Sustained Impact of an Antibiotic Stewardship Intervention for Community-Acquired Pneumonia

2016 ◽  
Vol 37 (10) ◽  
pp. 1243-1246 ◽  
Author(s):  
David X. Li ◽  
Marcela A. Ferrada ◽  
Edina Avdic ◽  
Pranita D. Tamma ◽  
Sara E. Cosgrove
Keyword(s):  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Infect Control Hosp ◽  
Short Term ◽  
Antibiotic Overuse ◽  
Additional Intervention

Antibiotic stewardship interventions targeting community-acquired pneumonia have been successful in reducing antibiotic overuse in the short term, but the sustainability of their effects has not been investigated. We report that improvements in antibiotic use due to a syndrome-focused intervention for community-acquired pneumonia were sustained 3 years later without additional intervention.Infect Control Hosp Epidemiol 2016;1–4

scholarly journals Clinical Progress Note: Procalcitonin in the Diagnosis and Management of Community-Acquired Pneumonia in Hospitalized Adults

2019 ◽  
Vol 14 (11) ◽  
pp. 691-693 ◽  
Author(s):  
Justin J Choi ◽  
Matthew W McCarthy ◽  
Matthew S Simon ◽  
Arthur T Evans ◽  
Wesley H Self ◽  
...  
Keyword(s):  
Bacterial Infections ◽  
Viral Infections ◽  
Secondary Analysis ◽  
Hospital Setting ◽  
Antibiotic Use ◽  
The United States ◽  
Community Acquired Pneumonia ◽  
Antibiotic Overuse ◽  
Diagnosis And Management ◽  
The Us

Community-acquired pneumonia (CAP) accounts for more than 1.5 million adult hospitalizations and 100,000 deaths each year in the United States.1 Antibiotic overuse in the hospital setting is an important contributor to the rise of antibiotic resistance, prompting increased efforts to limit inappropriate antibiotic use in hospitals.2 Procalcitonin, a precursor of the hormone calcitonin, is upregulated in bacterial infections and downregulated in viral infections. The US Food and Drug Administration has approved it as a serum biomarker to assist clinicians with decisions about using antibiotics.3 There is no consensus on how to best use procalcitonin in the management of CAP. We provide a practical update that includes a review of recent literature, added secondary analysis, and expert opinion surrounding the use of procalcitonin in the diagnosis and management of CAP in hospitalized adults.

scholarly journals 1991. Implementation of Rapid Turnaround PCR Bacterial/Viral Panel Testing in Community-acquired Pneumonia Decreases LOS, Antibiotic Cost, Antibiotic Charges, and Antibiotic Use

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S668-S668
Author(s):  
Rebecca D Shadowen ◽  
Akash Doshi ◽  
Rene Ndzi ◽  
Faraaz Kazimuddin
Keyword(s):  
Logistic Regression ◽  
Antibiotic Stewardship ◽  
Intervention Group ◽  
Binary Logistic Regression ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
T Test ◽  
Control Group ◽  
Panel Testing ◽  
Antibiotic Cost

Abstract Background Community-acquired pneumonia (CAP) is a significant infection contributing to hospitalization, morbidity, mortality, intensive care, antibiotic use, and healthcare costs. Antibiotic stewardship aims to improve appropriate antibiotic use which addresses these same issues. Accurate, confirmed diagnosis upon presentation of CAP patients using Respiratory Bacteria/Viral (RBVP) Polymerase Chain Reaction (PCR) panels can significantly impact outcomes in the CAP patient population. Methods In this cross-sectional study, commercially available RBVP PCR panels were used. Comparison of CAP patient populations was done before PCR use (2014–2015 control group) and after implementation (2016–2017 intervention group) using a provider choice intervention following education and order availability. Providers were educated via multiple means with lectures, individual meetings, online brief presentation, and group discussions. A nursing computer-based learning module was also developed and required to be completed. Independent sample t-test and binary logistic regression were used to analyze data. Results Out of total 2,523 observations in the study, 1,994 (79.03%) were in the control group and 529 (20.96%) were in the intervention group. An independent sample t-test showed significant differences in the mean of length of stay (LOS) (P = 0.04, 95% CI: 8.67–9.36), total antibiotic cost (TAC) (P = 0.000, 95% CI: 486.61–550.45), antibiotic charges (ACH) (P = 0.048, 95% CI: 1,815.79–2,009.75), and antibiotic defined daily doses (DDD) (P = 0.039, 95% CI: 6.84–7.42). Binary logistic regression results revealed statistical significance in LOS (P = 0.01, 95% CI: 0.9251–0.9902) and TAC (P = 0.000, 95% CI: 0.9989–0.9994). Actual savings per patient were LOS 0.88 days, TAC $202.73, ACH $240.23, and DDD 0.77. Conclusion The use of RBVP PCR panel testing in CAP patients decreases antibiotic use, LOS, and cost of care. This correlated with antibiotic de-escalation providing a significant contribution to antibiotic stewardship. PCR panel testing with rapid turnaround is widely available and cost effective. Disclosures All authors: No reported disclosures.

scholarly journals 2890. Antibiotic Overuse at Discharge in Hospitalized Patients with Bacteriuria or Treated for Pneumonia: A Multi-Hospital Cohort Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S78-S79
Author(s):  
Valerie M Vaughn ◽  
Lindsay A Petty ◽  
David Ratz ◽  
Anurag N Malani ◽  
Elizabeth Mclaughlin ◽  
...  
Keyword(s):  
Asymptomatic Bacteriuria ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Hospitalized Patients ◽  
Disease State ◽  
Antibiotic Overuse ◽  
Antibiotic Duration ◽  
Stopping Treatment ◽  
Healthcare Associated ◽  
Alternative Antibiotic

Abstract Background Antibiotics prescribed at hospital discharge account for half of antibiotic use related to hospitalization for urinary tract infection or bacterial pneumonia. It is unclear how much antibiotic use at discharge represents overuse, and thus, could potentially be improved through antibiotic stewardship. Methods From July 2017 to December 2018, trained abstractors at 46 Michigan hospitals collected detailed data on a sample of adult, nonintensive care, hospitalized patients with bacteriuria or treated for community-acquired or healthcare-associated pneumonia (discharge diagnosis of pneumonia plus antibiotic treatment). Antibiotic prescriptions at discharge were assessed for overuse using a guideline-based hierarchical algorithm: evaluating first for unnecessary antibiotics (noninfectious/nonbacterial syndrome), then excess duration (antibiotics needed, but prescribed for longer than necessary), and finally avoidable fluoroquinolones (safer alternative antibiotic available) (Figure 1). For each disease state, descriptive results are shown with comparisons by t- or Fisher’s exact tests. Results Of 17,157 patients (7,283 with bacteriuria; 9,874 treated for pneumonia), 30.1% of patients with bacteriuria had asymptomatic bacteriuria and 11.4% of patients treated for pneumonia did not meet diagnostic criteria for pneumonia. The most common antibiotics prescribed at discharge were fluoroquinolones. Nearly half (43.6%) of patients had antibiotic overuse at discharge (33.8% bacteriuria, 50.9% pneumonia), with a median 4 days of overuse after discharge (Table 1). For bacteriuria, 45.0% of overuse days at discharge were due to unnecessary antibiotics; for pneumonia, 61.2% were due to excess antibiotic duration (Figure 2). Patients with community-acquired pneumonia and those with sepsis on admission had the highest rates of antibiotic overuse at discharge (Table 2). Conclusion In the largest assessment of antibiotics at discharge to-date, antibiotic overuse at discharge was extremely common. Specific targets for discharge stewardship vary by disease state. Notably, interventions may be more effective at reducing fluoroquinolone prescribing at discharge indirectly by stopping treatment for asymptomatic bacteriuria and reducing excess duration in pneumonia. Disclosures All Authors: No reported Disclosures.

scholarly journals Response Adjusted for Days of Antibiotic Risk (RADAR): evaluation of a novel method to analyze antibiotic stewardship interventions

2017 ◽  
Author(s):  
Valentijn A. Schweitzer ◽  
Maarten van Smeden ◽  
Douwe F. Postma ◽  
Jan Jelrik Oosterheert ◽  
Marc J.M. Bonten ◽  
...  
Keyword(s):  
Relative Risk ◽  
Clinical Outcome ◽  
Antibiotic Stewardship ◽  
Sample Size Calculation ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Beta Lactam ◽  
Risk Of Mortality ◽  
Novel Method ◽  
Severe Community Acquired Pneumonia

ABSTRACTOBJECTIVESThe Response Adjusted for Days of Antibiotic Risk (RADAR)-statistic was proposed to improve efficiency of antibiotic stewardship trials. We studied the behavior of RADAR in a non-inferiority trial in which a beta-lactam monotherapy strategy (BL, n=656) was non-inferior to fluoroquinolone monotherapy (FQL, n=888) for moderately-severe community-acquired pneumonia (CAP) patients.METHODSPatients were ranked according to clinical outcome, using five or eight categories, and antibiotic use. RADAR was calculated as the probability that the BL group had a more favorable ranking than the FQL group. To investigate the sensitivity of RADAR to detrimental clinical outcome we simulated increasing rates of 90-day mortality in the BL group and performed the RADAR and non-inferiority analysis.RESULTSThe RADAR of the BL-group compared to the FQL group was 60.3% (95% confidence interval 57.9%-62.7%) using five and 58.4% (95% CI 56.0%-60.9%) using eight clinical outcome categories, all in favor of BL. Sample sizes for RADAR were 250 and 580 patients per study arm using five or eight clinical outcome categories, respectively, reflecting 38% and 89% of the original non-inferiority sample size calculation. With simulated mortality rates, loss of non-inferiority of the BL-group occurred at a relative risk of 1.125 in the conventional analysis, whereas using RADAR the BL-group lost superiority at a relative risk of mortality of 1.25 and 1.5, with eight and five clinical outcome categories, respectively.CONCLUSIONSRADAR favored BL over FQL therapy for CAP. Although RADAR required fewer patients than conventional non-inferiority analysis, the statistic was less sensitive to detrimental outcomes.

scholarly journals 178. Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes – National Healthcare Safety Network (NHSN), 2016–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Katryna A Gouin ◽  
Sarah Kabbani; Angela Anttila ◽  
Josephine Mak ◽  
Elisabeth Mungai ◽  
Ti Tanissha McCray ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Care Facility ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Long Term Care Facility ◽  
The Core ◽  
Use Of Resources ◽  
Core Elements

Abstract Background Since 2016, nursing homes (NHs) enrolled in the Centers for Disease Control and Prevention’s NHSN Long-term Care Facility (LTCF) Component have reported on their implementation of the core elements of antibiotic stewardship. In 2016, 42% of NHs reported implementing all seven core elements. Recent regulations require antibiotic stewardship programs in NHs. The objectives of this analysis were to track national progress in implementation of the core elements and evaluate how time dedicated to infection prevention and control (IPC) is associated with the implementation of the core elements. Methods We used the NHSN LTCF 2016–2018 Annual Surveys to assess NH characteristics and implementation of the core elements, defined as self-reported implementation of at least one corresponding stewardship activity. We reported absolute differences in percent implementation. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all seven core elements, while controlling for confounding by facility characteristics. Results We included 7,506 surveys from 2016–2018. In 2018, 71% of NHs reported implementation of all seven core elements, a 28% increase from 2016 (Fig. 1). The greatest increases in implementation from 2016–2018 were in Education (+19%), Reporting (+18%) and Drug Expertise (+15%) (Fig. 2). Ninety-eight percent of NHs had an individual responsible for antibiotic stewardship activities (Accountability), with 30% indicating that the role was fulfilled by an infection preventionist. Furthermore, 71% of NHs reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. NHs that reported at least 20 hours of IPC activity per week were 14% more likely to implement all seven core elements, when controlling for facility ownership and affiliation, 95% CI: (1.07, 1.20). Conclusion NHs reported substantial progress in antibiotic stewardship implementation from 2016–2018. Improvements in accessing drug expertise, providing education and reporting antibiotic use may reflect increased stewardship awareness and use of resources among NH providers under new regulatory requirements. NHs with at least 20 hours dedicated to IPC per week may have greater capacity to implement all core elements. Disclosures All Authors: No reported disclosures

scholarly journals Development of key quality indicators for appropriate antibiotic use in the Republic of Korea: results of a modified Delphi survey

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Bongyoung Kim ◽  
◽  
Myung Jin Lee ◽  
Se Yoon Park ◽  
Song Mi Moon ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Quality Indicators ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Republic Of Korea ◽  
Cochrane Library ◽  
Surgical Prophylaxis ◽  
Modified Delphi ◽  
Stewardship Program ◽  
The Republic

Abstract Background An effective antibiotic stewardship program relies on the measurement of appropriate antibiotic use, on which there is a lack of consensus. We aimed to develop a set of key quality indicators (QIs) for nationwide point surveillance in the Republic of Korea. Methods A systematic literature search of PubMed, EMBASE, and Cochrane Library (publications until 20th November 2019) was conducted. Potential key QIs were retrieved from the search and then evaluated by a multidisciplinary expert panel using a RAND-modified Delphi procedure comprising two online surveys and a face-to-face meeting. Results The 23 potential key QIs identified from 21 studies were submitted to 25 multidisciplinary expert panels, and 17 key QIs were retained, with a high level of agreement (13 QIs for inpatients, 7 for outpatients, and 3 for surgical prophylaxis). After adding up the importance score and applicability, six key QIs [6 QIs (Q 1–6) for inpatients and 3 (Q 1, 2, and 5) for outpatients] were selected. (1) Prescribe empirical antibiotic therapy according to guideline, (2) change empirical antibiotics to pathogen-directed therapy, (3) obtain culture samples from suspected infection sites, (4) obtain two blood cultures, (5) adapt antibiotic dosage to renal function, and (6) document antibiotic plan. In surgical prophylaxis, the QIs to prescribe antibiotics according to the guideline and initiate antibiotic therapy 1 h before incision were selected. Conclusions We identified key QIs to measure the appropriateness of antibiotic therapy to identify targets for improvement and to evaluate the effects of antibiotic stewardship intervention.

#61: Antibiotic Use for Community-Acquired Pneumonia Among Hospitalized Children in Japan

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S13-S13
Author(s):  
Chiaki Tao-Kidoguchi ◽  
Eiki Ogawa ◽  
Kensuke Shoji ◽  
Isao Miyairi
Keyword(s):  
Physician Behavior ◽  
Point Of Care ◽  
Descriptive Analysis ◽  
Antibiotic Use ◽  
Community Acquired Pneumonia ◽  
Clinical Criteria ◽  
Focus Of Infection ◽  
Tract Infections ◽  
Short Courses ◽  
Viral Etiologies

Abstract Background Judicious use of antimicrobials is the cornerstone of action against antimicrobial resistance. Respiratory tract infections account for over 80% of pediatric antibiotic use in Japan. Antibiotics are generally used empirically for most hospitalized patients with pneumonia although it is becoming clearer that viral etiologies account for approximately 70% of these cases. Defining the characteristics of patients who are managed with a short course of antibiotics and subsequently do well, may lead to setting clinical criteria for early termination of antibiotics. Methods We performed a retrospective descriptive analysis. Medical charts of patients aged 3 months to 18 years, who were admitted with a diagnosis of pneumonia, bronchitis, bronchiolitis, or asthma to the Department of Interdisciplinary medicine at the National Center for Child Health and Development from March 2018 through February 2019 were reviewed. Those who had respiratory symptoms and were started on antibiotics within 48 hours of hospitalization were included. Those who had a focus of infection elsewhere or were immunocompromised were excluded. Results Of the 556 candidates, 80 patients met the criteria. The median age was 1.5 years which included 42.5% (34/80) with comorbidities. Underlying conditions included 9 with trisomy 21, and 8 with perinatal issues. Rapid antigen testing was performed and 7 patients with RSV, 5 patients with influenza, 1 patient with human metapneumovirus were identified. The average duration of antibiotic therapy was 7.2 days (range 2–14 days). There were no statistical differences in the characteristics of patients who received antibiotics for more or less than 5 days. The positivity of the rapid antigen test tended to be higher in those who received antibiotics for a shorter period (25% vs. 15%). There were no differences in the rate of readmission or complications between the two groups. Conclusion We were unable to identify a clear characteristic of patients who received short courses of antibiotics for pneumonia. The trend observed for those who had a point of care testing may suggest that the use of a multiplex PCR testing covering a greater number of pathogens would influence physician behavior in antibiotic use.

scholarly journals 180. Leveraging the Electronic Medical Record as a Method of Antibiotic Stewardship

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S97-S97
Author(s):  
Christina M Kaul ◽  
Eric Molina ◽  
Donna Armellino ◽  
Mary Ellen Schilling ◽  
Mark Jarrett
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
P Value ◽  
Inpatient Setting ◽  
Post Intervention ◽  
Paired Samples ◽  
Viable Method

Abstract Background Overutilization of antibiotics remains an issue in the inpatient setting. What is more, many protocols geared toward curbing improper antibiotic use rely heavily on resource- and personnel-intensive interventions. Thus, the potential for using the EMR to facilitate antibiotic stewardship remains largely unexplored. Methods We implemented a novel change for ordering certain antibiotics in our EMR: ceftriaxone, daptomycin, ertapenem, imipenem, meropenem, and piperacillin-tazobactam. When ordering one of these antibiotics, providers had to note a usage indication, which assigned a usage duration as per our Antibiotic Stewardship Committee guidelines. Pre-intervention, manual discontinuation was required if a provider did not enter a duration. The intervention was enacted August 2019 in 13 hospitals. Data was collected from January 2018 to February 2020. Antibiotic usage was reported monthly as rate per 1000-patient days. Monthly pre- and post-intervention rates were averaged, respectively. Paired samples t-tests were used to compare pre- and post-intervention rates per unit type per hospital. A p-value of less than 0.05 was considered significant. Units with minimal usage, as defined by a pre- or post-intervention mean of 0, were excluded from analysis. Example of Ordering an Antibiotic Prior to Intervention Example of Ordering an Antibiotic After Intervention Results Ertapenem was noted to have a statistically significant decrease in utilization in seven units at three hospitals. Piperacillin-tazobactam was found to have a decrease in utilization in 19 units at eight hospitals. Daptomycin was found to have a decrease in utilization in one unit. Significant decreases in the utilization of ceftriaxone, imipenem, and meropenem were not noted. Example of Statistically Significant Decreased Utilization in Piperacillin-Tazobactam on a Medical-Surglcal Unit Conclusion Our study showed a statistically significant decrease in use of ertapenem, piperacillin-tazobactam and daptomycin using a simple built-in EMR prompt that curtails provider error. This should allow for an increased ease of integration, as the protocol does not require a host of resources for maintenance. Of note is decreased utilization of piperacillin-tazobactam and ertapenem across multiple hospitals, most notably on the medical and surgical wards. Thus, usage of the EMR without personnel-intensive protocols is a viable method for augmenting antibiotic stewardship in health systems. Disclosures All Authors: No reported disclosures

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