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.

Antibiotic Stewardship in the Neonatal Intensive Care Unit: Effects of an Automatic 48-Hour Antibiotic Stop Order on Antibiotic Use.

BACKGROUND: Meeting antibiotic stewardship goals in the neonatal intensive care unit (NICU) is challenging because of the unique nature of newborns and the lack of specificity of clinical signs of sepsis. Antibiotics are commonly continued for 48 hours pending culture results and clinical status. The goal of this study was to examine if the implementation of a 48-hour automatic stop (autostop) order during NICU admissions would decrease antibiotic use at UnityPoint Health-Meriter. METHODS: An observational double-cohort study was performed in a level 3 NICU. Antibiotic use was evaluated before and after the autostop initiative. The admission order set included 48 hours of ampicillin and gentamicin coverage. RESULTS: After the autostop initiation, total doses given per patient decreased by 35% and doses per patient-day decreased by 25% (P < .0001). The greatest effect was a 66% decrease in the use of vancomycin, an antibiotic not included in the admission order set. Providers proactively continued antibiotics for infants in whom they had high suspicion for sepsis and in those with positive blood or cerebral spinal fluid culture results. CONCLUSIONS: An admission-order autostop was highly effective at decreasing antibiotic usage with no doses intended for a pathogen missed. Fewer doses of certain antibiotics outside of the admission order set were administered, particularly vancomycin, which results in our speculation that provider awareness of the antibiotic stewardship initiative might have altered prescribing practices.

Prevalence, consequences, and solutions.

Since the early development of antibiotics, antimicrobial resistance has continued to emerge as a formidable adversary in the fight against infectious disease. Once an issue confined to hospitals, antibiotic resistance has now invaded communities, targeting not only the immunocompromised patient, but also those who are immunocompetent. To stem this crisis, researchers have developed more powerful and more costly antibiotics, which have only complicated the resistance problem. Education of the patient and the prescriber, as well as antimicrobial stewardship programs, are necessary to avert a global antibiotic resistance catastrophe.

Factors contributing to excessive antimicrobial prescribing.

Several elements are known to influence the prescribing behaviors of clinicians; these elements may indirectly contribute to the current antibiotic resistance crisis. Lack of knowledge and time, as well as prescriber beliefs and attitudes, may be just as persuasive as test results when a clinician considers prescribing an antibiotic. In addition, patient expectations and demands may also sway some prescribers to write a prescription for an antibiotic that is unnecessary. Although culture and susceptibility testing methods are widely available in outpatient and institutional settings, they are often underused. As a result, broad-spectrum antibiotics frequently are prescribed inappropriately. In addition, prescribers may be unaware of local resistance patterns, and available antibiograms may not be updated appropriately or referenced by clinicians. Prescriber and patient education, as well as shifts in beliefs and attitudes, are required to help fight antibiotic resistance.

Prospective evaluation of the treatment and outcome of community-acquired pneumonia according to the Pneumonia Severity Index in VHA hospitals.

The objective of the study were to determine if nationally recognized community-acquired pneumonia (CAP) guidelines (specific to antibiotic therapy) were being followed and to identify outcomes of treatment in hospitals that are VHA members. This was a prospective study using a medication use evaluation in an inpatient setting conducted in 46 institutions in the United States during the 1998-1999 CAP season. The subjects were 875 adult patients (> or =18 years of age) admitted from the emergency department or ambulatory care setting with a chest X-ray-confirmed diagnosis of CAP. Treatment pathways were in place in 58.7% (27/46) of institutions, with 18.3% of patients treated according to pathways. Twenty-seven percent of patients were PSI class I or II. A pathogen (blood or sputum) was identified in <10% of patients. The first dose of antibiotic was administered to patients 65% of the time in the emergency department. Antibiotic therapy in 592 of the 694 admitted to a general medical unit (mortality rate, 3%) complied with 1998 Infectious Diseases Society of America (IDSA) guidelines compared with 26 of the 65 admitted to the intensive care unit (ICU) (mortality rate, 4.6%). In patients admitted to other nongeneral medical, non-ICU areas, IDSA guidelines were followed in 95% of the patients. Mean length of stay and mortality for PSI classes I-V were 4.5, 4.6, 6.9, 6.2, and 7.1 days, respectively, and 0%, 0.7%, 1.1%, 2.5%, and 10.5%, respectively. Antibiotic therapy was modified in 733 of 875 patients. Approximately 90% of patients were eligible for conversion to oral (per os) therapy before discontinuation of parenteral (intravenous) antibiotics (mean time to eligibility, 1.8 days of parenteral antibiotics), with conversion in 65% (mean time to conversion to oral therapy, 4.6 days). Resolution of CAP occurred in 92% of patients; deterioration was more common in PSI class IV and V patients. In conclusion, inhospital mortality rates for all PSI classes were similar to those found in other recently conducted studies despite limited adherence to pathways. Greater use of treatment guidelines for patients admitted to the ICU and awareness of the intravenous to per os antibiotic conversion process are suggested.