scholarly journals Stewardship of Remdesivir Use in a Rural Community Hospital During the COVID-19 Pandemic

2021 ◽  
Vol 1 (S1) ◽  
pp. s45-s45
Author(s):  
Raghavendra Tirupathi ◽  
Melissa Gross
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Antibiotic Use ◽  
Supplemental Oxygen ◽  
Second Phase ◽  
Prior Authorization ◽  
Maximum Benefit ◽  
Days Of Therapy ◽  
Unrestricted Access ◽  
The Impact

Background: Remdesivir was granted EUA followed by full FDA approval for treatment of hospitalized COVID-19 patients on October 22, 2020, based on the results from the ACTT1 trial. Remdesivir use was initially restricted to infectious disease (ID) physicians in our hospital with prescription needing formal ID consultation until complete approval. Due to increasing case counts in our hospital, a decision was made to allow intensivists and hospitalists the authorization to prescribe remdesivir in a phased manner. In this retrospective study, we assessed the impact of phased-in prescribing on remdesivir utilization and days of therapy of antimicrobials. Methods: Remdesivir prescribing was streamlined by real-time institutional guidelines developed by a COVID-19 treatment committee constituting ID and other clinicians. Eligibility for remdesivir included positive SARS-CoV-2 PCR test, severe disease defined as persistent hypoxia (<94% oxygen saturation on room air), requiring supplemental oxygen and/or on mechanical ventilation (MV) for <72 hours, and symptom onset of <10 days. We retrospectively reviewed cohorts of 3 periods during which remdesivir was prescribed. In the first cohort A, between October 23, 2020, and November 12, 2020, remdesivir was restricted to ID physicians with formal ID consultation. Cohort B comprised inpatients between November 13, 2020, and December 6, 2020, when hospitalists and intensivists were allowed to prescribe remdesivir through an EMR order set after prior authorization by an ID physician via curbside or telephonic consultation. Cohort C, from December 7, 2020, to December 26, 2020, comprised inpatients with unrestricted prescribing of remdesivir by hospitalists and intensivists. We also evaluated antibiotic use. Results: In cohort A, SARS CoV-2 positivity was 20.3%; 64 inpatients tested positive and 35 patients (54.7%) who met the criteria were prescribed remdesivir after a formal consultation with an ID physician. In cohort B, requiring prior authorization by an ID physician, SARS-CoV-2 positivity rapidly increased to 34%; 193 patients tested positive and 97 patients (50.3%) received remdesivir. In cohort C, during unrestricted access, positivity further increased to 38%; 235 inpatients tested positive and 123 (52.5%) received remdesivir. Remdesivir use remained steady during the 3 phases of gradual de-escalation of restricted prescribing and safe handoff in the context of clear guidelines, as well as ongoing curbside education provided by ID physicians during the second phase. Cohort B demonstrated the best prescribing rates. Antimicrobial prescribing data were also collected during the 3 cohort phases (Figures 1–3). Conclusions: Remdesivir is an expensive antiviral with limited utility and maximum benefit in COVID-19 inpatients who are hypoxic but do not require mechanical ventilation. Stewardship of remdesivir with safe, gradual handoff to inpatient can be achieved without overuse.Funding: NoDisclosures: None

scholarly journals 229. Hospitalists Antimicrobial Scorecard Improves Antibiotic Prescribing at a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S116-S116
Author(s):  
Julia Sessa ◽  
Helen Jacoby ◽  
Bruce Blain ◽  
Lisa Avery
Keyword(s):  
Patient Care ◽  
Teaching Hospital ◽  
Antimicrobial Stewardship ◽  
Rank Order ◽  
Antibiotic Use ◽  
Outpatient Setting ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Days Of Therapy ◽  
The Impact

Abstract Background Measuring antimicrobial consumption data is a foundation of antimicrobial stewardship programs. There is data to support antimicrobial scorecard utilization to improve antibiotic use in the outpatient setting. There is a lack of data on the impact of an antimicrobial scorecard for hospitalists. Our objective was to improve antibiotic prescribing amongst the hospitalist service through the development of an antimicrobial scorecard. Methods Conducted in a 451-bed teaching hospital amongst 22 full time hospitalists. The antimicrobial scorecard for 2019 was distributed in two phases. In October 2019, baseline antibiotic prescribing data (January – September 2019) was distributed. In January 2020, a second scorecard was distributed (October – December 2019) to assess the impact of the scorecard. The scorecard distributed via e-mail to physicians included: Antibiotic days of therapy/1,000 patient care days (corrected for attending census), route of antibiotic prescribing (% intravenous (IV) vs % oral (PO)) and percentage of patients prescribed piperacillin-tazobactam (PT) for greater than 3 days. Hospitalists received their data in rank order amongst their peers. Along with the antimicrobial scorecard, recommendations from the antimicrobial stewardship team were included for hospitalists to improve their antibiotic prescribing for these initiatives. Hospitalists demographics (years of practice and gender) were collected. Descriptive statistics were utilized to analyze pre and post data. Results Sixteen (16) out of 22 (73%) hospitalists improved their antibiotic prescribing from pre- to post-scorecard (χ 2(1)=3.68, p = 0.055). The median antibiotic days of therapy/1,000 patient care days decreased from 661 pre-scorecard to 618 post-scorecard (p = 0.043). The median PT use greater than 3 days also decreased significantly, from 18% pre-scorecard to 11% post-scorecard (p = 0.0025). There was no change in % of IV antibiotic prescribing and no correlation between years of experience or gender to antibiotic prescribing. Conclusion Providing antimicrobial scorecards to our hospitalist service resulted in a significant decrease in antibiotic days of therapy/1,000 patient care days and PT prescribing beyond 3 days. Disclosures All Authors: No reported disclosures

scholarly journals Impact of Removal of Automatic 7-Day Stop Orders for Inpatient Antimicrobials

2020 ◽  
Vol 41 (S1) ◽  
pp. s264-s265
Author(s):  
Afia Adu-Gyamfi ◽  
Keith Hamilton ◽  
Leigh Cressman ◽  
Ebbing Lautenbach ◽  
Lauren Dutcher
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Interrupted Time Series Analysis ◽  
Series Analysis ◽  
Treatment Interruptions ◽  
Days Of Therapy ◽  
Quasi Experimental ◽  
The Impact

Background: Automatic discontinuation of antimicrobial orders after a prespecified duration of therapy has been adopted as a strategy for reducing excess days of therapy (DOT) as part of antimicrobial stewardship efforts. Automatic stop orders have been shown to decrease antimicrobial DOT. However, inadvertent treatment interruptions may occur as a result, potentially contributing to adverse patient outcomes. To evaluate the effects of this practice, we examined the impact of the removal of an electronic 7-day ASO program on hospitalized patients. Methods: We performed a quasi-experimental study on inpatients in 3 acute-care academic hospitals. In the preintervention period (automatic stop orders present; January 1, 2016, to February 28, 2017), we had an electronic dashboard to identify and intervene on unintentionally missed doses. In the postintervention period (April 1, 2017, to March 31, 2018), the automatic stop orders were removed. We compared the primary outcome, DOT per 1,000 patient days (PD) per month, for patients in the automatic stop orders present and absent periods. The Wilcoxon rank-sum test was used to compare median monthly DOT/1,000 PD. Interrupted time series analysis (Prais-Winsten model) was used to compared trends in antibiotic DOT/1,000 PD and the immediate impact of the automatic stop order removal. Manual chart review on a subset of 300 patients, equally divided between the 2 periods, was performed to assess for unintentionally missed doses. Results: In the automatic stop order period, a monthly median of 644.5 antibiotic DOT/1,000 PD were administered, compared to 686.2 DOT/1,000 PD in the period without automatic stop orders (P < .001) (Fig. 1). Using interrupted time series analysis, there was a nonsignificant increase by 46.7 DOT/1,000 PD (95% CI, 40.8 to 134.3) in the month immediately following removal of automatic stop orders (P = .28) (Fig. 2). Even though the slope representing monthly change in DOT/1,000 PD increased in the period without automatic stop orders compared to the period with automatic stop orders, it was not statistically significant (P = .41). Manual chart abstraction revealed that in the period with automatic stop orders, 9 of 150 patients had 17 unintentionally missed days of therapy, whereas none (of 150 patients) in the period without automatic stop orders did. Conclusions: Following removal of the automatic stop orders, there was an overall increase in antibiotic use, although the change in monthly trend of antibiotic use was not significantly different. Even with a dashboard to identify missed doses, there was still a risk of unintentionally missed doses in the period with automatic stop orders. Therefore, this risk should be weighed against the modest difference in antibiotic utilization garnered from automatic stop orders.Funding: NoneDisclosures: None

scholarly journals 154. Antibiotic Use During Three Separate Waves of the COVID-19 Pandemic at a Large Academic Medical Center in Detroit, MI

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S188-S189
Author(s):  
Deepika Sivakumar ◽  
Shelbye R Herbin ◽  
Raymond Yost ◽  
Marco R Scipione
Keyword(s):  
Retrospective Review ◽  
Bacterial Pneumonia ◽  
Medical Center ◽  
Academic Medical Center ◽  
Antibiotic Use ◽  
Percent Change ◽  
Academic Medical ◽  
Days Of Therapy ◽  
Time Periods ◽  
The Impact

Abstract Background Inpatient antibiotic use early on in the COVID-19 pandemic may have increased due to the inability to distinguish between bacterial and COVID-19 pneumonia. The purpose of this study was to determine the impact of COVID-19 on antimicrobial usage during three separate waves of the COVID-19 pandemic. Methods We conducted a retrospective review of patients admitted to Detroit Medical Center between 3/10/19 to 4/24/21. Median days of therapy per 1000 adjusted patient days (DOT/1000 pt days) was evaluated for all administered antibiotics included in our pneumonia guidelines during 4 separate time periods: pre-COVID (3/3/19-4/27/19); 1st wave (3/8/20-5/2/20); 2nd wave (12/6/21-1/30/21); and 3rd wave (3/7/21-4/24/21). Antibiotics included in our pneumonia guidelines include: amoxicillin, azithromycin, aztreonam, ceftriaxone, cefepime, ciprofloxacin, doxycycline, linezolid, meropenem, moxifloxacin, piperacillin-tazobactam, tobramycin, and vancomycin. The percent change in antibiotic use between the separate time periods was also evaluated. Results An increase in antibiotics was seen during the 1st wave compared to the pre-COVID period (2639 [IQR 2339-3439] DOT/1000 pt days vs. 2432 [IQR 2291-2499] DOT/1000 pt days, p=0.08). This corresponded to an increase of 8.5% during the 1st wave. This increase did not persist during the 2nd and 3rd waves of the pandemic, and the use decreased by 8% and 16%, respectively, compared to the pre-COVID period. There was an increased use of ceftriaxone (+6.5%, p=0.23), doxycycline (+46%, p=0.13), linezolid (+61%, p=0.014), cefepime (+50%, p=0.001), and meropenem (+29%, p=0.25) during the 1st wave compared to the pre-COVID period. Linezolid (+39%, p=0.013), cefepime (+47%, p=0.08) and tobramycin (+47%, p=0.05) use remained high during the 3rd wave compared to the pre-COVID period, but the use was lower when compared to the 1st and 2nd waves. Figure 1. Antibiotic Use 01/2019 to 04/2019 Conclusion Antibiotics used to treat bacterial pneumonia during the 1st wave of the pandemic increased and there was a shift to broader spectrum agents during that period. The increased use was not sustained during the 2nd and 3rd waves of the pandemic, possibly due to the increased awareness of the differences between patients who present with COVID-19 pneumonia and bacterial pneumonia. Disclosures All Authors: No reported disclosures

scholarly journals The COVID-19 Hospitalization Metric in the Pre- and Post-vaccination Eras as a Measure of Pandemic Severity: A Retrospective, Nationwide Cohort Study

2021 ◽  
Author(s):  
Nathanael Fillmore ◽  
Jennifer La ◽  
Chunlei Zheng ◽  
Shira Doron ◽  
Nhan Do ◽  
...  
Keyword(s):  
Disease Severity ◽  
Severe Disease ◽  
Supplemental Oxygen ◽  
Case Definition ◽  
Vaccination Status ◽  
P Value ◽  
Case Definitions ◽  
Pandemic Severity ◽  
Vaccine Availability ◽  
The Impact

Abstract Importance: Since the early days of the pandemic, COVID-19 hospitalizations have been used as a measure of pandemic severity. However, case definitions do not include assessments of disease severity, which may be impacted by prior vaccination.Objective: To measure how the severity of respiratory disease changed among inpatients with documented SARS-CoV-2 infection and to measure the impact of vaccination status on these trends, in order to evaluate the accuracy of the metric of “hospitalization plus a positive SARS-CoV-2 test” for tracking pandemic severity.Design: Retrospective cohort of inpatients with laboratory-confirmed SARS-CoV-2. All data were obtained from electronic health records.Setting: Multi-center, nationwide study conducted in the healthcare system of the US Department of Veterans Affairs (VA) from March 1, 2020, through June 30, 2021.Participants: All VA patients admitted to a VA hospital with a laboratory-confirmed SARS-CoV-2 infection within the 14-days prior to admission or during the hospital admission.Main Outcome: Moderate-to-severe COVID-19 disease, defined by use of any supplemental oxygen or documented SpO2 <94%, during an inpatient hospitalization between one day before and two weeks after a positive SARS-CoV-2 test.Exposure: SARS-CoV-2 vaccination status at the time of hospitalization. Patients were regarded as fully vaccinated starting 14 days after receiving the second of a 2-dose regimen or 14 days after receipt of a single-dose vaccine.Results: Among 47,742 admissions in 38,508 unique patients with laboratory-confirmed SARS-CoV-2, N=28,731 met the criteria for moderate-to-severe COVID-19. The proportion with moderate-to-severe disease prior to widespread vaccine availability was 64.0% (95% CI, 63.1-64.9%) versus 52.0% in the later period (95% CI, 50.9-53.2%), p-value for non-constant effect, <0.001. Disease severity in the vaccine era among hospitalized patients was lower among both unvaccinated (55.0%, 95% CI, 53.7-56.4%) and vaccinated patients (42.6%, 95% CI, 40.6-44.8%).Conclusions and Relevance: The proportion of hospitalizations that are due to severe COVID-19 has changed with vaccine availability, thus, increasing proportions of mild and asymptomatic cases are included in hospitalization reporting metrics. The addition of simple measures of disease severity to the case definition of a SARS-CoV-2 hospitalization is a straightforward and objective change that should improve the value of the metric for tracking SARS-CoV-2 disease burden.

scholarly journals Outcomes of COVID-19 in Patients With a History of Cancer and Comorbid Cardiovascular Disease

2020 ◽  
pp. 1-10
Author(s):  
Sarju Ganatra ◽  
Sourbha S. Dani ◽  
Robert Redd ◽  
Kimberly Rieger-Christ ◽  
Rushin Patel ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Mechanical Ventilation ◽  
Severe Disease ◽  
Multivariable Analysis ◽  
Supplemental Oxygen ◽  
Adverse Outcomes ◽  
Patients With Cancer ◽  
Vulnerable Patient ◽  
History Of ◽  
Secondary Endpoints

Background: Cancer and cardiovascular disease (CVD) are independently associated with adverse outcomes in patients with COVID-19. However, outcomes in patients with COVID-19 with both cancer and comorbid CVD are unknown. Methods: This retrospective study included 2,476 patients who tested positive for SARS-CoV-2 at 4 Massachusetts hospitals between March 11 and May 21, 2020. Patients were stratified by a history of either cancer (n=195) or CVD (n=414) and subsequently by the presence of both cancer and CVD (n=82). We compared outcomes between patients with and without cancer and patients with both cancer and CVD compared with patients with either condition alone. The primary endpoint was COVID-19–associated severe disease, defined as a composite of the need for mechanical ventilation, shock, or death. Secondary endpoints included death, shock, need for mechanical ventilation, need for supplemental oxygen, arrhythmia, venous thromboembolism, encephalopathy, abnormal troponin level, and length of stay. Results: Multivariable analysis identified cancer as an independent predictor of COVID-19–associated severe disease among all infected patients. Patients with cancer were more likely to develop COVID-19–associated severe disease than were those without cancer (hazard ratio [HR], 2.02; 95% CI, 1.53–2.68; P<.001). Furthermore, patients with both cancer and CVD had a higher likelihood of COVID-19–associated severe disease compared with those with either cancer (HR, 1.86; 95% CI, 1.11–3.10; P=.02) or CVD (HR, 1.79; 95% CI, 1.21–2.66; P=.004) alone. Patients died more frequently if they had both cancer and CVD compared with either cancer (35% vs 17%; P=.004) or CVD (35% vs 21%; P=.009) alone. Arrhythmias and encephalopathy were also more frequent in patients with both cancer and CVD compared with those with cancer alone. Conclusions: Patients with a history of both cancer and CVD are at significantly higher risk of experiencing COVID-19–associated adverse outcomes. Aggressive public health measures are needed to mitigate the risks of COVID-19 infection in this vulnerable patient population.

scholarly journals Proadrenomedullin Predicts Severe Disease in Children with Suspected Community-Acquired Pneumonia

2020 ◽  
Author(s):  
Todd A Florin ◽  
Lilliam Ambroggio ◽  
Cole Brokamp ◽  
Yin Zhang ◽  
Eric S Nylen ◽  
...  
Keyword(s):  
Disease Severity ◽  
Odds Ratio ◽  
Severe Disease ◽  
Antibiotic Use ◽  
Supplemental Oxygen ◽  
Community Acquired Pneumonia ◽  
C Reactive Protein ◽  
Chest Drainage ◽  
Reactive Protein ◽  
Complicated Pneumonia

Abstract Background Proadrenomedullin (proADM), a vasodilatory peptide with antimicrobial and anti-inflammatory properties, predicts severe outcomes in adults with community-acquired pneumonia (CAP) to a greater degree than C-reactive protein and procalcitonin. We evaluated the ability of proADM to predict disease severity across a range of clinical outcomes in children with suspected CAP. Methods We performed a prospective cohort study of children 3 months to 18 years with CAP in the emergency department (ED). Disease severity was defined as: mild (discharged home), mild-moderate (hospitalized but not moderate-severe or severe), moderate-severe (e.g., hospitalized with supplemental oxygen, broadening of antibiotics, complicated pneumonia), and severe (e.g., vasoactive infusions, chest drainage, severe sepsis). Outcomes were examined using proportional odds logistic regression within the cohort with suspected CAP and in a subset with radiographic CAP. Results Among 369 children, median proADM increased with disease severity [mild: median 0.53 nmol/L (IQR:0.43, 0.73), mild-moderate: 0.56 nmol/L (IQR:0.45, 0.71), moderate-severe: 0.61 nmol/L (IQR:0.47, 0.77), severe: 0.70 nmol/L (IQR:0.55, 1.04) (p=.002)]. ProADM was significantly associated with increased odds of developing severe outcomes (suspected CAP odds ratio (OR) 1.68 [95% CI, 1.2, 2.36], radiographic CAP OR 2.11 [95% CI, 1.36, 3.38]) adjusted for age, fever duration, antibiotic use, and pathogen. ProADM had an area under the ROC curve (AUC) of 0.64 (95%CI, 0.56,0.72) in those with suspected CAP and AUC 0.77 (95% CI, 0.68,0.87) in radiographic CAP. Conclusions ProADM was associated with severe disease and discriminated moderately well children who developed severe disease from those who did not, particularly in radiographic CAP.

scholarly journals Defining the Scope of Antimicrobial Stewardship Interventions on the Prescription Quality of Antibiotics for Surgical Intra-Abdominal Infections

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 73
Author(s):  
Güzin Surat ◽  
Ulrich Vogel ◽  
Armin Wiegering ◽  
Christoph-Thomas Germer ◽  
Johan Friso Lock
Keyword(s):  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Baseline Period ◽  
Tertiary Hospital ◽  
Significant Decline ◽  
Wound Complications ◽  
Postoperative Therapy ◽  
Days Of Therapy ◽  
Abdominal Infections ◽  
The Impact

Background: The aim of this study was to assess the impact of antimicrobial stewardship interventions on surgical antibiotic prescription behavior in the management of non-elective surgical intra-abdominal infections, focusing on postoperative antibiotic use, including the appropriateness of indications. Methods: A single-center quality improvement study with retrospective evaluation of the impact of antimicrobial stewardship measures on optimizing antibacterial use in intra-abdominal infections requiring emergency surgery was performed. The study was conducted in a tertiary hospital in Germany from January 1, 2016, to January 30, 2020, three years after putting a set of antimicrobial stewardship standards into effect. Results: 767 patients were analyzed (n = 495 in 2016 and 2017, the baseline period; n = 272 in 2018, the antimicrobial stewardship period). The total days of therapy per 100 patient days declined from 47.0 to 42.2 days (p = 0.035). The rate of patients receiving postoperative therapy decreased from 56.8% to 45.2% (p = 0.002), comparing both periods. There was a significant decline in the rate of inappropriate indications (17.4% to 8.1 %, p = 0.015) as well as a significant change from broad-spectrum to narrow-spectrum antibiotic use (28.8% to 6.5%, p ≤ 0.001) for postoperative therapy. The significant decline in antibiotic use did not affect either clinical outcomes or the rate of postoperative wound complications. Conclusions: Postoperative antibiotic use for intra-abdominal infections could be significantly reduced by antimicrobial stewardship interventions. The identification of inappropriate indications remains a key target for antimicrobial stewardship programs.

scholarly journals Impact of SARS-CoV-2 Infection Among Non-Invasive Ventilated ALS Patients

2021 ◽  
pp. 1-3
Author(s):  
Miguel Oliveira Santos ◽  
Sara Domingues ◽  
Marta Gromicho ◽  
Susana Pinto ◽  
Mamede de Carvalho
Keyword(s):  
Age Of Onset ◽  
Severe Disease ◽  
Neuromuscular Diseases ◽  
Supplemental Oxygen ◽  
Total Recovery ◽  
Non Invasive ◽  
Respiratory Involvement ◽  
Als Patients ◽  
The Impact ◽  
Lateral Sclerosis

Background: The impact of SARS-CoV-2 infection among neuromuscular diseases with respiratory involvement, including amyotrophic lateral sclerosis (ALS), is still to be elucidated. Objectives: We aim to characterize the clinical outcome of ALS patients non-invasive ventilated (NIV), following SARS-CoV-2 infection. Methods: We analyzed retrospectively our patients followed regularly at our ALS clinic, from the beginning of the COVID-19 pandemic (middle March 2020) to March 2021. We included patients on NIV with a documented SARS-CoV-2 infection. We recorded demographic and clinical data, including from the acute infectious illness. Results: Three men with spinal-onset ALS are described, mean age of onset was 55±9.1 years (45–61), and mean disease duration was 17.5±15.9 months (6.1–41). All of them were wheelchair-bounded, with a mean ALSFRS-R of 15.3±0.6 (15–16). One patient used NIV 15 hours/day, 2 between 4 to 7 hours/day, and all used assisted coughing twice daily. None had coexistent comorbidities. They were managed for SARS-CoV-2 infection as outpatients with fluticasone, bronchodilators, azithromycin and increasing frequency of assisted coughing. Supplemental oxygen (mean of 2 liters per minute) was needed in two patients, and one required NIV also during the daytime. Total recovery from SARS-CoV-2 infection was observed in all, despite being in an advanced stage of their disease, with severe respiratory involvement. Conclusions: Prompt medical treatment is recommended for ALS patients with severe disease infected by SARS-CoV-2.

scholarly journals 82. Post-Prescription Review with Threat of Infectious Disease Consultation and Sustained Reduction in Meropenem Use Over Four Years

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S58-S58
Author(s):  
Nandita S Mani ◽  
Kristine F Lan ◽  
Rupali Jain ◽  
H Nina Kim ◽  
John B Lynch ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Medical Center ◽  
Interrupted Time Series ◽  
Antibiotic Use ◽  
Percentage Change ◽  
Post Intervention ◽  
Sustained Reduction ◽  
Days Of Therapy ◽  
The University ◽  
The Impact

Abstract Background Following a meropenem shortage, we implemented a post-prescription review with feedback (PPRF) in November 2015 with mandatory infectious disease (ID) consultation for all meropenem and imipenem courses &gt; 72 hours. Providers were made aware of the policy via an electronic alert at the time of ordering. Methods A retrospective study was conducted at the University of Washington Medical Center (UWMC) and Harborview Medical Center (HMC) to evaluate the impact of the policy on antimicrobial consumption and clinical outcomes pre- and post-intervention during a 6-year period. Antimicrobial use was tracked using days of therapy (DOT) per 1,000 patient-days, and data were analyzed by an interrupted time series. Results There were 4,066 and 2,552 patients in the pre- and post-intervention periods, respectively. Meropenem and imipenem use remained steady until the intervention, when a marked reduction in DOT/1,000 patient-days occurred at both hospitals (UWMC: percentage change -72.1%, (95% CI -76.6, -66.9), P &lt; 0.001; HMC: percentage change -43.6%, (95% CI -59.9, -20.7), P = 0.001). Notably, although the intervention did not address antibiotic use until 72 hours after initiation, there was a significant decline in meropenem and imipenem initiation (“first starts”) in the post-intervention period, with a 64.9% reduction (95% CI 58.7, 70.2; P &lt; 0.001) at UWMC and 44.7% reduction (95% CI 28.1, 57.4; P &lt; 0.001) at HMC. Meropenem and Imipenem DOT (January 2013 – November 2019) Conclusion Mandatory ID consultation and PPRF for meropenem and imipenem beyond 72 hours resulted in a significant and sustained reduction in the use of these antibiotics and notably impacted their up-front usage. Disclosures All Authors: No reported disclosures

scholarly journals Age and chest radiography as possible parameters for rapid triage in COVID-19 outbreak surge

2020 ◽  
Author(s):  
Wei Enli Wycliffe ◽  
Tan Cher Heng ◽  
Monica Chan ◽  
Tan Thuan TOng ◽  
Surinder Kaur Pada ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Chest Radiography ◽  
Disease Surveillance ◽  
Characteristic Curve ◽  
Severe Disease ◽  
Clinical Status ◽  
Supplemental Oxygen ◽  
Receiver Operator Characteristic Curve ◽  
Receiver Operator Characteristic ◽  
Oxygen Supplementation

Abstract BackgroundTo evaluate the utility of age and chest radiography(CXR) in triaging COVID-19 patients for hospitalization versus isolation in non-hospital facilities, we examined how age and CXR at diagnosis were associated with clinical needs from late-January to early-April. MethodsClinical status of all COVID-19 cases was monitored for national disease surveillance. Cases were isolated in hospitals until SARS-CoV-2 RNA was undetectable on PCR. Age and CXR results on admission were analysed for association with oxygen supplementation and mechanical ventilation, the outcomes of interest.ResultsTill 4 April 2020, there were 1,481 COVID-19 cases in Singapore. Overall, 11.4% required supplemental oxygen while 4.8% required mechanical ventilation and intensive care. The respective proportions increased to 40.9% and 16.5% for cases aged ≥70 years. As a predictor of subsequent mechanical ventilation, age had an area under the receiver operator characteristic curve(AUROC) of 0.772 (95%CI:0.699-0.845). A combined criterion of either an abnormal CXR or age≥55 years had a sensitivity of 86.7% and specificity of 58.0% for the same outcome. A similar performance was observed for predicting oxygen supplementation needs.ConclusionsAge and CXR at diagnosis may be valuable in excluding severe disease, allowing safe triage for isolation in non-hospital facilities.

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