scholarly journals Outpatient Antibiotic Stewardship: A Growing Frontier—Combining Myxovirus Resistance Protein A With Other Biomarkers to Improve Antibiotic Use

2018 ◽  
Vol 5 (2) ◽  
Author(s):  
Patrick Joseph ◽  
Eliot Godofsky
Keyword(s):  
Respiratory Infection ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Protein A ◽  
Care Facility ◽  
Urgent Care ◽  
Cochrane Library ◽  
Specific Marker ◽  
Term Care ◽  
Resistance Protein

Abstract Background The majority of oral antibiotics are prescribed in outpatient primary and urgent care clinics for acute respiratory infections. Effective antibiotic stewardship must include proper prescribing for outpatients as well as for those in a hospital or long-term care facility. Methods Major databases, including MEDLINE and the Cochrane Library, were searched for prospective human clinical studies, including children and/or adults published between January 1966 and November 2017 that evaluated Myxovirus resistance protein A (MxA) as a biomarker for diagnosing viral infections as well as both C-reactive protein (CRP) and procalcitonin (PCT) as potential biomarkers for identifying and differentiating true bacterial upper respiratory infection (URI) from colonization. Results Ten prospective human studies, totaling 1683 patients, were identified that evaluated MxA as a viral biomarker in children and/or adults. Both systematic review articles, meta-analyses, and randomized controlled clinical trials that examined CRP and/or PCT as a biomarker for identifying clinically significant bacterial infections and supporting antibiotic stewardship were identified. Conclusions Quick and accurate differentiation between a viral and bacterial respiratory infection is critical to effectively combat antibiotic misuse. MxA expression in peripheral blood is a highly specific marker for viral infection. Combining MxA with other inflammatory biomarkers to test for respiratory infections offers enhanced sensitivity and specificity, forming an excellent tool for antibiotic stewardship in the outpatient setting.

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 Variation in Measures of Antimicrobial Use Across Four Nursing Homes, Atlanta, Georgia, 2019

2020 ◽  
Vol 41 (S1) ◽  
pp. s510-s510
Author(s):  
William Dube ◽  
Sahebi Saiyed ◽  
Patricia Comer ◽  
Michael Hanichen ◽  
Christie Klinczar ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Respiratory Infections ◽  
Local Treatment ◽  
Treatment Guideline ◽  
Transitions Of Care ◽  
Term Care ◽  
Start Date ◽  
Treatment Site ◽  
Days Of Therapy

Background: Although antibiotic stewardship programs (ASP) are now required in nursing homes, assimilating and responding to data to improve prescribing in nursing homes is novel. Four Atlanta-based skilled nursing facilities (SNFs) began collaborating (EASIL: Emory Antibiotic Stewardship in Long-Term Care) to share standardized prescribing data to allow interfacility comparisons and action. Methods: After SNF ASPs were evaluated and trained, standardized prescribing logs were submitted (January 2019 to June 2019) including the following data: start date, treatment site, prescriber attribution of order (ie, SNF order vs hospital order) and monthly resident days. SNF-specific point estimates of usage rates were calculated as pooled means for all antibiotic starts, SNF-order starts, and days of therapy (DOT), by treatment site per 1,000 resident days. Duration of urinary tract infection (UTI) therapy was assessed by calculating percentage of SNF-UTI starts over recommended duration defined by the local treatment guideline. Rate ratios (RRs) of use were calculated to compare SNF-specific rates to the largest SNF. The 95% CIs were calculated using normal approximation. Results: Monthly starts ranged from 124 to 177, with a pooled mean of 7.8 antibiotic starts (any type), 4.5 SNF-order starts, and 1.2 SNF-UTI starts per 1,000 resident days. Approximately half of all starts were SNF starts (range, 43%–53%), and less than half of DOT were attributed to SNF starts (range, 35%–45%). Overall, SNF-order treatment sites were most often UTIs (29%), lower respiratory infections (17%), and skin and soft-tissue infections (17%). SNF-order UTI starts per 1,000 patient days varied at 1 SNF (SNF B RR, 1.57; 95% CI, 1.04–2.36). SNF-order UTI DOT per 1,000 patient days was more variable, with SNFs B and C having significantly higher rates (B RR, 1.49, 1.24, and 1.82; C RR, 5.42; 95% CI, 4.65–6.34) than SNF A (Fig. 1). The percentage of SNF-order UTI starts that were over recommended duration ranged from 8% (nitrofurantoin, SNF A) to 100% (fluoroquinolones, SNF C) (Fig. 1). Conclusions: Although UTIs are the single most common reason to prescribe antibiotics after arriving in a SNF, they account for a small fraction of overall starts and an even smaller fraction of DOT. We identified outlier prescribing by different SNFs using 3 metrics, suggesting that distinct corrective actions are necessary to target distinct prescribing challenges (starts, duration, and transitions of care).Funding: NoneDisclosures: Scott Fridkin reports that his spouse receives consulting fees from the vaccine industry.

Differences in antibiotic prescriptions between direct-to-consumer telehealth and telehealth in the emergency department

2021 ◽  
pp. 1357633X2110349
Author(s):  
Peter Yao ◽  
Kriti Gogia ◽  
Sunday Clark ◽  
Hanson Hsu ◽  
Rahul Sharma ◽  
...  
Keyword(s):  
Emergency Department ◽  
Confidence Interval ◽  
Respiratory Infection ◽  
Antibiotic Stewardship ◽  
Odds Ratio ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Antibiotic Prescribing ◽  
Acute Respiratory Infections ◽  
Direct To Consumer

Background Telemedicine, which allows physicians to assess and treat patients via real-time audiovisual conferencing, is a rapidly growing modality for providing medical care. Antibiotic stewardship is one important measure of care quality, and research on antibiotic prescribing for acute respiratory infections in direct-to-consumer telemedicine has yielded mixed results. We compared antibiotic prescription rates for acute respiratory infections in two groups treated by telemedicine: (1) patients treated via a direct-to-consumer telemedicine application and (2) patients treated via telemedicine while physically inside the emergency department. Methods We included direct-to-consumer telemedicine and emergency department telemedicine visits for patients 18 years and older with physician-coded International Classification of Diseases, Tenth Revision acute respiratory infection diagnoses between November 2016 and December 2018. Patients in both groups were seen by the same emergency department faculty working dedicated telemedicine shifts. We compared antibiotic prescribing rates for direct-to-consumer telemedicine and emergency department telemedicine visits before and after adjustment for age, sex, and diagnosis. Results We identified a total of 468 acute respiratory infection visits: 191 direct-to-consumer telemedicine visits and 277 emergency department telemedicine visits. Overall, antibiotics were prescribed for 47% of visits (59% of direct-to-consumer telemedicine visits vs 39% of emergency department telemedicine visits; odds ratio 2.23; 95% confidence interval 1.53–3.25; P < 0.001). The difference in antibiotic prescribing rates remained significant after adjustment for age, sex, and diagnosis (odds ratio 2.49; 95% confidence interval 1.65–3.77; P < 0.001). Conclusion Patients seen by the same group of physicians for acute respiratory infection were significantly more likely to be prescribed antibiotics by direct-to-consumer telemedicine care compared with telemedicine care in the emergency department. This work suggests that contextual factors rather than evaluation over video may contribute to differences in antibiotic stewardship for direct-to-consumer telemedicine encounters.

A model for improving and assessing outpatient stewardship initiatives for acute respiratory infection

2019 ◽  
Vol 40 (10) ◽  
pp. 1198-1200 ◽  
Author(s):  
Joan Guzik ◽  
Pooja Kothari ◽  
Misha Sharp ◽  
Belinda Ostrowsky ◽  
Gopi Patel ◽  
...  
Keyword(s):  
Healthcare System ◽  
Respiratory Infection ◽  
Antibiotic Stewardship ◽  
Acute Respiratory Infection ◽  
Respiratory Infections ◽  
Acute Respiratory Infections ◽  
New Yorker ◽  
Stage 1

Many hospitals have established inpatient antibiotic stewardship programs (ASPs), but outpatient activities remain limited. In 2016, the United Hospital Fund (UHF), an independent nonprofit working to build a more effective healthcare system for every New Yorker, launched a 2-stage grant-funded initiative to evaluate outpatient antibiotic stewardship, focusing on adults with acute respiratory infections (ARIs). Conclusions from stage 1 included few outpatient antibiotic stewardship activities, variation in prescribing, macrolides as the most commonly prescribed antibiotic, and provider interest in improving prescribing.1

scholarly journals Direct costs of acute respiratory infections in a pediatric long‐term care facility

2015 ◽  
Vol 10 (1) ◽  
pp. 34-36 ◽  
Author(s):  
Meghan T. Murray ◽  
Elizabeth Heitkemper ◽  
Olivia Jackson ◽  
Natalie Neu ◽  
Patricia Stone ◽  
...  
Keyword(s):  
Long Term Care ◽  
Respiratory Infections ◽  
Care Facility ◽  
Direct Costs ◽  
Acute Respiratory Infections ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility

scholarly journals Active surveillance for acute respiratory infections among pediatric long-term care facility staff

2020 ◽  
Vol 48 (12) ◽  
pp. 1474-1477 ◽  
Author(s):  
Sibyl Wilmont ◽  
Natalie Neu ◽  
Alexandra Hill-Ricciuti ◽  
Luis Alba ◽  
Mila M. Prill ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Long Term Care ◽  
Respiratory Infections ◽  
Care Facility ◽  
Acute Respiratory Infections ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Facility Staff

scholarly journals Knowledge, Attitudes, and Practices of Pediatric Long-term Care Facility Staff Regarding Infection Control for Acute Respiratory Infections and Influenza Vaccination

2019 ◽  
Author(s):  
Lisa Saiman ◽  
Sibyl Wilmont ◽  
Alexandra Hill-Ricciuti ◽  
Meaghan Jain ◽  
Emily Collins ◽  
...  
Keyword(s):  
Long Term Care ◽  
Respiratory Infections ◽  
Care Facility ◽  
Clinical Staff ◽  
Acute Respiratory Infections ◽  
Term Care ◽  
Long Term Care Facility ◽  
Attitudes And Practices ◽  
And Control

Abstract We surveyed clinical staff and on-site teachers working at pediatric long-term care facilities regarding prevention and control of acute respiratory infections and influenza in staff and residents. We uncovered knowledge gaps, particularly among teachers and clinical staff working &lt;5 years at sites, thereby elucidating areas for targeted staff education.

scholarly journals Attributable Costs of Acute Respiratory Infections in a Pediatric Long-Term Care Facility

2015 ◽  
Vol 43 (6) ◽  
pp. S68-S69
Author(s):  
Elizabeth M. Heitkemper ◽  
Meghan T. Murray ◽  
Olivia Jackson ◽  
Natalie Neu ◽  
Patricia W. Stone ◽  
...  
Keyword(s):  
Long Term Care ◽  
Respiratory Infections ◽  
Care Facility ◽  
Acute Respiratory Infections ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility
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