Audit of antibiotic duration of therapy, appropriateness and outcome in patients with nosocomial pneumonia following the removal of an automatic stop-date policy

2012 ◽  
Vol 31 (8) ◽  
pp. 1819-1831 ◽  
Author(s):  
J. Do ◽  
S. A. N. Walker ◽  
S. E. Walker ◽  
W. Cornish ◽  
A. E. Simor
Keyword(s):  
Nosocomial Pneumonia ◽  
Duration Of Therapy ◽  
Stop Date ◽  
Antibiotic Duration

scholarly journals 1065. Evaluation of a Staphylococcus aureus Bacteremia Treatment Checklist

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S318-S319
Author(s):  
Hailey Soukup ◽  
Jessica Holt
Keyword(s):  
Staphylococcus Aureus ◽  
Primary Outcome ◽  
Blood Cultures ◽  
High Morbidity ◽  
Drug Selection ◽  
Evidence Based Treatment ◽  
Duration Of Therapy ◽  
Staphylococcus Aureus Bacteremia ◽  
Improved Outcomes ◽  
Antibiotic Duration

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with high morbidity and mortality. Appropriate management involves repeat blood cultures, echocardiography, drug selection/route, and duration of therapy. Multiple studies have demonstrated improved outcomes in patients who are managed by infectious disease (ID) physicians compared with non-ID physicians; however, not all sites have access to an ID provider. To improve management of SAB, a checklist was developed and approved for use in a large healthcare system in August 2015. Methods A retrospective review was conducted on 400 randomly selected patients with SAB, 200 pre- and 200 post-implementation of a four-part management checklist. The primary outcome was overall adherence to the checklist, which included: repeat blood cultures, echocardiography, correct antibiotic/route selection, and appropriate antibiotic duration. Secondary outcomes included adherence when an ID physician was not consulted, adherence to the four components individually, and appropriate imaging. Results Adherence to the four part bundle remained stable from 2015 to 2017, with overall adherence rates of 80% and 79%, respectively. From 2015 to 2017, patients without repeat blood cultures (7% vs. 2%, respectively) and inappropriate inpatient antibiotic selection (6% vs. 3%, respectively) improved. Outpatient prescribing (11% vs. 11%), lack of imaging (11% vs. 9%), and antibiotic duration (15% vs. 15%) were consistent from 2015 to 2017, respectively. In 2017, 13 patients were discharged on oral antibiotics and were deemed inappropriate per the study criteria, although 12 of these patients were on appropriate antibiotics while inpatient. Infectious diseases providers were consulted on 96% of cases in 2017, an increase from 90% in 2015. Conclusion Adherence to an evidence based treatment bundle remains consistent with a previous analysis, despite an increase in cases with an ID provider consulted. Repeating blood cultures and inpatient prescribing improved over the interval. Focus areas for improvement include imaging, outpatient prescribing, and duration of therapy. Disclosures All authors: No reported disclosures.

scholarly journals Duration of Antibiotic Therapy for General Medicine and General Surgery Patients Throughout Transitions of Care: An Antibiotic Stewardship Opportunity for Noninfectious Disease Pharmacists

2020 ◽  
pp. 001857872092826
Author(s):  
Kristin I. Brower ◽  
Ariel Hecke ◽  
Julie E. Mangino ◽  
Anthony T. Gerlach ◽  
Debra A. Goff
Keyword(s):  
Antibiotic Therapy ◽  
General Surgery ◽  
Antibiotic Stewardship ◽  
Total Duration ◽  
Outpatient Setting ◽  
Transitions Of Care ◽  
National Guidelines ◽  
Duration Of Therapy ◽  
Antibiotic Duration ◽  
Tract Infections

Background Overuse of antibiotics from the inpatient to outpatient setting is an antibiotic stewardship initiative where noninfectious disease (ID) pharmacists can have a large impact. Our purpose was to evaluate antibiotic durations across transitions of care from the inpatient to outpatient setting. Methods: This is a single-center, retrospective cohort analysis evaluating antibiotic durations from the inpatient and outpatient setting in adult patients admitted to general surgery and medicine services at an academic medical center between January 1, 2017 and September 20, 2017. The primary outcome was to assess total antibiotic duration for patients with uncomplicated and complicated urinary tract infections (UTI, cUTI), community-acquired pneumonia (CAP), and hospital-acquired pneumonia (HAP). Outpatient electronic discharge prescriptions were used to calculate intended antibiotic duration upon transitions of care. Excessive duration of therapy was defined as >3 days—UTI, >5 days—CAP, and >7 days—cUTI or HAP. Results: One hundred and one patients met inclusion criteria. Overall, most of the patients (81%) had antibiotics longer than recommended with only 3% receiving less than the recommended duration. Median total duration of therapy compared with recommended duration specified in national guidelines was UTI: 10 days [ 7 – 10 ], cUTI: 12 days [7.5-12.5], CAP: 7 days [ 7 – 9 ], HAP: 10 days [ 8 – 12 ]. The median antibiotic duration was shorter in patients with no cultures or culture negative results compared with patients with positive cultures for all indications (UTI: 10.3 vs 10.8 days, cUTI: 9 vs 12 days, CAP: 8 vs 9.1 days, HAP: 10.5 vs 19.8 days). Overall, the recommended duration of antibiotics was completed while inpatient in 34.7%, but varied by infection. More patients with UTI or cUTI completed recommended duration of therapy while inpatient vs for CAP or HAP (53.8% vs 28%, P = .03). Eighty percent of those with UTI, 18.2% with cUTI, 25.6% with CAP, and 31.2% with HAP had already received the recommended duration of treatment, or more, on day of hospital discharge. Conclusions: The median duration of antibiotic therapy for all indications evaluated was longer than recommended in national guidelines. Opportunities for stewardship by non-ID pharmacists to impact postdischarge antimicrobial use at transitions of care have been identified.

Diagnosis and management of nosocomial pneumonia

2016 ◽  
Author(s):  
Jean Chastre
Keyword(s):  
Nosocomial Pneumonia ◽  
Broad Spectrum ◽  
Quantitative Culture ◽  
Bacterial Killing ◽  
Culture Techniques ◽  
Second Stage ◽  
Duration Of Therapy ◽  
New Antibiotics ◽  
Stage Process ◽  
Micro Organisms

Quantitative culture techniques, performed before the introduction of new antibiotics, enable physicians to identify most patients who need immediate treatment for nosocomial pneumonia, and help select optimal therapy in a safe, well-tolerated manner. These techniques avoid resorting to broad-spectrum coverage of all patients with a clinical suspicion of infection, and may minimize the emergence of resistant micro-organisms in the intensive care unit. However, the full impact of this decision tree on patient outcome remains controversial. Antimicrobial therapy of patients with nosocomial pneumonia is a two-stage process. The first stage involves administering broad-spectrum antibiotics at doses maximizing bacterial killing as soon as possible to avoid inadequate treatment in patients with true bacterial pneumonia. The second stage focuses on trying to achieve this objective without overusing or abusing antibiotics. This will need the combination of a number of different steps, including commitment to focused and narrow treatment once the aetiological agents are known, switching to monotherapy after day 3, and shortening duration of therapy to 7–8 days in most patients, as dictated by the patient’s clinical response and microbiological information.

scholarly journals ADD it up: an evaluation of Antibiotic Duration at hospital Discharge at a community hospital

2021 ◽  
Author(s):  
Morgan Conner ◽  
William H Harris ◽  
John P Bomkamp
Keyword(s):  
Antibiotic Therapy ◽  
Hospital Discharge ◽  
Median Duration ◽  
Unmet Need ◽  
Community Acquired Pneumonia ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Duration Of Therapy ◽  
Days Of Therapy ◽  
Antibiotic Duration

Abstract Purpose According to the CDC, patients admitted to the hospital are commonly discharged on antibiotic therapy with prolonged courses of therapy, which contributes to excessive antibiotic exposure and adverse events. The purpose of this study was to evaluate total antibiotic duration of therapy at hospital discharge at Indiana University (IU) Health Arnett, White Memorial, and Frankfort Hospitals. Methods A multicenter, retrospective electronic health record review was conducted from January 1, 2019, to June 30, 2019. Patients were included if they were at least 18 years of age, began antibiotic therapy while admitted, and continued antibiotic therapy at hospital discharge for one of the following indications: skin/soft tissue infection (SSTI), urinary tract infection (UTI), community-acquired pneumonia (CAP) or acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The days-of-therapy (DOT) of each inpatient and outpatient antibiotic prescribed were collected to calculate the total DOT, which was utilized to determine the appropriateness of the duration of therapy. Results Of the 547 patients included, 233 patients (42.6%) had CAP, 120 (21.9%) had UTI, 101 (18.5%) had SSTI, and 93 (17%) had AECOPD. The median duration of antibiotic therapy across all indications was 9 days (IQR 7-11). Median duration for CAP was 9 days (IQR 7-10), AECOPD was 7 days (IQR 5-9), UTI was 8 days (IQR 6-10), and SSTI was 12 days (IQR 10-14). Conclusions Excess antimicrobial duration at hospital discharge represents an unmet need of antimicrobial stewardship programs.

scholarly journals 41. Impact of the Development of a Perioperative Antibiotic Pathway on Antibiotic Duration of Therapy, C.difficile Infection Rates and Surgical Site Infection Rates in the Adult Facial Reconstruction Population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S44-S44
Author(s):  
Lindsay McDonnell ◽  
Leigh A Kennedy
Keyword(s):  
Head And Neck ◽  
Free Flap ◽  
Statistical Significance ◽  
Intervention Group ◽  
Adult Patients ◽  
Infection Rates ◽  
Post Intervention ◽  
Duration Of Therapy ◽  
Perioperative Antibiotics ◽  
Antibiotic Duration

Abstract Background There is variability in the duration of peri-operative antibiotic prophylaxis for free flap reconstructions (FFRs) of the head and neck. Complications of FFRs such as surgical site infections (SSIs), can be devastating and lead to vessel thrombosis and flap loss. Infection rates for head and neck free flap reconstructions have been reported to be as high as 20–50% of cases.1 Despite recommendations from ASHP, IDSA and CDC, postoperative antibiotics are often prolonged at the clinician’s discretion, with many clinicians administering >24 hours of prophylactic antibiotics in cases of FFRs. Methods The departments of infectious disease, otorhinolaryngology and antimicrobial stewardship, developed a pathway for perioperative antibiotics for adult patients undergoing FFRs. Patients with criteria that put them at high risk for SSIs post-operatively, were given up to 72 hours of antibiotics. Patients without these risk factors, were allowed a maximum of 24 hours of antibiotics post-operatively. Next, dissemination and education of the pathway occurred. Our group then collected post –intervention data on antibiotic duration of therapy, C. difficile infections and SSIs in these patients. We collected data over a 6 month period (10/1/2018 to 3/31/2019) for patients undergoing FFRs who received ampicillin/sulbactam (n=33) and compared it to our baseline/pre-intervention data. Perioperative Antibiotic Recommendations for Adult Facial Reconstructive Surgery Pathway Results The mean duration of ampicillin-sulbactam usage decreased from 6.82 days to 4.24 days (p=0.0039). The hospital acquired C.difficile rate decreased from 6.06% to 0% (p=0.4923). The rate of SSIs increased from 3.13% pre-intervention to 9.09%, but this did not reach statistical significance (p=0.6132). One patient in the pre- intervention group and one patient in the post intervention group required a return to the operating room due to SSIs. Conclusion In conclusion, through the development of a pathway for perioperative antibiotics for adult patients undergoing FFRs, the duration of postoperative antibiotic therapy decreased significantly. The rates of SSIs increased after the pathway was introduced, but this was not statistically significant. The rates of C.difficile infections decreased, but this did not reach statistical significance. Disclosures All Authors: No reported disclosures

scholarly journals Diminishing returns, increasing risks: Impact of antibiotic duration of therapy on respiratory bacterial isolates in hospitalized patients during the coronavirus disease 2019 (COVID-19) pandemic

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Catherine Li ◽  
Ryan W. Chapin ◽  
Nicholas J. Mercuro ◽  
Christina F. Yen ◽  
Howard S. Gold ◽  
...  
Keyword(s):  
Multidrug Resistant ◽  
Case Control ◽  
Control Analysis ◽  
Gram Negative Bacteria ◽  
Bacterial Isolates ◽  
Gram Negative ◽  
Duration Of Therapy ◽  
Antibiotic Duration ◽  
Case Control Analysis ◽  
Hospital Days

Abstract In 829 hospital encounters for patients with COVID-19, 73.2% included orders for antibiotics; however, only 1.8% had respiratory cultures during the first 3 hospital days isolating bacteria. Case–control analysis of 30 patients and 96 controls found that each antibiotic day increased the risk of isolating multidrug-resistant gram-negative bacteria (MDR-GNB) in respiratory cultures by 6.5%.

Outcome of Treatment of Deep-Vein Thrombosis with Urokinase: Relationship to Dosage, Duration of Therapy, Age of the Thrombus and Laboratory Changes

1984 ◽  
Vol 51 (02) ◽  
pp. 236-239 ◽  
Author(s):  
A D’Angelo ◽  
P M Mannucci
Keyword(s):  
Degradation Products ◽  
High Rate ◽  
Bleeding Complications ◽  
Vein Thrombosis ◽  
Treatment Regimens ◽  
Duration Of Therapy ◽  
Laboratory Changes ◽  
Deep Vein ◽  
Dose Dependent ◽  
Higher Doses

SummaryForty-one patients with phlebographically proven DVT of the popliteal, femoral or iliac veins were treated with different regimens of urokinase (UK) given by continuous intravenous infusion. The four groups were comparable with respect to localization, extension and estimated age of the thrombi. Another phlebographic picture was taken within 48 hr after the end of UK infusion. Substantial lysis had occurred in 2 of 10 patients treated with 1500 U/kg/h for 2 days, in 4 of 11 treated with 2500/U/kg/h for 3 days, in 2 of 10 treated with 2500 U/kg/h for 7 days and in 4 of 10 treated with 4000 U/kg/h for 4 days. Only thrombi younger than 8 days could be lysed, with 61% (8/13) rate of lysis for thrombi less than 5 days old. Bleeding complications were observed more frequently with the higher doses and longer durations of therapy. The four treatment regimens all induced dose-dependent changes in fibrinogen, fibrin(ogen) degradation products, plasminogen and antiplasmin. Neither pre- nor postinfusion values of these parameters could differentiate patients with lysis from those without lysis. It is concluded that UK can provoke a high rate of thrombolysis of DVT treated early after the appearance of symptoms but that there is no relationship between UK-induced modifications of fibrinolysis and the outcome of therapy.

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