AntibiogramDSM: a combined local antibiogram and educational intervention.

Objective: To describe the development of a combined local antibiogram and assess its utility in an educational intervention. Design: Retrospective analysis of a combined, multi-healthcare system antibiogram with an educational intervention and pre-post analysis. Setting: Creation of the combined antibiogram included all health systems in Des Moines, Iowa. The educational intervention was delivered live via webinar and remained available on demand for one year. Participants: The combined antibiogram participants included four health systems representing eight hospitals. The educational intervention included 45 healthcare providers (15 live, 30 on demand) who elected to participate. Methods: Yearly antibiograms were collected from four health systems for 2017 and 2018 and from three health systems for 2019 and 2020. Each was aggregated into a single antibiogram, posted online, and analyzed retrospectively. In 2021, an educational intervention took place, which included pre-educational assessments, a one-hour presentation on local resistance rates and impact on common infections, and post-education assessments. The educational session was available online for one year. Correct responses before and after education were compared using NcNemar's test. Results: Over 4 yr, 123,168 isolates were included in the antibiogram, representing 57 species and 46 tested antibiotics. Before education, prediction of local resistance rates for E. coli and S. pneumoniae was poor. After the education session, there was improvement in the proportion of correct responses to case-based questions: pneumonia (31.8% vs 58.8%, P = 0.022), UTI (47.7% vs 85.3%, P < 0.001), sinusitis (75% vs 91.2%, P = 0.109), and diverticulitis (43.2% vs 88.2%, P = 0.002). Conclusions: A combined local antibiogram was useful in supporting an outpatient education program.

Change in Methicillin-Resistant Staphylococcus aureus Testing in the Intensive Care Unit as an Antimicrobial Stewardship Initiative.

Background: Methicillin-resistant Staphylococcus aureus (MRSA)-associated infections are a cause of morbidity and mortality in the intensive care unit (ICU). Vancomycin is a treatment option but is not without risks. Methods: A MRSA testing change-the switch from culture to polymerase chain reaction-was implemented at 2 adult (tertiary and community) ICUs located in a Midwestern US health system. Data from 2016 to 2020 were included in the study, and the median change in time to test results was examined. Results: During the study period, 71% of 19,975 patients seen at the 2 ICUs received MRSA testing. In the preintervention period, 91% and 99% of patients at the tertiary and community hospitals received testing via culture, respectively. Culture testing was used 1% and ∼0% of the time at the tertiary and community hospitals, respectively, in the postintervention period. A counterfactual estimate showed 36 (95% credible interval [CrI], 35, 37) and 32 (95% CrI, 31, 33) fewer hours until results were available at the tertiary and community hospitals, respectively. Conclusion: After the testing change, MRSA results were available in less time. Obtaining results sooner can assist with antimicrobial stewardship through the potential delay in initiating therapies such as vancomycin and/or quicker de-escalation of such therapies.

Clinical utility of methicillin-resistant Staphylococcus aureus nasal polymerase chain reaction (PCR) assays beyond respiratory infections.

We estimated the predictive value of methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) for blood, bone, and soft-tissue cultures. The specificities were 88.8%, 88.5%, and 92.7% for all cultures, blood cultures, and bone and soft-tissue cultures respectively, and the negative predictive values were 99.3%, 99.8%, and 92.7% respectively.

Impact of fluoroquinolone cascade reporting of urine samples on antibiotic prescribing rates in a network of urgent care clinics.

Cascade reporting is an antimicrobial stewardship strategy that has been successfully implemented in inpatient settings, but evidence of its impact on outpatient settings is scarce. We report on the impact on fluroquinolone prescribing at a network of urgent care clinics following the implementation of cascade reporting of Enterobacterales in urine cultures.

Trends in antibiotic use before and during the coronavirus disease 2019 (COVID-19) pandemic across an integrated health system with different antimicrobial stewardship program models trends in antibiotic use by ASP model.

Changes in antimicrobial use during the pandemic in relation to long-term trends in utilization among different antimicrobial stewardship program models have not been fully characterized. We analyzed data from an integrated health system using joinpoint regression and found temporal fluctuations in prescribing as well as continuation of existing trends.

Impact of Rapid Susceptibility Testing System on the Management of Gram-Negative Bacteremia in a Network of Community Hospitals.

BACKGROUND: Rapid initiation of optimal antimicrobial therapy is crucial for the management of Gram-negative (GN) bacteremia. We aimed to evaluate the impact of Accelerate PhenoTM (AxDx) system on change in therapy and length of stay among patients with GN bacteremia. METHODS: We conducted a retrospective cohort study of adult patients hospitalized who had at least 1 blood culture with presence of Enterobacterales. We compared clinical outcomes among patients who had their blood cultures processed through standard methods alone vs AxDx. RESULTS: We identified 255 bacteremia episodes among 243 unique patients. In the AxDx group, 31.1% of patients had deescalation of antibiotics within 48 h from blood culture collection compared to 20.0% of patients in the control group (P = 0.09). We found no impact of AxDx on the odds of deescalation at 48 h from blood culture collection [odds ratio (OR) 1.80 (95% CI 0.91-3.56), P = 0.09] or Gram stain report [OR 1.61 (95% CI 0.86-3.01), P = 0.14]. Escalation in therapy at 48 h from blood culture collection occurred in 16.8% and 16.9% of patients in the AxDx and control groups, respectively (P = 0.99). There was no impact on the odds of escalation at 48 h from blood culture collection [OR 0.99 (95% CI 0.47-2.11), P = 0.99] or Gram stain report [OR 1.26 (95% CI 0.57-2.80), P = 0.57]. No differences were seen in length of stay and mortality between the 2 groups. CONCLUSIONS: The impact of rapid identification and susceptibility technologies may differ according to the setting in which they are implemented.

Impact of BioFire FilmArray respiratory panel results on antibiotic days of therapy in different clinical settings.

Objective: The BioFire FilmArray Respiratory Panel (RFA) has been proposed as a tool that can aid in the timely diagnosis and treatment of respiratory tract infections but its effect on antibiotic prescribing among adult patients has varied. We evaluated the impact of RFA result on antibiotic days of therapy (DOTs) in 2 distinct cohorts: hospitalized patients and patients discharged from the emergency department (ED). Design: Retrospective cohort study. Setting: The study was conducted in 3 community hospitals in Des Moines, Iowa, from March 3 to March 16, 2019. Patients: Adults aged >18 years. Methods: Potential outcome means and average treatment effects for RFA results on antibiotic DOTs were estimated. Inverse probability of treatment weighting with regression adjustment was used. Results: We identified 243 patients each in the hospitalized and ED-discharged cohorts. Among hospitalized patients, RFA results did not affect antibiotic DOTs. Among patients discharged from the ED, we found that if all patients had had influenza detected, the average DOTs would have been 2.3 DOTs (-3.2 to -1.4) less than the average observed if all the patients had had a negative RFA (P < .0001); no differences in DOTs were observed when comparing an RFA with a noninfluenza virus detected compared to an RFA with negative results. Conclusions: The impact of RFA results on antibiotic DOTs varies by clinical setting, and reductions were observed only among patients discharged from the ED who had influenza A or B detected.

Antimicrobial stewardship in the treatment of skin and soft tissue infections.

BACKGROUND: Research on treating skin and soft tissue infections (SSTI) has shown improved patient outcomes with effective pharmaceutic prescribing. Antimicrobial stewardship programs can reduce consequences of broad-spectrum antimicrobial administration in SSTI treatment. METHODS: Prospective and historic control data were collected during two 7-month periods. Intervention consisted of implementing a new SSTI evidence-based treatment algorithm and provider education, including calls and medical record notes targeted at physicians. RESULTS: Of 412 patients, 76 and 86 were found eligible from the historic and intervention groups, respectively. The intervention group had a higher prevalence of appropriate antibiotic usage (33% vs 19%, respectively; P = .04). There was a lower median number of days from intravenous antibiotic therapy to oral conversion (3 vs 5; P < .0001) and a lower median number of days of antipseudomonal antibiotic use (3 vs 5; P = .03) in the intervention group, respectively. The intervention group also had fewer documented SSTI treatment complications (1% vs 8%, respectively; P = .04). The positive outcomes outlined demonstrate potential impacts made from the use of multidisciplinary antibiotic stewardship initiatives. CONCLUSIONS: Appropriate use of antimicrobial agents under the direction of an antimicrobial stewardship program can lead to improved outcomes for patients being treated for SSTIs.