scholarly journals The Effect of Insurance on Appropriate Hospital Discharge Antibiotics for Patients with Staphylococcus aureus Bacteremia

2020 ◽  
Author(s):  
Thomas McHale ◽  
Jim Medder ◽  
Jenenne Geske ◽  
Mark E Rupp ◽  
Trevor C Van Schooneveld
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Insurance Coverage ◽  
Academic Medical Center ◽  
Inappropriate Therapy ◽  
Commercial Insurance ◽  
Staphylococcus Aureus Bacteremia ◽  
The Impact

Abstract Background Inappropriate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics at discharge is poorly understood. Methods We used a retrospective cohort design to evaluate whether patients with SAB at a large academic medical center over 2 years were more likely to receive inappropriate discharge antibiotics, depending on their category of insurance. Insurance was classified as Medicare, Medicaid, commercial and none. Logistic regression was used to determine the odds of being prescribed inappropriate discharge therapy. Results A total of 273 SAB met inclusion criteria with 14.3% receiving inappropriate discharge therapy. In the unadjusted model, there was 2-fold increased odds of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared to commercial insurance, respectively (OR 2.08, 95% CI 1.39-3.13). After controlling for discharge with nursing assistance and ID consult, there was 1.6-fold increased odds (OR 1.57, 95% CI 0.998-2.53, p=0.064) of being prescribed inappropriate therapy for Medicare, Medicaid, and no insurance, compared to commercial insurance, respectively. We found that being discharged home without nursing assistance resulted in 4-fold increased odds of being prescribed inappropriate therapy (OR 4.16, 95% CI 1.77-9.77, p<0.01) and failing to consult an ID team resulted in 59-fold increased odds of being prescribed inappropriate therapy (OR 59.2, 95% CI 11.4-306.9, p<0.001). Conclusions We found strong evidence that non-commercial insurance, discharging without nursing assistance, and failure to consult ID are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge.

scholarly journals 158. The Effect of Insurance Coverage on Appropriate Selection of Hospital Discharge Antibiotics for Staphylococcus aureus Bacteremia

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S13-S13
Author(s):  
Thomas McHale ◽  
Jim Medder ◽  
Elizabeth Lyden ◽  
Jenenne Geske ◽  
Mark E Rupp ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Antimicrobial Therapy ◽  
Reference Group ◽  
Insurance Coverage ◽  
Inappropriate Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
The Impact ◽  
Selection Of

Abstract Background Inappropriate or inadequate antimicrobial therapy of Staphylococcus aureus bacteremia (SAB) is associated with worsened outcomes. The impact of insurance coverage on appropriate selection of antibiotics is poorly understood. In patients diagnosed with SAB, we assessed the impact of insurance coverage on appropriate selection and duration of antibiotics at discharge. Methods We analyzed 273 patients who were diagnosed with SAB during their hospitalization at Nebraska Medicine and were discharged on antibiotics in 2015 and 2016. Antimicrobial therapy was deemed inappropriate if (i) total treatment duration was less than 14 days, (ii) oral delivery route was used, (iii) vancomycin was used to treat methicillin sensitive S. aureus in non-β-lactam allergic patients, or (iv) any penicillin or cephalosporin was used to treat methicillin-resistant S. aureus. Insurance was categorized broadly into (i) no insurance, (ii) Medicaid, (iii) Medicare, and (iv) Commercial. We collected data on a suite of additional variables that included: type of infectious disease (ID) inpatient consult and location of discharge. Logistic regression was used to determine the odds of being prescribed inappropriate therapy in univariate and multivariate analyses and likelihood ratio tests (LRT) were used to evaluate the strength of evidence. Results In unadjusted models, not having insurance was associated with inappropriate antimicrobial therapy (Reference Group: Any insurance; OR No insurance 4.71; LRT P = 0.027). Two additional risk factors for inappropriate therapy were identified in unadjusted models: discharge location (Refrence Group: Nursing assistance; OR Home without assistance 3.37; 95% CI 1.34–8.46; LRT P = 0.008) and lack of an ID consult (Reference Group: Academic team; OR Not consulted 26.8, 95% CI 7.66–93.8; LRT P < 0.001). Conclusion We found strong evidence that not having insurance, being discharged to home without assistance, and not having an inpatient ID consult are risk factors for being prescribed inappropriate antimicrobial therapy for SAB upon hospital discharge; however, the sparsity of outcomes prevents us from drawing causal inferences. This study adds to the extensive body of evidence that has shown that uninsured patients tend to have suboptimal therapeutic choices. Disclosures All authors: No reported disclosures.

scholarly journals 301. Penicillin Versus Cefazolin or Anti-staphylococcal Penicillins for Penicillin-Susceptible Staphylococcus aureus Bacteremia

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S149-S149
Author(s):  
Mohammed Aldhaeefi ◽  
Jeffrey Pearson ◽  
Sanjat Kanjilal ◽  
Brandon Dionne
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Positive Blood Culture ◽  
Medical Center ◽  
Academic Medical Center ◽  
Similar Distribution ◽  
Clinical Failure ◽  
Staphylococcus Aureus Bacteremia ◽  
Definitive Therapy ◽  
Significant Difference

Abstract Background Staphylococcus aureus bacteremia is a significant cause of mortality. Penicillin (PCN) may have a role in the treatment of penicillin-susceptible Staphylococcus aureus (PSSA) bacteremia as it has a narrower spectrum of activity than cefazolin and is better tolerated than antistaphylococcal penicillins (ASPs). The aim of this study is to evaluate the safety and effectiveness of PCN versus cefazolin or ASPs in the treatment of PSSA bacteremia. Methods This is a single-center, retrospective study at a tertiary academic medical center. All patients with a PSSA blood culture from January 1, 2012 to September 1, 2019 were screened. Patients were excluded if they were treated with a definitive antibiotic (defined as antimicrobial therapy received 72 hours after positive blood culture) other than the study comparators, or if they received combination antibiotic therapy >72 hours from the initial positive blood culture result. The primary outcome was 60-day clinical failure, which was a composite endpoint of change in antibiotic after 72 hours of definitive therapy, recurrence of PSSA bacteremia, infection-related readmission, or all-cause mortality. Results Of 277 patients with PSSA bacteremia, 101 patients were included in the study; 62 (61%) were male and 11 (11%) had a β-lactam allergy. At baseline, 40 patients (40%) had hardware, 25 (25%) had an intravenous line, 6 (6%) were on dialysis, and 4 (4%) had active IV drug use, with similar distribution across antibiotic groups. Penicillin was the most common antibiotic used (Table 1). There was a significant difference among groups with respect to the 60-day clinical failure (log-rank p=0.019). In terms of unadjusted 60-day clinical failure, penicillin had similar outcomes to cefazolin (95% CI -0.29 to 0.104, p=0.376), however, it had statistically significant better outcomes in comparison to the ASPs, nafcillin or oxacillin (95% CI 0.023 to 0.482, p=0.031) (Table 1). Table 1. 60-day outcomes of PSSA bacteremia Conclusion Penicillin is effective and safe in the treatment of PSSA bacteremia and may be preferable to antistaphylococcal penicillins Disclosures All Authors: No reported disclosures

scholarly journals Uncomplicated Staphylococcus aureus Bacteremia Treatment Duration and Outcomes at an Academic Medical Center

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Daniel Taupin ◽  
Adolf W Karchmer ◽  
Roger B Davis ◽  
Mary T LaSalvia
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Duration ◽  
Medical Center ◽  
Academic Medical Center ◽  
Vein Thrombosis ◽  
Duration Of Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Academic Medical ◽  
Intravenous Antibiotics ◽  
Deep Vein

Abstract We compared outcomes and clinical characteristics of uncomplicated Staphylococcus aureus bacteremia planned for a 14-day or >14-day course of intravenous antibiotics. Treatment failure was infrequent in both groups (0% and 5%, respectively). Catheter-associated deep vein thrombosis, immunosuppression, and valvular dysfunction were associated with a longer planned duration of therapy.

scholarly journals Reduced Mortality of Staphylococcus aureus Bacteremia in a Retrospective Cohort Study of 2139 Patients: 2007–2015

2019 ◽  
Vol 70 (8) ◽  
pp. 1666-1674 ◽  
Author(s):  
Eloise D Austin ◽  
Sean S Sullivan ◽  
Nenad Macesic ◽  
Monica Mehta ◽  
Benjamin A Miko ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Medical Center ◽  
Academic Medical Center ◽  
Rapid Diagnostics ◽  
Staphylococcus Aureus Bacteremia ◽  
Group 3 ◽  
Group 2 ◽  
Mssa Infection ◽  
Group 1

Abstract Background Understanding the changing epidemiology of Staphylococcus aureus bacteremia, as well as the variables associated with poor outcomes, can yield insight into potential interventions. Methods This study was a retrospective, observational cohort study of adult patients at an academic medical center in New York City who had S. aureus bloodstream infections between 1 January 2007 and 31 December 2015. Participants were divided into 3 periods: group 1 (2007–2009), group 2 (2010–2012), and group 3 (2013–2015) for trend analysis. All clinical strains were genotyped (spa.). The main outcome was 30-day all-cause mortality. Results There were 1264 episodes of methicillin-susceptible S. aureus (MSSA) and 875 episodes of methicillin-resistant S. aureus (MRSA) bacteremia, with a rising proportion due to MSSA (55% group 1; 59% group 2; 63% group 3; P = .03.) There were no significant changes in average age, gender, Charlson score, and distribution of strain genotypes. Mortality in MRSA infection was unchanged (25% group 1; 25% group 2; 26% group 3), while mortality in MSSA infection significantly declined (18% group 1; 18% group 2; 13% group 3). The average time to antistaphylococcal therapy (AST) in MSSA infection declined during the study (3.7 days group 1; 3.5 group 2; 2.2 group 3). In multivariate analysis, AST within 7 days of initial positive MSSA culture was associated with survival. Conclusions Mortality in MSSA bloodstream infection is declining, associated with a decrease in time to targeted therapy. These results emphasize the potential for rapid diagnostics and early optimization of treatment to impact outcomes in MSSA bacteremia.

scholarly journals 202. Implementation of an Outpatient Parenteral Antimicrobial Therapy (OPAT) Collaborative for Patients with Staphylococcus aureus or Gram-Negative Bacilli Bacteremia Requiring Home Infusion: The PANTHIR Program

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S105-S105
Author(s):  
Jennifer K Ross ◽  
Kimberly D Boeser ◽  
Dana Simonson ◽  
Malia Hain ◽  
Kristi Killelea ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Antimicrobial Therapy ◽  
Medical Center ◽  
Academic Medical Center ◽  
Prolonged Treatment ◽  
High Morbidity ◽  
University Of Minnesota ◽  
Gram Negative ◽  
Home Infusion

Abstract Background Staphylococcus aureus (SA) and Gram-negative bacilli (GNB) bacteremia often require prolonged treatment courses due to high morbidity and mortality risk. Outpatient parenteral antibiotic therapy (OPAT) has emerged as a preferred delivery method. Few data have been published regarding the follow-up and adverse event rates among OPAT patients. We describe outcomes in patients with SA or GNB bacteremia transitioning from an academic medical center to home infusion, prompting the implementation of the Parenteral ANtimicrobial therapy Transitions to Home Infusion Review (PANTHIR) program. Methods A retrospective chart review of adult patients with SA or GNB bacteremia at the University of Minnesota Medical Center requiring home infusion represent a 26-month period. Baseline outcomes, including 30-day hospital readmissions and adverse drug events (ADEs), were calculated. The PANTHIR program was launched as an interdisciplinary collaborative with an infectious diseases (ID) provider, pharmacists, and home infusion specialists. Core program elements include inpatient identification, ID pharmacist review, care plan documentation and communication, and OPAT program measures. Results The retrospective cohort included 69 patients. 23.2% experienced a hospitalization within 30 days of discharge and 26.1% experienced an ADE (Table 1). The mean duration of therapy was 22 days. No patient received aminoglycosides and one required vancomycin. A primary goal was to improve the continuity of care for potentially life-threatening bacteremia during the vulnerable inpatient to outpatient transition. Electronic health record functionality allowed for creation of an OPAT navigator for infectious diseases (ID) pharmacist transition plan documentation, electronic communication with designated provider and home infusion pharmacist, and retrieval of focal data points for ongoing program evaluation. 28 patients have been enrolled in the PANTHIR program with outcomes data collection underway. Table 1. Retrospective data among University of Minnesota Medical Center patients hospitalized with SA or GNB bacteremia requiring home infusion on discharge. Conclusion Hospital readmission rates and ADEs are frequent among patients with SA or GNB bacteremia requiring OPAT via home infusion. An ID pharmacist-directed program in collaboration with an ID provider is feasible for OPAT transitions and may serve as a roadmap for other institutions. Disclosures Dana Simonson, PharmD, BCPS, Janssen (Advisor or Review Panel member, Other Financial or Material Support, Webinar Series Speaker Fall 2019)

scholarly journals Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis (Preprint)

2020 ◽  
Author(s):  
Sarah F Gilson ◽  
Craig A Umscheid ◽  
Neda Laiteerapong ◽  
Graeme Ossey ◽  
Kenneth J Nunes ◽  
...  
Keyword(s):  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Sociodemographic Factors ◽  
Commercial Insurance ◽  
Sociodemographic Differences ◽  
Academic Medical ◽  
Virtual Visits ◽  
The Impact

BACKGROUND Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. OBJECTIVE The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. METHODS We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. RESULTS Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. CONCLUSIONS Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.

scholarly journals Growth of Ambulatory Virtual Visits and Differential Use by Patient Sociodemographics at One Urban Academic Medical Center During the COVID-19 Pandemic: Retrospective Analysis

10.2196/24544 ◽  
2020 ◽  
Vol 8 (12) ◽  
pp. e24544
Author(s):  
Sarah F Gilson ◽  
Craig A Umscheid ◽  
Neda Laiteerapong ◽  
Graeme Ossey ◽  
Kenneth J Nunes ◽  
...  
Keyword(s):  
Care Delivery ◽  
Medical Center ◽  
Academic Medical Center ◽  
Age Groups ◽  
Sociodemographic Factors ◽  
Commercial Insurance ◽  
Sociodemographic Differences ◽  
Academic Medical ◽  
Virtual Visits ◽  
The Impact

Background Despite widespread interest in the use of virtual (ie, telephone and video) visits for ambulatory patient care during the COVID-19 pandemic, studies examining their adoption during the pandemic by race, sex, age, or insurance are lacking. Moreover, there have been limited evaluations to date of the impact of these sociodemographic factors on the use of telephone versus video visits. Such assessments are crucial to identify, understand, and address differences in care delivery across patient populations, particularly those that could affect access to or quality of care. Objective The aim of this study was to examine changes in ambulatory visit volume and type (ie, in-person vs virtual and telephone vs video visits) by patient sociodemographics during the COVID-19 pandemic at one urban academic medical center. Methods We compared volumes and patient sociodemographics (age, sex, race, insurance) for visits during the first 11 weeks following the COVID-19 national emergency declaration (March 15 to May 31, 2020) to visits in the corresponding weeks in 2019. Additionally, for visits during the COVID-19 study period, we examined differences in visit type (ie, in-person versus virtual, and telephone versus video visits) by sociodemographics using multivariate logistic regression. Results Total visit volumes in the COVID-19 study period comprised 51.4% of the corresponding weeks in 2019 (n=80,081 vs n=155,884 visits). Although patient sociodemographics between the COVID-19 study period in 2020 and the corresponding weeks in 2019 were similar, 60.5% (n=48,475) of the visits were virtual, compared to 0% in 2019. Of the virtual visits, 61.2% (n=29,661) were video based, and 38.8% (n=18,814) were telephone based. In the COVID-19 study period, virtual (vs in-person) visits were more likely among patients with race categorized as other (vs White) and patients with Medicare (vs commercial) insurance and less likely for men, patients aged 0-17 years, 65-74 years, or ≥75 years (compared to patients aged 18-45 years), and patients with Medicaid insurance or insurance categorized as other. Among virtual visits, compared to telephone visits, video visits were more likely to be adopted by patients aged 0-17 years (vs 18-45 years), but less likely for all other age groups, men, Black (vs White) patients, and patients with Medicare or Medicaid (vs commercial) insurance. Conclusions Virtual visits comprised the majority of ambulatory visits during the COVID-19 study period, of which a majority were by video. Sociodemographic differences existed in the use of virtual versus in-person and video versus telephone visits. To ensure equitable care delivery, we present five policy recommendations to inform the further development of virtual visit programs and their reimbursement.

scholarly journals 854. Impact of Antimicrobial Stewardship and Rapid Diagnostics in Children with Staphylococcus aureus Bacteremia

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S19-S19
Author(s):  
Stephanie N Welch ◽  
Rupal Patel ◽  
Lee Morris ◽  
Aimee Dassner ◽  
Nigel L Rozario ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Median Time ◽  
Antimicrobial Stewardship ◽  
Antimicrobial Therapy ◽  
Statistical Significance ◽  
Central Line ◽  
Antibiotic Exposure ◽  
Staphylococcus Aureus Bacteremia ◽  
Pediatric Icu ◽  
The Impact

Abstract Background Rapid diagnostic testing (RDT) in combination with antimicrobial stewardship programs (ASPs) has been associated with improved outcomes in adults with Staphylococcus aureus bacteremia (SAB). Data in children are lacking. In January 2017, Atrium Health implemented a pediatric ASP with blood culture RDT. The objective of this study was to determine the impact of those interventions. Methods This was a retrospective, multicenter, quasi-experimental study of children ≤18 years with monomicrobial SAB from March 2015 to August 2016 (pre-intervention; PRE) and March 2017 to August 2018 (post-intervention; POST). The primary outcome was time to an optimal antibiotic. Secondary outcomes included time to effective antibiotic, total antibiotic exposure in the first 5 days, duration of bacteremia, infectious diseases (ID) consultation, time to central line removal, hospital and pediatric ICU length of stay (LOS), need for vasopressors or intubation, recurrence of SAB within 90 days, and inpatient mortality. Results Of 101 patients with SAB, 32 and 36 met inclusion criteria for the PRE and POST groups, respectively. The median time to optimal antimicrobial therapy decreased by 23 hours (PRE 44.3 hours vs. POST 21.3 hours; P = 0.008). Duration of bacteremia (65h vs. 40.9 hours; P = 0.028) and mortality (12.5% vs. 0%; P = 0.044) was also significantly reduced. Differences in median time to effective therapy (7 hours vs. 5.1 hours; P = 0.74), total antibiotic exposure in the first 5 days (160.4 hours vs. 152 hours; P = 0.4), hospital LOS (9.9 vs. 8.5 days; P = 0.25), and pediatric ICU LOS (7 vs. 4 days; P = 0.11) did not meet statistical significance, but trended downward. The POST group had more patients with ID consultation (78% vs. 89%, P = 0.23) and shorter time to central line removal (68 hours vs. 20 hours; P = 0.037). There was no difference in the need for vasopressors (3 vs. 3 patients; P = 0.99) or intubation (2 vs. 4 patients; P = 0.68). Throughout the study period, recurrence of SAB only occurred in one patient (PRE). Conclusion Concurrent implementation of RDT and an ASP in pediatric patients with SAB decreased time to optimal antimicrobial therapy, duration of bacteremia, and mortality. RDT coupled with timely feedback from an ASP contributed to improved SAB management and clinical outcomes in children. Disclosures All Authors: No reported Disclosures.

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