Hospital-Level Variability in Broad-Spectrum Antibiotic Use for Children With Acute Leukemia Undergoing Hematopoietic Cell Transplantation

OBJECTIVETo explore the prevalence and drivers of hospital-level variability in antibiotic utilization among hematopoietic cell transplant (HCT) recipients to inform antimicrobial stewardship initiatives.DESIGNRetrospective cohort study using data merged from the Pediatric Health Information System and the Center for International Blood and Marrow Transplant Research.SETTINGThe study included 27 transplant centers in freestanding children’s hospitals.METHODSThe primary outcome was days of broad-spectrum antibiotic use in the interval from day of HCT through neutrophil engraftment. Hospital antibiotic utilization rates were reported as days of therapy (DOTs) per 1,000 neutropenic days. Negative binomial regression was used to estimate hospital utilization rates, adjusting for patient covariates including demographics, transplant characteristics, and severity of illness. To better quantify the magnitude of hospital variation and to explore hospital-level drivers in addition to patient-level drivers of variation, mixed-effects negative binomial models were also constructed.RESULTSAdjusted hospital rates of antipseudomonal antibiotic use varied from 436 to 1121 DOTs per 1,000 neutropenic days, and rates of broad-spectrum, gram-positive antibiotic use varied from 153 to 728 DOTs per 1,000 neutropenic days. We detected variability by hospital in choice of antipseudomonal agent (ie, cephalosporins, penicillins, and carbapenems), but gram-positive coverage was primarily driven by vancomycin use. Considerable center-level variability remained even after controlling for additional hospital-level factors. Antibiotic use was not strongly associated with days of significant illness or mortality.CONCLUSIONAmong a homogenous population of children undergoing HCT for acute leukemia, both the quantity and spectrum of antibiotic exposure in the immediate posttransplant period varied widely. Antimicrobial stewardship initiatives can apply these data to optimize the use of antibiotics in transplant patients.Infect Control Hosp Epidemiol 2018;797–805

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Quantifying Empiric Antibiotic Use in US Children’s Hospitals

Hospital Pediatrics ◽

10.1542/hpeds.2021-005950 ◽

2021 ◽

Author(s):

Kathleen Chiotos ◽

Lauren D’Arinzo ◽

Eimear Kitt ◽

Rachael Ross ◽

Jeffrey S. Gerber

Keyword(s):

Broad Spectrum ◽

Antibiotic Use ◽

Level Variation ◽

Hospital Level ◽

Broad Spectrum Antibiotic ◽

Children's Hospitals ◽

Broad Spectrum Antibiotics ◽

Children’S Hospitals ◽

Days Of Therapy ◽

Rule Out

OBJECTIVES Empirical broad-spectrum antibiotics are routinely administered for short durations to children with suspected bacteremia while awaiting blood culture results. Our aim for this study was to estimate the proportion of broad-spectrum antibiotic use accounted for by these “rule-outs.” METHODS The Pediatric Health Information System was used to identify children aged 3 months to 20 years hospitalized between July 2016 and June 2017 who received broad-spectrum antibiotics for suspected bacteremia. Using an electronic definition for a rule-out, we estimated the proportion of all broad-spectrum antibiotic days of therapy accounted for by this indication. Clinical and demographic characteristics, as well as antibiotic choice, are reported descriptively. RESULTS A total of 67 032 episodes of suspected bacteremia across 42 hospitals were identified. From these, 34 909 (52%) patients were classified as having received an antibiotic treatment course, and 32 123 patients (48%) underwent an antibiotic rule-out without a subsequent treatment course. Antibiotics prescribed for rule-outs accounted for 12% of all broad-spectrum antibiotic days of therapy. Third-generation cephalosporins and vancomycin were the most commonly prescribed antibiotics, and substantial hospital-level variation in vancomycin use was identified (range: 16%–58% of suspected bacteremia episodes). CONCLUSIONS Broad-spectrum intravenous antibiotic use for rule-out infections appears common across children’s hospitals, with substantial hospital-level variation in the use of vancomycin in particular. Antibiotic stewardship programs focused on intervening on antibiotics prescribed for longer durations may consider this novel opportunity to further standardize antibiotic regimens and reduce antibiotic exposure.

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Impact of an antimicrobial stewardship programme on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitals in Jordan

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa464 ◽

2020 ◽

Author(s):

Dawood Yusef ◽

Wail A Hayajneh ◽

Ali Bani Issa ◽

Rami Haddad ◽

Sayer Al-Azzam ◽

...

Keyword(s):

Acinetobacter Baumannii ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Antibiotic Use ◽

Broad Spectrum Antibiotic ◽

Carbapenem Resistant ◽

Restriction Policy ◽

Prior Approval ◽

Tertiary Teaching ◽

The Impact

Abstract Objectives To evaluate the impact of an antimicrobial stewardship programme (ASP) on reducing broad-spectrum antibiotic use and its effect on carbapenem-resistant Acinetobacter baumannii (CRAb) in hospitalized patients. Methods The study was a retrospective, ecological assessment in a tertiary teaching hospital over 6 years (January 2014 to December 2019). The intervention involved the implementation of an ASP in February 2018, which remains in effect today. This ASP consists of several components, including education, antibiotic guidelines, antibiotic restriction policy with prior approval, audit of compliance to the restriction policy and feedback. Restricted antibiotics were imipenem/cilastatin, ertapenem, meropenem, vancomycin, teicoplanin, tigecycline, colistin, amikacin, piperacillin/tazobactam, levofloxacin and ciprofloxacin. The intervention was evaluated by time-series methods. Results Statistically significant decreases in the level of antibiotic use, after the introduction of the ASP, were observed for the following antibiotics: imipenem/cilastatin (P = 0.0008), all carbapenems (P = 0.0001), vancomycin (P = 0.0006), colistin (P = 0.0016) and third-generation cephalosporins (P = 0.0004). A statistically significant decrease in the slope, after the introduction of the ASP, for ertapenem (P = 0.0044) and ciprofloxacin (P = 0.0117) was observed. For piperacillin/tazobactam, there was a significant increasing trend (P = 0.0208) before the introduction of the ASP. However, this increased trend was halted post-introduction of the ASP (P = 0.4574). The introduction of the ASP was associated with a significant impact on reducing the levels of CRAb (P = 0.0237). Conclusions The introduced antimicrobial stewardship interventions contributed to a reduction in the use of several broad-spectrum antibiotics, reversed the trends of increasing use of other antibiotics and were associated with a significant reduction in CRAb.

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Evaluating a Pharmacy-Driven 72-Hour Antibiotic Monitoring Program Implemented in a Community Hospital

Hospital Pharmacy ◽

10.1177/0018578719867661 ◽

2019 ◽

pp. 001857871986766

Author(s):

Vishal Patel ◽

Shaina Doyen

Keyword(s):

Infectious Diseases ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Community Hospital ◽

Monitoring Program ◽

Antibiotic Use ◽

Audit And Feedback ◽

Broad Spectrum Antibiotic ◽

Days Of Therapy ◽

The Impact

Background: Antimicrobial stewardship programs commonly utilize infectious diseases pharmacists to guide appropriate utilization of broad-spectrum antimicrobials. Strategies should be developed to increase staff pharmacist’s participation in decreasing broad-spectrum antibiotic use. Objective: The purpose of this study was to determine the effectiveness of a pharmacy-driven 72-hour antimicrobial stewardship initiative. Methods: A pharmacy-driven 72-hour antibiotic review policy was implemented at a community hospital. Targeted antibiotics included ertapenem, meropenem, and daptomycin. The hospital’s infectious diseases pharmacist provided policy education to staff pharmacists. All pharmacists provided prospective audit and feedback to physicians. Preimplementation and postimplementation data were collected through a retrospective chart review to analyze the impact of the initiative. Results: There were a total of 570 targeted antibiotic orders for review, of which 155 antibiotic orders met criteria for inclusion; 97 in the preimplementation group and 58 in the postimplementation group. Targeted antibiotic orders decreased postimplementation during the study period. Days of therapy per 1000 patient days decreased between the 2 groups, although this was statistically significant neither for the pooled targeted antibiotics nor for each individual antibiotic. There was a statistically significant increase in the number of appropriately prescribed targeted antibiotics from preimplementation compared to postimplementation (from 35% to 64%, P < .01). Pharmacist interventions documented for patients receiving the targeted antibiotics increased significantly during the intervention period ( P < .01). In addition, there was a total of $28 795.96 in cost avoidance based on the difference in antibiotic use between the 2 groups. Conclusion: Implementation of a pharmacy-driven 72-hour broad-spectrum antibiotic review in a large community-based hospital resulted in a reduction in utilization and hospital spending and a significant increase in appropriate use of targeted antibiotics, while also increasing pharmacist engagement with antimicrobial stewardship.

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Center-level variability in broad-spectrum antibiotic prescribing for children undergoing hematopoietic cell transplantion for acute leukemia.

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.623 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S277-S278

Author(s):

Caitlin Elgarten ◽

Staci Arnold ◽

Yimei Li ◽

Y Vera Huang ◽

Jeffrey S Gerber ◽

...

Keyword(s):

Acute Leukemia ◽

Broad Spectrum ◽

Hematopoietic Cell ◽

Antibiotic Prescribing ◽

Broad Spectrum Antibiotic

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Impact of national guidelines for antimicrobial stewardship to reduce antibiotic use in upper respiratory tract infection and gastroenteritis

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.427 ◽

2020 ◽

pp. 1-7

Author(s):

Daisuke Sato ◽

Tadahiro Goto ◽

Kazuaki Uda ◽

Ryosuke Kumazawa ◽

Hiroki Matsui ◽

...

Keyword(s):

Tract Infection ◽

Respiratory Tract ◽

Respiratory Tract Infection ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Antibiotic Use ◽

National Guidelines ◽

Broad Spectrum Antibiotic ◽

Significant Downward Trend ◽

Significant Change

Abstract Objective: To examine whether the issue and dissemination of national guidelines in the Manual of Antimicrobial Stewardship had an impact on reducing antibiotic use for acute respiratory tract infection (ARTI) and gastroenteritis. Method: An interrupted time-series analysis was performed using a large nationwide database from June 2016 to June 2018. Outpatients with ARTI or gastroenteritis aged ≥6 years were identified. The outcome measures were any antibiotic use and broad-spectrum antibiotic use. The season-adjusted changes in the rate of antibiotic prescriptions for 2 periods before and after the guideline issue date were examined. Results: There were 13,177,735 patients with ARTI and 300,565 patients with gastroenteritis during the study period. Among patients with ARTI, there was a significant downward trend in antibiotic use during the 2-year study period (−0.06% per week; 95% CI, −0.07% to −0.04%). However, there was no significant change in trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.01% per week; 95% CI, −0.10% to 0.07%). Similarly, for patients with gastroenteritis, there was no significant change in the trends of antibiotic use between the pre-issue period and post-issue period (trend difference, −0.02% per week; 95% CI, −0.04% to 0.01%). Similar associations were observed in analyses for broad-spectrum antibiotic use. Conclusions: Despite the issue of national guidelines to promote the appropriate use of antibiotics, there were no significant changes in trends of antibiotic use for outpatients with ARTI or gastroenteritis between the pre-issue and post-issue periods.

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Motivational Application of Standardized Antimicrobial Administration Ratios Within a Healthcare System

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.918 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s321-s321

Author(s):

Stephanie Shealy ◽

Joseph Kohn ◽

Emily Yongue ◽

Casey Troficanto ◽

Brandon Bookstaver ◽

...

Keyword(s):

Patient Care ◽

Healthcare System ◽

Antimicrobial Stewardship ◽

Broad Spectrum ◽

Healthcare Providers ◽

The United States ◽

Antimicrobial Use ◽

Gram Positive ◽

Specific Patient ◽

Antimicrobial Administration

Background: Hospitals in the United States have been encouraged to report antimicrobial use (AU) to the CDC NHSN since 2011. Through the NHSN Antimicrobial Use Option module, health systems may compare standardized antimicrobial administration ratios (SAARs) across specific facilities, patient care locations, time periods, and antimicrobial categories. To date, participation in the NHSN Antimicrobial Use Option remains voluntary and the value of reporting antimicrobial use and receiving monthly SAARs to multihospital healthcare systems has not been clearly demonstrated. In this cohort study. we examined potential applications of SAAR within a healthcare system comprising multiple local hospitals. Methods: Three hospitals within Prisma Health-Midlands (hospitals A, B, and C) became participants in the NHSN Antimicrobial Use Option in July 2017. SAAR reports were presented initially in October 2017 and regularly (every 3–4 months) thereafter during interprofessional antimicrobial stewardship system-wide meetings until end of study in June 2019. Through interfacility comparisons and by analyzing SAAR categories in specific patient-care locations, primary healthcare providers and pharmacists were advised to incorporate results into focused antimicrobial stewardship initiatives within their facility. Specific alerts were designed to promote early de-escalation of antipseudomonal β-lactams and vancomycin. The Student t test was used to compare mean SAAR in the preintervention period (July through October 2017) to the postintervention period (November 2017 through June 2019) for all antimicrobials and specific categories and locations within each hospital. Results: During the preintervention period, mean SAAR for all antimicrobials in hospitals A, B, and C were 0.69, 1.09, and 0.60, respectively. Notably, mean SAARs at hospitals A, B, and C in intensive care units (ICU) during the preintervention period were 0.67, 1.36, and 0.83 for broad-spectrum agents used for hospital-onset infections and 0.59, 1.27, and 0.68, respectively, for agents used for resistant gram-positive infections. After antimicrobial stewardship interventions, mean SAARs for all antimicrobials in hospital B decreased from 1.09 to 0.83 in the postintervention period (P < .001). Mean SAARs decreased from 1.36 to 0.81 for broad-spectrum agents used for hospital-onset infections and from 1.27 to 0.72 for agents used for resistant gram-positive infections in ICU at hospital B (P = .03 and P = .01, respectively). No significant changes were noted in hospitals A and C. Conclusions: Reporting AU to the CDC NHSN and the assessment of SAARs across hospitals in a healthcare system had motivational effects on antimicrobial stewardship practices. Enhancement and customization of antimicrobial stewardship interventions was associated with significant and sustained reductions in SAARs for all antimicrobials and specific antimicrobial categories at those locations.Funding: NoneDisclosures: None

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Pediatric antibiotic stewardship: successful interventions to reduce broad-spectrum antibiotic use on general pediatric wards

Infection ◽

10.1007/s15010-017-1009-0 ◽

2017 ◽

Vol 45 (4) ◽

pp. 493-504 ◽

Cited By ~ 25

Author(s):

Katharina Kreitmeyr ◽

Ulrich von Both ◽

Alenka Pecar ◽

Johannes P. Borde ◽

Rafael Mikolajczyk ◽

...

Keyword(s):

Broad Spectrum ◽

Antibiotic Stewardship ◽

Antibiotic Use ◽

Broad Spectrum Antibiotic

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Association of broad-spectrum antibiotic use with faecal carriage of oxyiminocephalosporin-resistant enterobacteriaceae in an intensive care unit

Journal of Hospital Infection ◽

10.1016/j.jhin.2005.12.017 ◽

2006 ◽

Vol 63 (3) ◽

pp. 306-315 ◽

Cited By ~ 11

Author(s):

R. Vignoli ◽

E. Calvelo ◽

N.F. Cordeiro ◽

R. Lucero ◽

E. Ingold ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Broad Spectrum ◽

Antibiotic Use ◽

Broad Spectrum Antibiotic ◽

Faecal Carriage

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Impact of Order-Set Modifications and Provider Education Following Guideline Updates on Broad-Spectrum Antibiotic Use in Patients Admitted With Community Acquired Pneumonia

Hospital Pharmacy ◽

10.1177/00185787211055797 ◽

2021 ◽

pp. 001857872110557

Author(s):

Jessica L. Colmerauer ◽

Kristin E. Linder ◽

Casey J. Dempsey ◽

Joseph L. Kuti ◽

David P. Nicolau ◽

...

Keyword(s):

Broad Spectrum ◽

Antibiotic Use ◽

Community Acquired Pneumonia ◽

Intervention Period ◽

Provider Education ◽

Broad Spectrum Antibiotic ◽

Post Intervention ◽

Post Intervention Period ◽

Days Of Therapy ◽

Order Set

Purpose: Following updates to the Infectious Diseases Society of America (IDSA) practice guidelines for the Diagnosis and Treatment of Adults with Community-acquired Pneumonia in 2019, Hartford HealthCare implemented changes to the community acquired pneumonia (CAP) order-set in August 2020 to reflect criteria for the prescribing of broad-spectrum antimicrobial therapy. The objective of the study was to evaluate changes in broad-spectrum antibiotic days of therapy (DOT) following these order-set updates with accompanying provider education. Methods: This was a multi-center, quasi-experimental, retrospective study of patients with a diagnosis of CAP from September 1, 2019 to October 31, 2019 (pre-intervention) and September 1, 2020 to October 31, 2020 (post-intervention). Patients were identified using ICD-10 codes (A48.1, J10.00-J18.9) indicating lower respiratory tract infection. Data collected included demographics, labs and vitals, radiographic, microbiological, and antibiotic data. The primary outcome was change in broad-spectrum antibiotic DOT, specifically anti-pseudomonal β-lactams and anti-MRSA antibiotics. Secondary outcomes included guideline-concordance of initial antibiotics, utilization of an order-set to prescribe antibiotics, and length of stay (LOS). Results: A total of 331 and 352 patients were included in the pre- and post-intervention cohorts, respectively. There were no differences in order-set usage (10% vs 11.3%, P = .642) between the pre- and post-intervention cohort, respectively. The overall duration of broad-spectrum therapy was a median of 2 days (IQR 0-8 days) in the pre-intervention period and 0 days (IQR 0-4 days) in the post-intervention period ( P < .001). Patients in whom the order-set was used in the post-intervention period were more likely to have guideline-concordant regimens ([36/40] 90% vs [190/312] 60.9%; P = .003). Hospital LOS was shorter in the post-intervention cohort (4.8 days [2.9-7.2 days] vs 5.3 days [IQR 3.5-8.5 days], P = .002). Conclusion: Implementation of an updated CAP order-set with accompanying provider education was associated with reduced use of broad-spectrum antibiotics. Opportunities to improve compliance and thus further increase guideline-concordant therapy require investigation.

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