Device Utilization Ratios in Infection Prevention: Process or Outcome Measure?

PURPOSE OF REVIEW: The purpose of this review is to describe the role of device utilization as a component of surveillance for healthcare-associated infections and describe its potential role as a measurement of healthcare quality. RECENT FINDINGS: Device utilization, while primarily a process-based measure in the prevention of device-associated infections can also serve as an important outcome in the evaluation of an infection prevention program. Device utilization can be an important and resource-efficient measurement when coupled with measurements of risk-adjusted infection rates. The measurement of the device utilization ratio can provide insight into the risk of device-associated harms, including non-infectious harms, which would not be captured with currently used infection-based surveillance metrics. Further study and validation of standardized, risk-adjusted device utilization measurements is an important area for future exploration.

Antibiotic Utilization and Opportunities for Stewardship Among Hospitalized Patients With Influenza Respiratory Tract Infection.

OBJECTIVE: Hospitalized influenza patients are often treated with antibiotics empirically while awaiting final diagnosis. The goal of this study was to describe the inappropriate continuation of antibiotics for influenza respiratory tract infections (RTIs). DESIGN: We retrospectively studied adults admitted to our institution over 2 respiratory flu seasons with positive influenza RTIs. Inappropriate antibiotic duration (IAD) was defined as antibiotic use for >24 hours after a positive influenza test in patients presenting with <72 hours of RTI symptoms and with no other indications of bacterial infection. RESULTS: During the study period, 322 patients included in this study were admitted for influenza RTI. Respiratory cultures were ordered for 50 of these patients (15.5%) and 71 patients (22%) had a positive chest x-ray, but antibiotics were prescribed to 211 patients (65.5%) on admission. Antibiotics were inappropriately continued in 73 patients (34.5%). Patients receiving IAD had a longer length of stay (LOS) (median, 6 days; range, 4-9 days) compared with those whose antibiotics were discontinued appropriately (median, 5 days; range, 3-8 days) and those who were not treated with antibiotics (median, 4 days; range, 3-6 days; P<.001). However, mortality was similar among these 3 groups: 3 patients (4.1%) from the IAD cohort died; 6 patients (4.3%) from the group with an appropriate antibiotic duration died; and 2 patients [1.8%] from the group given no antibiotics died (P=.510). The 30-day readmission rates were similar as well: 9 patients (12.3%) from the IAD group were readmitted within 30 days; 21 patients (15.2%) from the group with appropriate antibiotic duration were readmitted; and 11 patients (9.9%) from the group given no antibiotics were readmitted (P=.455). Total hospital costs were greater in patients treated with IAD ($10,645; range, $6,485-$18,035) compared with the group treated with appropriate antibiotic duration ($7,479; range, $4,866-$12,922) and the group given no antibiotics $5,961 (range, $4,711-$9,575). Thus, the hospital experienced a median loss in net hospital revenue of $2,076 per IAD patient compared with a patient for which antibiotic duration was appropriate. CONCLUSION: The majority of patients with influenza RTI received antibiotics on admission, and 34.5% were inappropriately continued on antibiotics without evidence of bacterial infection, which led to increased LOS, loss of net revenue, and no improvement in outcome. Thus, stewardship initiatives aimed at this population are warranted.

Carbapenem-Resistant Enterobacteriaceae: A Case Series of Infections at Hartford Hospital.

Infections due to carbapenem-resistant Enterobacteriaceae (CRE) represent a growing problem nationally, are difficult to treat, and are associated with high mortality rates. Features of CRE infection within Connecticut, a nonendemic area, have not been described in the medical literature. We report a case series of five patients with CRE isolates who were treated at Hartford Hospital in Hartford, Connecticut from 2011-2013. CRE isolates included three Klebsiella pneumoniae, one Klebsiella oxytoca, and two E. coli. Three isolates were obtained from urine cultures, one from respiratory culture, and one from blood and wound cultures. Four patients survived the hospital course, including three patients who had a hospital stay of > 100 days. In this nonendemic hospital, CRE infections were identified mainly in patients with multiple comorbidities who underwent catheter placement and surgical procedures, had contact with the health care system in the preceding 90 days, and tended to have prolonged, complicated hospital courses.

Cardiac tamponade as a result of Mycobacterium avium-complex pleural effusion.

Patients with advanced AIDS are prone to opportunistic infections, including disseminated disease from Mycobacterium avium-complex (MAC). We describe the first reported case of MAC related pleural effusion causing cardiac tamponade.