scholarly journals Perspectives on antimicrobial use at the end of life among antibiotic stewardship programs: A survey of the Society for Healthcare Epidemiology of America Research Network

2019 ◽  
Vol 40 (9) ◽  
pp. 1074-1076 ◽  
Author(s):  
Rupak Datta ◽  
Jeffrey Topal ◽  
Dayna McManus ◽  
Louise-Marie Dembry ◽  
Vincent Quagliarello ◽  
...  
Keyword(s):  
End Of Life ◽  
Antibiotic Stewardship ◽  
Research Network ◽  
Antimicrobial Use ◽  
Healthcare Epidemiology

Current infection prevention and antibiotic stewardship program practices: A survey of the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN)

2019 ◽  
Vol 40 (9) ◽  
pp. 1046-1049
Author(s):  
Kathleen Chiotos ◽  
Clare Rock ◽  
Marin L. Schweizer ◽  
Valerie M. Deloney ◽  
Daniel J. Morgan ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Antibiotic Stewardship ◽  
Infection Prevention ◽  
Research Network ◽  
Healthcare Facilities ◽  
Carbapenem Resistant ◽  
Stewardship Program ◽  
Current Infection ◽  
Healthcare Epidemiology ◽  
Carbapenem Resistant Enterobacteriaceae

AbstractWe used a survey to characterize contemporary infection prevention and antibiotic stewardship program practices across 64 healthcare facilities, and we compared these findings to those of a similar 2013 survey. Notable findings include decreased frequency of active surveillance for methicillin-resistant Staphylococcus aureus, frequent active surveillance for carbapenem-resistant Enterobacteriaceae, and increased support for antibiotic stewardship programs.

Prolonged postprocedural antimicrobial use: A survey of the Society for Healthcare Epidemiology of America Research Network

2019 ◽  
Vol 40 (11) ◽  
pp. 1281-1283 ◽  
Author(s):  
Mireia Puig-Asensio ◽  
Eli N. Perencevich ◽  
Daniel J. Livorsi
Keyword(s):  
Antimicrobial Prophylaxis ◽  
Research Network ◽  
Antimicrobial Use ◽  
Important Target ◽  
Surgical Antimicrobial Prophylaxis ◽  
Healthcare Epidemiology ◽  
Current Guidelines

AbstractContinuing surgical antimicrobial prophylaxis after the incision is closed is not recommended in current guidelines. Our survey found that only 30.8% of hospitals had fully adopted these new recommendations. Feedback on prophylaxis duration was infrequently provided. Promoting guideline-concordant surgical antimicrobial prophylaxis discontinuation is an important target for future stewardship interventions.

Interfacility transfer communication of multidrug-resistant organism colonization or infection status: Practices and barriers in the acute-care setting

2021 ◽  
pp. 1-6
Author(s):  
Katherine D. Ellingson ◽  
Brie N. Noble ◽  
Genevieve L. Buser ◽  
Graham M. Snyder ◽  
Jessina C. McGregor ◽  
...  
Keyword(s):  
Acute Care ◽  
Infection Prevention ◽  
Multidrug Resistant ◽  
Research Network ◽  
Resistant Organism ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Hospital Size ◽  
Academic Affiliation ◽  
Healthcare Epidemiology

Abstract Objective: To describe interfacility transfer communication (IFTC) methods for notification of multidrug-resistant organism (MDRO) status in a diverse sample of acute-care hospitals. Design: Cross-sectional survey. Participants: Hospitals within the Society for Healthcare Epidemiology of America (SHEA) Research Network (SRN). Methods: SRN members completed an electronic survey on protocols and methods for IFTC. We assessed differences in IFTC frequency, barriers, and perceived benefit by presence of an IFTC protocol. Results: Among 136 hospital representatives who were sent the survey, 54 (40%) responded, of whom 72% reported having an IFTC protocol in place. The presence of a protocol did not differ significantly by hospital size, academic affiliation, or international status. Of those with IFTC protocols, 44% reported consistent notification of MDRO status (>75% of the time) to receiving facilities, as opposed to 13% from those with no IFTC protocol (P = .04). Respondents from hospitals with IFTC protocols reported significantly fewer barriers to communication compared to those without (2.8 vs 4.3; P = .03). Overall, however, most respondents (56%) reported a lack of standardization in communication. Presence of an IFTC protocol did not affect whether respondents perceived IFTC protocols as having a significant impact on infection prevention or antimicrobial stewardship. Conclusions: Most respondents reported having an IFTC protocol, which was associated with reduced communication barriers at transfer. Standardization of protocols and clarity about expectations for sending and receipt of information related to MDRO status may facilitate IFTC and promote appropriate and timely infection prevention practices.

scholarly journals 139. association of Physician Orders for Life-sustaining Treatment (POLST) with Antimicrobial Use at End of Life in Cancer Patients: An Antimicrobial Stewardship Opportunity

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S199-S200
Author(s):  
Olivia Kates ◽  
Elizabeth M Krantz ◽  
Juhye Lee ◽  
John Klaassen ◽  
Jessica Morris ◽  
...  
Keyword(s):  
End Of Life ◽  
Cancer Patients ◽  
Symptom Management ◽  
Research Study ◽  
Antibiotic Use ◽  
Antimicrobial Use ◽  
Study Investigator ◽  
Days Of Therapy ◽  
Life Sustaining Treatment ◽  
Rate Ratios

Abstract Background IDSA/SHEA guidelines recommend that antimicrobial stewardship programs support providers in antibiotic decisions for end of life care. Washington State Physician Orders for Life-Sustaining Treatment (POLST) forms allow patients to indicate antimicrobial use preferences. We sought to characterize antimicrobial use in the last 30 days of life for cancer patients by presence of a POLST and antimicrobial use preferences. Methods We performed a single-center, retrospective cohort study of cancer patient deaths from January 1, 2016 - June 30, 3018. Patient demographics, clinical characteristics, POLST, and antimicrobial use within 30 days before death were extracted from electronic records. To test for an association between POLST completed at least 30 days before death and inpatient antimicrobial days of therapy (DOT) in the 30 days before death, we used negative binomial models adjusted for age, sex, race, and service line (hematologic versus solid malignancy); model estimates are presented as incidence rate ratios (IRR) with 95% confidence intervals (CI) Results Of 1796 patients, 406 (23%) had a POLST. 177/406 (44%) were completed less than 30 days before death, and 58/177 (32.8%) specified limited antibiotic use; 40/177 (23%) did not specify any antimicrobial use preference (Fig 1). Of 1295 patients with at least 1 inpatient day in the 30 days before death, 1070 (83%) received at least 1 inpatient antimicrobial with median DOT of 1077 per 1000 inpatient days (Tab 1). There was no difference in DOT among patients with and without a POLST > /= 30 days before death (IRR 0.92, CI 0.77, 1.10). Patients with a POLST specifying limited antibiotic use had significantly lower inpatient IV antimicrobial DOT compared to those without a POLST (IRR 0.64, CI 0.42–0.97) (Fig 2). Figure 1. Classification of Patients by Presence of POLST, Timing, and Antimicrobial Preference Content of POLST. Numbers shown represent the number of patients (percentage). Full antibiotic use refers to the selection “Use antibiotics for prolongation of life.” Limited antibiotic use refers to the selection “Do not use antibiotics except when needed for symptom management.” Table 1: Antimicrobial use for all patients and by advance directive group Figure 2. Forest plot of model estimates, represented as incidence rate ratios (IRR) with 95% confidence intervals (CI), for associations between POLST antimicrobial specifications completed at least 30 days before death and inpatient antibiotic days of therapy (DOT) in the 30 days before death. Estimates represent comparisons between each POLST category and no POLST completed at least 30 days before death. Dots represent the IRR and brackets extend to the lower and upper limit of the 95% CI. Blue estimates are for the inpatient antibiotic DOT outcome and red estimates are for the inpatient IV antibiotic DOT outcome. Conclusion POLST completion is rare > /= 30 days before death, with few POLSTs specifying antimicrobial use. Compared to those with no POLST in this time frame, patients who indicated that antibiotics should be used only for symptom management received significantly fewer inpatient IV antimicrobials. Early discussion of advance directives including POLST with specification of antimicrobial use preferences may promote more thoughtful use of antimicrobials near the end of life in a compassionate, patient-centered way. Disclosures Steven A. Pergam, MD, MPH, Chimerix, Inc (Scientific Research Study Investigator)Global Life Technologies, Inc. (Research Grant or Support)Merck & Co. (Scientific Research Study Investigator)Sanofi-Aventis (Other Financial or Material Support, Participate in clinical trial sponsored by NIAID (U01-AI132004); vaccines for this trial are provided by Sanofi-Aventis)

scholarly journals 1081. Use of Antimicrobials at the End of Life (EOL): A Retrospective Cohort Study Analyzing Providers’ Reasons for Prescribing Antimicrobials at the EOL, Their Benefits and Adverse Effects

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S383-S384
Author(s):  
Pooja Vyas ◽  
Prashant Malhotra ◽  
Santiago Lopez ◽  
Bruce Hirsch ◽  
Kayla D Finuf
Keyword(s):  
End Of Life ◽  
Symptom Relief ◽  
Symptom Control ◽  
Tertiary Care ◽  
Retrospective Chart Review ◽  
Antimicrobial Use ◽  
Care Hospital ◽  
Chi Square ◽  
Potential Benefits ◽  
Tract Infections

Abstract Background Infections are common in terminally ill patients, and although antibiotics are frequently prescribed, their benefit for symptom relief is not clear. Antimicrobials at the end of life (EOL) increase the risk of antimicrobial resistance and Clostridium difficile infection. Very few studies have described the risks and benefits of antimicrobials in patients at EOL. Here, we describe a retrospective chart review of antimicrobial use at EOL. Methods We reviewed electronic medical records of patients admitted in a palliative care unit of a tertiary care hospital between 2017 and 2018 and assessed antimicrobial use in the last 14 days of life. The analysis excluded neutropenic patients. Differences in demographics and symptom control between patients who did or did not receive antibiotics (AB+ or AB−) were analyzed using chi-square analyses; P-values were computed using Mann–Whitney tests. Results Of a total of 133 patients included, 89 (67%) received antimicrobials (AB+); however, the role of antibiotics was documented in only 12% of patients. The AB− and AB+ groups were similar with respect to demographics, including sex, and Charleston Comorbidity Index except for age (table). Documented infections were similar between AB− and AB+ groups, except urinary tract infections. No statistically significant differences were noted in documented symptoms including pain, dyspnea, fever, lethargy, and alteration of mental state or length of stay (LOS). Conclusion Our study did not show differences in frequencies of documented symptoms with use of antimicrobials at EOL. These results indicate that the risks of antimicrobial use may outweigh potential benefits and their use should be a part of goals of care discussions at EOL. Disclosures All authors: No reported disclosures.

scholarly journals Why is optimisation of antimicrobial use difficult at the end of life?

2019 ◽  
Vol 49 (2) ◽  
pp. 269-271 ◽  
Author(s):  
Jennifer Broom ◽  
Alex Broom ◽  
Phillip Good ◽  
Zarnie Lwin
Keyword(s):  
End Of Life ◽  
Antimicrobial Use

Practices to Improve Antimicrobial Use at 47 US Hospitals the Status of the 1997 SHEA/IDSA Position Paper Recommendations

2000 ◽  
Vol 21 (4) ◽  
pp. 256-259 ◽  
Author(s):  
Rachel M. Lawton ◽  
Scott K. Fridkin ◽  
Robert P. Gaynes ◽  
John E. McGowan ◽  
Keyword(s):  
Infectious Disease ◽  
Position Paper ◽  
Antimicrobial Use ◽  
Cross Sectional Survey ◽  
Phase 3 ◽  
Infectious Disease Physician ◽  
Cross Sectional ◽  
Antimicrobial Prescribing ◽  
The Status ◽  
Healthcare Epidemiology

Objective.To determine the status of programs to improve antimicrobial prescribing at select US hospitals.Design:Cross-sectional survey.Participants and Setting:Pharmacy and infection control staff at all 47 hospitals participating in phase 3 of Project Intensive Care Antimicrobial Resistance Epidemiology.Results:All 47 hospitals had some programs to improve antimicrobial use, but the practices reported varied considerably. All used a formulary, and 43 (91%) used it in conjunction with at least one of the other three antimicrobial-use policies evaluated: stop orders, restriction, and criteria-based clinical practice guidelines (CPGs). CPGs were reported most commonly (70%), followed by stop orders (60%) and restriction policies (40%). Although consultation with an infectious disease physician (70%) or pharmacist (66%) was commonly used to influence initial antimicrobial choice, few (40%) reported a system to measure compliance with these consultations.Conclusions:In most hospitals surveyed, practices to improve antimicrobial use, although present, were inadequate based on recommendations in a Society for Healthcare Epidemiology of America and Infectious Disease Society of America joint position paper. There is room to improve antimicrobial-use stewardship at US hospitals.

scholarly journals Choosing Wisely in Healthcare Epidemiology and Antimicrobial Stewardship

2016 ◽  
Vol 37 (7) ◽  
pp. 755-760 ◽  
Author(s):  
Daniel J. Morgan ◽  
Lindsay D. Croft ◽  
Valerie Deloney ◽  
Kyle J. Popovich ◽  
Chris Crnich ◽  
...  
Keyword(s):  
Delphi Method ◽  
Convincing Evidence ◽  
Choosing Wisely ◽  
Research Network ◽  
Individual Member ◽  
Medical Overuse ◽  
Hospital Epidemiology ◽  
Endotracheal Tubes ◽  
Top 40 ◽  
Healthcare Epidemiology

OBJECTIVETo identify Choosing Wisely items for the American Board of Internal Medicine Foundation.METHODSThe Society for Healthcare Epidemiology of America (SHEA) elicited potential items from a hospital epidemiology listserv, SHEA committee members, and a SHEA–Infectious Diseases Society of America compendium with SHEA Research Network members ranking items by Delphi method voting. The SHEA Guidelines Committee reviewed the top 10 items for appropriateness for Choosing Wisely. Five final recommendations were approved via individual member vote by committees and the SHEA Board.RESULTSNinety-six items were proposed by 87 listserv members and 99 SHEA committee members. Top 40 items were ranked by 24 committee members and 64 of 226 SHEA Research Network members. The 5 final recommendations follow: 1. Don’t continue antibiotics beyond 72 hours in hospitalized patients unless patient has clear evidence of infection. 2. Avoid invasive devices (including central venous catheters, endotracheal tubes, and urinary catheters)and, if required, use no longer than necessary. They pose a major risk for infections. 3. Don’t perform urinalysis, urine culture, blood culture, or Clostridium difficile testing unless patients have signs or symptoms of infection. Tests can be falsely positive leading to overdiagnosis and overtreatment. 4. Do not use antibiotics in patients with recent C. difficile without convincing evidence of need. Antibiotics pose a high risk of C. difficile recurrence. 5. Don’t continue surgical prophylactic antibiotics after the patient has left the operating room. Five runner-up recommendations are included.CONCLUSIONSThese 5 SHEA Choosing Wisely and 5 runner-up items limit medical overuse.Infect Control Hosp Epidemiol 2016;37:755–760

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