Changes in antibiotic use following implementation of a telehealth stewardship pilot program

2019 ◽  
Vol 40 (7) ◽  
pp. 810-814 ◽  
Author(s):  
Brigid M. Wilson ◽  
Richard E. Banks ◽  
Christopher J. Crnich ◽  
Emma Ide ◽  
Roberto A. Viau ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Term Care ◽  
Medical Centers ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Veterans Affairs Medical Centers

AbstractStarting in 2016, we initiated a pilot tele-antibiotic stewardship program at 2 rural Veterans Affairs medical centers (VAMCs). Antibiotic days of therapy decreased significantly (P < .05) in the acute and long-term care units at both intervention sites, suggesting that tele-stewardship can effectively support antibiotic stewardship practices in rural VAMCs.

scholarly journals 857. A Tele-Antibiotic Stewardship Program Influences Antibiotic Use at 2 Rural Veterans Affairs Medical Centers

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S19-S19
Author(s):  
Brigid Wilson ◽  
Richard Banks ◽  
Christopher Crnich ◽  
Emma Ide ◽  
Roberto Viau ◽  
...  
Keyword(s):  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Term Care ◽  
Limited Access ◽  
Days Of Therapy ◽  
The Mean ◽  
Length Of Therapy

Abstract Background Telehealth offers the possibility of supporting antibiotic stewardship in settings with limited access to people with infectious diseases (ID) expertise. Previously, we described preliminary results from a pilot project that used the Veterans Affairs (VA) telehealth system to facilitate a Videoconference Antimicrobial Stewardship Team (VAST) which connected a multidisciplinary team from a rural VA medical center (VAMC) with ID physicians at a remote site to support antibiotic stewardship. Here, we present 3 distinct metrics to assess the influence of the VAST on antibiotic use at 2 intervention sites. Methods Outcomes assessed antibiotic use in the hospital and long-term care units of 2 rural VAMCs in the year before and after VAST implementation, allowing for a 1-month wash-in period in the first month of the VAST. Using VA databases, we determined 3 metrics: the rate of antibiotic use (days of therapy per 1,000 bed days of care); the mean length of therapy (days); and the mean patient antibiotic spectrum index (ASI), a measure of antibiotic spectrum increasing from narrow to broad. Using segmented regression on monthly measures of each metric with a knot at the wash-in month (gray square), we calculated predicted values (solid lines), and confidence intervals (dashed lines) to examine trends before (black squares) and after (white squares) implementing the VAST. Results The rate of antibiotic use, mean length of therapy, and ASI decreased at Site A. As indicated in the figure, the effect was more pronounced in long-term care compared with the hospital, where the VAST sustained but did not accelerate downward trends. At Site B, the most notable influence of the VAST was on the ASI for the hospital and long-term care units. Conclusion The VAST is a feasible, sustainable program that is effective at inducing change in antibiotic use at 2 VAMCs. The influence of the VAST differed between the 2 sites and, at Site A had a more pronounced effect on the long-term care compared with hospital units. These distinct metrics capture changes in overall antibiotic use, length of therapy, and agent selection. Tele-antibiotic stewardship programs hold potential to improve antibiotic use at facilities with limited access to people with antibiotic stewardship expertise. Disclosures All authors: No reported disclosures.

scholarly journals Impact of an Antibiotic Stewardship Program in Long-term Care Facilities: A Nursing Home Network Experience

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S63-S63
Author(s):  
Fabian Andres Romero ◽  
Evette Mathews ◽  
Ara Flores ◽  
Susan Seo
Keyword(s):  
Nursing Home ◽  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Post Intervention ◽  
Term Care ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Care Facilities ◽  
The Impact

Abstract Background Antibiotic stewardship program (ASP) implementation is paramount across the healthcare spectrum. Nursing homes represent a challenge due to limited resources, complexity of medical conditions, and less controlled environments. National statistics on ASP for long-term care facilities (LTCF) are sparse. Methods A pilot ASP was launched in August 2016 at a 270-bed nursing home with a 50-bed chronic ventilator-dependent unit. The program entailed a bundle of interventions including leadership engagement, a tracking and reporting system for intravenous antibiotics, education for caregivers, Infectious Disease (ID) consultant availability, and implementation of nursing protocols. Data were collected from pharmacy and medical records between January 2016 and March 2017, establishing pre-intervention and post-intervention periods. Collected data included days of therapy (DOT), antibiotic costs, resident-days, hospital transfers, and Clostridium difficile infection (CDI) rates. Variables were adjusted to 1,000 resident-days (RD) and findings between periods were compared by Mann–Whitney U test. Results A total of 47,423 resident-days and 1,959 DOT were analyzed for this study. Antibiotic use decreased from 54.5 DOT/1000 RD pre-intervention to 27.6 DOT/1000 RD post-intervention (P = 0.017). Antibiotic costs were reduced from a monthly median of US $17,113 to US $7,073 but was not statistically significant (P = 0.39). Analysis stratified by individual antibiotic was done for the five most commonly used antibiotics and found statistically significant reduction in vancomycin use (14.4 vs. 6.5; P = 0.023). Reduction was also found for cefepime/ceftazidime (6.9 vs. 1.3; P = 0.07), ertapenem (6.8 vs. 3.6; P = 0.45), and piperacillin/tazobactam (1.8 vs. 0.6; P = 0.38). Meropenem use increased (1.3 vs. 3.2; P = 0.042). Hospital transfers slightly trended up (6.73 vs. 7.77; P = 0.065), and there was no change in CDI (1.1 s 0.94; P = 0.32). Conclusion A bundle of standardized interventions tailored for LTCF can achieve successful reduction of antibiotic utilization and costs. Subsequent studies are needed to further determine the impact on clinical outcomes such as transfers to hospitals and CDI in these settings. Disclosures All authors: No reported disclosures.

scholarly journals Antibiotic Stewardship Implementation at Hospitals Without On-Site Infectious Disease Specialists: A Mixed-Methods Study

2021 ◽  
Vol 1 (S1) ◽  
pp. s65-s65
Author(s):  
Daniel Livorsi ◽  
Eli Perencevich ◽  
Kenda Stewart Steffensmeier ◽  
Matthew Goetz ◽  
Heather Reisinger
Keyword(s):  
Infectious Disease ◽  
Acute Care ◽  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Acute Care Hospitals ◽  
Antibiotic Use ◽  
Full Time ◽  
Term Care ◽  
Days Of Therapy

Background: Hospitals are required to have antibiotic stewardship programs (ASPs), but there are few models for implementing ASPs without the support of an infectious disease (ID) specialist, defined as an ID physician and/or ID pharmacist. In this study, we sought to understand ASP implementation at hospitals within the Veterans’ Health Administration (VHA) that lack on-site ID support. Methods: Using a mandatory 2016 VHA survey, we identified acute-care hospitals that lacked an on-site ID specialist. For each hospital, antibiotic use (2018–2019) was quantified as days of therapy (DOT) per 1,000 days present, based on NHSN methodology for tracking all antibacterial agents. From July 2019 through April 2020, we conducted semistructured interviews with personnel involved in or affected by ASP activities at 7 qualifying hospitals. All interview transcripts were analyzed using thematic content analysis. Results: Of the 7 acute-care hospitals, 6 (86%) had a long-term care unit; 3 (43%) had an intensive care unit; and 2 (29%) had full-time employment equivalents dedicated to stewardship. Sites averaged 1,075 (SD, ±654) and 148 (SD, ±96) admissions per year in acute-care and long-term care, respectively. At the site-level, mean antibiotic use was 486 DOT (SD, ±98) per 1,000 days-present in acute-care and 207 DOT (SD, ±74) per 1,000 days present in long-term care. We interviewed 42 personnel across the 7 sites. Although sites reported using similar interventions to promote antibiotic stewardship, the shape of these interventions varied. The following 4 common themes were identified: (1) The primary responsibility for ASPs fell on the pharmacist champions, who were typically assigned multiple other non-ASP responsibilities. (2) The pharmacist champions were more successful at gaining buy-in for stewardship initiatives when they had established rapport with clinicians, but at some sites, the use of contract physicians and frequent staff turnover were potential barriers. (3) Some sites felt that having access to an off-site ID specialist was important for overcoming institutional barriers to stewardship and improving the acceptance of their stewardship interventions. (4) In general, stewardship champions struggled to mobilize institutional resources, which made it difficult to advance their programmatic goals. Conclusions: In this study of 7 hospitals without local ID support, we found that ASPs are largely a pharmacy-driven process. Remote ID support, if available, was seen as helpful for implementing stewardship interventions. These findings may inform the future implementation of ASPs in settings lacking local ID expertise.Funding: NoDisclosures: None

scholarly journals 92. Successful Scale-up of an Intervention to Decrease Unnecessary Urine Cultures Led to Improvements in Antibiotic Use

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S177-S177
Author(s):  
Larissa Grigoryan ◽  
John Van ◽  
David J Ramsey ◽  
Melanie Goebel ◽  
Annette Walder ◽  
...  
Keyword(s):  
Antibiotic Therapy ◽  
Antibiotic Stewardship ◽  
Long Term Care ◽  
Urine Culture ◽  
Antibiotic Use ◽  
Term Care ◽  
Days Of Therapy ◽  
Bed Days ◽  
And Control

Abstract Background We previously conducted a successful single-site intervention to improve compliance with antibiotic stewardship guidelines for asymptomatic bacteriuria (ASB). In this dissemination project we explored whether we could facilitate antibiotic stewardship for ASB at a distance, in four distant VA medical centers. Methods Each site champion received a decision-aid algorithm, interactive teaching based on actual cases, and support with data collection. The focus of the intervention was on teaching providers in acute and long-term care to avoid ordering unnecessary urine cultures. We measured DOT (days of antibiotic therapy), LOT (length of antibiotic therapy) and urine cultures ordered per 1,000 bed-days monthly in the intervention sites and four matched control sites. Both DOT and LOT captured all systemic antibiotics initiated on day -1 to +2 of a urine culture order. We conducted segmented regression analyses for the three outcomes for the intervention and control sites separately, and difference in differences analysis for urine cultures. Results Over the baseline and intervention years, 12,260 urine cultures were ordered in 6823 unique patients in the acute and long-term care wards at the 8 sites. During the baseline year, the average urine-culture related DOT was 45.1 and LOT was 34.7, per 1000 bed-days. Both DOT and LOT decreased significantly over the intervention period in the intervention sites (p &lt; 0.05 for both); a significant decrease was not seen in the control sites (Figures 1 and 2). For urine cultures, at baseline the average number of cultures ordered per month per 1000 bed-days was 13.6. Both intervention and control sites saw a significant decrease in urine cultures over the baseline year. In the intervention year, urine cultures continued to decrease in the intervention sites (p=0.001) but increased in the control sites (Figure 3). Figure 1. Days of Therapy (DOT) per 1,000 bed-days, for antibiotics started within -1 to +2 days of a urine culture Figure 2. Length of Therapy (LOT) per 1,000 bed-days, for antibiotics started within -1 to +2 days of a urine culture Figure 3. Urine Cultures per 1,000 bed-days Conclusion Our externally-facilitated intervention significantly decreased local antibiotic use (both DOT and LOT) and urine cultures. Unnecessary urine cultures are a major driver of unnecessary antibiotic use for ASB, and our focus on diagnostic stewardship for urine cultures led to antibiotic stewardship. Our next step will be to further disseminate our intervention to other VA facilities. Disclosures All Authors: No reported disclosures

scholarly journals 2044. An Assessment and Feedback Model Bringing Antimicrobial Stewardship Program Expertise to Long-Term Care Facilities

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S687-S687
Author(s):  
Philip Chung ◽  
Kate Tyner ◽  
Scott Bergman ◽  
Teresa Micheels ◽  
Mark E Rupp ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Rank Test ◽  
Post Intervention ◽  
Term Care ◽  
Clostridioides Difficile ◽  
Stewardship Program ◽  
Days Of Therapy ◽  
Care Facilities

Abstract Background Long-term care facilities (LTCF) often struggle with implementation of antimicrobial stewardship programs (ASP) that meet all CDC core elements (CE). The CDC recommends partnership with infectious diseases (ID)/ASP experts to guide ASP implementation. The Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) is an initiative funded by NE DHHS via a CDC grant to assist healthcare facilities with ASP implementation. Methods ASAP performed on-site baseline evaluation of ASP in 5 LTCF (42–293 beds) in the spring of 2017 using a 64-item questionnaire based on CDC CE. After interviewing ASP members, ASAP provided prioritized facility-specific recommendations for ASP implementation. LTCF were periodically contacted in the next 12 months to provide implementation support and evaluate progress. The number of CE met, recommendations implemented, antibiotic starts (AS) and days of therapy (DOT)/1000 resident-days (RD), and incidence of facility-onset Clostridioides difficile infections (FO-CDI) were compared 6 to 12 months before and after on-site visits. Paired t-test and Wilcoxon signed rank test were used for statistical analyses. Results Multidisciplinary ASP existed in all 5 facilities at baseline with medical directors (n = 2) or directors of nursing (n = 3) designated as team leads. Median CE implemented increased from 3 at baseline to 6 at the end of follow-up (P = 0.06). No LTCF had all 7 CE at baseline. By the end of one year, 2 facilities implemented all 7 CE with the remaining implementing 6 CE. LTCF not meeting all CE were only deficient in reporting ASP metrics to providers and staff. Among the 38 recommendations provided by ASAP, 82% were partially or fully implemented. Mean AS/1000 RD reduced by 19% from 10.1 at baseline to 8.2 post-intervention (P = 0.37) and DOT/1000 RD decreased by 21% from 91.7 to 72.5 (P = 0.20). The average incidence of FO-CDI decreased by 75% from 0.53 to 0.13 cases/10,000 RD (P = 0.25). Conclusion Assessment of LTCF ASP along with feedback for improvement by ID/ASP experts resulted in more programs meeting all 7 CE. Favorable reductions in antimicrobial use and CDI rates were also observed. Moving forward, the availability of these services should be expanded to all LTCFs struggling with ASP implementation. Disclosures All authors: No reported disclosures.

scholarly journals Impact of Training Consultant Pharmacists on Antimicrobial Stewardship Programs in Long-Term Care Facilities

2020 ◽  
Vol 41 (S1) ◽  
pp. s446-s448
Author(s):  
Muhammad Salman Ashraf ◽  
Philip Chung ◽  
Alex Neukirch ◽  
Scott Bergman ◽  
R. Jennifer Cavalieri ◽  
...  
Keyword(s):  
Antimicrobial Stewardship ◽  
Repeated Measures ◽  
Long Term Care ◽  
Antibiotic Use ◽  
Rank Test ◽  
Term Care ◽  
Days Of Therapy ◽  
Care Facilities ◽  
Core Elements

Background: The CDC recommends that consultant pharmacists support antimicrobial stewardship programs (ASPs) in long-term care facilities (LTCFs). We studied CDC-recommended ASP core elements implementation and antibiotic use in LTCFs before and after training consultant pharmacists. Methods: Between August 2017 and October 2017, consultant pharmacists from a regional long-term care pharmacy attended 5 didactic sessions preparing them to assist LTCFs in implementation of CDC-recommended ASP core elements. Training also included creating a process for evaluating appropriateness of all systemic antibiotics and providing prescriber feedback during their monthly mandatory drug-regimen reviews. Once monthly “meet-the-expert” sessions were held with consultant pharmacists throughout the project (November 2017 to December 2018). LTCF enrollment began in November 2017 and >90% of facilities joined by January 2018. After enrollment, consultant pharmacists initiated ASP interventions including antibiotic reviews and feedback using standard templates. They also held regular meetings with infection preventionists to discuss Core Elements implementation and provided various ASP resources to LTCFs (eg, antibiotic policy template, guidance documents and standard assessment and communication tools). Data collection included ASP Core Elements, antibiotic starts, days of therapy (DOT), and resident days (RD). The McNemar test, the Wilcoxon signed-rank test, generalized estimating equation model, and the classic repeated measures approach were used to compare the presence of all 7 core elements and antibiotic use during the baseline (2017) and intervention (2018) year.Results: In total, 9 trained consultant pharmacists assisted 32 LTCFs with ASP implementation. When evaluating 27 LTCFs that provided complete data, a significant increase in presence of all 7 Core Elements after the intervention was noted compared to baseline (67% vs 0; median Core Elements, 7 vs 2; range, 6–7 vs 1–6; P < .001). Median monthly antibiotic starts per 1,000 RD and DOT per 1,000 RD decreased in 2018 compared to 2017: 8.93 versus 9.91 (P < .01) and 106.47 versus 141.59 (P < .001), respectively. However, variations in antibiotic use were detected among facilities (Table 1). When comparing trends, antibiotic starts and DOT were already trending downward during 2017 (Fig. 1A and 1B). On average, antibiotic starts decreased by 0.27 per 1,000 RD (P < .001) and DOT by 1.92 per 1,000 RD (P < .001) each month during 2017. Although antibiotic starts remained mostly stable in 2018, DOT continued to decline further (average monthly decline, 2.60 per 1,000 RD; P < .001). When analyzing aggregated mean, antibiotic use across all sites per month by year, DOT were consistently lower throughout 2018 and antibiotic starts were lower for the first 9 months (Fig. 1C and 1D). Conclusions: Consultant pharmacists can play an important role in strengthening ASPs and in decreasing antibiotic use in LTCFs. Educational programs should be developed nationally to train long-term care consultant pharmacists in ASP implementation.Funding: Merck & Co., Inc, provided funding for this study.Disclosures: Muhammad Salman Ashraf and Scott Bergman report receipt of a research grant from Merck.

scholarly journals 199. Evaluating long-term care pharmacy dispense data to monitor antibiotic use in U.S. nursing homes

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S104-S104
Author(s):  
Katryna A Gouin ◽  
Stephen M Creasy ◽  
Manjiri Kulkarni ◽  
Martha Wdowicki ◽  
Nimalie D Stone ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Long Term Care ◽  
National Level ◽  
Antibiotic Use ◽  
Prescribing Patterns ◽  
Antibiotic Prescribing ◽  
Term Care ◽  
Days Of Therapy ◽  
Antibiotic Courses

Abstract Background Automated reporting of antibiotic use (AU) in nursing homes (NHs) may help to identify opportunities to improve antibiotic prescribing practices and inform implementation of stewardship activities. The majority of U.S. NHs contract with long-term care (LTC) pharmacies to dispense prescriptions and provide medication monitoring and reviews. We investigated the feasibility of leveraging LTC pharmacy electronic dispensing data to describe AU in NHs. Methods We analyzed all NH antibiotic dispenses and monthly resident-days in 2017 reported by a large LTC pharmacy. The dispense-level data included facility and resident identifiers, antibiotic class and agent, dispense date and days of therapy (DOT) dispensed. We identified NH antibiotic courses, inclusive of both antibiotic starts and continuations from hospital-initiated courses, by collapsing dispenses of the same drug to the same resident if the subsequent dispense was within three days of the preceding end date. The course duration was the sum of DOT for all dispenses in the course. The AU rate was reported as DOT and courses per 1,000 resident-days. Results AU was described in 326,713 residents admitted to 1,348 NHs (9% of U.S. NHs), covering 38.1 million resident-days. There were 576,228 dispenses for a total of 3.3 million antibiotic DOT at a rate of 86 DOT/1,000 resident-days. After collapsing dispenses, 324,306 antibiotic courses were defined at a rate of 9 courses/1,000 resident-days. During the year, 45% of residents received an antibiotic. The most frequently prescribed classes by DOT and courses were cephalosporins, penicillins, urinary anti-infectives and quinolones (Fig. 1). The top agents by DOT were levofloxacin (12%), sulfamethoxazole/trimethoprim (12%) and cephalexin (11%). Most course durations were 1–7 days (54%) or 8–14 days (35%) (Fig. 2). Long-term antibiotic courses (&gt; 30 days) contributed to 5% of courses and 30% of overall DOT. The mean duration per course was 7.5 days when courses &gt; 30 days were excluded. Figure 1. Distribution of antibiotic courses and days of therapy by antibiotic class for 324,306 antibiotic courses and 3.3 million days of antibiotic therapy dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017 Figure 2. Distribution of antibiotic course duration and cumulative percent of total antibiotic days of therapy for 324,306 antibiotic courses dispensed to 1,348 nursing homes from a long-term care pharmacy in 2017 Conclusion LTC pharmacy dispenses may be an accessible data source to report NH AU rates and prescribing patterns by antibiotic class and agent. Further evaluation of data sources for facility- and national-level AU reporting in NHs is needed to support stewardship implementation. Disclosures All Authors: No reported disclosures

scholarly journals Determining Antibiotic Use in Long-Term Care Facilities Across Tennessee

2020 ◽  
Vol 41 (S1) ◽  
pp. s185-s186
Author(s):  
Cullen Adre ◽  
Youssoufou Ouedraogo ◽  
Christopher David Evans ◽  
Amelia Keaton ◽  
Marion Kainer
Keyword(s):  
Infection Control ◽  
Antimicrobial Stewardship ◽  
Long Term Care ◽  
Respiratory Infections ◽  
Antibiotic Use ◽  
Term Care ◽  
Days Of Therapy ◽  
Care Facilities ◽  
Core Elements

Background: Antibiotic stewardship is an area of great concern in long-term care facilities nationwide. The CDC promotes 7 core elements of antimicrobial stewardship. Based on information obtained from the Infection Control Assessment and Response (ICAR) Program, the 2 core elements most infrequently achieved by LTCFs are tracking and reporting. Currently, minimal data are available on antibiotic use (AU) in LTCFs in Tennessee. To address both issues, the Tennessee Department of Health (TDH) developed a monthly antibiotic use (AU) point-prevalence (PP) survey to provide LTCFs with a free tool to both track and report their AU and to gather data on how LTCFs are using antibiotics. Methods: We used REDCap to create a questionnaire to collect information on selected antibiotics administered in Tennessee LTCFs. This self-administered survey was promoted through the TDH monthly antimicrobial stewardship and infection control (ASIC) call as well as at various conferences and speaking engagements across the state. Antimicrobial stewardship leads for each facility were targeted. Antibiotics were grouped into 4 classes according to their indications: C. difficile infections, urinary tract infections, skin and soft-tissue infections (SSTIs) and respiratory infections. We determined AU percentage by dividing the number of days of therapy for a drug by a facility’s average census. Individualized reports are provided to each participating facility on a quarterly basis. Results: Currently, 16 facilities have participated in the survey. Overall, 40.7% of antibiotics prescribed were in the common for SSTI category and 39.3% were common for respiratory infections. The top 33 most commonly prescribed antibiotics were amoxicillin (156 days of therapy [DOT]), nitrofurantoin (92 DOT), and levofloxacin (88 DOT). The average percentage of residents on antimicrobials on the day of survey was 12.3%; within this group, 57% of antibiotics were initiated in the LTCF, whereas 43% were present upon admission. Conclusions: Early results from the TDH AU PP survey revealed that drugs commonly used for SSTIs and respiratory infection were the most common antibiotic prescriptions and a potential area of focus for TDH’s antimicrobial stewardship efforts. None of the 3 most frequently prescribed antibiotics, however, fall under the SSTI indication, despite SSTI being the most commonly prescribed indication based on the survey’s evaluation metrics. This finding could be related to the larger number of antibiotics that fall under the SSTI indication. Preliminary data are being used to guide the direction of TDH’s future ASIC calls to better suit disease states, which have room for improvement.Funding: NoneDisclosures: None

scholarly journals 2012. Trends in Microbiological Culture Collection Across Veterans Affairs Medical Centers and Community Living Centers, 2010 to 2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S675-S675
Author(s):  
Haley Appaneal ◽  
Aisling Caffrey ◽  
Stephanie Hughes ◽  
Vrishali Lopes ◽  
Robin L Jump ◽  
...  
Keyword(s):  
Antibiotic Use ◽  
Culture Collection ◽  
Veterans Affairs ◽  
Community Living ◽  
Term Care ◽  
Medical Centers ◽  
Community Living Centers ◽  
Veterans Affairs Medical Centers ◽  
Tract Infections ◽  
Over Time

Abstract Background Microbiological cultures are critical in the diagnosis of infection, identification of pathogenic organisms, and tailoring antibiotic use. However, unnecessary collection of cultures, particularly from the urine, may lead to overuse of antibiotics. There have been no national studies to evaluate trends in the collection of cultures in acute and long-term care settings. Here we describe changes in the collection of cultures nationally across Veterans Affairs medical centers (VAMCs) and Community Living Centers (CLCs). Methods All positive and negative cultures collected from 2010 to 2017 among Veterans admitted to VAMCs or CLCs were included. Cultures were categorized by specimen source (urine, blood, skin and soft tissue, or lung). Joinpoint software was used for regression analyses of trends over time and to estimate annual average percent changes with 95% confidence intervals (CI). Results A total of 5,089,640 cultures from 158 VAMCS and 342,850 cultures from 146 CLCs were identified. The number of cultures collected for all culture types in VAMCs and CLCs decreased significantly. The number of cultures collected per admission decreased significantly by 5.5% annually among VAMCs (95% CI −7.0 to −4.0%) and by 8.4% annually among CLCs (95% CI −10.1 to −6.6%). The proportion of positive cultures decreased 1.6% annually among VAMCs (95% CI −2.3 to −0.9%) and remained stable among CLCs (-0.4% annually, 95% CI, −1.1 to 0.4%). The most common culture source among VAMCs was blood (36.2%), followed by urine (31.8%), and among CLCs was urine (56.9%), followed by blood (16.0%). Urine cultures decreased by 4.5% annually among VAMCs (95% CI −5.4 to −3.6%) and 7.0% annually among CLCs (95% CI −7.6 to −6.4%). Conclusion Our study demonstrates a significant reduction in the number of cultures collected over time. Positive cultures decreased significantly in VAMCs, possibly indicating fewer culture-positive infections.In both VAMCs and CLCs, decreases in cultures taken may represent an important reduction in the collection of unnecessary cultures nationally driven by increased awareness about over-testing and over-treatment of presumed infection, particularly urinary tract infections. Disclosures All authors: No reported disclosures.

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