone can significantly reduce the risk of cross-transmission of infection in healthcare facilities.Methods: Hospital based educational intervention.Results: The study results showed the overall improvement pre and post educational intervention regarding hand hygiene skills, five moments and donning and doffing of PPE was significantly improved from 56.50% to 94.51%. If we see the knowledge and skills among doctors between department than we found significantly low knowledge and skills among (pre-interventional) doctors of radiology 23.33% followed by orthopedics 42.50%. The post educational interventions improvement in intensive care unit, laboratory, ENT and dental department were near 100% and lowest observed in departments in pediatrics (84%).Conclusions: The study shows that need for the doctors to increase their knowledge and skill related to infection prevention and control practice by assessing their existing knowledge and skills in small groups and according to observations intervention also plan and its improved knowledge and skill significantly.

scholarly journals Experience With Ceftolozane-Tazobactam for the Treatment of Serious Pseudomonas aeruginosa Infections in Saudi Tertiary Care Center

2020 ◽  
Vol 13 ◽  
pp. 117863372090597 ◽  
Author(s):  
M Bosaeed ◽  
A Ahmad ◽  
A Alali ◽  
E Mahmoud ◽  
L Alswidan ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Clinical Success ◽  
Care Center ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Signs And Symptoms ◽  
Central Line ◽  
Multidrug Resistant ◽  
Resistance Mechanisms ◽  
Duration Of Treatment

Introduction: Multidrug-resistant Pseudomonas aeruginosa isolates have multiple resistance mechanisms, and there are insufficient therapeutic options to target them. Ceftolozane-tazobactam is a novel antipseudomonal agent that contains a combination of an oxyimino-aminothiazolyl cephalosporin (ceftolozane) and a β-lactamase inhibitor (tazobactam). Methods: A single-center retrospective observational study between January 2017 and December 2018 for patients who had been diagnosed with carbapenem-resistant P aeruginosa infections and treated with ceftolozane-tazobactam for more than 72 hours. We assessed clinical success based on microbiological clearance as well as the clinical resolution of signs and symptoms of infection. Results: A total of 19 patients fit the inclusion criteria, with a median age was 57 years, and 53% were female. The types of infections were nosocomial pneumonia, acute bacterial skin, and skin structure infections; complicated intra-abdominal infections; and central line–associated bloodstream infections. All of the isolates were resistant to both meropenem and imipenem. The duration of therapy was variable (average of 14 days). At day 14 of starting ceftolozane-tazobactam, 18 of 19 patients had a resolution of signs and symptoms of the infection. Only 14 of 19 patients (74%) had proven microbiological eradication observed at the end of therapy. During therapy, there was no adverse event secondary to ceftolozane-tazobactam, and no Clostridium difficile infection was identified. The 30-day mortality rate was 21% (4/19). Conclusions: Multidrug-resistant P aeruginosa infection is associated with high mortality, which would potentially be improved using a new antibiotic such as ceftolozane-tazobactam. Studies are required to explain the role of combination therapy, define adequate dosing, and identify the proper duration of treatment.

scholarly journals Impact of the coronavirus disease 2019 (COVID-19) pandemic on nosocomial Clostridioides difficile infection

2020 ◽  
pp. 1-5 ◽  
Author(s):  
Manuel Ponce-Alonso ◽  
Javier Sáez de la Fuente ◽  
Angela Rincón-Carlavilla ◽  
Paloma Moreno-Nunez ◽  
Laura Martínez-García ◽  
...  
Keyword(s):  
Tertiary Care ◽  
Control Period ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
Incidence Density ◽  
Care Hospital ◽  
Patient Mobility ◽  
Clostridioides Difficile ◽  
Defined Daily Doses ◽  
The Impact

Abstract Objectives: The coronavirus disease 2019 (COVID-19) pandemic has induced a reinforcement of infection control measures in the hospital setting. Here, we assess the impact of the COVID-19 pandemic on the incidence of nosocomial Clostridioides difficile infection (CDI). Methods: We retrospectively compared the incidence density (cases per 10,000 patient days) of healthcare-facility–associated (HCFA) CDI in a tertiary-care hospital in Madrid, Spain, during the maximum incidence of COVID-19 (March 11 to May 11, 2020) with the same period of the previous year (control period). We also assessed the aggregate in-hospital antibiotic use (ie, defined daily doses [DDD] per 100 occupied bed days [BD]) and incidence density (ie, movements per 1,000 patient days) of patient mobility during both periods. Results: In total, 2,337 patients with reverse transcription-polymerase chain reaction–confirmed COVID-19 were admitted to the hospital during the COVID-19 period. Also, 12 HCFA CDI cases were reported at this time (incidence density, 2.68 per 10,000 patient days), whereas 34 HCFA CDI cases were identified during the control period (incidence density, 8.54 per 10,000 patient days) (P = .000257). Antibiotic consumption was slightly higher during the COVID-19 period (89.73 DDD per 100 BD) than during the control period (79.16 DDD per 100 BD). The incidence density of patient movements was 587.61 per 1,000 patient days during the control period and was significantly lower during the COVID-19 period (300.86 per 1,000 patient days) (P < .0001). Conclusions: The observed reduction of ~70% in the incidence density of HCFA CDI in a context of no reduction in antibiotic use supports the importance of reducing nosocomial transmission by healthcare workers and asymptomatic colonized patients, reinforcing cleaning procedures and reducing patient mobility in the epidemiological control of CDI.

The impact of vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated VRE bacteremia

2021 ◽  
pp. 1-6
Author(s):  
Sun Young Cho ◽  
Hye Mee Kim ◽  
Doo Ryeon Chung ◽  
Jong Rim Choi ◽  
Myeong-A Lee ◽  
...  
Keyword(s):  
Policy Change ◽  
Tertiary Care ◽  
High Risk Patient ◽  
Hospital Setting ◽  
Molecular Characteristics ◽  
Screening Policy ◽  
Before And After ◽  
Vancomycin Resistant ◽  
Healthcare Associated ◽  
The Impact

Abstract Objective: To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting. Design: A quasi-experimental before-and-after study. Setting: A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea. Methods: Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis. Results: After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001–0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%). Conclusions: The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.

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